Introduction: Postoperative nutritional management plays a crucial role in recovery following major abdominal surgery. Traditionally, delayed feeding has been practiced; however, early enteral feeding is increasingly being recommended under enhanced recovery protocols. Aim: To compare the effect of early enteral feeding versus delayed feeding on postoperative recovery following major abdominal surgery. Methods: This prospective comparative study included 120 patients undergoing major abdominal surgery at a tertiary care hospital. Patients were divided into early feeding (n=58) and delayed feeding (n=62) groups. Early feeding was initiated within 24 hours postoperatively, while delayed feeding was started after return of bowel function. Parameters assessed included return of bowel function, postoperative complications, hospital stay, and recovery outcomes. Statistical analysis was performed using t-test and Chi-square test with p<0.05 considered significant. Results: Early enteral feeding resulted in significantly faster return of bowel function, including earlier bowel sounds, passage of flatus, and stool (p<0.001). The duration of postoperative ileus was significantly reduced in the early feeding group. Postoperative complications such as abdominal distension and prolonged ileus were significantly lower, while other complications were comparable between groups. The early feeding group also showed significantly shorter hospital stay, earlier ambulation, lower pain scores, and higher rate of good recovery (p<0.001). Conclusion: Early enteral feeding significantly improves postoperative recovery, reduces complications, and shortens hospital stay without increasing risk, supporting its routine use in major abdominal surgery.

Background:  Diabetes mellitus (DM) and hypertension (HTN) are significant non-communicable conditions with overlapping risk factors and high morbidity and mortality. Their prevalence in adults, in order to plan their prevention, requires understanding. Objective: To find out the prevalence of diabetes mellitus and hypertension in adults population. Methods: The study was a cross sectional study carried out between Jan, 2024 and December, 2024 with 422 adults who received outpatient and community care. Consecutive sampling was used to select the participants. The socio-demographic information was gathered using structured questionnaires. Blood pressure was recorded with the help of standardized sphygmomanometer and diabetes was evaluated with the help of random blood glucose and history recorded. Data was analyzed in SPSS v24, and the descriptive statistics, chi-square and p-values less than 0.05 were taken into account as significant. Results: The average age of respondents was 44.6 ± 13.8 years and 53.6% of them were females. The diabetes mellitus prevalence was 29.9%, hypertension 37.4%, and 21.8% had both. The disease prevalence of both diseases rose considerably with age (p < 0.001). Urban residents were more likely to have diabetes (p = 0.018), whereas men had higher chances of having hypertension (p = 0.041). Conclusion: Diabetes mellitus and hypertension are very common in adults and mostly in the older age and urbania. The widespread cooccurrence highlights the fact that screening at an earlier age, combined management, and health programs of the population would be necessary to decrease morbidity and complications.

Introduction: choledochal cyst is dilatation of bile duct, is more common in women and children, and has risk of malignant transformation. Abdominal pain and jaundice are most common presentation of disease. MRCP is gold standard for diagnosis. Surgery is Main treatment, Excision of cyst and reconstruction with Roux En Y hepaticojejunostomy is option of choice. Some patients need liver resection or even liver transplant. Methods: data regarding demography, type of cyst, surgical details and post operative complications of those patients were collected who had undergone surgery for CC. Results: study includes 81 patients, 66.7% patients were female, with median age of 16 years. Overall complication rate was 11.1%, bile leaks 4.9%, biliary stricture 2.5% and malignancy rate 1.2% and mortality rate was 1.2% and reoperation required in 6.2% patients.  Conclusion: considering variations in presentation, treatment and malignant potential of choledochal cyst, surgery should be performed when diagnosis is conformed.

Introduction: Percutaneous nephrolithotomy (PCNL) is considered the gold standard treatment for large and complex renal calculi. Traditionally, PCNL is performed in the prone position; however, the supine position has emerged as an alternative approach with potential anesthetic and surgical advantages. This study aimed to compare the efficacy, safety, and perioperative outcomes of supine versus prone position PCNL in patients undergoing renal stone surgery at a single tertiary care center. Methodology: A prospective comparative study was conducted at a single tertiary care center including 196 patients diagnosed with renal calculi requiring percutaneous nephrolithotomy (PCNL). Patients were equally divided into two groups: Group A (n=98) underwent PCNL in the supine position, while Group B (n=98) underwent PCNL in the prone position. Demographic characteristics, stone size, operative time, fluoroscopy duration, stone-free rate, length of hospital stay, and perioperative complications were recorded and analyzed. Statistical analysis was performed using SPSS version 25, and a p-value of <0.05 was considered statistically significant. Results: The mean operative time was significantly shorter in the supine group (72.4 ± 10.5 minutes) compared to the prone group (89.7 ± 12.3 minutes, p<0.05). Fluoroscopy time was also reduced in the supine group (5.8 ± 1.4 minutes) versus the prone group (7.2 ± 1.6 minutes, p<0.05). Stone-free rates were comparable between the two groups, with 90% in the supine group and 88% in the prone group (p>0.05). The mean hospital stay was shorter in the supine group (2.8 ± 0.7 days) compared to the prone group (3.6 ± 0.9 days, p<0.05). Minor postoperative complications were observed in 10% of patients in the supine group and 16% in the prone group. Conclusion: Supine PCNL is a safe and effective alternative to prone PCNL, offering shorter operative time, reduced fluoroscopy exposure, and shorter hospital stay while maintaining comparable stone clearance rates. The supine position may provide additional benefits in selected patients and should be considered a viable option in modern urological practice.

Introduction: Non-contact ACL injuries are prevalent in pivoting sports. We evaluated a 16-week technology-enhanced neuromuscular training program for injury prevention in young athletes. Methods: In this RCT, 320 pivoting-sport athletes (mean age 19.3±2.2 years; 51% female) were randomized to intervention (wearable sensors, ML auto-prescription, digital twin optimization, VR perturbation training) or control. Primary outcome: non-contact ACL injury incidence. Secondary outcomes: biomechanical, neuromuscular, and proprioceptive measures. Results: The intervention reduced non-contact ACL injury rates versus control (3.1 vs. 9.7/1,000 athlete-exposures; adjusted HR 0.29, 95% CI: 0.16–0.52; p<0.001; NNT=21). Significant between-group improvements favored the intervention for knee abduction moment, knee flexion at contact, co-contraction ratio, reactive stabilization, and Y-Balance scores (all p≤0.003; Cohen's d=0.76–1.18). Adherence (92.3% vs. 78.6%) and protocol completion (92.5% vs. 75.6%) were higher in the intervention group, with >94% ML prescription accuracy. Findings were robust across sensitivity analyses and in female athletes (HR 0.35; p=0.004). Conclusion: A 16-week technology-driven neuromuscular program significantly reduces non-contact ACL injury risk in young pivoting-sport athletes through measurable biomechanical and neuromuscular adaptations, with high feasibility and adherence supporting its integration into standard injury-prevention practice.

