Introduction: Objective: To evaluate the impact of soft tissue biotype on aesthetic outcomes of tooth-supported fixed restorations in anterior regions.
Materials and Methods: A cross-sectional clinical study was conducted on 120 patients requiring anterior tooth-supported fixed prostheses. Gingival biotype was assessed using the probe transparency method and categorized into thin and thick types. Aesthetic outcomes were evaluated using gingival contour, papillary fill, color match, and marginal adaptation scores. Data were analyzed using SPSS version 25, and associations were tested using the Chi-square test and independent t-test. Results: Thick gingival biotype demonstrated significantly better aesthetic outcomes compared to thin biotype (p < 0.05). Thin biotype cases showed increased gingival recession and compromised papillary fill.
Conclusion: Soft tissue biotype significantly influences aesthetic outcomes in fixed prosthodontics, and its assessment is essential for achieving predictable and satisfactory results.

Introduction: The study was conducted to determine the prevalence of enteric fever among patients presenting to Services Institute of Medical Sciences / Services Hospital Lahore (SIMS/SHL) between May 2020 and November 2025 and to describe the antimicrobial resistance (AMR) profile of Salmonella Typhi isolates. In this retrospective, descriptive cross sectional study, clinical and laboratory records of all patients with suspected typhoid fever (≥ 38 °C for ≥ 5 days) were reviewed. Blood cultures were processed, and S. Typhi isolates were tested against eight antibiotics using the Kirby Bauer disc diffusion method. Isolates were categorized as non resistant, multidrug resistant (MDR), or extensively drug resistant (XDR). Empirical therapy comprised third generation cephalosporins and was modified according to culture results. Of 7 048 suspected cases, 358 (1.2 %) were culture confirmed typhoid. Among the isolates, 56 (15.6 %) were non resistant, 83 (23.1 %) MDR, and 217 (60.1 %) XDR. All isolates were sensitive to meropenem, imipenem, and azithromycin. Sensitivity to ceftriaxone, ciprofloxacin, and chloramphenicol was 36 %, 33 %, and 36 %, respectively. XDR typhoid accounted for more than half of culture positive cases, highlighting a critical therapeutic challenge. Robust public health measures—vaccination, safe water and sanitation, and strict antibiotic stewardship programs—are imperative to curb the spread of resistant Salmonella strains..

Objective: To evaluate the effect of different flap designs on periodontal healing of the adjacent second molar following surgical extraction of impacted mandibular third molars. Methodology: A comparative clinical study was conducted on 120 patients requiring surgical removal of impacted mandibular third molars. Patients were randomly divided into two groups based on flap design: envelope flap (Group A) and triangular flap (Group B). Periodontal parameters including probing depth (PD), clinical attachment level (CAL), plaque index (PI), and gingival index (GI) of the adjacent second molar were assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results: Both flap designs showed significant improvement in periodontal parameters over time. However, Group A demonstrated better periodontal healing with significantly lower probing depth and attachment loss at 3 months (p < 0.05). Conclusion: Envelope flap design resulted in superior periodontal healing compared to triangular flap following impacted mandibular third molar surgery.

Introduction: Acute pancreatitis can have many causes, with biliary stones and alcohol being the most common. Pancreatic duct ascariasis, which happens when the Ascaris lumbricoides worm moves into the pancreatic duct, is rare but preventable, especially in areas where the parasite is common. Objective: This study aimed to find out how common pancreatic duct ascariasis is among patients with acute pancreatitis, as well as how it presents and how it is managed. Methods: We carried out a retrospective, cross-sectional study at the Gastroenterology Department of District Headquarter Teaching Hospital, Lower Dir, from June 10 to December 6, 2023. Thirty patients aged 18 to 60 years, diagnosed with acute pancreatitis based on epigastric pain, high serum amylase or lipase, and imaging results, were included using purposive sampling. Patients with other gastrointestinal diseases, cancer, or a history of alcohol use or surgery were excluded. We collected data on demographics, symptoms, and ultrasound findings such as main pancreatic duct dilation and hyperechoic linear shadows. Patients with confirmed cases had Endoscopic Retrograde Cholangiopancreatography (ERCP) to remove the worm using a Dormia basket or balloon. We analyzed the data with IBM SPSS v25, using descriptive statistics and Chi-square tests, and considered p-values less than 0.05 as significant. Results: Half of the patients (15 out of 30) with acute pancreatitis were found to have pancreatic duct ascariasis. The other cases were due to non-specific causes or other complications. Statistical analysis showed significant links (p<0.05) between ascariasis and epigastric pain, high serum amylase or lipase, and typical ultrasound findings. All worms in confirmed cases were removed successfully with ERCP, which provided a cure. Conclusion: Ascaris lumbricoides is an important and preventable cause of acute pancreatitis in our region, making up half of the cases in this study. Abdominal ultrasound is a useful first test, and ERCP is the best method for confirming and treating the condition. Public health efforts like deworming and better sanitation are key to prevention. Larger, future studies are needed to confirm these results.

