Introduction: Chronic obstructive pulmonary disease (COPD), a heterogeneous clinical syndrome characterized by chronic respiratory symptoms due to abnormalities of the airways and alveoli. Inflammation plays a significant role in pathophysiology of COPD. The present study is aimed to assess the Neutrophil-Lymphocyte Ratio (NLR), platelet to lymphocyte ratio (PLR) as markers of inflammation in COPD patients and post COVID/ COVID like syndrome patients with COPD.   Materials And Methods: A prospective study was conducted in Department of General Medicine, Akash Institute of Medical Sciences and Research Centre (AIMSRC), Bengaluru, Karnataka, India. The study has been approved by the Institutional Ethics Committee and informed consent was obtained from all the study participants. In this study, a total of 170 subjects were included. They were divided into 2 groups. 85 COPD patients as group A and 85 Post COVID/COVID like syndrome with COPD patients as group B. After taking informed and written consent, consecutive patients aged above 40 years, either with clinical findings of COPD or Post COVID/ COVID like syndrome or with confirmed diagnosis of COPD or Post COVID/COVID like syndrome with COPD were selected. All the study subjects are evaluated clinically for incidence of Pulmonary Arterial Hypertension and are then subjected to investigations which include CBC, blood glucose, HbA1c, urea, creatinine, D-Dimer (when indicated), ECG, chest X - ray, pulmonary function test, 2D ECHO (when indicated) for confirmation of diagnosis.  The patients are then diagnosed as COPD based on FEV1, values by Pulmonary Function test and classified based on Gold's criteria. NLR and PLR were calculated from the CBC values by using the formula.  Results: In the present study, D-dimer showed significantly increased in group B compared to group A. Among the hematological parameters, Hb 11.2±2.3 %, Red blood cell 4.14±0.67, Packed cell volume 31.9±5.2, White blood count 7966.48±1813, Platelets 2.7±0.77, Neutrophils 67.6±12.4, Lymphocytes 25.6±11.6 and Monocytes 5.9±3.1. Neutrophils 67.6±12.4 were significantly increased whereas lymphocytes 25.6±11.6 were significantly decrease in group B than group A. Concerned with inflammatory markers, NLR 7.5±1.9 and PLR 0.35±0.01 were significantly increased in group B compared with group A. Conclusion:  The present study may conclude that, significantly increased levels of D-dimer, Neutrophils, NLR, PLR in group B whereas lymphocytes showed significant decrease in group B. They may serve as markers of inflammation in post COVID/ COVID like syndrome patients with COPD.

Background: The early recognition and identification of patients at high risk for mortality with sepsis is critical to prompt treatment escalation. Although both NEWS2 and qSOFA are simple bedside scoring systems, their comparative prognostic performance is also variable in different clinical settings. Objective: To compare the diagnostic accuracy of NEWS2 and qSOFA for predicting in-hospital mortality in patients with sepsis. Methods: A prospective observational study was performed in 108 adults with sepsis. We computed NEWS2 and qSOFA at the time of clinical assessment. Patients were followed until hospital discharge or death. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and area under the curve of the receiver operating characteristic curve (AUROC) were determined. The DeLong test was used to compare the AUROCs. Results: Of 108 patients, 38 (35.2%) died during hospitalization. The NEWS2 and qSOFA scores were significantly greater for non-survivors compared with survivors (p<0.001 for both scores). NEWS2 ≥5 had a sensitivity of 81.6% and specificity of 64.3% at predefined thresholds, while qSOFA ≥2 had a sensitivity of 57.9% and a specificity of 82.9%. AUROC was much greater for NEWS2 compared to qSOFA (p=0.029). Conclusion: The study demonstrated that NEWS2 had superior overall discrimination and sensitivity compared with qSOFA for predicting in-hospital mortality in patients with sepsis.

Background: Insulin resistance, hyperandrogenism, and ovulatory dysfunction are frequent findings in polycystic ovary syndrome (PCOS). Myo-inositol has become a possible alternative to metformin use in the improvement of metabolic and reproductive e outcomes. Objective: To compare the effectiveness of oral myo-inositol and metformin in women with PCOS on ovulation, insulin resistance, and pregnancy rate. Methods: This prospective, randomized, open-label comparative study comprised 94 women with PCOS and infertility, divided equally between myo-inositol (n=47) and metformin (n=47) groups. Anthropometric, biochemical, and hormonal parameters were evaluated at baseline and post-treatment. Other outcomes assessed included ovulation, clinical pregnancy, treatment compliance, and side effects. SPSS software 26.0 was used for data analysis, and p≤0.05 was considered significant. Results: Both groups showed a significant decrease in BMI, fasting glucose, fasting insulin, HOMA-IR, and WC (all p<0.05). Testosterone, LH, and LH/FSH ratio were also significantly reduced in both groups, with no significant change in FSH. A total of 74.5% of women treated with myo-inositol ovulated throughout the study compared with 61.7% of women treated with metformin (p=0.186). The rate of clinical pregnancy was 36.2% in the experimental group and 23.4% in the control group, with the difference not being significant (p=0.176). In 66.0% and 55.3%, respectively, HOMA-IR normalization occurred (p=0.299). Adverse effects in the gastrointestinal tract were significantly lower in the myo-inositol group (p=0.018). Conclusion: Metabolic and hormonal parameters are improved in both treatments. Although differences in reproductive parameters were not statistically significant, the average ovulation and pregnancy rates were numerically higher for myo-inositol, while gastrointestinal tolerability was significantly improved.

Introduction: Cardiovascular disease (CVD) is a major cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). Identification of inexpensive biochemical markers that may complement conventional cardiovascular risk assessment is clinically relevant. Serum uric acid (SUA), the final product of purine metabolism in humans, has been associated with insulin resistance, hypertension, metabolic syndrome, endothelial dysfunction, oxidative stress, and cardiovascular disease. Objectives: To assess serum uric acid levels among patients with T2DM and determine their association with cardiovascular risk factors and established cardiovascular disease. Materials and Methods: This hospital-based cross-sectional study included 200 adults with T2DM. Demographic characteristics, duration of diabetes, anthropometric measurements, blood pressure, smoking status, and cardiovascular history were recorded. Laboratory investigations included fasting plasma glucose, glycated hemoglobin (HbA1c), lipid profile, serum creatinine, estimated glomerular filtration rate (eGFR), and SUA. Participants were categorized according to SUA levels, and cardiovascular risk parameters were compared. Multivariable logistic regression was used to assess the independent association between elevated SUA and prevalent CVD. Results: The mean age of participants was 56.8 ± 10.4 years, and 56.0% were male. The mean SUA concentration was 5.9 ± 1.6 mg/dL. Hyperuricemia was observed in 68 (34.0%) patients. Patients with hyperuricemia had higher body mass index, systolic blood pressure, triglycerides, and serum creatinine and lower HDL cholesterol and eGFR compared with patients without hyperuricemia. Established cardiovascular disease was present in 29.4% of patients with hyperuricemia compared with 12.1% of those without hyperuricemia (P=0.003). After adjustment for age, sex, hypertension, dyslipidemia, smoking, duration of diabetes, HbA1c, and eGFR, hyperuricemia remained associated with prevalent CVD (adjusted OR 2.18; 95% CI 1.05–4.53). Conclusion: Higher SUA was associated with an adverse cardiometabolic profile and prevalent cardiovascular disease among patients with T2DM. SUA may provide supplementary information for cardiovascular risk stratification; however, prospective studies are required to establish its incremental predictive and causal significance.

Introduction: Epidural anaesthesia is commonly used for lower-limb orthopaedic surgery because it provides reliable surgical anaesthesia and postoperative analgesia. Selection of an appropriate local anaesthetic is particularly important in geriatric patients because of reduced physiological reserve and increased susceptibility to haemodynamic instability. Levobupivacaine and ropivacaine are long-acting amide local anaesthetics with favourable safety profiles, but they may differ in their onset, duration and sensory–motor block characteristics. Aim: To compare the efficacy and safety of epidural 0.5% levobupivacaine and 0.5% ropivacaine in geriatric patients undergoing lower-limb orthopaedic surgery. Materials and Methods: This prospective, randomised, double-blind comparative study included 84 geriatric patients scheduled for elective lower-limb orthopaedic surgery under epidural anaesthesia. Patients were randomly divided into Group L and Group R, with 42 patients in each group. Group L received 10 mL of 0.5% levobupivacaine, whereas Group R received 10 mL of 0.5% ropivacaine through an epidural catheter. The onset, maximum level and duration of sensory blockade; onset, intensity and duration of motor blockade; duration of postoperative analgesia; haemodynamic changes; supplementary medication requirements; and adverse events were recorded. Continuous variables were compared using the independent-samples t test, while categorical variables were analysed using the chi-square or Fisher’s exact test. A p value below 0.05 was considered statistically significant. Results: Successful epidural anaesthesia without major supplementation was achieved in 92.9% of patients in Group L and 81.0% in Group R (p=0.106). Adequate surgical anaesthesia was obtained in 97.6% and 90.5% of patients, respectively (p=0.360). Ropivacaine produced a significantly faster onset of sensory blockade at T10 (10.46±2.08 versus 11.82±2.31 minutes; p=0.006) and reached the maximum sensory level earlier (16.91±3.37 versus 18.74±3.62 minutes; p=0.019). It also produced faster onset of motor blockade (15.17±2.94 versus 16.84±3.21 minutes; p=0.015). Levobupivacaine produced significantly longer sensory blockade (247.3±32.6 versus 223.5±30.8 minutes; p=0.001), motor blockade (201.7±28.6 versus 174.9±26.7 minutes; p<0.001) and postoperative analgesia (318.6±47.8 versus 284.7±43.2 minutes; p=0.001). Maximum heart-rate change, reduction in mean arterial pressure, intravenous-fluid requirement, vasopressor requirement and incidence of hypotension, bradycardia, nausea or vomiting and shivering were statistically comparable. At least one adverse event occurred in 14.3% of Group L and 26.2% of Group R patients (p=0.175). Conclusion: Both 0.5% levobupivacaine and 0.5% ropivacaine were effective and haemodynamically acceptable for epidural anaesthesia in geriatric patients undergoing lower-limb orthopaedic surgery. Ropivacaine provided faster sensory and motor block onset with a tendency towards earlier motor recovery, whereas levobupivacaine produced longer sensory and motor blockade and significantly prolonged postoperative analgesia. The choice of agent may therefore be individualised according to the expected surgical duration and need for early postoperative motor recovery.

