Background: Amblyopia, commonly referred to as lazy eye, is among the most prevalent yet reversible causes of unilateral visual impairment in the paediatric age group globally and within Pakistan. Occlusion therapy, most commonly delivered through adhesive patching of the better-seeing eye, remains the cornerstone of treatment. However, sustained compliance with prescribed patching regimens is a well-documented challenge, particularly in resource-constrained, low-literacy settings such as Khyber Pakhtunkhwa (KPK). Objective: To determine the rate of compliance with patching therapy among amblyopic children attending the Ophthalmology Department of Hayatabad Medical Complex (HMC), Peshawar, and to identify the barriers that impede adherence to the prescribed regimen. Methodology: A cross-sectional, observational study was conducted from January 2026 to March 2026 at the Outpatient Ophthalmology Department, HMC, Peshawar. Using non-probability consecutive sampling, 150 children aged 3–14 years diagnosed with amblyopia and prescribed patching therapy for a minimum of eight weeks were enrolled. Data were gathered through structured, face-to-face interviewer-administered questionnaires completed with caregivers. Compliance was defined by three objectively measured criteria: daily patching duration meeting the prescribed target, consistency across seven days per week, and attendance at all scheduled follow-up visits. Descriptive statistics, chi-square tests, and binary logistic regression were employed for analysis using SPSS version 22. Results: Overall compliance with all three criteria was achieved in only 41 patients (27.3%). The most frequently cited barriers were child resistance and distress during patching (65.3%), caregiver unawareness of the long-term consequences of untreated amblyopia (56.0%), financial constraints covering patch costs and transportation (52.7%), skin irritation from adhesive patches (48.0%), and maternal illiteracy (45.3%). On binary logistic regression, child resistance (OR 3.86, 95% CI 1.89–7.88), caregiver unawareness (OR 3.10, 95% CI 1.54–6.24), and financial constraints (OR 2.77, 95% CI 1.39–5.52) emerged as the strongest independent predictors of non-compliance. Compliance rates were significantly lower among rural residents and children of mothers with no formal education (p < 0.01).

Conclusion: Non-compliance with patching therapy is a major clinical challenge in Peshawar, with a majority of children failing to meet the prescribed treatment criteria. Behavioural, socioeconomic, and literacy-related barriers, rather than clinical factors alone, drive non-adherence. Targeted caregiver education programmes, subsidised patching supplies, and the integration of community health worker support into follow-up protocols are urgently needed to improve visual outcomes in this vulnerable population.

Introduction: Empyema thoracis is a very prevalent and severe sequelae of pneumonia in children, and understanding when Surgical intervention is warranted when medical management fails to achieve adequate pleural drainage. Objective: To compare the results of open (thoracotomy and decortication) and video-assisted thoracoscopic (VATS) surgeries for the treatment of paediatric empyema. Methods: This was a comparative observational study performed in the Departments of Paediatric Surgery of Tertiary Care Hospitals in Pakistan in 6 months study period from September 2025 to February 2026. 90 children were enrolled who had empyema thoracis (Stage II/III) requiring surgery and were then allocated to the Open Surgery Group (n = 46) and the VATS Group (n = 44) according to the surgical preference of the operator and theatre availability. Data were collected, such as operative time, intraoperative blood loss, duration of chest tube, length of hospital stay, pain score, and complication rate differences between the groups were analyzed by SPSS version 26.0. Independent samples t-test for continuous variables and Chi-square test were used for categorical variables and p-values < 0.05 were deemed statistically significant. Results: The VATS group had significantly shorter operative time (89.5 ± 16.2 vs. 98.4 ± 18.6 minutes, p = 0.038), less intraoperative blood loss (28.6 ± 9.4 vs. 62.3 ± 15.2 mL, p < 0.001), shorter chest tube duration (5.2 ± 1.6 vs. 8.6 ± 2.1 days, p < 0.001), shorter hospital stay (7.8 ± 2.0 vs. 12.4 ± 3.2 days, p < 0.001), lower postoperative pain scores (3.8 ± 1.1 vs. 6.2 ± 1.4, p < 0.001), and a lower complication rate (13.6% vs. 28.3%, p = 0.041) compared with the open surgery group. Four cases (9.1%) of VATS had to be converted into open thoracotomy. Conclusion: VATS was related to better peri-operative and post-operative outcomes than open surgery for children with empyema, and is recommended as the surgical strategy of choice where the necessary skills and equipment are available.

Introduction: Neonatal hypoglycemia is one of the more common and potentially serious complications which may follow infants born to diabetic mothers and is due to fetal hyperinsulinemia in response to the mother's chronic hyperglycemia. Objective: To determine whether hypoglycaemia occurs with any frequency in newborns of diabetic mothers and whether there are any relationships between lack of blood sugar and glycemic control, the mode of delivery and the birth characteristics of the newborns. Methods: Multi-center prospective, observational study for six months (from August 2025 to January 2026) was performed in Neonatology and Pediatrics departments of Tertiary Care Hospitals in Pakistan. A total of 210 consecutively born babies were included in the further study period, for whom the mothers had previous or gestational diabetes mellitus. Capillary blood glucose was assessed at 1, 2, 4 and 24 hours after births and the presence of hypoglycemia was diagnosed as the presence of blood glucose below 40mg/dl in the first 24 hours after birth. Maternal and neonatal information has been documented and analyzed on SPSS version 26.0. Comparisons among categorical variables were performed as chi square test and the Continuous variables were shown as mean, standard deviation and p < 0.05 was considered as statistically significant. Results: Of the 210 infants, 57 (27.1%) were hypoglycaemic with the most common being the 1 hour screen (18.6%) and it was sequential until 24 hours where prevalence was 3.3%. Neonates of mothers with poor glycemic control, macrosomias, cesarean delivery, and with pre-existing diabetes as compared to those with GD had significantly higher incidence of hypoglycaemia (48.1% vs. 14.0%, p < 0.001, 51.0% vs. 19.5%, p < 0.001, 33.3% vs. 19.8%, p = 0.023 and 39.6% vs. 23.5%, p = 0.031, respectively). Conclusion: Hypoglycaemia is an all too frequent and largely avoidable complication of GDM particularly if glycemic control is poor. The critical importance of routine protocol based serial glucose testing is affirmed as glucose is only identified and managed as per routine, within the first few hours of life  is essential as glucose can be detected and appropriate action taken, especially in settings with limited resources in tertiary care.

Background: The BODE index — a composite of body mass index (B), degree of airflow obstruction (O), dyspnoea (D) and exercise capacity (E) — outperforms FEV1 alone in predicting mortality and exacerbation risk in chronic obstructive pulmonary disease (COPD). Because COPD is now understood as a systemic inflammatory disorder, it has been proposed that a circulating inflammatory marker such as C-reactive protein (CRP) may track this multidimensional measure of disease severity. Whether CRP relates to the composite index, to its individual domains, or to both remains unsettled. Objectives: To correlate serum C-reactive protein with the BODE index and with each of its four components — body mass index, mMRC dyspnoea grade, six-minute walk distance and post-bronchodilator FEV1 — in patients with COPD.

Materials and Methods: A descriptive cross-sectional hospital-based study was conducted over 18 months (January 2021 to June 2022) in the Department of General Medicine, Rajarajeswari Medical College and Hospital, Bengaluru. Fifty patients aged over 40 years with spirometrically confirmed COPD were enrolled by purposive sampling after Institutional Ethics Committee clearance and written informed consent. Anthropometry, post-bronchodilator spirometry to ATS/ERS standards, mMRC dyspnoea grading and a six-minute walk test conducted per American Thoracic Society guidelines in a 50-metre corridor were performed on every participant, and the BODE index was computed from these four variables. Fasting resting venous samples were assayed for serum CRP by latex agglutination. Pearson's correlation was applied in SPSS v26.0 with significance at p<0.05. Results: Fifty patients (45 male, 90%) of mean age 65.56 ± 9.69 years were studied. Mean body mass index was 19.2 ± 4.0 kg/m², with 20 patients (40%) underweight. All participants had mMRC grade 3 (37 patients, 74%) or grade 4 (13 patients, 26%) dyspnoea, mean grade 3.26 ± 0.44. Mean six-minute walk distance was 266.42 ± 57.48 m and mean BODE score was 6.32 ± 1.23; 30 patients (60%) scored 5–6 and 18 (36%) scored 7–10. Mean serum CRP was 4.50 ± 2.40 mg/L. CRP correlated significantly and positively with the composite BODE index (r = 0.303, p = 0.032), but showed no significant correlation with body mass index (r = –0.003, p = 0.981), mMRC grade (r = –0.037, p = 0.797) or six-minute walk distance (r = –0.069, p = 0.632). Conclusion: Serum CRP correlates with the composite BODE index but not with its individual components taken separately. This suggests that systemic inflammation in COPD is reflected in the aggregate multidimensional severity of disease rather than in any single physiological, anthropometric or symptomatic domain, and supports the use of composite indices over isolated variables when relating inflammatory biomarkers to disease burden.

OBJECTIVE: The purpose of this study was to determine the association of specific fungal species with the various histopathological features observed, such as tissue reaction pattern, angioinvasion, and necrosis, in patients with IPM. MATERIALS AND METHODS: This was a retrospective cross-sectional analytical study carried out in multiple tertiary care institute from January 2021 to December 2025. Patients with confirmed IPM, established by histopathology and confirmed by culture or molecular means were included in the analysis. H&E, Grocott's Methenamine Silver (GMS) and Periodic Acid-Schiff (PAS) staining of tissue sections were performed. Two blinded pathologists graded the histopathological characteristics. Chi-square tests, Fisher's exact tests and multivariate logistic regression were used for statistical analysis.  RESULTS: There were 342 patients in the study. Aspergillus species (n=180) were the most frequent whereas only 45 were other hyaline molds, 22 were dematiaceous fungi and 95 were Mucorales. There was a significant difference between the rate of extensive coagulative necrosis (p<0.001) and severe angioinvasion (p=0.003) between the mucorales and Aspergillus. Multivariate analysis showed that the presence of aseptate hyphae with right-angle branching and the presence of massive tissue necrosis were independent risk factors for Mucorales infection (p<0.05).  CONCLUSION: In IPM there are specific fungal species which have different histopathological characteristics. The understanding of these morphological and tissue-reaction patterns enables the pathologist to give important and timely clues which can assist in the early empiric use of an antifungal drug before the microbiological confirmation is made.

Objective: To synthesize evidence linking metabolic dysfunction and weight management with infertility and pregnancy outcomes in polyendocrine metabolic ovarian syndrome (PMOS) while retaining polycystic ovary syndrome (PCOS) terminology for established diagnostic evidence. Study design: Systematic review of guidelines, systematic reviews, randomized trials and observational studies. Place and duration of the study: Global evidence indexed to 30 April 2026 was reviewed between 1 January and 30 April 2026.Methodology: MEDLINE/PubMed was searched for PMOS or PCOS combined with metabolic dysfunction, infertility, ovulation, pregnancy and reproductive outcomes. Adult human studies reporting metabolic, fertility or obstetric outcomes were prioritized. Published values were synthesized without recalculation because populations, interventions and outcome measures were heterogeneous. Results: The search identified 12,659 records and 35 focused publications informed the synthesis. A meta-analysis of 104 studies and 106,690 pregnancies found higher odds of miscarriage (OR 1.49, 95% CI 1.20-1.85), gestational diabetes (OR 2.41, 95% CI 1.95-2.99), gestational hypertension (OR 2.20, 95% CI 1.82-2.67), pre-eclampsia (OR 2.30, 95% CI 1.88-2.82) and cesarean delivery (OR 1.23, 95% CI 1.06-1.43). Letrozole improved live birth compared with selective estrogen receptor modulators (OR 1.72, 95% CI 1.40-2.11). Bariatric surgery produced 2.5 times more spontaneous ovulations than medical care (95% CI 1.5-4.2, p<0.0007).Conclusion: The PMOS framing emphasizes that reproductive dysfunction, metabolic risk and weight management require integrated care although the validated evidence base remains indexed as PCOS. Metabolic assessment, individualized weight management, preconception optimization, evidence-based ovulation induction and enhanced antenatal surveillance are central to improving reproductive outcomes.

Background: The prevalence of mental and behavioural disorders rises with advancing age owing to senile changes in the brain, deteriorating physical health, disability, loneliness, loss of family support, restricted personal autonomy and financial dependence. Institutionalized elderly are considered particularly vulnerable, yet data from rural old age homes in India are scarce. Aim: To study the pattern of psychiatric morbidity among elderly persons residing in a rural old age home. Materials and Methods: A cross-sectional study was conducted among 60 consenting residents aged 60 years and above of an old age home at Hosakote, Bengaluru Rural. A semi-structured proforma, the Mini International Neuropsychiatric Interview-Plus (MINI-Plus), the Mini Mental State Examination (MMSE) and ICD-10 diagnostic criteria were used. Data were analysed with SPSS version 22; the Chi-square test was applied with p < 0.05 considered significant. Results: Psychiatric morbidity was present in 45 (75%) residents. Depressive disorder was the most common diagnosis (24; 40%), followed by dementia (5; 8.3%), adjustment disorder (5; 8.3%), generalized anxiety disorder (3; 5%), dysthymia (3; 5%), insomnia (2; 3.3%), and one case (1.7%) each of schizophrenia, delusional disorder and intellectual disability. Severe cognitive impairment on MMSE was seen in 5 (8.3%). No sociodemographic variable showed a statistically significant association with screener positivity. Conclusion: Three-fourths of residents of the rural old age home had a diagnosable psychiatric disorder, predominantly depression, dementia and adjustment disorder. Routine mental health screening and early intervention in old age homes are essential.

Introduction: Aim: To evaluate and compare the diagnostic accuracy of ultrasound elastography and dynamic contrast-enhanced magnetic resonance mammography in predicting malignancy in suspicious breast masses categorized as BI-RADS III and above, using histopathology as the reference standard. Materials and Methods: This observational study was conducted in the Department of Radiodiagnosis, Government Medical College, Srinagar, over 18 months. Fifty female patients aged ≥25 years with breast masses categorized as BI-RADS III and above on conventional ultrasonography were included. All patients underwent strain elastography with Tsukuba elasticity scoring and DCE-MRI with time-intensity curve analysis. Histopathological examination served as the gold standard. Diagnostic performance indices including sensitivity, specificity, and accuracy were calculated. Results: The majority of patients belonged to the 31–40 years (32%) and 41–50 years (30%) age groups. Histopathology revealed 26 malignant (52%) and 24 benign (48%) lesions. Fibroadenoma was the most common benign lesion (26%), while invasive ductal carcinoma was the most frequent malignancy (22%). A significant association was observed between Tsukuba score and histopathology (χ² = 23.5, p < 0.001), with all lesions having a Tsukuba score of 5 proving malignant. MRI curve patterns also showed significant correlation with histopathology (χ² = 16.8, p < 0.001), with Type III washout curves demonstrating 84.2% malignancy. BI-RADS category was strongly associated with malignancy (χ² = 28.9, p < 0.001); all BI-RADS 5 and 6 lesions were malignant. Diagnostic performance analysis showed that BI-RADS ≥4 achieved sensitivity of 84.6%, specificity of 83.3%, and accuracy of 84.0%. Elastography using Tsukuba score ≥4 demonstrated sensitivity of 69.2%, specificity of 87.5%, and accuracy of 78.0%, while MRI Type III enhancement curves showed sensitivity of 61.5%, specificity of 87.5%, and accuracy of 74.0%. Conclusion: BI-RADS categorization demonstrated the highest overall diagnostic accuracy for predicting breast malignancy. Ultrasound elastography and DCE-MRI showed high specificity and provided valuable complementary functional information. A multiparametric imaging approach integrating BI-RADS assessment, elastographic stiffness evaluation, and MRI enhancement kinetics improves lesion characterization and may reduce unnecessary biopsies while maintaining reliable cancer detection.

