International Journal of Research in Medical Sciences

Methodological considerations in the use of systemic inflammatory indices for risk stratification in acute appendicitis

2026-08-30T08:30:01+0530

Systemic inflammatory indices derived from the complete blood count, including the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index, have gained interest as low-cost adjuncts for diagnosing and risk-stratifying acute appendicitis. Using a recent retrospective study by Örün et al as an illustrative example, this commentary examines four recurring methodological issues in this literature: validation against a non-independent reference standard that shares laboratory input with the indices themselves; small subgroup sizes that yield imprecise discrimination estimates; substantial heterogeneity in proposed cut-off values across studies and populations; and incomplete reporting of effect sizes, such as regression coefficients presented without accompanying odds ratios or confidence intervals. These issues recur across much of the published literature, including existing systematic reviews and meta-analyses, and limit the extent to which encouraging single-study findings can be translated into validated bedside tools. We argue that future studies should validate these indices against independent reference standards such as histopathology, employ adequately powered analyses, pre-specify and externally validate cut-off values, and adhere to established reporting guidelines such as the TRIPOD statement. Addressing these structural weaknesses would strengthen the evidence base supporting the clinical adoption of systemic inflammatory indices in acute appendicitis.

Jejunojejunal intussusception caused by a jejunal lipoma in a 92-year old patient: CT diagnosis

2026-08-30T08:31:24+0530

Adult intussusception is an uncommon cause of bowel obstruction and is usually associated with an identifiable pathological lead point. Among benign etiologies, submucosal lipomas of the small bowel are rare but may induce intussusception when they reach a significant size. We report the case of a 92-year-old man who presented with acute abdominal pain and subocclusive syndrome. Because of his history of bilateral inguinal hernias, strangulated hernia was initially suspected. Contrast-enhanced CT instead demonstrated an uncomplicated jejunojejunal intussusception caused by a 46-mm submucosal jejunal lipoma, with no evidence of bowel ischemia. Conservative management resulted in a favorable clinical outcome. This case highlights the pivotal role of CT in establishing the diagnosis, identifying the benign lead point, excluding ischemic complications, and guiding appropriate management in elderly patients presenting with acute abdominal pain.

IgA nephropathy presenting with an atypical nephrotic phenotype in an adolescent: a diagnostic challenge

2026-08-30T08:29:04+0530

IgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide and classically presents with recurrent hematuria, variable proteinuria, and slowly progressive renal impairment. However, atypical presentations mimicking nephrotic syndrome with generalized edema and extrarenal fluid overload are uncommon, particularly in adolescents, posing significant diagnostic challenges. We report the case of a 17-year-old male admitted with progressive facial edema evolving to generalized edema, abdominal distension, dyspnea, and bilateral pleural effusion. Laboratory evaluation revealed subnephrotic-range proteinuria associated with severe nephrotic-like manifestations, including hypoalbuminemia, hypercholesterolemia, microscopic hematuria and hypertension., and transient deterioration of renal function. Initial differential diagnoses included primary nephrotic syndrome, minimal change disease, seronegative autoimmune nephropathy, and secondary glomerular disorders. Autoimmune studies, including antinuclear antibodies (ANA), anti-double stranded DNA, anti-neutrophil cytoplasmic antibodies (ANCA), and anti-glomerular basement membrane antibodies, were negative. Renal biopsy demonstrated mesangial abnormalities consistent with IgA nephropathy, supporting the final diagnosis. The patient received multidisciplinary management with favorable clinical and renal evolution. IgA nephropathy may rarely present with an atypical nephrotic phenotype characterized by severe edema, pleural effusion, and systemic volume overload, particularly in younger patients. Histopathological assessment remains essential for diagnosis in atypical clinical scenarios. This case highlights the importance of considering IgA nephropathy in the differential diagnosis of nephrotic syndrome and underscores the relevance of integrating clinical, laboratory, and histopathological findings. In addition, a focused review of the literature is provided to contextualize uncommon nephrotic presentations of IgAN and their diagnostic implications.

A case report on the role of amygdala anatomy in psychiatric disorders

2026-08-30T08:29:00+0530

The amygdala is a key structure within the medial temporal lobe involved in emotional processing, fear responses, social behaviour, and stress regulation, and growing evidence suggests that structural and functional alterations of the amygdala contribute to several psychiatric disorders. This case report and systematic review with meta-analysis examined the relationship between amygdala anatomy and psychiatric disorders, with particular attention to trauma-related dissociative symptoms. A 43-year-old Asian female was admitted to an inpatient psychiatric unit with suicidal ideation and recurrent dissociative episodes characterized by unresponsiveness, loss of control, and out-of-body experiences in the context of repeated childhood sexual trauma; electroencephalography, computed tomography of the head, and routine laboratory investigations were within normal limits. A systematic literature search of PubMed/MEDLINE, PsycINFO, Google Scholar, Web of Science, and the Cochrane Library was conducted for studies published between 2000 and 2025 examining amygdala volume, structure, connectivity, or functional activity in adults with psychiatric disorders compared with healthy controls. Twenty-five studies comprising 1,847 patients and 1,562 healthy controls were included in the meta-analysis using random-effects models and Hedges' g. Significant reductions in amygdala volume were reported in antisocial personality disorder (g=-0.64, 95% CI: -0.82 to -0.46, p<0.001), dissociative disorders (g=-0.42, 95% CI: -0.67 to -0.17, p=0.001), and substance use disorders (g=-0.35, 95% CI: -0.58 to -0.12, p=0.003), whereas increased amygdala volume was reported in post-traumatic stress disorder (g=0.48, 95% CI: 0.29-0.67, p<0.001) and anxiety disorders (g=0.39, 95% CI: 0.21-0.57, p<0.001). Heterogeneity ranged from moderate to high, with I² values of 58-76%, and trauma history significantly moderated amygdala volume effects. These findings support an association between psychiatric disorders and disorder-specific alterations in amygdala structure and function, while the presented case illustrates the possible clinical relevance of trauma-related amygdala dysregulation in dissociative symptomatology. Further longitudinal and multimodal neuroimaging studies are required to clarify causal mechanisms and determine the clinical utility of amygdala-based biomarkers.

Bilateral undescended testes with intraabdominal non seminomatous germ cell tumor – a rare clinical challenge

2026-08-30T08:35:44+0530

Cryptorchidism is the most common congenital anomaly of the male genitalia, with nearly 72-77% of undescended testes located in the inguinal canal. Among malignancies arising in undescended testes, seminoma is the most frequent type, accounting for approximately 50-60% of cases. Tumors arising from intra-abdominal testes may grow to considerable sizes before detection, and delayed diagnosis often results in advanced-stage disease at presentation. We report a case of bilateral cryptorchidism in a young male who presented with vague lower abdominal pain, without any prior history of abdominal swelling or distension. The patient had noticed an empty scrotum since around 10 years of age but did not seek medical evaluation due to social stigma. Eventually, at the age of 21 years, he developed a large intra-abdominal non-seminomatous germ cell tumor arising from an undescended testis. The patient subsequently underwent an exploratory laparotomy with right radical orchidectomy and left orchidectomy, followed by advice to undergo adjuvant chemotherapy and regular follow-up.

Jaffe-Campanacci syndrome presenting as young stroke

2026-08-30T08:32:28+0530

Jaffe-Campanacci syndrome is a rare clinical entity characterized by multiple non-ossifying fibromas, café-au-lait macules, and various extraskeletal manifestations, which have a debated association with neurofibromatosis type 1. Fewer than 30 cases have been reported in the literature, making the diagnosis and characterization of this disease challenging. We report a rare case of a 16-year-old girl who presented with an acute onset of headache, left-sided weakness, slurring of speech, and sudden loss of consciousness. Neuroimaging revealed a right gangliocapsular haemorrhage with a midline shift, consistent with a haemorrhagic stroke. MRI confirmed a large subacute intracerebral haemorrhage, and genetic analysis revealed positivity for the NF1 gene mutation. This case is noteworthy because haemorrhagic stroke is an extremely uncommon presentation of Jaffe-Campanacci syndrome and highlights the possible association between vascular abnormalities and the syndrome. Early identification of the characteristic skeletal and cutaneous manifestations is essential for the correct diagnosis and correct medical management. Reporting such unusual presentations of Jaffe Campanacci syndrome contributes to a better understanding of the disease spectrum and its relationship with neurofibromatosis type 1.

Image-guided bone marrow aspirate concentrate and platelet-rich plasma therapy for a chronic high-grade anterior cruciate ligament tear: a case report

2026-08-30T08:32:08+0530

The anterior cruciate ligament (ACL) is a critical stabilizing structure of the knee joint, responsible for maintaining both anteroposterior and rotational stability. ACL injuries are among the most common sports-related ligamentous injuries to cause debilitating condition. Surgical reconstruction forms the end point of recommendation, nevertheless emerging techniques like orthobiologics using bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) form alternate therapy. A 26-year-old male cyclist and fitness enthusiast presented with chronic knee instability and functional limitation secondary to a high-grade ACL tear. The patient continued to experience recurrent episodes of instability and was advised to undergo ACL reconstruction. Reluctant to pursue surgical intervention, the patient opted to undergo image-guided orthobiologic treatment. BMAC and high-concentration PRP were administered under ultrasound and fluoroscopic guidance directly into the injured ACL fibers, infrapatellar region, and intra-articular compartment. The procedure was performed on an outpatient basis. Clinical follow-up demonstrated progressive functional improvement over six months. Resting pain resolved within the first month, while objective clinical examination revealed improvement in ligament stability as reflected by Lachman test (Grade II to Grade I) with a firm endpoint. At six months, the patient reported approximately 90% functional recovery, complete resolution of subjective instability episodes, and successful return to long-distance cycling, aerobic exercise, and agility-based activities without pain or stiffness which was noteworthy. The observed clinical and functional improvements suggest that targeted regenerative intervention(s) offer feasible line of treatment in the management of ACL tear where conventional conservative management has failed.

Pleomorphic invasive lobular carcinoma of the breast mimicking chronic abscess: a case report

2026-08-30T08:31:48+0530

Pleomorphic invasive lobular carcinoma (PLC) is a rare and aggressive subtype of invasive lobular carcinoma that can present with atypical clinical features, often resembling benign inflammatory conditions. A 36-year-old female presented at NIMS hospital, Jaipur, Rajasthan with diffuse swelling of the left breast, clinically suspected to be a chronic abscess. Imaging revealed an ill-defined lesion involving the entire breast. FNAC suggested malignancy. Modified radical mastectomy was performed. Histopathology confirmed pleomorphic invasive lobular carcinoma with extensive lymphovascular and perineural invasion and metastases in all 22 axillary lymph nodes. Immunohistochemistry showed Luminal B molecular subtype. PLC is an aggressive tumor that may mimic benign conditions, leading to diagnostic delay. Accurate diagnosis requires clinicoradiologic correlation and histopathological confirmation with immunohistochemistry.

Severe Plasmodium falciparum malaria: a multisystemic collapse with gangrene, acute kidney injury and seizures

2026-08-30T08:31:45+0530

Severe Plasmodium falciparum malaria is associated with life-threatening complications due to widespread microvascular dysfunction and multiorgan involvement. While cerebral malaria, acute kidney injury, and acute lung injury are recognized complications, rare manifestations such as peripheral gangrene and subarachnoid hemorrhage are seldom reported. We report the case of a 60-year-old female from rural India who presented with high-grade fever, chills, and respiratory distress. Laboratory evaluation confirmed P. falciparum malaria with severe parasitemia. Her clinical course was complicated by acute lung injury, generalized seizures, subarachnoid hemorrhage, acute kidney injury, coagulopathy, and evolving peripheral gangrene. She required intensive care support, intravenous artesunate, ventilatory assistance, anticonvulsants, and transfusions. Despite developing dry gangrene necessitating partial amputation of fingers, the patient improved with aggressive management and was discharged in stable condition. This case highlights the potential for P. falciparum malaria to cause rare and severe complications, including asymmetrical peripheral gangrene and subarachnoid hemorrhage. Early recognition of atypical manifestations, multidisciplinary care, and timely intervention are crucial for improving survival and reducing morbidity in severe malaria.

Perioperative adrenal crisis unmasking previously undiagnosed secondary adrenal insufficiency in a young woman with acute appendicitis: a case report

2026-08-30T08:31:43+0530

Secondary adrenal insufficiency often presents with vague, nonspecific symptoms and may remain undiagnosed until physiological stress precipitates adrenal crisis. A 19-year-old female presented with right lower quadrant abdominal pain, nausea, and light-headedness. Imaging findings were suspicious for acute appendicitis, and laparoscopic appendectomy was performed. Further history revealed a three-year history of intermittent dizziness, headaches, poor appetite, and generalized weakness that had never been evaluated. On admission, she had marked bilateral lower limb weakness despite unremarkable magnetic resonance imaging of the brain and spine. Laboratory evaluation demonstrated a morning cortisol level of 1.12 μg/dl, and subsequent testing revealed suppressed adrenocorticotropic hormone levels, consistent with secondary adrenal insufficiency. Following surgery, the patient developed hypotension, tachycardia, and tachypnoea despite initial management, raising concern for perioperative adrenal crisis. She responded to intravenous fluids and stress-dose hydrocortisone with rapid haemodynamic stabilization and gradual improvement in symptoms and mobility. This case highlights the diagnostic challenge of secondary adrenal insufficiency in young patients with longstanding nonspecific symptoms, particularly in the absence of characteristic electrolyte abnormalities. It also emphasizes that acute illness and surgical stress may unmask previously unrecognized adrenal insufficiency and underscores the importance of prompt recognition and glucocorticoid therapy to prevent potentially life-threatening complications.

An interesting case of Contarini’s syndrome in a young patient

2026-08-30T08:31:34+0530

Pleural effusion is a common disease of the pleura. The pleural effusion is usually unilateral and bilateral pleural effusion is less commonly seen. In bilateral pleural effusions usually the same etiology is present on both the sides but bilateral pleural effusions due to the two different etiologies on the two sides is rare. Here we are describing an interesting case of Contarini’s syndrome where exudative pleural effusion was present on each side but due to the two different etiologies on the two sides.

Hypokalemic periodic paralysis as an atypical presentation of primary hyperparathyroidism: a case report

2026-08-14T09:44:46+0530

Excess production of parathyroid hormone from a parathyroid adenoma or hyperplasia or carcinoma can lead to hypercalcemia. It produces a wide range of clinical manifestations ranging from abdominal pain to renal calculi. Other electrolyte abnormalities such as hypomagnesemia and hypokalemia are also seen. Complications due to hypokalemia primarily involves the cardiovascular system. Hypokalemic periodic paralysis is an unusual presentation of primary hyperparathyroidism. It presents with acute onset episodes of flaccid paralysis which usually improves following potassium supplementation. We report the case of a 37-year-old male presenting with acute weakness of the extremities with laboratory investigations suggestive of hypercalcemia, hypokalemia, normal anion gaps metabolic acidosis and alkaline urine suggestive of renal tubular acidosis. On further evaluation, the patient was identified to have a right parathyroid adenoma which was managed through surgical excision. Evaluation of secondary endocrine disorders that can lead to hypokalemia is important for early recognition and appropriate management.

