Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by persistent synovial inflammation and progressive joint destruction. This study aims to explore the intricate pathological mechanisms of RA and evaluate the impact of contemporary pharmacologic treatments. A comprehensive literature review and meta-analysis were conducted, synthesizing data from clinical trials, cohort studies, and systematic reviews. Key pathological mechanisms identified include the roles of pro-inflammatory cytokines (TNF-α and IL-6), autoantibodies (RF and ACPA), and dysregulated immune cells (T cells and B cells). The study highlights the efficacy of biologic DMARDs (TNF inhibitors, IL-6 receptor antagonists, B-cell depleting agents) and targeted synthetic DMARDs (JAK inhibitors) in reducing disease activity and improving functional outcomes. Despite their efficacy, these treatments are associated with adverse events, primarily infections, necessitating careful patient monitoring. The findings underscore the importance of early and aggressive intervention, the potential of combination therapies, and the need for personalized treatment approaches. Future research should focus on long-term safety and developing biomarkers for tailored therapies to enhance patient outcomes and quality of life

Background: Mitral valve disease remains a significant global health burden requiring surgical intervention. Minimally invasive mitral valve surgery (MIMVS) has emerged as an alternative to conventional open approaches, aiming to reduce surgical trauma and improve recovery. However, questions remain regarding optimal myocardial protection in MIMVS given the typically longer ischemic times. Custodiol® cardioplegia (histidine-tryptophan-ketoglutarate solution) is widely used for myocardial protection, this study evaluates its effectiveness in both conventional and minimally invasive techniques. Methods: A retrospective analysis was carried out included 527 adult patients who underwent mitral valve repair or replacement at Heidelberg University Hospital between 2014 and 2019. Patients were stratified into conventional (median sternotomy) and minimally invasive (right minithoracotomy) surgical groups. All procedures employed Custodiol® for cardioplegic myocardial protection. The primary endpoint was myocardial injury as measured by peak creatine kinase-MB (CK-MB) levels. Secondary endpoints included operative metrics (aortic cross-clamp and cardiopulmonary bypass times), intensive care unit (ICU) and total hospital length of stay, incidence of postoperative arrhythmias, bleeding and transfusion requirements, and perioperative mortality. Results: Minimally invasive procedures had significantly longer aortic cross-clamp and cardiopulmonary bypass times, necessitating larger volumes of Custodiol® solution. Despite these extended durations, the minimally invasive group achieved clinical outcomes comparable or superior to the conventional group. Peak CK-MB levels were higher in patients undergoing minimally invasive mitral valve replacement compared to other subgroups, but this elevation did not translate into worse clinical outcomes. Patients who underwent valve repair (as opposed to valve replacement) experienced faster recovery, evidenced by shorter ICU and hospital stays. Notably, there were no operative or in-hospital mortalities in the minimally invasive groups. Conclusion: Minimally invasive mitral valve surgery with Custodiol® myocardial protection is a safe and effective approach. Despite longer perfusion and cross-clamp times inherent to less invasive techniques, patient outcomes (including myocardial preservation and postoperative recovery) were equivalent to those of conventional surgery. The minimally invasive approach additionally offers benefits such as quicker rehabilitation and improved cosmetic results, without compromising patient safety or surgical efficacy.

Protein C plays a key role in the regulation of hemostasis, and its deficiency is associated with an increased risk of thromboembolism. Protein C-deficient women are at particular risk of developing thromboembolic complications during antenatal period and delivery. The incidence of thromboembolic events is estimated to be 1000 times higher than in normal women. We report the case of a 28-year-old woman with cortical vein thrombosis, who experienced a successful pregnancy and delivery despite protein C deficiency. She was anticoagulated with heparin during the second part of her pregnancy. Our observation suggests that ambulatory full-dose subcutaneous LMWH therapy during pregnancy constitutes adequate prevention. However, definite guidelines are still under making

Introduction: Postpartum anaemia is a common cause of maternal morbidity in developing countries and is traditionally managed with oral iron therapy. However, poor compliance and delayed haematological response limit its effectiveness, prompting the need to evaluate alternative treatment options such as intravenous iron.

