Background: Medial compartment knee osteoarthritis (OA) is a major cause of chronic pain and disability in the elderly. While physiotherapy remains the cornerstone of conservative management, biomechanical unloading through valgus (medial unloader) knee bracing may offer additional benefit by reducing medial tibiofemoral joint stress and improving functional mobility. Aim: To evaluate the effectiveness of a medial unloader knee brace combined with standardized physiotherapy compared with physiotherapy alone in elderly patients with symptomatic medial compartment knee OA. Materials and Methods: This prospective randomized controlled trial was conducted in the Orthopedics Outpatient Department and Physical Medicine & Rehabilitation Unit at Bharatratna Atalbihari Vajpayee Medical College, Pune, from July 2024 to June 2025. A total of 120 participants aged ≥65 years with Kellgren–Lawrence grade II–III medial compartment OA were randomly allocated into two groups: brace + physiotherapy (n = 60) and physiotherapy alone (n = 60). Outcomes—including WOMAC Pain, WOMAC Function, total WOMAC, six-minute walk distance (6MWD), and EQ-5D-5L quality-of-life index—were assessed at baseline, 6 weeks, 12 weeks, 6 months, and 1 year. Statistical analysis was performed using SPSS v26, with p < 0.05 considered significant. Results: Both groups demonstrated improvement over time; however, the brace + physiotherapy group showed greater and earlier reductions in WOMAC Pain (68.5 → 32.7) compared with physiotherapy alone (67.9 → 51.8) at 1 year. Functional outcomes followed a similar pattern, with larger improvements in WOMAC Function (72.8 → 43.1 vs. 73.4 → 60.4). The brace group also achieved a greater increase in 6MWD (298.4 m → 378.2 m) compared with the physiotherapy-only group (302.1 m → 331.6 m). Quality-of-life improvement measured by EQ-5D-5L was more pronounced in the brace group (0.51 → 0.74 vs. 0.52 → 0.60). All major outcomes showed statistically significant between-group differences (p < 0.001). Brace adherence was acceptable, with 78% achieving the recommended daily wear duration. Conclusion: The addition of a medial unloader knee brace to standardized physiotherapy provides significantly superior improvements in pain, function, walking endurance, and quality of life compared with physiotherapy alone in elderly patients with medial compartment knee osteoarthritis. This combined approach represents an effective nonoperative strategy for enhancing mobility and reducing disability in this high-risk population.

Background: Chronic lateral epicondylitis is common in elderly individuals, where degenerative tendon changes limit recovery and impair daily function. Eccentric strengthening has emerged as a tendon-specific intervention, but limited evidence exists comparing it with counterforce bracing in older adults. Objective: To compare the effectiveness of an 8-week supervised eccentric wrist-extensor strengthening program versus standard counterforce forearm bracing on pain, grip strength, tendon function, and disability (measured by the Patient-Rated Tennis Elbow Evaluation [PRTEE] score; 0 = best, 100 = worst) in elderly patients with chronic lateral epicondylitis, with follow-up at 3, 6, and 12 months. Methods: A prospective randomized study was conducted in the Orthopedics Outpatient Department and the Physical Medicine & Rehabilitation Unit at Bharatratna Atalbihari Vajpayee Medical College, Pune. A total of 120 patients aged >60 years were randomized into two equal groups: supervised eccentric strengthening (n = 60) and counterforce bracing (n = 60). Outcomes included Numeric Pain Rating Scale (NPRS), grip strength (kg), and PRTEE disability scores. Assessments were performed at baseline, 8 weeks, 3 months, 6 months, and 12 months. Data were analyzed using appropriate statistical tests with significance set at p < 0.05. Results: At 8 weeks, the eccentric group demonstrated a greater reduction in pain (NPRS 7.8 → 3.2; 58.9% improvement) compared with the bracing group (7.6 → 5.1; 32.9% improvement). Grip strength improved by 35.6% (17.4 → 23.6 kg) in the eccentric group versus 12.3% (17.1 → 19.2 kg) in the bracing group. Mean PRTEE scores (0–100, higher scores = worse disability) reduced substantially in the eccentric group (62.5 → 28.4) compared with the bracing group (63.1 → 44.2). Long-term follow-ups showed sustained improvement in NPRS, grip strength, and PRTEE scores for the eccentric group at 3, 6, and 12 months, whereas the bracing group exhibited plateauing and partial loss of early gains. Conclusion: An 8-week supervised eccentric wrist-extensor strengthening program provides significantly greater and longer-lasting improvements in pain, grip strength, and PRTEE-measured disability than counterforce forearm bracing in elderly patients with chronic lateral epicondylitis. Eccentric strengthening should be considered the preferred first-line, tendon-specific rehabilitation strategy in this population.