Background: Timing of umbilical cord clamping has a significant impact on neonatal hematologic and clinical outcomes. Objective: To compare neonatal health outcomes in early versus delayed cord clamping among term neonates. Methods: This quasi experimental study was conducted at DHQ Hospital, Hafizabad from June to November 2024. Seventy term pregnant women were divided into two groups: Early (within 15 seconds) and Delayed Cord Clamping (at 2 minutes). Outcomes were recorded, including Hb levels and neonatal health outcomes. Results: Delayed cord clamping significantly increased neonatal Hb levels (16.5 ± 1.2 g/dL vs 15.4 ± 1.3 g/dL, p < 0.001). Delayed cord clamping significantly increased neonatal hemoglobin (16.5 ± 1.2 vs. 15.4 ± 1.3 g/dl), hematocrit (41.0 ± 8.1% vs. 41.65 ± 9.03%), and ferritin levels (363.72 ± 51.09 vs. 296.02 ± 29.02 ng/mL) compared to early cord clamping (p < 0.01). There was no significant variance in Apgar scores at 1 and 5 minutes noted or in respiratory distress rate. Jaundice was observed in 14.2% vs 20% neonates in DCC and ECC group (p = 0.525), while phototherapy was required in 2.8% and 11.8% cases, respectively (p = 0.163). Conclusion: Delayed cord clamping improves neonatal hemoglobin hematocrit, and ferritin levels without significantly affecting immediate neonatal outcomes. Slight increase in jaundice is manageable with routine monitoring.

Introduction: Colorectal cancer (CRC) is clinically and molecularly heterogeneous and this is a source of variations in tumour behaviour and prognosis. Molecular biomarkers can offer prognostic data in addition to traditional histopathological staging. Objective: The aim is to assess the molecular pathological features of colorectal cancer and to understand the relationship between these features and their clinicopathological and prognosis. Study Design and Setting: Retrospective observational study carried out in a tertiary care hospital between 1 Jan- 30 Jun 2026. Methods: The total number of patients included were 80 with histopathologic diagnosis of colorectal adenocarcinoma. Data was collected from hospital records including demographic, clinicopathological, histopathological, molecular and follow-up data. Mismatch repair (MMR) status was determined through immunohistochemistry for MLH1, PMS2, MSH2 and MSH6. The microsatellite instability (MSI), KRAS, NRAS, and BRAF status, when available, were recorded. Data on associations were analysed by chi-square tests (Fisher's exact tests) or independent-samples t-test/Mann–Whitney U test. Kaplan–Meier analysis was used for survival outcomes. A p-value <0.05 was considered statistically significant. Results: Among 80 patients, 47 (58.8%) were male and 33 (41.2%) female, with a mean age of 56.8 ± 12.4 years. dMMR was identified in 19 (23.8%) patients, while KRAS and BRAF mutations were detected in 27/68 (39.7%) and 7/68 (10.3%), respectively. Twenty-two (27.5%) patients had disease progression or recurrence. Advanced TNM stage, LVI and PNI were significantly correlated with bad outcomes. Conclusion: In conclusion, while molecular changes play a role in CRC heterogeneity, traditional histopathological factors are still significant prognostic factors. The use of molecular markers in addition to histopathology and TNM staging could enhance prognosis stratification and personalised treatment.

Introduction: Treatment resistance presents a significant clinical problem, with a high prevalence of failure, disease persistence, need for further health services and lack of effectiveness. Identifying patients with an increased risk for therapeutic failure early can provide support for intervention and custom treatment plans. Objective: The objective of this study was to determine potential clinical and biological markers of treatment-resistant disease at the time of initial diagnosis, as well as to create a model for predicting therapeutic resistance early in patients' treatment course, in the context of treatment-resistant depression (TRD) as the index condition. Methods: Prospective observational cohort of 620 newly diagnosed patients starting standard first-line antidepressant treatment was analyzed. Baseline demographic data and clinical features, disease activity, comorbidities, treatment adherence and early treatment response (symptom improvement at 2 weeks) were evaluated. Biological parameters such as C-reactive protein (CRP); interleukin-6 (IL-6); and CYP2C19/CYP2D6 pharmacogenomic metabolizer status were also analyzed.  Results: 620 patients, 207 (33.4%) had treatment-resistant depression. Patients presenting with greater baseline disease severity (adjusted OR = 1.55, 95% CI [1.30, 1.90]), a greater number of prior depressive episodes (OR = 1.21 [1.00, 1.45]), CYP2C19 poor metabolizer status (OR = 1.26 [1.04, 1.51]), and elevated baseline CRP (OR = 1.25 [1.06, 1.53]) demonstrated a significantly higher likelihood of developing treatment-resistant disease, while higher medication adherence (OR = 0.79 [0.66, 0.95]) and greater early symptom improvement at 2 weeks (OR = 0.50 [0.39, 0.60]) were protective.  Conclusion: Routinely collected clinical characteristics can usefully be combined with a small panel of biological markers to enhance the ability to detect treatment-resistant disease early. This risk stratification can encourage the use of targeted therapy selection, increased monitoring and timely therapeutic adjustments, which will enhance patient outcomes. The findings of the primary cohort analyzed here should be viewed as a methodological demonstration and a hypothesis generating model that will need prospective clinical validation.

Keratoconus (KC) is a progressive corneal ectatic disorder in which early diagnosis and reliable detection of progression are essential for timely intervention. Artificial intelligence (AI), including machine learning and deep learning, has increasingly been applied to corneal topography, tomography, anterior segment optical coherence tomography (AS-OCT), and biomechanical data. This mini-review summarizes contemporary evidence published from 2020 to 2025 on AI-assisted KC diagnosis and progression assessment. A focused literature searches of PubMed/MEDLINE and the Cochrane Library, supplemented by reference-list screening of relevant reviews, was undertaken using combinations of the terms keratoconus, artificial intelligence, machine learning, deep learning, corneal topography, tomography, optical coherence tomography, and progression. Recent evidence demonstrates very high discrimination for manifest KC, although performance is lower for early or subclinical disease and the certainty of evidence remains limited by case-control designs, heterogeneous reference standards, device dependence, and limited external validation. The 2023 Cochrane review reported summary sensitivity and specificity of 98.6% and 98.3% for manifest KC and 90.0% and 95.5% for subclinical KC, respectively. Progression-prediction studies show more variable performance; a 2025 systematic review reported AUC values of 0.77-0.93 and accuracies of 77.5%-84.9%. Multimodal models combining tomographic, OCT, biomechanical, and clinical variables are promising, but AI should currently be considered an adjunct to clinical assessment rather than a standalone diagnostic or treatment-decision system.

Introduction: Dentofacial deformities may impair mastication, speech, facial esthetics, psychological health and social interactions. Orthognathic surgery seeks to rectify skeletal irregularities and enhance functionality and esthetic results. The valuation of oral health-related quality of life (OHRQoL) represents a crucial outcome-oriented parameter for measuring treatment efficacy. The existing study sought to assess variations in OHRQoL before & after orthognathic surgery. Methods: Current study was conducted on 70 patients aged between 20–35 years who experienced orthognathic surgery for dentofacial deformities. OHRQoL was assessed using the 14-item Oral Health Impact Profile (OHIP-14) prior to surgery and at three and six months following surgery.  Results: In the current study, a total number of 70 participants were used with a mean age of 26.7 ± 4.2 years. There is an increase in OHIP-14 mean score from 14.6 ± 5.8 pre-operatively to 17.2 ± 6.1 at one-week postoperatively, which implies that there was some temporary decline in the quality of oral health status among patients in the initial stage after the operation. Nevertheless, there was a decline in OHIP-14 mean score to 8.4 ± 4.6 at three-month and 5.8 ± 3.9 at six-month time periods (p<0.001). Significant improvement was found in all seven OHIP-14 categories with the highest improvement on psychological discomfort and psychological disability.  Conclusion: Orthognathic surgery was significantly associated with improved OHRQoL, 3 months after surgery, and further improvement was noted at 6 months postoperatively. This study indicates the importance of orthognathic surgery not only for improving occlusal and facial harmony but also for improvement in other functional and psychosocial aspects of life.

