Background: A prospective observational study to evaluate the incidence and to study the course of dry eye was performed in Khaja BandaNawaz Teaching & General Hospital,Kalaburagi on 110 patients posted for cataract surgery. These patients underwent a routine workup for cataract surgery along with the assessment of dry eye using parameters of Dry eye severity and grading scheme.  These patients underwent manual small incision cataract surgery (supero-temporal incision) and were followed up on post operative days POD-7,30&60. The objective parameters of the Dry eye severity and grading scheme namely Schirmer’s Test-I, TBUT, Ocular surface Staining were compared pre and postoperatively by standard statistical tools.  It was found that in significant number of patients Dry eye develops following surgery in terms of symptoms, Schirmer’s Test-I, TBUT and ocular surface staining which peaks on the postoperative day 7. These parameters start improving in successive days probably due to reduced frequency of use of antibiotic steroid drops, continued use of preservative free lubricating drops and the gradual recovery of corneal sensation which restores the feedback loop of the lacrimal functional unit. Although baseline values are not reached, however there is a trend towards return of normal values over our period of study. The Incidence of dry eye on post-operative day 7 was found to be 68.18% based on Dry Eye Evaluation and Grading Scheme.

Background & Methods: The aim of the study is to study the Role of minimal access surgery in esophageal cancers surgery. All surgeries the two groups were performed on patients underwent resection of the esophageal tumor, lymph nodes dissection, jejunostomy, & left neck anastomosis. Results: Postoperative complications & mortality were shown in above Table; the incidence of Regurgitation & anastomotic leakage was most common. Moreover, the risk of pulmonary infection was followed; the results did not show a statistical significance. Conclusion: The multimodal concept treating esophageal cancer with a combination of chemo(radio)therapy & surgery is a most promising approach for extended long-term survival. Thereby, minimally invasive surgery proved to have reduced perioperative morbidity with equivalent oncological radicality & outcomes compared with open esophagectomy. So far, it seems that in locally advanced tumors & complex cases, robotic assistance allows highest oncological radicality without risking more complications. Furthermore, today’s improvements of existing robotic platforms lay the foundation for future innovations such as artificial intelligence as well as data & skill sharing.

Background: Preeclampsia is a major cause of maternal and fetal morbidity and mortality worldwide, particularly among high-risk pregnant women. While low-dose aspirin is commonly prescribed for prophylaxis, the potential benefit of omega-3 fatty acids in preventing preeclampsia remains underexplored. This study aims to evaluate the efficacy of low-dose aspirin, omega-3 fatty acids, and their combination in preventing preeclampsia in high-risk pregnant women. Materials and Methods: A randomized controlled trial was conducted involving 300 high-risk pregnant women aged 18–40 years, recruited from a tertiary care hospital. Participants were randomly assigned into three groups (n = 100 each): Group A received low-dose aspirin (81 mg/day), Group B received omega-3 fatty acids (1 g/day), and Group C received a combination of low-dose aspirin and omega-3 fatty acids. Treatment was initiated at 12–16 weeks of gestation and continued until delivery. The primary outcome was the incidence of preeclampsia, while secondary outcomes included gestational hypertension, maternal adverse events, and neonatal outcomes. Results: The incidence of preeclampsia was significantly lower in Group C (8%) compared to Group A (15%) and Group B (12%) (p < 0.05). The combination therapy also showed a reduction in gestational hypertension (10% in Group C vs. 18% in Group A and 14% in Group B). Maternal adverse events were comparable across all groups. Neonatal outcomes, including birth weight and Apgar scores, were improved in the combination group. The relative risk reduction of preeclampsia in Group C compared to Group A was 46.7%, and compared to Group B was 33.3%. Conclusion: The combination of low-dose aspirin and omega-3 fatty acids appears to be more effective in reducing the incidence of preeclampsia and gestational hypertension compared to either intervention alone. This combined approach may be a promising strategy for preventing preeclampsia in high-risk pregnant women. Further large-scale studies are warranted to confirm these findings.

Background: Pregnant women with high-risk cardiovascular profiles are at increased risk of developing hypertensive disorders, preeclampsia, and adverse cardiovascular events. Low-dose aspirin (LDA) has been suggested as a potential prophylactic intervention to reduce such risks. This study aimed to evaluate the cardioprotective effects of low-dose aspirin in pregnant women with high-risk cardiovascular profiles. Materials and Methods: A randomized, controlled clinical trial was conducted involving 120 pregnant women identified with high-risk cardiovascular profiles, including hypertension, diabetes, obesity, or a history of preeclampsia. Participants were randomly divided into two groups: Group A (n = 60) received daily low-dose aspirin (75 mg) from 12 weeks of gestation until delivery, while Group B (n = 60) received a placebo. The primary outcomes assessed were incidence of preeclampsia, maternal cardiovascular events, and neonatal outcomes. Secondary outcomes included blood pressure levels, proteinuria, and gestational age at delivery. Statistical analysis was performed using the Chi-square test and Student’s t-test, with a significance level set at p < 0.05. Results: The incidence of preeclampsia was significantly reduced in Group A (15%) compared to Group B (30%) (p = 0.02). Maternal cardiovascular events occurred in 3% of patients in Group A versus 10% in Group B (p = 0.04). Neonatal outcomes, including birth weight and Apgar scores, were notably better in Group A. Mean systolic blood pressure was lower in the LDA group (120 ± 8 mmHg) compared to the placebo group (128 ± 10 mmHg) (p = 0.01). No significant adverse effects related to aspirin use were reported. Conclusion: Low-dose aspirin administration in pregnant women with high-risk cardiovascular profiles demonstrated significant cardioprotective effects, with reduced incidence of preeclampsia, improved maternal cardiovascular health, and enhanced neonatal outcomes. Low-dose aspirin appears to be a safe and effective prophylactic intervention in this high-risk population. Further studies with larger sample sizes are warranted to validate these findings.

Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder during pregnancy, associated with an increased risk of developing diabetic retinopathy (DR). Early screening and timely management of DR in pregnant women with GDM are crucial to prevent vision-related complications. This study aims to assess the prevalence of DR among pregnant women with GDM and evaluate the efficacy of various screening and management approaches. Materials and Methods: A cross-sectional study was conducted on 150 pregnant women diagnosed with GDM attending the antenatal clinics at a tertiary care hospital. Retinal screening was performed using non-mydriatic fundus photography and ophthalmological examinations at baseline and during follow-up visits. Participants were divided into two groups: Group A (n=75) received standard glycemic control and ophthalmologic screening, while Group B (n=75) received additional interventions including telemedicine consultations and retinal laser therapy when required. Data were analyzed using descriptive and inferential statistics, with p-values < 0.05 considered statistically significant. Results: The prevalence of DR in the study population was found to be 18% (27 out of 150). Mild non-proliferative DR was identified in 12% of cases, while 6% had moderate to severe forms. Group B showed a significantly lower progression rate of DR compared to Group A (5% vs. 12%, p = 0.03). Visual acuity was preserved in 95% of participants receiving additional interventions. Telemedicine consultation improved patient adherence to screening schedules by 30%. Conclusion: The study highlights the importance of early screening and comprehensive management of diabetic retinopathy in pregnant women with gestational diabetes. Incorporating advanced screening techniques and telemedicine consultations can significantly reduce the progression of DR, thereby preserving visual health during pregnancy.

Introduction - The liver, a key organ in metabolism, detoxification and immunity is severely affected in chronic liver disease (CLD), which involves progressive damage leading to fibrosis and cirrhosis. Major causes include alcohol, hepatitis B and C and Non-alcoholic fatty liver disease (NAFLD). CLD frequently causes hematological abnormalities like anemia (normocytic normochromic in 75% of cases), macrocytosis, and coagulation disruptions due to inflammation, blood loss and reduced red blood cell lifespan. This study aimed to assess these abnormalities in decompensated CLD patients to guide interventions and reduce associated risks. Material & Methods - A cross-sectional analytical study was conducted on 100 decompensated CLD patients at Mahatma Gandhi Medical College, Jaipur from January 2024 to December 2024, to evaluate hematological abnormalities and hemostatic derangements. Detailed patient histories and blood analyses, including CBC, liver function tests, and peripheral blood smear assessments were performed to guide treatment and reduce morbidity. Results - Alcohol is the leading cause of chronic liver disease (CLD) responsible for 64% of cases, followed by Hepatitis B (15%) and cryptogenic causes (14%). Anemia is prevalent, with 92% of patients having hemoglobin levels below 10 gm%. Thrombocytopenia affects 70% of cases, and coagulation abnormalities such as prolonged prothrombin time and elevated INR are common. Hypoproteinemia is observed in 83% of patients, reflecting significant protein deficiency associated with CLD. These findings highlight the need for targeted interventions to address hematological and coagulation disturbances in CLD patients. Conclusion - The study highlights common hematological abnormalities in decompensated chronic liver disease including anemia, thrombocytopenia, hypoalbuminemia and prolonged PT/APTT. Early detection and management are essential for reducing morbidity and improving patient outcomes, with findings consistent with trends seen in other studies despite some variations

Background: Congenital Heart Defects (CHDs) are among the most prevalent birth defects, contributing significantly to neonatal morbidity and mortality. Various genetic and environmental factors, including maternal nutrition and lifestyle, have been implicated in the etiology of CHDs. This study aimed to assess the influence of maternal dietary patterns, lifestyle habits, and nutritional status during pregnancy on the development of CHDs in infants. Materials and Methods: A case-control study was conducted between January 2024 and January 2025 at a tertiary care hospital. A total of 300 pregnant women were enrolled, consisting of 150 mothers of infants diagnosed with CHDs (case group) and 150 mothers of healthy infants (control group). Data were collected using structured questionnaires covering maternal dietary intake, physical activity, substance use (alcohol, tobacco), and prenatal supplement intake. Serum levels of essential nutrients, including folate, vitamin B12, and iron, were measured. Statistical analysis was performed using SPSS version 27.0, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Mothers of infants with CHDs had significantly lower intake of folate (Mean = 320 µg/day) and vitamin B12 (Mean = 2.4 µg/day) compared to controls (Mean = 450 µg/day for folate, Mean = 3.6 µg/day for vitamin B12) (p < 0.001). Serum folate and vitamin B12 levels were also markedly lower in the case group (p < 0.001). Additionally, maternal smoking (OR = 3.5, 95% CI: 1.9–6.3) and alcohol consumption (OR = 2.8, 95% CI: 1.5–5.2) during pregnancy were significantly associated with increased risk of CHDs. Physical inactivity was observed in 65% of cases compared to 35% of controls (p < 0.01). Conclusion: The findings indicate that inadequate maternal nutrition, specifically lower folate and vitamin B12 intake, along with detrimental lifestyle factors such as smoking and alcohol consumption during pregnancy, contribute to the risk of developing CHDs in infants. Public health initiatives aimed at improving maternal nutrition and promoting healthier lifestyle choices during pregnancy are essential to reduce the incidence of CHDs.

Background: Obesity is a growing public health concern globally and has been associated with various respiratory complications. This study aimed to evaluate the effect of body mass index (BMI) on pulmonary function test (PFT) parameters in adults. Methods: A cross-sectional study was conducted on 100 adults aged 25-65 years who underwent PFT and BMI measurements. Participants were categorized into four groups based on BMI: underweight (n=10), normal weight (n=40), overweight (n=30), and obese (n=20). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and other PFT parameters were analyzed across the BMI groups. Regression analyses were performed to assess the relationship between BMI and PFT parameters, adjusting for age, gender, and smoking status. Results: The study population had a mean age of 42 years and a mean BMI of 27.5 kg/m2. Significant differences in FVC, FEV1, and FEV1/FVC ratio were observed across the BMI groups (p < 0.05). Obese individuals exhibited a mean FVC of 3.1 L and a mean FEV1 of 2.4 L, compared to 4.2 L and 3.3 L, respectively, in normal-weight individuals. BMI was inversely correlated with FVC (r = -0.32, p = 0.001) and FEV1 (r = -0.28, p = 0.005) after adjusting for confounders. Conclusions: Higher BMI was associated with reduced pulmonary function, particularly decreased FVC and FEV1 values. These findings suggest that obesity may have a detrimental impact on respiratory health and emphasize the importance of maintaining a healthy weight to preserve optimal pulmonary function.

