Background: Nephrotic syndrome (NS) is a chronic kidney disorder characterized by significant metabolic disturbances, including dyslipidemia, hypoalbuminemia, and proteinuria, which contribute to disease progression and increased risk of relapse. Aims and Objectives: This study aims to analyze the biochemical and clinical variations in pediatric NS across different disease phases and assess their implications for disease prognosis and management. Materials and Methods: This is a hospital-based longitudinal observational study conducted to assess lipid profile alterations in 1–12-year-old pediatric patients diagnosed with idiopathic NS during the first episode, remission, and relapse. A comprehensive statistical analysis was performed to evaluate clinical and biochemical parameters in children with NS across three phases: first episode, relapse, and remission. Analysis of variance and post hoc comparisons were applied to identify significant differences in lipid profile (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], very LDL, triglycerides), serum albumin, total protein, creatinine, and 24-h urine protein excretion. Statistical analysis was performed by the Statistical Package for the Social Sciences version 24. Significance levels were denoted as P≤0.05. Results: The study found significant differences in lipid profile parameters during relapse, with high levels of total cholesterol, LDL, and triglycerides and declining HDL levels. Relapse also led to reduced serum albumin and protein levels, increased disease activity, and transient renal impairment. Conclusion: This study underscores the importance of metabolic monitoring in pediatric NS. Persistent lipid abnormalities and protein loss indicate a heightened risk of relapse and long-term cardiovascular and renal complications. Targeted interventions, including lipid-lowering strategies, nephroprotective therapies, and early management of proteinuria, may improve patient outcomes.

Background: Knee osteoarthritis (KOA) is one of the leading causes of chronic pain, reduced mobility, and functional disability in aging populations. Periarticular corticosteroid injection is frequently used to achieve rapid symptom relief; however, its comparative effectiveness against other conservative, biological, and surgical treatment modalities remains unclear. Aims and Objectives: This study evaluates the short‑term and long‑term clinical outcomes of periarticular steroid injection in comparison with eight other commonly practiced interventions. Materials and Methods: This retrospective observational study included 144 KOA patients treated at a tertiary care hospital. Patients were categorized into nine groups (n=16 each): periarticular steroid injection, lifestyle modification, quadriceps strengthening, limb alignment correction, arthroscopic lavage, platelet-rich plasma (PRP), hyaluronic acid (HA), high tibial osteotomy (HTO), and proximal fibular osteotomy (PFO). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS) scores were recorded at baseline, post-intervention, and at 2‑year follow‑up. Statistical analysis included analysis of variance, the Chi‑square test, and correlation analysis. Results: Periarticular steroid injection demonstrated the highest immediate improvement in WOMAC scores (mean 5.0±0.75, P<0.05 vs. conservative groups). Long-term improvements were highest in the HTO, PFO, PRP, and HA groups (P>0.05 compared to steroids). Conservative measures showed significantly poorer outcomes. Complication rates were minimal and statistically insignificant across all groups. Conclusion: Periarticular steroid injection is highly effective for immediate relief in KOA. Long‑term improvement is greater with biologics (PRP, HA) and surgical realignment (HTO, PFO). Conservative measures yield lower overall benefit. All modalities were safe with low complication rates.

Background: High body mass index (BMI) is associated with an increase in cancer, especially female gynecological cancers like endometrium, ovarian cancers as well as breast cancers. There is an increase in obesity incidence worldwide including in Nepal. This is resulting in a surge in cancer in female population. Aims and Objectives: This present study was designed to evaluate the association between high BMI and female gynecological cancers in Nepal. Materials and Methods: In this hospital-based prospective study conducted at Birat Medical College Teaching Hospital, 385 adult gynecological patients underwent treatment over a 12-month period from 1st October 2024 to 1st October 2025. Demographic data, cancer stage, BMI status, and treatment outcomes were recorded in excel and data were analyzed using descriptive statistical methods such as frequency, percentage, and mean by statistical software (SPSS Version 23, 2015). Results: Among 385 patients, 67.0% women were of young age (40–60 years) and 20.7% women were of elderly age (>60 years). Major bulk of disease was formed by breast cancer (54.2%), cervical cancer (23.6%), and ovarian cancer (16.8%). Almost 38.1% diagnosed cases were advanced stage. Treatment-wise, they received surgery (70.1%), chemotherapy (96.1%), radiotherapy (70.6%), hormonal therapy (38.9%), and palliative care (3.1%). 4.34% patients of high BMI cases left the treatment and there was 8.69% mortality in high BMI groups during the 1-year study. Conclusion: High BMI was associated with female gynecological cancers along with poor prognosis.

