Background: Surgical-site infection (SSI) remains a frequent postoperative complication after abdominal surgery and contributes to prolonged hospitalization, additional procedures, and increased healthcare expenditure. Identifying locally relevant predictors supports targeted perioperative prevention.

Objectives: To determine the incidence, clinical and microbiological profile, associated factors, and short-term outcomes of SSI following elective abdominal surgery. Methods: This prospective hospital-based observational study included 100 adults undergoing elective abdominal surgery at Gandhi Medical College, Secunderabad, Telangana, India, from November 2024 to April 2025. Demographic, comorbidity, and operative variables were recorded. Participants were monitored for SSI for 30 postoperative days. Associations were evaluated using the chi-square test or Fisher’s exact test, followed by exploratory binary logistic regression. Results: The mean age was 49.7 ± 14.8 years, and 56% were male. Open surgery was performed in 62%, and 35% of procedures lasted longer than 120 minutes. SSI developed in 18 patients, comprising 11 superficial incisional, five deep incisional, and two organ-space infections. Cultures were positive in 15 cases; Staphylococcus aureus was the predominant isolate. Diabetes mellitus, age ≥60 years, obesity, smoking, anaemia, ASA grade III, open surgery, prolonged operative duration, drain placement, and preoperative hospitalization exceeding 2 days were associated with SSI on univariate analysis. Diabetes mellitus, operative duration longer than 120 minutes, and preoperative stay longer than 2 days remained independent predictors. Patients with SSI had a longer postoperative hospital stay than those without infection. Conclusion: SSI affected nearly one-fifth of patients following elective abdominal surgery. Preoperative metabolic optimization, avoidance of unnecessary hospitalization, efficient operative practices, and structured 30-day surveillance should form key components of SSI prevention.

Background and Objectives: Acute appendicitis is a prevalent etiology of acute abdomen necessitating emergent surgical intervention. Even with better imaging, it is still hard to make an early and correct diagnosis. Delays can cause perforation and more illness. Hematological and inflammatory indicators are low-cost, easily accessible technologies that could enhance diagnostic precision. To find out how useful certain hematological and inflammatory indicators are for diagnosing acute appendicitis in adults. Methods: This prospective observational study encompassed 50 individuals exhibiting clinical suspicion of acute appendicitis at MGM hospital, Warangal during the period from May 2024 to March 2025 . Demographic data, clinical features, and laboratory parameters including total leukocyte count (TLC), neutrophil percentage, neutrophil–lymphocyte ratio (NLR), C-reactive protein (CRP), and platelet count were recorded at admission. Every patient had an appendectomy, and the histopathological exam was the best way to tell if they had appendicitis. We used sensitivity, specificity, and predictive values to look at how well the lab markers worked as diagnostic tools. Results: The mean age of the 50 patients was 27.8 ± 9.6 years, and 32 (or 64%) were male and 18 (or 36%) were female. Of the individuals examined, 44 (88% of the total) had acute appendicitis verified by histopathology, while 6 (12%) had appendixes that were normal. With a sensitivity of 84.1% and specificity of 66.7%, 38 patients (or 76% of the total) had elevated TLC levels (>11,000/mm³). With a sensitivity of 81.8%, 36 patients (72%) showed an elevated neutrophil percentage (>75%). With a sensitivity of 88.6% and specificity of 83.3%, the best diagnostic accuracy was shown by an elevated NLR (>3.5) in 40 patients (80%). There was a significant association between elevated CRP levels (>10 mg/L) and complex appendicitis (p < 0.05) in 34 patients, or 68% of the total. When TLC, NLR, and CRP were used together, the diagnosis accuracy reached 92%. Conclusion: Acute appendicitis can be further confirmed by the use of inflammatory and hemostatic markers, such as C-reactive protein (CRP) and non-lumbar region (NRL). By incorporating clinical assessment into their usage, early diagnosis can be improved, negative appendectomy rates can be reduced, and surgical intervention can be facilitated more quickly.