Background & Methods: The aim of the study is to study the accuracy of Sentinel lymph mode biopsy in early breast cancer. Ccarefully identification and evaluation all blue SLN specimens. All lymph nodes in the specimen identify and dissected from the surrounding tissue by the pathologist. We accessed the number of nodes and their dimensions. SLNs were stained with hematoxylin and eosin (H&E). SLNBs were sectioned and examined for tumour cells.

Results: The accuracy and false negative rate (FNR) according to the number of dissected SLNs. The sentinel node accuracy was 94.9% and the FNR was 5% in all patients with ALND. The FNR of the biopsy decreased as the number of removed lymph nodes increased. Specifically, the FNR was 00% when more than four lymph nodes were removed.

Conclusion: The sentinel lymph node biopsy is a safe, reliable and reproducible operation that provides an accurate assessment of nodal metastasis for the breast cancer patient. It continues to add to the trend in breast surgery in which the surgeon provides less surgery while maintaining a standard of care that minimizes breast cancer morbidity and mortality.

Background: Intermittent hypoxia (IH) is characterized by repeated episodes of reduced oxygen availability, which can influence cardiovascular autonomic regulation. Understanding the impact of IH on autonomic functions is critical for elucidating potential mechanisms underlying cardiovascular pathologies. This study aimed to evaluate the effects of IH on cardiovascular autonomic regulation in healthy adults using heart rate variability (HRV) and blood pressure variability (BPV) as indices. Materials and Methods: A randomized crossover study was conducted involving 30 healthy adults (mean age: 25 ± 3 years, 15 males, 15 females). Participants were subjected to two conditions: normoxia (control) and intermittent hypoxia (12% O2 for 5 minutes, interspersed with 5 minutes of normoxia, repeated over 1 hour). Cardiovascular autonomic regulation was assessed by measuring HRV and BPV using a portable electrocardiogram (ECG) and continuous blood pressure monitoring device. Data were analyzed using time-domain and frequency-domain parameters of HRV and BPV. Statistical comparisons between the two conditions were made using paired t-tests with a significance level of p < 0.05. Results: Compared to the normoxia condition, IH exposure resulted in a significant reduction in HRV parameters including SDNN (from 65.4 ± 12.3 ms to 52.8 ± 10.7 ms, p = 0.01) and RMSSD (from 42.6 ± 9.5 ms to 31.3 ± 8.2 ms, p = 0.004). Additionally, LF/HF ratio increased from 1.7 ± 0.4 to 2.5 ± 0.5 (p = 0.002), indicating enhanced sympathetic modulation. BPV parameters showed a significant increase in systolic BPV (from 10.2 ± 2.1 mmHg to 14.5 ± 2.4 mmHg, p = 0.03), suggesting elevated vascular reactivity under IH conditions. Conclusion: Intermittent hypoxia significantly alters cardiovascular autonomic regulation in healthy adults by reducing HRV and increasing sympathetic dominance, as indicated by the LF/HF ratio. Additionally, elevated BPV suggests increased vascular reactivity under hypoxic conditions. These findings highlight the potential adverse effects of recurrent hypoxia on cardiovascular health, warranting further investigation into preventive and therapeutic strategies.

Background: Fetal hemoglobin (HbF) plays a crucial role in modulating disease severity in sickle cell anemia (SCA) and β-Thalassemia by reducing sickling, hemolysis, and transfusion dependency. The relationship between HbF levels, hemoglobinopathy subtypes, and blood transfusion requirements remains an area of interest. This study aims to compare HbF levels across different hemoglobinopathy groups and analyze their association with transfusion dependency. Methods: A cross-sectional, hospital-based study was conducted on 130 patients diagnosed with β-thalassemia major (BTM), β-thalassemia trait (BTT), sickle cell anemia (SCD), sickle cell trait (SCT), and sickle-thalassemia trait (STT). HbF levels were measured using high-performance liquid chromatography (HPLC), and their association with transfusion dependency and disease severity was analyzed. Statistical comparisons were performed using independent t-tests and one-way ANOVA, with significance set at p< 0.05. Results: BTM patients had the highest HbF levels (Mean = 86.95%), reflecting their reliance on HbF due to absent adult hemoglobin. SCD patients showed elevated HbF levels (Mean = 13.72%), correlating with reduced disease severity. SCT and BTT groups had lower HbF levels (Mean = 2.25% and 3.11%, respectively), aligning with their clinically milder presentations. Patients requiring blood transfusions had significantly higher HbF levels (Mean = 24.5%) compared to those not requiring transfusions (Mean = 2.94%) (p< 0.001), suggesting that increased HbF levels alone do not always prevent transfusion dependency, particularly in severe cases. Conclusion: HbF levels vary significantly across hemoglobinopathy subtypes, with higher levels offering a protective effect in SCD but failing to eliminate transfusion dependency in BTM. The study highlights the importance of HbF as a disease-modifying factor and the need for genetic screening to predict clinical severity and optimize treatment strategies. Further research is required to explore genetic influences on HbF expression and potential therapeutic interventions.

Background Alcoholic hallucinosis appears as a rare alcohol abuse complication that produces auditory hallucinations in patients after they consume a heavy amount of alcohol. The symptoms of alcoholic hallucinosis show a clear awareness combined with a more prolonged duration and they sometimes appear similar to schizophrenia symptoms. According to International Classification of Diseases (ICD-10) the condition falls under Alcohol-Induced Psychotic Disorder Predominantly Hallucinatory Type. Case Presentation A 25-year-old married male suffering from poverty showed up at the emergency department because he had been experiencing auditory hallucinations together with sporadic visual hallucinations and delusions of persecution for two months. The patient had been struggling with alcohol use disorder for seven years with his alcohol use quantity intensifying across the years and multiple instances of brief abstinence. During his hospital admission he presented with poor sleep quality along with shaking hands and mistrust toward his wife. The patient demonstrated psychotic feature inheritance together with alcohol dependency in his closest blood relatives. His psychiatric evaluation showed he displayed fear along with persecutory ideas because both his distress and his experience of auditory hallucinations involving commands with derogatory remarks. Medicare hospital staff provided him treatment that included Lorazepam, Chlordiazepoxide, Olanzapine along with Vitamin B-Complex. Gradually his symptoms of withdrawal became less severe so did his hallucinations. Conclusion The patient's condition demonstrates how alcoholic hallucinosis interacts with delirium tremens therefore requiring staffers to distinguish between them. Several factors such as the extended illness period and mental clarity and familial psychiatric history indicate that this patient might truly have a primary psychotic disorder. The patient requires prolonged monitoring to establish an official diagnosis as well as determine whether psychiatric treatment needs to continue.

