International Journal of Research in Medical Sciences

A case series of congenital neck swellings

2026-01-31T08:24:20+0530

Congenital neck swellings are diverse group of anomalies present at birth or in 1^st or 2^nd decade of life, resulting from developmental defects during embryogenesis. These swellings may arise from remnants of the branchial apparatus, thyroglossal duct, lymphatic system or vascular malformations. Common entities include thyroglossal duct cysts, branchial cleft anomalies, cystic hygromas (lymphangiomas), dermoid cysts and vascular malformations. Though many lesions are benign, they may present with cosmetic deformity or infection. Early and accurate diagnosis is essential for effective management and to prevent complications or recurrence. A total of 5 patients, clinically diagnosed as congenital neck swellings were included. Detailed history and clinical examination were performed for all patients. Diagnostic investigations such as USG and CT/MRI were undertaken. All patients underwent surgical excision of the swelling with appropriate technique based on the type and location of the lesion. Histopathological examination was done to confirm the diagnosis. Patients were followed up postoperatively to monitor for complications and recurrence. Congenital neck swellings, though often benign, requires accurate diagnosis and timely surgical intervention. Clinical and radiological findings are often non-specific, making histopathological evaluation crucial for definitive diagnosis. Surgical excision remains the definitive treatment, and histopathology provides the final confirmation. Early identification and appropriate treatment lead to an excellent outcome with no recurrence.

Management of attention-deficit/hyperactivity in a patient with fibular hemimelia

2026-01-31T08:24:23+0530

Fibular hemimelia (FH) is a rare condition defined by the partial or complete absence of the fibula, often accompanied by associated deformities and anomalies, with an estimated incidence of 1 in 40,000 live births. In parallel, attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder marked by patterns of inattention, hyperactivity, and impulsivity that disrupt daily functioning and quality of life. The ADHD medication may influence children with FH, given their shared developmental risk factors. Understanding the interplay between these conditions is vital for developing comprehensive care strategies that address both the physical and behavioral challenges faced by these individuals. This case describes an 8-year-old male with ADHD and anxiety linked to FH. The patient faced challenges in learning, reading and attention, along with disruptive behaviors and feelings of bullying from peers. Evaluation indicated appropriate hygiene, a linear thought process and mild anxiety, with the patient describing his mood as “okay.” As a part of his treatment plan, the patient was prescribed 18 mg of methylphenidate HCl daily, 15 mg of L-methylfolate and referred for psychological testing. The intersection of FH and ADHD presents clinical challenges that require a nuanced understanding of both conditions. FH can result in significant limb discrepancies and may necessitate orthopedic interventions, while ADHD is often treated with stimulant medications that, while effective, can have side effects including potential impacts on growth. This highlights the importance of monitoring growth in children with both conditions, as stimulant use may influence physical health outcomes. Upon follow up, the patient demonstrated improved attention and behaviour, with no evidence of growth suppression.

A rare presentation of benign lymphoepithelial cyst in laryngopharynx

2026-01-31T08:26:54+0530

Lymphoepithelial cysts are rare benign lesions with uncertain etiopathogenesis, mainly affecting salivary glands and oral mucosa. These most commonly present as lesions within the parotid gland and is typically associated with HIV infection in immunocompromised patients. These lesions also present in oral mucosa where the most common sites are floor of mouth and tongue. This case report presents an unusual presentation of a benign lymphoepithelial cyst (BLEC) in an immunocompetent patient arising from the palatine tonsil and extending up to laryngopharynx. A middle-aged male patient presented with symptoms of a swelling in the throat, and clinical examination as well as imaging features were similar to a mucocele, but on surgical excision and histopathological examination, it turned out to be a benign lymphoepithelial cyst. Even though these lesions exhibit indolent clinical behavior, with no tendency to recur after conservative surgical management, these are frequently misdiagnosed clinically due to the similarity of presentation to other common oral mucosal lesions. Hence an accurate clinical diagnosis requires histopathological correlation, especially in those cases which present in unusual locations.

From shadows to spotlight: how two cases redefined Barth syndrome awareness in Belarus: two case reports with a literature review

2026-01-31T08:25:36+0530

Barth syndrome (BTHS) is an uncommon congenital sex-linked recessive cardiovascular disease resulting from impaired cardiolipin metabolism. The main cause of this condition is a mutation of the TAZ gene (TAFAZZIN), which activates the mitochondrial enzyme acyltransferase/transacylase, necessary for the biosynthesis of cardiolipin. The frequency of BTHS is 1 case per million men, and the total number of reported cases worldwide is about 250. The article presents 2 cases of BTHS diagnosis in the same city. A 9-year-old boy who was admitted to the intensive care unit of the Grodno Regional Children's Clinical Hospital was identified in pediatric observation. In the case of an adult patient, an 18-year-old boy was hospitalized in the Grodno Regional Cardiology Center with an exacerbation of heart failure. In both cases, cardiovascular complications were identified when an adult had an atypical phenotype of cardiomyopathy-dilated right ventricular cardiomyopathy and a broad spectrum of comorbidities, and a pediatric patient had visible cardiomegaly, which may be associated with changes in energy metabolism in the heart over time, as evidenced by imaging results. In addition, both patients underwent thorough genetic testing, which confirmed the diagnosis of BTHS in these two cases. This article illustrates the importance of raising awareness about BTHS in the Eastern European region.

Guillain-Barré syndrome and hyper-immunoglobulin E syndromes: an unusual correlation

2026-01-14T08:35:16+0530

Hyper immunoglobulin E (IgE) syndrome (HIES), also known as Job's syndrome, is a rare primary immunodeficiency disorder characterized by elevated levels of serum IgE, recurrent skin and lung infections, and eczema. Guillain-Barré syndrome (GBS) is an acute autoimmune condition that affects the peripheral nervous system, leading to muscle weakness and paralysis. This case report presents a unique instance of a 24-year-old male diagnosed with both HIES and GBS, exploring the clinical presentations, diagnostic challenges, and treatment approach.

A case of Cryptococcus laurentii meningitis in an immunocompromised patient: case report

2026-01-31T08:26:56+0530

Cryptococcosis is an important opportunistic fungal infection among immunocompromised, AIDS patients and those under immunosuppressive therapy. While C. neoformans and C. gattii are the most common pathogens attributed to cryptococcosis, C. laurentii infections are also on the rise. Here, we report a case of meningitis caused by C. laurentii in an HIV infected, male patient with a low CD4+ T cell count. C. laurentii, though rare, has been reported as an etiological agent of cutaneous, pulmonary, disseminated and ocular infections in AIDS as well as HIV negative individuals. Species differentiation is necessary as C. laurentii has been reported to have higher resistance to azoles and flucytosine. Infections caused by Cryptococcus non-neoformans infection are rare and require extensive investigation to be substantiated. Increasing reports of infection caused by other cryptococcal species, can be attributed to the growing number of immunocompromised and debilitated patients with predisposing factors, improvements in their detection and identification, and enhanced awareness of such non-typical infections.

Microsurgical clipping of a ruptured lobulated anterior communicating artery aneurysm arising from a fenestrated complex: a case report

2026-01-31T08:26:52+0530

Fenestrations of the anterior communicating artery (ACOM) are uncommon vascular variants that predispose to aneurysm formation due to structural defects and altered hemodynamics. Their association with lobulated, broad-neck aneurysms creates significant diagnostic and surgical challenges. Herein this case reports a case of a 60-year-old woman with hypertension and diabetes presented with World Federation of Neurosurgical Societies grade IV subarachnoid hemorrhage. Digital subtraction angiography revealed a lobulated aneurysm with a broad neck (4.8 mm) arising from the superior limb of a fenestrated ACOM complex. Emergency left pterional craniotomy was performed. Sequential clipping was employed: a 9 mm straight clip remodeled the aneurysmal neck and secured a perforator, followed by a 4-mm fenestrated clip across the neck for complete obliteration. Indocyanine green angiography confirmed aneurysm exclusion with preservation of parent vessels and perforators. Postoperatively, the patient showed modest neurological improvement but succumbed on day 19 due to ventilator-associated pneumonia and comorbidities. Fenestrated, lobulated ACOM aneurysms are technically demanding. Tailored clip strategies, careful preservation of perforators, and intraoperative angiography are crucial for safe and effective microsurgical management.

Intra-oral intramuscular lipoma in a child masquerading as plunging ranula diagnosed on cytology

2026-01-31T08:26:50+0530

Intra-oral intramuscular lipomas are rare, especially in pediatric populations. Their clinical presentation may mimic more common cystic lesions such as plunging ranulas, often leading to diagnostic confusion. We reported a rare case of an intramuscular lipoma of the floor of the mouth in a child, initially suspected to be a plunging ranula due to its submandibular swelling and soft, fluctuant consistency. Fine needle aspiration cytology (FNAC) revealed mature adipocytes without cystic or inflammatory elements, confirming the diagnosis of intramuscular lipoma. Surgical excision was performed, and histopathology corroborated the cytological findings. This case highlights the diagnostic challenge posed by intramuscular lipomas in the oral cavity of children and underscores the critical role of FNAC in distinguishing them from more common cystic lesions like plunging ranulas. Early and accurate diagnosis is essential to guide appropriate surgical management and prevent recurrence.

A real- world experience with asciminib in elderly CML-CP patients intolerant to previous

2026-01-31T08:25:47+0530

Tyrosine kinase inhibitors (TKIs) have transformed the management of chronic myeloid leukemia in chronic phase (CML-CP). However, long-term therapy is often limited by intolerance, adverse events, and quality of life (QOL) concerns. Asciminib, is the 1st and only approved BCR. ABL1 inhibitor that works by STAMP (Specifically Targeting the ABL Myristoyl Pocket), has demonstrated efficacy and tolerability in patients previously treated with ≥2 TKIs. We report two elderly CML-CP patients with intolerance to multiple TKIs who achieved sustained responses with asciminib. A 60-year-old woman with CML-CP, diabetes, hypertension, and CKD. After intolerance to Dasatinib and Nilotinib (due to recurrent pleural effusion), she was switched to Asciminib in March 2025. Since then, her leukemia remains under complete molecular control, and her overall condition is stable with manageable comorbidities. A 77-year-old male with CML (chronic phase, November 2022) presented with weight loss, anorexia, and fatigue. Initial TKIs (Nilotinib, Dasatinib, Imatinib) led to cytopenias/intolerance, but since June 2024 on Asciminib 80 mg OD, he has achieved deep molecular response (BCR-ABL 0.139% as of July 2025) and remains clinically stable with manageable cytopenias. These real-world cases highlight the clinical utility of asciminib in elderly, comorbid CML-CP patients who are intolerant to the previous TKIs. Asciminib provided durable molecular responses and superior tolerability, consistent with trial data, and represents a valuable therapeutic option in this challenging patient population.

Furfuryl palmitate emollient in pediatric atopic dermatitis: real-world case report

2026-01-31T08:25:42+0530

Atopic dermatitis (AD) is a chronic inflammatory disease that can be characterized by impaired barrier dysfunction, immune dysregulation, and oxidative stress. While long-term corticosteroid therapy is effective for the treatment of AD, safety concerns often limit use and contribute to poor adherence, especially in children, thus compelling the need for safer, non-steroid options. Furfuryl palmitate, a strong antioxidant with skin barrier-protective properties, has been shown to reduce oxidative damage and inflammation in AD. This case report focuses on two children, aged 4 and 9 years, with moderate AD [eczema area and severity index (EASI) scores 18-19.5] treated with Relizema^® cream, which contains furfuryl palmitate. They received it either as ongoing treatment after stopping corticosteroids or along with calcineurin inhibitors. Between 3 and 6 months of treatment, both children demonstrated significant clinical improvement, including improvement in erythema, pruritus, and lichenification, and there were no adverse effects or disease flares. Improvements were also noted in sleep quality, emotional well-being, and caregiver stress. The dual mechanism of hydration and modulation of oxidative stress with furfuryl palmitate is an effective strategy for long-term management of AD to maintain long-term remission, while increasing adherence. This case report supports furfuryl palmitate in the cream form as an effective, well-tolerated, non-steroid option for pediatric patients with AD, and furfuryl palmitate cream is another valuable resource for long-term proactive management of AD that aims to restore the barrier function of the skin and prevent relapses of AD.

