International Journal of Research in Medical Sciences

Modulation of the gut-brain axis through selective inhibition of the sodium-glucose cotransporter type 1: physiological and therapeutic implications

2026-06-30T07:05:15+0530

The sodium-glucose cotransporter type 1 (SGLT1) is fundamental in intestinal glucose absorption. Its selective inhibition modulates the gut-brain axis by increasing carbohydrate delivery to the distal ileum, which stimulates the secretion of incretins such as glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) by enteroendocrine L-cells. Objectives were to analyze the physiological bases and clinical evidence of gut-brain axis modulation through SGLT1 inhibition, as well as its therapeutic implications. Systematic literature review (2019-2026) in PubMed, Scopus, and Cochrane regarding SGLT1 kinetics, incretin release, postprandial glycemic control, and the safety profile of selective and dual inhibitors. Intestinal SGLT1 inhibition delays glucose absorption, triggering a sustained endogenous release of GLP-1 and PYY. This afferent signaling, mediated by the vagus nerve to hypothalamic centers, promotes early satiety. Clinically, inhibitors like sotagliflozin demonstrate efficacy in reducing postprandial hyperglycemia and inducing weight loss. The gastrointestinal safety profile is associated with controlled malabsorption that favorably modifies microbiota composition. SGLT1 inhibition represents a comprehensive therapeutic approach. By activating the physiological pathways of the gut-brain axis, it offers significant benefits in metabolic control, positioning itself as a promising strategy for diabetes and obesity management.

Weight-bearing asymmetry patterns in patients with stroke: a systematic review

2026-06-30T07:06:36+0530

Stroke frequently results in weight-bearing asymmetry (WBA), a common motor impairment that negatively affects postural stability, gait, and increases fall risk. Identifying asymmetry patterns and reliable assessment methods is essential for individualized rehabilitation. This systematic review synthesized evidence on weight-bearing asymmetry patterns in stroke survivors and the tools used to assess and quantify them. The review followed PRISMA guidelines. A literature search of PubMed and Google Scholar identified randomized controlled trials published between 2015 and 2025 using keywords related to stroke, hemiplegia, weight bearing, postural control, postural sway, asymmetry patterns, and measurement methods. Eligible studies included individuals with stroke, objective evaluation of WBA, and reporting of asymmetry patterns and measurement tools. Data extraction focused on asymmetry types, assessment methods, and intervention approaches. 7 randomized controlled trials involving approximately 266 participants were included. Common WBA patterns included greater loading on the non-paretic limb, lateral weight shift, and reduced paretic limb loading during static and dynamic tasks. Measurement tools included force platforms, GAITRite systems, weight-bearing scales, and clinical balance measures. Interventions including insoles, weighted gait training, modified sit-to-stand training emphasizing symmetry, ankle–foot orthoses, shoe lifts on the non-paretic limb, tilt-based postural training, and weight-shift-triggered electrical stimulation improved symmetry indices and functional outcomes. Force platforms and symmetry indices were the most reliable methods for capturing static and dynamic asymmetries. Accurate assessment combined with targeted interventions can enhance postural control, gait symmetry, and functional recovery after stroke survivors during rehabilitation programs and clinical practice.

Interventions on childhood obesity: a systematic review

2026-06-30T07:05:19+0530

Childhood obesity is a significant medical issue that affects children and adolescents, representing a growing global health concern. Despite its well-documented contribution to cardiovascular disease, non-insulin dependent (type 2) diabetes, and other chronic noncommunicable diseases, it was previously overlooked by individuals. However, in recent years, researchers have conducted various interventional studies to address this pressing health issue. This systematic review evaluates interventional studies conducted between 2000 and 2024 that focus on reducing childhood obesity. Relevant studies were collected from multiple sources that focus on obesity reduction in children. After applying pre-determined selection criteria, only 44 out of 120 studies were chosen and analyzed in detail. The extracted data from eligible research studies included key general characteristics such as the author’s name, year of research studied, year of publication, method of sampling and data collected, and study design. Additionally, the study population characteristics such as participant age, sex, sample size, and follow-up details were recorded. The type of intervention and its duration, the measures used to assess childhood weight, and the main findings were also extracted. The extracted data were summarized and presented in the form of table. Based on the findings, it was concluded that among various intervention strategies for managing childhood obesity, combining diet therapy with motivational counseling on diet and exercise produced the best results. It is recommended that a multidisciplinary school-based approach, involving family participation, may be the most feasible and effective strategy, ultimately leading to better outcomes in childhood obesity management.

Artificial intelligence and the domino effect in nursing: implications for education, clinical care and healthcare systems amid a workforce shortage

2026-06-30T07:05:18+0530

Artificial intelligence (AI) is rapidly emerging as a transformative technology in healthcare, offering innovative solutions to address complex challenges such as increasing patient demands, technological advancements, and the global nursing workforce shortage. The integration of AI into nursing practice has the potential to create a domino effect across multiple dimensions of healthcare systems, including clinical care, nursing education, and workforce management. This critical review examines the current evidence on the role of artificial intelligence in nursing and explores its implications for healthcare delivery amid workforce shortages. A comprehensive literature review was conducted using electronic databases including PubMed, Scopus, Web of Science, CINAHL, and Google scholar, focusing on studies published between 2015 and 2025. The findings indicate that AI technologies such as machine learning, predictive analytics, natural language processing, and robotics are increasingly being used to support clinical decision-making, enhance patient monitoring, automate administrative tasks, and improve healthcare efficiency. In nursing education, AI-driven simulation and adaptive learning platforms are enhancing clinical reasoning and skill development among students. However, challenges related to ethical concerns, data privacy, technological infrastructure, and workforce preparedness remain significant barriers to widespread adoption. The review highlights the need for integrating AI competencies into nursing curricula and developing regulatory frameworks to ensure responsible implementation. Artificial intelligence should be viewed as a complementary tool that strengthens nursing practice, enhances patient outcomes, and supports sustainable healthcare systems in the context of ongoing workforce shortages.

Satisfaction in rhinoplasty patients using costal and septal grafts: presentation of cases

2026-06-17T09:09:28+0530

Rhinoplasty is one of the most frequently performed procedures in plastic and reconstructive surgery, with both aesthetic and functional implications. The use of cartilaginous grafts has become a fundamental tool to achieve structural stability, nasal definition, and long-term support. However, evidence regarding the association between graft origin and patient-reported aesthetic satisfaction remains limited. A case series of 16 patients who underwent rhinoplasty with cartilaginous graft was conducted, classified according to the origin of the graft as costal (n=9) or septal (n=7). The median preoperative satisfaction score was 3.5 (IQR=6), rising to 7.5 (IQR=2) postoperatively, representing a statistically significant improvement (p=0.0007). Patients with costal graft showed a median postoperative satisfaction of 7 (IQR=5.5), while those with septal graft showed a median of 9 (IQR=2), with no statistically significant difference between groups (p=0.2237). A descriptive tendency toward reduced nasal congestion and obstruction was also observed postoperatively. Rhinoplasty with cartilaginous graft significantly improves patient aesthetic self-perception regardless of graft origin. No significant difference in postoperative satisfaction was found between costal and septal grafts. Future studies with larger samples and homogeneous graft combinations are needed.

Diagnostic and therapeutic challenges in autism spectrum disorder with comorbid bipolar disorder

2026-06-30T06:58:35+0530

Autism spectrum disorder (ASD) is frequently associated with a variety of psychiatric comorbidities. Bipolar disorder (BD) is a mood disorder associated with ASD. The diagnosis and treatment of BD in the background of ASD presents unique difficulties in management of the patient in both diagnosis and management. Overlapping symptoms, inadequate communication of patient history and pharmacological limitations compromises treatment success. The paper discusses an adolescent male with ASD and complexities faced in diagnosing and treating secondary BD It showcases a 16 year old male with ASD with acute aggression, suicidal ideation, and severe school refusal. He was initially given a diagnosis of DMDD and GAD. His symptoms proceeded to a manic episode and a revised diagnosis of bipolar I disorder. Backed by strict parental monitoring and multidisciplinary school tracking, the patient achieved complete mood stabilization and extreme treatment compliance. The diagnostic process in the ASD-BD population is hindered by the lack of communication in history taking, masking of symptoms. Pharmacological management is complicated due to sensitivity to adverse events and limited treatment options. The comorbid ASD and BD require a highly targeted, multidisciplinary approach. There is a need for ASD specific diagnostic tools and specialized guidelines to prevent misdiagnosis and polypharmacy. The stabilization is achievable and requires tracking and tailored pharmacological strategy for optimal treatment.

Hidden in plain sight: omental tuberculosis disguised as ovarian cancer – a case report

2026-06-17T09:09:32+0530

We present the case of a 39-year-old woman with no significant past medical history who developed a six-month history of bilateral lower limb pain, progressive weakness, weight loss, abdominal distension, and intermittent fever. Clinical examination revealed pallor, hepatomegaly, right-sided pleural effusion, and a firm pelvic mass. Radiological evaluation suggested peritoneal carcinomatosis with possible skeletal metastases; however, pleural fluid cytology was negative for malignant cells. Histopathological analysis of an omental biopsy revealed epithelioid granulomas with caseous necrosis, and Ziehl–Neelsen staining confirmed acid-fast bacilli, establishing the diagnosis of disseminated tuberculosis. The patient showed significant improvement with antitubercular therapy. This case points out the requirement of considering tuberculosis in presentations that mimic malignancy, particularly in high prevalence countries.

Late-onset systemic lupus erythematosus masquerading as rheumatoid arthritis with multisystem involvement: a diagnostic challenge

2026-06-17T09:09:32+0530

Late-onset systemic lupus erythematosus (SLE), occurring after the age of 60 years, often presents with atypical features, which leads to delayed diagnosis. This report highlights how an atypical presentation led to misdiagnosis as rheumatoid arthritis, resulting in delayed recognition and diagnostic challenge of late-onset SLE. A 61-year-old Indian woman presented with a 1-year history of bilateral inflammatory symmetrical polyarthralgia involving both small and large joints which was initially treated as rheumatoid arthritis without significant improvement. Over time, she developed worsening fatigue, cold intolerance and bilateral periorbital swelling with mild bilateral pedal oedema. Investigations revealed pancytopenia, raised inflammatory markers, hypocomplementemia; strongly positive ANA (4+, homogeneous pattern, 1:640), along with positivity for anti-Ro52, anti-SSA, anti-ribosomal P protein, and ANCA-P. She had mild left ventricular systolic dysfunction (Ejection fraction of 45%), suggesting possible autoimmune cardiac involvement. HRCT thorax revealed features of interstitial lung disease (ILD) suggesting non-specific interstitial pneumonitis (NSIP) pattern. Based on clinical, serological, and immunological findings, the patient fulfilled the 2019 EULAR/ACR criteria for SLE with a score of 18, confirming the diagnosis of late-onset SLE. This case emphasizes the diagnostic difficulty of late-onset SLE, especially when classical cutaneous manifestations are absent and the disease closely resembles rheumatoid arthritis. Early consideration of autoimmune evaluation in elderly patients with unexplained multisystem involvement may help prevent delayed diagnosis and progressive organ damage.

An unusual presentation of compartment syndrome following deep venous thrombosis

2026-06-30T07:04:58+0530

A young female in her early 30s was admitted in medicine department of our hospital for swelling in left lower limb with decreased urine output. She had history of lower segment caesarean section (LSCS) done for obstructed labour and was bedridden. Venous color Doppler was done which was suggestive of deep vein thrombosis (DVT) in left lower limb. Surgery reference was sent for increased left lower limb swelling. On examination there was compartment syndrome in left lower limb for which urgent fasciotomy was done in emergency setting and patient was transferred under surgery department. Later debridement was done for unhealthy muscles and multiple cycles of VAC were applied when wound was healthy and granulated. In between VAC dressings, hypertonic saline dressings were also done to decrease muscle oedema. Patient was kept on LMWH injection. Patient was discharged on Tab Dabigatran after approximately 1 month of admission with stable vitals and edematous left lower limb. After 4 cycles of VAC application patient was planned for STSG. Debridement and STSG from right thigh to cover raw area along with assistance from plastic surgery department. Patient was vitally stable postoperatively with minimal soakage was done of right thigh donor area. Postoperatively dressing was removed which showed healthy graft uptake with no collection underneath it.

