Introduction: Diabetic nephropathy is one of the common causes of native kidney dysfunction and is the commonest cause of end-stage renal disease in the United States. Renal changes that are associated with diabetes mellitus are complex, ranging from early hyper filtration with an increased glomerular filtration rate (GFR) to late nephro sclerosis and fibrosis with azotaemia. Renal duplex Doppler USG is useful, both to detect renal dysfunction before obtaining results of conventional clinical and laboratory tests and to predict subsequent renal status.

Aims & Objectives: To evaluate the diagnostic usefulness of renal resistive index by duplex Doppler ultrasonography for detection of renal dysfunction in diabetic patients and also to compare renal RI as a diagnostic tool for diagnosis of diabetic nephropathy with the biochemical diagnosis.

Materials and Methods: A cross-sectional study was done for a duration of one and half year on 50 patients who were admitted in Chengalpattu Medical College. Only those patients biochemically diagnosed as having diabetic nephropathy are included.

Results: Among our study population, 78 % shows pathological resistive index and 22 % shows Normal resistive index. Mean resistive index was found to be 0.71±0.04 and varied from 0.60 to 0.82. Similarly, it was found RI significantly higher in diabetic patients (0.69±0.05).

Conclusion: In the present study, we showed that renal vascular resistance was higher in patients with macroalbuminuria. After an adjustment of eGFR, RI remained significant and was an independent risk factor for the presence of albuminuria.

Background: Mitral valve calcification (MVC) is a common degenerative condition observed in elderly patients and is associated with increased cardiovascular morbidity. Diabetes mellitus (DM), a prevalent metabolic disorder in aging populations, has been implicated as a risk factor for accelerated vascular and valvular calcification. This study aims to evaluate the association between DM and the severity of MVC in elderly patients undergoing echocardiographic assessment. Materials and Methods: A cross-sectional observational study was conducted on 150 elderly patients (aged ≥65 years) who underwent transthoracic echocardiography at a tertiary care center between January 2024 and December 2024. Patients were divided into two groups: those with diagnosed Type 2 DM (n=80) and non-diabetic controls (n=70). The severity of MVC was graded using standardized echocardiographic criteria (mild, moderate, severe). Relevant clinical data, including HbA1c levels, duration of diabetes, hypertension, and lipid profiles, were recorded. Statistical analysis was performed using the chi-square test and logistic regression to determine the association between DM and MVC severity, with p<0.05 considered significant. Results: Among diabetic patients, severe MVC was observed in 45% (n=36), moderate in 35% (n=28), and mild in 20% (n=16). In contrast, non-diabetic patients exhibited severe MVC in 20% (n=14), moderate in 30% (n=21), and mild in 50% (n=35). A significant association was found between the presence of DM and higher grades of MVC (p=0.002). Furthermore, patients with poor glycemic control (HbA1c ≥8%) showed a higher prevalence of severe MVC (52%) compared to those with controlled diabetes (HbA1c <7%) (38%). Conclusion: Diabetes mellitus is significantly associated with increased severity of mitral valve calcification in elderly patients. Poor glycemic control further exacerbates the extent of calcification. These findings highlight the importance of stringent metabolic control to potentially mitigate valvular degeneration in diabetic elderly populations.

Background: Many tropical illnesses frequently show as fever and jaundice. Tropical infections can impact the liver in a variety of ways, ranging from a little, and temporary increase of liver enzymes to acute liver failure (ALF). Aims: The purpose of this study was to determine the cause of fever and jaundice-related admissions at NRS Medical College and Hospital, as well as to examine patient outcomes and clinical and laboratory profiles. Materials and methods: This is a prospective, observational study conducted at a single center. It runs from February 2023 until May 2024. Patients were admitted to the Nilratan Sircar Medical College and Hospital's general medicine ward through opd and emergency. Only patients who met the suggested inclusion and exclusion criteria were allowed to participate in the trial. This research involved 50 patients. Result: In HepB (6), 4 patients had <150 SGOT /SGPT level after 4 weeks(U/L), 1 patient had 150-1000 SGOT /SGPT level after 4 weeks(U/L) and 1 patient had >1000 SGOT /SGPT level after 4 weeks(U/L).  In HepE (11), 9 patients had <150 SGOT /SGPT level after 4 weeks(U/L), 1 patient had 150-1000 SGOT /SGPT level after 4 weeks(U/L) and 1 patient had >1000 SGOT /SGPT level after 4 weeks(U/L)  In Dengue Fever (6), 6 patients had <150 SGOT /SGPT level after 4 weeks(U/L). In Leptospirosis (9), 7 patients had <150 SGOT /SGPT level after 4 weeks(U/L) and 1 patient had 150-1000 SGOT /SGPT level after 4 weeks(U/L) Conclusion: We find that the most prevalent causes of fever and jaundice lasting fewer than seven days are hepatitis A and hepatitis E. Other causes include sepsis with MODS, dengue fever, and leptospirosis. Thrombocytopenia is often linked to people with dengue fever and leptospirosis. Leptospirosis and sepsis are more strongly associated with leukocytosis and severe renal damage. In tertiary care facilities, the prognosis for viral hepatitis is favorable.The prognosis for leptospirosis with bleeding symptoms and encephalopathy is poor.