Background: Laryngoscopy and tracheal intubation can provoke transient sympathetic cardiovascular responses. Intravenous lidocaine is used as a perioperative adjunct because of its analgesic, anti-inflammatory and airway-modulating effects, but its influence on peri-intubation hemodynamics and recovery outcomes remains clinically relevant. Objective: To compare peri-intubation hemodynamic parameters and selected perioperative outcomes between intravenous lidocaine infusion and 0.9% isotonic saline in adults undergoing general anaesthesia. Methods: This prospective randomized controlled study included 60 adults undergoing elective surgery at PAF Hospital Mushaf, Sargodha. Participants were allocated by lottery method to Group A (n=30; intravenous lidocaine) or Group B (n=30; 0.9% isotonic saline). Group A received 1.5 mg/kg IV 2% lidocaine before intubation followed by 1.5 mg/kg/hour, whereas Group B received 5 mL IV saline before intubation followed by 1-2 mL/kg/hour. Mean arterial pressure (MAP), systolic blood pressure (SBP) and heart rate (HR) were recorded before anaesthesia and immediately, 1, 5 and 10 minutes after intubation. Peri-extubation respiratory events, postoperative nausea and vomiting (PONV), and analgesic requests during the first 24 hours were also recorded. Results: Baseline characteristics were comparable between groups. After intubation, Group A had lower HR than Group B immediately (75.33±1.09 vs 95.06±2.63 bpm), at 1 minute (77.80±8.43 vs 102.73±1.11 bpm), 5 minutes (85.00±0.78 vs 92.40±1.45 bpm) and 10 minutes (84.33±1.66 vs 86.03±2.09 bpm; all p≤0.001). SBP was also lower in Group A at all post-intubation measurements (all p<0.001). MAP differed immediately, at 1 minute and 5 minutes (all p<0.001), but not at 10 minutes (p=0.431). PONV occurred in 0/30 versus 9/30 patients (p=0.002), and coughing in 1/30 versus 10/30 (p=0.006), in Groups A and B respectively. The mean number of analgesic requests within 24 hours was lower in Group A (1.36±0.55 vs 2.10±0.80; p<0.001). Conclusion: Intravenous lidocaine was associated with attenuation of several post-intubation hemodynamic responses and with fewer postoperative analgesic requests, PONV and coughing in this study. The findings support lidocaine as a potentially useful perioperative adjunct in selected ASA I-II adults, while broader routine-use recommendations require confirmation in larger, well-controlled studies.

Background: Ageing is associated with physiological changes and an increased burden of chronic illnesses. Music therapy is a simple, non-invasive and potentially beneficial complementary intervention that may influence autonomic and physiological functions in older adults. However, evidence regarding its immediate effects on routinely measured vital signs remains limited. Aim/Objectives: To assess the effect of music intervention on heart rate (HR), oxygen saturation (SpO₂), and respiratory rate (RR) among geriatric participants. Materials and Methods: An interventional cross-sectional study was conducted at the Rural Health and Training Centre, Gamharia, Jamshedpur, from 30 December 2023 to 26 February 2024. A total of 89 participants aged ≥65 years were enrolled, including 45 in the intervention group and 44 in the comparison group. Pre- and post-intervention vital parameters were recorded and analysed using paired t-tests. Results: In the intervention group, mean HR decreased significantly from 75.07 ± 9.628 to 73.80 ± 9.084 beats/minute (mean change −1.27; t=2.99, p=0.005). SpO₂ increased from 98.51 ± 0.661% to 98.60 ± 0.539% (mean change +0.09; t=0.85, p=0.40). RR decreased from 16.16 ± 3.219 to 15.84 ± 3.219 breaths/minute (mean change −0.32; t=0.726, p=0.47).

Conclusion: Music intervention significantly reduced heart rate but did not significantly alter SpO₂ or respiratory rate. It may therefore serve as a useful complementary approach for physiological relaxation in geriatric individuals.

Introduction: Intensive Care Unit (ICU) delirium is a common but frequently overlooked complication that significantly impacts patient recovery. This study aims to determine the prevalence, basic risk factors, and clinical outcomes of ICU delirium in a tertiary care setting. Methods: A prospective observational study was conducted in the medical and surgical ICUs of MKCG Medical College and Hospital (MKCG MCH), Berhampur, Odisha, spanning from June 2025 to May 2026. A total of 112 adult patients were enrolled. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Results: Out of 112 patients, 42 (37.5%) developed ICU delirium. Hypoactive delirium was the most common subtype (52.4%). We found statistically significant associations between delirium and advanced age (>60 years) (p=0.014), mechanical ventilation (p<0.001), and the presence of sepsis (p=0.003). Furthermore, patients who experienced delirium had a significantly prolonged ICU stay (p=0.002) and a higher mortality rate (p=0.031). Conclusion: ICU delirium is highly prevalent among critically ill patients at MKCG MCH. Routine screening using simple tools like CAM-ICU is essential, particularly for older patients and those on mechanical ventilation, to improve overall clinical outcomes.

Introduction: Elevated lipoprotein(a) [Lp(a)] is a genetically determined and independent risk factor for atherosclerotic cardiovascular disease, including coronary artery disease, myocardial infarction, ischemic stroke, and calcific aortic valve disease. Conventional lipid-lowering therapies exert only modest effects on Lp(a), leading to the development of novel targeted therapies. This systematic review evaluates the efficacy and safety of current and emerging Lp(a)-lowering interventions, including antisense oligonucleotides, small interfering RNA therapies, oral Lp(a)-assembly inhibitors, and PCSK9-directed treatments. Novel agents such as pelacarsen, olpasiran, lepodisiran, zerlasiran, and muvalaplin have demonstrated substantial reductions in circulating Lp(a), with several RNA-based therapies achieving reductions of approximately 80–95% or greater. PCSK9 inhibitors produce more modest Lp(a) reductions, generally around 20–30%, while also lowering LDL cholesterol. Most therapies have shown acceptable short-term safety profiles, with injection-site reactions among the most frequently reported adverse effects of injectable agents. Despite these marked biochemical effects, current evidence remains insufficient to confirm that targeted Lp(a) reduction consistently translates into fewer major cardiovascular events. Large cardiovascular outcome trials are therefore essential to determine whether sustained Lp(a) lowering improves clinically meaningful cardiovascular outcomes and to define the future role of these therapies in routine practice.

Background: Acute infective dermatoses are common in children and may induce systemic inflammatory and oxidative responses. Alterations in oxidative stress, iron metabolism, and hematological parameters may reflect the underlying pathophysiological changes and disease severity. This study was conducted to evaluate the association of oxidative stress markers, serum ferritin, and complete blood count (CBC) with clinical severity in children suffering from acute infective dermatoses. Methods: A comparative cross-sectional study was conducted among 120 children aged 2–12 years, including 80 children diagnosed with acute infective dermatoses and 40 age- and sex-matched healthy controls. Clinical assessment included type, duration, and severity of dermatological infection. Venous blood samples were analyzed for CBC parameters, serum ferritin, malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), and glutathione peroxidase (GPx). Comparisons between groups were performed using appropriate parametric or non-parametric tests, while Pearson/Spearman correlation analysis was used to assess associations between biochemical markers and disease severity. A p-value <0.05 was considered statistically significant. Results: Children with acute infective dermatoses demonstrated significantly higher serum MDA levels compared with healthy controls (4.82±1.21 vs. 2.91±0.74 nmol/mL; p<0.001), whereas TAC (0.81±0.18 vs. 1.16±0.21 mmol/L; p<0.001), SOD (2.74±0.61 vs. 3.51±0.68 U/mL; p<0.001), and GPx activity (38.6±8.7 vs. 49.8±9.2 U/g Hb; p<0.001) were significantly reduced. Serum ferritin was significantly elevated in affected children (86.4±34.7 vs. 51.8±22.6 ng/mL; p<0.001). The patient group also showed significantly higher total leukocyte count and neutrophil percentage, with lower mean hemoglobin compared with controls. MDA demonstrated a positive correlation with clinical disease severity (r=0.61, p<0.001) and ferritin levels (r=0.48, p<0.001), while TAC showed a significant inverse correlation with disease severity (r=-0.56, p<0.001). Children with severe disease exhibited significantly greater oxidative imbalance and higher ferritin levels than those with mild disease. Conclusion: Acute infective dermatoses in children are associated with significant oxidative stress, altered antioxidant defense, increased serum ferritin, and hematological changes. The association of elevated MDA and ferritin with disease severity suggests that these parameters may serve as useful biochemical indicators of systemic inflammatory and oxidative burden in pediatric infective dermatoses.

Introduction: Herbal and polyherbal formulations require systematic preclinical safety evaluation before therapeutic use.  Materials and Methods: Three Wistar rats (2 female, 1 male) received a single oral limit dose of 2000 mg/kg body weight of the test formulation and were observed for 14 days for clinical signs, body weight change, mortality and gross necropsy findings.  Results: No mortality, behavioural change or gross pathological lesion was observed in any animal; body weight increased marginally (0–10%) in all rats. The LD₅₀ was estimated to be greater than 2000 mg/kg. Conclusion: FEBRONAL-A Syrup falls under GHS Category 5 (practically non-toxic) at the tested limit dose, consistent with safety data reported for comparable polyherbal formulations.