Bilateral malignant brenner tumour ovary; an extremely rare occurrence

2026-01-31T08:25:41+0530

Malignant Brenner tumours (MBTs) are extremely rare ovarian neoplasms, constituting 1–5% of all Brenner tumours. They are typically found in women of the perimenopausal or postmenopausal age group of 50–70 years. MBT often manifest with nonspecific symptoms such as abdominal pain, abnormal uterine bleeding, and weight loss. Definitive diagnosis is possible on histologic examination only, as imaging features and serologic markers are non-specific and give inconsistent results. Being an extremely rare neoplasm, our knowledge about MBT is restricted to case series and case reports. Adding to the rarity, we report a bilateral MBT ovary in a 55-year-old perimenopausal woman presenting with the chief complaint of bilateral lower abdominal pain and discomfort. Ultrasonographic imaging revealed bilateral large adnexal masses of heterogeneous echogenicity, suggesting bilateral malignant ovarian tumour. CA125 was within the reference value. The patient then underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, and after the histopathologic examination diagnosis of bilateral MBT was made. Patient is on regular follow-up and was disease-free for 4 years until recently, when she developed pleural effusion and is under further investigation.

Congenital extranasal glial heterotopia in infancy: a rare case report

2026-01-31T08:25:37+0530

A seven-month-old female child has been presented with extra nasal mass on the dorsum of the nasal bridge since birth. On clinical examination a 1.6x1.4 cm globular, firm, non-compressible, non-pulsatile mass was noted over the nasal dorsum, slightly left of midline. Radiological studies were suggestive of extranasal glioma without intranasal or intracranial extension. Histopathological examination revealed a non-encapsulated, ill-defined lesion composed of sheets and nests of benign and mature glial tissue. Glial heterotopia is defined as the mass of mature brain tissue isolated from the cranial cavity or spinal canal. Nasal glial heterotopias are congenital tumors. The nose and nasopharynx are the most common sites of location. Nasal glial heterotopias are rare benign lesions that can be challenging to diagnose clinically and radiologically due to their uncommon presentation. In this case report; we discuss a rare case of extranasal glial heterotopia, highlighting its clinical presentation, diagnostic challenges, radiological and histopathological features.

Management of autism and attention-deficit hyperactivity disorder in Dup15q syndrome

2026-01-31T08:25:34+0530

Dup15q syndrome is an uncommon neurogenetic disorder caused by duplications of chromosome 15q11.2-13.1, typically through idic (15) or interstitial duplications. Its prevalence is about 1 in 5,000 births and is characterised by hypotonia, developmental delays, intellectual disability, autism, and seizures, with greater severity in maternally derived duplications. Symptoms overlap with related conditions such as Prader-Willi and Angelman syndromes. Early detection and intervention, supported by a robust database, will improve quality of life. An 11-year-old girl with Dup15q syndrome was referred for psychiatric evaluation due to her emotional and behavioral issues at school. She had a history of developmental delays and persistent autistic traits. Her parents noted early morning awakenings and negative self-talk. At the time of evaluation, she was receiving psychotropic and antiepileptic medications. The review found her restless and tense, with limited insight. To ensure her safety, the school provided one-on-one support during medication adjustments, and she showed some improvement in the following weeks. However, she still faced challenges with sensory dysregulation and emotional reactions. Dup15q syndrome is a complex neurogenetic disorder that requires early detection and intervention for optimal outcomes with genetic testing and personalized care strategies. Addressing the behavioral, social, and sensory challenges associated with the condition is essential, as these difficulties will intensify with age. Ongoing research and the development of support networks are vital to enhancing the quality of life for individuals with Dup15q syndrome and their families.

Idiopathic recurrent facial palsy: a detailed investigation

2026-01-31T08:25:36+0530

The seventh cranial nerve may be partially or completely damaged, resulting in central or peripheral facial palsy. This leads to weakness of facial muscles, distorted facial expressions and drooling on the affected side. Common causes include cold exposure, pregnancy-related fluid retention, middle ear infections and herpes zoster infection. This case report discusses a 33-year-old male, Mr. RSY, who presented with right-sided facial palsy for the fifth time. Previous episodes occurred annually from 2020 to 2023. He is a chef from Erode who presented to the Medicine OPD with mouth deviation, incomplete right eye closure with positive Bell’s phenomenon, and mild headache and neck pain. He had no relevant medical history or recent cold exposure. Blood tests were normal and chest X-ray revealed mild hilar lymphadenopathy. ENT examination and HRCT of the temporal bone were normal. The only notable finding was the involvement of the seventh cranial nerve. Management included a seven-day course of corticosteroids, antiviral drugs and physiotherapy. The physiotherapy regimen comprised facial massage, facial exercises and stimulation. A home exercise program was also advised. The patient improved significantly with this combined treatment and recovered within four weeks. This case underscores the importance of early and comprehensive management of facial palsy with corticosteroids and physiotherapy for full recovery. It also highlights some patients' potential seasonal recurrence patterns, warranting further research to elucidate the exact pathogenesis and risk factors associated with facial palsy.

Shigella gastroenteritis with myocarditis and acute kidney injury: a case report

2026-01-31T08:24:29+0530

Shigella are a well-known cause of acute gastrointestinal infections but sometimes it can present with extraintestinal manifestations. Extra intestinal complications of shigella includes seizures, encephalopathy, reactive arthritis, acute kidney injury of Haemolytic-Uremic Syndrome (HUS). Other severe manifestations can involve the myocarditis. severe hyponatremia, bacteremia, and a leukemoid reaction. Shigella myocarditis refers to a very rare complication during or after a Shigella infection. Viral infections are more common cause of acute myocarditis. Bacterial myocarditis is very rare but only few cases shigella myocarditis have been reported in the past. This article presents a 38year old male presenting with a case of shigella gastroenteritis complicated by myocarditis and acute kidney injury. He was presented with dysentery and chest pain with electrocardiogram showing ST-T changes, his echo showed global hypokinesia with low ejection fraction. Stool examination revealed shigella species. This event was resolved with treatment of antibiotics.

Lantern on dome of St Paul’s: successful removal of a cervical fibroid with unusual presentation: a case report

2026-01-31T08:24:22+0530

Fibroids are most common benign tumour. Most commonly fibroids are situated in the body of uterus but rarely in cervix accounting only about 1-2% of all cases. We report a case of a 49 years old nulliparous women with gradually increasing abdominal mass for one and half year associated with urinary symptoms. A huge mass of 20week size of gravid uterus revealed in abdominal examination which was non tender, firm in consistency, immobile with regular margin and smooth surface. In USG abdomen and pelvis showed huge abdominopelvic mass. CT revealed mass lesion occupying body of uterus and cervix with displacement of endometrium and elongated cervix. Ureters displaced laterally. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathological examination confirmed diagnosis confirmed diagnosis of benign smooth muscle tumour -cervical leiomyoma with significant inflammation. The postoperative period was uneventful.

Lymphoid-rich lesions of the salivary glands: how not to miss malignancy

2026-01-31T08:24:18+0530

Salivary gland lesions with prominent lymphoid components pose a significant diagnostic challenge in cytopathology due to considerable morphological overlap among reactive, benign, and malignant conditions. While fine-needle aspiration cytology (FNAC) is commonly used as a first-line diagnostic tool, its accuracy may be limited by sampling variability and tumor heterogeneity, particularly in lymphoid-rich neoplasms where the epithelial component is minimal or obscured. This report presents three cases that illustrate frequent diagnostic pitfalls in lymphoid-rich salivary gland lesions: acinic cell carcinoma with prominent lymphoid stroma initially misdiagnosed as chronic sialadenitis, adenoid cystic carcinoma of the submandibular gland with cervical lymph node metastasis, and Warthin’s tumor mimicking chronic granulomatous sialadenitis on cytology. These cases underscore the importance of meticulous cytomorphological assessment, adequate sampling, and comprehensive clinicoradiological correlation. Histopathological examination remains indispensable for establishing a definitive diagnosis in ambiguous cases. Greater awareness of lymphoid-rich variants of salivary gland tumors and maintaining a low threshold for surgical biopsy are essential to avoid missed or delayed diagnoses of malignancy.

The osteo-hepatic axis: a review of bone disease, insulin-like growth factor-1, and fracture risk in fatty liver disease

2026-01-31T08:24:24+0530

Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcoholic fatty liver disease (AFLD) represent emerging global health burdens with significant extra-hepatic complications. Among these, metabolic bone disease, particularly osteoporosis, has gained recognition as a major determinant of patient morbidity and quality of life. This narrative review synthesizes current evidence on the pathophysiological interplay between fatty liver diseases and bone health, with special emphasis on insulin-like growth factor-1 (IGF-1) dysregulation and bone mineral metabolism. The liver serves as the primary source of circulating IGF-1 and is crucial for vitamin D metabolism. In MASLD and AFLD, hepatocellular injury leads to IGF-1 deficiency, which impairs osteoblast function and bone formation. Concurrently, vitamin D deficiency and secondary hyperparathyroidism promote increased bone resorption. Chronic inflammation, characterized by elevated cytokines like TNF-α and IL-6, further exacerbates bone loss through the RANKL/OPG pathway. In AFLD, additional direct toxic effects of alcohol on osteoblasts compound the problem. Clinical studies consistently demonstrate reduced bone mineral density and increased fracture risk in these populations. Despite this evidence, standardized screening protocols and management guidelines for bone disease in non-cirrhotic fatty liver disease patients are lacking. This review highlights the critical need for integrated care models that address both hepatic and skeletal health, advocating for routine bone density assessment in MASLD/AFLD clinics. Future research should focus on comparative studies between MASLD and AFLD, exploration of IGF-1 as a dual biomarker, and development of targeted therapeutic strategies to mitigate fracture risk in this vulnerable and growing patient population.

Mitochondrial dysfunction in refractory angina: therapeutic rationale for cardiolipin stabilization with elamipretide

2026-01-31T08:24:18+0530

Refractory angina remains a significant clinical challenge despite advances in pharmacological therapy and coronary revascularization. Conventional anti-anginal agents primarily target myocardial oxygen demand or coronary blood flow; however, a substantial proportion of patients continue to experience persistent symptoms, particularly those with coronary microvascular dysfunction or ischemia in the absence of obstructive coronary artery disease. Increasing evidence suggests that impaired myocardial energetics and mitochondrial dysfunction play a central role in ischemic symptom generation. Cardiolipin, a key phospholipid of the inner mitochondrial membrane, is essential for maintaining electron transport chain integrity and efficient oxidative phosphorylation. Disruption of cardiolipin structure during ischemia contributes to mitochondrial dysfunction, reduced adenosine triphosphate (ATP) production, and increased susceptibility to ischemia. Elamipretide is a novel mitochondria-targeted peptide designed to stabilize cardiolipin and improve mitochondrial function under ischemic conditions without significant hemodynamic effects. This review examines the pathophysiological basis of refractory angina with a focus on mitochondrial dysfunction, outlines the pharmacological rationale for targeting cardiolipin, and critically appraises the preclinical and emerging clinical evidence supporting elamipretide as a potential therapeutic strategy. Targeting myocardial bioenergetics represents a mechanistically distinct and promising approach for selected patients with refractory angina.

Andreas Vesalius: novel anatomist of the Roman empire: a review article

2026-01-31T08:26:55+0530

Andreas Vesalius, born in Brussels on December 31, 1514, and passing away in Zante in 1564, hailed from a distinguished line of physicians. He grew up in the coastal low countries, which were part of the seventeen provinces. These regions, now encompassing mainly The Netherlands, Belgium, Luxembourg, and the north of France, enjoyed a certain degree of cultural, economic, and political autonomy. In 1529, Vesalius left Brussels to pursue studies at the Catholic University of Leuven. from 1533 to 1536, he journeyed to France to further his medical education at the University of Paris. Vesalius' predecessors and contemporaries had also written about anatomical teaching, his work "De Humani Corporis Fabrica" is now widely regarded as a pivotal advancement in the methodology and teaching of anatomical science. Vesalius' predecessors and contemporaries had also written about anatomical teaching, his work
"De Humani Corporis Fabrica" is now widely regarded as a pivotal advancement in the methodology and teaching of
anatomical science.