Introduction: Background Meningitis is a medical emergency requiring rapid and accurate diagnosis. While cerebrospinal fluid (CSF) analysis remains the gold standard, it is invasive and not always immediately accessible. MRI offers a non-invasive alternative; however, the optimal MRI sequence for detecting meningeal inflammation has not been definitively established.Objective: To compare the diagnostic accuracy of contrast-enhanced T2 FLAIR (CE-T2 FLAIR) and contrast-enhanced T1-weighted imaging (CE-T1WI) MRI sequences in diagnosing infective meningitis, using CSF analysis as the gold standard.Methods: A cross-sectional study was conducted at the Department of Radiology, Mayo Hospital Lahore. Sixty clinically suspected meningitis patients were enrolled using non-probability convenient sampling. All patients underwent non-contrast MRI followed by CE-T2 FLAIR and CE-T1WI sequences. CSF analysis via lumbar puncture served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated.Results: The mean patient age was 44.98 ±15.11 years, with male predominance (60%). CSF positivity was confirmed in 43.33% of patients. CE-T2 FLAIR demonstrated sensitivity of 96.15%, specificity of 82.35%, PPV of 80.65%, NPV of 96.55%, and diagnostic accuracy of 88.33%. CE-T1WI showed sensitivity of 69.23%, specificity of 85.29%, PPV of 78.26%, NPV of 78.38%, and diagnostic accuracy of 78.33%.

Conclusion: CE-T2 FLAIR demonstrated significantly superior sensitivity and overall diagnostic accuracy compared to CE-T1WI for detecting meningeal inflammation. Routine incorporation of CE-T2 FLAIR into MRI protocols for suspected meningitis is recommended to facilitate earlier diagnosis and improve clinical outcomes.

Introduction: After surgery, pain is common and can make recovery harder for patients with bone injuries. Good pain control helps patients feel better and avoid problems like blood clots and infections. Pain happens when nerves send signals to the brain after injury. Inflammation can make the pain worse. Many patients have moderate to severe pain in the first two days after surgery, especially in orthopaedics. Inadequate pain management can impede healing and result in chronic pain. Inadequate pain management can impede healing and result in chronic pain. To manage pain, doctors frequently combine various medications. Diclofenac and ketorolac are two common medications. By obstructing bodily chemicals, both lessen pain and swelling. Although ketorolac is a fairly effective medication, its negative effects limit its use. This study uses the Visual Analog Scale (VAS), a pain index, to assess the effectiveness of ketorolac and diclofenac in reducing pain following surgery.  Material and Methods: Two equal groups of 332 postoperative orthopaedic patients with pain were randomly selected. Group B (166 patients) received Ketorolac 30 mg IV every 8 hours for 48 hours, while Group A (166 patients) received Diclofenac 75 mg IV every 12 hours. Patients who fulfilled the requirements for inclusion and gave their informed consent were included. The Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) were used to capture baseline data on sociodemographic characteristics, common postoperative symptoms, and pain scores. There were three categories for pain: mild (0–3), moderate (4–6), and severe (7–10). At 2, 6, 12, 24, and 48 hours following therapy, pain scores and additional parameters were evaluated. Results:  Baseline VAS and NRS pain scores were comparable between the Diclofenac and Ketorolac groups. However, from 2 to 48 hours postoperatively, the Diclofenac group showed significantly lower pain scores on both VAS and NRS scales compared to the Ketorolac group (p < 0.05 at all intervals), indicating superior analgesic efficacy of Diclofenac Conclusion: Diclofenac significantly reduced VAS and NRS scores from 2 hours onward, indicating that it was a more effective and long-lasting postoperative pain reliever than ketorolac in orthopedic trauma patients during a 48-hour period.

Background: Antepartum hemorrhage (APH) is a major obstetric complication associated with significant perinatal morbidity and mortality. Early diagnosis and timely management are essential to improve outcomes. Objective: To evaluate perinatal outcomes in women presenting with antepartum hemorrhage. Methodology: This descriptive study was conducted at DHQ Hospital Landikotal from March 2023 to March 2024 after ethical approval. A total of 98 pregnant women (gestational age ≥28 weeks) with APH were included. Data on demographic variables and perinatal outcomes (low birth weight, stillbirth, neonatal death) were collected. Statistical analysis was performed using SPSS version 23, with p-value <0.05 considered significant. Results: The mean age was 30.20 ± 4.55 years. Low birth weight was the most frequent outcome (40.8%), followed by stillbirth (22.4%) and neonatal mortality (10.20%). Low birth weight and stillbirth showed a significant association with gestational age ≤35 weeks (p<0.05). No significant association was observed between parity and neonatal mortality.  Conclusion: Antepartum hemorrhage is strongly associated with adverse perinatal outcomes, particularly low birth weight, stillbirth, and neonatal death. Early diagnosis and improved antenatal care are crucial to reduce these risks.

Introduction: Ageing is universal and occurs naturally as a part of the developmental process in life of all  living beings. There has been a considerable rise in the number of people with age more than 60 years due to availability of better health care facilities. People in old age are extra vulnerable to mental health problems along with other health problems. Hence the study was planned. Aim of study: To study about the mental health problems and the associated co-morbidities in residents of old age home of North Western Rajasthan. Methodology: The study was a Descriptive Cross-sectional Observational type of study conducted on 209 residents of old age home, Bikaner, Rajasthan after taking permission from the ethical committee of the institution and the authority of old age home. Inclusion criteria- All the persons residing at old age home for atleast 6 months. Tools used- semi-structured Proforma, old records of old age home, Hindi Mental Status Examination, Diagnostic criteria of ICD-10. Data analysed using descriptive statistics.  Results: Excluding the ones as already diagnosed as Mentally Retarded (MR) and suffering from Psychotic Disorders, the most common mental illness was Depression in the residents who were not reported to be suffering from any mental illness followed by dementia and then anxiety disorders.  Conclusion: More than one half of the residents of old age home were suffering from atleast one or more mental health problems indicating the urgent need to provide professional help to them.

