Introduction: Resting motor threshold (MT) is a critical parameter for calibrating treatment intensity (TI) in transcranial magnetic stimulation, yet little is known about its variability in heterogeneous outpatient populations. This observational study analyzed data from 1101 patients receiving deep TMS, examining demographic, diagnostic and pharmacological influences on MT and TI. The mean MT was 58.7% stimulator output (SD = 11.7) and the mean TI was 54.9% of MT (SD = 9.8). MT increased with age and was slightly higher in males while diagnostic subgroup analysis revealed elevated MT in schizophrenia and dementia compared to mood disorders. Medication effects were pronounced: anticonvulsants, benzodiazepines, antipsychotics and lithium elevated MT, dopaminergic drugs lowered it and polypharmacy was linked with higher thresholds. TI correlated positively with MT (r = 0.58) but was also shaped by diagnostic protocols and clinician discretion. Clustering analysis identified three subgroups: low MT - low TI, high MT - high TI and intermediate patterns. These findings demonstrate that MT and TI are influenced by demographic, diagnostic and pharmacological factors in routine practice, highlighting the need for individualized calibration, periodic reassessment and medication-aware dosing strategies to optimize treatment outcomes.

Introduction: Both cognitive impairment (CI) and frailty are highly prevalent in aging populations and are independently associated with adverse health outcomes. However, their combined contribution to rapid renal function decline remains incompletely characterized in retrospective studies. Objectives: To examine the independent and synergistic associations between CI, frailty index (FI), and rapid renal function decline (RRFD) in community-dwelling and hospitalized elderly individuals in India. Methods: This retrospective cohort study enrolled 1,156 adults aged ≥65 years from five centers in India (2020–2024). Cognitive status was assessed by MoCA (Montreal Cognitive Assessment; CI defined as score <26). Frailty was quantified using the 36-item Frailty Index. Primary outcome was RRFD (annual eGFR decline ≥5 mL/min/1.73 m²) over 36 months. Serial eGFR measurements were performed at 6-monthly intervals. Results: Mean age was 72.8 ± 7.1 years; 47.8% female. CI was present in 38.2% (n=442) and frailty (FI >0.25) in 41.4% (n=479). The 36-month cumulative incidence of RRFD was 22.4% in participants without either condition, 38.3% in those with frailty alone, 42.1% in CI alone, and 65.3% in those with both. On multivariable Cox regression, frailty (HR 2.46; 95% CI 1.78–3.40; p<0.001) and CI (HR 2.19; 95% CI 1.58–3.04; p<0.001) independently predicted RRFD. The combined presence of both conditions conferred a nearly four-fold increased hazard (HR 3.92; 95% CI 2.64–5.82; p<0.001). Frailty index correlated strongly with annual eGFR decline rate (r=−0.63; p<0.001). Conclusion: Cognitive impairment and frailty are independently and synergistically associated with rapid renal function decline in elderly individuals. Routine frailty and cognitive screening in CKD care may identify high-risk patients warranting intensified nephroprotective interventions.

Introduction: Anaemia during pregnancy remains a major nutritional and public health concern, especially in resource-limited settings. It contributes to maternal morbidity, impaired functional capacity, and adverse perinatal outcomes. Objectives: To estimate the prevalence and severity of anaemia among pregnant women attending a tertiary care hospital and to assess selected demographic, obstetric, and healthcare-related risk factors. Methods: This cross-sectional study was conducted among 100 pregnant women attending the antenatal outpatient department. Demographic profile, obstetric variables, antenatal care details, iron-folic acid intake, clinical symptoms, and haemoglobin levels were recorded. Anaemia was classified according to haemoglobin status. Associations were assessed using appropriate statistical tests, with statistical significance considered at p<0.05. Results: The mean age of the study population was 24.8 ± 4.2 years, and the mean haemoglobin level was 10.3 ± 1.4 g/dL. The overall prevalence of anaemia was 64.0%. Moderate anaemia was the most common category, observed in 34.0%, followed by mild anaemia in 24.0% and severe anaemia in 6.0%. Anaemia was significantly associated with rural residence, lower educational status, lower socioeconomic status, multigravida status, advanced trimester, fewer antenatal visits, and irregular iron-folic acid intake. Easy fatigability and pallor were the most frequent clinical features. Conclusion: Anaemia was highly prevalent among pregnant women attending the study hospital, with moderate anaemia being the dominant pattern. Strengthening antenatal screening, nutrition counselling, regular iron-folic acid supplementation, and early follow-up can reduce the burden of anaemia in pregnancy.