Hemoglobinopathies are the most common inherited blood disorders in India, with a disproportionately high burden in tribal populations due to genetic clustering, consanguinity, and limited healthcare access. High Performance Liquid Chromatography (HPLC) has become the method of choice for screening and diagnosis. Aim: To determine the prevalence and spectrum of hemoglobinopathies in a tribal-dominant population of Andhra Pradesh using HPLC, and to evaluate demographic and community-wise distribution. Methods:
This cross-sectional study included 3725 individuals screened through hospital, antenatal, and community-based programs in Alluri Sitarama Raju district, Andhra Pradesh. EDTA blood samples were analyzed using the Bio-Rad D-10 HPLC system. Demographic data (age, gender, community, area) were recorded, and results were compared with previous Indian studies. Results:
Out of 3725 samples, 3084 (82.8%) showed abnormal hemoglobin patterns and 641 (17.2%) were normal. The most common abnormality was Sickle Cell Trait (1928 cases; 51.7%), followed by Sickle Cell Anemia (1025; 27.5%). Less frequent abnormalities included Sickle+β-thalassemia (16; 0.4%), β-thalassemia trait (40; 1.1%), β-thalassemia major (16; 0.4%), and other variants (47; 1.3%). Females predominated (61.7%), reflecting antenatal-driven screening. The 0–10 year age group accounted for 35.4% of cases, with ≤30 years forming 77% of the total burden. Community analysis revealed clustering among Bagatha (28.4%) and Valmiki (27.0%) tribes, while area-wise distribution showed that 73.4% of cases were concentrated in 10 mandals, notably Hukumpeta, Koyyuru, and Chinthapalli. Conclusion:
This study demonstrates an exceptionally high prevalence of hemoglobinopathies in tribal Andhra Pradesh, with sickle disorders contributing nearly 80% of cases. The findings highlight the need for expanded community-based screening, premarital and antenatal counseling, molecular confirmation of variants, and targeted interventions under the National Sickle Cell Anemia Elimination Mission (NSCAEM).

Hemoglobinopathies are the most common inherited blood disorders in India, with a disproportionately high burden in tribal populations due to genetic clustering, consanguinity, and limited healthcare access. High Performance Liquid Chromatography (HPLC) has become the method of choice for screening and diagnosis. Aim: To determine the prevalence and spectrum of hemoglobinopathies in a tribal-dominant population of Andhra Pradesh using HPLC, and to evaluate demographic and community-wise distribution. Methods:
This cross-sectional study included 3725 individuals screened through hospital, antenatal, and community-based programs in Alluri Sitarama Raju district, Andhra Pradesh. EDTA blood samples were analyzed using the Bio-Rad D-10 HPLC system. Demographic data (age, gender, community, area) were recorded, and results were compared with previous Indian studies. Results:
Out of 3725 samples, 3084 (82.8%) showed abnormal hemoglobin patterns and 641 (17.2%) were normal. The most common abnormality was Sickle Cell Trait (1928 cases; 51.7%), followed by Sickle Cell Anemia (1025; 27.5%). Less frequent abnormalities included Sickle+β-thalassemia (16; 0.4%), β-thalassemia trait (40; 1.1%), β-thalassemia major (16; 0.4%), and other variants (47; 1.3%). Females predominated (61.7%), reflecting antenatal-driven screening. The 0–10 year age group accounted for 35.4% of cases, with ≤30 years forming 77% of the total burden. Community analysis revealed clustering among Bagatha (28.4%) and Valmiki (27.0%) tribes, while area-wise distribution showed that 73.4% of cases were concentrated in 10 mandals, notably Hukumpeta, Koyyuru, and Chinthapalli. Conclusion:
This study demonstrates an exceptionally high prevalence of hemoglobinopathies in tribal Andhra Pradesh, with sickle disorders contributing nearly 80% of cases. The findings highlight the need for expanded community-based screening, premarital and antenatal counseling, molecular confirmation of variants, and targeted interventions under the National Sickle Cell Anemia Elimination Mission (NSCAEM).

