Background & Method: Cholecystectomy, the surgical removal of the gallbladder, is one of the most common elective surgeries performed worldwide. However, in resource-limited settings, it poses significant challenges due to limited access to surgical expertise, diagnostic tools, and post-operative care. This study aims to assess the feasibility, outcomes, and challenges associated with cholecystectomy in such settings. A retrospective review of 100 patients who underwent cholecystectomy at a tertiary healthcare facility in a resource-limited setting between January 2020 and December 2022 was conducted. Patient demographics, clinical indications, perioperative details, complications, and outcomes were analyzed. Descriptive statistics were used to summarize the data, and significant results were identified using Chi-square tests for categorical variables. Results: A total of 100 patients (52 males and 48 females) with a mean age of 45.6 years were included. The most common indication for surgery was symptomatic cholelithiasis (87%), followed by acute cholecystitis (10%) and gallbladder cancer (3%). Laparoscopic cholecystectomy (LC) was attempted in 75% of cases, while 25% underwent open cholecystectomy (OC) due to technical or resource limitations. The most common complication was wound infection (9%), and the overall mortality rate was 2%. Conclusion: Cholecystectomy can be safely performed in resource-limited settings, with acceptable outcomes. However, challenges such as inadequate surgical facilities, postoperative care, and delays in diagnosis need to be addressed to improve surgical outcomes

Introduction: Accurate estimation of gestational age (GA) is crucial for guiding obstetric care, influencing decisions regarding fetal monitoring, delivery planning, and high-risk pregnancy management. Traditional biometric parameters such as biparietal diameter, head circumference, abdominal circumference, and femur length lose precision in late pregnancy, particularly in growth-restricted fetuses. Fetal kidney length (FKL), which demonstrates consistent linear growth, offers a promising alternative marker for GA assessment. Aims and Objectives:  This study aimed to evaluate the efficacy of FKL (Fetal Kidney Length) in predicting GA (Gestational Age) during the second and third trimesters and to compare its performance with established biometric indices. Methodology:  This prospective, hospital-based cross-sectional observational study was conducted at the Department of Radio diagnosis, Mahatma Gandhi Memorial Medical College & M.Y. Hospital, Indore, over one year (February 2024 – January 2025). A total of 370 singleton pregnancies between 20–40 weeks were included. FKL was measured bilaterally on ultrasound, averaged, and compared with conventional parameters, including BPD, FL, HC, and AC. Statistical Analysis:  Data were analyzed using SPSS v25.0. Correlations were tested using Pearson’s method, regression models assessed predictive strength, and ANOVA/t-tests compared parameter performance. A p-value <0.05 was considered statistically significant. Results:  FKL showed a strong, statistically significant positive correlation with GA across all gestational groups, often outperforming traditional biometric markers in late pregnancy. Conclusion: FKL is a reliable sonographic parameter for GA estimation, particularly when conventional indices are limited, supporting its integration into routine obstetric ultrasound protocols.

Introduction: The prevalence of coronary artery diseases in India is increasing, hence to assess associated risk factors for coronary artery bypass graft (CABG) surgeries shall contribute in minimizing in hospital deaths. Acute liver ischemia-related complication is a rare complication of on-pump CABG surgery, but with high mortality. AIM: To evaluate changes in liver function tests and incidence of acute liver injury after on-pump CABG surgery. Methods: 150 patients were serially enrolled and data collected were ALT, AST, ALP, total and direct bilirubin level preoperatively and at 24, 48, 72 hours after the surgery as well as at discharge. Furthermore, those with abnormal liver function tests or suffering viral hepatitis were excluded. Results: 15% female and 85% male patients, primarily aged between 56 to 65 (with ages ranging from 35 to 85). 67.82% had previously suffered a heart attack, 68.56% were diabetic, 28.50% had hyperlipidemia and 68.56% were hypertensives. Further, 74.78% were either smokers or tobacco chewers. 63.5% patients suffered from obesity. The average cardiac ejection fraction  was 30-45%.  The mean cardiopulmonary time duration was 125.50 minutes and aortic cross clamp time was 76.50 minutes. For 100% of patients, inotropic drugs were used and for 1.5%  patients, an intraaortic balloon pump was used after separation from cardiopulmonary bypass. The pre-operative total bilirubin level had a mean of 0.69 ± 0.35 mg/dL, peaking upto 2.45 on first post operative day. The direct bilirubin levels peaked at 1.56 mg/dL in this same period (Table 3).  Age, gender, and BMI  were evaluated. Significant correlation between age and AST levels POD from pre-operative levels (t:3.12, p<.05). Age had negative significant correlation with ALP elevation on 3rd (t: -1.89 , p<.05). Male gender had significant elevation on ALP levels 1st POD(t: 1.98 , p<.05). Female gender had significant correlation with total bilirubin changes at discharge time from pre-operative levels(t: 3.05, p<.05). BMI showed  negative correlation with total bilirubin changes on 2nd POD(t: -3.89 , p<.05). According to regression analysis results, with the exception of a direct and significant correlation between prior myocardial infarction (MI) and changes in total bilirubin levels within the first 48 hours post-surgery (t:-2.704 , p<.05), there was no other significant effect by cardiovascular risk factors such as HTN, HLP or DM. A negative correlation was found between Ejection fraction and AST levels on 1st POD (t:-3.4, p<.05). A negative correlation was found between Ejection fraction and bilirubin levels on 2nd POD (t:-2.4, p<.05).  3rd POD (t: -2.67, p<.05). A negative correlation was found between Ejection fraction and total bilirubin levels 3rd POD (t: -1.9, p<.05). Smoking history significantly correlated with elevation in AST levels POD 2&3 and bilirubin levels on 3rd POD.  Conclusion: In the majority of cases, the LFT return close to normal levels at the time of discharge from hospital. Cardiopulmonary bypass time and aortic cross clamp time and inserting IABP contributed maximum to  acute liver injury in  on-pump CABG surgery. We recommend surgeons should evolve strategies based on competency to reduce pump and clamp time. A patient's biochemical liver tests levels may elevate after surgery if the patient is elderly, history of MI, has a low cardiac ejection fraction reserve, and  smokes cigarettes.