Diogenes syndrome presenting with severe self-neglect and hoarding behaviour in an elderly woman: a case report

2026-08-19T09:38:31+0530

Diogenes syndrome (DS) is an uncommon behavioural condition characterized by severe self-neglect, domestic squalor, hoarding behaviour, social withdrawal, and poor insight. It is frequently associated with psychiatric or neurocognitive disorders but may also occur without a clearly identifiable underlying condition, making diagnosis challenging. We report a 76-year-old woman with a two-year history of collecting discarded materials, progressive deterioration in personal hygiene, and marked neglect of her living environment, along with recent forgetfulness. Despite severe behavioural disturbance, she remained oriented with preserved bedside memory. Clinical evaluation excluded psychotic, mood, obsessive-compulsive, and major neurocognitive disorders. She was managed with psychoeducation, behavioural strategies, caregiver involvement, and low-dose antipsychotic medication, resulting in gradual improvement over five months. This case highlights that severe self-neglect may occur despite preserved cognition, suggesting underlying executive dysfunction rather than global cognitive decline.

The ear, the nerves and the joints: a diagnostic puzzle in newly diagnosed HIV infection: a case report of HIV-associated inflammatory arthropathy mimicking Hansen disease and other infectious rheumatological mimics

2026-08-30T08:31:15+0530

A 53-year-old man with newly diagnosed HIV-1 infection (CD4+ T-cell count 178 cells/µL) developed a 3-month febrile inflammatory polyarthritis, dactylitis, painful auricular inflammation, nodular and ulcerative skin lesions, hypopigmented macules, and enlargement of bilateral common peroneal and ulnar nerves. Rheumatoid factor, anti-cyclic citrullinated peptide antibody and antinuclear antibody were negative. Slit-skin smears from two sites were negative for acid-fast bacilli (bacteriological index 0); the patient declined skin and lymph-node biopsies. Computed tomography of the chest showed bilateral cavitary consolidation, although sputum acid-fast smears and cartridge-based nucleic acid amplification testing were negative, mycobacterial culture was not performed, and bronchoscopic lavage was non-diagnostic. HIV-associated inflammatory arthropathy remained the working diagnosis. Arthritis and auricular inflammation improved during antiretroviral treatment, empirical antituberculous therapy and a tapering course of prednisolone, but Hansen disease and a lepra reaction could not be confidently excluded.

Guillain-Barré syndrome after living-related renal transplantation: a case report and literature review

2026-08-30T08:29:16+0530

Guillain-Barré syndrome (GBS) is a rare but potentially life-threatening neurological complication after kidney transplantation. Diagnosis may be challenging because its presentation can mimic calcineurin-inhibitor neurotoxicity, metabolic disturbances, or infection-related neuromuscular disorders. A 34-year-old man with a living-related renal transplant performed in 2020 presented with a two-day history of progressive ascending weakness, distal paresthesia, and an inability to ambulate following a self-limited diarrheal illness. A neurological examination revealed symmetric flaccid quadriparesis and generalized areflexia. Respiratory deterioration necessitated ventilatory support, while renal allograft function remained stable throughout his hospitalization. Cerebrospinal fluid analysis demonstrated albuminocytologic dissociation, and nerve-conduction studies showed prolonged distal and F-wave latencies with reduced conduction velocities. These findings were consistent with acute inflammatory demyelinating polyradiculoneuropathy. Cytomegalovirus DNA polymerase chain reaction testing was negative. The patient received intravenous immunoglobulin (2 g/kg over 5 days), ventilatory support, and intensive rehabilitation. Progressive neurological recovery began within the first week of treatment. He was successfully weaned from ventilatory support and regained independent ambulation. At the 3-month follow-up, his motor strength had completely recovered, with preserved renal allograft function and no neurological sequelae. GBS should be considered in kidney transplant recipients presenting with acute progressive weakness, even in the absence of active cytomegalovirus infection or graft dysfunction. Early cerebrospinal fluid evaluation, electrophysiological testing, and prompt administration of intravenous immunoglobulin can result in complete neurological recovery while preserving allograft function.

Efficacy of hand arm bimanual intensive therapy on upper limb co-ordination in a child with Rett syndrome: a case report

2026-08-30T08:30:04+0530

Rett syndrome (RTT) is a severe, progressive, neurodevelopmental disorder, which affects predominantly females. RTT is characterized by developmental regression of spoken language and hand use that, with hand stereotypies and impaired ambulation, constitute the four core diagnostic features. Children with RTT exhibit significant impairments in purposeful hand use and bimanual coordination due to neurodevelopmental regression, yet structured bimanual intervention protocols are sparsely reported. The aim of the study is to find out the efficacy of hand arm bimanual intensive therapy on upper limb co-ordination in a child with RTT. This study involved a child of age 4 years diagnosed with RTT, selected based on predefined inclusion and exclusion criteria. Prior informed consent was obtained from the parent/caregiver of the subject. A pre-test assessment was conducted to evaluate upper limb coordination by bimanual fine motor function classification. The child underwent hand arm bimanual intensive therapy for 4 weeks, with session conducted of 35-40 minutes per day, 4 sessions per week. Following the intervention period, the post-test was assessed by same outcome measure as in pre-test. Following the four weeks of intervention, the participant showed progressive improvement in upper limb coordination and bimanual functional performance, with observable gains in voluntary use of hand. The magnitude of improvement ranged from mild to moderate as suggested in bimanual fine motor classification, suggesting positive effects of hand arm bimanual intensive therapy. Hand arm bimanual intensive therapy improved upper limb coordination in child with Rett syndrome following a 4-week intervention.

Awake oral fibreoptic intubation with dexmedetomidine sedation in severe maxillofacial trauma following bear mauling: a case report

2026-08-30T08:29:13+0530

Awake fibreoptic intubation (AFOI) is considered the gold standard for securing the anticipated difficult airway. Sedation should provide comfort while preserving spontaneous ventilation and airway reflexes, with dexmedetomidine offering cooperative and arousable sedation. A 57-year-old male from a hilly district in North-East India presented with extensive facial lacerations and near-mutilation following a bear attack. Following resuscitation and primary wound closure, he was posted for emergency left eye evisceration. Airway assessment revealed restricted mouth opening with an un-assessable Mallampati class, while associated bony injuries had not been excluded. Communication was severely limited by facial trauma and a language barrier, necessitating a trained translator. Anticipating difficult bag-mask ventilation and intubation, awake oral fibreoptic intubation under dexmedetomidine sedation with airway blocks was planned. After high-risk consent, dexmedetomidine was administered with a 50-µg bolus followed by 0.4 µg/kg/h infusion. Antisialagogue premedication and airway anaesthesia using glossopharyngeal, bilateral superior laryngeal and transtracheal lignocaine blocks were provided within recommended dose limits. Oral AFOI using an armoured endotracheal tube was successfully achieved on the second attempt. Anaesthesia was subsequently maintained with inhalational agents and intermittent vecuronium. After reversal with sugammadex, extubation was performed when the patient was fully awake and obeying commands. This case highlights the role of dexmedetomidine-assisted awake oral fibreoptic intubation with airway blocks in severe maxillofacial trauma when the nasal route is unsuitable, emphasizing meticulous consent, documentation and management of language barriers in emergency anaesthesia.

Severe multiorgan toxicity following low-dose copper sulfate poisoning in a patient with Psoriasis vulgaris on methotrexate: a case report

2026-08-30T08:32:00+0530

Acute copper sulfate poisoning usually causes severe toxicity only after large ingestions. We report a man in his early 50s with psoriasis vulgaris receiving methotrexate who developed severe intravascular hemolysis, methemoglobinemia, acute hepatotoxicity, and acute kidney injury after ingesting only 1 g of copper sulfate. Serial peripheral blood smears, biochemical parameters, and clinical progression confirmed delayed multi-organ toxicity. He recovered following aggressive supportive care, forced alkaline diuresis, and withdrawal of methotrexate, without requiring dialysis. This case suggests that psoriasis-associated copper dysregulation and methotrexate-induced oxidative stress may lower the threshold for severe copper sulfate toxicity.

Traumatic primary enterocutaneous fistula: a case report

2026-08-30T08:35:31+0530

Enterocutaneous fistula (ECF) is an abnormal communication between the gastrointestinal tract and the skin. Approximately 80% of ECFs occur as a complication of surgical procedures, while the remaining 20% are associated with trauma, inflammatory bowel disease (such as Crohn’s disease), radiation exposure, or malignancy. In trauma patients without prior abdominal surgery, primary traumatic enterocutaneous fistulas (ECFs) are rare, accounting for less than 1.5% to 5% of all ECF cases. We present a case of a 14-year-old male who developed an enterocutaneous fistula following abdominal trauma caused by a bicycle handle injury. The patient presented with feculent discharge seven days after the incident. Notably, the site of trauma was located on the anterior abdominal wall, whereas the fistula opening was identified posteriorly, corresponding to the exact counterpoint of the injury. The patient had no prior history of any surgical intervention.

Liver cirrhosis in Bangladesh: a systematic review of etiology, complications and management gaps

2026-08-30T08:36:14+0530

Liver cirrhosis represents a significant and growing cause of morbidity and mortality in Bangladesh, reflecting the increasing burden of chronic liver diseases in low- and middle-income countries. This systematic review aims to evaluate the current etiological patterns of cirrhosis in Bangladesh, summarize its major complications and clinical outcomes, and identify critical gaps in prevention and management. A comprehensive literature search was conducted across MEDLINE/PubMed, Scopus, Web of Science, Google Scholar, and BanglaJOL from database inception to August 29, 2025. Eligible studies included observational studies, clinical trials, and national reports involving Bangladeshi populations with chronic liver disease or cirrhosis. Study selection, data extraction, and quality assessment followed PRISMA 2020 guidelines. Due to substantial methodological heterogeneity, findings were synthesized narratively. Of 1,847 identified records, 62 studies met eligibility criteria. Most were single-center hospital-based cross-sectional studies from tertiary centers in Dhaka. Hepatitis B virus (HBV) remains the predominant etiology, accounting for 30-60% of cirrhosis cases, while hepatitis C virus (HCV) contributes 5-20%. Recent meta-analyses indicate a pooled HBV prevalence of 4.0% (95% CI: 3.0-5.1%) in the general population. Non-alcoholic fatty liver disease (NAFLD/MASLD) has emerged as a rapidly increasing cause, with community prevalence of 25-35% among adults, rising to over 50% in individuals with metabolic risk factors. Major health system challenges include inadequate HBV/HCV screening, limited access to endoscopy and liver transplantation, insufficient hepatocellular carcinoma (HCC) surveillance, and absence of structured NAFLD/MASLD management pathways. Bangladesh is experiencing an epidemiological transition from viral to metabolic causes of cirrhosis, necessitating strengthened viral hepatitis control, expanded metabolic disease prevention, improved specialist services, and establishment of standardized national surveillance programs.

Role of biomarkers in management of laryngeal dysplasia: a systematic review

2026-08-30T08:30:00+0530

Laryngeal dysplasia is a premalignant lesion with variable potential for progression to laryngeal squamous cell carcinoma, highlighting the need for reliable biomarkers that can improve diagnosis, risk stratification, and patient surveillance. This systematic review evaluated the current evidence regarding the role of molecular and histological biomarkers in the management of laryngeal dysplasia. A comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for studies published between January 2020 and September 2025 in accordance with the PRISMA 2020 guidelines. Twenty-four eligible studies were included after screening 2,847 records. Data regarding biomarker type, study design, testing methods, and diagnostic and prognostic outcomes were extracted and synthesized qualitatively. The evidence demonstrated that overexpression of p53, Ki-67, and PD-L¹was consistently associated with an increased risk of malignant transformation. Dysregulated microRNAs, particularly miR-21, miR-146, and miR-223, together with DNA methylation markers, also showed promising diagnostic and prognostic utility. Combined biomarker panels consistently outperformed conventional histopathology alone, achieving reported sensitivity of up to 89% and specificity of up to 84% for predicting malignant transformation. Although the current evidence supports the potential clinical value of these biomarkers as adjuncts to histopathological assessment, considerable heterogeneity in study design, laboratory techniques, and reporting limits their routine clinical application. Further well-designed multicenter prospective studies with standardized biomarker assessment protocols are required before these biomarkers can be incorporated into routine clinical practice for the diagnosis, prognostication, and follow-up of patients with laryngeal dysplasia.

Addiction psychiatry and nursing: emerging research and the evolving roles of nurses

2026-08-30T08:35:33+0530

Substance use disorders (SUDs) represent a major global public health challenge associated with significant morbidity, mortality, psychiatric comorbidity, social disruption, and economic burden. Addiction psychiatry has evolved considerably over the past decade through advances in neurobiology, psychopharmacology, digital health, precision medicine, and integrated behavioral healthcare models. Concurrently, the role of nurses in addiction psychiatry has expanded beyond traditional bedside care to encompass prevention, screening, harm reduction, treatment coordination, psychotherapy, medication-assisted treatment (MAT) support, recovery-oriented care, research, leadership, and policy advocacy. Emerging evidence demonstrates that nurses are central to improving outcomes among individuals with SUDs, particularly in integrated mental health settings. Contemporary addiction nursing emphasizes person-centered care, trauma-informed approaches, stigma reduction, motivational interviewing, relapse prevention, and community engagement. This review examines current developments in addiction psychiatry and explores the evolving responsibilities of nurses across clinical, educational, research, and policy domains. The review synthesizes evidence from peer-reviewed literature published between 2019 and 2026, highlighting innovations, challenges, and future directions in addiction nursing practice. Findings indicate that advanced psychiatric nurses are increasingly involved in comprehensive assessment, integrated treatment planning, harm reduction initiatives, and management of dual diagnoses. Despite substantial progress, barriers such as workforce shortages, inadequate education, stigma, fragmented services, and limited policy support continue to impede optimal care delivery. Strengthening addiction-focused nursing education, expanding advanced practice roles, promoting interprofessional collaboration, and supporting evidence-based practice are critical for addressing the growing burden of SUDs.

Clinical readiness and generalizability of artificial intelligence in implant dentistry: a systematic review of diagnostic accuracy, treatment planning, prognosis and external validation

2026-08-30T08:28:58+0530

Artificial intelligence (AI) is increasingly being incorporated into digital dentistry. In implant dentistry, machine-learning and deep-learning systems have been investigated for radiographic diagnosis, anatomical segmentation, treatment planning, prosthetically driven implant positioning, and prediction of implant-related outcomes. To systematically evaluate the clinical applications of AI in implant dentistry, with particular emphasis on diagnostic accuracy, treatment planning, prognosis, external validation, generalizability, and clinical applicability. A systematic review will be conducted according to PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library will be searched from inception to the final search date. Studies evaluating AI, machine learning, deep learning, neural networks, or related computational approaches in human implant dentistry will be considered. Diagnostic studies will be assessed using QUADAS-², prognostic studies using QUAPAS where applicable, and prediction-model studies using PROBAST+AI. Reporting quality of prediction models will be assessed using TRIPOD+AI. Current evidence demonstrates promising AI performance in anatomical segmentation, CBCT analysis, implant treatment planning, prosthetically driven positioning, and prediction of implant-related outcomes. However, the literature is heterogeneous with respect to datasets, algorithms, reference standards, outcome definitions, validation procedures, and performance measures. Many studies remain retrospective, and external validation and evidence of clinical utility are comparatively limited. AI has considerable potential as a decision-support technology in implant dentistry. The principal research priority is now progression from technical accuracy toward externally validated, explainable, calibrated, clinically useful, and patient-centered AI systems. Keywords AI; machine learning; deep learning; dental implants; implant dentistry; CBCT; implant planning; implant prognosis; peri-implantitis; digital dentistry.

