Abstract: Objective:This study aims to assess undernutritionusing conventional anthropometric indices (i.e. stunting, wasting and underweight) alongside CIAF among the Korku children under five years of age in Melghat region of Maharashtra. Methods: A cross-sectional study was conducted among 384 children under five years belonging to the Korku Tribal community in Melghat, Maharashtra using a systematic random sampling technique. The nutritional status of the children was assessed by measuring their weight and length/height. Z-scores were calculated using WHO Anthro software and classified according to standard indices. The CIAF prevalence was measured to assess overall anthropometric failure based on a combination of these standard indices. Associations between categorical variables were examined using chi-square test, while differences in mean values across sexes were assessed using independent samples t-test. Results: The overall prevalence of underweight, stunting, wasting are 40.9%, 54.7%, and 14.8% respectively. The prevalence of anthropometric failure among under-five children is 67.7% based on CIAF. The most common CIAF category was stunting and underweight (25.3%), followed by stunting only (19.3%), wasting with underweight and stunting (6.8%), wasting and underweight (4.9%), stunting and overweight (3.4%), underweight only (3.4%), wasting only (3.1%) and overweight only (1.6%%). Chi-square tests indicated statistically significant difference between sexes and anthropometric failure categories p<0.05. Conclusion: The present study among the under-five children of Korku tribal community highlights limitations of relying solely on conventional indicators and supports the use of CIAF as a more comprehensive measure of the overall burden of anthropometric failure.
Keywords: Korku, Pre-school children, CIAF, Nutritional status, India, Tribe, Under-five

Abstract: Background: India registers most births but far fewer deaths, and the district pattern of that shortfall is poorly described. Methods: We analysed National Family Health Survey-5 indicators for 705 districts across 36 states. Precision-weighted models with state-clustered variance, wild cluster bootstrap inference and fractional logits estimated correlates of birth registration, death registration and their difference, across all districts and then within states. Results: Median birth registration was 94.9% and median death registration 76.2%, a median gap of 17.1 percentage points. Death registration was below 70% in 279 districts. Institutional births predicted death registration strongly across districts (9.13 points per standard deviation) but not within states (-0.06), a reversal reproduced by every estimator. Eighty-eight districts in 17 states registered 90% or more of births yet under 70% of deaths. Conclusion: Facility contact tracks birth registration, not death registration. Death certification appears to need its own workflow.
Keywords: Civil registration, Death registration, Vital statistics, District inequality, India.

Abstract: Background: The AB-PMJAY, is a publicly financed healthcare scheme in India targeting the poor and marginalised populations. This study was conducted to understand the schemes implementation in one of the poorest districts in Bihar. Methods: This was a cross-sectional mixed methods study. The quantitative part included a sample size of 130 eligible beneficiaries. The qualitative part of the study included In-depth Interviews (IDIs) with 20 eligible beneficiaries. Results: Although the scheme has been implemented for over seven years, awareness and utilisation of the scheme was low. Only 50% of the eligible families had the card to access the free services. Also, many private hospitals refused treatment to eligible beneficiaries. Although direct costs were minimal for beneficiaries, indirect costs were significant and contributed to catastrophic health expenditures. Conclusions : The implementation of AB-PMJAY is affected by poor awareness, hospital denial, informal payments and non-existing facilitators within the hospital system.
Keywords: Ayushman Bharat, PM-JAY; Health Insurance, Catastrophic health expenditure, Out-of-pocket expenditure, Bihar, Universal health coverage, Financial risk protection