Background:  Dacryocystitis is a common infection of the lacrimal apparatus. It occurred due to obstruction of the nasolacrimal duct. This study was undertaken to isolate and identify the specific bacterial pathogens causing dacryocystitis and to determine their in-vitro antibacterial susceptibilities to commonly used antibacterial agents. Methods: The patients were recruited from the outpatient and inpatient departments of the institute of ophthalmology & study was done in the Department of Microbiology, JNMC, AMU, and Aligarh (UP). Purulent materials expressed from the infected lacrimal sac were collected from clinically diagnosed patients and were transported to the bacteriology division of the department of microbiology for further processing. Identification of organisms was made by conventional methods. Antimicrobial susceptibility was done as recommended by the Clinical and Laboratory Standards Institute by using the Kirby-Bauer disc diffusion method. Results: A total of 67 patients were included in the study. Among 67 samples collected, 53 (79.1%) cultures tested positive for microbial growth. A total of 55 microorganisms were isolated with two specimens showing mixed growth. The predominant bacterial species isolated was Staphylococcus aureus. Conclusion: Staphylococcus aureus was found to be a significant contributor to dacryocystitis. In this study, vancomycin, levofloxacin, and amikacin showed higher efficacy against Gram-positive isolates compared with other antibacterial agents, while meropenem, ceftriaxone-sulbactam, piperacillin-tazobactam, and amikacin was more effective against Gram-negative isolates.

Introduction: Topical myocardial cooling using ice slush or cold saline has historically been used as an adjunct to cold cardioplegia during cardiac surgery to enhance myocardial protection. However, its additional benefit remains controversial, and concerns about potential pulmonary complications and phrenic nerve injury have been reported. Aims: To evaluate the effects of topical cardiac hypothermia on intraoperative and early postoperative outcomes in patients undergoing planned aortic and/or mitral valve surgery. Materials and methods: The present study was a prospective observational study. This study was conducted over a period of one and a half years (July 2022–January 2024) at the Ward, ICU, and OT of the Department of Cardiothoracic and Vascular Surgery, IPGMER and SSKM Hospital, Kolkata. The study population included all patients undergoing surgery for aortic and/or mitral valve disease in the aforementioned department, based on the defined inclusion and exclusion criteria. The sample size for the study was 40 patients. Result: The two groups were comparable in age, sex, and type of surgery. Restoration of sinus rhythm, pacing requirement, and intraoperative events did not differ significantly between groups. On postoperative day 1, hazy lung fields were significantly more common in the topical cooling group (80.0% vs. 50.0%; p = 0.0467). Diaphragmatic elevation on postoperative day 4 was higher in the topical cooling group (30.0% vs. 10.0%) but was not statistically significant. No mortality was observed in either group up to postoperative day 5. Post operative day 1 Creatinine Kinase (Myocardial Band)(CK-MB) was significantly elevated(89.82 ± 90.19 vs. 45.38 ±31.46; p= 0.0443) in topical cooling group. Also patients in topical cooling group took significantly more time(6.69 ±3.81 vs. 3.89 ±1.64; p= 0.0078) to restore to sinus rhythm post cardiopulmonary bypass(CPB). Conclusion: Not only Topical myocardial cooling did not provide additional myocardial protection, but was actually detrimental to the myocardium, and was associated with a higher incidence of early postoperative pulmonary changes. Routine use of topical ice slush in addition to cold cardioplegia may be unnecessary and could increase pulmonary morbidity.

Hypertrophic cardiomyopathy is a common disorder of cardiac muscle associated with sudden cardiac death  The paper highlights three cases which came for autopsy to MLPM centre with history of sudden death. On autopsy and further on histopathological examination it was revealed that the cause of death was HOCM in a these cases. In one of the case it was revealed in history that a familial tendency of sudden death existed and on review of literature it was found that HOCM can be a likely cause in such cases. The paper brings forth the findings during autopsy and concludes that preventive measures can reduce the burden of deaths due to HOCM.

Background: Background: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disorder characterized by interface hepatitis, hypergammaglobulinemia, and circulating autoantibodies. It has a strong female predominance, while presentation in males, especially with negative autoimmune markers, is rare. Case Presentation: We report a 28-year-old male presenting with jaundice and elevated liver enzymes. Viral markers and metabolic workup were negative. Serum IgG was markedly elevated, while autoimmune serology (ANA, SMA, anti-LKM1) was negative. Liver biopsy showed chronic active hepatitis with interface activity and portal inflammation. His revised AIH score was 16, confirming the diagnosis of autoimmune hepatitis. He responded well to corticosteroids and azathioprine. Conclusion: This case underscores the importance of considering seronegative AIH in young males with unexplained hepatitis and hyperglobulinemia. Histopathology and scoring systems remain indispensable in establishing the diagnosis where serology is inconclusive.

