Background: Postoperative sore throat (POST) is a common complication following general anesthesia with endotracheal intubation, affecting 12.1–70.3% of surgical patients. While traditionally considered minor, POST causes significant patient discomfort, dissatisfaction, and prolonged hospital stays. N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine and magnesium sulfate possess analgesic and anti-inflammatory properties that may mitigate POST. Objective: This study compared the efficacy of nebulized ketamine versus magnesium sulfate in reducing POST incidence and severity in patients undergoing general anesthesia with endotracheal intubation. Methods: Eighty-eight patients were randomly allocated to two groups: Group 1 (n=44) received 250 mg magnesium sulfate nebulization, and Group 2 (n=44) received 50 mg ketamine nebulization, both in 5 mL normal saline administered for 15 minutes prior to anesthesia induction. POST was assessed immediately after extubation and at 6, 12, and 24 hours postoperatively using a 4-point severity scale (0–3). Hemodynamic parameters were monitored throughout the perioperative period. Results: Ketamine nebulization resulted in significantly lower POST incidence at 4 hours (11.4% vs 27.3%, p = 0.002) and 6 hours (6.8% vs 18.2%, p = 0.039) compared to magnesium sulfate. Visual Analogue Scale (VAS) pain severity scores were significantly lower in the ketamine group at 4 hours (2.72±0.87 vs 3.69±0.96, p = 0.016) and 6 hours (1.95±0.88 vs 2.84±1.02, p = 0.039). Hemodynamic parameters remained stable and comparable between groups throughout the study. Both agents demonstrated excellent safety profiles with no serious adverse events or emergence delirium. Conclusion: Preoperative nebulization with 50 mg ketamine significantly reduces POST incidence and severity compared to 250 mg magnesium sulfate nebulization, particularly in the immediate postoperative period. Ketamine nebulization represents a simple, cost-effective, and safe prophylactic measure for POST prevention and should be considered for routine use in patients undergoing general anesthesia with endotracheal intubation.

Background: Metabolic syndrome (MetS) represents a clustering of cardiovascular risk factors with increasing prevalence among working populations. Sedentary office employees may be particularly vulnerable due to prolonged sitting, irregular sleep patterns, and occupational stress. However, the combined influence of sleep duration and work-related stress on metabolic syndrome development in this population remains insufficiently characterized. Methods: A cross-sectional study was conducted involving 428 sedentary office employees from corporate and government organizations. Sleep duration was assessed using self-report questionnaires and categorized as short (<6 hours), normal (6-8 hours), or long (>8 hours). Occupational stress was measured using the Job Content Questionnaire. Metabolic syndrome was defined according to the harmonized criteria. Anthropometric measurements, blood pressure, and fasting blood samples were obtained. Results: Mean age was 38.6 ± 9.2 years, with 54.2% males. Metabolic syndrome prevalence was 28.7%. Short sleepers demonstrated significantly higher MetS prevalence (42.6%) compared to normal sleepers (22.4%; p<0.001). High occupational stress was associated with increased MetS prevalence (38.4% vs. 21.6%; p<0.001). Multivariate logistic regression identified short sleep duration (OR=2.48, 95% CI: 1.56-3.94, p<0.001) and high job strain (OR=2.12, 95% CI: 1.38-3.26, p<0.001) as independent predictors of MetS. Significant interaction was observed between short sleep and high stress (OR for interaction=1.86, p=0.018), with combined exposure yielding MetS prevalence of 52.4%. Conclusion: Both short sleep duration and high occupational stress independently contribute to metabolic syndrome risk among sedentary office employees, with synergistic effects when occurring together. Workplace health programs should address both sleep hygiene and stress management to reduce cardiometabolic risk.

