Background: Arterial lactate is rapidly measurable in sepsis, but the prognostic value of serial concentrations relative to a single early measurement requires clarification. Objectives: To evaluate arterial lactate as a predictor of in-hospital mortality in patients with sepsis or septic shock presenting to the emergency department and to assess serial values and the recorded clearance index. Methods: This prospective observational study included 150 patients managed in a hospital over six months. Clinical variables, arterial lactate, total leukocyte count, and outcomes were recorded. Lactate was measured at baseline and at 24, 48, and 72 hours. Survivor and non-survivor values were compared, and receiver operating characteristic analysis assessed mortality discrimination. Results: Mean age was 46.60 ± 15.31 years, 65.3% were male, and in-hospital mortality was 40.0%. Mean lactate increased from 1.07 ± 0.32 mmol/L at baseline to 2.64 ± 1.91 mmol/L at 24 hours, declined to 2.39 ± 1.86 mmol/L at 48 hours, and reached 1.19 ± 0.67 mmol/L at 72 hours. Non-survivors had higher lactate than survivors at 24 hours (4.59 ± 1.20 versus 1.38 ± 1.00 mmol/L) and 48 hours (4.09 ± 1.63 versus 1.29 ± 0.95 mmol/L). The 24-hour area under the curve was 0.925; a 4.05 mmol/L cut-off provided 93.2% sensitivity and 95.6% specificity. The 48-hour area under the curve was 0.876. The signed clearance index showed poor discrimination. Conclusion: Arterial lactate at 24 and 48 hours identified mortality risk more accurately than baseline lactate or the recorded clearance index. Serial lactate assessment should complement haemodynamic and clinical reassessment in sepsis care.

Background: Age-related macular degeneration (AMD) is a leading cause of irreversible central vision loss in the elderly, primarily affecting the macula.

Objective: This review examines the pathophysiology of AMD, evaluates current treatment modalities, and highlights outcomes from ongoing management strategies.  Methods: Relevant clinical studies, epidemiological data, and randomized clinical trials were reviewed to assess disease mechanisms and the efficacy of available therapies.  Results: Oxidative stress, genetic susceptibility, and retinal pigment epithelium (RPE) dysfunction are central to AMD pathology. Anti-vascular endothelial growth factor (anti-VEGF) therapy significantly improves visual outcomes in neovascular (wet) AMD, whereas antioxidant supplementation offers limited benefit in dry AMD. Conclusion: AMD remains a significant public health concern. Anti-VEGF therapies have revolutionized the management of wet AMD, but preventive strategies and novel therapeutic approaches are essential to address the unmet needs in dry AMD.

Background: Type 2 diabetes mellitus (T2DM) is widely considered a lifelong, progressive condition. However, growing clinical evidence indicates that structured lifestyle interventions can restore normal blood sugar levels, reduce reliance on medications, and achieve true clinical remission. Objective: This study evaluates the clinical outcomes of an intensive, inpatient Low-Carbohydrate Healthy-Fat (LCHF) dietary intervention paired with supportive holistic therapies, based on the Disease Reversal Program (DIAREV) framework in Odisha. Methods: We examined a case series of 27 adult patients with T2DM who completed a supervised 5-day inpatient LCHF protocol. The program included comprehensive medical evaluations, personalized counselling, strict carbohydrate restriction (), supervised medication reduction, yoga, and breathwork, followed by structured post-discharge tracking. Statistical significance was determined using paired comparisons between baseline and post-intervention metrics. Results: Participants experienced profound metabolic improvements across all tracked markers. The average body weight dropped significantly by  (shifting from  to , ). Fasting blood sugar (FBS) levels fell by an average of  ( to , ), and postprandial blood sugar (PPBS) decreased by  ( to , ). Mean HbA1c levels fell by  ( down to , ). Overall, an  diabetes remission rate () was achieved, with  of the cohort reaching levels . Conclusion: A medically supervised LCHF inpatient protocol offers a safe, highly effective pathway for rapid glycemic recovery, safe medication de-escalation, and meaningful T2DM reversal.

Introduction: Organophosphorus compound (OPC) poisoning is a severe medical emergency in underdeveloped nations, associated with substantial morbidity and death due to cholinergic crisis and systemic consequences. Early assessment of severity is critical for prompt action. Serum amylase, C-Reactive  Protein (CRP), and Total Leukocyte Count (TLC) are examples of biochemical markers that may be used as objective prognostic indicators. Objectives: To evaluate and correlate TLC, CRP, and serum amylase levels with clinical severity and outcomes in OPC poisoning and assess their prognostic utility. Methods: A  cross-sectional study was conducted on 126 patients with OPC poisoning admitted within 24 hours at a tertiary care hospital. Severity was assessed using the Peradeniya Organophosphorus Poisoning (POP) scale. Blood samples for TLC, CRP, and serum amylase were obtained at admission. Clinical outcomes including need for mechanical ventilation and mortality were recorded. Statistical analysis was performed using SPSS v26, with p<0.05 considered significant.