Background: Pulmonary endarterectomy (PEA) is a definitive surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH), characterized by persistent pulmonary artery obstruction due to organized thromboembolic material. Left untreated, CTEPH leads to progressive right heart failure and increased mortality. PEA involves the removal of fibrotic thromboembolic material from the pulmonary vasculature under deep hypothermic circulatory arrest, thereby restoring pulmonary hemodynamics and improving right ventricular function. With experienced surgical teams, PEA offers excellent long-term survival and significant symptomatic relief, making it the treatment of choice for operable CTEPH. Case Description: In this observational series of seven male patients with CTEPH, PEA led to significant clinical and hemodynamic improvements. Despite varied comorbidities, six patients had isolated CTEPH, and one had an associated right atrial mass. Functional status and oxygenation improved postoperatively, with SpO₂ rising from 80–97% pre-op to 85–98% post-op. Right ventricular dysfunction and tricuspid regurgitation showed echocardiographic improvement. Hemodynamics improved with RVSP reductions ranging from 9% to 79%. Surgical interventions included PEA and mass excision, with one postoperative mortality. Overall, PEA was effective in enhancing outcomes in CTEPH. Conclusions: PEA is the gold-standard treatment for CTEPH, offering a potential cure by removing obstructive clots from the pulmonary arteries. Performed under deep hypothermic circulatory arrest, it significantly improves hemodynamics, right heart function, and survival. With improved surgical techniques and patient care, outcomes are excellent at experienced centres. While not without risks, PEA provides substantial benefits and remains the preferred option for eligible patients, with multidisciplinary evaluation essential for optimal treatment planning.

Introduction: Sleep, along with exercise and nutrition, is crucial for health, supporting immunity, metabolism, hormone balance, and cardiovascular health. Adults are advised to get seven to nine hours of sleep daily by the "National Sleep Foundation" and the "American Academy of Sleep Medicine." Sleep regulation is managed by the brain's hypothalamic suprachiasmatic nuclei (SCN), which control the sleep/wake cycle. Medical staff working night shifts disrupt their natural sleep cycle, affecting vital physiological parameters like heart rate and blood pressure. Shift work, characterised by three or more time slots for 24-hour coverage, often leads to altered sleep, the most common health issue among shift workers. This can dysregulate the autonomic nervous system, potentially causing hypertension, cardiovascular disease, and cerebrovascular disease. Despite their crucial role in healthcare, there is limited knowledge on how shift work impacts medical staff's cardio-respiratory health. This study aims to examine these effects to improve the well-being of medical staff and the quality of care they provide by comparing cardio-respiratory parameters between shift and day duty workers. Aim: This study aims to assess the cardiorespiratory parameters among medical staff working on shift duty versus day duty. Materials and Methods: We conducted a cross-sectional study with medical staff members working in the Parent Institute who were between the ages of 25 and 40 years. The subjects were split into two equal groups: one group (the study group) had 100 staff working on shift duty, and the other group (the control group) had 100 staff on day duty. The investigation took eight months to complete. Using the mercury sphygmomanometer, the subjects' blood pressure was assessed. An unpaired t-test was used to compare different body composition measures.  Results: The study group had 36 female and 64 male staff members (N = 100) with an average age of 31.9  4.4 years, while the control group had 36 female and 64 male staff members (N = 100) with an average age of 33.0  4.6 years. According to the study, there was a significant difference (P value < 0.05) in heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate between the study group and the control group. Conclusion: Medical staff working on shift duty show increased heart rate, blood pressure, and respiratory rate as compared to staff working on day duty.

Background:  Lower extremity deep vein thrombosis (DVT) is a serious medical condition that can lead to life-threatening complications, including pulmonary embolism or long-term disability from post-thrombotic syndrome. Our study is to estimate risk factors, clinic-radiological evaluation, management, and outcome of lower extremity deep vein thrombosis. Material and Methods:  It is a retrospective observational study conducted at the ward and the outpatient department of SVIMS, SPMC (W), Tirupati. Patients diagnosed with lower extremity deep vein thrombosis and admitted to SVIMS during the period from April 2023 to July 2024. studied risk factors, clinic-radiological evaluation, management, and outcome of lower extremity deep vein thrombosis. Results: The mean age was 47.36 ± 16.39. 51.8% of the study population had DVT likely, and 48.2% had DVT not likely. 62.5% of the study population had PE likely, according to the Modified Wells score, while 37.5% had PE not likely, according to the Wells score. In this study, only 46.3% of the study population were on regular follow-up without any complications, followed by 33.9% of the study population who had irregular follow-up, and 3.6 % of the study population had died. Conclusion: The direct risk factors for deep vein thrombosis were previous surgeries, similar history, immobilization, and smoking. Patient needs to have regular follow-up to evaluate the recanalization. The patient needs to be highly motivated and educated about the importance of regular oral medication. Regular checkups of high-risk patients, early detection, and prompt treatment of the disease can reduce the chances of complications and enhance patient recovery.

Background: Stuttering affects approximately 80 million people worldwide, with adult prevalence estimated at 0.96% comprising both overt and covert manifestations. Limited treatment options with variable efficacy and accessibility challenges necessitate exploration of novel, culturally relevant interventions. Conch blowing (Shankhnaad), an ancient Indian respiratory practice, has demonstrated efficacy in improving respiratory function in sleep apnea and chronic obstructive pulmonary disease, suggesting potential applications in speech fluency disorders through enhanced breath control and respiratory muscle strengthening. Objective: To evaluate the efficacy and safety of conch blowing as an adjunct to standard speech therapy in adults with developmental stuttering. Methods: This randomized, assessor-blinded, parallel-group controlled trial enrolled 120 adults (aged 18-65 years) with developmental stuttering (Stuttering Severity Instrument-4 score ≥18). Participants were randomized 1:1 to receive either standard speech therapy plus daily conch blowing practice (15 minutes/day, 5 days/week) or standard speech therapy alone for 24 weeks. Primary outcome was change in SSI-4 total score at 24 weeks. Secondary outcomes included percent syllables stuttered, quality of life (Overall Assessment of the Speaker's Experience of Stuttering), anxiety (Beck Anxiety Inventory), self-efficacy, and respiratory function tests. Results: At 24 weeks, the intervention group (n=55) demonstrated significantly greater reduction in SSI-4 scores compared to controls (n=57): mean difference -6.4 points (95% CI: -8.1 to -4.7; p<0.001). Percent syllables stuttered decreased by 3.6% more in the intervention group (p<0.001). Anxiety scores improved with a between-group difference of -3.3 points (p<0.001), and quality of life scores showed a difference of -0.8 points (p<0.001). Respiratory function (FEV) increased by 0.3 L more in the intervention group (p=0.003). Adverse events were mild and primarily respiratory-related, with 20.0% experiencing any adverse event in the intervention group versus 8.3% in controls (p=0.086). Conclusions: Conch blowing as an adjunct to standard speech therapy produced clinically meaningful improvements in stuttering severity, speech fluency, anxiety, quality of life, and respiratory function with acceptable safety profiles. These findings support integration of this culturally informed, accessible practice into contemporary stuttering management protocols.

