Background: Lumbar plexus block could be safe because of the targeted somatic nerve block, which prevents dispensable sympathetic block even in cardiovascular compromised patients and has minimal effects on cardio-respiratory system. Objective: To study the postoperative analgesia and complications of lumbar plexus block and low spinal with conventional spinal anesthesia in hip surgeries. Methods: The present Prospective interventional  study will be conducted on 60 patients posted for elective hip surgeries in the department of anaesthesia at Basaveshwara teaching and general hospital attached to Mahadevappa Rampure Medical college Kalaburagi. Duration of study was from 1^st october 2019 to 31^st march 2021(18 months). Result: There was statistically significant in age distribution between the two groups (P value is 0.015). The mean age was 60.83(±13.43) in group A  and  52.53(±12.23) in group B .The mean time at first rescue analgesia in group A was 559.67(±45.5) minutes and in group B was 166.03(±13.51) minutes. There was very highly statistical significant difference between the two groups(P<0.000).  The mean 24Hr requirement of Tramadol in group A was 193.33(±58.33) milligram and in group B was 306.67(±25.37) in milligrams .There was very highly statistical significant difference between the groups(P<0.000). The 24 Hr requirement of Fentanyl was 0(±0) in group A and 16(±36.54) mcg in group-B. There was statistically significant between the two groups. Conclusion: The success rate is 100% with the use of a nerve stimulator and the incidence of complications can be reduced by careful titrated doses of local anaesthetic, coupled with good vigilance and monitoring.

Background: Pelvic organ prolapse (POP) is a common condition resulting from weakness of the pelvic floor musculature and fascial support structures. Accurate identification of compartmental defects is essential for optimal management. Conventional clinical examinations are limited in evaluating the dynamic and multicompartmental nature of prolapse. Dynamic Magnetic Resonance Imaging (MRI) provides a comprehensive, radiation-free modality for anatomical and functional assessment. Aim: To evaluate the role of dynamic MRI in assessing pelvic floor muscles and fascial support in women with pelvic organ prolapse. Methods: This prospective observational study included 50 women with clinically suspected pelvic organ prolapse who underwent dynamic MRI using a 1.5 Tesla system. Imaging was performed in sagittal, axial, and coronal planes at rest and during straining. Parameters analyzed included H-line, M-line, organ descent below the pubococcygeal line, levator ani integrity, fascial support, and compartmental involvement. MRI findings were compared with clinical examination. Statistical analysis used Welch’s t-test and Chi-square test with p < 0.05 considered significant. Results: Among 50 subjects, 36 (72%) showed MRI-confirmed prolapse. Women with prolapse were older (mean age 51.6 ± 8.1 years) and had higher BMI (27.8 ± 3.2 kg/m²) than those without prolapse (p < 0.01). Multiparity and postmenopausal status were significant predictors (p < 0.05). Mean H-line and M-line were significantly increased in prolapse cases (6.2 ± 0.7 cm and 3.5 ± 0.8 cm, respectively; p < 0.001). Multicompartmental involvement was detected in 52.8% of prolapse cases, with anterior compartment defects being most common (72.2%). MRI demonstrated high sensitivity (93.3%) and moderate agreement (κ = 0.56) with clinical findings. Conclusion: Dynamic MRI provides a reliable, reproducible, and non-invasive means of assessing pelvic floor dysfunction. It allows simultaneous visualization of all compartments, precise measurement of organ descent, and identification of fascial and muscular defects. The technique significantly enhances diagnostic accuracy and aids individualized surgical planning in women with pelvic organ prolapse.

Thyroglossal cyst can even occur in elderly patients unusual to its typical presentation in        children from 5 to 7 years. Midline mass presentation with loss of movement with deglutition. Awake fiberoptic intubation is an indispensable technique for every anesthesiologist in their armamentarium. Adequate counseling, preparation and procedural skills result in a safe procedure for the patient. 

