Background: Differentiating major depressive disorder (MDD) from bipolar disorder (BD) remains a clinical challenge, particularly in resource limited settings. Misdiagnosis can lead to inappropriate treatment and poorer outcomes. Objective: To compare socio demographic variables, family history, and clinical features of depressive episodes in patients with MDD and BD attending tertiary care hospitals in Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal and Modern Psychiatric Hospital, Narsinghar, Agartala, Tripura. Methods: We conducted a cross-sectional study among 75 patients with MDD and 60 patients with BD. We established diagnoses using the Mini International Neuropsychiatric Interview (MINI) and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV TR) criteria. We assessed sociodemographic data, family history, and stressful life events using a semi structured questionnaire and the Presumptive Stressful Life Events Scale. Severity of depression was measured using the validated Bengali version of the Beck Depression Inventory (BDI). Results: The mean age of MDD patients was 34.2 years compared to 32.6 years in BD (p = 0.28). MDD showed female predominance, while BD showed a near-equal distribution (p = 0.04). Educational attainment was significantly lower in BD compared to MDD (p = 0.01). Unemployment was higher in BD than MDD (p = 0.03).  BD patients had a significantly earlier age of onset (mean 24.8 years) compared to MDD (mean 32.9 years; p = 0.001). Recurrent episodes and positive family history were more frequent in BD (p = 0.001). Stressful life events were significantly associated with MDD (p = 0.001). BD patients scored higher on the BDI (39.2 ± 9.4) than MDD patients (27.1 ± 7.8; p = 0.001), with prominent features of guilt, suicidality, irritability, social withdrawal, fatigability, and loss of libido. MDD patients exhibited more insomnia, anorexia, weight loss, and somatic preoccupation. Conclusion: BD is characterised by earlier onset, recurrent episodes, stronger familial predisposition, and greater symptom severity, while MDD is more closely linked to stressful life events and somatic complaints. Early recognition of bipolarity in depressive presentations is essential to guide appropriate treatment and improve outcomes.

Background: Obsessive compulsive disorder (OCD) is a chronic psychiatric condition characterised by intrusive thoughts and repetitive behaviours. While neurobiological models explain part of its aetiology, psychosocial stressors, particularly stressful life events, may significantly influence symptom severity. Objective: To examine the role of stressful life events in predicting OCD severity among patients attending the Department of Psychiatry, Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal and Modern Psychiatric Hospital, Narsinghar, Agartala,Tripura. Methods: A hospital based cross sectional study was conducted with 120 patients diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) criteria. We collected sociodemographic and clinical data using a structured proforma. The Yale Brown Obsessive Compulsive Scale (Y BOCS) assessed symptom severity, while the Life Events Scale (LES) documented stressful events in the preceding 12 months. Statistical analyses included descriptive measures, independent t tests, chi square tests, and multiple regression. Results: Participants' mean age was 29.4 ± 8.6 years, with a slight male predominance (54.2%). Most patients (78.3%) reported at least one stressful life event. Family conflicts (32.5%) and academic/occupational stress (28.3%) were the most frequent categories. Patients with stressful life events had significantly higher Y BOCS scores (28.9 ± 5.8) compared to those without (21.4 ± 4.9, p < 0.001). Regression analysis revealed that family conflicts (β = 0.42, p < 0.01) and academic/occupational stress (β = 0.35, p < 0.05) were independent predictors of OCD severity, while financial difficulties and health related stressors were not statistically significant. Conclusion: Stressful life events, particularly family conflicts and academic/occupational stress, significantly contribute to OCD severity in the Indian context. These findings highlight the importance of adopting a biopsychosocial approach to OCD management, integrating pharmacological treatment with psychosocial interventions. Future longitudinal studies are warranted to clarify causal pathways.

