Background: Plate osteosynthesis and locked intramedullary nailing are established operative options for adult humeral shaft fractures. Both provide reliable stabilization, but they differ in surgical exposure, blood loss, fluoroscopy use, shoulder morbidity, and risk to the radial nerve. This study compared radiological healing, functional recovery, perioperative variables, and complications following the two techniques.  Methods: A prospective comparative study was conducted in the Department of Orthopaedics, Kakatiya Medical College, Hanumakonda, from April 2024 to March 2025. One hundred adults with acute humeral shaft fractures requiring operative fixation were enrolled, with 50 treated by open reduction and locking compression plate fixation and 50 by antegrade interlocking intramedullary nailing. Patients were reviewed at 2 weeks, 6 weeks, 3 months, and 6 months. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 6 months. Secondary outcomes included time to radiological union, union rate, Constant-Murley score, Mayo Elbow Performance Score (MEPS), shoulder abduction, operative time, blood loss, fluoroscopy exposure, hospital stay, and postoperative complications. Analysis was performed using IBM SPSS Statistics version 28.0.

Results: Baseline characteristics were comparable between groups. Intramedullary nailing required less operative time (82.6 +/- 15.2 vs 101.8 +/- 17.5 minutes, p < 0.001) and less estimated blood loss (118 +/- 40 vs 189 +/- 52 mL, p < 0.001), but greater fluoroscopy exposure (21.5 +/- 5.6 vs 7.2 +/- 2.0 images, p < 0.001). Mean union time was shorter after plating (16.3 +/- 3.2 vs 17.8 +/- 3.8 weeks, p = 0.038), whereas union by 24 weeks was similar (94% vs 90%, p = 0.461). At 6 months, the plate group had a lower DASH score (8.7 +/- 5.6 vs 13.2 +/- 7.1, p = 0.001), higher Constant-Murley score (88.6 +/- 7.4 vs 81.9 +/- 9.2, p < 0.001), and greater shoulder abduction (154 +/- 15 vs 142 +/- 18 degrees, p < 0.001). Shoulder pain or impingement was more frequent after nailing (18% vs 4%, chi-square = 5.01, p = 0.025). Iatrogenic radial nerve palsy occurred more often after plating, although the difference was not statistically significant (8% vs 2%, p = 0.169). Conclusion: Both techniques produced high union rates. Intramedullary nailing offered shorter surgery and lower blood loss, whereas plate fixation provided earlier radiological union and better shoulder-related function at 6 months. Implant choice should be individualized according to fracture location and morphology, soft-tissue condition, shoulder status, neurological findings, and surgical expertise.

Background: Postoperative nausea and vomiting (PONV) remains a frequent and distressing complication after general anaesthesia. Ondansetron provides rapid 5-hydroxytryptamine-3 receptor blockade, whereas dexamethasone has a slower onset and a longer biological effect. Direct comparisons are therefore clinically relevant, particularly where a single prophylactic agent is selected. The study is designed is to compare the efficacy and safety of intravenous ondansetron and dexamethasone for preventing PONV during the first 24 hours after elective laparoscopic surgery. Methods: This prospective, randomized, double-blind comparative study was conducted at Kakatiya Medical College, Hanumakonda, from April 2024 to March 2025. A total of 160 adults with American Society of Anesthesiologists physical status I or II were allocated to ondansetron 4 mg intravenously near the end of surgery or dexamethasone 8 mg intravenously after induction. Standardized general anaesthesia and postoperative analgesia were used. The primary outcome was any episode of nausea, retching, or vomiting within 24 hours. Secondary outcomes included early and late PONV, rescue antiemetic use, complete response, recovery indices, and adverse events. Data were analysed using IBM SPSS Statistics for Windows, version 28.0. Results: All 160 randomized patients completed follow-up. PONV within 24 hours occurred in 27 of 80 patients (33.8%) receiving ondansetron and 15 of 80 (18.8%) receiving dexamethasone (χ²=4.649, p=0.031; risk ratio 1.80, 95% confidence interval 1.04–3.12). Early PONV during 0–6 hours was comparable between groups (12.5% versus 15.0%; p=0.646), while late PONV during 6–24 hours was less frequent with dexamethasone (26.3% versus 8.8%; χ²=8.485, p=0.004). Rescue antiemetic treatment was required in 25.0% and 12.5% of patients, respectively (p=0.043). Complete response was achieved by 66.3% of the ondansetron group and 81.3% of the dexamethasone group (p=0.031). Transient postoperative hyperglycaemia was more frequent after dexamethasone (2.5% versus 12.5%; Fisher exact p=0.032). Conclusion: A single 8 mg dose of dexamethasone provided better 24-hour prophylaxis than ondansetron 4 mg, mainly through a reduction in late PONV and rescue antiemetic use. Ondansetron retained a similar early antiemetic effect and produced less transient hyperglycaemia. Drug selection should consider the timing of PONV risk and the patient’s metabolic profile.

