Background & Methods: The aim of the study is to compare intravenous ondansetron and palonosetron for prevention of post-operative nausea and vomiting in elective lower abdominal surgeries under sub arachnoid block. During the preoperative interview detailed information regarding the nausea intensity score and communication regarding need for rescue anti emetics in the postoperative period, were explained to the patients.  Results: A Significance reduction in the Category 1 of Nausea in Palonosetron Group for the Post OP time lapse of 180 min. till 48 hrs. Ondansetron Group had 19 episodes of Category 1 of Nausea at following intervals followed by 4 episodes of Category 2 & 3 of Nausea. Conclusion: We found that Both ondansetron and palonosetron for prevention of PONV in patients posted for elective lower abdominal surgeries under Sub Arachnoid Block, with palonosetron being significantly more effective than ondansetron in terms of long-term action when given 10 minutes before spinal anesthesia in patients undergoing lower abdominal surgeries. Efficacy of both the drugs for prevention of intra operative nausea and vomiting is comparable.

To study the infectious complications following allogeneic HSCT in pediatric patients in a tertiary care government hospital. This study aimed to examine the infectious complications following allogeneic hematopoietic stem cell transplantation (HSCT) in pediatric patients, focusing on bacterial, fungal, protozoal infections, and CMV reactivation. The results indicate that various parameters, including sex, age, diagnosis, stem cell source, type of match, and post-transplant immunosuppression, did not show statistically significant associations with the occurrence of these infections. Despite the lack of significant relationships between these factors and infection outcomes, it is crucial to continue monitoring and managing infections closely in pediatric HSCT recipients, as they remain at high risk for infectious complications. Further studies with larger sample sizes may help identify potential risk factors or trends that could guide preventive and therapeutic strategies for improving patient outcomes in this vulnerable population.

Background: In the second and third trimesters amniotic fluid is an indicator of fetal well-being. Amniotic fluid is majorly contributed by fetal urine production in the second half of pregnancy thereby Renal perfusion plays an important role in the dynamics of amniotic fluid. Fetal renal artery Doppler assessment provides a more objective and physiologically relevant insight into fetal renal perfusion. Renal artery Doppler indices, such as plasticity index (PI) can reflect changes in renal vascular resistance, potentially serving as early indicators of fetal hypoxia or compromised placental function. Objectives: The aim is to study the relationship of fetal renal artery doppler, MCA and UA doppler indices (PI–Value) with Amniotic fluid volume in normal pregnancies and those complicated by oligohydramnios and polyhydramnios. To study the role of Fetal renal artery doppler (PI) and pregnancy outcomes in patients with idiopathic abnormal amniotic fluid indices. Patients and methods: This was a prospective observational study done in patients attending the opd of Mahatma Gandhi Memorial Medical College & M.Y Hospital, over a period of one year.A total of 150 patients were taken after applying the inclusion and exclusion criteria. Pulsatility index (PI) of Fetal renal artery, Middle cerebral artery(MCA) and Umbilical artery were recorded along with the Amniotic fluid volume at 20 to 22wks and at 32 to 34wks of Gestational age. Pregnancy outcomes data were recorded in terms of gestational age at the time of delivery, mode of delivery. Results: In the 150 patients studied in the 2nd trimester, no significant variation in Doppler was observed across different AFI categories with P-Value of PI of Fetal renal artery (0.339), MCA (0.828), UA(0.538). However, in the 3rd Trimester there is statistically significant difference is seen between Fetal RA(PI)32wks and Amniotic fluid abnormalities (P-Value 0.001) and also the adverse outcomes like higher rates of cesarean delivery, preterm births, and increased incidence of fetaldistress. While CA and UA Doppler indices remained largely unaffected across AFI groups with P-Value 0.887 and 0.842 respectively. Conclusion: There is a relation between Fetal renal artery PI and amniotic fluid disorders in the Third trimester. Fetal RA PI increases in oligohydramnios and thereby higher rates of cesarean delivery, preterm births, and increased incidence of fetal distress. in pregnancies with Polyhydramnios Fetal RA PI is lower.

Background: Coronary heart disease is one of the most common causes of death worldwide. In the US, it is the leading cause of death among men and women.  Objective: To study of myocardial blush grading in ischemic postconditioning in acute myocardial infarction.  Methods: This case-control, cross sectional, hospital-based study was conducted at the SS Institute of Medical Sciences & Research centre, Davanagere, Karnataka. 50 cases and 50 controls have been taken in this study. Duration of study was from April 2016 to Oct 2017. Result: Among cases 28 patients (56%) had blush grade 3, 15 patients (30%) had blush grade 2 and 7 patients (14%) had blush grade 1 respectively after PCI. Among control group 10 patients (20%) had blush grade 3, 20 patients (40%) had blush grade 2 and 20 patients (40%) had blush grade 1 respectively after PCI. There was significant statistically significant difference of between two groups. Conclusion: Remote ischemic post conditioning was also associated with improvement in myocardial blush grading (MBG). MBG has been proposed as a more efficient marker, obtaining such a beneficial effect by simple manipulation of reperfusion is of major potential clinical interest. Obviously, it represents a feasible, safe, and efficient cardioprotective intervention.

Background: Hepatitis A is a common cause of acute viral hepatitis in children in developing countries, particularly in areas with poor sanitation. Understanding the clinical profile and outcomes is essential for effective management. Objective: To evaluate the demographic, clinical, biochemical, and outcome parameters of children diagnosed with hepatitis A in a tertiary care center in Western Maharashtra. Methods: A prospective observational study was conducted over a 2-year period (January 2022 to December 2023) involving 80 children aged 1–15 years with confirmed IgM anti-HAV positivity. Detailed clinical history, physical examination, laboratory investigations (including liver function tests), duration of hospital stay, and treatment outcomes were analyzed. Data were tabulated and statistically interpreted. Results: The majority of children (65%) were aged 5–10 years, and 58.75% were males. Jaundice (92.5%) and fever (85%) were the most common presenting complaints. Mean SGPT was 1250 IU/L and mean bilirubin 5.2 mg/dL. Most cases recovered completely (97.5%), with complications like cholestatic hepatitis (6.25%) and acute liver failure (1.25%) occurring infrequently. No mortality was recorded. Conclusion: Hepatitis A continues to be a significant cause of pediatric hospitalization in Western Maharashtra. The disease predominantly affects children aged 5–10 years and generally has a favorable outcome. Early diagnosis and supportive care ensure recovery, but preventive strategies including vaccination remain crucial.