Aims & Objectives: To compare the safety and efficacy of intravenous ferric carboxymaltose with oral ferrous sulphate in the treatment of postpartum anaemia, using improvement in haemoglobin and serum ferritin levels as outcome measures. Materials & Methods: This prospective, observational, comparative study was conducted at a tertiary care centre in Kolkata from July 2023 to December 2024. A total of 126 postpartum women aged ≥18 years with haemoglobin levels between 7–9 g/dL were enrolled and divided into two groups. Group A received intravenous ferric carboxymaltose (dose calculated by the Ganzoni formula), while Group B received oral ferrous sulphate 200 mg twice daily for six weeks. Haemoglobin and serum ferritin levels were assessed at baseline, 2 weeks, and 6 weeks. Adverse effects, compliance, and clinical improvement were also evaluated. Results & Analysis: Baseline characteristics were comparable between groups. Intravenous ferric carboxymaltose resulted in a significantly greater rise in haemoglobin and serum ferritin levels at both 2 and 6 weeks compared to oral iron (p < 0.0001). Patients receiving intravenous iron achieved target haemoglobin levels faster, with fewer adverse effects and better tolerability. Gastrointestinal side effects were significantly more common in the oral iron group. Conclusion: Intravenous ferric carboxymaltose is a safe, effective, and faster alternative to oral ferrous sulphate for the treatment of postpartum anaemia, offering superior haematological recovery with better compliance.

Background: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is essential following percutaneous coronary intervention (PCI) to reduce ischemic complications. Clopidogrel has been widely used for decades; however, variable platelet inhibition and clopidogrel resistance have led to the development of more potent agents such as prasugrel. Real-world comparative data between prasugrel and clopidogrel following PCI remain limited, particularly in the Indian population. Objectives: To compare the clinical outcomes, efficacy, and safety of prasugrel versus clopidogrel in patients undergoing PCI with drug-eluting stent implantation. Methods: This prospective, single-center observational study enrolled patients with acute coronary syndrome (ACS) undergoing PCI. Patients received aspirin plus either prasugrel or clopidogrel according to physician discretion. Clinical follow-up was conducted for one year. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, myocardial infarction, and stroke. Secondary outcomes included stent thrombosis, repeat revascularization, and bleeding events classified by the Bleeding Academic Research Consortium (BARC). Results: Baseline demographic and clinical characteristics were comparable. At one-year follow-up, the incidence of MACE was lower in the prasugrel group compared with clopidogrel, primarily driven by a reduction in myocardial infarction and stent thrombosis. Overall bleeding rates were comparable between groups, with no significant increase in major bleeding in the prasugrel group. Conclusion: Prasugrel demonstrated superior efficacy compared with clopidogrel in reducing ischemic events after PCI, without a significant increase in major bleeding. Prasugrel represents an effective alternative to clopidogrel for DAPT in appropriately selected patients undergoing PCI.

Background: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the cornerstone of management in patients undergoing percutaneous coronary intervention (PCI). Prasugrel and ticagrelor are potent P2Y12 inhibitors recommended over clopidogrel in acute coronary syndrome (ACS), yet real-world comparative data between these two agents remain limited. Objectives: To compare the clinical outcomes, safety, and efficacy of prasugrel versus ticagrelor in patients undergoing PCI with drug-eluting stents. Methods: This prospective, single-center observational study enrolled ACS patients undergoing PCI between July 2016 and December 2016. Patients received aspirin plus either prasugrel or ticagrelor based on physician discretion. Patients were followed for one year. Primary outcomes included major adverse cardiovascular events (MACE: composite of death, myocardial infarction, and stroke). Secondary outcomes included bleeding events (BARC classification), stent thrombosis, repeat revascularization, and mortality. Results: Among 392 patients (prasugrel n=120; ticagrelor n=272), baseline demographics, cardiovascular risk factors, and clinical presentation were comparable. At one-year follow-up, MACE occurred in 15.8% of prasugrel and 12.5% of ticagrelor patients (p=0.432). Rates of myocardial infarction, stent thrombosis, stroke, repeat revascularization, and mortality did not differ significantly. BARC ≥2 bleeding occurred only in the ticagrelor group (1.1%), though not statistically significant. Breathlessness (NYHA II–III) was significantly more frequent in the ticagrelor group (18% vs 8.3%, p=0.013). Conclusion: In real-world clinical practice, prasugrel and ticagrelor demonstrated comparable efficacy and safety after PCI. Ticagrelor was associated with a higher incidence of dyspnea, while major bleeding and ischemic outcomes were similar between groups. Both agents remain effective options for DAPT following PCI.

