Background: Cholecystectomy, a surgical procedure for gallbladder disease, is widely performed as either laparoscopic or open surgery. However, hospital stay duration varies due to several factors, including patient demographics, comorbidities, surgical approach, and postoperative complications. Understanding these determinants is crucial for optimizing recovery, reducing healthcare costs, and improving hospital resource utilization.

Objective: This study aims to analyze the factors influencing the length of hospital stay in patients undergoing cholecystectomy, comparing laparoscopic and open approaches and identifying key predictors of prolonged hospitalization. Methods: A retrospective cross-sectional study was conducted at Nalanda Medical College & Hospital, Patna, Bihar, from February 2024 to January 2025. Medical records of 100 patients who underwent either laparoscopic or open cholecystectomy were reviewed. Data collection included patient demographics (age, gender, BMI), comorbidities (diabetes, hypertension, cardiovascular disease), type of surgery, intraoperative complications, and hospital stay duration. Statistical analysis was performed using t-tests, ANOVA, and regression models to identify significant predictors of prolonged hospitalization. Results: The mean age of the patients was 48.6 ± 12.3 years, with 58% males and 42% females. The mean BMI was 26.4 ± 3.7 kg/m², and 35% had diabetes, 40% had hypertension, and 18% had cardiovascular disease. Laparoscopic cholecystectomy was performed in 75% of cases, while 25% underwent open cholecystectomy. A conversion rate of 10% from laparoscopic to open surgery was observed. The overall mean hospital stay was 4.2 ± 1.8 days, with laparoscopic cholecystectomy patients staying for 3.1 ± 1.2 days, open cholecystectomy patients for 6.8 ± 2.1 days, and converted cases for 7.5 ± 2.4 days. Older age (>60 years) (70%, p = 0.01), diabetes (71%, p = 0.03), hypertension (70%, p = 0.02), open cholecystectomy (92%, p < 0.001), conversion to open surgery (90%, p < 0.001), and postoperative complications (85%, p < 0.001) were all significantly associated with extended hospitalization. Conclusion: This study demonstrates that older age, comorbidities, open cholecystectomy, conversion to open surgery, and postoperative complications significantly prolong hospital stays after cholecystectomy. These findings emphasize the importance of preoperative risk assessment, surgical planning, and enhanced postoperative care to minimize hospital stays and improve patient outcomes. Future prospective studies should explore interventions that enhance surgical recovery and reduce hospital resource burdens.

Background: One of the most prevalent surgical emergencies is acute appendicitis, and the usual therapy is appendectomy. The minimally invasive technique, shorter recovery time, and decreased postoperative pain have contributed to laparoscopic appendectomy's (LA) broad acceptance over the last several decades. Nonetheless, open appendectomy (OA) is still sometimes done, especially in situations where there is a lack of resources or where laparoscopy is not an option. In order to find out whether surgical method is better for acute appendicitis, this study will compare the clinical results of LA and OA. Methods: From January 2024 to November 2024, researchers at Nalanda Medical College & Hospital in Bihar carried out a retrospective observational study. One hundred individuals who underwent treatment for acute appendicitis with either LA or OA were considered for the study. Time to return to regular activities, pain scores, length of hospital stay, demographic characteristics, intraoperative findings, postoperative problems, and length of operation were all part of the analysis. The two groups were compared statistically using suitable procedures such the t-test and chi-square test. Results: The research indicated that a considerably shorter hospital stay (2.8 ± 0.6 days) was linked to LA, in contrast to OA (4.5 ± 1.2 days) (p < 0.001). In comparison to the OA group, LA showed a quicker recovery time after surgery, with a return to normal activities in 7.4 ± 1.5 days, p < 0.001. In comparison to the OA group, the LA group had reduced postoperative pain levels (3.2 ± 1.1) on a 10-point scale (p < 0.001). There were fewer postoperative problems, such as wound infections (5% in LA vs. 12% in OA) and prolonged ileus (3% in LA vs. 9% in OA), even though the surgical time for LA was slightly greater (45.2 ± 8.7 min) than for OA (38.5 ± 6.4 min) (p = 0.015). Discussion: The findings of this study align with previous research advocating for the benefits of LA. The reduced postoperative complications and quicker recovery associated with LA contribute to its growing preference among surgeons. However, economic considerations, surgeon expertise, and institutional resources play a crucial role in determining the feasibility of widespread adoption of LA, particularly in low-resource settings. Conclusion: This study supports the use of LA as the preferred approach for managing acute appendicitis due to its advantages in postoperative recovery and complication rates. However, OA remains relevant in selected cases. Further prospective studies with larger sample sizes are recommended to confirm these findings and refine surgical decision-making.