Coronary artery bypass grafting (CABG) remains a cornerstone in the management of advanced coronary artery disease. The choice between off-pump and on-pump techniques continues to generate debate. This study aims to compare the early outcomes of off-pump versus on-pump CABG in a tertiary care setting. A retrospective analysis was conducted on 108 patients who underwent isolated CABG between January 2023 and January 2024 at Vardhman Mahavir Medical College and Safdarjung Hospital in New Delhi, India. Patients were divided into two groups based on the surgical technique employed: Off-Pump CABG (OPCAB, n=54) and On-Pump CABG (ONCAB, n=54). Early postoperative outcomes including operative time, duration of mechanical ventilation, ICU and hospital stay, incidence of atrial fibrillation, renal dysfunction, need for re-exploration, in-hospital mortality and 30-day mortality were analyzed and compared. Baseline demographic and clinical characteristics were comparable between the two groups. The only statistically significant difference observed was in the requirement of postoperative inotropic support, which was lower in the OPCAB group (p<0.05). All other early outcome parameters, including duration of mechanical ventilation, ICU stay, incidence of postoperative atrial fibrillation, renal complications, need for re-exploration due to bleeding, and in-hospital mortality showed no significant differences between the groups. Both off-pump and on-pump CABG techniques offer comparable early postoperative outcomes in terms of safety and efficacy. However, the significantly lower inotrope requirement in the off-pump group suggests a potential hemodynamic advantage that may be beneficial in select patient populations.

Background: Chronic obstructive pulmonary disease (COPD) is often associated with cardiovascular comorbidities, such as pulmonary artery hypertension (PAH) and left ventricular dysfunction (LVD). This study aimed to evaluate the prevalence of PAH and LVD in COPD patients, assess the early signs of heart failure, and investigate their correlations with COPD severity.  Methods: A cross-sectional observational study was conducted on 135 COPD patients. Echocardiography was performed to assess PAH and LVD. COPD severity was determined using spirometry and GOLD staging. Early signs of heart failure, comorbidities, and other clinical characteristics were also evaluated. Results: The prevalence of PAH and LVD was 71.1% and 74.8%, respectively. Significant correlations were found between COPD severity and the severity of PAH (p=0.027) and LVD (p=0.048). PAH severity was significantly associated with LVD severity (p=0.003). Early signs of heart failure were present in 34.8% of patients and were significantly associated with COPD severity (p=0.042), PAH (p<0.001), and LVD (p<0.001). Patients with PAH experienced significantly more exacerbations (p=0.024) and hospitalizations (p=0.007) compared to those without PAH.   Conclusion: The high prevalence of PAH and LVD in COPD patients and their significant correlations with disease severity highlight the importance of routine echocardiographic screening and early intervention. A multidisciplinary approach is essential for the optimal management of COPD patients with cardiovascular comorbidities.

Background: Hypertension (HTN) and Type 2 Diabetes Mellitus (T2DM) are major independent risk factors for cardiovascular disease. Their frequent coexistence is thought to exert a synergistic, detrimental effect on vascular health, leading to accelerated atherosclerosis. However, direct comparative data on key subclinical vascular markers remains crucial for risk stratification. Methods: This was a cross-sectional, comparative study involving 200 age- and sex-matched participants, divided into two groups: Group 1 (HTN-only, n=100) and Group 2 (HTN+T2DM, n=100). Arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) using applanation tonometry. Endothelial dysfunction was evaluated via brachial artery flow-mediated dilation (FMD). Fasting blood samples were analyzed for lipid profile, glycated hemoglobin (HbA1c), and biomarkers including high-sensitivity C-reactive protein (hs-CRP) and nitric oxide metabolites (NOx). Independent t-tests and Chi-square tests were used for statistical analysis. Results: The HTN+T2DM group exhibited significantly greater arterial stiffness, as indicated by a higher mean cfPWV compared to the HTN-only group (11.4 ± 1.6 m/s vs. 9.7 ± 1.2 m/s, p < 0.001). Endothelial function was markedly impaired in the HTN+T2DM group, with a significantly lower FMD percentage (4.3 ± 1.2% vs. 6.8 ± 1.5%, p < 0.001). Patients with HTN+T2DM also had significantly higher levels of hs-CRP (3.1 ± 1.1 mg/L vs. 1.9 ± 0.8 mg/L, p < 0.001) and lower levels of NOx (28.5 ± 7.2 µmol/L vs. 41.2 ± 8.5 µmol/L, p < 0.001). While both groups had controlled blood pressure, the HTN+T2DM group had poorer glycemic control (mean HbA1c 7.8 ± 0.9% vs. 5.6 ± 0.4%, p < 0.001). Conclusion: The coexistence of T2DM in patients with hypertension is associated with a significantly greater degree of arterial stiffening and more severe endothelial dysfunction compared to hypertension alone. These findings underscore the synergistic adverse vascular impact of these two conditions and highlight the need for aggressive, multifaceted management strategies in patients with this dual diagnosis.