Introduction: Urolithiasis is one of the most common urological conditions encountered in clinical practice, with urinary tract infection recognized as a significant risk factor. Understanding the relationship between urinary pathogens and stone composition is crucial for optimizing patient management and preventing recurrence. Objective: To determine the bacteriological profile of urine in patients with kidney stones and its association with stone composition. Study Design: Descriptive cross-sectional study. Setting and Duration: Department of Urology, Regional Headquarter Hospital Skardu, from 11-02-2024 to 11-07-2024.Methods: A total of 50 patients scheduled for surgical management of renal stones were enrolled. Preoperative mid-stream urine samples were collected for culture and sensitivity testing. Extracted renal stones were subjected to biochemical analysis following standard protocol. Data on demographic characteristics, clinical presentation, and urinary symptoms were collected using a structured proforma. Statistical analysis was performed using SPSS version 25.0. Results: The study included 29 (58.0%) males and 21 (42.0%) females, with the most affected age group being 20-40 years (54.0%). Pain was the universal presenting complaint (94.0%). While clinical UTI was suspected in 32 (64.0%) patients, microbiologically confirmed UTI was found in only 7 (14.0%) cases. Escherichia coli was the predominant pathogen (71.4%), followed by Klebsiella species (28.6%). Mixed stones (Calcium Oxalate + Calcium Phosphate) were the most common type (74.0%), followed by Uric acid (12.0%) and Struvite stones (12.0%). The highest rate of culture-positive UTI was observed in patients with Struvite stones (50.0%), compared to only 10.8% in patients with mixed stones. No culture-positive UTIs were found in patients with Uric acid or Cysteine stones. Conclusion: A strong association exists between Struvite stones and urinary tract infection, with E. coli and Klebsiella being the predominant organisms. Routine preoperative urine culture and postoperative stone analysis are essential for guiding antibiotic therapy and implementing preventive strategies.

Background: Intrapartum monitoring that is effective is very important for the enhancement of maternal and neonatal outcomes. The WHO Labour Care Guide (LCG) is a new instrument created to offer a comprehensive, evidence-based model, including clinical as well as supportive care parameters, while the WHO Modified Partograph has long been applied for labour monitoring. Objective: To compare the efficacy of the WHO Labour Care Guide and the WHO Modified Partograph in assessing feto-maternal outcomes for spontaneous labour. Methods: This randomized open-label controlled clinical trial was conducted at the Department of Obstetrics and Gynecology, Chhattisgarh Institute of Medical Sciences, Bilaspur (2023–2024). A total of 100 women with singleton pregnancies in spontaneous labour were enrolled and randomly assigned into two groups: Group A (LCG) and Group B (Modified Partograph), each with 50 participants. Maternal demographics, labour characteristics, delivery outcomes, and neonatal parameters were analyzed. Results: The two groups were similar in demographic and baseline clinical profiles. Group A had a significantly shorter active phase (2.52 vs. 3.85 hours, p = 0.001) and second stage of labor (48.1 vs. 65.5 minutes, p = 0.003) than Group B. The other outcomes, such as mode of delivery, NICU admissions, postpartum complications, and APGAR scores, were not statistically different, although trends benefited the LCG group. Conclusion: The WHO Labour Care Guide showed potential benefits over the Modified Partograph in decreasing the duration of labour and in favoring an increased individual, woman-centered system. The researchers suggest further large-scale studies to confirm these results.

Summary: This article, based on discussions in the Gifted group, part of the GIP - Genetic Intelligence Project, explores the challenges faced by individuals with high IQs. Based on reports from a group of over 500 gifted individuals from different countries, the debate "The 'Disorders' of a Brilliant Mind" reveals the complexity of the lives of these individuals, highlighting that genius is no guarantee of happiness or social success. This study analyzes the neurobiological, genetic and psychological impacts that accompany high intellectual ability , proposing the need for more inclusive environments and specialized support so that these individuals can develop their full potential. Abstract This article, developed from discussions within the Gifted group, part of the Genetic Intelligence Project (GIP), delves into the challenges faced by individuals with high IQ. Based on accounts from over 500 gifted individuals across various countries, the debate "The 'Disorders' of a Brilliant Mind" reveals the complexity of these individuals' lives, highlighting that genius is not synonymous with happiness or social success. This study examines the neurobiological, genetic, and psychological impacts that accompany high intellectual ability, advocating for more inclusive environments and specialized support to help these individuals fully develop their potential.

Background: At the global level, QOL among the elderly is an important area of concern which reflects the health status and well-being of this vulnerable population. In developing countries, demographic transition results in increasing life expectancy and an increase in the proportion of the elderly population soon. Objectives: To assess the Quality of Life of septuagenarians. To know the factors affecting the quality of life of septuagenarians. Methodology: A cross-sectional study was conducted in Visakhapatnam among the geriatric population aged 70-79 years during August –September 2021 using the World Health Organization QOL (WHO QOL) –BREF questionnaire. Results: Mean scores of the physical and psychological domains were almost the same (56.65+ 14.12 and 56.53+ 15.33) likewise mean scores of the social and environmental domains were slightly differed (62.55 ± 18.45 and 63.21 ± 18.36) and all the domains have highest maximum scores (100) except physical domain. These differences in mean domain scores across different levels of literacy, occupation, and social class were statistically significant. Conclusion: The mean scores of all the domains were higher among the 76-79 years as compared to the 70-75 years age group. There was a significant difference in mean scores of psychological, environment, and social domains (p=<0.05) between the two age groups. This study concludes that education, occupation, and social class were the major factors affecting the quality of life among the elderly.

