Patients of severe mitral stenosis (MS) in normal sinus rhythm (NSR) with left atrial appendage (LAA) inactivity and associated left atrial spontaneous echo contrast (LASEC) can develop aleft atrial (LA) or left atrial appendage thrombus, but oral anticoagulants (OACs) are not routinely prescribed in this subset of patients. Aim: Comparative assessment of LA and systemic levels of procoagulants (PF1+2: prothrombin fragment 1+2; PAI-1: plasminogen activator inhibitor-1, fibrinogen, and D-dimer) in patients of severe MS in NSR with LAA inactivity and associated LASEC versus severe MS in atrial fibrillation (AF).  Methods:35 patients of severe MS in NSR with LAA inactivity and associated LASECand 35 patients of severe MS in atrial fibrillation with a controlled ventricular rateand a mitral valve suitable for balloon mitral valvuloplasty (BMV), along with 35 healthy volunteers as controls, were enrolled in this study. All patients of MS underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) to assess the severity of MS, LAA function, grade of LASEC, and to exclude the presence of LA or LAA clot. A 24 -hour holter was done to determine the average heart rate and to exclude patients with paroxysmal AF in MS with NSR.Peripheral venous and LA blood samples were analysed for levels of procoagulants. Results: Baseline characteristics and coagulation profiles (bleeding time, clotting time, INR, and aPTT) were comparable in all groups. Most of the patients (91%) in both thegroups werein NYHA III or NYHA IV functional class. ECHO parameters between the two groups were similar except for left atrial emptying velocity (LAAEV) and Wilkin’s score (WS). LAAEVin patients of MS in atrial fibrillation were significantly lower in MSin AF than those with MS in NSR (12.61±2.8 cm/second vs 16.38±4.04 cm/sec, p=<0.001), and Wilkin’s score was significantly higher in patients of MS in AF than those in NSR (8.54± 0.85 vs 8.03±0.95, p=0.02).In left atrial blood, PF1+2 {MS in NSR vs MS in AF, 9017(6228-10963.5) pg/mL vs 7728.62(5584-13748) pg/mL, p=0.9171)}, PAI-1 {MS in NSR vs MS in AF 26.09±8.18 ng/ml vs 27.95± 17.26 ng/ml. p=0.568)}, D dimer {MS in NSR vs MS in AF, 290(110-590) vs 180(80-1068), p= 0.78} were similar in both patient groups. While fibrinogen levels in left atrial blood {MS in NSR vs MS in AF, 3.47± 0.89g/L vs 4.03 ± 0.01g/L, p=0.054} were significantly higher in patients with MS in AF as compared to those in NSR. Left atrial blood levels of PF1+2, PAI-1and serum fibrinogen in patient groups were significantly higher as compared to controls,and D-dimer levels were similar in all the groups. Systemic levels of PF1+2 {MS in NSR vs MS in AF, 2931 (1780-7191.25) pg/mL vs 6256 (3017-10867.5) pg/mL, p=0.048} and PAI-1 {MS in NSR vs MS in AF 15.11±6.74 ng/ml vs 21.85± 11.06ng/ml. p=0.0006)} were significantly higher in patients of MS in AF than those in NSR. Systemiclevels of fibrinogen {MS in NSR vs MS in AF (3.91± 0.129) g/L vs 4.38 ± 0.117g/L, p=0.066} and D dimer {MS in NSR vs MS in AF, 430(285-655) vs 320(155-695), p=0.53} were similar in both patient groups. Systemic levels of PF1+2, PAI-1, and serum fibrinogen in patient groups were significantly higher as compared to controls, and D-dimer levels were similar in all groups. Conclusion: There is activation of the coagulation system to a similar extent in patients of MS in sinus rhythm with LAA inactivity and associated LASEC (dense smoke; grade 2+ - 4+) compared to those of MS in atrial fibrillation. Hence, this subset of patients of MS in sinus rhythm should also receive oral anticoagulants as is recommended for patients in MS with AF to prevents thrombus formation in left atrium, till left atrial appendage function improvement.