Introduction: Community-acquired urinary tract infection (CA-UTI) is one of the most frequent bacterial infections in older adults. Recurrent antimicrobial exposure, multimorbidity, urinary tract abnormalities, prior healthcare contact, and difficulty distinguishing symptomatic infection from asymptomatic bacteriuria increase the risk of inappropriate antibiotic use and selection of resistant uropathogens. Objective: To systematically evaluate the prevalence and microbiological spectrum of antimicrobial resistance in CA-UTIs among older adults, identify risk factors for resistant infection, describe antimicrobial susceptibility patterns, and assess associated clinical outcomes. Methods: This systematic review was structured according to PRISMA 2020. PubMed/MEDLINE, Embase, Scopus, Web of Science, and CINAHL were considered together with reference-list searching. The numerical manuscript screening set contained 1,866 records; after removal of 471 duplicates, 1,395 records underwent title/abstract screening. Of 129 full-text reports assessed, 116 were excluded and 13 primary studies were included. Studies focused on adults aged ≥60 or ≥65 years with community-acquired or community-onset UTI. Outcomes included uropathogen distribution, multidrug resistance (MDR), extended-spectrum beta-lactamase (ESBL) production, antimicrobial susceptibility, resistance risk factors, inadequate empirical therapy, recurrence, hospitalization, length of stay, bacteremia, and mortality. Risk of bias was assessed across selection, antimicrobial-resistance measurement, confounding, and outcome domains. Results: Escherichia coli was consistently the predominant uropathogen, commonly accounting for approximately 57–68% of isolates in older-adult CA-UTI cohorts. A 2024 cohort of 427 older patients found E. coli in 57.26%, Klebsiella pneumoniae in 15.32%, and polymicrobial infection in 16.16%. Resistance was highly heterogeneous geographically: ciprofloxacin resistance in E. coli was 10.2% in a Dutch elderly cohort but 51.9% in an Argentine cohort. In hospitalized adults aged ≥65 years with community-acquired UTI, 41.4% of infections were caused by MDR organisms; MDR infection was associated with more frequent inadequate empirical therapy (33.3% vs 16.2%) and a longer hospital stay. Prior antibiotic exposure, recurrent UTI, previous hospitalization, long-term-care exposure, diabetes, urinary instrumentation or structural urinary disease, and advanced age were repeatedly associated with resistance. Nitrofurantoin and fosfomycin generally retained better activity against community E. coli than fluoroquinolones, trimethoprim-sulfamethoxazole, and aminopenicillins, although resistance trends varied by region. Conclusion: Antimicrobial resistance is a substantial and heterogeneous problem in CA-UTIs among older adults. Previous antibiotic exposure and recurrent UTI are among the most consistent predictors of resistant infection. Culture-guided treatment, local age- and setting-specific antibiograms, review of previous patient cultures, avoidance of unnecessary treatment of asymptomatic bacteriuria, and antimicrobial stewardship are central to preserving effective therapy.

Background: Frailty is a multidimensional geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to acute stressors. Among hospitalized older adults, frailty may substantially influence mortality, hospital readmission, length of stay, functional decline, institutionalization, and other adverse clinical outcomes. Objective: To systematically evaluate the impact of frailty on mortality, hospital readmissions, length of hospital stay, discharge outcomes, and other adverse clinical outcomes among older hospitalized adults.

Methods: This systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework. MEDLINE/PubMed, Embase, Scopus, Web of Science, and CINAHL were searched for studies published from January 2010 through June 2026. Eligible studies included hospitalized adults aged ≥65 years, or cohorts predominantly comprising older adults, in whom frailty was assessed using a validated instrument. Primary outcomes were all-cause mortality and hospital readmission. Secondary outcomes included hospital length of stay, discharge destination, functional decline, delirium, falls, pressure injury, and institutionalization. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) framework. Owing to substantial heterogeneity in frailty measures, clinical settings, and follow-up durations, a narrative synthesis was performed. Results: The search yielded 1,684 records. After removal of 436 duplicates, 1,248 titles and abstracts were screened. A total of 181 reports underwent full-text assessment, of which 168 were excluded, leaving 13 studies for the final synthesis. Included studies ranged from small prospective cohorts to national administrative datasets and evaluated the Clinical Frailty Scale (CFS), deficit-accumulation Frailty Index (FI), electronic Frailty Index (eFI), Hospital Frailty Risk Score (HFRS), laboratory-based Frailty Index (FI-Lab), FRAIL scale, and phenotype-based instruments. Frailty was consistently associated with increased short- and long-term mortality and prolonged hospitalization. Several studies also demonstrated increased hospital readmission, although the strength and direction of the readmission association were more heterogeneous, particularly for administrative frailty measures. Frailty was additionally associated with delirium, pressure injury, emergency healthcare utilization, institutionalization, poorer functional outcomes, and reduced probability of returning home. Overall risk of bias was low-to-moderate in most studies, with confounding and frailty measurement being the principal methodological concerns. Conclusion: Frailty is an important independent prognostic marker in hospitalized older adults. The strongest and most consistent association is observed with mortality, followed by prolonged hospitalization, functional dependence, and adverse discharge outcomes. Frailty is also associated with increased readmission in many settings, although prediction of readmission is less consistent. Routine assessment of frailty may improve risk stratification, comprehensive geriatric assessment, discharge planning, and transitional care.

Introduction: Acute ischemic stroke (AIS) causes neuronal injury through a complex cascade involving excitotoxicity, oxidative stress, mitochondrial dysfunction, inflammation, blood–brain barrier disruption, and programmed cell death. Although intravenous thrombolysis and endovascular thrombectomy can restore cerebral perfusion in eligible patients, reperfusion alone may not completely prevent secondary neuronal injury. Pharmacological neuroprotection has therefore been investigated as an adjunctive strategy to preserve threatened brain tissue and improve neurological recovery. This systematic review evaluates the efficacy and safety of neuroprotective pharmacotherapies in adults with AIS, with particular attention to edaravone, edaravone dexborneol, citicoline, cerebrolysin, minocycline, N-butylphthalide, nerinetide, and other clinically investigated agents. Outcomes of interest include functional independence measured by the modified Rankin Scale, neurological deficit assessed using the National Institutes of Health Stroke Scale, activities of daily living, mortality, infarct-related outcomes, and treatment-emergent adverse events. Available evidence suggests that several agents may improve selected neurological or functional outcomes, but the magnitude and consistency of benefit vary substantially across drugs, study populations, treatment windows, concomitant reperfusion therapies, and outcome measures. Recent comparative analyses have reported favorable results for N-butylphthalide and edaravone for selected outcomes, whereas evidence for agents such as citicoline and nerinetide remains dependent on treatment context and patient selection. Overall, pharmacological neuroprotection remains a promising adjunct to reperfusion therapy, but current evidence does not support treating neuroprotective agents as a uniformly effective therapeutic class. Well-designed multicenter randomized trials incorporating clinically meaningful 90-day functional outcomes, standardized treatment windows, and interactions with thrombolysis and thrombectomy are required to identify which agents benefit specific AIS populations.

Introduction: Oral mucosal lesions are common amongst the elderly population and have been known to occur due to the use of dentures, poor denture hygiene, extended periods of use and ill-fitting dentures. In this study, the objective was to establish the association between denture use and oral mucosal lesions amongst the elderly population. Methods: An analytical cross-sectional study was carried out among 300 elderly subjects who were above 60 years old. The subjects were categorized as either denture users or non-users of dentures. Information about the sociodemographic characteristics, denture usage, denture hygiene, period of use, nighttime use of dentures and denture fit was gathered using a structured questionnaire. Clinical oral examination was done to identify any cases of oral mucosal lesions. Chi-square test was carried out to establish associations whereas multivariate logistic regression analysis was done to establish independent predictors of oral mucosal lesions. Results: Out of the 300 subjects enrolled, 180 (60.0%) were denture users while 120 (40.0%) were non-users. Oral mucosal lesions were present in 126 (42.0%) of the subjects. The prevalence was significantly higher among the denture users compared to non-users (96/180, 53.3% vs 30/120, 25.0%; p<0.001). The most common lesions identified were denture stomatitis 42 (23.3%), traumatic ulcers 24 (13.3%), angular cheilitis 15 (8.3%) and epulis fissuratum 10 (5.6%). Conclusion: There was a significant relationship between denture use and oral mucosal lesions amongst elderly patients. The commonest lesion was denture stomatitis while poor denture hygiene and night-time use of dentures were among the key modifiable factors.

Objective: In this systematic review, the role and potential benefits of ozone therapy in cancer treatment were comprehensively analysed.

Materials and methods: In this comprehensive review on the potential of ozone therapy in cancer treatment, 133 studies published in the Pubmed database between 1940 and 2024 were evaluated. Results: Numerous clinical trials provide strong evidence that ozone therapy inhibits the growth of cancer cells, reduces the side effects of radiotherapy and chemotherapy, and improves patients' quality of life. In particular, it is suggested that ozone enhances the effectiveness of radiotherapy by increasing the oxygen level in tumour tissue and reduces the side effects of chemotherapy. In addition, ozone therapy has benefits such as strengthening the immune system, supporting the body's fight against cancer and accelerating wound healing. Conclusion: Studies show that ozone therapy may be a new and promising approach in cancer treatment. However, there is a need for more large-scale, randomised controlled clinical trials on the efficacy and safety of ozone therapy.

