Background: Acute calculous cholecystitis is a common surgical emergency, and both laparoscopic and open cholecystectomy are established treatment options. While laparoscopic surgery is increasingly favored, its outcomes in the acute setting continue to be compared with the conventional open approach. Material and Methods: This prospective comparative study was conducted on 140 patients with acute calculous cholecystitis, who were randomly assigned to undergo either laparoscopic cholecystectomy (n=70) or open cholecystectomy (n=70). Demographic characteristics, intraoperative parameters, and postoperative outcomes were recorded. Results: The two groups were comparable with respect to age, gender distribution, BMI, and ASA status. Operative time was shorter in the laparoscopic group (65.4 ± 12.8 min) than in the open group (85.7 ± 15.6 min, p<0.001). Mean intraoperative blood loss was significantly less in laparoscopic surgery (50.3 ± 18.7 mL) compared to open surgery (150.6 ± 40.2 mL, p<0.001). Conversion to open surgery was required in 7.1% of laparoscopic cases. Postoperative pain scores were lower in the laparoscopic group (3.2 ± 1.1 vs. 5.8 ± 1.4, p<0.001). Early ambulation and hospital discharge were achieved sooner with laparoscopic surgery (12.5 ± 3.6 h and 2.8 ± 1.2 days, respectively) compared to open surgery (24.7 ± 6.2 h and 5.1 ± 1.5 days; p<0.001). Return to normal activity was also faster in the laparoscopic group (7.2 ± 2.1 days vs. 14.5 ± 3.4 days, p<0.001). Wound infection was higher in the open group (8.6% vs. 1.4%, p=0.05). Conclusion: Laparoscopic cholecystectomy offers significant advantages over open cholecystectomy in acute calculous cholecystitis, with lower morbidity and faster recovery, supporting its role as the preferred surgical approach.

Background: Neuropsychiatric symptoms (NPS) such as irritability, agitation, sleep disturbances, delusions, and anxiety are common across neurological disorders and substantially affect patient outcomes. These symptoms contribute significantly to caregiver stress, particularly in India where family members serve as the primary caregivers with limited institutional support. Methods: This hospital-based, cross-sectional study was conducted at Indira Gandhi Medical College, Shimla, from June 2020 to May 2021. Eighty patient–caregiver dyads were recruited, including patients with dementia, seizure disorder, Parkinson’s disease, alcohol-induced amnestic syndrome, and cerebrovascular disease. All patients had at least one NPS. Cognitive functioning was assessed with the Addenbrooke’s Cognitive Examination–III (ACE-III), functional status with the Barthel Index, NPS with the  Neuropsychiatric Inventory–Questionnaire (NPI-Q), and caregiver burden with the Zarit Burden Interview (ZBI). Data were analyzed using chi-square/Fisher’s exact test, ANOVA, and correlation analyses. Results: The mean age of patients was 61.1 ± 22.4 years, with 60% females. Dementia was the most common diagnosis (60%), followed by seizure disorder (28.8%). In dementia, the most frequent NPS were irritability (79.2%), sleep disturbances (72.9%), and delusions (50.0%). Caregiver burden was substantial, with 39.6% reporting mild-to-moderate burden and 35.4% moderate-to-severe burden. Longer illness duration (p=0.0217) and greater functional dependency (p=0.0147) were significantly associated with higher burden. In seizure disorder, irritability (69.6%), anxiety (60.9%), and depression (52.2%) were most common, with caregiver burden significantly associated only with dependency in activities of daily living (p=0.0102). Across all conditions, NPI-Q severity correlated strongly with caregiver distress, particularly for psychotic and disruptive symptoms (p<0.01). Conclusion: NPS are highly prevalent across neurological disorders and represent a major driver of caregiver burden, especially in dementia. Functional dependency and psychotic features were the strongest predictors of distress. Early recognition and targeted management of NPS, along with caregiver education and support, are essential to improve outcomes for both patients and their families.

