Background: Chronic periodontitis is a persistent inflammatory disease that contributes to systemic inflammation through continuous release of bacterial products and pro-inflammatory mediators. Phase I periodontal therapy remains the cornerstone of treatment. Aim: To evaluate transient systemic inflammatory and hematological changes following Phase I periodontal therapy in patients with chronic generalized periodontitis. Materials and Methods: This prospective observational study included 40 systemically healthy patients aged 25–64 years. Clinical periodontal parameters were recorded at baseline and 30 days post-therapy. Serum C-reactive protein (CRP) levels and complete blood counts were assessed at baseline and on Days 1, 7, and 30 following ultrasonic scaling and root planing. Results: Serum CRP levels showed a significant transient rise on Day 1, followed by a progressive decline to below baseline values by Day 30. Short-term leukocytosis with neutrophilia and relative lymphopenia was observed and normalized during follow-up. Clinical periodontal parameters improved significantly at 30 days. Conclusion: Phase I periodontal therapy induces a transient systemic inflammatory response followed by resolution and an overall reduction in systemic inflammatory burden.

Background:Screening for undiagnosed diabetes is vital to reduce disease burden and prevent complications. Conventional diagnostic tests such as fasting plasma glucose (FPG) and the oral glucose tolerance test (OGTT) are limited by fasting requirements and poor reproducibility. Glycated haemoglobin (HbA1c) has emerged as a non-fasting, stable biomarker reflecting long-term glycemia. However, its optimal diagnostic threshold for Indian populations requires validation due to ethnic and metabolic variability. Objective: To assess the diagnostic accuracy of HbA1c in identifying undiagnosed diabetes and to determine the optimal cut-off value for screening high-risk Indian adults. Materials and Methods: A cross-sectional study was conducted on 203 adults aged ≥30 years at Tata Main Hospital, Jamshedpur. All participants underwent FPG, 2-hour OGTT, and HbA1c estimation. Diabetes was diagnosed using ADA (2010) and WHO (1999) criteria. Diagnostic accuracy parameters were calculated, and Receiver Operating Characteristic (ROC) curves were plotted to identify the optimal cut-off. Kappa statistics assessed agreement between HbA1c and glucose-based diagnosis. Results: The optimal HbA1c cut-off was 6.2%, yielding sensitivity 83.7%, specificity 86.1%, and AUC 0.90. The ADA threshold of 6.5% showed higher specificity (88.9%) but lower sensitivity (77.6%). Kappa agreement improved from 0.73 (substantial) at 6.5% to 0.78 (strong) at 6.2%. HbA1c correlated strongly with FPG (r = 0.81) and OGTT (r = 0.78; p< 0.001). Conclusion: HbA1c is a practical and accurate screening tool for undiagnosed diabetes. A cut-off of 6.2% offers superior diagnostic balance for Indian adults compared to the standard 6.5%.

Introduction: Cervical massage is a technique aimed at stimulating cervical ripening by encouraging the release of natural prostaglandins. It may reduce the need for medical induction by promoting the normal physiological onset of labour. Although studies have shown its potential to soften and efface the cervix, there is limited research on patient perception and satisfaction with this method. This study explores women's pain perception and satisfaction with cervical massage as an alternative to more invasive induction methods, such as membrane sweeping. Methods: This prospective, mono-centric study was conducted among low-risk pregnant women at a tertiary care hospital in Eastern India. The participants underwent cervical massage once they reached their expected date of delivery (EDD). Exclusion criteria included women with growth-restricted foetuses or those requiring formal induction. Data on pain during the procedure were collected using a Visual Analogue Scale (VAS). Postnatal questionnaires assessed patients' experiences, including whether they would recommend or repeat the procedure. Results: Of the 203 women screened, 104 were enrolled (52 primiparas and 52 multiparas). The majority (93%) had a single cervical massage. Pain scores ranged from no pain (31.73%) to moderate pain (16.35%). Regarding satisfaction, 38.46% of participants would recommend the procedure to others or agree to repeat it in subsequent pregnancies. The interval between cervical massage and labour onset was noted, with a higher rate of vaginal delivery among multiparas. Only 0.96% had prior knowledge of cervical massage. Discussion: While cervical massage showed less discomfort compared to membrane sweeping, only 38.46% of women would consider repeating it. This supports the need for further research on its effectiveness for cervical ripening and induction. The study highlights the need for more alternatives to formal induction methods.

Conclusion: Cervical massage is a promising alternative to membrane sweeping, but its efficacy and patient acceptability require further investigation.