A case of disseminated melioidosis: clinical insights and management

2026-06-30T07:05:14+0530

Melioidosis is an infectious disease of humans and animals resulting from infection with the gram-negative organism Burkholderia pseudomallei. Known as the “great mimicker”, melioidosis presents with a wide spectrum of disease including isolated cutaneous/pulmonary disease, primary bacteremia, visceral abscesses or fulminant fatal septicaemia. The mean incubation period is nine days (1-21 days) but symptoms can evolve more quickly (<24 h) following inhalational and/or presumed aspiration events. In acute disease, sepsis syndrome is common; >50% of patients are bacteremic at presentation and 20% develop septic shock. Pulmonary involvement is the most common acute infection in adults responsible for >50% of presentations, while pneumonia is seen in approximately 20% of paediatric cases. Presentations in children more frequently have skin involvement (60%), compared with 13% in adults. In our case report, patient was a 41year-old male, resident of Ratnagiri district, farmer by occupation, presented with fever for 1 month, cough and breathlessness for same period. He was successfully treated with meropenem and doxycycline and put on maintenance therapy for duration of 12 weeks.

Letrozole-induced autoimmune hepatitis presenting with decompensated cirrhosis in an elderly woman: a case report

2026-06-30T07:05:11+0530

Autoimmune hepatitis (AIH) is a chronic immune-mediated inflammatory liver disease characterized by progressive hepatocellular injury, elevated autoantibodies, and hypergammaglobulinemia. Drug-induced autoimmune hepatitis (DIAIH) is a rare clinical entity that closely resembles idiopathic autoimmune hepatitis in both clinical presentation and histopathological findings, making diagnosis challenging. Among the implicated medications, letrozole-associated autoimmune hepatitis has been reported only rarely in the literature. Herein this case reports the case of a 64-year-old female receiving letrozole therapy for breast carcinoma who presented with features of hepatic encephalopathy and worsening liver dysfunction. Laboratory investigations demonstrated markedly elevated liver enzymes, raised immunoglobulin G (IgG) levels, and positive anti-smooth muscle antibodies (ASMA). Radiological evaluation suggested chronic liver disease, while liver biopsy revealed interface hepatitis with established cirrhotic changes, findings consistent with autoimmune hepatitis. After exclusion of other causes of liver injury, a diagnosis of letrozole-induced autoimmune hepatitis was considered. Early recognition, prompt withdrawal of the offending drug, and timely initiation of appropriate management are essential to prevent progression to advanced liver disease and liver failure.

Unmasking lung adenocarcinoma through the pericardium: a case of malignant effusion with early tamponade

2026-06-30T07:05:11+0530

Pericardial effusion as an initial presentation of primary lung carcinoma is uncommon and poses diagnostic challenges due to its nonspecific clinical manifestation. Herein we report a case of a 51-year-old female with known diabetes mellitus, hypertension, and hypothyroidism who presented with generalized anasarca and dyspnea. Imaging revealed a right upper lobe mass with bilateral pulmonary metastases and moderate-to-severe pericardial effusion with early tamponade features. Cytological analysis of the pericardial fluid demonstrated malignant cells suggestive of adenocarcinoma, which was confirmed on histopathological examination of a lung biopsy. This case highlights the importance of considering malignancy, particularly adenocarcinoma of the lung, in patients presenting with pericardial effusion, even in the absence of prior cancer diagnosis.

From sicca to malignant evolution: a swift turn to multiple myeloma in primary Sjögren’s syndrome

2026-06-30T07:05:09+0530

Primary Sjögren’s syndrome (pSS) is a chronic autoimmune disorder characterized by exocrine gland involvement and systemic B cell hyperactivity. Although hematologic complications are recognized, transformation to multiple myeloma (MM) remains exceptionally uncommon. We report a 50-year-old woman who presented with constitutional symptoms, sicca manifestations and recurrent vasculitic skin lesions. Evaluation established a diagnosis of primary Sjögren’s syndrome with associated monoclonal gammopathy of undetermined significance (MGUS). Despite initial management and follow up, she subsequently developed worsening systemic symptoms accompanied by progressive extra glandular manifestations, prompting reassessment. Serial investigations confirmed progression to multiple myeloma within a relatively short interval. The patient was managed collaboratively by rheumatology and hematology departments and showed favorable clinical and laboratory response to therapy. This case highlights a rare malignant evolution in pSS and underscores the importance of maintaining a high index of suspicion in patients with persistent systemic symptoms, paraproteinemia, vasculitic manifestations or unexplained clinical deterioration. Careful longitudinal monitoring may facilitate earlier recognition of hematologic transformation and enable timely therapeutic intervention, potentially improving patient outcomes.

Severe hypertriglyceridemia presenting with abdominal pain and peripheral neuropathy in a patient with uncontrolled diabetes and chronic alcohol use: a case report

2026-06-30T06:58:56+0530

Severe hypertriglyceridemia (triglyceride levels >1000 mg/dl) is a recognized high risk metabolic condition, particularly when associated with pancreatitis and the third most common cause of acute pancreatitis. However, its presentation without pancreatic involvement poses substantial diagnostic challenges and may delay appropriate management. We report a case of a 42-year-old male with chronic alcohol consumption (approximately 180 ml whiskey daily) and poorly controlled type 2 diabetes mellitus who presented with abdominal pain, right scapular pain, and a six-month history of peripheral neuropathy. Laboratory evaluation revealed markedly elevated triglycerides (>2000 mg/dl), preserved pancreatic enzymes, and imaging demonstrating a normal pancreas with grade 1 fatty liver on CT scan. Upper gastrointestinal endoscopy revealed mild antral gastritis. The patient was managed with lipid-lowering therapy (fenofibrate-statin combination), aggressive glycemic control with insulin, injectable thiamine, alcohol cessation, and dietary modification, resulting in significant biochemical improvement with triglycerides declining from 2158 to 1054 mg/dL within one week. This case illustrates the synergistic role of insulin resistance and alcohol-induced dyslipidemia in precipitating extreme triglyceride elevation and underscores the importance of early recognition and intervention to prevent catastrophic complications such as acute pancreatitis and chylomicronemia syndrome.

The Pickwickian child: a case report of paediatric obesity hypoventilation syndrome

2026-06-30T06:58:55+0530

Childhood obesity is on the rise and with it are also some unusual complications like Obesity hypoventilation syndrome, the triad of which includes obesity, hypoventilation and sleep disordered breathing. The absence of a mechanical, neuromuscular or metabolic explanation is essential before making this diagnosis. We report the case of a 10-year-old male child who was brought to us for the first time with acute onset breathlessness on exertion and generalised oedema, with progressive weight gain in the last 3 years. He was diagnosed with OHS with severe Obstructive sleep apnoea leading to cardiac failure and eventually improved with antifailure treatment, sildenafil, lifestyle modifications and BiPAP. Prompt recognition and early initiation of treatment measures including stringent lifestyle modifications are essential in preventing complications of OHS like cardiac failure.

First dual-chamber leadless pacemaker implantation at Meitra United Heart Centre, Kasaragod: a regional milestone in an octogenarian with sick sinus syndrome: a case report

2026-06-30T06:58:52+0530

Leadless pacemaker technology has advanced to enable dual-chamber atrioventricular synchronous pacing through implant-to-implant communication between two independent leadless devices. We report the first AVEIR dual-chamber leadless pacemaker implantation performed at Meitra United Heart Centre (MUHC), marking a regional milestone for Kasaragod, Kannur, Coastal Karnataka, and Goa. An 86-year-old woman presented with sick sinus syndrome complicated by tachy-brady syndrome and presyncopal episodes. She underwent successful implantation of a dual-chamber leadless pacemaker via femoral venous access under general anesthesia using the Innvolution Pinnacle Agile Cath Lab at MUHC. Optimal electrical parameters were achieved, with a right ventricular threshold of 0.5 V at 0.4 ms and impedance of 750 Ω, and a right atrial threshold of 1.0 V at 0.4 ms and impedance of 310 Ω. Device-to-device communication was 100%. Postoperatively, the patient developed left femoral vein thrombosis, which was managed with anticoagulation therapy, and she was discharged in stable condition. This case demonstrates that dual-chamber leadless pacing is feasible in an octogenarian with sick sinus syndrome and may serve as an alternative to conventional transvenous pacing systems, while emphasizing the need to consider vascular access complications such as femoral vein thrombosis during patient selection.

Acute isoniazid toxicity presenting with refractory seizures, severe metabolic acidosis, and rhabdomyolysis: a case report

2026-06-30T06:58:51+0530

Isoniazid remains widely used in India due to the high burden of tuberculosis and HIV, with toxicity being an important clinical concern. While peripheral neuropathy and hepatotoxicity are common, acute overdose presenting with seizures and rhabdomyolysis is uncommon and potentially fatal. A 21-year-old male presented following intentional ingestion of approximately 9 g of isoniazid, with two episodes of generalized tonic–clonic seizures. On admission, he was drowsy but arousable (GCS 12/15). Initial management included gastric lavage and activated charcoal. Laboratory findings showed elevated creatine phosphokinase (2556 U/l) and mild metabolic acidosis. Liver enzymes rose from day 2, peaked by day 5, and normalized by day 12. CPK levels peaked on days 5–6 and declined thereafter, correlating with generalized myalgia. The patient was treated with intravenous fluids, 5 g pyridoxine, and alkaline diuresis, with gradual clinical and biochemical recovery. He was discharged on day 14 after psychiatric evaluation. This case emphasizes the need to recognize isoniazid toxicity, classically characterized by seizures, metabolic acidosis, and altered sensorium. Early administration of pyridoxine and supportive care are essential for a favorable outcome.

Beyond Medication: Pulmonary rehabilitation in an older adult with non-cystic fibrosis bronchiectasis and allergic bronchopulmonary aspergillosis – a case report

2026-06-30T06:58:50+0530

Bronchiectasis results from a vicious cycle of pulmonary infection, airway inflammation and impaired mucociliary clearance, leading to abnormal and permanent dilatation of bronchi. Allergic bronchopulmonary aspergillosis (ABPA) is a common infection seen in adults with non-cystic fibrosis bronchiectasis. We present the short and long-term effects of Pulmonary rehabilitation (PR) and exercise training in a 69-year-old female with bronchiectasis. The patient's refusal to take any medication led to referral for physiotherapy, being a non-pharmacological treatment, as a last resort. PR was based on an individualised protocol, as determined by the physiotherapeutic assessment. Treatment included patient and family education, various breathing exercises, nutritional counselling, endurance, strength and functional activity training over a period of 6 months to 1 year. Significant improvement in functional capacity after 4 months of training, 1 min sit-to-stand (STS) count improved from 17/min to 30/min, Leichester quality of life (LCQ) total scores improved from 9.9/21 to 15.95/21. Single breath count (SBC) improved from 6 to 14. Improvements in the amount of sputum (5 tablespoons per bout, 8-10 times a day to 1-2 tablespoons per day), colour and consistency from P3 to M2 (Miller and Jones classification), with reduced frequency of coughing bouts. 1 year follow up showed further improvement in LCQ scores to 24.87, 1 min STS to 36 per minute and SBC to 24. Pulmonary rehabilitation plays a vital role in older patients diagnosed with bronchiectasis in improving physical, mental and social impairments, thereby contributing to improved quality of life.

Severe hypercalcemia and nephrocalcinosis secondary to subcutaneous fat necrosis in a neonate with perinatal asphyxia: a case report

2026-06-30T06:58:50+0530

Subcutaneous fat necrosis of the newborn (SCFN) is a rare, self-limiting panniculitis that occurs predominantly in full-term neonates following significant perinatal stress. Although the cutaneous manifestations often resolve spontaneously, SCFN can be complicated by severe and potentially life-threatening metabolic derangements, particularly hypercalcemia. We report the case of a 2.5-month-old female infant with a history of Grade 3 hypoxic–ischemic encephalopathy (HIE) who presented with multiple indurated subcutaneous nodules and profound hypercalcemia complicated by bilateral medullary nephrocalcinosis. Biochemical evaluation demonstrated suppressed parathyroid hormone levels with markedly elevated 1,25-dihydroxyvitamin D, consistent with PTH-independent hypercalcemia due to extra-renal vitamin D activation. Prompt recognition and aggressive multimodal therapy, including hyperhydration, calcitonin, and systemic corticosteroids, resulted in normalization of serum calcium levels. This case underscores the importance of early diagnosis, vigilant metabolic monitoring, and timely intervention in neonates with SCFN to prevent irreversible renal complications.

