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Persistent postural-perceptual dizziness is a chronic functional vestibular disorder characterized by persistent dizziness, imbalance, motion sensitivity, and significant psychological distress, frequently including anxiety. Symptoms often persist despite normal imaging and multidisciplinary evaluation, contributing to diagnostic uncertainty and misattribution to psychiatric causes. Osteopathic cranial manipulative medicine is not routinely incorporated into the management of persistent postural-perceptual dizziness despite osteopathic principles, emphasizing the interrelationship between cranial structure, autonomic regulation, vestibular function, and psychological well-being. A 30-year-old female patient with a longstanding history of anxiety, depression, and post-traumatic stress disorder presented with a greater than two-year history of persistent postural-perceptual dizziness, recurrent falls, and imbalance that began following a motor vehicle accident. Her psychiatric symptoms had been refractory to psychotherapy and pharmacologic treatment, while her imbalance remained refractory to physical therapy and neurologic evaluation. The chronic persistence of vestibular symptoms coincided with worsening psychological distress and functional decline. Magnetic resonance imaging demonstrated a suprasellar pituitary lesion without a definitive explanation for her symptoms. Osteopathic structural examination identified decreased cranial rhythmic impulse amplitude, increased dural tension, and superior sphenoid strain at the sphenobasilar synchondrosis (SBS). Osteopathic manipulative treatment was performed, including osteopathic cranial manipulative medicine techniques directed at reducing dural tension and restoring balanced motion at the cranial base. Two treatment sessions were performed one week apart. Following the first treatment session, the patient reported mild improvement in balance and substantial reduction in anxiety symptoms. Following the second session, she reported further improvement in balance, anxiety, and ambulatory confidence compared with pretreatment baseline. Generalized Anxiety Disorder-7 scores improved to below the screening threshold for generalized anxiety disorder, while Patient Health Questionnaire-9 score improved from 11, consistent with moderate depression, to 5, consistent with mild depressive symptoms. The patient additionally reported fewer falls, improved confidence with ambulation, and immediate subjective relief following treatment. This case suggests a potential role of osteopathic cranial somatic dysfunction in persistent postural-perceptual dizziness and associated psychological distress refractory to conventional management. Identification and treatment of superior sphenoid strain were temporally associated with clinically meaningful improvements in vestibular symptoms, anxiety, depressive symptoms, and functional capacity. These findings support further investigation into osteopathic cranial manipulative medicine as a potential adjunctive treatment approach for persistent postural-perceptual dizziness and related neuropsychiatric symptomatology. This case also highlights the importance of comprehensive, multidisciplinary evaluation in patients whose physical symptoms may be prematurely attributed solely to psychiatric diagnoses.

Introduction Menstrual cups are a safe, cost-effective, and sustainable menstrual hygiene product; however, their awareness and acceptability among adolescents remain low due to socio-cultural barriers and misconceptions. The study aimed to assess the knowledge, awareness, myths, and acceptability of menstrual cups among adolescent girls and to evaluate factors influencing their willingness to use them. Materials and methods A community-based cross-sectional study was conducted among 812 adolescent girls aged 13-19 years in Nagamangala taluk, Karnataka, from February to April 2026. Data were collected using a pre-tested semi-structured questionnaire. Knowledge was categorized as adequate when >50% responses were correct. Associations were analyzed using the chi-squared test, with p < 0.05 considered statistically significant. Results Awareness of menstrual cups was observed in 308 (37.9%) participants. Adequate knowledge was present in 342 (42.1%), while myths and misconceptions were reported by 498 (61.3%). The most common misconception was fear of pain during insertion 362 (44.6%). Overall, 548 (67.5%) participants expressed willingness to use menstrual cups. Awareness increased significantly with age (&#x3c7;&#xb2; = 9.82, p = 0.002). Willingness was significantly higher among those aware, 220 (71.4%), compared to those not aware, 328 (65.1%) (&#x3c7;&#xb2; = 4.21, p = 0.040). Adequate knowledge was associated with higher acceptability (&#x3c7;&#xb2; = 14.7, p < 0.001), while the presence of myths was associated with lower willingness (&#x3c7;&#xb2; = 41.6, p < 0.001). Conclusion Despite low awareness and prevalent misconceptions, the acceptability of menstrual cups was relatively high, particularly after exposure to appropriate information. Strengthening menstrual health education and addressing myths may improve the adoption of menstrual cups among adolescents.

