Abstract Background: Zinc is essential for maintaining immune health, and its deficiency is prevalent in older populations, contributing to weakened defenses against infections. Prior research indicates that targeted zinc intake can help normalize levels and support T-lymphocyte activity in those with suboptimal status. Objective: We evaluated whether a 3-month course of 30 mg/day zinc supplementation could elevate serum zinc in adults over 65 years with initial levels below 70 μg/dL and explored its potential to enhance T-cell responses. Methods: This pilot trial randomized 30 participants to receive either 30 mg/day zinc (as zinc sulfate; n=15) or a low-dose control (5 mg/day zinc; n=15). The main focus was the shift in serum zinc from baseline to 3 months, with additional assessments of T-cell proliferation and select biomarkers. Results: Serum zinc rose significantly more in the zinc group (mean change: +18.1 μg/dL) than the control (±2.3 μg/dL; adjusted β=20.91 ± 2.35 μg/dL, P<0.001). Proliferation in response to anti-CD3/CD28 and phytohemagglutinin also improved (β=8.73 ± 3.15 ×1000 cpm, P=0.010; β=14.99 ± 3.70 ×1000 cpm, P<0.001, respectively), linked to higher T-cell counts (β=219.75 ± 40.67 cells/μL, P<0.001). Adjustments for T-cell numbers eliminated proliferation differences, suggesting benefits from expanded cell populations. Conclusion: Moderate-dose zinc supplementation effectively addresses marginal deficiency in older adults, with associated gains in T-cell numbers that may bolster immunity. Larger trials are needed to confirm infection-related outcomes.

Background: Endothelial dysfunction is a hallmark of essential hypertension. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase (NOS), reducing nitric oxide (NO) availability and thereby impairing vasodilation. This study aimed to evaluate serum ADMA and NO concentrations in hypertensive patients compared to healthy controls and to explore their correlation. Methods: A case–control study was conducted over a period of two years in a Government Medical College, including 110 hypertensive patients (59 without microalbuminuria and 51 with microalbuminuria) and 62 age- and sex- matched healthy volunteers. Serum ADMA was estimated by ELISA, and NO levels were measured using the Griess method. Statistical analyses included Student’s t-test, ANOVA, and Pearson correlation. Results: Serum ADMA levels were significantly elevated in hypertensives (196.58 ± 59.44 ng/ml in normoalbuminurics; 265.38 ± 129.97 ng/ml in microalbuminurics) compared to controls (78.86 ± 47.72 ng/ml, p<0.001). In contrast, serum NO concentrations were markedly reduced in hypertensives (8.61 ± 4.39 μmol/L and 5.58 ± 2.38 μmol/L) compared to controls (20.94 ± 5.55 μmol/L, p<0.001). A strong inverse correlation was observed between ADMA and NO (r = –0.732, p<0.001). Conclusion: Essential hypertension is associated with elevated ADMA and decreased NO concentrations, confirming endothelial dysfunction. ADMA may serve as a potential biomarker of vascular impairment and therapeutic target in hypertension management.

Background: Intraoperative Frozen Section (FS) examination plays a crucial role in gynecological oncology by guiding the extent of surgery and preventing over- or under- treatment. However, its diagnostic accuracy varies across tumor types. Objectives: To assess the diagnostic accuracy of frozen section compared with final histopathology and to evaluate its impact on intraoperative surgical decision-making in gynecological malignancies. Methods: A retrospective observational study was conducted at the Department of Pathology, Karnataka Medical College and Research Institute (KMC& RI), Hubballi, from January 2023 to January 2025. All gynecological specimens subjected to intraoperative frozen section were included. Frozen section diagnoses were compared with final paraffin section histopathology. Analyses for concordance, sensitivity, specificity, and surgical impact was done. Results: A total of 120 cases were included. Ovarian tumors constituted the majority (65%). Overall concordance between frozen section and final histopathology was 92.5%. Sensitivity and specificity for malignancy were 90.2% and 96.8%, respectively. Frozen section findings influenced the extent of surgery in 78.3% of cases, particularly in ovarian neoplasms. Conclusion: Frozen section is a reliable intraoperative diagnostic tool in gynecological oncology with high accuracy and significant impact on surgical management. Its judicious use can optimize patient outcomes and reduce unnecessary radical procedures.