Association between gestational weight gain and pregnancy outcomes in women with diabetes

2026-01-08T07:52:14+0530

Background: Hyperglycemia is a common complication of pregnancy, and the prevalence of both pregestational and gestational diabetes has increased substantially over the past decade. Hyperglycemia in pregnancy is associated with adverse maternal and neonatal outcomes. Pre-pregnancy weight and gestational weight gain (GWG) are important determinants of maternal and fetal health. To investigate the association between GWG and adverse maternal and neonatal outcomes in women with diabetes.

Methods: A retrospective study included 1,600 singleton pregnant women with diabetes who delivered at Rajavithi Hospital between January 2016 and December 2023. GWG was classified according to Institute of Medicine (IOM) recommendations based on pre-pregnancy body mass index (BMI).

Results: Among the 1,600 pregnancies, 4.81% were underweight, 44.69% normal weight, 30.94% overweight, and 19.56% obese. Excessive GWG was associated with increased risks of gestational hypertension (adjusted odds ratio (aOR) 5.70, 95% confidence interval (CI) 1.73-18.80), large-for-gestational-age (LGA) (aOR 2.22, 95% CI 1.63-3.01), macrosomia (aOR 1.97, 95% CI 1.05-3.70), and postpartum hemorrhage (aOR 2.58, 95% CI 1.24-5.40), while reducing the risk of small-for-gestational-age [SGA] (aOR 0.45, 95% CI 0.21-0.95). Insufficient GWG was associated with lower risks of preeclampsia (aOR 0.43, 95% CI 0.20-0.93) and LGA (aOR 0.64, 95% CI 0.42-0.96), but with a higher risk of preterm birth (aOR 1.87, 95% CI 1.11-3.15).

Conclusions: In women with diabetes, excessive GWG is associated with adverse maternal and neonatal outcomes. Insufficient GWG is associated with reduced risks of various adverse outcomes.

Awareness of skin lightening products and motivators of their use among Makurdi residents attending Dermatology Clinic in North Central Nigeria

2026-01-31T08:25:47+0530

Background: Skin lightening remains a common practice despite its documented risk. Most patients are unaware of their harmful effects, and even when they become aware the desire to lighten the skin supersedes. This behavior is driven by perceptions linking lighter skin with beauty, social status, or racial identity. This study assessed awareness and motivators for using skin lightening agents (SLAs) among Makurdi residents working or attending Federal Medical Centre, Benue State, Nigeria.

Methods: A cross-sectional study was conducted from June 21 to August 30, 2023, using a pretested self-administered questionnaire and convenience sampling. Participants included patients, relatives, secondary school pupils, and healthcare workers. Data were analyzed using SPSS version 25, with significance set at p<0.05.

Results: Of 421 targeted respondents, 399 participated. The mean age was 31.76±11.77 years; 58.9% were female. The prevalence of skin lightening practice was 50.1%. Common SLAs included creams and soaps with hydroquinone and corticosteroids. Self-reported adverse effects included skin irritation and discoloration. Significant associations existed between skin lightening practice and age, gender, education, occupation, hospital staff category, secondary school status, income below ₦50,000, skin color type, and adverse effects. Independent predictors of skin lightening included gender, marital status, occupation, satisfaction with skin color, perception of attractive skin, prior adverse effects, and a history of skin conditions.

Conclusions: High awareness of SLAs does not correlate with knowledge of their harmful effects. Continued use is driven by socio-cultural factors. Public health education and stricter regulation are essential to curb this practice.

Clinical significance of rheumatoid factor positivity in patients with smear-positive pulmonary tuberculosis

2026-01-31T08:24:17+0530

Background: Pulmonary tuberculosis (PTB) is a persistent infectious disease with immune disorder. Autoantibody, including rheumatoid factor (RF), is described during chronic infection; however, the clinical significance of RF in patients with smear-positive PTB has not been established. Objectives were to test the prevalence of RF positivity and its relation with severity of disease in the smear-positive PTB patients.

Methods: A cross-sectional study was undertaken among 100 smears positive PTB patients. Information on demographics and clinical history was obtained through a structured questionnaire. Serum RF concentrations were determined by standard immunoassays. Sputum smear grading was done as per the national TB guidelines. Results of descriptive statistics were calculated for all variables and associations were tested employing chi-square tests.

Results: Thirty percent of patients had RF positivity. The median serum RF concentration was 37.50 IU/ml (IQR: 27.75-55.50). It was found that patients with high sputum smear grading (2+ to 3+) were positive more for RF compared to low sputum smear grading (41.2% vs. 24.2%), but this association was not statistically significant (p=0.080).

Conclusions: Positivity of RF was prevalent in smear-positive PTB patients and tended to be associated with higher bacillary load. Our data indicate that RF elevation may be associated with immune activation during active TB.

Association of serum zinc levels with the atherogenic index in obese adults

2026-01-31T08:24:28+0530

Background: Obesity is associated with dyslipidemia and micronutrient imbalances, including altered serum zinc levels. The atherogenic index of plasma (AIP) is an emerging biomarker of cardiovascular risk. This study evaluated the association between serum zinc and AIP in obese adults.

Methods: In this comparative cross-sectional study at Sylhet MAG Osmani Medical College, Bangladesh (July 2022–June 2023), 60 participants were enrolled and divided by body mass index (BMI) according to WHO Asian guidelines: group A (obese, BMI ≥25 kg/m², n=30) and group B (healthy, BMI 18.5–24.9 kg/m², n=30). Serum zinc, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were measured, and AIP was calculated as log₁₀ (TG/HDL-C).

Results: The mean BMI was significantly higher in group A compared to group B (30.13±2.39 versus 21.88±1.87 kg/m²; p<0.001), while age and gender distribution were similar. Group A exhibited higher TG (188.53±36.93 versus 145.30±32.22 mg/dl; p<0.001) and lower HDL-C (39.43±5.93 versus 47.43±7.93 mg/dl; p=0.001). Serum zinc was significantly reduced (10.15±1.03 versus 13.13±1.34 µmol/l; p<0.001), and AIP was higher (0.32 versus 0.12; p<0.001) in obese participants compared to healthy subjects. Regression analyses showed a strong negative correlation between BMI and serum zinc (r=−0.797, p<0.001), a moderate negative correlation with TG (r=−0.591, p<0.001), and a moderate positive correlation with HDL-C (r=0.616, p<0.001).

Conclusion: Obese adults exhibited lower serum zinc levels and elevated AIP. BMI and lipid parameters, particularly TG and HDL-C, significantly predicted serum zinc status, highlighting the interrelationship between obesity, dyslipidemia, and micronutrient deficiency.

Assessment of the status of inoperable cervical cancer patients treated in a selected hospital: a single-center, observational study

2026-01-31T08:25:46+0530

Background: Cervical cancer remains a leading cause of cancer-related morbidity and mortality in low-resource settings. This study aimed to assess the socio-demographic and clinical characteristics of inoperable cervical cancer patients treated at a tertiary care hospital in Bangladesh.

Methods: A single-centered, observational study was conducted using retrospective data from patients diagnosed with inoperable cervical cancer. Patient demographics, tumor staging, histopathological features, and treatment modalities were analyzed. Statistical associations between variables were evaluated using chi-square and Fisher’s exact tests.

Results: The mean age of patients was 48.94 years, with 61.1% aged between 41 and 60. Over half (55.6%) were married at or before age 15, and 79.2% had three or more children. Most patients (83.3%) reported using oral contraceptives, and 23.6% had a family history of cancer. Stage IIB was the most common FIGO stage (52.8%), and squamous cell carcinoma (SCC) was the predominant histological type (73.6%). Tumor grade II was most frequent (73.6%). Standard chemoradiation was administered, including weekly cisplatin, external beam radiotherapy (EBRT) (mean dose 48.94 Gy), and intracavitary brachytherapy (80.6% received 21 Gy in three insertions). No significant associations were found between histopathological type (HPR) and stage (p=0.334) or family history and stage (p=1.000).

Conclusions: The study reveals a pattern of late-stage cervical cancer diagnosis in middle-aged women with identifiable socio-demographic risk factors. Strengthening early screening and awareness initiatives is critical to reducing the burden of inoperable cases in Bangladesh.

Grand multiparity and obstetric complications at the federal medical centre Umuahia, Abia State, Nigeria: a case control study

2026-01-31T08:25:46+0530

Background: Maternal mortality associated with multiparity increases steadily and speedily from the fifth pregnancy till the tenth or more with a mortality rate five times as high as in all women bearing children.

Methods: It was a five-year case controlled retrospective study of grand multiparous and multiparous women who presented at the hospital between January 1^st, 2010 and 31^st December, 2014. The population of the study consisted of 136 booked grand multiparous and 136 booked multiparous women who received antenatal, intranatal and postnatal care at the hospital during the period of the study. The entire population was used. The instruments for data collection were the obstetrics records and registers and the individual patient’s case notes that were obtained from the Medical Records Department and from labour ward of the Federal Medical Centre (F.M.C) Umuahia. Data were collected using researcher’s developed proforma and were analysed descriptively using SPSS/IBM version 20 and presented in frequencies, percentages, means and standard deviation. A chi-square test was used for comparison of data which was taken at p 0.05.

Results: The major findings showed that anaemia, chronic hypertension, antepartum haemorrhages, postdate, macrosomia, postpartum haemorrhage etc. were higher in the grand-multiparas compared to the multiparas. Multiparas had higher incidence of pre-eclampsia, caesarean section, low birth weight etc. than the grand-multiparas.

Conclusions: It is recommended that there is need to encourage female child education and equip obstetric facilities adequately to reduce the complications resulting from grand-multiparity.

Patterns of skin cancers at Federal Medical Centre, Makurdi, Benue State, North Central Nigeria: a 10-year retrospective study

2026-01-31T08:25:35+0530

Background: Skin cancers are increasingly recognized as a public health concern in Nigeria. Their patterns of occurrence often differ from global trends. Understanding these variations is essential for prevention, early diagnosis, and planning. This study assessed the clinicopathologic patterns of skin cancers at the Federal Medical Centre, Makurdi, Benue State, over a ten-year period.

Methods: A retrospective review was conducted on 96 patients diagnosed with skin cancers from 2014 to 2023. Demographic characteristics, tumor type, anatomical site, and year of diagnosis were obtained from medical records. Data were analyzed using statistical package for the social sciences (SPSS) version 23 and presented as proportions. A year-trend graph illustrated temporal patterns, while chi-square analysis tested associations, with significance set at p<0.05.

Results: The mean age at diagnosis was 45.34±20.17 years, with females accounting for 64.6% of cases. Squamous cell carcinoma (SCC) (33.3%) and malignant melanoma (MM) (28.1%) were the predominant histologic types, while basal cell carcinoma (BCC) was uncommon (4.2%). Among children aged 4-14 years, rhabdomyosarcoma (Rms) constituted 37.5% of tumors, and Kaposi sarcoma (Ks) represented 5.2%. A steady rise in incidence was observed, peaking in 2020. Chi-square analysis showed no significant association between gender and cancer type (p=0.334) or age and cancer type (p=0.098).

Conclusions: Skin cancers occurred more frequently in younger individuals and women. The high melanoma burden, SCC, and late presentation highlight the need for stronger public awareness, integration of skin cancer screening into primary care and HIV services, and improved cancer registry systems to enhance early detection and outcomes.

Young paediatricians on the frontline: awareness of neonatal stabilization in congenital diaphragmatic hernia prior to surgical referral

2026-01-31T08:25:43+0530

Background: In congenital diaphragmatic hernia (CDH), survival and morbidity hinge on meticulous cardiopulmonary stabilization during the minutes to hours after birth often led by young paediatricians. Core elements include no bag-mask ventilation, early endotracheal intubation, orogastric decompression, titrated oxygen to preductal saturation milestones, gentle ventilation with permissive hypercapnia, hemodynamic optimization for PPHN, transport readiness and deferral of surgical repair until physiologic stability. Objective: To evaluate young paediatricians’ knowledge and practices in early CDH stabilization, quantify guideline fidelity, identify gaps (including beliefs about early surgery) and determine educational/system factors associated with high performance.