Background: Resistant hypertension is characterized by uncontrolled blood pressure despite the use of three or more antihypertensive agents, including a diuretic. Nocturnal hypertension, defined as elevated nighttime blood pressure, is increasingly recognized as a major predictor of adverse cardiovascular outcomes, particularly stroke. This study aimed to investigate the association between nocturnal hypertension and the risk of stroke in patients with resistant hypertension over a three-year follow-up period. Materials and Methods: A longitudinal cohort study was conducted at a tertiary care hospital. A total of 312 patients diagnosed with resistant hypertension were enrolled. Nocturnal blood pressure was monitored using 24-hour ambulatory blood pressure monitoring (ABPM) at baseline. Patients were categorized into two groups: those with nocturnal hypertension (n = 176) and those without (n = 136). The primary endpoint was the occurrence of ischemic or hemorrhagic stroke, confirmed by clinical assessment and neuroimaging. Multivariate Cox proportional hazards models were used to assess the risk, adjusting for age, sex, diabetes, dyslipidemia, smoking, and baseline daytime blood pressure. Results: During a median follow-up of 36 months, 42 stroke events were recorded. The incidence of stroke was significantly higher in the nocturnal hypertension group (15.3%) compared to the non-nocturnal hypertension group (4.4%) (p < 0.001). After adjustment for confounders, nocturnal hypertension was associated with a 3.8-fold increased risk of stroke (adjusted hazard ratio [aHR] = 3.78, 95% confidence interval [CI]: 2.01–7.12; p < 0.001). Sensitivity analysis excluding patients with atrial fibrillation yielded similar results (aHR = 3.52, 95% CI: 1.85–6.73; p = 0.002). Conclusion: Nocturnal hypertension is strongly associated with an elevated risk of stroke in patients with resistant hypertension. Routine assessment of nighttime blood pressure using ABPM should be considered essential in this high-risk population to enhance risk stratification and guide therapeutic interventions aimed at reducing stroke incidence.

Background: Thyroid hormones, particularly triiodothyronine (T3) and thyroxine (T4), play pivotal roles in regulating metabolic rate. Even within the euthyroid range, subtle variations in these hormones may influence basal metabolic rate (BMR). This study aimed to evaluate the association between intra-individual thyroid hormone variability and metabolic rate changes in clinically euthyroid adults. Materials and Methods: A cross-sectional observational study was conducted on 120 euthyroid individuals (TSH: 0.45–4.5 mIU/L) aged between 20 and 50 years. Fasting blood samples were collected to measure free T3, free T4, and TSH levels using chemiluminescence immunoassay. BMR was estimated using indirect calorimetry. Participants were stratified into tertiles based on free T3 and T4 values. Pearson correlation and multivariate linear regression were used to analyze the relationship between hormone levels and BMR, adjusting for age, sex, BMI, and physical activity. Results: Participants with higher tertile free T3 values had significantly elevated BMR (mean BMR: 1520 ± 120 kcal/day) compared to the lowest tertile (mean BMR: 1360 ± 110 kcal/day; p<0.01). Free T4 also showed a modest but significant correlation with BMR (r = 0.28; p=0.03). TSH levels showed no significant correlation (r = –0.04; p=0.61). Multivariate regression indicated that free T3 independently predicted BMR (β = 0.31; p=0.005) after controlling for confounders (Table 1). Conclusion: Even within normal thyroid function, higher levels of free T3 are associated with increased metabolic rate. These findings suggest that minor hormonal fluctuations within the euthyroid range may have physiological relevance in energy expenditure and weight regulation.

Background: The COVID-19 pandemic has resulted in a significant number of survivors experiencing persistent respiratory dysfunction even months after recovery. Pulmonary rehabilitation (PR) has emerged as a promising intervention to restore pulmonary function, exercise capacity, and quality of life in these patients. However, prospective data evaluating the effectiveness of structured PR programs in post-COVID-19 populations remains limited. Materials and Methods: A prospective observational study was conducted involving 60 post-COVID-19 patients aged 25–70 years who exhibited respiratory dysfunction (defined by reduced spirometry parameters or exercise intolerance) 12 weeks post-infection. Patients were enrolled in an 8-week structured pulmonary rehabilitation program comprising supervised aerobic exercises, breathing retraining, education, and psychosocial support sessions, conducted thrice weekly. Primary outcomes assessed included forced vital capacity (FVC), six-minute walk distance (6MWD), and St. George’s Respiratory Questionnaire (SGRQ) scores. Baseline and post-rehabilitation parameters were compared using paired t-tests, with statistical significance set at p<0.05. Results: Of the 60 enrolled patients, 55 completed the program (mean age: 52.3±11.4 years; 58% male). The mean FVC improved significantly from 62.5±9.8% predicted at baseline to 74.3±8.7% post-rehabilitation (p<0.001). The 6MWD increased from 320.6±54.2 meters to 405.7±48.9 meters (p<0.001). SGRQ total scores decreased significantly from 58.2±10.1 to 41.6±9.5 (p<0.001), indicating better health-related quality of life. No serious adverse events were reported during the rehabilitation sessions. Conclusion: Pulmonary rehabilitation significantly improves lung function, exercise capacity, and quality of life in post-COVID-19 patients with persistent respiratory dysfunction. These findings support the integration of PR programs as a standard component of post-COVID care strategies.

Aims and Objectives: This study aims to evaluate and compare the effectiveness of vacuum-assisted closure (VAC) therapy and conventional dressings in the management of non-healing ulcers. The primary outcomes assessed include wound healing rate, infection control, patient comfort, and overall recovery time. Background: Wound management presents a persistent clinical challenge. Delayed wound healing contributes significantly to patient morbidity, disability, and healthcare resource burden. Therefore, advanced wound care modalities are needed. VAC therapy utilizes negative pressure to promote wound healing. It encourages granulation tissue formation and wound closure, offering a potentially cost-effective modern wound care solution compared to traditional dressings. Methodology: This prospective observational study included 60 patients admitted with non-healing ulcers at Veer Surendra Sai Institute of Medical Sciences and Research between May 2023 and April 2025. Patients were managed with either VAC therapy or conventional dressings. Results: The majority of patients were between 40 and 60 years old (48%). Males were more frequently affected than females, comprising 62% of the study population (male to female ratio of 1.60:1). VAC therapy was associated with a shorter average hospital stay (approximately 14 days) compared to conventional dressings (approximately 21 days). The most common ulcer location was the left ankle, and Staphylococcus aureus was the most frequently isolated organism. Post-VAC therapy, organism isolation was significantly reduced. The mean hospital stay for the VAC group was 14.36 days, compared to 20.76 days for the conventional dressing group. The most frequent end-of-treatment intervention in both groups was split-thickness skin grafting (STSG), observed in 40% and 33.33% of patients in the VAC and conventional dressing groups, respectively. Conclusion: Vacuum-assisted closure (VAC) therapy represents a significant advancement in wound management. This study, along with existing research, suggests that VAC therapy promotes enhanced healing with a low incidence of major complications. This makes VAC therapy is a potentially advantageous alternative to conventional dressings for various wound types. Specifically, VAC dressing use is associated with decreased hospital stays, improved pus culture sensitivity & improves outcome with more SSG.