Introduction: Intrauterine Growth Restriction (IUGR) poses significant risks in pregnancies complicated by gestational diabetes mellitus (GDM), affecting fetal development and leading to adverse perinatal outcomes. Early detection and intervention strategies are essential to mitigate these risks. Objective: To evaluate the effectiveness of early diagnostic and intervention strategies in reducing IUGR incidence and improving perinatal outcomes in patients with GDM. Methods: This prospective observational study involved 180 pregnant women with GDM, divided equally into a Standard Care Group and an Early Intervention Group. Patients in the intervention group received intensified glucose management, regular ultrasound monitoring, and specialized dietary counseling. Primary outcomes included IUGR incidence, fetal growth trajectory, and secondary outcomes like preterm delivery rates and NICU admissions. Statistical analysis was performed using chi-square, t-tests, and logistic regression. Results: IUGR incidence was significantly lower in the Early Intervention Group (11.1%) compared to the Standard Care Group (22.2%) (p=0.03). The intervention group also showed fewer preterm births (11.1% vs. 20%) and lower NICU admissions (7.8% vs. 16.7%), with improved maternal glycemic control. Conclusion: Early intervention strategies in GDM pregnancies effectively reduce IUGR incidence and improve perinatal outcomes, underscoring the importance of proactive monitoring and tailored glucose management for high-risk pregnancies. Future research should explore advanced diagnostic tools and interventions to enhance prenatal care in similar populations.

Background:  ADHD is a persistent neurodevelopmental disorder often continuing into adulthood and frequently accompanied by mood, anxiety, and other psychiatric conditions. Comorbidities, especially depression and bipolar disorder, worsen functional impairment and treatment outcomes. This study examines the prevalence of mood disorders among adults with ADHD in a tertiary centre in Eastern India. Materials And Method: This cross-sectional study included 100 adults with ADHD. Mood disorders were assessed using BDI-II and YMRS. Sociodemographic data were collected, diagnoses followed DSM-5, and statistical analysis was performed using SPSS with appropriate tests. Results: Among adults with ADHD, 47% had depressive symptoms, most commonly moderate depression, which was significantly higher than other grades. Manic symptoms were present in 17%, with mild mania being most frequent. Discussion: A large proportion of childhood ADHD persisted into adulthood, contributing to psychiatric comorbidities. In this study, overall, 64% showed mood symptoms: 47% depressive and 17% manic. Thorough screening for mood disorders in adult ADHD is strongly recommended.

Background: Skin disorders constitute a major public health concern, contributing significantly to morbidity and reduced quality of life. In India, dermatological conditions are highly prevalent, yet awareness and treatment-seeking behavior remain suboptimal. Aim: To assess the prevalence of common skin disorders, awareness levels, and treatment-seeking behavior among patients attending a tertiary care hospital. Methods: A hospital-based cross-sectional survey was conducted among 400 patients attending the dermatology outpatient department of Balaji Hospital, Raipur. A structured questionnaire was used to collect demographic data, clinical profile, awareness, and treatment practices. Results: The most common conditions were fungal infections (28%), acne (22%), eczema (15%), and pigmentary disorders (12%). Only 46% of participants had adequate awareness regarding skin diseases. Approximately 58% sought treatment from qualified dermatologists, while 42% relied on self-medication or alternative remedies. Conclusion: Skin diseases are highly prevalent, with significant gaps in awareness and appropriate healthcare utilization. Public education and improved access to dermatological services are essential.