Background: Surgical-site infection (SSI) remains a frequent complication after abdominal surgery, particularly when emergency presentation, physiological compromise, contamination, and adverse body composition coexist. Conventional preoperative assessment relies mainly on clinical and laboratory variables, although routinely obtained ultrasonography and computed tomography (CT) may provide additional information regarding intra-abdominal contamination and abdominal wall or skeletal-muscle characteristics. The study is designed to identify preoperative clinical, laboratory, and radiological predictors of SSI in adults undergoing abdominal surgery and to assess the discrimination of an integrated prediction model. Methods: Consecutive adults undergoing elective or emergency abdominal surgery were followed for 30 days. Preoperative variables included demographics, diabetes, smoking, American Society of Anesthesiologists (ASA) class, hemoglobin, serum albumin, surgical urgency, intended operative approach, and imaging findings. Subcutaneous fat thickness was measured at the umbilical level on CT or ultrasonography. Formal radiology reports were reviewed for intra-abdominal collection or ascites and extraluminal air. In the CT subgroup, visceral fat area and psoas-muscle attenuation were recorded at L3. SSI was classified using Centers for Disease Control and Prevention criteria.  Results: Among 260 participants, 49 developed SSI, giving a 30-day incidence of 18.8%. SSI was more frequent in patients with diabetes (32.4% versus 13.4%; chi-square = 12.48, p < 0.001), ASA class III-IV (34.3% versus 13.5%; chi-square = 14.15, p < 0.001), hypoalbuminemia (29.1% versus 9.0%; chi-square = 17.18, p < 0.001), emergency surgery (33.0% versus 9.1%; chi-square = 23.50, p < 0.001), preoperative collection or ascites (36.1% versus 13.6%; chi-square = 15.45, p < 0.001), and extraluminal air (44.8% versus 15.6%; chi-square = 14.41, p < 0.001). In the adjusted model, diabetes, ASA class III-IV, albumin below 3.5 g/dL, emergency surgery, and extraluminal air remained significant. Model discrimination was good (area under the receiver-operating-characteristic curve = 0.839). Conclusion: A compact preoperative model combining metabolic status, physiological reserve, serum albumin, urgency, and radiological evidence of contamination identified patients at increased SSI risk. Radiology should not replace clinical assessment, but structured extraction of imaging findings may strengthen perioperative risk stratification and support targeted preventive measures.

Background: Total knee replacement (TKR) is an effective surgical procedure for end-stage knee osteoarthritis. Diabetes mellitus is a common comorbidity among patients undergoing TKR and may influence postoperative recovery, functional outcomes, and complication rates. The present study was conducted to compare the clinical outcomes of diabetic and non-diabetic patients undergoing total knee replacement. Aim: To compare the clinical outcomes of diabetic and non-diabetic patients undergoing total knee replacement. Methods: A hospital-based comparative observational study was conducted among 120 patients undergoing primary total knee replacement. Patients were divided into two groups: diabetic (n=60) and non-diabetic (n=60). Baseline demographic and clinical characteristics were recorded. Functional outcomes were assessed using the Knee Society Score (KSS), WOMAC score, pain assessment by Visual Analogue Scale (VAS), range of motion, and rehabilitation parameters. Postoperative complications and duration of hospital stay were also evaluated. Statistical analysis was performed using Student’s t-test, Chi-square test, and Fisher’s exact test, with p<0.05 considered statistically significant. Results: The mean age of the study population was 62.3 ± 7.9 years. Baseline characteristics were comparable between the groups except for a significantly higher prevalence of hypertension among diabetic patients (60.0% vs. 41.7%, p=0.044). At six months, non-diabetic patients demonstrated significantly better functional outcomes with higher KSS scores (85.6 ± 8.3 vs. 79.8 ± 9.6, p=0.001) and lower WOMAC scores (26.8 ± 7.6 vs. 32.1 ± 9.1, p=0.001). Diabetic patients had significantly higher rates of superficial wound infection (16.7% vs. 5.0%, p=0.040), knee stiffness (18.3% vs. 6.7%, p=0.047), and overall postoperative complications (38.3% vs. 15.0%, p=0.004). They also experienced poorer pain relief, reduced range of motion, delayed ambulation, prolonged hosital stay, and delayed rehabilitation compared to non-diabetic patients. Conclusion: Diabetes mellitus is associated with poorer functional recovery, increased postoperative complications, slower rehabilitation, and longer hospitalization following total knee replacement. Optimizing diabetic control and implementing comprehensive perioperative care may improve outcomes in diabetic patients undergoing TKR.

Introduction:Chronic plaque psoriasis is a prevalent, immune-mediated inflammatory dermatological condition marked by erythematous, scaly plaques that considerably affect quality of life. Topical corticosteroids are essential in the treatment of mild to moderate psoriasis because of their anti-inflammatory, immunosuppressive, and antiproliferative properties. This study sought to assess the effectiveness and safety of topical corticosteroids in individuals with persistent plaque psoriasis.Methods: A randomized clinical trial was performed on 50 patients diagnosed with persistent plaque psoriasis. Patients were randomly assigned to two groups: Group A (n=25) was administered a high-potency topical corticosteroid (clobetasol propionate 0.05%), whereas Group B (n=25) received a medium-potency corticosteroid (betamethasone valerate 0.1%). The treatment was administered bi-daily for a duration of 8 weeks. The efficacy was evaluated utilizing the Psoriasis Area and Severity Index (PASI) score at baseline, 4 weeks, and 8 weeks. The safety assessment encompassed surveillance for undesirable effects including skin shrinkage, itching, and telangiectasia. Statistical analysis was conducted utilizing suitable methods, with p < 0.05 being significant.Results: The average baseline PASI scores were similar between Group A (12.8 ± 3.2) and Group B (12.5 ± 3.0) (p > 0.05). At 8 weeks, a notable decrease in PASI score was recorded in both groups; however, Group A exhibited a more pronounced drop (3.1 ± 1.2) than Group B (5.4 ± 1.6) (p < 0.001). A PASI-75 response was attained in 18 (72%) patients in Group A and 12 (48%) in Group B. Adverse effects were minor, comprising skin irritation in 4 (16%) patients in Group A and 3 (12%) in Group B, whereas skin atrophy was noted in 2 (8%) patients only in Group A.Conclusion: Topical corticosteroids are efficacious and typically safe for the treatment of persistent plaque psoriasis. Potent corticosteroids had greater efficiency than moderate-potency drugs, however they were linked to a marginally increased occurrence of local side effects. Meticulous oversight and suitable therapy duration are crucial for enhancing outcomes and reducing hazards.

