Abstract: Background: In contemporary orthopedic surgery, the ideal outcome is early postoperative mobilization and rehabilitation with only minor pain and discomfort. The present study compared ropivacaine with dexmedetomidine and ropivacaine with remifentanil for epidural anesthesia and analgesia in lower limb orthopedic surgery.

Materials & Methods: 90 patients scheduled for lower limb orthopedic surgery of both genders were divided into two groups of 45 each. Group I patients received Ropivacaine 0.75% 20 cc + 50mcg Inj. Remifentanyl (RF) and group II received Inj. Ropivacaine 0.75% 20 cc + Inj. Dexmedetomidine 50 mcg in normal saline diluted upto 1cc. Parameters such as time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to two segmental dermatomal regressions, and time to first rescue analgesic was recorded.

Results: Group I had 21 males and 24 females and group II had 25 males and 20 females. The mean duration of surgery (min) was 129.5 in group I and 105.6 in group II. Sensory block at T10 was 10.2 minutes in group I and in group II was 8.2 minutes. The mean time for maximum sensory block level (min) was 18.6 in group I and 15.2 minutes in group II. Complete motor block (min) was 23.1 in group I and 20.4 in group II. The mean dose of mephenteramine requirement was 9.6 mg in group I and 12.5 mg in group II. The difference was significant (P< 0.05). Complications were nausea/vomiting seen in 1 in group I, bradycardia seen in1 in group II, hypotension seen 1 in group I and 2 in group II and headache in 2 in group I and 1 in group II. The difference was significant (P< 0.05).

Conclusion: When combined with 0.75% ropivacaine in epidural anesthesia for lower limb orthopaedic surgery, dexmedetomidine functions as an excellent neuraxial adjuvant.

Abstract: Am: The aim of this investigation was to evaluate the levels of IL6 in saliva using the Enzyme-Linked Immunosorbent Assay (ELISA) technique and to ascertain the prognostic significance of these measurements in individuals with oral leukoplakia and Oral Squamous Cell Carcinoma.

Materials & Methods: The study included 30 participants, who were divided into three groups: OSCC (10), leukoplakia (10) and a control group of healthy individuals (10). The ELISA method was employed to analyze saliva and serum samples from each individual in all three groups. The collected data was subsequently subjected to statistical analysis for evaluation.

Results: The mean salivary IL-6 levels in the control group, leukoplakia and OSCC were 6.56 pg/mL, 34.57 pg/mL and 105.8 pg/mL, respectively. The rise in salivary IL-6 levels in OSCC was highly significant when compared to leukoplakia and the control group, with a p-value of 0.000 (p˂ 0.05). In addition, the mean salivary IL-6 levels increased across all grades of OSCC, from well-differentiated squamous cell carcinoma (WDSCC) to poorly differentiated squamous cell carcinoma (PDSCC), as well as across all grades of OED, from moderate dysplasia to severe dysplasia.

Conclusion: Salivary IL-6 levels have the potential to function as valuable prognostic biomarkers for oral leukoplakia and OSCC, indicating the potential involvement of IL-6 in the development and progression of these conditions. The non-invasive nature of salivary IL-6 renders it a valuable instrument for mass screening, rendering it a superior prognostic marker in comparison to serum IL-6.

ABSTRACT

Aim: To evaluate the utility of hematological and biochemical markers in diagnosing iron deficiency anemia (IDA) and differentiating it from anemia of chronic disease (ACD).

Material and Methods: This prospective observational study was conducted on 100 adult patients (aged 18–70 years) presenting with anemia (hemoglobin<12 g/dL for females and <13 g/dL for males). Patients were divided into two groups of 50 each: IDA, diagnosed by low serum ferritin (<15 ng/mL) and/or transferrin saturation (<20%) with microcytic hypochromic red cells, and ACD, identified by normocytic or microcytic anemia, elevated inflammatory markers (CRP, ESR), and normal or high serum ferritin (≥100 ng/mL). Hematological indices, iron studies, and inflammatory markers were analyzed, and diagnostic performance was assessed using receiver operating characteristic (ROC) curves.