Background: About 60% of all tarsal bone fractures are calcaneum fractures. 70% of all calcaneal fractures are intra-articular fractures. There are disagreements on how to operate on calcaneum fractures. In order to quantify the functional results of calcaneum fractures treated with open reduction and internal fixation with plate and screws, this study was conducted. Calcaneum intraarticular fractures are not unusual. The calcaneus is the tarsal bone that fractures most commonly. 60% of tarsal bone injuries and 2% of all fractures are calcaneal fractures. The most frequent mode of injury is axial loading, which results in bilateral calcaneal fractures when someone falls from a height. It is necessary to rule out further fractures such pelvic and spinal fractures that are linked to falls from height. Thanks to improved knowledge of fracture patterns and the availability of superior implants, the care of Calcaneal fractures has changed over the past several years from conservative to surgical management.Aim: To evaluate the functional outcome of calcaneal fractures treated surgically by plating in a tertiary care hospital. The goal of the current study is to evaluate the surgical outcomes of Calcaneal fractures treated with improved implants after intra-articular reduction.Material and Method: Patients who were hospitalized from the hospital's emergency and outpatient departments were the subjects of the study at the department of orthopedics. Twenty-five patients (20 men and 5 women) who met the inclusion and exclusion criteria for the study had 26 fractures that we assessed. All patients gave their informed consent.Results: We used plating, such as locking the calcaneal plate, to treat a total of 26 calcaneal fractures in 25 patients. There was a tendency for right-sided fractures among the 25. There were no lost patients to follow-up. Most of the patients were adults in the 30- to 45-year age range. The oldest and youngest patients were 53 and 19 years old, respectively. Therefore, falls from a height occurred most frequently when people were engaged in the construction industry. A small proportion of fractures occurred as a result of four-wheeler-related traffic accidents. In this investigation, there was a minor tendency toward right-side fractures. Compound fractures and bilateral fractures were excluded from this investigation.Conclusion: Open reduction and internal fixation with an expanded lateral approach and calcaneum locking plates and screws produce a high percentage of positive outcomes in displaced intra-articular calcaneum fractures and very few negative outcomes. For the treatment of displaced intra-articular calcaneum fractures, it may therefore be a superior alternative.

Background: Antenatal care (ANC) is a cornerstone of safe motherhood and a key strategy for reducing maternal and neonatal morbidity and mortality. Despite rapid urbanization, ANC utilization in Indian cities remains suboptimal due to social, economic, and health-system-related barriers. Lucknow, the capital of Uttar Pradesh, reflects the heterogeneity of urban India, making it an important study site. Objectives: To assess ANC utilization, identify socio-demographic determinants, and explore barriers to adequate ANC among pregnant women in urban Lucknow. Methods: A community-based cross-sectional study was conducted among 400 women who delivered within the preceding 12 months, selected by systematic random sampling from urban Primary Health Centres (PHCs) and ASHA-registered households across four urban zones of Lucknow. Data were collected using a pretested, structured interview schedule. ANC utilization was assessed using WHO (≥4 visits) and India's RMNCH+A framework. Chi-square test was used for association; p<0.05 was considered significant. Results: ANC registration was 92.0%, but only 53% registered in the first trimester. Adequate ANC (≥4 visits) was received by 66% of women. TT immunization (88%) and ultrasound (86%) coverage were high; however, birth preparedness counselling (49%) and danger sign awareness (45%) were poor. Education, socioeconomic status, early registration, and husband's support were significantly associated with adequate ANC (p<0.001). Conclusions: While ANC registration is high, quality and timing remain suboptimal. Targeted interventions addressing early registration, counselling quality, and demand-generation strategies—especially for low-SES and low-literacy groups—are urgently needed.

Introduction: Laryngoscopy and endotracheal intubation trigger a sympathetic stress response that may cause transient tachycardia and hypertension. In emergency general surgery, patients often present with pain, hypovolemia, sepsis, full stomach (rapid sequence induction), and “physiologically difficult airway” physiology—factors that can amplify peri-intubation cardiovascular instability. Materials and Methods: A prospective observational comparative study was conducted in adult patients undergoing general anesthesia with orotracheal intubation for emergency versus elective general surgery. Hemodynamics (HR, SBP, DBP, MAP) were recorded at standardized time points: baseline (pre-induction), post-induction (pre-laryngoscopy), immediately after intubation (T0), and at 1, 3, 5, and 10 minutes post-intubation. The primary outcome was peak change in MAP from post-induction to 1-minute post-intubation. Secondary outcomes included peak HR response, incidence of significant hypertension/tachycardia and peri-intubation hypotension. Results: A total of 200 patients were analyzed (Emergency n=100; Elective n=100). Emergency cases showed higher baseline HR/MAP and significantly greater post-intubation peaks. Peak MAP rise was +22.6 ± 10.8 mmHg in emergency vs +14.1 ± 9.6 mmHg in elective (p<0.001). Peri-intubation hypotension (MAP <65 mmHg within 10 min) was also more frequent in emergency cases (14% vs 6%, p=0.048). Conclusion: Emergency general surgery patients demonstrate greater pressor and tachycardic responses to laryngoscopy/intubation and higher rates of peri-intubation hypotension, emphasizing the need for optimized resuscitation, agent selection, and proactive hemodynamic strategies during airway management.

