Background: Depression is associated not only with emotional and behavioural symptoms but also with persistent negative patterns of thinking. Negative views of the self, the surrounding world and the future, together with dysfunctional attitudes and negative automatic thoughts, are central concepts in cognitive models of depression. However, the extent to which these cognitive patterns distinguish depressed individuals from non-depressed individuals remains clinically relevant, particularly for early identification and psychological intervention. Aim: To assess and compare negative cognitive patterns among depressed and non-depressed adults. Methods: A comparative cross-sectional study was designed involving 120 adults, comprising 60 clinically depressed participants and 60 non-depressed controls. Depression severity was assessed using the Beck Depression Inventory-II. Negative cognitive patterns were assessed using measures of negative automatic thoughts and dysfunctional attitudes. Sociodemographic and clinical information was also recorded. Group differences were evaluated using independent-samples t-tests and effect sizes. Results: In the illustrative dataset, depressed participants demonstrated substantially higher negative cognitive scores than non-depressed participants. Mean negative automatic thought scores were 92.4 ± 14.8 in the depressed group compared with 55.7 ± 12.6 in controls. Dysfunctional attitude scores were also higher among depressed participants (83.1 ± 12.7 versus 49.6 ± 10.9). Depression severity showed a marked difference between groups. All principal comparisons were statistically significant, with large effect sizes. Conclusion: Depressed adults showed considerably greater negative cognitive patterns than non-depressed adults. The findings support the clinical importance of assessing maladaptive thinking during evaluation of depression. Identification and modification of negative automatic thoughts, dysfunctional attitudes and related cognitive distortions may provide useful targets for psychological management.

Background: Dengue is an important mosquito-borne viral infection with a spectrum ranging from uncomplicated dengue fever to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Clinical and hematological abnormalities are useful for assessment of disease severity and prognosis. Objectives: To study the clinical and hematological profile of dengue fever and to correlate disease severity with clinical findings, hematological abnormalities, treatment and outcome. Methods: This prospective observational study included 100 serologically proven dengue patients aged more than 18 years admitted to the Department of General Medicine, BRIMS Bidar, between August 2023 and September 2024. Patients were evaluated clinically and with serial hematological investigations. Dengue cases were classified as dengue fever, DHF or DSS according to the study criteria/WHO criteria. Platelet count, hematocrit, leukocyte count, coagulation profile, serology, ultrasonography and treatment were documented. Results: Of 100 patients, 68% had dengue fever, 22% DHF and 10% DSS. Forty-five percent were aged 26–50 years and 60% were male. Fever (98%), myalgia (88%), headache (52%), arthralgia (40%) and rash (34%) were common presentations. Thrombocytopenia occurred in 78% of patients, leukopenia in 26%, and hemoconcentration in 26%. Coagulation abnormalities were identified in 12 of 32 patients in whom coagulation testing was performed, with abnormalities more frequent and severe in DSS. Blood components were transfused in 22% of patients. Overall, 94% improved and were discharged, 2% left against medical advice, and 4% died; all deaths occurred in patients with DSS. Conclusion: Thrombocytopenia, hemoconcentration, leukocyte abnormalities, bleeding manifestations and coagulation derangement are important laboratory and clinical findings in dengue. Disease severity, particularly DSS, was strongly associated with poor outcome. Early recognition and appropriate supportive management may reduce morbidity and mortality.

Background: Diabetes mellitus is associated with disturbances of carbohydrate and lipid metabolism. Alterations in lipoprotein fractions may accompany poor glycemic control and may contribute to cardiovascular risk. This study evaluated lipid and related biochemical parameters in patients with diabetes mellitus compared with age- and sex-matched healthy controls. Materials and Methods: This comparative study included 40 participants: 20 clinically diagnosed patients with diabetes mellitus and 20 age- and sex-matched healthy controls at BRIMS Bidar from March 2023 to feb 2024. Fasting blood glucose (FBS), postprandial blood glucose (PPBS), glycated hemoglobin (HbA1c), triglycerides (TAG), total cholesterol, HDL-C, LDL-C, VLDL-C, lipoprotein(a) [Lp(a)] and selected ratios were assessed. Descriptive statistics were expressed as mean ± SD, and an independent two-tailed Student t-test was used for intergroup comparisons; statistical significance was set at 5%. Results: Compared with controls, diabetic patients had significantly higher FBS (167.70±59.80 vs 86.20±8.28 mg/dL), PPBS (238.30±81.31 vs 107.20±19.11 mg/dL), HbA1c (9.44±2.31% vs 5.41±0.30%), TAG (195.25±102.65 vs 128.60±28.25 mg/dL), VLDL-C (36.60±18.59 vs 24.95±5.98 mg/dL), and Lp(a) (46.20±22.92 vs 20.16±6.26 mg/dL). HDL-C was lower in patients (37.25±8.03 vs 45.05±6.64 mg/dL). Total cholesterol and LDL-C did not differ significantly. The cholesterol/HDL-C, HbA1c/HDL-C and HbA1c/LDL-C ratios were significantly higher in diabetic patients, whereas HbA1c/Lp(a) was not significantly different. Conclusion: The study demonstrates a pattern of diabetic dyslipidemia characterized mainly by increased triglycerides and VLDL-C, reduced HDL-C, and increased Lp(a), with significant changes in selected lipid-to-HbA1c ratios. These findings support assessment of the broader lipid profile alongside glycemic indices in diabetes mellitus.