Introduction: Spinal anesthesia with hyperbaric bupivacaine is widely used for lower abdominal, gynecological, perineal, and lower limb surgeries due to its reliable sensory and motor block. However, its limited postoperative analgesic duration necessitates exploring adjuvants. Intrathecal neostigmine may prolong analgesia and reduce the need for rescue analgesics. This study compared the safety, efficacy, and adverse effect profile of intrathecal neostigmine with hyperbaric bupivacaine versus hyperbaric bupivacaine alone to improve postoperative pain management. Methods: A prospective observational study was conducted on 60 patients undergoing major lower Abdominal, Gynecological, Perineal, and Lower Limb surgeries under spinal anesthesia at Mahatma Gandhi Memorial Hospital, Warangal, and Government Maternity Hospital, Hanumakonda, over 24 months. Ethical clearance was obtained from the Institutional Ethical Committee. Results: There were no significant differences between groups in demographics, ASA status, or surgery duration. Group N (neostigmine) demonstrated a significantly faster onset of sensory and motor blocks (p = 0.005), longer sensory dermatome regression times, and significantly prolonged sensory and motor block duration compared to group B (bupivacaine) (p = 0.0001). Absolute analgesia was much longer with group N (p = 0.0001). Group N had always had the lowest mean VAS scores, which implied better pain control. Group B needed to receive more rescue analgesics and sooner than group N (p = 0.02). Group N had more adverse effects, with 27% nausea/vomiting compared to 3% in Group B, and hypotension was found in 3.3% and 10% in Group N and Group B, respectively. No significant complications were identified. Conclusion: Intrathecal neostigmine was found to provide a quicker block onset, longer analgesia, superior analgesia control, and lower analgesic requirements, but with increased mild adverse effects. It has been proven to have a better postoperative analgesic effect than hyperbaric bupivacaine.

Introduction: Sedation is a cornerstone of intensive care unit (ICU) management, with propofol and dexmedetomidine being the most widely used agents. Propofol is a γ-aminobutyric acid (GABA) receptor agonist with rapid onset and offset, making it a preferred agent for short-term sedation. However, propofol can cause dose-dependent hypotension, hypertriglyceridemia, and rarely, the potentially fatal propofol infusion syndrome. Dexmedetomidine, on the other hand, is a selective α2-adrenergic receptor agonist with sedative, anxiolytic, and analgesic-sparing properties. While short-term effects on haemodynamics and recovery are well-documented, evidence regarding long-term cognitive and cardiovascular outcomes remains limited. Materials and Methods: This prospective, randomized controlled study included 200 critically ill patients requiring mechanical ventilation for >48 hours. Patients were randomized to receive either dexmedetomidine or propofol infusion for sedation. Primary outcomes were long-term cognitive function (assessed at 3 months and 6 months using Montreal Cognitive Assessment [MoCA]) and cardiovascular outcomes (incidence of arrhythmias, myocardial infarction, new-onset hypertension or hypotension). Secondary outcomes included ICU stay duration, delirium incidence, and 90-day mortality. Results: Both groups maintained similar sedation depth (RASS –1.4 vs –1.5). Delirium incidence was significantly lower with Dexmedetomidine (19%) than Propofol (34%, p=0.018). At 3 and 6 months, MoCA scores were higher in the Dexmedetomidine group (26.8 and 27.1) compared to Propofol (24.9 and 25.2), both highly significant (p<0.001). Cognitive decline was seen in only 12% with Dexmedetomidine versus 31% with Propofol (p=0.002). Dexmedetomidine had fewer hypotension (23% vs. 39%) and tachyarrhythmias (7% vs. 19%), both significant. However, it caused more bradycardia (21% vs. 9%, p=0.018). Delirium during ICU stay (OR 2.95, p=0.001). Prolonged mechanical ventilation >7 days (OR 2.41, p=0.011). Propofol sedation itself was an independent risk factor (OR 1.98, p=0.034). Age >65 and higher APACHE II scores were not statistically significant. Conclusion: Dexmedetomidine provides superior long-term cognitive protection and a favourable cardiovascular profile compared with propofol in mechanically ventilated ICU patients. These findings suggest dexmedetomidine may be the preferred agent for prolonged ICU sedation, though individualised patient factors must guide choice.

Introduction: The paravertebral block (PVB) has been used with success, both as anaesthetic and analgesic techniques, for inguinal herniorrhaphy. PVB provides an analgesia equivalent to extensive peripheral nerve block for inguinal herniorrhaphy, offering an alternative method of postoperative pain management with fewer adverse events. PVB has been found to be more advantageous than conventional spinal anaesthesia for inguinal hernia repair, in terms of early ambulation and better postoperative pain scores. Materials and Methods: The study was an experimental double blinded randomized controlled study. After obtaining Institutional ethics committee’s approval 60 male patients of age group 18 to 65 years with ASA physical status 1 and 2 scheduled for elective unilateral hernia repair were selected for study. The patients were explained about the procedure and its complications, VAS scoring during the pre-operative examination. Result: The two groups were statistically comparable with respect to age, weight, preoperative vital parameters, SBP, DBP, SPO2. Intra operatively incidence of hypotension and use of vasopressor was high in group S, 25 patients (50%) as compared to no such incidence in group P. Total consumption of propofol was higher in group P compared to group S ( p < 0.001). The VAS score was highest at 6 hours for group P (p < 0.001) and 4 hours for group S (p 4 and repeated every 15 min until pain was relieved (VAS < 3).  Conclusion: To conclude Paravertebral block can be used as an alternative to spinal anaesthesia in unilateral inguinal hernia repair.

