Background: Severe malaria remains a leading cause of paediatric morbidity and mortality in tropical regions, including India. Identifying modifiable and non-modifiable risk factors for severe disease progression in children is essential for early clinical stratification and targeted therapeutic intervention. Objectives: To determine the prevalence, clinical spectrum, and independent risk factors associated with severe malaria in children aged 6 months to 12 years admitted to tertiary care hospitals in Hyderabad and Nellore, India, during May 2021 to March 2022. Methods: A prospective observational study was conducted among 60 children diagnosed with malaria at Malla Reddy Medical College for Women, Hyderabad and Narayana Medical College, Nellore. Children were classified into severe (n=38) and non-severe (n=22) malaria groups based on WHO 2015 criteria. Clinical, demographic, haematological, and parasitological parameters were analysed. Multivariate logistic regression was employed to identify independent predictors of severe disease. Results: Of 60 enrolled children, 38 (63.3%) fulfilled criteria for severe malaria. Plasmodium falciparum was the predominant species (60.0%) and was strongly associated with severe disease (adjusted OR 4.12; 95% CI 1.62–10.48; p=0.003). Severe acute malnutrition (OR 3.46; p=0.021), high parasite density >100,000/µL (OR 4.98; p<0.001), age 6–24 months (OR 2.06; p=0.042), incomplete vaccination status (OR 2.48; p=0.036), and delayed hospital presentation >72 hours (OR 2.84; p=0.028) were identified as significant independent risk factors. Severe anaemia and cerebral malaria were the most frequent severe manifestations, observed in 47.4% and 36.8% of severe cases, respectively. Conclusion: P. falciparum infection, severe malnutrition, high parasite burden, young age, incomplete immunisation, and delayed care-seeking significantly predict severe malaria in children in tertiary care settings. Early identification of these risk factors, combined with prompt antimalarial treatment and nutritional rehabilitation, is imperative to reduce severe malaria-associated paediatric mortality.

Background: To ensure the patient's comfort and the success of the procedure, sedation is necessary during a colonoscopy. Despite its widespread use, propofol can cause dose-dependent respiratory depression and hypotension, despite its fast onset and recovery. There is new hope for an alternative with a perhaps better safety profile: rimmazole, an ultra-short-acting benzodiazepine. In this study, the objective was to examine the PK-PD profiles of propofol and remimazolam in individuals who were due to have colonoscopies. Methods: This prospective comparison study involved 40 patients designated for elective colonoscopy at a tertiary care facility. Patients were randomly assigned to two groups: Group R (n = 20) was administered remimazolam, while Group P (n = 20) was administered propofol for procedural sedation. Sequential blood samples were obtained to ascertain plasma drug concentrations, and sedation depth was evaluated utilizing the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale. Pharmacokinetic parameters, including clearance, volume of distribution, and half-life, were computed. The primary outcomes included onset time, recovery time, hemodynamic stability, and adverse events. Pharmacokinetic-pharmacodynamic modeling was conducted utilizing nonlinear mixed-effects modeling. Results: Remimazolam had a markedly reduced context-sensitive half-life (0.75 ± 0.15 h) in contrast to propofol (1.8 ± 0.4 h, p < 0.001). The mean clearance of the remimazolam group (1.15 ± 0.25 L/min) exceeded that of the propofol group (0.85 ± 0.20 L/min, p < 0.01). The duration to achieve sufficient sedation (MOAA/S ≤ 3) was similar between groups (2.5 ± 0.5 min vs 2.0 ± 0.4 min, p > 0.05). Recovery time was significantly shorter in the remimazolam group (8.5 ± 2.0 min) compared to the propofol group (12.0 ± 3.0 min, p < 0.01). Hemodynamic stability was more effectively preserved with remimazolam, with fewer instances of hypotension (10% versus 30%) and respiratory depression (5% versus 25%) in comparison to propofol. Pharmacokinetic-pharmacodynamic modeling revealed a consistent concentration-effect relationship for both agents, with remimazolam exhibiting a broader therapeutic window. Conclusion: Remimazolam is an effective sedative that has a better PK-PD profile than propofol, which means it improves hemodynamic stability, has a faster recovery time, and is safer overall. As a substitute for procedural sedation during colonoscopies, it is both safe and effective.