A Seizure is a transient occurrence of signs or symptoms due to abnormal excessive or synchronous activity in the brain 1. Of all the patients who presented with hypocalcaemia during the medical emergency 20 to 25 percent of people experienced seizures.2The Hypocalcaemia can cause a variety of seizures, including generalized tonic-clonic, focal, absence seziures.3,4,5Alcohol consumption is complicated by vitamin deficiency and malnutrition since alcohol provides empty calories.(6)Seizures caused by alcohol are generally brief. Occurs within 6 to 48 hours of the last drink. Materials and Methods: The study conducted was a cross-sectional observational study. After obtaining Ethical committee clearance, all the individuals presenting to medical emergency ward with history of seizures were screened .Subjects with no alcohol consumption history were grouped together and those who had significant alcohol consumption xvi history and who fulfilled cage criteria were grouped together. Results:Out of 100 subjects, 58 individuals fulfilled cage criteria and 42 were non alcoholics. Mean Calcium level among alcohol group was 8.60mg/dl in alcoholic group.56.9% of Hypocalcaemia was noted among alcoholic group and only 17% of hypocalcaemia was noted in non-alcoholic group with a p value of 0.24 19% of alcoholics had low magnesium level as compared to 16.7% in non-alcoholic patients with a p value of 0.011. Conclusion: High prevalence of hypocalcaemia was noted among the alcohol related seizure patients, hypomagnesaemia was also noted in significant hypocalcaemia individuals. Hence both calcium and magnesium levels play a major role in evaluation of seizure patients.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia & associated complications. Increasing evidence suggests that oxidative stress plays a central role in the pathogenesis of T2DM by disrupting insulin secretion, inducing insulin resistance, & damaging pancreatic β-cells. Antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), & glutathione peroxidase (GPx) constitute the primary defense against oxidative stress. Objectives: To evaluate oxidative stress markers & antioxidant enzyme activities in patients with T2DM & analyze their correlation with glycemic control. Methods: This cross-sectional observational study included 100 patients with T2DM. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), malondialdehyde (MDA) levels, total antioxidant capacity (TAC), & activities of SOD, CAT, & GPx were measured. Correlation analyses were performed between oxidative stress parameters & glycemic indices. Results: Diabetic patients exhibited significantly higher MDA & lower TAC compared to reference values. Antioxidant enzyme activities were reduced in poorly controlled diabetics (HbA1c ≥ 8%). Strong positive correlation was found between MDA & HbA1c (r = 0.62, p < 0.001), while SOD & TAC showed negative correlations with FBG. Conclusions: Oxidative stress is significantly elevated in T2DM patients & negatively impacts antioxidant defense mechanisms. These findings support the role of oxidative imbalance in the pathogenesis of T2DM & highlight potential therapeutic targets.

Background: Preterm neonates are at increased risk for neurodevelopmental impairments. Kangaroo Mother Care (KMC), involving early and sustained skin–to–skin contact and exclusive breastfeeding promotion, has shown benefits in reducing mortality and morbidity in low birth weight infants. However, evidence on its impact on long-term neurodevelopmental outcomes remains limited. Objective: To evaluate the effect of early KMC initiation on neurodevelopmental outcomes at 12 months corrected age among preterm neonates. Methods: In this prospective cohort study, 100 preterm neonates (gestational age 28–36 weeks) admitted to a tertiary neonatal unit were enrolled. Fifty infants received early KMC (within 72 hours of birth; KMC group) and fifty received standard care without systematic early KMC (control group). Neurodevelopmental assessment at 12 months corrected age was performed using the Bayley Scales of Infant and Toddler Development–III (BSID-III). Results: At 12 months corrected age, neonates in the KMC group demonstrated significantly higher mean cognitive (95% CI: 100.4–105.8 vs 92.2–99.1, p < 0.001), language (97.1–103.5 vs 88.0–95.2, p = 0.002), and motor composite scores (94.7–101.3 vs 85.9–93.4, p < 0.001) compared with the control group. The incidence of neurodevelopmental delay was significantly lower in the KMC group (16% vs 38%; p = 0.01). Positive associations were also found between duration of daily KMC and composite scores. Conclusion: Early initiation of KMC in preterm neonates is associated with improved neurodevelopmental outcomes at 12 months corrected age. These findings support integrating early KMC into routine care practices to enhance developmental trajectories in preterm infants.