One step at a time: physiotherapy management following medial unicompartmental knee arthroplasty – a case report

2026-06-30T06:58:48+0530

This case report describes the rehabilitation of a 57-year-old male following medial unicompartmental knee arthroplasty (UKA). After four weeks of unsupervised home-based exercises, he presented with reduced knee flexion, quadriceps weakness, low confidence, and difficulty with stair climbing and sit-to-stand activities. A structured outpatient physiotherapy program focusing on mobility, strength, gait, and functional training was implemented. Over six weeks, the patient showed significant improvements in pain, range of motion, muscle strength, kinesiophobia, and functional performance, ultimately returning to work independently. This case highlights the value of supervised, individualized rehabilitation even when initiated later in the recovery phase.

A rare exophytic juvenile ossifying fibroma mimicking an extraosseous lesion: a diagnostic challenge

2026-06-30T07:03:57+0530

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion that predominantly affects children and adolescents and may present a diagnostic challenge due to its variable clinical and radiologic features. We report a rare case of a 9-year-old boy with an atypical presentation of JOF in the mandible, clinically mimicking an extraosseous lesion. Conventional imaging was inconclusive, whereas CT demonstrated a well-defined exophytic lesion with a hypodense centre and hyperdense peripheral margin. Histopathological examination confirmed the diagnosis of JOF. This case underscores the diagnostic difficulty associated with this underreported and unusual presentation.

Diabetic retinopathy and quality of life among adults with type 2 diabetes in Saudi Arabia

2026-06-20T07:16:33+0530

Background: Diabetic retinopathy is a common microvascular complication of type 2 diabetes mellitus and may affect quality of life. Evidence using generic quality-of-life instruments remains limited in Saudi Arabia. The objectives were to assess quality of life among adults with type 2 diabetes mellitus in Al-Ahsa, Saudi Arabia, using the WHOQOL-BREF, and to examine whether diabetic retinopathy is associated with domain scores.

Methods: This cross-sectional study included adults with type 2 diabetes mellitus identified from the management of population health records. Quality of life was assessed using the Arabic world health organization quality of life - brief (WHOQOL-BREF). Domain scores were transformed to a 0–100 scale. Independent-samples t-tests and multiple linear regression analyses were used to compare scores by retinopathy status and assess adjusted associations.

Results: A total of 529 participants were included, of whom 101 (19.1%) had diabetic retinopathy. No significant differences were found between participants with and without retinopathy in the physical, psychological, social relationships, or environmental domains in unadjusted analyses. In adjusted analyses, diabetic retinopathy was not significantly associated with any WHOQOL-BREF domain score. Cronbach’s alpha ranged from 0.542 to 0.806 across domains.

Conclusion: Diabetic retinopathy was not significantly associated with WHOQOL-BREF domain scores among adults with type 2 diabetes mellitus in Al-Ahsa. These findings suggest that retinopathy status alone may not independently predict overall quality of life when assessed using a generic instrument.

Factors associated with travel health engagement among international travellers in Riyadh: a clinic-based cross-sectional study 2026

2026-06-13T06:36:29+0530

Background: Despite the availability of travel medicine services, engagement remains suboptimal, particularly in primary healthcare settings in Saudi Arabia. The objective was to assess travel health knowledge, attitudes, and preventive practices (KAP) among international travellers attending primary healthcare clinics in Riyadh and to identify factors associated with preventive engagement.

Methods: A cross-sectional study was conducted among 400 adult travellers attending primary healthcare clinics at Prince Sultan Military Medical City, Riyadh. Data were collected using a structured, self-administered questionnaire. KAP domains were assessed and categorized using Bloom’s cutoffs. Associations between participant characteristics and KAP outcomes were examined using univariate tests and multivariable logistic regression.

Results: Participants were largely male (57.8%), with most traveling for tourism (80.5%). Preventive practices were notably suboptimal, with 66.2% classified as poor, compared with more balanced distributions in knowledge (34.0% poor) and attitude (47.0% poor). Only 38.2% of participants sought pre-travel health information. In multivariable analyses, preventive practices were strongly associated with travel to Africa (aOR, 7.69; 95% CI, 2.61–22.63) and traveling with companions (aOR, 5.61; 95% CI, 1.84–17.10). Higher education and income were significantly associated with improved knowledge, while obtaining pre-travel health information (aOR, 5.50; 95% CI, 3.05–9.92).

Conclusions: Preventive practices among international travellers in Riyadh remain inadequate despite moderate knowledge levels. Engagement appears to be driven primarily by behavioural and contextual factors rather than knowledge alone. Strengthening pre-travel counselling, promoting early trip preparation, and improving access to travel health services are critical to enhancing preventive uptake and optimizing primary care–based travel medicine services.

Optimizing diagnostic cascades: evaluating the sensitivity of NS1 antigen versus antibody serology in a rapidly evolving dengue outbreak

2026-06-30T07:05:06+0530

Background: Dengue fever, caused by DENV-1-4 serotypes, remains a major public health challenge with clinical manifestations ranging from mild febrile illness to severe complications such as Dengue Hemorrhagic Fever (DHF) and Expanded Dengue Syndrome (EDS). During the devastating 2023-2024 outbreak in Bangladesh, rapid and accurate diagnosis became essential for early intervention. This study evaluated the diagnostic performance of NS1 antigen testing compared with IgM/IgG serology and described the clinico-demographic profile of affected patients.

Methods: This prospective observational study was conducted at BIRDEM General Hospital, Dhaka, from June 2023 to February 2024 during the peak dengue epidemic. A total of 292 laboratory-confirmed dengue patients were enrolled. Sociodemographic data, clinical manifestations, and laboratory findings were collected from hospital records following ethical approval. Diagnostic sensitivity of NS1 antigen and antibody serology was compared using SPSS version 26 according to STROBE guidelines.

Results: The mean age of participants was 35.63±15.22 years; 54.8% were male and 83.9% were urban residents. Diabetes mellitus was present in 25.7% of cases. NS1 antigen showed the highest positivity rate (82.3%), whereas IgM and IgG positivity were 13% and 9.2%, respectively. Fever (76%), body ache (63.7%), headache (42.1%), and vomiting (41.1%) were common presenting symptoms. Thrombocytopenia (70.9%) and elevated SGPT (50.3%) were frequent laboratory abnormalities. Neuropsychiatric symptoms such as insomnia and irritability were observed in 7.9% of patients.

Conclusions: NS1 antigen is a superior early diagnostic marker during dengue outbreaks. Early identification of metabolic comorbidities and hepatic involvement may improve timely management and reduce dengue-related morbidity and mortality in resource-limited settings.

Impact of secondary surgical correction on self-perception, function and psychosocial outcomes in cleft lip and palate patients evaluated with the CLEFT-Q

2026-06-10T06:55:37+0530

Background: Cleft lip and/or palate (CLP) is associated with persistent aesthetic and psychosocial sequelae. While secondary corrections aim to improve appearance and function, their impact on patient-reported outcomes (PROMs) remains variable. This study compares facial self-image, functional outcomes and psychosocial well-being between CLP patients with and without secondary aesthetic correction.

Methods: A cross-sectional study was conducted using the CLEFT-Q instrument. Patients were divided into two groups based on their history of secondary aesthetic correction (Yes/No). Scores for facial self-image, function and psychosocial well-being were compared using Student’s t-tests, with significance set at p<0.05.

Results: Sixty-nine patients were included (n=29 Yes; n=40 No). Patients who underwent secondary correction reported significantly higher scores in facial self-image (2.37 vs. 1.95; p=0.015) and psychosocial well-being (2.96 vs. 2.69; p=0.019). No significant difference was found in functional outcomes (2.86 vs. 2.61; p=0.11).

Conclusions: Secondary correction significantly improves facial self-image and psychosocial well-being in CLP patients. These findings underscore the clinical value of secondary revisions as an essential component of comprehensive cleft care, demonstrating that benefits extend beyond anatomical reconstruction to significantly impact patient quality of life.

Effect of health education on prevention of nosocomial infections in primary health care facilities, Gombe State, Nigeria

2026-06-30T07:05:13+0530

Background: Nosocomial infections remain a significant threat to patient safety and public health worldwide. Data indicate that these infections pose ongoing challenges in healthcare settings.

Methods: This study, utilizing a quasi-experimental design, evaluates the baseline knowledge, attitudes, and practices of healthcare workers and assesses the impact of a tailored health education program on these factors. A total of 380 participants were enrolled, with data collected through a multistage sampling technique using questionnaires, pre- and post-intervention assessments, and direct observation of infection prevention practices.

Results: The result revealed significant improvements in knowledge and practices concerning nosocomial infections among participants in the intervention group (ward-A) compared to the control group (ward-B) following the administration of health education. Almost all participants in ward-A (97.4%) were aware of nosocomial infections, compared to only 65.8% in ward-B. Similarly, all Ward-A participants had received formal health education on the subject, whereas only 65.8% of ward-B participants reported the same. These differences were statistically significant, emphasizing the impact of health education. The study highlights a preference for interactive learning methods, including workshops and on-the-job training, as the most effective means of delivering health education.

Conclusions: These findings underscore the necessity for ongoing health education initiatives to strengthen infection prevention and control practices in healthcare settings.

Adverse effects of baricitinib in comparison to methotrexate in the treatment of severe alopecia areata

2026-06-30T07:05:10+0530

Background: Existing therapies for alopecia areata often yield suboptimal results and have some associated side effects. Janus kinase (JAK) inhibitors are a recent advancement in the treatment of alopecia areata which are treatment resistant or severe.

Methods: This analytical observational study was conducted in the department of Dermatology and Venereology of Bangladesh Medical University to compare the adverse effects of baricitinib and methotrexate in the treatment of severe alopecia areata. About 84 patients of alopecia areata were divided into two groups. Patients of group A were treated with oral baricitinib and group B were treated with oral methotrexate for 6 months.

Results: The most common adverse effects noted in baricitinib group was upper respiratory tract infection 14.3% and hyperlipidaemia was 11.9% of patients and in methotrexate group was nausea 28.6%, and elevated liver transaminase was 16.7 % patients. Serum transaminase (ALT) elevation was significantly raised from baseline to after 6 months (40.21±19.29, p<0.001) in methotrexate group, whereas there was no significant change (33.53±19.86, p=0.506) in baricitinib group. There was statistically significant change before and after treatment in serum creatinine (0.88±0.12, p=0.004) in baricitinib group, compared to no significant change in methotrexate group (p=0.222). There was significant rise in total cholesterol, triglyceride and LDL after 6 months of treatment with baricitinib and these results were statistically significant (p<0.001).

Conclusions: After 6 months of treatment, baricitinib has proven its superiority over methotrexate in terms of safety in the treatment of severe alopecia areata.

Stool antigen-based detection of Helicobacter pylori, knowledge and associated factors among patients with suspected gastrointestinal disorders at the Buea Regional Hospital

2026-06-30T07:05:08+0530

Background: Helicobacter pylori, the most common bacterial infection worldwide, has become a global health issue, with an estimated half of the population exposed to infection. H. pylori is classified as a class I carcinogen and is the most common bacterium that colonizes the stomach predominantly in childhood, accounting for approximately 89% of H. pylori infections. This study assessed the prevalence of H. pylori infection, knowledge, and associated risk factors among patients at the Buea Regional Hospital.

Methods: A hospital-based cross-sectional study was carried out among 180 selected participants. Data were collected through the administration of an interviewer-administered questionnaire designed using Epi Info (version 7.2.5.0). Descriptive statistics are presented as frequencies and percentages.

Results: The mean age of the participants was 40.81 years (standard deviation = 16.85). Among the 180 participants included in this study, 47% (96) were infected with H. pylori. More than half 60% (108) of the participants had good knowledge about H. pylori infection. Employed individuals had a lower risk of infection (aOR=0.37; 95% CI: 0.15-0.934; p=0.035). Compared with people with a tertiary education, those who attended secondary education had greater odds of infection (aOR=1.12, 95% CI: 1.033, 3.313; p<0.001). Individuals who used drugs regularly without a prescription had higher odds of infection (aOR=3.25; 95% CI: 1.118-9.46; p=0.03). alcoholic drinkers had lower odds of infection than does who did (aOR=0.48; 95% CI: 0.176-0.759; p=0.017). Those who used flushing toilets were less likely to have infection than those who used pit toilets were (aOR=0.23; 95% CI: 0.083-0.65; p=0.005).

Conclusions: The results of the current study in a resource-limited environment revealed a high prevalence of H. pylori, which was driven mainly by socioeconomic, behavioural and environmental factors. Specific measures based on education, hygiene and antimicrobial management are essential to minimize the burden of infections and their potential complications.

