Background: Ac Lumbo-sacral transitional vertebra (LSTV) represents a common congenital anomaly at the lumbo-sacral junction, often associated with altered biomechanics, early degeneration and chronic low back pain (CLBP). Despite its clinical significance, regional data from South Kashmir remain limited. Objective: To determine the prevalence and types of LSTV among chronic low back pain patients in South Kashmir, using radiological evaluation (X-ray and MRI), and to assess associated degenerative changes and radiculopathy. Methods: This hospital-based cross-sectional study included patients aged 16–80 years presenting with chronic low back pain at MMABM Hospital, GMC Anantnag in South Kashmir, from June 2024 to May 2025. All subjects underwent lumbo-sacral spine imaging—either X-ray, MRI, or both. LSTV was identified and classified according to Castellvi’s classification1. Degenerative changes, adjacent segment disc pathology, and nerve root involvement were assessed. Data were analyzed for prevalence, laterality, and radiological correlations. Results: Of 208 patients evaluated, 35%  (n=73) demonstrated LSTV on radiology. The most frequent subtype was Castellvi Type II (40%), followed by Type I (30%). Unilateral LSTV cases exhibited more severe degenerative changes and earlier disc space narrowing than bilateral types. Adjacent segment disc degeneration was observed in a majority of LSTV patients (70%), particularly at the L4–L5 level. Radiculopathy was present in a substantial proportion of cases with LSTV, frequently corresponding to foraminal stenosis or nerve root compression above the transitional level. Conclusion: LSTV is a frequent finding among chronic low back pain patients in South Kashmir, with a prevalence of approximately 35%. Unilateral variants are associated with more pronounced degeneration and radicular symptoms. Recognition of this variant on X-ray and MRI is vital for accurate diagnosis, classification, and management of low back pain.

Background: The assessment of the function of peripheral hearing organ is crucial to determine the pathophysiological aspect of the tinnitus and to make an appropriate treatment plan. Aim: The present study was aimed to evaluate the cochlear function in subjects with tinnitus independent of their hearing status.

Methods: The present study assessed 80 subjects that had tinnitus and were categorized in the two groups where Group I had 40 subjects that had tinnitus with hearing loss and Group II had 40 subjects with tinnitus and no hearing loss. Another 40 subjects formed control group including 40 subjects with hearing loss and no tinnitus. THI (Tinnitus Handicap Inventory) was used to assess the tinnitus-related discomfort levels. Any dead regions and cochlear functions were identified using the Otoacoustic Emissions (OAE) and PTA (pure-tone audiometry). Also, Threshold Equalizing Noise (TEN) was used. Results: The study results showed that there was a shift in the threshold from Group I when assessed with TEN (Transient Evoked Otoacoustic Emissions () with the statistical significance from Group I and control Group with p<0.05. Also, Group I showed both DR (distortion responses) and threshold shifts as showed by TEN. On the contrary, Transient Otoacoustic Emissions (TEOAE) did not show ant significant difference in Group II and control group. The results for Distortion Product Otoacoustic Emissions (DPOAE) in group II showed a significant reduction in emission amplitudes at 6 and 8 kHz. Conclusion: The study results showed that conventional methods of testing suits for evaluation of tinnitus subjects that have hearing loss. Also, in subjects with normal hearing and tinnitus, using additional methods as Tone-Evoked Noise (TEN) and Otoacoustic Emissions (OAE) enable a more accurate assessment of peripheral hearing mechanisms. No or limited otoacoustic emissions (OAEs) seen in Group I showed a potential decrease or function loss in OHC (outer hair cells) at a particular frequency. On the contrary, increased threshold of tone-equalizing noise (TEN) test points to possible dysfunction in IHC (inner hair cells). 

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition in the elderly, with recurrence rates ranging from 10-30% after initial management. Hyperfibrinolysis within the hematoma cavity contributes to repeated microbleeding and recurrence. Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential adjunctive therapy to reduce recurrence and improve outcomes. Aim: To evaluate the impact of adjunctive oral tranexamic acid on recurrence rates and the need for re-surgical intervention in patients with chronic subdural hematoma. Materials and Methods: This prospective cohort study was conducted in the Department of Neurosurgery, Government Medical College, Thiruvananthapuram, from January 18, 2023, to May 13, 2023. A total of 116 patients with asymptomatic or minimally symptomatic primary, recurrent, or residual CSDH were included and categorized into two groups: control (n=58) and TXA group (n=58). The TXA group received oral tranexamic acid (750 mg/day). Patients were followed up at 4 and 8 weeks. Primary outcomes included recurrence rate and need for re-surgical intervention. Secondary outcomes included radiological resolution and functional neurological outcome (GOSE). Statistical analysis was performed using independent t-test and Chi-square/Fisher’s exact test. Results: Baseline characteristics were comparable between groups (p>0.05). Recurrence occurred in 25.9% of the control group compared to 8.6% of the TXA group (p=0.014). Re-surgical intervention was required in 20.7% of controls versus 5.2% in the TXA group (p=0.021). Hematoma volume reduction at 4 and 8 weeks was significantly greater in the TXA group (p<0.001). Complete radiological resolution at 8 weeks was achieved in 75.9% of TXA patients versus 50.0% of controls (p=0.004). Favorable functional outcome (GOSE ≥7) was significantly higher in the TXA group (86.2% vs 67.2%, p=0.016). Conclusion: Adjunctive oral tranexamic acid significantly reduced recurrence rates and need for repeat surgery, while promoting faster hematoma resolution and improved functional outcomes. TXA appears to be a promising adjunctive therapy in the management of chronic subdural hematoma.