Methods: Multi-centre cross-sectional survey of junior paediatricians across labour wards, EDs and NICUs. A validated 48-item tool generated a stabilization fidelity score (SFS, 0–20). Multivariable models assessed associations between training exposures and high SFS (≥16/20).

Results: Among 312 respondents (mean age 28.4 years; 62% female, 61% tertiary centres), recent NRP was 68%, NICU ≥6 months 54%, CDH simulation 41%. Mean SFS was 13.8±3.4, 29.5% achieved ≥16/20. Strengths: intubation priority (84%), OG decompression (79%), transport checklists (74%). Gaps: avoidance of bag-mask ventilation (58%), correct preductal SpO₂ targets (46%), permissive hypercapnia (39%), stepwise PPHN management (41%). Notably, 35% believed earlier repair helps even when unstable; 18% were unsure. NRP, NICU time, simulation and unit checklists independently increased odds of high SFS.

Conclusions: Young paediatricians execute procedures well but often miss numeric targets and algorithmic PPHN therapy; misconceptions about early surgery persist. Low-cost levers checklists, simulation that drills the numbers, NRP reinforcement and explicit myth-busting (“stabilize first, repair later”) can raise fidelity and pre-operative readiness.

Perception and compliance to COVID-19 vaccine uptake among public transport users in Kiambu county

2026-01-31T08:26:52+0530

Background: The COVID-19 was declared a pandemic in 2020 and has so far affected 231 countries, causing over 700 million infections and approximately 7 million fatalities globally. The disease created a heavy burden and disorganized healthcare systems worldwide, with more serious pressure being felt in the African developing countries. Covid’s effects were felt at all levels of society, with serious implications for social, economic, educational, political, and human security. Since there is no known cure for COVID-19, creating immunity is key to prevent future morbidities and fatalities, through vaccination.

Methods: A cross-sectional study design to collect data from public transport users. Dependent variable was COVID-19 vaccine uptake, influenced by knowledge, perception, contextual, and socio-demographic factors. Kiambu County was selected purposively. Study population comprised consenting adults using public transport users. A multi-stage sampling approach was used where Kiambu County was first purposively selected, followed by simple random sampling of three sub-counties. Finally, simple random sampling of individual respondents. Data was collected through questionnaires, with 311 questionnaires being analyzed using SPSS 26.0 software.

Results: The proportion of public transport users who received the first dose of COVID-19 vaccine is 69.77% males and 30.23% females. Overall, 62.7% of the respondents complied with the first dose of the COVID-19. Overall, 23.15% of the total respondents complied to the complete COVID-19 vaccine uptake.

Conclusions: The findings showed a slightly lower average second-dose vaccination rate among males and a general decline in vaccination uptake among older age groups.

A comparative study of monopolar versus bipolar transurethral resection of prostate for the management of benign prostatic enlargement with particular reference to post operative complications

2026-01-14T08:35:19+0530

Background: Benign prostatic hyperplasia (BPH) is a very common disease seen in old age men and incidence increases with increasing age of the individual. The incidence of lower urinary tract symptoms like voiding and irritative (LUTS) secondary to BPH affects about 3% of male between 45 and 49 years of age, rising to above 30% in men over 80 years of age. Monoplar TURP (M-TURP) considered as a gold standard procedure for the resection of the prostate though bipolar TURP (B-TURP) has some benefits over the M-TURP.

Methods: 82 patients with eligible criteria sample size were taken. These patients were randomly divided into 2 groups: group 1 (41 patients) underwent M TURP, while group-2 (41 patients) underwent B-TURP.

Results: 82 patients were operated with M-TURP and B-TURP 41 patients each. Mean age of the patient was 66.4 years in M-TURP and 67.5 year in B-TURP, time of resection was more in B-TURP 51.3 min and 45.6 min in M-TURP. Residual prostate volume was less in B-TURP. PVRU improvement was more in B-TURP. Post op clot retention, TUR syndrome, mean fall in haemoglobin and blood transfusion was more in monopolar TURP.

Conclusion: B-TURP and M-TURP both procedures are good and improves lower urinary tract symptoms, although B-TURP is associated with less risk of dilutional hyponatremia, TUR syndrome, and blood loss, need of blood transfusion compared to M-TURP.

Understanding awareness and misconception of male infertility in South-Eastern India

2026-01-17T08:13:02+0530

Background: People worldwide have many misconceptions and awareness regarding reproductive health and fertility because infertility is still a taboo subject among all people. The public seek medical and psychological counsel and assistance from health experts about male infertility. Therefore, this study aimed to explore the awareness and misconception about male infertility among general population of South-eastern part of India.

Methods: The cross-sectional study was used. A total of 301 valid responses were received. Subjects were selected by convenient sampling method who are fulfilling the inclusive criteria. The structured questionnaire was developed in the google form and the link was shared among various groups.

Results: The 78.7% of participants reported of being aware of male infertility. Most participants (63.1%) had a moderate level of awareness, 21.3% had good awareness and 15.6% showed a low level of awareness regarding male infertility. The mean misconception score was 2.42±1.32, signifying an overall low level of misconception. There is a negative but negligible relationship (r=-0.063) between awareness and misconception. A statistically significant association was observed with gender (χ²=9.517, p=0.009) and awareness whereas gender and marital status (p<0.05) were significantly associated (p<0.05) with the degree of misconception (χ²=16.914, p<0.001), (χ²=15.47, p=0.004) respectively.

Conclusions: This study revealed moderate awareness but persistent misconceptions regarding male infertility, with gender differences which signifies need for targeted and culturally sensitive educational programme to dispel myths and promote shared responsibility in reproductive health.

Study of hepato-renal syndrome in patients of cirrhotic ascites in an academic hospital

2026-01-31T08:24:17+0530

Background: Acute renal impairment is common in patients with chronic liver disease, occurring in approximately one fifth of hospitalized patients with cirrhosis. Considering limited evidence of epidemiological information of this topic, the study was designed to identify the number of patients suffering from hepatorenal syndrome (HRS) among patients of cirrhotic ascites admitted in an academic hospital.

Methods: This hospital based cross-sectional type observational study was conducted at the department of medicine and gastroenterology. Total 100 subjects were interviewed. Data were collected by researcher with a structured questionnaire. After the interview the investigator recorded the collected information and later on transcribed into statistical software. Finally, data were analyzed by the SPSS 21.

Results: Total 100 subjects were studied and mean age was 46.31±10.75 years, ranging from 22 to 65 years. Majority of the participants were male (69%). The most common cause of cirrhosis of liver was chronic hepatitis B infection (45%), followed in second and third by NAFLD (25%) and chronic hepatitis C (18%). In according to the Child-Turcotte-Pugh class, about 51% were in CP class A, 36% were in class B and remaining 13% were in class C. Overall frequency of HRS was 17% and type 2 was predominant (7%-type 1 HRS vs 10%-type 2 HRS).

Conclusions: Less than one fifth of the patients developed HRS and it is associated with higher Child-Pugh class. However, further studies are needed to establish and use the findings.

Assessment of developmental dysplasia of the hip using ultrasonography in infants

2026-01-31T08:24:21+0530

Background: Developmental dysplasia of the hip (DDH) represents a spectrum of anatomical abnormalities that may lead to long-term functional impairment if not diagnosed and treated early. Ultrasonography allows real-time visualization of cartilaginous hip structures and is the preferred imaging modality during early infancy. This study aimed to evaluate ultrasonographic findings of DDH in infants and analyze associated demographic characteristics, risk factors and Graf classification patterns.

Methods: This cross-sectional study was conducted at the Department of Radiology and Imaging, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh, from July 2024 to June 2025. Thirty infants aged six months or younger underwent bilateral hip ultrasonography using the standardized Graf technique. Demographic variables, perinatal risk factors and sonographic parameters were recorded systematically. Data were analyzed using SPSS version 25.0.

Results: Female infants constituted 63.3% of the study population. Normal hips (Graf type I) were identified in 46.7% of infants, while 23.3% demonstrated physiologic immaturity (type IIa). Moderate to severe dysplasia (types IIb-IV) was observed in 26.7% of cases. Reduced α-angle, shallow acetabulum and increased β-angle were the most frequent abnormal findings. The proportion of normal hips increased with advancing age, indicating progressive acetabular maturation.

Conclusions: Ultrasonography is an effective, reliable modality for early detection of DDH, particularly among high-risk infants. Early identification facilitates timely intervention and may reduce the burden of late-presenting disease.

Maternal, perinatal, and socio-demographic factors associated with childhood disabilities: evidence from a cross-sectional study in Rajshahi, Bangladesh

2026-01-31T08:24:14+0530

Background: Childhood disability pertains to an important public health issue with a complex etiology which includes genetic, biological and environmental factors. However credible prevalence information about disability profiles and its associated factors are scarce, especially outside the major urban areas of Bangladesh. This study was designed to determine the prevalences of common disabilities among children in Rajshahi and their relationship with maternal, prenatal, and socio-demographic factors.

Methods: A cross-sectional study was conducted among 120 children attending Islami Bank Medical College and Hospital in Rajshahi, selected through purposive sampling. Data were collected via face-to-face interviews with mothers/guardians using a structured questionnaire. Descriptive statistics and chi-square tests were employed to analyze the distribution of disabilities and their associations with risk factors using SPSS version 22.

Result: This was a descriptive cross-sectional study done in the Department of Medicine, Islami Medical College and Hospital, Rajshahi, Bangladesh, July 2024 to June 2025. A purposive sample of 120 disabled children who visited the hospital in the study period were recruited. Relevant data were gathered through personal interview of mothers or caretakers, employing a predesigned and pretested semi-structured questionnaire. All disabled children then attending the institute during the study period were already included, and no one declined to participate.

Conclusion: The results highlight a multi-etiology of childhood disability in the study area, and underscore the contribution of perinatal events, maternal age and family disposition to its etiology. Integrated public health management strategies that address issues such as lack of prenatal care, early screening, parental awareness, and inclusive community-based support are urgently needed to reduce disability risks and improve quality of life of affected children.

Diagnostic performance of routine urinalysis parameters in urinary tract infection

2026-01-31T08:26:57+0530

Background: Urinary tract infection (UTI) is a common bacterial infection presenting from asymptomatic bacteriuria to severe disease. Early detection is essential, and urinalysis remains the most frequently used screening tool owing to its rapidity and low cost, although urine culture is the diagnostic gold standard. Dipstick tests such as leukocyte esterase (LE) and nitrite (NIT) are widely used, but their performance varies. This study assessed the diagnostic accuracy of LE, NIT, leukocyte count, and bacteriuria in predicting significant bacteriuria compared with urine culture.

Methods: This retrospective observational study included adult mid-stream urine samples processed in the Pathology and Microbiology Departments of FMMC Hospital, Mangalore (March, 2022). Of 3618 urinalysis samples, 306 had concurrent culture. Dipstick parameters (LE, NIT) and microscopic sediment findings (leukocyte count, bacteriuria) were recorded. Culture growth ≥10⁵ CFU/ml was taken as significant. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and kappa.

Results: Among 278 samples, females were slightly more represented. E. coli was the most common isolate (43.2%). Sixty-five percent showed >10⁵ CFU/ml growth. NIT was positive in 16%, while LE 3+ was the most frequent dipstick result. High leukocyte count (≥20 WBC/hpf) occurred in 37% and bacteriuria in 29%. High leukocyte count showed 43.4% sensitivity and 75% specificity. Combining ≥20 WBC/hpf with bacteriuria improved specificity (91.7%) and PPV (81.8%).

Conclusions: Routine urinalysis is useful as an initial screening tool, but microscopic sediment analysis is superior to dipstick testing. However, urine culture remains essential for definitive diagnosis.

Effectiveness of using medical health records as an educational tool in teaching integrated laboratory medicine in phase-II MBBS students

2026-01-31T08:26:55+0530

Background: Undergraduate medical students develop technical proficiency in laboratory medicine but frequently lack understanding of clinical significance. This knowledge gap impairs their integrated approach to data interpretation and makes analytical exercises challenging, highlighting the need for improved teaching methodologies.