Background: With India’s elderly population growing rapidly, institutional care through old age homes has become increasingly relevant. However, little is known about the comprehensive health and psychosocial challenges faced by this population. This study aimed to assess the socio-demographic characteristics, morbidity patterns, and quality of life of elderly individuals residing in old age homes in Ahmedabad district. Objectives: To study the medical and social problems among elderly individuals residing in selected old age homes and to assess the factors associated with poor quality of life. Methods: A cross-sectional study was conducted among 410 elderly residents across 19 registered old age homes in Ahmedabad district. Data were collected using a pre-tested semi-structured questionnaire covering socio-demographics, morbidity profile, psychosocial factors, and WHOQOL-BREF scale. Statistical analysis included chi-square tests and multiple logistic regression to identify factors associated with poor quality of life. Results: Hypertension (43.1%), musculoskeletal disorders (41.4%), and visual impairment (39.3%) were the most common morbidities. Nearly half of the participants (46.6%) reported poor quality of life. Factors significantly associated with poor quality of life included age ≥75 years, female gender, rural residence, presence of multiple morbidities, lack of family contact, non-working status, and lower socioeconomic class (p<0.05). Conclusion: Elderly residents of old age homes face a high burden of chronic illnesses and psychosocial challenges, contributing to poor quality of life. Targeted interventions focusing on medical care, mental health support, family involvement, and caregiver training are essential to improve their overall well-being.

Introduction: Allergic rhinitis is a common condition caused by allergens, leading to sneezing, nasal congestion, runny nose, and itching. The condition involves both early and late-phase allergic responses. Treatment includes antihistamines, nasal sprays, and sometimes immunotherapy. Cetirizine is an oral antihistamine that relieves sneezing and itching. Azelastine is a nasal spray that works faster and also reduces nasal inflammation. Material and Methods: This prospective, randomized comparative study was conducted in the ENT department of a tertiary care hospital over three months. A total of 100 patients aged 18–50 years with clinically diagnosed mild to moderate allergic rhinitis were included. Patients were randomly divided into two groups: Group A received Cetirizine 10 mg orally once daily, and Group B received Azelastine nasal spray twice daily, both for 14 days. Symptom severity was assessed using the Total Nasal Symptom Score (TNSS) at baseline, Day 7, and Day 14. Data were analyzed using standard statistical tests, and a p-value < 0.05 was considered significant. Results : The baseline characteristics such as age, gender, socioeconomic status, and place of residence were comparable between both groups, with no statistically significant differences. Both Cetirizine and Azelastine groups showed a significant reduction in Total Nasal Symptom Score (TNSS) over the 21-day period, with p < 0.001 in both groups. When comparing between the groups, Azelastine demonstrated significantly greater improvement in TNSS at day 7 (p = 0.045), day 14 (p = 0.018), and day 21 (p = 0.001). Sneezing reduced significantly over time in both groups (p < 0.001). The difference between the two groups was statistically significant at day 7 (p = 0.042) and day 21 (p = 0.048), but not at day 14 (p = 0.081). There was a significant reduction in nasal obstruction within each group (p < 0.001). Between-group comparison showed significant differences at day 7 (p = 0.025) and day 14 (p = 0.011), while the difference at day 21 was not statistically significant (p = 0.091). Nasal discharge also improved significantly in both groups over time (p < 0.001). A significant difference between the groups was observed only at day 21 (p = 0.031), while changes at day 7 (p = 0.176) and day 14 (p = 0.078) were not statistically significant. Both groups showed a significant decrease in nasal itching over time (p < 0.001). Significant differences between the groups were noted at day 7 (p = 0.034) and day 14 (p = 0.029), but not at day 21 (p = 0.067). The number of patients with absolute eosinophil count greater than 500 reduced significantly within both groups (p < 0.001). Between-group differences were statistically significant at day 7 (p = 0.018), day 14 (p = 0.007), and day 21 (p = 0.004). Conclusion: This study demonstrates that while both Cetirizine and Azelastine nasal sprays are effective in treating allergic rhinitis, Azelastine provides faster and more significant improvement in both clinical symptoms and inflammatory markers.