Background: Obesity is a well-recognized risk factor for the development of elevated blood pressure and related cardiovascular complications. The increasing prevalence of obesity in adults necessitates periodic evaluation of its association with blood pressure patterns to facilitate early identification and preventive interventions.

Material and methods: A cross-sectional observational study was conducted among 110 obese adults aged 18–60 years attending a tertiary care hospital. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m². Demographic data and anthropometric measurements were recorded using standardized techniques. Blood pressure was measured using a mercury sphygmomanometer following recommended guidelines, and the average of two readings was considered. Blood pressure was classified into normotensive, prehypertensive, and hypertensive categories. Data were analyzed using appropriate statistical methods, with a p value < 0.05 considered statistically significant. Results: The mean age of participants was 41.8 ± 10.6 years, with males comprising 56.4% of the study population. The mean BMI was 31.8 ± 2.4 kg/m². The overall mean systolic and diastolic blood pressure values were 134.6 ± 15.2 mmHg and 86.9 ± 9.8 mmHg, respectively. Based on blood pressure classification, 34.5% of participants were normotensive, 37.3% were prehypertensive, and 28.2% were hypertensive. Mean systolic blood pressure was significantly higher in males compared to females (p = 0.041), while the difference in diastolic blood pressure was not statistically significant. A significant association was observed between higher BMI categories and increased prevalence of hypertension (p = 0.018). Conclusion: A substantial proportion of obese individuals exhibited elevated blood pressure, with increasing BMI associated with a higher prevalence of hypertension. These findings highlight the need for routine blood pressure monitoring and early lifestyle interventions in obese populations.

Sudden cardiac death (SCD) following myocardial infarction (MI) remains one of the most critical complications contributing to global cardiovascular mortality. Despite major advancements in acute coronary syndrome management and secondary prevention strategies, individuals with prior MI continue to face substantially elevated risks of lethal ventricular arrhythmias and cardiac arrest. The pathophysiology involves electrical instability due to myocardial scarring, autonomic dysfunction, inflammation, adverse remodeling, and residual ischemia. This systematic review synthesizes current evidence on the incidence, mechanisms, predictors, risk-stratification methods, and preventive strategies of SCD after MI. A comprehensive search of major databases was conducted following PRISMA guidelines, and 72 studies were included. Findings indicate that the highest risk occurs within the first 30 days after MI, driven primarily by ventricular tachyarrhythmias. Long-term risk remains elevated in patients with reduced ejection fraction, extensive infarct size, autonomic imbalance, and persistent ischemia. Preventive measures such as guideline-directed pharmacotherapy, implantable cardioverter-defibrillators (ICDs), revascularization, and risk-score–based monitoring significantly reduce mortality. The review underscores the importance of early identification of high-risk patients and emphasizes integrated management approaches

Introduction- In case of general anesthesia, airway maintenance along with least complications is the most important goal of team of anesthesiologists. In clinical practice, laryngeal mask airway (LMA) devices demonstrate superiority in the management of supraglottic airways. The i-gel airway has recently been introduced as supraglottic airway apparatus. Hence the present study was done to compare between I -gel and fastrach LMA regarding intra operative management pros and cons and post op sore throat. Material and methods- This prospective randomised comparative study involved 50 adult patients (ASA I–II) undergoing elective surgeries under general anaesthesia. Patients were randomly divided into two groups: Group I (I-gel, n = 25) and Group F (LMA Fastrach, n = 25). The parameters evaluated encompassed insertion characteristics, intra-operative airway functionality, and post-operative airway complications. A standardised grading scale was used to rate sore throats after surgery at 1, 6, and 24 hours. We used SPSS version 25.0 to do the statistical analysis, and p < 0.05 was considered significant. Results- The two groups' baseline characteristics and demographic data were similar. Age, gender distribution, body mass index, ASA physical status, and length of operation did not differ statistically significantly (p > 0.05), suggesting proper group matching. In comparison to the Fastrach LMA group, the I-gel group showed a considerably greater first-attempt success rate (92%) and a shorter mean insertion time (14.2 ± 3.1) (p < 0.05). I-gel produced a considerably higher airway sealing pressure and a reduced incidence of air leak (24.6 ± 3.2 cm H₂O) (p < 0.05). The Fastrach group also required airway adjustment more frequently. At every time point measured, the I-gel group's incidence of post-operative sore throat was consistently lower. At one and six hours after surgery, the difference was statistically significant (p < 0.05). Conclusion- Compared to LMA Fastrach, I-gel works better during surgery and causes less airway problems after surgery. It is the best supraglottic airway device for routine elective surgeries because it is easy to insert, makes a good airway seal, and causes fewer sore throats after surgery. LMA Fastrach is still useful when intubation through a SAD is needed.