Background: Metabolic syndrome (MetS) is a cluster of interrelated risk factors that significantly increase the likelihood of cardiovascular events (CVEs). Heart rate variability (HRV), a non-invasive marker of autonomic nervous system function, has emerged as a potential predictor of cardiovascular risk. Reduced HRV reflects autonomic dysfunction, which is closely linked to adverse cardiac outcomes. This study aimed to assess HRV parameters as predictive markers for cardiovascular events in patients diagnosed with MetS. Materials and Methods: A prospective cohort study was conducted involving 150 patients diagnosed with MetS based on the International Diabetes Federation (IDF) criteria. HRV was assessed using a 24-hour Holter ECG monitoring system. Time-domain (SDNN, RMSSD) and frequency-domain (LF, HF, LF/HF ratio) parameters were recorded. Patients were followed for 12 months to monitor the occurrence of cardiovascular events, including myocardial infarction, stroke, and hospitalization due to heart failure. Statistical analysis was performed using Cox proportional hazards regression to evaluate the predictive value of HRV indices. Results: Among 150 patients, 28 (18.7%) experienced cardiovascular events during the follow-up period. Patients with reduced SDNN (<100 ms) showed a significantly higher incidence of CVEs (p = 0.002). The mean SDNN in patients with events was 85.4 ± 12.3 ms compared to 112.7 ± 15.6 ms in those without events. Similarly, an elevated LF/HF ratio (>2.5) was associated with increased risk (Hazard Ratio: 2.8; 95% CI: 1.6–4.9; p = 0.001). Multivariate analysis confirmed that both SDNN and LF/HF ratio were independent predictors of cardiovascular events after adjusting for age, gender, and other metabolic risk factors. Conclusion: HRV, particularly reduced SDNN and elevated LF/HF ratio, serves as a significant predictor of cardiovascular events in patients with metabolic syndrome. Routine HRV assessment could be a valuable tool in early risk stratification and management of this high-risk population.

Background: Heart failure with preserved ejection fraction (HFpEF) remains a therapeutic challenge, with limited options demonstrating significant cardiovascular benefit. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have recently emerged as potential cardioprotective agents beyond glycemic control. Angiotensin-converting enzyme (ACE) inhibitors are traditionally used in heart failure management but show limited efficacy in HFpEF. This study aims to compare the effectiveness of SGLT2 inhibitors versus ACE inhibitors in reducing cardiovascular events in patients with HFpEF. Materials and Methods: A retrospective cohort study was conducted involving 300 patients diagnosed with HFpEF (Left Ventricular Ejection Fraction ≥50%). Patients were divided into two groups: Group A (n=150) received SGLT2 inhibitors, and Group B (n=150) received ACE inhibitors. The primary outcome was the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, hospitalization for heart failure, and non-fatal myocardial infarction over 12 months. Data were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards models, with statistical significance set at p<0.05. Results: At the end of the follow-up period, Group A (SGLT2 inhibitors) demonstrated a significantly lower incidence of MACE (18%) compared to Group B (ACE inhibitors) with 30% incidence (p=0.012). Hospitalization for heart failure occurred in 10% of patients in Group A versus 20% in Group B. Cardiovascular mortality was 5% in Group A compared to 9% in Group B. The hazard ratio for MACE in the SGLT2 inhibitor group was 0.65 (95% CI: 0.45–0.90), indicating a 35% relative risk reduction compared to ACE inhibitors. Conclusion: SGLT2 inhibitors were more effective than ACE inhibitors in reducing cardiovascular events among patients with HFpEF. These findings support the consideration of SGLT2 inhibitors as a preferred therapeutic option in this patient population. Further randomized controlled trials are warranted to validate these results.

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures, with laparoscopic and open techniques being the two main approaches. While both methods are effective, they differ in terms of postoperative recovery, complication rates, and patient outcomes. This study aims to compare the clinical outcomes of laparoscopic versus open inguinal hernia repair in terms of operative time, postoperative pain, hospital stay, and complication rates. Materials and Methods: A prospective comparative study was conducted on 100 patients diagnosed with inguinal hernia, divided into two equal groups. Group A (n=50) underwent laparoscopic hernia repair, while Group B (n=50) underwent open hernia repair. Parameters such as operative time, postoperative pain (assessed using the Visual Analog Scale), hospital stay, and complications were recorded and analyzed. Statistical analysis was performed using SPSS software, with a p-value of <0.05 considered statistically significant. Results: The mean operative time was 65 ± 10 minutes for laparoscopic repair and 50 ± 8 minutes for open repair (p<0.05). Postoperative pain scores at 24 hours were significantly lower in the laparoscopic group (3.2 ± 1.1) compared to the open group (6.5 ± 1.3, p<0.01). The average hospital stay was 1.5 ± 0.5 days for laparoscopic repair versus 3.2 ± 0.8 days for open repair (p<0.05). The incidence of postoperative complications, such as wound infection and hematoma formation, was higher in the open repair group (15%) compared to the laparoscopic group (5%, p<0.05). Conclusion: Laparoscopic inguinal hernia repair offers advantages over the open technique, including reduced postoperative pain, shorter hospital stays, and fewer complications. However, it requires longer operative times and greater surgical expertise. Based on these findings, laparoscopic repair should be considered a preferred option, especially for patients seeking a faster recovery.

