International Journal of Research in Medical Sciences

Patient safety governance in artificial intelligence-enabled healthcare: a systematic review and the artificial intelligence patient safety governance model

2026-09-30T10:10:14+0530

Artificial intelligence (AI) is rapidly becoming part of everyday healthcare practice, helping hospitals and clinics diagnose diseases, recommend treatments, monitor patients and manage medical data. While these technologies offer significant opportunities to improve the quality and efficiency of healthcare, they also introduce new risks that could affect patient safety. This study examines how patient safety can be safeguarded in the era of AI-enabled healthcare. Using a systematic literature review (SLR) guided by the PRISMA (Preferred reporting items for systematic reviews and meta-analyses) approach, the study identifies recurring challenges related to unclear accountability in AI-supported decisions, overreliance on automated recommendations and operational monitoring that may expose patients to potential harm if not properly managed. Building on these insights, the study proposes the AI patient safety governance model (AIPSGM), a structured framework designed to ensure that patient safety is maintained throughout the lifecycle of AI deployment in healthcare institutions. The model highlights five governance pillars: safe AI design and validation, human oversight and clinical accountability, data governance and cybersecurity protection, operational monitoring and risk management and ethical and regulatory governance. In addition, the study introduces the AI Patient safety governance index (AIPSGI) as a practical tool that translates governance principles into measurable indicators that can help healthcare institutions assess their readiness for safe AI adoption. The findings suggest that patient safety in the AI era cannot be achieved through technological accuracy alone but requires continuous governance that integrates technological organizational, ethical and regulatory safeguards. Therefore, this study contributes to the emerging field of responsible AI in healthcare and concludes that patient safety in the AI era depends not only on technological capability but also on the strength of governance structures that guide how these technologies are designed, implemented and monitored.

Comparative efficacy of robotic assisted versus laparoscopic gynecologic surgery in Southeast Asia: a systematic review

2026-09-30T10:10:30+0530

With scientific evolution, the minimally invasive surgical techniques such as laparoscopic surgery (LS) and robotic-assisted surgery (RAS), have completely transformed gynecologic procedures by reducing patient morbidity, hospital stay and post procedure recovery. While there are several global literatures to validate these modalities, a focused analysis in Southeast Asia countries remains limited. To systematically compare published medical literatures on perioperative outcomes of RAS and LS in gynecologic surgeries across Southeast Asian countries. Adhering to PRISMA guidelines, we conducted a comprehensive search across PubMed, Embase, Cochrane Library and regional databases up to May 2025. Inclusion criteria encompassed studies from Southeast Asia comparing RAS and LS in gynecologic procedures, reporting on operative time, blood loss, complication rates, conversion rates and hospital stay. During the review, we identified 1,200 articles, 15 met inclusion criteria, encompassing 4,500 patients (RAS: 2,100; LS: 2,400). It was observed that RAS demonstrated reduced blood loss (mean difference: -50 mL; 95% CI: -70 to -30 mL) and shorter hospital stay (mean difference: -1.2 days; 95% CI: -1.5 to -0.9 days). However, operative times were observed to be longer in RAS (mean difference: +30 minutes; 95% CI: +20 to +40 minutes). However, no significant differences were observed in overall complication or conversion rates. In Southeast Asia, RAS offers advantages in blood loss and hospitalization duration over LS in gynecologic surgeries, albeit with increased operative times. These findings can facilitate surgical decision-making process, balancing benefits against resource availability.

Evidence-based nursing care in intensive care units: current practices, challenges and future directions

2026-09-30T09:59:54+0530

Nurses form the clinical backbone of every intensive care unit and the evidence they draw on at the bedside shapes how safely critically ill patients recover. This systematic review set out to bring together what is currently known about evidence-based nursing (EBN) in adult intensive care units (ICUs): the interventions in active use, the obstacles and enablers that decide whether these interventions actually take hold in practice, their measurable effect on patients and organizations and where the field appears to be heading. Seven databases (PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, Cochrane Library and Google Scholar) were searched for studies published between January 2015 and December 2025, following PRISMA 2020 methodology. Quantitative, qualitative and mixed-methods studies conducted in adult ICU settings were appraised using design-appropriate quality tools and synthesized narratively. Seventy-eight studies met the inclusion criteria. Interventions such as infection-prevention bundles, ventilator-care protocols, early mobilization, sedation optimization, delirium prevention, structured assessment and family-centered care were repeatedly linked to fewer healthcare-associated infections, shorter ventilation and ICU stays and stronger interdisciplinary teamwork. Understaffing, heavy workloads, limited research skills and weak organizational backing remained the main obstacles, while leadership, mentorship, standardized protocols and ongoing education helped interventions stick. Artificial intelligence, predictive analytics and tele-ICU services showed real promise but worked best alongside, rather than instead of, nursing judgment. Sustained investment in leadership, professional development and technology integration is needed to move evidence-based nursing further into everyday ICU care.