Anesthetic considerations and perioperative management in chronic obstructive pulmonary disease: from pre-anesthetic evaluation to safe extubation

2026-08-30T08:29:03+0530

Chronic obstructive pulmonary disease represents one of the most prevalent respiratory comorbidities in surgical patients and constitutes a major independent risk factor for postoperative pulmonary complications, alveolar collapse, and ventilatory failure. Anesthetic management demands a comprehensive understanding of underlying pathophysiological alterations, such as air trapping, auto-PEEP, and ventilation-perfusion mismatch. Objectives of the study were to analyze current evidence regarding pre-anesthetic optimization, selection of anesthetic techniques, intraoperative ventilatory support, and strategies for safe extubation in patients with chronic obstructive pulmonary disease. A narrative literature review of scientific articles published in biomedical databases (PubMed, Scopus, Web of Science) was conducted, focusing on perioperative pulmonary risk stratification, protective mechanical ventilation, neuromuscular blockade, and regional analgesia techniques. Preoperative optimization through smoking cessation, optimized bronchodilator therapy, and respiratory physiotherapy significantly reduces the incidence of postoperative pulmonary complications. During general anesthesia, protective ventilation strategies featuring low tidal volumes (6-8 ml/kg of predicted body weight), prolonged expiratory time to mitigate dynamic hyperinflation, and judicious PEEP titration improve gas exchange. Regional anesthetic and analgesic techniques demonstrate a distinct advantage by preserving respiratory mechanics and decreasing opioid consumption. Complete, quantitative reversal of neuromuscular blockade represents a critical cornerstone in preventing extubation failure. Successful perioperative management of patients with chronic obstructive pulmonary disease requires a coordinated strategy spanning from precise risk stratification to structured ventilatory weaning. Strict application of intraoperative protective ventilation and optimized analgesic control significantly decrease morbidity, mortality, and hospital length of stay.

The role of epigenetics in the pathogenesis of cutaneous diseases: a comprehensive review

2026-08-30T08:28:59+0530

Epigenetics has recently emerged as a highly innovative and dynamic area of study within dermatology. This field concentrates on modifications to gene expression that occur without altering the underlying DNA sequence. These altered expressions were initiated by environmental influences and lifestyle choices, and play a fundamental role in both the onset and progression of numerous dermatological disorders. This article aims to delineate the essential roles that epigenetic modifications play in driving the pathogenesis of diverse dermatological disorders, as well as to highlight their clinical applications within current skin research. A comprehensive review of recent literature was conducted to elucidate the role of epigenetic perturbations in driving skin disease pathogenesis, illustrate cutaneous responses to environmental stimuli, and evaluate therapeutic trials aimed at reversing these epigenetic shifts. This article comprehensively outlines the pivotal role of epigenetic modifications; specifically, DNA methylation, histone modification, and non-coding RNA pathways, in the pathogenesis of various dermatological disorders. Epigenetics offers a promising paradigm shift toward targeted interventions for traditionally imprecise dermatological treatments. The sheer multiplicity and redundancy of disease-associated epigenetic modifications frequently bottleneck therapeutic innovation. Overcoming this barrier requires a transition from symptomatic management to personalized medicine that can precisely reset disease-driving epigenetic switches.

Nanotechnology in dental implantology

2026-08-30T08:31:11+0530

Nanotechnology has expanded dental implant surface engineering from conventional macro- and microscale modification to deliberate control of surface characteristics at the nanometre scale. Nanostructured surfaces can modify surface chemistry, energy, roughness, wettability and topography, thereby influencing protein adsorption, cellular adhesion, differentiation and bone formation. Titanium and its alloys remain the principal materials for endosseous dental implants, while nanoscale modification using titanium dioxide nanotubes, hydroxyapatite, calcium phosphate, metallic nanoparticles, bioactive glass, polymers and hybrid coatings has been investigated to improve biological performance. Systematic evidence supports promising preclinical antibacterial effects of TiO₂ nanotubes, but clinical translation remains limited. Studies also emphasize the potential of nano-engineered surfaces to modulate inflammation, osteogenesis, corrosion resistance and localized drug delivery.

Team nursing as a strategic response to the global nursing workforce shortage: challenges, opportunities and future directions

2026-08-30T08:31:19+0530

The global nursing workforce shortage threatens patient safety, healthcare quality, workforce sustainability, and progress toward universal health coverage. Although expansion of nursing education and recruitment remains essential, increasing workforce numbers alone cannot provide an immediate solution to persistent shortages, maldistribution, burnout, turnover, skill-mix imbalances, and increasing clinical complexity. Team nursing, a collaborative care-delivery model in which nursing personnel with complementary competencies provide coordinated care under registered nurse leadership, has re-emerged as a potentially valuable workforce strategy. This narrative review examines the contemporary relevance of team nursing, its potential contribution to workforce optimization, associated implementation challenges, and future directions. Current evidence suggests that appropriately designed team nursing may improve workload distribution, optimize skill utilization, support novice nurses, strengthen collaboration, and increase organizational flexibility. However, poorly implemented models may contribute to fragmented care, communication failures, role ambiguity, inappropriate delegation, and excessive supervisory burden. Team nursing should therefore not be interpreted as a substitute for adequate staffing or as a mechanism for replacing registered nurses with less-qualified personnel. Its effectiveness depends on acuity-informed staffing, competency-based delegation, clear accountability, stable team composition, supportive leadership, and structured communication. Future models should integrate real-time workload assessment, digital coordination, competency mapping, and continuous outcome monitoring while preserving registered nurse accountability. Team nursing may serve as a pragmatic component of broader workforce reform, but its success depends on context-sensitive implementation, protection of professional nursing expertise, and rigorous evaluation.

Role of physiological evacuation in health preservation: a narrative review

2026-08-30T08:35:55+0530

Physiological evacuation (Istifrāgh-e-tabī) is an essential physiological process described in Unani medicine through which the body naturally eliminates Fuḍlāt (metabolic waste products) generated during digestion and metabolism. Proper physiological evacuation is considered crucial for maintaining humoral equilibrium, preserving Ḥarārat Gharīzī (innate heat), and preventing disease. This narrative review examined Unani literature alongside contemporary biomedical evidence retrieved from PubMed, Scopus, ScienceDirect, Web of Science, Google Scholar, and the AYUSH Research Portal. The literature was critically analyzed to explore the formation of Fuḍlāt, the concept of Huḍūm Arba‘a, and the physiological pathways of waste elimination, including gastrointestinal, renal, respiratory, cutaneous, and secretory routes. Classical Unani descriptions of Barāz (feces), Bawl (urine), Ḥayḍ (menstruation), ‘Araq (sweat), Laban (breast milk), Tanaffus (respiration), Lu‘āb (saliva), and Ānsū (tears) were found to correspond conceptually with modern physiological mechanisms responsible for removing carbon dioxide, urea, uric acid, creatinine, bile pigments, excess electrolytes, and inflammatory metabolites. Effective physiological evacuation supports metabolic homeostasis, immune regulation, acid–base balance, thermoregulation, and tissue health, whereas impaired clearance contributes to oxidative stress, inflammation, and metabolic dysfunction. The review demonstrates a strong conceptual similarity between Unani principles and modern biomedical understanding of physiological waste elimination, highlighting the potential relevance of Istifrāgh-e-Ṭabī in preventive and integrative healthcare.

Polyherbal formulations for sustainable glycemic control in diabetes mellitus: phytochemical profiling, mechanistic insights, standardization and integration with conventional therapeutic approaches

2026-08-30T08:35:53+0530

Diabetes mellitus is a chronic metabolic disease characterized by insulin resistance and pancreatic β-cell dysfunction persistent hyperglycemia, contributing to severe complications including cardiovascular, renal, hepatic, and neurological disorders. Worldwide incidence of diabetes has risen significantly, with over 537 million individuals affected in 2021, and projections indicate 783 million by 2045, imposing a significant public health and economic burden. Polyherbalism leverages synergistic interactions between multiple medicinal plants, enhancing therapeutic efficacy while minimizing toxicity. Commonly studied antidiabetic plants include Momordica charantia, Gymnema sylvestre, Trigonella foenum-graecum, Syzygium cumini, and Ocimum sanctum, which demonstrate hypoglycemic, antioxidant, and antihyperlipidemic activities by pathway like β-cell regeneration, decreased of glucose assimilation, and modulation of oxidative stress. This review highlights the potential of polyherbal formulations as safe, economically viable, and multi-targeted interventions for sustainable glycemic control, emphasizing the need for rigorous pharmacological, clinical, and formulation research to integrate traditional remedies into modern diabetes management.

Current perspectives on surgical antibiotic prophylaxis: guideline recommendations, prescribing patterns, antimicrobial resistance and future directions

2026-08-30T08:32:27+0530

Surgical antibiotic prophylaxis is an essential component of peri-operative infection prevention and plays an important role in reducing surgical site infections. Although guidelines and evidence-based approaches have been agreed upon on an international level, there is still a great deal of variation between healthcare institutions in the way that they prescribe, which can result in antimicrobial resistance, higher healthcare costs and morbidity among patients. This review highlights existing guidance for the use of surgical antibiotic prophylaxis (SAP), reviews the current antibiotic use trends, explores typical prescribing errors and adherence to guidelines, and explores their impact on AMR and clinical outcomes. A literature review was undertaken using international guidelines, peer-reviewed publications, surveillance reports and systematic reviews with a particular focus on antibiotic selection, timing of antibiotic prophylaxis, Duration of antibiotic prophylaxis, interventions to support antimicrobial stewardship and antibiotic prescribing practices in tertiary care, and emerging strategies to optimize SAP. There is evidence that proper implementation of the SAP guidelines lessens the risk of surgical site infections (SSIs). Inappropriate practices, such as the use of broad-spectrum antibiotics, delayed treatment and extended antibiotic coverage after surgery, however, are still common and lead to greater AMR, healthcare costs, and poor clinical outcomes. Rational antibiotic use can be achieved with antimicrobial stewardship initiatives, prescription audits, clinical pharmacist involvement, and/or electronic decision-support systems. While SAP continues to play a key role in preventing SSIs, it must be implemented in accordance with evidence-based recommendations. Enhancing antimicrobial stewardship, optimizing prescribing and implementing supportive technologies can optimize SAP, limit AMR, and improve surgical patient outcomes.

The efficacy of task-oriented training in patients with diabetic peripheral neuropathy: a narrative review

2026-08-30T08:32:15+0530

Diabetic peripheral neuropathy is one of the most common complications of diabetes mellitus and is frequently associated with impaired balance, reduced proprioception, gait abnormalities, and an increased risk of falls. Various rehabilitation interventions have been developed to address these deficits and improve functional performance in affected individuals. The aim of this review is to determine the effectiveness of task oriented training in patients with Diabetic Peripheral Neuropathy. A review of literature was conducted using 11 studies published between 2011 and 2025. The selected studies investigated different rehabilitation approaches, including task-oriented training, balance and stability training, Biodex Balance System training, biofeedback-based interventions, multisensory training, augmented feedback training, and sensorimotor gait training. Information related to study objectives, methodology, interventions, outcomes, and conclusions was extracted and analyzed. A total 11 studies reviewed, 10 reported significant improvements in balance and postural stability, 3 demonstrated improvements in coordination, 3 reported enhanced gait performance and functional mobility, 3 evaluated task-oriented training, and 1 investigated sensorimotor training. Technology-assisted interventions such as Biodex Balance System and Stability Trainer exercises showed superior outcomes compared to conventional physiotherapy in several studies. Improvements were also observed in proprioception, muscle activation, balance confidence, and fall-risk reduction. The findings of this review indicate that rehabilitation interventions are effective in improving balance, coordination, gait performance, proprioception, and functional mobility among individuals with diabetic peripheral neuropathy. Interventions incorporating task-oriented activities, sensory feedback, biofeedback technology, and progressive balance challenges appear to provide the greatest benefits.

Burnout among doctors in India: epidemiology, determinants, consequences and policy imperatives

2026-08-30T08:31:57+0530

Physician burnout, characterised by emotional exhaustion, depersonalisation and reduced professional accomplishment, is a major concern in India’s healthcare system. This review synthesised evidence on the prevalence, determinants, consequences and policy gaps related to physician burnout in India. Systematic searches of PubMed, Google Scholar and IndMED databases between January 2010 and December 2024 using the terms ("physician burnout" OR "occupational stress") AND ("India" OR "Indian"). WHO publications, National Health Profile reports, and National Medical Commission directives were grey literature that were reviewed. Studies utilising validated tools (Maslach Burnout Inventory, Copenhagen Burnout Inventory) and policy evaluations of working circumstances were given priority under the inclusion criteria. Career-stage stratification is seen in the incidence of burnout: 30–75% among medical students, 60–80% among residents (with a high of 85% in surgical specialities), and 35–65% among practicing physicians. An extra 600,000 doctors are needed nationwide due to critical labour shortages. Reduced patient safety, increased depression and suicidal ideation risks, and attrition in the healthcare system are some of the consequences. Current regulations lack nationally standardised, quantitatively defined and enforceable duty-hour limits and mandated institutional wellness infrastructure. Physician burnout is a systemic failure that calls for coordinated interventions, such as mandatory institutional wellness infrastructure, medicolegal reform, nationally standardised duty-hour regulations, strategic workforce expansion with equitable distribution, and cultural transformation that positions wellbeing as a professional competency. For policy accountability and adaptive improvement, national surveillance mechanisms must be established.

Falls in the geriatric population with epilepsy: a narrative review

2026-08-30T08:31:54+0530

Epilepsy is a common neurological disorder in older adults, with incidence rising significantly after 60 years of age. Falls represent a major source of morbidity and mortality in this population and occur more frequently in individuals with epilepsy than in age-matched controls. The increased risk is multifactorial, resulting from seizure-related events, adverse effects of antiseizure medications (ASMs), and age-related physiological changes such as impaired balance, frailty, cognitive decline, and comorbidities. Seizures may directly precipitate falls through loss of consciousness, impaired awareness, and postictal confusion, while ASMs contribute via dizziness, sedation, ataxia, and visual disturbances. Evidence from systematic reviews demonstrates a clear association between ASM use and increased fall risk in older adults. Fall-related injuries, including fractures and traumatic brain injury, lead to functional decline, reduced independence, and increased healthcare utilization. Effective management requires a multidisciplinary approach focused on optimizing seizure control, minimizing medication-related adverse effects, improving balance and mobility, and addressing environmental hazards. Early identification of high-risk individuals and implementation of targeted preventive strategies are essential to reduce fall-related complications and improve clinical outcomes in the geriatric epilepsy population.