Methods: A comparative study of 106 medical students randomly divided into control and intervention groups was conducted. The intervention group received instruction using duplicated medical health records, while the control group was taught using traditional case-based learning. Academic performance was assessed through standardized scoring with statistical analysis. A Likert scale questionnaire evaluated intervention group participants' perceptions.

Results: No significant difference was found between mean academic scores of control and intervention groups (p=0.567). However, qualitative assessment showed overwhelmingly positive reception, with 98.6% of intervention group students expressing favorable attitudes toward medical health records as effective educational resources for integrated laboratory medicine.

Conclusions: Medical health records represent a valuable educational resource for teaching integrated laboratory medicine to undergraduate medical students. However, their effectiveness in improving academic performance remains uncertain. Further studies with larger sample sizes and longer follow-up periods are recommended to strengthen understanding of this educational approach's potential benefits.

Efficacy of omalizumab in the management of moderate-to-severe asthma in paediatric patients: a clinical evaluation

2026-01-31T08:26:54+0530

Background: Children diagnosed to have mild-to-intense allergic asthma (AA) often present with comorbid chronic sinusitis (CS), which complicates the management of their condition and adversely affects their quality of life (QoL). Omalizumab (OM), a monoclonal antibody (MCA) targeting IgE, has demonstrated potential in the management of both conditions; however, the availability of real-world data in pediatric populations is still restricted.

Methods: This study involved children having mild-to-intense AA and chronic rhinosinusitis, recruited from the Pediatric Allergy and Pulmonology Clinic at Indira Gandhi Institute of Child Health, Bengaluru, India. Omalizumab was administered from January 2021 to May 2023, subcutaneously every 2-4 weeks at doses of 150-600 mg based on body mass index and baseline IgE levels. Asthma control was gauged using the Childhood Asthma Control Test (C-ACT), Asthma Control Test (ACT), fractional exhaled nitric oxide (FeNO), and lung function (LF) indices.

Results: Omalizumab treatment significantly improved asthma control, shown by increased C-ACT/ACT scores (p<0.05) and a notable drop in FeNO levels (p<0.05). LF indices associated with small airway function (PEF%pred, FEF75%, FEF50%, FEF25–75%) demonstrated noteworthy improvement (p<0.05), whereas changes in FEV1%pred and FEV1/FVC were not statistically significant. VAS scores for CS symptoms significantly decreased (p<0.05).

Conclusions: Omalizumab effectively treats children having mild-to-intense AA and CS, enhancing asthma control, small airway function, and alleviating sinusitis symptoms. These findings endorse omalizumab as an additional therapy for this difficult pediatric group.

Comparative evaluation of no touch vaginoscopy and conventional hysteroscopy in a tertiary care hospital of North India

2026-01-31T08:26:53+0530

Background: Optimal management of endometrial disease requires accurate and timely diagnosis followed by effective treatment. Modern outpatient hysteroscopy can be utilized as a first line method for diagnostic procedure. No touch technique (vaginoscopy) has been introduced in an attempt to make the procedure less painful as it includes reduced anesthetic risks and is cost effective. This study aimed to compare the vaginoscopic hysteroscopy and conventional hysteroscopy in context of pain and patient satisfaction. Also, to compare the procedure time, complications and use of anaesthesia associated with both the techniques

Methods: This is a hospital based prospective study which will be conducted on 100 women in department of obstetrics and gynaecology, DMC&H, Ludhiana. After taking informed consent patients will be randomised into 2 groups. Group A (n= 50) patients who will be undergoing vaginoscopic hysteroscopy and Group B (n= 50) who will be undergoing standard hysteroscopy. Both groups were compared based on demographic parameters, pain score, time required for procedure completion and need of anesthesia.

Results: The mean pain score, duration required for procedure completion and need of anesthesia was less in vaginoscopy group compared to standard hysteroscopy group.

Conclusions: The vaginoscopic approach is less painful, better tolerated, quicker to perform therefore, more successful than standard hysteroscopy technique.

The effects of EMG biofeedback therapy and facial nerve mobilization in Bell’s palsy

2026-01-31T08:26:51+0530

Background: Bell’s palsy is a common neurological disorder characterized by sudden, unilateral facial nerve paralysis, leading to both functional impairments and cosmetic concerns. While conventional treatment approaches are frequently employed to alleviate symptoms, emerging rehabilitation techniques such as electromyographic (EMG) biofeedback and facial nerve mobilization have shown promising potential in enhancing recovery outcomes. This study aimed to evaluate the combined effects of EMG biofeedback therapy and facial nerve mobilization on facial symmetry and functional recovery in patients with acute Bell’s palsy.

Methods: A total of 30 participants, aged 18–40 years, with unilateral Bell’s palsy classified as Grade III–V on the Modified House–Brackmann (HB) Scale were recruited. Participants were allocated into two groups: the experimental group (n=15) received EMG biofeedback and facial nerve mobilization, whereas the conventional group (n=15) underwent traditional physiotherapy. Both groups participated in 45-minute treatment sessions, five days per week, for four weeks. Outcome measures included the Sunnybrook Facial Grading Scale (SFGS) and surface electromyography (sEMG).

Results: Statistical analysis revealed significant improvements within both groups; however, the experimental group demonstrated greater gains. SFGS scores improved significantly within groups (p<0.001), with the experimental group achieving superior results (p<0.001) and a large effect size (r=–0.854). Surface EMG analysis indicated significantly higher post-treatment muscle activation across all facial muscles in the experimental group (p < 0.001).

Conclusions: These findings suggest that EMG biofeedback combined with facial nerve mobilization is an effective intervention for enhancing facial symmetry and functional recovery in acute Bell’s palsy, making it a promising addition to rehabilitation protocols.

Prevalence and correlates of depression and cognitive impairment among geriatric patients in a tertiary care hospital in Northern India: a cross-sectional study

2026-01-31T08:25:48+0530

Background: India's rapidly aging population faces a significant burden of neuropsychiatric disorders, which are often underdiagnosed in primary care due to atypical presentations and a focus on physical ailments. This study aimed to quantify the prevalence of depression and cognitive impairment and elucidate their socio-demographic and clinical correlates in geriatric patients at a tertiary care hospital in Northern India. A hospital-based, analytical cross-sectional study was conducted over six months in the Medicine Outpatient Department.

Methods: One hundred patients aged ≥60 years were recruited via consecutive sampling. Socio-demographic and clinical data were collected, and the geriatric depression scale-15 (GDS-15) and mini-mental state examination (MMSE) were used to assess depression and cognitive status, respectively.

Results: The mean age was 74.7±6.8 years, with 60% male participants. Multimorbidity was highly prevalent (80%). The prevalence of depressive symptoms (GDS-15 ≥5) was 57%, predominantly mild. Cognitive impairment (MMSE <24) was present in 45% of the cohort. Coronary artery disease (CAD) was significantly correlated with higher depression scores. Diabetes mellitus and recent hospitalization were significantly associated with poorer cognitive performance, while higher educational attainment was a protective factor for cognition.

Conclusions: There is a high burden of depression and cognitive impairment among geriatric outpatients, strongly linked with specific clinical conditions. Integrating routine screening for these disorders into primary care is essential for holistic geriatric health management.

Pathophysiological insights: insulin resistance and β-cell dysfunction as early markers of pre-diabetes

2026-01-31T08:25:48+0530

Background: Pre-diabetes represents a critical intermediate state of dysglycaemia where both insulin resistance (IR) and β-cell dysfunction (β-CD) contribute to progression toward type 2 diabetes mellitus (T2DM).

Methods: A cross-sectional study was conducted among 300 adults, divided into normal glucose tolerance (GT) (control n being 100), pre-T2DM (n being 120), and T2DM (n being 80) groups. Anthropometric and clinical measurements were documented, and biochemical assays were employed to calculate indices of IR (HOMA-IR, QUICKI, Matsuda index) and β-cell function (β-CF) (HOMA-β, insulinogenic index, disposition index, C-peptide). Logistic regression determined predictors of pre-T2DM, whereas ROC analysis evaluated discriminative efficacy.

Results: Participants with pre-T2DM and T2DM had greater BMI, waist circumference, and systolic blood pressure than NGT controls (p<0.001). IR measures exhibited a noteworthy stepwise worsening, characterized by increased HOMA-IR and decreased QUICKI and Matsuda indices (p<0.001). The function of β-cells deteriorated progressively among groups, evidenced by decreased HOMA-β, insulinogenic index, disposition index, and C-peptide levels (p<0.001). Logistic regression indicated that HOMA-IR ≥2.5 (OR being 3.48) and HOMA-β <100% (OR being 2.89) are noteworthy predictors of pre-T2DM. ROC analysis showed that the disposition index (AUC being 0.87) was the best way to tell the difference, better than measures of IR.

Conclusion: Both IR and β-CD are evident in pre-T2DM, but β-CD indices, particularly the disposition index, demonstrate superior predictive ability. These findings emphasize the need for early screening using combined indices beyond glucose levels to identify individuals at threat of progression.

WhyGM! – a prospective case-control study evaluating the etiology of idiopathic granulomatous mastitis

2026-01-31T08:25:45+0530

Background: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition affecting mostly young women usually within 5 years of childbirth and lactation. The etio-pathogenesis of this disease is not well understood leading to mismanagement causing progressive inflammation and multiple recurrences.

Methods: It was a case-control study design with cases comprising patients with histopathological diagnosis of IGM and matched controls comprising women with benign breast disease other than IGM. All patients were interviewed with a structured questionnaire to determine potential risk factors. Serum sample was analysed for anti-nuclear antibody (ANA), prolactin, globulin and tissue from biopsy specimen was analysed in cases for microbial growth. Specific Autoantibody, Immunoglobulin assay was done in case of ANA positivity or elevated globulin levels

Results: There was a significantly longer period of lactation (p=0.0002) and previous history of nipple discharge (p=0.038) among the cases. There was no evidence of uncommon infections caused by bacteria, mycobacteria or fungi. Markers for systemic autoimmunity such as serum ANA, Immunoglobulin levels (p=0.9531) and prolactin levels (p=0.1086) did not show a significant increase in case

Conclusions: IGM was associated with a significantly longer period of lactation and nipple discharge. There was no significant correlation with systemic autoimmunity, hyperprolactinemia or infections. The aetiology of IGM remains elusive with potential for further research into localized autoimmune phenomenon.

Diagnostic accuracy of the RUSH protocol in identifying the cause of shock: a prospective study from an Indian emergency department

2026-01-31T08:25:44+0530

Background: Shock is a life-threatening emergency characterized by inadequate tissue perfusion, requiring rapid identification of the underlying etiology to guide targeted management. Early clinical assessment may be unreliable because of overlapping presentations. The Rapid Ultrasound in Shock and Hypotension (RUSH) protocol provides a structured point-of-care ultrasonography (PoCUS) approach to differentiate shock subtypes at the bedside.

To evaluate the diagnostic accuracy of the RUSH protocol in identifying the etiology of non-traumatic undifferentiated shock in an Indian emergency department and to assess its agreement with the final confirmed clinical diagnosis.

Methods: This prospective observational study included 100 adult patients presenting with shock to a tertiary emergency department. All patients underwent a standardized RUSH examination performed by trained emergency physicians. Ultrasound-based provisional diagnoses were compared with final diagnoses established using comprehensive clinical evaluation, imaging and laboratory investigations. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen’s kappa coefficient.

Results: The mean patient age was 44.97±10.88 years, with a male predominance (69%). Distributive shock was the most common etiology (39%). The RUSH protocol showed the highest diagnostic accuracy for obstructive shock (sensitivity, specificity, PPV and NPV all 100%, κ=1.0). Good agreement was observed for cardiogenic (κ = 0.93), hypovolemic (κ=0.87) and distributive shock (κ=0.87), while overlap was greatest in hypovolemic/distributive shock (κ=0.76).

Conclusions: The RUSH protocol is a rapid, reliable bedside tool for early etiological diagnosis of shock and supports timely, goal-directed resuscitation in emergency settings.