Introduction: Essential hypertension is a major contributor to cardiovascular morbidity and mortality. Subclinical target organ damage often remains undetected until advanced stages. Microalbuminuria has emerged as an early marker of endothelial dysfunction and microvascular injury. This study aimed to evaluate the association between microalbuminuria and subclinical target organ damage in patients with essential hypertension. Objectives: To determine the prevalence of microalbuminuria, assess the presence of subclinical target organ damage, and evaluate the correlation between microalbuminuria and target organ damage parameters in essential hypertensive patients.  Methods: This hospital-based cross-sectional study included 200 patients diagnosed with essential hypertension. Urinary albumin-to-creatinine ratio was measured to detect microalbuminuria. Subclinical target organ damage was assessed using echocardiography for left ventricular hypertrophy, carotid Doppler for intima-media thickness, fundoscopic examination for hypertensive retinopathy, and estimated glomerular filtration rate for renal function. Statistical analysis was performed using appropriate parametric and non-parametric tests, and correlation analysis as conducted using Pearson’s correlation coefficient. Results: Microalbuminuria was observed in 41.5% of patients. Patients with microalbuminuria had significantly higher left ventricular mass index and carotid intima-media thickness and lower eGFR compared to those without microalbuminuria (p <0.001). The prevalence of left ventricular hypertrophy and hypertensive retinopathy was significantly higher among patients with microalbuminuria. A strong positive correlation was observed between urinary albumin-to-creatinine ratio and left ventricular mass index (r = 0.62) and carotid intima-media thickness (r = 0.58), while a negative correlation was observed with eGFR (r = −0.55) (p <0.001). Conclusion: Microalbuminuria is strongly associated with subclinical target organ damage in essential hypertension and serves as a valuable early marker of systemic vascular injury. Routine screening for microalbuminuria may aid in early risk stratification and prevention of long-term cardiovascular and renal complications.

Background: Non-alcoholic fatty liver disease (NAFLD) ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and advanced fibrosis, with inflammatory cytokines playing an important role in disease progression.

Aim: To evaluate the immunohistochemical expression of IL-6 and TNF-α in liver biopsies of patients with NAFLD and correlate their expression with clinicopathological parameters.

Materials and Methods: This prospective clinicopathological study included 60 adults with biopsy-proven NAFLD. Liver biopsies were assessed for steatosis, lobular inflammation, ballooning, fibrosis stage, and NAFLD Activity Score (NAS). Immunohistochemical staining for IL-6 and TNF-α was semiquantitatively scored and correlated with histologic diagnosis, NAS, fibrosis stage, biochemical parameters, and ultrasound fatty liver grade.

Results: NASH was the most common histologic diagnosis (60.0%), followed by borderline steatohepatitis (31.7%) and simple steatosis (8.3%). Advanced fibrosis was present in 63.3% of patients. High IL-6 and TNF-α expression was seen in 58.3% and 65.0% of cases, respectively, with both markers increasing significantly across worsening histologic categories (p<0.001). IL-6 and TNF-α showed strong positive correlations with NAS (r=0.938 and r=0.934) and fibrosis stage (r=0.858 and r=0.856), respectively (all p<0.001). Both markers also correlated significantly with ALT and ultrasound fatty liver grade.

Conclusion: IL-6 and TNF-α expression increases with histological severity of NAFLD and is highest in NASH. These markers correlate strongly with NAS and fibrosis stage and may serve as useful adjuncts to routine histopathological assessment.

