Background: Gallstone disease is a frequent cause of surgical consultation, and the operative complexity of cholecystectomy varies according to inflammatory, anatomical, and stone-related factors. Objectives: To describe demographic and clinical patterns, ultrasonographic characteristics, intraoperative findings, and factors associated with difficult cholecystectomy. Methods: This hospital-based prospective observational study included 100 consecutive adults undergoing cholecystectomy at Government Medical College, Srikakulam, Andhra Pradesh, India, from June to September 2023. Clinical findings, ultrasonography, operative details, postoperative outcomes, and histopathology were recorded. Patients were categorized into difficult and uncomplicated cholecystectomy groups. Categorical variables were compared using the chi-square or Fisher’s exact test, and continuous variables using the independent-samples t-test. Results: The mean age was 44.8 ± 12.6 years; 64.0% were women, and 70.0% were overweight or obese. Right upper abdominal pain occurred in 88.0%, and multiple gallstones were detected in 62.0%. Laparoscopic cholecystectomy was completed in 94.0%, while 6.0% required conversion. Difficult cholecystectomy occurred in 28.0%. Male sex, age above 50 years, body mass index ≥25 kg/m², previous acute cholecystitis, gallbladder wall thickness >4 mm, contracted gallbladder, and impacted neck or Hartmann’s pouch stone were significantly associated with operative difficulty. Difficult procedures had longer operative duration, greater blood loss, more complications, and prolonged hospitalization. Conclusion: Middle-aged women constituted the predominant group undergoing cholecystectomy. Previous inflammation and adverse ultrasonographic features were strong indicators of operative difficulty. Structured preoperative assessment can support surgical planning, counselling, and timely use of safe operative strategies.

Background: Renal cell carcinoma (RCC) is the most common primary malignancy of the kidney and exhibits considerable heterogeneity in presentation, pathological characteristics, and outcomes. Identification of prognostic factors remains important for risk stratification and clinical decision-making. Objectives: To evaluate the clinicopathological characteristics of RCC and identify factors associated with mortality in patients undergoing surgical management. Methods: A retrospective case series was conducted involving 18 patients with histopathologically confirmed RCC managed surgically at a tertiary care centre. Demographic, clinical, haematological, biochemical, radiological, pathological, and outcome-related variables were analysed. Fisher's exact test and Mann–Whitney U test were used to evaluate associations with mortality. Results: The mean age at presentation was 55.7 years (range 35–90 years). Males constituted 61.1% of the cohort. Clear-cell RCC was the predominant histological subtype (77.8%). Advanced pathological stage (T3–T4) demonstrated a significant association with mortality (p = 0.013). All mortality events occurred among patients with advanced-stage disease. Baseline serum creatinine was significantly higher among non-survivors than survivors (1.32 vs 0.97 mg/dL, p = 0.024). Patients with T3–T4 disease also demonstrated significantly higher baseline serum creatinine levels than those with T1–T2 tumours (1.24 vs 0.89 mg/dL, p = 0.036). Higher Fuhrman grades and lymph node positivity demonstrated increased mortality rates but did not reach statistical significance. Conclusion: Advanced pathological stage was significantly associated with mortality. Elevated preoperative serum creatinine demonstrated significant associations with both advanced disease and mortality, suggesting its potential utility as a readily available preoperative prognostic marker. Higher Fuhrman grade and lymph node involvement showed clinically important adverse prognostic trends.

Background: Solitary thyroid nodules (STNs) frequently occur in clinical practice, with a minor yet notable percentage containing malignancy. Timely detection of malignant thyroid neoplasms is essential for effective management and enhanced prognosis. This study sought to assess the clinical, cytological, and histological features of malignant thyroid tumors manifesting as solitary nodules in a tertiary referral center.Methods: This prospective observational study comprised 40 individuals with clinically confirmed solitary thyroid nodules at a tertiary referral center. All patients received comprehensive clinical assessment, thyroid function evaluations, ultrasonography, and fine-needle aspiration cytology. Patients had suitable surgical intervention based on the findings. Histopathological examination (HPE) of excised specimens was regarded as the definitive standard. A statistical analysis was conducted to ascertain the incidence and diagnostic precision.Results: Among the 40 patients, 12 (30%) were diagnosed with malignant thyroid tumors based on histological analysis. The majority of patients were aged 31 to 50 years (55%), exhibiting a significant female predominance (female:male ratio = 3:1). The predominant malignancy was papillary carcinoma (75%, n = 9), succeeded by follicular carcinoma (16.7%, n = 2) and medullary carcinoma (8.3%, n = 1). FNAC had a sensitivity of 91.7%, specificity of 85.7%, and an overall diagnostic accuracy of 87.5% in identifying cancer. Ultrasonographic characteristics, including hypoechogenicity (83.3%), microcalcifications (66.7%), and uneven margins (75%), demonstrated a significant correlation with malignant lesions.Conclusion: A malignancy was detected in a notable percentage (30%) of single thyroid nodules. FNAC is a highly sensitive and dependable preliminary diagnostic instrument, however histopathology is considered the gold standard. Timely identification coupled with suitable surgical intervention is crucial for enhancing patient outcomes.