Introduction: Diabetes mellitus is a complex, chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control. Type 2 diabetes is preceded by a latent and symptomatic phase called prediabetes that includes the dysglycaemic disorders of both fasting and post prandial glucose namely impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) respectively. Identifying individuals with pre-diabetes offers the opportunity to modify their risk prior to development of a significant sequel. Therefore, the study was aimed to find prevalence of pre- diabetes among individuals with metabolic risk and to categorize patients into IFG, impaired GTT, both abnormal, and both normal and to compare anthropometric measures and metabolic parameters in four groups. Methods: An observational cross-sectional study was conducted among the patients with metabolic risks attending the department of medicine at a tertiary care centre in Maharashtra over a period of 2 years. The study was conducted for a period of 2 years after taking clearance from the institutional ethics committee. Glucose tolerance test was performed for all the patients and results were calculated and the patients were divided into four groups: Group 1- FPG and GTT both normal, Group 2- normal FPG but abnormal GTT, Group 3- abnormal FPG but normal GTT and Group 4- FPG and GTT both abnormal. Results: We included 150 patients in the present study. The mean age of the study subjects was 43.01 ± 10.41 years with female preponderance. The mean body mass index was 27.47 ± 2.36 kg/m², the mean waist circumference was 90.23 ± 5.67 cms and mean waist to hip ratio was 0.94 ± 0.03. In Group 1, all the patients were having BMI >22.99, 45 subjects (93.75%) had abnormal waist circumference, 22 subjects (45.83) were hypertensive and 26 were non hypertensive (54.17%), 37 subjects (77.08%) had hypertriglyceridemia and 44 subjects (91.67%) had low HDL. In Group 2, all the patients were having BMI >22.99, 17 subjects (94.44%) had abnormal waist circumference, 9 subjects (50%) were hypertensive and 9 were non hypertensive (50%), 15 subjects (83.33%) had hypertriglyceridemia and 16 subjects (88.89%) had low HDL. In Group 3, all the patients were having BMI >22.99, 24 subjects (92.31%) had abnormal waist circumference, 13 subjects (50%) were hypertensive and 13 were non hypertensive (50%), 20 subjects (76.92%) had hypertriglyceridemia and 25 subjects (96.15%) had low HDL. In Group 4, all the patients were having BMI >22.99, 55 subjects (94.83%) had abnormal waist circumference, 34 subjects (58.62%) were hypertensive and 24 were non hypertensive (41.38%), 44 subjects (75.86%) had hypertriglyceridemia and 55 subjects (94.83%) had low HDL. Conclusions: In the sample studied, the prevalence of abnormal glucose metabolism was as high as 68.0%. These glucose metabolism abnormalities could be described as 12.0% for normal FPG but abnormal GTT, 17.33 % for abnormal FPG but normal GTT, and 38.67% for elevation in both FPG and GTT. The patients with metabolic risk factors had high prevalence of pre-diabetes. There was higher proportion impaired FPG, impaired GTT among patients having obesity, hypertension, dyslipidemia.

Background: Infraorbital space infections are rare but significant odontogenic infections that often result from the spread of infection from the canine space, commonly due to carious upper anterior teeth. Delayed intervention can lead to orbital and systemic complications. Case Presentation: A 65 -year-old female presented with a 5-day history of right infraorbital swelling, pain, and low-grade fever. Clinical and radiographic examination revealed a carious maxillary canine and lateral incisor with associated canine and infraorbital space infection. Surgical drainage via an intraoral vestibular incision was performed, approximately 5 mL of purulent exudate was evacuated, and the offending teeth were extracted. A corrugated drain was placed for 48 hours, and the patient was prescribed broad-spectrum antibiotics. Results: By the third postoperative day, there was a noticeable decrease in both discomfort and swelling. Within seven days, there was total remission, and a one-month follow-up revealed no signs of recurrence. Conclusion: Prompt recognition and early surgical drainage, combined with elimination of the source of infection and appropriate antibiotic therapy, provide excellent clinical outcomes and prevent complications associated with infraorbital space infections.