Bilateral pelvic ectopic kidneys represent an exceptionally rare congenital anomaly. Their co-occurrence with M&#xfc;llerian anomalies reflects shared embryological disruption of the metanephric and paramesonephric systems and carries significant clinical implications, particularly during pregnancy. A 37-year-old woman with no previous urological history presented with left flank pain. Renal ultrasound demonstrated bilateral pelvic ectopic kidneys and a 5 mm non-obstructing left renal calculus. Oral analgesia and increased fluid intake were advised. Repeat ultrasound six months later confirmed spontaneous passage of the calculus with no residual stone burden. The patient was concurrently under gynecological follow-up for a bicornuate uterus. A non-contrast pelvic magnetic resonance imaging (MRI), performed by the gynecology department, to characterize the uterine anomaly and deferred&#xa0;to a non-contrast protocol due to concurrent pregnancy, confirmed bilateral ectopic kidneys situated in the presacral and rectovaginal pouch of Douglas with aberrant vascular supply arising near the common iliac artery bifurcation. Renal function tests and urinalysis remained within normal limits&#xa0;throughout the follow-up period, including during pregnancy. The patient delivered at 37+3 weeks of gestation by elective cesarean section without maternal or urological complications and was maintained under urological surveillance post-partum, with computed tomography urography&#xa0;planned&#xa0;for full anatomical delineation. This case illustrates a rare embryologically linked combination of bilateral pelvic ectopic kidneys and a bicornuate uterus. Awareness of this association may aid multidisciplinary management across urology, gynecology, and obstetrics. Consideration should be given to evaluation for co-existing M&#xfc;llerian anomalies when congenital renal anomalies are identified, and vice versa.

Introduction Sinus cysts associated with visual impairment require surgical drainage of the cyst, and emergency surgery is often necessary, particularly in cases involving visual impairment. In this study, we examine the optimal timing of surgery with respect to visual prognosis, based on our own cases and a review of the literature. Materials and methods From April 2020 to March 2025, seven patients with sinus cysts and visual impairment underwent endoscopic surgery at the Department of Otolaryngology at Osaka Metropolitan University. Of these seven cases, three involved visual acuity impairment, three involved visual field impairment, and one involved diplopia. Results We conducted a further analysis of the three cases with decreased visual acuity. All cases of visual impairment underwent emergency surgery on the day of the initial consultation. Those with preoperative visual acuity between 0.1 and 1.0 recovered their original visual acuity. Conversely, the case with light perception showed only slight improvement. Conclusions Time from onset to treatment and preoperative visual acuity were considered important factors in the postoperative visual prognosis. For patients with visual impairment, especially those with severe preoperative visual acuity, emergency surgery was deemed necessary. In cases of diplopia, there is a high likelihood of improvement even with elective surgery performed in a planned manner after preoperative examinations and surgery scheduling. Because few cases of visual field defects have been reported, further case accumulation is warranted.

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is an exceptionally rare malignancy of uncertain histogenesis, with fewer than 110 cases reported in the literature since its initial characterization in 1965. PRMC typically presents as a large cystic retroperitoneal mass, but diagnosis remains challenging due to nonspecific imaging features and lack of biomarkers. Surgical resection remains the cornerstone of management, while the role of adjuvant therapies remains controversial. We present the case of a 46-year-old woman with high-grade PRMC successfully managed with robotic-assisted resection, to the best of our knowledge, the first reported malignant PRMC resection via this technique. We supplement this report with a literature review of clinicopathological features, proposed histogenesis, and therapeutic outcomes.