Background: Type 2 Diabetes Mellitus (T2DM) and hypertension are highly prevalent metabolic disorders that frequently coexist, sharing pathophysiological mechanisms such as insulin resistance, oxidative stress, and endothelial dysfunction. These alterations contribute to autonomic imbalance, an early yet underdiagnosed predictor of cardiovascular morbidity.Objectives: To assess and compare autonomic function among patients with T2DM, hypertension, comorbid disease, and healthy controls using standardized Autonomic Function Tests (AFTs), and to identify metabolic and hemodynamic predictors of autonomic dysfunction. Methods: A case–control study was conducted on 200 participants (aged 35–65 years) divided into four equal groups: T2DM, hypertension, comorbid, and controls. AFTs including E:I ratio, 30:15 ratio, Valsalva ratio, blood pressure response to standing, and handgrip test were performed as per Ewing’s protocol. Biochemical parameters such as HbA1c and blood pressure were recorded. Statistical analysis was done using ANOVA, Pearson’s correlation, and multiple regression (SPSS v26.0). Results: Comorbid participants exhibited the most pronounced autonomic dysfunction with significantly reduced E:I (1.12 ± 0.09) and 30:15 ratios (p < 0.001). HbA1c and systolic BP correlated inversely with parasympathetic indices (r = –0.61 and –0.33, respectively). Regression analysis identified HbA1c (β = –0.42, p = 0.002) and systolic BP (β = –0.33, p = 0.004) as independent predictors of dysfunction. Conclusion: Autonomic dysfunction occurs early in metabolic disorders and intensifies when diabetes and hypertension coexist. Routine use of AFTs can facilitate early detection of subclinical neuropathy, enabling timely interventions to reduce cardiovascular risk, especially in resource-limited settings.

Background: CVC insertion is most commonly done in critically ill patients and those patients posted for major surgeries who require strict hemodynamic monitoring. Keeping this in mind, proper placement of CVC becomes an important role in preventing potential complications of CVC insertion which is determined by CVC tip at or above the carina. So, this study was conducted to determine optimal depth of Right SCV-CVC insertion through highly accurate, Landmark and ECG techniques. Objective: To determine optimal depth of Right SCV-CVC insertion through Landmark and ECG technique. Methods: After ethical committee approval, total of 60 patients were considered for study, dividing 30 each in landmark and ECG groups randomly. All the CVC were inserted in Right SCV. In landmark technique, CVC inserted to a depth got by adding distance between puncture point and sternoclavicular notch and sternoclavicular notch to manubrium sterni. In ECG technique, CVC were inserted to depth were p-wave on ECG monitor returned to normal configuration. Then post-CVC CXR were taken to look for CVC tip. Proper CVC placement was defined by CVC tip at or 2 cms above carina. Results: The optimal depth of Right SCV-CVC through landmark technique was 14.2cms. The optimal depth of Right SCV-CVC through ECG technique was 14.3cms. The CVC tips were 66.6% placed at carina, 6.6% placed above carina in landmark technique. The CVC tips were 63.3% placed at carina, 6.6% placed above carina in ECG technique. Both techniques showed minimal complications. Interpretation: Both landmark and ECG techniques were comparable, equivalent in determining optimal depth of Right SCV-CVC insertion. Both techniques had minimal complications. Conclusion: Right SCV-CVC inserted through landmark and ECG techniques were equivalent in determining optimal depth of CVC insertion.

Background: Severe neonatal pulmonary valve stenosis produces critical right ventricular pressure overload and duct-dependent pulmonary blood flow. Balloon pulmonary valvotomy is the standard intervention; however, periprocedural anaesthetic decisions directly influence transvalvular flow, right ventricular performance, and post-intervention valve physiology. Case Summary: We report a term neonate presenting with cyanosis and severe pulmonary valve stenosis who underwent balloon pulmonary valvotomy in the cardiac catheterization laboratory. Pre-procedural echocardiography demonstrated a dysplastic pulmonary valve with high transvalvular gradient, right ventricular hypertension, and associated intracardiac shunts. Anaesthetic management focused on preserving right ventricular preload, maintaining ductal patency, and avoiding sudden changes in pulmonary vascular resistance that could compromise valve opening and right ventricular output. Transient hypoxaemia during balloon inflation was anticipated and managed without haemodynamic instability. Post-intervention echocardiography demonstrated a marked reduction in valve gradient with mild residual stenosis and preserved right ventricular function. Conclusion: This case highlights the intimate interaction between anaesthetic management and pulmonary valve physiology during neonatal valvotomy. Careful modulation of ventilation, oxygenation, and preload is essential to optimise valve opening and right ventricular recovery, even when the interventional procedure itself is uncomplicated.