Background: Ovarian masses encompass a broad spectrum of conditions ranging from benign cysts to malignant neoplasms. Due to the asymptomatic nature of early-stage ovarian cancer, diagnosis is often delayed, resulting in a poor prognosis and a five-year survival rate as low as 29% in India. Accurate differentiation between neoplastic and non-neoplastic lesions is essential for guiding clinical management. Ultrasound remains the first-line imaging modality owing to its accessibility, real-time capability, and cost-effectiveness. The Ovarian-Adnexal Reporting and Data System (O-RADS) was developed to standardize ultrasound-based risk stratification. By integrating morphological features with Doppler flow, O-RADS improves diagnostic accuracy and facilitates consistent reporting. Evaluating its effectiveness in routine clinical practice is crucial for enhancing patient care and outcomes. Objective To evaluate the effectiveness of the Ovarian-Adnexal Reporting and Data System (O-RADS) in classifying ovarian masses using standardized sonographic descriptors.  Methods: This hospital-based, prospective observational study was conducted over a period of one year in the Department of Radio Diagnosis at Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India, following approval from the institutional ethics committee. The study population comprised patients who were clinically suspected of having ovarian masses and were referred by the Department of Obstetrics and Gynaecology to the Department of Radio Diagnosis for pelvic ultrasound evaluation. A total of 80 patients meeting the inclusion criteria were enrolled for the study, A detailed history, physical examination findings, and radiological investigations were documented in a structured format. Each patient underwent transabdominal and transvaginal ultrasound evaluations, and based on the ultrasound findings, the O-RADS classification was assigned for risk stratification. All collected data were organized and tabulated using Microsoft Excel and subsequently analyzed using open-source statistical software (SPSS). Data from all the visits were tabulated in Microsoft Excel sheet for analysis.Further depiction of data was done in the form of tables and charts. SPSS was used to analyse the data. Results was correlated and compared with histopathological analysis wherever possible. Results: In this study,among  80patients,The maximum number of patients was in the age group between 31 to 40 years (32.5%), followed by 41 to 50 years (28.7%). The mean age group was 35.21±4.67. Among 80 patients, 32 (40%) were in the ORADS 2 category, followed by ORADS 3 18 (22.5%) both suggesting likely benign findings. Fewer patients were in higher-risk groups—ORADS 4 (15%) and ORADS 5 (8.8%)—which may suggest malignant features. In our study, after using colour score grading, 40 lesions (50%) showed no colour flow (colour score 1), 26 lesions (32.5%) were with minimal colour flow (colour score 2), 9 lesions (11.5%) demonstrated moderate colour flow (colour score 3), and 5 lesions (6.2%) showed severe colour flow (colour score 4). Results: This system facilitates appropriate management decisions, potentially reducing unnecessary surgeries and improving patient outcomes.

Background: Late-onset preeclampsia remains difficult to predict with traditional methods. Ophthalmic artery Doppler (OAD), due to its similarity with intracranial circulation, may offer a reliable, non-invasive alternative. Objective: To assess the role of OAD parameters—2nd peak systolic velocity (PSV2), peak systolic ratio (PSR), and pulsatility index (PI)—in predicting late-onset preeclampsia. Methods: A prospective study of 620 pregnant women (34–37 weeks gestation) was conducted. Doppler measurements were taken from both eyes and patients were followed until delivery. Statistical analysis determined the predictive value of each parameter. Results: PSV2 and PSR were significantly elevated, while PI was reduced in preeclamptic women (p < 0.01). PI showed the highest accuracy (sensitivity 85.86%, specificity 85.03%, AUC 0.859). PSV2 and PSR also demonstrated high negative predictive values (96.85% and 95.28%). Conclusion: OAD, particularly PI, is effective in predicting late-onset preeclampsia. Its integration into routine antenatal care could aid early detection and improve outcomes.

Background: Plantar fasciitis is a common cause of heel pain, often associated with repetitive stress and increased mechanical load on the plantar fascia. This study evaluates the diagnostic accuracy of ultrasonography in comparison to X-ray for plantar fasciitis and explores its correlation with body mass index (BMI). Methods: A cross-sectional observational study was conducted on 70 patients with clinically suspected plantar fasciitis. High-resolution ultrasound was used to assess plantar fascia thickness and echogenicity, and results were compared with X-ray findings. BMI was also recorded and analyzed in relation to fascia thickness. Results: Plantar fascia thickness ≥4 mm was seen in 80% of patients, with hypoechogenicity in 67.14%. Ultrasound showed high sensitivity (85.71%), specificity (71.43%), and diagnostic accuracy (84.29%). A significant correlation was found between higher BMI and increased fascia thickness (p = 0.03). In contrast, X-ray had low sensitivity (19.64%) and diagnostic accuracy (34.28%). Conclusion: Ultrasonography is a superior, non-invasive diagnostic tool for plantar fasciitis, especially in overweight individuals, and supports early diagnosis and targeted management strategies.

Background- In India, annually about 1,32,000 new cancer cases and 80,000 deaths occur due to HPV infection and the prevalence of HPV type 16 was found to be very high. Although cancer can be prevented by HPV vaccination, little is known to the general population about HPV vaccine and its associated factors in India. Material & Method- This cross-sectional study among the outpatient department of medical college and its associated hospitals for six months duration. Total 369 Participants were included in this study. After obtaining written informed consent, data was collected by using questionnaires from the participants. Result- The study showed that (10.9%) females have heard about HPV infection. (10.1%) of females knew about HPV vaccination. (23.9%) of females accepted that HPV vaccine is highly effective. (80.1%) have shown a positive attitude and agreed to get vaccinated if it is given free of cost by the Government. (100%) of females did not receive a single dose of HPV vaccine till date. (92.5%) females opted the Government sector as the vaccination place if vaccine is available. Conclusion- A large gap was found in knowledge regarding HPV infection and vaccination among young adult females. Perception and attitude towards vaccination was positively high among them so if the government launches a free vaccination program for them then they will receive a great acceptance from this potential group. Print and e media should also take responsibility for awareness.

Background: The detection and characterization of pulmonary lesions via cytological and image-guided methods constitute a cornerstone in respiratory pathology. We conducted a prospective evaluation comparing bronchial brushing, bronchoalveolar lavage (BAL), bronchoscopic biopsy, and CT-guided FNAC to assess their respective and combined diagnostic yields. Methods: In a cohort of 100 patients with suspected pulmonary lesions, samples were procured via fiberoptic bronchoscopy (n=66) and CT-guided FNAC (n=36). Diagnostic yield, sensitivity, specificity, and inter-method concordance were analyzed. Results: Diagnostic yields were highest in bronchial brushing (94.1%), followed by bronchoscopic biopsy (73.5%), BAL (68.4%), and sputum cytology (34.3%). CT-guided FNAC demonstrated a sensitivity of 92–98.4% and specificity of 95.8–100% in literature-supported cases. Conclusion: A multiplex approach involving these modalities maximizes diagnostic efficacy. Bronchial brushing remains the most sensitive for centrally located lesions, while CT-guided FNAC is optimal for peripheral ones.

Background & Methods: This study aims to evaluate the role of Optic Nerve Sheath diameter (ONSD) in determining increased Intracranial Pressure in Traumatic Brain Injuries by “point-of-care ultrasound”. A brief clinical history of the patient was recorded and tabulated along with GCS score. Eligible patients presenting to the Department of Radio-diagnosis were enrolled for ONSD assessment. Results: Raised ICP was detected in 46% of patients indirectly by NCCT findings. Mean ONSD values were significantly higher in these patients (Right: 6.08 ± 0.31 mm; Left: 6.07 ± 0.34 mm) versus those without raised ICP (Right: 5.38 ± 0.40 mm; Left: 5.34 ± 0.37 mm; p<0.001). A cut-off of 5.75 mm showed high diagnostic accuracy (Right eye AUC: 0.915; Left eye AUC: 0.927), with sensitivity and specificity >80%. A strong inverse correlation was observed between ONSD and GCS scores, and a significant association was found between increased ONSD and poor GOS outcomes (p<0.001). Conclusion: The strong inverse correlation between ONSD values and Glasgow Coma Scale (GCS) scores, along with a statistically significant association with Glasgow Outcome Scale (GOS) scores, validates the role of ONSD as both a diagnostic and prognostic marker. The study’s cutoff value of 5.75 mm demonstrated high sensitivity and specificity, with an AUROC exceeding 0.9, which is comparable or superior to other recent international studies. These metrics highlight its potential for early risk stratification, allowing for timely therapeutic intervention and improved outcomes. Our findings are consistent with a growing body of literature emphasizing the diagnostic accuracy and clinical relevance of ONSD measurements across diverse patient populations and healthcare environments.