Background: Acute kidney injury (AKI) is a heterogeneous clinical syndrome associated with significant morbidity, mortality, and risk of long-term renal impairment. Clinical and biochemical parameters alone often fail to identify the underlying etiology, making renal biopsy an important diagnostic tool in selected patients.

Aim: To evaluate the histopathological spectrum of renal biopsy findings in patients with AKI and correlate these findings with clinical and laboratory parameters.

Methods: This prospective observational study was conducted over 10 months (January–October 2025) at a tertiary care center in Maharashtra, India. A total of 100 adult patients with AKI who underwent native renal biopsy were included. Clinical features, laboratory parameters, and histopathological findings were recorded and analyzed. Biopsy diagnoses were categorized into glomerular, tubulointerstitial, and vascular/metabolic patterns. Clinicopathological correlations and short-term outcomes at 3 months were assessed.

Results: The mean age was 45.83 ± 13.53 years, with 54% males. Acute tubular injury/necrosis was the most common histopathological diagnosis (29%), followed by crescentic glomerulonephritis (13%), immune complex glomerulonephritis (11%), acute interstitial nephritis (11%), and thrombotic microangiopathy (10%). Tubulointerstitial lesions accounted for 44% of cases, glomerular lesions for 31%, and vascular/metabolic lesions for 25%. Significant correlations were observed between glomerular lesions and higher proteinuria and hematuria (p < 0.001). Renal biopsy influenced management in a substantial proportion, with 36% receiving steroids and 26% immunosuppressive therapy. At 3 months, 37% achieved complete recovery, 41% partial recovery, 18% progressed to chronic kidney disease, and mortality was 4%. Outcomes varied significantly by histopathological diagnosis (p = 0.003).

Conclusion: Renal biopsy in selected AKI patients reveals a wide spectrum of underlying pathologies and provides valuable diagnostic, therapeutic, and prognostic information. Urinary abnormalities correlate better with histopathological findings than serum creatinine alone. Early biopsy can facilitate identification of treatable lesions and improve patient outcomes.

Background: Endurance training induces profound remodeling of the cardiovascular system. However, comparative data simultaneously evaluating stroke volume, cardiac output, and post-exercise recovery kinetics across trained and untrained adults during graded exercise remain limited. Objective: To evaluate resting, peak, and submaximal cardiovascular parameters and recovery kinetics in trained versus untrained healthy adults using a standardized graded exercise testing protocol. Methods: A comparative cross-sectional design enrolled 60 healthy adults (30 trained, 30 untrained; age 18–35 years). Stroke volume was measured by Doppler echocardiography; cardiac output was calculated as SV × HR. Graded treadmill testing was performed to volitional fatigue, with continuous ECG monitoring. Heart rate recovery (HRR) was assessed at 1-minute post-exercise. Results: Trained individuals demonstrated significantly lower resting HR (58.4 ± 6.3 vs 74.8 ± 7.2 bpm; p < 0.001), higher resting SV (92.6 ± 10.5 vs 70.2 ± 8.4 mL; p < 0.001), and superior peak cardiac output (24.0 ± 2.8 vs 18.9 ± 2.1 L/min; p < 0.001). HRR at 1 minute was 50 ± 7 vs 30 ± 6 bpm (p < 0.001). Resting cardiac output was comparable between groups (p = 0.21), reflecting hemodynamic compensation. Conclusion: Trained adults exhibit coordinated central cardiovascular adaptation characterized by resting bradycardia, enhanced stroke volume, augmented maximal cardiac output, and superior autonomic recovery. These findings reinforce the physiological basis for cardiorespiratory fitness as a preventive health biomarker.