Abstract: Background: Effective referral systems are critical for reducing maternal mortality in tribal populations. However, limited evidence exists on the referral patterns and quality in India's Particularly Vulnerable Tribal Group districts. This prospective observational study analysed the temporal variations in obstetric referrals and pre-referral management quality in a tribal-dominated district of Odisha. Methods: A prospective observational study was conducted at the District Headquarters Hospital, Gajapati District, Odisha, from July 2024 to August 2025. All maternal referrals during 2,759 deliveries were analysed using specialized data collection protocols. Temporal patterns were assessed using correlation analysis and time series modelling with SPSS (version 26.0). Results: Among 2,759 deliveries, 909 (32.9%) were referred inward, and 451 (16.3%) were referred outward. Strong correlations were observed between daytime referrals-in and total referrals-in (r=0.862, p<0.001) and nighttime referrals-out and total referrals-out (r=0.875, p<0.001). Nighttime referrals-in correlated significantly with nighttime referrals-out (r=0.571, p=0.033). Pre-referral management varied considerably, with the highest scores for birth asphyxia (mean=8.0, SD=5.0) and absent management for postpartum haemorrhage and delayed labour progress (mean=0.0, SD=0.0). Time series analysis demonstrated a good model fit (R²=0.725). Conclusions: Significant temporal disparities exist in referral patterns, with a potential pass-through phenomenon during nighttime. Substantial gaps in pre-referral management highlight the urgent need for standardized protocols in tribal healthcare settings.
Keywords: maternal health, obstetric referrals, tribal populations, pre-referral management, healthcare delivery, India

Abstract: Background: India has no national drowning prevention strategy, and it is not known how completely routine systems record child drowning. Methods: We combined Global Burden of Disease state estimates with National Crime Records Bureau counts for 30 states in a Bayesian measurement-error model, using measured death-registration completeness to identify a state-varying recording ratio. We projected the national rate to 2030, ranked states on burden and measured child-health-system capacity, and appraised ten recommended interventions against their published evidence. Results: Paediatric drowning fell 39.3% over 2014-2023. Modelled deaths exceeded recorded deaths 3.1-fold. Adding the second source moved estimates by over 10% in 11 states; registration completeness predicted recording (coefficient 0.65, 95% CrI 0.42-0.88). Seven states were highest-priority with probability at least 0.90. Only two of ten interventions had a quantified effect estimate. Conclusions: Routine records capture about a third of child drowning deaths, and present evidence cannot rank prevention interventions.
Keywords: Bayes theorem, child, drowning, India, injury prevention, public health

Abstract: Background: Achieving equity in primary healthcare (PHC) resource distribution is essential for universal health coverage, yet regional disparities persist globally and nationally. Aligned with Saudi Vision 2030 and the Health Sector Transformation Program, this study evaluated equity and concentration in the distribution of primary healthcare centers (PHCCs), physicians, and nurses across 20 health regions in Saudi Arabia from 2015 to 2022. Methods: We conducted a descriptive, analytical study using Ministry of Health (MOH data (2015–2022). We assessed equity and regional concentration using the Gini coefficient and the Hirschman–Herfindahl Index (HHI), alongside descriptive statistics and resource-to-population ratios per 10,000 people. Results: Between 2015 and 2022, the Saudi population grew by 2.07%, while the total number of PHCCs declined by 7.09%, reflecting facility consolidation. Conversely, human resources expanded: PHCC physicians increased by 11.10% and nurses by 9.42%. Despite crude regional discrepancies, overall national distribution remained equitable and non-concentrated. Gini coefficients indicated consistent equality across PHCCs (mean = 0.269), physicians (mean = 0.178), and nurses (mean = 0.231). HHI values across all years and indicators remained well below 1,000 (range: 734.05–984.36), confirming a highly dispersed, non-concentrated resource allocation. Conclusion: Primary healthcare in Saudi Arabia has shifted toward a consolidated facility model backed by a growing workforce. While macro-level equity indices confirm equitable national resource dispersion, significant localized disparities between urban centers and smaller regions highlight the need for targeted, population-adjusted resource allocations.
Keywords: Primary healthcare, spatial equity, healthcare resources, Saudi Arabia

