Introduction: Microlaryngeal surgery (MLS) presents a unique challenge for the anaesthesiologist due to the shared airway with the surgeon. The primary goals are to provide optimal surgical conditions, ensure adequate oxygenation and ventilation, and facilitate a rapid, smooth recovery. This study aims to evaluate the haemodynamic stability, surgical condition quality, and postoperative recovery profile of a total intravenous anaesthesia (TIVA) technique with propofol and remifentanil. Material and Methods: A prospective observational study was conducted on 75 adult patients (ASA I-III) scheduled for elective MLS over six months. Anaesthesia was induced and maintained with TIVA (Propofol and Remifentanil infusion) with neuromuscular blockade. Ventilation was achieved via jet ventilation or a small-bore endotracheal tube. Haemodynamic parameters, surgical condition score (SCS), and recovery times were recorded. Result: All procedures were completed successfully. Haemodynamics remained stable with minimal response to laryngoscopy and surgical stimulation. The mean SCS was 4.2 ± 0.6 (on a 5-point scale), indicating excellent surgical conditions. The average time to eye-opening was 7.3 ± 2.1 minutes, and the time to Aldrete score ≥9 was 9.8 ± 2.5 minutes. No major complications like pneumothorax or significant airway trauma were observed. Conclusion: A TIVA-based technique using propofol and remifentanil provides excellent haemodynamic stability, superior surgical conditions, and rapid, predictable recovery for patients undergoing microlaryngeal surgery, making it a highly effective anaesthetic strategy for this shared airway procedure.

Meconium-stained liquor (MSL), occurring in 10–20% of deliveries, is a clinical indicator of fetal distress and is linked with increased maternal and neonatal complications. Its presence predisposes to meconium aspiration syndrome (MAS), neonatal morbidity, and maternal morbidities such as cesarean delivery, postpartum hemorrhage, and infections. Materials and Methods: This prospective observational study was conducted over 12 months at a tertiary care hospital, including 90 pregnant women divided into two groups: MSL group (n=45) and clear liquor group (n=45). Singleton term pregnancies in active labor were included, while multiple pregnancies, preterm labor, congenital anomalies, and maternal comorbidities were excluded. Maternal and neonatal outcomes, including mode of delivery, Apgar scores, NICU admissions, MAS incidence, and maternal complications, were recorded. Statistical analysis was performed using chi-square and t-tests, with p<0.05 considered significant. Results: Women with MSL had significantly higher cesarean delivery rates (44.5% vs. 22.2%, p=0.02). Neonates in the MSL group showed increased risk of low Apgar scores at 5 minutes (13.3% vs. 4.4%, p=0.03), NICU admissions (22.2% vs. 8.9%, p=0.04), and MAS (11.1% vs. 0%, p=0.02). Thick meconium was associated with worse outcomes, including higher cesarean rates (60% vs. 25%, p=0.01) and increased MAS incidence (16% vs. 5%, p=0.04). Maternal complications such as postpartum hemorrhage (8.9% vs. 2.2%, p=0.04) and infections (6.7% vs. 2.2%, p=0.03) were also more frequent in the MSL group. Conclusion: MSL is significantly associated with adverse fetomaternal outcomes, particularly when meconium is thick. Pregnancies complicated by MSL require close intrapartum monitoring, timely operative intervention, and vigilant neonatal care to reduce morbidity and mortality.

Introduction: Regional anaesthesia has become a cornerstone in obstetric care, offering effective pain relief during labor and delivery while minimizing risks to both mother and fetus. This article explores the role of regional anaesthesia in enhancing patient comfort and safety, focusing on techniques such as epidural and spinal anaesthesia. Materials and Methods: This study was designed as a prospective observational study/randomized controlled study conducted in a tertiary care hospital/obstetric center. Pregnant women undergoing elective or emergency cesarean section (C-section), labor analgesia, or other obstetric procedures requiring regional anesthesia were included. Singleton pregnancy at ≥37 weeks of gestation (or as per study protocol) and ASA (American Society of Anesthesiologists) physical status I or II were included. Results: Systolic and Diastolic Blood Pressure (BP) dropped after anaesthesia administration, with the lowest values recorded at 10 minutes post-injection (Systolic BP: 105 mmHg, Diastolic BP: 70 mmHg). This is expected, as regional anaesthesia causes vasodilation, leading to transient hypotension. Blood pressure begins to stabilize around the 15–20-minute mark, indicating that the body's compensatory mechanisms or interventions (e.g., IV fluids, vasopressors) were effective. Conclusion: Regional anaesthesia is a safe and effective option for obstetric patients, improving comfort and safety during labor and delivery. Future research should focus on optimizing techniques and addressing rare complications.