Background:  Pain is one of the most frequent reasons for hospital visits and remains a major challenge in clinical management due to variability in patient response and limitations of existing analgesic drugs. Traditional drug discovery is expensive, slow, and has high failure rates. This study evaluates the role of Artificial Intelligence (AI) in analgesic drug discovery using real-world clinical data from a tertiary care teaching hospital. A translational AI-assisted approach was adopted, integrating retrospective electronic health record (EHR) analysis with computational drug screening and prediction models. A total of 180 adult patients were included, with acute pain representing 60% and chronic pain 40%. Commonly prescribed drugs included paracetamol (78.9%) and NSAIDs (65.6%), while opioid use remained lower. Pain score reduction was statistically significant overall (mean change -2.9, p < 0.001), though chronic and neuropathic pain showed lower improvement. AI models demonstrated strong predictive performance, with XGBoost achieving the highest accuracy (89.4%) and AUROC (0.93). The AI pipeline identified multiple promising candidate compounds targeting COX-2, TRPV1, Nav1.7, NMDA receptor, and FAAH. The findings support the feasibility of AI-driven analgesic discovery using clinical hospital data and highlight the potential for developing safer, non-opioid analgesics.

Background: Metformin has a favorable safety profile; however, concurrent use of antidiabetic herbs may increase the risk of adverse events through pharmacodynamic interactions. Objectives: To evaluate the safety outcomes and adverse event profile associated with herb–metformin co-administration. Materials and Methods: A prospective observational study of 400 T2DM patients was conducted. Hypoglycaemia, gastrointestinal adverse effects, and renal safety outcomes were assessed. Result: Herbal users experienced significantly higher rates of hypoglycaemia and gastrointestinal adverse effects compared to non-users. Conclusion: Herb–metformin interactions pose important safety concerns requiring vigilant monitoring.

Background: Metformin has a favorable safety profile; however, concurrent use of antidiabetic herbs may increase the risk of adverse events through pharmacodynamic interactions. Objectives: To evaluate the safety outcomes and adverse event profile associated with herb–metformin co-administration. Materials and Methods: A prospective observational study of 400 T2DM patients was conducted. Hypoglycaemia, gastrointestinal adverse effects, and renal safety outcomes were assessed. Result: Herbal users experienced significantly higher rates of hypoglycaemia and gastrointestinal adverse effects compared to non-users. Conclusion: Herb–metformin interactions pose important safety concerns requiring vigilant monitoring.

Background & Method: The aim of the study is to compare study between functional outcomes of conservative treatment v/s volar plating in extra-articular fracture distal end radius. Patients presenting in the Emergency department and the Outpatient department were admitted for thorough evaluation. Detailed history was taken to rule out other systemic injury, ascertain the duration of injury, mode of injury, co morbid illness, and history of previous surgeries and for ruling out other major system involvement as a part of trauma screening. Result: At 6 months follow up the final result of functional outcome was compared. Plating group had 10(33.33%) Excellent, 14(46.7%) Good, 06 (20%) Fair and 0 poor functional outcome whereas Closed reduction and cast group had 4(13.33%) Excellent, 8(26.67%) Good, 16(53.33%) Fair and 2(6.67%) Poor outcome, showing that functional outcome of Plating group was better. Conclusion: In our prospective comparative study with extra articular fracture distal end radius treated with open reduction and volar plate fixation and managed conservatively with closed reduction and cast had a statistically significant (p value <0.05) Green and O‟Brien functional score at 6 months follow-up between the groups, and concluded that open reduction and volar plating has superior and better functional and radiological outcome when compared with Closed reduction and cast application.