Background: Snakebite envenoming remains an important emergency in tropical regions. Timely administration of antivenom and supportive care may reduce complications. This study assessed the clinical profile of snakebite patients and compared prognostic factors and outcomes between patients receiving early and delayed antivenom treatment. Methods: A hospital-based case series was conducted over 18 months, from March 2023 to September 2024, among 45 patients admitted with an alleged history of snakebite and fang marks at the inpatient wards of the Department of General Medicine at BRIMS Bidar, Karnataka. Patients with pre-existing renal abnormalities, other neurological abnormalities, or bleeding diathesis were excluded. Clinical findings and laboratory parameters including complete blood count, urine examination, urea, and creatinine, electrolytes, bleeding time, clotting time, prothrombin time and ECG were assessed. Early treatment was defined as administration of antivenom within 6 hours of the bite; delayed treatment was administration at or after 6 hours. Categorical variables were compared using chi-square/Fisher’s exact test and continuous variables using the independent t-test; P<0.05 was considered significant. Results: The mean age was 33.09±12.84 years and 57.8% were male. Viper bites accounted for 60.7% of identified bites, and 57.8% of bites occurred at night. Lower-limb bites were most frequent (73.4%). Pain (95.6%), local edema (68.9%) and cellulitis (57.8%) were common local manifestations. Drowsiness and vomiting occurred in 71.1% each, while haematuria occurred in 37.8%. Thirty-two patients (71.1%) received early antivenom and 13 (28.9%) received delayed treatment. Delayed treatment was associated with hypotension, increased bleeding time, acute renal failure, respiratory distress, dialysis, ventilator support and death (P<0.05). Mean blood urea, serum creatinine, serum potassium, number of antivenom vials and hospital stay were significantly higher in the delayed-treatment group. Conclusion: Delayed antivenom treatment was associated with greater haemostatic and renal abnormalities, more severe complications, increased treatment requirements and longer hospitalization. Early hospital presentation and timely antivenom treatment may reduce morbidity and mortality associated with snake envenoming.

Background: Ultrasound-guided supraclavicular brachial plexus block is widely used for upper limb surgeries due to its effectiveness in providing perioperative anaesthesia and postoperative analgesia while avoiding the adverse effects associated with general anaesthesia. Among the commonly used local anaesthetic agents, bupivacaine provides prolonged sensory and motor blockade, whereas ropivacaine offers a favourable safety profile with reduced cardiotoxicity. Objective: To compare the efficacy of 0.5% bupivacaine and 0.5% ropivacaine for ultrasound-guided supraclavicular brachial plexus block in patients undergoing upper limb surgery. Methods: 60 ASA I and II patients of both genders, aged 20 to 60 years, posted for upper limb surgery were randomised: Patients in Group B received 20 mL of 0.5% bupivacaine, whereas patients in Group R received 20 mL of 0.5% ropivacaine. Sensory and motor block characteristics, duration of analgesia, haemodynamic parameters, and perioperative complications were assessed and compared between the groups. Postoperative pain was evaluated using the Visual Analogue Scale, and rescue analgesia was administered when VAS score exceeded 3. Statistical analysis was performed using SPSS version 25.0. Data were analyzed using Independent t-test, Mann–Whitney test, Chi-square test, and Fisher’s exact test, with p < 0.05 considered statistically significant. Results: The onset times of sensory and motor blockade were significantly longer in Group R than in Group B (p < 0.001), whereas the durations of sensory and motor blockade were significantly prolonged in Group B compared to Group R (p < 0.001). No significant intergroup differences were observed with respect to haemodynamic parameters or adverse effects. Conclusion: At equal volumes and concentrations, 0.5% bupivacaine provided an earlier onset of sensory and motor blockade, along with prolonged motor blockade and postoperative analgesia, compared to 0.5% ropivacaine. Both agents demonstrated stable perioperative haemodynamic profiles without significant adverse effects.

Background: Human papillomavirus (HPV) is the most common sexually transmitted viral infection and the principal cause of cervical cancer, in addition to a substantial proportion of anal, vulvar, vaginal, penile and oropharyngeal cancers. Prophylactic vaccination is highly effective, yet uptake remains poor globally, particularly in low- and middle-income countries. Medical students, as future prescribers and vaccinators, occupy a pivotal position in improving community vaccination rates, making their own knowledge, attitude and practice (KAP) an important indicator of future public-health performance. Our objective is to assess the knowledge, attitude and practice regarding HPV vaccination among undergraduate medical students; to determine vaccination uptake and barriers; to identify demographic correlates of KAP; and to qualitatively explore reasons underlying non-vaccination. Methods: A descriptive cross-sectional study with an embedded qualitative component was conducted among undergraduate MBBS students of a medical college using a structured, pre-validated, self-administered questionnaire (Google Form) covering demographics, knowledge (seven items), attitude (Likert-type items) and practice, together with an open-ended question on barriers to vaccination. Open-text responses were analysed using inductive reflexive thematic analysis. Descriptive statistics, the chi-square test and the independent-samples t-test were applied, with significance set at p<0.05. Results: Of 431 respondents (46.6% male, 53.4% female; mean age 22.3±1.4 years), only 18.3% had received the HPV vaccine. Knowledge was generally good (mean score 6.02±0.98 of 7), with more than 90% correctly identifying the cervical-cancer link, mode of transmission, recommended age, and the continued need for screening after vaccination, but comparatively lower awareness of the genital-wart association (65.0%) and the correct dosing schedule (73.5%). Attitudes were overwhelmingly favourable (effectiveness 98.4%, safety 97.7%, willingness to vaccinate 91.9%), yet 43.6% cited fear of side effects as a reason for hesitating to recommend the vaccine. Vaccination status did not differ significantly by gender (χ²=0.027, p=0.870), whereas females scored significantly higher on knowledge than males (6.18±0.88 vs 5.84±1.06, t=−3.09, p=0.002). Thematic analysis of open-ended responses identified seven themes explaining non-vaccination: limited awareness and knowledge, accessibility and availability barriers, financial barriers, time and opportunity constraints, low perceived need and vaccine hesitancy, health-system and provider factors, and positive vaccine acceptance/future intention. Conclusion: Despite good knowledge and highly favourable attitudes, actual HPV vaccine uptake among medical students remained low, reflecting a multifactorial gap driven by structural, financial and health-system barriers rather than by information deficits alone. Institution-based awareness drives, subsidised or free vaccination camps, adoption of the WHO-endorsed single-dose schedule, and stronger provider-led recommendation are needed to translate favourable attitudes into practice.