Background: Recurrent acute otitis media (RAOM) and chronic suppurative otitis media (CSOM) represent two distinct clinical entities on the spectrum of middle ear disease. While both are driven by infection, their differing pathophysiology—intermittent acute inflammation in RAOM versus persistent inflammation with a tympanic membrane perforation in CSOM—suggests they may harbor different microbial ecosystems, impacting treatment efficacy. Methods: We conducted a cross-sectional comparative study at a tertiary otolaryngology center. Middle ear samples were collected from two distinct patient groups: children with RAOM undergoing myringotomy with tympanostomy tube insertion (RAOM group) and patients with CSOM presenting with active otorrhea (CSOM group). Samples were processed for aerobic and fungal culture, pathogen identification, and antibiotic susceptibility testing according to standard microbiological protocols. Results: A total of 177 patients were included: 85 with RAOM and 92 with CSOM. A positive culture was obtained from 75/85 (88.2%) RAOM samples and 88/92 (95.7%) CSOM samples. The microbiological profiles differed significantly between the groups (p < 0.001). The RAOM group was predominantly infected with typical respiratory pathogens: Streptococcus pneumoniae (36.0%), non-typeable Haemophilus influenzae (29.3%), and Moraxella catarrhalis (14.7%). In contrast, the CSOM group was dominated by Pseudomonas aeruginosa (46.6%), Staphylococcus aureus (26.1%), and Proteus mirabilis (11.4%). Polymicrobial infections were more frequent in CSOM (38.6% vs. 17.3%, p = 0.003). Resistance rates were higher in CSOM isolates. Methicillin-resistant S. aureus (MRSA) comprised 30.4% of S. aureus isolates in the CSOM group versus 12.5% in the RAOM group (p = 0.041). Ciprofloxacin resistance in P. aeruginosa was observed in 22.0% of isolates. Conclusion: RAOM and CSOM are microbiologically distinct diseases. RAOM is characterized by common respiratory pathogens, whereas CSOM is dominated by opportunistic and frequently resistant bacteria. These findings highlight the need for separate empirical treatment strategies and underscore the importance of culture-directed therapy in managing CSOM.

Introduction: Acute febrile illnesses (AFIs) represent a significant diagnostic and management challenge, with variable clinical outcomes. Early identification of patients at risk of severe disease is crucial for timely intervention. Serum ferritin, an acute-phase reactant, and vitamin D, an immunomodulator, have been implicated in the pathophysiology of severe infections, but their combined utility in undifferentiated AFIs is not well established. Methods: We conducted a prospective observational study at a single tertiary care center, enrolling 150 adult patients admitted with an AFI (fever >38.0°C for <7 days). Patients were stratified into mild (n=65), moderate (n=50), and severe (n=35) disease categories based on a composite severity score including organ dysfunction and ICU admission criteria. Serum ferritin, 25(OH)D, and C-reactive protein (CRP) levels were measured within 24 hours of admission. Statistical analysis was performed using ANOVA and Pearson correlation. Results: Serum ferritin levels showed a significant, graded increase with disease severity: mild (155.3 ± 55.6 ng/mL), moderate (420.1 ± 145.8 ng/mL), and severe (912.5 ± 315.2 ng/mL) (p<0.001). Conversely, serum 25(OH)D levels were inversely associated with severity: mild (25.8 ± 8.1 ng/mL), moderate (18.2 ± 6.4 ng/mL), and severe (12.1 ± 5.3 ng/mL) (p<0.001). Severe vitamin D deficiency (<12 ng/mL) was present in 48.6% of severe cases compared to only 7.7% in the mild group (p<0.001). Ferritin demonstrated a strong positive correlation with CRP (r=0.78, p<0.001) and length of hospital stay (r=0.69, p<0.001). 25(OH)D showed a significant negative correlation with the same parameters (r=-0.61 and r=-0.55, respectively; p<0.001). Conclusion: Elevated serum ferritin and decreased serum 25(OH)D levels at admission are strongly and independently associated with increased disease severity in patients with AFIs. These readily available biomarkers may serve as valuable prognostic tools for early risk stratification, facilitating targeted monitoring and resource allocation in this heterogeneous patient population

Introduction: Implant-supported dental restorations have become an increasingly popular and viable solution for the replacement of missing teeth, offering both functional and aesthetic benefits. With advancements in implant technology, surgical techniques, and prosthetic designs, dental implants have demonstrated high survival rates and predictable long-term outcomes, making them a cornerstone in contemporary restorative dentistry. AIM: To compare the microbial changes in dental and peri-implant subgingival plaque during peri-implant mucositis therapy. Methodology: A double-blinded, randomized, placebo-controlled clinical trial was conducted at Department of dentistry, Govt. Medical college, Dungarpur, from feb 2023 to jan 2024, including 62 patients diagnosed with peri-implant mucositis. Result: Both dental and peri-implant sites showed improvement in clinical parameters, including plaque index,bleeding on probing, and probing pocket depth.Dental sites exhibited slightly greater reductions compared to peri-implant sites.Microbial diversity shifted toward health-associated bacteria, with increases in Streptococcus and Rothia and decreases in Fusobacterium, Prevotella, and Porphyromonas. Conclusion: Therapy led to significant clinical improvement and reduced pathogenic bacteria in both dental and peri-implant sites. Overall, the microbial profile shifted toward a healthier composition more in dental patients comparative to peri implant in, indicating effective treatment outcomes.

Introduction: Cesarean section (CS) is one of the most frequently performed surgical procedures in obstetric practice and serves as a critical intervention to reduce maternal and fetal morbidity and mortality. AIM: To compare maternal and fetal outcomes in antenatal women undergoing elective and emergency cesarean section. Methodology: This hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at S.P. Medical College and its Associate Group of Hospitals in Bikaner, Rajasthan, located in the north-western region of India. The study spanned a duration of six months, from September 2024 to February 2025. Result: Emergency cesarean sections were associated with higher rates of maternal and neonatal complications, including lower APGAR scores, more NICU admissions, and longer hospital stays. Elective cesareans showed better outcomes, largely due to prior planning and fewer intra- and postoperative complications. Conclusion: Emergency cesarean sections lead to significantly higher maternal and neonatal complications than elective procedures, highlighting the need for improved antenatal care and timely obstetric planning.