Necrotizing fasciitis is a rapidly progressive and life-threatening soft tissue infection in which early diagnosis remains challenging when initial clinical findings are subtle or nonspecific. Hyperglycemic crises are frequently triggered by infection and may obscure the underlying etiology when metabolic abnormalities dominate the initial presentation. We report a case of a 52-year-old female with rheumatoid arthritis receiving chronic corticosteroid therapy, an important risk factor for atypical infectious presentations, who presented with altered mental status, dehydration, and severe hyperglycemia consistent with hyperosmolar hyperglycemic state in the setting of newly diagnosed type 2 diabetes mellitus. Initial evaluation revealed no clear infectious source aside from mild localized edema, and the patient was treated with intravenous fluids, insulin infusion, and broad-spectrum antibiotics. Despite early biochemical improvement, she developed persistent hyperlactatemia, refractory hypotension, and progressive lower extremity swelling with subsequent crepitus. Imaging revealed extensive gas within the deep fascial planes consistent with necrotizing fasciitis, requiring emergent surgical intervention. The patient improved following definitive management and was ultimately discharged. This case highlights the importance of continuous clinical reassessment and maintaining a high index of suspicion for occult infections in patients with hyperglycemic crises who fail to improve as expected.

Background Tuberculosis (TB) continues to be a significant contributor to childhood morbidity and mortality in high-burden countries, including India. Host nutritional status plays an important role in susceptibility to Mycobacterium tuberculosis, particularly through the modulation of cell-mediated immunity. Beyond its classical role in calcium homeostasis, vitamin D has important immunomodulatory effects, including enhancement of macrophage activity, promotion of phagosome-lysosome fusion, and induction of antimicrobial peptides such as cathelicidin. Although several studies in adults have reported an association between vitamin D deficiency and active TB, pediatric data, particularly from the Indian subcontinent, remain limited. The present study was conducted to determine the prevalence of vitamin D deficiency among children with TB and to examine its relationship with selected demographic and clinical characteristics. Methods This prospective study was conducted over a 12-month period and included 41 children aged &#x2264;18 years who were newly diagnosed with TB. Sociodemographic and clinical data were collected using a structured proforma. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured using a chemiluminescence assay and expressed in nmol/L. Vitamin D status was categorized as deficient (<50 nmol/L) or non-deficient (&#x2265;50 nmol/L). The distribution of vitamin D levels was analyzed according to age group, sex, socioeconomic status, TB diagnosis category, monthly family income, and diagnostic method. Results Among the 41 children with TB, vitamin D deficiency was observed in 37 (90.2%) participants, while only 4 (9.8%) had non-deficient vitamin D levels. The mean serum vitamin D level was 34.75 &#xb1; 11.28 nmol/L. Pulmonary TB was the most common diagnosis (41.5%), followed by abdominal TB (29.3%), central nervous system (CNS) TB (19.5%), and disseminated TB (9.7%). Vitamin D deficiency was observed across all age groups and socioeconomic strata. However, no statistically significant association was found between vitamin D deficiency and age group (p = 0.524), sex (p = 0.762), socioeconomic status (p = 0.908), TB diagnosis category (p = 0.640), monthly family income (p = 0.790), or diagnostic method (p = 0.730). Pearson correlation analysis showed weak, non-significant correlations between vitamin D levels and age (r = 0.082, p = 0.610), as well as monthly family income (r = 0.088, p = 0.584). Conclusions This study demonstrated a high prevalence of vitamin D deficiency among children diagnosed with TB. While no statistically significant association was identified between vitamin D deficiency and the demographic or clinical parameters assessed, the findings highlight the frequent occurrence of inadequate vitamin D levels in pediatric TB. Larger prospective studies are needed to further clarify the role of vitamin D in childhood TB and to explore the potential therapeutic value of vitamin D supplementation.