Background: Hypertensive Heart Disease (HHD) is a significant cause of cardiovascular morbidity and mortality worldwide. Early detection and risk stratification of HHD are critical for effective management and prevention of disease progression. Conventional biomarkers such as NT-proBNP and troponin have shown limitations in sensitivity and specificity. This study aimed to evaluate novel biomarkers for early detection and risk stratification of HHD in comparison with traditional markers. Materials and Methods: A cross-sectional study was conducted on 150 patients diagnosed with hypertension, divided into two groups: Group A (n = 100) with evidence of hypertensive heart disease, and Group B (n = 50) without evidence of hypertensive heart disease. Blood samples were collected from all participants and analyzed for novel biomarkers including Galectin-3, ST2, and MicroRNA-21, along with conventional markers such as NT-proBNP and high-sensitivity troponin. Echocardiography was performed to assess cardiac structure and function. Statistical analysis was conducted using independent t-tests, Pearson’s correlation, and Receiver Operating Characteristic (ROC) curves to evaluate the diagnostic performance of the biomarkers. Results: The levels of Galectin-3, ST2, and MicroRNA-21 were significantly higher in Group A compared to Group B (p < 0.001). ROC curve analysis revealed that ST2 had the highest sensitivity (88%) and specificity (85%) for detecting HHD, followed by Galectin-3 (sensitivity 82%, specificity 80%) and MicroRNA-21 (sensitivity 79%, specificity 76%). Combined use of these biomarkers showed improved diagnostic accuracy (AUC = 0.92) compared to traditional markers NT-proBNP (AUC = 0.76) and high-sensitivity troponin (AUC = 0.70). Conclusion: The novel biomarkers Galectin-3, ST2, and MicroRNA-21 demonstrated superior sensitivity and specificity compared to conventional markers for the early detection and risk stratification of hypertensive heart disease. The combined use of these biomarkers offers a promising diagnostic tool for improved risk assessment and management of HHD. Further longitudinal studies are recommended to validate these findings.

Background Pyogenic granuloma (PG) is a benign vascular lesion characterized by rapid growth, friability, and a tendency to bleed and recur. Traditional treatments include surgical excision, cryotherapy, and laser therapy, but these often involve scarring or recurrence. Recently, minimally invasive methods such as radiofrequency cauterization (RFC) and topical common salt application have gained attention. This study aims to compare the recurrence rates and cosmetic outcomes of these two treatment modalities. Method A prospective cohort study was conducted at the Department of Dermatology, Venereology, and Leprosy, M.G.M. Medical College & M.Y. Hospital, Indore, over 12 months. Fifty patients diagnosed with cutaneous pyogenic granuloma were randomized into two groups: Group A treated with RFC and Group B treated with common salt application. Patients were followed up for 3 months to assess recurrence rates and scarring outcomes. Data were analyzed using SPSS version 22.0, with a p-value <0.05 considered statistically significant. Results Both RFC and common salt application demonstrated identical recurrence rates of 8% at 3 months (p=1.000). However, scarring outcomes differed significantly (p=0.018). While 20% of patients in the RFC group experienced scarring, none in the common salt group had scarring. Lesions most commonly occurred on the head (54%) and were predominantly larger than 10mm (84%). The majority of patients reported bleeding as the primary symptom (80%). Conclusion Both RFC and common salt application are effective in preventing recurrence of pyogenic granuloma at 3 months. However, common salt therapy offers superior cosmetic results by eliminating scarring entirely. Given its affordability, safety profile, and ease of use, common salt application represents an excellent first-line treatment option for pyogenic granuloma.

Background Rheumatic heart disease (RHD) remains a significant cardiovascular burden, particularly among pregnant women in low- and middle-income countries. Pregnancy increases hemodynamic stress, which may exacerbate complications such as atrial fibrillation (AF), leading to adverse maternal and fetal outcomes. This study aims to compare the clinical outcomes, maternal complications, and perinatal prognosis in pregnant women with RHD with and without AF. Materials and Methods A prospective observational study was conducted on 120 pregnant women diagnosed with RHD at a tertiary care center. The participants were divided into two groups: Group A (n=60) included RHD patients with AF, and Group B (n=60) consisted of RHD patients without AF. Maternal echocardiographic parameters, hemodynamic stability, fetal outcomes, and peripartum complications were recorded. Statistical analysis was performed using SPSS software, and a p-value <0.05 was considered significant. Results The incidence of maternal complications such as heart failure (35% vs. 12%, p=0.01) and thromboembolic events (18% vs. 5%, p=0.03) was significantly higher in Group A. Adverse fetal outcomes, including preterm birth (28% vs. 15%) and intrauterine growth restriction (22% vs. 10%), were more common in the AF group. The mean left atrial diameter was significantly larger in Group A (48.6 ± 5.2 mm vs. 42.3 ± 4.8 mm, p=0.002). The requirement for intensive cardiac care was also higher in Group A (42% vs. 20%, p=0.004). Conclusion Pregnant women with RHD complicated by AF have a significantly higher risk of maternal and fetal complications compared to those without AF. Early detection and optimal anticoagulation strategies are essential to improving outcomes. Multidisciplinary management is recommended to mitigate perinatal risks

Pulmonary embolism (PE) is a life-threatening condition that requires immediate intervention. While CT pulmonary angiography (CTPA) is the gold standard for diagnosis (1,2), it may not always be feasible, especially in critically hemodynamically unstable patients. In some cases, other diagnostic criteria may be overlapping, making it confusing and extremely difficult to diagnose. We present a case of a patient who came to our emergency medicine department (EMD) in critically unstable condition where possibility of doing a CTPA was not possible. Based on clinical judgment, thrombolysis was administered without CTPA, Post thrombolysis patient stabilized enough to go for CTPA which confirmed the diagnosis of PE, further on patient made a remarkable recovery, ultimately walking out of the hospital. This case highlights the importance of clinical judgment in decision-making, even in an era dominated by high end diagnostic tools and artificial intelligence.