Background: Zirconia is a new restorative material that has gained great popularity in the field of prosthodontics because it is superior in terms of mechanical properties, though its inert surface does not allow a reliable adhesion with resin cements. Objective: To determine the impact of various surface modification methods on the bond strength of zirconia crowns with self-adhesive resin cements. Methodology: This experimental study was done at Department of Dental Materials. A total of 60 standardized zirconia (Y-TZP) specimens were produced using the CAD/CAM system and divided into four groups (n = 15 each): laser treatment, airborne-particle abrasion, tribochemical silica coating, and control (no treatment). Under uniform conditions, self-adhesive resin cement was used to adhere all of the specimens to composite resin substrates. The data were examined using SPSS version 26. After testing for normalcy using the Shapiro-Wilk test, one-way ANOVA and post hoc Tukey were performed. Results: The tribochemical silica coating group registered the highest bond strength, followed by airborne-particle abrasion and laser treatment, and the control group registered the lowest values. Surface treatment and failure mode (p = 0.010) were also found to be significantly associated, with treated groups having more mixed and cohesive failures. Conclusion: The bond strength of zirconia crowns with self-adhesive resin cements was significantly improved by surface modification, and the best technique to boost adhesion and failure resistance was tribochemical silica coating.

Introduction: Autoimmune diseases often present with overlapping and nonspecific clinical features, making diagnosis challenging. Autoantibodies, imaging, and histopathology are important diagnostic tools that may improve clinical correlation and diagnostic accuracy. Objective: To evaluate the role of autoantibodies, imaging, and histopathological findings in the diagnosis and clinical correlation of autoimmune diseases. Methods: This cross-sectional analytical study was conducted at KRL Hospital, Islamabad, from July 2024 to June 2025, including 192 patients with suspected or confirmed autoimmune diseases.  Results: The mean age was 41.6 ± 13.8 years, and 136 (70.8%) patients were female. ANA positivity was observed in 126 (65.6%) patients, while abnormal imaging findings were present in 117 (60.9%). Histopathology was performed in 86 (44.8%) cases, with diagnostic findings in 68 (35.4%). Confirmed autoimmune disease was significantly associated with positive ANA (75.8% vs. 30.2%; p<0.001), disease-specific antibodies (58.4% vs. 20.9%; p<0.001), abnormal imaging (69.1% vs. 32.6%; p<0.001), and diagnostic histopathology (40.9% vs. 16.3%; p=0.003). Positive ANA was the strongest predictor of confirmed autoimmune disease (aOR 4.12; p<0.001). Conclusion: Autoantibodies, imaging, and histopathology provide complementary diagnostic value in autoimmune diseases. A combined diagnostic approach improves confirmation and clinical correlation.

Objective: To compare the hemodynamic and analgesic outcomes of single-dose preemptive intravenous ibuprofen versus placebo in patients undergoing laparoscopic cholecystectomy.Methodology:This randomized controlled trial was conducted at the Department of Anesthesia, Civil Hospital Karachi over six months. A total of 110 patients (ASA I–II, aged 40–80 years) undergoing elective laparoscopic cholecystectomy were enrolled and randomly allocated into two groups (n=55 each). Group A received intravenous ibuprofen (400 mg) 15 minutes prior to induction, while Group B received placebo (normal saline). Hemodynamic parameters (SBP, DBP, MAP, heart rate) were recorded at 30 minutes postoperatively. Pain was assessed using the Visual Analog Scale, and time to first analgesic requirement was noted. Data was analyzed using SPSS version 20.Results:Baseline characteristics were comparable between the groups (p>0.05). The ibuprofen group demonstrated significantly lower systolic blood pressure (122.6 ± 15.6 vs 130.8 ± 15.7 mmHg, p=0.007), diastolic blood pressure (74.5 ± 10.1 vs 83.4 ± 9.5 mmHg, p<0.001), mean arterial pressure (91.1 ± 9.5 vs 99.0 ± 9.0 mmHg, p<0.001), and heart rate (73.8 ± 10.6 vs 78.9 ± 11.8 beats/min, p=0.019). The mean time to first analgesic requirement was significantly prolonged in the ibuprofen group (594.7 ± 98.2 vs 228.4 ± 81.3 minutes, p<0.001), while rescue tramadol consumption was significantly reduced (59.1 ± 16.5 vs 85.9 ± 20.9 mg, p<0.001).Conclusion:Preemptive intravenous ibuprofen significantly improves postoperative analgesia and hemodynamic stability while reducing opioid requirements in patients undergoing laparoscopic cholecystectomy..

Background: Patients who undergo mechanical mitral valve replacement require lifelong oral anticoagulant therapy in the form of warfarin to maintain proper functioning of their valve. All OACs come with the risk of bleeding or thrombosis. Compared to other anticoagulants, warfarin is peculiar due to its wider range of drug interactions and unique dose adjustments. Chaperoned monitoring of dosage is essential to avoid catastrophic bleeding and/or thromboembolic events. In our country, due to lack of warfarin clinics, there is an inherent belief amongst some surgeons that patients on warfarin inevitably succumb to its complications. This study aims to evaluate the patients' knowledge of warfarin, its monitoring, and the complications that are associated with un-prescribed dose changes and improper monitoring. In the process, we also attempted to evaluate and educate the patients about drug and dietary interactions of warfarin.Methodology: In the present cross-sectional study, we searched our database for all patients who underwent isolated mitral valve replacement surgery. A total of 164 patient underwent mitral valve replacement at our center, of which records and contact details of 110 patient were present out of which 18 patients were found to be dead at the time this study was conducted. Therefore, a total data of 92 patient were included in this study. All patients were traced and telephoned. over the Audio phone call, the interviewer filled a pre-designed questionnaire from the patient which was then used to evaluate the patient’s knowledge on warfarin, its monitoring, interactions, and complications of warfarin. A hand written data-form was extracted and subsequently re-entered into Microsoft excel sheet. Percentages and number were calculated manually. Results: In this study, a total of 110 patients were included out of whom 61 were male (55.45%) and 49 were females (44.5%). The maximum number of patients belonged to the 41-50 age group. As a whole, the patients were divided geographically with 78 (70.9%) from Pakistan and 32 (29%) from Afghanistan. The Post MVR survival rate was 83.6% i.e. 92 were still alive and 18 (16%) expired. Among the patients who expired, 5 (27.7%) survived less than 6 months, 7 (38.8%) survived 6-12 months and 6 (33.3%) survived more than 12 months after surgery. This study also recorded the comorbidities of these patients in which 47(51%) people were hypertensive, 21(22.8%) were diabetic, 8 (8.6%) had a stroke, 12 (13.0%) people had atrial fibrillation. At least once since surgery, 23 (25%) people had bleeding per nose, 17 (18.4%) had bruises, and 16 (17.3%) had increased menstrual flow on warfarin therapy. 83 (90%) patients knew about the function of warfarin while 9 (10%) didn’t know. 56 (60%) patients knew about the role of INR while 36 (40%) didn’t know about it. 65 (70%) got their INR tested regularly while 27 (30%) didn’t get their INR tested regularly. 24 (21%) knew about the diet and drug interaction of warfarin while 68 (61%) didn’t know about them.Conclusion: The majority of patients had moderate knowledge about the functioning of warfarin and the role of INR, but a significant drop was seen in knowledge regarding drug interactions and dietary restrictions.Recommendations:Every healthcare facility should provide a leaflet about the drug interactions, dietary restrictions, INR monitoring, and warfarin complications. Not only this but the doctors and nurses should also educate the patients about the post MVR care.