Background: Geriatric hip fractures represent a significant public health problem due to their high morbidity, mortality, and healthcare costs. Surgical fixation using implants is commonly performed to restore mobility and reduce complications associated with prolonged immobilization. However, implant failure remains a serious postoperative complication in elderly patients. This study aimed to identify predictors associated with implant failure in geriatric hip fractures. Methods: A retrospective observational study was conducted among patients aged 65 years and older who underwent surgical fixation for hip fractures between January 2019 and December 2023 at a tertiary care hospital. Demographic characteristics, fracture patterns, comorbidities, surgical details, and postoperative outcomes were extracted from medical records. Implant failure was defined as mechanical failure of fixation requiring revision surgery or radiological evidence of implant cut-out, loosening, or nonunion. Results: A total of 128 patients were included in the study. Implant failure occurred in 18 patients (14.1%). Advanced age, osteoporosis, unstable fracture patterns, and poor reduction quality were significantly associated with implant failure. Multivariate analysis identified severe osteoporosis and suboptimal fracture reduction as independent predictors of implant failure. Conclusion: Implant failure following geriatric hip fracture fixation is influenced by both patient-related and surgical factors. Careful surgical planning, optimization of bone quality, and achieving adequate fracture reduction may reduce the risk of implant failure in elderly patients.

Background: Non-Small Cell Lung Carcinoma (NSCLC) accounts for the majority of lung cancer cases and is frequently diagnosed at an advanced stage. Identification of simple, cost-effective prognostic biomarkers is essential for early risk stratification and disease burden assessment. Serum ferritin, an acute phase reactant and iron storage protein, has been implicated in tumor progression and inflammatory pathways associated with malignancy. Aim and Objectives:

To correlate and evaluate clinical characteristics and prognostic factors with serum ferritin levels and histopathological diagnosis, to predict prognosis in NSCLC based on serum ferritin levels, and to assess disease burden in relation to age, gender, habit, tumor site, and subtype. Materials and Methods: This prospective study was conducted in the Department of Pathology, M.P. Shah Medical College, Jamnagar, Gujarat, from June 2021 to December 2022. A total of 100 newly diagnosed NSCLC cases were included. Patients previously treated with anti-tumor therapy or conditions affecting ferritin metabolism were excluded. Four milliliters of venous blood were collected prior to treatment, and serum ferritin levels were measured using ELISA. Radiological and histopathological findings were correlated with ferritin levels. Statistical analysis was performed using Chi-square test and Pearson correlation. Results: Elevated serum ferritin levels were observed in 72% of cases. Adenocarcinoma constituted 61% of cases and squamous cell carcinoma 39%; however, A statistically significant association was observed between histopathological subtype and serum ferritin level (p = 0.002), with adenocarcinoma showing a higher proportion of elevated ferritin levels (83.6%) compared to squamous cell carcinoma (53.8%). Significant associations were noted between elevated ferritin levels and pleural effusion (92.9% high ferritin; p = 0.009), mediastinal lymphadenopathy (95% high ferritin; p = 0.001), and combined poor prognostic findings (100% high ferritin; p = 0.036). Correlation analysis demonstrated a strong positive correlation between ferritin and mediastinal lymphadenopathy (r = 0.52) and a moderate correlation with pleural effusion (r = 0.41). Correlation analysis demonstrated a moderate positive correlation between serum ferritin levels and adenocarcinoma subtype (r = 0.39, p < 0.001). Conclusion: Serum ferritin levels are significantly elevated in NSCLC patients with adverse radiological prognostic indicators. Elevated ferritin correlates significantly with adenocarcinoma subtype and adverse radiological prognostic indicators, suggesting that serum ferritin may reflect both tumor biology and disease burden in NSCLC.

Background: Hypertension is a common chronic disease and a major risk factor for heart disease, stroke, and kidney failure. It requires long-term or lifelong treatment. In India, many brands of the same antihypertensive drug are available, and their prices vary widely. Large price differences can increase the financial burden on patients and affect treatment adherence. This study was conducted to evaluate the cost variation of antihypertensive drugs available in different brands in the Jammu market and to compare them with Jan Aushadhi generic medicines. Materials and Methods: This was a cross-sectional, observational pharmacoeconomic study conducted over six months in retail and wholesale pharmacies in Jammu. Commonly prescribed antihypertensive drugs available in tablet or capsule form were included. Drugs available in identical strength and dosage form under two or more brands were analysed. The Maximum Retail Price (MRP) of each brand was recorded. Cost ratio and percentage cost variation were calculated using standard formulas. Data were analysed using descriptive statistics with Microsoft Excel and SPSS software. Results: A total of 42 antihypertensive drugs were analysed under 12 categories. Angiotensin Receptor Blockers (7 drugs), Calcium Channel Blockers (6 drugs), and Beta Blockers (6 drugs) were the most common categories. Significant price variation was observed among different brands in all drug classes. In many cases, branded drugs were 2 to 6 times more expensive than Jan Aushadhi generics. Some drugs such as Ramipril, Lisinopril, Telmisartan (40 mg), and Torsemide (10 mg) showed very high percentage cost differences exceeding 500%. Overall, Jan Aushadhi medicines were consistently more affordable. Conclusion: There is wide cost variation among different brands of antihypertensive drugs in the Jammu market. Jan Aushadhi generic medicines are significantly cheaper than branded drugs. Promoting the use of cost-effective generic medicines can reduce financial burden, improve medication adherence, and support better long-term management of hypertension.

Introduction: Diabetes mellitus is a chronic disease that requires long-term treatment, which can increase the financial burden on patients. Many branded and generic antidiabetic drugs are available in the market, and their prices vary widely. This study was conducted to compare the cost difference between Jan Aushadhi generic drugs and branded antidiabetic drugs available in the market. Material and Methods: A cost comparison study was conducted including 35 antidiabetic drugs from 11 different categories. The prices of Jan Aushadhi generic drugs and corresponding branded drugs were collected and compared. The percentage cost difference was calculated using a standard formula to determine the variation between generic and branded medicines. Drugs were grouped into single-drug therapy, dual-drug therapy, and insulin injections. Results: A significant price variation was observed between generic and branded drugs. In single-drug therapy, the percentage cost difference ranged from 158% to 265%, with branded drugs costing 2–4 times more than generics. Dual-drug combinations also showed high price differences, above 170%. Injectable insulin showed a lower cost difference of about 50%, but it still contributes to long-term treatment expenses. Conclusion: There is a wide cost variation between Jan Aushadhi generic and branded antidiabetic drugs. Generic medicines are considerably more affordable and can help reduce the economic burden of long-term diabetes treatment.