Background: Babesiosis and Lyme disease are tick-borne illnesses prevalent in the northeastern United States, with co-infections occurring in up to 20% of cases in endemic areas ^[1]. We report a rare case of a 65-year-old male with comorbidities including hypertension, overweight, prediabetes, and osteoarthritis, who developed co-infection following travel to Pennsylvania. The patient presented initially with upper respiratory infection-like symptoms, progressing to abdominal pain, hemolytic anemia, elevated liver enzymes, and depressive mood—a unique combination highlighting neurological involvement, which is atypical for babesiosis ^[2]. Despite initial treatment with doxycycline for suspected Lyme disease, symptoms persisted until Babesia microti was detected via PCR. This case underscores the diagnostic challenges of co-infections, the potential for rapid hemolytic complications, and the rare hepatobiliary and neuropsychiatric manifestations, emphasizing the need for comprehensive tick-borne panels in endemic regions ^[3].

Background: Proximal humerus fractures frequently occur in the geriatric population because of osteoporosis and low-energy trauma such as falls. These fractures account for significant morbidity in these cases. There is a debate regarding the optimal management of cases, whether surgical management or conservative management is appropriate in these cases. The current study aimed to determine the functional and radiological outcome of conservative versus surgical management of proximal humerus fractures in geriatric patients presenting to our tertiary care hospital. Methods: This was a prospective observational study involving 30 patients aged 60 years and above who had fractures of the proximal humerus and were included in the study. The patients were divided into conservative (n=15) and surgical treatment (n=15, mostly PHILOS plating). Descriptive and inferential statistics were used to analyze baseline demographics, fracture type, radiological union, complications, and functional outcomes (Neer scoring system). Results: The mean age of the cohort was 67.6 ± 4.2 years. Falls were the commonest mechanism (60%). Two-part fractures were more frequently managed by the conservative method. The three- and four-part fractures predominated in surgically managed cases. Union within 8 weeks occurred in 66.7% of surgical cases versus 53.3% conservatively managed cases. Non-union was seen in 2 patients (13.3%) post-surgery. Complications differed: varus malunion in the conservative group and surgical site infection or implant failure in the operative group. Functionally, 56.7% achieved excellent outcomes, with surgery showing a slight advantage in complex fractures. Conclusion: Conservative management was effective for simpler two-part fractures, whereas surgical fixation, particularly PHILOS plating, offers better outcomes in complex patterns despite higher complication risks. Individualized treatment based on fracture type and patient factors is recommended.

Background: India's geriatric population is expanding rapidly, leading to an increased prevalence of age-related morbidities. With the decline of joint family systems, more elderly are residing in old age homes (OAHs). Current Challenges, health needs, and management of geriatric people differ from others. A thorough examination of geriatric people for morbidity and related risk factors is required to improve the delivery of health care to the elderly. Objectives: This study aimed to describe the socio-demographic profile, morbidity patterns, and associated risk factors among elderly individuals living in OAHs. Materials & methods: A cross-sectional study was conducted over two months, including all 120 eligible residents (≥60 years) from all six OAHs in Tirupati. Data on socio-demographics, lifestyle factors, and morbidities were collected via interviews, clinical examinations, and medical record reviews. Results: The mean age of participants was 72.15 ± 10.77 years, with a female predominance (63.3%). The most prevalent morbidities were musculoskeletal disorders (50.0%), hypertension (35.0%), visual problems (33.3%), and psychological disorders (21.7%). Hypertension was significantly associated with literacy (p=0.03). Psychological morbidities were significantly higher among illiterates (p=0.004), those who were married (p=0.02), unemployed (p=0.005), and those from non-nuclear family backgrounds (p=0.02). Respiratory morbidities were significantly associated with advanced age (>75 years, p=0.04) and alcohol use (p=0.02). Conclusion: Common health issues included musculoskeletal problems, hypertension, visual impairments and respiratory conditions. Psychological morbidities were higher in illiterates, married individuals, the unemployed, those from joint families, and those with BMI <25. Integrated geriatric care programs are urgently needed to enhance quality of life.