Background: Heart failure, an intricate and inexorably progressive clinical entity, characterised by deleterious neurohormonal activation, ventricular remodelling, and renal compromise, persists as a formidable contributor to global morbidity and mortality. While conventional therapeutic agents have hitherto imparted incremental benefit, the advent of Angiotensin Receptor-Neprilysin Inhibitors (ARNI) heralds a novel epoch in the pharmacotherapeutic governance of this multifactorial syndrome, offering a mechanistically synergistic dual inhibition of maladaptive pathways coupled with augmentation of endogenous compensatory mechanisms. This investigation was conceived to delineate, within a resource-constrained, ethnically distinctive clinical milieu, the cardiovascular and reno-protective ramifications of ARNI in individuals with heart failure manifesting either reduced or moderately reduced ejection fraction. Aims and Objectives: The overarching aim of this prospective study was to scrutinise, with empirical rigour, the longitudinal impact of ARNI therapy upon left ventricular systolic performance, renal functional indices, symptomatology, and adverse event profile in patients with HFrEF and HFmrEF. Furthermore, the inquiry sought to substantiate ARNI's clinical superiority within a real-world tertiary care setting of Eastern India. Methodology: This meticulously structured, forward-looking, observational cohort study was executed over a period extending from January 2024 to December 2024, encompassing one hundred rigorously selected patients within the Department of Cardiology at a tertiary care super-speciality hospital. Baseline, six-month, and twelve-month assessments included echocardiographic evaluation of ejection fraction, renal function parameters (eGFR, UACR), NYHA functional class stratification, and 6-minute walk distance. Statistical interrogation utilised parametric and non-parametric methodologies, with significance denoted at p<0.05. Results: The introduction of ARNI therapy culminated in a statistically and clinically significant augmentation of left ventricular ejection fraction, with mean values improving from 35.6% to 41.2% in HFrEF and 44.1% to 48.7% in HFmrEF cohorts over twelve months (p<0.001). Concomitantly, renal function demonstrated salutary preservation, with eGFR improving from 58.3 to 62.9 ml/min/1.73m² (p=0.002) and UACR exhibiting a mean decrement of 21.7% (p<0.001). Symptomatic amelioration was evident, with 68% of patients experiencing ≥1 NYHA class improvement, and 6-minute walk distance increasing by a mean of 74.5 metres (p<0.001). The adverse event profile remained within acceptable confines, devoid of catastrophic sequelae. Conclusion: The present inquiry unambiguously reaffirms the indispensable role of ARNI as a cornerstone in the contemporary therapeutic armamentarium for heart failure, conferring not merely haemodynamic modulation but orchestrating a multifaceted reversal of pathophysiological derangements encompassing myocardial remodelling and renal compromise. Within the constraints of this single-centre, real-world study, ARNI therapy emerged as a clinically efficacious and well-tolerated intervention, underscoring its imperative incorporation into standardised heart failure management protocols, particularly for populations within resource-constrained, ethnically diverse healthcare settings.

Aim & Background: Hepatic disorders during pregnancy pose significant risks to both maternal and fetal health, often leading to increased morbidity and mortality. This observational study aimed to investigate fetal and maternal outcomes in patients diagnosed with hepatic disorders during pregnancy. Methods: A total of 52 pregnant women with hepatic disorders, indicated by deranged liver function tests (elevated serum bilirubin, PT INR, liver enzymes such as ALP, AST, and alkaline phosphatase), were enrolled in this study. The maternal outcomes were assessed based on cure, stability at discharge, or death, while fetal outcomes included parameters like stillbirth, preterm birth, NICU admission, intrauterine growth restriction (IUGR), and congenital anomalies. Results: Out of 12,754 antenatal admissions during the study period, 52 cases (0.4%) were diagnosed with jaundice. The majority of patients (65%) were aged between 21 and 25 years, with 48% being primigravida. The highest incidence of hepatic disorders occurred in the third trimester. Most patients (90%) were from lower socioeconomic classes, and the majority had jaundice symptoms like yellowish skin and sclera, nausea, vomiting, fever, and abdominal pain. Viral hepatitis was the most common cause, accounting for 28.8% of cases, with hepatitis E virus (HEV) being the most prevalent (46.7%). Maternal mortality was 17.31%, and HELLP syndrome was the leading cause of death. Vaginal delivery occurred in 45% of patients, while 49% underwent LSCS. Preterm deliveries constituted 41%, and neonatal mortality was 19%, with NICU admission required in 84% of neonates. Conclusion: Hepatic disorders, particularly viral hepatitis, are significant contributors to maternal and fetal morbidity during pregnancy.  Clinical Significance: Early diagnosis, routine antenatal screening, and timely management are essential to improving outcomes. Public health interventions, improved sanitation, and antenatal care can help reduce the incidence of jaundice in pregnancy. Multidisciplinary care involving obstetricians, neonatologists, and well-equipped NICUs is crucial for better maternal and perinatal outcomes.

Background: A sedentary lifestyle is known to adversely affect multiple physiological systems, including the respiratory system. Physical inactivity leads to decreased respiratory muscle efficiency and reduced lung volumes, which may predispose individuals to respiratory disorders. In contrast, athletes often display superior pulmonary function due to regular training-induced adaptations. This observational study aimed to compare lung volumes and respiratory muscle strength between sedentary individuals and trained athletes. Materials and Methods: A cross-sectional observational study was conducted involving 60 male participants aged 20–30 years, divided into two groups: 30 sedentary individuals and 30 endurance-trained athletes. Lung function tests including Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV₁), and Peak Expiratory Flow Rate (PEFR) were measured using a digital spirometer. Respiratory muscle strength was assessed through Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP) using a respiratory pressure meter. Data were analyzed using an independent t-test, with p < 0.05 considered statistically significant. Results: Trained athletes showed significantly higher FVC (5.1 ± 0.6 L) compared to sedentary individuals (3.9 ± 0.5 L, p < 0.001). FEV₁ values were also greater in athletes (4.3 ± 0.4 L) versus the sedentary group (3.2 ± 0.3 L, p < 0.001). PEFR demonstrated a similar trend (athletes: 610 ± 45 L/min; sedentary: 470 ± 40 L/min, p < 0.001). MIP and MEP values were significantly elevated in the athletic group (MIP: 130 ± 15 cmH₂O; MEP: 180 ± 20 cmH₂O) compared to sedentary counterparts (MIP: 95 ± 12 cmH₂O; MEP: 135 ± 18 cmH₂O, p < 0.001). Conclusion: The findings highlight that trained athletes exhibit superior lung volumes and respiratory muscle strength compared to individuals with a sedentary lifestyle. These results reinforce the importance of regular physical activity in maintaining optimal respiratory function and preventing pulmonary deterioration associated with inactivity.

Background: Persistent patent ductus arteriosus (PDA) in preterm neonates remains a significant clinical concern, contributing to adverse pulmonary and cardiac outcomes. While the immediate hemodynamic effects of PDA are well documented, its long-term consequences on cardiopulmonary health into early childhood require further investigation. Materials and Methods: A prospective cohort study was conducted, involving 120 preterm infants (<32 weeks gestation) admitted to a tertiary neonatal intensive care unit. Sixty infants with echocardiographically confirmed persistent PDA beyond 14 days of life were included in the study group, while 60 matched controls without PDA formed the comparison group. Clinical parameters, need for respiratory support, pulmonary arterial pressures (measured by echocardiography), and cardiac function (left ventricular ejection fraction) were assessed at discharge, 6 months, and 24 months. Incidence of bronchopulmonary dysplasia (BPD), pulmonary hypertension (PH), and recurrent lower respiratory tract infections (LRTIs) were recorded. Results: Infants with persistent PDA had a significantly higher incidence of BPD (48.3% vs. 21.7%, p=0.003), PH at 6 months (36.7% vs. 13.3%, p=0.007), and recurrent LRTIs within 2 years (55% vs. 26.7%, p=0.002) compared to controls. At 24 months, mean pulmonary artery systolic pressure was elevated in the PDA group (38.5 ± 6.2 mmHg vs. 30.1 ± 5.3 mmHg; p<0.001). No significant differences were observed in left ventricular function (mean EF: 66.8% vs. 68.2%; p=0.210). Conclusion: Persistent PDA in preterm infants is associated with an increased risk of long-term pulmonary complications, notably bronchopulmonary dysplasia and pulmonary hypertension, as well as higher susceptibility to respiratory infections. These findings support the need for early identification and targeted intervention to mitigate chronic cardiopulmonary morbidity in this vulnerable population.