Background: Multidrug-resistant (MDR) bacterial infections in chronic wounds pose a major challenge in Indian hospitals, particularly in tropical climates where humidity promotes biofilm formation and resistance dissemination. Conventional antibiotics are increasingly ineffective against prevalent MDR pathogens such as Pseudomonas aeruginosa, Acinetobacter baumannii, ESBL-producing Escherichia coli, and methicillin-resistant Staphylococcus aureus (MRSA). Traditional Ayurvedic use of Azadirachta indica (neem) for wound care offers promise, but crude extracts have limited bioavailability. Nanotechnology, especially green-synthesized neem-mediated silver nanoparticles (AI-AgNPs), may enhance antimicrobial potency and wound regeneration. Objective: To evaluate the in vitro antimicrobial activity of neem-based nanoformulations (AI-AgNPs and chitosan nanoparticles) against MDR clinical isolates from Indian hospital wound samples and assess their in vivo wound-healing efficacy in a tropical climate-relevant model. Methods Neem leaf ethanolic extract was used for green synthesis of AI-AgNPs and chitosan nanoparticles (AI-CNPs), characterised by UV-Vis, TEM, DLS, XRD, and FTIR. MDR isolates (n=20 each) from Surat/Ahmedabad hospitals were tested via disc diffusion, broth microdilution (MIC/MBC), biofilm assay, and SEM. In vivo excisional wound healing was evaluated in Wistar rats (n=6/group) with topical AI-AgNPs hydrogel, measuring closure rate, bacterial load, histopathology, and biochemical markers. Results: AI-AgNPs showed zones of inhibition 22–30 mm, MIC 0.125–0.390 mg/mL, and >70–85% biofilm inhibition, superior to crude extract. SEM revealed membrane rupture. In vivo, AI-AgNPs hydrogel achieved 95% wound closure by day 14, >3 log₁₀ CFU/g reduction, enhanced collagen deposition, and no toxicity. Conclusions: Neem nanoformulations demonstrate potent, bactericidal activity against MDR wound pathogens and accelerate healing, supporting their potential as affordable, indigenous alternatives for managing tropical MDR infections in India.

Introduction Nutritional deficiencies remain a major public health concern globally, particularly among children, where they adversely affect growth, immunity, and organ development. The skin is one of the earliest organs to reflect systemic nutritional imbalance because of its rapid cellular turnover and dependence on micronutrients and macronutrients. Cutaneous manifestations, including xerosis, hyperpigmentation, dermatitis, and hair changes, often serve as early clinical indicators of nutritional deficiency in children. Early recognition of dermatological signs plays a crucial role in preventing morbidity and mortality associated with malnutrition.  Materials and Methods: This hospital-based cross-sectional observational study was conducted among pediatric patients from January 2025 to December 2025 presenting with dermatological complaints suggestive of nutritional deficiencies. Anthropometric measurements, clinical examination, dietary history, and laboratory investigations were performed. Patients were categorized according to nutritional deficiency type and dermatological findings were documented and analyzed. Results Among 120 pediatric patients studied, protein-energy malnutrition was identified in 35% of cases, vitamin deficiencies in 40%, and mineral deficiencies in 25%. Xerosis, hyperpigmentation, angular stomatitis, and hair changes were the most common manifestations. Statistical analysis showed significant correlation between severity of malnutrition and frequency of cutaneous manifestations. Conclusion Cutaneous manifestations are important clinical markers of underlying nutritional deficiencies in children. Early diagnosis through dermatological examination enables timely therapeutic intervention and improves overall health outcomes.

Abstract Background: Postoperative sore throat (POST) remains a frequent and distressing complication following endotracheal intubation. Elderly patients may be particularly vulnerable due to age-related mucosal fragility and increased likelihood of difficult intubation. The role of lignocaine-containing lubricating jelly in preventing POST remains controversial. Objective: To compare the incidence and severity of POST in elderly patients undergoing general anaesthesia using endotracheal tubes lubricated with 2% lignocaine jelly versus plain lubricating jelly. Methods: This prospective randomized study included 50-60 years, ASA I–III, undergoing elective surgery under general anaesthesia with orotracheal intubation. Patients were allocated into two groups (n=30 each): Group LI (2.5 mL of 2% lignocaine jelly) and Group LU (2.5 mL of plain KY jelly). POST incidence and severity (4-point scale) were assessed at 1, 6, 12, and 24 hours post-extubation. Number of intubation attempts and duration of laryngoscopy were recorded. Results: Demographic variables were comparable between groups (p>0.05). Mean intubation duration was higher in elderly patients with Mallampati grade III–IV airways. POST incidence at 1, 6, 12, and 24 hours was 36.7%, 40%, 26.7%, and 20% in the LI group versus 26.7%, 20%, 10%, and 6.7% in the LU group. Statistical significance was observed at 6 hours (p=0.04) and 12 hours (p=0.03). Mean sore throat scores were significantly lower in the LU group at 12 hours. Conclusion: In elderly patients, plain lubricating jelly demonstrated equal or better efficacy than lignocaine jelly in reducing POST. Lignocaine jelly did not confer additional benefit.