Results: Elevated levels of TLC, CRP, and serum amylase were significantly associated with increased severity of poisoning, higher POP scores, and poor clinical outcomes. Patients requiring ventilatory support and those with mortality demonstrated markedly higher biomarker levels. A positive correlation was observed between these markers and disease severity. Conclusion: TLC, CRP, and serum amylase are simple, cost-effective, and reliable biomarkers for assessing severity and predicting outcomes in OPC poisoning. Their combined use with clinical scoring systems enhances early risk stratification and management.

Background: Chronic kidney disease (CKD) is a global burden and is now recognized as a major public health problem worldwide. Patients with CKD have alterations in thyroid hormone metabolism. This study aims to evaluate the status of thyroid hormone profile in different stages of CKD. Objectives of the study: To is to evaluate thyroid function abnormalities in patients with chronic kidney disease and correlate these changes  with the severity of renal impairment Materials and Methods : This was an observational case control study conducted in department of Medicine CMCRI , Chitradurga  for a duration of 12 months from June 2025 to June  2026. A total of 50 subjects were prospectively included in the study. Patients who fulfill the criteria for CRF and who were on conservative management were taken for the study. A thyroid profile was done in all patients who fulfill the criteria. Results : The mean T3 and T4 were decreased significantly with reduced creatinine clearance and later stages of CKD. Conclusion: The serum level of total T3 and free T4 is directly proportional to the creatinine clearance level. Total T3 and free T4 correlated with the severity of the renal failure. TSH values will be useful to differentiate hypothyroidism from non- thyroidal illness due to CKD.

Background: Varicocele is a major cause of infertility, affecting around 15% of males. Existing diagnostic tools are often insensitive to early parenchymal changes. Shear wave elastography (SWE) is a non-invasive method to measure tissue stiffness and evaluate testicular dysfunction.
Methods: We conducted a case-control study that included 50 patients with varicocele and 50 age-matched controls. Participants underwent scrotal ultrasound, SWE and semen analysis. Sarteschi classification was used to determine the varicocele grade. Testicular volume and stiffness were assessed and correlated with semen parameters and grade of varicocele.
Results: SWE was significantly stiffer in varicocele patients than in controls (left: 5.15 ± 0.67 vs. 3.06 ± 0.21 kPa/m/s; right: 3.67 ± 0.40 vs. 2.27 ± 0.20 kPa/m/s; p<0.001). Increased stiffness was associated with higher grades of varicocele (Grade II: 4.83 kPa/m/s; Grade IV: 6.4 kPa/m/s; p<0.001). An inverse correlation was found between left testicular stiffness and sperm concentration (r = -0.81; p<0.01), with 50% of cases showing oligospermia.
Conclusion: SWE shows a significant diagnostic potential in quantifying the increased testicular stiffness in patients with varicocele, which correlates strongly with higher grades and impaired semen quality.

Background: Intertrochanteric Fractures are one of the devastating injuries in elderly. These fractures are associated with complications like hypostatic pneumonia, catheter sepsis, deep vein thrombosis, cardio respiratory failure and decubitus ulcer. Urgent surgical treatment, early rehabilitation and mobilization of the patient is important for better prognosis of the patients. Proximal femoral nail (PFN) has the unique advantage of closed reduction, preservation of fracture hematoma, less tissue damage during surgery, early rehabilitation and early return to work. Method: Total number of 30 cases of intertrochanteric fractures were selected for this study at Department of Orthopaedics, R.K.Damani Medical College and Dr. Hedgewar Hospital, Chha.Sambhajinagar during the period of Jan. 2019 to Dec. 2021. Result: Total 30 patients were included in present study. Mean age of the patients was 70.30 ± 9.23 years. Female patients (57 %) were common than male patients (43 %).  History of fall (80 %) was most common mode of injury. According to Tranzo’s classification, Type 3 fractures (53 %) were most common, followed by type 2 fractures (33%). Assessment of hip function was done using modified Harris Hip scoring system. Good function was noted in 53% patients, excellent function in 27% followed by fair function in 13% patients and poor function in 7% patients respectively. One patient had implant related complication and one had limb shortening. There was no infection, mal-union, or non-union noted in our patients. Conclusion: It was found that PFN is stronger construct to withstand cyclical loading and unloading in trochanteric region. PFN was found to be better in high risk cases. PFN provides stable fixation, early mobilisation and good functional outcome.

