Background: Burst abdomen, or acute postoperative fascial dehiscence, is a serious complication after emergency laparotomy. It is usually seen in patients who enter surgery with sepsis, poor nutritional reserve, anemia, or raised postoperative abdominal pressure. Since emergency midline laparotomy remains common in district and teaching hospitals, local identification of modifiable risk factors may help surgeons strengthen perioperative care. It is designed to evaluate the clinical, biochemical, operative, and postoperative risk factors associated with burst abdomen after emergency midline laparotomy. Materials and Methods: This hospital-based observational study included 180 adult patients who underwent emergency midline laparotomy between January 2024 and June 2026. Patients were followed during the postoperative period for partial or complete fascial disruption. Demographic factors, comorbidities, hemoglobin, serum albumin, operative indication, wound contamination, closure details, postoperative cough, surgical-site infection, re-exploration, mortality, and length of stay were recorded. Data were analyzed using IBM SPSS Statistics version 28. Categorical variables were compared using the chi-square test or Fisher exact test, and continuous variables were compared using the independent-samples t test. Variables significant in univariate analysis were entered into binary logistic regression. A p value less than 0.05 was considered statistically significant. Results: Burst abdomen occurred in 22 of 180 patients, giving an incidence of 12.2%. The condition was more frequent among patients aged above 60 years, males, diabetics, undernourished patients, anemic patients, and those with serum albumin below 3.0 g/dL. Generalized peritonitis or dirty wounds, longer operative duration, postoperative cough, surgical-site infection, and a suture length:wound length ratio below 4:1 were also significantly associated with burst abdomen. On multivariable analysis, surgical-site infection, hypoalbuminemia, anemia, postoperative cough or strain, and inadequate suture length remained independent predictors. Patients with burst abdomen had higher re-exploration rates, longer hospital stay, greater need for intensive care, and higher mortality. Conclusion: Burst abdomen after emergency midline laparotomy was strongly related to impaired host healing, wound contamination, postoperative infection, raised abdominal strain, and suboptimal fascial closure mechanics. Routine nutritional assessment, correction of anemia, careful management of peritonitis, strict prevention of surgical-site infection, control of cough, and attention to adequate fascial bite and suture length may reduce this preventable complication.

Background: The uterus demonstrates considerable anatomical variation in its position within the pelvis. The most common uterine position is anteverted and anteflexed, while retroverted, retroflexed, mid-position, and lateral deviations represent less frequent anatomical variants. Although traditionally considered normal physiological variations, several studies have suggested associations between uterine position and gynecological symptoms including dysmenorrhea, infertility, and adverse pregnancy outcomes. Aim: To study anatomical variations of uterine position and evaluate their association with dysmenorrhea, infertility, and pregnancy outcomes among women. Materials and Methods: A hospital-based cross-sectional observational study was conducted among 150 women aged 20–40 years attending the Department of Obstetrics and Gynecology over a period of 12 months. Uterine position was assessed using pelvic examination and transabdominal or transvaginal ultrasonography. Patients were categorized into anteverted anteflexed, retroverted retroflexed, mid-position, and laterally deviated uterus groups. Dysmenorrhea severity, infertility status, and pregnancy outcomes were recorded and analyzed. Statistical analysis was performed using Chi-square test and ANOVA, with p<0.05 considered statistically significant. Results: Among 150 women, anteverted anteflexed uterus was observed in 62.0%, retroverted retroflexed uterus in 24.7%, mid-position uterus in 8.0%, and laterally deviated uterus in 5.3%. Moderate to severe dysmenorrhea was significantly more common in women with retroverted uterus (59.5%) compared with anteverted uterus (23.7%) (p<0.001). Infertility was identified in 37.8% of women with retroverted uterus compared with 12.9% among women with anteverted uterus (p=0.002). Adverse pregnancy outcomes including recurrent miscarriage, preterm delivery, and cesarean delivery were significantly higher among women with retroverted uterus (p=0.014). Conclusion: Retroverted and retroflexed uterine positions were significantly associated with increased dysmenorrhea, infertility, and unfavorable pregnancy outcomes. Recognition of uterine anatomical variations may help clinicians improve patient counseling and management strategies.

Aim of Study: To evaluate the combined efficacy of autopsy findings, dental record analysis, and toxicological screening in establishing the identity of unidentified decedents in Punjab, Pakistan, and to assess the relative contribution of each discipline in a resource-constrained setting. Study Duration: January 2025 to June 2025. Study Place: Department of Forensic Medicine & Toxicology, King Edward Medical University, Lahore, and Punjab Medical College/Faisalabad Medical University, Faisalabad. Methodology: A cross-sectional, descriptive study was conducted on all unidentified decedents brought to the two participating forensic departments over a 6-month period. A structured proforma was used to document demographic data, autopsy findings (including age, sex, stature, external identifiers, and pathological lesions), dental status (using post-mortem dental radiography and charting), and toxicological screening results (blood, urine, and vitreous humor). Ante-mortem dental records were sought from the Punjab Forensic Science Agency (PFSA) database and NADRA for comparison. Data were analyzed using SPSS version 26.0, with descriptive statistics and chi-square tests used to determine associations between identification success and the number of forensic modalities used. Results: A total of 412 unidentified decedents were included in the study. The majority were male (68.2%), with most cases aged between 21–40 years (42.7%). Road traffic accidents were the leading cause of death (38.6%), followed by firearm injuries (24.3%). Successful identification was achieved in 67.5% of cases (n=278). The combination of all three disciplines (autopsy + dental + toxicology) yielded the highest identification rate (84.3%), followed by autopsy + dental (72.1%), and autopsy alone (55.4%). Dental records were available for only 34.7% of decedents, with a 91.2% match rate in cases where ante-mortem records were available. Toxicology was positive in 31.3% of all cases, with commonly detected substances being alcohol (42.6%), opioids (28.7%), and benzodiazepines (18.3%). Conclusion: A multidisciplinary approach significantly improves the identification rate of unidentified decedents. While dental record comparison is highly effective when records are available, its utility is limited by low record availability. Toxicology provides critical information about the circumstances of death and may aid in identification through circumstantial linkage. Enhancing the dental record database and establishing a central forensic identification system are essential steps for improving identification outcomes in Punjab.

Objective:  To highlight definite correlation between red cell distribution width (RDW) and C reactive protein (CRP) in neonatal sepsis. Methods: This cross sectional study was conducted at the Neonatal Intensive Care Unit of Combined Military Hospital, Peshawar from October 2022 to April 2023. A total of 60 neonates (birth to 28 days) with neonatal sepsis were selected. Neonates with gestational age <30 weeks, perinatal asphyxia, birth weight >90th percentile, family history of hematological disorders or >1 episode of sepsis were excluded. RDW and CRP were measured from the same blood sample. Pearson correlation coefficient was calculated. Results: Mean age was 15.75±5.36 days; 53.3% were male. Mean gestational age was 37.45±1.36 weeks and mean birth weight 2.94±0.30 kg. Mean RDW was 17.43±1.07% and mean CRP was 7.72±0.94 mg/L. A strong positive correlation was found between RDW and CRP (r=0.887, p<0.0001). The correlation was significant across all subgroups including gestational age, age, gender, birth weight, total leukocyte count, platelet count, onset of sepsis and blood culture status. Conclusion: RDW shows a strong positive correlation with CRP in neonatal sepsis. RDW, being a simple and inexpensive parameter, may be used alongside CRP for early assessment of neonatal sepsis.

Background: Diabetic nephropathy is one of the most important microvascular complications of diabetes mellitus and remains a major cause of chronic kidney disease. Although albuminuria and estimated glomerular filtration rate are commonly used for clinical assessment, renal biopsy provides direct evidence of glomerular, tubulointerstitial and vascular injury. Poor glycaemic control, dyslipidaemia and chronic low-grade inflammation may contribute to progressive renal damage in diabetic nephropathy. The current study is designed to assess the association of HbA1c, lipid profile and inflammatory markers with pathological changes in renal biopsy specimens of patients with diabetic nephropathy. Materials and Methods: A total of 110 patients with diabetes mellitus and biopsy-proven diabetic nephropathy were included. Clinical details, duration of diabetes, blood pressure, HbA1c, lipid profile, renal function parameters, urine albumin-creatinine ratio, high-sensitivity C-reactive protein, interleukin-6 and tumour necrosis factor-alpha were recorded. Renal biopsy findings were classified according to diabetic nephropathy pathological classes and graded for interstitial fibrosis/tubular atrophy, interstitial inflammation, arteriolar hyalinosis and arteriosclerosis. Statistical analysis was performed using chi-square test, one-way ANOVA and correlation analysis. A p-value of <0.05 was considered statistically significant. Results: The mean age of the study population was 56.8 ± 10.9 years, and the mean duration of diabetes was 10.7 ± 4.8 years. Pathological class IIa was observed in 22 patients (20.0%), class IIb in 30 patients (27.3%), class III in 36 patients (32.7%) and class IV in 22 patients (20.0%). Mean HbA1c increased progressively from class IIa to class IV, from 7.1 ± 0.8% to 9.4 ± 1.2% (F=26.51, p<0.001). Total cholesterol, triglycerides and LDL cholesterol were significantly higher in advanced pathological classes, while HDL cholesterol showed a declining trend. Inflammatory markers also increased with pathological severity; hs-CRP rose from 2.8 ± 1.1 mg/L in class IIa to 7.6 ± 3.1 mg/L in class IV (F=19.56, p<0.001). Advanced pathological lesions were significantly associated with poor glycaemic control, dyslipidaemia and elevated hs-CRP. Tubulointerstitial fibrosis and arteriolar hyalinosis were more frequent among patients with higher HbA1c, raised triglycerides and increased inflammatory markers. Conclusion: Poor glycaemic control, atherogenic dyslipidaemia and systemic inflammation showed significant association with advanced pathological changes in diabetic nephropathy. Combined biochemical and inflammatory marker assessment may help identify patients at greater risk of progressive renal structural damage.

Background & Methods: The aim of the study is to compare quality and duration of Post-operative pain relief after a single shot caudal epidural block with either Inj. bupivacaine 0.25% or Inj. ropivacaine0.25%. Patients were induced with iv Ketamine 2mg/kg and maintenance done with O2, N2O, Halothane (0.5 – 1%) through Jackson Rees circuit in children <20 kg and Bains circuit in children >20 kg. Results: Duration of analgesia in group B (0.25%  Bupivacaine) ranged from 180-540 min with mean duration of 328.2 min and in group R (0.25% Ropivacaine) ranged from 180-480 min with a mean duration of 343.8 min. The p value between the two groups is <0.05 i.e. 0.429 which indicates a significant difference in post-operative analgesia duration between the two groups. Conclusion: The incidence of post-operative pain in paediatric age group not only associated with major surgeries but also in minor surgeries. Postoperative pain is an acute pain and should be treated adequately to decrease morbidity and hospital stay so it is the duty of anesthesiologist to relief not only intra operative pain but also postoperative pain in paediatric patients. There for we conducted this study and found that postoperative pain relief is better with ropivacaine than Bupivacaine in caudal epidural block.

Background: Traumatic oral and maxillofacial defects in older adults are associated with significant functional, aesthetic, and psychosocial consequences. Rehabilitation requires a multidisciplinary approach involving surgical reconstruction, prosthodontic rehabilitation, nutritional support, physiotherapy, and long-term follow-up. Understanding the factors associated with successful rehabilitation may help improve patient outcomes. Objective: To evaluate rehabilitation strategies and functional outcomes among older patients with traumatic oral and facial defects .Methods: A cross-sectional study was conducted involving 120 patients aged 65 years and older who received treatment for traumatic oral and facial defects at a tertiary care hospital. Demographic characteristics, causes of trauma, rehabilitation modalities, functional outcomes, and quality-of-life scores were recorded. Descriptive statistics summarized the data, while logistic regression identified factors associated with successful rehabilitation. Results: Among 120 patients, 60.0% were male and the mean age was 74.2 ± 6.8 years. Falls were the leading cause of injury (48.3%), followed by road traffic accidents (26.7%). Mandibular fractures were the most common defect (35.0%). Open reduction and internal fixation (33.3%) was the most frequently performed intervention, followed by implant-supported prostheses (20.8%). Six months after rehabilitation, improvements were observed in mastication (79.2%), swallowing (81.7%), speech (74.2%), and facial appearance satisfaction (75.8%). Mean quality-of-life scores improved significantly from 42.6 ± 11.4 before rehabilitation to 71.8 ± 10.2 after treatment (p < 0.001). Implant-supported prostheses and digital surgical planning were associated with improved rehabilitation outcomes, whereas diabetes mellitus reduced the likelihood of successful recovery. Conclusion: Comprehensive multidisciplinary rehabilitation may substantially improve functional recovery and quality of life in older patients with traumatic oral and facial defects. Individualized treatment planning and the use of advanced reconstructive techniques appear to enhance rehabilitation outcomes.

Background: Sexual Assault has become a serious public health, social and legal issue worldwide, affecting all age groups and both genders negatively and triggering extreme physical, psychological and social consequences and trauma for the survivors of sexual assault. There is a lack of quality research regarding this issue in Pakistan. The purpose of this study is to determine the demographic features of the victims of sexual assault, the circumstances leading to sexual assault, and how it can affect the psychological perspective of survivors of sexual assault. The cases of sexual assault are assessed through medical and legal examination. Thus, individuals who are referred for medicolegal purposes can be studied to assess the circumstances leading to sexual assault, the background of the victims and the consequences of sexual assault trauma. Objective: To reveal some situational and demographic trends of sexual abuse and particular risk factors of sexual abuse reported to the center. The impacts of sexual assault on the victim on the social, psychological and physical levels. Methodology: This study looked at data collected at one point in time from the Medicolegal Section of Liaquat University Hospital in Hyderabad. All 97 cases of sexual assault referred for medicolegal examination were selected by simple random sampling. Data were collected by a structured questionnaire and from the medicolegal files of the participants. The data were analyzed by descriptive statistics such as frequency and percentage for categorical data and mean and standard deviation for numerical data. Chi-square test was applied for association. Significance was set at p less than 0.05. The software used for computations: SPSS version 27.Results: Ninety-seven individuals formed the study pool. Sixty-one participants identified as female. Among those recorded, young individuals showed up frequently, fifty-four cases altogether. Unmarried individuals showed up seventy-one times in responses. Secondary schooling came up twenty-seven times as a response, quite a bit more than others. Intermediate level education followed that, recording sixteen instances. Physical contact stood out as the main kind of abuse noted, eighty-eight cases tallied. Threats played a role for many; exactly seventy-one said they’d been threatened. Reports came back from 92.8 percent, making it ninety submissions in all. A quarter, roughly, said they had faced domestic abuse at some point, twenty-six people in number. Psychosocial consequences were common among participants. Most people involved said they pulled away socially - seventy out of ninety-seven noted this change. Trouble believing others showed up often, too, affected seventy-four individuals across the group. School work took a hit for eighty-five folks, nearly nine out of ten facing some kind of struggle there. The weight on mental health and daily connections feels clear when looking at these numbers. Young women who are not married tend to experience this harm more frequently than others seen here. Emotional fallout, along with shifts in how one relates to society, sticks around long after the event itself.Conclusion: Sexual assault is a serious public health and social issue, mainly affecting young females. Findings were presented on the various demographic and socioeconomic factors making individuals more vulnerable to sexual assault. In addition, severe psychosocial effects on survivors of sexual assault were reported, such as emotional distress, anxiety, depression and social isolation. To deal with the negative effects of sexual assault, strategies for sexual assault prevention as well as public awareness campaigns and accessible psychological support should be set up in order to decrease the burden of sexual assault and to promote the well-being of its survivors.

Background: Cardiovascular disease (CVD) remains the foremost cause of morbidity and mortality worldwide, with rural populations bearing a disproportionate burden due to structural healthcare inequities, limited health literacy, and inadequate preventive care. Understanding the Knowledge, Attitudes, and Practices (KAP) of rural community members regarding CVD prevention is essential for designing targeted, evidence-based health interventions.Objective: This study aimed to assess the level of knowledge, prevailing attitudes, and current practices related to CVD prevention among rural community residents, and to determine whether gender-based differences exist between male and female participants. Methods: A descriptive cross-sectional KAP survey was conducted among 300 adults (150 males and 150 females) aged 18–65 years residing in rural areas. Participants were selected using stratified random sampling. A structured, pre-validated, self-administered questionnaire containing 45 items across three domains knowledge (15 items), attitudes (15 items), and practices (15 items) was used. Data were analyzed using SPSS version 26.0. Descriptive statistics, chi-square tests, and independent t-tests were employed. Statistical significance was set at p < 0.05. Results: The mean knowledge score was 9.2 ± 2.4 out of 15, indicating moderate knowledge levels. Only 48.3% of participants demonstrated adequate overall knowledge. Females scored significantly higher on knowledge (10.1 ± 2.1) compared to males (8.3 ± 2.6) (p = 0.003). Attitudes were moderately positive (mean score 10.4 ± 2.1 / 15), but only 42.7% recognized family history as a non-modifiable risk factor. Practices were substantially deficient, with only 31.7% reporting regular physical activity and 23.3% having undergone blood pressure screening in the past 12 months. Significant gender differences were observed in dietary habits (p = 0.012) and smoking practices (p < 0.001). Educational attainment was positively correlated with all three KAP domains (r = 0.48, p < 0.001).Conclusion: Rural community residents exhibit moderate knowledge and attitudes but markedly poor preventive practices regarding CVD. Gender-specific disparities underscore the need for tailored health education programs. Community-based interventions focusing on behavioral change, health literacy promotion, and structured screening programs are urgently warranted in rural settings.

Background: Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly known as Polycystic Ovary Syndrome (PCOS), is a complex endocrine-metabolic disorder affecting adolescent females and young women. It is associated with monthly irregularities, hyperandrogenism, insulin resistance, metabolic disorders, and perhaps early cardiovascular autonomic dysfunction. Objective: To examine cardiovascular autonomic and neuroendocrine dysfunction in adolescents with PMOS, compare the results with those of healthy age-matched controls, and investigate their possible implications for pre-anesthetic cardiovascular risk evaluation. Methods: This comparative cross-sectional study was conducted from January 2024 to September 2025 at Khawaja Muhammad Safdar Medical College in Sialkot, Pakistan, in collaboration with the Department of Internal Medicine at the University of Buffalo in Buffalo, New York, United States. Additional clinical data were acquired from Shahida Islam Teaching Hospital in Lodhran, Punjab, Pakistan. A total of 150 female adolescents, aged 13 to 19 years, were enrolled, consisting of 75 individuals with PMOS and 75 healthy controls. Clinical, anthropometric, cardiovascular autonomic, neuroendocrine, and metabolic attributes were assessed. Heart rate variability, orthostatic response, fasting glucose, fasting insulin, lipid profile, gonadotropins, total testosterone, prolactin, and morning cortisol were evaluated. Results: Adolescents with PMOS exhibited markedly elevated body mass index, waist circumference, resting heart rate, blood pressure, fasting insulin, HOMA-IR, LH/FSH ratio, total testosterone, triglycerides, and LDL-C in comparison to controls. They exhibited diminished SDNN, RMSSD, and high-frequency power, alongside an elevated LF/HF ratio, signifying decreased parasympathetic activity and sympathetic dominance. HOMA-IR, fasting insulin, total testosterone, waist circumference, morning cortisol, and LH/FSH ratio exhibited a positive correlation with the LF/HF ratio and a negative correlation with RMSSD.Conclusion: Adolescents with PMOS demonstrated significant cardiovascular autonomic, neuroendocrine, and metabolic dysfunction compared with healthy controls. Early cardiometabolic screening and preventive intervention are recommended in adolescents with PMOS.