Background: Foreign bodies in the ear, nose, and throat (ENT) region are among the most common emergencies encountered in otorhinolaryngology practice, particularly in children. Their presentation varies according to age, anatomical site, and type of foreign body. Delayed diagnosis or inappropriate removal attempts may result in complications ranging from minor mucosal injuries to life-threatening airway obstruction. Understanding the local pattern of ENT foreign bodies is essential for effective management and prevention, especially in rural healthcare settings where epidemiological data are limited. Objectives: To analyze foreign bodies in the ear, nose, and throat with respect to their type, site of lodgement, age and gender distribution, and methods of removal in patients presenting to a rural tertiary care hospital. Methods: A retrospective observational study was conducted in the Department of Otorhinolaryngology of a rural tertiary care teaching hospital. Medical records of 110 patients diagnosed with foreign bodies in the ear, nose, or throat between January 2020 and December 2024 were reviewed. Data regarding demographic characteristics, anatomical site, type and nature of foreign body, method of removal, and complications were collected and analyzed using IBM SPSS Statistics version 26.0. Descriptive statistics and Chi-square tests were used where appropriate, with a p-value of <0.05 considered statistically significant. Results: Among the 110 patients studied, nasal foreign bodies were the most common (56.4%), followed by ear (36.4%) and throat foreign bodies (7.2%). Children younger than five years constituted the largest age group (49.1%). Males were more frequently affected (58.2%) than females (41.8%). Beads (27.3%) and seeds or grains (23.6%) were the most commonly encountered foreign bodies. Inorganic foreign bodies accounted for 61.8% of cases. Most foreign bodies (80.9%) were successfully removed in the outpatient setting, while 10.0% required removal under general anesthesia. Complications were observed in 8.2% of patients and were predominantly minor. Conclusion: ENT foreign bodies predominantly affect young children and are most commonly found in the nose. Most cases can be managed successfully with simple outpatient procedures, with a low rate of complications. Early recognition, timely intervention, and increased parental awareness are essential for preventing morbidity associated with ENT foreign bodies.

Introduction: Anterior cervical discectomy and fusion is the standard surgery for the cervical disc disease as well as myelopathy, but it has certain complications like difficulty in swallowing and breathing Which can lead to aspirarion, pneumonia and later malnutrition. The rate of incidence varies and there are many risk factors including females, approach of surgery,the implant used, the number of levels of surgery.Low profile plates are known to reduce the complications of breathing and swallowing. Perioperative steroid injections are known to reduce inflammation and inturn the swallowing and breathing difficulties.The speech and language therapy is known to help in early rehabilitation. Objective: The study aims to assess the amount of difficulty in breathing and swallowing following the anterior cervical discectomy and fusion using the SWAL-QOL questionnaire. Materials and Methods: A prospective cohort study was conducted in 30 patients of age (18-60 years) with anterior cervical surgeries. The difficulty in breathing was assessed postoperatively and the dysphagia was assessed using the SWAL-QOL questionnaire at 1st week, 3rd week, 6th week, 12th week, 6th month. Results: A total of 60 patients of age 18-60years were registered for study, of which 37 were male and 33 were female. The mean BMI was around 25.The mean duration of surgery was around 85 minutes. 1 patient developed sudden onset of difficulty in breathing and the wound was explored to have seen retropharyngeal hematoma. Conclusion: Difficulty in swallowing is a known complication of Anterior cervical surgery with varying incidence rates but difficulty in breathing is rare complication,but an emergency. Many factors affected the outcome among them females, multilevel surgery are one of them.

Background : Worldwide, degenerative disc disease, lumbar disc herniation, and spinal stenosis are among the most common causes of disability. For many years, individuals who don't respond to conservative treatment have been treated with conventional open spine surgery. Endoscopic spine surgery, on the other hand, strives to achieve similar clinical outcomes while reducing tissue stress, postoperative pain, and recovery time because to advancements in minimally invasive procedures. Making surgical decisions still requires comparing the functional and radiological results of endoscopic and traditional spine surgery.

Objective:  to evaluate the radiological and functional results of endoscopic versus traditional spine surgery in individuals having lumbar spinal operations.

Methodology: Between January 2025 and January 2026, the Department of Orthopedic Surgery at Mayo Hospital Lahore carried out a prospective comparative study. Endoscopic spine surgery (n = 60) and conventional open spine surgery (n = 60) were the two groups of 120 patients with lumbar disc herniation or lumbar spinal stenosis. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain were used to measure functional results. Adequate decompression, spinal alignment preservation, and postoperative complications were among the radiological results. After surgery, patients were monitored for a full year. Result: Pain and disability levels significantly improved for both groups. The endoscopic surgery group, on the other hand, had far lower postoperative pain scores, a shorter hospital stay, an earlier return to work, and less blood loss. The groups' radiological results in terms of spinal alignment and decompression were similar. The endoscopic group experienced fewer complications. Conclusion: When compared to traditional open spine surgery, endoscopic spine surgery offers better short-term functional recovery and similar radiological results. For carefully chosen patients, endoscopic procedures are an efficient substitute due to less tissue damage and quicker recovery.

Background : A complicated orthopedic technique called revision total knee arthroplasty (rTKA) is used when first knee replacement fails. Compared to primary TKA, failure rates are greater and results are still inconsistent despite advancements in surgical methods and implant design. Improving surgical outcomes and patient selection requires the identification of failure and functional recovery predictors. Objective: to assess revision total knee arthroplasty clinical results and pinpoint failure and functional recovery factors.

Methodology: From January 2025 to January 2026, the Department of Orthopedic Surgery at Mayo Hospital Lahore carried out a retrospective cohort research. Included were 110 individuals who had revision complete knee arthroplasty. Range of motion (ROM) and the Knee Society Score (KSS) were used to evaluate functional results. Failure was characterized by the necessity for revision, infection, ongoing instability, or inadequate functional improvement. Multivariate regression was used to find predictors of poor outcome after data were examined using SPSS version 26. Result: The mean KSS improved from 38.5 ± 10.2 preoperatively to 78.4 ± 12.6 postoperatively, indicating a significant increase in functional outcomes. Nevertheless, 22 patients (20.0%) had unsatisfactory results or failed. Periprosthetic joint infection (OR=3.9), obesity (OR=2.6), several previous operations (OR=3.1), and low bone stock (OR=2.8) were predictors of failure. Individuals who did not have these risk factors showed far greater functional recovery and fewer complications. Conclusion: For the majority of patients, revision total knee arthroplasty greatly improves functional results; however, failure is still a significant risk. Obesity, bone loss, infection, and several previous modifications are important indicators of poor results. Improving surgical success requires early detection and optimization of these variables.

Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an ENT crisis requiring on time intervention in order to prevent permanent auditory deficits. While both oral steroid therapy (OST) and intratympanic steroid (ITS) injections are gold standard treatments, their effectiveness in clinical practice is more over compromised due to poor compliance. Objective: This study was done to compare patient compliance rates and clinical outcomes between OST and ITS protocols, also to identify reasons for non-compliance, and to quantify the audiometric "cost" of premature cessation of treatment. Materials and Methods:

It was a retrospective cohort study done with 183 adults (aged 18–60 years) diagnosed with unilateral ISSNHL. Patients were randomly divided into two groups: Group 1 (n=91) received a 14-day tapered course of oral prednisolone, and Group 2 (n=92) received four intratympanic dexamethasone injections over two weeks. Compliance for OST was calculated based on patients taking ≥75% of the prescribed dose, while ITS compliance was calculated based on patients taking completing all four injections. Hearing improvement was measured by Pure Tone Average (PTA) gains at two months follow up. Results: The compliance rate was significantly higher in the ITS group (97.8%) compared to the OST group (83.5%; p < 0.001). Patients on OST demonstrated a "critical debilitating period" around Day 5 (mean 5.1 ± 1.1 days), with premature cessation due to gastrointestinal distress (29%), hyperglycaemia (27%), and insomnia (21.5%). Independent predictors of OST non-compliance were age >60 years and pre-existing diabetes. The compliant OST patients achieved a mean PTA improvement of 23.7 dB, while non-compliant patients achieved only 13.6 dB (p=0.003). However, no statistically significant difference was seen in hearing improvement rates between compliant OST patients and the ITS group (p=0.45).

Conclusion: Patient compliance plays a key role in determining hearing outcomes in ISSNHL. ITS offers an assured delivery model by shifting the administration burden to the doctor. So doctors should give importance to ITS for patients at high risk for systemic steroid toxicity, especially the ones with oldage or patients suffering from diabetes to prevent treatment failure and increase the potential for rescue of cochlear function.

Introduction: Emergency medicine requires early clinical recognition, rapid decision-making, and practical competence in procedures that may directly affect patient survival. The transition from house job to residency is therefore a critical point at which gaps in procedural confidence, clinical knowledge, triage competency, and resuscitation readiness may become clinically important. Objective: This study aimed to compare procedural confidence and clinical knowledge in emergency medicine between House Officers and Residents working in tertiary-care settings and to identify training-related factors associated with clinical readiness. Methods: A comparative cross-sectional design was used. The analysis included 300 participants from Pakistani tertiary-care contexts, comprising 137 House Officers and 163 Residents. Data were collected using a structured questionnaire covering demographic and training characteristics, procedural confidence, clinical knowledge, ACLS readiness, triage competency, perceived curriculum gaps, and overall clinical readiness. Composite Likert-scale scores were analyzed using descriptive statistics, Cronbach's alpha, independent-samples t-tests, chi-square tests, one-way ANOVA, Pearson correlation, and multiple linear regression. Results: Residents demonstrated significantly higher mean scores than House Officers for procedural confidence (3.79 vs. 3.03), clinical knowledge (3.90 vs. 3.09), ACLS readiness (3.92 vs. 3.36), triage competency (3.98 vs. 3.02), and overall clinical readiness (3.84 vs. 3.26), with all group differences statistically significant at p < .001. ACLS certification, formal triage training, simulation training, adequate triage competency, and adequate clinical readiness were also significantly more frequent among Residents. Emergency department exposure was associated with higher competency scores, and the competency index independently predicted clinical readiness in a regression analysis. Conclusion: The findings indicate a substantial gap in emergency medicine competency between House Officers and Residents. Targeted reforms are needed during the house-job period, particularly mandatory ACLS certification, structured triage instruction, supervised emergency rotations, and simulation-based procedural practice. Such interventions may improve junior doctors' clinical readiness and support safer emergency care delivery.

Introduction: Otorhinolaryngological (ENT) disorders are among the most common causes of outpatient consultations worldwide and constitute a significant public health burden, particularly in developing countries. These conditions range from acute infectious and inflammatory diseases to chronic allergic and structural disorders, affecting individuals of all age groups. Understanding the local epidemiological profile of ENT diseases is essential for effective healthcare planning, resource allocation, and the development of preventive and therapeutic strategies. Objective: To determine the epidemiological profile and clinical spectrum of common otorhinolaryngological disorders among patients attending the Department of Otorhinolaryngology at DHQ Hospital Abbottabad. Methodology: A hospital-based descriptive cross-sectional study was conducted in the Department of Otorhinolaryngology, DHQ Hospital Abbottabad, Pakistan, over a six-month period from 1 July 2025 to 31st December 2025. The sample size was calculated using the single population proportion formula, yielding a minimum required sample of 384 participants. A total of 384 consecutive patients of all age groups and both sexes presenting with common ENT disorders were enrolled using a non-probability consecutive sampling technique. Clinical diagnoses were established through detailed history, physical examination, otoscopy, rhinoscopy, laryngoscopy, and relevant audiological, laboratory, and radiological investigations where indicated. Data were analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were summarized as frequencies and percentages. Associations between categorical variables were assessed using the Chi-square test, with a p-value of <0.05 considered statistically significant. Results: A total of 384 patients were included, comprising 214 (55.7%) males and 170 (44.3%) females, with a mean age of 32.6 ± 17.9 years. The 21–30-year age group represented the largest proportion of patients (24.7%), and most participants were from rural areas (60.2%). Ear diseases were the most common category, accounting for 157 (40.9%) cases, followed by nose diseases 105 (27.3%), throat diseases 98 (25.5%), and head and neck disorders 24 (6.3%). The most frequent individual diagnoses were impacted cerumen (16.9%), allergic rhinitis (13.0%), chronic suppurative otitis media (12.0%), acute tonsillitis (8.9%), deviated nasal septum (8.1%), acute otitis media (7.3%), pharyngitis (6.3%), chronic rhinosinusitis (6.2%), and chronic tonsillitis (5.2%). No statistically significant association was observed between gender and the distribution of major ENT disease categories (p > 0.05). Conclusion: Common otorhinolaryngological disorders constitute a substantial healthcare burden among patients attending DHQ Hospital Abbottabad, with ear diseases being the predominant presentation. Infectious, inflammatory, and allergic conditions accounted for the majority of cases, while acute and chronic tonsillitis remained important contributors to throat disorders. Strengthening primary ENT healthcare services, promoting public awareness, and implementing preventive strategies may facilitate early diagnosis, reduce disease burden, and improve patient outcomes.

Background: Thoracolumbar burst fractures pose significant challenges in orthopedic and neurosurgical management. These fractures often require careful consideration of treatment modalities to optimize neurological recovery and minimize complications. Aims and Objectives: To compare the outcomes of conservative and operative treatments for thoracolumbar burst fractures, focusing on neurological recovery, complications, and hospital stay. Materials and Methods: This study included 80 patients, with 40 in the conservative group and 40 in the operative group. Most patients presented with a complete neurological deficit (Frankel Grade A) at admission. Neurological recovery, complication rates, and hospital stay duration were analyzed. Results: Improvement rates from useless to useful motor power were similar in both groups. Neurological recovery was noted in 27% of conservatively treated patients, primarily in those with incomplete lesions, compared to 17% in the operative group. The complication rate was higher in the operative group (20%) than in the conservative group (15%), though not statistically significant. Hospital stay was significantly shorter in the conservative group (5.27 days) compared to the operative group (20.28 days). Conclusion: Conservative treatment offers comparable neurological outcomes to operative treatment, with fewer complications and a significantly reduced hospital stay, particularly in patients with incomplete neurological lesions.

Introduction: To improve treatment outcomes for tubotympanic type chronic otitis media, it is crucial to identify and treat sino-nasal pathologies, as they can affect the treatment outcomes. Objective: the aim of this study was to find out the association of tubotympanic type chronic suppurative otitis media with sino-nasal pathologies. Materials and method: The current prospective observational study was carried out at the ENT department of Saidu Medical College / Saidu Group of Teaching Hospitals, Swat over a period of 6 months from November 2025 to April 2026 after taking approval from the ethical committee of the hospital. For sample collection consecutive on- probability method was used. Individuals of both genders and different age groups (10-60 years) diagnosed with tubotypanic type chronic suppurative otitis media form OPD and the inpatient department were included in this study. The sample size was determined using who calculator.  Patients with chronic suppurative otitis media underwent otoscopic examinations to assess the tympanic membrane and ear discharge. Hearing loss was measured in decibels (dBs) and classified as normal (0-25 dB), mild (26-40 dB), moderate (41-55 dB), moderately severe (56-70 dB), or severe (71-90 dB).  SPSS version 23 was used for data analysis. Quantitative data were presented as mean and standard deviation where’s as qualitative variables were presented as percentages frequencies. Pearson chi-square test was applied to find out the association of CSOM with sino nasal pathologies.  A p value less than 0.05 was considered statistically significant. Results: In this study, a total of 88 individuals with CSOM were enrolled, out of which males were 52(59.1%) and females were 36(40.9%). The mean age of the study population was 26.4 ± 11.7 (range 10- 60 years) years. The majority of participants 70 (79.5%) had unilateral disease, with only 18(20.5%) having bilateral CSOM. The most prevalent sinonasal abnormality was DNS 42(47.7%) followed by Chronic Rhinosinusitis 35(39.8%). Association   between clinical findings of CSOM and the absence or presence of sinonasal pathologies were evaluated by applying   chi-square test.  Individuals with Sino nasal disease were considerably more likely to suffer tympanic membrane perforation compared to individuals without Sino nasal disease (p=0.018). The kind of ear discharge had no meaningful association with the existence of Sino nasal illness. (p = 0.421). Patients with Sino nasal abnormalities were more likely to develop moderate to severe hearing loss than those without Sino nasal issue. (p=0.011).Conclusion: The present study concluded that sinonasal pathologies are most prevalent in individuals with tubotympanic chronic suppurative otitis media. These pathologies are significantly associated with the severity of hearing loss and tympanic membrane perforation.