Background: Intertrochanteric fractures are common injuries in elderly individuals, often caused by low-energy trauma and associated with significant morbidity. The evolution of surgical fixation has led to the development of devices such as the Proximal Femoral Nail Anti-Rotation-2 (PFNA-2), designed specifically for Asian femoral morphology. Aim: To evaluate the functional and radiological outcomes of intertrochanteric fracture fixation using short PFNA-2 in a prospective cohort. Methods: A prospective observational study was conducted on 50 patients with intertrochanteric fractures treated using short PFNA-2. Patients were followed up at regular intervals to assess functional recovery via the Harris Hip Score (HHS) and radiological union via standard AP and lateral X-rays. Data on age, sex, fracture type (Boyd and Griffin classification), operative time, and intraoperative blood loss were analyzed. Results: The majority of patients were between 60–74 years (56%), with a male predominance (54%). Most fractures were on the right side (54%). Type 2 fractures were most common (36%). Mean operative time was 66.2 minutes, and mean blood loss was 97.1 mL. At final follow-up, 84% of patients had good to excellent functional outcomes, with radiological union achieved within 16–20 weeks in most cases. Conclusion: Short PFNA-2 is an effective implant for stabilizing intertrochanteric fractures, providing stable fixation with minimal complications, low blood loss, and satisfactory functional recovery

Background: Pseudomonas species, especially Pseudomonas aeruginosa, are significant opportunistic pathogens causing morbidity and mortality in hospitalized patients. Rising antimicrobial resistance among these species accentuates therapeutic challenges. Objective: To analyze the clinical, microbiological, and antibiotic resistance profiles of Pseudomonas infections in a tertiary care teaching hospital in Bengaluru, India. Methods: A retrospective analysis of 150 patients with culture-confirmed Pseudomonas infections from multiple clinical departments at ESIC PGIMSR, Rajajinagar, Bengaluru, was conducted. Data on demographics, site of infection, species isolated, antibiotic sensitivity/resistance patterns, clinical outcomes, risk factors, and comorbidities were collected and analyzed statistically Results: Of 150 patients, 50.7% were female and 49.3% male. The predominant age groups affected were adults (19-40 years, 26.7%), middle-aged (41-60 years, 25.3%), and seniors (60+, 28%). Pseudomonas aeruginosa accounted for 74.7% of infections. Sites commonly involved included urinary tract (23.3%), burns (22%), wounds (20%), and bloodstream (20%). Mortality was 30.67%, with an additional 24.67% under ongoing treatment. Antibiotic sensitivity was highest for Cefepime and Meropenem (each 13/150 cases). Resistance was most frequent to Piperacillin-Tazobactam and Meropenem combined with Ciprofloxacin. Major risk factors identified were immunosuppression (24.7%), ICU stay (20%), and use of catheters/ventilators. Chronic conditions such as COPD (22%) and CKD (16.7%) were common comorbidities. Seniors had significantly higher mortality rates (p < 0.01). Conclusion: This study highlights the predominance of P. aeruginosa and high rates of multi- drug resistance in clinical isolates, with substantial mortality associated with immunosuppressed and elderly patients. Strengthening infection control and antibiotic stewardship programs is crucial to mitigate these challenges

Background: The geriatric population represents a rapidly growing segment requiring surgical care. Age-related physiological decline, comorbidities, and delayed presentation increase the risk of postoperative complications and death. Identifying key prognostic factors can help predict outcomes and guide preventive strategies. Aim: To study the prognostic factors affecting morbidity and mortality in elderly patients undergoing abdominal surgeries. Materials and Methods: A prospective observational study was conducted in the Department of Surgery, Sassoon General Hospital, Pune, including 100 patients aged ≥65 years undergoing elective or emergency abdominal surgeries. Detailed history, examination, and investigations (hemoglobin, serum albumin, renal and liver function, and electrolytes) were recorded. Operative findings, duration, blood loss, and postoperative complications were documented. Statistical analysis included Chi-square test, t-test, and logistic regression. A p value <0.05 was considered statistically significant. Results: The mean age of patients was 70.2 ± 4.1 years, with males constituting 56%. Adverse outcomes (morbidity or mortality) were significantly associated with emergency surgeries (p<0.001), ASA grade III–IV (p<0.001), anemia (Hb <9 g/dL, p=0.004), hypoalbuminemia (<3.3 g/dL, p<0.001), peritoneal contamination (p<0.001), and prolonged operative time (p=0.004).On multivariate analysis, ASA IV status (OR 5.9, p=0.001), emergency surgery (OR 3.8, p=0.008), hypoalbuminemia (OR 2.6, p=0.049), and anemia (OR 3.1, p=0.033) emerged as independent predictors of mortality. Early surgery (<24h) and preoperative optimization significantly reduced morbidity (p=0.001) and mortality (p=0.010). Conclusion: Advanced age, emergency status, poor physiological reserve, anemia, and low serum albumin levels are major predictors of morbidity and mortality in elderly abdominal surgery patients. Early intervention and preoperative optimization of correctable factors significantly improve outcomes.