Background: The optimal timing of laparoscopic cholecystectomy for acute cholecystitis remains controversial. Objective: To compare the effects of early versus delayed laparoscopic cholecystectomy on surgical outcomes, conversion rate, postoperative morbidity, and histopathological findings in patients with acute cholecystitis. Methods: This was a comparative cross-sectional study conducted at Riphah international Hospital Islamabad from March 2024 to September 2025, including 175 patients diagnosed with acute cholecystitis who underwent laparoscopic cholecystectomy. Patients were categorized into two groups according to the timing of surgery: early laparoscopic cholecystectomy (performed within 72 hours of symptom onset or during the index admission) and delayed laparoscopic cholecystectomy (performed 6–12 weeks after initial conservative management). Results: Baseline demographic and clinical characteristics were comparable between groups. Early laparoscopic cholecystectomy was associated with shorter operative time (78.4 ± 21.6 vs. 92.7 ± 25.4 minutes; p<0.001), lower blood loss (68.5 ± 34.7 vs. 84.2 ± 39.8 mL; p=0.005), and reduced conversion to open surgery (6.8% vs. 17.2%; p=0.034). Postoperative hospital stay (2.4 ± 1.1 vs. 3.8 ± 1.6 days; p<0.001), total hospital stay (3.9 ± 1.8 vs. 8.6 ± 2.7 days; p<0.001), pain scores (3.8 ± 1.2 vs. 4.4 ± 1.5; p=0.004), readmission rates (4.5% vs. 13.8%; p=0.031), and overall morbidity (13.6% vs. 26.4%; p=0.033) were significantly lower in the early surgery group. Conclusion: Early laparoscopic cholecystectomy provides superior outcomes compared with delayed surgery in acute cholecystitis, resulting in lower conversion rates, reduced morbidity, shorter hospitalization, and fewer chronic inflammatory histopathological changes.

Background: Cancer in the elderly is often diagnosed at advanced stages due to multiple barriers at the patient, provider, and healthcare system levels. Understanding these factors is essential for improving timely diagnosis and outcomes. Aim: To evaluate the factors contributing to delayed cancer diagnosis among elderly patients. Methods: A cross-sectional study was conducted at Sree Mookambika Institute of Medical Sciences (SMIMS), Kulasekharam, over a one-year period. A total of 120 patients aged 65 years and above with newly diagnosed cancers were enrolled. Data were collected using a structured questionnaire covering socio-demographic characteristics, clinical profile, and patient-, provider-, and system-related barriers. Stage at diagnosis and functional status were documented. Statistical analysis was performed using descriptive measures and chi-square tests to assess associations. Results: The mean age of the study participants was 69.8 ± 7.5 years, with a nearly equal distribution of males (51.7%) and females (48.3%). The majority resided in rural areas (61.7%) and had low educational status. Gastrointestinal (25%), lung (20.8%), and breast cancers (18.3%) were most common. Overall, 70% of patients were diagnosed at late stages (III–IV). The leading patient-related barriers included attributing symptoms to ageing (50%) and difficulty in travelling (48.3%). Provider-related barriers such as lack of prompt referral (35%) and symptom dismissal (31.7%) were reported. System-related challenges included long waiting times for tests (56.7%) and absence of screening programs (60%). Patient- and system-related barriers were significantly associated with late-stage presentation (p < 0.05). Conclusion: Delayed cancer diagnosis among elderly patients is multifactorial, with prominent contributions from patient misperceptions, healthcare access issues, and systemic gaps. Interventions such as targeted awareness campaigns, strengthening referral systems, and implementing elderly-focused screening strategies are essential to promote earlier diagnosis.

Diabetes mellitus is a long-term metabolic disease linked to a number of systemic and craniofacial changes. Diabetes-related skeletal and metabolic alterations can cause abnormalities in anthropometric measures of the face, including Gonial index and facial Width. These craniofacial parameters can be accurately and consistently assessed through radiological assessment. Osseous tissue is composed of water and both organic and inorganic materials. A remarkable 99 percent of the overall body's calcium is stored in bone.  Material and Methods: The study was conducted in the Department of Anatomy at the MPTMC, Siddharthnagar, in collaboration with Integral institute of medical sciences & Research, Integral University, Lucknow, Uttar Pradesh, The research group comprised 152 individuals, 76 of whom had diabetes and the remaining 76 did not, with the aim of  measuring and comparing the Gonial Index and facial Width of people with and without diabetes. Facial Width and Gonial Index were measured using predefined anatomical landmarks on the CT  Scan images. Results: Diabetic patients showed altered craniofacial anthropometric measurements when compared to the control group, and these differences were statistically significant (p < 0.05).Conclusion: Radiological assessment of these parameters can aid in understanding craniofacial changes associated with diabetes and may contribute to early diagnostic and therapeutic considerations.

Background: One of the most common complications of a ventral hernia mesh repair is seroma, which can cause the drain to remain in place for longer, slow down recovery, and even lead to infection or needing additional surgery. An antifibrinolytic agent, tranexamic acid (TXA), has shown to decrease postoperative fluid collections in breast and body-contouring surgery; however, its use in ventral hernioplasty is limited and only reported in a few regional papers. Objective: To determine the effect of TXA on the incidence of seroma and drain related complications after undergoing open Ventral Hernia repair at Mercy Hospital, Peshawar. Methods: A cross-sectional comparison study was done in department of surgery at Mercy Hospital, Peshawar, from 1st May 2025 to 30th April 2026. Sixty patients matched for age and sex who were undergoing elective open ventral hernioplasty with mesh were divided into TXA and non-TXA groups. Sixty TXA and non-TXA adults undergoing elective open ventral hernioplasty with mesh were matched for age and sex. A TXA group (n=30) who were given 1 g of intravenous TXA followed by 500 mg orally every 8 hours for a total of 5 days, and a non-TXA group (n=30) who were given standard care. The main outcome measured was clinically or sonographically detected seroma within 30 days. Secondary outcomes included total drain output, time to removal of the drain, time to resolution of seroma and surgical-site infection. Data were analyzed in SPSS v26 and chi-square and independent-samples t-tests were performed where p< 0.05.Results: ((All are illustrative values until cohort data is entered.) Seroma occurred in 6/30 (20.0%) of the TXA group versus 14/30 (46.7%) of controls (p=0.028; OR 0.29, 95% CI 0.09–0.90). Both mean total drain output and time to drain removal were less with TXA (p<0.01). There were no reports of thromboembolic events. Conclusion: Perioperative TXA was associated with a decreased incidence of seroma and less drain burden after ventral hernioplasty, with no additional thrombotic risk, and is a low-cost adjunct to consider.

Background: Cancer of breast is the most common cancer affecting women worldwide, and is the second most common cause of cancer death next to lung cancer. The incidence of carcinoma breast patients has increased over a period of few years, reason being either increased awareness or early diagnosis. Breast cancer is a disease of old age with peak incidence in the fifth and sixth decades in the western countries, but in India the disease is seen a decade earlier, probably because of shorter life expectancy in Indian women (about 65.3 years as per Indian data in 2005)^. The risk factors for breast cancer in western population include late age of childbirth, nulliparity, smaller duration of breast feeding, smoking etc. while in India early menarche and late menopause are the risk factors and longer duration of breastfeeding,early childbirth and multiparity are protective factors. Material and methods: Thirty patients of breast cancer were assessed on the basis of their clinical presentation, histological subtype and biomarker expression and their observations were compared with that of the western world. Results: Lump in the breast was found to be the most common clinical presentation. Invasive Ductal Carcinoma(NOS) was the most common histopathological subtype. Patients usually present here as locally advanced type. Triple negative breast cancers are more common in this region while in other parts of the world, Luminal A is the commoner subtype.  Conclusion: Carcinoma breast in this region varies in clinical, histological and tumour marker presentation with that of the western world.

Introduction: Treatment of rare facial cleft is complex, and the evaluation of its long-term results is challenging because of the low incidence. Case report: A 8 months old male child, resident of Jaspura, Bharatpur presented with probable diagnosis was Congenital facial cleft. Facial bipartition with bilateral cleft lip repair surgery was done. Conclusion: Early surgical intervention is required. Better instrumentation/anesthesia/ICU care have improved surgical results  and With proper counselling and public awareness, we can improve the quality of life of these patients.

Introduction: Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system characterized by inflammatory demyelination, axonal degeneration, and progressive neurological disability. Conventional magnetic resonance imaging (MRI) plays a pivotal role in diagnosis and disease monitoring but demonstrates limited correlation with clinical disability. This discrepancy, often referred to as the clinico-radiological paradox, has stimulated interest in advanced MRI techniques capable of detecting microstructural and metabolic abnormalities beyond visible lesions. Objective:To review the current evidence regarding advanced MRI biomarkers of disease progression in multiple sclerosis and evaluate their associations with clinical disability. Methods:A structured review of published literature was conducted focusing on magnetization transfer imaging (MTI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), quantitative susceptibility mapping (QSM), and functional MRI (fMRI). Studies investigating relationships between advanced MRI metrics and disability outcomes were evaluated. Results: MTI consistently demonstrates reductions in magnetization transfer ratio reflecting demyelination and axonal loss. DTI reveals abnormalities in fractional anisotropy and diffusivity parameters associated with microstructural damage. MRS identifies reductions in N-acetylaspartate, indicating neuronal dysfunction and loss. QSM detects abnormal iron accumulation in deep gray matter structures associated with disease progression. Functional MRI demonstrates dynamic alterations in brain connectivity that evolve throughout disease stages. Collectively, these techniques exhibit stronger associations with disability progression than conventional lesion burden alone. Conclusion: Advanced MRI biomarkers provide multidimensional assessment of multiple sclerosis pathology and offer promising tools for monitoring disease progression. Standardization of imaging protocols and large longitudinal studies are necessary to facilitate translation into routine clinical practice.

Background: Exercise training is a guideline-recommended therapy in chronic heart failure (HF), but the comparative efficacy of aerobic versus resistance modalities across functional, cardiopulmonary, neuromuscular, and quality-of-life domains is incompletely defined. Methods: In this single-centre, parallel-group randomized controlled trial, 140 patients with chronic stable HF (NYHA II–III) on optimized medical therapy were randomized 1:1 to supervised aerobic (Group A) or resistance (Group B) training for 12 weeks. The primary outcome was change in 6-minute walk test (6MWT) distance. Secondary outcomes were peak oxygen uptake (peak VO₂), muscle strength, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and safety. 126 patients (63 per group) completed the trial. Results: 6MWT distance improved in both groups, with greater gains after aerobic training (+60 vs +40 m; p=0.01). Peak VO₂ rose more with aerobic training (+3.6 vs +1.7 mL/kg/min; p<0.001). Resistance training produced larger improvements in handgrip strength (+34.4% vs +11.3%; p<0.001) and KCCQ score (+22.1 vs +17.3 points; p=0.03). Modality effects persisted after multivariable adjustment. No deaths occurred and adverse-event rates were comparable. Conclusions: Aerobic and resistance training confer distinct, modality-specific benefits in chronic stable HF — aerobic training optimizing cardiopulmonary capacity and resistance training optimizing strength and quality of life — supporting individualized and potentially combined exercise prescription.

Background: The kidneys are supplied by segmental arteries that function as end arteries with minimal collateral circulation. Variations in the apical and upper segmental renal arteries are of considerable surgical importance, particularly during renal transplantation, partial nephrectomy, and other nephron-sparing procedures. This study aimed to evaluate the morphological variations of the apical and upper segmental branches of the renal artery and assess their clinical significance. Methods: A descriptive cross-sectional anatomical study was conducted on 100 adult human kidneys. Eighty-two kidneys were examined by dissection, while 18 fresh specimens were studied using the corrosion cast technique. The apical and upper segmental arteries were analyzed for their origin and branching patterns. Variations were categorized and expressed as frequencies and percentages. Results: Nine patterns of origin were identified for the apical segmental artery. The most common pattern was origin directly from the renal artery along with other segmental branches (25%), followed by origin from or along the upper segmental artery (20%) and from the anterior division of the renal artery (19%). Direct aortic origin was observed in 3% of specimens. The upper segmental artery exhibited six patterns of origin, with the most frequent being origin from the anterior division of the renal artery (30%), followed by origin from the renal artery with other segmental branches (28%). Rare aortic origin was observed in 1% of specimens. Conclusion: Significant variations exist in the origin of apical and upper segmental renal arteries. Awareness of these variations is essential for accurate preoperative planning and minimizing vascular complications during renal surgical procedures

Introduction: The use of fixed orthodontic appliances is believed to cause a higher risk of enamel demineralization and white spot lesion formation, as a result of plaque accumulation and microleakage at the bracket-adhesive interface. Bioactive adhesives have also been developed to achieve bonding efficiency and potentially enamel protection.Objective: To evaluate microleakage and enamel demineralization around orthodontic brackets bonded using conventional and bioactive brackets after artificial aging.Methods: A comparative in vitro experimental study was carried out using 150 human extracted premolars. There were 75 specimens in each of two groups: conventional orthodontic adhesive and bioactive adhesive. Samples were tested following bracket bonding by artificial ageing using thermocycling. Dye penetration analysis was used to measure microleakage, and the standardized scoring methods were applied to evaluate enamel demineralization. SPSS version 26 was used for data analysis. Independent sample t-test, Mann–Whitney U test, chi-square test, and correlation analysis were performed, and p≤0.05 was set as the criterion for significance.Results: The microleakage of Bioactive adhesive was significantly smaller than that of conventional adhesive (p<0.001). The conventional adhesive group had more microleakage scores than the bioactive adhesive group, with higher scores being more common. The bioactive group also experienced significantly less enamel demineralization (p<0.001). Conclusion: Bioactive orthodontic adhesive showed greater resistance to microleakage and demineralization of enamel after artificial aging than conventional adhesive. The other protective properties of this one indicate the possibility of clinical application in the prevention of enamel damage caused by fixed orthodontic appliances.

Background:Chronic kidney disease (CKD) is a progressive disorder characterized by irreversible loss of renal function, oxidative stress, inflammation, and fibrosis. Despite conventional therapies, CKD continues to progress in many patients. Empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, has demonstrated promising renoprotective effects beyond glycemic control. Objective: To evaluate the pharmacological renoprotective effects of empagliflozin on renal function, biochemical markers, and histopathological changes in an experimental model of chronic kidney disease.

Methodology: CKD was induced in adult Wistar rats using an adenine diet. Animals were divided into four groups: control, CKD, CKD treated with low-dose empagliflozin (10 mg/kg/day), and CKD treated with high-dose empagliflozin (25 mg/kg/day). Renal function tests, urinary biomarkers, oxidative stress markers, inflammatory cytokines, fibrotic markers, histopathological examination, and immunohistochemical analysis were performed. Data were analyzed using one-way ANOVA with Tukey's post hoc test. Results: Empagliflozin significantly improved renal function by reducing serum creatinine, blood urea nitrogen, uric acid, albuminuria, and albumin-to-creatinine ratio while increasing eGFR. It also restored antioxidant enzyme activity, suppressed inflammatory cytokines (TNF-α, IL-6, and CRP), reduced TGF-β1-mediated fibrosis, and preserved normal renal histology. The high-dose treatment produced greater improvements than the low-dose regimen. Conclusion: Empagliflozin effectively attenuated CKD progression through antioxidant, anti-inflammatory, antifibrotic, and renoprotective mechanisms, supporting its potential as an effective therapeutic agent for chronic kidney disease.

Background:High-risk pregnancy remains a major contributor to maternal and perinatal morbidity and mortality worldwide. In India, approximately 20–30% of pregnancies are categorized as high risk and account for a substantial proportion of adverse maternal and neonatal outcomes. Early identification and timely intervention are essential for improving fetomaternal outcomes.Aim:To evaluate maternal and fetal outcomes among women with high-risk pregnancies and compare outcomes according to pregnancy booking status.Materials and Methods:A prospective observational study was conducted at CKM Government Maternity Hospital, Warangal, from September 2022 to August 2024. A total of 250 pregnant women with identified obstetric or medical risk factors were enrolled. Detailed demographic, clinical, obstetric, and laboratory data were collected. Maternal outcomes, mode of delivery, neonatal outcomes, NICU admissions, and perinatal morbidity and mortality were analyzed using SPSS version 23.0.Results:Most women belonged to the 21–25-year age group (48.8%), were multiparous (64.4%), and resided in rural areas (60%). Common risk factors included anemia (51.6%), history of medical or genetic disorders (61.6%), thyroid disorders (28%), hypothyroidism (24.8%), gestational hypertension (16%), and gestational diabetes mellitus (12.4%). Caesarean delivery was performed in 62.8% of cases. Small-for-gestational-age neonates constituted 33.6% of births. NICU admission was required in 71.4% of newborns. Poor fetal outcome occurred in 19.7% of pregnancies and was significantly more frequent among unbooked or referred cases. Maternal mortality was observed in 2% of cases, with all deaths occurring among unbooked pregnancies.Conclusion:High-risk pregnancies are associated with substantial maternal and neonatal morbidity. Comprehensive antenatal surveillance, timely referral, and strengthening of booking and follow-up services are essential to improve maternal and fetal outcomes.

Introduction: Lymphangioleiomyomatosis (LAM) is a rare, progressive cystic lung disease that predominantly affects women and is frequently misdiagnosed due to nonspecific respiratory symptoms. We report the case of a 58-year-old woman with progressive exertional dyspnoea despite maximal inhaler therapy for presumed asthma. High-resolution CT demonstrated diffuse, thin-walled pulmonary cysts, and thoracoscopic lung biopsy confirmed sporadic LAM. The patient was commenced on sirolimus therapy, resulting in stabilisation of lung function and sustained symptomatic improvement over a 2-year follow-up period. This case highlights the importance of considering LAM in women with unexplained dyspnoea and preserved spirometry and supports the long-term efficacy and tolerability of sirolimus in real-world clinical practice.