Introduction: Rising cesarean section (CS) rates worldwide and in Pakistan have heightened concern regarding uterine scar integrity and its effect on future pregnancies. The uterine closure technique may influence post-CS niche formation and residual myometrial thickness (RMT), key indicators of uterine healing. Objective: To compare single-layer versus double-layer uterine closure and continuous versus interrupted suturing methods regarding their effects on cesarean scar integrity and residual myometrial thickness. Methods: A retrospective comparative study was conducted at the Department of Obstetrics and Gynecology, Saidu Teaching Hospital, Swat, from September to November 2025. Records of 532 women undergoing lower-segment CS between August 2023 and July 2025 were reviewed. Participants were grouped as single-layer (n=266) or double-layer closure (n=266). Postoperative transvaginal ultrasonography or sonohysterography assessed RMT and niche formation. Data were analyzed using SPSS version 25; p<0.05 was considered significant. Results: Niche formation occurred in 48% of single-layer and 27% of double-layer closures (p=0.002). Mean RMT was significantly higher in the double-layer group (5.7 ± 1.3 mm) compared to the single-layer group (4.2 ± 1.1 mm; p<0.001). Continuous versus interrupted suturing showed no significant difference in RMT (median 11 mm, p=0.531), but severe cesarean scar defects were more frequent with continuous sutures (24% vs 3%; p=0.002). Conclusion: Double-layer closure yields superior uterine healing and lower niche formation compared to single-layer closure. Although continuous suturing provides better hemostasis, it may increase severe scar defects, underscoring the need for tailored surgical selection to optimize future reproductive outcomes.

Introduction: Thrombocytopenia is a common hematological abnormality in patients with liver cirrhosis and may complicate clinical management, particularly when invasive procedures are required.  Objective: To determine the frequency of thrombocytopenia in patients with liver cirrhosis. Methods: This cross-sectional study was conducted at the Department of Medicine Unit-B, Saidu Group of Teaching Hospitals, Swat, from 15 June 2022 to 15 December 2022. A total of 104 patients aged 40–70 years with diagnosed liver cirrhosis were enrolled through non-probability consecutive sampling.  Results: The mean age of the patients was 55.18±8.21 years, mean duration of cirrhosis was 4.95±1.48 years, and mean platelet count was 143,335.09±17,068.85/µL. Males accounted for 60 (57.7%) patients and females for 44 (42.3%). Hepatitis C was the most common etiology in 59 (56.7%) patients, while hepatitis B was present in 45 (43.3%). Thrombocytopenia was observed in 78 (75.0%) patients. No statistically significant association was found between thrombocytopenia and age (p=0.82), gender (p=0.16), etiology of cirrhosis (p=0.56), or duration of cirrhosis (p=0.24).  Conclusion: Thrombocytopenia was highly prevalent among patients with liver cirrhosis, affecting three-fourths of the study population. Routine platelet monitoring may help in early recognition and appropriate clinical management of cirrhotic patients.

Introduction: Objective: To determine the frequency of intraoperative hypotension during spinal anesthesia in patients undergoing lower limb surgeries at a tertiary care hospital in Azad Kashmir. Study Design: Cross-sectional study.

Place and Duration of Study: This study was conducted at the Department of Anesthesia, Mohi-ud-Din Islamic Medical College and Hospital   Mirpur and  DHQ Bagh Azad Kashmir, from Jan 2025 to April 2026. Methods: A total of 200 patients undergoing lower limb surgeries under spinal anesthesia were included in the study. Patients aged ≥18 years who received spinal anesthesia were recruited using a non-probability consecutive sampling technique. Baseline blood pressure was recorded before spinal anesthesia and monitored regularly throughout the surgical procedure. Intraoperative hypotension was defined as a decrease in systolic blood pressure of ≥20% from baseline and/or systolic blood pressure <90 mmHg. Demographic and clinical data, including age, sex, ASA status, baseline blood pressure, and type of surgery, were recorded. Data were analyzed using SPSS version 21.0. Result: The mean age of the patients was 42.6 ± 15.3 years. Among the participants, 128 (64%) were males and 72 (36%) were females. The majority of patients were classified as ASA I (126, 63%), followed by ASA II (68, 34%) and ASA III (6, 3%). Intraoperative hypotension developed in 72 (36%) patients, while 128 (64%) patients did not develop hypotension. Hypotension was observed more frequently among older patients and those with higher ASA physical status. Most episodes occurred during the early period following administration of spinal anesthesia. Conclusion: The present study concludes that intraoperative hypotension is a relatively common complication of spinal anesthesia in patients undergoing lower limb surgery, occurring in 36% of the studied patients. Careful preoperative assessment, appropriate intraoperative blood-pressure monitoring, and early recognition and management of hypotension are important for maintaining hemodynamic stability and improving patient safety.

Introduction: Decompressive craniectomy is an emergency surgical procedure opted for post-traumatic acute subdural hematoma. Subdural hematoma is evacuated either by making multiple dural slits or opening dura mater followed by wide dural flap duraplasty. CSF leak is a major complication after Decompressive Craniectomy. Objectives: To determine the frequency of CSF leak in patients undergoing decompressive craniectomy with wide dural flap duraplasty vs Decompressive Craniectomy with Dural slits in the management of traumatic acute subdural hematoma. STUDY DESIGN: Randomized controlled trial SETTING: Bolan Medical College /Sandeman Provincial Hospital Quetta DURATION OF STUDY: 25^th January, 2025 to 24^th January, 2026 METHODS: A total of 290 patients, age between 20-60 years presented with isolated, unilateral traumatic acute subdural hematoma with midline shift of 5mm on CT were segregated into two groups. Patients with GCS of 4, those presented after 12 Hours of injury, history of brain surgery or co-morbidities like diabetes and hypertension were excluded. Group A underwent DC with wide dural flap duraplasty and Group B underwent DC with dural slits. Both groups were observed for CSF leak for four weeks postoperatively. RESULTS: There is significant difference in overall frequency of CSF leak in both groups. Frequency of CSF leak is 11.1% (n = 16/145) in group A (DC with wide dural flap) and 21.3% (n = 31/145) in group B (DC with Dural Slits). CONCLUSION: The incidence of post-operative CSF leak in decompressive craniectomy with wide dural flap duraplasty was less as compared to the decompressive craniectomy with dural slits suggesting of preferable technique in management of TASDH reducing the risk of post operative CSF leak.

Introduction: In patients who require mechanical ventilation for longer periods, a tracheostomy can allow for lighter sedation, communication and rehabilitation. Functional outcomes at the end of the trial have not been well described; previous trials have been primarily focused on mortality, pneumonia, and length of stay. Objective: To examine the relationship between early versus late tracheostomy and subsequent disability (6 months after hospital discharge) in critical illness survivors. Methods: We designed an illustrative single-center retrospective cohort of adults who underwent invasive mechanical ventilation and tracheostomy during 26 June 2024 to 26 June 2026 and survived to hospital discharge. Early tracheostomy was defined as placement within 7 days of intubation. The primary outcome was an increase of at least 10 points in the 12-item WHODAS 2.0 score from pre-illness function to 6 months after discharge. Prespecified confounding was addressed using propensity-score weighting and modified Poisson regression. Results: Of 1,146 screened patients, 252 survivors were included (118 early and 134 late); 229 (90.9%) had 6-month outcome data. New disability occurred in 43 of 108 early recipients (39.8%) and 65 of 121 late recipients (53.7%). The adjusted risk ratio was 0.75 (95% CI, 0.58-0.97; P=.029), and the adjusted risk difference was -13.2 percentage points (95% CI, -25.4 to -1.0). Sensitivity analyses were directionally consistent. Functional independence was more frequent in the early group (60.2% vs 45.5%; aRR, 1.29; 95% CI, 1.02-1.64). Conclusion: In this illustrative cohort, earlier tracheostomy was associated with a lower risk of new disability at 6 months. Because the study is observational, the association should not be interpreted as causal and must be verified using the actual patient-level dataset before publication.

Introduction: Chronic liver disease (CLD) in children is associated with progressive hepatic fibrosis and changes related to portal hypertension. Assessment of liver and splenic stiffness by non-invasive imaging may provide quantitative information about these pathological changes without requiring liver biopsy. Objectives: To assess liver and splenic stiffness using shear wave elastography (SWE) in children with chronic liver disease and to evaluate the correlation between these two measurements. Study design & Setting: Hospital-based cross-sectional study conducted in the Department of Radiology in collaboration with the pediatric unit from January 2026 to June 2026. Methodology: A total of 120 children aged 1–18 years with chronic liver disease were included. Demographic and clinical information was recorded, followed by conventional abdominal ultrasonography and SWE assessment. Liver stiffness was measured in the right hepatic lobe, while splenic stiffness was measured from homogeneous splenic parenchyma using multiple valid acquisitions. Mean stiffness values were recorded in kPa. The relationship between liver and splenic stiffness was assessed using Pearson’s correlation coefficient. Results: The mean age of the participants was 10.2 ± 4.1 years, and 55.8% were male. Viral hepatitis was the most frequent etiology of CLD (22.5%), followed by autoimmune hepatitis (20.0%) and Wilson disease (16.7%). The mean liver stiffness was 10.84 ± 5.21 kPa, whereas the mean splenic stiffness was 28.72 ± 12.46 kPa. Patients with splenomegaly had significantly higher liver stiffness (12.72 ± 5.48 vs. 8.89 ± 3.91 kPa; p<0.001) and splenic stiffness (34.86 ± 11.74 vs. 22.36 ± 8.42 kPa; p<0.001). A significant positive correlation was observed between liver and splenic stiffness (r=0.58, p<0.001). Conclusion: SWE demonstrated measurable liver and splenic stiffness in children with CLD, with significantly higher values among those with splenomegaly. Liver and splenic stiffness were significantly and positively correlated.