Severe malnutrition in adults is frequently multifactorial and may result from overlapping nutritional, infectious, inflammatory, and systemic conditions. Identifying the dominant contributors can be challenging, particularly when patients present without classic gastrointestinal symptoms. We report the case of a 24-year-old woman with a more than 10-year history of failure to gain weight despite adequate nutritional intake, associated with progressive bilateral lower limb weakness, anasarca, delayed pubertal development with primary amenorrhea, and severe functional decline. Despite multiple hospitalizations and nutritional interventions, her condition continued to deteriorate. Comprehensive evaluation revealed Helicobacter pylori (H. pylori)-associated gastritis with micronutrient deficiencies, while further investigation identified a right psoas abscess associated with a marked systemic inflammatory response. Management included H. pylori eradication therapy, surgical drainage of the abscess, antibiotic therapy, and structured nutritional rehabilitation. The patient subsequently experienced substantial weight gain, resolution of edema, restoration of mobility, attainment of menarche, and sustained clinical recovery. This case highlights the multifactorial nature of severe malnutrition and the potential contribution of both chronic gastrointestinal infection and occult deep-seated infection to nutritional decline. In patients with unexplained severe malnutrition accompanied by disproportionate inflammatory markers, clinicians should maintain a high index of suspicion for occult infectious foci and consider early imaging to avoid diagnostic delay and facilitate timely intervention.

Colonic stricture secondary to appendicitis is exceptionally rare. We report a unique case of ascending colon stricture developing one year after treatment for complicated appendicitis in a patient on long-term hemodialysis. A 68-year-old male with a 26-year history of hemodialysis underwent percutaneous drainage for appendicitis with abscess formation, followed by an interval laparoscopic appendectomy. One year postoperatively, he developed nausea and vomiting. Colonoscopy revealed a circumferential stricture in the ascending colon without mucosal abnormalities. A contrast enema demonstrated a 2 cm apple-core stricture. Laparoscopic right colectomy was successfully performed despite extensive adhesions. Histopathological examination confirmed chronic inflammatory stricture with submucosal fibrosis and no evidence of malignancy. The patient recovered well with the resolution of symptoms. This case demonstrates that complicated appendicitis with abscess formation can cause delayed colonic stricture, particularly in immunocompromised patients such as those on chronic hemodialysis. Clinicians should be aware of this potential delayed complication when managing patients with a history of complicated appendicitis.

Gastric antral vascular ectasia (GAVE) can result in upper gastrointestinal bleeding (UGIB) and is an important diagnostic consideration, especially in the elderly. It is often mistaken for portal hypertensive gastropathy given its similar endoscopic appearances and occurrence in comparable patient populations. We present the case of an elderly patient who presented to the emergency department (ED) with UGIB due to GAVE. A 75-year-old female patient with a past medical history of peptic ulcer disease, hypertension, rheumatoid arthritis, and type II diabetes mellitus presented to the ED for repeat syncopal episodes, nausea, diarrhea, and fatigue. The patient had melanotic stool, significant blood-loss anemia, and an abdominal computed tomography (CT) scan showing hepatic cirrhosis. The patient was administered intravenous packed red blood cells, ceftriaxone, octreotide, and pantoprazole, and was admitted to the hospital. Esophagogastroduodenoscopy (EGD) showed no varices but GAVE, which was then treated with argon plasma coagulation. The patient experienced no further bleeding and was discharged on hospital day 3. GAVE is a rare cause of UGIB with which emergency physicians should be familiar. Immediate stabilization in the ED, followed by prompt and direct endoscopic therapy, is critical for its treatment.