Background: Maternal obesity is becoming a widespread problem and is linked to adverse labour induction, such as increased labour duration and the rate of cesarean section. It is necessary to choose an efficient induction agent in order to increase the results in high BMI women.Purpose: To compare the efficacy and safety of misoprostol and prostaglandin E2 in induction of labour in high BMI pregnant women.Methods: The study was a prospective comparative study carried out at Saidu Group of Teaching Hospitals & Temergara Teaching Hospital Temergara from November 2025 to April 2026. One hundred pregnant women with a BMI of 30kg/m 2 were split into two groups that were given misoprostol or prostaglandin E2. Measures of outcomes were vaginal delivery rate, induction-delivery interval, cesarean section rate, maternal complications, and neonatal outcomes. Analysis of data was done in SPSS version 26.Findings: Misoprostol had a much higher vaginal delivery rate (72% vs 60%), and a shorter induction-to-delivery time. The rates of cesarean section and failed induction were lower than the rates of prostaglandin E2. There were no differences in maternal and neonatal outcomes.Conclusion: Misoprostol induces labour better compared to prostaglandin E2 in women with high BMI and has equal safety profiles.

Background: Trauma remains a major cause of morbidity and mortality in India, particularly affecting young and economically productive populations. Objectives: To study the demographic profile, injury patterns, management, and outcomes of trauma patients presenting to the Emergency Medicine Department of SKIMS. Methods: Prospective observational study conducted over one year. Systematic random sampling was used. Data were analysed using SPSS v26. Results: A total of 1211 trauma patients were included. Road traffic accidents were the commonest cause (48.2%). Majority were males (72.3%) and from rural areas (63.2%). Most patients were managed conservatively (58.8%). Mortality was 6.9%. Conclusion: Young males from rural backgrounds constitute the most vulnerable group. Strengthening road safety measures, peripheral healthcare, and trauma systems is essential.

Lipoprotein (a) [Lp(a)] has emerged as an important independent risk factor for atherosclerotic cardiovascular diseases, particularly coronary artery disease (CAD) and ischemic stroke. Structurally similar to low-density lipoprotein (LDL), Lp(a) contains apolipoprotein B-100 linked to apolipoprotein(a), which contributes to its proatherogenic, proinflammatory, and prothrombotic properties. This systematic review evaluates current evidence regarding the role of Lp(a) in the pathogenesis, diagnosis, risk stratification, and prognosis of coronary artery disease and stroke. Evidence from epidemiological, genetic, and clinical studies consistently demonstrates that elevated Lp(a) levels are associated with increased risk of myocardial infarction, coronary stenosis, recurrent cardiovascular events, ischemic stroke, and cerebrovascular disease independent of traditional lipid parameters. Elevated Lp(a) contributes to endothelial dysfunction, plaque formation, vascular inflammation, and impaired fibrinolysis, thereby accelerating atherosclerosis and thrombotic events. The review also highlights the significant genetic determination of Lp(a) concentrations and the variability of cardiovascular risk across different populations and ethnic groups. Although conventional lipid-lowering therapies have limited effects on Lp(a), emerging therapies including antisense oligonucleotides, PCSK9 inhibitors, and RNA-targeted treatments show promising reductions in circulating Lp(a) levels. Despite growing recognition of its clinical significance, challenges remain regarding standardized measurement, universal screening recommendations, and therapeutic integration into routine cardiovascular practice. Overall, this review emphasizes that Lp(a) is an important but underrecognized cardiovascular risk factor and may play a critical role in future personalized cardiovascular risk assessment and prevention strategies.

Background: Adult hearing loss is a common otorhinolaryngological problem with heterogeneous clinical presentation and multifactorial causation. Its pattern varies according to age, noise exposure, systemic comorbidities, and middle-ear disease burden. Objectives: To describe the clinical spectrum, risk factors, and audiological patterns of hearing loss among adults attending a tertiary care ENT centre. Methods: This hospital-based observational study included 100 adult patients with hearing-related complaints attending the Department of ENT, KIMS, Amalapuram, Andhra Pradesh, India, from August 2025 to January 2026. Demographic details, presenting symptoms, duration of illness, risk factors, otoscopic findings, and relevant comorbidities were recorded. All patients underwent clinical ENT examination and pure-tone audiometry. Hearing loss was classified according to laterality, type, severity, audiogram pattern, and probable clinical diagnosis. Data were analysed using descriptive statistics. Results: The mean age was 48.6 ± 15.2 years, and males constituted 56.0% of the study population. Bilateral hearing loss was observed in 62.0% of patients. Tinnitus was the most common associated symptom, followed by ear discharge and aural fullness. Noise exposure was the leading risk factor, followed by smoking, recurrent otitis media, diabetes mellitus, and hypertension. Sensorineural hearing loss was the most frequent audiological type, seen in 52.0%, while conductive and mixed hearing loss accounted for 28.0% and 20.0%, respectively. Moderate hearing loss was the commonest severity category. Age-related sensorineural hearing loss, chronic otitis media-related hearing loss, and noise-induced hearing loss were the major clinical diagnoses. Conclusion: Sensorineural hearing loss was the predominant audiological pattern in this tertiary care ENT population. Advancing age, noise exposure, metabolic comorbidities, and chronic middle-ear disease were important contributors. Early screening, risk-factor modification, and timely audiological rehabilitation are essential to reduce functional disability.

Background: Allergic rhinitis is a common inflammatory disorder of the nasal mucosa and an important cause of recurrent sneezing, nasal obstruction, watery rhinorrhea, and impaired daily functioning. Clinic-based data from otorhinolaryngology outpatient settings are useful for understanding local disease burden and symptom patterns. Objectives: To estimate the prevalence of allergic rhinitis among patients attending an otorhinolaryngology outpatient department and to describe the clinical profile, disease pattern, triggers, examination findings, and associated conditions among affected patients. Methods: This observational cross-sectional study was conducted in the Department of Otorhinolaryngology, KIMS, Amalapuram, Andhra Pradesh, India, from August 2025 to January 2026. A total of 100 consecutive outpatient attendees were evaluated. Allergic rhinitis was diagnosed clinically using characteristic symptoms and supportive anterior rhinoscopic findings. Disease pattern and severity were classified using ARIA-based clinical categories. Data were summarized using frequencies, percentages, mean, and standard deviation. Results: Allergic rhinitis was diagnosed in 42 patients, giving a prevalence of 42.0%. The mean age of the study population was 31.8 ± 12.6 years, and the 21-30 years age group was most commonly represented. Sneezing was the leading symptom among allergic rhinitis cases, followed by nasal obstruction, watery rhinorrhea, and nasal itching. Seasonal symptoms were present in 52.4%, while 59.5% had persistent disease. Dust exposure was the most common trigger. Pale nasal mucosa and inferior turbinate hypertrophy were the commonest examination findings. Conclusion: Allergic rhinitis was frequently observed among ENT outpatient attendees, with a predominance of sneezing, nasal obstruction, watery rhinorrhea, persistent symptoms, and dust-related exacerbation.