Background: Type 2 diabetes mellitus (T2DM) is a multisystem disorder frequently associated with metabolic complications such as non-alcoholic fatty liver disease (NAFLD) and microalbuminuria. Both conditions are linked to insulin resistance and may reflect early hepatic and renal involvement. Objectives: To determine the prevalence of NAFLD in patients with T2DM and to assess its association with microalbuminuria. *A prospective observational study was conducted among 73 patients with T2DM at a tertiary care hospital from April 2024 to September 2025. NAFLD was diagnosed using ultrasonography, and microalbuminuria was assessed using the urine protein–creatinine ratio (UPCR). Biochemical parameters, including glycemic indices, lipid profile, and liver enzymes, were analyzed. Statistical significance was set at p < 0.05. Results: The prevalence of NAFLD was 67.12%, and microalbuminuria was present in 68.49% of participants. A statistically significant association was observed between NAFLD and microalbuminuria (p = 0.0173). NAFLD was more prevalent in patients with microalbuminuria (76.00%) than in those without (47.83%), corresponding to a 1.59-fold increased likelihood. Patients with NAFLD had significantly higher fasting and post-prandial blood glucose levels. Elevated SGPT levels suggested hepatocellular injury. LDL, triglycerides, and UPCR were higher in the NAFLD group, although absolute differences were modest. Coexistence of NAFLD and microalbuminuria was noted in 52.05% of participants, indicating a high-risk metabolic phenotype. Conclusion: NAFLD is highly prevalent among patients with T2DM and shows a significant association with microalbuminuria, suggesting early renal involvement. NAFLD should be regarded as a marker of systemic metabolic dysfunction. Early screening and integrated management targeting glycemic control, dyslipidemia, and renal parameters are essential to reduce disease progression and complications.

Background: Acute appendicitis is among the most frequent conditions causing acute abdominal pain that needs an immediate surgical intervention. Prompt and accurate diagnosis of the condition is very important for avoiding unneeded operations and complications of treatment delay. The Alvarado score is a very simple and popular clinical score system used to help diagnose acute appendicitis. At the same time, the accuracy of this score may vary in various population groups. The objective of the study was to assess the diagnostic accuracy of the Alvarado scoring system based on histological criteria. Methods A cross-sectional study design was used on 300 patients with a diagnosis of clinically suspected acute appendicitis by undergoing an appendectomy. Demographic data, clinical data, laboratory data, imaging data, intraoperative findings, and histopathologic diagnosis were obtained and analyzed through SPSS version 26 software. Comparison between continuous variables was done using independent samples t-test or Mann Whitney U-test while categorical variables were analyzed by Chi square test. Binary logistic regression was done for predictive ability of Alvarado score for histopathological diagnosis of acute appendicitis. Diagnostic accuracy was done by analyzing sensitivity, specificity, PPV, NPV, accuracy, and ROC curve analysis. Results: Of the total of 300 patients enrolled in this study, 191 patients (63.7%) had histopathologically proved acute appendicitis, while 109 patients (36.3%) were found to have no positive histopathological results. Migratory pain (P = 0.013), anorexia (P < 0.001), nausea and vomiting (P = 0.026), rebound tenderness (P < 0.001), and Alvarado risk category (P < 0.001) were significantly correlated with histopathologically proved acute appendicitis. However, there were no significant correlations for gender (P = 1.000), residence (P = 0.266), ultrasound results (P = 0.690), CT scan results (P = 0.648), type of surgery (P = 0.097), and intraoperative results (P = 0.751). Age was also not significantly different between histopathology positive and histopathology negative groups (independent-samples t-test: P = 0.967; Mann-Whitney U test: P = 0.944). The binary logistic regression revealed that the Alvarado score was significantly predicting histopathologically proved acute appendicitis (β = 1.585; OR = 4.88, 95% CI: 3.36-7.09; P < 0.001). With an Alvarado score cut-off value of ≥7, the score system attained a sensitivity of 83.77%, specificity of 100.0. Conclusion: Alvarado scoring was highly accurate in diagnosing acute appendicitis confirmed by histopathology. An Alvarado score of ≥7 was an excellent indicator of high specificity and positive predictive value in addition to sensitivity and accuracy. It was a good predictor of acute appendicitis independently and can be used in the evaluation of acute appendicitis.

