Introduction: Pseudo exfoliation syndrome (PEX) is characterized by the accumulation of fibrillar material in ocular tissues, notably associated with an increased risk of glaucoma, particularly pseudo exfoliative glaucoma (PXG). This study aims to investigate the incidence of glaucoma among patients with PEX in Uttarakhand, India, highlighting demographic factors and clinical characteristics influencing disease prevalence. Methods: A retrospective analysis was conducted using medical records from ophthalmic centers in Uttarakhand over five years. Patients aged 40 years and above diagnosed with PEX were included. Data on demographic profiles, ocular findings, and systemic comorbidities were collected. Glaucoma diagnosis was based on optic nerve changes and visual field defects. Statistical analysis included descriptive statistics, chi-square tests, t-tests, and logistic regression. Results: Among 500 PEX patients, 30% were diagnosed with glaucoma, with PXG being predominant (24%). Older age, higher intraocular pressure, and systemic hypertension were identified as significant risk factors for glaucoma development. The study underscores the substantial incidence of glaucoma in PEX patients in Uttarakhand, emphasizing the necessity for regular screening and early intervention. Management strategies should address modifiable risk factors to mitigate disease progression and preserve vision. Conclusion: This study provides critical insights into glaucoma incidence in PEX patients, advocating for proactive management strategies and comprehensive healthcare approaches to improve outcomes and reduce blindness associated with this condition.

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with cirrhosis, frequently precipitating renal dysfunction, specifically hepatorenal syndrome-acute kidney injury (HRS-AKI). While albumin infusion is the standard of care to prevent this complication, the optimal timing of its administration remains poorly defined, particularly in the high-risk subgroup of patients with alcoholic liver disease (ALD). Methods: We conducted a prospective, single-center, comparative cohort study. A total of 120 patients with ALD-related cirrhosis and a first episode of SBP were enrolled and divided into two groups based on the timing of albumin infusion (1.5 g/kg on day 1, 1 g/kg on day 3): the Early Group (n=60, infusion started <6 hours post-diagnosis) and the Standard Group (n=60, infusion started 6–24 hours post-diagnosis). The primary endpoint was the incidence of renal dysfunction at day 7, defined according to KDIGO criteria. Secondary endpoints included in-hospital mortality, 30-day mortality, and SBP resolution. Results: Baseline characteristics, including MELD-Na score (24.1 ± 4.5 vs. 24.6 ± 4.8, p=0.56) and baseline serum creatinine (1.31 ± 0.3 mg/dL vs. 1.34 ± 0.4 mg/dL, p=0.68), were comparable between the Early and Standard groups. The incidence of renal dysfunction at day 7 was significantly lower in the Early Group compared to the Standard Group (16.7% vs. 35.0%, p=0.021). In-hospital mortality was also significantly reduced in the Early Group (11.7% vs. 26.7%, p=0.035), as was 30-day mortality (18.3% vs. 36.7%, p=0.025). The Early Group demonstrated more rapid stabilization of renal function and a faster decline in C-reactive protein levels. Conclusion: In cirrhotic patients with alcoholic liver disease and SBP, early administration of albumin within 6 hours of diagnosis is associated with a significant reduction in the incidence of renal dysfunction and improved short-term survival compared to standard timing. These findings suggest that a narrow therapeutic window exists for optimizing the protective effects of albumin in this vulnerable population.

Introduction: Childhood obesity is a growing global health problem affecting millions of children. It leads to physical health issues like high blood pressure and liver disease, as well as emotional problems such as low self-esteem and depression. Early lifestyle changes in schools and homes can reduce these risks. Materials and Methods: This study included 100 children aged 7–15 years, divided equally into four groups: school-based intervention, combined school and home intervention, home-based intervention, and a control group. Data on body measurements, diet, physical activity, mental health, and obesity-related diseases were collected at the start, after 1 year, and after 5 years. Statistical tests compared changes across the groups. Results: Age and gender were fairly balanced across groups. At baseline, body weight and waist size were similar in all groups. After one year, BMI decreased significantly in intervention groups, especially in the combined group. These improvements lasted up to five years, where the combined program showed the best BMI control. Intervention groups also had less depression, better self-esteem, fewer obesity-related illnesses, more exercise, less screen time, healthier eating, and lower blood pressure than controls. Conclusion: Lifestyle programs, especially those combining school and home efforts, can effectively reduce childhood obesity, improve mental health, and lower risks for future diseases. Early and ongoing support from both schools and families is important for healthy child development.

