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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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