Background:  Tuberculous meningitis (TBM) is the most severe manifestation of extrapulmonary tuberculosis and frequently causes neurological complications. Simultaneous involvement of the central nervous system, cranial nerves, peripheral nerves, and kidneys is exceedingly rare and may create a diagnostic overlap with autoimmune disorders. Case Series: We describe five patients diagnosed with TBM presenting with polyneuritis cranialis, Miller–Fisher syndrome (MFS)-like manifestations, and glomerulonephritis. The patients presented with combinations of diplopia, ophthalmoplegia, cranial nerve palsies, gait instability, areflexia, hematuria, hypertension, and altered neurological status. Cerebrospinal fluid examination demonstrated lymphocytic pleocytosis, elevated protein levels, and reduced glucose concentrations. MRI findings showed leptomeningeal enhancement in all cases. Cartridge-based nucleic acid amplification testing (CBNAAT/MTBNAAT) confirmed Mycobacterium tuberculosis in cerebrospinal fluid specimens. Renal involvement manifested as microscopic hematuria, proteinuria, and glomerulonephritis. All patients received antitubercular therapy, corticosteroids, intravenous immunoglobulin, and supportive care. Results: Clinical improvement was observed in four patients within 8 weeks. Ophthalmoplegia and cranial neuropathies improved substantially after therapy. One patient experienced persistent neurological deficits at 6-month follow-up. Conclusion: This case series highlights a rare overlap syndrome characterized by TBM-associated cranial polyneuritis, Miller–Fisher variant features, and glomerulonephritis. Early recognition and multidisciplinary management are critical for favorable outcomes

Background: Periodontitis and type 2 diabetes mellitus (T2DM) share a bidirectional relationship mediated through chronic inflammation and altered host immune responses. Diabetes adversely influences periodontal healing and may affect treatment outcomes following periodontal therapy.

Aim: To compare periodontal clinical outcomes following non-surgical periodontal therapy in patients with periodontitis with and without T2DM over a 12-month follow-up period. Materials and Methods: This prospective cohort study included 100 patients diagnosed with Stage II–III periodontitis. Fifty patients with controlled T2DM constituted Group A, while 50 systemically healthy patients formed Group B. All participants underwent scaling and root planing with oral hygiene reinforcement. Clinical parameters including Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) were recorded at baseline, 3, 6, 9, and 12 months. Statistical analysis was performed using repeated measures ANOVA and independent t-tests. A p-value <0.05 was considered statistically significant. Results: Both groups demonstrated significant improvements in all periodontal parameters throughout follow-up. However, non-diabetic patients exhibited significantly greater reductions in PPD and gains in CAL at 6, 9, and 12 months (p<0.05). At 12 months, mean PPD reduction was 2.91±0.54 mm in non-diabetic patients compared with 2.38±0.62 mm among diabetic patients (p<0.001). CAL gain was also significantly higher among non-diabetic individuals (2.54±0.57 mm vs 2.05±0.60 mm, p=0.001). Conclusion: Non-surgical periodontal therapy effectively improved periodontal health in both cohorts; however, patients without T2DM achieved superior clinical outcomes. Diabetes may negatively influence periodontal healing despite adequate periodontal treatment.

Aims: To correlate psychosocial impact of polycystic ovary syndrome with quality of life in adolescent girls. Methods and Material:   The study design is Cross sectional study of 100 participants, from Study period of August 2022 to January 2024, at Department of Obstetrics and Gynecology NSCB (M.P). The data is analyzed by using statistical software-SPSS Version 21. Results: In our study depressed mood among adolescent girls with PCOS shown that 44% had no depressive symptoms, 35% Adolescent had mild, 20% had moderate and only 1% had severe depressed mood symptom and Anxious mood assessment showed that 43% of adolescents had no anxious mood, 35% had mild anxious mood, and 22% had moderate anxious mood. We also enquired about school attendance, academic performance and effect on participation in co curricular activities and found that school attendance of 62% girls was affected, 42% had impact on academic performance and 55% shown to have disinterest in co- curricular activities. Conclusions: The impact of PCOS in adolescents seen in our study, emphasises the significant impairment in quality of life caused by the disorder. Understanding these aspects are crucial for developing effective diagnosis and management to improve the well-being of adolescents with PCOS. A holistic care strategies to support educational outcomes to address both the physical and psychological aspects of the syndrome.

Background: Atherosclerosis is a progressive vascular disorder that begins long before the appearance of clinical cardiovascular disease. Traditional lipid parameters such as total cholesterol and low-density lipoprotein cholesterol (LDL-C) are widely used for cardiovascular risk assessment; however, emerging biomarkers including apolipoprotein B (ApoB), apolipoprotein A-I (ApoA-I), their ratio (ApoB/ApoA-I), and lipoprotein(a) [Lp(a)] may provide superior prediction of early atherogenic changes. Objectives: To evaluate the association of ApoB/ApoA-I ratio and Lp(a) levels with early atherogenic changes and determine their role as independent predictors among adult patients. Methods: A hospital-based cross-sectional study was conducted among 400 adults attending a tertiary care center. Anthropometric measurements, lipid profile, ApoB, ApoA-I, and Lp(a) levels were assessed. Early atherogenic changes were evaluated using carotid intima-media thickness (CIMT). Multivariate logistic regression analysis was performed to identify independent predictors of increased CIMT (>0.8 mm). Results: Among 400 participants, 168 (42.0%) demonstrated increased CIMT. Mean ApoB/ApoA-I ratio and Lp(a) levels were significantly higher in patients with increased CIMT compared with those having normal CIMT (0.94±0.21 vs. 0.71±0.18 and 41.2±16.4 mg/dL vs. 24.7±12.1 mg/dL, respectively; p<0.001). Multivariate analysis revealed that ApoB/ApoA-I ratio (OR=2.84, 95% CI: 1.96–4.12, p<0.001) and elevated Lp(a) (OR=2.31, 95% CI: 1.52–3.50, p<0.001) were independent predictors of early atherogenic changes.

Conclusion: Elevated ApoB/ApoA-I ratio and Lp(a) levels are strongly associated with increased CIMT and may serve as independent predictors of early atherosclerosis. Incorporating these biomarkers into routine cardiovascular risk assessment may improve early detection of high-risk individuals.

Introduction: Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder that is related to the occurrence of unfavourable maternal and neonatal outcomes. High blood sugar can cause problems like preeclampsia, cesarean section, macrosomia, low blood sugar in the baby, and admission to a neonatal intensive care unit (NICU). This study aimed to assess the maternal and neonatal outcomes of GDM. Objective: To compare maternal and neonatal outcomes and to estimate the occurrence of pregnancy complications among women with GDM. Methodology: This was a cross-sectional study done in the Department of Obstetrics and Gynecology Saidu Group of Teaching Hospitals, Swat, Pakistan between January and December 2025. All 100 women who were diagnosed with GDM based on the criteria of the oral glucose tolerance test were enrolled with consecutive sampling. A structured proforma was completed to record the demographic, obstetric history, glycemic control status, maternal complications, and neonatal outcome. Data were analyzed by SPSS version 27.0, and p-values less than 0.05 were considered statistically significant. Results: The mean maternal age was 31.4 ± 5.8 years. Multiparous women constituted 58% of participants, while 42% were primigravida. Cesarean delivery was performed in 62% of cases. Maternal complications included preeclampsia (18%), preterm delivery (22%), and polyhydramnios (12%). The mean neonatal birth weight was 3.42 ± 0.61 kg. Macrosomia was observed in 20% of newborns, neonatal hypoglycemia in 15%, respiratory distress syndrome in 10%, hyperbilirubinemia in 14%, and NICU admission in 18%. Poor glycemic control was significantly associated with adverse neonatal outcomes (32% vs. 14%, p=0.021), while higher maternal BMI was associated with cesarean delivery (p=0.034). Maternal age >35 years was significantly associated with preeclampsia (p=0.041).Conclusion: GDM has significant morbidity for the mother and the fetus. To minimise adverse outcomes and enhance the health of mothers and neonates, early screening, optimal glycemic control, and careful antenatal care are important.

Background: PCOS is one of the most prevalent endocrine disorders in reproductive-age women and is linked to menstrual disorders, infertility, obesity, insulin resistance, and metabolic problems. Therefore, knowledge of its prevalence and risk factors is important to enable early diagnosis and management. Objective: To estimate the prevalence of PCOS and find factors associated with PCOS in reproductive-age women visiting a tertiary care hospital. Methodology: The cross-sectional study was carried out  in Department of Obstetrics and Gynecology Saidu Group of Teaching Hospitals, Swat, Pakistan between January and June 2026. All 100 women aged between 18 and 45 years were sampled consecutively to get the desired population. A structured questionnaire was used to collect data on demographic characteristics, body mass index (BMI), menstrual history, family history of PCOS, physical activity, and infertility. All cases of PCOS were diagnosed based on the Rotterdam criteria. Data were analyzed using SPSS version 26.0, and a p-value<0.05 was taken as statistically significant. Results: The 100 participants, the mean age was 27.8 ± 5.6 years. PCOS was diagnosed in 32 women, yielding a prevalence of 32.0%. Obesity was significantly associated with PCOS (50.0% vs. 23.5%; p=0.004), as was a positive family history of the disorder (57.1% vs. 22.2%; p=0.001). Menstrual irregularities were more frequent among women with PCOS compared to those without PCOS (68.8% vs. 20.6%; p<0.001). Physical inactivity (62.5% vs. 35.3%; p=0.012) and infertility (34.4% vs. 11.8%; p=0.009) were also significantly associated with PCOS. No significant association was observed between educational status and PCOS prevalence (p=0.427).Conclusion: Almost one-third of the reproductive-age women, who were referred to the tertiary care hospital, were found to have PCOS. Obesity, family history, menstrual irregularities, physical inactivity, and infertility were significant risk factors. Lifestyle changes and early screening could help decrease the burden of PCOS and reproductive outcomes.

Background: Effective interprofessional communication is essential for patient safety and teamwork in the operating room. Existing assessment tools predominantly evaluate non-technical skills within individual disciplines and fail to comprehensively assess communication among multidisciplinary operating room professionals. This study aimed to develop and validate an Interprofessional Communication Assessment Tool for Operating Room teams (IP-CAT-OR).Methods: A sequential exploratory mixed-methods study was conducted at Ayub Teaching Hospital, Abbottabad, Pakistan. Instrument development followed the AMEE Guide for questionnaire development. A literature review was initially performed to identify communication constructs and gaps in existing assessment instruments. Focus group discussions involving 22 operating room professionals, including surgeons, gynecologists, anesthetists, residents, and scrub nurses, were conducted to generate communication-related items. Qualitative data were coded and thematically analyzed using Braun and Clarke's framework. Content validation was performed through a two-round Delphi process involving six experts in health professions education. Cognitive interviews were subsequently conducted to evaluate item clarity and respondent understanding. Results: Literature review identified significant gaps in the assessment of interprofessional communication within operating room environments. Initial qualitative exploration generated 78 communication-related items. Following synthesis, refinement, and expert review, 44 items were retained and subsequently reduced to a final 33-item instrument. Five major themes emerged: relationship building, exchange of information, emotional intelligence, situational awareness, and maintaining a positive working environment. Content validation demonstrated satisfactory psychometric properties, with an overall Content Validity Index of 0.82. Conclusion: The IP-CAT-OR is a novel, content-validated instrument developed specifically to assess interprofessional communication among operating room professionals. The tool may facilitate assessment, training, and quality improvement initiatives aimed at enhancing teamwork, communication, and patient safety within surgical environments.

Background: Any involuntary loss of urine is termed as urinary incontinence. It frequently results in social isolation, nervousness, low self-esteem, and a fear of leaking during daily activities. Objective: The objective of this study was to determine the prevalence of different types of urinary incontinence in women presenting at Gynaecology outpatient department. Material and methods: A cross-sectional study was carried out at the department of Gynae/Obstt of Shaikh Zayed Women Hospital, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, Sindh from January 1, 2025 to December 31, 2025 after taking formal permission from the ethical committee of the hospital. The sample size was calculated as 170 using WHO calculator. Women of different age groups (25-65 years) presented to OPD for any gynaecological complaint were included in the study after taking informed consent. Pregnant women and women with urinary tract fistulas were excluded from the study. The non-probability consecutive sampling technique was used to collect the data .A structured proforma was used to collect data. SPSS version 23 was used for Data analysis. Descriptive data such as age, BMI and parity was presented in the form of mean and standard deviation. Categorical variables like different types of urinary incontinence (UI) were presented as prevalence and percentage. Results: A total of 170 women were enrolled in this study. The mean age of the study population was 44.66 ± 8.36 year. Out of the total participants, 30 (17.65%) had urinary incontinence. The most prevalent urinary incontinence was stress urinary incontinence 17 (56.67%), followed by Mixed urinary incontinence 8 (26.67%) and Urgency urinary incontinence 8 (16.67%). Conclusion: The present study concluded that the prevalence of urinary incontinence was 17.65% and the most prevalent urinary incontinence was stress followed by Mixed UI and Urgency UI.

Introduction: Objective:The present study is designed to evaluate the tissue immunoexpression of CD 133 in cases of oral squamous cell carcinoma (OSCC), oral potentially malignant disorders (OPMDs) and normal oral mucosa to determine its role as a potential biomarker in oral malignancy and premalignancy. Materials and Methods:A total of 70 subjects comprising cases of OSCC (N=30), OPMDs (N=30) and Healthy individuals (N=10) were included. Immunohistochemical staining was performed on paraffin-embedded tissue specimens. CD133 immunoreactivity was noted, compared among the study participants and statistically analysed at p<0.05 via SPSS version 20.Results:Strong to moderate levels of immunoexpression was observed in cases of OSCC (N=23;76.67%) followed by OPMDs (N=19; 63.34%). Absence of CD133 was observed in the normal oral mucosal specimens of healthy individuals. A highly significant (p<0.0001) difference was observed while comparing the tissue immunoexpressionof CD133 among the study participants. Conclusion:Varied expression of CD133 was observed in tissue samples of OSCC as compared to OED tissue samples of OPMDs and normal oral mucosa of healthy individuals. Immunohistochemical assessment of CD133 revealed that it can be of clinical importance for differentiating between OSCC, OPMDs and and normal oral mucosa thus can be used as a predictive marker in oral malignancy and premalignancy. The immunohistochemical expression of CD133 in OSCC, OPMDs, and normal oral mucosa also sheds light on the potential function of CD133 in the genesis and progression of oral cancer.

This cross-sectional analysis was carried out to find the results of fluoroquinolones (moxifloxacin, ciprofloxacin, levofloxacin and gemifloxacin) on QTc interval prolongation among 100 volunteers’ healthy individuals (85% males of age 20 to 40 years) at Gomal Medical College in 2023 in Dera Ismail Khan, Pakistan. Volunteers were randomized to receive a single dose of oral moxifloxacin (400 mg), ciprofloxacin (500 mg), levofloxacin (500 mg), or gemifloxacin (320 mg) (25 per group). QTc (Bazett’s) was measured (ECG) at baseline and steady state (48 hours after dose administration). Moxifloxacin produced the most pronounced QTc change (7/25 volunteers (28%), 5 with a change >60 ms (20%)), followed by ciprofloxacin (4/25 (16%)) and levofloxacin (2/25 (8%)), whereas gemifloxacin did not induce any prolongation. Paired t-tests demonstrated that mean QTc intervals were elongated markedly after use of moxifloxacin, ciprofloxacin, and levofloxacin (p0.05, ANOVA). These findings underscore the higher risk of torsades de pointes with moxifloxacin in healthy volunteers, particularly in resource-constrained settings with high rates of polypharmacy, calling for better pharmacovigilance and judicious prescribing.

Background: The increasing adoption of digital technologies in healthcare has transformed the way individuals access health information and healthcare services. Digital health literacy plays a crucial role in enabling individuals to obtain, evaluate, and utilize digital health information effectively, thereby influencing healthcare-seeking behavior. However, disparities in digital health literacy between urban and rural populations may affect equitable healthcare utilization. Objectives To assess the level of digital health literacy among adults attending primary healthcare centers in urban and rural communities and to determine its impact on healthcare-seeking behavior. Methods A facility-based cross-sectional study was conducted among 200 adults attending selected urban and rural primary healthcare centers between May 2025 and October 2025. Participants were recruited using systematic random sampling. Data were collected using a structured questionnaire comprising sociodemographic characteristics, healthcare-related variables, healthcare-seeking behavior, and the validated eHealth Literacy Scale (eHEALS). Descriptive statistics, Chi-square tests, and multivariable logistic regression analyses were performed using SPSS version 26.0. Statistical significance was set at p < 0.05. Results Among the 200 participants, 58.5% demonstrated adequate digital health literacy, while 41.5% had inadequate digital health literacy. Adequate digital health literacy was significantly more prevalent among urban participants than rural participants (72.0% vs. 45.0%; p < 0.001). Overall, 66.0% of participants searched for health information online before seeking medical consultation, 44.5% utilized telemedicine services, and 63.0% sought professional healthcare within 48 hours of symptom onset. Conclusion Digital health literacy is a significant determinant of healthcare-seeking behavior among adults attending primary healthcare centers. Higher digital health literacy is associated with timely healthcare utilization, increased adoption of telemedicine services, and reduced self-medication practices.

Background & Objectives Diabetic foot ulcers (DFUs) are a premier driver of morbidity, prolonged hospitalization, and non-traumatic lower extremity amputations. This study evaluates the clinical profile, risk factors, microbiological patterns, and treatment outcomes among patients presenting to a major tertiary healthcare center in Southern Odisha. Methods: A hospital-based cross-sectional study was conducted at Maharaja Krishna Chandra Gajapati (MKCG) Medical College and Hospital, Berhampur, spanning from October 2020 to October 2022. One hundred and twenty () diagnosed Type 2 Diabetes Mellitus patients with active foot ulceration were enrolled. Comprehensive clinical screening, neurological evaluation (10-g Semmes-Weinstein monofilament), vascular assessment (Ankle-Brachial Index), wound grading (Wagner-Meggitt system), and deep tissue cultures were systematically executed. Results: The study cohort featured a profound male predominance (, 71.67%) with a mean age of  years. Poor long-term glycemic control was endemic, with a mean  of . Peripheral neuropathy was detected in 82.5% () of the cohort, while peripheral arterial disease (PAD) was verified in 38.33% (). According to the Wagner-Meggitt classification, Grade 3 ulcers were the most frequent presentation (, 34.17%), followed closely by Grade 2 (, 26.67%). Microbiological cultures yielded positive bacterial growth in 91.67% of cases, with Gram-negative bacilli dominating the spectrum. Pseudomonas aeruginosa (, 28.18%) and Klebsiella pneumoniae (, 21.82%) were the primary isolates. Surgical intervention was mandatory for most patients; split-skin grafting (SSG) was completed in 31.67% () of patients, while major lower-limb amputations were restricted to 12.5% (). Conclusion: DFU presentations in Southern Odisha are highly complex, marked by late medical presentation, advanced Wagner grades, and a dominant Gram-negative, multi-drug resistant bacterial profile. Early sensory assessment, timely surgical debridement, targeted empirical antibiotic selection focusing on Gram-negative cover, and strict systemic glycemic optimization are vital to maximize limb-salvage outcomes.