Background: Knee osteoarthritis (OA) is a chronic, degenerative joint disorder and a leading cause of disability among the elderly. It is characterized by progressive cartilage loss, pain, stiffness, and reduced mobility. With the growing aging population and limited surgical accessibility, non-surgical management remains the cornerstone of OA care. Interventions such as exercise therapy, bracing, and lifestyle modification have shown promising results in improving function, alleviating pain, and delaying disease progression. Aim: To evaluate and compare the effectiveness of exercise therapy, bracing, and lifestyle modification in the non-surgical management of knee osteoarthritis among elderly patients. Methods: This prospective randomized clinical study was conducted in the Outpatient Department, Department of Orthopedics, Government Medical College, Sindhudurg, Maharashtra, from August 2024 to July 2025, including 120 elderly patients diagnosed with primary knee OA. Patients were randomly assigned into three groups: Group A: Exercise therapy (quadriceps strengthening, stretching, and aerobic activity)

• Group B: Bracing (unloader brace or neoprene sleeve)
• Group C: Lifestyle modification (weight management, posture correction, and ergonomic advice)

Each intervention lasted 12 weeks, with assessments at baseline, 6 weeks, 3 months, and 6 months. Outcomes were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) for pain. Statistical analysis was done using SPSS v26.0, with a significance level of p< 0.05. Results: Out of 120 participants, 114 completed follow-up. The mean WOMAC score decreased significantly in all groups—Exercise: 63.1 → 37.2, Bracing: 61.7 → 41.5, and Lifestyle: 62.5 → 48.6. Correspondingly, VAS scores improved from 7.0 → 3.9, 7.2 → 4.5, and 7.1 → 5.6, respectively. The percentage reduction in WOMAC and VAS was highest in the exercise group (41% and 44%), followed by bracing (33% and 37%), and lifestyle modification (22% and 21%) (p< 0.001). At 6 months, 92% of exercise group participants maintained symptom improvement versus 85% in bracing and 76% in lifestyle groups. No major adverse effects were observed. Conclusion: All three non-surgical modalities—exercise therapy, bracing, and lifestyle modification—proved beneficial in managing pain and improving function in elderly knee OA patients. Among them, structured exercise therapy demonstrated the most significant and sustained improvement, making it the most effective conservative approach. Bracing served as an effective adjunct, while lifestyle modification reinforced long-term outcomes. The results support a multimodal, patient-centred, non-surgical approach to optimize quality of life and delay surgical intervention in elderly patients with knee osteoarthritis.

Background: Hip fractures are a significant cause of morbidity and mortality in the elderly population. This study aimed to compare the functional and radiological outcomes of two treatment modalities, Group Helical blade (HB) and Group compressive screw (CS), for hip fractures. Methods: This randomized controlled trial included 100 patients with hip fractures, divided into two groups: Group HB (n=49) and Group CS (n=51). The patients were followed up and assessed for functional outcomes using the Harris Hip score and radiological outcomes using tip apex distance and RUSH score. Results: The study found that both groups had similar functional outcomes in terms of Harris Hip score (p=0.157). However, the radiological outcome, RUSH score, was significantly higher in Group HB compared to Group CS (p=0.041). There was no significant difference in tip apex distance between the two groups. Conclusion: This study suggests that both treatment modalities have similar functional outcomes, but Group HB had a significantly better RUSH score compared to Group CS. Further studies are needed to confirm these findings and determine the long-term outcomes of these treatment modalities.

Lifestyle modification is the cornerstone of type 2 diabetes mellitus (T2DM) management, serving as the first-line therapeutic strategy alongside pharmacological interventions. This systematic review explores the role of dietary modification, physical activity, weight reduction, and behavioral interventions in improving glycemic control and preventing complications associated with T2DM. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2024. The review included randomized controlled trials, cohort studies, and meta-analyses that assessed the effects of structured lifestyle programs on HbA1c levels, insulin sensitivity, and metabolic outcomes. Findings from 62 high-quality studies revealed that consistent adherence to balanced nutrition, moderate-intensity exercise, and structured behavioral support significantly improves glycemic outcomes, reduces cardiovascular risk factors, and delays disease progression. Evidence also supports that lifestyle modification enhances the effectiveness of pharmacological treatment, reduces medication dependency, and improves quality of life. These findings underscore the vital role of patient education, community-based programs, and personalized lifestyle interventions in managing T2DM.