Background: Chronic wounds are a significant burden in healthcare worldwide, especially for patients suffering from diabetes who have vascular insufficiency or also become immobility for extensive periods. Slow healing causes a high disease burden, prolonged hospitalisation, and high medical costs. Negative Pressure Wound Therapy (NPWT) is a method of managing wounds which promotes granulation tissue, angiogenesis and reduced exudates by controlling the application of sub-atmospheric pressure. It is commonly used, but there are inconsistent reports regarding real-world clinical outcomes and cost-effectiveness in these healthcare settings.Methods: A retrospective observational cohort study was performed in a tertiary care centre between December 2023 and December 2025. A series of 130 adult patients with chronic wounds that underwent treatment with NPWT were enrolled through consecutive sampling. Extracted data from the electronic medical records consisted of wound characteristics, duration of therapy, time to closed wound, complications and overall treatment cost. Statistical tests were conducted with SPSS. Baseline characteristics were descriptively summarised and associations were tested using chi-square tests and independent t-tests. Survival analysis using the Kaplan–Meier method was also performed for time-to-healing, and p < 0.05 was considered as statistical significance. Results: The overall complete wound healing rate was 82.3% and the average healing period was 41.7 ± 14.3 days. Complications were documented in 22.3% of patients, wound infection being the most common (11.5%). The mean cost per patient treated with NPWT was less than historical costs for conventional dressing data, and the cost per healed wound showed greater economic efficiency. Diabetes and peripheral arterial disease emerged as strong determinants of delayed healing. Conclusion: NPWT has been shown to have high healing rates and an acceptable complication profile, leading to favourable long-term cost-effectiveness in the management of chronic wounds. These results support its wider implementation into everyday clinical settings.

Background: Wound closure is an integral part of surgical practice with a significant impact on healing, infection rate, structures and cosmetic results and overall patient satisfaction. The  selection of an appropriate method for wound closure is a major issue in the reduction of postoperative complications and optimizing recovery. Sutures, surgical staples and tissue adhesives are commonly employed methods of wound closure, each with its own advantages and disadvantages. Methods: This retrospective observational study was done at Deep Hospital, Ludhiana and the record review period ranges from January 2022 to December 2024. 180 patients, in whom the surgical wound was closed by sutures (n=70), staples (n=60) or tissue adhesives (n=50), were analyzed. Demographics, surgery type, wound classification, operative duration, time to healing, cosmetic result and complications were evaluated. Statistical analysis was done using SPSS, p < 0.05 was considered as significant statistically. Results: The global infection rate was 10.5%, being the lowest in the tissue adhesive group (6.0%), followed by staples (11.7%) and sutures (12.9%). Tissue adhesives had the shortest mean healing time (9.2 ± 2.1 days) and better cosmetic results. Surgical staples were also related to a significantly decreased operative time (5.6 ± 1.4 minutes; p < 0.001). The dehiscence of wounds must be low since it is similar in all groups. Hypertrophic scar formation was significantly more frequent in the staples group. Conclusions: Tissue adhesives had superior cosmetic results and facilitated more rapid healing in clean, low-tension wounds, whereas surgical staples provided a benefit in operative time. Sutures continued to be a strong and flexible material. Choice of closure method has to be tailored according to wound type and clinical situation.

Background: Frailty is a multidimensional clinical syndrome that reflects reduced physiological reserve and increased vulnerability to adverse outcomes in older adults. Its role in predisposing hospitalized elderly patients to healthcare-associated infections (HAIs) and multidrug-resistant organism (MDRO) colonization is increasingly recognized but remains insufficiently explored in routine clinical settings. Aim: To evaluate the association between the Clinical Frailty Scale (CFS) and the occurrence of HAIs and MDRO colonization in hospitalized older adults. Methods: This prospective observational study conducted over a period of 12 months, included 120 patients aged ≥65 years admitted to Sree Gokulam Medical College, a tertiary care hospital. Frailty was assessed within 24 hours of admission using the CFS and categorized as non-frail (1–3), pre-frail (4–5), and frail (6–9). Active surveillance for HAI was carried out in the sample population. Microbiological cultures were performed to identify pathogens and determine antimicrobial resistance. Statistical analysis included chi-square testing and multivariate logistic regression. Results: The overall incidence of HAIs was 28.3%, while MDRO colonization was observed in 34.2% of patients. A significant increase in both outcomes was noted with higher frailty scores. Frail patients had higher rates of HAIs (45.5%) and MDRO colonization (58.2%) compared to pre-frail and non-frail groups (p<0.001). Frailty independently predicted HAIs (adjusted OR 3.1) and MDRO colonization (adjusted OR 3.8). Conclusion: Higher CFS scores are strongly associated with increased risk of HAIs and MDRO colonization. Routine frailty assessment may aid in early risk identification, targeted infection prevention, and improved antimicrobial stewardship in hospitalized elderly populations.