Background: Trochanteric fractures of the femur are common injuries in the elderly, often associated with osteoporosis and low-energy trauma, though they may also occur in younger individuals following high-energy injuries. Surgical management is essential to restore function and reduce complications. Among available techniques, Proximal Femoral Nailing (PFN) has emerged as the preferred internal fixation method, while External Fixation (EF) remains an alternative, particularly in high-risk or resource-limited settings. This study aimed to compare outcomes of PFN and EF in the management of trochanteric fractures. Materials and Methods: This randomized controlled trial was conducted at the Department of Orthopedics, Era’s Lucknow Medical College & Hospital, over 24 months. A total of 80 patients aged >18 years with trochanteric fractures were enrolled and randomly allocated into two groups: Group A (EF, n=40) and Group B (PFN, n=40). Outcomes assessed included union rate, operative parameters, cost, functional outcomes using the Harris Hip Score (HHS), limb shortening, range of motion, and complications. Data were analyzed using SPSS v25.0, with p<0.05 considered statistically significant. Results: Baseline demographic variables including age, gender, and laterality were comparable between groups (p>0.05). PFN was associated with significantly higher intraoperative blood loss (259.38 ± 78.80 mL vs. 43.88 ± 19.20 mL), longer operative time (80.68 ± 17.21 min vs. 40.58 ± 12.82 min), universal anesthesia requirement, and higher cost (₹27,275.0 ± 2483.87 vs. ₹13,397.50 ± 1799.08) (p<0.001). Union was achieved in 100% of PFN cases and 95% of EF cases (p=0.152). Functional outcomes measured by HHS were significantly better in PFN patients at 3 weeks, 3 months, and 6 months (p<0.001). Complications such as pin tract infection (32.5%) and pin loosening (7.5%) occurred exclusively in the EF group (p<0.001). Conclusion: Both PFN and EF are effective in achieving high union rates in trochanteric fractures; however, PFN provides superior functional recovery, earlier mobilization, and fewer complications, despite higher cost and operative demands. EF remains a useful alternative for elderly or comorbid patients and in resource-constrained settings, but PFN should be considered the preferred modality in most cases.

INTRODUCTION: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia resulting from defects in insulin secretion, insulin action, or both. AIM: To examine the musculoskeletal manifestations in patients with diabetes mellitus and their correlation with disease duration, microvascular and macrovascular complications, and other associated factors at a tertiary care centre in Northwest Rajasthan. METHODOLOGY: This cross-sectional study was conducted at the Diabetic Research Centre, Bikaner over a period of 1 yr from jan 2024 to dec 2024. The study population comprised patients with diabetes mellitus attending the outpatient department (OPD) of the Diabetic Research Centre during the study period. RESULT: Musculoskeletal complications were present in 36.5% of diabetic patients, with osteoarthritis and shoulder capsulitis being the most common, and showed a significant association with microvascular complications (p = 0.0001) but not with macrovascular complications. Patients with musculoskeletal involvement had significantly higher HbA1c, HsCRP, ESR levels and lower vitamin D levels compared to those without such complications. CONCLUSION: Musculoskeletal complications are frequent in diabetes, particularly among middle-aged and elderly patients, and are strongly linked to poor glycemic control and microvascular complications. Early identification and management of metabolic control and inflammatory status may help reduce the burden of musculoskeletal morbidity in diabetic patients.