Introduction: Arteriovenous fistula (AVF) remains the preferred vascular access for haemodialysis in end-stage renal disease (ESRD) patients; however, complications significantly affect its longevity and patient outcomes. Objective: To evaluate the spectrum and predictors of complications following AVF creation in ESRD patients over a two-year period. Methods: This observational study included 2000 ESRD patients undergoing AVF creation between 2021 and 2022. Patients were categorized into radiocephalic (RC) and brachiocephalic (BC) AVFs. Early (<48 hours) and late complications were recorded, including infection, bleeding, rupture, thrombosis, stenosis, and aneurysm formation. Hepatitis C virus (HCV) status was also analyzed. Results: BC AVFs demonstrated higher early complication rates, particularly rupture, bleeding, and infection within 48 hours. RC AVFs showed infection as the most frequent complication. Thrombosis and stenosis were observed in both groups, contributing to access failure. Notably, 50% of HCV-positive patients developed AVF aneurysms. Conclusion: AVF complications vary based on fistula type and patient factors. Early complications are more common in BC AVFs, whereas infections predominate in RC AVFs. HCV infection significantly increases aneurysm risk. Timely surveillance and patient selection are essential to improve AVF outcomes.

Introduction: Late-life depression frequently coexists with cognitive impairment, and hypovitaminosis D has been implicated in both conditions. We examined the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and cognition among older adults with major depressive disorder (MDD). Materials and Methods: Cross-sectional study at a tertiary-care geriatric psychiatry clinic. Consecutive patients aged ≥60 years with DSM-5 MDD were enrolled. Exclusions: dementia diagnosis, delirium, severe neurological disease, current high-dose vitamin D, or malabsorption. Depression severity was measured by GDS-15; cognition by MoCA-Basic; disability by WHODAS-12. Fasting 25(OH)D was quantified (LC–MS/MS). Vitamin D status: deficient <20 ng/mL, insufficient 20–29 ng/mL, sufficient ≥30 ng/mL. Multivariable linear and logistic regressions assessed associations between 25(OH)D and cognitive outcomes adjusting for age, sex, education, BMI, comorbidity, antidepressant use, physical activity, and season. Results: N=220 (mean age 68.8±6.3 y; 58% women). Vitamin D deficiency was present in 41.8%, insufficiency in 33.2%. Mean MoCA-B score was 22.1±3.9; mild cognitive impairment (MCI) threshold (<25) was met by 62.3%. Each 10 ng/mL higher 25(OH)D associated with +1.1 MoCA-B points (β=0.11 per ng/mL; p<0.001) and lower odds of MCI (aOR 0.68, 95% CI 0.52–0.88). Compared with sufficiency, deficiency had lower MoCA-B (−2.3 points, p<0.001) and higher odds of executive dysfunction (Trails-B time ≥1.5 SD; aOR 1.94, 95% CI 1.10–3.45) Conclusion: In geriatric depression, lower 25(OH)D correlates with worse global cognition and executive function independent of confounders. Given mixed trial data, screening and correction of deficiency may be reasonable as part of comprehensive care while prioritizing evidence-based depression and cognitive interventions.

Background: Denture-related oral lesions (DROLs) are common among elderly individuals due to prolonged prosthesis use, poor oral hygiene, systemic factors, and inadequate dental care. Objective: To assess the prevalence and patterns of DROLs among elderly denture wearers based on retrospective clinical records. Methods: A retrospective study of 1,200 elderly patients (≥60 years) attending the prosthodontics department between 2015–2020 was conducted. Demographic data, denture history, and clinical findings of oral mucosal lesions were extracted. Lesions were categorized according to WHO criteria. Statistical analysis included chi-square and logistic regression tests. Results: The prevalence of DROLs was 41.8%. The most common lesions were denture stomatitis (52.4%), traumatic ulcers (26.8%), and angular cheilitis (12.6%). Females exhibited higher prevalence than males (p<0.05). Poor denture hygiene, continuous denture wearing, and prolonged denture use (>10 years) were significantly associated with lesion occurrence. Conclusion: Nearly half of elderly denture wearers presented with oral lesions, emphasizing the need for regular follow-ups, prosthesis replacement, and patient education.