Introduction: Surgery is the primary treatment for oral cancer, aiming for complete tumor removal with adequate margins to prevent recurrence. Current intraoperative margin assessment using frozen sections is limited by sampling errors and low sensitivity. EGFR-targeted fluorescence molecular imaging offers real-time visualization of tumor tissue, potentially improving surgical precision and patient outcomes. AIM: To assess the feasibility and accuracy of EGFR-targeted fluorescence molecular imaging for real-time intraoperative margin evaluation in oral cancer surgery. Methodology: This prospective observational study included 105 patients diagnosed with primary oral cancer and scheduled for curative surgical resection and carried out in the department of  Dentistry, Govt. Medical college, Barmer.The total duration of the study was 1 yr. Result: Fluorescence molecular imaging accurately detected all tumor-positive margins (100%) and demonstrated moderate detection of close (73% accuracy) and negative margins (66.8%). The tongue was the most common tumor site, and most patients presented with T2 stage tumors and N0 lymph node status. Conclusion: Oral cancer predominantly affects middle-aged and elderly males, with the tongue being the most common site. Fluorescence molecular imaging effectively identifies tumor-positive and close margins, enhancing surgical precision and outcomes.

Introduction: Green tea, derived from the leaves of Camellia sinensis, is one of the most widely consumed beverages globally, appreciated not only for its refreshing taste but also for its multiple health-promoting properties. Rich in polyphenolic compounds, particularly catechins such as epigallocatechin-3-gallate (EGCG), green tea exhibits potent antioxidant, anti-inflammatory, and antimicrobial effects.  AIM: To evaluate the effectiveness of green tea mouthwash in improving oral health status among oral cancer patients. Methodology: This study was designed as a single-blind, randomized controlled trial to evaluate the effectiveness of green tea mouthwash in improving oral health among oral cancer patients, conducted at department of dentistry, Govt. Medical college, Dungarpur for 1 yr. The study received ethical approval, and informed consent was obtained from all participants. Result: The study results showed that oral mucositis, ulcers, gingival inflammation, halitosis, and xerostomia were highly prevalent before intervention. After six months, patients using green tea mouthwash demonstrated significant improvement with fewer oral side effects compared to the control group. These findings confirm the effectiveness of green tea mouthwash in enhancing oral health status among oral cancer patients. Conclusion: Green tea mouthwash significantly improved oral health status by reducing treatment-related complications such as mucositis, ulcers, and gingival inflammation in oral cancer patients. It can be considered a safe, effective, and natural adjunct to conventional oral care

Introduction: Preterm premature rupture of membranes (P-PROM) is clinically defined as the rupture of fetal membranes before the completion of the 37th gestational week, and it represents a significant concern in obstetrics due to its association with maternal morbidity, neonatal mortality, and preterm labor, especially in developing countries where access to advanced perinatal care may be limited. AIM: The relationships of inflammatory blood markers with maternal periodontal and dental states and their effects on preterm membrane rupture development. Methodology: This was a prospective case–control study carried out in the department of dentistry Govt. Medical College Barmer over a period 1year. A total of 90 pregnant women between 24 and 36 weeks of gestation were included in the study. Result: Women in the PROM group exhibited higher leukocyte count, NLR, PLR, and PCT, along with worse oral health indices including DMFT, plaque index, gingival index, and periodontal depth, compared to controls.Correlation analysis showed a positive association between inflammatory markers and oral disease severity, while platelet indices had weak or negative correlations. Conclusion: Women with PROM showed higher systemic inflammatory markers and poorer oral health compared to controls, with inflammation positively correlating with oral disease severity.Multiparity and earlier gestational age were also associated with increased PROM risk, highlighting the importance of oral hygiene and maternal health monitoring during pregnancy.

Background: Leptospirosis is an important zoonotic infection with varied clinical presentations ranging from mild flu-like illness to severe multiorgan involvement with high mortality and morbidity. Because of its vague signs, early identification is frequently challenging, and linkage with test markers is crucial. Aim: To assess the relationship between leptospirosis patients' seropositivity and clinical and laboratory markers. Materials and methods: Patients with a clinical suspicion of leptospirosis participated in a cross-sectional study and underwent ELISA testing for IgM antibodies. The results of ELISA were compared with clinical characteristics and laboratory tests, such as hematological, renal, and liver function indicators. Results: Among 619 suspected cases, 211 (34.08%) were seropositive. Anemia (Hb ≤10 g/dl) was noted in 14.69% cases, while leukocytosis (>11,000/mm³) occurred in 9.95%. Thrombocytopenia (<1.5 lakh/mm³) was observed in 26.06%. Renal involvement was common, with raised BUN (>20 mg/dl) in 20.37% and serum creatinine >1.5 mg/dl in 19.9%. Hyponatremia and hypokalemia were found in 11.84% and 29.85% respectively. Liver function tests showed Hyperbilirubinemia (>1.2 mg/dl) in 14.2%, elevated SGOT in 16.58%, and SGPT in 13.74% cases. Statistically significant correlations were observed between ELISA positivity and deranged renal (p=0.0001) as well as liver function parameters (p=0.0001). Conclusion: Leptospirosis manifests as a variety of test abnormalities and clinical manifestations. The relevance of combining clinical and laboratory evaluation for early identification and improved patient treatment is shown by the significant link found between ELISA positive and both renal and hepatic impairment.