Background: Acute cerebral ischemia (ACI), primarily ischemic stroke, is a major cause of disability and mortality worldwide, with a growing burden in India. Stroke pathophysiology is closely linked to metabolic alterations such as hyperglycemia, electrolyte imbalance, and inflammation, which influence both acute outcomes and recovery. Objective: To evaluate the prevalence of metabolic abnormalities in patients with ACI and assess their association with short-term functional outcomes. Methods: This prospective observational study was conducted at Chandramma Dayanand Sagar Institute of Medical Education and Research on 250 patients admitted with clinically and radiologically confirmed acute cerebral ischemia between October 2023 and June 2025. Blood samples were collected within 24 hours of symptom onset and analysed for key metabolic parameters including blood glucose, serum electrolytes (Na⁺, K⁺, Ca²), lactate, arterial blood gases (ABG), and serum lipid profile. Patients were monitored for neurological outcomes using the NIH Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at admission and at 30-day follow-up. Statistical analysis was performed using SPSS version Results: The mean age of patients was 64.5 ± 10.8 years; 59% were male. Hypertension (68.8%) and diabetes (55.2%) were the most common comorbidities. Metabolic abnormalities included hyperglycaemia (65%), hyponatremia (42%), elevated lactate (38%), metabolic acidosis (24.8%), dyslipidaemia (45.6%), and leucocytosis (40.4%). Poor functional outcomes (mRS ≥3 at 30 days) were significantly associated with hyperglycaemia (p<0.01), hyponatremia (p<0.05), elevated lactate (p<0.01), metabolic acidosis (p<0.01), and leucocytosis (p<0.05). Dyslipidaemia showed a non-significant trend toward adverse outcomes. Conclusion: Metabolic alterations are highly prevalent in ACI and strongly associated with worse short-term outcomes. Early identification and correction of hyperglycemia, electrolyte imbalance, and metabolic acidosis should be integrated into acute stroke management. Routine metabolic profiling may serve as a cost-effective strategy to improve prognosis in stroke patients, particularly in high-burden countries such as India.

Background: Urinary tract infections (UTIs) are highly prevalent among elderly patients and are associated with increased morbidity, recurrence, and healthcare burden. Age-related physiological changes, comorbidities, and antimicrobial resistance complicate treatment decisions in this population. Fosfomycin and nitrofurantoin are commonly recommended oral agents for lower UTIs, but comparative evidence regarding their efficacy and safety in elderly patients remains limited.Objectives: To systematically review and compare the clinical efficacy, microbiological outcomes, recurrence rates, and safety of fosfomycin and nitrofurantoin in elderly patients with urinary tract infections. Methods: A systematic literature search was conducted across major electronic databases to identify randomized controlled trials, observational studies, and meta-analyses comparing fosfomycin and nitrofurantoin for the treatment of UTIs. Studies including elderly patients (≥65 years) or reporting age-stratified outcomes were included. Primary outcome assessed was clinical cure, while secondary outcomes included microbiological eradication, recurrence rates, and adverse events. Due to heterogeneity and limited elderly-specific data, results were synthesized qualitatively with tabulated comparisons. Results: A total of 18 studies met the inclusion criteria. Overall, nitrofurantoin demonstrated higher sustained clinical and microbiological cure rates compared with single-dose fosfomycin, particularly at follow-up beyond 28 days. Fosfomycin showed good short-term clinical response but was associated with higher recurrence rates. Both antibiotics were generally well tolerated in elderly patients when used for short-course therapy, with no significant increase in serious adverse events. Conclusion: Nitrofurantoin appears to provide more durable therapeutic outcomes than single-dose fosfomycin in elderly patients with lower UTIs, while fosfomycin remains a useful alternative in selected cases. Individualized antibiotic selection based on renal function, comorbidities, resistance patterns, and patient adherence is essential. Further high-quality studies focused specifically on elderly populations are needed to strengthen evidence-based recommendations.