Background: Hip fractures are increasing globally, with the Asian population projected to contribute over 50% by 2050. Unstable intertrochanteric (IT) fractures in elderly and young adults are associated with high morbidity. Dynamic hip screw systems are often inadequate for such cases, necessitating alternative fixation techniques like proximal femoral nailing (PFN). Aim: To evaluate the functional outcome of unstable intertrochanteric fractures in young adults and elderly patients treated with PFN. Methods: A prospective analytical observational study was conducted at KIMS General Hospital, Amalapuram, from February 2022 to August 2024. A total of 121 patients with AO/ASIF A2 and A3 type unstable IT fractures were included. Patients underwent closed reduction and internal fixation using short or long PFN systems. Standard surgical techniques and postoperative protocols were followed. Functional outcomes were assessed at 6 months using the Modified Harris Hip Score. Data analysis was performed using SPSS v25; p-values <0.05 were considered significant. Results: Of 121 patients, 68 were male and 53 female (mean age 67.92 years). A2 fractures accounted for 87 cases and A3 for 34. Short PFN was used in 88 patients; long PFN in 33. Union occurred by 10–12 weeks in 59 patients and 16–20 weeks in 62. Functional outcomes were excellent in 61.15%, good in 28.92%, satisfactory in 4.90%, and poor in 4.90%. The reoperation rate was 4.13% and overall complication rate was 9.91%. Conclusion: PFN provides a reliable and biomechanically superior option for managing unstable IT fractures, with good functional outcomes and low complication rates when applied with surgical precision

Introduction: The process of ageing affects the skin in multiple ways. The effects of skin ageing, both internal and external have the potential to produce significant morbidity. Most of the geriatric population have atleast one skin disorder, and many have two or more. The aim of our study was to evaluate the prevalence and pattern of physiological and pathological skin changes in geriatric population. Materials and Methods: Two hundred patients above the age of 60 years, attending Dermatology OPD at a Teritiary Hospital located in south India were enrolled in the study. A detailed clinical history including demographic details, family history, drug history, previous history of skin diseases, were recorded in a proforma after obtaining informed consent from each individual patient. A detailed physical examination and dermatological examination was done and findings recorded. Relevant investigations like complete haemogram, diabetic profile, KOH mount, culture & sensitivity, wood s lamp examination, biopsy and immunofluorescence was done when indicated. Results: In our study, we included two hundred patients above the age of 60 years. The male to female ratio was 1.38 : 1. All patients had one or more physiological and degenerative skin changes, the commonest was wrinkling present in 140 (70%) patients followed by xerosis in 135(67.5%) and idiopathic guttate hypomelanosis in 62 (31%) patients. Among the Benign tumors, the most common was seborrheic keratosis seen in 55(27.5%) patients. Infections and infestations were seen in 81(40.5%) patients and 65(32.5%) patients had eczema. Conclusion: Dermatological disorders in geriatric population are very common. Recognition and management of these conditions is important in improving the quality of life and avoiding serious adverse effects in elderly patients.

Background: Acute appendicitis in older adults presents unique clinical challenges. Atypical symptoms and age-related physiological changes frequently contribute to delayed diagnosis and increased complication rates, including perforation and sepsis. Objectives: To synthesize contemporary literature on the clinical presentation, diagnostic strategies, and management of acute appendicitis in geriatric patients, providing evidence-based recommendations to improve clinical outcomes. Methods: This was a prospective observational study conducted in the Department of General Surgery at Meenakshi Medical College, Kanchipuram, Tamil Nadu, India, over a period of 18 months from January 2023 to June 2024. The study was approved by the Institutional Ethics Committee. The study included elderly patients aged ≥60 years who were diagnosed with acute appendicitis either clinically or radiologically and underwent surgical or conservative management.  Results: Presentation: Only 25-40% of elderly patients exhibit classic signs; many experience vague discomfort, confusion, or decline in function. Diagnosis: Laboratory markers (e.g., leukocytosis, CRP) are less predictive; normal values are common. Contrast-enhanced CT offers >95% sensitivity and specificity. Intervention: Laparoscopic appendectomy is favored for its reduced wound infections, quicker ambulation, and lower pain scores compared to open surgery. Medical Management: Antibiotic therapy alone may be an option in high-risk cases but is associated with a recurrence rate of ~30% within a year. Outcomes: Mortality rates in elderly appendicitis patients are 4-8 times higher than in younger individuals. Early mobilization, optimised pulmonary function, and delirium prevention are crucial. Conclusion: A high index of suspicion, early use of advanced imaging, laparoscopic intervention, and integrated geriatric care pathways are central to reducing morbidity and mortality from appendicitis in older adults.

Background: Gastrointestinal perforation leading to peritonitis represents a life-threatening condition requiring immediate surgical intervention. In elderly patients, this emergency is compounded by delayed presentations, physiological deterioration, and comorbid conditions, which contribute to poor surgical outcomes. This study evaluates the clinical presentation, surgical management, and postoperative outcomes of elderly patients presenting with gastrointestinal perforation peritonitis. Methods: This prospective observational study included 280 patients who underwent emergency laparotomy for gastrointestinal perforation between July 2024 and June 2025 at a tertiary care center in South India. Of these, 65 patients aged 60 years and above formed the elderly subgroup. Data collected included demographic profiles, comorbidities, etiology and site of perforation, operative findings, complications, ICU requirement, length of stay, and mortality. Outcomes were statistically compared between elderly and non-elderly groups. Results: Elderly patients constituted 23.21% of the study cohort. The predominant perforation sites were duodenum (32.3%) and ileum (29.2%). Common etiologies included acid peptic disease and typhoid. Comorbidities were seen in 86.15% of elderly patients, with diabetes and hypertension being the most frequent. Elderly patients had significantly higher rates of postoperative complications—particularly respiratory issues (40%) and surgical site infections (35.38%). ICU admissions were needed in 26.1% of elderly cases. The mortality rate among the elderly (13.84%) was significantly higher compared to the younger population (5.55%). Conclusion: Elderly patients with gastrointestinal perforation peritonitis require specialized perioperative management due to higher morbidity and mortality. Prompt diagnosis, aggressive resuscitation, and careful surgical planning are essential to improve outcomes in this vulnerable group.