Background & Methods: The aim of the study is to Evaluation of ketamine, dexamethasone and dexmedetomidine nebulisation in prevention of post-operative sore throat. Patients were randomly assigned to one of three groups using the chit method: Group K (50 mg nebulized ketamine), Group D (8 mg nebulized dexamethasone), and Group M (50 µg nebulized dexmedetomidine).    Results: The descriptive statistics (number of patients, mean, and standard deviation) of respiratory rate (RR) in breaths per minute for the Dexamethasone, Dexmedetomidine, and Ketamine nebulization groups at various time points: Baseline, Post Nebulization, Pre Induction, Post Induction, Post Extubation (0 hours), 2 hours, 4 hours, and 6 hours. The table also includes the F-statistic and p-value from a one-way ANOVA comparing the means of the three groups at each time point. Conclusion: No single nebulized agent demonstrated a clear statistically significant advantage over the others in preventing POST. However, trends in the data suggest potential differences in effects on cough and hoarseness, with dexmedetomidine showing promise for POST reduction and dexamethasone and ketamine potentially offering benefits for hoarseness prevention.

Background: Accurate evaluation of the upper airway is essential during pre-anaesthetic assessment & in the diagnosis of laryngeal pathologies. Conventional clinical examination may be insufficient, & imaging plays a crucial role in identifying anatomical variations & pathological abnormalities. Objective: To assess the diagnostic yield & clinical utility of imaging modalities—primarily CT, MRI, & flexible laryngoscopy—in evaluating upper airway anatomy in patients scheduled for anaesthesia or presenting with laryngeal complaints. Methods: A prospective study of 100 patients undergoing pre-anaesthetic assessment or presenting with suspected laryngeal afflictions was conducted. Imaging findings were correlated with clinical evaluation & final diagnosis. Results: Imaging altered airway management plans in 28% of pre-operative patients. Laryngeal pathologies were detected in 62% of symptomatic patients, with CT showing high sensitivity (92%) in detecting structural abnormalities. Key imaging predictors of difficult intubation included reduced mandibular space, thickened epiglottis, airway narrowing, & subglottic stenosis. Conclusion: Imaging significantly enhances the accuracy of upper airway evaluation, improves detection of laryngeal disease, & aids anaesthetists in planning safe airway management.

Abstract: Introduction; - Mitral regurgitation (MR) is associated with increased risk of life-threatening arrhythmias. Studying premature ventricular contraction (PVC) characteristics in MR patients may help identify those at risk for sudden death. Electrocardiographic Imaging (ECGI) was used to noninvasively map PVCs in MR patients.  Materials and Methods: ECGI was performed on 52 patients with primary MR prior to mitral valve surgery and on 15 age-matched healthy volunteers. Body surface ECG recordings were obtained with 256 electrodes. Ventricular geometry was obtained from CT/MRI scans. Epicardial potentials were reconstructed on 502 biventricular locations. PVCs were mapped in 13 patients. Activation times (AT) and the total ventricular AT (TVAT; maximum AT - minimum AT) were computed. PVC site of origin (SOO) and morphology were identified from AT maps. PVC burden was quantified as the rate of PVCs over the mapping duration.  22/52 patients underwent follow-up ECGI three months after surgery. PVCs were mapped in 6/22 patients.  Results: Sinus rhythm activation in the MR group was similar to control (TVAT: 68±12 vs. 71±11 ms). Pre-surgery PVC burden was 0.69 PVC/min (Control: 0.03 PVC/min). In the MR group, 82 and 49 PVCs were recorded before and after surgery respectively. PVCs were polymorphic, had wide QRS (TVAT > 120 ms) and a predominant RBBB activation pattern. PVCs mostly originated from the peri-annular region, both before (56/82, 68%) and post-surgery (37/49, 76%). PVC burden decreased in four and increased in three patients after surgery.  Conclusions: PVCs in MR patients predominantly originated from the peri-annular region before and after surgical repair. 