Results: The IDA group had significantly lower hemoglobin (8.2 ± 1.5 g/dL), MCV (65 ± 5 fL), and MCHC (29 ± 2 g/dL) compared to the ACD group (9.5 ± 1.3 g/dL, 80 ± 7 fL, and 32 ± 2 g/dL, respectively; p < 0.001). Serum ferritin (8 ± 4 ng/mL vs. 150 ± 30 ng/mL, p < 0.001) and transferrin saturation (10 ± 2% vs. 20 ± 5%, p < 0.001) showed the most significant differences between the groups. Inflammatory markers, including CRP and IL-6, were elevated in ACD. Serum ferritin had the highest diagnostic accuracy (AUC: 0.95), followed by transferrin saturation (AUC: 0.93), RDW (AUC: 0.91), and IL-6 (AUC: 0.92).

Conclusion: Hematological and biochemical markers, particularly serum ferritin, transferrin saturation, and RDW, effectively differentiate IDA from ACD. Inflammatory markers such as CRP and IL-6 provide additional diagnostic value for ACD. An integrated approach combining these markers can guide precise diagnosis and tailored treatment.

Abstract: Aim: This study aimed to compare the effectiveness of Acyclovir combined with corticosteroid therapy versus corticosteroid therapy alone in the treatment of idiopathic facial nerve palsy (Bell’s palsy) in terms of recovery rates, time to recovery, patient satisfaction, and incidence of complications.

Materials and Methods: A prospective, randomized, and comparative clinical trial was conducted with 100 patients diagnosed with idiopathic facial nerve palsy within 72 hours of symptom onset. Patients were randomly assigned into two groups: Group A received oral Acyclovir (400 mg five times daily) for 10 days combined with oral Prednisolone (1 mg/kg/day) for 10 days followed by a taper, while Group B received oral Prednisolone (1 mg/kg/day) for 10 days followed by a taper. Recovery was assessed at 2, 4, and 12 weeks using the House-Brackmann (HB) grading scale. Secondary outcomes included time to recovery, patient satisfaction, and adverse events. Data were analyzed using SPSS version 25.0, and a p-value <0.05 was considered statistically significant.

Results: Baseline characteristics, including age, gender, and comorbidities, were similar between the groups. At 12 weeks, recovery rates (HB Grade I/II) were significantly higher in Group A (96%) compared to Group B (80%; p = 0.01). Group A also demonstrated faster recovery, with a mean recovery time of 4.2 ± 1.5 weeks compared to 5.6 ± 2.0 weeks in Group B (p = 0.01). Patient satisfaction was higher in Group A, with a mean score of 8.5 ± 1.2 versus 7.3 ± 1.5 in Group B (p = 0.01). Complications were minimal and comparable between the groups.

Conclusion: Acyclovir combined with corticosteroid therapy is more effective than corticosteroids alone in the treatment of idiopathic facial nerve palsy. It significantly improves recovery rates, accelerates recovery time, and enhances patient satisfaction without increasing adverse events. These findings support the use of antiviral therapy as an adjunct to corticosteroids, particularly when initiated early.

Abstract: Aim: To assess the clinical, hematological and biochemical profiles and socioeconomic status of children with Severe Acute Malnutrition in central Uttar Pradesh.

Materials and Methods: Study duration was 13 months from Dec 22 to Dec 23. All children between age of 6 months to 59 months admitted with weight for height<3SD, mid arm circumference <11.5 cm, bipedal edema with any of the co-morbidity like diarrhea, dysentery, lower respiratory tract infections, urinary tract infections, sepsis. Children with metabolic diseases, hereditary condition, chronic disorders like cardiac, renal, CNS, cerebral palsy were excluded from the study. Sample size of 121 was calculated. After obtaining parental consent demographic data was collected. Relevant history concerning etiology of SAM was taken. Anthropometric data was collected and all relevant investigations were done.