Urinary tract infections (UTIs) are among the most common bacterial infections in the elderly and are associated with increased morbidity, recurrence, and healthcare utilization. Age-related physiological changes, multiple comorbidities, polypharmacy, and declining renal function complicate antibiotic selection in this population. Fosfomycin and nitrofurantoin are widely recommended oral agents for the treatment of lower UTIs; however, comparative evidence regarding their efficacy and safety in elderly patients remains limited. This systematic review aimed to evaluate and compare the clinical and microbiological outcomes of fosfomycin and nitrofurantoin in elderly patients with UTIs. A comprehensive literature search of major electronic databases was conducted to identify randomized controlled trials, observational studies, and systematic reviews comparing fosfomycin and nitrofurantoin in the treatment of UTIs. Studies including elderly patients or reporting age-stratified outcomes were preferentially analyzed. Clinical cure, microbiological eradication, recurrence rates, and adverse events were assessed. The available evidence indicates that nitrofurantoin is associated with higher sustained clinical and microbiological cure rates, particularly at longer follow-up intervals, whereas fosfomycin demonstrates good short-term efficacy but higher rates of bacteriological persistence and recurrence. Both agents were generally well tolerated in elderly patients when used for short durations, with no significant increase in serious adverse events reported. In conclusion, nitrofurantoin appears to offer more durable therapeutic outcomes than single-dose fosfomycin in elderly patients with lower UTIs, while fosfomycin remains a useful alternative in selected cases. Individualized treatment decisions considering renal function, comorbidities, antimicrobial resistance patterns, and patient adherence are essential. Further high-quality studies focusing specifically on elderly populations are needed to strengthen evidence-based recommendations.

Background: Surgically induced astigmatism (SIA) is an important determinant of postoperative visual outcome following cataract surgery. The location of the incision plays a vital role in influencing the amount and axis of astigmatism. Superior incisions often produce against-the-rule (ATR) astigmatism, whereas temporal incisions are associated with lesser SIA and faster visual recovery.Aim: To compare the surgically induced astigmatism between superior and temporal small incision cataract surgery (SICS). Materials and Methods: A prospective comparative study was conducted on 100 patients with age-related cataract, divided into two groups: 50 underwent superior SICS (Group A) and 50 underwent temporal SICS (Group B). Preoperative and postoperative keratometry were performed using a manual or automated keratometer. SIA was calculated using vector analysis at 6 weeks postoperatively. Statistical analysis was done using SPSS version 23.0, and p ≤ 0.05 was considered significant. Results: The mean surgically induced astigmatism was 1.02 ± 0.34 D in the superior group and 0.65 ± 0.28 D in the temporal group (p < 0.001). Superior SICS induced more ATR astigmatism, while temporal SICS produced minimal change with a tendency toward with-the-rule (WTR) astigmatism. Postoperative uncorrected visual acuity (UCVA) was significantly better in the temporal group (p = 0.01). Conclusion: Temporal SICS induces less postoperative astigmatism and provides better uncorrected visual outcomes compared to superior SICS. Therefore, the temporal incision is preferable for minimizing astigmatism and achieving optimal refractive stability in cataract surgery.

Background: Chronic kidney disease (CKD) is a growing global health problem, and many patients require regular hemodialysis (HD) for survival. The rapid osmotic and fluid shifts during HD can influence ocular parameters, particularly intraocular pressure (IOP). Understanding these changes is important, especially for patients with coexisting glaucoma or ocular hypertension. Aim: To evaluate intraocular pressure changes before and after hemodialysis in patients with chronic kidney disease. Materials and Methods: A prospective observational study was conducted on 100 patients undergoing maintenance hemodialysis. Intraocular pressure was measured using a Goldmann applanation tonometer within 30 minutes before and after HD. Dialysis parameters including ultrafiltration volume, duration, and blood pressure were recorded. Statistical analysis was done using paired t-test and Pearson correlation. Results: The mean pre-dialysis IOP was 15.6 ± 2.79 mmHg, which decreased to 14.8 ± 2.58 mmHg post-dialysis (p < 0.001). A mild positive correlation was found between the degree of IOP reduction and ultrafiltration volume (r = 0.284, p = 0.004). Patients on long-term dialysis (>3 years) showed greater IOP reduction compared to those with shorter dialysis duration. Conclusion: Hemodialysis produces a statistically significant decrease in intraocular pressure due to osmotic and fluid shifts. Regular ophthalmic assessment is recommended in CKD patients undergoing dialysis to detect and manage ocular complications early.