Biomaterials in prosthodontics: current trends and future directions

2026-08-30T08:31:31+0530

Alqutaibi AY, Baik A, Almuzaini SA, Farghal AE, Alnazzawi AA, Borzangy S, et al. Polymeric denture base materials: a review. Polymers (Basel). 2023;15(15):3258.
Pjetursson BE, Sailer I, Makarov NA, Zwahlen M, Thoma DS. All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part II: multiple-unit FDPs. Dent Mater. 2015;31(6):624-39.
Osman RB, Swain MV. A critical review of dental implant materials with an emphasis on titanium versus zirconia. Materials (Basel). 2015;8(3):932-58.
Rezaie F, Farshbaf M, Dahri M, Masjedi M, Maleki R, Amini F, et al. 3D printing of dental prostheses: current and emerging applications. J Compos Sci. 2023;7(2):80.
Alghazzawi TF. Advancements in CAD/CAM technology: options for practical implementation. J Prosthodont Res. 2016;60(2):72-84.
Javaid M, Haleem A. Current status and applications of additive manufacturing in dentistry: a literature-based review. J Oral Biol Craniofac Res. 2019;9(3):179-85.
Vallittu PK, Boccaccini AR, Hupa L, Watts DC. Bioactive dental materials—do they exist and what does bioactivity mean? Dent Mater. 2018;34(5):693-4.
Sun J, Jiang J, Huang Z, Ma X, Shen T, Pan J, et al. Smart biomaterials in restorative dentistry: recent advances and future perspectives. Mater Today Bio. 2025;35:102349.
Revilla-León M, Özcan M. Additive manufacturing technologies used for processing polymers: current status and potential application in prosthetic dentistry. J Prosthodont. 2019;28(2):146-58.
Najeeb S, Zafar MS, Khurshid Z, Siddiqui F. Applications of polyetheretherketone (PEEK) in oral implantology and prosthodontics. J Prosthodont Res. 2016;60(1):12-9.
Albrektsson T, Wennerberg A. Oral implant surfaces: part 2—review focusing on clinical knowledge of different surfaces. Int J Prosthodont. 2004;17(5):544-64.
Tappa K, Jammalamadaka U. Novel biomaterials used in medical 3D printing techniques. J Funct Biomater. 2018;9(1):17.
Liu Y, Fang M, Zhao R, Liu H, Li K, Tian M, et al. Clinical applications of polyetheretherketone in removable dental prostheses: accuracy, characteristics, and performance. Polymers (Basel). 2022;14(21):4615.
Chander NG, Gopi A. Trends and future perspectives of 3D printing in prosthodontics. Med J Armed Forces India. 2024;80(4):399-403.
Hench LL, Jones JR. Bioactive glasses: frontiers and challenges. Front Bioeng Biotechnol. 2015;3:194.
Albrektsson T, Brånemark PI, Hansson HA, Lindström J. Osseointegrated titanium implants: requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand. 1981;52(2):155-70.
Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JYK. Clinical complications with implants and implant prostheses. J Prosthet Dent. 2003;90(2):121-32.
Padhye NM, Calciolari E, Zuercher AN, Tagliaferri S, Donos N. Survival and success of zirconia compared with titanium implants: a systematic review and meta-analysis. Clin Oral Investig. 2023;27(11):6279-90.
Souza JGS, Nagay BE, Martins R, Bertolini M, Shibli JA, Aparicio C, et al. Engineered surface strategies to manage dental implant-related infections. Periodontol 2000. 2025;00:1-56.
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A comprehensive review of renal calculi (Ḥaṣā al-Kulya): Unani and modern understanding

2026-08-30T08:29:12+0530

Nephrolithiasis, commonly termed urolithiasis, is characterized by the development of calculi anywhere within the urinary tract. The occurrence of this condition varies across different regions and is influenced by multiple factors, including climate, age, gender, dietary patterns, and genetic predisposition. The highest incidence is typically reported during the second and third decades of life, with males being affected more frequently than females in an approximate ratio of 2:1. Stone formation results from supersaturation of urinary solutes such as calcium, oxalate, and uric acid, along with low levels of citrate. This physicochemical imbalance promotes crystal aggregation and subsequent calculus formation. From the perspective of Unani medicine, calculi (Ḥaṣā) are believed to develop due to the retention and accumulation of dense, morbid matter (Mādda Ghalīẓ) within the organs, coupled with impaired expulsion. Progressive deposition of this material eventually leads to stone formation. The concept of Hararat (heat) contributes to the evaporation of Ratubat (moisture), resulting in desiccation (Tajfīf), condensation, and hardening of the retained matter into calculi.

Touchless monitoring in medical-surgical nursing: clinical applications of radar, camera-based and contact-free vital sign technologies: a narrative review

2026-08-30T08:29:05+0530

Touchless monitoring technologies have emerged as an innovative approach to continuous physiological surveillance in medical-surgical nursing by enabling the assessment of vital signs without direct physical contact. Conventional contact-based monitoring systems, although reliable, are associated with limitations such as patient discomfort, skin injury, sensor displacement, false alarms and increased risk of infection transmission. Recent advances in radar-based sensing, camera-based monitoring, remote photoplethysmography, thermal infrared imaging, radiofrequency sensing, ballistocardiography and artificial intelligence (AI) have facilitated accurate, real-time monitoring of respiratory rate, heart rate, body temperature, movement patterns, sleep behaviour and tissue perfusion. This narrative review summarizes current evidence regarding the principles, clinical applications, advantages, challenges and future directions of touchless monitoring technologies in medical-surgical nursing. The reviewed literature indicates that these technologies can enhance early recognition of physiological deterioration, improve patient comfort, preserve skin integrity, reduce unnecessary physical contact and strengthen patient safety across postoperative care, intensive care, burn management, rehabilitation, infection prevention and remote patient monitoring. AI-driven predictive analytics further improve clinical decision-making by identifying subtle physiological changes before overt deterioration occurs. Despite these advantages, barriers including measurement accuracy, motion artefacts, interoperability, cybersecurity, implementation costs, ethical concerns and workforce preparedness continue to limit widespread clinical adoption. Touchless monitoring should be considered a complementary clinical decision-support tool that augments rather than replaces comprehensive nursing assessment. Continued technological innovation, rigorous clinical validation, standardized implementation strategies and ongoing nursing education are essential for the safe, effective and ethical integration of these technologies into evidence-based medical-surgical nursing practice.

From static to dynamic prosthodontics: digital recording of mandibular function for personalized prosthetic rehabilitation

2026-08-30T08:28:57+0530

Conventional prosthodontic diagnosis and treatment planning rely extensively on static records such as diagnostic casts, maxillomandibular relationship records, facebow transfers, interocclusal records, and mechanical articulators. Although these methods remain clinically valuable, they provide only a limited representation of the continuously changing relationship between the maxilla, mandible, temporomandibular joints, dentition, and neuromuscular system. Advances in digital dentistry have enabled the acquisition of three-dimensional anatomical information together with patient-specific mandibular movement. Intraoral scanning, facial scanning, cone-beam computed tomography, digital maxillomandibular registration, optical jaw tracking, computerized occlusal analysis, and virtual articulation can now be combined to develop increasingly comprehensive digital representations of the prosthodontic patient. Incorporating movement into a three-dimensional virtual patient introduces a fourth dimension-time-and provides an opportunity to evaluate prosthetic designs under dynamic rather than purely static conditions. This transition may be particularly relevant to complete dentures, implant-supported prostheses, and extensive restorative rehabilitation. However, differences among acquisition systems, registration errors, limited standardization, equipment costs, and insufficient long-term clinical evidence currently restrict widespread implementation. This narrative review discusses the evolution from static to dynamic prosthodontic records, contemporary technologies for recording mandibular function, their integration with virtual articulation, and their potential contribution to personalized prosthetic rehabilitation. Emerging concepts including four-dimensional virtual patients, artificial intelligence-assisted movement analysis, and functional digital twins are also considered.

Digital impressions in contemporary prosthodontics: an overview of intraoral scanning technology, applications and future trends

2026-08-30T08:28:55+0530

Digital technology has progressed significantly in recent years, resulting in substantial advancements in dentistry. The integration of computer-aided design and computer-aided manufacturing (CAD/CAM) has simplified clinical procedures while improving precision, efficiency, and communication between clinicians and dental laboratories. The introduction of intraoral scanners (IOS), together with advances in CAD/CAM technology, has further transformed conventional impression procedures. Digital impressions improve patient comfort, facilitate immediate visualization of the scanned area, simplify data storage, and enable rapid electronic transfer of information to dental laboratories. Recent investigations have demonstrated that digital impressions can provide clinically acceptable accuracy for many fixed prosthodontic and implant-supported restorations. However, their accuracy is influenced by scanner characteristics, scanning strategy, scan length, operator experience, surface characteristics, and intraoral conditions. Recent advances in artificial intelligence, photogrammetry, cloud-based platforms, and three-dimensional printing are expected to further expand their clinical applications.

Post-vaccination hepatitis B seroprotection among kidney transplant recipients in Saudi Arabia: a retrospective cohort study

2026-08-12T09:40:35+0530

Background: Evidence regarding post-vaccination hepatitis B virus (HBV) seroprotection among kidney transplant recipients in Saudi Arabia remains limited. This study estimated the prevalence of seroprotection and evaluated factors associated with vaccine nonresponse.

Methods: This single-center retrospective cohort study included adult kidney transplant recipients followed at Prince Sultan Military Medical City, Riyadh, Saudi Arabia, who had documented hepatitis B vaccination and subsequent quantitative measurement of antibodies to hepatitis B surface antigen (anti-HBs). Seroprotection was defined as an anti-HBs concentration of at least 10 mIU/ml. Participant characteristics were compared according to seroprotection status. Multivariable logistic regression was used to evaluate associations between non-seroprotection and total number of hepatitis B vaccine doses.

Results: Among 100 kidney transplant recipients, the mean (SD) age was 41.4 (15.2) years, and 66 participants (66.0%) were male. Overall, 69 recipients achieved seroprotection (69.0%; 95% CI, 59.4-77.2%), whereas 31 (31.0%) remained non-seroprotected. Vaccine dose category differed significantly by seroprotection status (p=0.014); 80.6% of non-seroprotected recipients had received only 1 to 2 doses compared with 50.7% of seroprotected recipients. In the adjusted model, no variable was independently associated with non-seroprotection. Each 10-year increase in age was associated with higher, but not statistically significant, odds of non-seroprotection (aOR, 1.44; 95% CI, 0.96-2.16; p=0.079).

Conclusions: Nearly one-third of vaccinated kidney transplant recipients lacked serological protection against HBV. Routine post-vaccination anti-HBs testing and individualized booster or revaccination strategies should be considered, particularly for older recipients and those who have received fewer vaccine doses.

Experimental characterization of ionization chamber stem effects in low-density media for flattened and flattening-filter-free photon beams

2026-08-30T08:36:10+0530

Background: Accurate dosimetry in low-density media is essential for stereotactic body radiation therapy (SBRT) of lung tumors, particularly with small radiation fields and flattening filter-free (FFF) photon beams. This study experimentally evaluated ionization chamber stem effects under low-density conditions.

Methods: This experimental dosimetric study was conducted from March 2025 to June 2025 at the Department of Radiation Oncology, Sutter Gould Medical Foundation, Modesto, CA, USA. A PTW TN30013 Farmer-type ionization chamber was evaluated for 6 MV, 6 MV FFF, 10 MV and 10 MV FFF photon beams in a low-density Styrofoam phantom (0.04–0.05 g/cm³) and in-air conditions for field sizes ranging from 2×2 cm² to 20×20 cm² and depths from 1.5 to 20 cm.

Results: Within the phantom, ionization readings for FFF beams were 5–20% lower than those for flattened beams at shallow depths due to reduced scatter. In-air measurements for FFF beams were up to 30% higher than flattened beams for small field sizes. Stem effects remained below 0.6% across all tested conditions. Collimator rotation dependence was negligible (<0.05%, p>0.05). Significant interactions between beam type, setup and depth were observed (p<0.001).

Conclusions: The PTW TN30013 chamber demonstrated stable and reliable performance in low-density media relevant to lung SBRT. Stem-related perturbations were clinically negligible, although beam-specific correction factors remain important for FFF small-field dosimetry.

Trimester specific changes in nutritional and iron related biomarkers among pregnant women in Calabar, Nigeria: a longitudinal study

2026-08-30T08:36:13+0530

Background: Nutritional deficiencies are common in pregnant women in developing countries and contribute to poor pregnancy outcomes. This longitudinal study assessed trimester‑specific trends in nutritional and iron‑related biomarkers in Calabar, Nigeria.

Methods: Seventy‑two pregnant women (18-41 years) were enrolled in the first trimester and followed to the third trimester at the University of Calabar Teaching Hospital. Fifty age‑ and parity‑matched non‑pregnant women served as controls. Blood samples were collected at 10, 24 and 36 weeks of gestation. Total protein, albumin, iron, unsaturated iron‑binding capacity (UIBC), ferritin, folate, vitamin B12 and soluble transferrin receptors (sTfR) were analysed; total iron‑binding capacity (TIBC) and transferrin saturation (TS) were calculated.

Results: Albumin, folate and vitamin B12 were significantly lower in pregnant women by the second trimester compared to non‑pregnant controls. Within the pregnant cohort, albumin (39.6±7.7 to 24.3±2.7 g/L, p=0.001), ferritin (65.7±54.8 to 30.3±20.4 ng/mL, p=0.01) and total protein (74.4±12.4 to 60.5±4.1 g/L, p=0.01) declined progressively. Folate dipped in the second trimester (14.8±8.2 ng/mL) before rising in the third. Serum iron and TS% increased significantly in the third trimester. Over 90% of participants had abnormal total protein or albumin levels by the third trimester.

Conclusions: Key nutritional biomarkers decline significantly in the second and third trimesters, supporting enhanced targeted nutritional monitoring and interventions in later pregnancy.

The epidemiology of femoral head osteonecrosis in Bangladesh: a population-based study of etiological prevalence and risk factors

2026-08-30T08:35:57+0530

Background: Femoral head osteonecrosis (FHO) is a debilitating condition leading to progressive hip joint destruction. Epidemiological data in Bangladesh are limited. This study aimed to describe the demographic profile, etiology, sex distribution, affected side, and residence patterns among patients with FHO.

Methods: A cross-sectional study was conducted on 122 patients diagnosed with FHO. Data were collected on age, sex, occupation, residence, etiology, and affected side. Descriptive statistics were used for frequency and percentage distributions. Associations between categorical variables, including sex and residence with etiology, were analyzed using Fisher’s exact test.