Introduction: The manifestation of B-cell neoplasms and neuroendocrine tumours (NETs) within the anatomical precincts of the female genital tract remains an oncological rarity, demanding astute diagnostic rigour and an integrative therapeutic arsenal. This study aims to meticulously catalogue and decipher the clinical, histomorphological, and therapeutic characteristics of B-cell neoplasms and NETs arising in gynaecologic organs. Over a 3-year period, 200 patients were analysed. Immunohistochemistry, imaging, FIGO staging, surgical pathology, and outcomes were studied. Materials and methods: This retrospective study was conducted in the Department of Gynaecology, encompassing 200 women diagnosed between 2019 and 2022. Inclusion required histologically confirmed B-cell lymphoma or NET of any female reproductive organ. Data included clinical history, imaging, FIGO stage, immunohistochemistry, treatment, and follow-up. Results: Of the 200 patients, 89 had B-cell lymphomas and 111 had NETs. Ovarian involvement predominated. DLBCL was the commonest lymphoma; cervical NEC the commonest NET. Radical surgeries were undertaken in 63% of NETs. Immunohistochemistry showed high expression of CD20 in lymphomas, and chromogranin A and synaptophysin in NETs. The overall 3-year survival rate was 66.8%. High Ki-67 index and incomplete resections correlated with poor outcome. Conclusion: The rarified landscape of gynaecologic B-cell lymphomas and NETs demands astute morphological suspicion and therapeutic integration. Multimodal management, including immunohistochemistry and aggressive surgery, improves outcomes.

Introduction Gestational trophoblastic neoplasia (GTN), a pathological conglomerate emanating from dysregulated trophoblastic proliferation post-conception, encompasses a spectrum ranging from hydatidiform moles to aggressive neoplasms such as choriocarcinoma, PSTT, and ETT. These entities exhibit formidable metastatic proclivities—especially to Pulmonary, cerebral, and hepatic parenchyma—and display a disconcerting dichotomy between chemosensitivity and pharmacological defiance. This study undertakes a deep morphological, immunohistochemical, and clinical appraisal of GTN through the prism of retrospective oncogynaecological analytics. Aims & Objectives This investigation seeks to (i) delineate the histopathological heterogeneity of GTN in 100 cases (ii) correlate immunohistochemical markers with clinicopathological behavior  (iii) evaluate patterns of metastasis and their prognostic valence, (iv) identify predictors of chemoresistance using multivariate analytics  (v) assess β-hCG kinetics in therapeutic surveillance  (vi) construct a multimodal prognostic schema for individualized therapy. Materials and Methodology:  A retrospective observational analysis was conducted on 100 histologically and immunohistochemically confirmed GTN cases (2021–2024) from a tertiary oncogynaecological institute in Eastern India. Inclusion criteria necessitated availability of tissue blocks, complete serum β-hCG profiles, and therapeutic follow-up. Histopathological grading was done under microscopy which was accentuated with digital pathology. Immunohistochemical panels comprised β-hCG, CK18, p63, Ki-67, and hPL. Statistical inferences utilized logistic regression, Cox proportional hazards, and ROC curve modeling to interrogate chemoresistance and survival endpoints. Results:  Choriocarcinoma emerged as the predominant histotype (41%), followed by invasive mole (27%), PSTT (18%), ETT (8%), and mixed elements (6%). Pulmonary metastasis was the most frequent (n=62), with cerebral and hepatic metastases signifying poorer outcomes. Ki-67 >75% and mitotic rates >10/10 HPF were independently associated with chemoresistance (OR: 3.84; p<0.001). β-hCG thresholds >289,000 mIU/mL predicted EMA-CO failure with 81% sensitivity, although β-hCG lacked statistical independence in survival modeling. EMA-CO resistance occurred in 23% of cases, and salvage therapy yielded limited remissions. PSTT and ETT exhibited unique resistance phenotypes with low mitotic indices and hormonal silence. Conclusion:  GTN embodies an ontological paradox: neoplasms of gestational lineage yet capable of malignant entropy. This study underscores the inadequacy of monomarker paradigms and the necessity for a nuanced, histo-temporal, immunophenotypic, and anatomical framework in the prognostication and management of GTN. A recalibration of therapeutic algorithms toward individualized, multidimensional profiling is imperative to navigate the refractory and metastatic labyrinths of this protean pathology.

Background: One of the most common musculoskeletal ailments in the world is low backache. One important diagnostic technique for assessing spinal disorders is magnetic resonance imaging, or MRI. The purpose of this study is to evaluate MRI results in individuals who come with mild back pain and identify any anomalies. Objectives: To evaluate the MRI findings in patients with low backache and correlate the imaging findings with demographic and clinical characteristics. Materials and Methods: A cross-sectional observational study was conducted over 18 months at a tertiary care hospital. A total of 160 patients aged 18–70 years with clinically significant low back pain underwent MRI of the lumbosacral spine. Data regarding age, sex, symptom duration, and MRI abnormalities were recorded and analyzed. Results: The mean age of the participants was 44.5 ± 11.2 years. The most common age group affected was 41–60 years (47.5%). Male-to-female ratio was 1.2:1. MRI revealed that the most common pathology was intervertebral disc degeneration (80%), followed by disc bulge (65.6%), disc herniation (29.3%), Modic changes (25.6%), and spinal canal stenosis (20.6%). Multiple level involvement was observed in 42.5% of cases. The L4-L5 level was the most frequently affected. Conclusion: MRI is an essential diagnostic modality for evaluating patients with low backache, particularly for detecting disc pathology and degenerative changes. The findings emphasize the importance of early imaging in appropriate clinical settings for prompt diagnosis and treatment planning.