Background: Acute myocardial infarction (AMI) in young adults is an emerging public health concern, with distinct clinical features and risk factor profiles compared to those in older populations. Aims and Objectives: This study aimed to evaluate the clinical features, risk factors, and outcomes of AMI in young adults (aged 18–45 years) and explore gender and age-specific differences. Materials and Methods: This prospective observational study was conducted at Pt. B.D. Sharma PGIMS, Rohtak, India, from December 2022 to 2024. We enrolled 108 consecutive patients aged 18–45 years with a confirmed AMI. Data on demographics, risk factors, clinical presentation, laboratory parameters, and complications were also collected. Descriptive statistics and comparative analyses by sex and age groups (18–34 vs. 35–45 years) were performed. Results: Of 108 patients (mean age 35.1±4.4 years), 87.96% were male. Smoking (77.89%) and dyslipidemia (high triglyceride: 48.38%; low high density lipoprotein: 42.7%) were the most prevalent risk factors, predominantly in males. Females exhibited higher rates of hypertension (30.77%), diabetes (23.08%), and a family history of ischemic heart disease (38.46%). ST-elevation myocardial infarction was observed in 75.93% of the cases, with anterior wall myocardial infarction being the most common (54.88%). Heart failure occurred in 22.22% of the patients, with higher rates in females (30.77%). Elevated homocysteine (79.63%) and high-sensitivity C-reactive protein (63.89%) levels underscored the role of inflammation. Conclusion: AMI in young adults is predominantly male-driven, with smoking and dyslipidemia being the leading risk factors. Females presented with more metabolic risk factors than men. Inflammatory markers such as homocysteine and hsCRP were significant contributors.

Background: The hallmarks of fibromyalgia (FM), a chronic pain syndrome, include tiredness, cognitive impairment, and extensive musculoskeletal discomfort. An imbalance in the autonomic nerve system may play a major role in its pathogenesis, leading to changes in visceral and cardiovascular control, according to mounting evidence. Heart rate variability (HRV) is a sensitive, non-invasive measure of sympathovagal balance and autonomic regulation. Aims and Objectives: The purpose of this study was to compare HRV indices between FM patients and age- and sex-matched healthy controls in order to evaluate autonomic dysfunction in FM utilizing short-term HRV analysis. Materials and Methods: Thirty patients with FM diagnosed using the 2016 updated American College of Rheumatology’s criteria, and 30 healthy volunteers were included in this cross-sectional research. In accordance with Task Force standards, standardized 5-min rested electrocardiograms were obtained, and HRV characteristics were examined in the time domains and frequency domains. The data were analyzed using Statistical Package for the Social Sciences 26.0, with t-tests for between-group comparisons. P<0.05 was considered statistically significant. Results: When compared to healthy controls, FM patients showed a significant decrease in HRV indicators. The RMSSD was 19.3±7.2 ms compared to 38.7 ± 10.1 ms (P<0.001*), and the mean standard deviation of NN intervals (SDNN) was 22.6±8.1 ms rather than 41.2±9.4 ms (P<0.001*). Frequency-domain measurements revealed a higher low-frequency/high-frequency (LF/HF) ratio (1.72±0.65 vs. 1.15±0.48, P=0.003*), indicating greater sympathetic dominance and decreased parasympathetic modulation, along with significantly lower LF power (315±120 ms2 vs. 520±160 ms2, P<0.001*) and HF power (210±98 ms2 vs. 450±142 ms2, P<0.001*). Conclusion: Significantly decreased HRV in both the temporal and frequency domains is a symptom of substantial autonomic dysfunction linked to FM. The concept of impaired central autonomic control in FM is supported by these data, which highlight a condition of sympathovagal imbalance. For determining the severity of an illness and tracking treatment plans meant to restore autonomic balance, HRV may be a helpful biomarker.

Background: Idiopathic intracranial hypertension (IIH) is an ailment of unidentified cause, associated with clinical features of increasing intracranial pressure (ICP), without any structural or other identifiable reasons. IIH is diagnosed by the modified Dandy criteria, which include invasive measurement of ICP. This study will help in understanding the utility of the non-invasive tests (transcranial Doppler [TCD], as well as the optic nerve sheath diameter [ONSD]) versus the invasive methods in evaluating and monitoring the IIH cases. Aims and Objectives: To study the flow dynamics by TCD in patients of IIH before and after lumbar puncture and its correlation with ONSD. Materials and Methods: Patients of either gender between the ages of 18 and 65 years presenting with suspected IIH were screened for enrolment in the study for the case group. A total of 25 cases and 25 controls were enrolled. Cerebrospinal fluid (CSF) assessment, as well as magnetic resonance imaging evaluation of the brain for ONSD, was done. A TCD study was done to assess the standard parameters such as mean flow velocity (MFV), peak systolic velocity (PSV), end-diastolic velocity, pulsatility index (PI), and resistance index (RI). Results: The mean PSV, mean MFV, mean RI, and mean PI were significantly higher in the case group versus the control group, both pre- and post-CSF drainage (P<0.05). In the case group, significant correlations were noted between PI and ONSD in the anterior cerebral artery (r=0.57), and PSV and ONSD (r=0.53) in the middle cerebral artery. PSV of BA was also significantly correlated with ONSD (r=0.48). Conclusion: Mean flow velocities indicated by PI and PSV had a positive correlation with ONSD, indicating that if one goes up, the other will also increase and vice versa. A normalization of TCD parameters was noted, with a lowering of ICP through lumbar puncture and CSF withdrawal. This indicates that TCD has utility in monitoring as well as managing IIH cases non-invasively.