Introduction: Population ageing is a global public health priority, with the number of elderly individuals rising alongside a mounting burden of chronic disease. This transition is particularly pronounced in India, where integrated, community based geriatric care is increasingly essential. This study aimed to assess the morbidity profile among the geriatric population in Haldwani block and compare findings between urban and rural areas to identify associated determinants. Methods: This community based cross sectional study was conducted among 610 elderly participants (305 urban, 305 rural) using a validated, pretested interview schedule. Morbidity was defined as the presence of one or more chronic conditions. Multivariable binary logistic regression was performed to identify independent predictors of chronic illness and multimorbidity. Results: The study revealed a high morbidity burden, with 58.0% of participants suffering from at least one chronic condition and 31.1% experiencing multimorbidity. Visual impairment (29.7%), hypertension (29.5%), diabetes (22.8%), and lower backache (19.7%) were the most prevalent issues. Health seeking behavior differed significantly by residence: rural elderly more commonly used government facilities (56.3%), whereas urban elderly mainly preferred private doctors (61.2%). Rural residence was the strongest independent predictor of morbidity (aOR: 3.29; 95% CI: 2.33–4.65; p<0.001), while participants aged 80 years and above faced significantly higher odds (aOR: 3.90; 95% CI: 2.01–7.58; p<0.001) compared to the 60–69 age group. Conclusion: Chronic morbidity, particularly sensory and musculoskeletal impairment, was much higher among rural older adults. These findings underscore the need for targeted geriatric outreach, regular sensory screening, and robust primary care level followup to mitigate health inequalities and address the functional health needs of the elderly in diverse geographic settings.

Introduction: Lipoprotein (a) [Lp(a)] has emerged as an important independent risk factor for atherosclerotic cardiovascular diseases, particularly coronary artery disease (CAD) and ischemic stroke. Structurally similar to low-density lipoprotein (LDL), Lp(a) contains apolipoprotein B-100 linked to apolipoprotein(a), which contributes to its proatherogenic, proinflammatory, and prothrombotic properties. This systematic review evaluates current evidence regarding the role of Lp(a) in the pathogenesis, diagnosis, risk stratification, and prognosis of coronary artery disease and stroke. Evidence from epidemiological, genetic, and clinical studies consistently demonstrates that elevated Lp(a) levels are associated with increased risk of myocardial infarction, coronary stenosis, recurrent cardiovascular events, ischemic stroke, and cerebrovascular disease independent of traditional lipid parameters. Elevated Lp(a) contributes to endothelial dysfunction, plaque formation, vascular inflammation, and impaired fibrinolysis, thereby accelerating atherosclerosis and thrombotic events. The review also highlights the significant genetic determination of Lp(a) concentrations and the variability of cardiovascular risk across different populations and ethnic groups. Although conventional lipid-lowering therapies have limited effects on Lp(a), emerging therapies including antisense oligonucleotides, PCSK9 inhibitors, and RNA-targeted treatments show promising reductions in circulating Lp(a) levels. Despite growing recognition of its clinical significance, challenges remain regarding standardized measurement, universal screening recommendations, and therapeutic integration into routine cardiovascular practice. Overall, this review emphasizes that Lp(a) is an important but underrecognized cardiovascular risk factor and may play a critical role in future personalized cardiovascular risk assessment and prevention strategies.

Background: Fungal rhinosinusitis (FRS) is a spectrum of sinus diseases with significant morbidity and, in invasive forms, high mortality. Multidetector Computed Tomography (MDCT) using the Functional Endoscopic Sinus Surgery (FESS) protocol enables detailed anatomical delineation of paranasal sinus pathology. However, its diagnostic accuracy relative to histopathology as the gold standard requires systematic evaluation. Objective: To determine the diagnostic accuracy of MDCT using the FESS protocol in the diagnosis of fungal sinusitis, with histopathology serving as the gold standard. Methods: A cross-sectional study was conducted at the Department of Radiology, Govt. Kot Khawaja Saeed Teaching Hospital, Lahore. A total of 65 patients (mean age 50.29 ± 13.38 years; 61.54% male) presenting with sinonasal symptoms underwent non-contrast MDCT using a Toshiba Aquilion 16-slice scanner under the FESS protocol, followed by surgical biopsy with histopathological analysis. Results: Sensitivity and specificity of MDCT for diagnosing fungal sinusitis were 84.62% (95% CI: 70.27–92.75) and 80.77% (95% CI: 62.12–91.49), respectively. Positive predictive value was 86.84%, negative predictive value was 77.78%, and overall diagnostic accuracy was 83.08%. Sensitivity was highest in patients over 60 years of age (90.91%), and highest specificity was observed in male patients (92.30%). Conclusion: MDCT using the FESS protocol demonstrates substantial diagnostic accuracy for fungal sinusitis, enabling differentiation of subtypes and extent of disease including intracranial and intraorbital extension. Its integration into preoperative workup is recommended. Histopathological correlation remains essential for definitive diagnosis.

Background: Sepsis-associated acute kidney injury (AKI) is a frequent and serious complication associated with increased morbidity, mortality, and prolonged hospitalisation. Serum creatinine is a simple and widely available marker used to assess renal dysfunction and may help predict outcomes in these patients. The study aimed to study the association between serum creatinine levels and outcomes in sepsis patients with acute kidney injury. Material and Methods: This prospective observational study was conducted in the Department of Emergency Medicine, GEMS Hospital, Srikakulam, from April 2023 to September 2024. A total of 114 adult patients with sepsis and AKI were included. Patients were divided into Group 1 (serum creatinine <2.3 mg/dL, n=48) and Group 2 (≥2.3 mg/dL, n=66). Clinical profile, interventions, duration of stay, and outcomes were compared. Results: Patients with higher serum creatinine had a significantly greater prevalence of combined diabetes and hypertension (40.91% vs 22.92%, p=0.001). Ventilator support was more frequent in Group 2 (59.09% vs 35.41%). Mean emergency stay (86.64 vs 32.72 hours), ICU stay (4.73 vs 1.67 days), and hospital stay (15.34 vs 9.45 days) were significantly prolonged (p=0.0001). Mortality was higher in Group 2 (12.12% vs 4.17%, p=0.05). Conclusion: Elevated serum creatinine is associated with increased severity, greater intervention requirement, prolonged hospitalisation, and higher mortality in sepsis patients with AKI. It is a useful prognostic marker for early risk stratification.