Introduction: Alveolar osteitis (dry socket) is one of the most common postoperative complications following impacted mandibular third molar surgery, with reported incidence ranging from 1% to 30% depending on risk factors and surgical difficulty (Blum, 2002; Bowe et al., 2011). It is characterized by premature disintegration of the blood clot, severe postoperative pain, and delayed wound healing. Several preventive measures have been proposed, including local antimicrobial agents such as metronidazole and chlorhexidine gel (Caso et al., 2005; Torres-Lagares et al., 2006). However, direct comparisons between these two agents remain limited in randomized clinical settings. Objective: To compare the effectiveness of topical metronidazole gel and chlorhexidine gel in preventing dry socket following surgical extraction of impacted mandibular third molars. Methods: In this randomized controlled clinical trial, patients undergoing impacted mandibular third molar surgery were randomly allocated into two groups. Group A received intra-alveolar metronidazole gel, while Group B received intra-alveolar chlorhexidine gel immediately after extraction. Patients were evaluated on postoperative days 2, 4, and 7 for incidence of dry socket, pain severity using a Visual Analog Scale (VAS), and other postoperative complications. Statistical analysis was performed using chi-square and independent t-tests, with significance set at p < 0.05. Results: The incidence of dry socket was lower in the chlorhexidine group compared to the metronidazole group. Chlorhexidine gel demonstrated a statistically significant reduction in dry socket occurrence (p < 0.05), consistent with previous reports highlighting its broad-spectrum antimicrobial and substantivity properties (Caso et al., 2005). Pain scores were also lower in the chlorhexidine group during the early postoperative period. Both interventions were well tolerated, and no major adverse reactions were observed.Conclusion: Chlorhexidine gel appears to be more effective than metronidazole gel in preventing dry socket following impacted mandibular third molar surgery. Its routine application may be recommended, particularly in high-risk patients, in line with existing evidence supporting chlorhexidine-based preventive strategies (Torres-Lagares et al., 2006)

Background: To characterize structural retinal biomarkers on spectral- domain optical coherence tomography (SD-OCT) in patients receiving long-term hydroxychloroquine (HCQ) therapy with clinically normal fundus ndings, and to correlate these ndings with dosage-related risk factors. Methods: A retrospective observational case series of four rheumatoid arthritis patients on chronic HCQ therapy was conducted at Parul Sevashram Hospital. All underwent comprehensive ophthalmic examination including BCVA, slit-lamp biomicroscopy, Goldmann applanation tonometry, dilated fundus evaluation, color photography, red-free imaging, and SD-OCT macular cube (512×128) with high-de nition raster scans. For all the patients, daily dose of HCQ per body weight and cumulative dose as per years of intake were calculated according to 2016 AAO guidelines. Results: Mean age was 61.0 ± 4.7 years. Mean duration of HCQ therapy was 11.5 ± 2.6 years. All patients demonstrated outer retinal abnormalities on SD-OCT despite normal fundus appearance. Parafoveal outer nuclear layer thinning was present in 100% of eyes, while ellipsoid zone disruption with classical  flying saucer configuration was observed in 75% of patients. Mean daily dose was 450 mg, with one patient exceeding 5 mg/kg/day, corresponding to more advanced structural loss. Conclusion: Structural retinal damage occurs before clinical and functional de cits in HCQ toxicity. Routine SD-OCT screening combined with strict adherence to weight-based dosing is essential to prevent irreversible vision loss.