Introduction: Childhood fever is a prevalent concern globally, influencing parental health- seeking behaviours and caregiving practices. This study explores these dynamics in urban and rural settings of Surendranagar and Bhuj districts, Gujarat, India, focusing on factors such as cultural beliefs, socioeconomic status, and healthcare access. Methods: Using an observational survey design, 120 parents were interviewed from February to July 2024. Data collection involved in-depth interviews and questionnaires, examining parental recognition of fever, decision-making processes, use of home remedies, and barriers to healthcare access. Thematic analysis identified patterns in parental practices and influential factors. Results: Parents employ both subjective (tactile assessments) and objective (thermometer readings) methods to recognize fever, influenced by cultural norms and previous experiences. Home remedies like herbal teas and oil massages are commonly used, reflecting a blend of traditional wisdom and modern medical advice. Challenges include limited healthcare access, financial constraints, and reliance on community advice. Conclusion: Understanding parental practices in childhood fever management is crucial for developing targeted interventions. Enhanced healthcare access, culturally sensitive education, and community engagement are recommended to optimize health outcomes for children.

Introduction: Fever is a common concern among caregivers, prompting significant healthcare-seeking behaviours shaped by cultural beliefs, economic constraints and accessibility challenges. Understanding parental attitudes and beliefs about childhood fever is crucial for effective healthcare delivery. Methods: This community-based, multi-centric study employed observational methods and surveys to explore parental perspectives across urban and rural settings in Surendranagar and Bhuj districts. A total of 120 parents were surveyed from February to July 2024, focusing on their beliefs and attitudes regarding childhood fever management. Results: Thematic analysis identified several key factors influencing parental decisions: fever perceived as both a natural defence mechanism and a sign of serious illness, influenced by cultural norms and economic considerations. Caregivers relied on traditional remedies and peer advice while facing challenges such as limited healthcare access and financial constraints. Emotional responses varied from anxiety and worry to resilience and cautious optimism. Trust in healthcare providers and peer influence significantly shaped decision-making processes. Conclusion: The study highlights the complex interplay of cultural, economic and social factors in parental fever management. Addressing these factors through targeted healthcare interventions, including community education and improved access to affordable healthcare is essential for enhancing paediatric fever management and ensuring better health outcomes for children.

Background: anaemia and malnutrition are critical public health concerns in developing countries, particularly affecting children under five. Both conditions significantly contribute to morbidity and mortality in this age group. This study aimed to investigate the association between the severity of anaemia and malnutrition profiles (wasting and stunting) among children aged 6 to 59 months. Methods: An observational, cross-sectional study was conducted on 218 children at a tertiary care hospital from July 2024 to October 2024. Haemoglobin levels were measured and categorized into mild, moderate, and severe anaemia based on WHO guidelines. Anthropometric data, including weight and height, were collected to assess malnutrition (wasting and stunting). Pearson’s correlation coefficient, Chi-square test, and regression analysis were used to evaluate associations between anaemia severity and malnutrition. Results: A significant association was found between anaemia severity and stunting, with the prevalence of stunting increasing as anaemia worsened (mild: 51.72%, moderate: 65.12%, severe: 72.92%). Correlation coefficients for anaemia and stunting ranged from 0.235 to 0.352 (p < 0.05). However, the association between anaemia severity and wasting was weaker and not statistically significant. Regression analysis confirmed that severe anaemia significantly impacted stunting and showed a weaker, non-significant impact on wasting. Conclusion: This study highlights a strong association between anaemia severity and stunting in children, suggesting that chronic malnutrition is more closely linked to anaemia outcomes than acute malnutrition. Targeted public health interventions addressing both anaemia and nutritional deficiencies, especially those causing stunting, are essential to reduce the burden of anaemia in children.

Background: Masked hypertension (MH), defined as normal office blood pressure (OBP) but increased ambulatory blood pressure (ABP), is a condition that is underdiagnosed and is linked with greater cardiovascular risk. The aim of this study was to determine the prevalence of MH and its cardiovascular risk profile in working adults through ambulatory blood pressure monitoring (ABPM). Methods: A cross-sectional observational survey was performed in 200 employed adults aged 25–60 years with normotensive OBP (<130/80 mmHg). All the subjects were subjected to 24-hour ABPM for the detection of MH. Demographic information, lifestyle variables, and cardiovascular risk indicators—such as lipid profile, fasting blood glucose, and Framingham risk score—were assessed and analyzed. Results: Prevalence of MH was identified to be 24.8% in the subjects. MH subjects had significantly elevated daytime systolic and diastolic ABP but not their OBP values. They also had higher total cholesterol, LDL cholesterol, fasting glucose, and Framingham risk scores as compared with normotensive persons, suggesting an increased burden of cardiovascular risk. Lifestyle habits of smoking and physical activity were not different across groups. The findings highlight the diagnostic advantage of ABPM compared to OBP in identifying concealed hypertensive profiles. Conclusion: Masked hypertension is common in working adults and is linked to a poor cardiovascular risk profile. ABPM is a better detection tool than OBP for identifying actual blood pressure status and needs to be included in routine screenings to enhance early diagnosis and risk stratification.