Epidemiological profile, management and outcomes of chronic subdural hematoma in Ado-Ekiti, Nigeria

2026-06-30T07:04:58+0530

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition among older adults, with varied clinical presentations and outcomes. In resource-limited settings, understanding its epidemiology and treatment outcomes is important for improving patient care. Objective was to evaluate the epidemiological profile, clinical presentation, management strategies, and outcomes of patients with chronic subdural hematoma in Ado-Ekiti, Nigeria.

Methods: This retrospective descriptive and analytical study included patients managed for CSDH at a tertiary hospital between January 2022 and December 2025. Data were extracted from medical records and analyzed using SPSS version 25. Variables assessed included socio-demographic characteristics, clinical features, radiological findings, treatment modalities, and outcomes. Logistic regression identified predictors of poor outcome, defined as death or lack of clinical improvement at discharge.

Results: A total of 187 patients were studied. The mean age was 66.4±12.8 years, with males accounting for 71.7% of cases. Head trauma occurred in 75.9%, mainly from falls (54.9%). Headache (79.7%) and hemiparesis (63.1%) were the most common symptoms. Surgical treatment was performed in 79.7%, predominantly via burr hole drainage (81.2%). Full recovery occurred in 51.9%, while mortality was 8.6%. Predictors of poor outcome included age ≥70 years, severe Glasgow Coma Scale score at presentation, bilateral hematoma, and midline shift, whereas surgical treatment was protective.

Conclusions: CSDH predominantly affects elderly males and is commonly associated with minor head trauma. Early diagnosis and timely surgical intervention are associated with favorable outcomes.

Incidence and patterns of post-tonsillectomy hemorrhage in paediatric patients: a hospital-based study

2026-06-30T06:58:48+0530

Background: Post-tonsillectomy hemorrhage (PTH) is a potentially serious complication in pediatric patients, contributing to increased morbidity, hospital readmission, and healthcare burden. Its incidence and clinical patterns vary depending on multiple patient- and procedure-related factors, particularly in developing healthcare settings. The aim of the study was to determine the incidence and patterns of PTH in pediatric patients and evaluate associated risk factors, timing, severity, and management outcomes.

Methods: This hospital-based observational study was conducted over 1 year in a tertiary care hospital in Bangladesh, including 220 pediatric patients who underwent tonsillectomy. Data were collected using a structured format covering demographic variables, type and timing of hemorrhage, severity, clinical presentation, management strategies, and associated risk factors. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26, with results expressed as frequency and percentage. A p≤0.05 was considered statistically significant.

Result: The mean age of patients was 8.6±3.2 years, with a male predominance (60.00%). Secondary hemorrhage (90.91%) was more common than primary hemorrhage (9.09%), most frequently occurring on days 5-10 (58.00%). Mild hemorrhage accounted for 46.36% of cases, while 10.91% required surgical intervention. Oral bleeding was present in 100.00% of patients, followed by blood-stained saliva (71.82%) and hematemesis (25.45%). Conservative management was sufficient in 46.36% of cases, whereas 12.73% required blood transfusion. Major associated risk factors included Diathermy technique (45.45%), infection (40.00%), and dehydration (32.73%).

Conclusion: Post-tonsillectomy hemorrhage is predominantly secondary in nature, with identifiable risk factors and varied clinical severity. Early recognition, improved surgical techniques, and effective postoperative care are essential to minimize complications and enhance pediatric patient outcomes.

Knowledge, attitudes, and perceptions of gynecologists regarding physiotherapy in obstetric and gynecological care: a cross-sectional study

2026-06-30T06:58:47+0530

Background: Physiotherapy is an essential component of obstetric and gynecological care, supporting women during pregnancy, childbirth, postpartum recovery, and the management of pelvic floor disorders. Despite its proven clinical benefits, its integration into routine gynecological practice remains inconsistent and may be influenced by physicians' knowledge, attitudes, and perceptions.

Methods: This cross-sectional study included 133 gynecologists from selected healthcare facilities in Dhaka, Gazipur, and Munshiganj, Bangladesh, between January and July 2023. Data were collected through face-to-face interviews using a structured questionnaire covering socio-demographic characteristics, knowledge, attitudes, and perceptions. Descriptive statistics and Spearman's correlation coefficient were used for data analysis with SPSS version 25.

Results: Most gynecologists demonstrated good knowledge of obstetric physiotherapy. Overall, 91% recognized its general benefits, while 96.2% acknowledged its role in facilitating normal delivery and strengthening core muscles after childbirth. However, knowledge gaps existed regarding cesarean scar rehabilitation (33.8%) and diastasis recti management (47.4%). More than half (55.6%) considered physiotherapy expensive, and 62.4% perceived it as time-consuming. Although 51.1% routinely referred patients for pregnancy-related exercise, 57.1% never referred patients for physiotherapy. No significant correlations were found between professional experience or working hours and knowledge, attitude, or perception scores.

Conclusions: Gynecologists demonstrated satisfactory awareness of obstetric physiotherapy but limited knowledge of pelvic rehabilitation and post-cesarean recovery. Despite generally positive attitudes, low referral rates indicate a gap between knowledge and clinical practice, highlighting the need for continuing professional education and better integration of physiotherapy services into obstetric and gynecological care.

Association of serum calcium level with preeclampsia

2026-06-30T06:58:38+0530

Background: Preeclampsia and its associated complications remain major causes of maternal and perinatal morbidity and mortality worldwide. Among the various risk factors, hypocalcemia has been suggested as a possible contributor to the development of preeclampsia. To determine the association between serum calcium levels and preeclampsia in pregnant women.

Methods: This case-control study was conducted in the Department of Obstetrics and Gynecology, Rangpur Medical College Hospital, Rangpur, Bangladesh. Ethical approval and institutional permission were obtained before data collection. Pregnant women with gestational age ≥20 weeks, including 50 preeclamptic women and 50 normotensive pregnant women, were enrolled according to predefined selection criteria. Detailed clinical history, physical examination and relevant laboratory investigations were performed. Data were analyzed using SPSS version 23. Chi-square test was applied for categorical variables and unpaired t-test for continuous variables. A p value <0.05 was considered statistically significant.

Results: Women with preeclampsia were significantly younger, with 40.0% aged <20 years compared to 12.0% in controls (p<0.001). Overweight and obesity were more common among preeclamptic women (66.0% and 24.0%, respectively), whereas most controls had normal BMI (84.0%). Preeclamptic women had significantly higher pulse rate and blood pressure. Mean serum calcium and corrected serum calcium levels were significantly lower in the preeclampsia group (7.38±0.37 mg/dl and 7.61±0.17 mg/dl) compared with controls (9.07±0.53 mg/dl and 9.10±0.62 mg/dl). Hypocalcemia was observed in 80.0% and 84.0% of preeclamptic women based on serum calcium and corrected calcium, respectively. No significant difference in calcium levels was found between moderate and severe preeclampsia.

Conclusions: Low serum calcium is significantly associated with preeclampsia, suggesting hypocalcemia may play a role in its pathogenesis.

Predictive factors of postoperative outcome after cervical spine surgery at the Soavinandriana Hospital Center, Madagascar: a retrospective analytical study

2026-06-09T07:17:28+0530

Background: Cervical spinal disorders represent a major cause of neurological morbidity. The aim of this study was to identify predictive factors of postoperative outcome after cervical spine surgery at the Soavinandriana Hospital Center.

Methods: We conducted a retrospective analytical study in the Neurosurgery Department of CENHOSOA from January 1^st, 2020 to December 31^st, 2023. Patients operated on for cervical spine disorders during this period were included. Epidemiological, clinical, paraclinical, operative, and outcome parameters were analyzed. A comparative analysis according to the surgical approach was performed.

Results: Fifty-seven patients were included among 864 hospitalized patients. The mean age was 48 years (±14.93), with a balanced sex distribution. The anterior approach accounted for 78.94% (n=45) of surgical procedures. The main surgical indications were cervical myelopathy in 40.35% (n=23) and traumatic cervical lesions in 31.57% (n=18). Postoperative clinical improvement was observed in 78.94% (n=45) of cases. Postoperative complications and infections were significantly more frequent after posterior approach surgery (p=0.026). The anterior approach was associated with a shorter hospital stay (OR=19.9; p=0.027). Cervical fractures and dislocations were independent factors associated with intensive care unit admission.

Conclusions: Cervical spine surgery provides satisfactory clinical improvement with low postoperative mortality. The anterior approach was associated with shorter hospital stay and fewer postoperative infectious complications.

The influence of geographical origin of medical students on their opinions about the value of medicinal plants in cancer treatment

2026-06-30T07:05:17+0530

Background: During medical study in university students should learn about both traditional-based medicine and evidence-based medicine in order to tackle different clinical aspects of practice. This study aimed to get to know about medical students' understanding about usage of different types of plants based medicine in treatment of various forms of cancer.

Methods: Using an online survey “Google forms” information was collected among Grodno State Medical University (GrSMU) 100 medical students from Asian origin (India and Sri Lanka) and 100 Belarusian medical students participated.

Results: Students from Asian origin (India) found out to be more deeply related to traditional-based medicine while students from Belarus were less likely to trust this form of medicine.

Conclusions: In conclusion, we've found out that heterogeneity of knowledge about plant-based medicine in the cure of oncological diseases between medical students of different regions. Medical students from Asia (especially from India) are more engaged with the use of plants-based medicine for treatment of oncological disease.

BREAST-Q outcomes after autologous breast reconstruction: a comparative analysis of deep inferior epigastric perforator, transverse rectus abdominis myocutaneous, and latissimus dorsi flaps

2026-06-17T09:09:30+0530

Background: Autologous breast reconstruction is commonly performed after mastectomy; however, the impact of different flap techniques on patient-reported outcomes remains unclear.

Methods: An observational, analytical, cross-sectional study was conducted at Hospital General de México “Dr. Eduardo Liceaga.” Thirty women who underwent unilateral breast reconstruction following mastectomy for breast cancer between 2016 and 2024 were included. Patients were reconstructed with a deep inferior epigastric perforator (DIEP) flap, Latissimus dorsi flap, or transverse rectus abdominis myocutaneous (TRAM) flap (n=10 per group). Patient-reported outcomes were assessed 12 months after surgery using the validated BREAST-Q questionnaire.

Results: The mean age was 51.6 years, with no significant differences among groups (p=0.225). Overall BREAST-Q scores were highest in the DIEP group (88.9), followed by the TRAM (84.2) and latissimus dorsi (82.3) groups. Most BREAST-Q domains showed no significant differences between reconstruction techniques, including psychosocial well-being, sexual well-being, satisfaction with breast appearance, adverse effects of radiation, satisfaction with information, satisfaction with the surgeon, satisfaction with the medical team, and satisfaction with staff (all p>0.05). Physical well-being of the chest was significantly higher in the Latissimus Dorsi group than in the DIEP and TRAM groups (p=0.045). Abdominal satisfaction was significantly higher in the DIEP group compared with the TRAM group (p<0.0001).

Conclusions: All three autologous reconstruction techniques achieved high postoperative satisfaction. Significant differences were observed only in chest physical well-being, favouring the latissimus dorsi flap, and abdominal satisfaction, favouring the DIEP flap. These findings support individualized flap selection according to patient priorities and expected donor-site outcomes.

Association of thyroid autoimmunity with psoriasis

2026-06-30T06:58:34+0530

Background: Psoriasis is a chronic, relapsing, multifactorial inflammatory disorder of the skin. Psoriasis has been found to be associated with different autoimmune disorders; autoimmune thyroid disorder is one of them. Several studies have suggested an association of thyroid autoimmunity with psoriasis.

Methods: A total of 63 patients with psoriasis and equal number of age and sex matched apparently healthy subjects were included. Psoriasis area and severity index (PASI) score was calculated. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroglobulin (AbTG), antithyroidperoxidase antibody (AbTPO) and TSH receptor Ab levels were measured in all of the subjects.

Results: The mean age of psoriasis patients was 35.8±16.7 years compared to 35.4±16.9 years in the control group and was found non-significant (p=0.899). Psoriasis group consisted of 63.5% males and 36.5% females, while the control group had 66.7% males and 33.3% females (p=0.709). Majority of psoriasis patients and control subjects were euthyroid (87.3% and 96.8% respectively). Anti TPO antibodies were elevated in 34.9% psoriasis patients compared to 4.8% in control group which was statistically significant (p<0.001). Anti TG Antibodies were elevated in 46.0% psoriasis patients compared to 7.9% in control group and was statistically significant (p<0.001).