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that may result in dehydration, malnutrition, and electrolyte imbalance. Wernicke's encephalopathy (WE), caused by thiamine deficiency, and refeeding syndrome (RFS), a metabolic complication of nutritional rehabilitation, are rare but serious sequelae of prolonged starvation in HG. We present the case of a multiparous woman in her 30s with severe HG and missed miscarriage at approximately 16 weeks, who developed refractory hypokalaemia, hypomagnesaemia, and evolving neurological symptoms following medical management of miscarriage. Magnetic resonance imaging demonstrated symmetrical medial thalamic and mammillary body changes suspicious for WE. She improved following intravenous thiamine and vitamin B complex replacement, potassium and magnesium correction, and multidisciplinary care. This case underscores the importance of early thiamine prophylaxis in severe HG and highlights persistent refractory electrolyte abnormalities as a potential early indicator of RFS and evolving WE.

Acral lentiginous melanoma presents reconstructive challenges due to its location in weight-bearing areas. We report the case of a 65-year-old female patient with plantar melanoma treated with wide local excision and sentinel lymph node biopsy. Reconstruction was performed using a split-thickness skin graft. The patient achieved complete graft integration without complications and preserved ambulation. This case supports that skin grafting should be considered a first-line reconstructive option in selected plantar defects, minimizing morbidity compared to flap-based techniques.

Background Methicillin-resistant Staphylococcus aureus (MRSA) continues to pose a major global public health concern due to its resistance to commonly used antibiotics. Ceftaroline has emerged as a promising therapeutic agent against MRSA; however, local susceptibility data remain limited. This study evaluated the in vitro susceptibility of clinical MRSA isolates to ceftaroline using the E-test strip method and described antimicrobial susceptibility patterns and clinical characteristics of affected patients in a tertiary care setting. Methods This prospective, observational, cross-sectional study included non-repetitive MRSA-positive clinical samples obtained from patients aged &#x2265;1 year over a two-year period. Identification and baseline antimicrobial susceptibility testing were performed using the VITEK 2 automated microbiological identification system. Ceftaroline susceptibility was determined using E-test minimum inhibitory concentration (MIC) strips. Results Out of 180 patients assessed, 167 MRSA isolates were included in the final analysis. The mean patient age was 34.51 &#xb1; 21.35 years, with 103 (61.7%) males. Surgical departments accounted for 99 (59.3%) of isolates, while most patients were admitted to wards (134; 80.2%). Surgical site infections (61; 36.5%) and skin and soft tissue infections (30; 18.0%) were the most frequent diagnoses. Pus samples constituted 90 (53.9%) of the isolates. Ceftaroline demonstrated high in vitro activity against MRSA, with 166 (99.4%) of isolates being susceptible and only one (0.6%) resistant. Most MIC values ranged from 0.1 to 0.4 &#xb5;g/mL. Tetracycline, vancomycin, linezolid, and daptomycin also demonstrated sensitivity rates above 80%. Conclusions These findings demonstrate excellent in vitro susceptibility of MRSA isolates to ceftaroline and support further multicenter studies incorporating clinical outcome data to evaluate its therapeutic role in tertiary care settings. Its clinical use should, however, be reserved for MRSA infections resistant to other antimicrobials.

Childbirth is a crucial experience that impacts women's lives, and the choice between vaginal delivery and cesarean section (C-section) is a critical decision in obstetrics. Maternal satisfaction is influenced by multiple factors since the childbirth experience is a composite of physical, emotional, and social components. Understanding patient evaluation is crucial for providing patient-centered care and improving maternity and neonatal care services. This systematic review aimed to compare patient satisfaction between vaginal and cesarean delivery patients and identify influencing factors. We performed a thorough search of databases&#xa0;for studies&#xa0;published between 2000 and 2024&#xa0;on&#xa0;patient-reported satisfaction with vaginal delivery vs. C-section interventions. Eligible studies were assessed for methodological quality and relevance. The findings indicated that most women were satisfied with their delivery experience, with vaginal delivery leading to higher satisfaction than C-sections. Factors influencing satisfaction include maternal education, domicile, planned delivery care, healthcare professional gender, complications, partners' education, pain control measures, Apgar scores, and injuries. However, satisfaction levels were not significantly different across other maternal demographic factors or pregnancy-related characteristics. Certain features, such as planned pregnancy and excellent prenatal care, improved satisfaction with both vaginal and cesarean deliveries. The presence of a supporting companion during birth significantly boosted satisfaction levels, especially in primary care settings. Inadequate communication is associated with decreased maternal satisfaction. Therefore, healthcare practitioners should prioritize patient-centered care, good communication, and support. Targeted interventions are recommended, considering factors that influence the delivery of maternal and child care services.