Results and conclusion: The majority of affected children were from rural areas and lower socioeconomic backgrounds, with a high incidence of incomplete immunization. . Faulty feeding practices, low calorie intake aggravates the malnutrition amongst children.  Common clinical presentations included lower respiratory tract infections, diarrhea, and sepsis, with a notable prevalence of anemia with most children have moderate anaemia and microcytic hypochromic is most common. Some of these children had biochemical abnormalities like hypocalcemia, hypokalemia, hyponatremia, hypoglycaemia.

Abstract: Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by altered metabolism, particularly in amino acid pathways.

Methods: A case-control study compared plasma amino acid profiles between 75 children with ASD and 75 typically developing controls. High-performance liquid chromatography-tandem mass spectrometry analyzed 20 standard amino acids.

Results: Significant elevations in glutamate (84.5 ± 12.3 vs 65.2 ± 10.8 μmol/L, p<0.001) and reductions in glutamine (445.2 ± 58.6 vs 512.4 ± 62.3 μmol/L, p<0.001) and tryptophan (42.3 ± 8.4 vs 52.6 ± 7.9 μmol/L, p<0.001) were observed in the ASD group. Strong correlations emerged between glutamate levels and ADOS-2 scores (r=0.62, p<0.001).

Conclusion: The study demonstrates distinct amino acid profiles in ASD, suggesting potential biochemical markers for diagnosis and monitoring. These findings may guide the development of metabolic screening tools and targeted therapeutic interventions.

Abstract: Background: Functional Endoscopic Sinus Surgery represents an advanced surgical technique that has significantly transformed the approach to chronic sinus disorders. Hence; the present study was conducted for assessing and comparing between Dexmedetomidine and Remifentanil for controlled hypotension and recovery under general anaesthesia in Endoscopic Sinus Surgery.

Materials &Methods: A total of 100 patients classified as ASA grade I/II were included in the study. The participants were aged between 20 and 60 years. Each patient underwent a thorough clinical examination, along with basic laboratory tests, chest X-rays, and electrocardiograms. The patients were randomly assigned to one of two groups: Group A, consisting of 50 patients who received dexmedetomidine, and Group B, comprising 50 patients who were administered Remifentanil. Intraoperative assessments and evaluations were performed for one hour postoperatively. The results will be documented and compared between the two groups. Statistical analysis will be conducted using SPSS software, with a significance level set at a p-value of less than 0.05.

Results: Mean age of the patients of group A and group B was 52.3 years and 50.7 years respectively. majority proportion of patients were males. Mean BMI of the patients of group A and group B was 24.8 Kg/m2 and 23.1 Kg/m2.Mean duration of surgery among patients of group A and group B was 83.5 minutes and 81 minutes respectively. Mean time to extubation among patients of group B was shorter in comparison to patients of group A.

Conclusion: Remifentanil and dexmedetomidine both facilitated hypotensive anesthesia and provided optimal intraoperative conditions for endoscopic sinus surgery; however, recovery outcomes were marginally superior with remifentanil compared to dexmedetomidine.

Abstract: Background: Type 2 diabetes mellitus (T2DM) is a leading public health problem, that is affecting both developed and developing countries. The present study was evaluated correlation of HbA1c and dyslipidemia in patients of chronic kidney disease..

Materials & Methods: 60 patients of chronic kidney disease of both genders were put in group I and healthy control in group II. Estimation of lipid profile such as total cholesterol, LDL, VLDL, HDL, triglyceride, HbA1C, urea, creatinine, and creatinine clearance level was measured. Patients were also subjected to Ultra-sonography (USG) for detection of CKD.

Results: Age group 21-30 years had 7 patients in group I and 9 subjects in group II, 31-40 years had 12 and 14, 41-50 years had 18 and 17 and >50 years had 23 and 27 subjects respectively. Smoking was seen in 45 in group I and 28 in group II. Hb1AC level was normal in 13 and 39, impaired in 27 and 16 and diabetic in 20 and 5 in group I and II respectively. Dyslipidemia was present in 29 in group I and 14 in group II. The difference was significant (P< 0.05).