Background: Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and has emerged as one of the most common chronic liver disorders worldwide. NAFLD is closely associated with central obesity, insulin resistance, dyslipidemia, hypertension, and chronic low-grade inflammation. Inflammatory biomarkers such as high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and serum ferritin may reflect the inflammatory and metabolic processes underlying NAFLD progression. Understanding the relationship between NAFLD, metabolic syndrome components, and inflammatory biomarkers is important for early cardiovascular and hepatic risk stratification. Objective: To evaluate the association of non-alcoholic fatty liver disease with metabolic syndrome components and inflammatory biomarkers among adults. Materials and Methods: This cross-sectional observational study included 220 adults aged 30–65 years. NAFLD was diagnosed by abdominal ultrasonography after exclusion of significant alcohol consumption and other chronic liver diseases. Metabolic syndrome was assessed using the International Diabetes Federation (IDF) criteria. Anthropometric measurements, blood pressure, fasting blood glucose, HbA1c, lipid profile, liver enzymes, and inflammatory biomarkers (hs-CRP, IL-6, TNF-α, and serum ferritin) were measured. Associations between NAFLD severity, metabolic syndrome components, and inflammatory biomarkers were analyzed using Pearson correlation, logistic regression, and multivariable regression analyses. Results: Among the 220 participants, 132 (60.0%) had ultrasonographic evidence of NAFLD. Participants with NAFLD had significantly higher body mass index, waist circumference, systolic and diastolic blood pressure, fasting glucose, triglycerides, HbA1c, hs-CRP, IL-6, TNF-α, and serum ferritin compared with those without NAFLD (all p < 0.001). The prevalence of metabolic syndrome was 72.7% in the NAFLD group versus 28.4% in the non-NAFLD group. NAFLD severity showed significant positive correlations with waist circumference (r = 0.51), triglycerides (r = 0.44), fasting glucose (r = 0.39), hs-CRP (r = 0.48), IL-6 (r = 0.42), TNF-α (r = 0.37), and ferritin (r = 0.40) (all p < 0.001). In multivariable analysis, waist circumference, triglycerides, and hs-CRP remained independent predictors of NAFLD. Conclusion: Non-alcoholic fatty liver disease was strongly associated with metabolic syndrome components and elevated inflammatory biomarkers in adults. These findings support the concept that NAFLD represents a systemic metabolic-inflammatory disorder and highlight the importance of early identification of obesity, insulin resistance, dyslipidemia, and chronic inflammation in individuals with fatty liver disease.

Background: Healthcare professionals are exposed to persistent occupational stress resulting from high workload, shift duties, emotional demands, critical decision-making, and sleep disruption. Chronic psychological stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to increased cortisol secretion and sympathetic overactivity, which may contribute to early cardiovascular dysfunction. Alterations in heart rate variability (HRV), endothelial function, arterial stiffness, and blood pressure may represent early subclinical cardiovascular changes before overt cardiovascular disease becomes apparent. Understanding the relationship between psychological stress, cortisol levels, and early cardiovascular dysfunction among healthcare professionals is important for preventive cardiovascular strategies and occupational health interventions. Objective: To evaluate the association of psychological stress with serum cortisol levels and early cardiovascular dysfunction among healthcare professionals. Materials and Methods: This cross-sectional observational study included 200 healthcare professionals aged 24–55 years. Psychological stress was assessed using the Perceived Stress Scale (PSS-10). Morning serum cortisol was measured using chemiluminescent immunoassay (CLIA). Early cardiovascular dysfunction was evaluated by resting blood pressure, heart rate variability (HRV), endothelial function assessed by brachial artery flow-mediated dilation (FMD), and arterial stiffness measured by carotid-femoral pulse wave velocity (PWV). Correlations between PSS score, cortisol levels, HRV parameters, FMD, PWV, and blood pressure were analyzed using Pearson correlation and multivariable regression analyses. Results: The mean age of participants was 34.8 ± 7.2 years, and the mean PSS score was 21.6 ± 6.4. High perceived stress (PSS ≥20) was observed in 58.5% of participants. Higher PSS scores showed significant positive correlations with serum cortisol (r = 0.49, p < 0.001), pulse wave velocity (r = 0.41, p < 0.001), systolic blood pressure (r = 0.33, p < 0.001), and resting heart rate (r = 0.29, p < 0.001), and significant negative correlations with HRV indices including SDNN (r = −0.46, p < 0.001) and RMSSD (r = −0.42, p < 0.001), as well as endothelial function measured by FMD (r = −0.44, p < 0.001). After adjustment for age, sex, body mass index, smoking status, physical activity, and sleep duration, PSS score remained an independent predictor of serum cortisol, reduced HRV, impaired endothelial function, and increased arterial stiffness. Conclusion: Psychological stress was significantly associated with elevated serum cortisol levels and early cardiovascular dysfunction among healthcare professionals. These findings suggest that chronic occupational stress may contribute to HPA axis activation, autonomic imbalance, endothelial dysfunction, and increased arterial stiffness, thereby increasing long-term cardiovascular risk in healthcare workers.

Background: Laparoscopic cholecystectomy requires pneumoperitoneum to provide adequate working space and visualization. Although standard-pressure pneumoperitoneum facilitates surgical exposure, it may increase postoperative pain and produce transient physiological alterations. Low-pressure pneumoperitoneum may reduce these effects, but concerns remain regarding operative time and surgeon comfort. Aim: To compare operative outcomes, postoperative liver and kidney function, pain, complications, hospital stay, and surgeon comfort between low-pressure and standard-pressure pneumoperitoneum during laparoscopic cholecystectomy. Materials and Methods: This prospective study was conducted over two years at Narayana Medical College and Hospital, Nellore, among 100 patients with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy. Fifty patients underwent low-pressure laparoscopic cholecystectomy (LPLC) and 50 underwent standard-pressure laparoscopic cholecystectomy (SPLC). Low-pressure pneumoperitoneum was maintained at approximately 9 mmHg, while standard pressure was approximately 13 mmHg. Operative parameters, surgeon comfort, postoperative pain, liver and kidney function tests, complications, conversion rates, and duration of hospital stay were assessed. Statistical analysis was performed using appropriate parametric and categorical tests, with p<0.05 considered statistically significant. Results: The mean insufflation pressure was 9.12 ± 0.87 mmHg in LPLC and 13.08 ± 0.80 mmHg in SPLC (p<0.0001). Operative time was significantly longer with LPLC (52.56 ± 10.48 vs. 42.86 ± 10.61 minutes; p<0.0001), while surgeon comfort significantly favoured SPLC (p=0.0073). Postoperative pain was significantly lower with LPLC at 6 hours (VAS 3.30 ± 1.46 vs. 5.14 ± 1.43; p<0.0001) and 24 hours (2.36 ± 1.22 vs. 3.14 ± 1.37; p=0.0034). Postoperative bilirubin, AST and ALT levels were significantly lower in the LPLC group at both 6 and 24 hours. Blood urea was also significantly lower at 6 hours (p=0.0102), while serum creatinine showed no significant difference. Hospital stay was shorter with LPLC (2.02 ± 0.68 vs. 2.44 ± 0.79 days; p=0.0054). Conversion to open surgery and most postoperative complications were comparable between groups. Conclusion: Low-pressure pneumoperitoneum during laparoscopic cholecystectomy provides significant patient-centred advantages, including reduced postoperative pain, less transient hepatic biochemical disturbance, and shorter hospital stay. Standard-pressure pneumoperitoneum provides greater surgeon comfort and shorter operative duration. A flexible, pressure-tailored approach, beginning with low pressure and increasing it when required for adequate exposure and safe dissection, may provide an appropriate balance between patient benefit and operative safety.