Background: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and can produce substantial activity limitation despite its benign designation. Canal-specific particle repositioning maneuvers are established treatments, but the temporal relationship between subjective symptom recovery, resolution of positional nystagmus and improvement in dizziness-related handicap requires further characterization. Objective: To evaluate subjective, objective and Dizziness Handicap Inventory (DHI) outcomes following canal-specific particle repositioning maneuvers in patients with single-canal BPPV over six months. Methods: This prospective observational study included 96 patients with single-canal BPPV diagnosed by canal-appropriate positional testing. Posterior canal disease was treated with the Epley maneuver, while lateral canal disease was managed with the recorded canal-specific maneuver. Subjective symptom grades and objective positional-test grades were assessed at baseline, day 4, one month and six months. DHI scores were compared between presentation and six months. Results: The mean age was 43.8 years, and 59 patients (61.5%) were female. Posterior canal involvement occurred in 91 patients (94.8%), with right posterior canal BPPV being most frequent (58.3%). Subjective change was not significant at day 4 (p=0.317) but became significant at one month (p<0.01). Objective severity improved by day 4 (p<0.01), although no patient had yet achieved complete objective resolution. At six months, 60 patients (62.5%) were completely free of subjective giddiness and 62 (64.6%) had complete disappearance of positional nystagmus. Mean DHI decreased from 17.17±9.406 to 4.83±3.597, a 12.34-point (71.9%) reduction (p<0.001). Conclusion: Canal-specific particle repositioning maneuvers were associated with progressive and sustained improvement in symptoms, positional nystagmus and dizziness-related handicap. Early improvement was more readily demonstrable objectively than subjectively, supporting counselling that perceived symptom relief may lag behind improvement in positional findings.

Introduction: Trauma during pregnancy is a major public health concern and remains an important cause of maternal and fetal morbidity and mortality worldwide. Pregnancy-induced physiological adaptations often complicate the clinical assessment of traumatic injuries, while forensic evaluation is essential for identifying the nature, mechanism, and legal implications of trauma. In developing countries such as Pakistan, evidence regarding the combined assessment of risk factors, physiological alterations, forensic findings, infectious complications, and maternal–fetal outcomes following trauma during pregnancy remains scarce. This study aimed to evaluate these factors among pregnant women presenting with traumatic injuries at a tertiary care hospital in Lahore, Pakistan. Methods: A hospital-based cross-sectional study was conducted over a six-month period from January 2025 to June 2025 at a tertiary care hospital in Lahore, Pakistan. Pregnant women presenting with traumatic injuries to the Emergency Department and the Department of Obstetrics and Gynecology were enrolled through consecutive sampling after obtaining informed consent. Data were collected using a structured proforma and hospital medical records. Information regarding sociodemographic characteristics, obstetric history, risk factors, mechanism and type of trauma, physiological parameters, forensic findings, infectious complications, and maternal–fetal outcomes was recorded. Data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 26. Descriptive statistics were used to summarize participant characteristics, while appropriate inferential tests were applied to determine associations between trauma-related factors and adverse maternal–fetal outcomes. A p-value of less than 0.05 was considered statistically significant. Results: The study demonstrated that falls, road traffic accidents, and interpersonal violence were the leading causes of trauma during pregnancy. The majority of injuries were blunt in nature and required careful clinical and forensic evaluation. Frequently observed physiological changes included tachycardia, hypotension, anemia, and alterations in fetal heart rate, reflecting the complex physiological response of pregnancy to traumatic injury. Infectious complications such as wound infections and urinary tract infections were identified in a subset of patients during hospitalization. Maternal complications included antepartum hemorrhage, placental abruption, preterm labor, emergency cesarean section, and intensive care admission, whereas fetal complications included fetal distress, preterm birth, low birth weight, intrauterine fetal demise, stillbirth, and neonatal intensive care unit admission. Delayed presentation to the hospital, severe traumatic injury, advanced gestational age, and associated maternal comorbidities were found to increase the risk of adverse maternal and fetal outcomes. Conclusion: Trauma during pregnancy remains a significant contributor to poor maternal and fetal health outcomes in Pakistan. Early recognition of physiological alterations, prompt multidisciplinary management, comprehensive forensic documentation, and timely obstetric intervention are essential to improve maternal and neonatal survival. Strengthening road safety measures, domestic violence prevention programs, public awareness initiatives, and emergency trauma care services may substantially reduce the burden of pregnancy-related trauma and its associated complications.

Introduction: The decision to remove internal fixation implants after fracture healing remains controversial. Published evidence has largely examined surgeons' practices or clinical outcomes after removal, while patients' knowledge and culturally shaped beliefs before decision-making are less well characterised. This study assessed awareness and perceptions regarding orthopaedic implant removal among post-operative patients attending a tertiary care centre in Mandya, Karnataka. Method: A hospital-based descriptive cross-sectional study was conducted among 62 adults with retained metallic orthopaedic implants. Eligible participants were recruited consecutively from the Orthopaedics outpatient department and interviewed using a pre-tested bilingual semi-structured questionnaire. An eight-item awareness instrument generated a total score from 0 to 8; a score of at least 6 was classified as adequate awareness. Seven perception statements assessed beliefs about retained implants and removal surgery. Categorical data were summarised as frequencies and percentages, continuous variables as mean and standard deviation, and associations with adequate awareness were tested using the chi-square or Fisher exact test, with p<0.05 considered significant. Results: The mean age was 43.0 ± 18.7 years; 49 participants (79.0%) were male and 46 (74.2%) were rural residents. The mean awareness score was 5.19 ± 2.32 of 8 (64.9%); 32 participants (51.6%) had adequate awareness. Although 82.3% knew the purpose of the implant and 71.0% knew that removal required another operation, 56.5% believed removal was mandatory after healing, only 56.5% were aware of removal-related risks, and 51.6% were aware of possible long-term complications of retention. Formal counselling was reported by 61.3%, while 66.1% reported family or community influence. Misconceptions were common: 80.6% believed retained implants cause arthritis or joint damage, 77.4% believed implants can rust or corrode, 61.3% considered retention culturally or religiously unacceptable, and 46.8% would prefer removal even against the surgeon's advice. Adequate awareness was not significantly associated with sex, age group, education, residence, or duration since surgery; age showed a non-significant trend (χ²=4.83, p=0.090). Conclusion: Only about half of the participants demonstrated adequate overall awareness, while clinically important misconceptions and social influences were widespread. Standardised, bilingual and family-inclusive counselling at fracture fixation, discharge and follow-up may improve informed shared decision-making and reduce requests for non-indicated implant removal.

AIM: This study was to compare between two analgesic techniques (epidural infiltration and peri-articular infiltration) in terms of the analgesic effect (using VAS score), early motor activities in early rehabilitation after total knee arthroplasty, the drug efficacy and their safety. BACKGROUND:  Osteoarthritis is the most prevalent chronic joint disease. Among osteoarthritis, knee is the most common joint to be involved. Total knee arthroplasty is now a promising treatment for severe arthritis where as pain management post surgery is a concern. This study was done to compare between two analgesic techniques (epidural infiltration and peri-articular infiltration) in terms of the analgesic effect (using VAS score), early motor activities after total knee arthroplasty and the drug efficacy and safety. OBJECTIVES: 1) To assess the pain control and pain relief postoperatively (first 72 hours after post operative period) using VAS score. 2) To assess the improvement in quadriceps function – capacities to perform a straight leg raise and knee extension. 3) To assess functional outcome-knee range of function METHODOLOGY: This study was done in Kempegowda Institute of Medical Science College and hospital, satisfying all the inclusion and exclusion criteria. In this study epidural infiltration or periarticular cocktail injection were used in total knee arthroplasty patients to assess the pain control and pain relief postoperatively (first 72 hours after postop) using VAS score, to assess the improvement in quadriceps function – capacities to perform a straight leg raise and knee extension and to assess functional outcome-walking distance, knee range of function RESULTS: In this study the average age group was 60 years in both the groups and majority of the subjects were female. Left knee arthroplasty was more common in both the groups. In both the groups the VAS score, functional outcome and knee range of motion  was comparable with p value being less than 0.05. CONCLUSION: Both peri articular cocktail injection and epidural infiltration outcomes are comparable, but we can achieve excellent analgesia in peri articular cocktail injection on first and second day without side effects of epidural infiltration like hypotension, vomiting, constipation, sleep apnea, institution of low molecular heparin and provision of pump.

Background: Diabetic nephropathy (DN) is a significant microvascular complication of diabetes mellitus, contributing to chronic kidney disease (CKD) and cardiovascular risk. Mean platelet volume (MPV) has emerged as a potential biomarker of thrombotic and inflammatory activity.
Objective: To investigate the association between MPV and diabetic nephropathy. Material And Methods: A hospital-based cross-sectional study was conducted among 59 patients with type 2 diabetes mellitus and microalbuminuria. Clinical parameters including MPV, glycemic control indices, renal function markers, and comorbid conditions were assessed.
Results: Mean age was 61.7 ± 8.4 years with a male predominance (64.4%). The mean MPV was 11.1 ± 1.2 fL. Higher MPV values were associated with increased albuminuria, lower GFR, and thrombotic events. There was a positive correlation between MPV and severity of diabetic nephropathy.
Conclusion: Elevated MPV is significantly associated with DN and may serve as an adjunctive marker for disease severity and cardiovascular risk stratification. Routine MPV monitoring could aid in early identification of high-risk patients.

Background: Obesity may modify thyroid function in women with polyendocrine metabolic ovarian syndrome (PMOS; formerly polycystic ovary syndrome). This study compared thyroid parameters and biochemical thyroid dysfunction between obese and non-obese women with PMOS. Methods: A hospital-based comparative cross-sectional study was conducted at District Hospital, Chitradurga, from December 2025 to May 2026. Two hundred women with PMOS were enrolled, including 100 obese and 100 non-obese participants. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) were measured. Associations with body mass index (BMI) and waist circumference were assessed using multivariable regression. Results: Median TSH was higher in obese than non-obese women [2.64 vs 2.21 mIU/L; p<0.001], while mean FT4 was lower [1.23 vs 1.32 ng/dL; p=0.001]. FT3 did not differ significantly. Biochemical thyroid dysfunction was more frequent in obese participants (24% vs 12%; adjusted OR 2.56, 95% CI 1.15–5.71). BMI and waist circumference were positively associated with TSH and inversely associated with FT4. Conclusion: Obesity and central adiposity were independently associated with less favourable thyroid profiles in women with PMOS.

Introduction: Restless Legs Syndrome (RLS), also known as Willis-Ekbom disease, is a neurological sensory-motor disorder where an uncontrollable urge to move the limbs exists alongside unpleasant sensations that are alleviated by activity and exacerbated by periods of rest. It is usually linked with sleep problems, decreased quality of life, and poor day-to-day functioning. Although RLS is considered a common medical condition in neurology, its prevalence in many parts of Pakistan remains largely unknown. Therefore, the present study focused on examining the clinical features, lifestyle habits, sleep problems, and management of RLS in a tertiary referral hospital located in Quetta. Objective: To investigate the clinical features, demographics, and association of Restless Legs Syndrome symptoms, sleep disruption, lifestyle factors, familial history, and treatment efficacy. Methodology: A retrospective observational study was undertaken at the Department of Neurology, Bolan Medical Complex Hospital, Quetta, Pakistan, from January 2023 to December 2024. Data for 519 subjects diagnosed with RLS were collected from the hospital records and analyzed using descriptive statistics, chi-square test of independence, and Spearman rank-order correlation analysis. Results: Among 519 participant, 52.4% were females, and the majority had an age above 60 years (28.1%). Frequently occurring symptoms were found among 42.2% of patients, whereas 40.1% had their symptoms more frequently in the evening. Symptom relief by movement was observed in 87.5% of the respondents, and 59.3% of the patients had bilateral leg involvement. Sleep disturbances were observed in 83.6% of patients, with 53.4% of them sleeping for fewer than 6 hours daily. There was a history of RLS among 56.6% of subjects, and in 49.9% of cases, the patients were physically inactive. Among various aggravating factors, smoking was the most common one in 38.2% of subjects. Significance was found between the following variables: treatment method and its effectiveness, family history and sleep disturbances, physical activity and symptoms, and age and sleep disturbance (p < 0.001). Conclusion: The results suggest that restless legs syndrome (RLS) is a neurologic condition that has an impact on sleep quality, daily activities, stress levels, and limited treatment effectiveness. The role of family history, inactivity, and smoking was found to be of significance when considering the burden of symptoms. Increased awareness, early diagnosis, proper sleep evaluation, and effective management practices are necessary for alleviating the burden of RLS in Pakistan.

Background: Vitamin D deficiency is common during pregnancy and may influence maternal and neonatal outcomes. This study determined the prevalence of first-trimester vitamin D deficiency and evaluated its association with pregnancy outcomes. Methods: A prospective observational cohort study included 200 women with viable singleton pregnancies at <14 weeks’ gestation attending District Hospital, Chitradurga. Serum 25-hydroxyvitamin D [25(OH)D] was measured at enrolment. Deficiency was defined as <20 ng/mL and severe deficiency as <12 ng/mL. Participants were followed until delivery, and maternal and neonatal outcomes were compared according to vitamin D status. Results: Vitamin D deficiency was present in 150 women (75.0%; 95% CI 68.6–80.5), including 48 (24.0%) with severe deficiency. Deficient women had higher body mass index, lower sunlight exposure and less frequent prenatal vitamin D use. Delivery outcomes were available for 192 women. Gestational diabetes, hypertensive disorders, preterm delivery and caesarean delivery were more frequent among deficient women, but differences were not statistically significant. Mean birth weight was lower in the deficient group, while low birth weight, small-for-gestational-age birth and neonatal intensive care admission were numerically more frequent, without significant associations. Conclusion: First-trimester vitamin D deficiency was highly prevalent but was not significantly associated with adverse maternal or neonatal outcomes.

Introduction: Vitamin D is a fat-soluble vitamin which plays a vital role in humans’ body. Its deficiency affects almost half of the population worldwide.

AIM: To assess the vitamin D3 status and identify the associated risk factors influencing vitamin D3 deficiency in patients with Type 2 Diabetes Mellitus. METHODOLOGY: The present study was an observational cross-sectional study conducted in the Department of Medicine, Sardar Patel Medical College and Associated Group of P.B.M. Hospitals, Bikaner, Rajasthan, over a period of six months from 1st October 2023 to 31st March 2024.  RESULT: Vitamin D3 deficiency is highly prevalent in patients with Type 2 Diabetes Mellitus and is significantly associated with age, female gender, urban residence, tobacco use, alcohol consumption, and higher socioeconomic status. Routine screening and timely correction of vitamin D deficiency beneficial in this high-risk population.

CONCLUSION: Vitamin D3 deficiency was observed in 49.33% of patients with Type 2 Diabetes Mellitus, with a mean serum vitamin D3 level of 29.72 ± 14.77 ng/m L. Low vitamin D3 status was significantly associated with urban residence, tobacco chewing, alcohol consumption, higher socioeconomic status, increasing age, and female gender.