Background: Vitamin D plays a critical role in immune modulation and glucose metabolism. Recent studies suggest that vitamin D deficiency (VDD) may influence hospitalization outcomes in patients with Type 2 Diabetes Mellitus (T2DM). However, the extent of this association remains unclear in prospective cohorts. This study aimed to evaluate the impact of VDD on clinical outcomes among hospitalized T2DM patients. Materials and Methods: This prospective cohort study was conducted over a 12-month period at a tertiary care hospital. A total of 200 adult patients diagnosed with T2DM and admitted for various causes were enrolled. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured within 24 hours of admission. Patients were categorized into two groups: Vitamin D deficient (<20 ng/mL, n=118) and non-deficient (≥20 ng/mL, n=82). Primary outcomes included length of hospital stay (LOS), incidence of in-hospital complications, and 30-day readmission rate. Data were analyzed using SPSS version 26, with significance set at p < 0.05. Results: The mean LOS was significantly longer in the VDD group (8.2 ± 3.1 days) compared to the non-deficient group (5.4 ± 2.6 days; p = 0.001). In-hospital complications such as infections (32.2% vs. 18.3%; p = 0.03) and acute kidney injury (15.3% vs. 6.1%; p = 0.04) were more prevalent in vitamin D deficient patients. The 30-day readmission rate was also higher in the VDD group (20.3%) versus the non-deficient group (11.0%; p = 0.048). Multivariate regression analysis confirmed VDD as an independent predictor of prolonged hospitalization and increased complication risk. Conclusion: Vitamin D deficiency is significantly associated with adverse hospitalization outcomes in patients with T2DM. Early identification and correction of VDD may potentially improve clinical prognosis and reduce healthcare burden in this population.

Background: Hypertension remains a major contributor to global cardiovascular morbidity and mortality, with effective management hinging on long-term medication adherence. However, adherence to antihypertensive therapy is often suboptimal and influenced by various sociodemographic and geographic factors. This study aimed to compare medication adherence patterns among urban and rural hypertensive populations using real-world registry-based data. Materials and Methods: A cross-sectional, observational study was conducted using data from a regional hypertension registry covering both urban and rural primary healthcare centers. A total of 800 patients (400 urban, 400 rural) diagnosed with hypertension for at least 12 months were included. Medication adherence was assessed using the validated 8-item Morisky Medication Adherence Scale (MMAS-8). Patients were categorized as having high (score=8), medium (score 6–7), or low adherence (score <6). Sociodemographic variables, comorbidities, and medication regimens were also recorded. Statistical analysis was performed using chi-square tests and logistic regression. Results: High adherence was observed in 52.5% of urban participants compared to 37.8% in rural participants (p<0.01). Low adherence was more prevalent in the rural group (29.5%) than in the urban group (18.3%). Common factors associated with poor adherence in rural areas included lower education levels (p<0.01), irregular follow-up visits (p=0.03), and lack of access to healthcare facilities (p<0.01). In contrast, in urban areas, polypharmacy and adverse drug reactions were primary contributors to reduced adherence (p=0.04). Multivariate analysis revealed that rural residence (OR: 1.78; 95% CI: 1.21–2.63) and low literacy (OR: 2.11; 95% CI: 1.46–3.05) were significant independent predictors of poor adherence. Conclusion: The study highlights significant disparities in antihypertensive medication adherence between urban and rural populations. Tailored interventions such as community-based health education, improving rural healthcare access, and adherence counseling could help bridge this gap and improve long-term hypertension management outcomes.

Background: Hypertension is a major contributor to global cardiovascular morbidity and mortality. Despite optimal blood pressure control, many patients remain at high risk for adverse cardiovascular events. Microalbuminuria, a marker of endothelial dysfunction and early vascular injury, has emerged as a potential predictor of cardiovascular risk in hypertensive individuals. Early detection of microalbuminuria offers an opportunity for timely intervention and prevention of long-term complications. Methods: This hospital-based, cross-sectional observational study was conducted over one year at a tertiary care center in Central India. A total of 110 adult patients with essential hypertension were enrolled. Patients with diabetes, chronic kidney disease, or overt proteinuria were excluded. Urine samples were analyzed for albumin-to-creatinine ratio (UACR) to detect microalbuminuria, defined as UACR between 30–300 mg/g. Clinical and biochemical data including lipid profile, blood pressure, serum creatinine, and body mass index (BMI) were collected. Statistical analysis was performed using SPSS software. Results: Microalbuminuria was detected in 38.2% of the study population. It was significantly more prevalent in patients aged >60 years, those with poor blood pressure control, elevated LDL levels, higher BMI, and history of smoking. The microalbuminuria group also showed significantly higher mean systolic and diastolic blood pressure, LDL cholesterol, serum creatinine, and UACR values compared to those without microalbuminuria (p < 0.05). These findings highlight a strong association between microalbuminuria and cardiovascular risk factors. Conclusion: Microalbuminuria is a prevalent and clinically significant marker of cardiovascular risk in hypertensive patients. Its early detection can aid in identifying high-risk individuals, allowing for intensified risk factor management. Routine screening for microalbuminuria in hypertensive patients should be integrated into clinical practice to enhance cardiovascular risk stratification and prevent long-term complications.

Background: Metabolic syndrome (MetS) is a multifactorial condition characterized by central obesity, insulin resistance, dyslipidemia, and hypertension. Thyroid dysfunction, particularly hypothyroidism, may influence these metabolic components, potentially aggravating cardiovascular risk. However, the relationship between thyroid abnormalities and MetS remains underexplored in many regional populations. Aim: To study the spectrum and prevalence of thyroid dysfunction in patients with metabolic syndrome and its association with individual metabolic components. Material and Methods: This hospital-based cross-sectional study was conducted over 18 months at Raipur Institute of Medical Sciences, Chhattisgarh. A total of 200 patients diagnosed with metabolic syndrome (based on NCEP ATP III criteria) were evaluated. After obtaining informed consent, anthropometric and biochemical parameters were recorded. Thyroid function was assessed using chemiluminescence immunoassay, and patients were classified into euthyroid, subclinical/overt hypothyroidism, and subclinical hyperthyroidism groups. Statistical analysis was performed using SPSS v26. Results: Among the 200 MetS patients, 34.5% exhibited thyroid dysfunction—subclinical hypothyroidism (23.5%) being the most prevalent, followed by overt hypothyroidism (8.5%) and subclinical hyperthyroidism (1.5%). Females had a higher frequency of thyroid dysfunction compared to males. Significant associations were found between thyroid dysfunction and elevated triglycerides, low HDL levels, hypertension, and impaired fasting glucose (p<0.05). Conclusion: Thyroid dysfunction is common among patients with metabolic syndrome, with a significant proportion showing subclinical hypothyroidism. The strong association between thyroid abnormalities and individual components of MetS underlines the need for routine thyroid screening in these patients to facilitate early detection and management.

