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.