Background: Fragility fractures are a major cause of morbidity, disability, and mortality among the elderly, often resulting from low-energy trauma in the setting of osteoporosis and age-related decline. Understanding the prevalence and distribution of these fractures is essential for strengthening preventive and geriatric orthopedic care. Aim: To determine the prevalence and pattern of fragility fractures among geriatric patients in a tertiary care hospital. Methods: A hospital-based cross-sectional study was conducted among 200 elderly patients (≥60 years) presenting with fractures. Clinical history, demographic details, comorbidities, radiological findings, and metabolic bone parameters were recorded. Fragility fractures were defined as fractures resulting from low-energy mechanisms such as a fall from standing height. Statistical analysis included chi-square tests, t-tests, ANOVA, and 95% confidence intervals, with p < 0.05 considered significant. Results: The prevalence of fragility fractures was 66% (n = 132). Patients with fragility fractures were significantly older than those with non-fragility fractures (74.1 ± 7.2 vs. 70.3 ± 7.6 years; p = 0.0014). Females (65.9%) were more commonly affected. Osteoporosis (84.8%), vitamin D deficiency (72.7%), and recurrent falls (68.9%) were markedly higher among fragility fracture cases. Hip fractures were the most frequent (29%), followed by vertebral (20.5%), wrist (11.5%), proximal humerus (8.5%), and pelvic insufficiency fractures (8.3%). Hip fracture patients were older and exhibited higher comorbidity burden and metabolic bone deficits. Conclusion: Fragility fractures are highly prevalent in the geriatric population, with hip and vertebral fractures comprising the majority. Advancing age, female sex, osteoporosis, vitamin D deficiency, and recurrent falls significantly contribute to fracture risk. Early geriatric screening, fall-prevention programs, and metabolic bone health optimization are crucial for reducing fracture burden.

Background: Disability among elderly is a significant public health concern globally and in India. It impacts quality of life, independence, and caregiving burden. This study assessed the prevalence of disability among elderly in rural Kolar and evaluated the effectiveness of an Information, Education, and Communication (IEC) intervention on disability management among caregivers. Methods: A quantitative, quasi-experimental one-group pre-test post-test research design was adopted using convenient sampling, 60 elderly individuals and their 60 caregivers from selected rural villages of Kolar were included. Disability prevalence was assessed using the Katz Activities of Daily Living (ADL) scale. A structured knowledge questionnaire measured caregiver knowledge. IEC intervention using charts and live demonstrations was administered. Post-test was conducted after 7 days of intervention. Results: Pre-test caregiver knowledge mean score was 6.42 (SD 2.32), increasing significantly to 19.78 (SD 5.40) in the post-test (p<0.005). Disability prevalence showed a considerable proportion of mild to moderate impairment based on ADL. No significant association was found between socio-demographic variables and post-test scores. Conclusion: Disability among elderly is prevalent and requires timely intervention. IEC strategies significantly improve caregiver knowledge on disability management. Community-based educational programs can strengthen elderly care and reduce disability burden.