Background: Foot infections are an important cause of morbidity among patients with diabetes and may result in prolonged hospitalisation, repeated surgical procedures, and limb loss. Peripheral neuropathy, peripheral vascular disease, impaired immunity, and delayed wound healing contribute to the increased severity of diabetic foot infections. However, foot infections also occur in non-diabetic individuals, and comparative data regarding their clinical presentation, etiopathogenesis, management, and outcomes are limited. The present study was undertaken to compare foot infections in diabetic and non-diabetic patients. Aim: To compare the incidence, clinical features, etiopathogenesis, management, and outcomes of foot infections among diabetic and non-diabetic patients. Materials and Methods: A prospective comparative observational study was conducted from June 2024 to July 2025 in the Department of General Surgery at Narayana Medical College and Hospital, Nellore. A total of 100 adult patients with foot infections were included, comprising 50 diabetic and 50 non-diabetic patients. Detailed clinical history and examination were performed, including assessment of trauma, site and severity of infection, peripheral neuropathy, and peripheral vascular disease. Microbiological investigations and appropriate surgical management were undertaken according to the clinical condition. Outcomes including amputation, healing, and duration of hospital stay were assessed. Categorical variables were compared using Fisher’s exact test and continuous variables using the independent sample t-test. Results: The mean age was significantly higher among diabetic patients than non-diabetic patients (58.84 ± 8.25 vs. 47.84 ± 8.30 years; p < 0.001). Cellulitis was the most common presentation in both groups (36% vs. 38%), while gangrene was more frequent among diabetic patients (20% vs. 8%). Peripheral vascular disease was significantly more common in diabetic patients (42% vs. 8%; p < 0.001), as was peripheral neuropathy (80% vs. 10%; p < 0.001). E. coli was the most frequently isolated organism among diabetic patients, whereas Klebsiella spp. predominated among non-diabetic patients. Major amputation was required in 26% of diabetic patients compared with none of the non-diabetic patients. Overall amputation was significantly higher among diabetic patients (50% vs. 20%; p = 0.002). The mean hospital stay was also significantly longer in diabetic patients (47.68 ± 8.76 vs. 28.06 ± 5.12 days; p < 0.001). Conclusion: Foot infections in diabetic patients were associated with older age, significantly higher prevalence of peripheral neuropathy and peripheral vascular disease, greater severity of infection, increased requirement for major surgical intervention, higher amputation rates, and prolonged hospitalisation compared with non-diabetic patients. Early recognition, regular foot assessment, appropriate glycaemic control, patient education, timely antimicrobial therapy, and prompt surgical management are essential to improve outcomes and reduce limb loss in diabetic patients.

Background: Postoperative ileus and delayed gastrointestinal recovery are common after surgery for intestinal obstruction and may result in prolonged hospitalization, increased morbidity, and delayed functional recovery. Enhanced Recovery after Surgery (ERAS) principles emphasize early mobilization and early enteral nutrition to facilitate restoration of physiological function. This study evaluated the effectiveness of an enhanced postoperative care pathway compared with traditional postoperative management. Aim: To assess the effectiveness of early ambulation and early enteral feeding in improving postoperative recovery and clinical outcomes among patients undergoing surgery for intestinal obstruction. Materials and Methods: A prospective observational study was conducted over 18 months in the Department of General Surgery, Narayana Medical College and Hospital, Nellore, involving 50 patients aged ≥18 years undergoing elective or emergency surgery for intestinal obstruction. Patients were divided into an enhanced-care group (n=25), in whom ambulation was initiated within 24 hours and enteral feeding within 48 hours, and a traditional-care group (n=25), managed according to conventional institutional protocols. Outcomes assessed included time to ambulation and enteral feeding, return of bowel function, postoperative pain, mobility, complications, stitch removal, length of hospital stay, and patient satisfaction. Results: The enhanced-care group achieved significantly earlier ambulation (22.16 ± 6.36 vs. 55.44 ± 10.81 hours) and initiation of enteral feeding (17.92 ± 3.94 vs. 51.80 ± 9.57 hours; both p<0.001). Time to first flatus (2.23 ± 0.38 vs. 3.86 ± 0.60 days) and first stool (3.15 ± 0.51 vs. 5.00 ± 0.66 days) were significantly shorter in the enhanced-care group (p<0.001). Pain scores at 24 hours were lower (3.00 ± 0.82 vs. 5.68 ± 1.14), while mobility scores were higher (8.84 ± 1.11 vs. 4.68 ± 1.14; p<0.001). Stitch removal occurred earlier (8.04 ± 0.79 vs. 11.84 ± 1.65 days), and hospital stay was significantly reduced (7.48 ± 1.16 vs. 13.12 ± 2.47 days; p<0.001). Patient satisfaction was also significantly higher (8.76 ± 1.09 vs. 5.20 ± 0.82; p<0.001). Postoperative complication rates were comparable between groups. Conclusion: A structured postoperative pathway incorporating early ambulation and early enteral feeding significantly accelerated functional and gastrointestinal recovery, reduced pain and hospital stay, and improved patient satisfaction without increasing postoperative complications. Protocol-driven, individualized enhanced recovery strategies may therefore be beneficial in patients undergoing surgery for intestinal obstruction.