Background: Acute appendicitis is among the most frequent conditions causing acute abdominal pain that needs an immediate surgical intervention. Prompt and accurate diagnosis of the condition is very important for avoiding unneeded operations and complications of treatment delay. The Alvarado score is a very simple and popular clinical score system used to help diagnose acute appendicitis. At the same time, the accuracy of this score may vary in various population groups. The objective of the study was to assess the diagnostic accuracy of the Alvarado scoring system based on histological criteria. Methods A cross-sectional study design was used on 300 patients with a diagnosis of clinically suspected acute appendicitis by undergoing an appendectomy. Demographic data, clinical data, laboratory data, imaging data, intraoperative findings, and histopathologic diagnosis were obtained and analyzed through SPSS version 26 software. Comparison between continuous variables was done using independent samples t-test or Mann Whitney U-test while categorical variables were analyzed by Chi square test. Binary logistic regression was done for predictive ability of Alvarado score for histopathological diagnosis of acute appendicitis. Diagnostic accuracy was done by analyzing sensitivity, specificity, PPV, NPV, accuracy, and ROC curve analysis. Results: Of the total of 300 patients enrolled in this study, 191 patients (63.7%) had histopathologically proved acute appendicitis, while 109 patients (36.3%) were found to have no positive histopathological results. Migratory pain (P = 0.013), anorexia (P < 0.001), nausea and vomiting (P = 0.026), rebound tenderness (P < 0.001), and Alvarado risk category (P < 0.001) were significantly correlated with histopathologically proved acute appendicitis. However, there were no significant correlations for gender (P = 1.000), residence (P = 0.266), ultrasound results (P = 0.690), CT scan results (P = 0.648), type of surgery (P = 0.097), and intraoperative results (P = 0.751). Age was also not significantly different between histopathology positive and histopathology negative groups (independent-samples t-test: P = 0.967; Mann-Whitney U test: P = 0.944). The binary logistic regression revealed that the Alvarado score was significantly predicting histopathologically proved acute appendicitis (β = 1.585; OR = 4.88, 95% CI: 3.36-7.09; P < 0.001). With an Alvarado score cut-off value of ≥7, the score system attained a sensitivity of 83.77%, specificity of 100.0. Conclusion: Alvarado scoring was highly accurate in diagnosing acute appendicitis confirmed by histopathology. An Alvarado score of ≥7 was an excellent indicator of high specificity and positive predictive value in addition to sensitivity and accuracy. It was a good predictor of acute appendicitis independently and can be used in the evaluation of acute appendicitis.

Introduction: Sleep disturbances and zinc deficiency are prevalent yet underrecognised clinical concerns in the geriatric population. Serum zinc, as an essential trace element involved in neurotransmission and neuroendocrine regulation, may have a significant role in sleep and mental health, though evidence specifically addressing older adults remains limited. Aim: To evaluate the associations between serum zinc levels, sleep quality, insomnia severity, and mental health outcomes in geriatric patients attending a tertiary care centre. Materials and Methods: This cross-sectional observational study was conducted at . Forty geriatric patients aged ≥60 years were enrolled. Serum zinc was measured by atomic absorption spectrophotometry and classified as low (<70 µg/dL), normal (70–120 µg/dL), or high (>120 µg/dL). Sleep quality, insomnia severity, depressive symptoms, and anxiety were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Geriatric Depression Scale-15 (GDS-15), and Generalised Anxiety Disorder-7 (GAD-7). Statistical analyses were performed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA). Pearson correlation and independent samples t-tests were applied; a p-value <0.05 was considered statistically significant. Results: The mean age was 72.3 ± 6.1 years; 55% were female. Low serum zinc was identified in 40% of participants. Poor sleep quality (PSQI >5) was present in 80%, moderate-to-severe insomnia (ISI ≥15) in 35%, and depressive symptoms (GDS-15 ≥5) in 45%. Serum zinc showed statistically significant negative correlations of moderate strength with PSQI (r = −0.45, p = 0.004) and ISI (r = −0.39, p = 0.010), and a weak but statistically significant negative correlation with GDS-15 (r = −0.31, p = 0.049). Participants with low serum zinc had significantly poorer sleep quality (PSQI: 11.2 ± 2.8 vs 9.0 ± 2.9, p = 0.010) and higher depressive scores (GDS-15: 6.2 ± 2.5 vs 4.6 ± 2.3, p = 0.020) compared to those with non-low zinc.

Conclusion: Zinc deficiency was prevalent in 40% of geriatric participants and was significantly associated with impaired sleep quality, greater insomnia severity, and higher depressive scores. Routine zinc assessment and targeted nutritional optimisation may represent a modifiable approach to improving sleep and mental health in older adults.