Background: Chronic rhinosinusitis (CRS) and nasal polyposis are multifactorial inflammatory disorders influenced by host immunity, microbiota, and systemic inflammatory states. Persistent gastrointestinal dysfunction and gut microbiota alterations following SARS-CoV-2 infection have been increasingly recognized, particularly among elderly individuals. Disruption of the gut–nose–lung axis and associated micronutrient malabsorption may contribute to increased sinonasal disease burden in this population. Objective: To systematically evaluate the association between post-SARS-CoV-2 gut dysbiosis and malabsorption syndrome and the incidence and severity of sinonasal disease in elderly individuals. Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines. PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched from January 2020 to December 2025. Studies including elderly patients (≥60 years) with clinically or radiologically confirmed sinonasal disease and prior COVID-19 infection with documented dysbiosis or gastrointestinal dysfunction were eligible. Primary outcomes were CRS incidence, nasal polyposis incidence, and sinonasal disease severity. Random-effects meta-analysis was performed, with risk of bias assessed using the Newcastle–Ottawa Scale and Cochrane RoB 2 tool. Results: Twenty-three studies (n = 8,742 participants) were included, with 19 eligible for quantitative synthesis. Elderly patients with post-COVID dysbiosis demonstrated significantly increased odds of CRS (OR 2.14; 95% CI 1.62–2.81; I² = 49%) and nasal polyposis (OR 2.48; 95% CI 1.79–3.43; I² = 53%). Vitamin D deficiency was associated with greater polyp severity (OR 2.32), while functional iron deficiency increased fungal superinfection risk (OR 2.11). Surgical requirement (RR 1.76) and recurrence rates (RR 1.68) were significantly higher in patients with persistent dysbiosis. Microbiota restoration strategies were associated with reduced recurrence (RR 0.64). Conclusion: Post-SARS-CoV-2 gut dysbiosis and malabsorption in elderly individuals are significantly associated with increased incidence and severity of sinonasal disease. Recognition of the gut–nose–lung axis and targeted microbiota modulation may represent novel adjunctive strategies for chronic rhinosinusitis management in the post-pandemic era.

Background Cutaneous manifestations are common in patients with diabetes mellitus (DM) and may serve as early indicators of glycemic disturbances or complications. Despite their high frequency, there is limited data on the spectrum and prevalence of skin disorders in diabetic patients in the Indian clinical setting. This study aimed to investigate the prevalence and pattern of cutaneous manifestations in patients with diabetes mellitus attending DY Patil University, School of Medicine, Ambi, Pune. Methods: A prospective observational study was conducted over a 6-month period (June 2025 – December 2025) at the Department of Medicine and Dermatology, DY Patil University, School of Medicine, Ambi, Pune. A total of 100 patients with a confirmed diagnosis of diabetes mellitus (both type 1 and type 2) were enrolled consecutively. Detailed dermatological examinations were performed for each patient to identify cutaneous signs. Relevant clinical history, duration of diabetes, glycemic control (HbA1c), and associated comorbidities were recorded. Descriptive statistics were used to determine the prevalence of cutaneous manifestations. Results: Among the 100 diabetic patients studied, cutaneous manifestations were identified in a majority of cases. The overall prevalence of skin changes was X% (n = Y). The most common dermatological findings included:

• Infections (fungal and bacterial) – observed in A%
• Diabetic dermopathy – seen in B%
• Xerosis and pruritus – recorded in C%
• Acanthosis nigricans – present in D%
• Bullous disorders and neuropathic ulcerations – less frequent but clinically significant

A statistically significant association was observed between poor glycemic control (HbA1c >7%) and the presence of certain skin manifestations (p < 0.05). The duration of diabetes also correlated with increased frequency of dermatological abnormalities. Conclusion: Cutaneous manifestations are highly prevalent in patients with diabetes mellitus and encompass a wide spectrum of infectious and non-infectious conditions. Early recognition of skin changes can aid in timely diagnosis, optimization of glycemic control, and prevention of complications. Routine dermatological assessment should be integrated into the clinical care of diabetic patients to improve overall outcomes.

Background: Falls among the elderly have become a major public health concern globally, with the rapid increase in ageing population. Objectives of the study were to assess the fall risk status of the elderly people, their activities of daily living and functional dependence, and to understand the impact of falls on both the elderly and their caregivers. Methodology: This community based mixed method study was conducted in rural South India among 350 elderly people aged more than 65 years using a pre-tested structured questionnaire from March 2025 to June 2025. Dependence on daily activities, fall risk assessment and risk factors for elderly fall were assessed by quantitative method. Qualitative method was used to better explore the effects of fall among the elderly.  Mean, median, proportions and chi-square test were used to analyse quantitative data. The data collected by in-depth interview were analysed by thematic content analysis. Results: Prevalence of fall was found to be 58.8%. 97.1% were fully independent for their daily activities and 76% had low risk of fall based on Fall Risk Assessment tool. Dependence on family members, social withdrawal were some of the problems faced by the elderly after fall. Helping the elderly in doing their routine activities and restriction of activities were some of the challenges faced by the caregivers of elderly. Conclusion: Elderly individuals are at risk of falls due to advancing age and associated health conditions like vision impairment and mobility issues. Caregivers also face considerable challenges, including increased responsibilities and limited support.

Background: There is a common pathophysiological basis rooted in insulin resistance for both Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). Their coexistence significantly amplifies cardiovascular morbidity and mortality. Objective: To evaluate the prevalence of metabolic syndrome (MetS) among patients with Type 2 Diabetes mellitus (T2DM) aged ≥ 30 years and assess the clinical and biochemical correlations between diabetes parameters and components of metabolic syndrome. Methods: A cross-sectional study was conducted over one year in fifty admitted patients aged ≥ 30 years with established T2DM in the Department of General Medicine at Shri Guru Ram Rai Institute of Medical and Health Sciences, Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India. Metabolic syndrome was diagnosed using NCEP ATP III criteria. Anthropometric, clinical, and biochemical variables were recorded and analyzed using appropriate statistical tests. Results: Among 50 admitted participants (mean age 53.6 ± 9.1 years), 28 patients (56%) fulfilled criteria for metabolic syndrome. Most prevalent components were Central obesity (72%), hypertension (68%), and low HDL cholesterol (60%). Mean BMI was significantly higher in the metabolic syndrome group (30.4 ±2.6 kg/m²) compared to non-metabolic syndrome group (27.9 ± 2.3 kg/m²; p<0.001). In MetS patients, mean HbA1c levels were also higher (8.6 ± 1.1%) in comparison to non-MetS (7.8 ±0.9%; p=0.02). There were significant positive correlations between waist circumference and triglyceride levels (r=0.48, p=0.003). Conclusion: It was observed that more than half of Type 2 DM patients over 30 years demonstrated metabolic syndrome. Major dominant contributors were central obesity and hypertension. Routine MetS screening should be integrated into diabetes management to reduce cardiovascular risk burden.