Background: Gallbladder disease is common in India, often managed surgically by cholecystectomy. While chronic cholecystitis is the most frequent indication, histopathological examination of excised specimens can reveal a wider diagnostic spectrum, including premalignant and incidental malignant lesions. Objective: To evaluate the histopathological spectrum of gallbladder lesions in cholecystectomy specimens and assess their association with demographic and clinical features. Methods: This cross-sectional observational study was conducted on 66 patients undergoing cholecystectomy at a tertiary care centre in Barasat, West Bengal. Gross pathological features were recorded, and all specimens were subjected to routine histopathological examination. Data on clinical presentation, age, sex, socioeconomic status, and gallstone presence were analyzed. Results: The most common histopathological diagnosis was chronic cholecystitis (72.8%), followed by acute cholecystitis (12.1%) and cholesterolosis (9.1%). Premalignant and malignant lesions—including dysplasia, metaplasia, and adenocarcinoma—were detected in 6.0% of cases. Gallstones were present in 75.8% of specimens and showed strong correlation with inflammatory lesions. Adenocarcinoma and dysplastic changes were seen exclusively in patients over 40 years and often occurred without associated gallstones. Conclusion: A wide spectrum of histopathological changes can be observed in gallbladder specimens, including incidental premalignant and malignant lesions. The findings support the practice of routine histopathological evaluation of all cholecystectomy specimens, regardless of gross appearance or clinical suspicion.

Vitamin D3, also known as cholecalciferol, is a critical micronutrient involved in various physiological processes essential for human health, including skeletal development, immune function, cardiovascular regulation, and metabolic stability. This systematic review aims to evaluate and synthesize the scientific evidence on the health effects of Vitamin D3 deficiency, drawing upon a comprehensive analysis of over 120 peer-reviewed studies spanning randomized controlled trials, cohort analyses, and cross-sectional investigations published from 2000 to 2024. Vitamin D3 deficiency, which affects more than one billion people globally, has emerged as a silent pandemic due to its insidious association with both communicable and non-communicable diseases. Our findings reveal that insufficient levels of Vitamin D3 are linked with an elevated risk for osteoporosis, autoimmune disorders, cardiovascular anomalies, insulin resistance, neuropsychiatric disturbances, and recurrent infections. Mechanistically, the deficiency compromises calcium-phosphate homeostasis, disrupts inflammatory cytokine balance, and impairs genomic regulation via Vitamin D receptor-mediated pathways. Furthermore, geographic, ethnic, and lifestyle factors play a significant role in the prevalence and severity of hypovitaminosis D, underscoring the need for targeted interventions. The review also explores the emerging role of Vitamin D3 in modulating epigenetic expression, preventing cellular apoptosis, and maintaining endothelial integrity. Public health implications call for widespread awareness, universal screening programs, and strategic supplementation efforts. Timely identification and correction of Vitamin D3 deficiency may serve as a preventive tool against a host of chronic diseases, emphasizing its role not just in bone health but as a vital component of holistic wellbeing.

Introduction: Migraine is a common and disabling primary headache disorder with significant impact on quality of life. Prophylactic therapy is indicated in patients with frequent or debilitating attacks. Propranolol and amitriptyline are widely used first-line agents; however, their comparative safety profiles remain a subject of interest. This study aims to compare the safety profiles of propranolol and amitriptyline in patients undergoing prophylactic treatment for migraine. By identifying and analyzing adverse drug reactions associated with both medications, this study seeks to aid clinicians in making evidence-based choices tailored to patient profiles¹⁰. Materials and Methods: A prospective, randomized, open-label study was conducted involving 100 patients diagnosed with migraine without aura. Participants were divided into two groups: Group A received propranolol (40–80 mg/day), and Group B received amitriptyline (10–25 mg/day) for 12 weeks. Participants were evaluated at baseline and at 4, 8, and 12 weeks. Adverse drug reactions (ADRs) were documented using the WHO-UMC causality assessment scale. Blood pressure, heart rate, ECG, and laboratory parameters (liver and renal function tests) were monitored at each visit. Results: Propranolol: Higher rates of Fatigue (26% vs 12%), Dizziness (18% vs 10%), and Bradycardia (14% vs 0%). Lower rates of Dry Mouth (6%) and Weight Gain (2%). Amitriptyline: Significantly higher rates of Dry Mouth (34% vs 6%) and Weight Gain (28% vs 2%).  Propranolol caused a statistically significant reduction in BP (126/82 → 118/76, p=0.03), consistent with its beta-blocker action. Amitriptyline had minimal, non-significant effect (124/80 → 122/78, p=0.45). Confirms significantly higher sedation scores for Amitriptyline at both Week 4 (4.9 vs 2.1) and Week 12 (4.4 vs 1.9), aligning with its known sedative effects. Conclusion: Both propranolol and amitriptyline are effective for migraine prophylaxis, but their safety profiles differ significantly. Propranolol may be better suited for patients without cardiac comorbidities, while amitriptyline is preferable for patients who benefit from its sedative effects.