Background: Diabetes mellitus is a chronic condition characterized by elevated blood glucose levels and is commonly associated with ocular complications, including diabetic retinopathy, cataracts, and glaucoma. One under-explored aspect of diabetes is diabetic keratopathy, which involves changes to the corneal structure, including alterations in central corneal thickness (CCT). The aim of this study was to investigate the relationship between diabetes mellitus and CCT in patients attending a tertiary care center. Methods: A case-control study was conducted involving 100 diabetic and 100 non-diabetic patients, with 50 participants in each group. Central corneal thickness was measured using ultrasound pachymetry. The study assessed the impact of gender, duration of diabetes, and glycemic control (HbA1c levels) on CCT. Results: The mean CCT was significantly higher in diabetic patients (564.54 ± 24.56 µm) compared to non-diabetic controls (519.45 ± 25.98 µm, P < 0.002). No significant gender differences were observed in CCT among diabetic patients (578.87 ± 30.12 µm for males and 551.78 ± 29.11 µm for females, P = 0.256). A positive correlation between CCT and diabetes duration was found, with longer duration correlating with thicker corneas. However, no significant association was found between CCT and glycemic control (P = 0.231). Conclusion: The study found a significant increase in CCT in diabetic patients compared to non-diabetic individuals. Though the duration of diabetes influenced corneal thickness, glycemic control did not show a significant effect. The findings suggest that CCT may serve as a useful indicator in managing diabetic patients, particularly in preoperative assessments and glaucoma evaluations. Further investigation into the relationship between diabetic keratopathy and corneal ectatic disorders is warranted.

Vitiligo is one of the commonest skin disorders with a presumed autoimmune aetiology. The management options for this disease have undergone a sea of change over the last two or three decades and we are now in a much better position to treat this disease than in the past. Treatment options such as Narrowband Ultraviolet B (NB-UVB), Targeted Phototherapy, and Excimer laser on the medical front, in addition to epidermal cell transplantation and melanocyte culture transplants on the surgical front, have all revolutionized the management of this psychologically devastating disease.

Background: This meta-analysis synthesizes findings from two community-based cross-sectional studies conducted in rural Lucknow (2014–2015), focusing on maternal and neonatal care practices, ANC utilization, delivery outcomes, breastfeeding, and postnatal care. Both studies interviewed the same sample of 368 recently delivered women (RDWs) using multi-stage random sampling. Methods: Data from both papers (Yadav et al., IJCMPH 2020; Yadav et al., NJMAS 2016) were extracted, compared, and pooled for a combined analysis of ANC registration, TT immunization, IFA tablet distribution, delivery practices, birth weight, breastfeeding initiation, colostrum feeding, and neonatal complications. Complementary and divergent findings were identified. Results: ANC registration stood at 89.4%, with 70.4% completing at least 3 ANC visits. Institutional delivery was near-universal at 97.5%. Low birth weight prevalence was 10.3%. ASHA workers dominated all facilitation roles (86–91%). Exclusive breastfeeding was reported at 81%; colostrum feeding at 75.8–93.5%. Neonatal complication rate was 13%. Significant heterogeneity was found in breastfeeding initiation rates between the two studies (27.7% vs 48.4% within 1 hour). Conclusions: ASHA workers are the cornerstone of maternal and neonatal health services in rural Lucknow. Despite progress in institutional delivery and ANC coverage, significant gaps remain in early breastfeeding, post-natal follow-up, and IFA tablet consumption. Strengthening frontline healthcare workers and improving health literacy are critical to achieving Sustainable Development Goals.

The recent literature on carers’ burden in mental disorders is reviewed. Families bear the major responsibility for such care. Carers face mental ill health as a direct consequence of their caring role and experience higher rates of mental ill health than the general population. The production of burden in carers is a complex process and is related to gender, age, health status, ethnic and cultural affiliation, lack of social support, coping style, in addition to the stressors of the disorder itself. Carers appear to suffer from at least moderate levels of psychological symptomatology. The behavioral problems associated with mental disorders further increase the stress levels of carers. The findings from the review afford a comprehensive understanding of the care-giving situation with its outcomes, and its practical application in devising effective support strategies for family carers.