Background: Dengue has no specific antiviral therapy, and outcome depends on timely recognition of patients entering the critical phase. Routine laboratory investigations — the complete haemogram, hepatic transaminases and renal parameters — are inexpensive and universally available, and may therefore provide practical severity markers in district-level practice. Objectives: To measure haematological parameters, hepatic transaminases and renal function in adults with serologically confirmed dengue and to correlate these with disease severity as graded by the World Health Organization (WHO) 2009 classification. Methods: A longitudinal, hospital-based study was conducted in the Department of General Medicine, McGann District Teaching Hospital, Shivamogga, Karnataka, from January 2021 to June 2022. Consecutive adults (>18 years) positive for dengue NS1 antigen or IgM by enzyme-linked immunosorbent assay were enrolled after written informed consent. Patients with pre-existing liver disease, alcoholic hepatitis (aspartate aminotransferase [AST] to alanine aminotransferase [ALT] ratio ≥2:1), recent hepatotoxic drug exposure or transaminase-raising co-infections were excluded. Complete haemogram, liver function tests and renal function tests were performed on admission. Means were compared across the three severity groups using one-way analysis of variance and associations with severity assessed by Pearson correlation; p<0.05 was considered significant. Results: Of 130 patients (75 male, 57.7%; mean age 40.41 ± 15.95 years), 75 (57.7%) had dengue without warning signs, 40 (30.8%) dengue with warning signs and 15 (11.5%) severe dengue. Thrombocytopenia was universal (all 130 patients had platelet counts below 100 × 10⁹/L) and leucopenia was present in 60.0%. Mean platelet count fell progressively with severity (27,667 ± 17,389 vs 39,250 ± 13,981 vs 40,920 ± 13,937/mm³; p=0.006), while mean haematocrit rose (42.49 ± 3.15% vs 41.83 ± 2.63% vs 39.65 ± 2.05%; p=0.021). Neutrophil and lymphocyte percentages also differed significantly (p=0.029 and p=0.032). Total leucocyte count and haemoglobin did not differ across groups. Conclusion: Rising haematocrit, falling platelet count and, most strikingly, elevated AST and ALT track closely with dengue severity. Transaminases showed the strongest correlations of all measured variables and, together with renal parameters, deserve routine measurement on admission as an aid to risk stratification.

Introduction: Intrinsic capacity (IC), comprising cognition, psychological health, vitality, sensory function (vision, hearing), and locomotion, represents the functional reserve essential for healthy aging. Despite its relevance, limited data exist on IC among older adults with cancer. This study aimed to evaluate the proportion of impaired IC and its associated factors in geriatric oncology patients at a tertiary care center in eastern India. Methods: This hospital-based cross-sectional study was conducted from February 2024 to January 2025. A total of 231 cancer patients aged 60 years and above were selected. IC domains were assessed as follows: cognition (Mini-Mental State Examination score less than 24), psychological health (Geriatric Depression Scale-15 score of 5 or more), vitality (Mini Nutritional Assessment-Short Form), locomotion (Timed Up and Go test over 13 seconds), vision (screening question), and hearing (whisper test). Comorbidities were evaluated using the Charlson Comorbidity Index, and fall risk was assessed with the Morse Fall Risk Scale. Associations were analyzed using chi-square tests, t-tests, and Pearson correlation coefficients, with significance set at p < 0.05. Results: The mean age was 64 years, with 63.6% of participants being male. Impairment in at least one IC domain was present in 95.2% of patients. The most frequently affected domains were psychological health (78.8%), locomotion (51.1%), cognition (43.7%), and nutrition (83.1% were either malnourished or at risk). Multiple domain impairments were common, with 56.3% affected in three or more areas. Age, female sex, lower education, sleep disturbance, and certain comorbidities were significantly associated with IC deficits. Higher body mass index was linked to better cognition and lower depression scores. Conclusion: IC impairment is highly prevalent in older cancer patients, often involving multiple domains. Integrating IC assessment into routine geriatric oncology care can support targeted interventions that preserve functional capacity and improve quality of life.