: Introduction; - Gender differences in cardiovascular disease (CVD) extend beyond biological variations to encompass sociocultural, behavioral, and healthcare-access factors that influence disease recognition, management, and outcomes. Despite major advances in cardiac therapeutics, sex-specific inequities persist globally, with women often underdiagnosed and undertreated. This study aimed to compare the clinical presentation, management patterns, and short-term outcomes of CVD between men and women in a tertiary-care setting. Methods: A hospital-based comparative cross-sectional study was conducted among 300 adult CVD patients (150 males, 150 females) attending the Department of Cardiology between April 2024 – March 2025. Data on demographics, risk factors, clinical features, investigations, treatment modalities, and 30-day outcomes were collected using a pre-tested proforma. Statistical analyses were performed using SPSS v26.0. Chi-square and t-tests assessed gender differences; multivariate logistic regression identified independent predictors of adverse outcomes. A p-value < 0.05 was considered significant. Results: Females were older (61.6 ± 11.5 y) than males (57.2 ± 10.8 y, p = 0.001) and had higher rates of diabetes (42.7 %) and obesity (34.0 %), whereas males predominated in smoking (76.7 %) and alcohol use (68.7 %) (p < 0.001). Women presented more often with atypical symptoms (38.7 % vs 17.3 %, p < 0.001) and longer pre-hospital delay (5.0 ± 2.4 h vs 3.2 ± 1.6 h, p < 0.001). Coronary angiography and PCI were performed less frequently in females (67.3 % vs 83.3 %, p = 0.002; 36.7 % vs 52.0 %, p = 0.009). In-hospital complications occurred in 27.3 % of women vs 16.7 % of men (p = 0.022), and 30-day readmission was higher in females (14.0 % vs 7.3 %, p = 0.039). Multivariate analysis identified female gender (AOR 1.89; 95 % CI 1.01–3.56; p = 0.046), age > 65 y (AOR 2.41; p = 0.008), diabetes (AOR 1.98; p = 0.034), and presentation delay > 4 h (AOR 2.73; p = 0.004) as independent predictors of adverse outcomes. Conclusion: Significant gender disparities persist in the presentation and management of cardiovascular disease. Women tend to present later with atypical symptoms, receive fewer invasive interventions, and experience higher complication and readmission rates. These findings underscore the need for gender-responsive cardiovascular care, equitable procedural access, and heightened clinical vigilance for atypical presentations in women to improve overall cardiac outcomes.

Introduction; - The present study was undertaken to assess the proportion of burst abdomen in post midline laparotomy patient using interrupted sutures versus continuous suture technique in sheath closure. Patients to be included in the study and data- complaints, General examinations, Abdominal examination, Biochemical evaluation of blood sugar, blood urea, electrolytes and other specific investigations, post op course carefully observed and criteria managed to analyse morbidity, hospital stay. Hence study conducted in 50 patients who underwent laparotomy 25 patients in which them Interrupted X suture was applied, they were followed up in the early post-operative period and regular follow up- 3 of the patients developed wound dehiscence, in contrast with control group in which 9 patients developed burst abdomen.  1 of our patients from the study group developed incisional hernia,7 from control group developed incisional hernia.