Background and Aims: Postoperative sore throat (POST) is a well-recognized complication after general anesthesia (GA). Numerous nonpharmacological and pharmacological measures have been used for attenuating POST with variable success. The present study was conducted to compare the efficiency of preoperative nebulization of normal saline and magnesium sulfate in reducing the incidence of POST following GA. Materials and methods:  Following institutional ethical committee approval and written informed consent, a prospective randomized double-blinded study was conducted in 100 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologist (ASA) status 1 or 2 undergoing elective surgery of approximately 2 h or more duration requiring tracheal intubation. Patients in Group A are nebulized with 3 ml of normal saline and the patients in Group B are nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulfate for 15 min, 5 min before induction of anesthesia. The incidence of POST at rest and on swallowing and any undue complaints at 0, 2, 4, and 24 h in the postoperative period are evaluated Results: No significant difference in postoperative sorethroat was observed on swallowing in between magnesium sulphate and normal saline at zero and 2nd hour. significant difference was observed at 4th,12th and 24th hour between magnesium sulphate and normal saline in reducing the incidence of post-operative sore throat.

Diverticular disease is extremely common especially amongst the elderly. It mainly presents as sigmoid diverticulitis but there is potential for serious complications. In the acute setting Computed Tomography is the gold standard investigation and helps classify the stage. Evidence to support outpatient treatment of uncomplicated diverticulitis is appearing however hospital admission and treatment with intravenous antibiotics is often required and is highly effective. The decision to proceed with elective surgery is judged on an individual basis with a long-term conservative approach suitable for most. For elective surgery there is evidence to advocate a laparoscopic approach. In Hinchey stage III or IV disease, laparotomy followed by either a Hartmann’s procedure or ideally, a resection followed by primary anastomosis may be required. Radiologically guided drainage of an abscess is an established alternative and laparoscopic lavage is another less invasive option that has emerged. Following successful acute medical management, colonoscopy is usually performed several weeks after resolution to rule out other colonic pathology.

Aims: Following the Royal College of Psychiatrists' recommendations, assessments were carried out by the community rehabilitation team in Newham, East London, using the Camberwell Assessment of Needs for the Elderly (CANE) to assess the needs and quality of service provided to all patients over the age of 65 years. Results: 49 patients were screened using the CANE. The majority of needs appeared to be met by the current service provision. However, certain needs remained unmet: daytime activity (in 36.7% of patients), lack of company (in 22.4% of patients), help with eyesight and hearing difficulties (in 20.4% of patients) and help with money and budgeting (in 18.4 % of patients) were the most prominent. Implications: Whereas most psychiatric and practical needs were well met, service planning needs to focus on outreach day activity and befriending services. Mental health services need to closely monitor physical problems which are more specific to older people e.g. eyesight and hearing, and include these in their care plans.

We aimed to investigate the income of trauma and elective work in our unit and compare inpatient stay and resource allocation. We performed a prospective study of trauma and elective admissions for a one-week period. We calculated the income received using health resource group coding. 48 trauma patients were admitted of which 36 required operative intervention. This generated £134,321 for primary procedures followed by an extra £18,141 for those requiring no surgery. The total income for the week was £171,941. 71 elective patients underwent surgery. The total income generated was £150,318 for this week. This was a typical week in a busy unit. No consultants were on leave. Although the income was higher in the trauma group this was loss making due to the length of stay of those patients with hip fractures. Attempts at profitability should include enhanced rehabilitation services and more realistic tariff for proximal femur fractures.