BACKGROUND: Sleep disorders represent a diverse range of conditions that profoundly affect both individual well-being and societal healthcare expenditures (1). These conditions, which include sleep-disordered breathing, insomnia, narcolepsy, circadian rhythm disturbances, and restless legs syndrome, are prevalent in contemporary society. The connection between microbiota and the gut-brain axis (GBA) is characterized by a bidirectional relationship (3). The present research aims to assess the impact of sleep and gut health on healthy young volunteers. AIM AND OBJECTIVES: To study the impact of sleep on gut health and bowel patterns and relationship between sleep and gut disturbances. MATERIALS AND METHODS: A cross-sectional comparative study was carried out with 150 participants within the age range of 20 to 40 years, spanning two months at a tertiary care hospital. The study focused on individuals who reported a prior history of gastrointestinal conditions. A well-structured, self-designed questionnaire was administered to all participants, which included sections on demographic details, medical history, sleep patterns, gut health status related to gut and sleep physiology, and various lifestyle questions. RESULTS AND CONCLUSION: People who were sleeping < 6 hours a day since long duration are having more GI issues like abdominal cramps, bloating, constipation, nausea, diarrhoea and loss of appetite were more in subjects who were sleeping for lesser duration.

Background: Urban slum populations face a growing burden of non-communicable diseases (NCDs) due to various lifestyle risk factors. Despite increasing urbanization and the expanding slum population, there's limited comprehensive epidemiological data on NCD risk factors in these vulnerable communities. Materials and Methods: A cross-sectional study was conducted among adult residents (≥18 years) from randomly selected urban slums in metropolitan areas. A stratified random sampling approach was used to recruit participants. Data was collected using a modified WHO STEPS instrument to assess behavioural risk factors, anthropometric measurements, and blood pressure. Multivariate logistic regression was used to identify associations between sociodemographic factors and NCD risk factors. Results: Among 1,248 participants, the prevalence of major NCD risk factors included tobacco use (42.3%), insufficient fruit and vegetable intake (89.7%), inadequate physical activity (37.8%), hypertension (28.4%), and overweight/obesity (31.2%). Clustering of three or more risk factors was observed in 58.7% of participants. Significant associations were found between education level, income status, and risk factor prevalence. Conclusion: Urban slum populations demonstrate a high burden of modifiable NCD risk factors. The alarming prevalence of risk factor clustering necessitates urgent, context-specific preventive interventions targeting these vulnerable communities. Addressing social determinants alongside behavioural risk factors is essential for comprehensive NCD prevention in urban slums.

This pictorial essay focuses on incidental and significant ophthalmologic findings observable on routine CT brain scans. Although neuroimaging is generally intended to assess the brain parenchyma, orbit-related findings can occasionally surface and carry vital diagnostic relevance. We present 10 case-based illustrations derived from CT, emphasizing findings often overlooked in the orbital "blind spot" during neuroimaging interpretation.

Baroreceptor reflex sensitivity (BRS) and heart rate variability (HRV) markers have been observed to differ between healthy men and women, with lower BRS and higher parasympathetic markers in women. Building on this understanding, our study aimed to investigate gender differences in autonomic function among individuals with hypertension. We examined 44 hypertensive patients and 36 normotensive subjects, with an average age of 53 years. After discontinuing antihypertensive therapy for two weeks under monitoring, we assessed HRV and calculated BRS. Blood pressure and heart rate, at rest, were significantly higher in the hypertensive group compared to the normotensive group. Hypertensive patients exhibited lower total power, low frequency power, high frequency power, root mean square successive difference, and PNN50 compared to normotensive controls. Additionally, BRS was lower in hypertensive subjects. When comparing these parameters within gender groups, significant reductions were only observed in the female hypertensive group. Furthermore, the difference in BRS within the female group was twice that within the male group. Multiple regression analysis identified gender, age, HDL cholesterol, and blood pressure as independent explanatory variables of BRS and HRV. Our findings suggest that gender plays a crucial role in determining BRS and HRV, with hypertensive women experiencing more pronounced impairments in autonomic function compared to hypertensive men.

Background: Breast lesions with atypical imaging features often pose diagnostic challenges, necessitating accurate histopathological evaluation for appropriate management. Fine Needle Aspiration Cytology (FNAC) and Core Needle Biopsy (CNB) are commonly used minimally invasive diagnostic tools. This study aims to compare the diagnostic accuracy of FNAC and CNB in evaluating such breast lesions. Materials and Methods: This prospective comparative study included 100 female patients aged 25–70 years presenting with breast lesions showing atypical features on mammography and/or ultrasonography. Each patient underwent both FNAC and CNB, followed by surgical excision or clinical follow-up as a reference standard. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for each modality. Results: CNB demonstrated a sensitivity of 92.5%, specificity of 95.4%, PPV of 94.8%, NPV of 93.3%, and an overall diagnostic accuracy of 94%. FNAC, on the other hand, showed a sensitivity of 78.2%, specificity of 85.1%, PPV of 81.5%, NPV of 82.3%, and diagnostic accuracy of 81%. CNB was significantly more accurate than FNAC (p<0.01) in detecting malignancy in lesions with ambiguous imaging characteristics. Conclusion: Core Needle Biopsy is superior to Fine Needle Aspiration Cytology in diagnosing breast lesions with atypical imaging features. CNB offers greater diagnostic precision, reducing the risk of under-diagnosis and aiding in timely therapeutic intervention.

Medical education always relied on lectures and observational learning as the main methods for teaching procedural skills. There is a lack of evidence comparing effectiveness of skill lab training with traditional teaching methods, particularly within the context of undergraduate medical education in India.  To address this gap, rigorous research is needed to evaluate the impact of skill laboratory training on students' acquisition of clinical procedural knowledge. The aim of this study is exploring the effectiveness of skill laboratory training versus conventional teaching methods in instructing third-year MBBS students on the insertion of Ryle’s tube, or nasogastric tube (NGT), in patients. Results supports the incorporation of skill laboratories into medical education.  Skill labs facilitate active learning, which improves knowledge retention and skill acquisition. It allows students to bridge the gap between theoretical knowledge and practical application, thereby enhancing their understanding and competence in clinical procedures.

