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),