Background: Vitamin D exerts effects on airway smooth muscle, innate antimicrobial defence and the glucocorticoid response, all of which are biologically plausible routes by which deficiency could worsen asthma. Objectives: To determine the prevalence of vitamin D deficiency among adults with physician-diagnosed asthma, and to examine its association with the level of asthma control, the frequency of exacerbations in the preceding twelve months, and spirometric function. Methods: A cross-sectional study was conducted in the Department of Biochemistry and Respiratory Medicine. One hundred and twenty adults aged 18–65 years with asthma diagnosed per Global Initiative for Asthma (GINA) criteria and on stable therapy for at least three months were enrolled. Serum 25(OH)D was measured by chemiluminescent immunoassay and classified as deficient (<20 ng/mL), insufficient (20–29 ng/mL) or sufficient (≥30 ng/mL). Asthma control was assessed by the Asthma Control Test (ACT), exacerbations in the previous year were ascertained from records and structured recall, and post-bronchodilator FEV₁ was recorded. Groups were compared by one-way ANOVA, Kruskal–Wallis and chi-square tests; associations were quantified by Pearson and Spearman correlation and by multiple linear regression adjusted for age, sex and body mass index. Results: Mean serum 25(OH)D was 20.08 ± 8.36 ng/mL. Sixty-four patients (53.3%) were deficient, 44 (36.7%) insufficient and only 12 (10.0%) sufficient. Serum 25(OH)D correlated positively with ACT score (r = 0.360, 95% CI 0.193–0.507; p < 0.001) and post-bronchodilator FEV₁ (r = 0.364; p < 0.001), and inversely with exacerbation count (r = −0.318, 95% CI −0.471 to −0.148; p < 0.001). Mean exacerbations fell across vitamin D strata from 1.92 ± 1.29 in deficient patients to 0.83 ± 1.03 in sufficient patients (Kruskal–Wallis H = 7.96; p = 0.019). In multivariable regression, each 1 ng/mL rise in 25(OH)D was associated with a 0.162-point increase in ACT score (95% CI 0.089–0.235; p < 0.001) independent of age, sex and BMI.  Conclusion: Vitamin D deficiency was highly prevalent in this asthma cohort, and serum 25(OH)D showed consistent, independent associations with asthma control, exacerbation frequency and lung function when analysed as a continuous variable. These associations attenuated when vitamin D status and outcomes were dichotomised, indicating that categorical cut-offs discard clinically meaningful information. The cross-sectional design precludes causal inference, and randomised supplementation data remain the appropriate basis for treatment decisions.

Introduction: Asthma and chronic obstructive pulmonary disease (COPD) are common conditions among general population. The prevalence of asthma is 1% to 18% whereas COPD affects 6% of adult population. pressurized Metered dose inhalers[PMDI] are the most commonly used routes of drug administration in these patients .The proper technique of using the PMDI is vital for treatment. Its observed from different studies thst most patients use the technique wrong at multiple steps This study is done to evaluate the wrong techniques in using Pmdi seen in patients and correct it. Methodology: patients were asked to show their technique of using PMDI. WHO checklist was used to assess the technique.Any error at each step was noted. The data was analysed to see the percentage of participants doing it wrong. Afterwards patients were notified their error and correct technique was demonstrated. Results: 93% patients in our study group did error while using PMDI. Maximum error was done on steps involving  holding the breathe after pressing the canister, inhaling while at same time  pressing canister and noting /adjusting dose (step-8 ,2,9). Conclusion: study shows that there is significant number of patients use the PMDI by erong technique.

Introduction: Aim: To study the pattern and frequency of dermatoses in patients aged 60 years and above, to describe the clinical pattern of various dermatological disorders in the elderly, and to determine the prevalence of skin diseases and their association with underlying systemic disorders. Methods: A hospital-based cross-sectional observational study was conducted among 300 consecutive patients aged ≥60 years attending the Dermatology Outpatient Department of a tertiary care teaching hospital. Detailed demographic data, clinical history, dermatological examination, physiological skin changes, and systemic comorbidities were recorded. Relevant laboratory investigations were performed whenever indicated. Data were analyzed using descriptive statistics and the Chi-square test, with p<0.05 considered statistically significant. Results: The majority of patients belonged to the 60–69 years age group (57.7%), with males constituting 60.7% of the study population. Itching was the most common presenting complaint (72.3%). Plaques (46.7%) were the predominant morphological lesion, while wrinkling (23.7%) and xerosis (20.7%) were the most frequent physiological skin changes. Fungal infections (22.7%) were the most common dermatological disorder, followed by eczematous disorders (12.7%), generalized pruritus (11.3%), and papulosquamous disorders (9.0%). Tinea cruris et corporis was the commonest fungal infection, asteatotic eczema was the predominant eczematous disorder, and herpes zoster was the most frequent viral infection. Hypertension (23.3%) and type 2 diabetes mellitus (21.7%) were the most prevalent systemic comorbidities. Generalized pruritus showed notable associations with diabetes mellitus and chronic kidney disease. No statistically significant association was observed between dermatological disorders and age group (p=0.553) or gender (p=0.516). Conclusion: Dermatological disorders are highly prevalent among the elderly, with fungal infections, eczematous disorders, and generalized pruritus being the most common conditions. Physiological skin changes and systemic comorbidities contribute substantially to disease burden. Comprehensive dermatological evaluation, regular screening for systemic illnesses, and integrated multidisciplinary management are essential for early diagnosis, appropriate treatment, and improved quality of life in the geriatric population.