Background: Short-term memory (STM) refers to the temporary storage and maintenance of information over brief intervals, typically seconds, and represents a foundational cognitive domain in human information processing. Aim of this study is to evaluate the short-term memory performance of healthy young adults using a multi-task cognitive functions. Materials and Methods: A cross-sectional sample of 50 healthy young adults (aged 18–24 years) was recruited. Participants were screened for neurological and psychiatric conditions and intake of drug history. The short term memory or working memory was evaluated in 3 sessions of verbal, visual words and again repeating the same sessions with a gap of 20 min. by applying memory enhancing methods were calculated in percentage. Results: The present study shows comparison of memory status before and after applying of memory enhancing methods in Word test & Object test were the results were very significant. Conclusion: The findings affirm that a multi-task approach provides a robust assessment of STM capacity in young adults. In our study were have observed that subjects are having more short term memory for object test due to high attention, participation in tasks. Short term memory for object test was significantly higher than word test which may be due to good sight.

Abstract Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in India, with a substantial burden attributed to poor awareness, delayed diagnosis, and inadequate management, particularly in rural settings. Objective: To assess the knowledge, attitude, and practices (KAP) regarding COPD among patients attending a tertiary care hospital in the Garhwal region of Uttarakhand. Methods: A cross-sectional study was conducted among diagnosed COPD patients using a pretested semi-structured questionnaire. Data on demographic characteristics, risk factors, knowledge of disease etiology and prevention, attitudes toward disease severity, and practices including healthcare-seeking behavior, smoking cessation, and inhaler use were collected and analyzed. Results: The study demonstrated significant deficiencies in patient awareness and disease understanding. A large proportion of patients had inadequate knowledge regarding COPD risk factors, with poor recognition of smoking and biomass fuel exposure as primary causes. Preventive awareness and understanding of long-term management were limited. Attitudinal assessment revealed underestimation of disease severity and delayed healthcare-seeking behavior. Practices were suboptimal, with frequent continued exposure to risk factors, improper inhaler use, and reliance on delayed or inappropriate treatment prior to tertiary care consultation. These findings indicate substantial gaps in disease awareness and self-management. Conclusion: COPD patients exhibit poor knowledge, unfavorable attitudes, and inadequate practices, contributing to delayed diagnosis and poor disease outcomes. Targeted educational interventions and improved patient counseling are essential to enhance disease awareness, treatment adherence, and overall management.

Introduction: With the rapid integration of Artificial Intelligence (AI) in healthcare, it is essential for nurses to possess foundational knowledge and preparedness to work with AI-based tools. In Southern Punjab, Pakistan, there is limited understanding of nurses’ AI literacy, attitudes, and readiness for implementation. Objective: To assess the knowledge, perceptions, and acceptance of AI among registered nurses in Southern Punjab. Methodology: A descriptive cross-sectional study was conducted among 60 registered nurses. Data were gathered using a structured, close-ended questionnaire and analyzed using SPSS version 25 to evaluate participants’ knowledge levels and perceptions regarding the use of AI in clinical practice. Results: Among the 60 participants, 80% were female, and 50% held a BSc Nursing degree. None of the respondents reported receiving formal training in AI. Only 14.6% acknowledged the potential role of AI in nursing practice, while 94% opposed its inclusion in the nursing curriculum. Despite these limitations, 60% of participants expressed willingness to receive AI training in the future, and 55% believed AI could eventually improve patient care quality if implemented properly. Furthermore, 83.3% of respondents were working in hospital settings, which may influence their exposure and adaptability to new technologies. Conclusion: This study reveals a substantial gap in AI knowledge and training among nurses in Southern Punjab. While current understanding and acceptance levels are low, the willingness to learn presents an opportunity. Institutional efforts such as targeted training programs, workshops, and curriculum reforms are critical to equipping the nursing workforce for a technology-driven future in healthcare.