Aims and Objectives: The aim of this study is to evaluate the beneficial effects of oral clonidine in attenuating the haemodynamic responses associated with laryngoscopy and intubation and comparing its effect with a placebo (oral ranitidine) in patients already on antihypertensive drug treatment undergoing for general anaesthesia with respect to anxiolysis, sedation, anaesthetic requirements, heart rate, blood pressure, attenuation of sympathetic responses to laryngoscopy and intubation and undesirable effects. Methods: 100 ASA I and II status receiving antihypertensive treatment posted for a variety of elective surgical procedures were selected randomly and divided into two groups of 50 each. Group I received 150µg oral clonidine and Group II oral ranitidine 150mg 90 minutes before induction of anaesthesia. Anxiolysis, sedation, antisialogogue effect, heart rate, systolic and diastolic pressure were recorded during premedication and 90 minutes after premedication. Also the HR, systolic, diastolic blood pressures were recorded noninvasively during induction,1,3,5,10,15,30 minutes from the onset of laryngoscopy. Results: After premedication (90 minutes later) with oral clonidine 150µg heart rate, diastolic blood pressure, were equally comparable to oral ranitidine(placebo), however systolic blood pressure decreased in the clonidine group. After intubation, the incidence of tachycardia was significantly greater in the placebo group than in clonidine group (p <0.001). Rise in SBP and DBP were also statistically significant in placebo group than in clonidine group (p<0.001). Conclusion: Clonidine provides a better anxiolysis, sedative and antisialogogue effect  when compared with placebo group. Oral clonidine 150µg  provides a consistent, reliable and effective attenuation of pressor response as compared to a placebo (ranitidine150 mg).

Background: Rib fractures are among the most common injuries following blunt chest trauma and are associated with significant morbidity. Conventional chest radiography is routinely used for diagnosis; however, it often fails to detect non displaced and costochondral fractures. Ultrasonography (USG) has emerged as a potential alternative imaging modality due to its ability to visualize both osseous and cartilaginous components of the ribs, the absence of radiation, and bedside applicability. This study aimed to compare the diagnostic sensitivity of ultrasonography with radiography in detecting rib fractures. Methods: This hospital-based prospective observational study was conducted at Meenakshi Medical College Hospital and Research Institute, Kanchipuram, over a period of 18 months. Fifty patients with suspected rib fractures following blunt chest trauma were included using convenience sampling. All participants underwent both ultrasonography using a 7.5 MHz linear transducer and chest radiography (PA and oblique views). Rib fractures were identified based on cortical discontinuity, acoustic shadowing, or associated hematoma on USG and fracture lines on radiographs. Statistical analysis was performed using SPSS version 22. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and McNemar’s test was applied for paired comparisons. Results:     Out of 50 patients, rib fractures were confirmed in 34 patients involving 44 ribs. Ultrasonography detected fractures in 33 patients (96.07% sensitivity), whereas radiography identified fractures in 27 patients (79.4% sensitivity). On a per-rib basis, USG demonstrated a sensitivity of 95.4% compared to 77.2% for radiography. Both modalities showed 100% specificity. Ultrasonography required significantly less time (mean 13.7 minutes) compared to radiography (mean 25.8 minutes; p < 0.001). USG missed two posterior rib fractures obscured by the scapula. Conclusion: Ultrasonography is more sensitive and time-efficient than conventional radiography for the detection of rib fractures following blunt chest trauma. It serves as a valuable diagnostic tool in emergency settings, although limitations exist in visualizing posterior and scapula-covered ribs.