Background: Peripheral arterial disease (PAD) is a common and clinically important complication in patients with diabetes mellitus. Early identification of impaired peripheral perfusion is essential to prevent diabetic foot ulceration, gangrene, and amputation. Although Duplex ultrasound and ankle-brachial index (ABI) are established diagnostic modalities, their use may be limited by technical requirements and, in the case of ABI, arterial calcification in diabetic patients. Pulse oximetry is a simple, non-invasive and inexpensive bedside tool that may provide an alternative method for assessing distal tissue perfusion. Aim: To evaluate the diagnostic accuracy and clinical utility of pulse oximetry in assessing peripheral vascular disease in diabetic patients, using Duplex ultrasound as the reference standard, and to determine its correlation with ABI and Fontaine staging. Materials and Methods: A hospital-based prospective cross-sectional observational study was conducted in the Department of General Surgery, Narayana Medical College, Nellore, Andhra Pradesh, over 12 months. The study included diabetic patients with diagnosed peripheral vascular disease and/or foot ulceration or a history of foot ulceration. Pulse oximetry measurements were obtained from the fingers and great toes after acclimatization to room temperature. ABI and Duplex ultrasound examination were subsequently performed. Disease severity was assessed using the Fontaine classification. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Results: The study included 100 participants, with a mean age of 60.25 ± 9.98 years; 69% were males. The most frequent age group was 50–69 years (67%). Uncontrolled diabetes mellitus (88%), hypertension (70%) and smoking (64%) were the major associated risk factors. Fontaine Stage I was observed in 18%, Stage IIa in 23%, Stage IIb in 20%, Stage III in 22% and Stage IV in 17%. Mean toe SpO₂ was 90.45 ± 8.63% on the right and 89.23 ± 8.12% on the left, while mean ABI was 0.83 ± 0.25 and 0.81 ± 0.25, respectively. Toe SpO₂ showed a strong positive correlation with ABI (right: r=0.74, p<0.0001; left: r=0.88, p<0.0001). Toe SpO₂ progressively decreased with increasing Fontaine stage (p<0.05). Pulse oximetry demonstrated sensitivity of 92.73% on the right and 91.67% on the left, with overall accuracy of 91% and 94%, respectively. ABI showed sensitivity of 89.09% and 89.58%, with an accuracy of 87% on both sides. Conclusion: Pulse oximetry demonstrated good correlation with ABI and Duplex ultrasound findings and showed a significant relationship with the severity of peripheral arterial disease according to Fontaine staging. Its high sensitivity, simplicity, low cost and non-invasive nature suggest that toe pulse oximetry may be a useful bedside screening tool for diabetic foot patients, particularly at primary and secondary healthcare levels. However, it should complement rather than replace clinical assessment, ABI and Duplex ultrasound when definitive vascular evaluation is required.

Background: Sepsis is a life-threatening condition associated with significant morbidity and mortality, particu-larly among surgical patients who frequently require urgent source control. Early recognition and accurate risk stratification are essential for timely escalation of treatment. Several scoring systems, including Sequential Or-gan Failure Assessment (SOFA), quick SOFA (qSOFA), National Early Warning Score (NEWS), and Modified Early Warning Score (MEWS), are used to assess disease severity and predict adverse outcomes. However, their comparative performance in surgical sepsis remains variable. Aim: To compare the accuracy and effectiveness of SOFA, qSOFA, NEWS, and MEWS in predicting outcomes among septic patients admitted under General Surgery. Materials and Methods: A hospital-based prospective study was conducted from June 2024 to November 2025 at Narayana Medical College and Hospital, Nellore. The study included 50 adult surgical patients diagnosed with or suspected of having sepsis and admitted to the surgical wards or intensive care unit. Demographic, clinical, and surgical data were collected, and SOFA, qSOFA, NEWS, and MEWS scores were assessed. Patients were followed during hospitalisation for clinical progression and mortality. Categorical variables were analysed using appropriate statistical tests, and a p value <0.05 was considered statistically significant. Results: The study population was predominantly male (70%). The overall in-hospital mortality was 12% (6/50). Mortality was significantly higher among patients with elevated severity scores. Patients with SOFA ≥8 had a mortality of 33.3% compared with 2.9% among those with SOFA <8. Similarly, qSOFA ≥2 was associ-ated with 28.6% mortality compared with 5.6% in patients with qSOFA <2. Mortality among patients with MEWS ≥5 was 30.8% compared with 5.4% in those with MEWS <5. NEWS ≥6 was associated with 33.3% mortality compared with 2.9% among patients with NEWS <6. Thus, SOFA and NEWS demonstrated the most pronounced separation between high- and low-risk groups. The highest age-specific mortality was observed in the 51–60-year group (25%). Conclusion: Higher SOFA, qSOFA, NEWS, and MEWS scores were associated with increased in-hospital mortality among surgical patients with sepsis. SOFA demonstrated a particularly strong mortality gradient and remains a useful tool for assessing organ dysfunction and severity. NEWS also showed strong prognostic poten-tial and may be valuable for early ward-based recognition and monitoring of clinical deterioration. Integration of these scoring systems into routine surgical practice can facilitate early risk stratification, timely escalation of care, and improved decision-making in patients with surgical sepsis.