Background: SARS COVID - 19, an infectious disease that is declared as pandemic by WHO and emerging again with newer strains. Heart failure is another deadly disease condition to which geriatric population is more susceptible. Few phytochemicals present in tamarind leaves like apigenin and epicatechin were reported to inhibit the SARS - COV - 2 enzyme named PDB ID : 6 LU7. Ethanolic extract of tamarind leaves was also proposed to reduce the prolongation of QT and RR intervals of ECG in Wistar rats along with lowering the serum enzymes' levels like LDH and CPK indicating cardiac protection in doxorubicin induced cardiac toxicity characterized by heart failure. Ethanolic extract of tamarind leaves was suggested to be used as a safer antioxidant to check MRSA endocarditis and heat stress. Methods: Fresh tamarind leaves were collected and dried under shade at normal room temperature to prepare coarse powder by a sterilized pestle and mortar. Ethanolic Extract of dried tamarind leaves was extracted using 98% ethanol by Soxhlet Apparatus used for extraction of 98 % ethanolic extract of dried tamarind leaves at  a range of 60 degree to 70 degree centigrade.  Ethanolic extract ( 98% ) of dried tamarind leaves' powder was then evaporated to dryness by keeping the extract in Hot Air Oven used for drying of ethanolic extract ( 98% ) of tamarind leaves at 60 degree centigrade. Dried ethanolic extract ( 98% )of tamarind leaves was provided to willingly participated septic arthritic patients orally at 1 gram / Kg bodyweight after 2 hours of breakfast once daily orally up to consecutive 28 days depending on severity of septic arthritis duly diagnosed by their registered doctors. Results: Septic arthritic patients responded well to the treatment of ethanolic extract (98%) of tamarind leaves at recommended dosage regimen which was evaluated by due recording of recovery from swelling, pain, redness and other characteristic signs of septic arthritis. As ethanolic extract (98%) of tamarind leaves produced curative effects in the affected joint or joints which are pharmacokinetically considered under peripheral compartment of the body, the extract can easily reach the organs like heart, lungs, liver, kidney and even brain those come under central compartment of the body according to pharmacokinetic principles. Moreover, the phytochemicals present in ethanolic extract ( 98% ) of tamarind leaves  acted in septic arthritis of peripheral joints means these can reach at sufficient concentrations to other peripheral organs also and can produce protective effects against corona virus infection by inhibiting SARS - COV - 2 enzyme named PDB ID : 6 LU7. The extract can easily reach at sufficient concentration to heart and may reduce the prolongation of QT and RR intervals of ECG in cardiac diseases' suffering patients. Conclusion: Ethanolic extract of dried tamarind leaves extracted by 98% ethanol can be well utilized as ethical preventive therapies for COVID and heart failure more particularly for geriatric population those have compromised metabolism and excretion systems for synthetic drugs due to their old age and ageing factors.

Background Surgical Site Infections (SSIs) represent a significant nosocomial complication, frequently culminating in protracted postoperative morbidity. They serve as catalysts for delayed wound resolution, prolonged hospitalization, and a measurable escalation in both direct medical costs and indirect socio-economic burden, particularly in resource-constrained surgical infrastructures. Objective: The overarching aim of this prospective observational cohort investigation, conducted at Calcutta National Medical College and Hospital over a 15-month duration, was to quantitatively assess the incidence of SSIs and to elucidate their microbial etiology alongside associated demographic, clinical, and perioperative risk parameters. Methods: A methodologically rigorous design was employed wherein patients undergoing surgical interventions were evaluated for SSI development based on CDC criteria. A multifactorial analytical framework incorporating demographic data, systemic comorbidities, wound characteristics, and procedural durations was applied. Statistical interrogation was performed using multivariate logistic regression to extract independent predictors of SSI occurrence. Results The cumulative incidence of SSIs within the study population was determined to be 28.5%. Microbiological surveillance revealed Staphylococcus aureus and Escherichia coli as the preeminent causative organisms. Advanced age (>60 years), diabetic status, anemia, surgical procedures exceeding 90 minutes, and operations performed during the hot-humid summer season emerged as statistically significant and independently associated risk amplifiers. Conclusion: The findings accentuate the criticality of implementing rigorously standardized perioperative infection control measures, including targeted antimicrobial prophylaxis, optimized host factor modulation, and strict intraoperative asepsis. Strategic prioritization of these factors is essential to mitigate the considerable SSI burden observed in tertiary care surgical settings in low-to-middle-income countries.