Background: Accurate stroke risk stratification is essential for guiding anticoagulation therapy in patients with atrial fibrillation (AF). The CHA₂DS₂-VASc score is widely used but has limitations in discriminating risk among intermediate-risk patients. The ABC-Stroke score, which incorporates biomarkers, has emerged as a promising alternative.  Aim: To compare the effectiveness of CHA₂DS₂-VASc and ABC-Stroke scores for stroke risk stratification in atrial fibrillation outpatients.  Materials and Methods: This observational cross-sectional study included 120 adult patients with atrial fibrillation attending the outpatient department of a tertiary care hospital. Clinical data were collected, and CHA₂DS₂-VASc scores were calculated using standard criteria. ABC-Stroke scores were determined using age, clinical history, and relevant cardiac biomarkers. Stroke risk categorization and predictive performance of both scores were compared using appropriate statistical analyses.  Results: The mean CHA₂DS₂-VASc score was 3.21 ± 1.34, while the mean ABC-Stroke score was 7.86 ± 2.11 (p < 0.001). High-risk classification was observed in 39.1% of patients using CHA₂DS₂-VASc and 50.0% using the ABC-Stroke score (p = 0.014). The ABC-Stroke score demonstrated superior discriminative ability with a higher area under the curve (0.79 vs 0.68), along with greater sensitivity and specificity. Moderate agreement between the two scores was noted (κ = 0.41).  Conclusion: The ABC-Stroke score demonstrated superior predictive performance compared to the CHA₂DS₂-VASc score for stroke risk stratification in atrial fibrillation outpatients. Incorporation of biomarker-based assessment may enhance identification of high-risk patients and support more individualized stroke prevention strategies.

Background: Insulin resistance plays a central role in the pathophysiology of hypertension and contributes significantly to cardiovascular risk. Although HOMA-IR and TyG index are widely used surrogate markers of insulin resistance, their dependence on fasting parameters limits routine applicability. HbA1c-derived indices have emerged as potential non-fasting alternatives for identifying insulin resistance.  Objectives: To compare HbA1c-derived indices with fasting-based indices (HOMA-IR and TyG index) for detecting insulin resistance in hypertensive patients.  Materials and Methods: This hospital-based cross-sectional analytical study included 200 hypertensive patients. Fasting plasma glucose, fasting insulin, fasting triglycerides, and HbA1c were measured. Insulin resistance was assessed using HOMA-IR, TyG index, and HbA1c-derived indices. Statistical analysis included comparison of means, chi-square test, correlation analysis, receiver operating characteristic curves, and agreement analysis using Cohen’s kappa.  Results: Insulin resistance was detected in 56.0% of patients using HOMA-IR and 62.0% using the TyG index. Patients with insulin resistance had significantly higher HbA1c, HOMA-IR, TyG index, and HbA1c-derived index values (p < 0.001). HbA1c-derived indices showed good sensitivity (73.2%) and specificity (76.8%). Strong positive correlations were observed between HbA1c and HOMA-IR (r = 0.68) and TyG index (r = 0.63). Substantial agreement was noted between HbA1c-derived indices and fasting-based indices.  Conclusion: HbA1c-derived indices demonstrate good diagnostic performance and substantial agreement with fasting-based indices for detecting insulin resistance in hypertensive patients. They represent a simple, cost-effective, and reliable alternative for routine screening of insulin resistence

Introduction: Iron deficiency anemia (IDA) represents a significant global health burden with potential cardiovascular implications. While overt cardiac manifestations in severe anemia are well-documented, subclinical cardiac dysfunction in mild-to-moderate IDA remains inadequately characterized. Methods: This cross-sectional study enrolled 186 adults (93 with IDA and 93 age- and sex-matched healthy controls). Comprehensive echocardiographic assessment including conventional parameters, tissue Doppler imaging, and speckle-tracking echocardiography for global longitudinal strain (GLS) analysis was performed. IDA was defined as hemoglobin <12 g/dL in females and <13 g/dL in males with serum ferritin <30 ng/mL and transferrin saturation <20%. Results: Patients with IDA demonstrated significantly impaired left ventricular GLS (-17.8 ± 2.4% vs -20.6 ± 1.9%, p<0.001) compared to controls. Diastolic dysfunction markers were notably altered, with elevated E/e' ratio (9.8 ± 2.7 vs 7.2 ± 1.8, p<0.001) and reduced e' velocity (8.4 ± 2.1 vs 11.2 ± 2.3 cm/s, p<0.001) in the IDA group. Left atrial volume index was significantly higher in IDA patients (32.4 ± 6.8 vs 26.7 ± 5.2 mL/m², p<0.001). Hemoglobin levels showed positive correlation with GLS (r=0.52, p<0.001) and negative correlation with E/e' ratio (r=-0.48, p<0.001). Multivariate analysis identified ferritin levels (β=-0.34, p=0.002) and hemoglobin (β=-0.29, p=0.008) as independent predictors of impaired GLS. Conclusion: Iron deficiency anemia is associated with subclinical left ventricular systolic and diastolic dysfunction detectable through advanced echocardiographic techniques, even in asymptomatic individuals. Early cardiovascular screening may be warranted in IDA patients