Background: Shock, a life-threatening condition characterized by inadequate oxygen and nutrient delivery to vital organs, can lead to multi-organ failure and high mortality rates, particularly in pediatric populations, with septic shock contributing to approximately 60% of global mortality in children under five. This study aims to evaluate the predictive utility of the SI, MSI and SIPA in determining hospital length of stay and clinical outcomes. This study also seeks to enhance early identification of critically ill patients requiring intensive monitoring and timely intervention upon PICU admission, Patients and Methods: This prospective, observational study was conducted at the Paediatric Intensive Care Unit of JLN Medical College & Associated Group of Hospitals, Ajmer, from September 2023 to August 2024. Children aged 1 month to 18 years admitted to the PICU with shock were included. Exclusions included patients with a PICU stay of <2 hours, those outside the 1 month to 18 year age range, with multiple congenital anomalies, patients admitted with continuous CPR who did not achieve stable vital signs, referred shock patients arriving more than 4 hours after diagnosis and children whose parents did not provide consent. Ethical Information was collected from them using a pre-structured Proforma. Results: The study enrolled 100 pediatric shock patients (1 month-18 years). Male patients comprised 57%, with 40% being infants and 68% from rural areas. The mean hospital stay was 8.6 ± 5.47 days, with 66% survival and 34% mortality. Sepsis was the most common diagnosis (35%). Both Shock Index and Modified Shock Index were significantly higher in non-survivors (p<0.05 and p<0.001 respectively), showed increasing positive correlation with hospital stay (p<0.001) and were significantly elevated in patients requiring mechanical ventilation and inotropic support (p<0.001 for all). Abnormal SIPA values were also significantly associated with mortality (p<0.05) and longer hospital stays. Conclusion: This study concluded that elevated Shock Index, Modified Shock Index  and abnormal SIPA values at admission and during early monitoring were significantly associated with increased mortality, greater need for inotropic or ventilatory support and longer hospital stays, establishing their prognostic relevance in pediatric shock.

INTRODUCTION: Allergic rhinitis (AR) is a common yet underdiagnosed chronic inflammatory condition among children, leading to significant morbidity and affecting quality of life. This study aimed to estimate the prevalence of AR and associated risk factors among school-going children in central Rajasthan. AIM: To estimate the prevalence of allergic rhinitis among school going children in Ajmer aged 6 to 18 years using an ISAAC. METHODOLOGY: A cross-sectional study was conducted from September 2023 to August 2024 in Ajmer, Rajasthan. A total of 1000 children aged 6-18 years were surveyed using the standardized ISAAC questionnaire. RESULT: The study found a considerable prevalence of allergic rhinitis and related symptoms among children, with many experiencing persistent nasal issues and mild to moderate interference in daily activities. A strong association was observed between allergic rhinitis and other atopic conditions, especially asthma and atopic dermatitis. CONCLUSION: Allergic rhinitis is common among children and often coexists with other atopic conditions, impacting daily activities and quality of life. Early identification and management are essential to reduce symptoms and prevent complications.

Background: Gitelman syndrome (GS) is an autosomal recessive, salt-losing tubulopathy caused by a defect in the thiazide-sensitive Na⁺-Cl⁻ cotransporter in the distal convoluted tubule. It presents with hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. In resource-limited settings, diagnosis is often made on clinical and biochemical grounds without genetic confirmation. Objective: To describe the clinical and biochemical spectrum of six patients with GS diagnosed over two years at a tertiary care center. Methods: This case series included six patients diagnosed clinically and biochemically with GS between 2024 and 2025. Data on demographics, presenting symptoms, biochemical parameters, treatment, and outcomes over six months were collected at a tertiary care hospital in Dr. RPGMCT and a Himachal Pradesh, India. Genetic testing was not performed due to unavailability. Results: The mean age of patients was 39.7 ± 13.1 years (range 17–45 years), including 4 males and 2 females. One female had a history of hypertension; the rest had no co morbidities. All patients presented with generalized weakness, 5/6 had muscle cramps, 4/6 fatigue, and 3/6 paresthesias. Tetany was observed in 2 patients. Biochemical evaluation showed hypokalemia (2.50 ± 0.21 mEq/L), metabolic alkalosis (HCO₃⁻ 32 ± 1.41mEq/L),pH7.492 ± 0.016, hypomagnesemia (1.20 ± 0.14mg/dL), and hypocalciuria (urinary calcium 45 ± 18 mg/day). Plasma renin activity and aldosterone were elevated in all. Patients were treated with spironolactone, potassium, and magnesium supplements, resulting in symptomatic and biochemical improvement over six months, Conclusion: Recognition of the biochemical triad—hypokalemia, hypomagnesemia, and hypocalciuria-is crucial for diagnosis of Gitelman syndrome, even without genetic testing. Early identification prevents unnecessary investigations and complications. Gitelman syndrome (GS) is a rare autosomal recessive disorder affecting the thiazide-sensitive sodium-chloride co transporter (NCC),