Conclusion: The CKD group had a considerably higher prevalence of dyslipidemia than the control group, as seen by elevated TG, LDL, and low HDL.

Abstract: Background: Functional Endoscopic Sinus Surgery represents an advanced surgical technique that has significantly transformed the approach to chronic sinus disorders. Hence; the present study was conducted for assessing and comparing between Dexmedetomidine and Remifentanil for controlled hypotension and recovery under general anaesthesia in Endoscopic Sinus Surgery.

Materials &Methods: A total of 100 patients classified as ASA grade I/II were included in the study. The participants were aged between 20 and 60 years. Each patient underwent a thorough clinical examination, along with basic laboratory tests, chest X-rays, and electrocardiograms. The patients were randomly assigned to one of two groups: Group A, consisting of 50 patients who received dexmedetomidine, and Group B, comprising 50 patients who were administered Remifentanil. Intraoperative assessments and evaluations were performed for one hour postoperatively. The results will be documented and compared between the two groups. Statistical analysis will be conducted using SPSS software, with a significance level set at a p-value of less than 0.05.

Results: Mean age of the patients of group A and group B was 52.3 years and 50.7 years respectively. majority proportion of patients were males. Mean BMI of the patients of group A and group B was 24.8 Kg/m2 and 23.1 Kg/m2.Mean duration of surgery among patients of group A and group B was 83.5 minutes and 81 minutes respectively. Mean time to extubation among patients of group B was shorter in comparison to patients of group A.

Conclusion: Remifentanil and dexmedetomidine both facilitated hypotensive anesthesia and provided optimal intraoperative conditions for endoscopic sinus surgery; however, recovery outcomes were marginally superior with remifentanil compared to dexmedetomidine.

Abstract: Background: To determine serum lipid profiles, fasting blood samples have traditionally been used as the most reliable method. However, fasting can pose significant challenges, particularly for children, and individuals associated with diabetes, and cardiovascular disease, and it also serves as a barrier to widespread population screening. Therefore, our study aims to assess the validity of lipid profile results obtained from non-fasting blood samples by comparing them with those derived from fasting blood samples.

Objectives: To evaluate whether there is any change in the measurement of lipid profile in fastingversus non-fasting states

Material and Methods: This study included about 98 patients at Medanta from October to December 2024. Fasting and random blood samples were analyzed for lipid profiles, including serum cholesterol, triglycerides, HDL, LDL, and VLDL, in the clinical biochemistry laboratory using Vitros dry chemistry autoanalyzers. Serum values from fasting and Postprandial lipid profiles were obtained, compared, and correlated. Statistical analysis was conducted using SPSS version 32, employing paired sample t-tests and Pearson’s correlation. A p-value of < 0.05 was considered statistically significant.

Results: The comparison of lipid profiles between fasting and non-fasting states revealed a significant difference in triglycerides (TG) and very low-density lipoprotein (VLDL) levels (p < 0.001). Mean TG and VLDL levels were higher in the non-fasting state (152.84 ± 58.3 mg/dL and 30.56 ± 11.54 mg/dL, respectively) compared to the fasting state (135.04 ± 46.9 mg/dL and 19.63 ± 11.6 mg/dL, respectively).  A significant level of correlation was observed (r > 0.936, p < 0.001) between fasting and non-fasting samples across all lipid parameters.

Conclusion: Our study concludes that non-fasting lipid profiles are better for patient convenience while providing comparable diagnostic and prognostic capabilities for monitoring and treating dyslipidaemias. Further research is needed to establish non-fasting reference intervals in a larger population.

Abstract: Aim: The study aimed to explore the relationship between allergic rhinitis (AR) and the histopathological characteristics of nasal polyps (NP), focusing on differences in clinical, histopathological, and immunological features between AR and non-AR patients.