Introduction: The sole essence of anaesthesia is relief of pain in intra and post-operative period. Any adjuvant which will increase post operative analgesia duration without any significant side effects will be beneficial for the patients. MATERIALS AND METHODS: This study was done in sixty ASA grade I and II patients undergoing elective lower limb surgeries. The patients were randomly assigned to one of the two groups, each containing 30 patients, Group BC (received intrathecal clonidine with bupivacaine) and Group BCN (received transdermal nitroglycerine patch with intrathecal clonidine with bupivacaine). Vitals were monitored, along with onset of sensory and motor block, regression of two segment sensory block, and visual analogue scale for duration of analgesia. RESULTS: In the patients receiving transdermal NTG patch along with intrathecal bupivacaine and clonidine showed significant prolongation in the duration of analgesia, delayed time of requirement of first rescue analgesic, decreased requirement of number of rescue analgesics, good VAS score, stable hemodynamic profile with no significant intra-operative or postoperative complications. CONCLUSION: In our study, we have compared the efficacy of transdermal nitroglycerine patch with intrathecal clonidine in bupivacaine.  The clinical advantage of transdermal nitroglycerine patch with intrathecal clonidine over only intrathecal clonidine in bupivacaine is that, it prolongs the duration of analgesia, delays the time of requirement of first rescue analgesic, decreases the requirement of number of rescue analgesics, with a stable hemodynamic profile and no significant intraoperative or postoperative complications.

Background: In surgical patients, the postoperative results are heavily influenced by their preoperative nutritional state. There is evidence linking malnutrition to an increased risk of surgical complications, longer hospital stays, infection rates, and mortality. Patients undergoing general surgery at Nalanda Medical College & Hospital in Bihar were studied to determine the effect of their preoperative nutritional state on the success of their operation.

Methods: 100 patients undergoing general surgery were part of a retrospective cross-sectional study that ran from October 2023 to November 2024. Nutritional Risk Screening (NRS-2002), blood albumin levels, and Body Mass Index (BMI) were used to evaluate the nutritional health of patients before surgery. Surgical site infections (SSIs), length of hospital stay, postoperative complications (such as pneumonia and wound healing delays), and mortality rates were all part of the postoperative outcomes that were examined. The statistical analyses that were conducted to assess the relationships between nutritional status and surgical outcomes involved descriptive statistics, chi-square tests for categorical variables, and logistic regression. Results: Malnourished patients (defined by low BMI, hypoalbuminemia, or high NRS-2002 scores) had significantly worse postoperative outcomes compared to well-nourished patients. The incidence of SSI was 44.4% in malnourished patients compared to 9.1% in well-nourished patients (p<0.05). Malnourished patients also experienced longer hospital stays (mean: 12.8 days vs. 6.2 days; p<0.05), and a higher rate of postoperative complications, including wound dehiscence and pneumonia. Logistic regression analysis confirmed that low serum albumin levels were a strong predictor of increased postoperative morbidity and mortality (OR: 3.5; 95% CI: 2.1–5.8). Conclusion: Preoperative malnutrition is strongly associated with worse surgical outcomes, according to the study. The risk of infections, prolonged hospitalisation, and surgical sequelae is greatly increased in malnourished patients.  Routine preoperative nutritional assessment and targeted interventions, including dietary counseling and nutritional supplementation, should be integrated into surgical care protocols to enhance recovery and reduce morbidity. Further prospective, multi-center studies are needed to validate these findings and establish standardized nutritional intervention strategies for surgical patients.