Background: Acute pancreatitis (AP) in parts of India presents at a considerably younger age and with a far greater male preponderance than in Western series, a pattern attributed largely to alcohol-associated disease. Whether bedside clinical scoring tracks radiological severity in such demographically atypical cohorts has received little attention. Access to contrast-enhanced computed tomography (CECT) in district and rural hospitals is also limited, making the strength of the clinical–radiological relationship a question of practical consequence. Objectives: To describe the demographic and clinico-radiological profile of AP at a government tertiary centre in north Karnataka, and to quantify the relationship between the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the modified CT severity index (mCTSI) as continuous and stratified measures. Methods: Fifty consecutive adults with AP admitted between June 2022 and December 2023 were enrolled prospectively. BISAP was calculated within 24 hours of admission and mCTSI from CECT of the abdomen and pelvis performed on days 3–7. Relationships were examined by Pearson and Spearman correlation, simple linear regression, and one-way analysis of variance of mCTSI across BISAP strata with test for linear trend. Results: Mean age was 33.82 ± 8.03 years (range 16–50) and 49 of 50 patients (98.0%) were male; no patient was above 60 years. Mean BISAP was 1.38 ± 0.97 and mean mCTSI 5.60 ± 1.85. Radiological severity was mild in 2 patients (4.0%), moderate in 39 (78.0%) and severe in 9 (18.0%). BISAP correlated significantly with mCTSI (Pearson r = 0.657, p < 0.001; Spearman ρ = 0.692, p < 0.001), explaining 43.1% of the variance. Regression yielded mCTSI = 3.86 + 1.26 × BISAP (95% CI for slope 0.84–1.68, p < 0.001). Mean mCTSI rose monotonically across BISAP strata from 3.60 ± 0.84 at BISAP 0 to 8.00 ± 1.41 at BISAP ≥ 3 (ANOVA F(3,46) = 11.95, p < 0.001; test for linear trend p < 0.001). Conclusions: In a young, overwhelmingly male AP cohort, BISAP showed a robust graded dose–response relationship with radiological severity, with each additional BISAP point corresponding to approximately 1.26 points of mCTSI. No patient met the age criterion of BISAP, compressing the usable score range and suggesting that locally recalibrated thresholds are needed. Bedside scoring offers a defensible interim severity estimate where CECT is delayed or unavailable.

Background: Thyroid cancer is most common endocrine malignancy and there is high incidence of thyroid nodule detection in ultrasonography in general population. Determination of the thyroid nodule as benign or malignant depends upon certain characteristic features like calcifications, vascularity, echogenicity of the nodule etc. Calcification within the thyroid gland occur in both benign and malignant thyroid disease. Calcification patterns within thyroid nodules, particularly microcalcifications, are considered important predictors of malignancy and are incorporated into various thyroid risk stratification systems. Objective: To evaluate the association of different ultrasonographic calcification patterns in thyroid nodules with thyroid malignancy. Materials and Methods: This Prospective observational study was conducted in the Department of Radiodiagnosis, Kidwai Memorial Institute of Oncology, Bengaluru, over the study period of 2 years (December 2020-December 2022). A total of 100 patients with thyroid nodules underwent ultrasonography followed by cytological or histopathological confirmation were included. Calcification patterns were classified as microcalcification, macrocalcification, peripheral rim calcification, and comet-tail artefacts. The sonographic findings were correlated with the final pathological diagnosis. Statistical analysis was performed to determine the association between calcification patterns and malignancy. Results: The study included 100 patients aged 12-75 years (mean age: 50.16 years). Of these, 79 were females and 21 were males. 53 nodules were benign and 47 were malignant. Microcalcifications were observed in 26 malignant nodules and only 6 benign nodules, demonstrating a significant association with malignancy. Macrocalcifications were identified in 7 nodules, including 4  benign and 3 malignant lesions. Peripheral rim calcification was observed in 2 malignant nodules, both of which also demonstrated microcalcifications. Comet-tail artefacts were predominantly associated with benign colloid nodules. Conclusion: Microcalcifications are a significant ultrasonographic predictor of thyroid malignancy, particularly papillary thyroid carcinoma. Accurate differentiation between microcalcifications, macrocalcifications, and comet-tail artefacts improves risk stratification and facilitates appropriate patient management.