Background: Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the most prevalent neurodegenerative disorders worldwide. Recent studies suggest that oxidative stress and metal dysregulation play pivotal roles in their pathophysiology. This study investigates the potential of oxidative stress markers (malondialdehyde (MDA), glutathione (GSH)) and trace metals (iron, copper, manganese) as biomarkers for early diagnosis and disease monitoring in AD and PD. Objective: To assess the relationship between oxidative stress markers and trace metal concentrations in AD and PD patients and explore their potential as biomarkers for disease diagnosis and prognosis. Methods: A case-control study was conducted at Index Medical College, Hospital, and Research Center, Indore, involving 64 AD patients, 64 PD patients, and 64 age-matched healthy controls. Blood samples were analyzed for oxidative stress markers (MDA, GSH) and trace metals (iron, copper, manganese, zinc). Clinical assessments were performed using MMSE for AD and UPDRS for PD. Statistical analyses (ANOVA, correlation) were used to evaluate the data. Results: MDA levels were significantly elevated, and GSH levels were significantly reduced in both AD and PD patients compared to controls. Trace metal dysregulation was observed, with elevated iron and copper in both diseases and increased manganese in PD. A significant negative correlation was found between MDA levels and MMSE scores in AD, and a positive correlation between manganese levels and UPDRS scores in PD.  Conclusions: Oxidative stress markers and trace metals are potential biomarkers for early diagnosis and monitoring disease progression in AD and PD. These biomarkers can provide valuable insights into the pathophysiology of these disorders and may facilitate non-invasive, accessible diagnostics. Further research is needed to validate these findings in larger cohorts

Background: Alzheimer’s disease (AD) and Parkinson’s disease (PD) are neurodegenerative disorders marked by oxidative stress and metal dysregulation, which contribute significantly to neuronal damage. This study investigates the role of antioxidant and chelation therapies in modulating oxidative stress and metal imbalance in AD and PD. Objective: The primary aim of this study is to evaluate the efficacy of antioxidant and chelation therapies in reducing oxidative stress markers and trace metal imbalance in AD and PD patients. Additionally, the study explores the potential of these markers as biomarkers for disease progression and therapeutic monitoring. Methods: This observational case-control study included 64 AD patients, 64 PD patients, and 64 healthy controls. Blood samples were collected from participants to assess oxidative stress markers (malondialdehyde [MDA] and glutathione [GSH]) and trace metals (iron, copper, manganese, and zinc). Data on clinical severity was obtained through the Mini-Mental State Examination (MMSE) for AD patients and Unified Parkinson’s Disease Rating Scale (UPDRS) for PD patients. The effects of antioxidant (Donepezil for AD, Levodopa for PD) and chelation therapies were also evaluated. Results: The study found significantly elevated MDA levels and reduced GSH levels in both AD and PD patients, indicating increased oxidative stress. Trace metal analysis revealed elevated iron, copper, and manganese levels in AD and PD patients compared to controls. Significant positive correlations were observed between oxidative stress markers and metal concentrations. Antioxidant and chelation therapies showed preliminary improvements in oxidative stress markers and clinical symptoms, especially in PD patients. Conclusion: Oxidative stress and metal imbalance play a critical role in the pathophysiology of AD and PD. Antioxidant and chelation therapies show promise in modulating these pathophysiological mechanisms, highlighting their potential as therapeutic strategies. Further research with larger sample sizes and longer follow-up is needed to validate these findings and optimize treatment protocols.

Background: Background: Myocardial ischemia continues to be one of the foremost causes of morbidity and mortality worldwide, posing an immense burden on healthcare systems, particularly in developing countries. In addition to conventional cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia, newer determinants including sedentary behavior, psychosocial stress, excessive digital exposure, and substance or supplement misuse have emerged as significant contributors. Objectives: This study aims to evaluate both traditional and evolving risk factors of myocardial ischemia and their psychosocial implications among patients presenting to a tertiary care center. Methods: A prospective, single-centre observational study was conducted in the Emergency Medicine Department of KLE’s Dr. Prabhakar Kore Hospital, Belagavi, from October 2023 to March 2024. Adult patients presenting with symptoms and electrocardiographic changes suggestive of myocardial ischemia were enrolled. Data were collected on demographic details, comorbidities, dietary and lifestyle patterns, occupational factors, screen exposure, supplement use, and psychological stress levels. The social and family impact following ischemic events was also assessed. Results: Out of 7,714 patients screened, 7,564 were included in the analysis. The male-to-female ratio was 0.98:1, with a mean age of 52.4 years. Sedentary lifestyle (32%), prolonged screen time (>5 hours/day, 72%), hypertension (61%), diabetes (54%), and psychosocial stress (68%) were identified as major risk factors. Post-event evaluation revealed that 61% of patients experienced impaired family or social interactions. The overall mortality rate was 1.9%. Conclusion: The study highlights the growing influence of behavioral and psychosocial factors alongside conventional risks in the pathogenesis of myocardial ischemia. Early preventive strategies emphasizing lifestyle modification, stress management, and digital discipline, coupled with family-centered rehabilitation, are essential to reduce the clinical and social burden of ischemic heart disease

Background: Acute dyspnea is a prevalent and challenging symptom in emergency settings, often stemming from either cardiac or pulmonary etiologies.Differentiating between these causes is crucial for appropriate management.Lung ultrasound (LUS), particularly the identification of B-lines, has emerged as a valuable tool in this diagnostic process. The differential diagnosis is broad, encompassing both cardiac and pulmonary etiologies.Timely and accurate differentiation is crucial, as it directly influences management strategies and patient outcomes.

Aims And Objectives:

1.To evaluate the diagnostic accuracy of B-lines in lung ultrasound for distinguishing between cardiac and pulmonary causes of acute dyspnea.

2.To assess the prognostic significance of B-line patterns in predicting patient outcomes, including mortality and readmission rates.