Prevalence and diagnostic implications of anti-citrullinated peptide antibody in smear-positive pulmonary tuberculosis patients

2026-01-31T08:24:16+0530

Background: Generation of autoantibodies have been described in several infectious diseases including tuberculosis. Rheumatoid arthritis-specific autoantibodies: anti-citrullinated protein antibody presents in pulmonary tuberculosis, patient without evidence of cross-reactivity in tuberculosis bacilli antigens. To evaluate prevalence of ACPA positivity and its association with sputum smear acid-fast bacilli (AFB) grading in pulmonary tuberculosis patients with positive smear.

Methods: This descriptive, observational study was carried out during June 2020 to July 2021 at the Department of Rheumatology, Bangladesh Medical University and National Institute of Diseases of Chest and Hospital Dhaka. One hundred adult, smear-positive pulmonary tuberculosis (TB) patients were recruited by consecutive sampling. Levels of serum ACPA were detected by ELISA. Sociodemographic, clinical and laboratory measures were described with descriptive statistics and compared by chi-square tests.

Results: Positivity of ACPAs was found in 28.0% of patients, with 12.0% showing high levels of ACPA (>60 IU/ml). The median value in the serum ACPA positive patients was 66.0 IU/ml (IQR: 48.5–88.0). Positive-ACPA was also slightly more common in patients with sputum smear grade of 2+ to 3+ compared to that of the lower smearing grades, but without statistical significance (p=0.821).

Conclusions: A significant proportion of smear-positive pulmonary tuberculosis cases showed positivity to ACPA. These results indicated that ACPAs should be interpreted with caution in tuberculosis-endemic regions to prevent the misdiagnosis of inflammatory arthritis.

Assessment of liver cranio-caudal dimensions using sonography in healthy adult Bangladeshi people

2026-01-31T08:24:24+0530

Background: Accurate assessment of liver size is an essential component of hepatobiliary evaluation and ultrasonography remains the preferred modality for routine measurement. Population-specific normative data are necessary to improve diagnostic accuracy, yet limited evidence exists for Bangladeshi adults. This study aimed to determine the cranio-caudal length (CCL) of the liver in healthy Bangladeshi adults and examine its relationship with sex, body mass index (BMI) and body surface area (BSA).

Methods: A cross-sectional analytical study was conducted among 70 healthy adults (35 males, 35 females) at Sir Salimullah Medical College, Dhaka, Bangladesh. Anthropometric variables were recorded and liver CCL was measured via standardized ultrasonography using a 3.5 MHz convex transducer during maximal inspiration. Data were analyzed using t-tests and Pearson’s correlation. A p≤0.05 was considered statistically significant.

Results: Males had significantly greater liver CCL (12.17±0.82 cm) than females (11.65±0.88 cm; p=0.014). BMI demonstrated no significant correlation with liver length in either sex, whereas BSA showed a significant positive correlation among females (r=0.35, p=0.04). No meaningful association was observed between liver length and BSA in males.

Conclusions: Liver CCL varies significantly by sex in healthy Bangladeshi adults, while BMI shows limited predictive value. BSA exhibits a modest association with liver size among females. These findings provide population-specific reference values that may enhance the clinical interpretation of hepatic ultrasonography.

A multimodal artificial intelligence framework for the early detection of diet-related maculopathy using trophic biomarkers and fundus imaging

2026-01-31T08:25:44+0530

Background: Diet-related maculopathy (DRM) is a progressive retinal condition associated with chronic nutritional deficiencies, oxidative stress, and impaired macular metabolism. Early detection is challenging because biochemical deterioration precedes clinically visible retinal changes. This study aimed to develop and validate a multimodal artificial intelligence (AI) framework integrating fundus imaging with trophic biomarkers to enhance early DRM detection.

Methods: A prospective diagnostic model validation study was conducted among 580 adults aged 30-65 years at a Asim eye care Center in Ghaziabad, Delhi-NCR between January 2023 and March 2025. Fundus images were analysed using a fine-tuned ResNet-50 convolutional neural network, whereas plasma concentrations of lutein, zeaxanthin, vitamins A, C, and E, zinc, and docosahexaenoic acid (DHA) were processed using a Random Forest classifier. A fusion architecture integrated both outputs. Model performance was assessed through accuracy, sensitivity, specificity, and area under the ROC curve. Longitudinal follow-up assessed predictive lead time.

Results: The multimodal AI model achieved an accuracy of 95.2%, sensitivity of 93.1%, specificity of 96.4%, and an AUC of 0.972. Lutein, zeaxanthin, and DHA were the most significant biochemical predictors, whereas macular reflectance patterns and early drusen signatures were the strongest image-derived features. The model detected DRM on average 11.2 months before clinical diagnosis. Nutritional insufficiencies were present in 42.1% of participants.

Conclusions: The multimodal AI framework demonstrated excellent diagnostic capability and substantial predictive lead time, enabling early identification of DRM and supporting personalized nutritional intervention. This integrative approach may improve preventive retinal care and reduce long-term visual impairment.

The urologists' perspective in management of lower urinary tract symptoms: the questionnaire-based evidence from nationwide survey in India

2026-01-31T08:25:42+0530

Background: Lower urinary tract symptoms (LUTS) encompass storage, voiding, and post-micturition disturbances, commonly associated with conditions such as benign prostatic hyperplasia (BPH), overactive bladder (OAB), and urinary tract infections (UTIs). Despite their high prevalence and significant impact on quality of life (QoL), LUTS are often under-recognized. This survey assesses urologists’ perspectives on the diagnosis and management of LUTS, focusing on real-world practices in the Indian context.

Methods: A cross-sectional survey was conducted among 438 urologists in India from October 2024 to December 2024 to assess clinical practices in managing LUTS. A 20-question questionnaire captured diagnostic preferences, treatment approaches, and clinical perspectives. Responses were compiled and analyzed using Microsoft excel 365, with results presented as counts and percentages and visualized to highlight trends across participants.

Results: In the survey, 80.4% of urologists reported urine culture as the most commonly performed diagnostic test. Age (62.3%) and symptom severity (34.2%) were the main factors guiding treatment decisions. For uncomplicated UTIs, 83.8% preferred Nitrofurantoin. BPH was the most frequent comorbidity with OAB (68.5%), and 53.4% identified lack of patient awareness as a major challenge. For OAB maintenance, 59.4% preferred Mirabegron monotherapy.

Conclusions: The survey provides valuable insights into contemporary prescribing practices in urology. Nitrofurantoin remains the mainstay for uncomplicated UTIs, Mirabegron is increasingly adopted as first-line and maintenance therapy for OAB, and Silodosin, alone or in combination with Dutasteride or Tadalafil, is preferred in BPH, particularly in patients with comorbidities. Limited patient awareness, especially in OAB, highlights the need for improved education and greater integration of individualized, evidence-based pharmacotherapies into routine practice.

Proenkephalin for early post–MI risk stratification: comparative prognostic performance versus NT‑proBNP and GRACE

2026-01-31T08:25:40+0530

Background: Accurate post–myocardial infarction (MI) risk stratification is essential, yet clinical scores and natriuretic peptides incompletely capture early cardiorenal stress. Proenkephalin (PENK), a stable endogenous opioid precursor, reflects early glomerular dysfunction and neurohormonal activation. This study evaluated PENK for mortality prediction after MI compared with NT-proBNP and the GRACE risk score and identified optimal cutoffs.

Methods: In this prospective observational cohort, 50 consecutive MI patients enrolled between December 2024 and July 2025 at a tertiary center were studied. Clinical variables, lifestyle factors, comorbidities, hemodynamics, Killip class, MI type and biomarkers (Troponin-I, serum creatinine, NT-proBNP and Proenkephalin) were measured at presentation and Day 28. GRACE scores were calculated at baseline. The primary outcome was all-cause mortality. Cox proportional hazards models assessed independent prognostic value and ROC analysis compared discrimination and derived cutoffs.

Results: Mean age was 62.25±15.19 years; 68% were male, 66% smokers, 46% diabetics and 48% hypertensive. STEMI constituted 62%. Killip class I–IV: 42%, 28%, 8% and 22%. Troponin-I declined from 5,925±11,262 to 784±1,431 pg/ml (p=0.005). NT-proBNP remained elevated (4,019±4,096 to 3,880±3,695 pg/ml, p=0.001). PENK decreased from 138±35 to 89.7±28.5 pg/ml (p=0.003). Mean GRACE score was 133.6±38.1, mortality was 6%. PENK (HR 1.004, p=0.011), NT-proBNP (HR 1.001, p=0.048) and GRACE (HR 1.015, p=0.002) independently predicted mortality. ROC AUCs were 0.78 (PENK), 0.74 (NT-proBNP) and 0.69 (GRACE).

Conclusions: Proenkephalin provided the strongest mortality discrimination after MI with high negative predictive value, complementing NT-proBNP and GRACE for refined post-MI risk stratification.

Risk factors associated with wound dehiscence in post-laparotomy patients: a prospective observational study

2026-01-31T08:25:39+0530

Background: Wound dehiscence is a serious post-operative complication following laparotomy, associated with increased morbidity, prolonged hospitalization, and additional surgical interventions. Understanding the risk factors is crucial for prevention and improved patient outcomes. This study aimed to evaluate the risk factors associated with wound dehiscence in post-laparotomy patients.

Methods: A prospective observational study was conducted at Shri Bhausaheb Hire Government Medical College and Hospital, Dhule, Maharashtra from March 2023 to December 2024, including 80 patients who developed wound dehiscence following laparotomy. Data collected included demographics, clinical presentation, nature of surgery, comorbidities, laboratory parameters, and management strategies.

Results: The mean age was 52.4±14.2 years with male predominance (67.5%). Emergency surgeries accounted for 73.75% of cases. Ileal perforation (21.25%) and intestinal obstruction (18.75%) were the most common diagnoses. Anemia (67.5%), hypoalbuminemia (58.75%), and diabetes mellitus (47.5%) were prevalent comorbidities. Surgical site infection was present in 80% of patients. Most cases presented on postoperative day 6-7 (63.75%). Conservative management was successful in 70% of cases.

Conclusion: Wound dehiscence is multifactorial, with significant associations to emergency surgery, anemia, hypoalbuminemia, diabetes mellitus, and surgical site infection. Early identification of risk factors and appropriate perioperative management may reduce incidence and improve outcomes.

Exploring the issues and trends in online teaching during the COVID-19 pandemic among nursing students at selected colleges

2026-01-31T08:25:38+0530

Background: The COVID-19 pandemic precipitated an unprecedented shift from conventional classroom learning to digital pedagogy, profoundly influencing nursing education. Understanding nursing students’ perceptions of issues and evolving trends in online teaching is critical for strengthening digital learning ecosystems. This study aimed to explore the issues encountered and the emerging trends perceived by nursing students regarding online teaching during the COVID-19 pandemic.

Methods: A descriptive analytical study was conducted among 665 nursing students from selected colleges in Chennai using a structured Google Form. Data were collected through a validated Likert-scale questionnaire encompassing demographic factors, issues, and trends in online education. Descriptive statistics summarized the distribution of responses, while chi-square tests assessed associations between variables.

Results: Students reported substantial challenges, including poor home learning environments, reduced concentration, limited peer interaction, technical disruptions, and significant eye strain. Internet instability emerged as the most prominent issue (39.8% strongly agreed). Despite these barriers, students acknowledged positive educational transformations, notably increased flexible learning formats, micro-modules, advanced digital tools, and blended-learning prospects. Significant associations were noted between issues/trends and variables such as age, year of study, course type, gadget used, and internet source.

Conclusions: Findings illustrate a dual landscape wherein nursing students experience critical barriers yet recognize promising technological and pedagogical advancements. Strengthening digital infrastructure, enhancing e-pedagogy, and institutionalizing blended learning models are essential for future-ready nursing education.

Cholelithiasis risk factors in young age patients less than 30 years of age

2026-01-31T08:25:38+0530

Background: Gall-stone disease is increasingly reported in adults younger than 30 years, yet age-specific determinants remain underexplored in South Asia. The objective was to identify independent risk factors for symptomatic cholelithiasis in North-Indian adults aged 15–29 years and to develop a pragmatic bedside risk-score.