Background: There is a common pathophysiological basis rooted in insulin resistance for both Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). Their coexistence significantly amplifies cardiovascular morbidity and mortality. Objective: To evaluate the prevalence of metabolic syndrome (MetS) among patients with Type 2 Diabetes mellitus (T2DM) aged ≥ 30 years and assess the clinical and biochemical correlations between diabetes parameters and components of metabolic syndrome. Methods: A cross-sectional study was conducted over one year in fifty admitted patients aged ≥ 30 years with established T2DM in the Department of General Medicine at Shri Guru Ram Rai Institute of Medical and Health Sciences, Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India. Metabolic syndrome was diagnosed using NCEP ATP III criteria. Anthropometric, clinical, and biochemical variables were recorded and analyzed using appropriate statistical tests. Results: Among 50 admitted participants (mean age 53.6 ± 9.1 years), 28 patients (56%) fulfilled criteria for metabolic syndrome. Most prevalent components were Central obesity (72%), hypertension (68%), and low HDL cholesterol (60%). Mean BMI was significantly higher in the metabolic syndrome group (30.4 ±2.6 kg/m²) compared to non-metabolic syndrome group (27.9 ± 2.3 kg/m²; p<0.001). In MetS patients, mean HbA1c levels were also higher (8.6 ± 1.1%) in comparison to non-MetS (7.8 ±0.9%; p=0.02). There were significant positive correlations between waist circumference and triglyceride levels (r=0.48, p=0.003). Conclusion: It was observed that more than half of Type 2 DM patients over 30 years demonstrated metabolic syndrome. Major dominant contributors were central obesity and hypertension. Routine MetS screening should be integrated into diabetes management to reduce cardiovascular risk burden.

We evaluated lung ultrasound (LUS) use in diagnosing pulmonary TB (PTB) in adults. From Sept 2022 to Feb 2024, 100 patients (12–60 years) with suspected or confirmed PTB were enrolled in a prospective study. A trained radiology resident performed LUS, including upper abdominal scanning (“extended LUS”). LUS was considered positive if two of three findings—subpleural nodules, consolidation, or “isolated” converging B-lines—were present. Sensitivity and specificity were calculated using microbiological confirmation or clinical-radiological response to therapy as reference.

Six patients were PTB-negative. LUS showed findings in 98% (71% females). Common findings: converging B-lines (77%), consolidation (65%), regular B-lines (64%), subpleural nodules (50%), miliary pattern (43%), confluent B-lines (23%), pleural effusion (15%), pleural irregularity (12%), and cavities (7%). Sensitivity and specificity of LUS were 62.8% and 83.3%, respectively. Extended LUS improved sensitivity to 69.1%.
In conclusion LUS, especially extended LUS, is a useful adjunct in PTB diagnosis.

Background  Difficult laparoscopic cholecystectomy remains a major contributor to bile duct injury (BDI), particularly when the critical view of safety (CVS) cannot be achieved due to severe inflammation, fibrosis, or distorted anatomy. Bailout strategies that avoid dissection in Calot’s triangle are therefore essential. We describe our experience with a modified lateral dorsal infundibular approach for difficult laparoscopic cholecystectomy, designed to facilitate safe subtotal cholecystectomy (STC) while minimizing operative complexity and risk. Methods A retrospective analysis of prospectively maintained data was performed on patients undergoing difficult laparoscopic cholecystectomy at a tertiary care center between April 2025 and January 2026. Patients with preoperative predictors and/or intraoperative findings of difficult gallbladder who ultimately required STC were included. Demographic data, imaging findings, operative details, postoperative outcomes, and complications were analyzed. The surgical technique emphasized subserosal dorsal infundibular dissection above Rouviere’s sulcus, avoiding Calot’s triangle. Results Seventy-two patients with difficult laparoscopic cholecystectomy were analyzed (mean age 55.1 years; 70.8% female). Acute cholecystitis was present in 41.6%, including gangrenous cholecystitis in 25%. Conversion to open surgery was required in one patient (1.38%). The lateral dorsal infundibular approach was successfully completed laparoscopically in 90.3% of cases. Fenestrating STC was performed in 2.7% and reconstituting STC in 6.9%. Postoperative bile leak occurred in two patients (2.7%) and resolved with ERCP. There were no bile duct or vascular injuries, no reoperations, and no mortality. Mean operative time was 85.5 ± 21.5 minutes, and mean hospital stay was 8.6 ± 3.2 days

Background: Anaemia is a prevalent condition among geriatric patients, associated with increased morbidity, mortality, and reduced quality of life. This study aimed to evaluate the clinical profile, etiological factors, and complications of anaemia in elderly individuals at a tertiary care centre. Methods: A prospective, hospital-based observational study was conducted over two years, involving 2700 patients aged >60 years with anaemia (haemoglobin <13 g/dL in males, <12 g/dL in females). Data collection included detailed clinical history, physical examination, laboratory investigations (complete blood count, peripheral smear, iron studies, etc.), and radiological assessments. Anaemia severity was graded as mild (10.1–13 g/dL), moderate (7–10 g/dL), or severe (<7 g/dL). Statistical analysis assessed associations between variables. Results: The mean age was 67.81 ± 4.51 years, with 67.96% in the 61–70 years group and a female predominance (59.56%). Generalized weakness (30.04%) was the most common symptom, followed by breathlessness (20.41%). Radiological findings highlighted chronic kidney disease (29.93%) and acute kidney disease (29.11%). Moderate anaemia predominated (74.59%), with normocytic normochromic at 32% and normocytic hypochromic pattern at 32%, followed by microcytic hypochromic pattern at 21%. Nutritional anaemia (30.81%) was the leading cause, followed by chronic kidney disease (29.92%). Peripheral smear findings showed a significant association with anaemia severity (p < 0.0001), but no significant links with age or gender. Conclusion: Anaemia in geriatric patients is multifaceted, primarily driven by nutritional deficiencies and chronic diseases like kidney and liver disorders. Early screening and targeted interventions are crucial to mitigate functional decline and improve outcomes in this vulnerable population.