3.To compare the effectiveness of lung ultrasound in detecting B-lines with traditional imaging modalities like chest X-ray and computed tomography in the context of acute dyspnea.

4.To investigate the impact of B-line quantification on clinical decision-making and management strategies in emergency department settings.

5.To explore the feasibility and reliability of implementing B-line assessment in prehospital and point-of-care settings for rapid diagnosis.

Methods In this prospective observational study conducted in the Emergency Department on 20 adult patients between may and June 2025, we aimed to evaluate the diagnostic utility of B-line lung ultrasound (LUS) in differentiating cardiac from pulmonary causes of acute dyspnea.Adult patients presenting with acute dyspnea were assessed using a standardized 8-zone LUS protocol, focusing on identifying B-lines—vertical, hyperechoic artifacts originating from the pleural line. Diagnostic performance metrics, including sensitivity, specificity, and interobserver reliability, were calculated to assess the accuracy of B-line LUS in distinguishing between cardiac and pulmonary etiologies of acute dyspnea. Results: The cohort comprised 20 adults (mean age 68.5 ± 12.3 years; 55% male) presenting with acute dyspnea. Lung Ultrasound Findings:  B-profile (B-lines with lung sliding): Observed in 12 patients (60%), indicative of cardiogenic pulmonary edema. B'-profile (B-lines without lung sliding): Detected in 8 patients (40%), suggesting non-cardiogenic causes such as pneumonia or ARDS. Final Diagnoses:Cardiac Etiology: 12 patients (60%) diagnosed with acute decompensated heart failure. Pulmonary Etiology: 8 patients (40%) diagnosed with conditions like pneumonia or ARDS. Diagnostic Performance: Sensitivity: 90% ,Specificity: 85% ,Positive Predictive Value (PPV): 92% ,Negative Predictive Value (NPV): 80% . Conclusion: B-line lung ultrasound (LUS) is a rapid, non-invasive, and highly effective diagnostic tool for differentiating between cardiac and pulmonary causes of acute dyspnea in the emergency department.The presence of B-lines, particularly when observed with lung sliding (B-profile), is strongly indicative of cardiogenic pulmonary edema, whereas B-lines without lung sliding (B'-profile) suggest non-cardiogenic causes such as acute respiratory distress syndrome (ARDS) or pneumonia.LUS offers advantages over traditional imaging methods, including higher sensitivity and specificity, absence of ionizing radiation, and the ability to perform bedside assessments, facilitating timely and appropriate therapeutic interventions.Integrating B-line LUS into clinical practice can enhance diagnostic accuracy, optimize patient care, and improve outcomes for patients presenting with acute dyspnea.

Background: Aortic pseudoaneurysms are rare but life-threatening vascular complications that can develop after cardiac surgery. While most postoperative pseudoaneurysms involve a single location, occurrence at multiple aortic segments is exceptional. Case Presentation: We report a 56-year-old male who developed multiple pseudoaneurysms in both the thoracic and abdominal aorta within one month of undergoing cardiac surgery. The patient presented with progressive chest pain and breathlessness.  CT aortogram demonstrated two anterior thoracic pseudoaneurysms (T7: 14 × 12 mm; T9: 26 × 24 mm) and a large abdominal pseudoaneurysm near the left renal artery (45 × 30 mm) containing mural thrombus. Associated findings included moderate cardiomegaly and significant right atrial enlargement. Lower limb arteries were normal. Results: Given the high rupture risk, the patient was evaluated in a multidisciplinary heart team meeting to plan definitive repair. The etiological differential included chronic atherosclerosis, iatrogenic injury, and mycotic aneurysm. Conclusion: This case illustrates the importance of early postoperative surveillance in high-risk cardiac surgery patients, the role of high-resolution CT imaging in diagnosis, and the necessity of multidisciplinary decision-making for complex pseudoaneurysm presentations.

Background: High-sensitivity cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are established biomarkers in cardiology. While hs-cTn is crucial for diagnosing myocardial necrosis, and NT-proBNP reflects hemodynamic stress, their combined utility for risk stratification in a broad acute coronary syndrome (ACS) population is not fully defined. Methods: We conducted a prospective, single-center cohort study enrolling consecutive patients admitted with a diagnosis of ACS (ST-elevation myocardial infarction [STEMI] or non-ST-elevation ACS [NSTE-ACS]). Admission blood samples were analyzed for hs-cTnT and NT-proBNP. Patients were categorized into four groups based on established cut-off values: Group 1 (normal hs-cTnT/normal NT-proBNP), Group 2 (elevated hs-cTnT/normal NT-proBNP), Group 3 (normal hs-cTnT/elevated NT-proBNP), and Group 4 (elevated hs-cTnT/elevated NT-proBNP). The primary endpoint was a composite of MACE, including all-cause mortality, non-fatal myocardial infarction, and urgent revascularization within 6 months. Results: A total of 482 patients were included in the final analysis (mean age 64.2 ± 11.8 years; 68.9% male). The incidence of MACE at 6 months was significantly different across the four groups. MACE occurred in 3.5% of patients in Group 1 (n=114), 12.8% in Group 2 (n=172), 15.2% in Group 3 (n=66), and 34.6% in Group 4 (n=130) (p < 0.001 for overall comparison). Patients with dual biomarker elevation (Group 4) had a significantly higher risk of MACE compared to all other groups. In a multivariate Cox proportional hazards model adjusted for traditional risk factors, dual elevation of hs-cTnT and NT-proBNP remained the strongest independent predictor of MACE (Hazard Ratio: 4.12, 95% Confidence Interval: 2.55–6.65, p < 0.001). Conclusion: The combined assessment of hs-cTn and NT-proBNP on admission provides powerful synergistic prognostic information in patients with ACS. This dual biomarker strategy effectively identifies a very high-risk subgroup of patients who may benefit from more intensive monitoring and therapeutic interventions.