Epidural anaesthesia is a critical modality in anaesthetic practice, especially for surgeries involving the lower abdomen and limbs. Accurate identification of the epidural space is essential for procedural success. Traditionally, the loss of resistance (LOR) to air technique is employed, but it carries inherent risks such as pneumocephalus and dural puncture. In contrast, the Modified Drip Method (MDM) presents a potentially safer and more precise alternative. Aims and Objectives:  This study aimed to compare the efficacy, success rate, and complication profile of the Modified Drip Method with the conventional LOR-to-air technique in locating the lumbar epidural space. Methodology: This prospective randomised controlled trial was conducted on 60 patients aged 18–60 years, scheduled for elective surgeries under epidural anaesthesia. Participants were randomly divided into two equal groups: Group LOR (Loss of Resistance) and Group MDM (Modified Drip Method). Key variables measured included time to identify the epidural space (T1), catheter insertion time (T2), success rate, and complications. Statistical Analysis:  Data were analyzed using SPSS version 25.0. Mean values were compared using independent t-tests, and categorical data were assessed using Chi-square or Fisher’s exact test. A p-value < 0.05 was considered statistically significant. Results:  MDM showed a higher success rate (92% vs. 80%) and faster catheter insertion (3.0 vs. 5.2 minutes), with fewer complications. Although p-values were not statistically significant, trends favored MDM. Conclusion: The Modified Drip Method appears to be a promising, efficient, and safer technique for epidural space identification and warrants wider clinical adoption.

Background & Methods: The aim of the study is to study Aspartate Transaminase: Alanine transaminase ratio in patients of chronic liver disease. Haematological and biochemical workup will include measurement of haemoglobin, total leucocyte count, platelet count, prothrombin time and serum concentration of bilirubin (both direct and indirect), protein, albumin, alanine aminotransferase and aspartate aminotransferase. Results: The mean age of patients with alcoholic chronic liver disease (ALD) and those with non-alcoholic causes of CLD. The mean age of patients with ALD was 45.57 years (SD = 11.92), while the mean age of patients with non-alcoholic CLD was 47.57 years (SD = 13.15). However, the t-statistic of -0.794 and the corresponding p-value of 0.426 indicate that this difference in mean age is not statistically significant. Conclusion: Prospective studies are needed to investigate the temporal changes in clinical, laboratory, and imaging parameters in patients with different CLD etiologies, allowing for a better understanding of disease progression and prognosis. Given the potential of the AST/ALT ratio as a diagnostic marker, further research is needed to validate its utility in differentiating between different CLD etiologies and predicting disease outcomes.

Background: Type 2 Diabetes Mellitus (T2DM) poses a major public health challenge globally, with increasing prevalence in low-resource and primary care settings. Early identification and effective management at the primary healthcare level are crucial for preventing long-term complications and improving quality of life. This study aims to assess the clinical characteristics and treatment outcomes of patients with T2DM in primary care clinics. Materials and Methods: A cross-sectional observational study was conducted among 200 adult patients diagnosed with T2DM attending three primary health centers over a period of six months. Data on demographics, clinical parameters (HbA1c, fasting blood glucose, BMI, comorbidities), medication adherence, and lifestyle modifications were collected. Management outcomes were evaluated based on changes in glycemic control after a 3-month follow-up period. Statistical analysis was performed using SPSS v25.0. Results: The mean age of participants was 54.6 ± 9.8 years, with a male-to-female ratio of 1.2:1. Hypertension (52%) and dyslipidemia (41%) were the most common comorbidities. At baseline, 68% had poor glycemic control (HbA1c > 7%). After three months of management involving pharmacotherapy, dietary counseling, and physical activity promotion, 43% of patients achieved target HbA1c levels (<7%). Patients with higher medication adherence showed significantly better outcomes (p < 0.05). BMI reduction was observed in 36% of participants, and lifestyle adherence correlated positively with glycemic improvement. Conclusion: Primary care settings play a pivotal role in managing T2DM effectively. With appropriate interventions, a substantial proportion of patients can achieve improved glycemic control and reduced cardiovascular risk. Strengthening primary healthcare infrastructure and promoting patient-centered care are key to better diabetes outcomes.

Background & Methods: The aim of the study is to study prevalence of hepatitis b infection in people living with HIV in Gwalior region. Through reference analysis of, Epidemiology of viral hepatitis and HIV co-infection. ‖ by Miriam J. Alter, Journal of Hepatology, which quoted that it is estimated that 6–15% suffered from chronic HBV infection in HIV patient. Results: The majority of patients have no high-risk occupations, with 79.33% in the HIV-only group and 77.78% in the co-infected group. Truck drivers represent a higher percentage in the co-infected group (16.67%). The p-value for this distribution is 0.54, indicating no significant difference in occupation distribution between the groups. Conclusion: This study underscores the importance of continuous monitoring, targeted prevention, and comprehensive care strategies for HIV and Hepatitis B coinfected patients. The findings reinforce the need for integrated healthcare services that address the unique challenges faced by this vulnerable population.

Pulmonary hypertension (PH) is a common and serious complication of mitral valve disease, contributing to increased perioperative risk and long-term morbidity. Mitral valve replacement (MVR) is often performed to alleviate hemodynamic burden, but its effect on pulmonary artery pressures requires further evaluation. Objective of the study was to assess the impact of MVR on pulmonary artery systolic pressures (PASP) in patients with mitral valve disease and coexisting pulmonary hypertension using echocardiographic measurements. This retrospective observational study included 60 patients with rheumatic or degenerative mitral valve disease and echocardiographically confirmed PH who underwent isolated or combined MVR at a tertiary care center. PASP was measured preoperatively and at follow-up using transthoracic echocardiography. Patients were stratified based on PH severity. Changes in PASP and associated clinical parameters were statistically analyzed. The mean preoperative PASP was 59.3 ± 10.6 mmHg. Following MVR, the mean postoperative PASP significantly decreased to 39.7 ± 8.9 mmHg (p < 0.001). The greatest reduction was observed in patients with moderate PH. Clinical symptoms, including dyspnea, improved in the majority of patients. No early postoperative mortality was reported. Mitral valve replacement is associated with a significant reduction in pulmonary artery systolic pressures in patients with mitral valve disease and pulmonary hypertension. These findings underscore the therapeutic benefit of surgical intervention in appropriately selected patients and support early surgical referral before irreversible pulmonary vascular remodeling occurs.

Introduction: Spinal anaesthesia is widely used for elective caesarean sections due to its rapid onset, effective sensory and motor blockade, and reduced maternal and neonatal risks. However, a common physiological complication is maternal hypotension, which results from sympathetic blockade leading to vasodilation, venous pooling, and decreased cardiac output. These effects are further worsened during pregnancy due to aortocaval compression by the gravid uterus. Fluid therapy—administered either as a preload before spinal anaesthesia or as a coload during the procedure—is commonly used to prevent hypotension. This study compares the effectiveness of preloading versus coloading with crystalloids in preventing spinal anaesthesia-induced hypotension. Objective: To compare the proportion of spinal anaesthesia-induced maternal hypotension in parturients undergoing elective caesarean section who are preloaded versus coloaded with crystalloids at the Department of Anaesthesiology, Government Medical College, Thiruvananthapuram. Methodology: A hospital-based prospective observational study was conducted among 128 parturients aged 20 to 35 years, all scheduled for elective lower segment caesarean section under spinal anaesthesia. Participants were grouped based on whether they received preloading or coloading with crystalloids. Maternal age, BMI, blood pressure readings, and incidence of hypotension were recorded and analyzed. Results: Both groups were comparable in terms of age, BMI, and baseline parameters. The incidence of spinal-induced hypotension was significantly higher in the preload group (59.4%) compared to the coload group (34.4%). Conclusion: Co-loading with crystalloids during spinal anaesthesia is more effective in reducing the incidence of maternal hypotension compared to preloading. Timely administration of fluids during spinal anaesthesia helps maintain hemodynamic stability and improves maternal outcomes during elective caesarean delivery.