Abstract: Objectives: To evaluate the microbial profile and antimicrobial susceptibility patterns of bloodstream infections in a multidisciplinary intensive care unit (ICU) of a tertiary care hospital in East Delhi. Materials and Methods: A retrospective cross-sectional study was conducted from January to December 2025, including 160 blood culture-positive ICU patients. Bacterial identification was performed using standard microbiological methods, and antimicrobial susceptibility testing was carried out by the Kirby–Bauer disc diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical Analysis: Data were analysed using SPSS version 27.0. Categorical variables were expressed as frequencies and percentages. Fisher's exact test was used for comparison of categorical variables. A p-value &lt;0.05 was considered statistically significant. Results: Gram-negative bacilli constituted 83.7% of bloodstream isolates, with Acinetobacter baumannii (44%) being the predominant pathogen, followed by Enterobacter spp. (26.9%), Pseudomonas aeruginosa (13.4%), and Klebsiella pneumoniae (12.7%). Gram-positive cocci accounted for 13.1% of isolates, with Staphylococcus aureus as the leading pathogen and an MRSA prevalence of 42.8%. Gram-negative isolates exhibited high resistance to cephalosporins and fluoroquinolones, while carbapenem susceptibility in A. baumannii was approximately 20%. All Gram-positive isolates remained susceptible to vancomycin and linezolid (100%). Colistin retained excellent in vitro activity against all tested Gram-negative isolates, including multidrug-resistant strains, with MICs ranging from 0.125–1 µg/mL and no colistin resistance detected. Conclusion: Bloodstream infections in the ICU were predominantly caused by multidrug-resistant Gram-negative pathogens, particularly carbapenem-resistant Acinetobacter baumannii. Preserved colistin susceptibility despite extensive resistance to other antimicrobials highlights its continued therapeutic value while emphasizing the urgent need for antimicrobial stewardship, ongoing resistance surveillance, and strengthened infection prevention and control measures.
Keywords: Bloodstream infections, Intensive care unit, Antimicrobial resistance, Acinetobacter baumannii, MRSA, Colistin.

Abstract: Background: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic cholelithiasis, but operative difficulty is highly variable and difficult to anticipate preoperatively. The Parkland Grading Scale (PGS) provides an objective intraoperative measure of gallbladder inflammation and dissection difficulty. Reliable preoperative predictors of a difficult (PGS grade 3-5) operative course could improve risk stratification, operating-room planning, and informed consent. Methods: In this prospective observational study conducted at the Department of Surgical Gastroenterology and Liver Transplantation, Bangalore Medical College and Research Institute-Super Speciality Hospital, Bengaluru (January 2025-June 2026), 102 consecutive patients undergoing elective LC for symptomatic cholelithiasis were evaluated. Preoperative clinical, haematological, biochemical and radiological parameters were recorded against the intraoperative PGS. Continuous variables were compared using the Mann-Whitney U and Kruskal-Wallis tests (Shapiro-Wilk testing for normality) and categorical variables using the chi-square or Fisher exact test. Receiver operating characteristic (ROC) analysis was used to quantify the discriminative value of individual continuous parameters, and multivariable logistic regression was used to identify independent predictors. The study was approved by the Institutional Ethics Committee, and written informed consent was obtained from all participants. Results: The cohort comprised 77 women and 25 men (mean age 45±14 years); 62/102 patients (60.8%) had a Difficult intraoperative grade. BMI, weight, and USG gallbladder wall thickness demonstrated excellent discrimination (AUC 1.00, 0.99 and 1.00 respectively; 95% confidence intervals). A BMI cut-off of 25 kg/m² and a GB wall thickness cut-off of 4.3 mm each achieved 100% sensitivity and 100% specificity in this cohort, and a weight cut-off of 68.8 kg achieved 95.2% sensitivity and 97.5% specificity. Operative time, an intraoperative rather than preoperative parameter, likewise discriminated perfectly (45 minutes in every Easy/Moderate case versus 95-140 minutes in every Difficult case), consistent with its being a direct correlate of the same intraoperative course. Among the moderate-effect preoperative variables, presence of comorbidity (diabetes and/or hypertension; χ² p=0.015), lower platelet count (p=0.037), and shorter prothrombin time (PT; p=0.008) were associated with a Difficult course; C-reactive protein, neutrophil: lymphocyte ratio, leucocyte count and bilirubin fractions were not (all p&gt;0.10). On multivariable logistic regression of these moderate-effect variables (adjusting for age, platelet count, PT and comorbidity), PT (adjusted OR 0.83 per second, 95% CI 0.71-0.96, p=0.012) and presence of any comorbidity (adjusted OR 3.70, 95% CI 1.09-12.56, p=0.036) remained independent predictors (model likelihood-ratio p=0.006; Nagelkerke R²=0.11). Conclusions: In this cohort, BMI, weight, and ultrasonographic gallbladder wall thickness were exceptionally strong, clinically actionable preoperative discriminators of a difficult laparoscopic cholecystectomy, each outperforming the discrimination typically reported in the published literature. Comorbidity burden and coagulation/haematological indices (PT, platelet count) added modest, independent information beyond these markers, while CRP and NLR did not behave as classically expected in this predominantly elective cohort. Given the unusually high discrimination observed for BMI and GB wall thickness, external validation in independent, multicentre cohorts is recommended before these cut-offs are adopted into routine preoperative counselling and operative planning.
Keywords: laparoscopic cholecystectomy, Parkland Grading Scale, cholelithiasis, operative difficulty, predictive factors, cholecystitis