Autoimmune encephalitis (AE) is a potentially reversible cause of acute neuropsychiatric deterioration; however, diagnosis may be delayed when symptoms overlap with those of pre-existing neurologic disorders. We report the case of a 27-year-old woman with known multiple sclerosis (MS) who presented with acute psychosis and rapidly progressed to focal seizures, encephalopathy, catatonia, dyskinesias, and autonomic instability. Initial neuroimaging demonstrated no evidence of active demyelination or other acute intracranial pathology, raising diagnostic uncertainty regarding atypical MS relapse, infectious encephalitis, and other inflammatory processes. Cerebrospinal fluid (CSF) analysis revealed marked lymphocytic pleocytosis, while extensive infectious studies were negative. Electroencephalography&#xa0;demonstrated focal seizure activity arising from the left frontal region, followed by diffuse slowing with superimposed beta activity suggestive of a delta brush-like pattern. Given the characteristic clinical progression and inflammatory CSF findings, AE was strongly suspected, and immunotherapy with high-dose corticosteroids and plasma exchange was initiated before diagnostic confirmation. The diagnosis was ultimately established by positive anti-N-methyl-D-aspartate (NMDA) receptor antibodies in both CSF and serum. This case highlights the importance of recognizing clinical features atypical for MS relapse, including acute psychosis, seizures, and rapidly progressive encephalopathy, and underscores the risk of diagnostic anchoring in patients with established neurologic disease. Early recognition of anti-NMDA receptor encephalitis and prompt initiation of immunotherapy remain critical to optimizing outcomes in this potentially reversible condition.

Gastric antral vascular ectasia (GAVE) is an under-recognised cause of chronic gastrointestinal blood loss and iron-deficiency anaemia, caused by dilated antral vessels that cause chronic gastrointestinal bleeding, gradually depleting iron stores and leading to reduced haemoglobin levels. Its presentation is often subtle and may occur without overt gastrointestinal bleeding. We report an 82-year-old patient admitted following an unwitnessed fall, associated with postural hypotension and normocytic anaemia (Hb 90 g/L). Oesophagogastroduodenoscopy (OGD) demonstrated linear GAVE&#xa0;in the gastric antrum without active bleeding. The patient also sustained a fragility pelvic fracture. Intravenous iron therapy was administered to correct severe iron deficiency, resulting in improved haemoglobin levels and resolution of underlying clinical symptoms. This case highlights an important and often under-recognised presentation of GAVE, in which anaemia manifests predominantly through falls or orthostatic features rather than gastrointestinal symptoms. Early recognition of this pattern is crucial, as targeted treatment may reduce the risk of recurrent falls, fractures, and subsequent functional decline in older adults.

Disseminated peritoneal nematode infestation is a rare extra-intestinal manifestation of ascariasis, typically occurring following bowel perforation. We report a case of a male in his 60s presenting with features of acute small bowel obstruction, including abdominal pain, distension, obstipation, and bilious vomiting, with a history of perforated appendicitis managed surgically six months prior. Contrast-enhanced computed tomography suggested small bowel obstruction. Intraoperative findings revealed dense adhesions, gangrenous ileum, and multiple nodular lesions over the small bowel, mesentery, and omentum. Resection of the gangrenous segment with primary anastomosis was performed. Histopathological examination confirmed nematode infestation with associated granulomatous inflammation. The findings suggest transperitoneal dissemination following prior appendicular perforation. This case highlights a rare presentation of ascariasis mimicking granulomatous disease and emphasizes the importance of considering parasitic etiologies in atypical intra-abdominal pathology, particularly in endemic regions.