Conclusions: This study showed significantly higher frequency of elevated anti TPO antibodies and anti-thyroglobulin (TG) antibodies in psoriasis patients compared to control group. So, there is association between thyroid autoimmunity and psoriasis. However, further large-scale studies are required to expand our knowledge about thyroid autoimmunity and its association with psoriasis.

The PDR-SEQS classification and reconstructive algorithm for breast defects after phyllodes tumor resection: a retrospective cohort study

2026-06-30T06:58:34+0530

Background: Phyllodes tumors (PTs) are fibroepithelial neoplasms requiring surgical resection, frequently causing complex reconstructive defects. Currently, no standardized framework exists to guide reconstructive decision-making. This study proposes a novel classification and algorithm based on objective volumetric loss and skin-envelope quality.

Methods: A retrospective cohort study was conducted at a tertiary referral center in the period between June 2020 and December 2024. Adult patients undergoing breast reconstruction following PT resection with a minimum 12-month follow-up were included. Two objective parameters were developed: the phyllodes defect ratio (PDR), quantifying volume loss relative to the contralateral breast, and the skin envelope quality score (SEQS), evaluating residual soft-tissue condition. These metrics informed a five-tier reconstructive decision-making algorithm.

Results: Thirty-five patients met inclusion criteria. Mean PDR and SEQS values were 41.5%±34.3 and 4.8±1.5, respectively. The most prevalent subtype was IIIb (45.7%), followed by II (42.9%). Reconstructive strategies escalated according to algorithm-defined complexity, with autologous reconstruction predominating. Despite extensive defects, definitive reconstruction was achieved in most patients, with infrequent major complications and no compromise of algorithm applicability.

Conclusions: The PDR–SEQS classification provides an objective, clinically applicable framework for managing breast defects following PT resection. By integrating proportional volumetric deficiency and soft-tissue quality, the proposed algorithm standardizes reconstructive decision-making, facilitating reproducible surgical planning from prosthetic to complex autologous approaches. External multicenter validation is warranted.

Health-related quality of life and psychological distress among patients with type 2 diabetes using semaglutide

2026-06-30T06:58:27+0530

Background: Semaglutide is increasingly used for type 2 diabetes mellitus (T2DM), but its real-world association with health-related quality of life (HRQoL) and psychological wellbeing remains underexplored in Saudi Arabia. The study aims to assess HRQoL and psychological distress among patients with T2DM according to current semaglutide use.

Methods: This analytical cross-sectional study included 349 adults with T2DM attending outpatient diabetic clinics in Taif, Saudi Arabia, between September 2025 and February 2026. HRQoL was assessed using the Arabic EQ-5D-5L, including EQ-5D-5L index and EQ-VAS scores, while psychological distress was assessed using the Arabic PHQ-4. Adjusted regression models examined associations between semaglutide use and study outcomes.

Results: Among 349 participants, 145 were semaglutide users and 204 were non-users. Semaglutide use was not significantly associated with EQ-VAS score (B=-0.091, 95% CI: -2.259 to 2.078, p=0.935) or EQ-5D-5L index score (B=-0.030, 95% CI: -0.062 to 0.003, p=0.072). However, semaglutide use was associated with higher odds of pain/discomfort (OR=2.610, 95% CI: 1.385-4.917, p=0.003), anxiety/depression (OR=2.175, 95% CI: 1.213-3.899, p=0.009), and any psychological distress (OR=2.929, 95% CI: 1.503–5.710, p=0.002).

Conclusions: Semaglutide use was not associated with better overall HRQoL, but was associated with higher odds of pain/discomfort and psychological distress. Longitudinal studies are needed to clarify whether these associations reflect treatment effects, baseline patient complexity, or unmeasured clinical factors.

Histopathological findings in grade IV capsular contracture clinically diagnosed at the Hospital General de México

2026-06-30T06:58:27+0530

Background: To describe the histopathological findings in capsular tissue obtained from female patients with grade IV capsular contracture (Baker classification) who underwent explantation with capsulectomy at the Hospital General de México.

Methods: An observational, retrospective and descriptive study was conducted at the Plastic and Reconstructive Surgery Service of the Hospital General de México "Dr. Eduardo Liceaga." Female patients with breast implants who were clinically diagnosed with grade IV capsular contracture (Baker) between June 2023 and June 2026 were included. All patients underwent explantation with capsulectomy and capsular specimens were sent for histopathological analysis to the hospital's Pathology Department. Pre-surgical variables (age, implant longevity, number of previous exchanges), intraoperative variables (implant integrity, placement plane, type of capsulectomy) and histopathological findings were analyzed. Descriptive statistics were used, with absolute frequencies and percentages for qualitative variables and means and standard deviations for quantitative variables.

Results: A total of 50 female patients were included, with a mean age of 49.1±10.1 years (range: 30–70 years). The mean implant longevity was 12.4 years and 86% had no previous implant exchange. The implant was intact in 92% of cases, the retro glandular plane was identified in 78% and total capsulectomy was performed in 88%. Fibrosis was present in 100% of specimens, predominantly moderate (35, 70%) and extensive/marked (11, 22%). Synovial metaplasia was identified in 33 (66%) of cases. Chronic inflammation was present in 35 (70%) of cases, with nonspecific/mild inflammation being the most prevalent subtype (19, 38%), followed by granulomatous foreign body-type inflammation (10, 20%) and xanthomatous inflammation (6, 12%). Dystrophic calcification was found in 8 (16%), stromal hyalinization in 4 (8%), hemorrhage in 3 (6%), bacterial colonies in 1 (2%) and apocrine metaplasia in 2 (4%). Residual mammary parenchymal findings were identified in 7 (14%) of cases. All 50 (100%) specimens were negative for malignancy.

Conclusions: The histopathological analysis of periprosthetic capsules in patients with grade IV capsular contracture demonstrates a consistent pattern dominated by fibrosis, present universally and synovial metaplasia, identified in two-thirds of cases. The presence of chronic inflammation in the majority of patients and dystrophic calcification in a relevant subset reflects a sustained foreign body response. No specimen showed evidence of malignancy. These findings provide a histopathological baseline for grade IV capsular contracture in a Mexican tertiary care center.

Role of topical tranexamic acid in reducing post-TURP hematuria: a randomized controlled study

2026-06-30T06:58:36+0530

Background: Postoperative hematuria is a common and clinically significant complication following transurethral resection of the prostate (TURP). Tranexamic acid (TXA), an antifibrinolytic agent, has been investigated to reduce perioperative bleeding in various surgical settings. This study aimed to evaluate the efficacy and safety of topical TXA added to irrigating fluid during monopolar TURP in reducing postoperative hematuria and related outcomes.

Methods: This prospective randomized controlled study was conducted at Dinajpur Medical College Hospital from July 2024 to December 2025. 50 men undergoing monopolar TURP for benign prostatic hyperplasia (BPH) were randomly assigned (1:1) into two groups. The TXA group received 1.5% glycine irrigation with 500 mg/l topical TXA, while the control group received standard 1.5% glycine irrigation. Primary outcomes included duration of gross hematuria and postoperative hemoglobin drop. Secondary outcomes were clot retention, duration of bladder irrigation, catheterization, hospital stay and blood transfusion rate. Data were analyzed using SPSS version 26.

Results: The TXA group demonstrated a significantly shorter duration of gross hematuria (18.6±6.3 vs. 31.4±8.2 hours; p<0.001) and a smaller postoperative hemoglobin reduction (0.9±0.4 vs. 1.6±0.6 g/dl; p<0.001). Fewer patients required bladder irrigation beyond 24 hours (12.0% vs. 36.0%; p=0.04). Differences in clot retention (8.0% vs. 28.0%; p=0.07) and blood transfusion rates (4.0% vs. 16.0%; p=0.16) were not statistically significant.

Conclusions: Topical TXA in irrigating fluid during TURP effectively reduces postoperative hematuria and hemoglobin loss without significant adverse effects, making it a safe and cost-effective adjunct in BPH surgery.

Exploring gender disparities among first authors in Alzheimer's disease publications: an analysis of potential underrepresentation of women

2026-06-30T07:06:35+0530

Background: Gender imbalance in scientific research remains a persistent issue, with women being underrepresented in authorship positions, especially as first authors. This study aims to investigate gender disparities in Alzheimer's disease research, focusing on the representation of female first authors.

Methods: An epidemiological study was conducted using data extracted from the PubMed and National Institute of Health databases, spanning 20 years (2003-2022) and focusing on Alzheimer's disease articles. The gender of the initial authors was determined using the Namsor website.

Results: Of the 142 publications analysed, 141 had specified initial authors, with 77 females and 64 males. The annual number of first authors, both male and female, showed variations throughout the study period. India had the highest gender ratio (3), followed by China (2.67) and Mexico (2). Fisher's Exact Test revealed a significant association between the first author's gender and their country of origin.

Conclusions: The correlation between gender and country underscores the importance of addressing cultural and institutional factors in promoting inclusivity and diversity.

Risk factors for abdominal wound dehiscence after emergency laparotomy

2026-06-20T07:16:35+0530

Background: Abdominal wound dehiscence (AWD) is a serious postoperative complication following emergency laparotomy and is associated with substantial morbidity and mortality. This study was performed to determine the incidence of AWD and to identify significant preoperative, intraoperative and postoperative risk factors.

Methods: A retrospective observational study was conducted on 300 adult patients undergoing emergency open laparotomy at a tertiary care teaching hospital. Demographic, clinical and laboratory parameters were recorded. Categorical variables were analysed using Chi-square or Fisher’s exact test and continuous variables using independent t-test. Variables with p<0.10 on univariate analysis were entered into multivariate logistic regression. A p<0.05 was considered statistically significant.

Results: The overall incidence of AWD was 7.0% (21/300). On univariate analysis, surgical site infection (OR 6.9; 95% CI 3.1–15.2; p<0.001), hypoalbuminemia (OR 5.1; 95% CI 2.4–10.7; p=0.002), peritonitis (OR 4.2; 95% CI 2.0–8.9; p=0.004), anemia (OR 3.1; 95% CI 1.4–6.7; p=0.01), operative duration >3 hours (OR 2.6; 95% CI 1.2–5.6; p=0.02) and postoperative sepsis (OR 3.0; 95% CI 1.3–6.9; p=0.01) were significantly associated with AWD. Multivariate analysis identified surgical site infection (adjusted OR 5.8; 95% CI 2.6–12.9; p<0.001), hypoalbuminemia (adjusted OR 4.2; 95% CI 1.9–9.1; p=0.001) and peritonitis (adjusted OR 3.6; 95% CI 1.6–8.0; p=0.003) as independent predictors.

Conclusions: Infective and nutritional factors are major determinants of abdominal wound dehiscence following emergency laparotomy. Early identification and optimization of these risk factors may reduce postoperative morbidity and mortality.

Optimizing hypertension care in the real world: a physician survey on telmisartan‑based combination therapy

2026-06-10T06:55:38+0530

Background: Hypertension is a leading cause of global cardiovascular morbidity and mortality and most patients require combination therapy to achieve recommended blood pressure targets and reduce cardiovascular risk.

Methods: This cross-sectional, questionnaire-based survey was conducted among 98 physicians attending a scientific meeting organized by the Cardiological society of India (CSI). The survey evaluated real-world hypertension management, including BP targets, use of combination therapy, preferred drug combinations and factors influencing telmisartan selection.

Results: Most physicians reported frequent use of combination therapy at the time of treatment initiation, with 46% indicating its use in 20-40% of patients and 38% in 40-60% of patients. Blood pressure targets varied, with nearly half of respondents (48%) aiming for <130/80 mm Hg, while 30% targeted <140/90 mm Hg. Telmisartan plus amlodipine emerged as the most preferred first‑line combination (48%), followed by telmisartan plus chlorthalidone (31%). The telmisartan–amlodipine combination was commonly selected for patients with uncontrolled blood pressure (44%) and those presenting with stage 2 hypertension (41%). Triple therapy with telmisartan, cilnidipine, and chlorthalidone was predominantly reserved for resistant hypertension (57%). Regression of left ventricular hypertrophy (31%) and the presence of microalbuminuria (29%) were key factors influencing preference for telmisartan.