Background: Severe asthma remains a significant clinical challenge, often inadequately controlled by high-dose inhaled corticosteroids and systemic therapies. Recent advances have introduced inhaled biologic agents targeting specific inflammatory pathways, offering potential improvements in disease control. This study aims to compare the efficacy and safety of two inhaled biologic therapies—Drug A (anti-IL-5) and Drug B (anti-IL-4R)—in patients with severe asthma. Materials and Methods: A randomized, double-blind clinical trial was conducted on 120 patients with severe persistent asthma. Participants were divided into two groups (n=60 each): Group A received inhaled Drug A biweekly, while Group B received inhaled Drug B monthly, both for a duration of 24 weeks. Primary outcomes measured were changes in Asthma Control Test (ACT) scores, forced expiratory volume in 1 second (FEV₁), and frequency of exacerbations. Secondary outcomes included patient-reported quality of life and adverse events. Results: Group A showed a significant improvement in ACT scores (mean increase from 12.5 to 21.8) compared to Group B (13.0 to 19.4; p<0.05). FEV₁ increased by 18% in Group A versus 12% in Group B. The number of exacerbations reduced by 65% in Group A and 50% in Group B. Mild adverse effects were reported in 10% of patients in Group A and 15% in Group B, with no serious complications observed in either group. Conclusion: Both inhaled biologic therapies demonstrated effectiveness in improving asthma control and lung function in severe asthma patients. However, Drug A exhibited superior clinical outcomes with fewer exacerbations and better overall symptom control. These findings support the potential role of inhaled anti-IL-5 agents as a preferred option in biologic-based asthma management.

Introduction: Lifestyle modifications have gained increasing attention as complementary strategies for managing dyslipidemia. Among them, yoga and meditation are known to promote physical and mental well-being. This study aimed to evaluate the effect of a structured yoga and meditation program on lipid profile parameters in adult participants. Materials and Methods: A prospective interventional study was conducted on 60 adults aged 30–55 years with borderline or mildly elevated lipid levels. Participants were enrolled in a 12-week yoga and meditation program that included daily 45-minute sessions comprising asanas, pranayama, and guided meditation. Lipid profiles—including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)—were measured at baseline and at the end of the study using enzymatic colorimetric assays. Results: At the end of 12 weeks, significant improvements were observed in lipid parameters. Mean total cholesterol decreased from 210.6 ± 12.3 mg/dL to 189.4 ± 10.5 mg/dL (p < 0.001), triglycerides reduced from 168.7 ± 14.1 mg/dL to 142.9 ± 12.6 mg/dL (p < 0.01), and LDL-C levels dropped from 132.8 ± 10.4 mg/dL to 115.3 ± 9.7 mg/dL (p < 0.01). HDL-C showed a modest increase from 42.1 ± 4.8 mg/dL to 47.6 ± 5.1 mg/dL (p < 0.05). No adverse events were reported. Conclusion: The study findings suggest that regular practice of yoga and meditation may contribute to favorable changes in lipid profile and thus could be an effective non-pharmacological intervention for cardiovascular risk reduction

Background: Mechanical heart valve (MHV) replacement necessitates long-term anticoagulation to prevent thromboembolic complications. Traditionally, Vitamin K antagonists (VKAs) like warfarin have been the mainstay therapy, but newer oral anticoagulants (NOACs) are being increasingly explored. This study aims to compare the efficacy and safety profile of VKAs and NOACs in MHV patients in a real-world clinical setting. Materials and Methods: A retrospective cohort study was conducted over 18 months at a tertiary care hospital. A total of 200 patients with mechanical heart valves were included: 100 received warfarin and 100 received a NOAC (dabigatran or rivaroxaban). Patients were monitored for thromboembolic events, bleeding complications, INR control (for warfarin group), and overall medication adherence. Data were analyzed using SPSS v26, and statistical significance was set at p < 0.05. Results: The incidence of thromboembolic events was 4% in the warfarin group and 7% in the NOAC group (p = 0.08). Major bleeding episodes occurred in 6% of warfarin users and 3% of NOAC users (p = 0.12). Time in therapeutic range (TTR) was achieved in 78% of the warfarin group. Medication adherence was slightly higher in the NOAC group (92%) compared to the warfarin group (86%). Although statistical significance was not observed in all categories, NOACs showed a favorable trend in bleeding outcomes and adherence. Conclusion: While VKAs remain the standard of care for patients with mechanical heart valves, NOACs demonstrated a comparable safety profile in this observational analysis. Further large-scale randomized trials are needed before recommending routine NOAC use in this patient population.

Background: Degenerative Aortic Valve Disease (DAVD) is a progressive condition characterized by calcification and fibrosis of the aortic valve, often leading to aortic stenosis in elderly populations. Recent studies suggest that chronic inflammation plays a critical role in the early stages of valve degeneration. This study aims to evaluate specific inflammatory biomarkers as early indicators of DAVD. Materials and Methods: A cross-sectional analytical study was conducted involving 60 participants aged 50–75 years. Group A included 30 patients diagnosed with early-stage DAVD through echocardiography, while Group B comprised 30 age- and sex-matched healthy controls. Serum levels of high-sensitivity C-reactive protein (hs-CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor-alpha (TNF-α) were measured using ELISA. Statistical analysis was performed using independent t-tests and Pearson correlation coefficients. Results: The mean hs-CRP levels were significantly higher in Group A (4.2 ± 0.8 mg/L) compared to Group B (1.3 ± 0.5 mg/L) (p < 0.001). Similarly, IL-6 and TNF-α levels were elevated in Group A (IL-6: 12.5 ± 2.1 pg/mL, TNF-α: 18.7 ± 3.4 pg/mL) compared to controls (IL-6: 4.8 ± 1.5 pg/mL, TNF-α: 9.3 ± 2.2 pg/mL) (p < 0.001 for both). A positive correlation was observed between biomarker levels and echocardiographic markers of valve degeneration. Conclusion: Elevated levels of hs-CRP, IL-6, and TNF-α are significantly associated with early stages of DAVD. These inflammatory biomarkers could serve as valuable tools in the early detection and risk stratification of patients, potentially allowing timely interventions to delay disease progression.