Background: Both Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are aetiological agents of acute and chronic liver disease existing throughout the world. The high genetic variability of HBV and HCV genome is reflected by eight genotypes (A to H) and six genotypes (1 to 6), respectively. Each genotype has a characteristic geographical distribution, which is important epidemiologically. Previous studies from the province of Sindh, Pakistan have reported that genotypes D and A as well as D and B are prevalent HBV genotypes, and for HCV genotypes 3a and 3b to be dominant. The aim of this study was to investigate the prevalence of co-infection of both HBV and HCV genotypes in physically healthy females at two universities in Karachi, Sindh, Pakistan and HBV diagnosed patients41,42,56-59. Methodology: Blood was collected from a total of 4000 healthy female volunteer students and 28 HBV diagnosed patients. Serum samples obtained were screened for Hepatitis B surface antigen (HBsAg), anti-HBs antibodies and anti-HCV antibodies by immunochromatography and ELISA. Genotyping was carried out for 6 HBV genotypes (A through F) and 6 HCV genotypes (1 through 6). Genotyping data of HBV and HCV positive individuals are described. Results: Out of 4028 volunteers, 172 (4.3%) tested positive for HBsAg. All 172 serum samples were genotyped by PCR for both HBV and HCV. Out of 172 HBsAg positive samples, 89 (51.7%) showed a single HBV genotype D infection, followed by genotypes A (6.4%), F (4.6%), B (3.5%), E (1.7%), and C (1.7%). Out of 43 positives for HCV by PCR from the two universities and Anklesaria Hospital, 65.1% showed infection with 3a, followed by genotypes 5a (11.6%), 6a (11.6%), 3b (9.3%) and 2a (2.3%). Hence, the co-infection rate of both these viruses is 25% (43/172) among HBs Ag positive individuals. Conclusion: Genotype D for HBV and genotype 3a for HCV appears to be the dominant genotype prevalent in Karachi’s population and co-infection of both these viruses does exist in HBsAg positive individuals.

Background and objectives: Laryngoscopy and tracheal intubation are associated with haemodynamic responses which might increase morbidity and mortality in some patients. Lornoxicam is a non-steroidal anti-inflammatory drug, which when added to fentanyl successfully attenuated the pressor response of intubation. The aim of this study was to evaluate the effect of lornoxicam individually on the haemodynamic response and serum catecholamine levels following laryngoscopy and tracheal intubation. Methods: Fifty adult patients scheduled for general anaesthesia with endotracheal intubation were enrolled in this randomised, double-blind placebo- controlled study. They were divided into two equal groups to receive intravenously either lornoxicam 16 mg or placebo, half an hour before surgery. Systolic, Diastolic and mean arterial pressure and heart rate were recorded before and after the induction of anaesthesia, and every minute after intubation for 10 minutes. Serum catecholamine levels were measured before induction and 1 minute after intubation. Results: After induction, there was a significant decrease in blood pressure in both groups. In the control group, a significant increase in serum catecholamine levels 1 minute after intubation as well as a significant increase in the haemodynamic parameters was observed in the first 3 minutes after tracheal intubation (P <0.05). Conclusion: Lornoxicam 16 mg attenuates the pressor response to laryngoscopy and intubation of the trachea.

The concept of CH was first introduced by Sjaastad and colleagues in 1983.4 The International Headache Society published its first diagnostic criteria in 1998 which was revised in 2004.5 Patients with CH may have histories of head and neck trauma. Pain is often unilateral. Headache is frequently localized in the occipital area. However, pain may also be referred to the frontal, temporal or orbital regions. Headaches may be triggered by neck movement or sustained neck postures.6 Headache is constant with episodic throbbing attacks, like a migraine. Patients may have other symptoms mimicking a migraine such as nausea, vomiting, photophobia, phonophobia, and blurred vision. Due to the fact that there is a significant overlap of symptoms between CH and migraine without aura, CH is often misdiagnosed as migraine. CH is commonly found in patients after whiplash injuries, especially in the chronic phase.7 Anatomical studies have provided a basis for the pathogenesis of CH. The suboccipital nerve (dorsal ramus of C1) innervates the atlanto-occipital (AO)joint and dura matter over in the posterior fossa. Therefore, a pathologic condition of AO joint is a potential source for occipital headache. It has been reported that pain from the C2-3 and C3-4 cervical facet joints can radiate to the occipital area, frontotemporal and even periorbital regions. Even pathology in C5 or C6 nerve roots have been reported to cause headache.8 The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibres in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to interact with sensory fibres from the upper cervical roots. This functional convergence of upper cervical and trigeminal sensory pathway sallows the bidirectional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head.

Infertility is the inability to naturally conceive, carry or deliver a healthy child. The World Health Organization definition based on 24 months of trying to get pregnant is recommended as the definition that is useful in clinical practice and research among different disciplines. All over the World it affects an estimated 10%-15% of couples of reproductive ages. In recent years, the number of couples seeking treatment for infertility has dramatically increased. There is less information about effective psychiatric treatments for this population; however, there is some data to support the use of psychotherapeutic interventions. The stress of the non-fulfilment of a wish for a child has been associated with emotional squeal such as anger, depression, anxiety, marital problems and feelings of worthlessness among the parents. In general, among infertile couples, women show higher levels of distress than their male partners. Various research studies support the theory that distress is associated with lower pregnancy rates among women pursuing infertility treatment. Since psychological factors play an important role in the pathogenesis of infertility, exploration of this is also an important task to manage this devastating problem, which has cultural and social impact.