Background: Preeclampsia and eclampsia are hypertensive disorders of pregnancy characterized by multisystem involvement, with the placenta playing a central role in their pathophysiology. Histomorphological abnormalities and aberrant expression of placental biomarkers are increasingly recognized as indicators of disease severity and progression. This study aims to compare placental histopathological changes and biomarker profiles in patients diagnosed with preeclampsia and eclampsia. Materials and Methods: This cross-sectional observational study was conducted on 60 placental samples obtained post-delivery, grouped into preeclampsia (n=30) and eclampsia (n=30) cases. Gross and microscopic evaluations were performed, noting features such as infarcts, fibrinoid necrosis, syncytial knots, and villous maturation. Immunohistochemistry was applied to assess the expression of biomarkers including vascular endothelial growth factor (VEGF), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFlt-1). Statistical analysis was performed using SPSS version 26.0. Results: Placental infarctions were significantly more frequent in eclampsia cases (80%) compared to preeclampsia (56%) (p<0.05). Increased syncytial knotting (>30% of terminal villi) was observed in 73% of eclampsia samples versus 48% in preeclampsia. VEGF expression was markedly reduced in both groups but was lower in eclampsia (mean H-score: 45.3 ± 12.1) than preeclampsia (mean H-score: 63.5 ± 15.4). Conversely, sFlt-1 expression was significantly elevated in eclampsia (mean H-score: 142.6 ± 19.2) compared to preeclampsia (mean H-score: 120.8 ± 14.7). PlGF levels showed a pronounced decline in eclampsia samples. Conclusion: Histomorphological alterations and aberrant biomarker expression patterns were more severe in eclampsia than in preeclampsia, reflecting the increased placental dysfunction associated with disease severity. The integration of histopathology with biomarker profiling may enhance diagnostic precision and risk stratification in hypertensive pregnancy disorders.

Background: Hypertension, traditionally associated with older populations, is increasingly being diagnosed in young adults. Early onset of elevated blood pressure poses long-term health risks and increases the likelihood of cardiovascular complications. This study aimed to assess the prevalence of hypertension and identify associated risk factors among individuals aged 18–35 years. Materials and Methods: A cross-sectional study was conducted among 500 young adults aged between 18 and 35 years in an urban setting. Participants were recruited through stratified random sampling from colleges and workplaces. Blood pressure was measured using a calibrated sphygmomanometer following standard guidelines. Demographic data, lifestyle habits, and family history were collected using a structured questionnaire. Hypertension was classified according to the American Heart Association criteria. Statistical analysis was performed using SPSS version 26.0, with logistic regression to identify significant predictors. Results: The prevalence of hypertension among the participants was 18.4% (n=92), with a higher proportion in males (22.1%) than females (14.5%). Key risk factors significantly associated with hypertension included obesity (OR=2.9, p<0.01), family history of hypertension (OR=2.4, p=0.03), sedentary lifestyle (OR=1.8, p=0.04), and high salt intake (OR=2.1, p=0.02). Smoking and alcohol consumption also showed a positive correlation but did not reach statistical significance (p>0.05). Conclusion: The findings indicate a concerning prevalence of hypertension in young adults, with modifiable lifestyle and dietary factors playing a crucial role. Early identification and preventive strategies targeting this age group are essential to reduce future cardiovascular disease burden.

Background: Myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. Early and accurate diagnosis is critical for prompt management. Cardiac biomarkers such as Troponin I, Creatine Phosphokinase-MB (CPK-MB), and Lactate Dehydrogenase (LDH) are widely used for diagnosis and prognosis. This study aims to assess the diagnostic value and trend of these biomarkers in patients presenting with acute MI. Materials and Methods: A hospital-based cross-sectional study was conducted over a period of six months at a tertiary care center. A total of 100 patients clinically diagnosed with acute myocardial infarction were included. Blood samples were collected within 6 hours of symptom onset. Serum levels of Troponin I, CPK-MB, and LDH were measured using standard chemiluminescent immunoassays. Statistical analysis was performed using SPSS version 25, with results expressed as mean ± SD and significance determined at p<0.05. Results: Out of 100 patients, 68 were male and 32 were female with a mean age of 56.3 ± 12.1 years. Elevated Troponin I levels (>0.04 ng/mL) were found in 94% of cases, with a mean value of 6.5 ± 3.2 ng/mL. CPK-MB levels averaged 56.2 ± 20.4 IU/L (reference range <25 IU/L), elevated in 89% of cases. LDH levels were raised in 78% of patients, with a mean value of 624.3 ± 115.7 IU/L (reference range <480 IU/L). Troponin I showed the highest sensitivity (94%) for MI diagnosis, followed by CPK-MB (89%) and LDH (78%). Conclusion: Troponin I, CPK-MB, and LDH are reliable biomarkers in the diagnosis of myocardial infarction. Among them, Troponin I demonstrated the highest sensitivity and specificity for early detection. Combined assessment of these markers can enhance diagnostic accuracy, especially in resource-limited settings.

Background: Obesity and altered fat distribution are well-established risk factors for hypertension. Various anthropometric indices like Body Mass Index (BMI), Waist-Hip Ratio (WHR), and Waist-Height Ratio (WHtR) are commonly used to assess the risk. However, their predictive accuracy for hypertension remains debated, especially among middle-aged populations. Materials and Methods: A cross-sectional study was conducted on 300 middle-aged individuals (aged 40–60 years) attending general health check-ups. Anthropometric measurements including height, weight, waist, and hip circumference were recorded. BMI, WHR, and WHtR were calculated. Blood pressure was measured using a standardized digital sphygmomanometer. Hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg. Receiver Operating Characteristic (ROC) analysis was used to evaluate the predictive power of the indices. Results: Out of 300 participants, 165 (55%) were hypertensive. Mean BMI, WHR, and WHtR were 27.3 ± 4.5, 0.92 ± 0.08, and 0.57 ± 0.05 respectively. WHtR showed the highest area under the ROC curve (AUC = 0.82), followed by WHR (AUC = 0.76) and BMI (AUC = 0.71). WHtR ≥0.55 was identified as the optimal cut-off with 79% sensitivity and 75% specificity. Conclusion: Among the three indices, WHtR was the most effective predictor of hypertension in middle-aged individuals. It may serve as a better screening tool in clinical and community settings compared to BMI or WHR.

Background: Cardiovascular disease (CVD) is a leading cause of death, both in developing and developed nations. Traditionally, cardiovascular (CV)risk is assessed by using one of the several risk algorithms that take into account the presence and severity of the various major CV risk factors. The commonly used risk assessment tools for this purpose include Framingham risk score (FRS). Studies have confirmed that Epicardial adipose tissue (EAT) represent a true visceral fat and has been proposed as a cardio metabolic risk factor. Epicardial adipose tissue thickness (EATT) has been clinically correlated with metabolic syndrome, subclinical atherosclerosis and coronary artery disease.  Material And Methods This is a Prospective and analytical study was conducted in the Department of Cardiology of a tertiary level referral private institute in South India - Aster MIMS, Calicut, Kerala, India. The clinical evaluation will include history regarding the presence or absence of CV risk factors, duration of CV risk factors, symptoms suggestive of CAD etc. Physical examination will height, weight & blood pressure (BP) measurement and the examination of CV system. BP will be measured in the right arm in supine position, using a standard sphygmomanometer. Biochemical investigations will include a fasting lipid profile and fasting & 2-h post-prandial blood glucose estimation. Results Mean age of the study subjects was found to be 58.55±9.55 years with majority (55.5%) in the 41-60 age group. The distribution of sex was studied here. Out of 1001 patients taken, 68.7 % of the samples were male and 31.3 % were female. Median LVEF was 60%. RWMA was present in 32.1% study subjects. Median EAT was 0.30 cm while the median CIMT was 0.9 mm. Three vessel disease was found in 18.9% study subjects. 24.6% study subjects had two vessel disease. LMCA disease was found in 3.9% subjects. Two vessel disease was the most common finding (24.7%). Median ASCVD was 10.65. Median FRS was 7.95 and medan JBS3 was 19.40. Conclusions Our study concludes overall sensitivity of Clinical Risk scores in isolation for detection of significant CAD is low and their negative predictive value for ruling out significant CAD is low. The positive predictive value for predicting CAD is high for all the clinical risk scores. The Imaging parameters in isolation EAT and CIT have a better Sensitivity and Negative predictive value to predict significant CAD.