Results: The study population comprised 72 males (59%) and 50 females (41%). The most affected age group was 18–29 years (42.6%). Rural patients accounted for 65.6% of the cohort. Idiopathic FHO was the predominant etiology (41%), followed by steroid-induced cases (27.9%) and trauma (13.1%). Ankylosing spondylitis, alcohol intake, sequelae of Perthes disease, and thalassemia were less common. Right hip involvement occurred in 44.3% of patients, left in 18%, and bilateral in 37.7%. Sex distribution showed idiopathic FHO was more frequent in males (41.7%), while steroid-induced cases were higher in females (44%), with a statistically significant association (p < 0.001). Residence did not show a significant association with etiology (p = 0.288).

Conclusions: Idiopathic and steroid-induced osteonecrosis are the leading causes of FHO in Bangladesh, with males more frequently affected and a high proportion of rural cases. The findings highlight the need for targeted awareness, early diagnosis, and management strategies, particularly in young adults and rural populations.

Determinants of vaccine hesitancy among parents: a cross-sectional survey-based study

2026-08-30T08:31:38+0530

Background: Vaccine hesitancy is among the top 10 global health threats. In Saudi Arabia, despite good vaccination coverage (e.g., 96% for measles-mumps-rubella), parental confidence is low. This study assessed the frequency of vaccine hesitancy among parents in Taif City, Saudi Arabia, and its associated demographic and health-related characteristics, including domain-specific attitudes (behavior, attitude, safety, and efficacy).

Methods: Parents of children aged 2 months-7 years completed an online Arabic questionnaire collecting sociodemographic data, vaccination history, and the parent attitudes on childhood vaccines (PACV) measure. The scale ranged from 0 to 100, with a score of 50 or higher suggesting indecision. Associations were analyzed by the chi-square or Fisher’s exact test, the Mann-Whitney U test, or the Kruskal-Wallis H test.

Results: The prevalence of hesitating was 19.8% (87/440). The mean PACV score was 34.1±19.4. The highest score was in the attitude category (4.99±3.9), followed by safety and efficacy (4.12±2.5) and behavior (1.03±1.4). Strong predictors were divorced or widowed status (50.0% versus 17.2%; p<0.001), younger age (75.0%; p=0.017), incomplete immunization (38.5% versus 14.2%; p<0.001), and previous refusal (62.3% versus 14.0%; p<0.001).

Conclusions: Hesitancy towards vaccination was observed among ~20% of the parents in Taif. Their attitudes and concerns regarding safety and efficacy were of great significance. General hesitancy is low, but specific communication strategies, systematic screening with the PACV measure, and interventions for first-time parents and single mothers are recommended.

Text neck syndrome and early cervical spondylosis among young Sudanese adults: a cross-sectional study of digital device use, postural habits and neurological symptoms

2026-08-30T08:32:13+0530

Background: Text neck syndrome and early cervical spondylosis are increasingly prevalent among young adults due to prolonged electronic device usage and inadequate postural practices. This study examined the burden of text neck syndrome and its association with digital device use, posture, and neurological symptoms among young Sudanese people.

Methods: A descriptive cross-sectional hospital-based study was conducted at the Neurology Clinic of Prince Digna Referral Hospital, Sudan, between November 2024 and January 2025. A total of 174 participants aged 17–63 years were recruited using convenience sampling. Data were collected using a structured interviewer-administered questionnaire and clinical assessment. Statistical analysis was performed using SPSS version 26.

Results: The median age of participants was 34 years (IQR: 28-42 years), and 50.6% were females. Prolonged screen exposure exceeding 6 hours/day was reported by 69.5%, while 96.6% adopted forward head posture during device use. Neck pain and neck stiffness were reported by 99.4% and 97.1% of participants, respectively. Neurological symptoms included upper-limb numbness (43.7%) and weakness (24.1%). Daily screen time demonstrated a weak positive correlation with neck pain severity (r_s=0.23, p=0.002). Prolonged screen exposure independently predicted severe cervical symptoms (AOR=4.21, 95% CI: 2.01-8.83, p<0.001). Receiver operating characteristic analysis demonstrated good predictive performance for screen exposure duration (AUC=0.81).

Conclusions: Text neck syndrome symptoms and manifestations suggestive of early cervical spondylosis represent a substantial clinical burden among Sudanese adults and are associated with prolonged screen exposure, forward head posture, and poor ergonomic awareness.

Impact of obesity on clinical and angiographic characteristics in patients with ST-elevation myocardial infarction

2026-08-30T08:31:26+0530

Background: Obesity is a well-established cardiovascular risk factor and is strongly associated with metabolic dysregulation, systemic inflammation, and accelerated atherosclerosis. However, its influence on clinical presentation, laboratory parameters, and coronary angiographic characteristics in patients with ST-elevation myocardial infarction (STEMI) remains controversial.

Methods: The study included 75 patients with STEMI who were admitted to the Grodno Regional Cardiological Center (Belarus) for treatment from July to October 2025. Patients were divided into two groups according to body mass index (BMI): group 1 (obese, BMI≥30 kg/m²; n=37) and group 2 (non-obese, BMI≤29.9 kg/m²; n=38). All patients underwent clinical, laboratory, and instrumental studies. Statistical analysis was performed using STATISTICA 12.0.

Results: Obese patients had a significantly higher prevalence of diabetes mellitus compared with non-obese patients (35.13% versus 7.89%, p=0.04). They also demonstrated a distinct metabolic profile characterized by higher triglycerides (p=0.001) and lower HDL cholesterol concentrations (p=0.037). No significant differences were observed in cardiac biomarkers, or renal function parameters. Angiographically, involvement of the left anterior descending artery (p=0.025) and left circumflex artery (p=0.03) was more frequent in obese patients. The rate of percutaneous coronary intervention and the number of implanted stents were comparable between groups.

Conclusions: Obesity in STEMI patients is associated with a higher burden of metabolic disturbances and more frequent multi-vessel coronary involvement, particularly affecting the left coronary system. These findings highlight the complex interaction between adiposity, metabolic dysregulation, and atherosclerotic severity in acute coronary syndromes.

Prevalence of white coat and coincidental hypertension among preoperative patients

2026-08-30T08:29:18+0530

Background: Hypertension is a major global health concern with significant perioperative implications. White coat hypertension (WCH) and coincidental hypertension (CH) are undiagnosed blood pressure patterns that affect surgical outcomes, sometimes causing unnecessary interventions or delays. This study determined the prevalence of WCH and CH during preoperative assessment at the BMU and associated clinical factors.

Methods: This cross-sectional study was conducted at the department of anesthesia, analgesia and intensive care medicine, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from April 2024 to March 2025 among 2,084 adults who underwent elective surgery at the preoperative assessment unit (PAU). Patients ≥18 years were purposively sampled, blood pressure was measured, and patients were classified as known hypertensive, normotensive, or undiagnosed. Undiagnosed cases were followed up to pre-induction and categorized as white coat or coincidental hypertension. Data were analyzed using SPSS version 27.0.

Results: Among the 2,084 preoperative patients, 445 (21.4%) were hypertensive, 1,561 (74.9%) were normotensive and 78 (3.7%) had previously undiagnosed hypertension, including 26 (33.3%) with white-coat hypertension and 52 (66.7%) with coincidental hypertension. Patients with coincidental hypertension were older, had more comorbidities, experienced more surgical cancellations (11.5% versus 0%; p=0.049), and had significantly higher systolic and diastolic blood pressure throughout the follow-up than those with white coat hypertension (all p<0.05).

Conclusions: Undiagnosed hypertension is common in the preoperative setting, with coincidental hypertension being more prevalent than white coat hypertension and associated with higher perioperative risk and surgical postponement.

Post-tonsillectomy outcomes: a prospective analysis of morbidities in 70 patients

2026-07-17T10:41:06+0530

Background: Tonsillectomy is one of the most commonly performed surgical procedures in otolaryngology. Despite its routine nature, postoperative morbidities remain a significant concern for both surgeons and patients. Objective was to prospectively analyze the outcomes of tonsillectomy with a specific focus on the spectrum and frequency of early postoperative morbidities following cold dissection tonsillectomy.

Methods: This prospective study was conducted at the department of otolaryngology-head and neck surgery, Medical College for Women and Hospital, Dhaka, from July to December 2010. A total of 70 patients undergoing tonsillectomy for recurrent tonsillitis were enrolled using purposive sampling. Pain was assessed using a 0-10 numeric rating scale. Data were analyzed by SPSS version 23.0.

Results: Among 70 patients, females predominated (61.43%), with the highest proportion aged 21-30 years (38.57%). Most operations (50%) lasted 20-30 minutes. Senior surgeons performed 42.86% of procedures. On postoperative day 1, dysphagia was the most frequent morbidity (68.57%), followed by otalgia (12.86%) and nausea or vomiting (2.86%). Instrumental injuries occurred in 14.29% of patients. Secondary hemorrhage occurred in one patient (1.43%) on day 6. On postoperative day 7, throat pain persisted in 28.57%, dysphagia in 22.86%, and otalgia in 20%. Pain scores showed 17 patients scoring 5/10 on day 1, reducing to 30 patients scoring 1/10 by day 7.

Conclusions: Dysphagia and pain are the predominant early morbidities following cold dissection tonsillectomy. Instrumental injuries remain notable, particularly with less experienced surgeons. Secondary hemorrhage is rare but requires vigilance.

Emergence hemodynamic changes and postoperative outcomes in hypertensive patients receiving antihypertensive therapy undergoing general anesthesia: an observational study

2026-08-30T08:29:14+0530

Background: Hypertensive patients undergoing general anesthesia often continue antihypertensive therapy through the perioperative period, yet whether the number of preoperative antihypertensive agents predicts the need for intraoperative anesthetic modulation or postoperative outcome remains unclear. This study aimed to characterise antihypertensive medication burden, anesthetic modulation requirement and postoperative adverse events in hypertensive patients undergoing general anesthesia.

Methods: This prospective observational study enrolled 60 diagnosed hypertensive patients undergoing elective surgery at Bangladesh Medical University, Dhaka, over twelve months. Patients were grouped as normotensive, hypotensive or hypertensive according to intraoperative blood pressure deviation from baseline. Number of antihypertensive medications, frequency of anaesthetic modulation, systolic, diastolic and mean arterial pressures according to medication count and postoperative adverse events were recorded and analyzed using SPSS version 26.0.

Results: Single-drug therapy was used by 63.3% of patients, two-drug combinations by 23.3% and three or more drugs by 13.4%. Hypotensive patients most often required two episodes of anesthetic modulation (50.0%), while hypertensive patients most often required three (63.0%). Blood pressure did not differ significantly by medication count at any time point (p>0.05). Postoperative nausea and vomiting occurred in 50% of hypertensive, 33.3% of hypotensive and 9.3% of normotensive patients (p=0.007) and coughing occurred only in hypertensive patients (25%, p=0.003).

Conclusions: Antihypertensive medication count did not predict perioperative hemodynamic instability, whereas intraoperative blood pressure status was strongly associated with modulation requirement and postoperative adverse events.

Diagnostic performance of ACR TI-RADS in solitary thyroid nodule: a comparative study with FNAC in a tertiary care hospital in Bangladesh

2026-08-30T08:32:18+0530

Background: Thyroid nodules are highly prevalent in iodine-deficient regions in Bangladesh. The American college of radiology thyroid imaging reporting and data system (ACR TI-RADS) offers a standardized, non-invasive ultrasound-based risk stratification tool. This study evaluates its diagnostic accuracy against Fine Needle Aspiration Cytology (FNAC), the gold standard.

Methods: This cross-sectional study was conducted from April 2025 to March 2026 at BIRDEM General Hospital, Dhaka. A total of 85 adult patients (≥18 years) with solitary thyroid nodule underwent high-resolution USG for ACR TI-RADS grading, followed by USG-guided FNAC (Bethesda classification). Diagnostic accuracy metrics sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and area under the curve (AUC) were calculated using FNAC as the reference standard.

Results: Among 85 participants, females constituted 81.2% with a male-to-female ratio of 1:4.3. The mean age was 43.6±11.8 years. ACR TI-RADS distribution: TR2 (19.0%), TR3 (35.3%), TR4 (27.0%), TR5 (18.7%). FNAC revealed suspicious for follicular neoplasm (2.4%) and non-diagnostic (3.5%). Using TR≥4 as the cut-off for malignancy (n=82 after excluding non-diagnostic cases), ACR TI-RADS demonstrated: sensitivity 85.7%, specificity 80.88%, PPV 48.00%, NPV 96.49%, accuracy 81.71%, positive likelihood ratio (LR+) 4.48, negative likelihood ratio (LR−) 0.18 and AUC 0.862 (p<0.001).

Conclusions: ACR TI-RADS exhibits excellent negative predictive value (96.49%) and a strong negative likelihood ratio (0.18), confirming its high reliability as a rule-out test for malignancy in solitary thyroid nodule. Low-risk (TR1–3) nodules can be safely managed with sonographic surveillance, while high-risk (TR4–5) nodules warrant FNAC confirmation.

Comparison of efficacy of glucosamine, chondroitin sulfate and a fixed dose combination of glucosamine and chondroitin sulfate in the treatment of osteoarthritis

2026-08-30T08:36:22+0530

Background: The study aimed to compare the efficacy of glucosamine, chondroitin sulfate and a fixed dose combination (FDC) of glucosamine and chondroitin sulfate in patients with osteoarthritis (OA) of the knee.

Methods: This was an open-label prospective comparative cohort study conducted from November 2023 to April 2024. Subjects were recruited consecutively from the orthopaedics outpatient department of GCMCH, Chidambaram, and assigned to one of three treatment groups based on the treating physician's prescription. Study tools including a patient data collection form and Western Ontario McMaster Universities Arthritis Index (WOMAC) questionnaires were used to measure outcomes at baseline and at monthly intervals over 4 months.

Results: After 4 months, the fixed dose combination group showed a statistically significant reduction in WOMAC pain score compared to glucosamine and chondroitin sulfate monotherapy groups (p=0.009). No significant differences were observed among the groups for stiffness (p=0.234) or physical function (p=0.439). The fixed dose combination consistently produced the greatest numerical improvement across all WOMAC domains.

Conclusions: The fixed dose combination of glucosamine 750 mg and chondroitin sulfate 600 mg is slightly more effective than either agent used alone, demonstrating greater relief of pain in patients with osteoarthritis of the knee.

The paradox of gender and depression in Indian geriatric outpatients: a study revealing higher depressive symptoms among males

2026-08-30T08:36:21+0530

Background: Epidemiological data from Western populations show a higher prevalence of depression in elderly women, attributed to biological and psychosocial factors. However, this pattern is challenged by sociocultural contexts that shape gender roles and aging experiences. The geriatric gender gap in depression within Indian clinical populations remains inadequately characterized. This study investigated gender-based differences in the prevalence and correlates of depressive symptoms in geriatric outpatients in Northern India.

Methods: A hospital-based, cross-sectional study was conducted over six months in the Medicine Outpatient Department of a tertiary-care hospital. A total of 100 consecutive patients (60 men, 40 women) aged ≥60 years were enrolled. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). Between-group comparisons and gender-stratified correlation analyses were performed.