Background: Preanaesthetic medication plays an important role in the anaesthetic care of children by allaying anxiety, decreasing vagal stimulation and preventing postoperative psychological sequelae. This study was undertaken to evaluate the efficacy of dexmedetomidine when administered orally as a hypnotic and anxiolytic compared to oral combination ketamine/midazolam as preanaesthetic medication in paediatric patients. Methods: Sixty-six children aged 2-6 years posted for elective surgical procedures were randomly allocated to one of two groups ‘Group D’ and ‘Group MK’. Group D received oral dexmedetomidine 3 µg/kg and group MK received 0.25 mg/kg oral midazolam (up to a maximum of 15 mg) mixed with 2.5 mg/kg oral ketamine. Drug acceptance was noted. Heart rate, arterial pressure, respiratory rate, sedation score and anxiolysis score were noted before drug administration and every 5 min for up to 30 min after drug administration. Parental separation score at 30 min and mask acceptance score in addition to parental satisfaction were also noted. Results: premedication with oral MK appeared to be superior to oral dexmedetomidine, in addition to evident haemodynamic stability and higher degree of parental satisfaction (90%), but 97% of children better accepted oral dexmedetomidine. No significant side effects were attributable to either premedication. Emergence from anaesthesia was comparable between groups. Conclusion: premedication with oral midazolam ketamine appeared to be superior to oral dexmedetomidine, with evident haemodynamic stability and a higher degree of parental satisfaction, although oral dexmedetomidine was more accepted by the children.

Introduction:Diabetes mellitus (DM) is a group of metabolic disorders that causes decreased insulin secretion and varying degrees of peripheral insulin resistance that leads to elevated blood glucose levels. Symptoms of marked increase in blood glucose levels include polydipsia, polyphagia, polyuria and weight loss. Sodium-glucose cotransporter 2 (SGLT2) inhibitors enhance urinary glucose excretion, which consequently reduces hyperglycemia. They exert favorable effects on various biomarkers, including blood glucose, body weight, blood pressure, albuminuria, and fatty liver. In contrast, dipeptidyl peptidase-4 (DPP-4) inhibitors decrease glycaemic variability by stimulating glucose-dependent insulin secretion. Material and Methods: This is a Prospective, randomized, Open-label was conducted among Type 2 DM patients attending the outpatient department of Medicine in Index Medical College and Hospital over a period of 2 years. Male or female patients between 40 to 60 years of age and Patients with type 2 diabetes who had not used any glucose-lowering agents within 8 weeks before consenting, or those who had used only metformin were included. All the Type 2 DM patients attending outpatient department (OPD) of Medicine were randomly divided into Dapagliflozin Group and Sitagliptin Group. Subjects willing to participate and written informed consent was obtained from each participant before study. The treatment drug (dapagliflozin 10 mg/day and sitagliptin 100 mg/day) was administered for 12 weeks. Results: Although there was no significant difference among the two study groups, the lowering effect of Fasting proinsulin/insulin ratio tended to be greater in the Sitagliptin group then in the dapagliflozin group. The mean changes in the HOMA- β values from baseline to week 12, as markers of β-cell function, are presented in Table 9. Although there were significant differences from baseline to week 12, the changes in the HOMA- β tended to improve in the two study groups. The mean ± SD change in HOMA-β at 12 weeks from baseline to 12 weeks were 5.9 ± 1.7 and 15.85 ± 0.56 in the dapagliflozin and sitagliptin groups, respectively. The mean ± SD change in HOMA- IR at 12 weeks from baseline to 12 weeks were 1.08 ± 0.03 and 0.68 ± 0.05 in the dapagliflozin and sitagliptin groups, respectively. Conclusion: The response after 24 weeks of treatment was not significantly different between the sitagliptin and dapagliflozin groups. However, in the lower BMI subgroup, sitagliptin demonstrated superior efficacy in improving glycaemic variability than did dapagliflozin. Finally, our results demonstrated that, for the treatment of Indian patients with early-stage type 2 diabetes, patients should be stratified according to baseline BMI when selecting between sitagliptin and dapagliflozin.

Most studies do not provide strong evidence for beneficial health-related effects of supplements taken singly, in pairs, or in combinations of 3 or more.5 In some studies, or subgroups of the study populations, there is encouraging evidence of health benefits such as increased bone mineral density and decreased fractures in postmenopausal women who use calcium and vitamin D supplements. Huang et al 5 performed a systematic review to synthesize the published literature on the efficacy of multivitamin and mineral supplements and certain commonly used single vitamin or mineral supplements in the primary prevention of cancer and chronic disease in the general adult population. The authors concluded that the strength of evidence for the efficacy of multivitamin/mineral supplementation in the general adult US population was very low for primary prevention of cancer, cardiovascular disease, and hypertension; and low for cataract and age-related macular degeneration.