Background:  Rheumatic Heart Disease (RHD) remains a significant public health concern, particularly in low- and middle-income countries. Its prevalence is influenced by various socioeconomic determinants such as income, education, housing, and access to healthcare. This study aims to evaluate and compare the correlation between RHD prevalence and socioeconomic factors in urban and rural populations. Materials and Methods: A cross-sectional observational study was conducted over a period of 12 months across two regions—urban and rural—in central India. A total of 600 participants (300 urban and 300 rural) aged between 10 to 40 years were enrolled. Clinical diagnosis of RHD was confirmed via echocardiography. Socioeconomic data were collected through structured interviews using a pre-validated questionnaire. Statistical analysis was performed using chi-square and logistic regression models to assess correlations between RHD and various socioeconomic indicators. Results: RHD prevalence was significantly higher in the rural population (11.3%) compared to the urban population (5.7%) (p < 0.01). Low household income (OR: 3.1; 95% CI: 1.8–5.2), overcrowded housing (OR: 2.4; 95% CI: 1.5–4.0), and limited access to healthcare facilities (OR: 4.6; 95% CI: 2.2–9.3) were strongly associated with RHD. In urban areas, parental illiteracy showed a moderate correlation (OR: 1.9; 95% CI: 1.1–3.3). Multivariate analysis confirmed that socioeconomic disadvantage was a significant predictor of RHD in both populations. Conclusion:  The study highlights a strong correlation between low socioeconomic status and the prevalence of Rheumatic Heart Disease, with rural populations being disproportionately affected. Targeted public health strategies focusing on improving living conditions, healthcare accessibility, and education are essential for the effective control and prevention of RHD.

Background: Mitral valve stenosis (MVS), characterized by narrowing of the mitral valve orifice, leads to impaired left atrial emptying and increased pulmonary pressure. Chronic kidney disease (CKD) is associated with systemic inflammation, endothelial dysfunction, and accelerated vascular calcification, potentially influencing the progression of valvular heart diseases. This study aimed to assess the impact of CKD on the clinical course and outcomes of patients with MVS. Materials and Methods: A prospective cohort study was conducted involving 120 patients diagnosed with rheumatic MVS. Patients were stratified into two groups: Group A (n=60) with CKD (stages 3–5) and Group B (n=60) without CKD. Echocardiographic evaluations, including mitral valve area (MVA), transmitral gradient, and pulmonary artery systolic pressure (PASP), were performed at baseline and 12 months. Major adverse cardiovascular events (MACE) were recorded. Statistical analysis was done using SPSS v26.0. Results: At baseline, the mean MVA in Group A was 1.3 ± 0.2 cm², compared to 1.4 ± 0.3 cm² in Group B (p = 0.08). After 12 months, Group A showed a more significant decline in MVA (mean decrease 0.18 ± 0.04 cm²) than Group B (0.09 ± 0.03 cm², p < 0.01). PASP increased significantly in Group A (mean increase 9.4 ± 2.3 mmHg) compared to Group B (5.1 ± 1.7 mmHg, p < 0.01). Incidence of MACE was higher in CKD patients (30% vs. 12%, p = 0.01), with increased rates of hospitalization for heart failure and atrial fibrillation. Conclusion: CKD is associated with accelerated progression of mitral valve stenosis and poorer clinical outcomes, including increased pulmonary pressures and higher rates of cardiovascular events. Early identification and integrated management strategies are crucial in this high-risk population.

Background:  Preeclampsia remains a significant cause of maternal and fetal morbidity and mortality worldwide. Early identification of at-risk individuals is critical for timely intervention. This study aimed to evaluate and compare the diagnostic utility of select maternal serum biomarkers for early prediction of preeclampsia across multiple tertiary care centers. Materials and Methods: A prospective cohort study was conducted over 18 months across five tertiary care hospitals in India. A total of 600 pregnant women between 11–14 weeks of gestation were enrolled and followed until delivery. Serum levels of Placental Growth Factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), Pregnancy-Associated Plasma Protein-A (PAPP-A), and uterine artery pulsatility index (UtA-PI) were measured. Participants were categorized based on the development of preeclampsia (n = 92) or normotensive pregnancy (n = 508). Receiver Operating Characteristic (ROC) analysis was used to determine the predictive accuracy of each biomarker and combinations thereof. Results: PlGF and sFlt-1 showed the highest individual predictive value for preeclampsia, with AUCs of 0.87 and 0.82, respectively. The sFlt-1/PlGF ratio was significantly elevated in women who developed preeclampsia (mean: 92.3 ± 11.4) compared to normotensive controls (mean: 37.8 ± 7.5; p < 0.001). Combining PlGF, sFlt-1, and PAPP-A with UtA-PI improved prediction accuracy (AUC = 0.91). The integrated biomarker model demonstrated a sensitivity of 86.9% and specificity of 84.2% for early prediction. Conclusion: This multi-center cohort study highlights the value of combining maternal serum biomarkers with Doppler indices in the early prediction of preeclampsia. Routine use of these biomarkers in the first trimester could enhance risk stratification and improve maternal-fetal outcomes through early surveillance and targeted interventions.