Background: Hernia repair, whether mesh-based or non-mesh, is a common surgical procedure worldwide. Mesh repair is popular due to its low recurrence rates, although infection, chronic discomfort, and foreign body reactions remain concerns. This retrospective study examines hernia recurrence following mesh and non-mesh repair. Methods: This retrospective observational study examined 100 hernia repairs performed at Nalanda Medical College & Hospital in Patna, Bihar, between January 2024 and December 2024. We examined demographics, surgical details, recurrence rates, and post-operative issues in mesh and non-mesh repair patients' medical records. Patients with primary hernia repairs throughout the research period were eligible, but those with incomplete data, reoccurring hernias, or major co-morbidities that would affect surgical results were not. We examined recurrence rates and other clinical outcomes using chi-square and Kaplan-Meier survival analysis. Results: The mesh repair group had 8.3% recurrence, compared to 30% for the non-mesh group. The mesh group experienced less postoperative discomfort (11.7 percent vs. 22.5%) and shorter hospital stays (3.4 vs. 4.8 days) than the control group. Despite no statistically significant difference, the mesh group had a higher infection rate (4.2% vs. 2.8%). Conclusion: This study found that mesh surgery improved hernia repair recurrence and surgical outcomes. Most hernia patients should select mesh repair due to its lower recurrence rate and faster recovery. It's vital to identify patients carefully and monitor them long-term to spot issues. Future prospective studies should employ larger sample sizes and longer follow-up to confirm these findings and examine long-term patient outcomes.

Background: Emergency laparotomies are life-saving procedures performed for various acute abdominal conditions. However, they are associated with high mortality and morbidity rates, particularly in resource-limited settings. Identifying key predictors of adverse outcomes can help in optimizing perioperative management and improving patient survival.

Objectives: This study aims to analyze the predictors of mortality and morbidity in patients undergoing emergency laparotomies at Nalanda Medical College & Hospital, Bihar. The primary objective is to determine the 30-day postoperative mortality rate, while the secondary objectives include identifying risk factors contributing to postoperative complications, prolonged hospital stay, and ICU admissions. Methods: This retrospective cross-sectional study included 100 patients who underwent emergency laparotomies between December 2023 and November 2024. Data were extracted from hospital records, including demographic details, comorbidities, surgical indications, intraoperative findings, postoperative complications, and outcomes. Statistical analyses, including logistic regression and chi-square tests, were conducted to assess significant predictors of mortality and morbidity. Results: The overall 30-day mortality rate was 18%. Advanced age, preoperative sepsis, shock, and multiple comorbidities were significant predictors of mortality (p < 0.05). Morbidity was common, with 45% of patients experiencing at least one major postoperative complication, including surgical site infections (32%), sepsis (21%), and multi-organ failure (12%). The mean hospital stay was 10.5 days, with 35% of patients requiring ICU admission. Patients presenting with bowel perforation and peritonitis had significantly higher mortality rates. The need for intraoperative blood transfusion and prolonged operative time were also associated with worse outcomes. Discussion: The study findings align with previous literature highlighting sepsis, hemodynamic instability, and comorbidities as major risk factors for poor outcomes. Early identification of high-risk patients using predictive scoring systems and optimized perioperative care can help reduce mortality and morbidity. Strengthening ICU facilities, enhancing surgical decision-making, and implementing structured postoperative monitoring are essential strategies for improving outcomes. Conclusion: Emergency laparotomies remain a high-risk surgical procedure with significant mortality and morbidity. Identifying key risk factors allows for better perioperative management and improved patient survival. Future research should focus on prospective multicenter studies and enhanced perioperative protocols to optimize outcomes.