Meta-analysis of insights into HHEX (rs1111875) and SLC30A8 (rs13266634) gene variants and type 2 diabetes mellitus

2026-09-30T10:09:39+0530

Type 2 diabetes mellitus (T2DM) is aggravated by inherited factors, peripheral insulin resistance and environmental factors. Genome wide association studies (GWAS) revealed more than 400 genetic loci to be associated with T2DM. The function of HHEX gene rs1111875 variant and the insulin secretion response after a glucose load might impact the risk of T2DM mainly via altering pancreatic β-cell activity. The solute carrier family 30, member 8 (SLC30A8) is primarily expressed in pancreatic β-cells and may play a key role in insulin secretory pathway. This current study revealed a significant association between HHEX A>G variant and T2DM in allele (A versus G: p=0.004), Codominant (AA versus GG: p=0.001), Dominant (AA versus AG + GG: p=0.02) and recessive (AA+AG versus GG: p=0.002) inheritance models and for HHEX C>T variant under recessive inheritance model (CC+CT versus TT: p=0.035). In addition, for SLC30A8 C>T variant also associated with T2DM under allele (C versus T: p=0.001), dominant (CC versus CT+TT: p=0.001), recessive (CC+CT versus TT: p=0.001), codominant [(CC versus CT: p=0.007) and (CC versus TT: p≤0.001)] inheritance models. HHEX (rs1111875) and SLC30A8 (rs13266634) gene variants revealed that these gene variants can be a potential factor for etiopathogenesis of T2DM.

CytoSorb hemoadsorption in diverse hyperinflammatory states with multi-organ dysfunction: a clinical case series

2026-09-30T10:03:45+0530

Hyperinflammatory syndromes resulting in cytokine storm are a major contributor to morbidity and mortality in critically ill patients with infections and systemic inflammatory conditions. CytoSorb hemoadsorption therapy has been increasingly utilized as an adjunctive modality to mitigate excessive cytokine burden. This study aimed to evaluate the clinical utility of CytoSorb therapy across diverse hyperinflammatory conditions presenting with multi-organ dysfunction. This case series describes three patients with distinct etiologies-severe malaria with acute liver failure, dengue-associated hemophagocytic lymphohistiocytosis (HLH), and septic shock with cardiomyopathy-who developed multi-organ dysfunction and were treated with CytoSorb therapy alongside standard care. Clinical, biochemical, and hemodynamic parameters were monitored before, during, and after CytoSorb intervention. Inflammatory markers including C-reactive protein (CRP), procalcitonin, interleukin-6 (IL-6), and ferritin were evaluated. Across all cases, CytoSorb therapy was associated with marked clinical improvement, including stabilization of hemodynamics, reduction in inflammatory markers (e.g., CRP decreased from 245.4 to 5.8 mg/l), and recovery of organ function. Patient A required three CytoSorb sessions integrated with sustained low-efficiency dialysis (SLED) for severe malaria-associated multi-organ dysfunction. Patient B received two sessions during HLH-associated hyperinflammation. Patient C underwent one session during peak cytokine surge in septic shock with cardiomyopathy. All patients achieved 100% survival with de-escalation to ward care. CytoSorb hemoadsorption demonstrates potential therapeutic utility across heterogeneous cytokine-driven conditions when initiated early and combined with standard care. These findings support the integration of extracorporeal cytokine removal as an adjunctive strategy in critically ill patients with hyperinflammatory states.

Labial adhesions due to vulvar lichen sclerosus in young females: a rare case series

2026-09-09T06:55:58+0530

Lichen sclerosis (LS) is a chronic inflammatory dermatosis primarily affecting the anogenital area. It commonly presents in postmenopausal women but may occur at any age. LS can cause extreme pruritic, pain and loss of vulvar architecture with resorption of the labia majora, minora and stenosis of the vaginal introitus and urethral meatus. In rare cases, it can lead to vulvar leukoplakia, labial adhesions, and urinary outflow obstruction. Here, we report 3 cases of young females presenting with urinary symptoms, labial fusion, and leukoplakia. Examination revealed labial fusion, and a white lesions involving labia majora. They underwent reconstruction. Biopsy confirmed LS with features of squamous leukoplakia and mild dysplasia. Early recognition and intervention in lichen sclerosus is crucial to prevent anatomical and functional complications. Multidisciplinary management is key for optimal outcomes in young patients.