Methods: A prospective, unmatched case–control study enrolled 50 ultrasound-confirmed gall-stone cases and 50 stone-free controls at a tertiary hospital between January and June 2024. Exposures included anthropometry, dietary glycaemic load, physical activity, hormonal factors, family history and β-thalassaemia trait. Multivariable logistic regression generated adjusted odds ratios (aOR), and a four-item risk-score was evaluated by receiver-operating-characteristic analysis.

Results: Central obesity (waist-to-height ≥0.50) was present in 70% of cases versus 40% of controls (aOR 3.0; 95% CI 1.3–6.9). A high-glycaemic diet was reported by 60% versus 32% (aOR 2.6; 1.1–6.1). Among females, prolonged combined oral-contraceptive use ≥60 months occurred in 42% versus 12% (aOR 4.1; 1.1–15.6). Family history showed a crude OR 3.2 but attenuated after adjustment (aOR 2.4; 0.8–7.4). β-thalassaemia trait (12% versus 4%) preferentially yielded pigment stones yet was not an independent predictor (aOR 3.4; 0.6–19.0). The four-item score (central obesity, high-glycaemic diet, inactivity, family history) achieved an AUROC of 0.82, with a cut-off ≥2 giving 80% sensitivity and 70% specificity.

Conclusion: Early-onset cholelithiasis in this cohort is chiefly a metabolic–hormonal entity linked to visceral adiposity, refined-carbohydrate intake and extended oestrogen exposure. Simple anthropometric and lifestyle measures can triage high-risk youth for targeted counselling and ultrasound surveillance, offering a scalable strategy to curb the rising burden of gall-stone disease in the most productive years of life.

Formulation and evaluation of herbal periodontal films of M. paradisiaca for periodontitis

2026-01-31T08:25:34+0530

Background: The present work aims to formulate and evaluate the herbal films of M. paradisiaca for periodontitis.

Methods: Dental films were formulated using the ethanolic extract of M. paradisiaca by maceration with different polymers like HPMC K4M, Carbopol P71P. The ethanolic extract of M. Paradisiaca was subjected for the pre-formulations studies like preliminary phytochemical screening and the results showed the presence of flavonoids, carbohydrates, tannins, alkaloids, glycosides etc.

Results: The films were prepared by using the solvent casting technique and the films were subjected for various evaluation studies like thickness, hardness, folding endurance, surface PH. Based on the physiochemical parameters the formulation F1 were considered to be the best.

Conclusions: The present study reveals that both formulated films showed satisfactory film parameters. From the present investigation it can be concluded that film formulation incorporating banana peel extract can be a potential novel drug dosage form for treatment of Periodontitis.

A case-control study on clinical outcome and risk factors associated with carbapenem resistant isolates from critical care unit at a tertiary care hospital in Gujarat

2026-01-31T08:25:33+0530

Background: The increasing prevalence of carbapenemase-producing organisms (CPO) is concerning because of the rapid dissemination of carbapenemase genes. Main objectives of the work were to study the prevalence of CPO and their genes using the Xpert^® Carba-R assay in bacterial isolates from critical care settings, as well as to study patient-specific risk factors and comorbidities associated with carbapenem-susceptible organisms (CSO) and carbapenem-resistant organisms (CRO).

Methods: A prospective, observational, case-control study was conducted from January 2023 to March 2024. Bacterial identification & susceptibility testing was done using VITEK^®2 Compact and Kirby-Bauer disc diffusion method. Study consisted of 100 patients (50 carbapenem-resistant cases and 50 carbapenem-susceptible controls). CRO were further studied for carbapenemase production using the Xpert^® Carba-R assay test to detect the bla_KPC (KPC), bla_NDM (NDM), bla_VIM (VIM), bla_OXA-48(OXA-48), and bla_IMP (IMP) genes.

Results: Carbapenem Resistant Acinetobacter baumanii (CRAB) [40.35%] was the most common isolate, followed by Carbapenem Resistant Pseudomonas aeruginosa (CRPA) [23.95%], Carbapenem Resistant Klebsiella penumoniae (CRKP) [21.52%], and Carbapenem Resistant Escherichia coli (CREC) [15.27%]. CRKP showed the highest carbapenemase production (42%). NDM carbapenemases were most common (54%), followed by NDM + OXA-48 co-production (30%). No genes were detected in 12% of isolates. IMP, VIM, and KPC genes were not detected. Carbapenem resistance was significantly associated with male sex, lengthy hospital stays, in-situ Foley’s catheter, and multiple co-morbidities. Mortality was 14% in cases and 4% in controls (OR, 3.9; 95% CI, 0.76 to 19.83).

Conclusions: In conclusion, CRO infections were associated with multiple risk factors, longer hospital stays and higher mortality compared to CSO infections.

A cross-sectional study to evaluate smartphone addiction among undergraduate medical students

2026-01-31T08:24:27+0530

Background: The rapid global proliferation of smartphones has raised concerns regarding “smartphone addiction,” a behavioural condition characterized by compulsive use and functional impairment. Medical students, due to high academic demands and extensive reliance on digital platforms, may be particularly vulnerable. This study aimed to estimate the prevalence of smartphone addiction among undergraduate medical students in Kutch, Gujarat, India and to examine factors associated with addictive smartphone use.

Methods: A cross-sectional study was conducted among 195 undergraduate medical students between April 2025 and June 2025. Data were collected using a pre-designed, pre-tested structured questionnaire that included the Smartphone Addiction Scale–Short Version (SAS-SV). Smartphone addiction was determined using the established cut-off score of ≥ 33. Associations between smartphone addiction and demographic or usage-related variables were evaluated using the Chi-square test.

Results: Among the 195 participants, 51 students met criteria for smartphone addiction, yielding a prevalence of 26 percent. Participation was highest from Phase-3 Part-2 (n=58), with 11 identified as addicted, while Phase-1 showed the highest number of addicted students (n=20 out of 57). Most respondents reported average daily smartphone use of 3–6 hours (n=91), with 28 classified as addicted. Social media was the most common primary use (n=98), among whom 33 were addicted. Academic phase, daily duration of use and primary purpose of use did not show statistically significant associations with smartphone addiction. In contrast, students’ self-perception of smartphone use demonstrated a highly significant association (p<0.00001).

Conclusions: Self-perception of excessive smartphone use emerged as the only significant predictor of smartphone addiction, underscoring the importance of subjective awareness when designing preventive or corrective strategies for medical students.

A prospective case-control study on the efficacy of subcutaneous suction drainage in reducing surgical site infections following laparotomy

2026-01-31T08:24:26+0530

Background: Surgical site infections (SSIs) are one of the major postoperative complications and their management still remains to be a gruelling task. The worldwide incidence of SSI ranges between 0.5 and 15%, but in India it shows a significant increase of about 23 to 38%. The placement of suction drains in surgical wounds has proved to be quite promising especially in emergency laparotomies. The objective of this study was to compare the incidence of SSIs in abdominal surgical wounds with subcutaneous suction drains versus those where drains were not used.

Methods: This is a case-control study of 60 patients undergoing midline exploratory laparotomy surgeries admitted in the gastrosurgery and general surgery department of Hitech Medical college and Hospital, Bhubaneswar. Among them, closed subcutaneous drain was placed before the skin closure for every alternate patient and for the others no subcutaneous drain was placed. The patients for whom subcutaneous drain were placed were considered as cases while the other group of patients were considered as control group.

Results: The patients in the case group had lower incidence of SSI compared to the control group. When compared between the emergency and elective cases, the emergency cases showed higher propensity for SSI.

Conclusions: Subcutaneous suction drains have proved to be safe and effective in preventing SSIs in abdominal surgeries, especially in emergency and colorectal surgeries.

Comparative evaluation of linear and curvilinear ultrasound transducers for confirmation of endotracheal tube placement in emergency intubation

2026-01-31T08:24:26+0530

Background: Accurate and rapid confirmation of endotracheal tube (ETT) placement is critical in emergency airway management, as unrecognized oesophageal intubation can lead to catastrophic outcomes. Although waveform capnography is considered the gold standard, it has limitations in low pulmonary flow states. Point-of-care ultrasonography has emerged as a useful adjunct, but the optimal choice of ultrasound transducer for ETT confirmation remains unclear. This study aimed to compare the speed and reliability of linear and curvilinear ultrasound transducers for confirming ETT placement in emergency intubation.

Methods: A hospital-based non-randomized controlled trial was conducted over 18 months (January 2020 to June 2021) in the Emergency Department of a tertiary care centre in South India. Adult patients (≥18 years) undergoing emergency endotracheal intubation were included, while those in cardiac arrest with ongoing CPR or requiring surgical airways were excluded. Participants were allocated to linear or curvilinear transducer groups using the serial-numbered opaque sealed envelope technique. The primary outcomes were time to exclusion of oesophageal intubation and time to confirmation of left lung sliding, while secondary outcomes included total procedure time up to five-point auscultation and operator confidence.

Results: Eighty-seven patients were analyzed (46 linear, 41 curvilinear). Baseline characteristics were comparable between groups. The linear transducer demonstrated significantly shorter times for exclusion of oesophageal intubation, confirmation of left lung sliding, and total procedure time (p<0.0001 for all). Operator confidence was significantly higher with the linear transducer. Procedural times showed no association with age or indication for intubation, though shorter times were observed in male patients.

Conclusions: Linear ultrasound transducers provide faster and more reliable confirmation of ETT placement with higher operator confidence compared to curvilinear transducers, supporting their preferential use in emergency airway management.

A comprehensive lot-to-lot variation assessment and comparative analysis of the Concerro CE-SDS kit against the Sciex CE-SDS kit for monoclonal antibody size variant analysis

2026-01-31T08:24:22+0530

Background: Monoclonal antibodies (mAbs) are complex biotherapeutics whose quality and integrity must be stringently monitored throughout development and manufacturing. Capillary electrophoresis sodium dodecyl sulfate (CE-SDS) is the definitive analytical technique used globally for assessing size heterogeneity, including the presence of low molecular weight (LMW) fragments, high molecular weight (HMW) species, and ensuring accurate estimation of size of protein’s component. The objective of this study was to evaluate the analytical performance and manufacturing consistency of the newly introduced Concerro CE-SDS Kit against the established market innovator, the Sciex CE-SDS kit.

Methods: This study performed a head-to-head comparison utilizing the therapeutic monoclonal antibody Ipilimumab (Yervoi®). Analysis was conducted under both reduced and non-reduced conditions. Critical analytical performance indicators, including migration time, calculated peak area (mAu), calculated peak area percent (CPA%) were monitored during this study.

Results: The Concerro CE-SDS kit demonstrated analytical performance comparable to the Sciex CE-SDS kit, with similar precision and profile matching. Lot-to-lot variability for the Concerro CE-SDS kit showed %RSD values upto 10%.

Conclusions: The Concerro CE-SDS kit is affirmed as a robust, analytically equivalent alternative for high-precision size variant characterization in GxP/QC environments.

Spectrum and antifungal susceptibility of Candida and Cryptococcus species isolated from HIV-positive patients in a tertiary care center in North India

2026-01-31T08:24:23+0530

Background: In people with HIV, opportunistic fungal infections are a leading cause of morbidity and death. Local data on pathogen distribution and antifungal resistance guide clinical management.

Methods: A cross-sectional study was conducted (November 2019–March 2021) among 200 HIV-positive adults with suspected fungal infection at a tertiary care hospital in New Delhi, India. A total of 323 clinical specimens were collected, including oral swabs, blood, urine, sputum, and cerebrospinal fluid (CSF). Yeasts were identified by microscopy, germ tube test, chromogenic agar, and automated ID systems. Antifungal susceptibility was evaluated using Etest and CLSI microbroth dilution methods.

Results: Of 323 specimens, 89 (27.5%) were culture positive. Candida species predominated in oral swabs (38/39, 97.4%) and sputum (18/23, 78.3%), while Cryptococcus neoformans was isolated from 15/15 culture-positive CSF samples. Among 67 Candida isolates, resistance to fluconazole was 14.9% (10/67), itraconazole 9.0% (6/67), and voriconazole 3.0% (2/67); all were susceptible to amphotericin B. MIC50/90 values for C. albicans were 0.25/0.5 µg/ml (fluconazole) and 0.5/1 µg/ml (amphotericin B). Sixteen C. neoformans isolates were fully susceptible to voriconazole, fluconazole, itraconazole, and amphotericin B.