Background: Intertrochanteric femur fractures are a common cause of morbidity in the elderly, and timely surgical fixation is essential for early mobilization and functional recovery. Proximal femoral nail (PFN) and dynamic hip screw (DHS) are the most frequently used implants; however, their comparative outcomes remain a subject of clinical interest. Material and Methods: This prospective cohort study was conducted on 80 patients aged ≥60 years with intertrochanteric femur fractures. Patients were allocated into two groups: PFN fixation (n=40) and DHS fixation (n=40). Baseline demographic data were recorded, and intraoperative parameters such as operative time, blood loss, and fluoroscopy exposure were documented. Postoperative complications and functional outcomes were assessed. Functional recovery was evaluated using the Harris Hip Score (HHS) at 6 weeks, 3 months, and 6 months. Statistical analysis was performed using SPSS version 26.0, with p <0.05 considered significant. Results: Baseline characteristics, including age, gender distribution, fracture laterality, and AO/OTA classification, were comparable between groups. PFN fixation was associated with shorter operative time (78.6 ± 10.4 vs. 92.3 ± 11.7 min, p <0.001) and lower intraoperative blood loss (148.5 ± 32.1 vs. 212.7 ± 38.5 ml, p <0.001), though fluoroscopy exposure was higher (69.8 ± 9.2 vs. 55.6 ± 8.7 sec, p <0.001). Postoperative complications were significantly fewer in the PFN group (12.5% vs. 30.0%, p = 0.048). Functional outcomes favored PFN, with higher HHS at 3 months (71.8 ± 8.4 vs. 65.6 ± 9.3, p = 0.004) and 6 months (86.2 ± 6.5 vs. 78.9 ± 7.1, p <0.001). Conclusion: Proximal femoral nail fixation provides superior intraoperative and functional outcomes with fewer complications compared to dynamic hip screw fixation in elderly patients with intertrochanteric femur fractures. PFN may be considered the preferred option in this population.

Introduction: Pseudo exfoliation syndrome (PEX) is characterized by the accumulation of fibrillar material in ocular tissues, notably associated with an increased risk of glaucoma, particularly pseudo exfoliative glaucoma (PXG). This study aims to investigate the incidence of glaucoma among patients with PEX in Uttarakhand, India, highlighting demographic factors and clinical characteristics influencing disease prevalence. Methods: A retrospective analysis was conducted using medical records from ophthalmic centers in Uttarakhand over five years. Patients aged 40 years and above diagnosed with PEX were included. Data on demographic profiles, ocular findings, and systemic comorbidities were collected. Glaucoma diagnosis was based on optic nerve changes and visual field defects. Statistical analysis included descriptive statistics, chi-square tests, t-tests, and logistic regression. Results: Among 500 PEX patients, 30% were diagnosed with glaucoma, with PXG being predominant (24%). Older age, higher intraocular pressure, and systemic hypertension were identified as significant risk factors for glaucoma development. The study underscores the substantial incidence of glaucoma in PEX patients in Uttarakhand, emphasizing the necessity for regular screening and early intervention. Management strategies should address modifiable risk factors to mitigate disease progression and preserve vision. Conclusion: This study provides critical insights into glaucoma incidence in PEX patients, advocating for proactive management strategies and comprehensive healthcare approaches to improve outcomes and reduce blindness associated with this condition.