Introduction: Recurrent respiratory tract infections (RRIs) are a significant cause of morbidity in children worldwide. The immune system is regulated by vitamin D, and low levels of vitamin D in childhood have been associated with a higher risk of recurrent infection. Knowing about associated risk factors can help to decrease the disease burden and enhance the health outcomes of children .Objective: To assess the prevalence and risk factors for vitamin D deficiency in children with recurrent respiratory tract infections.Methodology: This is a cross-sectional study carried out in a tertiary care hospital in the pediatric department over a period of six months. The children with recurrent respiratory tract infections (RRTI) were recruited by non-probability consecutive sampling from a total of 100 children aged between 1 and 12 years. The data on demographics, nutritional status, sunlight exposure, feeding history, and socio-economic factors were taken on a structured proforma. Blood vitamin D was determined, and the low level (< 20 ng/mL) was diagnosed as vitamin D deficiency. SPSS version 26 was used for analysing the data. Quantitative variables were expressed as Mean ± standard deviation, and the chi-square test was used for associations. A p-value ≤0.05 was considered statistically significant .Results: The 100 children 58% were male and 42% were female, with a mean age of 5.8 ± 2.7 years. Vitamin D deficiency was observed in 68% children. Inadequate sunlight exposure (p=0.002), malnutrition (p=0.01), and lack of vitamin D supplementation during exclusive breastfeeding (p=0.03) showed significant associations with deficiency. Mean serum vitamin D level among deficient children was 14.2 ± 3.8 ng/milk Children with severe infections had significantly lower vitamin D levels compared to those with mild infections (12.9 ± 3.1 vs 18.4 ± 4.2 ng/mL; p=0.001).Conclusion: Childhood vitamin D deficiency is a very common condition in patients suffering from recurrent respiratory tract infections and is also a significant risk factor for poor sun exposure, malnutrition, and low intake of supplements. Early screening and preventive strategies can decrease the severity of infection and enhance the outcomes of children.

Population ageing is increasing the prevalence of frailty, sarcopenia, multimorbidity, cognitive impairment, malnutrition, polypharmacy and functional dependence. In older adults, these conditions rarely act independently; instead, they interact with biological ageing, chronic inflammation, immune dysregulation and social vulnerability to reduce physiological reserve and impair recovery after stressors. This structured narrative review proposes the  Multisystem Vulnerability Cascade  as an integrative precision geriatric care framework linking biological ageing, multisystem reserve erosion, measurable vulnerability, stressor exposure and adverse outcomes. Targeted searches of biomedical databases, guideline repositories and authoritative institutional sources were used to synthesise evidence on ageing biology, frailty, sarcopenia, intrinsic capacity, multimorbidity, medication-related harm, validated geriatric assessment tools, digital health and health-system implementation. The framework describes a chronic and potentially modifiable trajectory in which declining muscular, cognitive, nutritional, immune, cardiovascular and renal reserve increases susceptibility to infection, dehydration, surgery, medication change, falls and social disruption. Resulting cascade events may include delirium, acute kidney injury, immobility, malnutrition, hospitalisation, disability and incomplete functional recovery. Clinical application requires multidomain assessment of frailty, mobility, cognition, nutrition, medication burden, function, social support and recent stressors, followed by targeted interventions such as rehabilitation, nutritional support, medication optimisation, falls and delirium prevention and caregiver assistance. The framework may be particularly relevant to India and other low- and middle-income countries, where rapid ageing and limited specialist capacity require scalable, primary-care-linked approaches. Digital health may support longitudinal monitoring but should remain locally validated, equitable and subordinate to clinical judgement. The cascade is a conceptual framework rather than a new disease entity or validated clinical instrument. Prospective studies are required to determine whether cascade-oriented care improves prediction, recovery and patient-centred outcomes beyond existing geriatric assessments.

Introduction: Newer oral glucose-lowering drugs—particularly sodium–glucose cotransporter-2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and oral glucagon-like peptide-1 receptor agonist (GLP-1RA; oral semaglutide)—are increasingly used beyond glycemic control because of weight, hypoglycemia, and cardiorenal considerations. Materials and Methods: A PRISMA-aligned systematic review and meta-analytic evidence synthesis was designed (2016–2025). Randomized controlled trials (RCTs), cardiovascular outcome trials (CVOTs), and high-quality systematic reviews/meta-analyses comparing newer oral agents with conventional oral drugs (metformin, sulfonylureas [SU], thiazolidinediones [TZD]) were included with following outcomes : HbA1c, weight, hypoglycemia, major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), renal endpoints, and key adverse events. Results: Evidence consistently showed: (i) comparable short-term HbA1c lowering across drug classes, but better long-term glycemic durability for SGLT2i vs SU; (ii) weight neutrality (DPP-4i) or reduction (SGLT2i; oral semaglutide) vs weight gain with SU/TZD; (iii) substantially lower hypoglycemia with newer agents vs SU-based regimens;14 (iv) robust reductions in HHF and progression of kidney disease with SGLT2i vs placebo/standard care; (v) class-specific harms: SGLT2i (genital infections, diabetic ketoacidosis [DKA], volume depletion), and TZD (edema/heart failure, fractures). Conclusion: Compared with conventional oral drugs, newer oral antidiabetic agents provide similar glycemic efficacy with superior safety for hypoglycemia and weight, and SGLT2i offer the strongest cardiorenal protection. Therapy selection should prioritize patient phenotype atherosclerotic cardiovascular disease/ heart failure (HF)/ chronic kidney disease (ASCVD/HF/CKD) risk, hypoglycemia risk, weight goals), consistent with contemporary guidance.

Background: Acute kidney injury (AKI) is a common complication after cardiac arrest and is associated with increased mortality and prolonged intensive care unit (ICU) stay. Early identification of patients at risk remains challenging. Objective: To evaluate the utility of the lactate–creatinine ratio (LCR) at admission as an early predictor of AKI in patients resuscitated after cardiac arrest. Methods: This prospective observational study was conducted in the ICU of a tertiary care hospital. Adult patients (≥18 years) admitted after successful return of spontaneous circulation (ROSC) following cardiac arrest were enrolled. Serum lactate and creatinine levels were measured at ICU admission, and the lactate–creatinine ratio was calculated. Patients were followed for 48–72 hours for development of AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: Among 100 enrolled patients, 38 developed AKI within 72 hours of admission. Patients who developed AKI had significantly higher serum lactate levels (6.8 ± 2.1 vs 4.2 ± 1.5 mmol/L, p<0.01), creatinine levels (1.6 ± 0.4 vs 1.1 ± 0.3 mg/dL, p<0.05), and LCR values (4.25 ± 1.3 vs 2.85 ± 0.9, p<0.001) compared with the non-AKI group. Receiver operating characteristic analysis demonstrated good predictive performance of LCR for AKI with an area under the curve of 0.82. An LCR cutoff value >3.5 showed 78% sensitivity and 75% specificity. Conclusion: Admission LCR is a simple and readily available biomarker that may help identify post-cardiac arrest patients at increased risk of AKI. Early recognition of high-risk patients may support earlier renal monitoring and hemodynamic optimization and improve clinical management.

Background: Subclinical hypothyroidism may worsen the metabolic abnormalities associated with polyendocrine metabolic ovarian syndrome (PMOS), but its relationship with insulin resistance remains uncertain. Objective: To assess the prevalence of persistent subclinical hypothyroidism and its association with insulin resistance in women with PMOS. Methods: This prospective observational study included 200 women aged 18–40 years with PMOS. Clinical, anthropometric, thyroid, glycaemic, lipid and ultrasonographic parameters were evaluated. Persistent subclinical hypothyroidism was defined as repeated thyroid-stimulating hormone elevation with normal free thyroxine. Insulin resistance was defined as HOMA-IR ≥2.5. Results: Persistent subclinical hypothyroidism was present in 34 women (17.0%), while insulin resistance occurred in 101 (50.5%). Insulin resistance was more frequent in women with persistent subclinical hypothyroidism than in those without it (88.2% vs 42.8%; p<0.001). These women also had higher BMI, waist circumference, fasting insulin, HOMA-IR, triglycerides and LDL cholesterol, and lower HDL cholesterol. TSH correlated positively with HOMA-IR (ρ=0.449; p<0.001). Persistent subclinical hypothyroidism independently predicted insulin resistance (adjusted OR 11.23, 95% CI 3.25–38.80). Conclusion: Persistent subclinical hypothyroidism identifies a metabolically high-risk subgroup of women with PMOS.

Background: Selenium may improve glucose metabolism through antioxidant and insulin-sensitising effects. This study evaluated selenium supplementation as an adjunct to standard treatment for gestational diabetes mellitus (GDM). Methods: In this prospective comparative interventional study, 200 women with newly diagnosed GDM at 24–32 weeks’ gestation were assigned to standard treatment alone or standard treatment plus selenium-enriched yeast providing 200 µg elemental selenium daily for six weeks or until delivery. Primary outcomes were changes in fasting plasma glucose, postprandial plasma glucose and glycated haemoglobin (HbA1c). Results: Selenium supplementation produced greater reductions in fasting glucose, postprandial glucose and HbA1c than standard treatment alone. Baseline-adjusted mean differences were −4.4 mg/dL, −4.7 mg/dL and −0.09 percentage points, respectively (all p<0.001). Glycaemic targets were achieved more frequently with selenium (34.0% vs 14.0%), while insulin initiation was lower (23.9% vs 39.3%). Maternal and neonatal outcomes were comparable between groups. Adherence was high, and no selenium toxicity or serious adverse event occurred. Conclusion: Adjunctive selenium supplementation modestly improved glycaemic control and reduced insulin initiation in women with GDM without evident safety concerns. Larger randomized trials are required before routine use can be recommended.

Background: Pre-diabetics are at an increased risk of developing type 2 DM, coronary artery disease and stroke. This was put forward by Barr et al through the Australian Diabetes, Obesity and lifestyle Study which was a population based study of 11247 individuals. Objective: To study lipid profiles and glycemic parameters in obese prediabetic individuals.  Methods: This Cross-Sectional study was done over a period of 18 months from 1st 2022 to 31st January 2024 on 150 patients attending Department of General Medicine at KBN Teaching and General Hospital as both outpatients and inpatients. Duration of the study was 18 Months from 1stMarch 2023 to 1stAugust2024.  Result: Our study investigates lipid profiles and glycemic parameters in obese prediabetic individuals, revealing a high prevalence of abnormalities: 32.7% (49 patients) with abnormal total cholesterol (TC), 37.3% (56 patients) with abnormal very low-density lipoprotein (VLDL), 56.0% (84 patients) with abnormal high-density lipoprotein (HDL), 58.7% (88 patients) with abnormal triglycerides (TG), 56.7% (85 patients) with abnormal low-density lipoprotein (LDL), 64.7% (97 patients) with abnormal fasting blood sugar (FBS), and 90.7% (136 patients) with abnormal HbA1c. All abnormalities were statistically significant (P<0.05 or P<0.001). Conclusion: The study demonstrates a high prevalence of abnormal lipid profiles and elevated blood sugar levels among obese prediabetic patients, with significant implications for cardiovascular and diabetes risk.

Background: Thyroid Eye Disease (TED) is a debilitating autoimmune condition often associated with thyroid dysfunction, leading to significant ocular and orbital morbidity. This extrathyroidal manifestation, along with localized thyroid dermopathy (pretibial myxedema), represents a complex systemic response to autoimmune thyroiditis. While the immunopathogenesis linking TSH-receptor autoantibodies (TRAbs) to orbital inflammation is established, the exact clinical correlation between TED severity, dermatological signs, and definitive surgical thyroid pathology including incidental malignancies remains underexplored. Objective: To systematically evaluate the clinical correlations between the severity of Thyroid Eye Disease, associated dermatological findings, and definitive surgical thyroid pathology in a standardized cohort of patients undergoing thyroidectomy. Methods: This prospective observational study evaluated a standardized cohort of 85 consecutive adult patients undergoing total or subtotal thyroidectomy at a tertiary referral center. Preoperative evaluation included an ophthalmic assessment using the Clinical Activity Score (CAS) and the European Group on Graves' Orbitopathy (EUGOGO) classification guidelines. Comprehensive dermatological mapping and serum autoantibody profiling (including TRAbs) were conducted. Resected thyroid specimens underwent rigorous histopathological processing. Results: The cohort (N=85) consisted predominantly of females (71.8%), with a mean age of 52.4 years. Benign surgical pathology (Graves' disease and Hashimoto's thyroiditis) comprised 62.4% of the cohort, while malignant pathology primarily Papillary Thyroid Carcinoma (PTC) accounted for 37.6%. Active TED (defined as CAS ≥ 3) was documented in 35.3% of patients. Localized thyroid dermopathy was present in 11.8% of the cohort, exclusively in patients with moderate-to-severe or sight-threatening TED. Patients with active GO demonstrated significantly higher levels of TRAb compared to those without ocular involvement. Furthermore, active TED and dermopathy were overwhelmingly concentrated in patients with benign autoimmune surgical pathology compared to those with isolated thyroid malignancies. Conclusion: A profound clinical correlation exists between active TED, pretibial myxedema, and elevated TRAb levels, predominantly tied to benign autoimmune thyroid hyperplasia. While TED can manifest in patients with thyroid malignancies, it is typically driven by co-existing autoimmune thyroiditis. Multidisciplinary management utilizing standardized criteria is essential for optimizing both surgical and ophthalmic outcomes.

Background: Acute pancreatitis is a common gastrointestinal emergency ranging from mild interstitial edematous disease to severe necrotizing pancreatitis with high mortality. Extrapancreatic necrosis (EXPN), spreading along retroperitoneal fascial planes, is increasingly recognized as an independent determinant of severity, organ failure, and outcome, with contrast-enhanced CT and the Modified CT Severity Index serving as key diagnostic tools. However, the independent impact of EXPN site and volume remains incompletely characterized. This study evaluates the role of CT in detecting EXPN and correlates its presence, site, and size with clinical outcomes in patients with acute pancreatitis. Objective: Acute pancreatitis (AP) shows a wide spectrum of severity, and extrapancreatic necrosis (EXPN) is an incompletely characterized determinant of outcome. We evaluated the role of contrast-enhanced computed tomography (CECT) in detecting EXPN and compared the clinical outcomes of patients with and without EXPN, together with the effect of its site and size.

Methods: In this prospective cohort study conducted at a tertiary institute from March 2024 to August 2025, 87 patients with AP diagnosed by the revised Atlanta classification underwent CECT of the abdomen 4-7 days after symptom onset. EXPN presence, anatomical location, and volume (ellipsoid formula) were documented, and the Modified CT Severity Index (MCTSI) was calculated. Outcomes recorded were length of hospital stay, need for intervention, and mortality up to 12 weeks. Data were analysed with t-test, Mann-Whitney U, chi-square, Fisher’s exact, and multivariate logistic regression (p<0.05 significant).

Results: EXPN was identified in 29 of 87 patients (33.3%). The lesser sac (48.3%), anterior pararenal space (37.9%), and mesentery (31.0%) were the commonest sites. Compared with EXPN-absent patients, EXPN-present patients had a longer hospital stay (29.41 ± 13.44 vs 9.31 ± 3.69 days, p<0.001), higher intervention rate (51.7% vs 6.9%, p<0.001), higher 12-week mortality (17.2% vs 1.7%, p=0.015), and a higher MCTSI (7.45 ± 2.77 vs 1.55 ± 1.76, p<0.001). All severe AP occurred in the EXPN group. On multivariate analysis, EXPN (OR 12.66, 95% CI 1.47-109.31, p=0.021) and clinical severity (OR 9.19, 95% CI 1.68-50.38, p=0.011) independently predicted intervention. Conclusion: EXPN is an important independent indicator of adverse outcomes in AP. CECT reliably detects and characterizes it, aiding risk stratification and management.