Introduction Early-stage knee osteoarthritis is characterized by joint pain, stiffness, and functional limitations, often without significant radiographic changes. Patients typically present with symptoms such as morning stiffness and difficulty in mobility, particularly stair climbing. Early diagnosis and intervention are crucial to slow disease progression, improve quality of life, and preserve joint function. Objective: To evaluate and compare the efficacy of methotrexate (MTX),  leflunomide (LEF) and combination of methotrexate and Leflunomide in reducing inflammation and improving function in patients with early-stage knee osteoarthritis. Material and Methods:  This randomized, interventional, open-label study was conducted after 15days, 3 months and 6 months. A total of 312 patients with symptomatic early-stage knee OA (Kellgren-Lawrence grade I–II) and clinical signs of inflammation were randomized into three groups. group A patients treated with methotrexate (15 mg/week), group B treated with leflunomide (10–20 mg/day) and group C treated with methotrexate plus leflunomide. The primary outcome was the reduction in pain measured by VAS and WOMAC scores. Secondary outcomes included changes in CRP, ESR, WBC.  Results:  A total of 312 osteoarthritis patients were evaluated, with a higher prevalence in females (55.1%) and the most affected age group being 50–59 years (35.9%). Knee pain was the most common symptom, present in all patients (100%), followed by morning stiffness in 274 patients (87.8%) and difficulty in climbing stairs in 267 (85.6%). Symptom severity increased with higher Kellgren-Lawrence (KL) grades. Among treatment groups, the combination of Methotrexate and Leflunomide (Group C) showed the most significant improvement across all clinical and inflammatory parameters at 6 months: VAS score decreased from 7.6 ± 1.2 to 1.9 ± 0.5 (p < 0.0001), WOMAC score from 63 ± 9 to 18 ± 4 (p < 0.0001), CRP from 12.5 ± 2.6 to 2.9 ± 1.1 mg/L (p < 0.021), and ESR from 39 ± 6 to 12 ± 2 mm/hr (p < 0.021). Monotherapies also showed improvements but were less pronounced. Conclusion: Combination therapy with Methotrexate and Leflunomide significantly outperformed monotherapies in reducing pain, improving joint function, and lowering inflammatory markers, indicating its superior therapeutic potential in early-stage knee osteoarthritis.

ion The increasing prevalence of overweight and obesity among school-aged children has emerged as a critical public health concern worldwide. This study evaluates overweight and obesity in a school-based program by examining key indicators, including Body Mass Index (BMI), body composition, and health-related behavioral patterns. Behavioral data collected from food frequency questionnaires and activity logs highlighted poor dietary habits, characterized by excessive snack and sugary drink consumption and inadequate vegetable intake. Childhood overweight and obesity have become global public health challenges, leading to an increased need for targeted assessment strategies. Schools are considered key venues for implementing programs to address these issues due to their structured environment and access to children. Material and Methods This is Prospective, Randomized and Observational study was conducted in the Department of Physiology, Index Medical College. The study was conducted in both private and government schools of Index city. Adolescents from 1-18 years of age are studying in sixth, seventh, eighth, ninth and Tenth standard was included for the study. The investigator finished data collection of the control group first and then only collected data of the experimental group. Different schools were selected for intervention which was away from the schools in control group to minimise contamination of information. There is one question on sleeping habit, a child who has slept for less than 8 hours during nighttime is at the potential risk of developing obesity. Good sleeping habit was given a score of one, and otherwise, a score of zero was given.Results Intervention Group: The mean BMI is 25.8 and in Control Group: The mean BMI is 26.0 Both the intervention and control groups have similar mean BMI values, with the intervention group being slightly lower (25.8 vs. 26.0). The difference in BMI is quite small (only 0.2), which suggests that, at baseline, the two groups are very similar in terms of BMI. In the intervention group, 60% had good eating habits, 30% had fair habits, and 10% had poor habits. In the control group, the respective percentages were 50%, 35%, and 15%. Intervention group had a baseline blood pressure of 120/80 ± 10 mmHg, while the control group had 122/82 ± 12 mmHg. Physical activity has a coefficient of -0.8, indicating a strong negative association with BMI (increased physical activity reduces BMI). Dietary changes have a coefficient of -0.6, suggesting that dietary improvements also reduce BMI. Socioeconomic status has a coefficient of 0.3, implying a minor positive association with BMI. Conclusion This study found that a school-based intervention including counseling and access to an after school exercise program was feasible for nurses to deliver with high fidelity and acceptable to overweight and obese adolescents, but the majority of adolescents did not participate in the after school exercise program. While such a program delivering weight management counseling to overweight and obese adolescents within the school setting is theoretically appealing and has tremendous public health potential, it was not found to be effective in improving BMI or key obesogenic behaviors. 