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with limited treatment options and poor prognosis. This study aimed to evaluate the clinicopathological relevance of selected molecular markers in TNBC, focusing on their potential utility for early risk stratification. Methods: In this prospective observational study, 100 patients with histologically confirmed TNBC were evaluated for Ki-67, p53, EGFR, and CK5/6 expression using immunohistochemistry. Tumour size, histological grade, lymph node status, and lymphovascular invasion were recorded. Associations between marker expression and clinicopathological variables were assessed using Chi-square and t-tests, with effect sizes estimated using Cramér’s V. Results: High Ki-67 expression was observed in 82% of cases and was significantly associated with tumour size (χ² = 4.88, p = 0.027, Cramér’s V = 0.221). p53 was overexpressed in 53% of tumours. EGFR and CK5/6 positivity were seen in 32% and 42% of cases, respectively. A basal-like phenotype (EGFR+ or CK5/6+) was identified in 61% of cases. Although no statistically significant associations were found between basal-like status and grade, nodal involvement, or lymphovascular invasion, basal-like tumours exhibited numerically higher rates of lymph node positivity (50.8% vs. 43.6%) and lymphovascular invasion (49.2% vs. 41.0%). Effect sizes for these associations were small (Cramér’s V < 0.1). Conclusion: Ki-67 showed a statistically significant correlation with tumour size, suggesting its relevance as a proliferative marker in TNBC. While basal-like markers did not show statistically significant associations, they were linked to clinically meaningful trends toward more aggressive features. These findings support the integration of Ki-67, p53, EGFR, and CK5/6 into routine pathology reporting to aid in early risk stratification, especially in resource-limited settings.

Background: Chronic smoking is a major risk factor for developing obstructive pulmonary diseases due to its direct impact on airway inflammation, alveolar destruction, and reduced lung compliance. Pulmonary Function Tests (PFTs) serve as essential diagnostic tools to evaluate the functional status of the lungs in smokers. This study aims to assess and compare various pulmonary parameters in chronic smokers and non-smokers. Materials and Methods: A cross-sectional observational study was conducted on 100 participants aged 25–60 years. The subjects were divided into two groups: Group A (50 chronic smokers with a smoking history of >10 years and >10 pack-years) and Group B (50 age-matched non-smokers). Pulmonary function was assessed using a spirometer, measuring parameters such as Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV₁), FEV₁/FVC ratio, and Peak Expiratory Flow Rate (PEFR). Statistical analysis was done using unpaired t-test and significance was set at p<0.05. Results: The mean FEV₁ in smokers was significantly lower (1.92 ± 0.45 L) compared to non-smokers (2.84 ± 0.51 L, p<0.001). Similarly, the FEV₁/FVC ratio was reduced in smokers (68.5 ± 7.8%) in contrast to non-smokers (80.1 ± 6.3%, p<0.001). PEFR was also considerably lower in smokers (295 ± 45 L/min) compared to controls (405 ± 52 L/min). These findings indicate a predominance of obstructive patterns in chronic smokers. Conclusion: Chronic smoking significantly impairs lung function, predominantly causing obstructive changes. Routine spirometric screening in smokers can facilitate early diagnosis and management of respiratory impairment. Public health strategies should reinforce smoking cessation programs to preserve lung health.