Background: Portal hypertension (PHT) is a severe condition stemming from either cirrhotic (CPH) or non-cirrhotic (NCPH) etiologies, each with distinct pathophysiology and prognosis. Doppler ultrasonography offers a non-invasive means to assess portal hemodynamics, but comparative data from specific, underserved populations, such as those in tribal regions of India where NCPH is prevalent, are scarce. Methods: This prospective, comparative observational study was conducted over a one-year period in a tertiary hospital serving a tribal population in Maharashtra. A total of 180 consecutive patients with PHT were enrolled and categorized into CPH (n=92) and NCPH (n=88) groups based on clinical, biochemical, and imaging criteria. All patients underwent a standardized abdominal Doppler ultrasound protocol to measure portal vein diameter (PVD), portal vein velocity (PVV), hepatic artery resistive index (HA-RI), splenic artery resistive index (SA-RI), and portal vein congestion index (CI). Results: Patients with CPH were older than those with NCPH (54.2 ± 9.8 vs. 38.5 ± 12.1 years, p<0.001). While PVD was elevated in both groups, it was significantly larger in the NCPH group (15.1 ± 2.2 mm vs. 14.2 ± 1.8 mm, p=0.015). The most significant hemodynamic differences were observed in flow dynamics and arterial resistance. The CPH group demonstrated significantly lower mean PVV (11.8 ± 2.9 cm/s vs. 15.6 ± 4.1 cm/s, p<0.001) and a consequently higher CI (0.16 ± 0.05 vs. 0.12 ± 0.04 cm·s, p<0.001). The mean HA-RI was markedly elevated in the CPH group compared to the NCPH group (0.79 ± 0.06 vs. 0.65 ± 0.07, p<0.001). Using a cut-off of >0.72, HA-RI showed a sensitivity of 90.2% and a specificity of 88.6% for distinguishing CPH from NCPH. Conclusion: Distinct portal hemodynamic patterns differentiate CPH from NCPH. Specifically, low portal vein velocity, a high congestion index, and a markedly elevated hepatic artery resistive index are characteristic features of cirrhotic portal hypertension. These non-invasive Doppler parameters, particularly HA-RI, serve as valuable discriminators, aiding in etiological diagnosis and management planning in resource-limited settings.

Background: Sepsis is a critical condition characterized by organ dysfunction that arises from an uncontrolled response of the host to infection, and its occurrence is on the rise in intensive care units around the globe. Despite progress in medical science, sepsis continues to pose a major global health issue, leading to high rates of morbidity and mortality among patients in intensive care units (ICUs) Timely recognition and effective management of sepsis are essential for enhancing patient outcomes, which requires dependable biomarkers and scoring systems to evaluate the severity of the disease. This study aims to examine the relationship between serum uric acid levels and the Quick Sequential Organ Failure Assessment (qSOFA) score in critically ill ICU patients diagnosed with sepsis. Methodology: Blood samples were collected for complete blood counts, serum procalcitonin, arterial blood gases, blood glucose levels, prothrombin time with international normalized ratio, liver function assessments, renal function evaluations, serum lactate, and serum uric acid levels on the first day of the ICU admission. Results: The Spearman correlation analysis revealed a very strong positive relationship between q-SOFA scores and serum uric acid concentrations (Spearman’s ρ = 0.884, p < 0.001), as well as between q-SOFA scores and serum procalcitonin concentrations (ρ = 0.901, p < 0.001), suggesting that both biomarkers significantly rise with increasing q-SOFA scores. A strong association was also found between uric acid and procalcitonin levels (ρ = 0.831, p < 0.001). Conclusion: Clinical scoring systems such as qSOFA, when combined with cost-effective biochemical markers like uric acid or PCT, can improve early risk assessment and assist in prioritizing patients for closer monitoring or treatment escalation.

Background: Chronic rhinosinusitis (CRS) is a prevalent condition with multiple risk factors. The aim of this study is to determine the prevalence and risk factors of CRS among an urban population, with specific emphasis on environmental, lifestyle, and comorbid conditions. Methods: Hospital-based cross-sectional analysis was carried out in 750 adult patients presented to the otorhinolaryngology outpatient department of a tertiary care hospital. CRS was identified according to the EPOS 2012 criteria. Demographic data, medical history, environmental exposure, and lifestyle factors were recorded in a structured questionnaire. Statistical inference was done to see whether risk factors were associated with CRS. Results: 180 patients (24%) were diagnosed with CRS. The most frequent concomitant risk factors were allergic rhinitis (54.4%), gastroesophageal reflux disease (25.6%), and smoking (32.2%). Exposure to the environment was reported by 46.7% of the patients. CRS with nasal polyps (CRSwNP) was more frequently associated with allergic rhinitis and asthma, whereas CRS without nasal polyps (CRSsNP) was more associated with GERD and smoking. Logistic regression analysis revealed that allergic rhinitis and environmental exposures were independent predictors of CRS. Conclusion: Factors responsible for CRS in urban populations are varied and involve allergic rhinitis, GERD, smoking, and environmental toxins. The identification of these risk factors is important to develop preventive and therapeutic approaches in CRS.