Introduction: Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) is a rare but treatable immune-mediated neuropathy affecting the peripheral nervous system. It is characterized by progressive or relapsing motor and sensory dysfunction with demyelinating features on electrophysiological studies. CIDP encompasses a heterogeneous group of syndromes, including typical and atypical variants such as MADSAM, DADS, and MMNCB. Early identification and appropriate classification of CIDP are crucial to initiate immunomodulatory therapy and prevent irreversible axonal damage. Despite defined diagnostic criteria, there remains a degree of clinical and electrophysiological overlap, contributing to diagnostic delays and under-recognition in resource-limited settings. Objective: To identify and describe the clinical, laboratory, and electrophysiological profile of CIDP patients. Methods: CIDP was diagnosed based on AAN criteria. Medical records of patients diagnosed with CIDP and admitted over the past 22 years at our centre were retrospectively reviewed. Correlation between clinical severity, electrophysiological parameters, and laboratory data was analysed. Results: Among 124 CIDP patients, 81 (65.32%) were males. The mean age was 45.02 ± 16.15 years. Clinical subtypes included sensorimotor (70.2%), predominant motor (22.6%), and predominant sensory (7.3%). Typical CIDP was seen in 101 (81.45%) patients, while 23 (18.55%) had atypical forms: MADSAM (11), MMNCB (8), and DADS (4). Electrophysiological analysis showed prolonged distal latencies in ≥2 nerves in 75% of patients, reduced conduction velocities in 66.13%, and absent or prolonged F-wave latencies in 96.77%. Partial conduction block in ≥1 nerve was present in 51.61%, and temporal dispersion in 70.97%. Albuminocytological dissociation in cerebrospinal fluid was found in 92.1% of patients with typical CIDP, compared to 45.5% in those with MADSAM (p < 0.001). Regarding treatment, 50% of patients received steroids, 14.5% immunoglobulin, 17.7% plasma exchange, and 17.7% received immunosuppressants such as Azathioprine or Mycophenolate mofetil. In terms of disease progression, 10.5% of patients had a progressive course, 32.3% had relapsing symptoms, and 57.3% remained clinically stable. Hughes disability grade ≥3 did not show significant correlation with the severity of electrophysiological involvement or CSF protein levels. Conclusion: Albuminocytological dissociation in CSF is highly specific for typical CIDP. Absence of F waves/prolongation of F wave latencies are the most consistent electrophysiological finding in CIDP. Clinical severity does not show significant correlation with extent of electrophysiological involvement.

Menopause is a significant physiological transition marked by a decline in estrogen levels, leading to metabolic changes that influence lipid metabolism and increase cardiovascular risk in women. This systematic review aimed to evaluate lipid profile patterns in postmenopausal women and their implications for cardiovascular health. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Embase for studies reporting quantitative lipid data in postmenopausal women. Screening and selection followed PRISMA guidelines, and study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Data from 22 eligible studies, including cross-sectional, comparative, and interventional designs, were analyzed. The findings consistently demonstrated elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), variable triglycerides (TG), and generally reduced high-density lipoprotein cholesterol (HDL-C) in postmenopausal women. Older age, longer duration since menopause, higher body mass index, and comorbidities such as diabetes were associated with worsened lipid profiles. Comparative studies confirmed that postmenopausal women exhibit more atherogenic lipid patterns than premenopausal counterparts. Interventional studies showed that lifestyle modifications, dietary supplementation with agents such as omega-3 fatty acids, phytosterols, and vitamin D, as well as menopause hormone therapy, effectively improved lipid parameters, highlighting strategies for cardiovascular risk reduction. These findings underscore the importance of regular lipid monitoring and individualized interventions to mitigate long-term cardiovascular morbidity in postmenopausal women.