Conclusions: The survey highlights a growing preference among clinicians for early combination therapy, intensive BP targets and therapies providing sustained 24-hour BP control. Telmisartan-based combinations were widely preferred, reflecting their complementary mechanisms and cardio-renal protective benefits. These findings suggest increasing adoption of guideline-directed strategies in real-world hypertension management.

Clinical outcomes of plasma exchange in acute and chronic antibody-mediated rejection following kidney transplantation: a prospective observational study

2026-06-13T06:36:27+0530

Background: Antibody-mediated rejection (ABMR) remains a major cause of renal allograft dysfunction and graft loss after kidney transplantation. Plasma exchange (PE) is widely used for antibody removal; however, its effectiveness in acute and chronic ABMR remains incompletely defined.

Methods: This prospective observational study was conducted at the Institute of Kidney Diseases and Research Centre–Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India. The study included 60 kidney transplant recipients with biopsy-proven ABMR treated between September 2017 and November 2019. Patients were classified as acute ABMR (n=30) or chronic ABMR (n=30) according to Banff criteria. All patients received plasma exchange in combination with corticosteroids, intravenous immunoglobulin, and optimization of maintenance immunosuppression. Demographic, clinical, histopathological, immunological, and renal outcomes were assessed at baseline, 6 months, and 5 years.

Result: Baseline demographic and laboratory characteristics were comparable between groups (p>0.05). Acute ABMR demonstrated significant improvement in histological activity scores following treatment, including C4d, glomerulitis, peritubular capillaritis, and vasculitis (p≤0.002), whereas chronic ABMR showed no significant histological improvement (p>0.05). At 6 months, acute ABMR was associated with significantly better renal function, lower proteinuria, and lower donor-specific antibody levels than chronic ABMR (all p<0.001). At 5 years, acute ABMR maintained superior renal outcomes with lower serum creatinine, lower proteinuria, lower persistent donor-specific antibody positivity, and higher estimated glomerular filtration rate (p<0.001). Chronic ABMR was associated with more hospitalizations (p<0.001), infection-related admissions (p=0.004), cardiovascular events (p=0.002), mortality (p=0.044), and graft loss requiring maintenance dialysis (p=0.026).

Conclusion: Plasma exchange is associated with substantial histological and functional recovery in acute ABMR but provides limited benefit in chronic ABMR. Early diagnosis and intervention may improve long-term allograft survival and clinical outcomes.

Study on the knowledge, attitude, and practice of pharmacovigilance among the postgraduate trainees in a tertiary care hospital, Dibrugarh

2026-06-20T07:16:34+0530

Background: Adverse drug reactions (ADR) are a major cause of illness and death worldwide. Pharmacovigilance (PV) helps in improving patient′s safety through reporting and assessment of ADR, but underreporting by healthcare professionals remains a major drawback. Therefore, the study was conducted to assess the knowledge, attitude and practice (KAP) regarding PV among the postgraduate trainee of a tertiary care hospital who are often the first line treatment providers.

Methods: The study was cross-sectional, questionnaire based designed to assess KAP among 280 postgraduates. Data were analysed using descriptive statistics, Pearson′s correlation, multiple regression analysis, and Chi-square test.

Results: The study highlighted that attitude of the postgraduate medical residents and practical exposure to ADR related activities play a greater role than knowledge alone in improving ADR reporting.

Conclusions: The findings provide evidence for strengthening institutional support and continuing medical education among the healthcare workers on the topic.

Relationship between metabolic parameters and lifestyle factors in type 2 diabetes mellitus: a retrospective analysis

2026-06-30T07:06:37+0530

Background: This study examined the correlation between metabolic biomarkers (e.g., fasting blood sugar, HbA1C, cholesterol, creatinine) and lifestyle factors (e.g., smoking, body weight, blood pressure) in pre-diabetes and diabetes patients. We wanted to find patterns that may affect metabolic disorders and cardiovascular disease (CVD) in these populations.

Methods: A medical outpatient department patient and laboratory data was used in a retrospective cross-sectional study. FBS, PPBS, HbA1C, lipid profiles, creatinine levels, urine microalbumin, blood pressure, BMI, and risk factors like smoking were analysed using t-tests, ANOVA, and multivariate regression.

Results: The study found significant lipid abnormalities in diabetic individuals. Patients with diabetes had an average triglyceride level of 286.6 mg/dl. Low HDL levels (averaging 36.3±5.8 mg/dl) were also observed. We also had high LDL levels, which increase the risk of cardiovascular disease. The highest triglyceride (305.80 mg/dl) and VLDL (61.16 mg/dl) levels were found in participants aged 60-70. AIP, a key CVD risk marker, was high in older diabetics (0.80), indicating a strong link between age, dyslipidemia, and cardiovascular risk. Furthermore, smoking worsened these lipid irregularities. Males had higher triglycerides than females (p=0.036), but fasting blood sugar, HbA1C, and LDL did not differ.

Conclusions: Research shows a high prevalence of dyslipidemia in diabetics, characterized by elevated triglycerides, low HDL, and high LDL, all linked to increased CVD risk. Early detection and treatment of lipid issues are crucial, particularly for older adults and smokers, who are more prone to atherosclerotic events.

Beyond recovery: post COVID-19 complications

2026-06-30T07:06:37+0530

Background: Although most patients recover from the acute phase of coronavirus disease 2019 (COVID-19), a substantial proportion continue to experience persistent symptoms and organ-specific complications, collectively referred to as post COVID-19 syndrome (PCS). These manifestations like pulmonary fibrosis emerging as a significant long-term concern, particularly among those with moderate to severe illness. Data on the prevalence, spectrum, and risk factors of post-COVID complications from the Indian subcontinent remain limited.

Methods: A prospective study was conducted at the department of pulmonary medicine, Mediciti Institute of Medical Sciences, involving 100 patients who recovered from acute COVID-19. Data collection included assessments at 1, 3, and 6 months post-recovery, using the WHO Global COVID-19 Clinical Platform Case Report Form. HRCT chest scans and relevant investigations were performed, with statistical analysis conducted using SPSS version 26.

Results: 68% of participants developed PCS, with higher incidence among older patients (>60 years, 57.3%) and females (44.1%). Complications observed were pulmonary fibrosis (26.4%), deep vein thrombosis/pulmonary thromboembolism (2.9%), heart failure (2.9%), tuberculosis (1.4%), and pneumothorax (1.4%). Significant associations were found between PCS and factors such as age, sex, smoking, severity of COVID-19, admission status, and vaccination status (p<0.05).

Conclusions: PCS is prevalent among recovered COVID-19 patients, especially older adults, females, smokers, and those with severe illness. Vaccination appears to have a protective role. Long-term follow-up and comprehensive rehabilitation programs are essential for managing PCS, particularly for high-risk groups.

Natural history and outcome of patients with Wilson’s disease from a tertiary care hospital in Odisha

2026-06-30T07:06:35+0530

Background: Wilson’s disease (WD) is a rare autosomal recessive disorder of defected copper metabolism in the liver. Excessive copper deposition causes oxidative stress, impaired mitochondrial function, and eventually leads to hepatic, neurologic, renal, and other organ dysfunction. Diagnosis of WD can be challenging due to its rarity, highly variable clinical manifestations, and non-specific diagnostic tests that are currently available.

Methods: It was a prospective observational study carried out in tertiary care hospital in Odisha during the period of 18 months. All the patients were subjected to a detail general and systemic examination as per the standard protocol. The past history of hepatic or psychiatric illness and family history of similar illness were taken from all patients. An ophthalmological examination for the presence of Kayser-Fleischer ring was carried out by examination with naked eye and by slit lamp evaluation.

Results: Of the 28 patients with Wilson’s disease, 18% patients had history of consanguineous parentage and they had significantly younger age at onset than patients without history of consanguineous parentage. Out of 11 patients who had family history of Wilson’s disease, 2 patients had death of sibling due to the disease.

Conclusions: It has been concluded from the study that features of chronic liver disease were the commonest manifestation of Wilson’s disease. Screening of all asymptomatic siblings for Wilson’s disease is a very important issue and must be carried out in all. Early and correct diagnosis and institution of proper treatment and lifelong continuation can prevent devastating consequences as the disease is treatable.

Effect of stellate ganglion block on graft re-exploration rates in free flap graft placement surgeries in patients with head and neck cancer: a randomized controlled trial

2026-06-30T07:05:18+0530

Background: Free flap reconstruction is frequently used after extensive head and neck cancer surgery. Sympathetic blockade may improve flap perfusion by reducing vasospasm. This study evaluated whether stellate ganglion block (SGB) reduces graft re-exploration in head and neck free flap surgeries.

Methods: In this double-blinded randomized controlled trial, 70 patients undergoing free flap reconstruction were randomized to receive ultrasound-guided SGB with bupivacaine and triamcinolone (test group) or saline (control group). The primary outcome was grafting re-exploration. Secondary outcomes included graft failure and block-related adverse effects.

Results: Baseline demographic and intraoperative characteristics were comparable between groups. Graft failure occurred in 5 patients in the control group and 2 patients in the test group (OR 3.33, 95% CI 0.55–20.22). Re-exploration was required in 1 patient in the control group and none in the test group (OR 3.36, 95% CI 0.13–88.39). No block-related adverse events occurred.

Conclusion: Stellate ganglion block was safe and showed a trend toward reduced graft-related complications, although statistical significance was not achieved. Larger studies are needed to confirm these findings.

Correlation between histopathological variant and anatomical site of meningiomas: a single centre study

2026-06-30T07:05:16+0530

Background: Meningiomas are among the most common primary tumors of the central nervous system, arising from arachnoidal cap cells. They show diverse histopathological variants and occur at various sites within the craniospinal axis. Studying the correlation between histological subtype and tumor location may help in predicting tumor behavior, guiding surgical management and assessing prognosis.

Methods: A retrospective study was conducted over one year for a sample size of 51 histopathologically confirmed cases of meningioma. Clinical details, anatomical location, histopathological subtype and WHO grade were reviewed. Tumors were classified according to WHO 2021 criteria and the association between histological variants and anatomical sites was analysed.

Results: Of all the cases studied, 58.8% were females and 41.2% males, with the highest incidence in the 51–60 years age group (33.3%). The most common site was the parasagittal region (41.1%), followed by free convexity (19.6%) and spinal region (11.7%). Histologically, meningothelial meningioma was the most frequent subtype (60.7%), followed by fibroblastic (13.7%), transitional (5.88%) and psammomatous (5.88%) variants. WHO Grade I tumors accounted for 86.2% of cases, Grade II for 9.88% and Grade III for 3.92%. Higher-grade tumors demonstrated increased mitotic activity, hypercellularity, necrosis and brain infiltration. A significant correlation was observed between certain histological variants and anatomical sites, particularly meningothelial meningioma in the parasagittal region.

Conclusions: Meningiomas commonly occur in middle-aged females and are most frequently located in the parasagittal region. The meningothelial subtype and WHO Grade I tumors predominate. Correlation between histological subtype and tumor location provides useful insights for clinical management and prognosis.

Prevalence of carbapenem-resistant isolates from clinical samples in a tertiary care hospital Vadodara, Gujarat

2026-06-30T07:05:14+0530

Background: Carbapenem resistance in Gram-negative bacilli is a major concern due to the increasing antibiotic resistance, treating infections caused by Enterobacteriaceae has become more challenging. Objective was to investigate the prevalence of blaNDM, blaOXA, blaKPC, blaIMP, blaVIM producing carbapenem-resistant Enterobacteriaceae and non lactose fermenter.

Methods: The prospective observational study was conducted from September 2025 to October 2025 at department of microbiology, Parul Institute of Medical Sciences and Research. Total 100 samples were identified by VITEK 2. A modified carbapenem inactivation method was performed to detect presence of carbapenemase. O.K.N.V.I resist-5 is a rapid in vitro multiplex immunoassay kit used for the phenotypic detection of blaKPC, blaOXA, blaVIM, blaIMP, blaNDM directly from bacterial colonies.

Results: A total 100 clinical samples were taken from that 60 (60%) Enterobacteriaceae and non lactose fermenter analysed by VITEK 2. Out of them 25 (41%) isolates were multidrug resistant carbapenem Enterobacteriaceae. From 25 (41%) samples 10 (40%) were urine samples, followed by 5 (20%) blood culture, 5 (20%) pus discharge, 2 (8%) drain fluid, 2 (8%) were ET, 1 (4%) CSF. Out of 25 MDR Enterobacteriaceae and non lactose fermenter 10 (40%) were Klebsiella pneumoniae isolated 4 blaNDM, 1 OXA, 5 blaNDM and blaOXA, followed by 6 (24%) E. coli isolated 1 blaNDM, 1 blaOXA, 4 blaNDM and blaOXA, 3 (12%) Pseudomonas aeruginosa isolated 1 blaVIM and 2 blaNDM, 4 (16%) Acinetobacter baumannii isolates 4 blaNDM, 1 (4%) Acinetobacter lwoffii blaVIM gene was detected.