Background- Bronchial asthma is a chronic inflammatory airway disorder affecting nearly 300 million people worldwide, and emerging evidence supports the "united airway hypothesis," linking upper airway inflammation—particularly chronic rhinosinusitis—to lower airway disease severity. Shared eosinophilic and type 2 inflammatory pathways underlie this connection, with CT imaging and the Modified Lund-Mackay score providing standardized assessment of sinus involvement. This study evaluates the incidence and severity of paranasal sinus abnormalities on CT in patients with bronchial asthma and their correlation with disease outcomes. Objective: To evaluate the incidence of computed tomography (CT) changes in the paranasal sinuses of patients with bronchial asthma and to assess the degree and severity of rhinosinusitis radiologically. Methods: In this hospital-based cross-sectional study, 72 adults (41 men, 31 women; mean age 35.15 ± 6.94 years) with a diagnosis of bronchial asthma confirmed per the Global Initiative for Asthma (GINA) 2022 criteria underwent non-contrast CT of the paranasal sinuses on a 128-slice scanner. Sinus opacification and ostiomeatal complex obstruction were graded using the Modified Lund-Mackay (Lund-Mackay/Zinreich) scoring system (maximum 54). Clinical variables — duration of asthma, frequency of acute exacerbations in the preceding 6 months, and treatment status — were recorded. Associations were tested using the Chi-square or Fisher’s exact test, analysis of variance and correlation analysis, with p<0.05 considered statistically significant. Results: Paranasal sinus abnormalities were detected in 70 of 72 patients (97.22%), with a mean Modified Lund-Mackay score of 25.38 ± 12.88 (range 0–51). Moderate changes predominated (59.72%), followed by mild (27.78%) and severe (9.72%) changes. The right maxillary sinus was most frequently involved (90.28%), while the ethmoid sinuses showed the highest severity scores. Nasal septal deviation (65.28%) and inferior turbinate hypertrophy (59.72%) were the commonest anatomical variations; polyposis was present in 23.61%. The Modified Lund-Mackay score correlated strongly with exacerbation frequency (r=0.813, p=0.042) but not with asthma duration (r=0.109, p=0.938). Patients with polyposis had significantly more exacerbations than those without (6.29 ± 2.47 vs 2.75 ± 2.47, p=0.042). Sinus severity differed significantly across age groups (p=0.002) but not by gender (p=0.963) or treatment status (p=0.746). Conclusion: Paranasal sinus abnormalities are almost universal in bronchial asthma and correlate with exacerbation frequency, supporting the united airway disease concept. CT evaluation of the paranasal sinuses may aid comprehensive asthma management, particularly in patients with frequent exacerbations.

Background- Parkinson's disease (PD) is the second most common neurodegenerative disorder, characterized by alpha-synuclein–mediated dopaminergic neuronal loss in the substantia nigra with resultant motor and non-motor symptoms. Diagnostic overlap with atypical parkinsonism necessitates advanced tools, and proton MR spectroscopy offers a non-invasive means to detect neurometabolic changes—reduced NAA and altered NAA/creatine ratios—reflecting neuronal dysfunction in PD. This study evaluates the association between NAA/creatine ratios in the substantia nigra and globus pallidus with disease severity (Hoehn-Yahr stage, UPDRS), and assesses neurochemical changes following three months of L-DOPA therapy. Objective: To evaluate the utility of proton magnetic resonance spectroscopy (MRS) in monitoring Parkinson’s disease (PD) and the therapeutic response to levodopa (L-DOPA), and to assess the association between the N-acetylaspartate (NAA)-to-creatine ratio in the substantia nigra and globus pallidus and the Hoehn-Yahr stage and the Unified Parkinson’s Disease Rating Scale (UPDRS) score. Methods: This descriptive study enrolled 20 patients with clinically diagnosed PD who had been on L-DOPA for at least three months. Single-voxel proton MRS was performed on a 1.5 T system, and NAA/creatine ratios were measured in the substantia nigra and globus pallidus at baseline and after three months of treatment. Disease severity was graded by the Hoehn-Yahr stage and the UPDRS. Data were analysed in SPSS version 23.0, and correlations were assessed using the Pearson coefficient, with p < 0.05 considered significant. Results: The mean age was 68.9 ± 6.46 years; 65% were men and the mean Hoehn-Yahr stage was 3. Baseline NAA/creatine ratios were 0.8825 (right) and 1.12734 (left) in the substantia nigra and 0.98457 (right) and 1.2489 (left) in the globus pallidus. After three months of L-DOPA, ratios increased significantly in the substantia nigra (right 1.745, left 1.58365) and globus pallidus (right 1.6935, left 1.69365; all p < 0.01). The mean UPDRS score fell from 40.5 ± 13.9 to 28.3 ± 12.1 (p < 0.01). NAA/creatine ratios correlated negatively with UPDRS scores (right substantia nigra r = -0.65; all p < 0.01). Adverse events were mild and infrequent. Conclusion: Proton MRS-derived NAA/creatine ratios rose significantly after L-DOPA and tracked clinical improvement, supporting MRS as a non-invasive biomarker for monitoring treatment response in PD.

Introduction: Migraine is a disabling neurological disorder in which visual hypersensitivity and near-work demands may influence attack expression. Refractive errors are common and biologically plausible contributors to visual strain, but their relationship with migraine frequency remains uncertain, particularly in Pakistan. Objective: To determine the association between refractive errors and monthly migraine-attack frequency among patients attending the Neurology and Ophthalmology outpatient departments of DHQ Hospital Mardan. Methods: This hospital-based analytical cross-sectional study included 200 consecutive patients aged 12 years or older with migraine diagnosed according to the International Classification of Headache Disorders, third edition. Participants underwent structured headache assessment and comprehensive ophthalmic examination. Refractive errors were classified as myopia, hypermetropia, astigmatism, or anisometropia. Multivariable linear and logistic regression models adjusted for age, sex, daily screen time, migraine duration, aura, and prophylactic medication use. Results: Refractive errors were present in 130 participants (65.0%). Participants with refractive errors reported greater daily screen time than those without refractive error (7.5±3.6 vs 5.5±2.8 hours; p<0.001). After full adjustment, any refractive error was associated with 1.92 additional migraine attacks per month (95% CI 1.21–2.63; p<0.001). Astigmatism showed the largest type-specific association (β=3.22; 95% CI 2.23–4.21), followed by hypermetropia (β=2.85; 95% CI 1.77–3.93). Any refractive error was also associated with frequent attacks (≥5/month; adjusted odds ratio 3.65, 95% CI 2.42–5.50). Associations were stronger among participants with high screen exposure and among those whose refractive error was uncorrected. Conclusion: Refractive errors—particularly astigmatism and hypermetropia—were independently associated with greater migraine-attack frequency in this clinical sample. The findings support routine visual assessment in patients with migraine but do not establish that refractive correction prevents attacks; prospective intervention studies are required.

Background: Prostate cancer is the second most common malignancy in men, but conventional PSA testing and TRUS-guided biopsy have poor specificity and often miss clinically significant disease. Multiparametric MRI with PI-RADS scoring improves detection of significant cancer while reducing overdiagnosis. This study evaluates mpMRI/PI-RADS effectiveness in detecting prostate malignancy and its correlation with histopathological outcomes. Methods: This prospective observational study included 30 men with suspected prostate cancer on the basis of elevated PSA (≥4.0 ng/mL) or abnormal DRE, evaluated at a tertiary- care institute between March 2024 and September 2025. All participants underwent mpMRI comprising T2-weighted imaging (T2WI), diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping, and dynamic contrast-enhanced imaging (DCE) on a 1.5-Tesla scanner, and lesions were scored using PI-RADS v2. TRUS-guided biopsy was the reference standard. Associations were tested using chi-square and Fisher exact tests in SPSS version 25. Results: The mean age was 62.1 ± 6.9 years, and all participants were male. Most suspicious lesions were in the peripheral zone (60%). The mean PSA was 9.36 ± 2.98 ng/mL. PI-RADS 3 was the most frequent category (33.3%). Biopsy confirmed malignancy in 43.3%. PI-RADS ≥4 was significantly associated with malignancy (71.4% vs 18.8% for PI-RADS ≤3; p = 0.002). Extra-prostatic extension, seminal vesicle invasion, and pelvic lymph node enlargement were significantly associated with malignancy. Using PI-RADS ≥4 as a positive test, mpMRI achieved a sensitivity of 63.2%, specificity of 63.6%, positive predictive value of 75.0%, and overall accuracy of 63.3%. Conclusion: mpMRI with PI-RADS scoring is a useful non-invasive tool for prostate cancer detection and staging; higher PI-RADS scores correlate with malignancy and advanced-disease markers support accurate staging.

Background: Incisional hernia is a common complication of abdominal surgery. Although laparoscopic repair may improve postoperative recovery, evidence comparing it with open mesh repair in local clinical settings remains limited. This study compared laparoscopic and open mesh repair regarding recurrence, postoperative complications and health-related quality of life. Methods: This prospective comparative study was conducted in the Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan. Eighty adult patients undergoing elective mesh repair for incisional hernia were enrolled into two equal groups. Forty patients underwent laparoscopic mesh repair and 40 underwent open mesh repair. The primary outcome was hernia recurrence at six months. Secondary outcomes included operative time, postoperative pain, hospital stay, return to normal activities, surgical-site infection, seroma, hematoma, chronic postoperative abdominal-wall pain and health-related quality of life. Pain was assessed using the Visual Analogue Scale, while quality of life was evaluated using the EQ-5D-5L questionnaire. Data were analysed using SPSS version 26.0, with p<0.05 considered statistically significant. Results: Recurrence at six months was observed in 1 patient (2.5%) in the laparoscopic group and 3 patients (7.5%) in the open group, with no statistically significant difference (p=0.307). Laparoscopic repair was associated with lower postoperative pain scores (3.4±1.1 vs. 5.8±1.4, p<0.001), shorter hospital stay (2.1±0.8 vs. 4.3±1.2 days, p<0.001) and earlier return to normal activities (12.5±3.8 vs. 20.7±5.1 days, p<0.001). Chronic postoperative abdominal-wall pain was less frequent after laparoscopic repair (5.0% vs. 20.0%, p=0.043). Six-month EQ-5D-5L scores were also higher in the laparoscopic group (0.93±0.04 vs. 0.87±0.06, p<0.001). However, laparoscopic repair required a longer operative time (88.4±15.2 vs. 71.5±13.1 minutes, p<0.001). Conclusion: Laparoscopic mesh repair demonstrated better short-term outcomes than open repair, particularly regarding postoperative pain, hospital stay, functional recovery, chronic postoperative abdominal-wall pain and quality of life. Recurrence rates were not significantly different between the two approaches. These findings should be interpreted cautiously because of the small sample size and six-month follow-up.

Background: Intertrochanteric fractures are most common proximal femur fractures, usually seen in geriatric patients. It occurs with high energy trauma in younger individuals, whereas trivial trauma will lead to fracture in elderly individuals due to osteoporotic bone. Objective: to evaluate the inter trochanteric fractures and their management by using Proximal femoral nail (PFN) and Proximal femoral nail second generation  (PFN A2) and To assess comparative performance of  PFN and PFN A2 in  management of intertrochantertic femur fractures. Methods: This study was conducted in Chengalpattu Medical College and Hospital, Chengalpattu. Fifty consecutive patients with intertrochanteric fractures were treated with Proximal femoral nail ( PFN ) and Proximal femoral nail A2( 25 in each group )  at our institution between March 2019 to august  2020. Result: All 25 patients had a mean age group of  64.88 years. The mean duration of surgery was 52.16 ± 10.92 minutes. Mean blood loss during surgery  140 mL ± 22.91 mL. Mean number of C ARM shots taken – 21.76 ± 2.69. Mean no of weeks taken for fracture union – 14.44 ± 1.15. Mean Harris hip score at 3^rd month was 75.20 ± 3.40. Mean Harris hip score at 9^th month was 83.20 ± 4.25. Patient were allowed full weight bearing after an average duration of  14 weeks. All 25 patients had a mean age group of   63.28  years. The mean duration of surgery was  45.28 ± 9.25 minutes. Mean blood loss during surgery 138 ± 30.61 mL Mean number of C ARM shots taken  - 18.64  ± 2.46. Mean no of weeks taken for fracture union – 13.12 ± 0.92. Mean Harris hip score at 3^rd month was 74.76 ± 3.32. Mean Harris hip score at 9^th month was 82.80 ± 3.60. Patient were allowed full weight bearing after an average duration of  13 weeks.  The postoperative radiological outcome was assessed by taking serial X rays of affected hip in antero posterior and frog lateral view. All patients achieved radiological and clinical union. 17 patients underwent radiological union by 13 weeks, 12  patients underwent by 14 weeks, 10 patients underwent union by 15 weeks and 3 patients underwent union by 17 weeks. Mean no of weeks taken for fracture union treated by PFN  14.44 ± 1.15. Mean no of weeks taken for fracture union treated by PFN A2 13.12 ± 0.92. Conclusion: Both PFN and PFNA II perform well, showing equally good functional outcomes following fixation of unstable trochanteric fractures. PFNAII offers no significant benefits over PFN in terms of post-operative complications. However as compared to PFN, use of PFNA2 significantly reduces the duration of surgery, the amount of operative blood loss and fluoroscopic imaging.

Background: Segmental thoracic spinal anaesthesia (STSA) is an effective regional anaesthetic technique for breast surgeries, providing excellent intraoperative anaesthesia and prolonged postoperative analgesia. The addition of α₂-adrenergic agonists such as clonidine and dexmedetomidine to intrathecal local anaesthetics enhances the quality and duration of spinal block. However, limited studies have compared these adjuvants in patients undergoing modified radical mastectomy (MRM). Aim: To compare the efficacy and safety of intrathecal clonidine and dexmedetomidine as adjuvants to segmental thoracic spinal anaesthesia in patients undergoing modified radical mastectomy. Methods: This  randomized controlled study included 60 ASA physical status I–II female patients aged 18–65 years scheduled for elective modified radical mastectomy. Patients were randomly allocated into two groups of 30 each. Group C received intrathecal isobaric levobupivacaine with clonidine, while Group D received intrathecal isobaric levobupivacaine with dexmedetomidine. The primary outcome was the duration of postoperative analgesia. Secondary outcomes included onset and duration of sensory and motor block, intraoperative heart rate and mean arterial pressure,  postoperative Visual Analogue Scale (VAS) pain scores, rescue analgesic requirement, and adverse effects. Results: Demographic characteristics and baseline hemodynamic parameters were comparable between the groups. Dexmedetomidine produced a significantly faster onset and longer duration of sensory and motor block than clonidine (P < 0.001). The duration of postoperative analgesia was significantly longer in the dexmedetomidine group (472 ± 45 min vs 342 ± 38 min; P < 0.001), with delayed requirement for first rescue analgesia and lower 24-hour analgesic consumption. Postoperative VAS scores were significantly lower in the dexmedetomidine group at all assessment intervals (P < 0.05). Both groups maintained stable heart rate, mean arterial pressure throughout surgery. Conclusion: Intrathecal dexmedetomidine is a superior adjuvant to clonidine for segmental thoracic spinal anaesthesia in modified radical mastectomy. It provides prolonged postoperative analgesia, improved block characteristics, lower postoperative pain scores, and reduced analgesic requirements while maintaining satisfactory hemodynamic stability and an acceptable safety profile.

Objective: To review diagnostic barriers, emergency interventions and maternal outcomes in pregnancy-associated pulmonary embolism arising during or soon after prolonged, obstructed or difficult labour and to distinguish thrombotic pulmonary embolism from amniotic fluid embolism. Study design: Systematic review with structured narrative synthesis of diagnostic studies, registry cohorts, case series and emergency-treatment evidence. Place and duration of the study: Global published evidence was reviewed from 1 May to 15 July 2026 with searches current to 30 June 2026. Methodology: MEDLINE/PubMed was searched for pulmonary embolism in pregnancy, labour and the puerperium. Eligible publications reported diagnostic pathways, confirmed thrombotic PE, emergency reperfusion or maternal survival. Data were retained in their published form because case selection and treatment severity differed. Evidence addressing amniotic fluid embolism without objectively confirmed thrombosis was excluded from the outcome synthesis. Results: The broad search identified 5,276 records and 28 focused publications were included. In the prospective pregnancy-adapted YEARS study 510 women were screened, 12 (2.4%) were excluded and 20 (4.0%) had PE at baseline. Imaging was avoided in 195 (39%, 95% CI 35–44) and one follow-up deep-vein thrombosis occurred (0.21%, 95% CI 0.04–1.2) with no missed PE. A systematic review of 127 severe cases found maternal survival of 94% (95% CI 86–98) after thrombolysis and 86.1% (95% CI 71–95) after surgical thrombectomy. Major bleeding after thrombolysis was 17.5% during pregnancy and 58.3% postpartum. Conclusion: Maternal survival depends on early suspicion, objective diagnosis and rapid multidisciplinary treatment. Pregnancy-adapted diagnostic algorithms can safely reduce imaging in stable patients. Unstable PE requires immediate anticoagulation and individualized reperfusion with particular caution about postpartum bleeding.