Materials and Methods: This prospective study included 140 patients diagnosed with nasal polyps, 98 of whom had AR. Participants were evaluated using clinical history, nasal endoscopy, and skin prick tests or serum-specific IgE for AR diagnosis. Nasal polyp tissues were collected during functional endoscopic sinus surgery (FESS), processed for histopathological and immunohistochemical analysis, and classified into eosinophilic and non-eosinophilic types. Data were analyzed using descriptive statistics, chi-square tests, and multiple regression analysis, with a significance level of p < 0.05.

Results: The study revealed that 75.51% of AR patients had eosinophilic nasal polyps compared to 40.48% in non-AR patients (p < 0.001). Subepithelial edema (84.69% vs. 50.00%, p < 0.001), basement membrane thickening (89.80% vs. 54.76%, p < 0.001), glandular hyperplasia (60.20% vs. 30.95%, p = 0.003), and inflammatory cell infiltration (94.90% vs. 64.29%, p < 0.001) were significantly more common in AR patients. Clinical symptoms such as sneezing (89.80% vs. 40.48%, p < 0.001) and rhinorrhea (84.69% vs. 50.00%, p < 0.001) were also more frequent in AR patients. Multiple regression analysis identified AR as a significant predictor of eosinophilic inflammation (OR = 3.49, p < 0.001).

Conclusion: This study confirms a strong association between AR and eosinophilic nasal polyps, with AR significantly influencing the histopathological and immunological features of nasal polyps. AR patients exhibited more severe inflammation and clinical symptoms, emphasizing the need for targeted therapeutic strategies addressing the underlying mechanisms in AR-associated nasal polyps.

Abstract: Aim: The study aimed to explore the relationship between allergic rhinitis (AR) and the histopathological characteristics of nasal polyps (NP), focusing on differences in clinical, histopathological, and immunological features between AR and non-AR patients.

Materials and Methods: This prospective study included 140 patients diagnosed with nasal polyps, 98 of whom had AR. Participants were evaluated using clinical history, nasal endoscopy, and skin prick tests or serum-specific IgE for AR diagnosis. Nasal polyp tissues were collected during functional endoscopic sinus surgery (FESS), processed for histopathological and immunohistochemical analysis, and classified into eosinophilic and non-eosinophilic types. Data were analyzed using descriptive statistics, chi-square tests, and multiple regression analysis, with a significance level of p < 0.05.

Results: The study revealed that 75.51% of AR patients had eosinophilic nasal polyps compared to 40.48% in non-AR patients (p < 0.001). Subepithelial edema (84.69% vs. 50.00%, p < 0.001), basement membrane thickening (89.80% vs. 54.76%, p < 0.001), glandular hyperplasia (60.20% vs. 30.95%, p = 0.003), and inflammatory cell infiltration (94.90% vs. 64.29%, p < 0.001) were significantly more common in AR patients. Clinical symptoms such as sneezing (89.80% vs. 40.48%, p < 0.001) and rhinorrhea (84.69% vs. 50.00%, p < 0.001) were also more frequent in AR patients. Multiple regression analysis identified AR as a significant predictor of eosinophilic inflammation (OR = 3.49, p < 0.001).

Conclusion: This study confirms a strong association between AR and eosinophilic nasal polyps, with AR significantly influencing the histopathological and immunological features of nasal polyps. AR patients exhibited more severe inflammation and clinical symptoms, emphasizing the need for targeted therapeutic strategies addressing the underlying mechanisms in AR-associated nasal polyps.

Abstract: Background: Patients may experience discomfort from ureteric stents, which is mostly related to smooth muscle spasm, urine reflux into the ureters, and irritation of the bladder mucosa. The present study was conducted to compare Mirabegron and Tamsulosin in treating Stent related Lower Urinary Tract Symptoms after Urological Procedure.