Conclusions: Knowledge of the prevalence of genes responsible for carbapenemase in a particular region will help in antibiotic stewardship for the selection of empiric antibiotics.

Haemoglobin variants seen in a secondary care hospital of Nagaland, India

2026-06-30T07:05:13+0530

Background: Haemoglobinopathies is one of the commonest Globin gene disorders in the world, especially in South east Asia and in India the Northeastern regions in particular. These conditions represent a major health burden with significant morbidity and mortality and cause considerable social and financial burdens. However, there is a scarcity of data on haemoglobinopathies or haemoglobin (Hb)variants among the population of Nagaland a Northeastern states of India. This retrospective study was conducted with an aim to fill the data gap on various Hb Variants in the region.

Methods: The present study is a retrospective study, conducted in secondary hospital in Nagaland. A total of 646 Hb high-performance liquid chromatography (HPLC) and complete blood count (CBC) data were collected from patients whose sample were sent to laboratory for Hb variants screening.

Results: In a total of 646 patient data analysed, 44.27% had a normal Hb HPLC pattern, while 55.73% shows abnormal Hb variants. HbE homozygous was observed in 23.84%, heterozygous HbE 16.56%, heterozygous β-thalassemia 9.44%, heterozygous sickle cell 2.17%, homozygous sickle cell/sickle cell β-thalassemia1.86%, Compound form of HbE homozygous with β-thalassemia 0.93%. Among the Hb variants detected, HbE variants is the commonest variants.

Conclusions: The study analysed 646 samples using HPLC, finding over half 55.73% with abnormal haemoglobin patterns, mainly HbE variants. As Scarcity of data is seen in the region, this study provides an important baseline for future research highlighting the need for screening, genetic counselling, and molecular studies.

Association of serum uric acid in type II diabetes mellitus patients with and without diabetic retinopathy: a case control study

2026-06-30T07:05:12+0530

Background: The objective of the study was to assess the association between serum uric acid levels and diabetic retinopathy.

Methods: An analytical case-control study was planned in which a total of 200 diabetic patients aged 40 to 65 years were enrolled divided into 2 groups, 100 diabetic patients with retinopathy and 100 diabetic patients without retinopathy. Both the groups of patients underwent complete ocular examination including assessment of best visual acuity, intraocular pressure, diabetic profile and uric acid assessment.

Results: Prevalence of hyperuricemia was 41% in cases as compared to 19% in controls, thus depicting a significant difference between two groups. Uric acid levels of mild and moderate NPDR cases were significantly lower than that of cases with severe/very severe non-proliferative diabetic retinopathy (NPDR) while proliferative diabetic retinopathy (PDR) cases had higher mean value as compared to all the NPDR types.

Conclusions: The findings of the study suggest that diabetic retinopathy is marked by an increase in uric acid levels and hyperuricemia.

A study of equity in availing free adult cataract surgery in northeastern Indian states of Mizoram and Meghalaya

2026-06-30T07:05:08+0530

Background: Equitable access to free cataract surgery is essential for eliminating preventable blindness. This study evaluates equity in the uptake and follow-up of free adult cataract surgery in the Northeastern Indian states of Mizoram and Meghalaya.

Methods: A cross-sectional study was conducted over a period of nine months, enrolling adults with operable cataracts. Participants were categorised based on the timing of diagnosis and surgery. Structured interviews were administered to 238 patients (Mizoram: n=100; Meghalaya: n=138) to collect data on demographics, economic status, surgery attendance, and post-operative follow-up. Data were analysed using SPSS to identify determinants of service utilisation and assess disparities.

Results: Significant inter-state disparities were observed. Mizoram demonstrated higher surgery uptake (58% vs. 36%) and post-operative follow-up (95% vs. 45%) compared to Meghalaya. The Meghalaya cohort had a higher proportion of female participants (72% vs. 53%), illiteracy (52% vs. 8%), and low-income individuals (44% vs. 21%). While attendance did not differ significantly by gender or marital status, socioeconomic factors were critical. Higher post-operative attendance was associated with adequate income (77.5% vs. 61.1%, p=0.07) and lower indirect costs. Patients who did not attend follow-up incurred higher mean travel expenses (INR 1119 vs. INR 683, p=0.008). Living with adult children significantly increased attendance for both surgery and follow-up.

Conclusions: Despite the provision of free surgery, uptake and follow-up are inequitable, heavily influenced by socioeconomic status, indirect costs, and household support structures. Targeted interventions to reduce indirect expenses and mobilize family support are necessary to achieve equitable access to cataract care in these regions.

A comparative study between peripheral blood smears, RBC indices and histograms in anemia in the geriatric age group

2026-06-30T07:05:07+0530

Background: Hematological evaluation in geriatric age group is essential, as anemia and red cell disorders contribute significantly to morbidity and mortality. Overlap between symptoms of anemia and features of natural aging make its diagnosis in the elderly difficult. This study was done to compare the diagnostic utility of peripheral blood smears, RBC indices, and histograms in evaluating anemia in the geriatric age group.

Methods: This was a comparative study done on 298 cases of anemia for a period of 1 year from February 2024 to January 2025 in a tertiary care teaching hospital. Blood samples were examined using microscopy for peripheral blood smears, automated hematology analyzers for RBC indices and histogram interpretation. Findings were noted and analyzed.

Results: Out of 298 cases, across the different diagnostic methods (peripheral blood smear, RBC indices and RBC histograms), normocytic normochromic anemia was the most common type (62.4-67.40%), followed by microcytic hypochromic anemia (27.20-29.50%), macrocytic anemia (4.70-5.40%), hemolytic anemia (2%) and dimorphic anemia (1.30%).

Conclusions: The many forms of anemia can only be diagnosed using peripheral smear, RBC indices and histogram. A combined approach using PBS, RBC indices, and histograms ensures greater diagnostic accuracy in geriatric patients, where anemia is often multi-factorial and can mimic natural aging.

Bivariate and multivariate regression analysis of pesticide exposure duration, protective practices and PON1 (192Q/R) polymorphism among agricultural workers in Malerkotla and Rupnagar Districts of Punjab, India

2026-06-30T07:05:05+0530

Background: Occupational pesticide exposure poses a significant public health risk among agricultural workers, particularly in developing regions with limited safety practices. Genetic variability, especially in the paraoxonase 1 (PON1) gene, influences individual susceptibility to organophosphate toxicity. The PON1 (192Q/R) polymorphism affects enzyme activity involved in pesticide detoxification.

Methods: A cross-sectional study was conducted at RIMT university hospital among 200 pesticide-exposed agricultural workers from the Malerkotla and Rupnagar districts of Punjab, India. Participants (184 males, 16 females) were selected based on occupational exposure. Exposure characteristics and safety practices were assessed using structured questionnaires. Genotyping of the PON1 (192Q/R) polymorphism was performed using PCR-RFLP. Bivariate logistic regression was used to examine associations between genotype and gender, while multivariate logistic regression evaluated relationships between exposure variables using combined genotype (QR+RR vs QQ) and allele (R vs Q) models. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: No significant association was observed between PON1 polymorphism and gender. The QR genotype showed higher odds of occurrence in females (OR=3.61; p=0.28), whereas the RR genotype showed reduced odds (OR=0.70; p=0.52). The R allele was not significantly associated with gender (OR=0.75; p=0.59). Multivariate analysis indicated a gradual increase in the odds of R allele-containing genotypes with longer pesticide exposure, with workers exposed for >40 years showing higher odds (adjusted OR≈2.08), though not statistically significant (p=0.08). Protective measures were associated with reduced odds but lacked significance.

Conclusions: PON1 (192Q/R) polymorphism was not associated with gender; however, prolonged pesticide exposure showed a non-significant trend toward increased R allele prevalence, highlighting the need for improved occupational safety practices.

Clinical and angiographic outcomes of very long drug eluting stents in patients with coronary artery disease undergoing percutaneous coronary intervention: a prospective observational study

2026-06-30T07:05:04+0530

Background: To evaluate the procedural feasibility and clinical and angiographic outcomes of very long drug-eluting stents (DES) in patients with diffuse coronary artery disease undergoing percutaneous coronary intervention (PCI).

Methods: This observational study included 111 consecutive adult patients with de novo long coronary lesions treated with DES ≥48 mm between March 2018 and September 2019 at the Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow. Clinical outcomes at 1 and 6 months included major adverse cardiac events (MACE) such as myocardial infarction, angina and congestive heart failure. Angiographic outcomes at 6 months included in-stent restenosis, target lesion revascularization, target vessel revascularization and stent thrombosis.

Results: No significant correlation was observed between clinico-angiographic outcomes and stent length, stent diameter, stent polymer, multi-vessel PCI or diabetic status (p>0.05). However, diabetic status significantly affected clinical outcomes at 6 months (p=0.020). The incidence of angina was significantly higher at 6 months compared with 1 month. Survival analysis at 1 and 6 months showed no significant difference in patient survival (p=0.778).

Conclusions: Very long DES implantation for diffuse coronary lesions appears safe and effective, with low rates of adverse clinical and angiographic events. Stent length, diameter and polymer type did not significantly influence outcomes.

Role of thymosin alpha-1 in improving pregnancy outcomes in patients with implantation failure

2026-06-30T07:05:00+0530

Background: Implantation failure remains a significant challenge in assisted reproductive technology, with nearly 10–15% of couples experiencing recurrent issues despite multiple treatment attempts. Immune dysregulation is believed to contribute substantially to this condition. Thymosin Alpha-1, an immunomodulatory agent, may improve reproductive outcomes. This study evaluated its effectiveness as an adjunct therapy in patients with implantation failure in an Indian clinical setting.

Methods: This retrospective study analyzed a prospectively maintained database of patients diagnosed with recurrent implantation failure (RIF) who received thymosin alpha-1 therapy. Demographic details, clinical characteristics, infertility profile, prior treatment history, dosing regimen and pregnancy outcomes were evaluated

Results: A total of 102 participants were included. The mean age was 34.62±5.80 years and the mean BMI was 30.59±1.80 kg/m². The mean duration of infertility was 9.06±5.73 years. Pregnancy was achieved in 62 (60.8%) women following thymosin alpha-1 therapy, while 40 (39.2%) did not conceive. Most participants received 12 doses (58.8%), with a mean dose of 11.18 and median of 12 doses. The most common infertility etiology was diminished ovarian reserve (58.0%), followed by male factor (40.0%).

Conclusions: Thymosin alpha-1 was associated with encouraging pregnancy outcomes, with 60.8% achieving conception. These findings suggest a potential benefit of immunomodulatory therapy in implantation failure; however, larger controlled studies are needed to confirm its efficacy.

Correlation of tumor infiltrating lymphocytes in invasive breast carcinomas: a morphological study

2026-06-30T07:04:59+0530

Background: The aim of the study is to analyse the stromal tumor-infiltrating lymphocytes (sTILs) in invasive breast carcinomas and assess the percentage of sTILs in invasive breast carcinomas using a single H and E slide following a standardized protocol. Also, to study the correlation between sTILs and known prognostic factors.

Methods: Two year retrospective study of 190 cases using a single representative H and E slide examined by 2 observers. TILs assessed based on current recommendations from the 2014 International TILs Working Group (ITWG) for the evaluation of TILs. Histological type, histological grade, molecular subtypes using relevant IHC markers, number of lymph nodes isolated, number of lymph nodes positive with extracapsular invasion, lymphovascular invasion, perineural invasion, TNM stage and tils in percentage were documented.

Results: The collected data was analysed with IBM SPSS statistics for Windows, version 23.0. Correlation of TILS with age, SBR grade, ER, PR, Ki67, molecular subtype-showed statistical significance with an acceptable p value.

Conclusions: Many studies have supported the evidence of TILS, in different levels and density which is predictive of response to neoadjuvant chemotherapy. In certain breast carcinoma subtypes, it has a prognostic value in patients treated with adjuvant chemotherapy. From our study TILs show a correlation with few of the known prognostic factors. There is a paucity of data in Indian literature on TILs and its implications. Understanding of the role of TILs regarding could be of importance in devising novel immunotherapeutic strategies in breast cancer treatment.