Background: Obesity, particularly visceral adiposity, is a well-established risk factor for hypertension. The Visceral Adiposity Index (VAI), a gender-specific mathematical model based on waist circumference, body mass index (BMI), triglyceride levels, and HDL-cholesterol, serves as an indirect marker of visceral fat dysfunction. This study aims to investigate the association between VAI and both systolic blood pressure (SBP) and diastolic blood pressure (DBP), elucidating a potential pathophysiological connection between central obesity and elevated blood pressure. Materials and Methods: A cross-sectional observational study was conducted on 200 adult participants (aged 25–60 years). Anthropometric measurements, fasting lipid profiles, and blood pressure readings were collected. VAI was calculated using standard gender-specific formulas. Participants were categorized into quartiles based on their VAI scores. The association of VAI with SBP and DBP was analyzed using Pearson’s correlation and multivariate linear regression, adjusting for confounding variables such as age, sex, physical activity, and smoking status. Results: The mean VAI among participants was 2.89 ± 1.34. A statistically significant positive correlation was found between VAI and both SBP (r = 0.48, p < 0.001) and DBP (r = 0.39, p < 0.001). Multivariate analysis demonstrated that for every unit increase in VAI, SBP increased by an average of 3.7 mmHg (p = 0.002) and DBP by 2.4 mmHg (p = 0.004), independent of BMI. Participants in the highest VAI quartile had significantly higher mean SBP (138.6 ± 9.4 mmHg) and DBP (86.2 ± 7.1 mmHg) compared to those in the lowest quartile (SBP: 122.3 ± 8.1 mmHg, DBP: 76.4 ± 6.9 mmHg). Conclusion: Visceral Adiposity Index shows a significant and independent association with both systolic and diastolic blood pressure, underscoring the role of visceral fat accumulation in the pathogenesis of hypertension. VAI may serve as a simple and effective surrogate marker to assess hypertension risk in individuals with central obesity.

Background: Sepsis is a critical and urgent infectious condition in clinical practice, traditionally diagnosed through blood culture, which identifies the presence (either suspected or confirmed) of infection along with systemic signs of an inflammatory response^1,2,3. Objective: To analyse the microbial spectrum among culture-positive sepsis patients admitted to the medicine ward. Methods: This observational study was conducted over six months at Assam Medical College and Hospital, including 80 adult sepsis patients. Culture-positive cases were analysed for type of infection and organism isolated. Results: Of the 80 patients, 47 (58.75%) were culture-positive. Gram-negative organisms predominated, with Escherichia coli (25.53%), Klebsiella pneumoniae (17.02%), and Staphylococcus aureus (14.9%) as the most common isolates. Blood, urine, sputum, wound, and other body fluid cultures contributed to pathogen identification. Conclusion: Gram-negative bacteria were the most frequent pathogens in culture-positive sepsis, reflecting the importance of early empirical antimicrobial coverage targeting these organisms.

Background: Fracture fixation with open reduction and compression plates is frequently used in diaphyseal radius/ulna fractures because of advantages like proper alignment, maintaining length, and rotational alignment. This study compares the outcomes of treatment of fracture cases with dynamic compression plates and intramedullary nailing by a square nail in mid-shaft radius/ulna fractures. Methods: This prospective comparative study included 40 patients with closed midshaft fractures of both radius and ulna, divided into two groups of 20 each. Group A underwent open reduction and internal fixation using dynamic compression plates (DCP), while Group B was treated with intramedullary (IM) square nails. Patients were followed clinically and radiologically for 6 months. Outcomes assessed included time to union, functional recovery using DASH and MEPS scores, and postoperative complications. Statistical analysis was performed using appropriate tests with significance set at p < 0.05. Results: A total of 40 patients with midshaft radius and ulna fractures were studied, divided equally into two groups: dynamic compression plate (DCP) and intramedullary (IM) nailing. The mean union time was significantly shorter in the DCP group (11.2 ± 2.1 weeks) compared to the IM group (12.5 ± 2.7 weeks, p = 0.04). Functional outcomes (DASH and MEPS scores) were comparable, with slightly better results in the DCP group. The complication rate was higher in the IM group (40%) versus DCP (20%). DCP demonstrated more consistent outcomes with fewer complications and faster healing than IM nailing. Conclusion: Treatment of diaphyseal forearm is challenging as it because of lack of censuses regarding treatment and it requires judicious selection of cases for using compression plates or IM nail. Within the limitation of the present study, it may be concluded that dynamic compression plate offers better overall outcomes in the treatment of diaphyseal radius/ulna fractures

Background: Postoperative nasal packing is applied routinely following septoplasty or submucosal resection to prevent bleeding and also to support the septum. It is, however, commonly accompanied by considerable discomfort, pain, and complications. The nasal clips have been proposed as a possible alternative that is expected to be well-tolerated by patients and to cause fewer adverse effects. The aim of this study is to compare the effectiveness, postoperative results, and patient satisfaction of nasal clips and anterior nasal packing use in patients who undergo septoplasty or submucosal resection. Methods: A prospective, comparative study was conducted on n=60 patients undergoing septoplasty or submucosal resection. Patients were randomized into 2 groups; Group A (nasal clip), and Group B (anterior nasal packing), with n=30 patients in each group. Demographic profiles, postoperative pain (VAS scores), complications and patient satisfaction data were recorded. The statistical analysis was done by using relevant tests and a p- value of less than 0.05 was deemed to be statistically significant. Results: Both groups were comparable demographically. Group A reported significantly lower postoperative pain from 6 hours onwards, especially after clip/pack removal and on Day 7 (p < 0.001). Complication rates were lower in the nasal clip group (6.7%) versus the nasal packing group (26.7%), with statistical significance (p = 0.04). Overall outcomes were also significantly improved with nasal clips as demonstrated by a high patient satisfaction rate of 66.7% as compared to 36.7 percent of the packing group (p = 0.02). Conclusion: In conclusion, nasal clips can be a possible, less invasive alternative to anterior nasal packing after septoplasty or SMR, requiring less pain medication, fewer complications, and showing higher patient satisfaction.