Background: Blood component wastage is an important indicator of  the efficiency and quality of transfusion services. Discarded blood components represent a loss of valuable biological resources and increase the operational costs of blood banks. Monitoring the patterns and causes of blood component  discard is essential for improving inventory management and optimizing blood utilization in high-volume transfusion centers. Aim: To analyze the patterns and causes of blood component discard in a tertiary care blood center over a four year period. Materials and Methods: A retrospective observational study was conducted at the Department of Immunohematology and Blood Transfusion of a tertiary care teaching hospital in North India from January 2022 to December 2025. Blood bank records including component preparation registers, discard registers, and transfusion-transmitted infection screening records were reviewed. Data regarding the total number of blood units processed and the reasons for discard were collected and analyzed. The causes of discard were categorized into seropositivity for transfusion-transmitted infections, platelet expiry, handling or storage damage, and other technical causes. Descriptive statistical analysis was performed, and discard rates were calculated as percentages. Results: During the study period, a total of 119,147 blood units were processed into components. Among these, 6,215 units were discarded for various reasons. Platelet expiry was 
the most common cause of discard (3,840 units; 61.8%), followed by seropositivity for transfusion-transmitted infections (2,336 units; 37.6%). Handling or storage damage accounted for 27 units (0.4%), while other causes constituted a very small proportion 12  units (0.19%). Among seropositive units, Hepatitis B infection accounted for the largest proportion, followed by hepatitis C and human immunodeficiency virus. Platelet concentrates showed the highest discard rate due to their short shelf life and fluctuating clinical demand. Conclusion: Platelet expiry and seropositivity remain the major causes of blood component discard in high-volume blood centers. Improved donor screening, better inventory management, and continuous monitoring of blood utilization patterns are essential strategies for reducing wastage and improving the efficiency of transfusion services. 

Background: Helicobacter pylori infection remains a major cause of peptic ulcer disease (PUD), particularly in developing countries. Objective: To determine the prevalence and multidrug resistance pattern of Helicobacter pylori among patients with peptic ulcer disease attending tertiary care hospitals in Pakistan. Methods: This was a hospital-based cross-sectional analytical study conducted at Tertiary Care Hospitals across major cities of Pakistan March, 2023, to September, 2025 including 255 adult patients presenting with clinically suspected peptic ulcer disease. Results: The overall prevalence of H. pylori infection was 68.2% (174/255). Infected patients were significantly younger (39.7 ± 12.8 years) compared to non-infected patients (45.8 ± 13.4 years; p = 0.002). Duodenal ulcer was strongly associated with infection (71.3%; p <0.001), while NSAID use was more common among H. pylori-negative patients (56.8%; p <0.001). The highest resistance rates were observed for metronidazole (58.6%), clarithromycin (44.8%), and levofloxacin (36.8%). Resistance to amoxicillin (16.1%) and tetracycline (10.9%) remained comparatively low. Multidrug resistance was identified in 36.8% of isolates, with dual clarithromycin–metronidazole resistance present in 27.6%. Conclusion: A high prevalence of H. pylori infection and a substantial burden of multidrug-resistant strains were observed among PUD patients. Elevated resistance to clarithromycin and metronidazole may compromise standard empirical therapy, highlighting the need for regional surveillance and susceptibility-guided treatment strategies to improve eradication outcomes.

Introduction: Nipah virus is a highly pathogenic zoonotic virus that has emerged as a significant global health concern due to its high case fatality rate, recurrent outbreaks, and potential for human-to-human transmission. This review aims to evaluate the current diagnostic strategies for Nipah virus and identify gaps that may affect early detection and outbreak control. A comprehensive literature search was conducted using electronic databases including PubMed, Scopus, Web of Science, and Google Scholar to identify studies published between 2000 and 2025 related to Nipah virus diagnostics, surveillance, and outbreak investigations. The findings indicate that molecular diagnostic techniques, particularly real-time reverse transcription polymerase chain reaction (RT-PCR), remain the primary method for early confirmation of infection, while serological assays such as IgM and IgG ELISA are commonly used for supportive diagnosis and epidemiological surveillance. Despite the availability of reliable laboratory methods, several challenges continue to limit early detection, including nonspecific early clinical symptoms, limited diagnostic infrastructure in outbreak-prone regions, delays in sample transport, and the absence of widely available rapid point-of-care tests. Emerging diagnostic technologies such as multiplex PCR, loop-mediated isothermal amplification, and genomic sequencing offer promising opportunities for improving rapid detection and outbreak monitoring.

