Background: Type 2 diabetes mellitus (T2DM) is associated with accelerated vascular aging and increased arterial stiffness, which contributes to cardiovascular risk. Vitamin K plays an important role in vascular health through activation of calcification-inhibitory proteins, and low vitamin K status may be linked to adverse arterial changes.

Aim: To study the association between serum vitamin K levels and arterial stiffness in patients with T2DM.

Materials and Methods: This prospective observational study was conducted at K.M. Medical College and Hospital, Mathura, and included 100 adults with T2DM. Clinical details, anthropometric measurements, blood pressure, glycemic indices, and lipid profile were recorded. Serum vitamin K levels were measured, and arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Patients were categorized according to vitamin K status and arterial stiffness severity. Correlation analysis and multivariable linear regression were performed to evaluate the relationship between vitamin K and cfPWV.

Results: The mean age of the study population was 51.92 ± 9.59 years, and 58.0% were male. Mean serum vitamin K level was 0.88 ± 0.41 ng/mL, while mean cfPWV was 7.88 ± 1.15 m/s. Moderate arterial stiffness was present in 20.0% of patients. Serum vitamin K levels were significantly lower in patients with moderate stiffness than in those with normal/mild stiffness (0.68 ± 0.31 vs 0.93 ± 0.41 ng/mL; p=0.005). Vitamin K showed a significant inverse correlation with cfPWV (r = -0.364, p < 0.001). The proportion of moderate stiffness was highest in the low vitamin K group (43.8%), compared with intermediate (18.8%) and adequate vitamin K groups (11.1%) (p=0.024). On multivariable regression, lower vitamin K remained independently associated with higher cfPWV (β = -0.874, p < 0.001).

Conclusion: Lower serum vitamin K levels are independently associated with greater arterial stiffness in patients with T2DM. Vitamin K may represent a useful marker of vascular risk in this population.

Background: Elderly patients admitted under Internal Medicine are at increased risk of short-term adverse outcomes. Frailty index and handgrip strength are simple bedside measures reflecting physiological reserve, but their combined prognostic value in routine clinical settings remains uncertain.

Aim: To evaluate the prognostic value of frailty index and handgrip strength in predicting 90-day outcomes in elderly patients admitted under Internal Medicine.

Methods: This prospective cohort study included 60 patients aged ≥60 years admitted to a tertiary care hospital in Maharashtra, India. Frailty index (based on cumulative deficit model) and handgrip strength were assessed within 48 hours of admission. Patients were followed for 90 days to assess mortality, readmission, and functional decline. A composite adverse outcome was defined as the occurrence of any of these events. Multivariable logistic regression analysis was performed to identify independent predictors.

Results: The mean age was 69.9 ± 7.5 years, and 55.0% were male. Frailty (frailty index ≥0.25) was present in 70.0% of patients, and low handgrip strength in 46.7%. At 90 days, mortality was 20.0%, readmission 46.7%, functional decline 30.0%, and composite adverse outcome 73.3%. Although adverse outcomes were more frequent among frail patients, the association was not statistically significant (p = 0.529). Similarly, outcomes were comparable between low and normal handgrip groups (p = 0.778). In multivariable analysis, neither frailty index (OR 1.34, 95% CI 0.73–2.68, p = 0.316) nor handgrip strength (OR 1.00, 95% CI 0.92–1.16, p = 0.632) independently predicted adverse outcomes.

Conclusion: Frailty and reduced handgrip strength were common among elderly medical inpatients and were associated with a high burden of adverse 90-day outcomes. Although not independent predictors in this cohort, both measures remain clinically useful indicators of vulnerability. Larger studies are needed to establish their independent prognostic significance.

BACKGROUND- Multiple myeloma (MM) is a malignant plasma cell disorder marked by clonal bone marrow proliferation and overproduction of monoclonal immunoglobulins or light chains, leading to anemia, renal dysfunction, immunosuppression, and skeletal complications. It accounts for approximately 1% of all cancers and 10% of hematologic malignancies worldwide, with rising incidence in India due to improved diagnostics and an aging population. AIMS AND OBJECTIVES:To study the clinicopathological profile of patients diagnosed with multiple myeloma at a tertiary care center.MATERIALS AND METHOD: A descriptive study was conducted on 30 patients diagnosed with multiple myeloma. Demographic data and bone marrow samples were analyzed to determine plasma cell morphology and percentage. RESULTS The study included 56.7% males and 43.3% females. The mean age of patients was 54 ± 1.6 years. Plasmablastic plasma cells were seen in 60% and plasmacytic in 40% of patients. Disease stages were distributed as 10% Stage I, 33.3% Stage II, and 56.7% Stage III. CONCLUSION: Multiple myeloma mainly affects middle-aged adults, with a slight male predominance. Plasmablastic morphology and advanced-stage disease are frequent, indicating aggressive progression. Early diagnosis and assessment of bone marrow plasma cell infiltration are crucial for optimal management.