Introduction; - Antiplatelet therapies are a cornerstone in the management of acute coronary syndromes (ACS), largely due to the prominent role that platelet activation and aggregation play in the pathophysiology of the disease. P2Y12 inhibitors are integral to the management of ACS Aim: The study aims to evaluate the real-world efficacy, side effects, symptoms, repeat myocardial infarction (MI), and bleeding profile of P2Y12 inhibitors in ACS management. Methods: A meticulously designed prospective observational study was conducted on patients diagnosed with ACS, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina. Participants were stratified based on the prescribed P2Y12 inhibitors. Key clinical endpoints, such as side effects, symptoms, repeat MI, bleeding profile, and all-cause mortality, were assessed over a structured 1-month follow-up period. Results: A total of 100 patients were enrolled. After 1 month of taking P2Y12 inhibitors, side effects noted included insomnia, nausea, vomiting, and dyspnoea in 91% of patients. Additionally, 21% of patients experienced chest pain, and 9% had a repeat MI. The majority of repeat MI and recurring symptoms were observed in patients aged 70-90 years. The risk-benefit equilibrium of these agents underscores the necessity of precision medicine in tailoring antiplatelet therapy for ACS patients. Conclusion: P2Y12 inhibitors are integral to contemporary ACS management, with clopidogrel being the most commonly used drug in this syndrome, compared to ticagrelor. In this study, the side effects of clopidogrel were more frequent than those of ticagrelor, but they were mild and transient. Fewer patients experienced a repeat MI after using these drugs, and overall, symptoms and side effects were relatively manageable. However, a significant proportion of patients experienced side effects after taking P2Y12 inhibitors in the management of acute coronary syndrome.

Background: The current study explores the sacral index's importance as a tool for determining biological sex. It seeks to establish the relevance and reliability of this anatomical measurement in forensic and anthropological contexts, providing insights into its potential utility in sex determination. Materials & methods: The present study was conducted on 110 adult human sacra of known sex, 50 of which were male and 60 females. The mean maximum sacral length and mean maximum sacral breadth were measured using a sliding vernier calliper, which provides precise measurements of the sacrum's dimensions. Following these measurements, the sacral index was calculated to assess the relative proportions of the sacrum. The collected data underwent statistical analysis to evaluate trends and the significance of the results. Results: The mean maximum sacral length is significantly greater in males (118.6 mm) compared to females (103.7 mm). However, there is no significant difference in the mean maximum sacral width between males (117.31 mm) and females (116.53 mm). Notably, the mean sacral index is higher in females (104.5 mm) than in males (97.54 mm), which is highly significant. Conclusion: The sacral index is a reliable tool for determining biological sex. It measures the sacrum, the triangular bone at the base of the spine.

Background: Pyogenic granuloma (PG) is a benign vascular proliferation of the skin and mucosa that frequently occurs in response to trauma, hormonal influences, or unknown stimuli. Various treatment modalities exist, including surgical excision, laser therapy, and radiofrequency cautery (RFC), but these may cause scarring or recurrence. Common salt application has emerged as a potential alternative treatment due to its ease of use and cost-effectiveness. This study aims to compare the effectiveness of RFC ablation and common salt application in the management of PG. Methods: A prospective cohort study was conducted over 12 months at a tertiary care hospital. Fifty consenting adults with cutaneous PG were randomized into two treatment groups: RFC ablation (Group A) and common salt application (Group B). The primary outcome measures were complete healing after 14 days, scarring after one month, and recurrence after three months. Data were analyzed using SPSS version 22.0, with statistical significance set at p < 0.05. Results: The study population comprised 50 patients, with a male predominance (78%). Lesions were most commonly found on the head (54%) and were predominantly >10mm in size (84%). Complete healing rates after 14 days were identical in both treatment groups (84%, p = 1.000). However, scarring after one month was significantly higher in the RFC group (20%) compared to the common salt group (0%) (p = 0.018). Recurrence rates at three months were low and similar in both groups (8%). Conclusion: Both RFC ablation and common salt application effectively treat pyogenic granuloma, achieving high healing rates. However, common salt application offers an advantage in preventing post-treatment scarring, making it a preferable option for patients concerned with cosmetic outcomes. Further studies with larger sample sizes and longer follow-up are recommended to confirm these findings.