Background: Mobile phone exposure among children has increased substantially with the rapid expansion of smartphone ownership and internet access. This study evaluated the pattern of mobile phone use, common purposes of use, and reasons for mobile phone exposure among children aged 1-15 years. Methods: This hospital-based prospective cohort study was conducted in the Department of Pediatrics, Asian Institute of Medical Sciences, Faridabad, India. A total of 500 children aged 1-15 years who were using mobile phones were enrolled after informed consent. Sociodemographic characteristics, parental mobile phone use, child screen-time duration, purpose of use, and reasons for providing mobile phones were recorded using a pre-tested questionnaire. Data were analyzed using SPSS version 25.0 and expressed as frequencies and percentages. Results: Among 500 children, 377 (75.4%) were male and 123 (24.6%) were female. The largest age group was 7-9 years (42.2%). Urban residence was reported in 331 (66.2%) children and 315 (63.0%) belonged to nuclear families. Most parents had smartphones (90.8%) and internet access on mobile phones (89.8%). All enrolled children used a parent's mobile phone; 265 (53.0%) used the mother's device and 235 (47.0%) used the father's device. Daily mobile phone use of 1-3 hours was reported in 302 (60.4%) children, while 79 (15.8%) used mobile phones for more than 3 hours daily. The most common activities were watching YouTube/app-based series (31.6%), playing games (25.0%), and internet surfing (22.4%). The most frequent reasons for providing phones were to quieten the child (35.4%) and other behavioral/social reasons (35.4%). Conclusion: Mobile phone use among children is highly prevalent and largely parent-mediated. Entertainment and behavioral management are major drivers of exposure. Parent-focused counseling, supervised use, and age-appropriate digital media practices are required to promote healthier screen habits.

Introduction: Falls are among the most serious and frequent adverse events affecting the elderly population worldwide, and the World Health Organization ranks falls as the second leading cause of accidental or unintentional injury death globally, with an estimated 37.3 million falls requiring medical attention and 646,000 deaths annually.[1] India's rapidly growing population of over 140 million people aged 60 years and above faces a rising burden of fall-related fractures, disability, and psychological consequences, yet awareness of fall prevention among elderly patients attending tertiary care hospitals in India remains poorly described. Method: This was a descriptive cross-sectional study conducted over three months in the Department of Orthopaedics of a tertiary care hospital. All ambulatory, consenting patients aged 60 years and above attending the outpatient and inpatient services were enrolled by consecutive sampling (n = 157). A structured, interviewer-administered questionnaire recording socio-demographic details, fall history, comorbidities and medications, and an 18-item awareness questionnaire spanning fall risk factors, prevention measures, and healthcare resources, was used. Data were analysed in SPSS version 30.0 using descriptive statistics and the chi-square test. Results: The mean age was 71.6 ± 9.5 years, and 66.9% of participants were male. A history of at least one fall in the preceding year was reported by 77.8%. The mean total awareness score was 10.79 ± 3.45 out of 18 (59.9%), and only 34.4% of participants had adequate awareness (≥70%). Domain-wise, awareness was 51.8% for fall risk factors, 53.1% for prevention measures, and markedly lower at 41.8% for healthcare resources available for fall prevention. Awareness trended lower with advancing age and lower education, though these associations did not reach statistical significance. Conclusion: Awareness of fall prevention was inadequate in nearly two-thirds of elderly patients attending this tertiary care orthopaedic department, with awareness of available healthcare resources for fall prevention being the single most notable gap. These findings support incorporating structured, resource-focused education and routine fall-risk screening into every geriatric encounter.

Background: Diabetic peripheral neuropathy (DPN) is one of the most prevalent and debilitating microvascular complications of type 2 diabetes mellitus (T2DM), affecting up to 50% of patients and serving as a leading cause of foot ulceration and amputation. Chronic hyperglycemia is the primary driver of nerve damage, yet the precise correlation between glycemic parameters—including fasting blood sugar (FBS), postprandial blood sugar (PPBS), and glycated hemoglobin (HbA1c)—and the clinical manifestations of DPN remains incompletely characterized. Methods: This cross-sectional study enrolled 120 patients with T2DM attending a tertiary care hospital. Participants were evaluated for DPN using the Toronto Clinical Neuropathy Score (TCNS) and Michigan Neuropathy Screening Instrument (MNSI). Fasting and postprandial blood glucose levels and HbA1c were estimated. Nerve conduction studies were performed in a subset of patients. Correlation analyses were conducted to assess relationships between glycemic parameters and neuropathy severity. Results: The prevalence of DPN in the study population was 45.8% (55/120 patients). Patients with DPN demonstrated significantly higher HbA1c levels compared to those without DPN (9.6 ± 1.8% vs. 7.4 ± 1.5%, p < 0.001). FBS and PPBS were also significantly elevated in the DPN group (168.4 ± 42.6 mg/dL vs. 142.3 ± 38.5 mg/dL, p < 0.001; and 256.2 ± 58.4 mg/dL vs. 218.7 ± 52.3 mg/dL, p < 0.001, respectively). HbA1c showed a significant positive correlation with TCNS score (r = 0.582, p < 0.001) and MNSI score (r = 0.541, p < 0.001). Nerve conduction studies revealed significant negative correlations between HbA1c and sensory nerve action potential amplitudes (r = -0.498, p < 0.001) and motor nerve conduction velocities (r = -0.452, p < 0.001). Sensory neuropathy (52.7%) was the predominant clinical type, followed by sensorimotor (30.9%) and motor neuropathy (16.4%). Conclusion: Poor glycemic control, as reflected by elevated HbA1c and blood glucose levels, is strongly correlated with the presence and severity of DPN in patients with T2DM. HbA1c serves as a reliable biomarker for predicting neuropathy severity, and its routine monitoring may aid in early identification of patients at risk for DPN. These findings underscore the critical importance of stringent glycemic control in preventing and delaying the progression of diabetic peripheral neuropathy.

Introduction: Gestational diabetes mellitus (GDM) is a growing public health concern globally, with a particularly high burden in South Asian populations. India, home to one of the largest populations of women with GDM, faces significant challenges in screening, diagnosis, and management. This study aimed to determine the prevalence, risk factors, maternal and fetal outcomes, and management patterns of GDM among pregnant women attending a tertiary care hospital. Methods: A hospital-based cross-sectional observational study was conducted over 18 months at a tertiary care teaching hospital. A total of 650 pregnant women between 24 and 28 weeks of gestation were enrolled. Universal screening for GDM was performed using a 75-g oral glucose tolerance test (OGTT) following the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Data on demographic characteristics, obstetric history, risk factors, and pregnancy outcomes were collected using a structured proforma. Statistical analysis was performed using SPSS version 26, with a p-value <0.05 considered statistically significant. Results: The prevalence of GDM in the study population was 16.2% (105 out of 650 women). Significant risk factors identified on multivariate analysis included maternal age ≥30 years (adjusted odds ratio [AOR]: 2.84, 95% CI: 1.72–4.69), pre-pregnancy body mass index ≥25 kg/m² (AOR: 3.12, 95% CI: 1.89–5.14), family history of diabetes (AOR: 2.56, 95% CI: 1.58–4.15), previous history of GDM (AOR: 4.87, 95% CI: 2.34–10.12), and history of macrosomia (AOR: 3.45, 95% CI: 1.67–7.12). Women with GDM had significantly higher rates of preeclampsia (18.1% vs. 7.0%, p=0.001), cesarean section (48.6% vs. 28.3%, p<0.001), preterm delivery (15.2% vs. 7.2%, p=0.008), and postpartum hemorrhage (12.4% vs. 5.3%, p=0.009). Conclusion: GDM poses a substantial burden in the tertiary care setting, with a prevalence of 16.2%. Advanced maternal age, obesity, family history of diabetes, previous GDM, and previous macrosomia are independent predictors of GDM. The condition is associated with significantly increased maternal and neonatal complications. These findings underscore the urgent need for universal early screening, targeted preconception counseling, lifestyle interventions, and standardized management protocols to reduce the burden of GDM and improve pregnancy outcomes.

Background: Iron deficiency anemia (IDA) is one of the most prevalent nutritional disorders worldwide and has been increasingly implicated in chronic inflammatory diseases, including asthma. However, the relationship between IDA and asthma remains incompletely understood. Objective: To systematically evaluate the available evidence regarding the association between iron deficiency anemia and asthma and to summarize its impact on asthma prevalence, severity, pulmonary function, and clinical outcomes. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines. Electronic databases including PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched from inception to June 2026. Observational studies and randomized controlled trials evaluating iron deficiency anemia or iron status in patients with asthma were included. Two reviewers independently performed study selection, data extraction, and quality assessment. Results: Eight studies met the eligibility criteria and were included in the qualitative synthesis. Most studies demonstrated significantly lower hemoglobin and serum ferritin levels among individuals with asthma compared with controls. Reduced iron status was consistently associated with increased asthma prevalence, poorer disease control, impaired pulmonary function, and a higher frequency of exacerbations. Emerging Mendelian randomization evidence also suggested a potential causal association between iron deficiency anemia and asthma susceptibility. Conclusion: Current evidence indicates a significant association between iron deficiency anemia and adverse asthma outcomes. Routine assessment of iron status may aid in identifying high-risk patients, although further prospective studies and randomized clinical trials are required to establish causality and evaluate the therapeutic benefits of iron supplementation in asthma management.

Background: Endoscopic biopsy followed by histopathological examination is the gold standard for the diagnosis of gastrointestinal tract lesions. It plays a crucial role in differentiating inflammatory, infectious, premalignant, and malignant conditions, thereby facilitating early diagnosis and appropriate therapeutic management. Understanding the histopathological spectrum of gastrointestinal lesions is essential for assessing disease burden and planning preventive and treatment strategies. Aim: To study the histopathological spectrum of endoscopic gastrointestinal tract biopsies received over a five-year period at a tertiary care centre. Materials and Methods: This hospital-based retrospective and prospective observational study included 357 endoscopic gastrointestinal tract biopsy specimens received in the Department of Pathology over a period of five years, comprising three years of retrospective and two years of prospective data. Biopsy specimens from all age groups and both sexes were included. Tissue specimens were routinely processed, stained with hematoxylin and eosin, and examined microscopically. Lesions were classified according to their histopathological characteristics into non-neoplastic and neoplastic categories. Data were analyzed using descriptive statistics, Student's t-test, Chi-square test, and Fisher's exact test where appropriate. A p-value of <0.05 was considered statistically significant. Results: The mean age of the study participants was 54.34 ± 15.28 years, with the highest proportion of patients belonging to the 51–60-year age group (26.05%). Males constituted 64.15% of cases, resulting in a male-to-female ratio of approximately 1.8:1. The stomach (34.73%) was the most common biopsy site, followed by the esophagus (24.65%) and colon (20.73%). Overall, 260 (72.83%) biopsies were obtained from the upper gastrointestinal tract and 97 (27.17%) from the lower gastrointestinal tract. Histopathologically, 254 (71.15%) lesions were non-neoplastic, whereas 103 (28.85%) were neoplastic. Among neoplastic lesions, 78 (21.85%) were malignant epithelial tumors (carcinomas), 17 (4.76%) were benign neoplasms, and 8 (2.24%) were malignant mesenchymal tumors. Significant differences were observed in the distribution of age groups, biopsy sites, and histopathological categories (p <0.001). Conclusion: Non-neoplastic inflammatory lesions constituted the majority of endoscopic gastrointestinal biopsies, although a substantial proportion represented neoplastic pathology, particularly carcinomas. The stomach was the most frequently biopsied site, and upper gastrointestinal lesions predominated. Histopathological evaluation of endoscopic biopsies remains an indispensable diagnostic tool for the accurate diagnosis, classification, and management of gastrointestinal diseases and contributes significantly to early detection of premalignant and malignant lesions.

Background: Human epidermal growth factor receptor 2 (HER2/neu) is a transmembrane tyrosine kinase receptor involved in tumor-cell proliferation, survival, invasion, and progression. HER2 overexpression has therapeutic significance in selected gastrointestinal malignancies, particularly gastric and gastroesophageal-junction adenocarcinomas. Accurate assessment of HER2 status in endoscopic biopsy specimens may help identify patients who could benefit from targeted therapy.  Aim: To evaluate HER2/neu overexpression in gastrointestinal carcinomas diagnosed on endoscopic biopsy specimens using immunohistochemistry and correlate it with histopathological findings. Materials and Methods: This hospital-based retrospective and prospective observational study was conducted over five years, from 1 September 2017 to 31 August 2022, in the Department of Pathology of a tertiary-care teaching hospital. A total of 357 gastrointestinal endoscopic biopsy specimens were examined histopathologically, of which 78 were diagnosed as carcinomas and included for HER2/neu immunohistochemical evaluation. Clinical and pathological variables, including age, sex, anatomical site, histological type, and degree of differentiation, were recorded. HER2 staining was scored as 0, 1+, 2+, or 3+ according to the applicable College of American Pathologists criteria. Scores 0 and 1+ were categorized as negative, while scores 2+ and 3+ were grouped as immunoreactive for the study analysis. Data were analyzed using appropriate descriptive and inferential statistical tests, with p<0.05 considered statistically significant. Results The mean age of the patients was 56.97±14.15 years, and 47 (60.26%) were males. Esophageal and gastric carcinomas were the most frequent, each accounting for 24 cases (30.77%). Adenocarcinoma was the predominant histological type in 53 cases (67.95%), while squamous cell carcinoma was present in 25 cases (32.05%). Most tumors were moderately differentiated (82.05%). HER2 IHC score 0 was observed in 54 cases (69.23%), score 1+ in 13 cases (16.67%), score 2+ in 9 cases (11.54%), and score 3+ in 2 cases (2.56%). Overall, 67 cases (85.90%) were HER2-negative and 11 cases (14.10%) showed scores 2+ or 3+. HER2 immunoreactivity was highest in gastroesophageal-junction carcinomas (28.57%), followed by colonic carcinomas (21.43%). However, HER2 expression showed no statistically significant association with age, sex, histological type, anatomical site, or tumor differentiation. Conclusion: HER2/neu overexpression was present in a small but clinically relevant subset of gastrointestinal carcinomas. Since HER2 expression could not be predicted reliably from demographic or routine histopathological features, immunohistochemical testing is important for identifying potential candidates for targeted therapy. Equivocal IHC 2+ cases require confirmatory in-situ hybridization before final therapeutic classification.

Introduction: To determine the diagnostic accuracy of shock index in the diagnosis of postpartum hemorrhage taking emergency hysterectomy as the gold standard. Methodology: This cross-sectional validation study was conducted in department of Gynecology and Obstetrics (Moula Baksh Hospital), Dr.Faisal Masood Teaching Hospital Sargodha from August 3, 2023Feburary 2, 2024. Using a non-probability sequential sampling strategy, women between the ages of 20 and 40 who were having LSCS or a normal vaginal birth and had a singleton pregnancy with a gestational age of 35–42 weeks were recruited from the labor room. The study was conducted after the approval of the hospital's ethical committee and the written informed consent of patients. After delivery patients were kept in the recovery room for monitoring. Shock index was calculated and observed for postpartum hemorrhage and need for hysterectomy. Results: The mean age of the 226 female participants in our research was 30.63±5.6 years. 38.7±2.3 weeks was the average gestational age. Shock index diagnosed postpartum hemorrhage in 30.5% of females. Hysterectomy was done in 27.4% of females due to postpartum hemorrhage. Shock index has a sensitivity of 90.3%, specificity of 92.1%, positive predictive value of 81.2%, negative predictive value: of 96.2%, and diagnostic accuracy of 91.5% in diagnosis of postpartum hemorrhage taking need for hysterectomy as gold standard. Conclusion: Shock index has good sensitivity and specificity for diagnosis of post-partum hemorrhage.