Objective: To determine the correlation between body mass index and FSH and LH ratio in polycystic ovarian syndrome women. Study Design: Cross sectional study. Duration and Place of Study: Conducted from 15 November 2025 to 15 February 2026 at Department of Obstetrics and Gynaecology, PAF Hospital Sargodha. Methodology: A total of 80 women of age 18 to 40 years with polycystic ovarian syndrome were included. Body mass index was determined using the standard formula of body weight in kilograms divided by the square of height in meters. Venous blood specimens were collected to quantify serum follicle-stimulating hormone and luteinizing hormone concentrations after which the LH/FSH ratio was computed. Statistical evaluation of the collected data was performed using the SPSS version 26. Pearson correlation test was applied to assess association between body mass index and hormone ratio. Results: Mean age was 27.22 ± 5.75 years and mean body mass index was 27.30 ± 2.63 kg/m². Mean hormone ratio was 2.67 ± 0.28. Married women were 83.8%. A statistically significant positive association was observed between body mass index and the hormone ratio (r = 0.311, p = 0.005). Strongest correlation was seen in women with disease duration ≤ 24 months (r = 0.400, p = 0.005). Conclusion: Body mass index was positively associated with follicle stimulating hormone to luteinizing hormone ratio in polycystic ovarian syndrome women.

Background:  Hepatic encephalopathy (HE) marks a decisive turning point in the natural history of cirrhosis, converting compensated disease into a decompensated state with substantially reduced survival. Although the syndrome is in principle reversible once the precipitating event has been corrected, in-hospital mortality remains high. Whether outcome differs systematically according to which factor precipitated the episode, and how prognostic scores such as the Child–Pugh, MELD and MELD-Na indices perform in this setting, are questions of direct clinical relevance to triage and resource allocation in resource-limited hospitals. Objectives: To determine in-hospital mortality among cirrhotic patients admitted with hepatic encephalopathy stratified by precipitating factor, to describe the severity of underlying liver dysfunction using the Child–Pugh, MELD and MELD-Na scores, and to compare the mean duration of hospital stay associated with each major precipitant. Materials and Methods: A prospective, descriptive, hospital-based observational study was conducted in the Department of General Medicine, Ballari Medical College and Research Centre (formerly Vijayanagar Institute of Medical Sciences), Ballari, Karnataka. Eighty-five consecutive patients above 12 years of age with established cirrhosis presenting with hepatic encephalopathy of any grade were enrolled after Institutional Ethics Committee clearance and written informed consent. Patients with psychiatric illness, altered sensorium due to metabolic disease or head injury, acute alcohol intoxication or alcohol withdrawal were excluded. Sample size was estimated with nMaster v2.0. All patients underwent complete blood count, liver and renal function tests, serum electrolytes, coagulation profile, ascitic fluid analysis and abdominal ultrasonography. Child–Pugh, MELD and MELD-Na scores were computed for every patient, and in-hospital mortality and length of stay were recorded prospectively. Analysis was performed in IBM SPSS Statistics v23.0 using frequency and percentage analysis, with the chi-square or Fisher's exact test at a 5% significance level. Results: Overall in-hospital mortality was 29 of 85 (34.1%). Case fatality varied widely by precipitant: pneumonia 3 of 5 (60.0%), gastrointestinal bleeding 18 of 33 (54.5%), constipation 5 of 19 (26.3%), electrolyte imbalance 2 of 9 (22.2%) and spontaneous bacterial peritonitis 1 of 10 (10.0%); no deaths occurred among the 6 patients with iatrogenic or procedure-related precipitants. Gastrointestinal bleeding alone accounted for 18 of the 29 deaths (62.1%). Mean Child–Pugh score was 10.29, mean MELD score 24.06 and mean MELD-Na score 25.38, indicating advanced Child class C disease with high predicted short-term mortality. Mean length of stay was longest for constipation at 10.57 days, followed by infection (9.95), gastrointestinal bleeding (9.89) and electrolyte imbalance (9.71 days). Conclusion: One in three patients admitted with hepatic encephalopathy died in hospital. Gastrointestinal bleeding and pneumonia were the precipitants associated with the highest case fatality and together dominated mortality, whereas procedure-related and metabolic triggers were largely survivable. High mean Child–Pugh, MELD and MELD-Na scores confirm that these patients present with severely decompensated liver disease. Prompt endoscopic control of variceal haemorrhage and aggressive management of pneumonia offer the greatest scope for improving survival.