Background: Osteoarthritis is one of the leading conditions of the global disability burden.1 It is characterized by damage to the smooth joint cartilage surface and degradation of the joint's integrity can cause symptoms such as pain and lack of mobility. Total joint arthroplasty is the most successful treatment for advanced osteoarthritis of the hip or knee joint. Socioeconomic status (SES) has a significant impact on an individual's health. Socioeconomic deprivation or components hereof have been associated with worse postoperative outcomes, higher risk of postoperative complications, prolonged hospitalization and readmissions due to lower rates of surgery, higher disease severity, and worse preoperative health.6,8 Aim To evaluate the association between socioeconomic status (SES) and patient-reported outcomes before and one year after total knee arthroplasty (TKA) or total hip arthroplasty (THA), and to assess whether changes in symptoms were clinically meaningful in an Indian population.

Methods A prospective observational cohort study was conducted between September 2023 and August 2024 at a tertiary care teaching hospital in Northern India. A total of 101 patients aged ≥45 years who underwent primary TKA or THA for primary osteoarthritis were included. Socioeconomic status was stratified using the modified Kuppuswamy scale.

Patient-reported outcome measures (PROMs) included:

• Oxford Knee Score (OKS)
• Oxford Hip Score (OHS)
• Western Ontario and McMaster Universities Arthritis Index (WOMAC)
• Visual Analog Scale (VAS) for pain
• EuroQol 5-Dimensions (EQ-5D)

Linear mixed-effects regression models were used to examine the relationship between SES and both pre- and postoperative PROMs, adjusting for age and sex. Potential confounders included BMI, ASA classification, Charnley classification, smoking status, and alcohol use. Results Of the 101 patients enrolled, those from lower SES groups were more frequently female, and a greater proportion were ASA Grade III. At baseline, patients from lower SES strata reported significantly worse OKS (β = 3.52, P = 0.003). Among THA patients, lower SES was also associated with worse OHS (β = 4.63, P = 0.002), higher WOMAC scores (β = 10.9, P = 0.001), and more pain on VAS (β = −0.88, P = 0.001). No statistically significant differences in EQ-5D scores were noted across SES groups, benefits which were observed across SES groups but were most marked in patients with higher adherence, particularly from middle and higher SES backgrounds. Conclusion In this one-year study conducted between September 2023 and August 2024, patients from lower socioeconomic backgrounds presented with worse preoperative symptoms and demonstrated less clinically meaningful improvement one year after TKA or THA. We can use these findings particularly with tailored strategies to improve access and adherence among lower SES groups.

Introduction: Peripheral neuropathy is a prevalent but often neglected complication of hepatic cirrhosis. The objective of this study was to investigate the electrophysiological pattern distinguishing motor and sensory nerve involvement in cirrhotic individuals. Methods: Fifty male cirrhosis patients aged 25 to 50 were included. Bilateral motor and sensory nerve conduction studies (NCS) of the median, ulnar, tibial, and sural nerves were performed. Parameters such as conduction velocity, amplitude, and latency were compared with age-matched reference values. Results: All motor nerves demonstrated slowed conduction velocities, with the tibial and ulnar nerves being most affected. Sensory nerves—particularly the median and sural—showed markedly reduced amplitudes and prolonged latencies. The predominant pattern was symmetrical, mixed, sensorimotor polyneuropathy of axonal type. Conclusion: Hepatic cirrhosis affects both motor and sensory nerves, with sensory fibers showing earlier and more severe changes. Incorporating electrophysiological screening into the management of cirrhosis could aid in early detection and improve long-term outcomes.

Background: Surgical site infections (SSIs) significantly increase morbidity following emergency laparotomy. The efficacy of subcutaneous drains in preventing SSIs remains controversial.Methods: Prospective comparative study of 80 consecutive emergency laparotomy patients at a tertiary care center in India (July 2023-March 2025). Patients were allocated to Group A (n=40, negative suction closed drains) or Group B (n=40, no drains). Primary outcome was SSI incidence within 30 days (CDC criteria). Secondary outcomes included wound complications, hospital stay, microbiological profile, and need for surgical intervention. Analysis used χ² tests and t-tests (p<0.05 significant). Results: SSI incidence was 12.5% (5/40) in Group A versus 45.0% (18/40) in Group B (χ²=10.79, p=0.0013), representing 72.2% relative risk reduction. Group A had zero hematomas/seromas versus 10% each in Group B (p=0.005). Mean hospital stay was 5.95±1.36 vs 6.80±1.69 days. All Group A SSIs occurred early (POD 2-3) while Group B SSIs were delayed (POD 4-6). Gram-negative enteric organisms (E.coli, Klebsiella) were absent in Group A but comprised 35% of Group B SSIs (p<0.01). No Group A patients required surgical intervention versus 15% in Group B (p=0.034). Conclusions: Negative suction closed drains significantly reduce SSI rates, wound complications, and need for re-intervention following emergency laparotomy, particularly by eliminating gram-negative enteric infections associated with fluid accumulation.