Results: The prevalence of clinically significant depressive symptoms (GDS-15 ≥5) was significantly higher in men (68.3%) compared to women (40.0%) (p=0.004). The mean GDS-15 score was also significantly elevated in men (5.4±2.3) relative to women (4.1±2.3) (p=0.004). Among men, depression scores correlated positively with coronary artery disease (r=0.32, p=0.01); no significant clinical correlates were identified in women.

Conclusions: This study reveals a significant reversal of the typical gender disparity in geriatric depression within a North Indian clinical sample. The findings suggest that culturally constructed masculine roles, compounded by age-related stressors like retirement, may predispose elderly men to higher depression risk. This underscores the need for gender-sensitive mental health screening tailored to aging populations in India.

Anticandidal efficacy of Shikakai and rose petals in herbal denture cleanser formulation: an in vitro study

2026-08-30T08:36:17+0530

Background: Chemical denture cleansers may cause irritation, discoloration, and allergic reactions in denture wearers. Herbal agents with antimicrobial properties are being explored as safer alternatives to prevent denture-associated infections such as oral candidiasis. This study aimed to develop and evaluate a natural denture cleanser using Acacia concinna (Shikakai) and Rosa spp. (rose petals).

Methods: Dried plant materials were extracted using the Soxhlet extraction method and subjected to qualitative phytochemical screening. Antimicrobial activity against Candida species was assessed in vitro. The extracts were formulated into effervescent tablets for immersion-type denture cleansing. The tablets were evaluated for weight variation, hardness, friability, pH, disintegration time, and in vitro dissolution. Cleaning efficiency and anticandidal activity were also studied.

Results: Phytochemical screening confirmed the presence of flavonoids, saponins, tannins, and glycosides, with Shikakai extract showing a richer phytochemical profile. Antimicrobial studies demonstrated stronger antifungal activity of Shikakai against Candida species compared to rose petal extract. The formulated tablets met acceptable quality control parameters. In vitro dissolution studies showed about 20% release within one hour and nearly 90% release within six hours. Shikakai-based formulations exhibited superior cleaning efficiency and anticandidal activity.

Conclusions: Shikakai-based herbal denture cleanser tablets showed effective antifungal activity, satisfactory tablet properties, and good cleaning performance, indicating their potential as a natural alternative to synthetic denture cleansers. Further clinical studies are needed to confirm long-term safety and user acceptability.

Effective management of peripheral vertigo in the real-world setting: an expert survey with neurologists in India

2026-08-30T08:36:08+0530

Background: Benign paroxysmal positional vertigo (BPPV) accounts for approximately 20% of all cases of vertigo. Despite successful repositioning maneuvers, a significant proportion of patients experience residual dizziness, characterized by a persistent sensation of imbalance without true vertigo. The Epley maneuver remains the standard treatment for BPPV; however, adjunctive therapy with betahistine has been shown to facilitate vestibular compensation, thereby reducing residual dizziness and the risk of recurrent vertigo. This study aimed to assess expert opinions on the role of betahistine 48 mg/day for 3 months in preventing vertigo recurrence and reducing residual dizziness in patients with BPPV in real-world clinical practice.

Methods: Total 43 neurologists from diverse regions across India treating BPPV participated in the survey. A literature review based on the Medline database search was used to prepare a structured questionnaire about BPPV management, treatment practices, recurrence, and residual dizziness.

Results: Among the surveyed experts, 37% reported vertigo recurrence in 10-25% of patients following repositioning maneuvers. A majority (56%) indicated routine prescribing of betahistine at 48 mg/day. Furthermore, 67% opined that improved vestibular compensation and enhanced vestibular blood supply contributed to reduced recurrence, while 68% acknowledged the dose-dependent efficacy of betahistine. Notably, 35% reported a 75-90% reduction in residual dizziness with betahistine 48 mg/day administered for 3 months.

Conclusions: Residual dizziness and recurrence remain common after successful repositioning maneuvers in BPPV. Expert opinion from real‑world practice supports adjunctive treatment with betahistine 48 mg/day for at least 3 months to facilitate vestibular compensation and significantly reduce residual dizziness and recurrence, with a favorable safety profile.

A cross-sectional study of etiology, clinical profile, prognosis and outcome of acute kidney injury in a tertiary care hospital

2026-08-30T08:35:39+0530

Background: Acute kidney injury (AKI) is a common and serious clinical condition associated with significant morbidity, mortality, prolonged hospital stay, and increased healthcare burden. Early identification of etiological factors and severity is essential for timely intervention and improved outcomes.

Methods: A hospital-based analytical cross-sectional study was conducted among 150 patients with AKI admitted to a tertiary care hospital over 18 months. Patients fulfilling acute kidney injury network (AKIN) diagnostic criteria were included. Demographic characteristics, clinical profile, urine output, etiological factors, AKI type, AKIN stage, treatment modalities, and outcomes were recorded. Relevant laboratory investigations and imaging studies were performed, and data were analyzed using descriptive statistics.

Results: The mean age of participants was 43.96 years, with a male predominance. Oliguria was the most common clinical presentation. Sepsis was the leading etiological factor, followed by poisoning and snake bite. Intrinsic renal AKI was the predominant type, while post-renal AKI was uncommon. Most patients presented with AKIN stage 3 disease. Conservative management was sufficient for many patients, whereas others required hemodialysis. Recovery was observed in the majority of patients, although mortality remained higher among those with severe AKI and associated systemic illness.

Conclusions: Sepsis, poisoning, and snake bite were the major contributors to AKI in the study population. Early diagnosis, prompt identification of the underlying etiology, timely treatment, and appropriate renal replacement therapy are essential for improving clinical outcomes and reducing AKI-related mortality.

A cross-sectional study to assess and compare artificial intelligence-generated content for medical professionals with UpToDate on management of acute coronary syndrome

2026-08-14T09:44:46+0530

Background: The rapid rise of artificial intelligence (AI) in medicine offers new ways to generate educational content, but its readability and accessibility for both clinicians and patients remain underexplored. This study compares AI-generated medical information to a standard clinical reference.

Methods: This cross-sectional study analyzed educational content on acute coronary syndrome (ACS) management generated by DeepSeekAI and retrieved from UpToDate. Readability was assessed using four established metrics: Flesch reading ease (FRE), Flesch-Kincaid grade level (FKGL), SMOG index, and difficult word percentage. Data were collected across six distinct topics related to ACS management, and the scores for each tool were statistically compared.

Results: Readability analysis revealed notable disparities between the two sources. UpToDate consistently produced content with significantly higher FRE scores (e.g., UpToDate FRE up to 40.2 vs. DeepSeek AI FRE down to 2.7 for topic 1) and considerably lower FKGLs, SMOG Indices, and percentages of difficult words across all examined topics. While both sources generated text with relatively high reading levels indicative of medical content, DeepSeekAI consistently demonstrated lower readability, suggesting more complex vocabulary and sentence structures.

Conclusions: UpToDate content on ACS management is more readable and accessible for clinicians than DeepSeekAI-generated content, highlighting the need to improve readability in AI-generated medical materials for effective clinical use.

Knowledge, attitude and practice related to menstrual blood-derived mesenchymal stem cells donation among female students and faculties in a tertiary care hospital

2026-08-14T09:44:45+0530

Background: Mesenchymal stem cells (MSCs) are multipotent progenitor cells that play a significant role in regenerative medicine and tissue repair. Menstrual blood, similar to umbilical cord blood and bone marrow, is a rich, renewable, and non-invasive source of MSCs. Menstrual blood–derived mesenchymal stem cells (MenSCs) have shown promising potential in the treatment of various degenerative, inflammatory, and autoimmune conditions. Therefore, this study was conducted to assess the knowledge, attitude, and practice regarding menstrual blood donation and MenSCs among female students and faculty in a tertiary care hospital.

Methods: A cross-sectional study was conducted during the period of January 2026 to July 2026 in Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, among 197 female medical students and faculty chosen by convenience sampling. Data were collected using a self-administered semi-structured questionnaire.

Results: Out of 197 participants, 49.2% of participants had good knowledge, 61.4% had a good attitude, and only 1% of the participants had donated menstrual blood.

Conclusions: This research revealed that both female students and faculty possessed limited knowledge and engaged in less-than-ideal practices regarding MenSCs, even though they generally held a positive view towards donating MenSCs. These results underscore a notable gap between knowledge and practice, necessitating focused educational efforts.

Investigating the correlation of ferritin and uric acid levels in hypothyroidism: a case-control study

2026-08-15T08:37:32+0530

Background: Hypothyroidism is one of the most prevalent endocrinological disorder in our country as well as other parts of the world. Uric acid is a known antioxidant while ferritin, besides its role in iron storage is an acute-phase reactant. The present study is an endeavour to study the metabolic changes in uric acid and ferritin levels in relation to subclinical and overt hypothyroidism.

Methods: The 34 subclinical, 27 overt hypothyroid and 35 age and sex matched control individuals in the age group of 18-60 years were included. Serum thyroid stimulating hormone (TSH), Free thyroxine (fT4) and ferritin were measured using electrochemiluminescence immunoassay techniques; while uric acid was measured using Uricase, Trinder-End Point spectrophotometric method.

Results: The serum uric acid levels were found to be significantly higher in overt hypothyroidism as compared to subclinical hypothyroidism. No significant difference was found in the serum ferritin levels of the individuals with subclinical and overt hypothyroidism.

Conclusions: Hence, the present study suggests that hypothyroidism results in an increased serum uric acid level most probably caused by decreased renal clearance of uric acid due to compromised fT4 function. However, no such effect was found in serum ferritin levels.

Laparoscopic totally extraperitoneal repair versus open Lichtenstein hernioplasty in bilateral inguinal hernia: a comparative analysis

2026-08-19T09:38:29+0530

Background: Bilateral inguinal hernia presents distinctive operative challenges. This study compared perioperative outcomes of open bilateral Lichtenstein hernioplasty and laparoscopic totally extraperitoneal (TEP) repair at a government tertiary care institution in Eastern India.

Methods: Historical patient records of 52 men with bilateral inguinal hernia were analysed. Group A (n=26) underwent open bilateral Lichtenstein hernioplasty; group B (n=26) underwent laparoscopic TEP repair. Primary outcome: visual analogue scale (VAS) pain score at 24 hours. Secondary outcomes: operative time, hospital stay, return to normal activity, complication rate, and hernia recurrence. Continuous variables are presented as mean±standard deviation (SD) and compared by independent t-test, reported with mean difference (MD) and 95% confidence intervals (CI). Categorical variables compared by Chi-square or Fisher exact test.

Results: Groups were comparable at baseline. VAS score was significantly lower in group B (3.3±0.9 versus 6.1±1.2; MD -2.8, 95% CI -3.4 to -2.2; p<0.001), exceeding the minimum clinically important difference of 1.5 points. Hospital stay was shorter (1.6±0.5 versus 3.2±0.7 days; MD -1.6, 95% CI -1.9 to -1.3; p<0.001) and return to activity was earlier (6.8±2.1versus 13.5±2.8 days; MD -6.7, 95% CI -8.1 to -5.4; p<0.001) in group B. Operative time was longer in group B (80±14 versus 64±11 min; MD +16, 95% CI 9.2-22.8; p<0.05). Complication rate (7.7% versus 23.1%; relative risk [RR] 0.33, 95% CI 0.07-1.50; p>0.05) and recurrence (0% versus 3.8%; p>0.05) did not differ significantly.

Conclusions: Laparoscopic TEP repair provides superior postoperative recovery over open bilateral Lichtenstein hernioplasty in terms of pain, hospital stay, and return to activity, without compromising safety or recurrence. It should be the preferred approach in appropriately selected patients at centres with trained laparoscopic surgeons.

Sociodemographic determinants, wound severity classification and economic impact of animal bites: a cross-sectional study at an anti-rabies clinic in rural Maharashtra, India

2026-08-30T08:36:04+0530

Background: Objectives were to study socio-demographic factors associated with animal bites, assess wound severity, and estimate work/school days lost.

Methods: A descriptive cross-sectional study was conducted at the anti-rabies clinic, Sub-District Hospital, Karad, among 400 new animal bite patients. Data were analyzed using descriptive statistics and Chi-square tests.

Results: Majority were males (66.3%), aged 18-45 years (41.8%). Severe Class III bites predominated (72.5%), mainly from street dogs (82%). Lower limbs were most affected (61%). Soap-and-water wound washing was reported by 38.5%. Anti-rabies serum was administered to 42.3% of patients. Students (58.6%) and skilled workers (29.3%) reported highest absenteeism (1-3 days). Daily wage loss was noted in 37.3%.

Conclusions: Animal bites, predominantly by stray dogs, cause significant morbidity and indirect economic burden through lost wages and school days. Strengthened rabies prophylaxis and community awareness are essential.

Clinical profile, etiology and outcome of patients with pregnancy related acute kidney injury attending a tertiary care hospital in Goa, India

2026-08-30T08:35:59+0530

Background: Pregnancy-related acute kidney injury (PRAKI) remains a significant contributor to maternal morbidity and mortality in developing countries, despite a global decline in incidence. Data from Indian tertiary care centers continue to demonstrate a predominance of preventable obstetric and infectious causes.

Methods: This combined prospective and retrospective observational study included pregnant women aged 18-42 years diagnosed with PRAKI at Goa Medical College. Patients with pre- existing kidney disease were excluded. Demographic variables, obstetric profile, etiologies, severity of AKI (KDIGO criteria), need for renal replacement therapy, and renal outcomes were analyzed.

Results: Seventy-two women were included, with a mean age of 30.6±5.5 years. Most patients presented in the third trimester (88.9%). Sepsis was the most common etiology (41.6%), followed by preeclampsia (22.2%) and postpartum hemorrhage (12.5%). Severe AKI predominated with 59.7% classified as KDIGO stage 3. Complete renal recovery occurred in 55.6% of patients, partial recovery in 26.4%, while 8.3% became dialysis-dependent. Overall mortality was 9.7%. Progression to chronic kidney disease (CKD) was observed in 35% of patients during follow-up.

Conclusions: PRAKI continues to cause substantial renal morbidity and mortality. Sepsis and hypertensive disorders of pregnancy remain the leading etiologies. Early diagnosis, timely intervention, and long-term renal follow-up are crucial to improving outcomes.

Effectiveness of autologous leukocyte platelet-rich fibrin on orthodontic tooth movement: a split-mouth clinical study

2026-08-30T08:35:48+0530

Background: Prolonged orthodontic treatment is associated with increased risk of enamel demineralization, root resorption, periodontal complications and reduced patient compliance. Leukocyte platelet-rich fibrin (L-PRF), an autologous platelet concentrate rich in growth factors and cytokines, has been proposed as a biological adjunct to accelerate orthodontic tooth movement. To evaluate the effectiveness of L-PRF in enhancing orthodontic canine retraction.

Methods: A split-mouth clinico-experimental study was conducted on nine patients aged 15–25 years requiring bilateral maxillary first premolar extractions. The right side received L-PRF placement in the extraction socket and served as the experimental side, while the left side acted as the control. Canine retraction was performed using nickel-titanium closed-coil springs delivering 150 g force. Tooth movement was assessed using three-dimensional digital models at baseline (T0), one month (T1), two months (T2) and three months (T3). Data were analyzed using paired t-test, repeated measures ANOVA and Bonferroni post-hoc analysis.