Background: Recent years have witnessed a notable surge in Candida infections. Historically, although C. albicans is most commonly associated with infection, recent studies have revealed emergence of non albicans Candida (NAC) species. In many cases NAC spp., have surpassed C. albicans. In contrast to C. albicans, NAC spp. demonstrate varying degrees of resistance to commonly prescribed antifungal drugs for preventing and treating infections. The aim of the present study was to identify and evaluate antifungal susceptibility pattern of Candida spp. isolated from various clinical specimens. Material and methods: Clinical isolates of Candida spp. were identified upto species level as per the standard mycological protocol. Antifungal susceptibility testing (AFST) of these isolates was performed by disc diffusion method as outlined Clinical and  Laboratory Standards Institute’s (CLSI) M44-A guidelines. Results: A total of 247 isolates from various clinical specimens were Candida spp. NAC spp. were predominant over C. albicans. Among various Candida spp., C. tropicalis was the commonest. Fluconazole resistance was observed in 29.1% of Candida isolates. Itraconazole resistance was noted in 29 (11.7%) isolates.  Ketoconazole resistance was observed in 20.6% of Candida isolates. No clinical isolate of Candida spp. were resistant to Amphotericin B.  Conclusion: To conclude, non albicans Candida species are important and emerging cause of infections. C. tropicalis, C. krusei and C. glabrata are important NAC spp. As the susceptibility of Candida isolates to antifungal drugs varies as per the species, antifungal susceptibility testing is often necessary to guide clinicians for selecting most appropriate antifungal therapeutic agent.

Background: Sarcopenia—progressive loss of skeletal muscle mass, strength, and physical performance—is a major geriatric syndrome linked to falls, functional dependence, prolonged hospitalisation, and mortality. Data from dedicated Indian geriatric-medicine inpatient units applying the Asian Working Group for Sarcopenia (AWGS) 2019 criteria are virtually absent. Objectives: To determine the prevalence and clinical determinants of sarcopenia using AWGS 2019 criteria among elderly inpatients (age ≥60 years) at a tertiary-care geriatric unit, and to assess severity distribution, sarcopenic obesity, gender patterns, comorbidity associations, geriatric-assessment scores, and biochemical correlates. Methods: A hospital-based cross-sectional study enrolled 100 consecutive inpatients aged ≥60 years over 6 months. Sarcopenia was diagnosed by low appendicular skeletal muscle mass index (ASMI) on bioelectrical impedance analysis (BIA; <7.0 kg/m² men, <5.7 kg/m² women) combined with low handgrip strength (<28 kg men, <18 kg women) and/or low gait speed (<1.0 m/s). Sarcopenic obesity used BIA percent body fat (≥27% men, ≥38% women). Comprehensive geriatric assessment (MNA-SF, SARC-F, Barthel ADL, Lawton IADL, GDS-15, HMSE, CCI) and laboratory parameters were recorded. Analysis used independent t-tests, chi-square tests, and binary logistic regression (SPSS v26). Results: Mean age was 71.3±6.6 years (55% male). Sarcopenia prevalence was 62%; probable sarcopenia 99%; severe sarcopenia 55%. Low gait speed was universal (100%). Male sex was associated with higher prevalence (70.9% vs 51.1%; p=0.009). A steep BMI gradient was observed (underweight 89.5% → obese 21.4%; p<0.001). Sarcopenic obesity was present in 38%, all of whom would be missed by BMI alone. COPD carried the highest comorbidity-wise prevalence (78.3%). Sarcopenic patients had significantly lower MNA-SF, Barthel ADL, Lawton IADL, and HMSE scores, higher GDS, and lower haemoglobin, albumin, and vitamin D (all p<0.05). On multivariable regression, lower BMI was the sole independent determinant (adjusted OR 0.82, 95% CI 0.75–0.90; p<0.001; Nagelkerke R²=0.41). Conclusion: Sarcopenia affected 62% of elderly inpatients, with severe sarcopenia in 55%. Lower BMI was the sole independent determinant. Sarcopenic patients showed worse nutritional, functional, cognitive, and depressive profiles alongside lower haemoglobin, albumin, and vitamin D. Universal admission screening with AWGS 2019-aligned tools and BIA-based body-composition assessment are recommended for all elderly admissions.

Background: Population ageing constitutes a rapidly intensifying global public health issue. In India, the elderly population faces a distinctive triad of challenges: rising chronic morbidity, polypharmacy, and substantial out-of-pocket expenditure (OOPE).¹ Geriatric individuals residing in rural areas are particularly vulnerable due to restricted access to organized healthcare financing mechanisms, low health literacy, and insufficient insurance coverage.² This research sought to assess the pharmacoeconomic implications and existing medication utilization trends among the elderly population living in a rural community of Telangana. Methods: A community-based cross-sectional study was conducted in Annaram village, Karimnagar district, Telangana, from April to July 2025. Using simple random sampling from the village health register, 196 individuals aged between 60–80 years were enrolled. Data pertaining to socio-demographic profile, morbidity burden, medication utilization, and average monthly medical expenditure over the last three months were collected through direct face-to-face interviews using a pre-tested, semi-structured questionnaire. Descriptive statistics including frequencies and percentages were used for data analysis. The association between polypharmacy and perceived financial burden among study participants is identified by the application of Chi-square analysis.

Results: Among the 196 participants, the highest proportion (38.3%) belonged to the 65–69-year age group; males constituted 57.1%. A significant prevalence of illiteracy was noted in 77.0% of the participants. Hypertension was the most common comorbidity (40.8%), followed by osteoarthritis (24.5%) and diabetes mellitus (18.9%). The phenomenon of polypharmacy (4–5 medications per day) was recorded in 24.0%, whereas a more severe form of polypharmacy (≥6 medications per day) was reported in 1.5%. Monthly medication expenditure remained below ₹1,000 for 82.6% of participants; however, 66.3% regarded their medication expenses as a considerable financial burden. Government-sponsored drug subsidies were the predominant cost-reduction strategy (68.9%), while health insurance coverage was reported by only 15.8% of study population. Conclusion: Despite partial coverage through government subsidy initiatives, a significant proportion of the rural elderly population in Telangana continues to experience financial hardship attributable to chronic medical expenditure. It is essential to prioritize policies that enhance the public health supply chain framework, encourage the adoption of generic pharmaceuticals, and broaden the scope of health insurance programs tailored specifically for geriatric populations.

Introduction: Childhood obesity has emerged as a major public health concern worldwide and is increasingly prevalent in developing countries, including Pakistan. Inadequate sleep duration has been identified as a potential risk factor for obesity through its effects on appetite regulation, metabolism, and physical activity. However, limited evidence exists regarding this association among Pakistani school children.Objectives: To determine the association between sleep duration and obesity among secondary school children (Grades 6ᵗʰ to 8ᵗʰ) of Gulshan Town, Karachi, Pakistan.Methodology: This six-month prospective case-control study was conducted across three government and three private schools in Gulshan-e-Iqbal Town, Karachi (December 2018 – April 2019). A total of 252 children — 126 obese (cases) and 126 non-obese (controls) — meeting the diagnostic criteria were enrolled through stratified random sampling. Quantitative data were expressed as mean ± SD; qualitative variables as frequencies and percentages. Post-stratification chi-square tests were applied and odds ratios (OR) calculated at 95% confidence intervals (CI). A p-value of ≤0.05 was considered statistically significant.Results: The mean age was 13.01 ± 0.79 years in cases and 13.49 ± 0.40 years in controls. Poor sleep duration (<8 hours) was found in 85 (67.5%) cases versus 60 (47.6%) controls. Obese children were 2.27 times more likely to experience poor sleep duration (OR = 2.27; 95% CI; p = 0.01). The association was stronger in females (OR = 3.21; p = 0.01) and in children aged 12–13 years (OR = 2.25; p = 0.05).Conclusion: Childhood obesity is significantly associated with poor sleep duration. Targeted, school-based interventions addressing sleep hygiene, physical activity, and dietary habits are urgently needed in Pakistan.

Drug-induced osteoporosis is an increasingly recognized cause of secondary osteoporosis and fragility fractures that extends beyond the well-established effects of corticosteroids. Emerging evidence indicates that several commonly prescribed non-corticosteroid medications, including proton pump inhibitors, antiepileptic drugs, aromatase inhibitors, androgen deprivation therapies, selective serotonin reuptake inhibitors, thiazolidinediones, antiretroviral agents, loop diuretics, and calcineurin inhibitors, may adversely affect bone health through diverse mechanisms such as impaired calcium and vitamin D metabolism, hormonal suppression, increased bone resorption, reduced osteoblast activity, and disturbances in mineral homeostasis. This systematic review evaluates current evidence regarding the association between these medications and osteoporosis-related outcomes, including reductions in bone mineral density and increased fracture risk. Findings from observational studies, randomized clinical trials, cohort studies, case-control studies, and meta-analyses suggest that several drug classes are significantly associated with skeletal deterioration, particularly among older adults, postmenopausal women, cancer patients, and individuals requiring long-term pharmacotherapy. Among the identified medications, aromatase inhibitors, androgen deprivation therapies, antiepileptic drugs, and thiazolidinediones demonstrated the strongest and most consistent associations with bone loss and fracture risk, while accumulating evidence continues to clarify the skeletal effects of proton pump inhibitors, selective serotonin reuptake inhibitors, and antiretroviral therapies. These findings highlight the importance of recognizing medication-related bone disease as a growing clinical and public health concern, emphasizing the need for early risk assessment, routine monitoring of bone health, and implementation of preventive strategies in high-risk populations. Further prospective studies are required to strengthen causal evidence and optimize approaches for the prevention and management of drug-induced osteoporosis beyond corticosteroid exposure.

Background Thermoregulation is a vital physiological process that maintains body temperature within a narrow range despite environmental fluctuations. Sweat glands play a crucial role in heat dissipation through evaporative cooling. Understanding sweat gland physiology is important for evaluating normal temperature regulation and disorders affecting heat balance. Objective: To assess thermoregulatory responses and sweat gland activity among healthy adults under controlled environmental conditions. Materials and Methods A cross-sectional observational study was conducted among 100 healthy adult volunteers aged 18–40 years. Baseline body temperature, heart rate, and sweat rate were measured. Participants were exposed to a controlled warm environment (35°C) for 30 minutes. Changes in body temperature, sweating rate, and physiological responses were recorded and analyzed using descriptive statistics. Results The mean baseline body temperature was 36.8 ± 0.3°C, which increased to 37.3 ± 0.4°C following heat exposure. The average sweat rate increased from 0.12 ± 0.05 mL/min at rest to 0.78 ± 0.21 mL/min after exposure. Male participants demonstrated higher sweat rates compared with females. Significant positive correlations were observed between body temperature and sweat production. Conclusion Sweating is an effective thermoregulatory mechanism that increases proportionally with body temperature. Sweat gland activity contributes significantly to maintaining thermal homeostasis. Understanding sweat physiology is essential for the prevention and management of heat-related disorders.

Background: Fine needle aspiration cytology (FNAC) is a minimally invasive diagnostic tool, but inadequate sampling often necessitates repeat procedures. Rapid on-site evaluation (ROSE) with toluidine blue staining offers a potential solution for immediate adequacy assessment and preliminary diagnosis. Objectives: To evaluate the effectiveness and feasibility of toluidine blue for ROSE in FNAC compared to conventional Papanicolaou/Giemsa staining, focusing on sample adequacy, diagnostic accuracy, staining quality, procedural efficiency, and clinical impact. Methods: This prospective randomized observational study enrolled 150 patients (75 per group) undergoing FNAC at Santosh Medical College and Hospital from June 2024 to December 2025. Participants were randomized to ROSE with toluidine blue or standard FNAC. Sample adequacy, number of passes, diagnostic accuracy (compared to final histopathology where available), staining quality, turnaround time, and operator feedback were assessed. Statistical analysis used Chi-square and t-tests (p<0.05 significant). Results: ROSE with toluidine blue achieved significantly higher sample adequacy (96.0% vs. 84.0%, p=0.011), higher single-pass adequacy (77.3% vs. 60.0%, p=0.023), and fewer repeat procedures (2.7% vs. 12.0%, p=0.026). Diagnostic accuracy was superior (98.6% vs. 94.7%, p=0.045), with sensitivity 96.4% and specificity 100%. Toluidine blue provided excellent cytoplasmic detail and rapid preliminary diagnosis (mean 4.2 ± 1.1 minutes). Operator satisfaction was high (mean scores 4.4-4.8/5). Conclusion: Toluidine blue ROSE significantly improves FNAC performance, reduces patient burden, and is feasible and cost-effective, supporting its routine integration in cytopathology services.

Introduction: Pulpal sensibility tests are commonly used in endodontic diagnosis to assess pulpal nerve response. Objective: To evaluate the effect of common analgesics on pulpal sensibility tests, including electric pulp testing and cold testing. Methodology: This randomized, double-blind, placebo-controlled trial was conducted at School of Dentistry Islamabad from September 2025 to March 2026, included 184 healthy adult participants divided equally into two groups: ibuprofen 400 mg and paracetamol 1000 mg. Baseline electric pulp test threshold values and cold test responses were recorded before drug administration, and post-drug testing was performed one hour after administration. Results: Results demonstrated that the ibuprofen group showed a significant increase in EPT threshold values from 21.4 ± 4.8 to 24.9 ± 5.2 (mean change: 3.5, p<0.001), whereas the paracetamol group showed only a small increase from 21.7 ± 4.6 to 22.8 ± 4.9 (mean change: 1.1, p=0.08). Similarly, cold test response time increased significantly in the ibuprofen group from 1.42 ± 0.36 to 1.91 ± 0.44 seconds (mean change: 0.49 seconds, p<0.001), compared to a non-significant increase from 1.45 ± 0.34 to 1.58 ± 0.39 seconds (mean change: 0.13 seconds, p=0.06) in the paracetamol group. Conclusion: Ibuprofen significantly reduced pulpal sensory responsiveness compared with paracetamol, as shown by increased EPT threshold values, prolonged cold test response time, and a higher frequency of delayed cold responses.

Background Triple-negative breast cancer (TNBC) is an immunohistochemically distinct and highly aggressive subtype of breast cancer characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. In India, TNBC presents at a younger age and exhibits more aggressive biological behavior compared to Western cohorts. This study aimed to describe the clinico-pathological features, demographic characteristics, and treatment patterns of TNBC patients presenting to a regional tertiary care oncology center in Eastern India. Methods This retrospective descriptive study evaluated N = 86 histologically and immunohistochemically confirmed TNBC patients treated at the Acharya Harihar Postgraduate Cancer Centre, Cuttack, Odisha, between January 2022 and December 2024. Data regarding demographics, tumor characteristics, histopathological grade, clinical stage, and therapeutic interventions were extracted from electronic and paper medical records. Descriptive statistical analysis was performed. Results The mean age of the cohort was 46.8 +/- 10.2 years, with 55.8% (n = 48) of the patients being pre-menopausal. A significant majority of the patients resided in rural areas (72.1%, n = 62). Invasive ductal carcinoma, not otherwise specified (NOS), was the predominant histological type (95.3%, n = 82). High histological grade (Scarff-Bloom-Richardson Grade III) was observed in 72.1% (n = 62) of the cases. Most patients presented at advanced clinical stages: Stage II in 52.3% (n = 45) and Stage III in 41.9% (n = 36). Lymph node metastasis was present in 65.1% (n = 56) of patients. Regarding treatment, 37.2% (n = 32) received neoadjuvant chemotherapy (NACT), while 62.8% (n = 54) underwent upfront surgery followed by adjuvant chemotherapy. Modified Radical Mastectomy (MRM) was the most common surgical procedure (79.1%, n = 68), and breast conservation surgery (BCS) was performed in 20.9% (n = 18) of cases. Anthracycline followed by taxane-based chemotherapy was administered to 86.0% (n = 74) of patients.

Conclusion TNBC patients presenting to our tertiary center in Eastern India exhibit a young age at onset, a high prevalence of pre-menopausal status, predominant rural background, advanced clinical stage at presentation, and high-grade tumors. Mastectomy remains the primary surgical intervention due to late presentation and structural barriers to breast conservation. There is an urgent need to improve regional screening, raise awareness, and optimize diagnostic pathways to detect TNBC at earlier, more curable stages.

Background: Central venous cannulation is a commonly performed procedure in critically ill and surgical patients for hemodynamic monitoring, administration of medications, and fluid management. The conventional landmark technique is associated with variable success rates and procedure-related complications. Ultrasound guidance has emerged as an alternative approach that may improve procedural outcomes and patient safety. Aim: To compare the success rate and complications of ultrasound-guided versus landmark technique for central venous cannulation. Materials and Methods: A hospital-based comparative cross-sectional study was conducted among 200 patients requiring central venous catheterization. Participants were allocated to either the ultrasound-guided group (n=101) or the landmark technique group (n=99). Demographic characteristics, procedural success rates, number of attempts, cannulation time, and procedure-related complications were recorded and compared between the groups. Statistical analysis was performed using Student’s t-test, Chi-square test, and Fisher’s exact test, with p<0.05 considered statistically significant. Results: Baseline demographic characteristics were comparable between the two groups. Overall successful cannulation was significantly higher in the ultrasound-guided group than in the landmark group (96.0% vs 87.9%, p=0.033). First-attempt success was achieved in 80.2% of patients in the ultrasound-guided group compared with 54.5% in the landmark group (p<0.001). The mean number of attempts required for successful cannulation was significantly lower with ultrasound guidance (1.36 ± 0.72 vs 2.08 ± 1.04, p<0.001), and cannulation time was significantly shorter (5.86 ± 2.13 minutes vs 9.74 ± 3.68 minutes, p<0.001). Overall complications occurred in 7.9% of ultrasound-guided procedures compared with 24.2% of landmark-guided procedures (p=0.002). Significant reductions were observed in arterial puncture, hematoma formation, pneumothorax, catheter malposition, and local bleeding in the ultrasound-guided group. Conclusion: Ultrasound-guided central venous cannulation provides higher success rates, requires fewer attempts, shortens procedure time, and significantly reduces complications compared with the landmark technique. Routine utilization of ultrasound guidance should be encouraged to improve the safety and effectiveness of central venous catheter placement.

Background: Anastomotic leakage is generally defined as disruption of the integrity of a surgically created intestinal connection resulting in leakage of luminal contents into the surrounding tissues or peritoneal cavity. Early identification of patients at increased risk is essential for optimizing perioperative management. The neutrophil-to-lymphocyte ratio (NLR), an inexpensive and readily available marker of systemic inflammation, has emerged as a potential predictor of adverse surgical outcomes. Objectives: To evaluate the association between preoperative neutrophil-to-lymphocyte ratio and the occurrence of postoperative leak following small bowel surgeries, and to assess variations in NLR between elective and emergency surgical settings. Methods: A prospective cohort study was conducted in the Department of General Surgery at Dr. D. Y. Patil Medical College, Hospital and Research Institute, Kolhapur. Forty-five adult patients undergoing elective or emergency small bowel surgeries with primary anastomosis were enrolled and followed prospectively. Preoperative NLR was calculated from complete blood counts obtained within 24 hours before surgery. Patients were monitored throughout hospitalization for development of postoperative leak. Statistical analyses included comparison of NLR between leak and non-leak groups and receiver operating characteristic (ROC) curve analysis to determine predictive performance. Results: Mean age observed was 48.04 ± 18.09 years. Emergency surgeries constituted 80.0% of cases. Postoperative leak occurred in 7 patients. Patients without leak demonstrated a significantly higher median preoperative NLR than those who developed leak (7.96 vs. 2.34; p=0.0068). The ROC analysis showed that pre-operative NLR had an AUC of 0.827, with a 95% CI of 0.676–0.978. The associated p-value was 0.0068, indicating statistically significant diagnostic performance. An optimal NLR cutoff value of 4.09 yielded a sensitivity of 71.4%, specificity of 81.6%, accuracy of 80.0%, positive predictive value of 41.7%, and negative predictive value of 93.9%. The mean time to leak occurrence was 5.4 days postoperatively. Conclusions: Preoperative NLR demonstrated significant discriminatory ability in identifying patients at risk of postoperative leak following small bowel surgery. Although patients who developed leaks exhibited lower NLR values than those without leaks, the high negative predictive value suggests that NLR may be useful for identifying patients at lower risk of postoperative leak. Preoperative NLR should be considered an adjunctive tool for perioperative risk stratification and clinical surveillance rather than a standalone predictor.