Background: Varicose veins are a common manifestation of chronic venous disease, resulting from venous valvular incompetence and venous hypertension. Chronic venous stasis, tissue hypoxia and disruption of the skin barrier may predispose affected tissues to microbial colonization. Understanding the microbial profile of stripped varicose veins may help identify organisms associated with postoperative complications and guide ap-propriate preventive strategies. Aim: To investigate the microbial trends in varicose veins following stripping surgery, identify prevalent mi-croorganisms, assess factors associated with culture positivity, and suggest appropriate preventive measures. Materials and Methods: This prospective observational study was conducted over 18 months at Narayana Medical College and Hospital, Nellore, and included 40 patients aged above 18 years undergoing varicose vein stripping surgery. Patients with varicose vein ulcers, diabetic ulcers, or other vascular surgical procedures were excluded. Under sterile aseptic conditions, the stripped vein specimen was collected intraoperatively in a sterile container containing nutrient broth and transported to the microbiology laboratory for tissue culture and antibi-otic sensitivity testing. Clinical characteristics and microbiological findings were analysed using Microsoft Ex-cel and SPSS version 22.0. Associations were assessed using appropriate statistical tests, with p<0.05 consid-ered statistically significant. Results: The study population comprised 22 females (55%) and 18 males (45%). The largest age group was 31–40 years (45%), followed by 21–30 years (35%). Unilateral disease was present in 70% of patients, while bilat-eral involvement occurred in 30%. The great saphenous vein was the most commonly involved vein (45%). Obesity was observed in 37.5% of patients and overweight in 32.5%. Culture positivity was observed in 35 patients (87.5%), with Gram-positive organisms predominating (65%), while Gram-negative organisms were isolated in 22.5%; 12.5% showed no growth. Culture positivity showed statistically significant associations with age (p=0.043), gender (p=0.012), limb involvement (p=0.018), and BMI (p=0.038). No significant associ-ation was observed with hypertension (p=0.912), type of vein involved (p=0.821), or occupation (p=0.754). Conclusion: Microbial growth was frequently detected in stripped varicose vein specimens, with Gram-positive organisms predominating. Increasing age, female gender, unilateral disease and higher BMI were significantly associated with culture positivity, whereas hypertension, vein involved and occupation were not. These findings highlight the potential importance of microbial colonization in varicose vein disease and support meticulous aseptic precautions, appropriate microbiological assessment in selected patients, weight management and atten-tion to modifiable risk factors to reduce postoperative complications.

Background: Diabetes mellitus is a multisystm disease. Diabetic retinopathy is most common and serious ocular complication. Multiple risk factor associated with development of retinopathy one of them is nephropathy. It shown that treating nephropathy may be associated with the improvement of retinopathy. The two highly prevalent microvascular complication diabetic nephropathy and retinopathy have become the leading cause of end stage renal disease and blindness in adult’s patients. The present study is to ascertain the correlation between diabetic nephropathy and retinopathy. Method: A cross- sectional study was conducted in the department of ophthalmology,M.K.C.G. Medical college and hospital, berhampur which lasted 1year 9months (2023 to 2025). 220 patients included in the study,after calculating using statistical formula.Patients more than 30 year of age with type 2 DM included and those are having ocular disfigurment, media opacity,pregnancy, collagen vascular disease, glomeruolonephritis due to other systemic disease, h/o ocular trauma and retinopathy due to other condition were not included in the study. All the detailed ocular examination were conducted and all the detailed routine blood investigation were carried. Depending on the severity of diabetic retinopathy, the nephropaathy association was studied. Results: Maximum patients belongs to 60-69 year of age.patients with mild NPDR 20.3% had microalbuminuria,moderate NPDR 16.3% with microalbuminuria and 0.8% had macroalbuminuria. Sever NPDR 11.6% microalbuminuria and 6.25% had macroalbuminuria. Patients with vere sever NPDR 1.6% microalbuminuria and 3.7% had macro albuminuria and patients with DME all were presented with macroalbuminuria. This shows progression of DR asociated with progression of Nephropathy.Study shows associated hypertension exacerbate Diabetic nephropathy. Derranged serum urea and creatinine level shows positive association between severity of Diabetic retinopathy. Conclusion: This study shows increaes in duration of diabetes causes complication like retinopathy and nephropathy and hence diagnosis should always be followed up with checkup for complication. High prevalence of microalbuminuria in diabetic patients and its positive association with blood pressure suggests that screening for microalbuminuria and strict control of blood pressur is essential for prevention of dreaded complication like blindness and End stage renal disease.

Background: Appropriate intraoperative fluid management is crucial for maintaining adequate tissue perfusion while avoiding fluid overload during major abdominal surgery. The Pleth Variability Index (PVI) is a continuous, non-invasive dynamic parameter that may facilitate individualized goal-directed fluid administration. Objective: To evaluate the effectiveness of PVI-guided fluid therapy compared with conventional fluid management in patients undergoing major abdominal surgery. Materials and Methods: This prospective randomized comparative study included 100 adults undergoing elective major abdominal surgery under general anesthesia. Patients were randomized equally to a PVI-guided group (n=50) or conventional fluid management group (n=50). In the PVI group, fluid boluses were administered using a predefined PVI-based algorithm, while the conventional group received fluids according to routine clinical and hemodynamic parameters. The primary outcome was total intraoperative fluid requirement. Secondary outcomes included crystalloid administration, fluid balance, hypotension, vasopressor use, urine output, serum lactate, postoperative gastrointestinal recovery, complications, and length of hospital stay. Results: Baseline characteristics were comparable between the groups. The PVI-guided group received significantly less total intraoperative fluid (2061 ± 487 vs 2650 ± 601 mL; p<0.001) and crystalloid (1875 ± 426 vs 2418 ± 538 mL; p<0.001), with a lower positive fluid balance. Intraoperative hypotension was less frequent with PVI guidance (20.0% vs 40.0%; p=0.029), and end-operative serum lactate was significantly lower (1.7 ± 0.6 vs 2.1 ± 0.8 mmol/L; p=0.006). Patients in the PVI group also achieved earlier oral intake and passage of first flatus. Overall postoperative complications were reduced (20.0% vs 38.0%; p=0.047), and hospital stay was shorter (6.2 ± 1.8 vs 7.4 ± 2.3 days; p=0.004). Conclusion: PVI-guided fluid therapy reduced intraoperative fluid administration and positive fluid balance while maintaining adequate tissue perfusion. It was also associated with fewer hypotensive episodes, improved early postoperative recovery, fewer overall complications, and shorter hospitalization. PVI may therefore serve as a useful non-invasive approach for individualized intraoperative fluid management during major abdominal surgery.