Introduction hyperthyroidism arise due to immune-mediated inflammation and fibrosis of the orbital tissues, often leading to distressing symptoms and functional limitations. TED manifests with a variety of eye signs, including proptosis, dry eye, upper lid retraction, diminished vision, and ptosis^.[16] These signs can range from mild discomfort to severe vision-threatening complications, making early identification and management essential. While TED is well-recognized, its prevalence and severity can vary significantly across different demographic and clinical groups, including age and gender. Understanding these variations can aid in targeted interventions and optimized care Materials and Methods This was an observational, cross‑sectional study conducted at a tertiary eye care hospital in North India. Patients diagnosed with TED as per the Bartley and Gorman criteria amongst those who presented to the out‑patient department from August 2017 to January 2019 were included in the study. If lid retraction was seen, the presence of laboratory evidence of thyroid dysfunction, exophthalmos, optic nerve dysfunction or extra ocular muscle involvement was considered as TED. In case of no lid retraction in a patient with laboratory evidence of thyroid dysfunction, the presence of exophthalmos, optic nerve involvement or restrictive myopathy was considered as TED.  Results The most common presenting eye sign was diminished vision, observed in 66.7% of hyperthyroid patients, which was found to be statistically significant (p < 0.01). Other frequently reported signs included ptosis (65.6%) and proptosis (58.9%), both of which were also statistically significant. Intraocular pressure was significantly higher in participants with hyperthyroidism compared to the normal reference range. The mean IOP was 19.4 ± 2.8 mmHg, with 28% of participants exhibiting IOP levels above 21 mmHg. This elevation was more pronounced in individuals with longer disease duration (>2 years), suggesting a potential link between chronic hyperthyroidism and elevated IOP. Conclusion Thyroid eye disease affects the majority of thyroid disease patients. The ocular manifestation ranges from mildest to the most severe form. Early diagnosis and intervention can be beneficial in saving sight and globe. Hence a proper referral system between ophthalmologists and physician is mandatory. Also, many thyroid disorders are first time diagnosed form ocular manifestations so a regular health check-up including eye check-up is needed to pick the cases in early stage and referred among each other for better treatment outcome.

Cardio-metabolic risk factors and anemia represent significant public health challenges, particularly among postmenopausal women, who are more vulnerable to these conditions due to various physiological and metabolic changes associated with menopause. The postmenopausal period is marked by a decline in estrogen production, which plays a critical role in regulating lipid metabolism, glucose homeostasis, and antioxidant defense mechanisms. Postmenopausal women are at a heightened risk for cardio-metabolic disorders and anaemia due to hormonal shifts and oxidative stress. This study evaluates the relationship between antioxidant status, cardio-metabolic risk factors, and anaemia in a cohort of postmenopausal Indian women. Material and Methods A cross-sectional study was conducted between 2022 and 2024, involving 120 postmenopausal women aged 45–70 years. Participants were recruited from urban and rural settings in India, ensuring diverse socio-demographic representation. Anthropometric Measurements: Height, weight, BMI, waist-hip ratio (WHR). Blood Samples: Venous blood was collected for analysis of hemoglobin, lipid profiles, fasting glucose, ferritin, and total antioxidant capacity. Blood Pressure and Heart Rate: Recorded using a digital sphygmomanometer. Descriptive statistics were used to summarize participant characteristics. Results The mean age of the participants was 57.6 ± 6.8 years, with a range of 50 to 69 years. The average BMI was 27.8 ± 5.4 kg/m², indicating that a significant proportion of participants were overweight or obese. Participants were stratified into two groups based on their antioxidant levels (high vs. low). Hemoglobin levels were significantly lower in the group with low antioxidant status (mean Hb: 11.3 ± 1.2 g/dL) compared to the high antioxidant group (mean Hb: 12.8 ± 1.4 g/dL, p < 0.05). Table 2 details the comparison of antioxidant and anemia markers. Conclusion Improved antioxidant status is associated with reduced anaemia prevalence and enhanced cardio-metabolic profiles in postmenopausal women. Targeted interventions focusing on diet, lifestyle, and supplementation offer promising strategies for mitigating these health risks.