Background: Nasal bone fractures are the most frequently occurring facial fractures, making nasal injuries present in nearly 40% of patients suffering from maxillofacial trauma. In polytrauma patients, nasal injuries often go unnoticed at the time of initial resuscitation. During this time, life-threatening injuries take precedence among clinicians. Patients who go undiagnosed, or poorly managed for nasal bone fractures, may experience functional sequelae such as nasal obstruction and/or septal deviation as well as aesthetic sequelae which negatively impact their quality of life. Radiological evaluation, with computed tomography (CT), has become an indispensable part of the workup to enable for correct diagnosis, characterization of fracture types, and appropriate management. The aim of this study was to evaluate the radiological findings of nasal bone fractures in polytrauma patients and understand the clinical outcomes based on the type of management administered. Methods: Between January 2023 and June 2024, a prospective clinical study was carried out at one of the tertiary care centers in North India in the Departments of Otorhinolaryngology and Radiodiagnosis. A total of 72 polytrauma patients with a CT scan confirmed nasal bone fracture were included in the study. The study documented patient demographic, mechanism of injury, and associated systemic and maxillofacial injuries. Radiological evaluations were performed using both conventional radiographs and high-resolution CT scans. Fractures were classified based on displacement, comminution, and septal involvement. Management included conservative observation based on fracture type and injury, closed reduction, and open reduction and internal fixation (ORIF). All treatment options were based on fracture type and patient's health status. Outcomes were assessed at 6 months after treatment for nasal airway patency, symmetry, cosmetic satisfaction, and complications. Results: The majority of patients were male (79.1%) with an average age of 29.6 years. The etiology of injury was road traffic accidents (65.3%), physical assault (22.2%), and accidental fall (12.5%). A CT scan identified 100% of fractures at presentation, and included 28 comminuted fractures and 18 septal deviations. Plain radiographs missed 21% of subtle or complex injuries. Closed reduction was attempted in 41 patients (56.9%), open reduction with internal fixation (ORIF) was performed in 17 patients (23.6%), and 14 patients (19.5%) were treated conservatively. At follow-up of 6 months, functional and cosmetic outcomes were good in 86.1% of patients. The complications were residual nasal deformity (8.3%), persistent nasal obstruction (5.6%), and minor epistaxis (4.2%). There were better outcomes for patients who presented and were assessed using CT compared to those who were initially assessed using plain radiographs. Conclusion: Radiological evaluation - especially using CT - provides extensive information regarding nasal bone fractures in polytrauma, and is more sensitive and reliable in assessment than conventional radiography. Early recognition and appropriate management - from observation to surgical intervention - optimizes functional recovery and esthetic satisfaction. CT can substantially improve accuracy and enhance patient outcomes when used as part of the everyday polytrauma management pathway.

Background: Chronic Kidney Disease (CKD) is a progressive condition often advancing to End-Stage Renal Disease (ESRD), necessitating lifelong hemodialysis. Beyond technical care, patients face clinical challenges such as poor treatment adherence, anemia, and electrolyte imbalances. Structured support group programmes may help improve adherence and treatment outcomes, though evidence remains limited in the Indian context. Objectives: To evaluate the effect of a structured support group programme on selected clinical indicators—Urea Reduction Ratio (URR), hemoglobin, potassium, and phosphorus—among patients undergoing maintenance hemodialysis. Methods: A quasi-experimental pre-test–post-test control group design was adopted in the hemodialysis unit of a tertiary hospital in Kerala. A total of 120 ESRD patients (60 experimental, 60 control), aged 30–65 years and on dialysis for at least six months, were enrolled using purposive sampling. The experimental group received a 6-week structured support group programme incorporating peer sharing, cognitive-behavioral strategies, relaxation techniques, and reinforcement sessions, while the control group continued routine care. Data on URR, hemoglobin, potassium, and phosphorus were collected at baseline, post-test 1 (6 weeks), and post-test 2 (10 weeks). Data were analyzed using Friedman test, Wilcoxon signed-rank test, and Mann–Whitney U test. Results: The experimental group demonstrated significant improvement in URR (66.68 ± 7.63 → 68.49 ± 7.53; χ² = 113.567, p < 0.001) and hemoglobin (9.62 ± 0.90 → 9.97 ± 0.62 g/dL; χ² = 7.604, p = 0.022). Serum potassium decreased favourably (5.30 ± 0.89 → 5.01 ± 0.78 mmol/L; Wilcoxon p < 0.05), stabilizing at safe levels, while serum phosphorus remained unchanged. Between-group analysis showed favorable but non-significant trends for URR and hemoglobin. Conclusion: The support group programme effectively improved dialysis adequacy, hemoglobin, and potassium regulation, while maintaining phosphorus stability. These findings support the integration of psychosocial support into routine hemodialysis care to complement pharmacological and technical management.