Results: Greater canine movement was observed on the L-PRF side throughout the study period. Statistically significant acceleration was noted during the initial phase of retraction, whereas differences during later intervals were not significant. Both groups demonstrated significant time-related variations in tooth movement.

Conclusions: L-PRF enhanced orthodontic tooth movement primarily during the early stages of canine retraction. It may serve as a safe, minimally invasive and biologically effective adjunct for accelerating orthodontic treatment and potentially reducing overall treatment duration.

Clinical, etiological and echocardiographic profile of atrial fibrillation in a tertiary care hospital: a cross-sectional observational study

2026-08-30T08:35:42+0530

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with increased morbidity, mortality, heart failure, thromboembolism, and reduced quality of life. The etiological spectrum of AF varies across populations, with rheumatic heart disease (RHD) remaining an important cause in developing countries. Echocardiography is essential for evaluating structural cardiac abnormalities in AF.

Methods: A hospital-based cross-sectional observational study was conducted among 100 patients with AF admitted to a tertiary care teaching hospital. Clinical history, physical examination, electrocardiography, laboratory investigations, and transthoracic echocardiography were performed. Clinical characteristics, etiologies, echocardiographic findings, and complications were analyzed.

Results: Most patients were elderly, with a female predominance. Dyspnea and palpitations were the most common presenting symptoms. RHD was the leading cause of AF, followed by hypertensive and ischemic heart disease. Mitral stenosis was the most frequent valvular lesion. Left atrial enlargement was the predominant echocardiographic finding, while varying degrees of left ventricular systolic dysfunction were also observed. Heart failure and stroke were the major complications. Valvular AF was more common than non-valvular AF.

Conclusions: AF in this population was predominantly associated with rheumatic valvular heart disease and structural cardiac abnormalities, particularly left atrial enlargement. Early clinical and echocardiographic evaluation is essential for identifying underlying causes, stratifying risk, and preventing complications such as heart failure and thromboembolism.

Clinical characteristics and treatment outcomes of benign laryngeal lesions: a retrospective observational study from a tertiary care centre

2026-08-30T08:35:37+0530

Background: The larynx is a complex organ of the upper aerodigestive tract responsible for phonation, respiration, and airway protection. Benign laryngeal lesions commonly present with hoarseness of voice and significantly affect quality of life. Early diagnosis and appropriate management are essential to restore normal vocal function and prevent chronic morbidity.

Methods: A retrospective observational study was conducted in the department of otorhinolaryngology, Assam Medical College and Hospital, Dibrugarh, from January 2024 to June 2025. Thirty patients with benign laryngeal lesions were evaluated based on clinical presentation, etiological factors, type of lesion, management, and treatment outcomes. Diagnosis was confirmed by laryngoscopic examination and histopathological analysis where indicated.

Results: The majority of patients belonged to the 25-48 years age group, with slight male predominance. Teachers constituted the largest occupational group (33.33%). Vocal abuse was the most common etiological factor (40%). Hoarseness of voice was the predominant presenting symptom. Vocal cord polyp was the most common lesion (36.7%), followed by vocal cord nodules (30%). Microlaryngeal surgery was performed in 46.7% of patients, while the remainder improved with conservative treatment including voice rest and speech therapy.

Conclusions: Benign laryngeal lesions are commonly associated with vocal abuse and predominantly affect individuals in the productive age group. Early diagnosis, vocal hygiene, and timely intervention provide favorable outcomes and help prevent chronic voice disorders.

Candida under the lens: species diversity and antifungal susceptibility trends

2026-08-30T08:35:28+0530

Background: Non-albicans Candida (NAC) species are increasingly responsible for mucosal and invasive candidiasis and often exhibit reduced susceptibility to antifungal agents. This study assessed the species distribution of clinical Candida isolates and their antifungal susceptibility profiles.

Methods: In a prospective study conducted from 2015 to 2018 at a tertiary care center in Varanasi, India, 711 Candida isolates obtained from blood, urine, aspirates, and mucosal swabs were analyzed. Species identification was performed using PCR-restriction fragment length polymorphism (PCR-RFLP); unresolved isolates were further characterized by MALDI-TOF mass spectrometry and sequencing.

Results: Antifungal susceptibility to fluconazole, voriconazole, caspofungin, and amphotericin B was determined using the CLSI broth microdilution method. NAC species accounted for 63% of isolates, with Candida tropicalis being the most prevalent. PCR-RFLP identified 92.5% of isolates, while MALDI-TOF MS and sequencing enabled identification of rare species, including C. mesorugosa, C. africana, and Pichia farinosa. Fluconazole showed high activity against C. albicans (94.3%) and C. glabrata (100%) but reduced activity against C. tropicalis (77.9%). Voriconazole demonstrated broad activity across species, and caspofungin exhibited low MICs for most isolates, although resistance was observed in 10.6% of C. glabrata. Amphotericin B remained active against most species, with elevated MICs noted in C. lusitaniae.

Conclusions: These findings underscore the importance of accurate species-level identification and routine antifungal susceptibility testing to optimize therapy for Candida infections.

Comparison of serum sodium and potassium levels in patients with cataract and individuals without cataract in a tertiary care center in North Kerala: a cross-sectional study

2026-08-30T08:35:22+0530

Background: Cataract remains a leading cause of treatable blindness worldwide, accounting for moderate to severe vision impairment or blindness in approximately 94 million people globally. The study aimed to compare serum sodium and potassium levels between individuals with and without cataract and to assess whether these electrolyte levels vary among the different types of senile cataract classified according to the LOCS III (lens opacities classification system III) classification.

Methods: A cross-sectional observational study was conducted on 200 patients aged 50-60 years attending the ophthalmology OPD at a tertiary care center from 2022 to 2024. Cataracts were graded after dilated fundus examination. Serum sodium and potassium levels were measured using ion-selective electrode technology (Beckman Coulter AU-5800). Statistical analysis included descriptive tools and Student’s t-test to assess differences between means.

Results: Mean serum sodium was higher in the cataract group (139.3 mEq/l) compared to the non-cataract group (136.6 mEq/l). Serum potassium was also slightly higher in the cataract group, though not statistically significant. Among cataract types, posterior subcapsular cataract showed the highest serum sodium levels. Nuclear sclerosis cases had marginally higher potassium levels than other types, but the difference was not significant.

Conclusions: Serum sodium levels were significantly higher in patients with cataract, though still within the normal range. This suggests that dietary sodium restriction might help delay cataract development.

A comparative analysis on safety and efficacy of telmisartan and ramipril in treatment of hypertension in a tertiary care hospital

2026-08-30T08:32:37+0530

Background: Hypertension is a major global health challenge and an important risk factor for cardiovascular disease. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly used first-line antihypertensive agents. This study evaluated the safety and efficacy of telmisartan and ramipril in patients with hypertension at a tertiary care hospital.

Methods: This prospective observational study included 113 adult patients with hypertension who received either telmisartan (n=56) or ramipril (n=57). Pre- and post-treatment systolic (SBP) and diastolic blood pressure (DBP) were assessed. Efficacy was evaluated by achievement of target blood pressure, while safety was assessed based on adverse drug reactions. Statistical analysis was performed using the chi-square test.

Results: Both treatments significantly reduced SBP and DBP. Post-treatment SBP shifted mainly to 120-140 mmHg, while DBP improved to 76-85 mmHg. Target blood pressure was achieved more frequently with telmisartan (96.4%) than ramipril (80.7%) (χ²=6.862, p<0.05). Telmisartan was also associated with fewer cases of cough and greater improvement in symptoms such as headache and fatigue.

Conclusions: Both telmisartan and ramipril effectively reduced blood pressure. However, telmisartan was more effective in achieving target blood pressure and showed better tolerability with fewer adverse effects, suggesting it may be a preferable option, particularly for patients intolerant to ACE inhibitors.

Effectiveness of Mulligan bent leg raise and instrument-assisted soft tissue mobilization techniques on hamstring flexibility and functional disability in non-specific low back pain: a randomized controlled trial

2026-08-30T08:32:34+0530

Background: Non-specific low back pain or NSLBP, a musculoskeletal condition that results in pain, decreased flexibility, and functional impairment, is commonly associated with hamstring tightness. Manual therapy techniques like Mulligan Bent Leg Raise (BLR) and IASTM, or Instrument-Assisted Soft Tissue Mobilization are frequently used to improve hamstring flexibility and alleviate discomfort. However, there isn't much information comparing their effectiveness in individuals with NSLBP.

Methods: A randomized comparison study was conducted with forty male volunteers, ages 18 to 40, who had tight hamstrings with NSLBP. Each of the two randomly allocated groups, Group A (Mulligan BLR) and Group B (IASTM), had 20 participants. Interventions were administered three times a week for two weeks. The outcomes were evaluated using the Numerical Pain Rating Scale (NPRS), the Quebec Back Pain Disability Scale (QBPDS), and Active Knee Extension Test (AKET).

Results: Both groups' functional impairment, hamstring flexibility, and pain significantly improved after treatment (p=0.001). Between-group analysis revealed that the Mulligan BLR group had better reductions in NPRS scores (mean difference=2.00), better improvements in left and right AKET scores (mean differences=10.45° and 10.55°, respectively), and a greater reduction in QBPDS scores (mean difference=12.90) (p=0.001).

Conclusions: Both Mulligan BLR and IASTM were effective in reducing pain, improving hamstring flexibility, and reducing functional impairment. However, Mulligan BLR demonstrated significantly better outcomes on all end measures and may be a more effective treatment for hamstring tightness associated with NSLBP.

Prevalence and sociodemographic predictors of anxiety among female nursing officers in a tertiary care hospital: a cross-sectional study

2026-08-30T08:32:03+0530

Background: Nursing professionals operating within high-acuity clinical environments face persistent workplace stressors, making them exceptionally vulnerable to psychological morbidity. Female nursing officers may be at extreme risk owing to biological, psychological and sociocultural factors. To estimate the prevalence of anxiety and identify its predictors among working female nursing officers in a tertiary care hospital.

Methods: Utilizing a cross-sectional observational framework, we evaluated 264 female nursing officers (ages 21–40) at a tertiary care facility in New Delhi. Psychic and somatic anxiety profiles were quantified via the hamilton anxiety rating scale (HAM-A). Baseline demographic variables were evaluated using Chi-square and Mann-Whitney U tests, while independent predictors of categorical severity were isolated through multivariate logistic regression modelling.

Results: The mean age was 29.34±5.87 years. Severe anxiety was observed in 75% of participants. Younger age (≤30 years) was significantly associated with higher anxiety severity (p=0.046). Logistic regression showed that age was an independent predictor, with each additional year reducing the odds of severe anxiety by ~10% (OR=0.90, p=0.013). Marital status and number of children were not significant predictors.

Conclusions: There is a high burden of severe anxiety among female nursing officers, particularly among younger individuals. Institutional interventions focusing on early-career nurses are essential.

Exploring the relationship between chronic pain and mental health disorders: a case-control study at a tertiary care hospital

2026-08-30T08:31:53+0530

Background: Chronic pain is a multifaceted condition that significantly affects patients’ quality of life and has been closely associated with mental health disorders such as depression, anxiety, and stress-related conditions. This study aimed to explore the association between chronic pain and mental health disorders among patients at a tertiary care hospital in India.

Methods: We conducted a case-control study involving 200 participants at a tertiary care hospital, from January 2024 to June 2024. The case group consisted of 100 patients diagnosed with chronic pain for more than three months, while the control group included 100 matched individuals without chronic pain. Data on depression, anxiety, and stress were collected using the validated depression, anxiety and stress scale-21 (DASS-21). Dietary and lifestyle habits, sleep quality, and socioeconomic factors were assessed through structured questionnaires. Statistical analysis was conducted using multivariate logistic regression to adjust for confounding variables, including age, gender, socioeconomic status, and comorbidities.

Results: The prevalence of symptoms of depression, anxiety, and stress in the chronic pain group was significantly higher compared to controls. The adjusted odds ratio (OR) for depression among the chronic pain group was 3.82 (95% CI: 2.05-7.13, p<0.001), for anxiety it was 2.94 (95% CI: 1.61-5.38, p<0.001), and for stress it was 4.18 (95% CI: 2.23-7.81, p<0.001) compared to controls.

Conclusions: Chronic pain is strongly associated with increased symptoms of depression, anxiety, and stress, emphasizing the need for integrated care approaches that address both physical and psychological health in chronic pain management.

Clinical spectrum and prognostic impact of precipitating factors in hepatic encephalopathy among patients with liver cirrhosis: a cross-sectional observational study

2026-08-30T08:35:26+0530

Background: Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of liver cirrhosis associated with significant morbidity and mortality. Early identification of precipitating factors is essential for timely management and improved clinical outcomes.

Methods: A hospital-based cross-sectional observational study was conducted among 110 patients with cirrhosis of liver presenting with hepatic encephalopathy at a tertiary care teaching hospital. Clinical history, physical examination, laboratory investigations, and radiological evaluation were performed to identify precipitating factors. Hepatic encephalopathy was graded using the West Haven classification, while liver disease severity was assessed using the Child-Pugh score. PHES and Stroop tests were performed in eligible patients. Clinical outcomes, including recovery and mortality, were analyzed.

Results: Most patients were middle-aged males with alcohol-related cirrhosis. Grade II hepatic encephalopathy and Child-Pugh class C were the most common presentations. Asterixis, icterus, and ascites were frequent clinical findings. At least one precipitating factor was identified in most patients, with constipation, infections, upper gastrointestinal bleeding, electrolyte imbalance, vomiting/diarrhoea, and acute kidney injury being the commonest. Neuropsychometric abnormalities were frequently detected. Higher grades of hepatic encephalopathy and advanced Child-Pugh class were significantly associated with poorer outcomes and increased mortality.

Conclusions: Hepatic encephalopathy is commonly precipitated by identifiable and potentially reversible factors. Early recognition and prompt correction of these factors, together with timely assessment of disease severity, are essential to improve prognosis and reduce morbidity and mortality in patients with liver cirrhosis.

Thyroid hormone dysfunction in liver cirrhosis

2026-08-30T08:31:29+0530

Background: Chronic liver disease (CLD) relentlessly progresses to fibrosis and cirrhosis unless the causative agent is eliminated. Cirrhosis leads to hepatic dysfunction and additionally has an effect on several systems. Liver is vital to thyroid hormone metabolism and also in the synthesis of thyroid binding globulin. Low free T3 syndrome is described in liver cirrhosis. Aim was to investigate the thyroid function of patients with CLD in relation to the severity of the disease.

Methods: This is a prospective observational, single centre, hospital-based case-control study, comparing thyroid function in 112 decompensated CLD subjects and 112 matched healthy controls.