Background: Normoglycaemic adults with a family history of type 2 diabetes mellitus (T2DM) may harbour subclinical cardiometabolic dysfunction independent of fasting plasma glucose. Visceral adiposity has been proposed as a key mechanistic link between hereditary risk and reduced cardiopulmonary fitness (CPF), yet integrated evidence from normoglycaemic populations remains limited. Objective: To evaluate the impact of visceral adiposity on cardiopulmonary fitness in normoglycaemic adults stratified by family history of T2DM, and to identify independent predictors of reduced aerobic capacity. Methods: A cross-sectional study enrolled 240 normoglycaemic adults aged 18–60 years: 120 with positive family history (FH+) and 120 without (FH–). Visceral adiposity was quantified using waist circumference (WC), waist–hip ratio (WHR), and Visceral Adiposity Index (VAI). Cardiopulmonary fitness was assessed via estimated VO₂max using the Bruce treadmill protocol. Multiple linear regression identified independent predictors of VO₂max. Results: FH+ participants demonstrated significantly higher VAI (2.34 ± 0.78 vs 1.68 ± 0.62; p < 0.001), WC (94.6 ± 8.1 vs 88.3 ± 7.4 cm; p < 0.001), and WHR (0.92 ± 0.05 vs 0.88 ± 0.04; p < 0.001). VO₂max was markedly reduced in FH+ individuals (29.6 ± 5.2 vs 34.8 ± 5.6 mL/kg/min; p < 0.001). A strong negative correlation was observed between VAI and VO₂max (r = −0.61; p < 0.001). On multiple regression, VAI (β = −0.48; p < 0.001), hs-CRP (β = −0.29; p = 0.002), and MDA (β = −0.21; p = 0.01) were independent predictors of reduced CPF (model R² = 0.52). Conclusion: Visceral adiposity is the strongest independent predictor of reduced cardiopulmonary fitness in normoglycaemic adults with familial T2DM risk. These findings support expanding early cardiometabolic screening beyond fasting glucose to include central adiposity indices and functional fitness assessment.

Background: Refractive errors are principal causes of visual impairment in children worldwide, with accurate objective refraction essential for effective subjective correction and spectacle prescription. Inconsistencies between streak retinoscopy (SR), automated refractometry (AR), and subjective acceptance necessitate comparative evaluation to optimize pediatric refractive protocols and prevent amblyopia and accommodative complications. Methods: Prospective cross-sectional observational study included 100 children (200 eyes) aged 5-15 years with presenting visual acuity <6/9, clear ocular media, and confirmed refractive errors. All participants underwent comprehensive ophthalmic evaluation: uncorrected/best-corrected Snellen visual acuity, slit-lamp biomicroscopy, tonometry, non-cycloplegic streak retinoscopy, automated refractometry, subjective refraction (trial frame with Jackson cross-cylinder refinement), and fundus examination. Primary outcome: proportion of subjective acceptance (patient-preferred prescription matching SR or AR findings) analyzed via Chi-square test and McNemar's test. Secondary outcomes: mean differences in spherical/cylindrical power and axis stratified by age groups (5-7, 8-10, 11-15 years) and refractive error types. Ethical approval obtained, informed consent from guardians. Results: Mean participant age 10.46 ± 2.73 years; 57% male. Myopia with astigmatism predominated (181/200 eyes, 90.5%). Overall subjective acceptance significantly favored SR: right eye 65% SR vs. 35% AR; left eye 63% SR vs. 37% AR. SR readings closely approximated subjective means-right eye: sphere -2.025 ± 1.42 D (SR) vs. -1.98 ± 1.38 D (subjective), cylinder -0.92 ± 0.78 D vs. -0.835 ± 0.72 D, axis 85.2° ± 22° vs. 82.5° ± 20°. Cylindrical component acceptance markedly superior for SR (right eye: 82%, χ²=45.6, p<0.001). Age-stratified analysis revealed SR dominance in 5-10 years (70-82% acceptance). Bland-Altman analysis confirmed tighter SR-subjectivity agreement limits (±0.5 D vs. AR ±0.75 D). Conclusion: Streak retinoscopy outperforms automated refractometry in predicting subjective refraction acceptance among pediatric patients aged 5-15 years, demonstrating superior accuracy across spherical, cylindrical, and axis parameters, particularly in myopic astigmatism.

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),