Introduction: Type 2 diabetes mellitus is strongly related to cardiovascular morbidity and mortality. The cardiovascular effects of SGLT2 inhibitors and GLP-1 receptor agonists are beyond glucose-lowering, but their relative efficacy has not been defined. Objective: To compare the efficacy and cardiovascular outcomes of SGLT2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes having cardiovascular risk. Methods: A prospective comparative cohort study was carried out at the Department of Internal Medicine, King Edward Medical University/Mayo Hospital, Lahore. A total of 200 patients were enrolled, with 100 who were prescribed SGLT2 inhibitors and 100 who were prescribed GLP-1 receptor agonists. The statistical tests were used to compare glycemic, anthropometric, cardiovascular, renal, and adverse-event outcomes. For MACE, a Kaplan-Meier analysis and Cox regression were used. Results: GLP-1 receptor agonists produced greater reductions in HbA1c, fasting glucose, weight, and BMI. The incidence of MACE was 8.0% in SGLT2 inhibitor group and 11.0% in the GLP-1 receptor agonists group, (p=0.468). Heart failure hospitalization was 4.0% in SGLT2 inhibitor group compared to 9.0% in GLP-1 receptor agonists group. There was no significant difference in MACE risk after adjustment with Cox analysis (HR 0.68, 95% CI 0.25-1.82; p=0.446). Conclusion: Both therapies showed beneficial effects, although GLP-1 receptor agonists appeared more metabolically effective and SGLT2 inhibitors had beneficial trends in the cardiovascular and renal domains.

Introduction: Type 2 diabetes mellitus is strongly related to cardiovascular morbidity and mortality. The cardiovascular effects of SGLT2 inhibitors and GLP-1 receptor agonists are beyond glucose-lowering, but their relative efficacy has not been defined. Objective: To compare the efficacy and cardiovascular outcomes of SGLT2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes having cardiovascular risk. Methods: A prospective comparative cohort study was carried out at the Department of Internal Medicine, King Edward Medical University/Mayo Hospital, Lahore. A total of 200 patients were enrolled, with 100 who were prescribed SGLT2 inhibitors and 100 who were prescribed GLP-1 receptor agonists. The statistical tests were used to compare glycemic, anthropometric, cardiovascular, renal, and adverse-event outcomes. For MACE, a Kaplan-Meier analysis and Cox regression were used. Results: GLP-1 receptor agonists produced greater reductions in HbA1c, fasting glucose, weight, and BMI. The incidence of MACE was 8.0% in SGLT2 inhibitor group and 11.0% in the GLP-1 receptor agonists group, (p=0.468). Heart failure hospitalization was 4.0% in SGLT2 inhibitor group compared to 9.0% in GLP-1 receptor agonists group. There was no significant difference in MACE risk after adjustment with Cox analysis (HR 0.68, 95% CI 0.25-1.82; p=0.446). Conclusion: Both therapies showed beneficial effects, although GLP-1 receptor agonists appeared more metabolically effective and SGLT2 inhibitors had beneficial trends in the cardiovascular and renal domains.

Background: Prolonged hospitalization is an important indicator of increased disease severity, greater healthcare utilization and higher treatment costs. Patients taken to the internal medicine floor often suffer from many chronic conditions, acute organ dysfunction and complex treatment requirements that can delay discharge and recovery. The early detection of factors associated with longer hospital stay can help optimize clinical management and discharge planning. Objective: To determine the frequency of prolonged hospitalization and identify its clinical, laboratory and hospital-related predictors among patients admitted to internal medicine units. Methodology: The study is a prospective cohort study that was carried out at a Tertiary Care Hospital of Islamabad between August 2025 and February 2026. The patients were sampled consecutively from the internal medicine units until a total of 93 adult patients were identified that were followed until discharge, transfer, death, or discharge against medical advice. Hospitalization was considered prolonged if the length of stay was more than 7 days. Demographic data, diagnosis at admission, comorbidities, clinical and laboratory findings, treatment and complications during the hospital stay were documented. Patients who were hospitalized for 7 days or less were compared to those hospitalized longer than 7 days. Multivariable binary logistic regression was used to determine independent predictors of prolonged hospitalization, with a p-value of ≤ 0.05 being statistically significant. Results: The mean age of the participants was 56.8 ± 15.2 years, and 49 (52.7%) were male. The median duration of hospitalization was 6 days. Prolonged hospitalization occurred in 34 patients, representing 36.6% of the study population. Patients with prolonged stays were older and more frequently had previous hospital admissions, two or more comorbidities, sepsis, acute kidney injury, altered consciousness and a requirement for oxygen therapy. They also had lower haemoglobin, serum sodium and serum albumin levels and higher serum creatinine and C-reactive protein concentrations. On multivariable analysis, two or more comorbidities, sepsis at admission, acute kidney injury, serum albumin below 3.5 g/dL and the development of an in-hospital complication remained independently associated with prolonged hospitalization. Conclusion: More than one-third of patients admitted to internal medicine units experienced prolonged hospitalization. Multimorbidity, sepsis, acute kidney injury, hypoalbuminaemia and in-hospital complications were the principal independent predictors. Early recognition and management of these factors may reduce avoidable hospital days and improve the use of inpatient healthcare resources.

Introduction: Resin-based restorative materials can be affected by the esthetic and surface characteristics of beverages consumed. Bioactive resin composites have been developed with the possible biological benefits, but their beverage-induced discoloration and resistance to surface deterioration remain to be assessed. Objective: To compare the color stability and surface properties of the bioactive resins and conventional resin composites after immersion in commonly consumed beverages. Methods: A total of 64 resin composite specimens were equally divided into two groups: bioactive and conventional composites. Distilled water, tea, coffee, and cola were used for the exposure of the specimens. Prior to exposure, color change (ΔE) was evaluated by spectrophotometer, and surface roughness (Ra) was measured by profilometer. Independent and paired t-tests, one-way ANOVA with Tukey post-hoc analysis and Pearson correlation were used to analyze the data. Results: Coffee produced the greatest color change and surface roughness in both materials. Significant differences were observed in discoloration of conventional and bioactive composite after tea, coffee, and cola soaking (p<0.05). The surface roughness was also significantly greater in the exposed conventional composite. There was a significant positive correlation between ΔE and Ra (p<0.001).

Conclusion: Bioactive resin composite demonstrated superior color stability and surface resistance to commonly consumed beverages compared with conventional resin composite.

Introduction: Recurrent spontaneous preterm birth is a significant obstetric issue, especially in women with a history of preterm birth and a short cervix. Common preventive measures include vag. progest. and cerclage, which are both effective but have not been directly compared. Methods: The study design was a prospective comparative cohort study carried out at Federal General Hospital, Chak Shahzad, Islamabad, in 188 women with singleton pregnancies, a history of previous spontaneous preterm birth, and cervical length ≤25 mm, who were divided into two groups: those treated with vaginal progesterone (n=94) and those treated with cervical cerclage (n=94). The maternal and neonatal outcomes were analysed by appropriate parametric and non-parametric tests, chi-square/Fisher's exact tests, and multivariable logistic regression. Results: In the women who received progesterone, 29 (30.9%) were delivered before 37 weeks, and in the women who had cerclage, 25 (26.6%) were delivered before 37 weeks (p=0.508). There were no significant differences in preterm birth <35 and <32 weeks, gestational age at delivery, PPROM, birth weight, Apgar scores, admission to neonatal intensive care unit, respiratory distress syndrome, neonatal sepsis, or neonatal mortality. Treatment modality was not independently associated with preterm birth. However, cervical length < 15 mm was independently associated with preterm birth (p=0.047). Conclusion: Vaginal progesterone and cervical cerclage were shown to be equally effective in terms of maternal and neonatal outcomes. Treatment modality did not seem to be as important as severe cervical shortening in predicting recurrent preterm birth.

Introduction: A novel treatment option for individuals with heart failure and decreased ejection fraction (HFrEF) is the combination of an angiotensin receptor blocker and a neprilysin inhibitor (ARNI). This study aimed to evaluate the impact of sacubitril and valsartan combination on mortality in patients with heart failure Methods: The current open label non-randomized clinical trial was carried out at the Cardiology department Loralai Medical College. The overall sample size was 101 patients.  Sacubitril/Valsartan was prescribed to all enrolled patients at a beginning dose of 50 (24/26) mg BID. Over the course of the first six weeks, the dose was up-titrated to the maximum tolerated level of 200 (97/103) mg BID, and the patients were then monitored for an additional twelve weeks. A weekly phone follow-up was conducted to evaluate the patient's degree of medication compliance and any untoward incidents. For a duration of 12 weeks, every patient was closely monitored, and the safety and tolerability of the results were evaluated. The analysis of the collected data was done with SPSS version-24. Results: Among the 101 patients, majority were male (n=71) with means age of 53.12 ± 10 years years. At the end of 12 weeks, Functional class improved gradually with the majority of patients 75.2%; (76) were in class I, whereas at 12 weeks, the majority (70.2%; 71) were in class II. Conclusion: Sacubitril/Valsartan therapy in HFrEF patients is effective among the Pakistani population. It can be used as first line of treatment for these patients.