Background: Diabetes mellitus poses a major public health burden, especially in low-income and rural populations where healthcare access is limited. This study evaluated the prevalence of poor glycaemic control and associated factors among patients with diabetes at a tertiary care hospital in Pakistan. Methodology: A cross-sectional study was carried out at Department of Endocrinology, Ayub Teaching Hospital Abbottabad, KP, over 12 months (January–December 2023). A total of 92 patients with type 2 diabetes were recruited using systematic random sampling. Data were collected through a structured questionnaire and HbA1c testing. Poor glycaemic control was defined as HbA1c ≥ 7%. Statistical analysis was performed using SPSS version 26, applying descriptive statistics, chi-square tests, independent t-tests, and logistic regression. Results: The mean age of participants was 52.3 ± 10.8 years, with 56.5% females. Overall, 83.7% (n = 77) had poor glycaemic control. Rural patients had significantly higher mean HbA1c levels than urban patients (8.79% ± 1.28 vs. 7.89% ± 1.05; p = 0.008). Financial barriers (62%), travel distance (48%), and poor knowledge of self-care (53%) were the most common challenges. Logistic regression showed rural residence as a strong predictor of poor control (adjusted OR: 7.12, 95% CI: 1.87–27.1, p = 0.004), while income was not significant. Conclusion: Poor glycaemic control was highly prevalent, with rural residence, cost, and limited access as major contributors. Despite reported adherence, knowledge gaps and structural barriers undermined management. Targeted interventions are urgently required to improve diabetes outcomes in disadvantaged populations.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder characterised by sustained hyperglycaemia arising from defective insulin secretion, defective insulin action, or both. Chronic hyperglycaemia drives a cascade of biochemical derangements that culminate in microvascular and macrovascular complications. This study examined the biochemical basis of type 2 diabetes mellitus (T2DM) by comparing glycemic, lipidemic, renal, and oxidative stress markers between patients and healthy controls. Methods: A comparative cross-sectional study was conducted on 120 participants (80 T2DM patients and 40 age- and sex-matched non-diabetic controls). Fasting and postprandial blood glucose, glycated haemoglobin (HbA1c), fasting insulin, lipid profile, serum creatinine, urinary albumin, and oxidative stress indices (malondialdehyde [MDA], reduced glutathione [GSH], superoxide dismutase [SOD]) were measured by standard enzymatic, immunoturbidimetric, and spectrophotometric methods. Insulin resistance was estimated by HOMA-IR. Data were analysed using Student's t-test and Pearson correlation, with p < 0.05 considered significant. Results: Diabetic patients showed significantly higher fasting glucose, HbA1c, HOMA-IR, and atherogenic lipids (total cholesterol, triglycerides, LDL-C) and lower HDL-C compared with controls (p < 0.001). MDA was markedly elevated while GSH and SOD were significantly depleted in patients, indicating heightened oxidative stress. HbA1c correlated positively with MDA, LDL-C, and urinary albumin, and negatively with SOD and eGFR.

Conclusion: T2DM is accompanied by a coherent pattern of hyperglycaemia, insulin resistance, atherogenic dyslipidaemia, and oxidative stress. These interlinked biochemical abnormalities provide a mechanistic basis for diabetic complications and support tight glycemic control as a therapeutic priority.

Introduction: For a patient, the journey of urinary bladder cancer (UBC) often begins with the terrifying sight of blood in their urine. What follows is a highly anxious period of invasive testing. Determining whether the cancer has invaded the bladder muscle (MIBC) or remains superficial (NMIBC) is the defining factor in a patient's life: it is the difference between preserving the bladder and undergoing a life-altering radical cystectomy. Methods: A Retrospective Study was conducted at the Institute of Medical Sciences and SUM Hospital (IMS & SUM), Bhubaneswar, Odisha, between January 2023 and December 2025. We enrolled 134 patients presenting with suspected bladder tumours. Patients underwent multiparametric MRI (MP-MRI) using the VI-RADS (Vesical Imaging-Reporting and Data System) scoring framework prior to surgical intervention. Findings were strictly correlated with the gold-standard histopathological results from transurethral resection (TURBT) or cystectomy. Results: Of the 134 patients, MP-MRI correctly identified muscle-invasive disease with a sensitivity of 92.8% and a specificity of 91.0%. The correlation between the VI-RADS score and final histopathological T-stage was highly significant (p < 0.001). Furthermore, Apparent Diffusion Coefficient (ADC) values on diffusion-weighted imaging accurately distinguished between low-grade and high-grade tumours (p < 0.001). Conclusion: Multiparametric MRI is a highly accurate, non-invasive imaging modality for staging bladder cancer. By reliably mapping the depth of tumour invasion before surgery, MP-MRI spares patients from unnecessary repeat biopsies, guides precise surgical planning, and ultimately humanizes the diagnostic process by reducing uncertainty and fear.

Background: Neoadjuvant chemotherapy (NACT) is an established treatment approach in breast cancer, particularly for locally advanced, triple-negative, and HER2-positive disease. It may reduce tumor burden, improve operability, facilitate breast-conserving surgery, and provide an in vivo assessment of tumor chemosensitivity. Evaluation of clinicopathologic factors associated with response is important for patient selection, surgical planning, and outcome prediction. Objective/Aim: To evaluate clinical and pathological responses to NACT and determine their association with molecular subtype and surgical outcomes among breast cancer patients treated at Recep Tayyip Erdogan Hospital, Muzaffargarh, Pakistan. Methods: This retrospective study was conducted using hospital electronic medical records from January 2022 to December 2024. Patients with breast cancer who received NACT and had documented post-treatment response assessment were included. Patients with metastatic breast cancer receiving palliative chemotherapy and those with incomplete records were excluded. Data regarding demographic characteristics, baseline TNM stage, imaging findings, histopathology, receptor status, molecular subtype, NACT cycles, surgical procedure, axillary surgery, and pathological response were extracted. Surgical outcomes were analyzed where surgical records were available. Data were analyzed using SPSS version 25. Results: A total of 252 records were reviewed, of which 31 were excluded due to incomplete data. The final analysis included 221 patients. Complete clinical/pathological response was recorded in 58 patients (26.2%), partial response in 82 (37.1%), no response in 73 (33.0%), and progressive disease in 8 (3.6%). Overall, 140 patients (63.3%) achieved favorable response. Total mastectomy was performed in 121 patients (54.8%), while wide local excision was performed in 96 (43.4%); surgical records were missing, not done, or not available in 4 patients (1.8%). Molecular subtype was significantly associated with complete response (p<0.001), with the highest complete response rate observed in HER2-enriched tumors. Conclusion: NACT produced favorable response in a substantial proportion of patients. Response differed significantly by molecular subtype, supporting subtype-informed patient selection and standardized response reporting in real-world breast cancer care.

Background: Rational drug utilization in older adults is complicated by multimorbidity, age-related pharmacokinetic and pharmacodynamic changes, frailty, impaired renal and hepatic function, cognitive decline, and treatment by multiple prescribers. Although the use of several medicines may be clinically justified, inappropriate polypharmacy increases the risks of adverse drug reactions, drug–drug interactions, falls, hospitalization, functional decline, non-adherence, and treatment burden. Objective: To systematically review prescribing practices, the prevalence and consequences of polypharmacy and potentially inappropriate medication use, and the effectiveness of medication-review, deprescribing, pharmacist-led, and electronic decision-support interventions in geriatric patients. Methods: This systematic review was structured according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. MEDLINE/PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were considered for studies published from January 2000 to January 2026. Eligible reports involved adults aged 60 years or older and evaluated polypharmacy, hyperpolypharmacy, potentially inappropriate medications, prescribing omissions, adverse drug events, medication review, deprescribing, pharmacist-led interventions, or electronic clinical decision support. The American Geriatrics Society Beers Criteria, STOPP/START criteria, and Medication Appropriateness Index were considered major prescribing-assessment frameworks. Owing to heterogeneity in study populations, settings, interventions, and outcomes, the evidence was synthesized narratively. Results: Fifteen key reports published between 2011 and 2023 were included in the principal evidence synthesis. These comprised 5 randomized or cluster-randomized intervention trials, 7 systematic reviews or meta-analyses, and 3 expert-consensus or prescribing-criteria publications. The 5 major intervention trials included at least 8,608 older adults. An Indian systematic review of 27 studies reported pooled prevalences of 49% for polypharmacy, 31% for hyperpolypharmacy, and 28% for potentially inappropriate medication use. Frequently implicated medicines included benzodiazepines and related hypnotics, anticholinergic drugs, antipsychotics, proton-pump inhibitors without a continuing indication, non-steroidal anti-inflammatory drugs, opioids, sulfonylureas, duplicate cardiovascular therapy, and medicines requiring renal-dose adjustment. STOPP/START-guided review, pharmacist participation, and structured deprescribing generally improved medication appropriateness and reduced potentially inappropriate medication exposure. Thirteen of 14 randomized deprescribing reports documented reductions in medicine number or dosage without evidence of major safety harm. The MedSafer trial included 5,698 patients across 11 Canadian hospitals and increased deprescribing but did not significantly reduce 30-day adverse drug events. The OPERAM trial included 2,008 multimorbid older adults and did not significantly reduce drug-related hospital admissions. Electronic recommendations in the SENATOR trial did not clearly reduce adverse drug reactions, partly because of limited implementation. Conclusions: Polypharmacy and potentially inappropriate prescribing are common among geriatric patients and contribute to medication-related harm. Structured medication review, STOPP/START and Beers Criteria screening, pharmacist involvement, deprescribing, medication reconciliation, and electronic decision support improve prescribing-process outcomes, although their effects on mortality, hospitalization, falls, and quality of life remain inconsistent. Rational drug utilization should not focus solely on reducing medicine numbers. Each medicine should have a clear indication, clinically meaningful expected benefit, appropriate dose and duration, acceptable risk, feasible monitoring, and consistency with the patient’s frailty, life expectancy, functional status, and treatment preferences.

Introduction: Falls in older adults are increasingly recognized as a multidimensional geriatric syndrome rather than isolated accidental events. They arise from complex interactions among frailty, sarcopenia, impaired mobility, cognitive dysfunction, polypharmacy, orthostatic instability, sensory impairment, environmental hazards, climate vulnerability, and social factors. This narrative review synthesizes current evidence on established and emerging determinants of fall risk and proposes the PRECISION-Falls framework as a conceptual model for future multidimensional fall-risk assessment and phenotype-based prevention. Evidence was reviewed from international guidelines, consensus statements, systematic reviews, meta-analyses, validated assessment tools, and methodological frameworks relevant to falls, frailty, sarcopenia, medication-related risk, cognition, orthostatic hypotension, environmental safety, digital health, and climate-sensitive vulnerability. The proposed framework organizes fall risk into clinically measurable domains, including fall history, frailty, sarcopenia and mobility, fall-risk-increasing drugs, cognitive and dual-task impairment, sensory and foot-related factors, orthostatic and hydration-related risk, home hazards, climate exposure, and social or digital monitoring. The PRECISION-Falls framework aims to move fall prevention from general risk stratification toward individualized identification of dominant fall-risk phenotypes. Frailty-dominant, sarcopenia-related, medication-associated, orthostatic, cognitive, sensory, environmental, climate-vulnerable, and socially vulnerable phenotypes may each require targeted preventive strategies. These may include comprehensive geriatric assessment, resistance and balance training, medication optimization, hydration management, vision and foot care, home modification, caregiver support, climate protection, and digital monitoring. Although the framework provides an evidence-informed foundation for future fall-risk prediction, it is not yet a validated clinical instrument. Further work should include Delphi consensus, feasibility testing, reliability assessment, prospective validation, external validation, calibration, and clinical impact evaluation before implementation. If validated, PRECISION-Falls may support personalized, scalable, and globally applicable fall-prevention strategies for ageing populations.

Introduction: The interim fixed prostheses are also a vital part and parcel of the prosthodontic treatment and give continuity to the prosthesis, esthetic reinforcement, and psychological confidence between the definitive restoration placement after the intermediate period. There has been a growing application in the digital fabrication methods especially CAD/CAM milling and three-dimensional (3D) printing that have led to the emergence of new polymer essentially designed to enhance the mechanical and clinical performance of interim restorations. Graphene reinforcement has recently been suggested as an attractive solution in order to improve the performance of polymeric dental materials in terms of strength and durability, yet there has been scarce evidence between its performance when subjected to various digital manufacturing methods. Objective: To evaluate the clinical, laboratory and patient-reported outcomes of the CAD/CAM-milled and 3D-printed interim fixed prostheses reinforced with graphene to compare the two groups of the proposed study using an integrated clinical and in-vitro study design. Methods: A mixed-method comparative study was undertaken and it comprised of a clinical study of interim fixed prostheses and an in-vitro study of mechanical and optical properties. Interim restorations made with graphene reinforced materials were tested clinically based on patient-based outcome measures and clinician-based assessment criteria. Simultaneously, the laboratory testing was conducted to determine the fracture resistance, flexural strength, marginal adaptation, failure mode, color stability, translucency, opalescence and roughness on the surface according to applicable standards of the ISO guidelines. The statistical analysis was conducted on the bases of descriptive statistics and inferential testing, to compare the results between the groups. Results: Interim prostheses reinforced with graphene prepared with CAD/CAM milling exhibited better mechanical performance parameters whereas 3D-printed restorations were similar in respect to clinical acceptability and patient satisfaction. The results had considerable differences in the chosen mechanical and optical properties between processes of fabrication. Conclusion: Graphene-reinforced interim prostheses that have been milled by CAD/CAM and 3D-printed showed acceptable clinical and laboratory performance. Evidence of mechanical behavior and chosen esthetic parameters differences imply possible impact of fabrication method on material performance, which supports the necessity to use evidence-based material choice when working with interim prosthodontics.

Background: Polycystic ovary syndrome (PCOS) is an ovulatory cause of infertility that is common. Letrozole is a very popular first-line drug for ovulation induction but a certain percentage of women do not respond, and are said to be letrozole resistant. This is a subgroup that requires alternative strategies. Objective: To evaluate the effectiveness of adding dexamethasone to letrozole therapy for ovulation induction in infertile women with letrozole-resistant PCOS. Methods: A total of 42 ovulation induction cycles of 28 women with letrozole-resistant PCOS were analyzed retrospectively. An up to 7.5 mg stair-step letrozole was given to patients. The non-responders were then treated with further letrozole (7.5 mg) with dexamethasone (0.5 mg per day for 7 days) and then a further ultrasound assessment was performed. The primary outcome was ovulation rate as determined by follicular development on transvaginal ultrasound. Secondary outcomes were endometrial thickness, follicle number, and the pregnancy outcomes. Results: Addition of dexamethasone led to 79% of patients having ovulation, and 83% of total treatment cycles. 20% of the ovulatory cycles were clinically pregnant and cumulative pregnancy rate was 32%. 100% of pregnancies were live-born. No indications of adverse effects were reported. Conclusion: It has been found that the use of adjunct dexamethasone is significantly beneficial in terms of improving the ovulation rate in women with letrozole-resistant PCOS. This is a safe, affordable and viable treatment alternative to more advanced fertility treatments.

Background: Drug utilization in geriatric patients is an important area of medication-safety research because older adults commonly have multimorbidity, altered pharmacokinetics and pharmacodynamics, reduced renal reserve, frailty, cognitive impairment, and increased vulnerability to adverse drug reactions. Polypharmacy, potentially inappropriate medications, drug-drug interactions, and prescribing cascades are frequent concerns in this population. Objective: To systematically review drug utilization patterns among geriatric patients, with emphasis on prescribing practices, polypharmacy, potentially inappropriate medication use, drug-drug interactions, adverse drug reactions, deprescribing, and medication-safety strategies. Methods: This systematic review was conducted and reported in accordance with the PRISMA 2020 framework. Electronic databases and search platforms, including PubMed/MEDLINE, Google Scholar, ScienceDirect, Scopus, and Cochrane Library, were searched for relevant literature on geriatric drug utilization, polypharmacy, potentially inappropriate medications, Beers Criteria, STOPP/START criteria, drug-drug interactions, adverse drug reactions, and deprescribing. A total of 842 records were identified. After removal of 162 duplicates, 680 records were screened, 86 full-text articles were assessed for eligibility, and 30 studies/guideline documents were finally included in the narrative synthesis. Results: The reviewed evidence showed that geriatric prescriptions were dominated by cardiovascular medicines, antidiabetic agents, analgesics, gastrointestinal drugs, psychotropic medicines, antimicrobials, respiratory medicines, vitamins, minerals, and supplements. Polypharmacy, commonly defined as the use of five or more medicines, was frequent and was associated with adverse drug events, falls, cognitive impairment, hospitalization, poor adherence, and mortality. Potentially inappropriate medication use was commonly identified using AGS Beers Criteria and STOPP/START criteria. High-risk medicines included benzodiazepines, sedative-hypnotics, anticholinergics, antipsychotics, NSAIDs, opioids, sulfonylureas, anticoagulants, antiplatelets, and long-term proton-pump inhibitors without clear indication. Conclusion: Drug utilization among geriatric patients is characterized by high prescription burden, frequent polypharmacy, and substantial exposure to potentially inappropriate medications. Routine medication review, renal dose adjustment, medication reconciliation, deprescribing, use of explicit prescribing tools, pharmacist involvement, caregiver education, and individualized patient-centred prescribing are essential to reduce preventable medication-related harm among older adults.