Background: Gallstone disease is a common hepatobiliary disorder all over the world and high lipid level metabolism, increased bile super saturation, and a decline in gallbladder motility are the main cause of it among obese individuals. The use of ultrasonography as the primary imaging method for the detection of gallstones can still be used because of its flexibility, availability and cost-effectiveness. In obese patients, the utility of conventional ultrasound can be affected however by increased subcutaneous fat, bowel gas interference and the limited acoustic penetration. With the optimized ultrasound techniques, it can be hoped that even better visualization of the gallbladder combined with increased diagnostic precision can be achieved. The aim of this study was to compare the efficacy of optimized ultrasound technique to the detection of gallstone in obese patients’ vs conventional ultrasound. Methods: The descriptive cross-sectional comparative study was carried out from July, 2024 till November 2024 in the Radiology Department of Divisional Headquarter Teaching Hospital, Mirpur Azad Kashmir. It was conducted by a multi-disciplinary research team with expertise in medicine, surgery, radiology and pathology. Ninety-seven consecutive obese patients, defined as having a body mass index (BMI) greater than or equal to 30 kg/m2, were recruited for the study, because of their clinical suspicion for gallstone disease. Obstetricians and gynecologists were subjected to abdominal ultrasonography examination, both by standard and optimized methods. Patient positioning, probe scanning, compression, and changing gain and depth were used for optimization, to improve visualization of the gall bladder. The data collected were analyzed using SPSS version 26. Results: Optimized ultrasound techniques showed better distinction of the gallbladder and better affability by gallstones in comparison with the standard ultrasound technique. Physical maneuver and technical parameters adjustments showed a substantial reduction of any imaging constrains due to obesity and bowel gas, thereby improving the image quality and diagnostic sensitivity. Conclusion: The use of optimized ultrasound techniques shows a large improvement in the accuracy of the diagnosis of gallstones in patients who are obese. The use of these modified scanning modalities in the general radiological routine could help shorten varying degrees of experiencing false-negative results, aid in early diagnosis and enhance a patient's management.

Background: Hypertension is a leading global health challenge characterized by persistently elevated blood pressure and a major contributor to cardiovascular disease, organ damage, and premature mortality. Its asymptomatic nature often delays diagnosis, earning it the label of a “silent killer.” Despite advances in treatment, global blood pressure control remains suboptimal due to factors such as poor adherence, limited healthcare access, and socioeconomic disparities. Objective: This review aims to evaluate recent advances in hypertension management, with a focus on updated clinical guidelines, pharmacological innovations, and emerging therapeutic strategies to improve clinical decision-making and patient outcomes. Methods: A narrative review was conducted using literature from major databases, including PubMed, Google Scholar, and Scopus. Key clinical guidelines from organizations such as the ACC/AHA, ESC, and WHO were analyzed. Emphasis was placed on high-quality evidence, including randomized controlled trials and consensus recommendations, to compare diagnostic criteria, treatment thresholds, and management strategies. Results: Recent guidelines recommend earlier diagnosis through lowered thresholds and emphasize individualized, risk-based treatment approaches. Lifestyle modifications remain central to management, supported by pharmacological advancements such as early combination therapy and single-pill regimens to enhance adherence. First-line agents include ACE inhibitors, ARBs, calcium channel blockers, and diuretics, while newer therapies like SGLT2 inhibitors provide additional benefits. Emerging interventions, including renal denervation and digital health technologies, further support improved blood pressure control and patient engagement. Conclusion: Updated hypertension management strategies highlight the importance of early detection, personalized treatment, and integrated care approaches. Addressing ongoing barriers—particularly in resource-limited settings—through patient education, improved access to care, and innovative technologies is essential to reducing the global burden of hypertension and improving long-term health outcomes.

Introduction: Significant impairment results from peripheral nerve injuries (PNIs), although endogenous recovery is frequently insufficient and sluggish (1). Schwann cells (SCs), the myelinating glia of the peripheral nervous system, are essential for nerve healing because they direct axon regeneration, remove debris, and remyelinate regenerating axons (2)(3). Conventional two-dimensional (2D) SC preparations frequently result in altered shape and decreased neurotrophic factor synthesis because they lack the intricate spatial cues and cell–matrix interactions of in vivo nerve tissue (5). Spheroids, hydrogels, scaffolds, and bioprinted structures are examples of three-dimensional (3D) SC culture models that maintain SC phenotypic and function while more closely mimicking the in vivo milieu. This narrative summary examines the biology of SCs and their roles in regeneration (Section 2), the emergence of 3D SC systems (Section 4) and their variations (Section 5), and the drawbacks of 2D culture (Section 3). We compare biomaterials (natural, synthetic, and hybrid; Table 2), model techniques (Table 1), and important studies (Table 3). Co-culture methods, stem cell-derived SCs, and advanced biomaterials (such conductive polymers and decellularized matrices) enhance 3D models even further. Applications include in vitro drug screening, disease modeling platforms, and nerve tissue engineering (grafts and conduits) (7) (8). Replicating the full brain architecture and transferring it to the clinic remains difficult despite advancements. Future potential include more biomimetic bioinks, stem cells derived from induced pluripotent stem cells (iPSCs), and standardized techniques to connect the lab and bedside. All things considered, 3D SC cultures have the potential to improve peripheral nerve regeneration studies and therapies (10).

Background: Getting effective pain relief after orthopedic surgeries is key to a smooth recovery. Ropivacaine, a long-lasting local anesthetic, is often used in regional blocks like the fascia iliaca compartment block (FICB). Magnesium Sulfate (MgSO₄), which acts as an NMDA receptor antagonist, has been explored as a way to enhance pain relief and cut down on opioid use. This study looks into how well MgSO₄ works when added to Ropivacaine for FICB in patients having surgery on their proximal femur. Methods: We conducted a prospective, randomized, controlled trial involving 50 patients undergoing proximal femur surgery, split into two equal groups. Group I received FICB with 20 ml of 0.2% Ropivacaine along with 150 mg of MgSO₄, while Group II got 20 ml of 0.2% Ropivacaine by itself. The main outcomes we focused on were the intensity of postoperative pain (measured by VAS scores), the time until the first request for rescue analgesia, and the total amount of opioids (tramadol) consumed in the first 24 hours. Results: Both groups were similar in terms of demographics and clinical characteristics. We didn’t find any statistically significant differences in VAS scores at any point. The average time until the first request for pain relief and total tramadol use were a bit lower in Group I, but these differences weren’t significant compared to Group II. Adding MgSO₄ didn’t negatively impact hemodynamic stability or lead to more complications. Conclusion: Using MgSO₄ alongside Ropivacaine in FICB was safe, but it didn’t significantly improve pain relief compared to using Ropivacaine alone. We recommend further studies with larger groups to confirm these results.