Background: Cataract remains the leading cause of blindness globally, with phacoemulsification surgery being the standard of care for visual rehabilitation¹. Adequate anesthesia is critical for surgical success, patient comfort, and safety². While peribulbar anesthesia has been traditionally employed, topical anesthesia is increasingly used to minimize complications and improve recovery³⁻⁵. Recent studies also emphasize the importance of anesthesia selection in high-risk groups such as those with cardiovascular disease⁶. Objectives: To compare intraoperative pain, postoperative comfort, and complication rates between topical and peribulbar anesthesia in cataract surgery. Methods: This prospective, comparative study included 100 patients aged ≥40 years with senile cataract undergoing phacoemulsification. Participants were randomized into Group A (topical anesthesia, n=50) and Group B (peribulbar anesthesia, n=50). Intraoperative pain was measured using the Visual Analogue Scale (VAS), postoperative comfort was assessed with a 5-point Likert scale at 1 and 24 hours, and complications were documented. Data were analyzed using Student’s t-test and chi-square test, with significance at p<0.05. Results: The groups were demographically comparable in age (62.1 ± 7.4 vs. 63.5 ± 6.8 years) and sex distribution. Intraoperative pain scores were significantly higher in the topical group (VAS 3.2 ± 1.1) compared to peribulbar (VAS 1.5 ± 0.8, p<0.05). Postoperative comfort was slightly higher with peribulbar anesthesia (4.3 ± 0.5) versus topical (4.1 ± 0.6). Complications were more frequent with peribulbar anesthesia, including chemosis (8%) and subconjunctival hemorrhage (6%), whereas supplemental anesthesia was more often required in the topical group (12% vs. 4%). Conclusion: Both techniques are safe and effective for cataract surgery. Topical anesthesia provides faster recovery and fewer local complications, though with slightly higher intraoperative discomfort. Peribulbar anesthesia offers superior analgesia but at the expense of local adverse events. Individualized anesthesia choice remains essential³⁻⁶.

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, with a disproportionate burden in low- and middle-income countries. Rural populations remain particularly vulnerable due to limited healthcare access, lower literacy levels, and restricted exposure to preventive health education.  Objective: To evaluate the knowledge, attitudes, and preventive practices regarding cardiovascular disease among middle-aged adults in a rural setting. Methods: This cross-sectional descriptive study included 324 middle-aged adults (aged 40–60 years) recruited through non-probability consecutive sampling. Data were collected using a structured, pretested questionnaire assessing sociodemographic characteristics, knowledge of CVD risk factors and symptoms, attitudes toward cardiovascular health, and preventive practices.  Results: The mean age of participants was 49.2 ± 5.8 years; 54.3% were males. Most participants had low educational attainment, with 38.6% reporting no formal education. While 73.5% had heard of CVD, only 57.4% identified smoking and 49.4% identified obesity as risk factors. Hypertension (71.9%) and diabetes (65.7%) were more frequently recognized. Chest pain (62.3%) was the most commonly reported warning symptom, whereas shortness of breath was less often recognized (44.8%). Although 82.1% of participants agreed that CVD is a serious condition, only 39.8% perceived themselves to be at personal risk. Conclusion: It is concluded that middle-aged adults in rural settings demonstrate moderate knowledge and positive attitudes toward cardiovascular disease, yet preventive practices remain poor.

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.