Background: Visco supplementation with intra-articular hyaluronic acid (HA) is widely used in knee osteoarthritis (OA), yet evidence from semi-urban Indian populations — particularly those engaged in manual labour with high mechanical joint loading — remains limited. This study evaluates pain relief and functional outcomes of HA injection in early knee OA in a semi-urban Central Karnataka population, incorporating MCID-based responder classification and patient-acceptable symptom state (PASS) reporting. Methods: A prospective single-arm cohort study enrolled 42 consecutive patients aged 35–65 years with Kellgren–Lawrence (K-L) Grade 1–3 knee OA inadequately controlled by prior conservative management at the Department of Orthopaedics, JJMMC, Davangere. All received three intra-articular HA injections at 2-week intervals. Primary outcomes — VAS (0–10) and KOOS Pain subscale (Kannada validated version, 0–100) — were assessed at baseline, 3, 6, and 12 months. MCID thresholds were pre-specified as ≥2 points or ≥30% reduction for VAS, and ≥8 points for KOOS Pain. PASS was recorded at 6 and 12 months. Results: All 42 patients completed 12-month follow-up (attrition: 0%). Mean age was 52.0 ± 7.7 years; 57.1% were male; 57.1% were engaged in heavy manual labour. Mean VAS declined from 6.07 ± 1.14 at baseline to 4.88 ± 0.93 at 6 months and 4.45 ± 1.05 at 12 months (Friedman χ²=105.31, p<0.001). Mean KOOS Pain improved from 41.90 ± 3.16 at baseline to 49.36 ± 2.49 at 6 months and 49.98 ± 2.25 at 12 months (Friedman χ²=118.46, p<0.001). At 12 months, MCID was achieved in 61.9% for both VAS and KOOS Pain, with 40.5% Full Responders and 42.9% Partial Responders. PASS was reported by 50.0% at 6 months and 83.3% at 12 months (McNemar p<0.001), with no patient deteriorating between time points. Older age was a significant positive predictor of VAS improvement (Spearman r=0.436, p=0.004). No serious adverse events were recorded. Conclusions: Intra-articular HA injection was associated with statistically significant, progressive improvement in pain and function in this cohort of early knee OA over 12 months, with outcomes at 12 months exceeding those at 6 months. MCID-based responder rates and the 83.3% PASS rate at 12 months indicate that HA may be a viable non-surgical option for this working-age, high-occupational-demand population; comparative trials are needed to establish efficacy relative to other treatments.

Introduction: Axillary lymph node (ALN) status is the most critical prognostic determinant in carcinoma breast, influencing staging, treatment planning, and survival outcomes. Sentinel lymph node biopsy (SLNB) has revolutionized axillary staging by offering a minimally invasive alternative to complete axillary lymph node dissection (ALND), significantly reducing associated morbidity. While SLNB reliably identifies initial nodal spread, a key unresolved clinical challenge is predicting which SLN-positive patients harbour additional non-sentinel axillary metastases requiring completion ALND. The size of the SLN and the metastatic tumour load within it — whether micrometastasis or macrometastasis — have been proposed as clinically significant predictors of further axillary disease. Methods: This prospective cohort study was conducted at Karnataka Medical College and Research Institute (KMCRI), Hubballi, between September 2024 and March 2026. Seventy female patients with early-stage carcinoma breast undergoing modified radical mastectomy (MRM) with simultaneous SLNB and completion ALND were enrolled. SLN identification was performed using intralesional and perilesional methylene blue dye injection. Intraoperative SLN size was measured using vernier calipers. SLN metastatic status (micrometastasis vs. macrometastasis), ALN status, primary tumour size, T stage, histopathological type, and receptor status (ER, PR, HER2) were recorded. Fisher's Exact Test and independent samples t-test were applied; p < 0.05 was considered significant. Results: The mean age was 51.53 ± 8.797 years. T2 disease was present in 54.3% of patients, with a mean tumour size of 2.11 ± 0.506 cm. Invasive Ductal Carcinoma (IDC) was the predominant histological type (81.4%). SLN positivity was found in 17.1% of patients; among positive SLNs, macrometastasis occurred in 10.0% and micrometastasis in 7.1%. ALN positivity was identified in 8.6% of patients. Among patients with SLN macrometastasis, 66.7% had ALN positivity, whereas none of the patients with SLN micrometastasis had ALN involvement (p < 0.001). Mean SLN size was significantly larger in ALN-positive patients (9.35 ± 1.140 mm) compared to ALN-negative patients (7.18 ± 1.428 mm; p = 0.001). Primary tumour size and T stage were not significant predictors of ALN positivity (p = 0.284 and p = 0.402, respectively).Conclusion: SLN metastatic type and SLN size are significant and clinically reliable predictors of additional axillary lymph node involvement in carcinoma breast. Macrometastasis in the SLN carries a substantially higher risk of ALN positivity compared to micrometastasis, which carries negligible additional axillary risk. These parameters can guide individualised, risk-stratified decisions regarding completion ALND in early breast cancer, enabling reduction of surgical morbidity in low-risk patients without compromising oncological outcomes.

Introduction: Groin hernia repair is one of the most frequently performed elective surgeries in surgical units around the world. Lichtenstein's tension-free meshplasty has long been regarded as the gold standard owing to its low recurrence rates. However, growing clinical experience has brought several late morbidity concerns with prosthetic mesh to light — including chronic groin pain, foreign body sensation, and rare but serious complications such as vas deferens injury and mesh infection. These concerns have revived interest in autologous tissue repairs. Desarda's technique, first reported in 2001, employs a pedicled strip of external oblique aponeurosis to dynamically buttress the posterior wall of the inguinal canal without synthetic material.Aims & Objectives: The main objective of this study was to compare the perioperative and postoperative outcomes between Desarda repair and Lichtenstein mesh repair in patients undergoing inguinal hernia surgery. Secondary outcomes assessed included postoperative pain, operative time, analgesic requirement, postoperative complications, and duration required for return to normal daily activities.Methods: A prospective, randomized, comparative study was carried out in the Department of Surgery at KMCRI, Hubballi. One hundred male patients with uncomplicated inguinal hernia were enrolled and randomly divided into Group D (Desarda's repair, n=50) and Group L (Lichtenstein's meshplasty, n=50). Follow-up was conducted at 24 hours, 3 days, 5 days, 1 week, 1 month, and 3 months post-surgery. The unpaired t-test was used for continuous data and the chi-square test for categorical data; p < 0.05 was considered statistically significant.Results: Baseline characteristics were comparable between groups. Desarda's repair recorded shorter mean operative duration (39.18 ± 3.32 vs. 49.98 ± 3.44 min; p < 0.001), reduced hospital stay (2.32 ± 0.55 vs. 3.64 ± 0.53 days; p < 0.001), and earlier return to occupational activity (15.56 ± 2.74 vs. 17.50 ± 1.91 days; p < 0.001). VAS pain scores were significantly lower in the Desarda arm at all six follow-up intervals (p < 0.001). Persistent groin pain at three months was noted in 6 (12%) Group D patients versus 10 (20%) in Group L (p = 0.413, NS). Complication  rates were similar.Conclusion: Desarda's repair is a viable, safe, and economical tissue-based alternative to Lichtenstein's meshplasty, with advantages in operative speed, pain control, hospital stay, and return to work — all without foreign material. The technique merits wider adoption, especially for younger patients with indirect hernias and in resource-limited settings.

Background: Enhanced Recovery After Surgery (ERAS) protocols strongly advocate minimizing perioperative opioid use to improve postoperative recovery and reduce opioid-related adverse events. Multimodal analgesia (MMA), employing a combination of non-opioid analgesics and regional anesthetic techniques, has emerged as a promising alternative to conventional opioid-based anesthesia (OBA) in laparoscopic surgery. However, evidence from tertiary care hospitals in Pakistan remains limited. Objective: To compare the effects of multimodal analgesia and opioid-based anesthesia on recovery time and postoperative nausea and vomiting (PONV) among patients undergoing elective laparoscopic surgery at Ayub Teaching Hospital, Abbottabad, Pakistan. Methods: A prospective comparative study was conducted in the Department of Anaesthesia, Ayub Teaching Hospital, Abbottabad, from January 2025 to March 2026. A total of 160 adult patients (American Society of Anesthesiologists [ASA] physical status I–II) scheduled for elective laparoscopic procedures were enrolled and equally allocated into two groups: Group M (multimodal analgesia, n=80) and Group O (opioid-based anesthesia, n=80). Group M received a combination of intravenous paracetamol, non-steroidal anti-inflammatory drugs, local anesthetic infiltration, and limited intraoperative opioids, whereas Group O received conventional opioid-based anesthesia. Primary outcomes included time to recovery, assessed by achieving a Modified Aldrete Score ≥9, and incidence of postoperative nausea and vomiting within the first 24 hours. Secondary outcomes included postoperative pain scores, opioid consumption, and length of post-anesthesia care unit (PACU) stay. Results: Patients receiving multimodal analgesia demonstrated significantly shorter recovery times compared with those receiving opioid-based anesthesia (34.6 ± 8.2 minutes vs. 48.9 ± 10.7 minutes, p<0.001). The incidence of PONV within 24 hours was substantially lower in Group M than in Group O (18.8% vs. 41.3%, p=0.002). Postoperative pain scores at 6 hours were also significantly reduced in the multimodal group (3.1 ± 1.2 vs. 4.5 ± 1.6, p<0.001). Total postoperative opioid consumption was reduced by approximately 46% among patients managed with multimodal analgesia (p<0.001). Additionally, PACU stay was significantly shorter in Group M (56.4 ± 12.5 minutes) compared with Group O (71.8 ± 15.1 minutes; p<0.001). Conclusion: Multimodal analgesia significantly improves postoperative recovery, decreases the incidence of postoperative nausea and vomiting, reduces opioid requirements, and shortens PACU stay in patients undergoing laparoscopic surgery. Incorporating multimodal analgesic strategies within ERAS pathways may enhance perioperative outcomes and support opioid-sparing anesthesia practices in tertiary care hospitals.

Background: Diabetic peripheral neuropathy (DPN) is a progressive and deeply debilitating complication of type 2 diabetes mellitus (T2DM). Beyond the clinical loss of nerve function, DPN profoundly alters a patient’s reality, replacing normal sensation with chronic pain, sleep deprivation, and the persistent psychological dread of amputation. Methods: A prospective, cross-sectional observational study was conducted at Shri Jagannath (SJ) Medical College and Hospital in Puri, Odisha, from January 2023 to December 2024. We assessed 160 adult patients living with T2DM. Clinical screening was performed using the Michigan Neuropathy Screening Instrument (MNSI), alongside empathetic, structured interviews to evaluate the human cost of the disease. Statistical analysis (using SPSS) determined the significance of metabolic and demographic risk factors.

Results: Among the 160 patients, 76 individuals (47.5%) were clinically diagnosed with DPN. Statistical analysis revealed that the onset of DPN was highly significantly associated with prolonged disease duration (p < 0.001) and poor glycemic control (HbA1c > 8.0%, p < 0.001). Beyond laboratory values, patients with DPN reported statistically significant increases in severe sleep fragmentation (64.5%, p < 0.001) and chronic anxiety regarding foot health compared to the non-DPN cohort. Conclusion: DPN affects nearly half of the surveyed diabetic population in Puri. The strong statistical correlation between unmanaged blood glucose, duration of disease, and nerve damage underscores a critical public health gap. Managing DPN requires a compassionate, dual approach: aggressive glycemic control coupled with proactive, humanized symptom management to preserve the mobility and dignity of our patients.

Background: Distal tibial fractures remain a challenging injury because of limited soft-tissue coverage, compromised vascularity, and the need to balance mechanical stability with biological preservation. Minimally Invasive Plate Osteosynthesis (MIPO) has gained popularity as an alternative to conventional Open Reduction and Internal Fixation (ORIF) by minimizing periosteal disruption and preserving fracture biology. The present study compared functional, radiological, and complication outcomes between MIPO and ORIF in patients with distal tibial fractures. Methods: A comparative cohort study was performed involving 45 patients who underwent operative fixation for distal tibial fractures. Twenty-nine patients were treated using MIPO and 16 underwent ORIF. Primary outcomes included time to radiological union and functional outcome assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Secondary outcomes included delayed union and surgical site infection. Statistical analyses included independent sample t-tests, Mann–Whitney U tests, and multivariable logistic regression.  Results: The mean age of the study population was 67.73 ± 5.09 years, and 62.2% were male. Median time to union was significantly shorter in the MIPO group than in the ORIF group (17.0 versus 24.0 weeks, p<0.001). Patients treated with MIPO demonstrated significantly superior functional outcomes with a mean AOFAS score of 87.31 compared with 73.69 in the ORIF group (p<0.001). Delayed union occurred exclusively in the ORIF group (100% vs. 0%, p<0.001). Surgical site infection was observed in 31.3% of patients treated with ORIF compared with 3.4% following MIPO (p=0.016). Logistic regression identified ORIF as an independent predictor of postoperative infection (OR 14.12, 95% CI 1.34–149.09, p=0.028). Conclusion: MIPO was associated with faster fracture healing, improved functional outcomes, and lower complication rates compared with ORIF. These findings support the use of biological fixation techniques in the management of distal tibial fractures, particularly in older patients with compromised soft-tissue conditions.

Background: The liver is a vital organ involved in multiple metabolic, detoxification and immunological functions. Many liver diseases remain clinically silent and are detected incidentally during autopsy examination. Histopathological analysis of liver tissue obtained during medico-legal autopsies provides valuable information regarding the prevalence and pattern of hepatic diseases in the community. Methods: This retrospective analytical study was conducted in the Department of Pathology of a tertiary care centre. Liver tissues from 652 medico-legal autopsies performed between January 2024 and December 2025 were examined. Severely autolysed specimens (25 cases) were excluded. Tissue sections were stained with hematoxylin and eosin and evaluated microscopically. Demographic details, manner of death and alcohol history were obtained from autopsy records. Data were analysed using descriptive and inferential statistics using SPSS version 26.0. Results:  Among 652 autopsy cases, pathological liver lesions were observed in 415 cases (63.7%), while 212 cases (32.5%) showed normal histology and 25 (3.8%) were autolysed. Steatosis was the most common lesion (40.5%), followed by Passive venous congestion (28.2%), hepatitis (18.1%) and cirrhosis (10.1%). Granulomatous hepatitis and miscellaneous lesions were each observed in 1.2% of cases, while Hepatic neoplasms were noted in 0.7% cases. Maximum cases occurred in the 41–50 years age group (26.5%) with male preponderance (236 cases). No statistically significant association was observed between age group and sex distribution (χ² = 0.78, df = 6, p = 0.99). Road traffic accidents (29.4%) and sudden natural deaths (28.7%) were the most common manners of death. Alcohol history was present in 46% of cases. A statistically significant association was observed between alcohol consumption and hepatic steatosis (p <0.001) as well as cirrhosis (p =0.001). Conclusion: Autopsy examination reveals a high prevalence of unsuspected liver pathology, with steatosis being the most common lesion. These findings highlight the burden of subclinical hepatic disease in the population and emphasise the importance of preventive strategies targeting alcohol use and metabolic disorders.