Introduction: Breast cancer is a leading oncologic cause of death in women, but early detection saves lives. The vast majority of the breast lesions is benign and is not given significant attention as compared to malignant. Preoperative diagnosis of a breast lump is a crucial part of the final therapeutic plan. The two most common techniques used to diagnose breast lumps are fine-needle aspiration cytology (FNAC) and TRUCUT biopsy. Aim: to compare the diagnostic efficacy of FNAC and tru-cut biopsy in the evaluation of a clinically palpable breast lump and to compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of FNAC with those of tru-cut biopsy. Materials and methods: This is a prospective comparative study of 150 patients. Patients were divided in two groups (75 in each group) based on Odd even numbering method. Odd-number patients underwent FNAC for diagnosing breast lump and even number patients underwent Tru-cut biopsy for diagnosing breast lump. All patients underwent surgical management. Post surgery lump’s Histopathological examination report was collected and considered gold standard then it was compared with pre operative FNAC/ Tru-cut biopsy report whichever was performed. Results:  out of 150 participants, most common age group having breast lump was 21-30 years. commonest age group for benign breast lesion was 21-30 and malignant lesion was 31-40 year. Sensitivity, specificity, PPV, NPV of FNAC was 81.25%, 98.30%, 92.85%, 95.08% respectively and for TRUCUT biopsy was 96.29%, 100%,100%, 97.95% respectively. Conclusion: Tru-cut biopsy has more sensitivity, specificity, and overall diagnostic accuracy than FNAC.

INTRODUCTION: Group discussions are at the centre of medical education, as the students learn more efficiently by SGT’s. Way back to 1988 George Brown described small group teaching as “getting students to talk and think”. In recent years’ major revolutionary changes have occurred in medical education, both in curriculum development and learning strategies, a small group teaching is one among them. A typical small group includes 8-12 learners and a facilitator. The students are given definitive objectives, which they achieve working as a team. The role of facilitator is to monitor that learning outcomes are attained in prescribed time.  AIM: To assess the effectiveness of small group teaching in comparison to large group teaching on medical undergraduate students.  METHODOLOGY: A prospective study was conducted on 1st MBBS students and faculty. They were asked to respond to structured questionnaire based on 3-point LIKERT scale regarding small group teaching and large group teaching. RESULTS: A total of 176 MBBS students and 20 faculty members responded to questionnaire. Analysis showed that, most of the students felt it student friendly (90%) and about 95% students were comfortable with this teaching strategy, with (81%) students feeling small group teaching as better learning method, promotes critical thinking in (89%), (84%) are motivated, retaining of knowledge in (84%). The faculty also preferred small group teaching over didactic lectures (88%), it being helpful for their professional development (80%), promoting student centered learning (70%). However, they had concerns regarding the resources available (40%) and standardization in delivery of goals and objectives (74%). CONCLUSION: Overall small group teaching for medical students has wide acceptability among students and faculty as it promotes effective learning, enables to acquire good communication skills and integrated approach towards effective medical education.

Background: Intermittent fasting (IF) has gained popularity not only for weight management but also for its potential health benefits, including improved cardiovascular function. The autonomic nervous system (ANS) plays a vital role in regulating heart rate and blood pressure. However, limited data exist on how IF influences cardiovascular autonomic regulation in healthy individuals. Materials and Methods: mA total of 60 healthy adult participants aged 20–40 years were enrolled in this 8-week prospective study. Subjects were divided into two groups: IF group (n=30) following a 16:8 fasting protocol (16 hours fasting, 8 hours feeding) and a control group (n=30) maintaining their regular diet. Heart rate variability (HRV), resting heart rate (RHR), and blood pressure (BP) were measured at baseline and post-intervention. HRV parameters such as SDNN (standard deviation of NN intervals) and RMSSD (root mean square of successive differences) were used to assess autonomic modulation. Results: After 8 weeks, the IF group showed a significant increase in SDNN (from 48.5 ± 10.2 ms to 61.3 ± 9.8 ms; p < 0.01) and RMSSD (from 35.2 ± 7.5 ms to 44.6 ± 6.9 ms; p < 0.05), indicating improved parasympathetic activity. Resting heart rate decreased significantly in the IF group (from 74.8 ± 6.3 bpm to 68.2 ± 5.7 bpm; p < 0.01). Systolic and diastolic BP showed modest reductions in the IF group compared to the control group, though not statistically significant. Conclusion: Intermittent fasting over eight weeks significantly improved cardiovascular autonomic regulation in healthy adults, as reflected by enhanced HRV and reduced resting heart rate. These findings suggest that IF may have a favourable impact on autonomic balance and cardiac health in normotensive individuals.

Introduction: Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 has had a devastating global impact. Identifying reliable biomarkers for predicting disease severity is crucial. The triglyceride to HDL cholesterol (Tg/HDLc) ratio is linked to insulin resistance and adverse cardiovascular events, making it a potential predictor of COVID-19 mortality. Materials & Methods: A retrospective, cross-sectional study was conducted in a rural tertiary hospital from April to June 2021. Data from 422 COVID-19 patients, including 152 non-survivors, were analyzed. Clinical, demographic, and biochemical markers, including Tg/HDLc ratio, were recorded. Statistical analysis was performed using Chi-square test, Mann Whitney U test and Binary logistic regression test. Results: Among 422 patients, 40.8% were aged 61-80 years, with 61.6% being males. Breathlessness (25.9%) was the most common symptom. Hypertension was the most prevalent comorbidity (13.7%). Oxygen support was required in 72.3% of cases, and 64% were discharged. Vaccination coverage was low, with only 12.8% vaccinated. Patients with SpO2 <90% and elevated Tg/HDLc ratios had a significantly higher mortality risk. The mean triglyceride levels, TG/HDLc ratio, IL-6, D-dimer, and serum ferritin levels were significantly higher in non-survivors compared to survivors (p=0.00). HDLc levels were significantly lower in non-survivors (p=0.00) in Mann Whitney U test . Binary logistic regression indicated that the Tg/HDLc ratio, D-dimer, and IL-6 were significant predictors of mortality. Conclusion: The Tg/HDLc ratio can serve as an early, non-invasive predictor of mortality in severe COVID-19 cases, aiding in timely intervention and management.