Background: Bronchodilators are a cornerstone in the management of obstructive airway diseases, improving airflow limitation and respiratory symptoms. Spirometry provides an objective assessment of pulmonary function and treatment response. The present study evaluated pulmonary function changes following bronchodilator therapy and examined factors influencing bronchodilator responsiveness. Material and Methods: A prospective observational study was conducted among 135 patients with bronchial asthma or chronic obstructive pulmonary disease receiving bronchodilator therapy. Pulmonary function tests were performed using computerized spirometry before and after administration of inhaled salbutamol. Forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC ratio, peak expiratory flow rate (PEFR), and forced expiratory flow between 25% and 75% of FVC (FEF₂₅–₇₅%) were recorded and analyzed. Results: The mean age of participants was 46.8 ± 12.4 years, and 60.7% were males. Significant improvements were observed in all pulmonary function parameters following bronchodilator therapy. Mean FEV₁ increased from 1.78 ± 0.54 L to 2.08 ± 0.57 L, while mean FVC increased from 2.72 ± 0.68 L to 2.95 ± 0.70 L (p < 0.001). Significant bronchodilator responsiveness was observed in 89 (65.9%) patients. Patients with bronchial asthma demonstrated a higher rate of significant responsiveness than those with COPD (78.2% vs. 49.1%, p < 0.001). A significant negative correlation was found between disease duration and improvement in FEV₁ (r = −0.312, p < 0.001). Conclusion: Bronchodilator therapy significantly improved pulmonary function in patients with obstructive airway diseases. Bronchodilator responsiveness was greater in bronchial asthma than in COPD, while longer disease duration was associated with reduced improvement in FEV₁. Spirometry remains a valuable tool for evaluating therapeutic response and disease progression.

Background: Transfusion transmitted infections (TTIs) remain a major challenge to blood safety worldwide, particularly in low- and middle-income countries. Screening of blood donors for infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis, and malaria is essential to reduce transfusion-related morbidity and mortality. Objective: To estimate the seroprevalence of TTIs among blood donors and evaluate associated demographic risk factors in a cohort of 100 donors in a retrospective hospital-based study. Methods: A retrospective cross-sectional study was conducted on 100 blood donors screened at medical institutions. Data regarding age, gender, and donation status (first-time vs repeat donors) were collected. Serological screening for HIV, HBV, HCV, syphilis, and malaria was analyzed. Statistical analysis was performed using chi-square test, with p < 0.05 considered significant. Results: Overall seroprevalence of at least one TTI was 14%. HBV was the most prevalent infection (6%), followed by HCV (3%), syphilis (3%), HIV (1%), and malaria (1%). First-time donors showed significantly higher TTI prevalence compared to repeat donors (p = 0.031). Male donors had higher seropositivity, though not statistically significant (p = 0.214). Younger age group (18–30 years) showed lower seroprevalence compared to older groups. Conclusion: TTIs continue to pose a measurable risk among blood donors, particularly first-time donors. Strengthening donor selection criteria and promoting voluntary repeat donation can improve transfusion safety.

Background: Non-invasive ventilation (NIV) is an established modality for managing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with type 2 respiratory failure. However, the optimal strategy for discontinuing NIV remains uncertain. This study compared three different NIV weaning strategies in patients with AECOPD and hypercapnic respiratory failure.

Methods: A randomized controlled trial was conducted at the Institute of Medical Sciences, Banaras Hindu University, Varanasi, from January 2023 to January 2024. A total of 120 patients with AECOPD and type 2 respiratory failure were randomly assigned into three groups: Group A (immediate withdrawal), Group B (stepwise reduction of pressure support), and Group C (stepwise reduction of NIV duration), with 40 patients in each group. The primary outcome was successful withdrawal of NIV, defined as the absence of a need for reinstitution of NIV within 48 hours. Secondary outcomes included total duration of NIV use and length of hospital stay. Results: Successful withdrawal rates were 77.5%, 85%, and 82.5% in Groups A, B, and C, respectively, with no statistically significant difference among the groups (p=0.677). Mean duration of NIV use was significantly different across the groups, being shortest in Group A (5.67±1.96 days), followed by Group C (6.02±1.52 days), and longest in Group B (6.90±2.27 days) (p=0.017). Mean hospital stay was 7.87 days in Group A, 9.30 days in Group B, and 8.20 days in Group C, without significant intergroup differences (p=0.438). None of the clinical parameters including pH, PaCO₂, Glasgow Coma Scale, maximum IPAP, and maximum EPAP significantly predicted weaning success. Conclusion: Stepwise reduction of pressure support achieved the highest success rate for NIV withdrawal, followed by stepwise reduction in duration and immediate withdrawal. Immediate withdrawal was associated with the shortest duration of NIV use and hospital stay. All three strategies were effective, suggesting that NIV discontinuation can be individualized according to patient characteristics and clinical requirements.

Background: ACS is a constellation of disorders resulting from an abrupt disruption of blood flow to the heart and has significant morbidity, mortality, and management implications. This study was designed to evaluate the differences of demographic, clinical characteristics, biochemical levels, angiographic findings and short-term outcomes between younger (≤45 years) and older (>45 years) patients with ACS. Methods: This was a prospective, cross-sectional study performed at a tertiary cardiac care center between January 2024 and December 2024. There was a total of 800 ACS patients available who were categorized into two groups: younger (≤45 years) and older (>45 years). A structured proforma for collection of data regarding demographic profile, cardiovascular risk factors (smoking, hypertension, diabetes, dyslipidemia and family history of CAD), clinical presentation (chest pain, shortness of breath, palpitations syncope or sweating ), biochemical parameters (total cholesterol LDL HDL triglyceride VLDL) and angiographic findings (single-vessel or multi-vessel disease) was used. Treatment (thrombolysis, PCI or medical) and early outcome measures (in-hospital death, in-hospital cardiac arrest, heart failure, hospital stay) were also registered. Database was analyzed using SPSS software (version 25) for descriptive statistics, the independent t-test and chi-square test with level of significance p ≤0.05.Results: Younger patients had less comorbidities, such as hypertension (10% vs 60%) and diabetes (5% vs 50%), healthier lipid status (total cholesterol, LDL and triglycerides). Older patients, in contrast, had a higher incidence of multi-vessel disease (50% vs. 20%) and presented with a more severe clinical picture that included an increased prevalence of dyspnea (40% vs. 10%), palpitations (20% vs.5%). Short-term outcomes were also significantly better for the younger patients with lower in-hospital mortality (2% vs 8%), fewer cardiac arrests (1% vs 5%) and shorter hospital stay (4.5 days vs 6.2 days).Conclusions: Among young patients with ACS, there is a lesser severity of disease and a better short-term outcome as compared to older counterparts. They have more severe CAD and higher mortality than the former group due to comorbidities, such as hypertension, diabetes, dyslipidemia. These results indicate that modifiable risk factors including dyslipidemia, hypertension and diabetes might have to be managed in an aggressive manner for older ACS patients to obtain better clinical outcomes. The results of this research indicate that there is a particular requirement to focus attention on targeted age-related treatment regimen in order to enhance the management and outcome of ACS patients.

Introduction: Glaucoma is a chronic progressive optic neuropathy and one of the leading causes of irreversible blindness worldwide. In addition to visual impairment, glaucoma can adversely affect psychological well-being, daily functioning, treatment burden, and overall quality of life. Assessment of patient-reported quality of life is therefore essential for comprehensive glaucoma management. Methods: A hospital-based cross-sectional observational study was conducted among 127 patients diagnosed with glaucoma attending the Ophthalmology Department of a tertiary care teaching hospital. Quality of life was assessed using the 36-item Glau-QoL questionnaire comprising seven domains: psychological well-being, self-image, daily life, burden of treatment, driving, anxiety, and confidence in healthcare. Descriptive statistics were used to summarize domain scores. One-way ANOVA and independent samples t-test were performed to evaluate the association of quality-of-life domains with monthly treatment cost and dose frequency. A p-value <0.05 was considered statistically significant. Results: The mean scores for psychological well-being, self-image, daily life, burden of treatment, driving, anxiety, and confidence in healthcare were 3.13±0.65, 3.02±0.69, 3.09±0.55, 3.06±0.63, 3.05±0.86, 3.06±0.70, and 3.13±0.74 respectively. Patients experienced moderate impairment across multiple quality-of-life domains. Monthly treatment cost showed a statistically significant association with psychological well-being (p=0.012) and anxiety (p=0.029), while no significant association was observed with other domains. Dose frequency did not significantly influence any quality-of-life domain (p>0.05). CONCLUSION: Glaucoma has a multidimensional impact on patients’ quality of life, particularly affecting psychological and functional aspects. Financial burden significantly influences psychological well-being and anxiety among glaucoma patients. Incorporating psychological support, patient education, and affordable treatment strategies may help improve overall quality of life and long-term disease management.

Background Alveolar osteitis, commonly known as dry socket, is a painful postoperative complication following tooth extraction, particularly mandibular third molar removal. It is characterized by disintegration or loss of the blood clot within the extraction socket, leading to exposed bone, delayed healing, and severe pain. Platelet concentrates, including platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have been proposed as biologically active adjuncts to enhance wound healing and reduce postoperative complications. Objective This systematic review and meta-analysis aimed to evaluate the effectiveness of platelet concentrates in preventing dry socket following tooth extraction based on evidence from randomized controlled trials (RCTs). Methods A structured review of RCTs comparing platelet concentrates (PRP, PRF, and related derivatives) with conventional socket management was conducted. Primary outcome was incidence of dry socket. Secondary outcomes included postoperative pain, soft tissue healing, and complication rates. Due to methodological heterogeneity, a narrative synthesis with comparative effect estimation was performed. Results Across included RCTs, platelet concentrates consistently demonstrated a reduction in dry socket incidence compared with conventional clot healing. PRF showed more consistent clinical benefits than PRP in recent studies. Patients receiving platelet concentrates reported reduced postoperative pain, improved socket healing, and faster epithelialization. However, variability in preparation protocols and outcome definitions limited precise pooled effect estimation. Conclusion Platelet concentrates appear to be effective adjuncts in reducing the incidence of dry socket and improving postoperative healing outcomes. However, heterogeneity among studies limits definitive quantitative conclusions. Standardized protocols and large-scale RCTs are required for stronger evidence.

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease characterized by declining lung function and poor survival. A ≥10% decline in forced vital capacity (FVC) is strongly associated with increased mortality. Pirfenidone is an approved antifibrotic therapy, but variations across trials and emerging biomarker data warrant integrated synthesis. Objectives: The primary objective is to quantify pirfenidone’s influence on preventing a ≥10% decline in Forced Vital Capacity (FVC). Secondary objectives include evaluating pirfenidone’s effects on serum biomarkers (SP-D, SP-A, KL-6), bronchoalveolar lavage markers, additional physiological measures (percent-predicted FVC and vital capacity). Methods: A PRISMA 2020–compliant systematic review and meta-analysis was conducted including randomized controlled trials evaluating pirfenidone for prevention of ≥10% FVC decline over 52–72 weeks. A DerSimonian–Laird random-effects model was used. Risk of bias was assessed using the Cochrane framework. Biomarker and mechanistic studies were included for qualitative synthesis. Results: Three RCTs (ASCEND, CAPACITY 004, CAPACITY 006) comprising 1247 participants were included in quantitative synthesis. Pirfenidone significantly reduced the risk of ≥10% FVC decline compared with placebo (RR = 0.59; 95% CI: 0.48–0.72; Z = 5.20; p < 0.000001). Heterogeneity was low (I² = 12.7%; χ² = 2.29, p = 0.32). This corresponds to a 41% relative risk reduction. Qualitative analysis of secondary studies demonstrated consistent reductions in serum SP-D levels, attenuated rises in KL-6, and bronchoalveolar lavage cytokine shifts toward anti-inflammatory profiles. Supportive physiological trials showed slower decline in vital capacity and FVC % predicted. Conclusions: Pirfenidone significantly reduces clinically meaningful FVC decline in IPF with high-certainty evidence. Converging functional, biomarker, and mechanistic data reinforce its antifibrotic and immunomodulatory effects. These findings support pirfenidone’s continued role as a cornerstone therapy in IPF management.

Background: Acute appendicitis is the most common abdominal surgical emergency. Hyperbilirubinemia has emerged as a potential non-invasive marker for predicting the severity of acute appendicitis, particularly appendiceal perforation and gangrene. This prospective study evaluated the role of preoperative serum bilirubin levels in assessing the severity of acute appendicitis and correlated the findings with histopathological examination (HPE). Methods: A prospective observational study was conducted at Bhaskar General Hospital, Hyderabad, from 2021 to 2024, enrolling 100 patients with clinically suspected acute appendicitis (Alvarado score ≥5) and who subsequently underwent appendectomy in the hospital. Preoperative and postoperative (7th post-operative day) serum total bilirubin (TSB) and direct bilirubin (DB) were measured. Histopathological examination of resected specimens served as the gold standard for diagnosing appendicitis type. Statistical analysis included ANOVA (F-test) and ROC curve analysis. Results: The mean age was 24.7 years (M:F = 1.7:1). HPE confirmed acute appendicitis (AA) in 84%, perforated appendix (PA) in 9%, and gangrenous appendix (GA) in 7% of cases. Elevated TSB (>1.2 mg%) was present in 70% and elevated direct bilirubin (>0.3 mg%) in 79% of patients. Mean preoperative TSB was significantly higher in PA (2.3 mg%) and GA (1.883 mg%) compared to AA (1.427 mg%) (p<0.001). For predicting perforated appendix, TSB yielded AUC = 0.866 (sensitivity 88.9%, specificity 80.2%, cut-off 1.75 mg%) and direct bilirubin AUC = 0.883 (sensitivity 88.9%, specificity 71.4%, cut-off 1.15 mg%). All cases of PA and GA had elevated direct bilirubin. Bilirubin levels decreased significantly on postoperative day 7 (p<0.005) across all groups. Conclusion: Serum bilirubin (total and direct) is a simple, inexpensive, and readily available preoperative marker that correlates with histopathological severity of acute appendicitis. TSB >1.5 mg/dl and direct bilirubin >0.7 mg/dl should raise clinical suspicion for complicated appendicitis and guide surgical decision-making.

Introduction: IDA is a leading nutritional problem in school-age children, and it hurts their growth, cognitive function, academic achievement, and immunity. Low food consumption, malnutrition, and low socio-economic status are significant contributing factors, especially in developing nations. Objectives: The prevalence of iron deficiency anemia (IDA) in school-going children and the relationship of the nutritional status of children aged 6-12 years with IDA were determined. Methodology: The cross-sectional study sample size of the study was 100 school-going children randomly selected from various schools, and this was a cross-sectional study. A structured questionnaire was used to gather demographic data, diet, and socioeconomic data. Body mass index was used to evaluate nutritional status using the WHO growth standards. Venous blood samples were taken to measure hemoglobin and serum ferritin. Hemoglobin levels below age-specific reference values were considered anemia. The data were analyzed using SPSS version 26. The quantitative data were analysed for the mean and the standard deviation, while the chi-square test was used to determine the association between the two variables, namely anaemia and nutrition status. The p-value of ≤ 0.05 was taken as the statistical significance. Results: The 100 participants 54% were males and 46% were females, with a mean age of 9.2 ± 1.8 years. Iron deficiency anemia was found in 38% of children. Poor nutritional status was observed in 60.5% of anemic children compared to 24.2% of non-anemic children, showing a significant association (p=0.003). The mean hemoglobin level among anemic children was 9.8 ± 1.1 g/dL compared to 12.4 ± 0.9 g/dL among non-anemic participants. Children with inadequate dietary iron intake and low BMI had a higher prevalence of anemia. Conclusion: Poor nutritional status was significantly linked to iron deficiency anemia, which was found to be highly prevalent among school-going children. Nutritional assessments, dietary counseling, and school-based screening programs are critical to combat the burden of anaemia and to improve the health outcomes of children.

Introduction: Neonatal sepsis is a great contributor to neonatal morbidity and mortality, particularly in developing countries. Even though the neonatal intensive care services have improved, delayed diagnosis, prematurity, and low birth weight are major factors associated with poor neonatal outcomes. Objectives: To assess clinical characteristics, risk factors, and outcomes of neonatal sepsis in the admitted neonates in the tertiary care pediatric unit. Methodology: This is a cross-sectional study in a tertiary care hospital in the pediatric department over six months. One hundred neonates (0 to 28 days) who had clinically and microbiologically confirmed neonatal sepsis were enrolled using consecutive sampling. A structured proforma was used to record demographic data, maternal risk factors, clinical features, laboratory findings, and outcomes. The data were analyzed by SPSS version 26. Mean ± standard deviation was calculated for quantitative variables, while frequencies and percentages were calculated for categorical variables. The Chi-square test was used to determine association, with a p≤0.05 value deemed to be statistically significant. Results: The 100 neonates 58% were males and 42% were females. The mean age at presentation was 11.4 ± 6.2 days. Early-onset sepsis was observed in 62% of patients. Common clinical features included fever (72%), poor feeding (65%), respiratory distress (54%), and lethargy (49%). Prematurity and low birth weight were present in 34% and 41% of neonates, respectively. Blood cultures were positive in 39% of cases, predominantly showing Klebsiella pneumoniae. Recovery occurred in 82% of patients, while mortality was observed in 6%. Prematurity (p=0.021) and low birth weight (p=0.034) showed significant association with adverse outcomes. Conclusion: Neonatal sepsis continues to be an important neonatal health issue. Important predictors of poor outcomes include prematurity, low birth weight, and culture-positive sepsis. Early diagnosis and prompt management will result in better survival of the neonates

Introduction: Objectives: To evaluate clinical and mucosal healing response to selective Janus kinase-1 (JAK-1) inhibitors and to compare the effectiveness of selective Janus Kinase inhibitors (JAKi) versus anti-integrin therapy in refractory ulcerative colitis (UC) patients in a real life setting in Pakistan. Methods: A prospective, real-world, multicenter cohort study was designed and performed from July 2025 till January 2026 (6-month duration) in the Tertiary Care Hospital Pakistan. 142 patients with moderate to severe refractory UC with history of failure of conventional steroids and anti-TNF drugs were included. Patients were randomized to oral selective JAK-1 inhibitors (Upadacitinib 45mg a day induction for 8 weeks and 15–30 mg a day maintenance) or intravenous anti-integrin therapy (Vedolizumab 300 mg every 0, 2, 6, and then 8 weeks). Mucosal healing at week 24 (Mayo Endoscopic Score [MES] ≤ 1) was the primary endpoint. Secondary outcomes were clinical remission (Partial Mayo Score ≤ 2), biochemical normalization of C-reactive protein (CRP) and fecal calprotectin, as well as safety parameters. Results: Selective JAK-1 inhibitor group showed more mucosal healing than the anti-integrin group (69.1% vs. 44.6% at week 24, p=0.003). Selective JAK-1 inhibitors also showed significantly higher clinical remission rates compared to other JAK inhibitors (73.5 % vs. 51.4 % with a p value of 0.007). The JAK-1 group achieved biochemical remission (defined as a reduction in fecal calprotectin to <150 µg/g) in 76.5%, compared with 54.1% of the anti-integrin group (p = 0.005). Additionally the patients treated with the JAK-1 inhibitors showed a greater symptomatic improvement (p < 0.05) within 2 weeks. Adverse events were comparable with transient hypercholesterolemia and mild acne being common in the JAK-1 arm and minor upper respiratory tract infections being prevalent in the anti-integrin arm. There were no cases of Dvt or Mace or mortality. Selective JAK-1 inhibitors in biological-experienced, refractory ulcerative colitis (UC) result in substantially higher and earlier rates of mucosal healing, clinical remission and normalization of biomarkers at 24 weeks versus anti-integrin therapy in routine clinical practice.