Geriatrics is the branch of medicine concerned with the care and treatment of elderly. In human body Dhatus get degenerated as the age advances due to prolonged structural and functional changes. During old age we cannot enhance the capacity of Dhatus, but they can be protected and rejuvenated. According to Ayurveda the drugs used for promoting and preserving health, strength and longevity in a healthy person are called Rasayana. They increase Bala and Ojas in healthy persons or recognized as on Ojaskara (vitalizer) in healthy subjects in general, they also subside the symptom of different diseases. The Rasayana maintain the entirety of Saptadhatu and optimum strength of body and senses promote memory, intelligence, and bodily glow, preserve youth age, lusture, complexion, voice and generosity. These effects of Rasayans can be proved by their antioxidant and adaptogenic properties. Adaptogens show the similar effects like Medhya, Pushtikara, Dhatuvriddhikara, Dehindri yadridhikara, Jivniya and improve immune system of body. Rasayanas act as immuno stimulatants, anabolics and geriatric remedies. The present article takes review on use of Rasayanas in Geriatric health care.

Prolonged ICU stay increases morbidity after cardiac surgery. Early identification of patients at risk is crucial.VIS quantifies pharmacological cardiovascular support and may predict adverse outcomes. Objective: To evaluate the predictive ability of maximum vasoactive–inotropic score (VISmax) in predicting prolonged ICU stay (>48 hours) in patients undergoing cardiac surgery. Methods: Prospective observational study of 107 patients. VISmax was calculated during the postoperative period. Patients were categorized into two groups: ICU stay ≤48 hours and >48 hours. Statistical analysis included Mann–Whitney U test, Spearman correlation, and receiver operating characteristic (ROC) curve analysis performed. Results: VISmax significantly associated with prolonged ICU stay (P<0.0001). AUC=0.995. Cut-off >15.5 showed 93.75% sensitivity and 100% specificity. Conclusion: VISmax is an excellent early predictor of prolonged ICU stay following cardiac surgery. A threshold of >15.5 demonstrates near-perfect discrimination and may aid in early risk stratification

Environmental contamination in hospital settings is a major contributor to Hospital-Acquired Infections (HAIs), posing significant risks to patients and healthcare workers. Effective monitoring of microbial contamination is essential to guide infection prevention strategies. Methods: A prospective observational study was conducted from January to June 2025. A total of 80 environmental samples, including surface swabs, air, and water samples, were collected from high-touch areas and critical hospital zones. Microbiological testing was performed using culture-based methods, with bacterial and fungal species identified and quantified in Colony-Forming Units (CFU). Data were analyzed to assess contamination patterns, differences across wards, surfaces, and temporal trends. Results: Of the 80 samples, 52 (65%) were positive for microbial growth. Surface swabs showed the highest contamination, followed by water and air samples. Predominant microorganisms included Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., and Candida albicans. ICUs and high-touch surfaces exhibited the highest microbial load. Temporal analysis revealed fluctuations in contamination over the six months. Conclusion: Microbiological testing is an effective tool for monitoring environmental contamination and guiding targeted infection control interventions. Routine surveillance of high-risk areas is recommended to reduce HAIs and enhance patient safety.

Pediatric diaphyseal fractures of both the radius and ulna are common injuries, and optimal management remains debated due to variations in remodeling potential and fracture stability. Conservative treatment continues to be widely used, but its functional outcomes require ongoing evaluation. Methods:A prospective study was conducted on 30 children aged 4–14 years with closed diaphyseal both-bone forearm fractures treated by closed reduction and above-elbow casting. Patients were followed at regular intervals for six months with serial radiographs to monitor angulation and clinical assessment of forearm rotational arcs. Final functional outcomes were graded based on rotational loss. Results: The majority of fractures involved the middle third of the forearm (56.66%). Early angulation increased slightly due to cast settling but demonstrated progressive correction through remodeling by six months. Among the 27 children completing conservative management, 51.85% achieved excellent outcomes, 33.33% good, and 14.81% fair, with no poor outcomes recorded. Three cases with early loss of reduction required surgical conversion.

Conclusion: Closed reduction and casting provide reliable functional and radiological outcomes for most pediatric diaphyseal forearm fractures when alignment and cast quality are closely monitored. Conservative management remains an effective first-line modality, with surgical intervention reserved for cases demonstrating early instability or failure to maintain acceptable reduction.

: Percutaneous nephrolithotomy (PCNL) is the standard intervention for large renal calculi. General anaesthesia (GA) has traditionally been used; however, segmental spinal anaesthesia (SSA) has emerged as an alternative, potentially improving haemodynamic stability and postoperative analgesia. Objectives: To compare haemodynamic responses, analgesic efficacy, and perioperative outcomes of GA and SSA in adult patients undergoing PCNL. Methods: A prospective comparative design was adopted. Adult patients undergoing elective PCNL were allocated to GA or SSA groups. Intraoperative haemodynamic parameters,postoperative pain scores, opioid consumption, and recovery indices were assessed. Outcomes were interpreted against evidence from recent randomized trials and meta-analyses. Results: SSA demonstrated significantly lower intraoperative heart rate and mean arterial pressure fluctuations. Postoperative pain scores and opioid requirements were consistently lower in SSA cohorts. Time to ambulation and oral intake were shorter in SSA, while stone-free rates and surgical duration were comparable. No increase in serious adverse events was reported. Conclusion: Segmental spinal anaesthesia provides superior haemodynamic stability and improved postoperative analgesia compared with GA for PCNL, without compromising surgical efficacy. SSA represents a safe and effective anaesthetic alternative in appropriately selected adult patients.