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with cirrhosis, frequently precipitating renal dysfunction, specifically hepatorenal syndrome-acute kidney injury (HRS-AKI). While albumin infusion is the standard of care to prevent this complication, the optimal timing of its administration remains poorly defined, particularly in the high-risk subgroup of patients with alcoholic liver disease (ALD). Methods: We conducted a prospective, single-center, comparative cohort study. A total of 120 patients with ALD-related cirrhosis and a first episode of SBP were enrolled and divided into two groups based on the timing of albumin infusion (1.5 g/kg on day 1, 1 g/kg on day 3): the Early Group (n=60, infusion started <6 hours post-diagnosis) and the Standard Group (n=60, infusion started 6–24 hours post-diagnosis). The primary endpoint was the incidence of renal dysfunction at day 7, defined according to KDIGO criteria. Secondary endpoints included in-hospital mortality, 30-day mortality, and SBP resolution. Results: Baseline characteristics, including MELD-Na score (24.1 ± 4.5 vs. 24.6 ± 4.8, p=0.56) and baseline serum creatinine (1.31 ± 0.3 mg/dL vs. 1.34 ± 0.4 mg/dL, p=0.68), were comparable between the Early and Standard groups. The incidence of renal dysfunction at day 7 was significantly lower in the Early Group compared to the Standard Group (16.7% vs. 35.0%, p=0.021). In-hospital mortality was also significantly reduced in the Early Group (11.7% vs. 26.7%, p=0.035), as was 30-day mortality (18.3% vs. 36.7%, p=0.025). The Early Group demonstrated more rapid stabilization of renal function and a faster decline in C-reactive protein levels. Conclusion: In cirrhotic patients with alcoholic liver disease and SBP, early administration of albumin within 6 hours of diagnosis is associated with a significant reduction in the incidence of renal dysfunction and improved short-term survival compared to standard timing. These findings suggest that a narrow therapeutic window exists for optimizing the protective effects of albumin in this vulnerable population.

Introduction: Childhood obesity is a growing global health problem affecting millions of children. It leads to physical health issues like high blood pressure and liver disease, as well as emotional problems such as low self-esteem and depression. Early lifestyle changes in schools and homes can reduce these risks. Materials and Methods: This study included 100 children aged 7–15 years, divided equally into four groups: school-based intervention, combined school and home intervention, home-based intervention, and a control group. Data on body measurements, diet, physical activity, mental health, and obesity-related diseases were collected at the start, after 1 year, and after 5 years. Statistical tests compared changes across the groups. Results: Age and gender were fairly balanced across groups. At baseline, body weight and waist size were similar in all groups. After one year, BMI decreased significantly in intervention groups, especially in the combined group. These improvements lasted up to five years, where the combined program showed the best BMI control. Intervention groups also had less depression, better self-esteem, fewer obesity-related illnesses, more exercise, less screen time, healthier eating, and lower blood pressure than controls. Conclusion: Lifestyle programs, especially those combining school and home efforts, can effectively reduce childhood obesity, improve mental health, and lower risks for future diseases. Early and ongoing support from both schools and families is important for healthy child development.

Background: Oxidative stress contributes to vascular stiffness and poor blood pressure (BP) control in older adults. Terminalia arjuna (TA) bark has been traditionally used for cardiometabolic support and exhibits antioxidant activity. Objective: To evaluate the efficacy and safety of standardized TA supplementation on clinic BP and antioxidant biomarkers in geriatric patients with primary hypertension. Material & Methods Design: 12-week, randomized, double-blind, placebo-controlled, parallel-group trial at two urban outpatient clinics. Participants: 120 adults ≥65 years with treated or untreated stage 1–2 hypertension (clinic SBP 140–169 or DBP 90–99 mmHg if untreated; or on ≤2 antihypertensives with SBP 130–159). Key exclusions: secondary hypertension, recent CVD events, eGFR <45 mL/min/1.73 m², active liver disease, polyherbal use. Interventions: TA 500 mg (standardized to ≥30% polyphenols; ≥5% arjunolic acid) twice daily vs matched placebo. Main Outcomes: Primary—change in clinic SBP at 12 weeks (ANCOVA adjusted for baseline). Secondary—clinic DBP; 24-h ambulatory SBP/DBP; serum malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD) activity; safety and adverse events (AEs). Results: 116/120 completed (TA n=58; placebo n=58). Mean (SD) age 71.8 (5.1) years; 54% female. Adjusted mean SBP change favored TA by −6.8 mmHg (95% CI −9.2 to −4.3; p<0.001). DBP difference −3.1 mmHg (−4.6 to −1.7; p<0.001). 24-h SBP/DBP improved by −5.1/−2.6 mmHg (both p≤0.002). MDA decreased (−0.72 µmol/L vs −0.18; p<0.001), TAC increased (+0.24 mM Trolox eq vs +0.05; p<0.001), and SOD rose (+2.8 U/mL vs +0.6; p<0.001). AEs were mild and similar between groups; no significant changes in liver or renal indices. Conclusions: In older adults with hypertension, 12 weeks of standardized TA reduced BP and improved antioxidant status with good tolerability. Larger, longer trials should confirm durability and clinical outcomes.