Results: In the present study majority of participants are between the ages of 31 to 50 years. TSH level was found to be elevated in hepatic encephalopathy (HE) patients with a higher West Haven grade compared to lower grades of encephalopathy. Reduced levels of FT3 and FT4 were found in higher grades of HE. MELD score and Child Pugh score severity correlation with FT3 has shown a reduced FT3 and was directly proportional to the severity of CLD.

Conclusions: Patients with CLD showed abnormalities in thyroid hormone concentrations and these abnormalities were related to advanced Child Pugh score and MELD score. Serum T3 level has been found to be low in significant number of cirrhotic patients.

Clinicopathological spectrum of glomerular disorders in adult versus elderly patients: a prospective observational study from a tertiary care centre in North India

2026-08-30T08:29:19+0530

Background: The clinicopathological spectrum of glomerular disorders differs between adult and elderly populations, yet comparative biopsy-based data from India are limited. We aimed to compare and characterise the histopathological profile, clinical presentation, and procedural safety of native kidney biopsy in adult (≤59 years) and elderly (≥60 years) patients at a tertiary care centre in north India.

Methods: A prospective observational study was conducted at AIIMS Rishikesh from October 2025 to February 2026. A total of 168 patients who underwent native kidney biopsy were enrolled and stratified into two age groups: adults (≤59 years, n=145) and elderly (≥60 years, n=23). Demographic, clinical, laboratory, histopathological, and post-procedural complication data were collected. Statistical analysis was performed using Chi-square/Fisher’s exact test for categorical variables and independent samples t-test for continuous variables.

Results: In adults, IgA nephropathy (14.4%), focal segmental glomerulosclerosis (FSGS, 13.1%), and membranous nephropathy (MN, 13.1%) predominated, while in elderly, MN (26.1%), diabetic kidney disease (DKD, 21.7%), pauci-immune crescentic glomerulonephritis (17.4%), and myeloma-related disorders (MGRS/LCCN, 17.4%) were most common. Hypertension (56.5% vs 28.3%; p=0.007), anuria (26.1% versus 7.6%; p=0.015), and serum urea (127.52 versus 82.08 mg/dl; p=0.004) were significantly higher in the elderly. ANA positivity was significantly higher in adults (55.0% versus 20.0%; p=0.040). Post-biopsy perinephric haematoma was significantly more frequent in the elderly (34.8% versus 11.0%; p=0.034).

Conclusions: Distinct age-specific differences in glomerular disease patterns were observed. The spectrum shifted from immune-mediated glomerulonephritis (IgAN, FSGS, lupus nephritis) in adults to metabolic, vascular, and paraprotein-related pathologies (MN, DKD, ANCA-GN, MGRS) in the elderly. Age alone should not preclude kidney biopsy, though heightened post-procedural vigilance is warranted in elderly patients.

Bridging therapy during delayed definitive radiotherapy in locally advanced head and neck squamous cell carcinoma: a prospective randomized study comparing induction TPF chemotherapy with oral metronomic chemotherapy

2026-08-30T08:29:17+0530

Background: Prolonged waiting periods before definitive radiotherapy remain a major challenge in the management of locally advanced head and neck squamous cell carcinoma (LA-HNSCC), particularly in resource-constrained healthcare settings. Bridging systemic therapy during this interval may help maintain disease control until definitive radiotherapy can be initiated. The aim of the study was to compare the efficacy and safety of induction docetaxel, cisplatin, and 5-fluorouracil (TPF) chemotherapy with oral metronomic chemotherapy (OMCT) as bridging treatment in patients with LA-HNSCC experiencing unavoidable delays before definitive radiotherapy.

Methods: A prospective randomized study was conducted in the Department of Radiotherapy, IPGME&R and SSKM Hospital, Kolkata, India, between February 2020 and November 2022. Sixty patients with biopsy-proven stage III-IVB LA-HNSCC were randomized to receive either two cycles of induction TPF chemotherapy (Arm A) or oral metronomic chemotherapy comprising weekly methotrexate and twice-daily celecoxib (Arm B) while awaiting definitive radiotherapy. Tumour response, treatment-related toxicities, disease-free survival (DFS), overall survival (OS), and quality of life were assessed. Survival outcomes were estimated using the Kaplan-Meier method.

Results: Baseline demographic and clinicopathological characteristics were comparable between the two treatment groups. Induction TPF chemotherapy achieved significantly higher objective tumour response before radiotherapy and superior complete response rates following treatment compared with OMCT. Disease-free survival was significantly longer in the TPF arm, whereas overall survival was comparable between the two groups during the study period.

Conclusions: Induction TPF chemotherapy provided superior tumour response and disease-free survival compared with oral metronomic chemotherapy.

Preoperative hyponatremia as a predictor of complicated acute appendicitis: a prospective observational study

2026-08-30T08:30:07+0530

Background: Acute appendicitis is the most frequent surgical emergency and a leading cause of acute abdominal pain, carrying a lifetime risk of approximately 6%. Clinical presentation is often misleading and hyponatremia has been proposed as a biochemical marker for complicated acute appendicitis. This study evaluated the role of serum sodium as a marker of appendicitis severity.

Methods: This hospital-based, observational prospective study was conducted in the department of general surgery, SMS Medical College, Jaipur, from August 2024 to September 2025, and enrolled 100 adult patients (>18 years) diagnosed with appendicitis. Patients were categorized into hyponatremic (serum sodium <135 mEq/l) and normonatremic groups. Data were collected on demographics, clinical presentation (Alvarado score), white blood cell count, surgical findings, and postoperative recovery. The primary objective was to evaluate serum sodium as a marker of appendicitis severity; secondary objectives were to assess its impact on surgical site infection rates and duration of hospital stay.

Results: Hyponatremic patients (mean age 36.76±17.54 years) were significantly older and predominantly male compared with normonatremic patients. Gastrointestinal symptoms including nausea/vomiting (84% versus 32%) and anorexia (76% versus 48%), were more prevalent in the hyponatremic group, and 94% of hyponatremic patients required hospitalization for 3 days or longer, compared with 66% of normonatremic patients. Hyponatremia showed a strong association with complicated pathology, but its predictive value for surgical site infection was weak (16% versus 12%), and white blood cell counts lacked specificity for differentiating disease severity between groups.

Conclusions: Serum sodium appears to be a reliable, objective surrogate marker for predicting complicated appendicitis, reflecting systemic inflammation and increased hospital resource utilization, and may aid early identification of high-risk patients who require urgent intervention, particularly when Alvarado scores are equivocal.

Methylene blue dye as a single tracer for sentinel lymph node biopsy in early breast cancer

2026-08-30T08:30:05+0530

Background: Sentinel lymph node biopsy (SLNB) can reduce the morbidity of axillary lymph node dissection (ALND) in clinically node-negative breast cancer, but dual-tracer SLNB requires nuclear medicine infrastructure that is unavailable in many Indian hospitals. We evaluated 1% methylene blue dye (MBD) as a single tracer for SLNB in a resource-constrained setting.

Methods: In this prospective observational study, 30 women with clinically node-negative, early-stage breast cancer (T1-T2, N0, M0) underwent periareolar injection of 3 ml of 1% MBD during modified radical mastectomy. Sentinel lymph node(s) were identified and harvested separately during axillary dissection, followed by complete axillary lymph node dissection in all patients during our unit’s learning phase for histopathological validation.

Results: A sentinel node was identified in 29 of 30 patients (96.67%). Among these 29 patients, sensitivity was 88.89%, specificity 95.00%, positive predictive value 88.89%, negative predictive value 95.00%, and overall accuracy 93.10%. The false-negative rate was 11.11%. No anaphylaxis, skin necrosis, allergic reaction, or wound complication occurred. Three patients (10.0%) developed transient skin tattooing that resolved spontaneously.

Conclusions: MBD-only SLNB achieved a high identification rate and diagnostic accuracy during the learning phase, with no major adverse events. It may provide a pragmatic, low-cost alternative for axillary staging where radioisotope-based SLNB is unavailable. Larger multicentre studies are required before ALND can be safely omitted after a negative MBD-only SLNB.

The Exploring the relationship between stress, sleep quality, mobile phone usage and physical activity among physiotherapy students: a survey study

2026-08-30T08:29:06+0530

Background: Physiotherapy students are frequently exposed to academic, clinical, and personal stressors that may affect their sleep quality, smartphone usage patterns, and physical activity levels. The aim of the study is to explore the relationship between stress, sleep quality, smartphone addiction, and physical activity among physiotherapy students.

Methods: A cross-sectional correlational study was conducted among 300 physiotherapy BPT and MPT students. Data were collected using the SSI, PSQI, SAS-SV and IPAQ-SF. Descriptive statistics were used to summarize participant characteristics and study variables. Since the data were non-normally distributed, Spearman’s rank correlation test was used to examine associations among variables.

Results: Among 300 participants, 203 (67.7%) were female and 97 (32.3%) were male, most were aged 21–25 years. Mild to moderate smartphone addiction was common, 55.3% showing mild and 40.3% moderate addiction. Nearly half of the students reported moderate stress (48.0%), moderate sleep disturbances (48.0%), while low physical activity was observed in 72.0%. Smartphone addiction showed a significant positive correlation with poor sleep quality (r=0.191, p=0.001), whereas physical activity was negatively correlated with sleep disturbances (r=−0.162, p=0.005). No significant associations were found between stress, smartphone addiction, physical activity, and sleep quality.

Conclusions: Smartphone addiction, poor sleep quality, moderate stress, and low physical activity were common among physiotherapy students. Higher smartphone addiction was associated with poorer sleep, while greater physical activity was linked to better sleep quality. Encouraging healthier smartphone habits and regular physical activity may support students' sleep and overall well-being.

An observational study of serum vitamin D levels in preeclamptic and eclamptic pregnant women in labour

2026-08-30T08:29:02+0530

Background: Hypertensive disorders of pregnancy (HDP), particularly preeclampsia and eclampsia, are major causes of maternal and perinatal morbidity and mortality. Emerging evidence suggests that vitamin D deficiency may contribute to the pathogenesis of these disorders through its effects on placental function, immune regulation, and vascular health.

Methods: This hospital-based observational cross-sectional study was conducted at Fakhruddin Ali Ahmed Medical College and Hospital over one year. A total of 112 pregnant women in labor were included, comprising 56 cases (preeclampsia/eclampsia) and 56 healthy normotensive controls. Serum 25-hydroxy vitamin D [25(OH)D] levels were measured using chemiluminescent immunoassay (CLIA). Serum calcium levels and relevant clinical and laboratory parameters were also assessed. Statistical analysis was performed using PSPP version 2.0.1.

Results: Vitamin D deficiency and insufficiency were significantly more common among cases compared to controls (p=0.021), while sufficient vitamin D levels predominated among controls. Vitamin D deficiency was more frequently observed in women with eclampsia, indicating an association with increasing disease severity. Serum calcium deficiency was also significantly higher among cases than controls (p<0.001). Additionally, systolic and diastolic blood pressures were significantly elevated among cases (p<0.001).

Conclusions: Vitamin D deficiency and low serum calcium levels were significantly associated with preeclampsia and eclampsia. Lower vitamin D levels were linked with greater disease severity, suggesting a potential role of vitamin D in HDP. Further studies are required to evaluate the role of routine screening and supplementation during pregnancy.

Evaluating the role of C-reactive protein velocity in identifying viral infections in children with elevated C-reactive protein levels

2026-08-30T08:28:56+0530

Background: C-reactive protein (CRP) is routinely used to differentiate between bacterial and viral infections in children. However, despite clinical features suggestive of viral illness, several viral infections may present with markedly elevated CRP levels, leading to diagnostic uncertainty and unnecessary antibiotic use. C-reactive protein velocity (CRPv) may improve identification of viral infections in children presenting with elevated CRP levels.

Methods: A prospective observational study was conducted among children aged 6 months to 12 years admitted with fever, and CRP >20 mg/l. Viral infection was confirmed using nasopharyngeal viral PCR. Serum CRP was measured at admission and after 24 hours to calculate CRPv. CRPv was compared between viral positive and viral negative groups using appropriate statistical tests.

Results: 61 children were enrolled, including 42 (68.9%) with PCR-confirmed viral infections and 19 (31.1%) in viral-negative group. CRP velocity was significantly lower in the viral-positive group (median (Q1–Q3): −0.458 (−1.39 to −0.177) vs. 0.375 (0.0625–0.458) mg/l/hour; p<0.001). ROC analysis demonstrated good performance of CRP velocity, with an AUC of 0.881 (95% CI: 0.786–0.976, p<0.001). A cutoff of ≤−0.125 mg/l/hour yielded a sensitivity of 78.6% and specificity of 94.7%.

Conclusion: CRP velocity demonstrated good discriminatory performance in identifying PCR-confirmed viral infections in children with elevated admission CRP level. A greater decline in CRP over the first 24 hours was strongly associated with viral infections, suggesting that serial CRP measurements may serve as a useful marker in early clinical decision-making and help optimize antimicrobial stewardship.

Leveraging ChatGPT to address patient queries on fever of unknown origin: opportunities and limitations

2026-08-30T08:29:01+0530

Fever of unknown origin (FUO) remains one of the most intriguing and diagnostically challenging syndromes in internal medicine. The term FUO itself implies a passive/negative approach to diagnosis, suggesting a state of uncertainty that may perpetuate medical inertia. FUO is defined as a temperature ≥38.3°C (101°F) on several occasions for at least three weeks without an established diagnosis despite appropriate evaluation.¹ In resource-limited settings an active and pragmatic approach is essential to expedite diagnosis and mitigate burden of undiagnosed fever cases.² In contrast, access to large language models like ChatGPT has been increasing over past few years.³Developed by OpenAI, ChatGPT is a large language model capable of giving human-like answers to queries related to health by compiling information from medical literature.⁵ Patients are increasingly using AI to clarify medical terminologies and physicians’ advice.³ Patients suffering from FUO search online for explanations of symptoms and investigations, where information may be incomplete or misleading.

Familial clustering and relapse patterns in alcohol dependence syndrome: a case series of four sibling groups

2026-08-19T09:38:30+0530

Alcohol dependence syndrome (ADS) is a chronic relapsing disorder resulting from a complex interaction of genetic, environmental, and psychosocial factors, with a positive family history being a strong predictor of early onset, greater illness severity, and recurrent relapse. This case series describes four sibling groups diagnosed with alcohol dependence syndrome (ICD-10: F10.2), all of whom initiated alcohol use during their early twenties, with an age difference of two to six years between siblings. Despite variations in psychosocial background and family structure, all groups demonstrated recurrent relapses following multiple treatment attempts. Common contributing factors included shared environmental exposure, family history of alcohol dependence, permissive attitudes towards alcohol use, impulsivity, psychosocial stressors, poor motivation for abstinence, and mutual reinforcement of drinking behaviour. In one sibling pair, relapse episodes occurred almost simultaneously following similar stressors, while other families illustrated the influence of parental alcohol use, impulsivity, and differing motivations with similar relapse trajectories. These findings highlight that familial influences extend beyond genetic vulnerability to include behavioural modelling, shared stressors, and environmental reinforcement, underscoring the importance of incorporating family-centred assessment and relapse prevention strategies in the management of ADS.