Material and Methods: This prospective, randomized, double-blind, placebo-controlled trial included 150 patients undergoing urological procedures with DJ stent placement. Participants were randomly allocated into three groups: Group I (Tamsulosin 0.4 mg), Group II (Mirabegron 50 mg), and Group III (Placebo). Symptom assessments were conducted using International Prostate Symptom Score (IPSS) and Urological Stent-Related Symptom Score (USSRS) at postoperative Day 1, after 3 weeks of intervention, and 3 weeks after stent removal. Data analysis included ANOVA and chi-square tests, with a p-value <0.05 considered significant.

Results: The Mirabegron group demonstrated significantly lower USSRS urinary symptom scores (26.3 ± 3.8) and body pain scores (17.6 ± 3.2) compared to Tamsulosin (32.5 ± 4.1, 27.2 ± 3.6) and Placebo (35.1 ± 4.5, 30.5 ± 3.9) (p=0.02, p=0.01). Additionally, IPSS storage and irritative subscores were significantly lower in the Mirabegron group (p=0.01, p=0.02), with superior improvements in Quality of Life (QoL) scores (p=0.05). Symptom relief was consistent at Day 1, after 3 weeks of intervention, and after 3 weeks post-stent removal.

Conclusion: Mirabegron 50 mg proved significantly more effective than Tamsulosin 0.4 mg and placebo in managing ureteral stent-related symptoms, showing superior outcomes in reducing urinary symptoms, body pain, and improving QoL. These findings position Mirabegron as a preferred monotherapy for managing ureteral stent-related discomfort.

Abstract: Introduction: Vitamin D deficiency has emerged as a significant concern in hospitalized patients, potentially influencing post-operative recovery outcomes. This study aimed to evaluate the prevalence of vitamin D deficiency among hospitalized patients and investigate its association with post-operative recovery outcomes in a tertiary care hospital.

Methods: A prospective observational cohort study was conducted over six months, involving 422 adult patients scheduled for elective surgery. Serum 25-hydroxyvitamin D levels were measured preoperatively, and patients were monitored for post-operative outcomes including length of hospital stay, wound healing complications, pain scores, analgesic requirements, and functional recovery parameters. Data was analyzed using SPSS version 26.0, with significance set at p<0.05.

Results: The study revealed a high prevalence (66.8%) of vitamin D deficiency (<20 ng/mL) among participants. Vitamin D-deficient patients demonstrated significantly longer hospital stays (8.4 ± 2.6 vs 5.2 ± 1.8 days, p<0.001), higher wound healing complications (27% vs 10.4%, p<0.001), and increased pain scores compared to vitamin D-sufficient patients. Quality of Recovery (QoR-15) scores were consistently lower in deficient patients across all time points. Additionally, vitamin D-deficient patients required higher analgesic doses (28.4 ± 8.6 vs 18.2 ± 6.4 mg/day, p<0.001) and showed delayed functional recovery parameters.

Conclusion: Vitamin D deficiency significantly impacts post-operative recovery outcomes, suggesting the potential benefit of routine preoperative vitamin D screening and optimization. These findings emphasize the need for implementing standardized protocols for vitamin D assessment and supplementation in surgical patients.

Sepsis, a complex clinical syndrome resulting from a dysregulated immune response to infection, remains a significant global health challenge, with high morbidity and mortality rates. Early identification and risk stratification are essential for improving patient outcomes. This multicenter prospective cohort study evaluates the role of serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) as predictive biomarkers in sepsis. Conducted across three tertiary care hospitals, the study examines the correlation between biomarker levels, sepsis severity, and clinical outcomes, including mortality and ICU length of stay. Results demonstrated that elevated LDH and CRP levels are strongly associated with adverse outcomes, underscoring their potential as cost-effective tools for risk stratification in diverse clinical settings. Incorporating these biomarkers into routine sepsis management protocols may improve early diagnosis, prognostication, and therapeutic decision-making. Further research is warranted to explore their dynamic changes during disease progression and validate findings across broader populations.