Background: Rotator cuff injuries are a common cause of shoulder pain, leading to functional limitations and reduced quality of life. While magnetic resonance imaging (MRI) is the gold standard for diagnosis, high-resolution ultrasonography (USG) is a non-invasive, cost-effective alternative. Aims and Objectives: The aim of the study was to compare the diagnostic performance of high-resolution USG and MRI in detecting rotator cuff tears and assessing tear severity, size, and correlation with symptoms. Materials and Methods: This cross-sectional study included 60 patients with clinically suspected rotator cuff injuries at Tirunelveli Medical College Hospital, over 18 months. Both USG (6–12 MHz linear transducer) and 1.5 Tesla MRI were performed on all patients. Tear type, size, and symptom status were recorded. The sensitivity and positive predictive value (PPV) of USG were calculated. Statistical analyses were performed using the Statistical Package for the Social Sciences v27. Results: The mean age was 67.6±10.6 years, with 58.33% males. Most tears were small (≤3 cm, 68.33%), whereas large tears accounted for 31.67%. USG detected 58.33% of full-thickness and 30% of partial-thickness tears, with seven missed cases. MRI detected 61.67% of full-thickness and 38.33% partial-thickness tears, confirming all USG-detected tears, and the USG demonstrated a sensitivity of 88.33% and a PPV of 100%. Full-thickness tears were more frequently symptomatic than partial-thickness tears (USG P=0.103; MRI P=0.034). Both modalities showed that tear size did not significantly correlate with symptom presence. Conclusion: Both USG and MRI effectively detect rotator cuff tears, with MRI slightly more accurate. High-resolution USG shows high sensitivity and predictive accuracy, making it a reliable, non-invasive, and affordable first-line diagnostic tool.

Elastic stable intramedullary nails are commonly used implant for fixation of unstable long bones in children. The removal of the nail can be cumbersome at times. The nail is commonly removed using pliers, and vice grip, and hammer. The removal of the nail, especially in the tibia and femur, can be at times difficult. A few other techniques have been described for the removal of nails, especially difficult ones. We describe and easy new technique for removal of nail, using used interlocking femur nail and hammer, which is easy and doesn’t need any special instrument.

Background: Elevated urine albumin creatinine ratio has been implicated in atherosclerotic cardiovascular disease. Arteriolosclerosis is an important causative factor for branch retinal vein occlusion (BRVO). There is a dearth of literature on the urine albumin creatinine ratio and BRVO. Aims and Objectives: The objective of the study was to determine whether an elevated level of urine albumin creatinine ratio be predictive of increased risk of BRVO in non‑diabetic population. Materials and Methods: Urine albumin creatinine ratio was assayed in 100 adult BRVO cases, and 100 age and sex matched controls in this 1-year-old case–control study. Results: There was a significant elevation of urine albumin creatinine ratio in BRVO patients (88.2±12.4 mg/g) in comparison to controls (18.5±4.1 mg/g) in our study. Analysis also showed that an elevated urine albumin creatinine ratio was a risk factor for BRVO, with an odds ratio=10.02. Conclusion: Health care professionals are urged to screen for the urine albumin creatinine ratio to provide substantial clinical and economic benefits to BRVO patients.

Background: Preterm birth remains a major global health concern and is a leading cause of neonatal morbidity and mortality. Cranial ultrasound (USG), being a safe, non-invasive, and bedside-available imaging tool, is widely used for screening and monitoring brain abnormalities in preterm infants. In tertiary care settings, where high-risk neonates are managed, understanding the spectrum of cranial USG findings can guide clinicians in decision-making and follow-up planning. Aims and Objectives: This study aims to assess the different clinical presentations of neonates with abnormal cranial USG. Materials and Methods: The observational descriptive study was conducted in the special newborn care unit/neonatal intensive care unit (SNCU/NICU) of Malda Medical College and Hospital for the period of 1 year. Preterm neonates admitted to SNCU/NICU were included. The first consecutive 100 preterm newborns admitted during the study period in SNCU/NICU from 15 December 2022 to 14 December 2023 were taken. Results: In this study, the majority of the cases were males (68%), and 17% of the cases, parents were married within 18 years. For most (60%) of the cases, gestational age was ≤32 weeks. Regarding cranial USG findings, abnormality was seen in 21% of cases. The gestational age and birth weight had a significant association with cranial USG findings. Conclusion: Cranial USG helps in early identification of neurological abnormalities among preterm as well as term neonates because of its high efficiency. Early identification of such abnormalities will help to prevent, protect, and further manage adversely affected infants. The same was observed in this study.