Association of vaso-occlusive crisis frequency with hepatic fibrosis in patients with sickle cell disease: a hospital-based observational study

2026-06-30T06:58:54+0530

Background: Sickle cell disease (SCD) is characterized by recurrent vaso-occlusive crises (VOC) and progressive multi-organ damage, including hepatic fibrosis. While iron overload is a known contributor to liver injury, the role of crisis frequency in hepatic fibrosis remains underexplored. This study aimed to evaluate the association between vaso-occlusive crisis frequency and hepatic fibrosis in patients with sickle cell disease.

Methods: This hospital-based cross-sectional observational study included 50 patients with confirmed sickle cell disease attending a tertiary care hospital in Dibrugarh, Assam. Liver stiffness measurement (LSM) was assessed using shear wave elastography as a surrogate marker of hepatic fibrosis. Crisis frequency, transfusion history, and iron profile parameters were recorded. The association between crisis frequency and liver stiffness was analysed using one-way analysis of variance (ANOVA).

Results: The mean LSM was 6.62±1.35 kPa. Fibrosis staging revealed 22% of patients in F0-F1, 62% in F2, and 16% in F3. Patients with higher crisis frequency had significantly increased liver stiffness compared to those with fewer crises (p=0.004). A statistically significant positive association was observed between crisis frequency and hepatic fibrosis.

Conclusions: Increased vaso-occlusive crisis frequency is associated with higher liver stiffness and may serve as a clinical predictor of hepatic fibrosis in SCD. Early identification of high-risk patients may facilitate timely monitoring and intervention.

A prospective identification and mechanistic evaluation of clinically significant drug–drug interactions in chronic kidney disease patients using the Micromedex® database

2026-06-30T06:58:52+0530

Background: Chronic kidney disease (CKD) patients are highly susceptible to drug–drug interactions (DDIs) due to polypharmacy and altered pharmacokinetics. To prospectively identify and characterize clinically significant DDIs in CKD patients using a standardized database approach.

Methods: A prospective observational study was conducted in 380 CKD patients (stages 1–5). Drug–drug interactions were identified using the Micromedex® database. Clinically significant DDIs were predefined as interactions classified as major or moderate severity or those requiring clinical intervention such as dose adjustment, monitoring, or drug avoidance. Interactions were categorized by severity and mechanism (pharmacokinetic/pharmacodynamic), including cytochrome P450 (CYP) involvement.

Results: A total of 61 clinically significant DDIs were identified, including 21 major, 28 moderate, and 12 minor interactions. Major DDIs were predominantly pharmacodynamic and associated with bleeding, nephrotoxicity, electrolyte imbalance, and cardiac conduction abnormalities. Pharmacokinetic interactions commonly involved CYP3A4, followed by CYP2D6, CYP2C9, and CYP2C19 enzymes.

Conclusion: Clinically significant DDIs are common in CKD patients and can be systematically identified using standardized tools such as Micromedex®. Most interactions are predictable and manageable through monitoring, dose adjustment, or avoidance strategies.

Assessing the prevalence, sociodemographic factors and psychosocial determinants associated with postpartum depression: a cross-sectional study in the urban field practice area of Bidar

2026-06-30T06:58:37+0530

Background: Postpartum depression (PPD) is a serious health issue that affects many women after childbirth. It includes a range of mood problems from mild sadness to severe depression, usually starting within four weeks after delivery and may last up to one year. To estimate the prevalence of postpartum depression among women within six months of delivery and to identify the socio-demographic, obstetric and psychosocial determinants associated with it.

Methods: An observational cross- sectional study was conducted among 150 Postpartum women (within 6 months of delivery) residing in the urban field practice area from 01 February 2026 to April 2026.Universal sampling method was used to collect the information from eligible postpartum women. A pretested questionnaire including socio-demographic, obstetric and psychosocial determinants and Edinburgh Postnatal Depression Scale (EPDS) – validated Hindi version were used to assess postpartum depression among the participants. Data was analysed using Microsoft excel and SPSS software.

Results: The prevalence of postpartum depression was 15 (10%) among study participants. Significant associations of postpartum depression among study participants were observed with age <25 years, uneducated, belonging to lower socioeconomic class, primiparous, caesarean section delivery, having female child, substance use by husband, having poor social support from husband and in-laws and domestic violence (p<0.05).

Conclusions: Poverty, caesarean section, female child, primiparous, domestic violence, substance use by husband and poor support from husband & in-laws have been identified as major contributors towards postpartum depression. This cross-sectional study highlights the need for early screening, counselling and strengthening of social support systems for mothers during the postpartum period to promote maternal mental health and overall family well-being.

Infection control awareness and compliance among dental students and dentists in India: a cross-sectional study

2026-06-30T06:58:26+0530

Background: A major cause of death and morbidity linked with clinical, diagnostic, and therapeutic procedures, healthcare associated infections (HAI) are a global health problem. In the context of patient safety, HAI is a crucial component of iatrogenic hazards. Dental professionals around the world are especially concerned about the spread of infection between patients and healthcare personnel in healthcare settings. Exposure to blood borne, aerogenic, and droplet associated microorganisms produced during clinical procedures can result in infections in dental practice. Direct contact with blood or fluids can result in transmission. Additionally, the possible transmission may be caused by inhaling aerosols containing oral fluids, droplet spatter, or indirect contact with infected equipment.

Methods: A cross-sectional study was done among dental students and dentists across Karnataka state in India. Convenience sampling technique was used and a minimum of 100 participants were required for this study. Totally 113 participants were enrolled in this study.

Results: Majority of the participants 62 (54.9%) were in the age group between 25 and 30 years. Based on gender the majority 71 (62.8%) were males and 42 (37.2%) were females. The majority of dentists, 112 (99.1%) believed that ineffective sterilization during clinical practice can transmit infection from one patient to another.112 (99.1%) dentists believed that apart from instrument sterilization, disinfection of dental chair, clinic, dental office is required.

Conclusions: Dentists have to be regularly updated regarding latest measures for infection control and adoption of latest technologies and techniques.

Hepatorenal complications in bleomycin-induced pulmonary fibrosis: a comprehensive review on its biochemical mechanisms and prophylactic considerations

2026-06-30T06:58:46+0530

Bleomycin induced pulmonary fibrosis (PF) has been one of the most habituated experimental models in idiopathic PF (IPF) exploration since the 1970s. The bleomycin model is a classic model of lung toxin. Though utmost of the studies established lung part, its dangerous goods on the liver and kidneys are still under explored. The applicable studies were searched on PubMed, Web of Science, and Google Scholar using the keywords “bleomycin”, “pulmonary fibrosis”, “hepatorenal toxin”, “oxidative stress”, “nephroprotection”, “liver injury”, “order injury”, “Nrf2 activators”, and “factory-deduced antioxidants” published in 2017-2024." Substantiation from these studies showed that bleomycin treatment significantly raises the situations of serum biochemical labels, like alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (peak), creatinine, and blood urea nitrogen (BUN). Increase in all biochemical labels suggest serious damage to the liver and kidneys. Studies have shown that the main mechanisms involved in this toxin are oxidative stress (ROS), mitochondrial dysfunction, activation of seditious cytokines and TGF-β1/Smad signalling. Curcumin, quercetin, silymarin and resveratrol are among factory- deduced bioactive composites which displayed promising defensive parcels These effects are suggestively through their antioxidant, anti-inflammatory, and antifibrotic conduct. These findings punctuate the need to consider and pierce multiple organs in bleomycin studies to make experimental fibrosis exploration more applicable systemically. Herbal antioxidants and Nrf2 activators can offer effective forestalment against liver and renal damage caused by bleomycin.

Comparison of oral and intravenous iron for the prevention and management of iron deficiency anaemia in pregnancy: a systematic review and meta-analysis

2026-06-30T06:58:55+0530

Iron-deficiency anaemia (IDA) affects nearly 38% of pregnant women worldwide and is linked to maternal complications and poor birth outcomes. Although oral iron is the standard treatment, its use is often limited by gastrointestinal side effects and poor adherence. Intravenous (IV) iron may offer faster and better-tolerated correction of anaemia. This systematic review and meta-analysis compared IV and oral iron for the prevention and management of IDA in pregnancy. This review was registered with PROSPERO and conducted according to PRISMA guidelines. A total of 4,216 articles were screened, and 17 eligible studies, including 16 randomized controlled trials, were included. Two reviewers independently performed data extraction and quality assessment. Random-effects meta-analysis using the DerSimonian and Laird method was conducted. Primary outcomes were haemoglobin and serum ferritin; secondary outcomes included maternal and neonatal outcomes and treatment-related adverse events. IV iron produced significantly greater improvements in haemoglobin (mean difference 0.7 g/dl; 95% CI: 0.4-1.0) and serum ferritin (mean difference 79.4 ng/ml; 95% CI: 21.8-137) than oral iron. The odds of maternal anemia were reduced by 71% with IV therapy (OR 0.29; 95% CI: 0.08-1.00). No significant differences were observed in cord haemoglobin or cord ferritin, although ferritin showed a favourable non-significant trend. Adverse events were less frequent with IV iron, but the difference was not statistically significant. IV iron was more effective than oral iron in improving haematological outcomes in pregnant women with IDA and may be preferred in moderate-to-severe anemia, oral iron intolerance, or late gestation.

Single-dose versus multiple-dose HPV vaccination for prevention of cervical cancer: a systematic review and meta-analysis

2026-06-30T06:58:54+0530

Cervical cancer remains a major global burden, especially in low- and middle-income countries (LMICs). Although HPV vaccination is a key preventive strategy, multi-dose schedules pose cost and logistical challenges. This review assessed whether single-dose HPV vaccination offers protection comparable to multi-dose regimens. Following PRISMA guidelines, we searched PubMed, Cochrane, Scopus, and Google Scholar (2000-2025) for RCTs, cohort studies, and case-control studies comparing single-dose with two- or three-dose HPV vaccination. Outcomes included persistent HPV infection, high-grade cervical lesions (CIN2/3, HSIL), and immunogenicity. Random-effects models were used to calculate risk ratios (RRs), and heterogeneity was assessed with I². Twenty-six studies were included (10 RCTs, 16 observational), involving females aged 9-26 years from multiple countries. Sample sizes ranged from 200 to 590,083, with follow-up of 1-16 years. Single-dose vaccination showed >90% efficacy against persistent HPV16/18 infection. Compared with unvaccinated controls, the pooled estimate showed no statistically significant difference (RR 1.05, 95% CI 0.73-1.52). Compared with two-dose schedules, no statistically significant difference was observed (RR 0.72, 95% CI 0.40-1.32). Similarly, comparison with multiple-dose schedules showed no statistically significant difference (RR 0.93, 95% CI 0.60-1.44). Seropositivity remained high at 16 years (98.8-99.4%). Heterogeneity was substantial (I² 93.6-96.8%). Single-dose HPV vaccination provides substantial, durable protection comparable to multi-dose regimens in most settings. These findings support WHO’s recommendation and reinforce single-dose vaccination as a practical, cost-effective strategy to expand coverage and accelerate cervical cancer elimination in LMICs.

Effect of motor control retraining exercise along with rotator cuff strengthening exercise on shoulder musculoskeletal pain among female throwball players: a pilot study

2026-06-30T06:58:39+0530

Due to the repetitive strain on the shoulder complex, throwball players are more susceptible to rotator cuff damage, altered scapular mechanics, and shoulder musculoskeletal pain. Overhead athletes can improve shoulder stability and function by combining strengthening exercises with motor control retraining. This study included 20 amateur female throwball players, ages 16 to 25, who had shoulder musculoskeletal pain. For 6 weeks, rotator cuff strengthening exercises and motor control retraining were performed four times a week as part of the intervention program. Global rating of change (GRC), shoulder range of motion (ROM), and the shoulder pain and disability index (SPADI) were some of the outcome indicators that were assessed before and after the intervention. Following the intervention, there were noticeable improvements in every outcome measure. GRC scores improved from -4.00±0.73 to 4.35±0.49, whereas SPADI scores decreased from 50.75±2.84 to 21.80±2.17, Furthermore, ROM increased in flexion (136.45° to 166.40°), extension (31.40° to 45.55°), internal rotation (66.60° to 86.10°), and external rotation (56.60° to 76.15°) (p<0.05). Combining motor control retraining with rotator cuff strengthening exercises reduced shoulder discomfort and improved function and range of motion in female throwball players.