Background: Oral Potentially Malignant Disorders (OPMDs) are a group of oral mucosal conditions with an increased risk of malignant transformation, particularly among smokeless tobacco users. Objective: To determine the prevalence of OPMDs among smokeless tobacco users and to identify associated risk factors. Methods: The current study was a cross sectional study carried out in Hospital for six months from July to December, 2025. A total of 140 smokeless tobacco users were recruited using non-probability consecutive sampling. Oral examination and a structured questionnaire were used to collect the data. Data was analyzed statistically using SPSS-26 version. The chi-square test and binary logistic regression were used and a p value less than or equal to 0.05 was deemed significant. Results: A total of 39.8 ± 11.2 years were found as the mean age of the participants. The most commonly used smokeless tobacco product was naswar. The overall prevalence of OPMDs was 37.9 % overall, of which the most common lesions were OSMFs and leukoplakia. There were significant correlations for duration of and frequency of smokeless tobacco use with OPMDs, as well as gender and low educational status (p < 0.05).  Conclusion: A high prevalence of OPMDs was observed among smokeless tobacco users. Long-term and regular use of tobacco can greatly raise the risk of getting OPMDs. Oral precancerous lesions are a burden that can be reduced by early screening and tobacco cessation interventions.

Background: There is a substantial burden on the health care systems of surgical emergencies especially in the low and middle-income countries, where lack of access to health care and delayed health seeking is associated with higher morbidity and mortality rates. Objective: To study the clinical profile of surgical emergencies presenting in a tertiary care hospital and pathological patterns. Methods: This retrospective cross-sectional study was conducted over six months in the Department of General Surgery. The 143 patients were included obtained by non-probability consecutive sampling.  Medical records were used to extract data from a structured proforma and analyzed in SPSS version 24. Descriptive statistics were used to present the data and the Chi-square test was applied to measure association with p value ≤0.05 as significant. Results: Of 143 patients, 60.1% were male, and most were aged 21 to 40 years. The most common presenting symptom was abdominal pain. Acute appendicitis (27.3%) and intestinal obstruction (21.7%) were the commonest surgical emergencies, followed by perforated viscus (15.4%). The most common pathological pattern was inflammatory conditions (42.7%). Successful management allowed 85.3% of patients to be discharged and mortality was low (4.2%). Conclusion: Surgical emergencies predominantly affect young males, with acute appendicitis being the most common condition. There is a need to improve emergency surgical services as early diagnosis and timely surgical intervention in a tertiary care center lead to good outcomes.

Introduction: With improved healthcare delivery and rise in the average life expectancy, the demographic transition in India projects the elderly population (aged ≥60 years) to reach 319 million by 2050 as per LASI (Longitudinal Ageing Study of India). Elderly patients face unique challenges with cognitive problems, rising disabilities, inadequate geriatric infrastructure and urban-rural divide in access to medical services. Their mortality patterns are also distinctive due to physiological senescence, comorbidities, polypharmacy and altered pharmacokinetics. Materials and methods: A total of 1000 elderly patients (>60years) visiting the hospital emergency department over a year were included in the study after due consent. The clinical presentation, disease patterns, comorbidities and outcomes were observed. Results: Mean age of the study group was 72.80±7.04 years with females predominating as 55.4% of the participants. The most common symptom was shortness of breath (37%) followed by fever (23.5%), giddiness (18%) and nausea/vomiting (17.5%). Hypertension (51%) followed by Type II Diabetes Mellitus (38.5%) were the most common comorbidities. Observed mortality among our patients was 7.8 %, with the most common causes being cardiovascular (30%), infection related (28%) and neurological (22%). Adverse outcomes were significantly associated with the delay in seeking medical attention (p < 0.0001) and older age. (p = 0.001). Patients arriving >5 days late had over 4 times higher risk of death compared to those arriving within 24h. [Relative risk: 4.13 (CI 2.34–7.29)].Conclusions: Our study indicates a need for standardised geriatric care protocols and mobilising public awareness to seek early medical attention and refraining from considering chronological age as the sole criterion for delaying or denying medical care.

Background: Short-course radiotherapy (SCRT) is increasingly used in elderly or frail rectal cancer patients who are unsuitable for surgery or chemoradiotherapy. Magnetic resonance imaging (MRI) plays a pivotal role in assessing tumor response after SCRT. However, data focusing exclusively on MRI-based response in non-surgical elderly cohorts remain limited. Objective: To evaluate MRI tumor response following SCRT in elderly patients with rectal cancer managed non-operatively at a single tertiary cancer centre. Methods: This retrospective observational study included 32 elderly patients (≥70 years) with biopsy-proven rectal adenocarcinoma treated with SCRT (25 Gy in 5 fractions) between January 2022 and December 2025. None underwent surgery due to frailty, comorbidity, metastatic disease, or patient preference. MRI pelvis was performed at baseline and 8–12 weeks after SCRT. Tumor response was assessed using magnetic resonance tumor regression grade (mrTRG). Changes in T stage, nodal status, and mesorectal fascia (MRF) involvement were analyzed. Results: The mean age was 76.8 ± 5.4 years; 59% were male. Baseline MRI showed locally advanced disease (cT3–T4) in 78%. Post-SCRT MRI demonstrated moderate-to-good response (mrTRG ≤ 3) in 21/32 patients (65.6%). Radiologic complete response (mrTRG 1) occurred in 4 patients (12.5%). Downstaging of T stage was observed in 18 patients (56.3%), and nodal regression (cN+ to cN0) in 11 patients (34.4%). MRF involvement decreased from 37.5% pre-treatment to 18.8% post-treatment. No acute grade 3–4 radiation toxicity was recorded. Conclusion: SCRT followed by interval MRI demonstrates meaningful tumor regression in a substantial proportion of elderly rectal cancer patients managed non-operatively. MRI-based response assessment using mrTRG provides a valuable tool for treatment evaluation and surveillance in frail patients unsuitable for surgery.

Introduction: Pruritus is one of the most common and debilitating symptoms associated with cholestatic liver diseases. It significantly impairs quality of life through sleep disturbances, fatigue, psychological distress, and reduced daily functioning. Despite its clinical importance, the underlying mechanisms of cholestatic pruritus remain incompletely understood. Methods A systematic literature search was conducted using PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library to identify relevant studies published between January 2000 and March 2026. Eligible articles included randomized controlled trials, observational studies, systematic reviews, meta-analyses, and clinical practice guidelines addressing the epidemiology, pathophysiology, diagnosis, and management of cholestatic pruritus. Data were synthesized narratively due to heterogeneity among study designs and outcome measures. Results Current evidence supports a multifactorial pathogenesis involving bile acids, endogenous opioid dysregulation, serotonergic pathways, and particularly the autotaxin–lysophosphatidic acid (LPA) signaling axis, which has emerged as a key mediator of cholestatic itch. Cholestatic pruritus frequently occurs in patients with primary biliary cholangitis, primary sclerosing cholangitis, intrahepatic cholestasis of pregnancy, and other cholestatic disorders. Evidence-based management follows a stepwise approach, with cholestyramine recommended as first-line therapy, followed by rifampicin, opioid antagonists, and sertraline in refractory cases. Emerging therapies, including ileal bile acid transporter (IBAT) inhibitors such as maralixibat and odevixibat, have demonstrated promising efficacy, particularly in patients with treatment-resistant disease. Advanced interventions, including plasmapheresis, molecular adsorbent recirculating system (MARS) therapy, and liver transplantation, may be considered for severe refractory cases. Conclusion Cholestatic pruritus is a complex and burdensome manifestation of cholestatic liver disease with a multifactorial pathophysiology. Recent advances in understanding the autotaxin–LPA pathway have provided important insights into disease mechanisms and therapeutic targets. A structured, evidence-based treatment strategy can substantially improve symptom control and quality of life, while emerging targeted therapies offer promising options for patients with refractory disease.

Introduction: Osteoarthritis of the knee is one of the most common degenerative joint disorders and a major cause of pain, disability, and reduced quality of life among the elderly population. As the disease progresses, patients experience severe pain, stiffness, deformity, and functional limitations that significantly impair daily activities. Total knee arthroplasty (TKA) has emerged as the gold standard treatment for end-stage osteoarthritis, providing effective pain relief and restoration of knee function. Aim: To evaluate the clinical and functional outcomes of total knee arthroplasty in patients with osteoarthritis of the knee. Methods: A prospective observational study was conducted in the Department of Orthopaedics at a tertiary care teaching hospital in Jaipur, Rajasthan. A total of 30 patients with advanced osteoarthritis of the knee who underwent total knee arthroplasty were included in the study. Demographic characteristics, clinical findings, operative details, functional outcomes, and postoperative complications were evaluated. Functional assessment was performed using the Knee Society Score (KSS), while pain severity was assessed using the Visual Analog Scale (VAS). Statistical analysis was carried out using appropriate tests, and a p-value of less than 0.05 was considered statistically significant. Results: The majority of patients belonged to the 60–69 years age group, and females constituted 60.0% of the study population. The mean Knee Society Score improved significantly from 42.6 ± 9.8 preoperatively to 86.9 ± 7.4 postoperatively (p < 0.001). The mean Visual Analog Scale score decreased from 8.1 ± 1.1 preoperatively to 2.3 ± 0.8 postoperatively (p < 0.001). Mean knee flexion improved from 82.5° ± 13.4° to 118.6° ± 10.2° following surgery. Excellent functional outcomes were observed in 53.3% of patients, while 26.7% achieved good outcomes. Overall, 80.0% of patients demonstrated excellent-to-good functional recovery. Postoperative complications were minimal, with 86.7% of patients experiencing no complications. Conclusion: Total knee arthroplasty is a safe, effective, and reliable treatment modality for advanced osteoarthritis of the knee. It provides significant pain relief, substantial improvement in knee function and range of motion, enhanced mobility, and improved quality of life with a low incidence of complications. The procedure remains the treatment of choice for patients with end-stage osteoarthritis who have failed conservative management.

Introduction: Inguinal Hernia repair one of the most common procedures performed in general surgery worldwide, and around 1 million procedures are performed each year worldwide. The gold standard for inguinal hernia repair for decades has been tension-free Lichtenstein technique (LT). Our study will give us the latest and updated statistics about the comparison of ilioinguinal neurectomy vs ilioinguinal nerve preservation in the groin pain after mesh repair for inguinal hernia. The results of this study will be shared with other local surgeons and recommendations will be given in light of this study results. Objective: To compare the degree of postoperative pain after ilioinguinal neurectomy with ilioinguinal nerve preservation during open mesh repair for inguinal hernia. Methodology: In this study a total of 58 patients in each group were observed. Complete history was taken from all patients followed by physical examination and routine pre-operative baseline investigations. All patients were randomly allocated in two groups Patients in group A were subjected to ilioinguinal neurectomy while patients in group B were subjected to ilioinguinal nerve preservation. Post operatively all patients were kept under observations for 2 days in ward and were discharged when stable. Postoperatively all patients were followed at regular intervals and at the end of 1^st post- operative month, intensity of pain was measured on visual analogue scale VAS. Score from 0-3 was considered as effective pain relief and form 4-10 was considered as in-effective pain relief. Any patients who lost to follow up were excluded from the study. Results: In our study, mean age in Group A was 33 years with SD ± 11.78 while mean age in Group B was 35 years with SD ± 12.91. In Group A, 88% patients were male and 12% patients were female. Where as in Group B, 90% patients were male and 10% patients were female. In Group A (ilioinguinal neurectomy) patients VAS was 0-3 in 90% of patients whereas in Group B patients (ilioinguinal nerve preservation) VAS was 0-3 in 73%. Conclusion: The study concluded that ilioinguinal neurectomyis more effective in terms of relieving post-operative pain after one month compared to ilioinguinal nerve preservation in open mesh repair procedure for inguinal hernia.

Introduction: ROP (retinopathy of prematurity) in premature infants has higher and significant association with low birth weight and lesser gestational age at birth. Anaemia in these infants is also known to have association with the high risk of ROP. Aim: The present study was aimed to comparatively assess the incidence of retinopathy in anaemic and non-anaemic subjects in India to assess the role of anaemia in retinopathy. Methods: The present study assessed 200 premature babies with consecutive birth at the Institute within the defined study period with the gestational age at birth <34 weeks or birth weight <200 grams were assessed to study the retinopathy of prematurity. The incidence of ROP was also assessed in neonates with anaemia and non-anaemic babies. Results: Among 200 subjects, 48 babies had ROP and rest 152 babies had zone 3A vascularized retina. Most common stage was stage 2 in 24 babies, stage 1 in 10 subjects, stage 3 in 8 subjects, and stage 4 in 2 babies. APROP (Aggressive Posterior ROP) was seen in 4 babies. Stage 5 was not seen in any study subject. In 48 babies with ROP, 25% (n=12) subjects needed treatment and 75% (n=36) babies had spontaneous regression. Among 32 babies, 50% (n=16) subjects had ROP. In remaining 168 babies without anaemia, 19% (n=32) babies had ROP. Among 200 study subjects, 22 had received blood transfusion where 54.5% (n=12) had ROP. In remaining 178 babies that did not get blood transfusion, 20.2% (n=36) babies had ROP. Conclusion: The present study concludes that anaemia is a vital risk factor that affects the incidence of ROP. Anaemia must be hence, managed and avoided in premature babies for management of retinopathy of prematurity.

Introduction: Sacrococcygeal pilonidal sinus disease (SPSD) is a chronic and recurrent disease with many surgical treatment options, but no universally approved standard approach. The procedure remains contentious because to the variable outcomes of recurrence, infection and wound healing. Objective To examine the clinical results of different surgical methods especially flap surgeries in the management of sacrococcygeal pilonidal sinus illness. Methodology This descriptive prospective study was undertaken at a tertiary care institution for a period of 12 years from January 2013 to December 2024. The study comprised 160 individuals aged between 16 and 35 years presenting with SPSD. The surgical techniques included Limberg flap, excision only, excision with primary closure and Karydakis operation. The results were compared in terms of surgical time, wound healing, hospital stay, postoperative infection and recurrence rates. SPSS version 20 was used for data analysis. Results Of 160 patients, 146 (91.25%) were men and 14 (8.75%) were girls. The Limberg flap was used in 83 patients (51.87%) and had the greatest results with the lowest rate of recurrence (6.02%), shortest hospital stay (mean 3.17 days) and fastest wound healing. Only excision had greater recurrence (38.33%) and extended healing time. Excision with primary closure and Karydakis operation had higher infection rates (58.33% and 60%) and recurrence rates (66.67% and 60%) respectively. Conclusion Flap based treatments especially the Limberg flap have shown to be more beneficial in the management of SPSD with reduced recurrence rates, faster healing and shorter hospital stay. It is the indicated preferable surgical procedure for improved clinical outcome.

Background: Elderly patients admitted under Internal Medicine are at increased risk of short-term adverse outcomes. Frailty index and handgrip strength are simple bedside measures reflecting physiological reserve, but their combined prognostic value in routine clinical settings remains uncertain.

Aim: To evaluate the prognostic value of frailty index and handgrip strength in predicting 90-day outcomes in elderly patients admitted under Internal Medicine.

Methods: This prospective cohort study included 60 patients aged ≥60 years admitted to a tertiary care hospital in Maharashtra, India. Frailty index (based on cumulative deficit model) and handgrip strength were assessed within 48 hours of admission. Patients were followed for 90 days to assess mortality, readmission, and functional decline. A composite adverse outcome was defined as the occurrence of any of these events. Multivariable logistic regression analysis was performed to identify independent predictors.

Results: The mean age was 69.9 ± 7.5 years, and 55.0% were male. Frailty (frailty index ≥0.25) was present in 70.0% of patients, and low handgrip strength in 46.7%. At 90 days, mortality was 20.0%, readmission 46.7%, functional decline 30.0%, and composite adverse outcome 73.3%. Although adverse outcomes were more frequent among frail patients, the association was not statistically significant (p = 0.529). Similarly, outcomes were comparable between low and normal handgrip groups (p = 0.778). In multivariable analysis, neither frailty index (OR 1.34, 95% CI 0.73–2.68, p = 0.316) nor handgrip strength (OR 1.00, 95% CI 0.92–1.16, p = 0.632) independently predicted adverse outcomes.

Conclusion: Frailty and reduced handgrip strength were common among elderly medical inpatients and were associated with a high burden of adverse 90-day outcomes. Although not independent predictors in this cohort, both measures remain clinically useful indicators of vulnerability. Larger studies are needed to establish their independent prognostic significance.

Objective: To assess the efficacy of giving IV paracetamol as a pre-emptive analgesic before surgery in decreasing post-operative pain and the need for analgesics in patients undergoing laparoscopic cholecystectomy. Methods: This is a randomized controlled study carried out for 6 months in the Department of Surgery of a tertiary care center. Adult patients (age 18-65 years) who were scheduled for elective laparoscopic cholecystectomy under general anesthesia were enrolled. The participants were randomly divided in two groups. Group A was given IV Paracetamol 1 g about 30 minutes prior to induction of anesthesia, while Group B received a placebo (normal saline). Visual Analog Scale (VAS) was used to measure postoperative pain at predetermined time points after surgery. The total amount of postoperative analgesics consumed, the time to the first analgesic of rescue and adverse events were documented and compared between the groups. Results: We conclude that patients receiving IV paracetamol before surgery had significantly reduced pain scores up to the 24th postoperative hour compared to the control group. The time to first rescue analgesia was significantly longer for Group A, and there was a significant decrease in the need for supplementary analgesics. No serious drug-related adverse effects were seen, and there were no significant differences in the hemodynamic stability or postoperative recovery between both groups. Conclusion: The use of IV Paracetamol as a pre-emptive analgesia for laparoscopic cholecystectomy is effective. It markedly decreases the intensity of postoperative pain, increases the time to first rescue analgesia, and decreases the consumption of postoperative analgesics but does not increase adverse effects.