Background: Optimal patient positioning is a critical factor for successful tracheal intubation. While the traditional supine (sniffing) position is commonly used, the 25° back-up position has shown promise in enhancing glottic visualization and intubation success. Objective: To compare intubation conditions, including glottic visualization, ease of intubation, number of optimization maneuvers, and safety outcomes between supine and 25° back-up positions. Methods: This prospective observational study enrolled 60 adult ASA I and II patients undergoing elective surgeries. Patients were allocated to either the supine (n=30) or 25° back-up (n=30) position groups. The primary outcomes were the Percentage of Glottic Opening (POGO) score and ease of intubation. Secondary outcomes included the number of optimization maneuvers and any complications. Results: Patients in the 25° back-up group had significantly higher POGO scores (p<0.05) and required fewer optimization maneuvers than those in the supine group. No major complications were observed in either group. Conclusion: The 25° back-up position provides superior glottic visualization and facilitates easier intubation with fewer optimization maneuvers compared to the traditional supine position. It is a feasible alternative in routine airway management.

Background: Physical activity has a well-established role in enhancing pulmonary function. Competitive athletes, due to rigorous training, are likely to exhibit superior lung function parameters compared to sedentary individuals such as office workers. This study aimed to compare peak expiratory flow (PEF) and forced vital capacity (FVC) among these two populations to evaluate the implications for preventive respiratory health. Materials and Methods: A cross-sectional comparative study was conducted involving 100 participants, including 50 competitive athletes and 50 age- and sex-matched office workers. Participants underwent a standardized pulmonary function test using a digital spirometer. Parameters assessed were PEF (L/min) and FVC (L). Data were statistically analyzed using SPSS version 26. Independent t-tests were employed to compare mean values between groups, with significance set at p<0.05. Results: The mean PEF among athletes was 540 ± 45 L/min, significantly higher than that of office workers (430 ± 38 L/min; p<0.001). Similarly, mean FVC in athletes was 5.1 ± 0.6 L, compared to 3.9 ± 0.5 L in office workers (p<0.001). A strong positive correlation was observed between physical activity level and pulmonary function (r = 0.72, p<0.001). Conclusion: Competitive athletes demonstrate significantly superior lung function parameters compared to sedentary office workers. These findings underscore the importance of regular physical activity in enhancing respiratory health and highlight the need for targeted preventive measures to improve pulmonary function in sedentary populations.

Background: Spontaneous pneumothorax (SP) represents a potentially life-threatening condition requiring rapid diagnosis and quantification to guide treatment. Various imaging-based approaches, including the Light index, Collins method, and volumetric CT estimation, have been proposed to assess pneumothorax size. This study aims to compare the reliability and clinical utility of these quantification methods in hospitalized patients. Materials and Methods: A retrospective observational study was conducted in a tertiary care hospital over 18 months, enrolling 60 patients diagnosed with spontaneous pneumothorax. Chest radiographs and CT scans were analyzed using three quantification techniques: (i) Light’s index, (ii) Collins’ method, and (iii) CT volumetric analysis (gold standard). Measurements were independently performed by two radiologists. Statistical analysis included intra-class correlation coefficient (ICC), Bland-Altman plots, and ANOVA for comparing mean values. Results: The mean pneumothorax size calculated using Light’s index was 28.6% ± 6.4%, Collins’ method showed 32.1% ± 7.3%, and CT volumetry yielded 33.5% ± 6.9%. The correlation with CT volumetry was higher for Collins’ method (ICC = 0.91) compared to Light’s index (ICC = 0.84). Bland-Altman plots indicated better agreement of Collins’ method with CT-based measurements. Differences were statistically significant (p < 0.05). Conclusion: Among the evaluated methods, Collins’ method demonstrated superior accuracy and consistency in estimating pneumothorax size, closely approximating CT volumetric values. It may serve as a practical alternative in settings where CT is not readily available

Background: Recurrent bacterial vaginosis (RBV) is a common vaginal dysbiosis characterized by the depletion of protective Lactobacillus species and overgrowth of anaerobic bacteria. Alterations in the vaginal microbiota have been increasingly associated with adverse pregnancy outcomes, particularly preterm birth (PTB). This study aimed to evaluate the composition of vaginal microbiota in pregnant women with a history of RBV and its potential association with PTB. Materials and Methods: A prospective observational study was conducted involving 120 pregnant women between 12–20 weeks of gestation. Participants were divided into two groups: Group A (n=60) with a documented history of RBV, and Group B (n=60) without any prior BV episodes. Vaginal swabs were collected and analyzed using 16S rRNA gene sequencing to characterize microbial profiles. Women were followed until delivery, and obstetric outcomes, particularly gestational age at birth, were recorded. Statistical analyses were conducted using SPSS v25.0, with p<0.05 considered significant. Results: Group A exhibited a significant reduction in Lactobacillus crispatus and an increase in Gardnerella vaginalis and Atopobium vaginae compared to Group B (p<0.001). Preterm birth (<37 weeks) occurred in 28.3% (17/60) of women in Group A versus 8.3% (5/60) in Group B (p=0.006). Logistic regression revealed that high relative abundance of G. vaginalis was an independent predictor of PTB (OR: 3.9; 95% CI: 1.6–9.4; p=0.002). Conclusion: Women with a history of RBV exhibit significant alterations in vaginal microbiota, particularly a reduction in protective Lactobacillus species and an increase in pathogenic anaerobes. These changes are strongly associated with an increased risk of preterm birth. Early microbial screening and targeted interventions may help reduce adverse pregnancy outcomes in this high-risk population.

Background: Circadian rhythm plays a pivotal role in the regulation of various physiological functions, including blood pressure (BP). Altered sleep patterns, particularly among medical students due to academic stress and irregular schedules, may disrupt this rhythm, potentially influencing BP regulation. This study aimed to evaluate the circadian variations in BP and their correlation with sleep quality and duration among undergraduate medical students. Materials and Methods: A cross-sectional observational study was conducted on 100 medical students aged 18–25 years. Participants were categorized into two groups based on sleep quality using the Pittsburgh Sleep Quality Index (PSQI): good sleepers (n=55) and poor sleepers (n=45). Ambulatory BP monitoring (ABPM) was performed for 24 hours to measure systolic and diastolic BP during daytime and nighttime intervals. Sleep duration, latency, and efficiency were recorded. Statistical analysis was done using SPSS v25.0, with Pearson correlation and independent t-tests applied for evaluating associations. Results: Daytime mean systolic BP in poor sleepers was significantly higher (126.3 ± 9.5 mmHg) than in good sleepers (118.7 ± 7.3 mmHg; p<0.01). Nighttime diastolic BP was also elevated in poor sleepers (74.2 ± 6.8 mmHg) compared to good sleepers (69.5 ± 5.9 mmHg; p=0.02). A negative correlation was observed between sleep duration and nocturnal BP (r = -0.42, p<0.05). Additionally, 30% of poor sleepers demonstrated a non-dipping BP pattern, in contrast to only 10% among good sleepers. Conclusion: Disrupted sleep patterns among medical students are associated with altered circadian BP variations, especially elevated nighttime BP and a higher prevalence of non-dipping patterns. These findings suggest the importance of maintaining healthy sleep hygiene to prevent early cardiovascular risks in young adults.