Background: Age-related sensorineural hearing loss (presbycusis) is a prevalent and often underdiagnosed condition in the elderly, leading to communication difficulties and social isolation. Early identification through screening audiometry may enable timely intervention and rehabilitation. Material and Methods: This hospital-based cross-sectional study was conducted on 156 geriatric participants aged ≥60 years attending the Otorhinolaryngology outpatient department. Individuals with middle ear pathology, prior ear surgery, or exposure to ototoxic agents were excluded. Detailed demographic data were recorded, and each participant underwent otologic examination, screening audiometry, and pure tone audiometry (PTA). Hearing thresholds were classified according to the WHO criteria. The diagnostic performance of screening audiometry was evaluated against PTA, and age-related changes in hearing thresholds were analyzed. Results: Among the participants, 43.6% were aged 60–69 years, 37.2% were 70–79 years, and 19.2% were ≥80 years. Males constituted 57.7% of the study population. Hypertension (56.4%) and diabetes mellitus (41.0%) were the most common comorbidities. Based on PTA, 39.1% of ears had normal hearing, while the remaining exhibited varying degrees of hearing loss, predominantly mild and moderate. Screening audiometry showed a sensitivity of 91.6%, specificity of 88.5%, positive predictive value of 92.6%, and negative predictive value of 87.1% when compared with PTA. Mean hearing thresholds increased progressively with age, and the correlation between age and degree of hearing loss was statistically significant (p < 0.01). Conclusion: Age-related hearing loss is highly prevalent among the elderly. Screening audiometry demonstrates high diagnostic accuracy and can serve as a practical tool for early detection, facilitating timely auditory rehabilitation and improved quality of life.

High-energy trauma, such as a car accident or osteoporosis, often results in a bimodal distribution of proximal humerus fractures in young men and old women. Most proximal humeral fractures are treated without surgery, however some severe breaks do need treatment. Disagreement exists on the best way to treat fractures in the upper part of the humerus. Treatment options range from rest to more intrusive procedures such plate osteosynthesis or open reduction and internal fixation (ORIF) (MIPO). Functional and radiographic results of the anterolateral deltoid splitting technique for proximal humerus fractures are analyzed in this research.

Background: Vitamin D is essential for calcium metabolism, bone mineralization and musculoskeletal health. In elderly patients, vitamin D deficiency can impair fracture healing and delay postoperative recovery after fracture fixation. Aim: The purpose of this study was to assess the prevalence of vitamin D deficiency among older hip fracture patients undergoing fixation and to determine whether serum vitamin D levels are associated with the speed and quality of functional recovery following surgery. Materials and Methods: Prospective observational study for 14 months from April 2024 to May PMT Loni. A total of 75 old patients (age ≥60 years) undergoing surgical fracture fixation were included. Serum 25-hydroxyvitamin D was measured preoperatively and compared with functional outcome scores, including the Harris Hip Score and the Disability of the Arm, Shoulder and Hand (DASH) score at six-month follow-up. Results: Over 75 participants, 64% were found to have vitamin D deficiency (30a ng/mL). Patients with adequate vitamin D had significantly faster fracture healing, and better functional recovery (p<0.05). Conclusion: Vitamin D insufficiency is very common in elderly patients with fractures and is an important factor for recovery time. Routine screening and supplementation could improve functional recovery after fractures fixation.

Background: Degenerative shoulder arthritis leads to chronic pain and functional limitation. Intra-articular biologic therapies such as platelet-rich plasma (PRP) and hyaluronic acid (HA) have gained increasing attention as joint-preserving alternatives to corticosteroid injections and surgery. This study aimed to compare the efficacy of PRP and HA injections in improving pain and shoulder function in patients with degenerative shoulder arthritis. Methods: A total of 70 patients diagnosed with degenerative shoulder arthritis were prospectively enrolled and randomized into two groups: Group A received PRP (n=35) and Group B received HA (n=35) intra-articular injections under ultrasound guidance. Pain and functional outcomes were assessed using the Visual Analogue Scale (VAS) and Constant-Murley Shoulder Score at baseline, 4, 12, and 24 weeks. Data were analyzed using Student’s t-test, chi-square test, and repeated-measures ANOVA, with a significance level of p<0.05. Results: Baseline demographic and clinical characteristics were comparable between the two groups (p>0.05). The mean reduction in VAS from baseline to 24 weeks was significantly greater in the PRP group (−4.6 ± 1.1) compared to the HA group (−3.6 ± 1.2) (p=0.0003). Similarly, the mean increase in Constant-Murley score was higher in the PRP group (+30 ± 9) than in the HA group (+21 ± 10) (p<0.001). A higher proportion of PRP-treated patients achieved clinically significant improvement in both pain (85.7% vs. 62.9%; p=0.029) and function (77.1% vs. 54.3%; p=0.044). No serious adverse events were reported in either group. Conclusion: PRP injections were more effective than HA in reducing pain and enhancing functional recovery in patients with degenerative shoulder arthritis, with comparable safety. PRP thus represents a promising, biologically driven treatment option for patients seeking non-surgical management of shoulder arthritis.