Conclusions: In this HIV cohort, mucosal and airway candidiasis predominated, while C. neoformans was the leading CSF pathogen. Fluconazole resistance in Candida was non-trivial, underscoring the need for susceptibility-guided therapy. Universal susceptibility among C. neoformans is reassuring. Regular surveillance is essential to guide empiric antifungal use and stewardship.

A morphometric study of dry adult human sacra and its clinical relevance

2026-01-31T08:24:15+0530

Background: The sacrum shows considerable anatomical variability, particularly in relation to the sacral hiatus and sacral canal. These variations are clinically important, as they may influence the success and safety of procedures such as caudal epidural anaesthesia, spinal interventions and pelvic surgeries. Detailed morphometric data are therefore essential for improving procedural accuracy and reducing complications. The present study aimed to evaluate the morphometric parameters of the sacrum, with special emphasis on the sacral hiatus and its relationship to the second sacral foramen and to assess their clinical significance.

Methods: The descriptive osteological study was conducted on fifty dry adult human sacra of unknown sex obtained from the Department of anatomy, and ESIC Medical College and Hospital, Faridabad, Haryana from May 2023 to December 2023. Measurements recorded included the length and anteroposterior diameter of the sacral hiatus, intercornual distance, the median distance between the lower margin of the S2 foramen and the apex of the sacral hiatus and the distance between the midpoint of the base of the hiatus and the S2 foramen. Data were analysed using descriptive statistics.

Results: Considerable variation was observed in all morphometric parameters, with specific ranges predominating for each measurement. In the present study, the length of the sacral hiatus most commonly ranged between 11–20 mm (44%). The anteroposterior diameter of the sacral canal at the level of the hiatus was predominantly 4–6 mm in 72% of specimens. The intercornual distance at the base of the sacral hiatus most frequently measured between 11–15 mm. Such variations highlight differences in sacral anatomy among individuals.

Conclusions: The study demonstrates significant morphometric variability of the sacrum, which has important clinical implications. Awareness of these variations can aid clinicians in improving the safety and success of caudal epidural anaesthesia and other sacral procedures, while also contributing valuable data for surgical planning and forensic identification.

Incidence and clinical outcomes of neonatal sepsis in neonatal intensive care unit admissions: a hospital-based study

2026-01-31T08:24:27+0530

Background: Neonatal sepsis is among the leading causes of mortality and morbidity among neonates, particularly in developing countries. There is limited data regarding the clinical presentation and epidemiological pattern of neonatal sepsis in Bangladesh. This study aimed to ascertain the incidence, clinical profile, and predictors of mortality of neonatal sepsis in a tertiary care center.

Methods: A retrospective observational study was conducted in Bangladesh Specialized Hospital (BSH), Dhaka, between January 2023 and December 2024. Among 576 neonatal intensive care unit (NICU) admissions, 66 neonates with sepsis diagnosed after clinical and laboratory criteria were observed. Data were extracted from electronic medical records related to demographics, clinical presentation, laboratory findings, and outcomes. Binary logistic regression analysis was performed to identify the predictors of mortality.

Results: The incidence of neonatal sepsis was 11.45% (66 out of 576 NICU admissions), with a mortality rate of 6.06% (4 out of 66 cases). Male neonates predominated (60.6%), and the majority were preterm (74.2%). All affected neonates were very low birth weight infants (<1500 g), with a mean birth weight of 1000 ± 320 g. Late-onset sepsis was more common than early-onset sepsis (59.1% vs 40.9%). Respiratory distress syndrome was observed in 66.7% of cases, and 27.2% required continuous positive airway pressure support. Blood culture positivity was detected in 24.2% of cases, while elevated C-reactive protein levels were present in 71.2%. The mean duration of NICU stay was 13.4 ± 6.7 days. Independent predictors of mortality included positive blood culture (AOR=5.21, p=0.012), thrombocytopenia (AOR=4.82, p=0.022), and hypoglycemia (AOR=6.34, p=0.010).

Conclusions: Neonatal sepsis accounted for 11.45% of NICU admissions and had a relatively low mortality (6.06%). Most cases occurred in preterm, very low birth weight neonates, with late-onset sepsis predominating. Positive blood culture, thrombocytopenia, and hypoglycemia were the key predictors of death, supporting early risk stratification and prompt targeted management.

Diagnostic performance of the Bengali version of inflammatory back pain criteria in patients with axial spondylarthritis: a case control study

2026-01-31T08:24:16+0530

Background: Axial Spondyloarthritis (axSpA) is a chronic inflammatory disease affecting the spine, which requires accurate and early diagnosis for effective management. Inflammatory back pain (IBP) is a key symptom of axSpA. While several diagnostic criteria sets for IBP exist, limited data is available on the Bengali version of these criteria. This study aimed to evaluate the diagnostic performance of the Bengali version of IBP criteria sets (Calin, Berlin set 8a, Berlin set 7b and ASAS) in patients with axSpA and mechanical back pain (MBP).

Methods: A total of 100 participants (50 axSpA patients and 50 MBP controls) were enrolled between April 2019 and September 2019 at Chattogram Medical College Hospital. Sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated for each IBP criteria set. ROC curve analysis was performed to assess overall diagnostic accuracy.

Results: The sensitivity of the Bengali Calin criteria was 88.4%, with a specificity of 78.9%. Berlin set 8a criteria demonstrated the highest sensitivity (92.3%) but lower specificity (77.0%). ASAS IBP criteria performed moderately with 78.0% sensitivity and 69.5% specificity.

Conclusions: The Bengali version of IBP criteria sets demonstrated strong diagnostic performance, with Berlin set 8a showing the highest sensitivity. These tools can aid in the early detection of axSpA in clinical settings in Bangladesh. Future research should focus on validating these criteria in larger, diverse populations.

Hyper-tuned convolutional neural network based pediatric skeletal bone age estimation model

2026-01-31T08:24:13+0530

Background: The pediatric skeletal bone age estimation model is developed to estimate the bone age in order to investigate the genetic and growth disorders of children’s. In this paper, a deep learning-based is presented for it.

Method: Initially, in this model, the standard RSNA dataset of hand X-ray images is read. Followed by median filtering to remove noise and segmentation of the hand bone region using k-mean clustering. After that, the Convolutional Neural Network (CNN) algorithm is used to estimate the bone age. In this article, the CNN algorithm is used over other deep learning algorithms due to its automatically extracting the features from the hand X-ray images and estimating the bone age. Furthermore, in this research, the hyper-parameter optimization of the CNN algorithm is done by finding the best parameter values using the metaheuristic algorithm to enhance the performance of it. The metaheuristic walrus optimization algorithm is used, and it determines the general hyperparameters, such as the learning rate of the CNN algorithm, based on the objective function.

Results: The simulation evaluation was done on MATLAB 2018b software. The standard RSNA dataset of hand X-ray images was used. The performance evaluation is done by splitting the same dataset into training and testing ratios and evaluated using the error metrics. The result indicates that the proposed model accomplishes the lower values of these error metrics over the previous approaches.

Conclusion: The proposed method efficiently measures pediatric skeletal bone age by processing hand X-ray images with the CNN algorithm, which has been optimized through hyperparameter tuning.

Mind over surgery: evaluating the effectiveness of mindfulness-based interventions in alleviating preoperative anxiety

2026-01-31T08:24:25+0530

Preoperative anxiety is a prevalent and clinically significant issue that adversely affects surgical outcomes, anesthetic requirements, postoperative recovery, and overall patient experience. As healthcare systems increasingly emphasize holistic and patient-centered care, mindfulness-based interventions (MBIs) have emerged as promising non-pharmacological strategies for addressing psychological distress prior to surgery. This integrative review synthesizes evidence from 40 studies, including randomized controlled trials (RCTs), quasi-experimental designs, cohort studies, mixed-method investigations, and qualitative analyses, to evaluate the effectiveness of MBIs in reducing preoperative anxiety among adult surgical patients. Across diverse surgical populations-ranging from general, orthopedic, cardiac, and oncologic to ambulatory and gynecologic procedures-MBIs consistently produced meaningful reductions in anxiety. Brief mindfulness practices, such as 5-15-minute breathing and awareness exercises, demonstrated rapid effectiveness, making them suitable for fast-paced clinical environments. More structured programs, including mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), produced the greatest benefits, especially in high-anxiety groups such as oncology and cardiac patients. Physiological improvements, including reduced heart rate, blood pressure, and cortisol levels alongside increased heart-rate variability, support the psychological findings and highlight the mind-body regulatory mechanisms involved. Qualitative evidence further revealed enhanced emotional grounding, reduced fear of anesthesia and surgical uncertainty, and improved perceived control. Overall, MBIs represent accessible, safe, cost-effective, and versatile interventions that can be integrated into modern preoperative care pathways. Their incorporation has the potential to improve emotional resilience, patient satisfaction, and perioperative outcomes.

Efficacy and safety of robotic laparoscopic surgery in the treatment of ureteropelvic junction obstruction in pediatric patients: a systematic review

2026-01-31T08:25:40+0530

Pediatric ureteropelvic junction obstruction (UPJO) has been replaced by robotic-assisted laparoscopic pyeloplasty (RALP) more and more frequently as compared to open and conventional laparoscopic procedures. This method is desirable as it leads to increased dexterity and visualization, but the method is constrained by cost, learning and lack of long-term consistency. The paper is a systematic review that summarizes the data regarding the effectiveness and safety of RALP in the child population. A detailed search of PubMed, Cochrane, Embase and Scopus (20002025) found 20 eligible studies including randomized controlled trials, prospective cohort and retrospective series. The inclusion criteria included patients aged less than 18 years who had undergone RALP to treat UPJO and have recorded successful outcomes. Information that was extracted included operative time, success, complications and hospital stay. The tools of quality assessment were RoB 2, ROBINS-I, NIH and AMSTAR-2. Synthesis of pooled data were done using random effects model. Across 1,420 pediatric cases, pooled success was 95.2% (range 92.6-100) with an overall complication rate of 8.5%, of which 2.1% were major (Clavien-Dindo ≥III). Mean operative time averaged 110 minutes for RALP versus 144 minutes for conventional laparoscopy, while hospital stay was comparable or shorter for RALP (1.8 vs 3.5 days vs open). Infants and complex UPJO cases demonstrated similar outcomes with slightly longer operative times. RALP achieves high success and low complication rates in pediatric UPJO, outperforming conventional laparoscopy in efficiency and postoperative recovery but heterogeneity, short follow-up and limited cost-effectiveness data temper definitive conclusions. Multi-institutional randomized trials with standardized outcome definitions remain essential to confirm long-term renal benefits and economic feasibility.

Access to mental health services during catastrophes and emergencies: nurses’ roles, barriers, and contributions

2026-01-31T08:24:19+0530

Catastrophes and emergencies, including natural disasters, armed conflicts, and public health crises, significantly disrupt health systems and exacerbate mental health needs among affected populations. Access to mental health services during such events remains limited, particularly in low-resource and humanitarian settings, where workforce shortages and system fragmentation are common. Nurses constitute the largest and most consistently available health workforce during emergencies and play a pivotal role in bridging mental health service gaps. This integrative review synthesizes evidence on nurses’ roles, barriers, and contributions in facilitating access to mental health services during catastrophes and emergencies. A comprehensive search of major electronic databases and grey literature identified 33 studies meeting inclusion criteria. Findings indicate that nurses contribute substantially through psychological first aid (PFA), mental health screening, referral coordination, medication continuity, community outreach, and supervision of non-specialist workers. Despite these contributions, multiple barriers hinder effective service delivery, including inadequate disaster-specific mental health training, limited resources, unclear role delineation, stigma surrounding mental illness, and psychological burden among nurses themselves. Facilitators such as pre-disaster preparedness training, task-sharing models, integrated care approaches, and supportive organizational policies were found to enhance nurses’ capacity to deliver mental health care in crisis contexts. Overall, the review highlights the critical importance of strengthening nursing capacity within emergency mental health and psychosocial support (MHPSS) frameworks. Investing in education, policy integration, and workforce support is essential to improve equitable access to mental health services and to enhance resilience among populations affected by catastrophes and emergencies.