Background: Liver lesions, including hepatocellular carcinoma and metastases, are major causes of cancer-related mortality. Accurate lesion segmentation and classification are crucial for diagnosis and management but remain limited by inter-observer variability and time-intensive manual methods. Artificial intelligence (AI), particularly deep learning, has emerged as a promising tool to automate these tasks with high precision. Purpose: To systematically review and synthesize evidence on AI-based methods for segmentation and classification of liver lesions using CT, MRI, and multimodal imaging. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, Web of Science, and IEEE Xplore were searched (January 2017–October 2025). Studies applying AI for segmentation or classification of liver lesions in human imaging were included. Data on imaging modality, architecture, validation, and diagnostic performance were extracted. Methodological quality was assessed using CLAIM, TRIPOD-AI, PROBAST-AI, and RQS tools. Pooled Dice coefficients and AUC values were estimated using random-effects models. Results: Sixteen studies (2017–2025) met inclusion criteria. Deep learning architectures, mainly CNNs and U-Net derivatives, dominated. Mean Dice scores were 0.93 (95% CI: 0.91–0.95) for liver segmentation and 0.83 (95% CI: 0.79–0.86) for lesion segmentation. Classification models achieved pooled AUC of 0.96 (95% CI: 0.94–0.98) and accuracy of 93%. Half the studies performed external validation, demonstrating strong generalizability. Conclusion: AI methods achieve high accuracy for liver lesion segmentation and classification, approaching radiologist-level performance. However, dataset heterogeneity, limited transparency, and lack of standardized reporting hinder clinical translation. Future work should focus on multicenter validation and explainable AI frameworks to enhance clinical adoption.

Background & Methods: The aim of the study is to evaluation and comparative study of metoclopropamide and lignocaine as intravenous pretreatment to alleviate pain on propofol injection in patients undergoing elective surgery under general anaesthesia. Patients will be explained about the procedure during the pre-anaesthetic visit. All patients will be asked to fast for 8 hrs. All the patients will be prescribed Alprazolam 0.25mg and Pantoprazole 40 mg orally the previous night. Results: Changes in diastolic pressure at baseline, 1min and 5min. The changes with time in both the groups were not significantly different. Conclusion: In the favour of our hypothesis we found that lignocaine 60 mg intravenous pretreatment and metoclopropamide 10mg intravenous pretreatment are equally efficacious in reducing the pain on propofol injection. We also assessed the postoperative recall of pain in both the study drug groups and found 6% in metoclopropamide group and 4% in lignocaine group recalled the pain and no significant difference in both groups. We also found no significant heamodynamic and cardiovascular changes produced by both the drugs, hence we conclude both metoclopropamide 10mg and lignocaine 60mg intravenous pretreatment is equally efficacious in reducing pain on propofol injection with lignocaine has better pain control than metoclopropamide

Background: Hypothyroidism alters carbohydrate metabolism and may affect glycosylated hemoglobin (HbA1c) independent of glycemia. This study evaluated the effect of thyroxine replacement therapy on HbA1c levels in non-diabetic patients newly diagnosed with hypothyroidism. Methods: A prospective observational study was conducted on 100 non-diabetic adults with newly detected primary hypothyroidism. Baseline fasting blood glucose (FBG), HbA1c, thyroid profile (TSH, FT4), and lipid profile were measured. All patients received levothyroxine (1.6 µg/kg/day) and were reassessed after 3 and 6 months of therapy. Results: Significant reductions were observed in HbA1c, TSH, total cholesterol, and LDL-C after 6 months of treatment, with corresponding increases in FT4 levels. FBG levels remained unchanged, suggesting that changes in HbA1c reflected altered erythrocyte turnover rather than true glycemic change. Conclusion: Thyroxine replacement in hypothyroid non-diabetic patients significantly reduces HbA1c independent of glucose metabolism. Clinicians should interpret borderline HbA1c levels cautiously in hypothyroid patients before and during thyroxine therapy