Background: Tuberculosis (TB) remains a major global health burden, particularly in low- and middle-income countries such as India. While the physical impact of pulmonary tuberculosis is well established, the associated psychiatric morbidity is often overlooked. Emerging evidence indicates that a significant proportion of TB patients suffer from mental health disorders, particularly depression and anxiety, which can adversely affect treatment adherence and clinical outcomes. The chronicity of the disease, coupled with factors such as stigma, social isolation, and socioeconomic stressors, contribute substantially to psychological distress in this vulnerable group. Methods: A cross-sectional observational study was conducted in the Department of Respiratory Medicine at Government Medical College and Hospital, Nizamabad. A total of 100 patients with confirmed pulmonary TB who were admitted for treatment and met the inclusion criteria were enrolled using purposive sampling. Participants aged 18 years or older who gave informed consent were included. Patients with pre-existing psychiatric illnesses or other chronic medical conditions were excluded. Psychiatric evaluation was conducted using the MINI International Neuropsychiatric Interview (MINI), a structured diagnostic tool. Additional data were collected on socio-demographic factors, clinical history, and socioeconomic status using the Sodhi and Sharma Socioeconomic Status Scale. Results: Out of the 100 patients evaluated, 46% were found to have psychiatric morbidity. Depression was the most common disorder, followed by anxiety. About 16% of patients exhibited comorbid depression and anxiety. Notably, the study found no statistically significant association between psychiatric morbidity and socioeconomic status (p = 0.34), education level (p = 0.997), type of treatment (p = 0.40), or presence of complications (p = 0.72). These findings suggest that psychiatric conditions in TB patients may arise independently of commonly measured socio-demographic and clinical variables. Conclusion: These findings underscore the need for routine psychiatric screening in TB treatment settings. Early identification and management of mental health issues are crucial for improving patient adherence, reducing the duration of illness, and enhancing overall treatment outcomes. Integration of mental health care into national TB control programs should be prioritized as part of a comprehensive and patient-centered approach to TB management.

INTRODUCTION: Diabetes mellitus, a prevalent metabolic disorder, not only affects organ function but also induces significant metabolic abnormalities, including disturbances in calcium homeostasis. Left ventricular hypertrophy identified as a threatening prognostic sign and an independent risk factor for cardiac death, coronary heart disease, ventricular dysrhythmias, and heart failure, is prevalent in type 2 diabetes mellitus (T2DM). The association between T2DM and LVH persists even in the absence of hypertension and obesity, suggesting additional contributing factors beyond traditional risk factors. This study explores the potential role of altered calcium homeostasis, indexed by serum calcium levels, in contributing to LVH prevalence in T2DM patients. MATERIALS AND METHODS: A cross sectional study conducted among Diabetic patients presenting to outpatient department and patients admitted in Medicine department, Government Medical College, Nizamabad, Telangana, India. All the design, analysis, interpretation of data, drafting and revisions followed the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) guidelines and the study was based on Declaration of Helsinki. History of myocardial infarction, coronary artery bypass or angioplasty, atrial fibrillation, moderate to severe valvular heart disease, stroke or occlusive peripheral vascular disease, heart failure. CBP (complete blood picture), RFT (renal function tests), LFT (liver function tests), Serum calcium, total cholesterol, triglycerides, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), FBS, PLBS, HBA1C. RESULTS: Overview of the distribution of study participants based on the presence or absence of Left Ventricular Hypertrophy (LVH). The data reveals a nearly equal distribution, with 51% of participants exhibiting LVH and 49% showing its absence. The age distribution of study participants stratified based on the presence or absence of Left Ventricular Hypertrophy (LVH). The results indicate insignificant associations between age groups and the occurrence of LVH (p=0.012). In the 40-49 age category, 23.8% of participants with LVH were observed, compared to 23.8% without LVH. Among individuals aged 50-59, 52.4% with LVH were noted, compared to 51.5% without LVH. Similarly, in the 60-69 age group, 19% had LVH, and 20.8% did not. For those aged 70 and above, 4.8% exhibited LVH, compared to 3.9% without LVH. CONCLUSION This study contributes valuable insights into the complex pathophysiology of cardiac complications in T2DM, emphasizing the importance of comprehensive cardiovascular risk assessment that includes serum calcium evaluation. Future research exploring mechanisms underlying the association between calcium dysregulation and LVH could potentially lead to novel therapeutic strategies aimed at reducing cardiovascular morbidity and mortality in diabetic populations.

Background: The efficacy of intrathecal dexmedetomidine as an adjuvant to local anesthetics has been evaluated in adult patients; however, less evidence supports its safety in elderly patients. The study aims to compare the duration of analgesia (defined as time to first analgesic request) of dexmedetomidine (5 mcg) and fentanyl (25 mcg) given intrathecally with bupivacaine in elderly patients undergoing elective orthopedic surgery. Methods: Forty elderly patients of either sex aged between 60-80 years, ASA II, were included in this prospective single-centre, randomized comparative study. The onset and duration of motor and sensory blockade, 2-segment sensory regression time, highest sensory level, and perioperative adverse effects were assessed.  Results: Duration of sensory (427.5±25.4 Vs 166.5±12.8 min) and motor (399.2±22.7 Vs 139.0±12.4 min) block, time to rescue analgesia (284.2±37.49 vs 146.7±25.4 min), and time for 2-segment sensory regression (123.2±16.0. Vs. 79.5±12.8 min) were significantly longer in the dexmedetomidine group than in the fentanyl group(P<0.001). Between the groups, there were no significant differences in the onset of sensory and motor block or the highest level of sensory block. There were no clinically significant differences between groups regarding hemodynamic and other adverse outcomes. Conclusions: The addition of 5 µg dexmedetomidine to 0.5% intrathecal hyperbaric bupivacaine is associated with significantly prolonging sensory and motor block and duration of postoperative analgesia without any clinically significant side effects.