Background: Differentiating benign from malignant adnexal masses remains a common diagnostic challenge. While MRI is widely used when ultrasound is indeterminate, contrast-enhanced ultrasound (CEUS) provides real-time vascular assessment at the bedside. Comparative data between CEUS and MRI are limited in Indian clinical practice. Objective: To compare the diagnostic performance of CEUS and MRI for indeterminate adnexal masses, using histopathology and/or follow-up as reference standards. Methods: In this prospective study, 100 women with indeterminate adnexal masses underwent CEUS and MRI. Risk categories were assigned using a five-point CEUS score (malignant if ≥3) and O-RADS MRI (malignant if ≥4). Diagnostic accuracy, sensitivity, specificity, predictive values, and area under the ROC curve (AUC) were calculated. Results: The prevalence of malignancy was 27% (n=27). Both CEUS and MRI achieved 100% sensitivity and 100% NPV. MRI demonstrated higher specificity (84% vs 76%) and accuracy (88% vs 82%) compared with CEUS. AUCs confirmed excellent performance for both modalities (CEUS 0.981, MRI 0.965). Cohen’s κ indicated substantial agreement (0.65). False positives were more frequent with CEUS (n=18) than MRI (n=12), predominantly in borderline and complex benign cysts. Conclusion: CEUS and MRI both provide excellent discrimination of indeterminate adnexal masses. MRI achieved greater specificity and overall accuracy, while CEUS offered strong sensitivity and real-time utility. CEUS may serve as a rapid triage tool in resource-limited settings, with MRI retained as the definitive imaging standard.

Background: Community-acquired pneumonia (CAP) is a leading respiratory related illness causing significant morbidity and mortality worldwide. Serum lactate is an important marker of tissue hypoperfusion and metabolic stress. It is used now increasingly as the potential marker for prognosis. The current study aimed to determine the prognostic value of serum lactate as a marker in adult patients with CAP. Methods: This prospective observational study was conducted in 40 adult patients (≥18 years) admitted with CAP at a tertiary care hospital. A thorough clinical examination, laboratory, and radiological assessment were made in each case.  The estimation of serum lactate was taken at the time of admission. Clinical outcomes were assessed in terms of the length of hospital stay, the need to be admitted to the intensive care unit (ICU), and in-hospital mortality. Analysis of data by appropriate statistical tests was carried out, and the correlation between serum lactate and outcomes was ascertained. Results: Of the 40 patients, 24 (60%) had elevated serum lactate (>2 mmol/L). Patients with higher lactate levels had significantly increased disease severity, longer mean hospital stay (9.2 ± 2.4 vs. 5.6 ± 1.8 days; p<0.01), higher ICU admission rates (45.8% vs. 12.5%; p=0.02), and greater mortality (20.8% vs. 0%; p=0.03) compared to those with normal lactate. Elevated lactate was an independent predictor of poor outcomes after adjusting for age and comorbidities. Conclusion: Our study found that serum lactate can be a simple, rapid, and reliable biomarker for prognosis in adult CAP patients. Incorporating lactate measurement in the routine evaluation of suspected CAP cases can enhance early risk stratification and guide ICU referrals if needed, and help in optimal resource utilization.