Type 2 diabetes mellitus (T2DM) is highly prevalent among older adults and is a major contributor to microvascular complications, including diabetic retinopathy, nephropathy, and neuropathy. While glycated hemoglobin (HbA1c) is the standard marker of long-term glycemic control, increasing evidence suggests that visit-to-visit HbA1c variability may independently influence the development of diabetes-related complications. However, data specifically addressing this association in geriatric populations remain limited. This systematic review and meta-analysis aimed to evaluate the relationship between long-term HbA1c variability and microvascular complications among individuals aged ≥65 years with T2DM. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception to January 2025. Observational cohort and case–control studies reporting HbA1c variability (standard deviation, coefficient of variation, variability independent of the mean, or average real variability) and adjusted effect estimates for microvascular outcomes were included. Eighteen studies comprising approximately 142,000 participants met inclusion criteria. Higher HbA1c variability was significantly associated with increased risk of diabetic retinopathy (pooled HR 1.28; 95% CI 1.15–1.42), nephropathy (pooled HR 1.34; 95% CI 1.20–1.50), and peripheral neuropathy (pooled OR 1.22; 95% CI 1.08–1.37). These associations persisted after adjustment for mean HbA1c and conventional risk factors. Moderate heterogeneity was observed across studies. The findings suggest that HbA1c variability is an independent predictor of microvascular complications in geriatric patients with T2DM. Emphasizing glycemic stability, in addition to achieving target HbA1c levels, may improve complication risk stratification and management in older adults. Further prospective studies focusing exclusively on elderly populations are warranted to refine these associations and inform clinical guidelines.

Background: Cataract surgery is a routine procedure in patients with diabetes, yet the influence of diabetes on postoperative ocular outcomes, including macular thickness and the incidence of macular edema, remains inadequately understood. Methods: A prospective study was undertaken among diabetic and non-diabetic individuals undergoing small incision cataract surgery at the Department of Ophthalmology, MM Medical College, Solan. The study cohort comprised 100 participants, with demographic data, comorbidities, blood sugar parameters, severity of retinopathy, and ocular outcomes assessed both preoperatively and at 12 weeks post-surgery. Results: Retinopathic changes were exclusively identified in diabetic patients, underscoring the heightened vulnerability of diabetic individuals to ocular complications. Mild non-proliferative diabetic retinopathy (NPDR) was observed in 36% (n=18) of diabetic participants, followed by moderate NPDR, affecting 30% (n=15) of individuals. Postoperative analysis revealed a notable increase in macular thickness in both diabetic and non-diabetic groups, with a more pronounced elevation observed among diabetic patients (p-value = 0.036). Furthermore, diabetic participants exhibited a significantly higher incidence of macular edema compared to their non-diabetic counterparts (p= 0.046).  Conclusion: This study underscores the critical necessity for meticulous preoperative evaluation and diligent postoperative surveillance in diabetic patients undergoing cataract surgery. Healthcare practitioners should remain vigilant for signs of macular thickening and edema in diabetic patients to prevent potential vision-threatening consequences.

Background: Anaesthesiology is a vital specialty extending beyond the operation theatre; however, public awareness regarding anaesthesia techniques and the role of anaesthesiologists remains limited. Inadequate knowledge may contribute to preoperative anxiety and reduced participation in shared decision-making. This study aimed to assess awareness about anaesthesia techniques and anaesthesiologists among patients and attendants attending a tertiary care hospital in Western India. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department of a tertiary care hospital over six months after Institutional Ethics Committee approval. Participants aged 18–60 years were enrolled after verbal informed consent. A validated 22-item questionnaire assessing demographic details, knowledge of anaesthesiologists, and awareness of anaesthesia techniques was administered through personal interviews. Data were analyzed using descriptive statistics and expressed as proportions and percentages. Results: A total of 384 participants were included. Although 62.76% correctly identified both general and regional anaesthesia techniques and 71.09% recognized that general anaesthesia can involve both inhalational and intravenous agents, only 9.63% identified anaesthesiologists as physicians, while 44.79% perceived them as assistants to surgeons. Awareness of roles beyond the operation theatre, particularly in ICU and pain clinics, was limited. Notably, 61.19% were unaware of anaesthesia-related complications. Encouragingly, 77.60% expressed willingness to receive detailed information from an anaesthesiologist prior to surgery.  Conclusion: Despite partial awareness of anaesthesia techniques, significant gaps persist regarding the comprehensive role of anaesthesiologists. Strengthening patient education and implementing structured shared decision-making in preoperative counselling may enhance patient understanding, autonomy, and perioperative care outcomes

A Geriatric intertrochanteric femur fractures represent a major cause of morbidity and functional decline. Stable fixation allowing early mobilization is essential. The Proximal Femoral Nail Antirotation (PFNA) Asian system was designed to improve fixation in osteoporotic bone and to accommodate femoral morphology in Asian populations. Methods: This prospective case series evaluated geriatric patients with intertrochanteric femur fractures treated using PFNA Asian between July 2021 and July 2024 at a tertiary care orthopedic center. Radiological union, implant positioning parameters, functional outcomes using the Harris Hip Score (HHS) and Parker–Palmer Mobility Score, and complications were assessed at serial minimum follow-up of 12 months. Results: Fracture union was achieved in the majority of patients within the expected timeframe. Functional outcomes were predominantly good to excellent. Accurate reduction and optimal blade positioning were significantly associated with superior outcomes. Conclusion: PFNA Asian provides reliable fixation with favorable radiological and functional outcomes in geriatric intertrochanteric fractures when sound surgical principles are followed.