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 & Methods: The aim of the study is to study CT-Based Evaluation of Diameters of the Thoracic Aorta at different level in the North Indian Population: Correlation with Age and Gender. A total of 84 subjects (both male and female) were enrolled after they met inclusion criteria. Well informed consent according to a protocol acknowledged by the medical college committee of medical research ethics was obtained from all the subjects before enlistment into the study. All the subjects had no cardiovascular abnormality at the time of the study. Results: The mean diameters of thoracic aorta (at aortic valve, ascending aorta, proximal to brachiocephalic trunk, proximal transverse arch, distal transverse arch, distal to left subclavian artery and aorta at diaphragm) of 21-40 yrs, 41-60 yrs and ≥61 yrs aged subjects were significantly (p<0.001) different and higher as compared to ≤ 20 yrs aged subjects. Further, the mean diameters of ascending aorta, proximal to brachiocephalic trunk, proximal TA, distal transverse arch and distal to LSA of both 41-60 yrs and ≥61 yrs aged subjects were also found to be significantly (p<0.05 or p<0.01) different and higher as compared to 21-40 yrs aged subjects. However, the mean diameters of all thoracic aorta not differed (p>0.05) between 41-60 yrs and ≥61 yrs aged subjects i.e. found to be statistically the same. Conclusion: Among, branches of arch aorta, the mean diameter of brachiocephalic trunk was the highest and left common carotid artery the least (BCT > LSA > LCCA). The mean diameter of thoracic aorta at aortic valve, ascending aorta, proximal to brachiocephalic trunk, proximal transverse arch, distal transverse arch, distal to left subclavian artery and aorta at diaphragm was found to be in descending order, decrease from proximal to distal i.e. highest at aortic valve and least at aorta at diaphragm. There is significantly high correlation between brachiocephalic trunk and left common carotid artery (r=0.62, p<0.001), brachiocephalic trunk and left subcavian atrtery (r=0.59, p<0.001) and left common carotid artery and left subclavian artery (r=0.59, p<0.001)

Background: Acute kidney injury (AKI) is a frequent & serious complication in hospitalized patients, associated with increased morbidity & mortality. Inflammation plays a crucial role in the pathophysiology of AKI. C-reactive protein (CRP), a widely available inflammatory biomarker, may reflect disease severity & prognosis in AKI. This study is an observation study who visited lnct medical college and seva kunj hospital from Khajrana Area for their regular checkup. Objectives: To evaluate the relationship between CRP levels & AKI severity, need for renal replacement therapy (RRT), length of hospital stay, renal recovery, & in-hospital mortality among patients with AKI. Methods: This prospective observational study included 100 adult patients diagnosed with AKI based on KDIGO criteria. Serum CRP levels were measured at AKI diagnosis & followed serially. Patients were classified according to AKI stage. Outcomes were analyzed in relation to CRP levels. Results: Higher CRP levels were significantly associated with advanced AKI stage, increased need for RRT, prolonged hospital stay, reduced renal recovery, & higher mortality. CRP at presentation was an independent predictor of adverse outcomes. Conclusion: CRP is a useful, inexpensive biomarker associated with AKI severity & prognosis. Its routine use may aid early risk stratification & clinical decision-making in AKI patients.

Background: Cutaneous Lupus Erythematosus (CLE) represents a heterogeneous group of autoimmune dermatological conditions that may occur independently or in association with systemic lupus erythematosus (SLE). Understanding clinical patterns and systemic associations is crucial for early diagnosis and comprehensive management. Objectives: To analyze the clinical spectrum of CLE, evaluate systemic involvement, immunological profiles, and assess multidisciplinary management approaches in a cohort of 100 patients. Methods: A retrospective observational study was conducted on 100 patients diagnosed with CLE over a five-year period. Clinical subtypes, demographic details, laboratory findings, systemic associations, and treatment modalities were analyzed. Results: Discoid lupus erythematosus (DLE) was the most common subtype (52%). Systemic involvement was observed in 34% of patients, with musculoskeletal and renal systems most frequently affected. Antinuclear antibody (ANA) positivity was seen in 68%. Multidisciplinary management involving dermatology, rheumatology, and nephrology was required in 41% of cases. Conclusion: CLE demonstrates varied clinical and systemic manifestations. Early recognition of systemic involvement and coordinated multidisciplinary care significantly improve patient outcomes

The aim of the study is to study Variations in the Tendons Forming Boundaries of the Anatomical Snuff Box with Clinical Implications. The tendon of the Extensor Pollicis Longus (EPL), located in the third extensor compartment, was having a single slip in 21 (38.2%) limbs and double slips in 34 (61.8%) limbs. These tendons were inserted into the capsule of the proximal interphalangeal joint before joining the extensor expansion. Awareness of variations in number and site of attachment is crucial for orthopedic surgeons when evaluating and managing conditions such as De Quervain’s tenosynovitis, first carpometacarpal arthritis, and trapeziometacarpal subluxation. Such anatomical insights can directly influence diagnostic accuracy and treatment outcomes

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.