Abstract: Background: Viral hepatitis remains a major global health concern, with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) contributing significantly to chronic liver disease, cirrhosis, and hepatocellular carcinoma. Contemporary hospital-based epidemiological data are essential for strengthening screening and elimination strategies in high-burden settings such as India. Methods: A retrospective observational study was conducted at the Virology Laboratory of a tertiary care hospital in East Delhi, India. Laboratory records from January 2024 to December 2025 were reviewed. Serological screening for HBsAg and anti-HCV antibodies was performed using ELISA-based assays. Demographic characteristics, temporal trends, age distribution, gender patterns, and indications for testing were analysed. Results: A total of 63,616 samples were screened for HBV and 50,951 for HCV during the study period. Overall, 1,468 patients were HBsAg positive (2.31%), while 2,426 were anti-HCV positive (4.76%). HBV seroprevalence remained stable between 2024 (2.32%) and 2025 (2.30%), whereas HCV positivity increased from 4.53% to 5.08%. Both infections demonstrated significant male predominance, accounting for 68.2% of HBV and 77.7% of HCV cases (p<0.00001). The highest burden was observed among individuals aged 21–40 years, followed by the 41–60-year age group. HBV cases were predominantly identified among symptomatic patients attending the Department of Medicine, whereas HCV positivity was highest among ART clinic attendees. Conclusions: HBV continues to exhibit a stable intermediate endemic pattern, while HCV remains disproportionately prevalent among high-risk populations. Strengthening targeted screening, surveillance, and linkage-to-care initiatives is essential to accelerate progress toward the World Health Organization’s 2030 viral hepatitis elimination targets.
Keywords: Hepatitis B, Hepatitis C, Seroprevalence, Epidemiology, Viral Hepatitis, ELISA.

Abstract: Introduction: Pap smear is a simple, cost effective tool for screening cervical pre cancer and cancerous lesions. However one the major limitation is the subjectivity, more so in borderline lesions like ASCUS and LSIL. Nuclear morphometry has evolved as an adjunct quantitative tool in various lesions at cytology. Similarly, Grey-Level Co-Occurrence Matrix (GLCM) is a measure of chromatin heterogeneity, coarseness and clumping which are the key features of atypia. This study aims to determine the utility of combined nuclear morphometric parameters and GLCM- texture analysis in Pap smears. Materials and Methods: This was a cross-sectional diagnostic analytical study involving 166 images obtained from cervical Pap smears. Nuclear morphometry and Gray-level co-occurrence textural features was performed using Image J software. Parameters analysed included area, perimeter, Feret, angular second moment (ASM), inverse difference moment (IDM), contrast, correlation, and entropy. The data was then analysed using SPSS software. Mean values were compared using ANOVA, and p < 0.05 was considered significant. Lesions were categorised as NILM/atrophy (n=64), ASCUS (n=26), LSIL (n=24), and HSIL/SCC (n=52). Results: The findings demonstrated a statistically significant difference GLCM texture parameters through various diagnostic groups. Angular Second Moment was significantly reduced in HSIL/SCC as compared to NILM (0.580 vs 0.983, p < 0.001). Significant increase was observed in contrast in HSIL/SCC (2459 vs 30.7, p < 0.001), reflecting prominent chromatin irregularity. Similarly, significant reduction in correlation was observed in HSIL/SCC (0.00014 vs 0.00213, p < 0.001), whilst a marked rise in entropy (0.703 vs 0.051, p < 0.001), signifying progressive chromatin deregulation. All the GLCM parameters showed intermediate values in LSIL and ASCUS. Nuclear morphometry also depicted significant differences across categories. Nuclear dimensions were reduced in HSIL/SCC nuclei (Feret X/Y values) compared with NILM (p < 0.001 for all), while nuclear area showed a decrease (p = 0.160) but was not statistically significant. Conclusion: GLCM texture analysis emerged as a powerful objective adjunct tool for differentiating precancerous and cancerous lesions of cervix. In future, these parameters can be incorporated into computer assisted, AI enables cervical cancer screening models.
Keywords: Image analysis, Cancer, Cervix, Chromatin texture, Cytology