Background: Extended-spectrum β-lactamase (ESBL) production represents a critical biochemical mechanism of resistance, leading to enzymatic degradation of β-lactam antibiotics and posing significant pharmacological challenges in clinical management. Objective: To assess the microbial spectrum of urinary, respiratory, and gastrointestinal infections among immunocompromised cancer patients, with a focused evaluation of urinary E. coli isolates, ESBL-associated antimicrobial resistance patterns, and pharmacological implications for therapy. Methods: A cross-sectional study was conducted among 170 patients from the oncology department at one of the tertiary care public hospitals in Karachi, Pakistan, from April 2021 to May 2023. Urine, sputum, and stool specimens were processed using standard microbiological culture and biochemical identification methods. Antimicrobial susceptibility testing of urinary E. coli isolates was performed to determine resistance patterns suggestive of ESBL activity. Data were analyzed using SPSS version 26, categorical variables were expressed as frequencies and percentages, and associations were assessed using the chi-square test with a significance level of p ≤ 0.05. Results: Escherichia coli was the predominant pathogen isolated from urinary tract infections (78.2%), whereas Staphylococcus aureus and Salmonella/Shigella species were most frequently identified in respiratory and gastrointestinal infections, respectively. Urinary E. coli isolates exhibited high resistance to β-lactam antibiotics and fluoroquinolones, consistent with the enzymatic inactivation mediated by ESBLs. Conclusion: ESBL-mediated resistance in urinary E. coli poses a significant biochemical and pharmacological challenge in immunocompromised cancer patients. Antimicrobial selection and routine susceptibility testing are essential to optimize treatment outcomes and limit the progression of antimicrobial resistance.

Background: Osteoarthritis of the knee is one of the most common degenerative joint disorders leading to pain, stiffness, and functional disability. Total knee arthroplasty (TKA) is an effective surgical treatment for advanced osteoarthritis; however, postoperative pain may delay early mobilization and rehabilitation. Intraoperative periarticular cocktail injection has emerged as an important component of multimodal analgesia aimed at improving postoperative pain control and functional recovery following TKA. Aim: To assess the functional outcome of intraoperative periarticular cocktail injection for pain control and improvement of knee motion following total knee arthroplasty. Methods: This prospective observational study was conducted in the Department of Orthopedics at Dhiraj Hospital, S.B.K.S. Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, from June 2023 to June 2025 after obtaining institutional ethical clearance. A total of 27 patients with osteoarthritis of the knee undergoing total knee arthroplasty were included in the study. Intraoperative periarticular cocktail injection consisting of triamcinolone, ketorolac, clonidine, bupivacaine, and distilled water was administered during surgery. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 6 hours, 12 hours, and daily up to the fourth postoperative day, with follow-up at 1 month and 3 months. Knee range of motion (ROM) and postoperative complications were also recorded. Data were analyzed using appropriate statistical methods and a p-value <0.05 was considered statistically significant. Results: The study demonstrated significant reduction in postoperative pain following periarticular cocktail injection. Mean VAS scores decreased progressively during follow-up, indicating effective pain control. Knee range of motion improved gradually during the postoperative period, with most patients achieving satisfactory functional recovery. The majority of patients experienced uneventful recovery, and only a small proportion developed minor postoperative complications. Conclusion: Intraoperative periarticular cocktail injection is an effective and safe technique for postoperative pain management in total knee arthroplasty. It provides adequate pain relief, facilitates early mobilization, improves knee range of motion, and contributes to better functional outcomes in patients undergoing knee replacement surgery.