Background: Stress urinary incontinence (SUI) is the involuntary leakage of urine during activities that increase intra-abdominal pressure such as coughing, sneezing, laughing, or exercise. It is commonly seen in middle-aged and elderly women and significantly affects quality of life. Platelet-Rich Plasma (PRP) is an autologous, safe, and cost-effective regenerative therapy that may improve urethral support and sphincter function. Aim: To evaluate the efficacy and safety of periurethral autologous Platelet-Rich Plasma injections in women with stress urinary incontinence. Methods: This prospective pilot interventional study was conducted in the Department of Obstetrics and Gynaecology, Government Doon Medical College, Dehradun, on 15 women diagnosed with stress urinary incontinence. Women aged 25–45 years fulfilling inclusion criteria were enrolled after informed consent and institutional ethical approval. Two periurethral PRP injections were administered at an interval of 6 weeks. Improvement was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), cough stress test, and 3-day bladder diary over a follow-up period of 6 months. Results: Most patients belonged to the 40–44 years age group. Mild SUI was observed in 9 patients and moderate SUI in 6 patients. Patients with mild SUI showed better improvement after PRP therapy. Improvement in urinary symptoms and voiding diary findings was noted after 6 months. No major adverse events were reported during the study period. Conclusion: Periurethral PRP injection appears to be a safe, minimally invasive, and effective treatment option for mild to moderate female stress urinary incontinence. Larger randomized controlled trials are required to validate these findings.

Introduction: Purpose: Diabetes in India has reached epidemic proportions, with South Asians exhibiting higher incidence at a younger age and lower BMI and waist circumference. Prediabetes is an intermediate state that may progress to diabetes if untreated. This study aimed to estimate the incidence of altered glucose tolerance in sedentary overweight adults and evaluate changes in glucose tolerance following one week of moderate-intensity exercise in individuals with prediabetes. Methodology: Capillary fasting blood glucose was measured in sedentary overweight adults (n=104, age 18–60 years) using a standardized glucometer. Participants with prediabetic values (100–125 mg/dL) underwent postprandial testing. Those with postprandial levels of 140–199 mg/dL were selected for a 75 g oral glucose tolerance test (OGTT), with measurements taken every 30 minutes for 2 hours. Individuals meeting prediabetic criteria were followed up. Participants performed brisk walking (moderate intensity, ~3–3.5 mph) for 30 minutes daily for 7 consecutive days, monitored using a pedometer application. OGTT was repeated post-intervention Results: Pre-diabetes was present in 27% of participants. Among these, 10 individuals showed elevated postprandial glucose levels. Mean fasting and postprandial glucose levels were 125.5±16.1 and 159.5±19.4 mg/dL, respectively. After one week of exercise, 2-hour OGTT glucose levels decreased significantly from pre-exercise levels (140.1±16.1 to 123.5±13.5 mg/dL; p=0.01). The results demonstrated a 9.6% reduction in glucose levels during the OGTT (p<0.05). Normal OGTT responses were observed in 80% of these participants after moderate exercise. Conclusion:

Prediabetes is a modifiable metabolic state that can be effectively managed through appropriate lifestyle and dietary interventions, thereby reducing the risk of progression to diabetes mellitus, particularly at a younger age. The present study demonstrated that even a short duration of moderate-intensity exercise resulted in significant improvement in glucose tolerance among sedentary overweight adults, highlighting its potential as an effective strategy for early diabetes prevention.

Background: Dental adhesives are very important in restorative dentistry to provide the durability of bonding between the tooth structure and the composite materials. Nonetheless, commercially available systems can be costly and can have unstable biocompatibility and clinical outcomes.  Objective: To compare the shear bond strength, biocompatibility, and clinical efficacy of an indigenous dental adhesive system to a conventional commercial adhesive system. Methodology: This comparative experimental research took place during one year in a dental research lab from April 2025 to October 2025. The non-probability consecutive sampling was used to select 140 extracted human premolars, which were divided into two equal groups (n=70). The biocompatibility was measured with the help of fibroblast cell viability tests, and long-term clinical performance was measured based on restoration retention, marginal integrity, and post-operative sensitivity. Data were analyzed with SPSS version 26, independent sample t-test and chi-square tests were run, and the p-value of 0.05 was taken as significant. Results: The average shear bond strength was similar between the native adhesive (17.92 ± 3.84 MPa) and the commercial adhesive (18.60 ± 4.01 MPa), and there was no significant difference (p=0.214). Nevertheless, cell viability was much better in the native group (89.45 ± 5.62) than in the commercial group (85.10 ± 6.21) (p=0.036). Conclusion: The native dental adhesive exhibited similar mechanical behavior and high biocompatibility with the commercial system, which indicates its possible usage as a cheaper and safer alternative when it comes to restorative dental procedures.

Introduction: Chronic diarrhea is a clinical issue that has a number of etiologies among which there are inflammatory, infectious, autoimmune, and neoplastic. Gastrointestinal biopsies have an important role in definitive diagnosis, management, and regional disease pattern in histopathological examination. This research paper was intended to access the range of histopathological observations in chronic diarrhea patients in Pakistan.  Methodology: The study was a descriptive cross-sectional study that was done on 165 patients who presented with chronic diarrhea over 12 months. Sampling was done using consecutive sample and endoscopy was done to collect gastrointestinal biopsies. Specimens were subjected to regular histopathological methods and examined on the basis of mucosal architecture, inflammatory patterns, and epithelial changes and distinctive pathology. Clinical and demographic data were registered. The analysis of the data was done using SPSS 25. Quantitative measurements were in terms of mean ± SD and qualitative measurement in terms of frequency and percentage. Chi-square, Fisher exact test and ANOVA were used to test the associations and p ≤  0.05 was taken to be significant. Results: The commonest histopathological diagnosis was nonspecific inflammation (37.0%), then inflammatory bowel disease (19.4%), infectious pathology (12.7%), celiac disease (10.9%), microscopic colitis (8.5%), and neoplastic lesions (6.7%). Specific patterns of histopathology were significantly connected to age and location of the biopsy site, yet not gender. The clinical manifestations like weight loss and abdominal pain were predictors of severe pathology. Conclusion: In chronic diarrhea, gastrointestinal biopsies can be very critical in the diagnosis. The knowledge of typical histopathological patterns may assist clinicians to make the right diagnosis at the right time and particularly in different etiological regions.