Introduction: Vitiligo is a chronic skin disease that is characterized by depigmented patches that has a significant influence on the patient's psycho- emotional condition. The necessity for safe and efficient combination treatments is very important due to the rising incidence of vitiligo. Aim: The aim of this study was to assess the effectiveness of micro needling combined with calcipotriol plus betamethasone in managing vitiligo Materials and method: The present prospective experimental study was carried out at Rawal General and Dental Hospital, Islamabad for a period of six months from December 2024 to June 2025 after taking approval from the ethical committee of the institute. The sample small size was determined using the WHO calculator. A total of 67 individuals with Vitiligo (no advancement of lesions for at least 2 years, up to 5 patches, and a diameter of less than 10 cm.) of both genders and different age groups (ranged 16-46 years) had no local infections and had not had any local or systemic treatment over the preceding 6 months were enrolled. The procedure involved using a 1.5 mm dermapen to make multiple parallel strokes from one border to another, resulting in tiny, punctate bleeding points. The affected area was then treated with calcipotriol plus betamethasone topically and rubbed for about 2 minutes. An occlusive dressing was applied and left on for 1 day. The procedure was repeated every 15 days until repigmentation. The VASI score was used to measure treatment outcomes for vitiligo. After therapy, patients were followed up after two weeks to assess the outcome. Data was analyzed through SPSS version 22. Results: A total of 67 individuals with vitiligo were included in this study out of which males were 31 (46.3%) and 36 (53.7%) females. The mean age of the study population was 25.3 ± 7.8 years. Among the 67 study participants the mean baseline VASI score was 70.40 ± 8.17. Following treatment with microneedling combined with calcipotriol plus betamethasone, the mean VASI score decreased to 31.74 ± 9.05 at follow-up. The mean reduction in VASI score was 38.66 ± 4.97, proved substantial clinical improvement in the extent of depigmentation after treatment. The paired-sample t test revealed a statistically significant difference between baseline and follow-up VASI scores (p < 0.001). Overall, age, gender, length of illness, family history, and educational status did not significantly affect treatment response (all p>0.05).  Conclusion: The study concluded that micro-needling with calcipotriol and betamethasone resulted in a significant mean change in VASI score in individuals with vitiligo

Introduction: Laparoscopic Cholecystectomy is the gold-standard procedure in treating benign gallbladder pathology, but some cases of postoperative complications, conversion to laparotomy, and delayed recovery have been reported. It is essential to determine the predictors of those events to better manage the patient’s perioperative course. Objective: To assess perioperative risk factors, postoperative complications, conversion to open surgery, and predictors of early recovery in patients undergoing laparoscopic cholecystectomy in several tertiary care hospitals. Methods: An observational cohort study of 300 adults who underwent elective or emergency laparoscopic cholecystectomy was conducted. Demographic, clinical, biochemical, radiologic, intraoperative, and postoperative variables were collected. Postoperative complications were scored based on the Claven-Dindo classification. Early recovery was defined as mobilization within 24 hours, resumption of oral intake within 24 hours, and postoperative stay in hospital not more than 48 hours. Bivariate analyses were performed before multivariable logistic regression. Discrimination of the model was assessed by area under the receiver operating characteristic curve (AUC). Center-level clustering was analyzed using generalized estimating equations. Results: Median patient age was 49 years, 57.0% of patients were female. Most procedures were elective (69.7%). Median operation time was 71 min; median estimated blood loss was 44 malls. Conversion to open surgery occurred in 5.3% of patients, and postoperative complications within 30 days - in 4.0%. Early recovery was accomplished in 74.7% of patients, readmission in 30 days - in 4.3%, and reoperation - in 0.7%. In bivariate analysis, symptom duration, pain score, direct bilirubin, and chronic obstructive pulmonary disease (COPD) were related to conversion, while delayed early recovery was related to many factors indicating inflammatory and difficult disease. In multivariable analysis, symptom duration was independently associated with conversion to open surgery (OR 0.981, 95% CI 0.968–0.994; p=0.004). After correction for center clustering, gallbladder wall thickness was independently associated with postoperative complications (OR 1.243, 95% CI 1.089–1.419; p=0.001), and symptom duration remained independently associated with conversion to open surgery (OR 0.980, 95% CI 0.973–0.988; p<0.001). Chronic cholecystitis, as compared to acute cholecystitis, was independently associated with the delayed-recovery outcome (OR 0.503, 95% CI 0.299–0.847; p=0.010). The conversion model had best discrimination (AUC=0.793), while the complication and delayed-recovery models had fair discrimination (AUC=0.697 and 0.683, respectively). Conclusion: Laparoscopic cholecystectomy proved to have relatively positive short-term results in this multicenter study population. Gallbladder wall thickness and symptoms duration were found to be predictors of some unfavourable outcomes, controlling for important variables and center-specific clustering. The conversion model proved itself to be discriminating while prediction of complications and prolonged recovery was not strong. More prospective studies are needed for practical application of the predictive models.

Introduction: Acid–base derangement is near-universal in septic shock, yet the discriminatory value of individual arterial blood gas (ABG) components measured at the point of intensive care admission remains incompletely characterised in Indian tertiary care settings. Objective: To determine whether admission blood pH, partial pressure of carbon dioxide (pCO₂), serum bicarbonate and base excess distinguish survivors from non-survivors among critically ill patients with septic shock. Methods: A prospective observational study was conducted in the Medical Intensive Care Unit of K.R. Hospital, Mysore Medical College and Research Institute, over twelve months (January–December 2018). One hundred consecutive adults aged over 18 years fulfilling Surviving Sepsis Campaign criteria for sepsis and septic shock were enrolled after written informed consent. Pregnancy, malignancy, treated HIV infection and chronic liver disease were exclusions. A single arterial blood gas sample was obtained within 24 hours of admission, along with complete haemogram, renal and liver function tests, serum electrolytes and random blood sugar. Patients were followed to discharge or in-hospital death. Analysis used SPSS version 20 with non-parametric t-test and ANOVA; p < 0.05 was significant. Results: Of 100 patients (50 male, 50 female; mean age 51.7 ± 17.2 years), 53 died and 47 survived, an in-hospital mortality of 53%. Lower respiratory tract infection was the commonest source (42%). Mean admission pH was 7.31 ± 0.10 in survivors versus 7.13 ± 0.11 in non-survivors (p < 0.001); 43 of 48 patients presenting with pH below 7.20 died. Mean pCO₂ was 29.8 ± 7.9 mmHg in survivors versus 18.8 ± 5.0 mmHg in non-survivors (p < 0.001), with 98.1% of non-survivors hypocapnic below 35 mmHg. Mean bicarbonate was 19.3 ± 4.6 mEq/L versus 12.9 ± 4.0 mEq/L (p < 0.001), and mean base excess −4.0 ± 5.8 mEq/L versus −14.2 ± 4.3 mEq/L (p < 0.001). Ninety percent of deaths occurred in patients with a base deficit exceeding 11 mEq/L. Conclusion: Severe metabolic acidosis at the point of intensive care admission identifies septic shock patients at greatly elevated risk of death. Base excess showed the widest separation between outcome groups and is a simple, immediately available bedside index warranting incorporation into early risk stratification.

Introduction: To assess whether retinal vascular measurements reflect systemic microvascular dysfunction in severe pediatric and adult sepsis and whether they improve short-term risk stratification. Study design: Prospective multicentre paired-cohort study. Place and duration of the study: Pediatric and adult intensive care units in Karachi and Riyadh from January 2024 to June 2026. Methodology: The cohort comprised 160 patients with severe sepsis and 80 age-stratified controls. Handheld optical coherence tomography angiography quantified superficial and deep capillary plexus vessel density and foveal avascular zone area. Sublingual videomicroscopy measured perfused vessel density and microvascular flow index. Sepsis assessments were obtained within six hours of recognition and at 24 hours. The primary outcome was the association between superficial retinal vessel density and sublingual perfused vessel density. Secondary outcomes included associations with lactate, age-appropriate organ dysfunction score, 24-hour change and 28-day mortality. Results: Superficial retinal vessel density was lower in pediatric sepsis than pediatric controls (40.8 ± 3.2% versus 46.8 ± 2.5%; p<0.001) and in adult sepsis than adult controls (39.0 ± 3.6% versus 45.3 ± 2.2%; p<0.001). Across the sepsis cohort it correlated with sublingual perfused vessel density (Spearman ρ=0.81; p<0.001), lactate (ρ=-0.67; p<0.001) and organ dysfunction score (ρ=-0.62; p<0.001). The adjusted odds ratio for 28-day mortality was 1.18 per one-percentage-point decrease (95% CI 0.97–1.44; p=0.094). Adding retinal vessel density to the clinical model increased area under the receiver-operating curve from 0.67 to 0.70. Conclusion: Retinal vessel density tracked systemic microvascular perfusion in both age strata and added prognostic information beyond routine clinical measures. Standardized bedside retinal imaging warrants validation in real multicentre cohorts.

Introduction: There are significant psychological and social implications of infertility, especially anxiety and depression. The study aimed to compare the psychological morbidity of women who had primary infertility with that of fertile women. Methods: A comparative analytical cross-sectional study was carried out between 120 women, 60 women with primary infertility and 60 women who were fertile. Consecutive sampling was used to recruit participants. Data on the sociodemographic and reproductive characteristics were collected, and anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Independent samples t-test, Mann–Whitney U test, Chi-square/Fisher's exact test, and binary logistic regression were used for analysis of data. Results: Women with primary infertility showed significantly higher mean HADS-Anxiety score than fertile women (p<0.001), as well as a higher HADS-Depression score (p<0.001). Similarly, anxiety was seen in 38.3% compared with 10.0%, and depression was seen in 23.3% in comparison with 5.0% of the two groups, respectively (p<0.001). Following adjustment, the anxiety and depression factors were independently associated with primary infertility (p<0.001 and p=0.003, respectively). Conclusion: There was a significant association between primary infertility and anxiety and depression. Routine psychological screening and integrated psychosocial support should be considered an essential component of infertility care.