Introduction: Aging is often associated with loneliness, depression, anxiety, reduced self-esteem, and decreased quality of life. Older adults residing in old age homes may experience social isolation and emotional distress due to separation from family and familiar environments. Reminiscence therapy, a non-pharmacological intervention involving the recall and sharing of past life experiences, has emerged as an effective strategy for enhancing psychological well-being among the elderly. Objectives: To assess the effectiveness of reminiscence therapy on psychological well-being and quality of life among older adults residing in old age homes. Methods: A quasi-experimental study was conducted among 60 older adults residing in selected old age homes. Participants were divided into an experimental group (n=30) and a control group (n=30). Baseline assessment of psychological well-being and quality of life was carried out using standardized assessment tools. The experimental group received structured reminiscence therapy sessions twice weekly for six weeks, while the control group received routine care. Post-intervention assessments were conducted at the end of the sixth week. Data were analysed using descriptive and inferential statistics. Results: The findings revealed that the mean psychological well-being score of participants in the experimental group significantly improved from 48.2 ± 8.6 during the pre-test to 71.4 ± 7.2 during the post-test. Similarly, the mean quality of life score increased from 52.8 ± 9.1 to 76.5 ± 8.4 following the intervention. Statistical analysis demonstrated a significant difference between pre-test and post-test scores in the experimental group (p < 0.001), whereas no significant changes were observed in the control group. The study also found a significant association between psychological well-being and quality of life among older adults. Conclusion: Reminiscence therapy is an effective, low-cost, and non-pharmacological intervention for improving psychological well-being and quality of life among elderly residents of old age homes. The integration of reminiscence therapy into routine geriatric nursing care may contribute to healthy aging and enhanced emotional health among older adults

This community-based cross-sectional study investigated Peshawar people' attitudes of traffic noise as a cardiovascular risk factor. A total of 384 respondents, chosen via stratified random sampling, completed a validated questionnaire given to them in person. Descriptive statistics, chi-square tests, and t-tests were employed to evaluate demographic data and awareness levels. Bloom's cut-off criterion revealed that overall awareness was shockingly low, with only 1% of respondents displaying "good" knowledge, 18.8% having "neutral" knowledge, and 80.2% having "poor" knowledge. Residents in low-traffic areas demonstrated higher levels of awareness than those in high-traffic zones (50.8% vs. 42.1%, p < 0.001). High-traffic populations were at a significantly higher risk of cardiovascular morbidity (28.6% reported hypertension or heart disease vs. 10.4% in low-traffic zones, p < 0.001). These findings show a large knowledge gap about noise-related cardiovascular risks, especially among the most exposed individuals. The study underlines the urgent need for targeted public health campaigns, the integration of environmental health into cardiovascular preventative strategies, and stricter noise control policies to eliminate this underestimated but manageable risk factor in urban Pakistan.

BACKGROUND: Leading cause of mortality in diabetes mellitus is cardiovascular diseases (CVD). It is more severe, complex and results in higher complication rates than in non-diabetics. Coronary artery calcium on CT is a well established marker of the total burden of coronary atherosclerosis. The objective of this study is to assess the Calcium Scoring by Agatston Scoring (AS) in MDCT in diabetics and non–diabetics and to compare the severity between them. METHODS: 50 Patients referred to the Department of Radio-Diagnosis, Sri Chamundeshwari Medical College Hospital  and research institute channapatna, were examined with SIEMENS SOMATOM PERSPECTIVE 128-MDCT scanner. The AS in LM, LCX, LCA and RCA was assessed and total AS was calculated. The total AS was categorized into no, mild, moderate, severe and extensive calcification. The number of vessels involved, number of lesions in each vessel and total AS was compared between the diabetics and non-diabetics.

RESULTS: In our study, most patients 42% were in the age bracket of 51-60 years. Most patients were males (86%) and rest were females (14%).  Most common pattern of vessel involvement in non-diabetics is single vessel and in diabetics was double and triple vessel. Diabetics had significantly more number of lesions in LAD, LCX and RCA when compared to the non-diabetics. The mean number of lesions in diabetics (14.20 ± 16.09) was higher than in non-diabetics (3.92 ± 3.96), (p value- 0.004). The total AS of diabetics was more than the non-diabetics (420.97 ± 713 vs 55.08 ± 97.67, p value- 0.018).  INTERPRETATION AND CONCLUSION: Diabetics had more extensive level of vessel involvement and more number of lesions in LAD, LCX and RCA than non-diabetics CAC by AS was significantly higher in diabetic than non -diabetics.

Introduction: Magnetic Resonance Urography (MRU) is a non-invasive imaging modality that provides excellent anatomical visualization of the urinary tract without ionizing radiation or iodinated contrast media. It is particularly useful in evaluating obstructive uropathy, especially in pediatric patients, pregnant women, and individuals with contraindications to conventional urographic studies. Aim: To evaluate the role of Magnetic Resonance Urography in the assessment of dilated urinary tract disorders and to determine its ability to identify the level, degree, and cause of urinary tract obstruction.  Materials and Methods: A descriptive study was conducted in the Department of Radio Diagnosis, Sri Chamundeshwari Medical College Hospital and Research Institute, Channapatna, from September 2024 to June 2026. Thirty-five patients with clinical and/or radiological evidence of obstructive uropathy were included. MR urography was performed using a 1.5 Tesla MRI scanner, and findings were analyzed with respect to the etiology, level, and severity of urinary tract dilatation. Results: Among the 35 patients studied, hydronephrosis was more commonly unilateral (80%), with a male predominance (M:F = 1.9:1). The most common presenting symptom was abdominal pain (54.28%). Calculus disease was the most frequent cause of unilateral hydronephrosis (34.18%), while ureteric stricture was the leading cause of bilateral hydronephrosis (37.71%). MRU successfully demonstrated the level and cause of obstruction in almost all cases, including calculi, pelvi-ureteric junction obstruction, ureteric strictures, bladder tumors, diverticula, ureterocele, megaureter, ectopic malrotated kidney, and uterine prolapse-related obstruction. Only one case showed no detectable cause on MRU and was later attributed to post-calculus residual dilatation. Conclusion: MRU using heavily T2-weighted sequences is highly accurate in determining the level, degree, and cause of urinary tract obstruction without radiation exposure or intravenous contrast administration. It is a valuable, non-invasive imaging modality for evaluating dilated urinary tract disorders and is particularly advantageous in pediatric patients, pregnant women, patients with contrast allergy, and those with impaired renal function. MRU has the potential to become an important alternative to conventional radiological investigations in the future.

Background: The human eye is a structurally intricate and physiologically dynamic organ composed of specialized components such as the cornea, retina, and optic nerve, all of which are essential for visual function. The maintenance of vision depends on tightly regulated cellular organization, physiological homeostasis, and biochemical signaling. Disruption of these processes due to degenerative diseases, trauma, or congenital defects often results in irreversible vision loss. Stem cell-based therapy has emerged as a promising regenerative strategy, aiming not only to restore damaged ocular structures but also to re-establish physiological function and biochemical balance.Objective: To analyze and integrate existing scientific evidence on the role of stem cells in ocular disorders, emphasizing their anatomical, physiological, and biochemical effects in ocular regeneration and functional recoveryMethodology: This review synthesizes current literature on the therapeutic role of stem cells in ocular diseases, with a focused integration of anatomical structures, physiological mechanisms, and biochemical pathways. Various stem cell types including embryonic stem cells, induced pluripotent stem cells (iPSCs), and adult stem cells such as limbal stem cells and mesenchymal stem cells were evaluated in terms of their regenerative capacity, functional integration, and molecular effects within ocular tissues.Results: From an anatomical perspective, stem cells demonstrate the ability to differentiate into key ocular cell types, including photoreceptors, retinal pigment epithelial (RPE) cells, and corneal epithelial cells, thereby contributing to structural restoration. Physiologically, transplanted stem cells support restoration of visual function by improving cellular communication, synaptic connectivity, and tissue homeostasis, while also enhancing neuroprotection and vascular stability.Biochemically, stem cells exert therapeutic effects through multiple mechanisms, including paracrine signaling and secretion of bioactive molecules such as vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and neurotrophic factors. These factors regulate critical pathways involved in cell survival, proliferation, and differentiation. Stem cells also modulate oxidative stress, reduce apoptosis, regulate inflammatory cytokines, and improve mitochondrial function and cellular metabolism. Furthermore, they play a significant role in angiogenesis regulation and extracellular matrix remodeling, which are essential for tissue repair in conditions such as age-related macular degeneration, diabetic retinopathy, and limbal stem cell deficiency.Conclusion: Stem cell therapy represents a transformative and multidisciplinary approach in ophthalmology, linking anatomical regeneration, physiological restoration, and biochemical modulation. While preclinical and clinical studies show encouraging outcomes, challenges such as immune compatibility, risk of tumorigenesis, ethical considerations, and lack of standardized protocols must be addressed. Future advancements should focus on targeted delivery systems, deeper understanding of molecular signaling pathways, and long-term safety to enable effective clinical translation of stem cell-based therapies in ocular diseases.

Introduction: Stress is an unavoidable part of daily life that causes people to face unpleasant conditions that activates various local and systemic physiological pathways, such as brain networks and hormone systems. Many dietary changes are used to mitigate its effects on the human body. The current study aims to determine and correlate serum levels of cortisol and betatrophin in rats fed on conventional lab diet, probiotics, and Synbiotic while subjected to the stressors of immobilisation and fasting. A randomised control trial was conducted at IIMC and NIH. A total of 50 male Sprague Dawley rats were chosen and divided into four experimental groups B1, B2, B3, and B4 (10 rats each). They were subjected to the stressors of immobilisation (2 hours/5 days/10 weeks) and fasting (10 hours/5 days/10 weeks), with Group B1 subjected to an extra 2 hours of fasting. Standard lab food was given to groups B1 and B2. Standard lab diet with Probiotics was provided to Group B3 and Standard lab diet with Synbiotic was given to Group B4. Blood samples were obtained at weeks 0, 4, and 10 to determine serum cortisol and betatrophin levels. The data was reported as Mean± S.D, with p≤0.05 was considered significant. After a 10-week trial, Group B4 had significantly lower serum levels of cortisol and betatrophin than the other groups. In this group, there was also a positive correlation between serum cortisol and betatrophin. The findings revealed that synbiotics played a major effect in improving cortisol and betatrophin levels in stressed rats.

Introduction: Polycystic ovary syndrome is a common endocrine disorder among reproductive-age women and is strongly associated with metabolic abnormalities including obesity, insulin resistance, and diabetes mellitus. Objective: To determine the frequency of polycystic ovary syndrome with diabetes mellitus and obesity among reproductive-age women presenting to tertiary care hospitals in Pakistan. Methods: This cross-sectional analytical study was conducted at Tertiary Care Hospital in Islamabad from March 2024 to September 2025, including 375 reproductive-age women presenting with reproductive or endocrine-related complaints. Results: The mean age of participants was 28.9 ± 6.4 years, with mean BMI of 29.7 ± 5.8 kg/m². Confirmed PCOS was identified in 156 (41.6%) women, diabetes mellitus in 88 (23.5%), and obesity in 171 (45.6%). PCOS with diabetes was present in 61 (16.3%), PCOS with obesity in 103 (27.5%), and combined PCOS with both diabetes and obesity in 47 (12.5%) participants. Women with PCOS had significantly higher BMI (32.1 ± 5.4 vs. 28.0 ± 4.9 kg/m²; p<0.001), greater waist circumference (98.3 ± 10.4 vs. 88.2 ± 9.7 cm; p<0.001), and higher diabetes prevalence (39.1% vs. 12.3%). Menstrual irregularity was the strongest predictor of PCOS (aOR 5.84; p<0.001), followed by obesity (aOR 4.68), hirsutism (aOR 4.11), and diabetes mellitus (aOR 3.92). Conclusion: PCOS is highly prevalent among symptomatic reproductive-age women in tertiary care settings and shows strong association with obesity and diabetes mellitus, highlighting the importance of integrated endocrine-metabolic screening..

Background: Fear of childbirth (FOC) is also a major psychological issue for pregnant women and can negatively influence their health, childbirth experience and request for cesarean section (CS). Previous birth experiences, especially traumatic or negative experiences are known as significant factors in maternal fear for upcoming pregnancies. An appreciation of the association between previous birth experiences and fear of childbirth is necessary to develop better counselling and obstetric practice. Objective: To find out the effect of previous birth experience on maternal fear of childbirth among pregnant women admitted in tertiary care hospitals in Karachi. Material and Methods: The cross sectional study was done in two multi-centers namely Creek General Hospital and SESSI Landhi Hospital, Karachi. Pregnant women who visited antenatal clinics during the study period and had 2 or more previous births were included in the study. A structured questionnaire consisting of demographic data, obstetric history, previous birth experience and fear of childbirth assessment was used for data collection. Previous birth experience was classified as positive or negative according to mother's perception of labor and delivery, pain, communication with health care staff or obstetric complications. A validated fear assessment scale was used to assess maternal fear of childbirth. SPSS version 26 was used to analyses the data. Categorical variables were presented as frequency and percentages and continuous variables as mean and standard deviation. Association of previous birth experience with fear of childbirth was analyzed and a p value of ≤0.05 was considered statistically significant. Results: The total number of pregnant women included in the study were 200. The average age of the participants was 28.6 ± 4.9 years. Of the participants, 42% had a negative previous birth experience and 58% had positive previous birth experiences. 46.5% of women had moderate or great fear of childbirth. For those women having a negative previous birth experience, the mean score for fear of childbirth was significantly higher than women with positive previous birth experience (68.1% vs. 30.2%, p < p<0.001). Previous cesarean section, long labor, insufficient pain management, and communication issues with healthcare providers were all factors that were significantly associated with an increased fear. Conclusion: Previous negative birth experiences are highly correlated with greater fear of childbirth for a mother in subsequent births. However, early identification of women who have had traumatic or suboptimal previous deliveries and provision of psychological support, effective counselling and respectful maternity care may help to decrease fear of childbirth and improve maternity outcomes.

Introduction: The 5-factor modified frailty index (mFI-5) is a validated, easily calculable preoperative risk stratification tool. However, its utility in predicting postoperative morbidity following total knee arthroplasty (TKA) in the Indian population remains understudied. Methods: A retrospective analysis of 99 consecutive patients who underwent primary TKA at Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, between January 2023 and January 2026 was conducted. The mFI-5 was calculated using five variables: diabetes mellitus, hypertension, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and functional dependence. Patients were stratified as non-frail (mFI 0–1), moderately frail (mFI 2), or severely frail (mFI ≥3). Primary outcomes included postoperative complications, ICU admission, 30-day readmission, and 30-day mortality. Secondary outcomes included length of hospital stay (LOS) and 3-month Knee Society Score (KSS).

Results: Mean age was 64.7 ± 7.6 years; 58.6% were female. mFI-5 scores ranged from 0 to 4: 56 patients (56.6%) were non-frail, 35 (35.4%) moderately frail, and 8 (8.1%) severely frail. Postoperative complications occurred in 0%, 11.4%, and 62.5% of non-frail, moderately frail, and severely frail patients respectively (p<0.001). ICU admission rates were 7.1%, 22.9%, and 37.5% (p=0.023). Thirty-day readmission rates were 0%, 11.4%, and 62.5% (p<0.001). Frail patients (mFI ≥2) had a 4.47-fold higher odds of ICU admission compared to non-frail patients. Mean LOS was significantly longer with increasing frailty (5.5 vs 6.1 vs 8.6 days; p<0.001). No 30-day mortality was recorded. Functional outcomes at 3 months did not differ significantly between groups (p=0.136).

Conclusion: The mFI-5 is a simple, effective preoperative tool for predicting postoperative morbidity, ICU admission, and 30-day readmission following TKA. Increasing frailty is associated with significantly higher complication rates and prolonged hospital stay. Routine preoperative mFI-5 assessment should be integrated into TKA surgical planning, particularly in resource-limited settings

Introduction: COVID‑19 has imposed an unprecedented global burden, with millions of deaths worldwide. Emerging evidence suggests that pre‑existing comorbidities may influence disease severity and prognosis, yet findings remain heterogeneous across populations. Understanding the independent impact of specific comorbidities is essential for risk stratification and clinical management.

Aim: To evaluate the prognosis of COVID‑19 in patients with exclusive comorbidities—type 2 diabetes mellitus, hypertension, or autoimmune disease—and to compare outcomes with patients without comorbidities. Methods: A retrospective comparative study was conducted at Bowring and Lady Curzon Hospital, Bengaluru, between October 2020 and February 2022. Case records of 224 COVID‑19‑positive patients aged 18–60 years were reviewed. Patients were categorized into five groups: diabetes mellitus, hypertension, autoimmune disease, HIV/AIDS, and non‑comorbid controls. Clinical outcomes, including mortality and duration of hospital stay, were analyzed using chi‑square and z‑tests, with p < 0.05 considered statistically significant. Results: Of the 224 patients, 79 had no comorbidities, 80 had diabetes mellitus, 60 had hypertension, 5 had autoimmune disease, and 5 had HIV/AIDS. Mortality was significantly higher in diabetic patients compared to controls (60 % vs 12.5 %, p = 0.0003). Hypertension (25 %), autoimmune disease (40 %), and HIV/AIDS (40 %) groups showed numerically increased mortality but without statistical significance (p = 0.06, p = 0.09, and p = 0.11, respectively). Mean hospital stay did not differ significantly across groups. Conclusion: Type 2 diabetes mellitus was associated with significantly poorer outcomes in COVID‑19 patients, while hypertension and autoimmune disease demonstrated more heterogeneous associations. These findings underscore the importance of comorbidity‑specific risk stratification and highlight the need for larger, multicentric studies to clarify the independent contributions of other comorbidities.