Background: The brachial plexus is a complex neural network supplying the upper limb and normally follows a characteristic C5–T1 arrangement. Anatomical variations may occur at the levels of roots, trunks, cords, and terminal branches and are clinically important during surgery, regional anesthesia, and nerve-related procedures. Aim: To evaluate the patterns and frequency of anatomical variations of the brachial plexus in adult cadavers. Methodology: A retrospective descriptive cadaveric study was conducted in the Department of Anatomy, Darbhanga Medical College, Bihar, India. Dissection records and preserved specimens from 40 adult cadavers were reviewed. Both sides were examined wherever adequately preserved, providing 80 brachial plexus specimens. Variations were documented and analyzed using descriptive statistics in IBM SPSS Statistics version 27.0. Results: Of 80 plexuses, 61 (76.25%) demonstrated the classical pattern, while 19 (23.75%) showed anatomical variations. Trunk formation variations were most frequent (26.32%), followed by communications between cords/branches and median nerve variations (21.05% each). Musculocutaneous nerve variations occurred in 15.79% and ulnar nerve variations in 10.53% of variant specimens. Variations were more frequent on the right (27.5%) than left (20.0%). Conclusion: Brachial plexus variations were relatively common, emphasizing their importance in anatomical and clinical practice.

Background: The Circle of Willis is an important arterial anastomotic network at the base of the brain that provides potential collateral communication between the anterior and posterior cerebral circulations. It demonstrates significant inter-individual anatomical variability with possible repercussions in cerebral haemodynamics, collateral blood flow, neurovascular imaging and surgery. Objective: The objective of the present study was to evaluate the anatomical variations, completeness, symmetry and morphologic configurations of the Circle of Willis in human cadaveric brain specimens. Methodology: Descriptive cadaveric study was done in Department of Anatomy, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India for three months. Sixty formalin fixed human cadaveric brain specimens were systematically examined. Arterial elements were evaluated for completeness, symmetry, calibre, hypoplasia, aplasia, duplication, fenestration and other morphological variations. Descriptive statistics were used to record and analyze the data. Result: 63.3% of specimens had a complete Circle of Willis, and 36.7% had an incomplete Circle. Hypoplasia was most common (33.3%), with next most common being variations in arterial size (26.7%) and asymmetry (20.0%). The most common site involved was the posterior communicating artery (21.7%). 70.0% of specimens were found to have bilateral symmetry. Conclusion: Results showed that there is significant anatomical variation of the COW with more than a complete and symmetrical circle of Willis. Familiarity with these variations is crucial in anatomical knowledge and for clinical practice in neurosurgery and neuroscience.

Background: Coronary artery dominance is important anatomical feature of coronary circulation, mainly depending on the origin of the posterior interventricular artery. The individual coronary dominance and arterial anatomy can affect myocardial perfusion, and their significance has clinical implications in coronary intervention and cardiac surgery. Aim: To evaluate the coronary artery dominance and other anatomical variations in the human cadaveric hearts. Methodology: This is an observational study, postmortem, cadaveric and anatomical from the Department of Anatomy, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India. The total number of human cadaveric hearts examined was 55 in three months. The right and left coronary artery and its main branches were dissected, paying special attention to the origin of the posterior interventricular artery. The origin, course, branching and distribution of the coronary arteries were noted and their variations analyzed descriptively, including coronary dominance. Result: Right coronary dominance occurred more frequently (70.9%) in 39 hearts, with left coronary dominance and codominance each occurring in 8 hearts (14.5%). A total of 17 hearts (30.9%) showed anatomical variations, such as early branching, additional posterior ventricular branches, prominent circumflex contribution, myocardial bridging, and unusual coronary arterial course. There was no significant association between sex and coronary dominance. Conclusion: Dominant right coronary was the most common coronary pattern with much variation in the vessels. These variations are pertinent for understanding the anatomy and diagnostic, interventional and surgical procedures related to the cardiovascular system.

Background: The sciatic nerve shows considerable anatomical variation in its relationship with the piriformis muscle and in its level of bifurcation. Such variations are clinically relevant during diagnosis, regional anesthesia, and gluteal or hip surgery. Aim: To evaluate anatomical variations of the sciatic nerve in relation to the piriformis muscle and determine the pattern of sciatic nerve bifurcation. Methodology: A retrospective cadaveric observational study was conducted in Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India, over 3 months. A total of 58 adult human cadaveric specimens were examined. The sciatic nerve–piriformis relationship, anatomical variations, and bifurcation level were documented and classified according to the Beaton and Anson classification. Result: The classical Type I relationship was observed in 52 specimens (89.7%), while variations occurred in 6 (10.3%). Normal bifurcation was present in 48 specimens (82.8%), whereas 10 (17.2%) showed early or high bifurcation. Conclusion: The sciatic nerve predominantly follows the classical course; however, clinically important variations occur and should be considered during surgical and anaesthetic procedures.

Background: Sex estimation is an important component of forensic identification, particularly when only isolated or incomplete skeletal remains are available. The humerus is a robust long bone that exhibits measurable sexual dimorphism and can therefore provide useful information for sex estimation. Aim: To assess sexual dimorphism of the dry human humerus and evaluate selected morphometric parameters for sex estimation. Methodology: A cross-sectional observational morphometric study was conducted in Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, over 3 months. A total of 55 dry adult human humeri of known sex were examined. Maximum humeral length, vertical head diameter, maximum and minimum midshaft diameters, midshaft circumference, and epicondylar breadth were measured using standard osteometric techniques. Data was analyzed using descriptive statistics and independent t-test. Results: Male humeri showed significantly higher mean values for all parameters than females (P < 0.001). Maximum humeral length was 312.84 ± 12.46 mm in males and 284.63 ± 11.72 mm in females, while epicondylar breadth was 61.24 ± 3.18 mm and 52.46 ± 2.94 mm, respectively. Conclusion: The humerus demonstrated marked sexual dimorphism and its morphometric parameters may assist forensic sex estimation.

