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