Wolff-Parkinson-White (WPW) syndrome is a rare congenital cardiac pre-excitation syndrome. PW syndrome in pregnancy,  this physiological process might be responsible for life threatening arrthymias leading to dangerous outcomes for both mother and the fetus. It is a ventricular pre-excitation syndrome of anterograde activation of the ventricle resulting from aberrant conduction pathway as well as the AV node. Very small percent of patients with WPW syndrome that is less than 1% are at risk of sudden cardiac death. Most of the antiarrthymic drugs are a threat to the fetus therefore careful choice of drug has to be made. Digoxin is the drug that is contraindicated in adults with WPW syndrome and some drugs like verapamil increase danger of ventricular fibrillation and therefore use of drugs are a topic of concern. we report a rare case of Wolff Parkinson White syndrome in a 20yrs old primigravida at 20weeks of gestation  presented with palpitations , shortness of breath and chest pain. The diagnosis was made by ECG , 2D ECHO. Holter and electrophysiology study of heart. She underwent radio frequency catheter posterior septal pathway ablation at 24weeks of gestation and was prescribed Metaprolol resulting in symptomatic improvement. Patient had regular antenatal and cardiology checkups until 37 weeks of gestation. At 37 weeks patient underwent LSCS and delivered a live healthy baby. The disease cause, manifestations, diagnostic tests and management and outcome are discussed.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) describes a range of conditions involving the liver that affect people who drink little or no alcohol. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and the metabolic syndrome is the main risk factor. AIMS & OBJECTIVE: To estimate the prevalence, risk factors and clinical profile of NAFLD of nonalcoholic fatty liver disease (NAFLD) among type 2 diabetes mellitus (T2DM) patients at a tertiary care center in Madhubani Medical College of Madhubani district of Bihar, India. METHODS AND MATERIALS: After obtaining institutional ethical committee clearance from the institute, one hundred patients of either sex having type II diabetes mellitus attending diabetic out-patient department of Medicine in Madhubani Medical College were included in the study. The study was done for a period of 1 year. A pre-designed study pro-forma was filled in relevant investigations and clinical assessments were carried out in all cases. All the patients underwent abdominal ultrasonography.                 RESULTS:   A total of 110 diabetic patients were studied. Out of these, 56 (56%) were female and 54 (54%) were male. Mean age of the patients was 47.62 ± 6.56 years. Fifty one (51%) of the diabetic patients were having fatty liver. Out of these 51 patients of fatty liver, 32 (62.74%) were female and 19 (37.25%) were male. Fatigue was seen in 44 (40.0%), generalized weakness in 16 (14.54%), heaviness right upper abdomen in 22 (20.0%) and pain right upper abdomen was seen in 28 (25.45%) of fatty liver patients while these were 41 (37.27%), 38 (34.54%), 17 (15.45%) and 13 (11.81%) in non-fatty liver patients respectively. CONCLUSION: Nonalcoholic fatty liver disease (NAFLD) is more commonly seen in type II diabetic patients. Serum triglyceride and serum cholesterol are significantly raised in NAFLD patients. Raised ALT and AST is not a common finding in our NAFLD study patients.

Introduction: Chondrosarcoma (CS) was the third most common primary bone malignancy. Frequently chondrosarcoma was occurring in long bones or in the pelvis. Their localization in the rib is rare. Case presentation: A 40-year-old female came to OPD with a painless, smooth, but firm right breast lump, observed by herself for the past 3-4 months. The lump was of insidious onset, slowly increasing, without any nipple discharge. She had normal menarche with no family history of breast or ovarian malignancy. She did not report ingesting any oral contraceptive pills.  Clinical presentation had supposed initially as a sarcoma of the breast. Preoperative unenhanced CT imaging showed well-defined round heterogeneous soft tissue density with hypo dense areas. A core-needle biopsy was taken, which was suggestive of chondrosarcoma grade II. The whole tumor was excised en-bloc along with 4th, 5th and 6th ribs. Reconstruction of the defect was undertaken with polypropylene plate and ipsilateral pedicle latissimus dorsi muscle flap was placed on the alloplastic mesh. The patient had an uneventful postoperative course and was discharged on the 10th postoperative day. No adjuvant treatment was administrated. Conclusion: Retro-mammary lesions should definitely be considered in the differential diagnosis of atypical presentations of breast lumps with non-conventional FNAC reports. MRI is an excellent modality for the evaluation of uncommon breast lumps. Mutilating mastectomy is not necessary for even large retro-mammary lesions. Chest wall reconstruction with titanium mesh is an effective method of reconstruction.

INTRODUCTION: Peri operative visual impairment/Blindness as an isolated complication following cardiac surgery is known to occur in 0.05-0.1% of cases (2). Most common etiology is ischemic damage to retina / optic nerve/ occipital cortex (2). We report a case of bilateral cortical blindness due to unilateral subdural hematoma in occipital region with spontaneous remission after 4 weeks.  CASE REPORT: 20 months old child with tetralogy of fallot’s (TOF), weighing 10 kg and saturation of 82% underwent elective intracardiac repair. Repair was performed through median sternotomy. Trans right atrial VSD closure, right ventricular outflow tract resection along with limited transannular patch augmentation was performed on cardiopulmonary bypass (CPB). Aorto-Bicaval cannulation was performed and baby was cooled to 28-degree ﮿C. Aortic X clamp time and CPB time were 180 min and 240 min respectively. CONCLUSION:  Cortical blindness is a rare and devastating complication after congenital heart repair. It can be transient if underlying cause is reversible.  Unilateral occipital SDH can result in bilateral cortical blindness in post operative period.          

Introduction; - Background: Sperm morphology, an essential parameter of semen quality, is a critical determinant of male fertility. It refers to the size and shape of sperm, influencing their ability to penetrate and fertilize an oocyte. There is a need for comprehensive research to determine the optimal duration and intensity of isotonic exercise for improving sperm morphology. Objectives: To study of effect of isotonic exercise on sperm morphology in healthy young adults Material and Methods: This study was conducted in the department of Physiology of a medical college & hospital situated in an urban city of Maharashtra. Study was conducted on 90 healthy males for a duration of 1 year. Semen examination of the sedentary healthy individuals (Group A) and those healthy individuals who were involved in regular isotonic exercises (weight lifting exercises for upper limbs, lower limbs and torso) for 1 year (Group B) and 5 years (Group C) respectively was done in accordance with the standardized method of the World Health Organization. Results: There was no significant difference (p>0.05) between control group A, study group B & study group C with respect to age, weight, height and body mass index. There was highly significant difference (p less than 0.001) in mean values of normal sperm morphology among the 3 groups. Normal sperm morphology was significantly higher in group B as compared to other 2 groups. Conclusion: Regular Isotonic exercises for over a year exerts a positive effect on the sperm morphology.