Background: Diabetes mellitus is a chronic metabolic disease that is linked with several systemic and oral complications, which include the increased risk of opportunistic fungi infections like oral candidiasis.  Objective: To identify the distribution and prevalence of Candida species in oral lesions of diabetic patients and how they relate to clinical and demographic variables. Methodology: This was a cross-sectional study, which was carried out in a one year period from June 2025 to December 2025. Consecutive sampling was utilized to enroll 400 diabetic patients with oral lesions. Oral swabs were taken aseptically and subjected to microscopy and culture on Sabouraud dextrose agar. Standard microbiological techniques were used to identify the species. The SPSS version 26 was used in data analysis, and associations were evaluated by a chi-square test with p ≤ 0.05 taken to be significant. Results: The incidence of oral Candida infection was 62%. The most commonly isolated species was Candida albicans and then C. glabrata, C. tropicalis, and C. krusei. The notable associations were noticed between Candida positivity and poor glycemic control, longer period of diabetes, smoking, denture use, and poor oral hygiene (p ≤ 0.05). Conclusion: Oral Candida infection is very common among diabetic patients, especially in diabetic patients who have poor metabolic control and poor oral habits. Prevention and control of candidal infection in this high-risk group require early detection and stringent management of glycemic and oral hygiene.

Introduction: Pioglitazone is a thiazolidinedione (TZD), which is a clinically proven oral antidiabetic medication that stimulates insulin sensitivity through the stimulation of peroxisome proliferator-activated receptor gamma (PPAR-γ). Although it has a good therapeutic potential to lower the level of blood glucose and enhance lipid metabolism, pioglitazone has major limitations, such as low photostability, low ADMET (adsorption, distribution, metabolism, excretion, toxicity) performance, and degradation during exposure to ultraviolet (UV) and sunlight. These are restrictions, which undermine its therapeutic effect, lower its shelf life and diminish patient adherence. Although several structural analogs of pioglitazone have been prepared to maximize the receptor affinity or enhance the pharmacokinetics, there is very less research, which is optimistically considering photostability and biological activity together. In an attempt to fill this research gap, the current research suggest a twofold approach, which combines computational drug designing with laboratory validation in the experimental setting. Computational step involves structural modification of aromatic ring to design pioglitazone analogs, molecular docking with AutoDock Vina to identify the binding affinity of the analogue with PPAR-y, prediction of ADMET using SwissADME and pkCSM, and prediction of photostability using HOMO-LUMO gap analysis using ORCA. Synthesis of the chosen analogs in the laboratory was through condensation reactions, purification by recrystallization and chromatography and characterization by spectroscopic techniques; 1H-NMR, IR and MS was the components of the experimental part. The photostability investigated by exposing the analogs to monitored UV and sunlight, and the profiles of degradation investigated by UV-Vis spectroscopy and thin-layer chromatography (TLC).  The study is useful because it provides a direction towards the computational prediction and in vitro validation to provide reliability and translational potential of the candidates. This involves the optimization of photostability and receptor affinity which was lab confirmed as well. One additional analog of the pioglitazone series was identified during the research term that have better stability, increased pharmacokinetic properties, and increased receptor affinity. This research is dual-validated lead that promises in future preclinical research and eventually help with better and safer treatment to the Type 2 Diabetes Mellitus disease (T2DM)..

Introduction: Critical care usually asses the electrolyte levels with accuracy and in no time to start the treatment. Blood sample are assessed in few seconds using ABG (arterial blood gas) analyzers, however, their accuracy is still controversial. Aim: The present study was aimed to comparatively estimate the electrolyte levels as chloride, potassium, and sodium in subjects hospitalized in critical care as assessed by blood gas analyzer and automated biochemistry analysis and to assess agreement degree in these two.  Methods: The study assessed 60 paired samples from arteries and veins from critical care subjects where electrolytes were assessed on ABA (Automated Biochemistry Analyzer) and ABG (Arterial Blood Gas) analysis. The data gathered were analyzed statistically. Results: The study results showed that levels of chloride, potassium, and sodium in study subjects was 100.77 ± 6.63 mmol/L, 3.85± 0.521 mmol/L, and 136.62±5.42 mmol/L respectively as seen on ABG analyzer. On ABA, their mean values were 100.45 ± 6.39 mmol/L, 88.02±0.541 mmol/L, and 136.63±5.79mmol/L respectively. The difference was non-significant for potassium, and sodium with respective p-values of 0.164 and 0.456 respectively, whereas, for chloride, these values were significant with p=0.04. The study showed a strong agreement in two tools with p-value of 0.00001 for all three biochemical markers. Conclusion: The present study concludes that there was no significant difference for the arterial blood gas analyzer and automated biochemistry analyzer measurements of chloride, potassium, and sodium. However, critically crucial decisions can be made by relying on the results attained from arterial blood gas analysis.  .

Noninvasive ventilation (NIV) is a cornerstone intervention for patients presenting with acute-on-chronic respiratory failure. However, NIV failure rates of 40–54% have been consistently reported, and delayed recognition of NIV failure correlates with significantly elevated mortality. The HACOR score—a composite index of Heart rate, Acidosis, Consciousness, Oxygenation, and Respiratory rate—was developed to predict NIV failure in hypoxemic patients. Its predictive utility in a broad, heterogeneous emergency department (ED) population with acute-on-chronic respiratory failure, including both COPD and non-COPD patients, requires further validation. Methods: A prospective observational study was conducted at the ED of Max Smart Super Speciality Hospital, Saket, New Delhi. A total of 226 patients meeting inclusion criteria (age ≥18 years, pH <7.35, PaCO₂ >45 mmHg, NIV-compliant) were enrolled. Arterial blood gases (ABG) were measured at admission, and at 1, 12, and 24 hours after NIV initiation. HACOR scores were calculated at baseline and at one hour of NIV. NIV failure was defined as requirement for endotracheal intubation post-NIV initiation. Sensitivity, specificity, predictive values, and odds ratio were calculated. Results: Of 226 patients, 29 (12.83%) experienced NIV failure. The mean age was 64.5 ± 9.43 years, with a predominance of male patients (74.3%). COPD was the most common underlying diagnosis (40.07%), followed by obesity-hypoventilation and OSA (16.8%). A HACOR score >5 at one hour of NIV demonstrated a sensitivity of 69.44%, specificity of 97.84%, positive predictive value (PPV) of 86.21%, negative predictive value (NPV) of 94.27%, and an overall accuracy of 93.21%. The odds ratio for NIV failure with HACOR >5 was 105.68 (95% CI: 31.26–357.31, p <0.0001). Conclusions: The HACOR score is a reliable, bedside-applicable tool for predicting NIV failure in patients with acute-on-chronic respiratory failure in emergency department settings, applicable to both COPD and non-COPD populations. A score >5 at one hour of NIV initiation should prompt consideration of early intubation to reduce morbidity and mortality.