Background: Chronic Kidney Disease (CKD) is a progressive condition that often leads to skin complications, including pruritus (itching) and impaired skin barrier function. Pruritus significantly impacts the quality of life of CKD patients, particularly those with advanced disease. The mechanisms underlying these skin-related complications are not well understood, and their association with CKD stages and dialysis status needs further exploration. Objective: To assess the impact of CKD on skin barrier function and pruritus severity in patients across different stages of CKD and dialysis status. Methods: A hospital-based observational study was conducted with 250 CKD patients across various stages (Stage 1 to Stage 5). The study evaluated transepidermal water loss (TEWL) as a measure of skin barrier function and pruritus severity using the Visual Analog Scale (VAS). Biochemical markers (serum urea, creatinine, albumin, calcium, and phosphorus) were also measured. Data were analyzed using descriptive statistics, correlation analysis, and multivariate regression. Results: TEWL and pruritus severity increased significantly with the progression of CKD. Stage 5 patients had the highest TEWL (12.5 g/m²/h) and the lowest skin hydration, while pruritus severity was most intense in Stage 5 patients (VAS score = 8.5). Dialysis status was found to exacerbate pruritus, with hemodialysis patients reporting the highest pruritus severity. Biochemical markers, particularly serum creatinine and urea, showed a positive correlation with TEWL and pruritus severity. Multivariate analysis revealed that TEWL, serum creatinine, dialysis status, and albumin levels were significant predictors of pruritus severity. Conclusion: This study highlights the significant impact of CKD on skin barrier function and pruritus severity, with advanced stages of CKD and dialysis status contributing to skin-related complications. The findings suggest that managing skin health and pruritus should be an integral part of CKD care, particularly in dialysis patients.

Background: Neonatal hypoglycaemia is a common metabolic disorder associated with significant morbidity if unrecognized. Early identification of risk factors is essential for timely intervention, particularly in high-risk neonates in tertiary care settings. This study aimed to assess the demographic, perinatal, and clinical factors associated with neonatal hypoglycaemia. Material and Methods: A cross-sectional, observational study was conducted over 18 months (July 2024–December 2024) at the NICU of Gujarat Adani Institute of Medical Sciences and G.K. General Hospital, Bhuj. A total of 100 neonates with hypoglycaemia (random blood sugar <45 mg/dL) were enrolled using convenience sampling. Clinical and demographic data, birth weight, gestational age, maternal history, and perinatal risk factors were recorded. Blood glucose was measured using glucometers, with confirmatory laboratory testing where required. Data were analyzed using SPSS v29, with descriptive statistics and associations evaluated at a significance level of p < 0.05. Results: Among the neonates, 62% were male and 38% female. Late preterm (34%) and term (31%) infants predominated. Based on gestational growth, 45% were AGA, 33% SGA, and 22% LGA. Inborn neonates comprised 78% of the cohort. Birth weight distribution showed 48% normal, 44% LBW, 7% VLBW, and 1% ELBW, with a mean weight of 2.74 ± 0.80 kg. Common risk factors included sepsis (56%), pregnancy-induced hypertension (42%), IDM (27%), IUGR (33%), polycythaemia (21%), and other comorbidities (32%). Clinical manifestations were largely absent; symptomatic neonates presented with jitteriness (6%), lethargy (4%), seizures (4%), and refusal to feed (2%). Conclusion: Sepsis, maternal PIH, and diabetes were prominent risk factors for neonatal hypoglycaemia. Most affected neonates were asymptomatic, emphasizing the need for routine glucose monitoring and early risk-based intervention to prevent adverse outcomes.