Background: The burgeoning geriatric demographic in India, projected to approach 324 million by 2050, presents a formidable challenge in the domain of rational pharmacotherapy, given their intrinsic physiological vulnerability and predisposition to polypharmacy-induced adversities. Polypharmacy, variably defined but conventionally considered as the concurrent use of five or more medications, has emerged as a pervasive contributor to iatrogenic morbidity in elderly individuals, with potentially inappropriate medications (PIMs) forming a significant proportion of the therapeutic regimens. Despite the growing global impetus towards deprescribing as a validated intervention to mitigate pharmacological excess, the Indian subcontinent remains inadequately represented in the empirical literature regarding structured deprescribing initiatives. Methods:  The investigation was conducted as a coordinated multicentric clinical initiative across tertiary care institutions in Eastern India. Elderly patients (aged ≥65 years) receiving one or more prescribed medications were prospectively enrolled. Prescription Event Monitoring (PEM) was utilized to longitudinally assess therapeutic regimens, with rigorous application of STOPP and AGS Beers Criteria to identify PIMs. Subsequently, individualized deprescribing interventions were initiated, with multidisciplinary team involvement ensuring clinical appropriateness, patient-centric considerations, and adherence to evidence-based guidelines. Serial monitoring for withdrawal phenomena, symptomatic deterioration, and therapeutic efficacy was performed over the study period. Results: Statistical analysis revealed a mean age of 74.2 ± 6.8 years with notable polypharmacy prevalence (68%) and a considerable PIM burden delineated via Beers (1.8 ± 1.1) and STOPP (1.5 ± 0.9) criteria. Deprescribing was successfully executed in 62% of cases, while ADRs were documented in 34%. Polypharmacy exhibited a statistically significant association with ADR occurrence (χ² = 9.21, p = 0.0024), and advancing age correlated with increased deprescribing likelihood (t = 2.14, p = 0.035). A robust positive correlation (r = 0.62, p < 0.001) was discerned between total drug burden and PIM prevalence. Multivariate analysis further identified polypharmacy and multimorbidity as independent predictors of inappropriate prescribing and ADR risk (p < 0.01), while deprescribing success was favourably influenced by lower PIM burden, interdisciplinary involvement, and absence of psychotropics. Conclusion: This study underscores the critical utility of structured, evidence-based frameworks such as the AGS Beers Criteria and STOPP guidelines in identifying and mitigating inappropriate prescribing practices among the elderly in India. Deprescribing, when systematically implemented through multidisciplinary collaboration, represents a pragmatic, efficacious, and patient-centric strategy to optimize pharmacotherapy in geriatric populations. The findings advocate for the integration of deprescribing protocols into routine clinical practice and national geriatric health policies. Further large-scale studies and resource-intensive development of region-specific deprescribing guidelines are warranted to sustain and expand this indispensable aspect of geriatric care in India.

Introduction Hemorrhoids are common anorectal conditions resulting from dilated venous plexuses in the anal canal. Surgical treatment becomes necessary in patients with advanced grades (III and IV), recurrent symptoms, or when conservative methods fail. This study aims to compare three commonly used surgical modalities—open hemorrhoidectomy, stapled hemorrhoidopexy, and DGHAL—in terms of operative parameters, pain scores, complications, and outcomes, thus contributing to evidence-based surgical decision-making in hemorrhoid management. Materials and Methods: This prospective observational study was conducted over 18 months in a tertiary care hospital. Patients diagnosed with grade III or IV hemorrhoids were included. Three surgical modalities—open hemorrhoidectomy, stapled hemorrhoidopexy, and Doppler-guided hemorrhoidal artery ligation (DGHAL)—were compared based on operative time, postoperative pain, hospital stay, and complications. Results: Out of 150 patients, 50 underwent each technique. Stapled Hemorrhoidopexy demonstrates the most favorable outcomes with the lowest mean (22.6 ± 4.2), indicating superior efficacy and consistency, while Open Hemorrhoidectomy shows the least favorable results with the highest mean (38.4 ± 6.5) and greatest variability, and DGHAL occupies an intermediate position (30.1 ± 5.3) in both effectiveness and data dispersion. Open Hemorrhoidectomy has the highest pain score (7.2 ± 1.1), indicating significantly more postoperative pain compared to the other methods. Stapled Hemorrhoidopexy shows moderate pain (3.4 ± 0.9), suggesting it is less painful than open surgery. DGHAL (Doppler-Guided Hemorrhoidal Artery Ligation) has the lowest pain score (2.9 ± 1.0), making it the least painful technique among the three. Conclusion: All techniques were effective, but stapled hemorrhoidopexy demonstrated faster recovery and less pain, making it suitable for prolapsing internal hemorrhoids. DGHAL is a promising alternative with fewer complications.