Introduction; - Myocardial infarction is decreased or complete stoppage of blood to a part of the heart muscles. In 2021, cardiovascular deaths accounted for 20.5 million deaths worldwide. The 65th World Health Assembly raised to act on NCD deaths and fixed a target of 25% reduction in the premature deaths due to the non-communicable diseases by 2025. Majority of the Indian population live in rural regions and the rural urban distribution is 68.8% in rural areas and 31,2% in urban areas. We assessed 1.the echocardiographic parameters of right ventricle in proximal RCA lesion in patients with IWMI. 2. to predict the significance of associated parameters in predicting IWMI patients with proximal RCA lesion at the very beginning. Material and Methods: A cross-sectional study was done in patients attending Cardiology Department, Government Medical College, Namakkal with symptoms suggestive of coronary artery syndrome with inferior wall myocardial infarction. We followed convenience sampling. The study was done from July 2022 to February 2023. We evaluated the clinical characteristics of the patients & the echocardiographic parameters. Results: The results of the study showed that non-smokers had more proximal lesion 31(75.6%) in the right coronary artery as compared to non-smokers 17 (47.2%) which is statistically significant. Peak systolic velocity (9.74 Vs 10.64) and ejection time (223 Vs 265) were less in the proximal group while isovolumic relaxation time (84 Vs 65), isovolumic contraction time (80 Vs 64) and myocardial performance index (0.64 Vs 0.39) were more in the proximal group and the difference is statistically significant. Conclusion: Sm, ET, IVRT, IVCT and MPI are useful parameters in predicting proximal RCA lesion in echocardiography.

Background: Atherosclerosis is a chronic inflammatory disease characterized by lipid accumulation in the arterial walls, leading to cardiovascular diseases (CVDs). Lipidomics, an advanced analytical approach, plays a crucial role in elucidating lipid metabolism and its impact on atherosclerosis progression. This study explores the role of lipidomics in identifying lipid biomarkers and their correlation with cardiovascular risk. Materials and Methods: A total of 100 patients with clinically diagnosed atherosclerosis and 50 healthy controls were enrolled. Serum lipid profiles were analyzed using high-performance liquid chromatography-mass spectrometry (HPLC-MS). Key lipid subclasses, including phospholipids, sphingolipids, and neutral lipids, were quantified. Statistical analysis was performed using SPSS software to determine significant variations in lipid profiles between groups. Results: The study revealed a significant increase in total cholesterol (220 ± 15 mg/dL), low-density lipoprotein (LDL) (140 ± 10 mg/dL), and triglycerides (180 ± 12 mg/dL) in atherosclerotic patients compared to controls. Sphingomyelin and ceramide levels were elevated by 35% in patients, indicating their potential role in disease progression. Additionally, phosphatidylcholine/phosphatidylethanolamine (PC/PE) ratio was significantly altered, suggesting lipidomic signatures associated with increased cardiovascular risk. Conclusion: Lipidomics provides valuable insights into the biochemical mechanisms of atherosclerosis and facilitates the identification of lipid biomarkers for early detection and risk assessment. The findings support the potential of lipidomic profiling in personalized cardiovascular risk management and therapeutic interventions.

Background: Lichen planus (LP) is a chronic inflammatory dermatosis characterized by hyperpigmented lesions with histopathological variability among its different variants. Accurate diagnosis relies on histopathological examination due to the overlapping clinical presentations. This study aims to analyze and compare the histopathological features of LP and its variants to enhance diagnostic accuracy. Materials and Methods: This prospective descriptive study was conducted at the Department of Pathology, Raja Rajeswari Medical College and Hospital (RRMCH), Bengaluru, over two years (June 2015–May 2017). A total of 100 skin biopsy specimens diagnosed as hyperpigmented skin lesions were examined. Among these, 76 cases were classified as non-neoplastic, predominantly consisting of LP and its variants. Standard histopathological techniques were employed, including hematoxylin and eosin staining, to assess epidermal and dermal changes. Results: Among the 76 non-neoplastic cases, classical lichen planus (CLP) was the most common variant (28.94%), followed by lichen planus pigmentosa’s (LPP) (14.47%). Other variants included hypertrophic LP (6.50%) and lichen simplex chronic us (5.20%). Histopathologic ally, hyperkeratosis (77.63%), acanthosis (69.73%), and pigment incontinence (52.63%) were frequently observed. Basal cell degeneration was noted in 51.31% of cases, and a perivascular inflammatory infiltrate was present in 73.68%. Clinico-histopathological correlation was observed in 94% of cases. Conclusion: Lichen planus and its variants exhibit distinct histopathological features, with CLP being the most prevalent subtype. Histopathological examination remains the gold standard for differentiating LP variants, aiding in precise diagnosis and management. Understanding the morphological spectrum is essential for accurate classification and therapeutic planning

Background: Psoriasis is a chronic, inflammatory skin condition characterized by erythematous, indurated papules and plaques covered with silvery scales. It significantly impacts patients' quality of life. Traditional topical treatments for mild to moderate psoriasis have limitations, including cutaneous atrophy and tachyphylaxis. Methotrexate, known for its immunosuppressive and cytotoxic properties, is effective in systemic use for psoriasis. This study evaluates the efficacy of 1% methotrexate gel as a topical treatment for psoriasis, focusing on localized lesions. Method: This prospective cross-sectional study was conducted at the Department of Dermatology, Venereology, and Leprosy, M.Y. Hospital, Indore, over a 12-month period. A total of 30 patients clinically diagnosed with psoriasis were included. Participants were treated with 1% methotrexate gel applied twice daily for six weeks. The Psoriasis Area Severity Index (PASI) and Erythema, Scaling, and Induration (ESI) scores were recorded at baseline, 2, 4, and 6 weeks to assess the severity and improvement of lesions. Physician Global Assessment was used to categorize improvement at the end of the study. Statistical analysis was performed using paired t-tests, with a p-value < 0.05 considered statistically significant. Results: Out of 30 participants, 63.3% were female and 36.7% were male, with a mean age of 31.57 ± 7.07 years. At baseline, the mean ESI score was 4.97 ± 1.03, which reduced to 4.33 ± 1.07 at 2 weeks, 3.67 ± 1.39 at 4 weeks, and 3.50 ± 1.41 at 6 weeks, showing a significant reduction in scores (p < 0.05). The mean percentage reduction in ESI was 12.89% at 2 weeks, 26.16% at 4 weeks, and 29.16% at 6 weeks. The Physician Global Assessment revealed that 47.1% of patients showed very good improvement, and 44.4% achieved excellent results. Conclusion: The study demonstrates that 1% methotrexate gel is an effective topical treatment for localized psoriasis, especially for lesions on the palms and soles. Significant improvements were observed in ESI scores and overall clinical outcomes over the 6-week treatment period. The findings indicate that topical methotrexate gel is a promising, non-invasive alternative to systemic therapies for localized psoriasis, with consistent and statistically significant benefits. Further studies with larger sample sizes and longer follow-up periods are recommended to confirm these results and assess long-term efficacy and safety.