Introduction: This research article explores the clinico-etiological profile of acute undifferentiated fever in children between the ages of 6 months and 15 years. Acute undifferentiated fever, defined as a sudden onset of fever without a clear underlying cause, is a common pediatric presentation that poses diagnostic challenges. This study aims to provide a comprehensive understanding of the potential etiologies and clinical characteristics associated with this condition in the targeted age group. Methods: This was a prospective, observational study conducted at a tertiary care pediatric hospital over a 12-month period. Children between the ages of 6 months and 15 years presenting with acute undifferentiated fever, defined as a temperature of 38°C or higher lasting less than 14 days without a clear source of infection, were enrolled in the study. A detailed clinical history, physical examination, and laboratory investigations, including complete blood count, inflammatory markers, and relevant microbiological tests, were performed to identify the underlying cause of the fever Results: The findings of this study highlight the diverse etiological spectrum of acute undifferentiated fever in children, with viral infections being the most common cause. This aligns with previous research, which has also identified viral illnesses as a leading contributor to AUF in the pediatric population. The study also underscores the importance of a comprehensive diagnostic approach, as the initial presentation of AUF can be non-specific and challenging to differentiate. The combination of clinical history, physical examination, and targeted laboratory investigations played a crucial role in establishing the underlying etiology and guiding appropriate management strategies. Conlusion: This study provides valuable insights into the clinico-etiological profile of acute undifferentiated fever in children, highlighting the diverse range of underlying causes and the importance of a structured diagnostic approach. The findings underscore the need for healthcare professionals to maintain a comprehensive understanding of the epidemiology, clinical features, and management strategies for AUF in the pediatric population.

PUBS is an uncommon condition with purple discoloration of the urine catheter system. This phenomenon is due to the presence of indigo and indirubin in the collected urine. PUBS was first published in 19784. Some academics would argue that PUBS was reported even earlier historically as an observation in Sir Henry Halford's bulletin in 18115-6. Two recent literature reviews suggested the prevalence of PUBS is as high as 9.8% in institutionalized patients with long-term urinary catheterisation

So what happens to a patient who is not on CPA? We are informed that such patients should still be open to secondary mental health services, should continue to receive clinical support, that reviews should take place regularly, and a social assessment should be available under the new guidance to local authorities FACS (Fair Access to Care Services), readily available on the Internet. The truth of the matter is that only those patients on enhanced CPA will receive immediate support, the rest will have to jump through the usual hurdles to prove they have a severe, enduring mental illness (enduring is not enough) in order to gain access to NHS ‘support’ facilities. Some patients are seen as more deserving than others, for example, those admitted to hospital under the Mental Health Act (voluntary admission may count against you), current or potential risk (theoretically, any patient with a mental health disorder, which seems to defeat the purpose of the exercise) or the presence of a dual diagnosis (depression with alcoholism, or is it the other way round?). Anyway, if in doubt, the patient is entitled to a formal reassessment CPA and may be admitted to the ‘new’ CPA list. If all fails, the patient (remember, one with severe, enduring mental health symptoms) may make a complaint to the local authority or even hire a lawyer.

Delayed hepatic artery thrombosis (HAT) is a rare complication of orthotopic liver transplantion (OLT) that may present with biliary sepsis or remain asymptomatic. Sonography is extremely sensitive for the detection of HAT in symptomatic patients during the immediate postoperative period. Magnetic resonance angiography (MRA) is a useful adjunct in patients with indeterminate ultrasound exams, those who have renal insufficiency or an allergy to iodinated contrast. In the absence of hepatic failure, conservative treatment appears to be effective for patients with HAT. Whole-graft orthotopic liver transplantation (OLT), Roux-en-Y biliary reconstruction, cold ischaemia and operative times, the use of blood and plasma, and the use of aortic conduits in arterial reconstruction are all risk factors associated with HAT. We present a patient with a case of delayed HAT three years after liver transplantation who presented with mild symptoms and was later found to have a massive hepatic abscess and significant necrosiswith positive cultures forClostridium perfringens. There was evidence of complete occlusion of the hepatic artery 2 cm from its origin.