Background: Central serous chorioretinopathy (CSCR) is a common retinal disorder in young adults, characterized by subretinal fluid accumulation. The etiology remains multifactorial, with recent evidence suggesting a potential link between vitamin D deficiency and retinal vascular dysregulation. Objective: To determine the association between serum vitamin D levels and central serous chorioretinopathy in a cohort of patients attending a tertiary care center. Methods: A cross-sectional observational study was conducted among 60 CSCR patients over six months. Demographic data, clinical subtypes (acute, recurrent, chronic), OCT patterns, and Best Corrected Visual Acuity (BCVA) were recorded. Serum 25(OH) vitamin D levels were measured and compared across age groups, subtypes, and controls. Results: Among 60 patients (48 males, 12 females), the majority belonged to the 31–40 year age group. Acute CSCR constituted 80% of cases. Mean serum vitamin D level among cases was 23.3 ± 3.1 ng/mL, significantly lower than controls (30.9 ± 2.2 ng/mL, p < 0.001). Vitamin D deficiency was most prominent in recurrent and chronic CSCR subtypes. BCVA ranged from 6/6 to 6/60, with over half presenting between 6/12 and 6/18. Conclusion: A significant association exists between low serum vitamin D levels and CSCR, especially in recurrent and chronic subtypes. Vitamin D screening should be considered as part of the clinical work-up in CSCR patients

Background: Background & Methods: The aim of the study is to evaluate the effect of chronic kidney disease on heart rate variability. In every case selected, thorough kidney disease history was taken. All the subjects were interviewed in accordance with the enclosed proforma. Correct procedure of the test was explained to all subjects. Results: The mean RR(s) in cases was 0.74±0.15, controls was 0.78±0.11s. The STD (SDNN)(s) in cases was 0.04±0.03s, controls was 0.05±0.03s. The mean Heart Rate (beats/min) in cases was 81.70±8.34 beats/min, controls was 73.19±9.21 beats/min. The RMSSD (ms) in cases was 25.86±18.04, controls was 32.79±21.52. The NN50 (count) in cases was 9.32±9.05, controls was 10.35±8.30. The pNN50 (%) in cases was 6.09±5.44% and controls was 7.16±5.87%. Conclusion: The results of the present study demonstrate that the chronic kidney disease patients influence HRV and change the autonomic balance in favor of an increased sympathetic tone. A high sympathetic and a low cardiovagal activity in patients with chronic kidney disease may contribute to the higher cardiac morbidity and mortality of chronic kidney disease patients. Alterations of autonomic nervous system functioning that promotes vagal withdrawal are reflected in reductions of heart rate variability (HRV) indices. CKD patients had a reduced HRV, indicating impaired autonomic function, compared with a reference group without impaired renal function.

Background: Beyond mortality prediction, peri-operative morbidity and prolonged ICU resource use substantially affect recovery and healthcare cost in coronary artery bypass grafting (CABG). Accurate risk estimation of these outcomes is critical in optimizing peri-operative management. The Society of Thoracic Surgeons (STS) score incorporates major non-fatal postoperative events, but its validity in Indian patients is poorly defined. This study aimed to evaluate the predictive accuracy of the STS score for postoperative morbidity and ICU outcomes following CABG in a South-Indian cardiac center. Methods: A retrospective review of 409 adult CABG patients was performed. Pre-operative variables, intra-operative parameters, and postoperative complications were abstracted from institutional records. STS-predicted morbidity risk was calculated online and compared with observed complications. Outcomes included renal failure, stroke, mediastinitis, re-exploration for bleeding, and prolonged ventilation. Model calibration (Hosmer–Lemeshow test) and discrimination (ROC AUC) were determined. Results: The study included 409 patients with a mean age of 60 ± 8 years, of whom 89.5 % were males. Comorbidities were highly prevalent, with diabetes observed in 68 % of patients, hypertension in 67 %, and dyslipidemia in 60 %. The overall observed postoperative morbidity was 2.2 %, comprising re-exploration for bleeding in 2.2 %, renal failure in 0.5 %, stroke in 0.2 %, and mediastinitis in 0.2 %. The mean ICU stay was 3.5 ± 1.6 days, and the mean duration of postoperative ventilation was 1.5 ± 1.1 days. The STS-predicted morbidity demonstrated a statistically significant correlation with observed events (p = 0.01), indicating good discriminatory ability. Receiver operating characteristic (ROC) analysis yielded an AUC of 0.79 (95 % CI 0.71–0.87), confirming strong predictive performance. Model calibration by the Hosmer–Lemeshow goodness-of-fit test showed satisfactory agreement between predicted and observed outcomes (p = 0.32). Conclusion: The STS model demonstrated acceptable discrimination and calibration for morbidity prediction and ICU stay estimation in Indian CABG patients. Incorporation of locally calibrated variables may further enhance predictive reliability for resource planning in low- and middle-income settings.