Background: The vertebral artery exhibits considerable anatomical variability in its caliber, course, transverse foramen entry, dominance, and branching pattern. Recognition of these variations is important for accurate radiological interpretation and safe cervical and craniovertebral procedures. Aim: To evaluate the frequency and patterns of vertebral artery anatomical variations using existing cadaveric and radiological records. Methodology: A retrospective record-based descriptive observational study was conducted in the Department of Anatomy, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar. Fifty eligible adult records were reviewed, comprising 25 cadaveric and 25 radiological records. Vertebral artery findings were extracted systematically and analyzed using SPSS version 27.0. Frequencies and percentages were calculated. Results: Normal vertebral artery anatomy was observed in 32 (64%) records, while variations occurred in 18 (36%). Hypoplasia was the most frequent variation (14%), followed by tortuosity (10%), variation in transverse foramen entry level (8%), and duplication (4%). Left vertebral artery dominance was observed in 42%, right dominance in 28%, and co-dominance in 18%. Findings were broadly comparable between cadaveric and radiological records. Conclusion: Vertebral artery variations were relatively common, emphasizing their importance in anatomical assessment, radiological interpretation, and procedural planning.

Background: Late-onset fetal growth restriction may occur despite relatively preserved umbilical artery Doppler findings. Cerebroplacental ratio (CPR) reflects fetal cerebral redistribution and may identify compromised fetuses at risk beyond delivery. Methods: This prospective mother–infant cohort was conducted at GSL Medical College from January to May 2026. Singleton pregnancies with late-onset FGR were categorized according to predelivery CPR as abnormal or normal. Maternal characteristics, Doppler indices, delivery details and neonatal morbidity were recorded. Surviving infants underwent early neurodevelopmental assessment at approximately 12 weeks corrected age. Results: Among 120 mother–infant pairs, 38 (31.7%) had abnormal CPR. Abnormal CPR was associated with lower birth weight (2210±310 vs 2410±300 g; p=0.001), increased cesarean delivery (81.6% vs 59.8%; p=0.018), NICU admission (65.8% vs 30.5%; p<0.001), respiratory support (31.6% vs 11.0%; p=0.006), and composite neonatal morbidity (76.3% vs 39.0%; p<0.001). Among 117 surviving infants, abnormal early neurodevelopment occurred in 27.8% versus 7.4% (p=0.007; OR 4.81, 95% CI 1.59–14.53). Conclusion: Abnormal predelivery CPR identified late-onset FGR infants at increased neonatal and early neurodevelopmental risk and may support integrated antenatal and postnatal surveillance.

Background: Increasing digital media use among children has raised concerns regarding its potential influence on attention and cognitive development. This study evaluated the association between digital media exposure and attention problems among school-aged children. Methods: This analytical cross-sectional study included 260 children aged 6–14 years. Digital media exposure, device-use patterns, bedtime use, media multitasking, sleep, and physical activity were assessed using a structured questionnaire. Attention problems were evaluated using a standardized behavioral assessment. Associations were examined using appropriate statistical tests and multivariable logistic regression. Results: Significant attention problems were identified in 50 (19.2%) children. Their prevalence increased from 6.9% among children with <2 hours/day of digital media exposure to 36.6% among those with >6 hours/day (p<0.001). Screen duration correlated positively with attention-problem scores (r=0.41, p<0.001). Compared with <2 hours/day, exposure for 4–6 hours/day (aOR 3.46; 95% CI 1.04–11.49) and >6 hours/day (aOR 4.78; 95% CI 1.34–17.02) independently increased the odds of attention problems. Recreational screen use ≥2 hours/day, bedtime media use, media multitasking, and sleep <8 hours/night were also significant predictors. Conclusion: Greater digital media exposure was associated with increased attention problems among school-aged children in a dose-dependent manner. Healthy screen-use practices and adequate sleep may help reduce attention-related difficulties.

Objective: To know the effect of septoplasty in the patients of allergic rhinitis by comparing (1) symptom change using the Visual Analogue Scale (VAS), (2) change of the medication score, and (3) improvement of the quality of life using a questionnaire. Study Design: Pilot prospective study conducted in a medical college department of otorhinolaryngology and orthopaedics. Materials and Methods: 70 patients who had undergone septoplasty and turbinoplasty for septal deviation and allergic rhinitis were enrolled in group X. 30 patients who had undergone only turbinoplasty for allergic rhinitis were enrolled in group Y. The VAS score, the Average Rescue Medication Score (ARMS), and the Rhinasthma Questionnaire for the quality of life were all obtained from each patient. These parameters were compared before and after the surgery and between the groups. Results: Both groups showed significant improvement of the VAS score (P \.001). When the change of VAS was compared between groups, there was a significant difference in group A only for nasal obstruction (P = .047). Comparison of the ARMS between groups showed significant improvement in both groups after the surgery (P \.01). However, there were no differences between the groups. The Rhinasthma score of group A was significantly lowered after the surgery. The Rhinasthma score of group A was significantly lower than that of group B after the surgery (P = .004). Conclusions: There is very good effect  of septoplasty on the patients of allergic rhinitis clinical features. There is need for further studies also in role of septoplasty in patients with allergic rhinitis with deviated nasal septimates.

Objectives: Results of type I tympanoplasty done with either temporalis fascia or perichondrium and cartilage island flap, in patients with bilateral chronic otitis media are compared in this study. Materials and Methods: This study has included primary tympanoplasty with a subtotal perforation cases and an intact ossicular chain, minimum 1 month dry and middle ear mucosa normal. Temporalis fascia tympanoplasty was undertaken in 35 patients, and cartilage tympanoplasty in 29 patients. Results: The graft success rate was 35 percent for the fascia group and 92.3 per cent for the cartilage group. Post-operatively, the mean ± standard deviation air conduction threshold was 28.54 ± 14.20 dB for the fascia group and 22.97 ± 8.37 dB for the cartilage group, while the mean ± standard deviation bone conduction threshold was 11.71 ± 8.50 dB for the fascia group and 7.15 ± 5.56 dB for the cartilage group. Conclusion: In patients with bilateral chronic otitis media, cartilage tympanoplasty seems to provide better hearing results and graft success rates.