Introduction Keratomycosis is a fungal infection of the cornea characterized by the invasion of fungal organisms into the corneal tissue, leading to symptoms like pain, redness, and potential vision loss. It primarily affects the corneal epithelium and stroma. Symptoms include ocular pain, photophobia, tearing, and a decline in visual acuity. Signs observed during slit-lamp examination may reveal corneal infiltrates, epithelial defect, and a distinct ring infiltrate, especially with Fusarium infections. Corneal blindness is the second most important cause of blindness in the world after cataract. In contrast to the visual loss from cataract which affects mainly the older age group, corneal ulceration is encountered in all ages.  Material and Methods A prospective study was conducted in the Department of Microbiology, Index Medical College over a period of 2 Years from January 2022 to July 2024. Patients with suspected fungal corneal ulcers presenting in the Out Patient Department (OPD) of Ophthalmology was investigated for fungal etiology in the Department of Microbiology was included in this study. Patients presenting with corneal ulcer defined as a loss of corneal epithelium with underlying stromal infiltration and suppuration associated with signs of inflammation was included in this study.  Results Fungal infections were prevalent, with Aspergillus spp. (22.4%) and Fusarium spp. (18.8%) as leading pathogens. The presence of Staphylococcus aureus is the most prevalent microorganism in this patient population, accounting for 26.5% of cases. Fusarium spp. and Pseudomonas aeruginosa also show notable percentages, suggesting a diverse range of pathogens. Candida spp. and Acanthamoeba spp. have lower prevalence rates, but their presence is still important to consider in clinical assessments. A majority of patients (65.9%) showed successful resolution, likely reflecting effective antifungal treatment regimens. A smaller group (34 patients) achieved partial resolution, suggesting that while there was some improvement, the outcomes were not fully satisfactory. No improvement was noted in 24 patients, highlighting the need for further investigation into the effectiveness of treatments for this subset. Conclusion Keratomycosis is one of the most difficult of  microbial keratitis for the ophthalmologists to diagnose and treat. The diagnostic work up is tedious and the topical antifungals are not as effective as antibiotics in bacterial keratitis. The treatment is prolonged and is often complicated by secondary glaucoma and medical failure. However, a high index of clinical suspicion and a judicious management approach will go a long way in reducing visual disability.

Background: Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and sometimes life-threatening hypersensitivity mucocutaneous disease triggered mostly by medication and infections. Even after recovering from skin problems without sequelae, survivors can have serious ocular complications leading to blindness despite local and systemic therapy. Early detection and aggressive treatment are important for the long-term prognosis of the eye. Eyelid margin and palpebral conjunctiva and fornix should be checked thoroughly to detect the cicatrical changes that make chronic ocular surface failure such as limbal cell deficiency and complete ocular surface keratinization. Amniotic membrane transplantation and cultivated oral mucosal graft are beneficial to reduce the risk of ocular surface failure. Materials and methods: This is a prospective study conducted in the Department of Dermatology at Tertiary Care Teaching Hospital over a period of 1 year. The data included information on gender, presenting age, causative medications/diseases, and systemic treatments. Regarding disease chronicity, Shanbhag et al. have defined the acute phase as the period between symptom onset of SJS/TEN up to 2 months later; the subacute phase was defined as 2–6 months after symptom onset; and the chronic phase was defined as more than 6 months after symptom onset. Based on clinical parameters, observed on ocular slit-lamp examination, the severity of involvement at the time of presentation was determined as mild, moderate, and severe. Result: A total of 40 patients were included in the study during the study period, of which 19 were males and 21 females. Out of these, 22 were SJS or SJS/TEN overlap and 8 were TEN patients. About 30.0% (12 patients) had mild involvement, 55.0% (22 patients) had moderate involvement, and 15.0% (6 patients) had severe involvement. At the end of the study period, 8 patients (29.6%) developed chronic sequelae of ocular manifestations. Out of these patients, 3 patients developed severe dry eye disease, 2 patients developed trichiasis, 2 patients had a diminution of vision, and 1 patient developed severe photophobia. Patients of SJS and SJS-TEN overlap had mild-to-moderate whereas patients of TEN had moderate to severe ocular manifestations. Conclusion: Stevens-Johnson syndrome and toxic epidermal necrolysis are complex immunological syndrome that can result in devastating complications of ocular surface scarring and keratinization leading to blindness. Early ophthalmic assessment and management as well as regular follow up care are key factors to recovery and prevention of ocular complications.