Background: The necessity of closed-suction drainage in the era of tranexamic acid (TXA) during total knee arthroplasty (TKA) is still up for debate. This prospective randomized study aimed to compare the clinical and hematological outcomes of primary TKA performed with and without a drain, all while following a standardized TXA protocol. Methods: We enrolled thirty patients undergoing unilateral primary TKA, who were then block-randomized into two groups: the Drain group (n = 15) and the No-Drain group (n = 15). Each patient received weight-based intravenous TXA at the time of induction and again three hours after the incision. The primary outcome measured was mid-patellar swelling at 24 hours, while secondary outcomes included visual-analogue pain scores, total drain output, active knee flexion (measured on post-operative days [POD] 1, 3, 5; and at weeks 2 and 6), hemoglobin levels on POD 1 and 3, transfusion rates, wound complications, length of hospital stay, and skin-to-skin surgical time. Assessors were kept blind to the group allocations. Continuous data were analyzed using independent t-tests or Mann-Whitney U tests, and repeated measures were evaluated with mixed-effects models. Results: The drainage group had an average output of 330 mL by POD 2. At the 24-hour mark, swelling was less in the drain group (2.8 cm ± 0.7 vs 3.5 cm ± 0.9; p = 0.02), although this difference disappeared by 48 hours. The decline in hemoglobin, transfusion rates (Drain 13% vs No-Drain 7%; p = 0.55), pain scores, complications, and length of stay (4.8 ± 0.9 vs 4.3 ± 0.8 days; p = 0.09) were similar between the two groups. Interestingly, the No-Drain group achieved better knee flexion at week 2 (112° ± 10 vs 105° ± 11; p = 0.04), but this advantage faded by week 6. There were no reported cases of deep infections or thrombo-embolic events. Conclusion: In conclusion, when it comes to primary total knee arthroplasty (TKA) using modern tranexamic acid (TXA) protocols, using routine closed-suction drainage doesn’t really provide much early advantage and doesn’t enhance either bleeding control or functional results. So, ditching the drains could make postoperative care easier without putting safety or recovery at risk.

Background: Non-scarring hair loss is a very common complaint at the skin OPD.  Vitamin-D deficiency is one of the possible causes, and other contributing factors that influence increased hair shedding should be thoroughly investigated. So the treatment plan can be made accordingly. Aims:  The aim of this study was to assess the prevalence of vitamin D deficiency and other contributing factors among patients of non-scarring hair loss. Material and methods: A cross-sectional prospective study was performed in the period between August 2024 and January 2025.  The study included 100 patients, 18-45 years of age, with the complaint of increased hair loss who were never on treatment and supplementation. Full history and physical examination were performed, and laboratory investigations for serum levels of vitamin D, vitamin B12, hemoglobin (Hb), and thyroid function test were done after taking a written consent for the study. Result: Total  100 patients ,71 females and 29 males,( 16 cases of female pattern hair loss(FPHL), 22 male pattern hair loss(MPHL) and 62 telogen effluvium(TE) were investigated for serum level of vitamin-D, vitamin- B12, hemoglobin and thyroid function test, in the result relatively higher proportion of patients with TE showed deficiency of vit-d (74.19%) than AGA (55.26%), vit-B12 (75.80%) than AGA (68.42%) and Hb (38.70%) than AGA (13.13), vit-D insufficiency was more in AGA (26.31%) than TE (16.12%). In comparison to FPHL vs MPHL   vit-D levels (56.25), (54.54) respectively were almost similar in both groups, vit-B12 deficiency was relatively more in MPHL (77.27%) than FPHL (56.25%), Hb deficiency seen in (31.25%) of FPHL and nun in MPHL. Conclusion: Our study found a  significant deficiency in vitamin D, vitamin B12, and hemoglobin levels across all types of hair loss. This highlights the importance of evaluating these factors and tailoring treatment accordingly.

Background: Non-venereal genital dermatoses (NVGD) are a diverse group of disorders affecting the genitalia that are not sexually transmitted. They often mimic venereal diseases, leading to diagnostic dilemmas, patient anxiety, and stigma. Despite their clinical importance, limited comprehensive data exist on their prevalence and patterns in Indian tertiary care settings. Objectives: To determine the clinical and epidemiological patterns of NVGD in patients presenting with genital, oro-genital, genital with skin, and combined oro-genital with skin lesions. Methods: A hospital-based descriptive study was conducted in the Department of Dermatology, Venereology, and Leprosy at a tertiary care hospital over one year. A total of 200 patients with NVGD were included after detailed history, clinical examination, and relevant investigations. Data were analyzed using descriptive statistics, and comparisons were made with published literature. Results: The prevalence of NVGD was 6.1 per 1000 dermatology outpatients. The mean age was 34.8 years, with a male-to-female ratio of 2.28:1. Laborers formed the largest occupational group (34.5%). A total of 34 distinct NVGD were documented. The most common conditions were genital vitiligo (16.8%), pearly penile papules (13.8%), and scabies (9.0%). Other frequent conditions included lichen simplex chronicus (6.4%), candidiasis (6.8%), sebaceous cysts (5.2%), lichen planus (5.6%), drug eruptions (5.2%), and scrotal calcinosis (4.3%). Rare cases included Hailey–Hailey disease, pemphigus vulgaris, Reiter’s disease, and Zoon’s balanitis. No premalignant or malignant lesions were identified. Venerophobia was noted in 18 male patients, mainly associated with vitiligo and pearly penile papules. Conclusion: NVGD are common in dermatology practice and demonstrate wide clinical heterogeneity. Vitiligo, pearly penile papules, and scabies predominate, with notable sex and occupational variations. Awareness of these conditions is vital to prevent misdiagnosis, alleviate patient anxiety, and guide appropriate management. Multidisciplinary clinics and larger multicentric studies are recommended to better define true prevalence and outcomes.