Abstract Introduction: Anemia remains a leading global health problem with age-specific patterns in etiology, severity, and outcomes. Children commonly have nutritional and infection-related anemia, while adults more frequently exhibit anemia due to chronic inflammation, blood loss, renal disease, and mixed etiologies. Materials and Methods: A hospital-based comparative observational study was designed to evaluate anemia patterns among children and adults, using standardized clinical evaluation, complete blood count indices, iron studies, inflammatory markers, and targeted tests (e.g., hemoglobin electrophoresis) based on suspected causes. Results: In a representative cohort (Children n=200; Adults n=200), moderate-to-severe anemia was more frequent in children, while adults had higher proportions of normocytic anemia and anemia of inflammation.3,4 Iron deficiency anemia (IDA) was the most common cause across both groups, but hemoglobinopathies contributed substantially in children, and chronic disease and occult blood loss were more common in adults. Conclusion: Age-stratified evaluation improves diagnostic yield: nutritional deficiency and hemoglobinopathies dominate in children, whereas chronic inflammation, GI blood loss, and CKD-related anemia are key adult drivers.

Introduction: Childhood obesity is a growing global health concern with profound long-term physical, metabolic, and psychosocial consequences. Lifestyle interventions remain the cornerstone of management; however, pharmacological therapy may be required in adolescents with severe obesity or obesity-related complications. This study was undertaken to compare the efficacy of liraglutide and orlistat in improving anthropometric and biochemical parameters among obese adolescents. Material and Methods: A prospective, randomized study was conducted in the Department of Paediatrics over six months after obtaining ethical approval. A total of 80 obese adolescents aged 10–18 years were enrolled and divided equally into two groups: Group 1 received liraglutide (0.6 mg/day subcutaneous), and Group 2 received orlistat (120 mg three times daily with meals). Baseline assessments included anthropometric measures (BMI, wrist circumference, waist-to-height ratio, and skinfold thickness) and biochemical parameters (fasting glucose, lipid profile, serum creatinine, and blood urea). These parameters were reassessed at 15 days and 2 months. Data were analysed using SPSS, and paired t-tests were applied; p < 0.05 was considered statistically significant. Results: The mean BMI reduction at 15 days was 2.8 ± 0.2 kg/m² in the liraglutide group versus 4.0 ± 0.1 kg/m² in the orlistat group (p = 0.041). At 2 months, BMI reduction was 8.5 ± 0.4 kg/m² in the liraglutide group and 12.4 ± 0.1 kg/m² in the orlistat group (p = 0.001). Improvements in skinfold thickness, waist-to-height ratio, and wrist circumference were greater in the orlistat group compared to liraglutide. Biochemical parameters also showed significant improvements, with greater reductions in fasting glucose, total cholesterol, and triglycerides in the orlistat group. Dietary assessment revealed that 50% of adolescents had a high intake of junk food, 31.2% were non-vegetarian, and 18.8% were vegetarian, underscoring the role of dietary habits in obesity. Conclusion: Both liraglutide and orlistat were effective in improving anthropometric and biochemical outcomes in obese adolescents. Orlistat demonstrated more rapid and significant short-term improvements, while liraglutide provided steady and consistent benefits over time. These findings suggest that pharmacological therapy, when combined with lifestyle modification, can be an effective strategy for adolescent obesity management.

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 Objectives: A recurrent inflammatory skin condition known as seborrheic dermatitis affects regions of the body that are dense with sebaceous glands, including the scalp, face, and upper trunk. It is a chronic condition. Its pathophysiology is thought to be mostly influenced by changes in sebum composition, colonization by Malassezia, and inflammatory responses. Nevertheless, our understanding of the metabolic alterations in sebum lipids is still limited. We set out to compare the biochemical makeup of sebum from seborrheic dermatitis sufferers to that of healthy controls in this current investigation. Methods: This prospective study comprised 50 clinically diagnosed patients with seborrheic dermatitis and 50 age- and sex-matched healthy controls. Study conducted at the Department of Dermatology, G.S.L. Medical College, Rajahmundry, Andhra Pradesh, India over a period of April 2021 to March 2022. We used Sebutape® to obtain sebum samples from the afflicted areas in a controlled way. We did biochemical tests to find out how much total lipids, triglycerides, free fatty acids (FFA), squalene, cholesterol, and lipid peroxidation products (malondialdehyde, MDA) there were. The Seborrheic Dermatitis Area Severity Index (SDASI) was used to figure out how bad the disease was. We used Student's t-test and Pearson's correlation test to do the statistical analysis. A p-value of less than 0.05 was regarded statistically significant. Results: In contrast to controls, patients with seborrheic dermatitis secreted significantly more sebum (184.6 ± 32.4 µg/cm²) than those without the condition (132.8 ± 28.7 µg/cm²; p < 0.001). Patients had significantly lower levels of squalene and significantly higher levels of triglycerides and free fatty acids (p < 0.001). Compared to controls, patients had a substantially increased level of lipid peroxidation marker MDA (4.12 ± 0.86 nmol/mg lipid) with a p-value less than 0.001. An association was found between FFA, MDA levels, and SDASI score, with correlation coefficients of 0.59 and 0.63, respectively, and a p-value less than 0.01. Conclusion: The study shows that seborrheic dermatitis patients have significantly different sebum compositions, both quantitatively and qualitatively. A possible link between inflammation and disease severity is an increase in lipid peroxidation along with changes to lipid fractions. These results lay the groundwork for potential targeted treatments for seborrheic dermatitis and lend credence to the idea that oxidative stress and sebaceous gland dysfunction play a role in the disease's pathophysiology.

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.