Introduction: Asthma is one of the most common chronic diseases in children and adults worldwide, and its incidence has increased steadily over recent decades. AIM: To assess and compare serum zinc levels between asthmatic and non-asthmatic children aged 2–14 years. Methodology: This hospital-based observational study was conducted in the Department of Paediatrics Medicine, Sardar Patel Medical College and P.B.M. Hospital, Bikaner, from November 2020 to October 2021. Result: The present study found significantly lower serum zinc levels in asthmatic children compared to non-asthmatic controls, with levels decreasing as asthma severity increased. This suggests a possible link between zinc deficiency and the severity of asthma. Conclusion: Serum zinc may influence asthma control, and its assessment with appropriate supplementation could aid in better management of asthma

Fourth-time cardiac surgery is an extremely uncommon and difficult clinical situation, with scant literature on outcomes and long-term prognosis. Each successive reoperation significantly increases surgical complexity, primarily due to the presence of dense mediastinal adhesions, altered anatomical landmarks, and scar tissue from prior interventions. These factors increase the risk of inadvertent injury to vital structures such as the great vessels, myocardium, and bypass grafts during reentry. In the present case, the patient had undergone three prior cardiac surgeries, necessitating a complex fourth redo procedure at our institute. Such reoperations are typically indicated in situations where previous surgical repairs or replacements have failed, or when new pathologies develop, including degenerated prosthetic valves, stuck mechanical valves, progressive valvular regurgitation, or occluded coronary artery bypass grafts leading to ischemic compromise. The perioperative risks in these patients are markedly elevated, with higher chances of excessive bleeding, prolonged cardiopulmonary bypass time, and increased morbidity and mortality. Therefore, meticulous surgical planning, the use of advanced operative techniques such as femoral or axillary cannulation before sternotomy, and the availability of experienced surgical and anesthetic teams are crucial for improving safety and outcomes. Furthermore, postoperative care must be highly specialized, focusing on maintaining hemodynamic stability, preventing low cardiac output syndrome, controlling infections, and providing multi-organ support when necessary. Despite the inherent risks, fourth-time cardiac surgery can be life-saving and may offer improved quality of life in carefully selected patients, highlighting the importance of individualized decision-making and multidisciplinary management

Introduction: Dengue fever is a common mosquito-borne viral infection caused by the dengue virus (DENV), a member of the Flaviviridae family. It is transmitted to humans primarily through the bite of infected Aedes aegypti and Aedes albopictus mosquitoes. AIM: To assess the correlation of hyperferritinemia with thrombocytopenia among patients of dengue fever admitted in a tertiary medical college hospital. Methodology: This was a hospital-based cross-sectional study conducted in the Department of Paediatrics, Sardar Patel Medical College and P.B.M. Hospital, Bikaner. The study was carried out over a period of six months, from September 2020 to February 2021. Result: In our study, serum ferritin levels were significantly higher in severe dengue compared to non-severe cases (p<0.001) and showed a strong negative correlation with platelet count (R= -0.61), indicating that rising ferritin levels are associated with greater disease severity. Bleeding manifestations were the most common complication, seen in 52% of severe dengue cases. Conclusion: Serum ferritin serves as a significant marker for early identification and differentiation of severe dengue from non-severe cases