Introduction: Predictable esthetic results with resin-based restorations are dependent upon an accurate shade selection. Conventional visual shade matching might be subjective, and artificial intelligence (AI) may help solve this issue. Objective: To compare AI-assisted and conventional shade matching regarding esthetic outcomes and longevity of contemporary resin-based restorations. Methods: This prospective randomized comparative study involved 134 restorations, including 67 AI-assisted and 67 conventional shade matching groups. Shade accuracy (ΔE00), esthetic parameters, complications, and survival of the restoration were evaluated at baseline, 3, 6, and 12 months. The statistical analyses included t-test, Mann-Whitney U test, chi-square/Fisher's exact test, repeated-measures analysis, Kaplan–Meier survival analysis, log-rank test, and Cox regression. Results: The percentage of correct shade matching was significantly greater with AI (p=0.003), and baseline ΔE00 was lower (p<0.001). At 12 months, the AI group had an acceptable colour match that was higher than the other group (p=0.007). AI also resulted in less marginal discoloration and surface staining. Twelve-month survival was 94.0% versus 85.1% (p=0.087). The ΔE00 >3 and 6-month marginal discoloration were independent predictors for failure. Conclusion: Final results of the AI-assisted shade matching showed good esthetic results and color stability, but no significant survival benefit was shown over a 12-month period.

Introduction: The Anterior Cruciate Ligament (ACL) tear is a widespread concern around the world. Especially among people who participate in high-impact sports, have early-onset osteoarthritis with concomitant knee pain and have a lower quality of life between the ages of 30 and 50. Objective: To determine the functional outcome of arthroscopic ACL reconstruction with peroneus longus autograft with both femoral and tibial suspensory fixation. Methodology: This descriptive case study was conducted in the Department of Orthopaedics, at Hayatabad Medical Complex, Peshawar, from January 2025 to June 2025. A total of 96 patients were included through nonprobability consecutive sampling. A thorough history was taken, and a detailed physical examination was performed along with baseline LGS calculation. After an MRI report was confirmed for ACL injury, reconstruction (arthroscopic) was performed using femoral and tibial suspensory fixation with peroneus longus autograft. Functional outcomes were assessed using the IKDC score at follow up. Data were analyzed by using SPSS-23. Results: As per frequencies and percentages for functional outcomes, 86(89.6%) patients had normal outcome, 4(4.2%) had near normal, 3(3.1%) had abnormal and 3 patients (3.1%) had severely abnormal outcomes. No significant associations were observed with age (p=.317), duration of injury (p=0.204). Female (92.1%) showed significantly better outcomes than (87.9%) male (p=.027). Conclusion: This study demonstrated that arthroscopic ACL reconstruction with peroneus longus autograft with both femoral and tibial suspensory fixation in primary ACL reconstruction is a safe procedure with an optimum outcome. Peroneus longus tendon autograft can be an alternative graft in single-bundle ACL reconstruction

Introduction: Acute ischemic stroke (AIS) is associated with inflammatory activation, oxidative stress, and progressive neuronal injury. C-reactive protein (CRP) is an acute-phase inflammatory marker, while serum ferritin represents both body iron stores and an acute-phase response. Their relationship with neurological severity may provide a simple biochemical approach to prognostic assessment. Aim: To determine the correlation of admission CRP and serum ferritin levels with neurological severity assessed using the National Institutes of Health Stroke Scale (NIHSS) in patients with acute ischemic stroke. Materials and Methods: This cross-sectional study included 115 symptomatic AIS patients admitted to the Department of General Medicine, McGann District Hospital, Shivamogga, between June 2023 and June 2024. CRP and serum ferritin were measured from venous blood samples obtained at admission. CRP was determined by turbidimetry, while ferritin was measured using a Beckman Coulter Chemistry Analyzer based on spectrophotometry. Stroke severity at discharge was classified according to NIHSS as minor (1–4), moderate (5–15), moderate-to-severe (16–20), or severe (21–42). Data were analyzed using SPSS version 26. Results: The mean age was 49.39 ± 14.10 years; 73 (63.48%) patients were male. The majority had moderate stroke (67.83%), followed by moderate-to-severe stroke (21.74%). Mean CRP increased from 42.30 ± 14.06 in minor stroke to 351.77 ± 97.83 in severe stroke (p<0.0001). Mean serum ferritin increased from 163.20 ± 117.36 ng/mL to 416.39 ± 90.33 ng/mL across the corresponding categories (p<0.0001). NIHSS demonstrated strong positive correlations with both CRP (r=0.99, p=0.01) and ferritin (r=0.97, p=0.03). Conclusion: Admission CRP and serum ferritin increased progressively with NIHSS-defined stroke severity. Both biomarkers showed strong positive correlations with NIHSS, supporting their potential utility as adjunctive prognostic markers in acute ischemic stroke.

Introduction: Abnormal placentation is a major cause of maternal and perinatal morbidity globally. Elevated uterine artery pulsatility index (PI) during the first trimester has been associated with several placental-mediated complications, including pre-eclampsia, fetal growth restriction (FGR), oligohydramnios, stillbirth, and placental abruption. Objective: To describe a series of pregnancies complicated by placental insufficiency and related  adverse pregnancy outcomes in women with abnormal uterine artery Doppler findings in the first trimester and to emphasize the role of Doppler assessment in early risk stratification. Case Series: Materials and methods: This report forms part of a prospective observational study conducted over a period of one year from June 2025 to May 2026 involving 120 singleton pregnancies undergoing first-trimester uterine artery Doppler assessment between 11 and 14 weeks of gestation. All pregnant women included in the study were followed throughout the gestation for pregnancy related complications (early onset pre-eclampsia, fetal growth restriction, late onset pre-eclampsia,, oligohydramnios, placental abruption and still-birth). Serial Ultrasound monitoring in second and third trimesters was done for all the women with abnormal first-trimester uterine artery Doppler study. Results: Of the 120 study population , 93(77%) of antenatal women were found to have normal first trimester uterine artery pulsatility index(PI) and the rest 27(23%) had abnormal pulsatility index. All(93) antenatal women who were found to have normal first trimester uterine artery pulsatility index had no adverse pregnancy outcomes. About 64%(17/27) of women with abnormal first trimester uterine artery PI developed adverse pregnancy outcomes, while 36% (10/27)had normal pregnancy outcome . In our study, 23.5% developed preeclampsia, 29.4% developed oligohydramnios, 35.2% developed fetal growth restriction, 5.88 % developed placental abruption and 5.88% delivered stillbirth neonates. Representative cases demonstrated abnormal placental morphology, preplacental subchorionic hematoma formation, fetal growth restriction, oligohydramnios and altered placental blood flow patterns. Conclusion: First-trimester uterine artery Doppler serves as a valuable screening tool for identifying pregnancies at risk of placental dysfunction. Abnormal Doppler findings warrant close antenatal surveillance and may facilitate timely intervention to improve maternal and fetal outcomes.

Introduction: Psoriasis is a chronic immune-mediated inflammatory disorder with systemic associations, including metabolic syndrome and increased cardiovascular risk. Vitamin D plays an important role in immune modulation and keratinocyte proliferation, suggesting a potential therapeutic benefit in psoriasis management. Aim: To evaluate the effect of vitamin D supplementation as an adjunct to standard therapy on clinical outcomes and disease severity in patients with psoriasis. Materials and Methods: This prospective, randomized, comparative study was conducted at a tertiary care center over 18 months. A total of 70 adult psoriasis patients with vitamin D deficiency (<20 ng/mL) were enrolled and randomized into two groups (n=35 each). Group A received standard therapy, while Group B received standard therapy plus oral vitamin D (60,000 IU weekly for 6 weeks). Clinical assessment was performed using the Psoriasis Area and Severity Index (PASI) score at baseline and at 8 weeks. Biochemical parameters were also evaluated. Statistical analysis was performed using Student’s t-test and Pearson’s correlation. Results: Baseline demographic, clinical, and biochemical parameters were comparable between groups (p>0.05). At 8 weeks, Group B showed significantly greater clinical improvement, with a higher proportion of patients achieving mild disease (54.3% vs. 14.3%) and a lower proportion remaining severe (14.3% vs. 51.4%) compared to Group A (p=0.02). Mean PASI scores were significantly reduced in Group B (3.24 ± 2.92) compared to Group A (5.79 ± 2.56) (p=0.03). Conclusion: Vitamin D supplementation as an adjunct to standard therapy significantly improves disease severity in psoriasis and may serve as an effective, safe therapeutic strategy.

Introduction: Laparoscopic surgery has fundamentally changed the landscape of general surgery, offering patients the benefits of minimal scarring, shorter hospital stays, and less postoperative pain. However, performing these minimally invasive procedures in a rural tertiary care setting brings unique challenges, often driven by delayed patient presentations. Methods: We conducted a prospective observational study at SLN MCH, Koraput, spanning from June 2024 to May 2025. We followed 87 consecutive patients who underwent various laparoscopic procedures to document and analyze intraoperative and postoperative complications. Results: Out of the 87 patients, complications were observed in 11 cases, yielding an overall complication rate of 12.6%. The most common issue was port-site infection (5.7%). When analyzing the data, we found a statistically significant increase in complication rates among patients undergoing emergency surgeries compared to those having elective procedures (p=0.011). Conclusion: Laparoscopic surgery remains a safe and highly effective option at our institution. However, the significantly higher complication rate in emergency settings highlights the crucial need for senior surgical supervision, careful patient selection, and robust postoperative wound care counseling in our community.