We plan to study the prevalence of COVID infection in the health care workers working both in COVID and non-COVID facility and also identify source of infection, the demographic pattern, difference in infection rate in health care workers working in COVID facility and non-COVID facility, compliance to use of PPE and following social distancing norms. Material Method: The RT PCR Positive health care workers were interviewed telephonically with informed consent for presence of symptoms, source of infection, method of donning and doffing of PPE while working in COVID and Non COVID facility, social distancing norms followed or not followed. Result: 117 staffs got tested. 40 found positive by RT PCR. The infection rate was more amongst staff working in non-COVID facility (65%) in comparison to COVID facility (22.5%). Infection rate among nursing staff was the highest (40%), followed by doctors (35%), technicians and attendants. Male were more affected than females. 25 staffs reported not wearing appropriate PPE, 16 staffs reported breaching social distancing protocol. Conclusion: Though all health care workers are equally trained during COVID pandemic, there is somehow low adherence to infection prevention practices among the health care workers working in non-COVID facility, thereby increasing the risk to infection. Non COVID facility staffs need to be specifically targeted for training and implementation of infection prevention practices.

Background: PCPNDT Act 1994 is enacted by Parliament of India came into existence to stop female feticide and to maintain sex ratio in India. The act prohibits sex discrimination both before and after conception. Various studies have been done in the past with regards to PCPNDT Act, however the impact of this law on the society is a continuous ongoing process. This study is being conducted to assess the awareness among the general population about PCPNDT Act and to study the impact of it on the attitude of the people regarding sex ratio, after its inception of almost 30 years ago. Methods: An observational, cross-sectional study was conducted at Multispecialty Hospital, Whitefield, Bengaluru South for 4 months period among women of reproductive age group (15-49yrs) visiting obstetrics OPD by using pre-tested semi-structured questionnaire as a study instrument.  Results: Majority of the females included in the study were aged between 21 to 30 years (56.1%) and are graduates accounting for about 50 (37.9%). Though majority had graduate degree, 65.2% were unemployed. Knowledge about the sex ratio were known by 72 (54.5%) and 71 (53.8%) were aware of Act. 67(50.8%) were responded that even in child sex ratio males being higher. 103 (78%) had opined that knowing about the sex ratio is important.  Conclusions: 21(15.9%) believed that foetal sex determination done in India with the primary motive by family members and most of them had idea that it is done at private hospital by foetal USG. None of them had the attitude of terminating their pregnancy even if they know the sex of their foetus and 129 (97.7%) study population were willing to educate people about the PCPNDT Act.

In India, the number of people with diabetes is increasing day-by-day. Due to a sole “Asian Indian Phenotype,” Indians develop diabetes an era earlier and have an earlier onset of complications. Hence, it is essential to evaluate earlier stage of disease progression. Prediabetes, typically defined as blood glucose levels above normal but below the thresholds of diagnosis of diabetes, is a risk state that defines a high chance of developing diabetes. The present study was Prospective, open label, comparative, randomized, parallel group, single center study. Comparison of two active treatment groups over a period of six months. Sixty patients of either sex in the age of more than 40 years with prediabetes, with HbAlc in the range of 5.7 to 6.4% at screening as per ADA. The effect of metformin and pioglitazone were observed on various parameters i.e. Serum Insulin, FBG, HbA1c, HOMA-IR. In metformin group the mean change in HOMA-IR from baseline to 6 months was 3.44 to 2.21 (-1.23); on the other hand, in Pioglitazone group from baseline to 6 months was 3.30 to 1.91 (-1.39). Whereas, serum insulin from 35.58 to 26.73 (-8.85) in metformin group; in Pioglitazone group from 35.13 to 21.77 (-13.36). Pioglitazone statistically highly significant than metformin group in improving glycemic indices. Though metformin and pioglitazone were equally effective in improving glycemic indices yet pioglitazone showed better results in improving Serum Insulin, FBG, HbA1c, HOMA-IR as compared with Metformin. Pioglitazone had minimal side effects as compared to Metformin.