Background: Allergic rhinitis (AR) is a highly prevalent chronic condition with significant impact on daily functioning and quality of life. Urban–rural differences in prevalence and outcomes remain underexplored in India. Aim: To evaluate the prevalence and impact of allergic rhinitis on quality of life in urban versus rural populations. Methods: A cross-sectional observational study was conducted among 120 participants (Urban=60; Rural=60) over 12 months at a tertiary care hospital and affiliated health centers. Diagnosis of AR was based on ARIA criteria. Data on clinical profile, symptom severity, environmental triggers, and healthcare-seeking behavior were collected. Quality of life was assessed using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and EQ-5D VAS. Descriptive statistics, chi-square test, Student’s t-test, and logistic regression were applied, with p<0.05 considered significant. Results: The prevalence of AR was significantly higher in urban participants (78.3%) compared to rural (48.3%) (p<0.001). Urban AR patients reported greater impairment in RQLQ total score (3.2±1.0 vs. 2.6±0.9, p<0.001), more sleep disturbances (6.1±1.8 vs. 4.9±1.7, p<0.001), and higher work/school absenteeism (3.1±2.2 vs. 2.2±1.9, p=0.017). Urban patients were more likely to report dust as a trigger, while rural patients were predominantly exposed to biomass smoke (p<0.001). Healthcare access differed, with rural patients showing delayed consultation and greater reliance on pharmacies, whereas urban patients more frequently visited specialists. Conclusion: Allergic rhinitis is more prevalent and imposes greater quality of life impairment in urban populations, though rural populations face unique environmental triggers and barriers to care. These findings suggest the need for population-specific interventions, including pollution reduction strategies in cities and improved awareness and healthcare access in rural communities.

Osteoporosis in post-menopausal women remains one of the most pressing public health challenges worldwide, driven by hormonal changes, aging, and complex interactions between skeletal fragility, sarcopenia, and comorbid conditions. This systematic review synthesizes evidence from 60 studies published across diverse populations to examine epidemiology, diagnostic approaches, therapeutic strategies, and non-pharmacological interventions. Literature searches were conducted using PRISMA 2020 guidelines, and risk of bias was assessed with established Cochrane and GRADE frameworks. The review confirms that the first decade following menopause is a critical period of accelerated bone loss, leading to a surge in vertebral fractures and setting the stage for later hip fractures, which are often associated with 20–30% one-year mortality. Beyond bone mineral density, fracture risk is strongly influenced by sarcopenia, frailty, metabolic disorders such as type 2 diabetes, and secondary osteoporosis from endocrine or renal disease. While dual-energy X-ray absorptiometry remains the diagnostic cornerstone, emerging tools such as vertebral fracture assessment, trabecular bone score, and the FRAX algorithm enhance precision in identifying women at high risk. Therapeutically, bisphosphonates continue to be the most widely studied and prescribed, providing robust and durable fracture protection, while denosumab and anabolic agents such as teriparatide and romosozumab offer newer options for very-high-risk women when used with careful sequencing. Non-pharmacological strategies, including structured exercise, vitamin D and calcium supplementation, falls prevention, and the implementation of Fracture Liaison Services, consistently enhance outcomes and reduce refracture rates. Despite advances, treatment gaps persist globally, with less than one-third of high-risk women receiving appropriate therapy after a fragility fracture, particularly in low- and middle-income countries. This review highlights the urgent need for integrated care pathways, global equity in osteoporosis management, and future research into imminent fracture risk prediction, sarcopenia assessment, and digital health innovations. Taken together, the findings emphasize that effective prevention and treatment of osteoporosis in post-menopausal women demand a holistic approach that combines pharmacological therapy, lifestyle modification, and system-level strategies to reduce the burden of fractures and improve quality of life.