Background: Oxidative stress contributes to vascular stiffness and poor blood pressure (BP) control in older adults. Terminalia arjuna (TA) bark has been traditionally used for cardiometabolic support and exhibits antioxidant activity. Objective: To evaluate the efficacy and safety of standardized TA supplementation on clinic BP and antioxidant biomarkers in geriatric patients with primary hypertension. Material & Methods Design: 12-week, randomized, double-blind, placebo-controlled, parallel-group trial at two urban outpatient clinics. Participants: 120 adults ≥65 years with treated or untreated stage 1–2 hypertension (clinic SBP 140–169 or DBP 90–99 mmHg if untreated; or on ≤2 antihypertensives with SBP 130–159). Key exclusions: secondary hypertension, recent CVD events, eGFR <45 mL/min/1.73 m², active liver disease, polyherbal use. Interventions: TA 500 mg (standardized to ≥30% polyphenols; ≥5% arjunolic acid) twice daily vs matched placebo. Main Outcomes: Primary—change in clinic SBP at 12 weeks (ANCOVA adjusted for baseline). Secondary—clinic DBP; 24-h ambulatory SBP/DBP; serum malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD) activity; safety and adverse events (AEs). Results: 116/120 completed (TA n=58; placebo n=58). Mean (SD) age 71.8 (5.1) years; 54% female. Adjusted mean SBP change favored TA by −6.8 mmHg (95% CI −9.2 to −4.3; p<0.001). DBP difference −3.1 mmHg (−4.6 to −1.7; p<0.001). 24-h SBP/DBP improved by −5.1/−2.6 mmHg (both p≤0.002). MDA decreased (−0.72 µmol/L vs −0.18; p<0.001), TAC increased (+0.24 mM Trolox eq vs +0.05; p<0.001), and SOD rose (+2.8 U/mL vs +0.6; p<0.001). AEs were mild and similar between groups; no significant changes in liver or renal indices. Conclusions: In older adults with hypertension, 12 weeks of standardized TA reduced BP and improved antioxidant status with good tolerability. Larger, longer trials should confirm durability and clinical outcomes.

Background: Differentiating benign from malignant adnexal masses remains a common diagnostic challenge. While MRI is widely used when ultrasound is indeterminate, contrast-enhanced ultrasound (CEUS) provides real-time vascular assessment at the bedside. Comparative data between CEUS and MRI are limited in Indian clinical practice. Objective: To compare the diagnostic performance of CEUS and MRI for indeterminate adnexal masses, using histopathology and/or follow-up as reference standards. Methods: In this prospective study, 100 women with indeterminate adnexal masses underwent CEUS and MRI. Risk categories were assigned using a five-point CEUS score (malignant if ≥3) and O-RADS MRI (malignant if ≥4). Diagnostic accuracy, sensitivity, specificity, predictive values, and area under the ROC curve (AUC) were calculated. Results: The prevalence of malignancy was 27% (n=27). Both CEUS and MRI achieved 100% sensitivity and 100% NPV. MRI demonstrated higher specificity (84% vs 76%) and accuracy (88% vs 82%) compared with CEUS. AUCs confirmed excellent performance for both modalities (CEUS 0.981, MRI 0.965). Cohen’s κ indicated substantial agreement (0.65). False positives were more frequent with CEUS (n=18) than MRI (n=12), predominantly in borderline and complex benign cysts. Conclusion: CEUS and MRI both provide excellent discrimination of indeterminate adnexal masses. MRI achieved greater specificity and overall accuracy, while CEUS offered strong sensitivity and real-time utility. CEUS may serve as a rapid triage tool in resource-limited settings, with MRI retained as the definitive imaging standard.

Background: Community-acquired pneumonia (CAP) is a leading respiratory related illness causing significant morbidity and mortality worldwide. Serum lactate is an important marker of tissue hypoperfusion and metabolic stress. It is used now increasingly as the potential marker for prognosis. The current study aimed to determine the prognostic value of serum lactate as a marker in adult patients with CAP. Methods: This prospective observational study was conducted in 40 adult patients (≥18 years) admitted with CAP at a tertiary care hospital. A thorough clinical examination, laboratory, and radiological assessment were made in each case.  The estimation of serum lactate was taken at the time of admission. Clinical outcomes were assessed in terms of the length of hospital stay, the need to be admitted to the intensive care unit (ICU), and in-hospital mortality. Analysis of data by appropriate statistical tests was carried out, and the correlation between serum lactate and outcomes was ascertained. Results: Of the 40 patients, 24 (60%) had elevated serum lactate (>2 mmol/L). Patients with higher lactate levels had significantly increased disease severity, longer mean hospital stay (9.2 ± 2.4 vs. 5.6 ± 1.8 days; p<0.01), higher ICU admission rates (45.8% vs. 12.5%; p=0.02), and greater mortality (20.8% vs. 0%; p=0.03) compared to those with normal lactate. Elevated lactate was an independent predictor of poor outcomes after adjusting for age and comorbidities. Conclusion: Our study found that serum lactate can be a simple, rapid, and reliable biomarker for prognosis in adult CAP patients. Incorporating lactate measurement in the routine evaluation of suspected CAP cases can enhance early risk stratification and guide ICU referrals if needed, and help in optimal resource utilization.