Abstract: Tracheobronchial amyloidosis (TBA) is a rare form of amyloid deposition limited to the airways and often presents with nonspecific respiratory symptoms, leading to diagnostic delay. We report a case of a 55-year-old male who presented with chronic cough, progressive dyspnea, wheezing, and intermittent hemoptysis. Computed tomography of the chest demonstrated irregular circumferential tracheal wall thickening with calcified nodular deposits causing significant luminal narrowing. Bronchoscopy revealed multiple pale-yellow, waxy nodules involving the anterior and lateral tracheal walls. Histopathological examination confirmed amyloid deposition with Congo red positivity and apple-green birefringence under polarized light. Extensive evaluation excluded systemic amyloidosis. The patient was successfully managed with bronchoscopic mechanical debulking and argon plasma coagulation, resulting in marked symptomatic improvement and no recurrence at six months. This case highlights the importance of considering TBA in patients with unexplained airway obstruction and emphasizes the role of bronchoscopic intervention in management.
Keywords: airway obstruction, argon plasma coagulation, bronchoscopy, localized amyloidosis, tracheobronchial amyloidosis

Abstract: Sporotrichosis is caused by fungus by Sporothrix schenckii manifesting clinically as cutaneous, mucocutaneous, extracutaneous type. Disseminated disease, characterized by presence of multiple lesions at more than two sites is rare. Culture, though gold standard is time consuming and delays treatment initiation. There are very few case reports describing the cytological findings in sporotrichosis, more so in the disseminated form. Here we report two rare cases of disseminated sporotrichosis diagnosed on cytology and confirmed on microbiological examination. Both cases were male and presented with multiple skin nodules on extremities. This case report highlights the importance of considering fungal infections, especially sporotrichosis in patients with atypical clinical presentations like multiple skin nodules. FNAC complemented by special stain aids in rapid diagnosis and planning appropriate treatment.
Keywords: Sporothrix, Fine needle aspiration cytology, Disseminated, fungal infection

Abstract: Leiomyomas are benign mesenchymal tumors commonly encountered in the female genital tract. Within the gastrointestinal system, they are typically found in the esophagus and stomach with colonic involvement being rare. We report a case of an incidental ascending colon leiomyoma in a middle-aged male undergoing evaluation for cholelithiasis. While Colonoscopy revealed a normal study, Contrast-enhanced computed tomography (CECT) revealed a right-sided colonic mass. Initial radiological and histopathological findings suggested a gastrointestinal stromal tumor (GIST). However, definitive diagnosis was established as leiomyoma on immunohistochemistry (IHC). This case highlights the diagnostic challenges posed by extraluminal colonic tumors and underscores the critical role of IHC in differentiating leiomyomas from GISTs, thereby preventing unnecessary adjuvant therapy. It also emphasizes the limitations of colonoscopy in detecting extraluminal lesions.
Keywords: Leiomyoma, Colon, Gastrointestinal stromal tumor, Immunohistochemistry