Background: Ultrasound-guided popliteal nerve block has emerged as an effective technique for providing perioperative analgesia in ankle surgeries. The addition of adjuvants like dexmedetomidine to local anaesthetics has been reported to enhance the block quality and prolong analgesia. This study aimed to evaluate the efficacy of dexmedetomidine as an adjuvant to local anaesthetics in ultrasound-guided popliteal nerve blocks for patients undergoing ankle surgery. Materials and Methods: A prospective, randomized, double-blind study was conducted on 60 adult patients (ASA I–II), scheduled for elective ankle surgery under popliteal nerve block. The patients were divided into two groups: Group A received 20 mL of 0.5% ropivacaine with 1 mL normal saline, while Group B received 20 mL of 0.5% ropivacaine with 1 µg/kg dexmedetomidine diluted to 1 mL. Block performance time, onset and duration of sensory and motor block, time to first analgesic request, and patient satisfaction scores were recorded. Results: The mean onset time of sensory block was significantly shorter in Group B (7.2 ± 1.4 minutes) compared to Group A (10.5 ± 1.8 minutes). The duration of sensory block was longer in Group B (620 ± 55 minutes) than in Group A (420 ± 45 minutes). Similarly, the time to first analgesic request was prolonged in Group B (645 ± 60 minutes) compared to Group A (440 ± 50 minutes). No major complications were observed in either group. Patients in Group B reported higher satisfaction scores postoperatively. Conclusion: The addition of dexmedetomidine to ropivacaine in ultrasound-guided popliteal nerve blocks significantly improves block characteristics and extends postoperative analgesia without increasing adverse effects. This combination is a safe and effective choice for ankle surgeries.

Background: Supratentorial craniotomies are associated with significant intraoperative and postoperative pain due to extensive scalp and skull manipulation. While general anesthesia forms the cornerstone of such procedures, it often falls short in controlling nociceptive responses from scalp incision. Preemptive scalp block has emerged as a potential adjunctive analgesic strategy to improve hemodynamic stability and postoperative comfort. This study evaluates the clinical efficacy of preemptive scalp block in patients undergoing supratentorial brain tumor excision under general anesthesia. Materials and Methods: A prospective, randomized, double-blind clinical study was conducted on 60 patients aged 18–60 years, scheduled for elective supratentorial craniotomy. Patients were divided into two groups (n=30 each): Group A received a preemptive scalp block with 0.25% bupivacaine (20 mL) at defined nerve territories, while Group B received a sham block with normal saline. Standard general anesthesia protocol was followed. Intraoperative hemodynamic parameters (heart rate, mean arterial pressure) were monitored at baseline, during skin incision, and at intervals up to 60 minutes post-incision. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 2, 4, 6, 12, and 24 hours. Rescue analgesic consumption was recorded. Results: Group A demonstrated significantly lower intraoperative heart rate and mean arterial pressure at the time of skin incision (HR: 78 ± 6.3 bpm vs 91 ± 5.8 bpm, p<0.001; MAP: 82 ± 4.7 mmHg vs 94 ± 6.2 mmHg, p<0.001). Postoperative VAS scores were also reduced in Group A at all time points (e.g., at 4 hours: 3.1 ± 1.0 vs 5.4 ± 1.2; p<0.001). Total rescue analgesic requirement within 24 hours was significantly lower in Group A (mean 75 mg tramadol vs 145 mg; p<0.001). Conclusion: Preemptive scalp block with bupivacaine significantly attenuates the hemodynamic response to scalp incision and provides superior postoperative analgesia in patients undergoing supratentorial brain tumor excision. It is a simple, safe, and effective adjunct to general anesthesia.

Congenital heart disease in pregnancy presents unique anaesthetic challenges due to the complex interaction between altered maternal physiology and underlying cardiac pathology. We present a case series of three patients with different congenital heart lesions who underwent caesarean section: a 27-year-old primigravida with ruptured sinus of Valsalva aneurysm (SOVA), a 31-year-old multigravida with uncorrected tetralogy of Fallot, and a 25-year-old primigravida with Eisenmenger syndrome secondary to atrial septal defect. Each case presented distinct hemodynamic challenges requiring tailored anaesthetic approaches. The SOVA patient developed progressive heart failure symptoms with a left-to-right shunt, requiring maintenance of systemic vascular resistance and avoidance of pulmonary congestion. The tetralogy of Fallot patient presented with cyanosis and right-to-left shunting, necessitating strategies to maintain systemic vascular resistance and prevent decreases in pulmonary vascular resistance. The Eisenmenger syndrome patient had severe pulmonary hypertension with bidirectional shunting, requiring specialized management including inhaled nitric oxide. All patients underwent general anaesthesia with etomidate induction and careful hemodynamic monitoring. Multimodal analgesia including transversus abdominis plane blocks was employed for postoperative pain management. All three patients achieved successful maternal and fetal outcomes, though the complexity of management varied significantly based on the underlying cardiac pathophysiology. This case series demonstrates that with individualized anaesthetic planning, appropriate monitoring, and understanding of specific cardiac lesion physiology, patients with diverse congenital heart diseases can undergo caesarean delivery safely.

Background: Introduction Occupational health is therefore, an aspect seeking attention at the individual, group and community levels. The related study deals with ergonomics—a link between the worker and his working environment. This would have impact on the body and discomfort reflected in various parts of the body bringing about certain health problems. The present article is an attempt to explore the health hazards among the bus drivers and conductors employed in State Road Transport Corporations. The attempt is directed at investigating risk factors at micro-level in a community of drivers and conductors. It not only establishes the link between health and work environment but also facilitates in assessing the adverse impacts that may be expected. Material and Method: The present study was carried out with the participation of 103 city bus drivers working in Medical college transportation system. As the population size was limited, all drivers have been invited to participate in the study. It is worth mentioning that having at least one year of experience, not having severe mental disorders as well as not having a second job were considered as initial criteria to include drivers in the study. Results The major physical health problems among the drivers were related to musculoskeletal system (37.8%) and followed by endocrinal system (26.66%), cardiovascular system (17.78%), anorectal system (10%), eye (7.78%), occupational injuries (7.78%), liver and biliary system (6.66%). Among the conductors, majority (42.02%) had musculoskeletal problem, followed by endocrinal (34.09%), cardiovascular (27.27%), respiratory (15.91%), dermatological (12.5%), gastro-intestinal (9.10%), eye (9.10%), orthopaedic (7.95%) and liver-biliary problem (6.82%). Conclusions   Preplacement and periodic health check-ups at frequent intervals with supportive health promotional activities can uplift the physical health of the study population

Background: Thyroid dysfunction and Vitamin D deficiency are prevalent endocrine disorders with potential interlinking pathophysiological mechanisms. Recent studies suggest an association between Vitamin D status and thyroid function, particularly in hypothyroid states. This study aims to evaluate and compare the serum Vitamin D levels in patients with overt and subclinical hypothyroidism. Objectives: To assess the Vitamin D status in patients diagnosed with overt and subclinical hypothyroidism and analyzes its correlation with thyroid function parameters. Materials and Methods: This cross-sectional observational study included 348 patients aged 18–65 years, categorized into two groups: 174 patients’ case with overt hypothyroidism (elevated TSH, decreased FT4) and 174 controls with subclinical hypothyroidism (elevated TSH, normal FT4). Serum 25-hydroxyvitamin D [25(OH)D] levels. Statistical analyses were performed to compare Vitamin D levels between groups and determine correlations with TSH and FT4. Results: The mean serum Vitamin D level was significantly lower in cases patients 21.40 ± 4.45 ng/mL) compared to control subclinical hypothyroid patients (30.41 ± 4.54 ng/mL, p < 0.0001). Vitamin D deficiency was observed in 64.0% of cases and 21.84% of control subclinical hypothyroid patients. An inverse correlation was found between serum 25(OH)D levels and TSH (r = -0.41, p < 0.01). No significant correlation was observed with FT4. Conclusion: Vitamin D deficiency is more prevalent and severe in patients with overt hypothyroidism compared to subclinical cases. The inverse association between TSH and Vitamin D levels suggests a potential contributory role of Vitamin D in thyroid dysfunction. Screening and supplementation of Vitamin D in hypothyroid patients may offer therapeutic benefits and improve overall endocrine health.