Introduction: Hypertension is the most prevalent modifiable cardiovascular risk factor among older adults and a major contributor to cerebrovascular disease. Poor blood pressure control is strongly associated with stroke and cognitive decline, yet the extent of neurological benefit derived from effective hypertension management in the elderly remains underexplored in routine clinical settings. Objectives: To assess the impact of hypertension management on neurological health outcomes, including stroke and cognitive impairment, among adults aged 60 years and above. Methods:
This observational analytical study was conducted over 12 months at a tertiary care teaching hospital and included 220 hypertensive adults aged ≥60 years. Participants were categorized into controlled and uncontrolled hypertension groups based on average blood pressure readings (<130/80 mmHg). Neurological outcomes assessed included history of stroke, cognitive function, and overall neurological morbidity. Cognitive status was evaluated using standardized screening tools. Multivariable logistic regression was performed to determine independent associations after adjusting for relevant confounders. Results:
Among the participants, 56.4% had controlled hypertension. Overall neurological morbidity was significantly lower in the controlled hypertension group compared to the uncontrolled group (19.4% vs. 39.6%, p < 0.001). Stroke prevalence was significantly reduced among participants with controlled blood pressure (11.3% vs. 25.0%, p = 0.006). Cognitive impairment was observed in 24.2% of the controlled group compared to 45.8% of the uncontrolled group (p = 0.002). Uncontrolled hypertension independently predicted neurological morbidity (adjusted OR 2.31; 95% CI: 1.34–3.98), stroke (adjusted OR 2.08; 95% CI: 1.12–3.87), and cognitive impairment (adjusted OR 1.89; 95% CI: 1.10–3.25). High medication adherence was associated with improved blood pressure control and significantly lower neurological morbidity. Conclusion:
Effective hypertension management is strongly associated with reduced risk of stroke, cognitive impairment, and overall neurological morbidity in older adults. Sustained blood pressure control and optimal medication adherence play a crucial role in preserving neurological health and preventing cerebrovascular events in aging populations.

This study looks into factors that predict heavy menstrual bleeding (HMB) in women taking letrozole and clomiphene citrate (CC) to induce ovulation. The quality of life of patients is impacted by HMB, a serious side effect of modern fertility treatments. Finding clinical, genetic, and demographic characteristics linked to HMB was the goal of the study.This study was conducted in Fatima Hospital, Baqai Medical University Karachi from January 2025 till june  2025  .Two hundred women between the ages of 18 and 40 participated in the observational comparative design. We gathered information on genetic variants (CYP19A1), age, BMI, and baseline hormone levels. The findings showed that compared to letrozole (18%), clomiphene was linked to a greater incidence of HMB (63%). Higher BMI, certain genetic variants, and greater baseline estrogen were found to be significant predictors of HMB using logistic regression. A safer profile was demonstrated by letrozole, particularly in PCOS patients. The results emphasize the necessity of customized ovulation induction procedures to maximize therapeutic benefits and minimize adverse consequences. To improve fertility treatment even further, future research should include lifestyle changes and genetic testing.

Background: Chronic pruritus is common in elderly patients and may arise from dermatological, systemic, drug-related, neuropathic, psychogenic, or idiopathic causes. This study assessed its prevalence, etiological factors, and clinical burden among elderly patients at a tertiary care centre. Methods: This prospective observational study included 300 patients aged ≥60 years from 1 August 2025 to 1 May 2026. Chronic pruritus was defined as itching lasting more than six weeks. Clinical features, comorbidities, etiological factors, pruritus severity, sleep disturbance, and Dermatology Life Quality Index scores were assessed. Results: Chronic pruritus was present in 128 patients, with a prevalence of 42.7% (95% CI 37.2%–48.3%). Most cases had generalized pruritus (62.5%), moderate-to-severe intensity (87.5%), nocturnal predominance (53.9%), and sleep disturbance (45.3%). Dermatological causes were most common (37.5%), followed by systemic (21.9%), mixed (16.4%), idiopathic (11.7%), drug-related (5.5%), neuropathic (3.9%), and psychogenic causes (3.1%). Xerosis was present in 62.5% of chronic pruritus cases. On multivariable analysis, increasing age, xerosis, polypharmacy, diabetes mellitus, and chronic kidney disease were independently associated with chronic pruritus. Pruritus severity was strongly associated with higher DLQI scores, sleep disturbance, and large/very large quality-of-life impairment. Conclusion: Chronic pruritus was highly prevalent among elderly patients and was mainly associated with xerosis, chronic kidney disease, diabetes mellitus, polypharmacy, and increasing age. Its strong impact on sleep and quality of life supports structured evaluation and targeted management.

Background: Patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) undergoing cardiothoracic surgery face elevated risks of prolonged mechanical ventilation (PMV). However, the comparative impact of these phenotypes and their independent predictors remain poorly characterized. This systematic review and meta-analysis aims to synthesize evidence on PMV predictors specifically in COPD and ILD populations Methods: We systematically searched PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception through January 2026. Observational studies and randomized controlled trials reporting PMV predictors (>24 hours ventilation) in adult patients with COPD or ILD undergoing cardiothoracic surgery were included. Two independent reviewers extracted data and assessed study quality using the Newcastle-Ottawa Scale. Random-effects meta-analysis pooled odds ratios (OR) for identified predictors. Results: Of 3,847 citations screened, 47 studies met inclusion criteria (n=28,459 patients): 38 studies (n=19,234) on COPD, 6 studies (n=3,892) on ILD, and 3 studies (n=5,333) comparing both phenotypes. The pooled PMV rate was 32.1% (95% CI 28.4-36.0%) in COPD and 41.8% (95% CI 36.2-47.6%) in ILD patients.

Independent predictors of PMV in COPD: COPD severity (GOLD III-IV: OR 2.45, 95% CI 2.01-2.99, I²=42%), age >70 years (OR 1.78, 95% CI 1.54-2.06, I²=31%), cardiopulmonary bypass time >120 min (OR 2.31, 95% CI 1.95-2.74, I²=38%), FEV₁ <50% predicted (OR 2.12, 95% CI 1.76-2.55, I²=47%), and preoperative oxygen use (OR 1.58, 95% CI 1.32-1.89, I²=28%). Independent predictors of PMV in ILD: Cardiopulmonary bypass time >120 min (OR 2.67, 95% CI 2.14-3.33, I²=25%), age >70 years (OR 2.12, 95% CI 1.68-2.67, I²=19%), preoperative oxygen dependency (OR 2.45, 95% CI 1.98-3.03, I²=22%), and DLCO <40% predicted (OR 2.28, 95% CI 1.74-2.99, I²=31%). ILD vs COPD: ILD patients had significantly higher PMV risk (OR 1.68, 95% CI 1.42-1.99, I²=34%, p<0.001). Conclusions: COPD and ILD are both strong independent predictors of PMV after cardiothoracic surgery, with ILD conferring significantly higher risk. Phenotype-specific predictors include COPD severity and FEV₁ for COPD, and oxygen dependency and DLCO for ILD. These findings support tailored perioperative risk stratification and management strategies based on lung disease phenotype.

Introduction: Depression and perceived stress are common but frequently under-recognized mental health concerns among elderly individuals. Community-level assessment is essential for identifying vulnerable older adults and planning early supportive interventions. Objectives: To estimate the prevalence of depression and perceived stress among elderly individuals in a community setting and to assess the relationship between depression, perceived stress and selected socio-demographic and clinical variables. Methods: This community-based cross-sectional study was conducted among 100 elderly individuals aged 60 years and above from the Sangareddy population between November 2025 and March 2026. Socio-demographic details, living arrangement, marital status, education and chronic illness history were recorded using a structured proforma. Depression was assessed using the Geriatric Depression Scale and perceived stress was assessed using the Perceived Stress Scale. Data were analysed using descriptive statistics and chi-square test, with statistical significance considered at p < 0.05. Results: The mean age of the study population was 70.4 ± 7.1 years, and females constituted 52.0%. Depressive symptoms were present in 46.0% of participants. Mild depression was observed in 28.0%, moderate depression in 14.0% and severe depression in 4.0%. Moderate perceived stress was reported by 52.0%, while 25.0% had high perceived stress. Depression was significantly associated with advanced age, living alone, widowed/single/separated status, chronic illness and higher perceived stress. Conclusion: Depression and perceived stress were common among elderly individuals in this community setting. Screening older adults for psychological distress, especially those living alone or having chronic illness, can strengthen early identification and community-based mental health support.

Introduction: Steatotic liver disease (SLD) is a recently adopted umbrella term encompassing a spectrum of disorders characterized by hepatic steatosis. The new nomenclature replaces the traditional non-alcoholic fatty liver disease (NAFLD) framework and emphasizes the central role of metabolic dysfunction in disease pathogenesis. Aim: To evaluate the clinical profile of patients with steatotic liver disease and assess the distribution of cardiometabolic risk factors across various etiological categories. Methods: A prospective observational study was conducted in the Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India. Two hundred consecutive patients diagnosed with steatotic liver disease on ultrasonography were enrolled over one year. Clinical characteristics, anthropometric measurements, biochemical parameters, imaging findings, and etiological classification were analyzed. Results: The mean age of the study population was 49.84 ± 15.45 years. Males constituted 52.5% of patients. Significant alcohol intake was reported in 26.5% of participants. BMI ≥23 kg/m² was observed in 76.0% of patients. Diabetes mellitus, hypertension, and dyslipidaemia were each present in 28.0% of cases. Hypertriglyceridaemia and low HDL cholesterol were observed in 59.5% and 67.0% of patients, respectively. MASLD was the predominant etiology (70.0%), followed by MetALD (16.0%), alcohol-related liver disease (9.5%), specific-etiology SLD (2.5%), and cryptogenic SLD (2.0%). Among MASLD patients, 21.4% fulfilled criteria for metabolic dysfunction-associated steatohepatitis (MASH). Conclusion: MASLD is the predominant form of steatotic liver disease in North Indian patients and demonstrates a strong association with obesity, dysglycaemia, hypertension, and dyslipidaemia. The contemporary SLD nomenclature effectively captures metabolic–alcohol overlap and provides a clinically meaningful framework for disease characterization.

Introduction: Transfusion of blood and blood components is always associated with a potential risk.Transfusion reaction means any transfusion related adverse event that occurs during or after the transfusion of whole blood, blood components, or human derived plasma products.Knowledge about various types of adverse transfusion reactions will help not only in their early identification and management but also in taking adequate measures to prevent the same. Aim&Objectives To study the frequency of adverse transfusion reactions of blood and blood components and to know the most common type of blood and blood components implicated in transfusion reaction. Materials and Methods: This  hospital based descriptive study was undertaken in the Department of Transfusion medicine, Government General Hospital and Medical College, Kadapa Andhra Pradesh, India over a period of one year i.e., from January 2023 to December 2023. Results: During 1 year study period, a total of 7498 blood and blood components were issued.The total number of transfusion reactions occurred were 48. In our study the frequency of transfusion reactions was found to be 0.20%. FNHTR(62.5%) is the most common type of transfusion reaction noted .Maximum reactions were seen in females (68.8%) and   occurred in the age group of 21-40 years (39.6%). Conclusion: Proper monitoring and knowledge of the signs and  symptoms of the ATRs help in the early identification of these reactions and hence timely management  and reporting.  It is the joint responsibility of the blood transfusion  consultant and their clinical counterpart to create awareness about safe transfusion services so that proper hemovigilance system can be achieved to  provide patient care. This study is an effort toward this direction.

Introduction: Elderly residents of long-term care facilities (LTCFs) experience high exposure to broad-spectrum antimicrobials, frequent hospital transitions, and prolonged shared accommodation — conditions that favour the acquisition and dissemination of multidrug-resistant organisms (MDROs). Robust pooled estimates of colonization burden are essential to inform infection prevention and control (IPC) policy in geriatric care. We synthesised the global evidence on the prevalence of MDRO colonization and its independent risk factors among LTCF residents. Methods: We performed a systematic review and meta-analysis in accordance with the PRISMA 2020 statement (PROSPERO: CRD42024456782). PubMed, Embase, Web of Science and Scopus were searched from inception to 31 December 2024 for observational studies reporting point prevalence of MDRO colonization (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], extended-spectrum β-lactamase-producing Enterobacterales [ESBL-E], carbapenem-resistant Enterobacterales [CRE], multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, and Clostridioides difficile) among residents aged ≥65 years in LTCFs. Two reviewers independently performed selection, data extraction, and risk-of-bias appraisal using the Joanna Briggs Institute (JBI) checklist for prevalence studies. Pooled prevalence estimates were obtained using random-effects meta-analysis with the DerSimonian–Laird estimator after Freeman–Tukey double-arcsine transformation. Heterogeneity was quantified with the I² statistic and explored through pre-specified subgroup analyses and random-effects meta-regression. Publication bias was assessed visually (funnel plot) and statistically (Egger’s regression). Independent risk factors were summarised as pooled adjusted odds ratios (aORs). Results: Of 3,280 records identified, 42 studies were eligible for qualitative synthesis and 38 (n = 22,167 residents across 24 countries) for meta-analysis. The pooled prevalence of any MDRO colonization was 38.7% (95% confidence interval [CI]: 34.2–43.4%; I² = 87.1%). ESBL-producing Escherichia coli (28.7%, 95% CI: 24.1–33.7%) and MRSA (21.4%, 95% CI: 17.8–25.4%) were the predominant pathogens. Prevalence varied significantly by region (Asia 46.1% vs Europe 31.8%; P < 0.001) and by facility income setting (low- and middle-income countries 50.8% vs high-income countries 33.6%; P < 0.001). Independent predictors of colonization were prior antibiotic exposure within 90 days (aOR 3.42, 95% CI: 2.67–4.39), presence of indwelling devices (aOR 2.81, 95% CI: 2.18–3.62), recent hospitalisation (aOR 2.46, 95% CI: 1.94–3.12), functional dependency (Barthel ≤40; aOR 1.92, 95% CI: 1.51–2.44) and prolonged LTCF stay > 12 months (aOR 1.74, 95% CI: 1.38–2.19). Egger’s test showed no evidence of small-study effects (P = 0.143). Conclusions: Approximately two in five LTCF residents harbour an MDRO, with a disproportionately high burden in low- and middle-income settings. Antimicrobial stewardship, device-care bundles, and structured post-discharge screening should be prioritised as cornerstones of IPC in geriatric long-term care.

Background: Atrial fibrillation (AF) is the most prevalent persistent cardiac arrhythmia and is closely linked to a heightened risk of thromboembolic stroke. The left atrial appendage (LAA) is acknowledged as the main location for thrombus development in non-valvular AF. Nevertheless, traditional clinical risk assessment tools like the CHA₂DS₂-VASc score fail to fully consider anatomical differences in the LAA that could affect stroke risk. Objective: This study aimed to evaluate various left atrial appendage shapes (chicken wing, cactus, windsock, and cauliflower) concerning thromboembolic risk and to ascertain if non-chicken wing shapes are linked to greater thromboembolic risk than the chicken wing type. Methodology: This analytical cross-sectional study took place at the Department of Cardiology, Mayo Hospital Lahore, between January 2025 and January 2026. Two hundred patients with non-valvular atrial fibrillation were recruited via consecutive sampling. The morphology of the LAA was evaluated through transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) and categorized into four types. Thromboembolic risk was assessed through the CHA₂DS₂-VASc score, detection of left atrial appendage thrombus, spontaneous echo contrast, and previous occurrences of ischemic stroke or transient ischemic attack. Data were examined with SPSS version 26, and statistical significance was assessed using the Chi-square test, ANOVA, and multivariate logistic regression analysis. Result: The predominant LAA shape was chicken wing (40%), followed by windsock (30%), cactus (18%), and cauliflower (12%). Morphologies other than chicken wings exhibited notably elevated rates of left atrial appendage thrombus (p < 0.001), spontaneous echo contrast, and previous stroke/TIA. Cauliflower shape exhibited the greatest thrombus occurrence (33%), next was cactus (22%), followed by windsock (15%), and chicken wing (8%). In the multivariate analysis, cauliflower (OR: 2.9) and cactus structure (OR: 2.1) were distinct predictors of thromboembolic incidents. Conclusion: The morphology of the left atrial appendage is greatly linked to thromboembolic risk in individuals with atrial.

Interface dermatitis is a common yet aetiologically heterogeneous reaction pattern in routine dermatopathology. This was a retrospective case series of eight histopathologically confirmed cases diagnosed between 2025 and 2026 at a tertiary care centre in Kerala with notable clinical and microscopic variation. Three presented with a lichenoid interface pattern (lichen planus, lichen planus pigmentosus, lichenoid drug eruption); three had vacuolar changes (discoid lupus erythematosus, dermatomyositis and fixed drug eruption); and two showed mixed patterns (erythema multiforme and pityriasis lichenoides et varioliformis acuta). In our study, drug triggers were confirmed in four cases; notably, one was associated with Sjögren syndrome and erythema multiforme, illustrating the diversity of autoimmune and iatrogenic causes. Histological overlap in these cases creates diagnostic hurdles, particularly where advanced testing is unavailable. This series highlights the value of meticulous clinicopathological correlation, targeted special stains, and thorough medication histories to ensure accurate diagnosis and optimal patient management in routine practice.

Introduction: Head and neck squamous cell carcinoma (HNSCC) represents a major oncological burden in Eastern India. Concurrent chemoradiotherapy (CCRT) with cisplatin is the standard of care for locally advanced HNSCC, but it is associated with severe toxicities. Malnutrition is highly prevalent in these patients and may exacerbate treatment toxicities, leading to poor compliance. This study aimed to evaluate the impact of baseline nutritional status, assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), on treatment-related toxicities and therapeutic compliance in HNSCC patients undergoing CCRT. Methods A prospective observational study was conducted at a regional cancer center in Cuttack, India, involving 160 adult patients with stage III–IV locally advanced HNSCC undergoing definitive CCRT. Baseline nutritional status was classified into SGA-A (well-nourished), SGA-B (moderately malnourished), and SGA-C (severely malnourished). Treatment toxicities were graded using the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Compliance was measured by chemotherapy dose reductions (>= 25%), radiotherapy interruptions (> 7 days), and emergency hospitalizations. Results Of the 160 enrolled patients, 30.0% (n = 48) were well-nourished (SGA-A), 45.0% (n = 72) were moderately malnourished (SGA-B), and 25.0% (n = 40) were severely malnourished (SGA-C), yielding a baseline malnutrition prevalence of 70.0%. Malnourished patients (SGA-B/C) experienced significantly higher rates of severe (Grade >= 3) oral mucositis (39.3% vs. 16.7%; p = 0.004), Grade >= 3 radiation dermatitis (28.6% vs. 12.5%; p = 0.03), and weight loss >= 10% during treatment (51.8% vs. 10.4%; p < 0.001) compared to well-nourished patients. Malnutrition was also strongly associated with treatment non-compliance, including radiotherapy interruptions > 7 days (33.9% vs. 10.4%; p = 0.002), chemotherapy dose reductions (26.8% vs. 8.3%; p = 0.01), and toxicity-related hospitalizations (30.4% vs. 12.5%; p = 0.02). Multivariable logistic regression identified malnutrition (SGA-B/C) as a powerful independent predictor of severe overall toxicity (adjusted OR: 3.84; 95% CI: 1.72–8.56; p = 0.001). A strong positive correlation was observed between percentage weight loss during treatment and total treatment interruptions (r = 0.64; p < 0.001). Conclusion Baseline malnutrition is highly prevalent in HNSCC patients in Odisha and serves as an independent predictor of severe chemoradiotherapy-induced toxicities and treatment interruptions. Early nutritional assessment using the PG-SGA, combined with proactive enteral support, is essential to minimize toxicities and preserve relative dose intensity in resource-constrained oncology frameworks.