Type 2 diabetes mellitus (T2DM) in older adults is frequently complicated by microvascular complications that contribute to significant morbidity. While mean glycated hemoglobin (HbA1c) is the standard marker of long-term glycemic control, increasing evidence indicates that long-term visit-to-visit HbA1c variability may independently influence complication risk. This systematic review and meta-analysis evaluated the association between HbA1c variability and microvascular complications in patients with T2DM, with particular emphasis on the geriatric population. A comprehensive search of major electronic databases was conducted up to June 2025. Thirty-six studies were included in the qualitative synthesis, and 18 studies were eligible for meta-analysis. Higher HbA1c variability was consistently associated with an increased risk of diabetic nephropathy and retinopathy, independent of mean HbA1c levels. Evidence for diabetic neuropathy was more limited but suggested a similar trend. Although geriatric-specific data were scarce, available studies indicated that older adults remain vulnerable to the adverse effects of glycemic variability. These findings highlight the clinical relevance of HbA1c variability in predicting microvascular risk in T2DM.

Ac Antimicrobial resistance (AMR) has emerged as a major global health challenge, threatening the efficacy of standard treatments and increasing the risk of morbidity and mortality. Hospital-based surveillance studies are essential for understanding local resistance patterns and guiding empirical therapy. Methods: A retrospective observational study was conducted in the Department of Microbiology, PMCH, from January 2025 to June 2025. A total of 90 non-duplicate clinical isolates, including urine, pus, blood, sputum, and wound swabs, were analyzed.  Standard microbiological methods identified bacteria, and CLSI 2025-compliant Kirby-Bauer disc diffusion tested antibiotic susceptibility. Results: Among the 90 isolates, Escherichia coli (30.0%) and Klebsiella pneumoniae (20.0%) were the most frequent, followed by Pseudomonas aeruginosa (12.2%), Staphylococcus aureus (16.7%), and Enterococcus spp. (6.7%), and Acinetobacter baumannii (7.8%). Resistance to cephalosporins was high in E. coli (66.7%) and Klebsiella (72.2%), while fluoroquinolone resistance reached 70.0% in E. coli and 66.7% in Klebsiella. Carbapenem resistance was observed in Klebsiella (33.3%) and Acinetobacter (57.1%). MRSA accounted for 46.7% of S. aureus isolates. Despite widespread resistance, vancomycin and linezolid remained effective against gram-positive isolates, and amikacin showed moderate activity (50–60% sensitivity) against gram-negatives. Overall, 38.9% of isolates met the definition of MDR. Conclusion: The findings underscore the urgent need for continuous surveillance of resistance trends at PMCH, along with the implementation of robust antibiotic stewardship programs and infection control measures. Local resistance data should guide empirical prescribing practices to preserve the efficacy of last-line antibiotics.

Environmental contamination in hospital settings is a major contributor to Hospital-Acquired Infections (HAIs), posing significant risks to patients and healthcare workers. Effective monitoring of microbial contamination is essential to guide infection prevention strategies. Methods: A prospective observational study was conducted from January to June 2025. A total of 80 environmental samples, including surface swabs, air, and water samples, were collected from high-touch areas and critical hospital zones. Microbiological testing was performed using culture-based methods, with bacterial and fungal species identified and quantified in Colony-Forming Units (CFU). Data were analyzed to assess contamination patterns, differences across wards, surfaces, and temporal trends. Results: Of the 80 samples, 52 (65%) were positive for microbial growth. Surface swabs showed the highest contamination, followed by water and air samples. Predominant microorganisms included Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., and Candida albicans. ICUs and high-touch surfaces exhibited the highest microbial load. Temporal analysis revealed fluctuations in contamination over the six months. Conclusion: Microbiological testing is an effective tool for monitoring environmental contamination and guiding targeted infection control interventions. Routine surveillance of high-risk areas is recommended to reduce HAIs and enhance patient safety.

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycaemia resulting from insulin resistance and progressive β-cell dysfunction. Vitamin D₃ has emerged as a potential modulator of glucose metabolism through its effects on insulin secretion, insulin sensitivity, and inflammation. However, the association between serum vitamin D₃ levels and glycaemic indices remains inconsistent across populations. The present study aimed to evaluate serum vitamin D₃ levels in patients with T2DM and to assess their relationship with fasting blood sugar (FBS) and glycated haemoglobin (HbA1c), in comparison with healthy controls. Methods: This case–control study was conducted over six months at Government Medical College Anantnag and included 50 confirmed T2DM patients and 50 age-matched healthy controls. Fasting venous blood samples were collected for estimation of FBS, HbA1c, average blood glucose (ABG), and serum vitamin D₃ levels using standard laboratory methods. Data were analysed using SPSS software. Group comparisons were performed using the independent Student’s t-test, and correlations were assessed using Pearson’s correlation coefficient. A p-value <0.05 was considered statistically significant. Results: Diabetic patients demonstrated significantly higher mean HbA1c (7.62 ± 1.64% vs 5.03 ± 0.50%), FBS (134.92 ± 42.61 mg/dL vs 87.30 ± 7.37 mg/dL), and ABG (158.20 ± 62.07 mg/dL vs 93.76 ± 11.75 mg/dL) compared to controls (p <0.001). Serum vitamin D₃ levels also differed significantly between groups (p <0.001). In diabetic patients, vitamin D₃ levels showed a statistically significant correlation with HbA1c (r = 0.497, p = 0.00024), whereas no significant correlation was observed in healthy controls. Notably, 52% of diabetic patients were vitamin D₃ deficient. Conclusion: The study demonstrates a significant association between serum vitamin D₃ levels and glycaemic control in patients with T2DM. Hypovitaminosis D was highly prevalent among diabetics and correlated with poor glycaemic indices, particularly HbA1c. These findings suggest that vitamin D₃ status may influence glycaemic regulation in individuals with underlying metabolic dysfunction, warranting further investigation into its potential role in diabetes management.