Background and aim Adipocytic tumors are among the most common soft tissue neoplasms, ranging from benign to malignant forms. Accurate differentiation between these entities is essential due to differences in prognosis and management. This study aims to evaluate the clinicopathological spectrum of lipomatous tumors, including their demographic profile, anatomical distribution, and histopathological spectrum, and to analyze factors associated with malignancy. Methods A retrospective observational study was conducted in the Department of Pathology at a tertiary care center from October 2019 to September 2025. A total of 114 histopathologically confirmed cases of adipocytic tumors were included. Clinical and pathological data were retrieved and analyzed. Tumors were classified according to the WHO classification. Ancillary techniques, including immunohistochemistry (MDM2 and CDK4), were performed in selected cases. Associations between tumor size, site, radiological features, and malignancy were assessed. Results The majority of patients were in the fourth to sixth decade age group (52 cases, 45%), with a male predominance (68 cases, 60%). The upper extremity was the most common site (32 cases, 28%), followed by the lower extremity (30 cases, 26%) and trunk (28 cases, 25%). Conventional lipoma was the most common tumor type (72 cases, 63%), followed by other variants such as fibrolipoma (12 cases, 11%) and angiolipoma (10 cases, 9%). The most common anatomical location was subcutaneous tissue, followed by deep soft tissue and intramuscular locations. Atypical lipomatous tumor/well-differentiated liposarcoma and myxoid liposarcoma were identified in a subset of cases. Radiologically, benign lesions showed homogeneous fat density, whereas malignant tumors demonstrated septal thickening, nodularity, and non-adipose components. Most tumors measured less than 5 cm (64 cases, 56%). MDM2/CDK4 immunohistochemistry findings indicate that atypical/malignant adipocytic neoplasms were positive in four cases. Conclusions Lipomatous tumors are predominantly benign, with lipoma being the most common subtype. Tumor size and location serve as important indicators of malignancy. Comprehensive histopathological evaluation, supplemented by ancillary techniques where necessary, is crucial for accurate diagnosis and appropriate management.

The rising prevalence of opioid use during pregnancy has contributed to increasing rates of neonatal opioid withdrawal syndrome (NOWS). Traditional management using the Finnegan Neonatal Abstinence Scoring System (FNASS) is associated with prolonged hospitalization, increased neonatal intensive care unit (NICU) utilization, and reduced maternal&#x2011;infant bonding. Function&#x2011;based models such as Eat, Sleep, Console (ESC) emphasize non&#x2011;pharmacologic care and may improve outcomes. This project aimed to transition from FNASS to ESC within a small safety&#x2011;net hospital and evaluate associated clinical outcomes. We conducted a single&#x2011;center quality improvement initiative using a phased implementation strategy over 2.5 years. Eligible neonates were >36 weeks gestation or >2000 grams with prenatal opioid exposure. Clinical outcomes were compared between infants managed with FNASS (n=24) and ESC (n=12). Due to the small sample size and skewed distributions, continuous variables were analyzed using Mann-Whitney U tests and reported as medians with interquartile ranges. ESC implementation was associated with shorter median length of stay (3.5 vs. 16.5 days; p<0.001), fewer days on pharmacologic treatment (0 vs. 11.5 days; p=0.008), and fewer days in the NICU (0 vs. 13.5 days; p<0.001). Infants in the ESC group spent a higher percentage of hospitalization bonding with their mothers (100% vs. 14.6%; p=0.002), although the total number of bonding days did not differ significantly (p=0.199). Pharmacologic treatment use was lower in the ESC group (0% vs. 54.2%; p=0.002). Transitioning to ESC was associated with reduced pharmacologic treatment, shorter hospitalization, decreased NICU utilization, and improved maternal&#x2011;infant bonding. These findings support the feasibility of ESC implementation in resource&#x2011;limited safety&#x2011;net settings and highlight a scalable framework for equitable NOWS care.