Background: Lichen planus (LP) is an idiopathic inflammatory skin condition characterized by recurrent lesions that can be resistant to standard treatments. While oral corticosteroids are commonly used for moderate to severe cases, they are associated with relapse and adverse effects. Methotrexate (MTX) is known for its immunosuppressive properties, but its efficacy as a topical agent for LP is underexplored. This study aimed to evaluate the efficacy of 1% methotrexate gel in treating lichen planus. Methods: This prospective cross-sectional study was conducted at the outpatient facility of the Department of Dermatology, Venereology, and Leprosy, M.Y. Hospital, Indore, over 12 months. Thirty patients diagnosed with lichen planus were included. Patients were administered 1% methotrexate gel twice daily for six weeks without any additional topical or oral medications. The Lichen Planus Area Severity Index (LPASI) was assessed at baseline, 2, 4, and 6 weeks. Physician Global Assessment Scores were also recorded at the end of 6 weeks. Data were analyzed using SPSS software version 20, and statistical significance was set at p < 0.05. Results: The study comprised 30 patients, predominantly female (60%) with a mean age of 25.97±8.06 years. Most patients (93.3%) had the disease for ≤6 months, and the wrist was the most affected site (63.3%). There was a consistent and significant reduction in the LPASI score from baseline (8.20 ± 2.99) to 6 weeks (6.97 ± 3.21) with p < 0.05 at all time points. Physician Global Assessment Scores showed that 47.1% of patients had a "Very Good" outcome, and 55.6% had an "Excellent" outcome after six weeks of treatment. Conclusion: 1% methotrexate gel is an effective topical treatment for lichen planus, demonstrating significant clinical improvement and good tolerability. The study supports its potential as an alternative to systemic therapy. However, larger-scale studies with long-term follow-up are recommended to validate these findings and assess the long-term safety and efficacy of methotrexate gel.

Background: Alopecia areata (AA) is a chronic, non-scarring autoimmune condition characterized by unpredictable hair loss. It affects approximately 2% of the global population, impacting individuals of all ages and leading to significant psychological distress. Although various treatment modalities exist, their long-term efficacy and impact on quality of life remain inconsistent. Methotrexate, an immunosuppressant traditionally used in systemic form, has recently been formulated as a 1% topical gel to minimize side effects. This study aims to evaluate the efficacy of 1% methotrexate gel in patients with localized AA. Method: This prospective cross-sectional study was conducted at the Department of Dermatology, Venereology, and Leprosy, M.Y. Hospital, Indore, over a 12-month period. A total of 30 patients clinically diagnosed with localized AA were included. Participants applied 1% methotrexate gel twice daily on affected areas without using other topical or oral medications. The Severity of Alopecia Tool (SALT) was used to assess hair loss at baseline, 2, 4, and 6 weeks. Data were analyzed using SPSS software version 20, with paired t-tests to compare SALT scores. A p-value < 0.05 was considered statistically significant. Results: The study included 30 patients (66.7% male, 33.3% female) with a mean age of 27.53±9.78 years. The majority had scalp involvement (93.3%), and all participants had AA for less than six months. No change in the SALT score was observed at 2 weeks compared to baseline. However, statistically significant reductions were noted at 4 weeks (6.86% reduction, p=0.001) and 6 weeks (10.53% reduction, p=0.001). Physician Global Assessment revealed poor improvement in 61.9% of patients, good improvement in 37.2%, and very good improvement in 5.9%. Conclusion: Topical 1% methotrexate gel demonstrated moderate efficacy in treating localized AA, with significant improvement observed at 4 and 6 weeks. However, the majority of patients experienced only limited improvement. The findings suggest that topical methotrexate may be a viable option for localized AA, but its overall effectiveness is moderate compared to other treatments such as minoxidil. Further research with larger sample sizes and longer follow-up periods is needed to assess long-term efficacy and comparative effectiveness.

Introduction; - Hypertension is a leading risk factor for stroke, and adherence to antihypertensive medication is critical for reducing stroke incidence. Hypertension, or high blood pressure, is one of the most significant modifiable risk factors for stroke, contributing to approximately 54% of all strokes worldwide. Stroke remains a leading cause of mortality and long-term disability, with significant economic and social burdens. Antihypertensive medications are proven to reduce blood pressure and, consequently, the risk of stroke. This study explores the relationship between stroke occurrence and compliance with antihypertensive therapy. Materials and Methods: - This study was a prospective cohort study conducted over a period of two years to evaluate the relationship between compliance with antihypertensive medication and the incidence of stroke among hypertensive patients. The study design was chosen to allow for the observation of temporal relationships between medication adherence and stroke outcomes. The study population consisted of 90 hypertensive patients recruited from outpatient clinics at a tertiary care hospital.  Inclusion criteria included diagnosed hypertension, age ≥40 years, and no prior stroke. Results:- The study population consisted of 90 hypertensive patients, compared to non-compliant patients, compliant individuals were slightly younger (57.3 vs. 60.1 years) with lower systolic (142.3 vs. 152.4 mmHg) and diastolic blood pressures (86.2 vs. 92.5 mmHg). Non-compliant patients had a significantly higher stroke incidence (40.0%) compared to compliant patients (10.0%). Non-compliance was the strongest predictor of stroke, with an adjusted odds ratio (OR) of 2.5 (95% CI: 1.8–3.4, p<0.001). Other significant risk factors included age ≥60 years (OR=1.8), low socioeconomic status (OR=2.1), and comorbidities (OR=1.9). After adjusting for confounders, non-compliance remained the most significant predictor of stroke (OR=2.5, p<0.001).  Conclusion:- This study adds to the growing body of evidence demonstrating the critical role of medication compliance in reducing stroke risk among hypertensive patients. Poor compliance with antihypertensive medication significantly increases stroke risk. Interventions to improve adherence are essential for stroke prevention.