Clinical phenotyping aids genotype prediction in hereditary ataxia: a case series

2026-09-30T10:03:48+0530

Hereditary cerebellar ataxias comprise a heterogeneous group of neurodegenerative disorders with overlapping clinical manifestations, often making accurate bedside diagnosis challenging. Careful clinical phenotyping remains essential to guide targeted genetic testing, particularly in resource limited settings. We retrospectively reviewed five patients with progressive hereditary ataxia at a tertiary care neurology centre. Detailed clinical evaluation, pedigree analysis, and comprehensive neurological examination were performed, followed by molecular genetic confirmation. The cohort included two patients with Spinocerebellar Ataxia Type 2 (SCA2), one with Spinocerebellar Ataxia Type 3 (SCA3/Machado–Joseph disease), and two with Friedreich's ataxia (FRDA). Distinctive clinical features were highly suggestive of the underlying genotype prior to molecular confirmation. Markedly slowed saccades and hyporeflexia characterized SCA2, whereas SCA3 demonstrated external ophthalmoparesis, pyramidal signs, and lower motor neuron involvement with preserved saccadic velocity. Both FRDA patients exhibited posterior column sensory loss with generalized areflexia and extensor plantar responses, consistent with corticospinal tract involvement. Pedigree analysis differentiated autosomal dominant from autosomal recessive inheritance, and repeat expansion size correlated with earlier disease onset and greater clinical severity. A systematic bedside assessment incorporating oculomotor findings, reflex pattern, sensory examination, pyramidal and lower motor neuron signs, and pedigree analysis enables reliable phenotypic differentiation among hereditary ataxias before genetic confirmation. Such an approach facilitates targeted molecular testing and optimizes diagnostic evaluation, particularly in resource-constrained settings.

Clinical heterogeneity in biopsy-proven adult focal segmental glomerulosclerosis

2026-09-30T09:59:49+0530

Focal segmental glomerulosclerosis (FSGS) is a histopathological pattern of podocyte injury and a major cause of nephrotic syndrome in adults. Despite a common histopathological diagnosis, patients may exhibit considerable variability in clinical presentation, disease severity, therapeutic response, and renal outcomes. This case series highlights the diverse clinical spectrum of biopsy-proven adult FSGS encountered in routine clinical practice.We report three adult female patients with biopsy-proven focal segmental glomerulosclerosis managed at a rural tertiary care teaching hospital. The first patient presented with long-standing nephrotic syndrome complicated by severe hypoalbuminemia, generalized edema, gross ascites, liver cirrhosis, and poor treatment adherence. The second patient developed relapsing nephrotic syndrome with persistent nephrotic-range proteinuria despite corticosteroid therapy, requiring treatment escalation and emergency hospitalization. The third patient presented predominantly with progressive acute kidney injury and deteriorating renal function in the presence of multiple comorbidities, representing an atypical clinical presentation of FSGS. Renal biopsy established the diagnosis in all three patients and guided individualized management.This case series demonstrates the marked clinical heterogeneity of biopsy-proven adult FSGS despite a common histopathological diagnosis. The findings emphasize the importance of timely renal biopsy, comprehensive clinicopathological correlation, and individualized therapeutic strategies for accurate diagnosis and optimal management.

Comprehensive emergency obstetric and newborn care at a rural community health centre in Northern India: a case series and quality improvement experience

2026-09-30T09:57:18+0530

Maternal mortality remains a significant public health challenge in low- and middle-income countries. Maternal sepsis, severe anaemia, delayed referral, and inadequate access to emergency obstetric care continue to contribute to maternal and neonatal morbidity, particularly in rural India. Strengthening Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services at Community Health Centres (CHCs) is essential for improving pregnancy outcomes and reducing preventable maternal deaths. This case series describes five representative maternal health interventions undertaken at Community Health Centre (CHC) Faridpur, Bareilly, Uttar Pradesh. The series includes emergency management of maternal sepsis with severe anaemia, life-saving emergency caesarean section in a critically ill pregnant woman following unsuccessful referral, implementation of a telephonic follow-up system for high-risk pregnancies, promotion of respectful maternity care through innovative discharge practices, and strengthening of institutional delivery services. Timely clinical assessment, multidisciplinary teamwork, adherence to evidence-based obstetric protocols, and patient-centred care resulted in favourable maternal and neonatal outcomes while improving continuity of antenatal care and community confidence in public health services. This case series demonstrates that strengthened emergency obstetric services, early recognition of high-risk conditions, coordinated multidisciplinary management, and innovative maternal health interventions can substantially improve maternal and neonatal outcomes in rural secondary healthcare settings. The experiences from CHC Faridpur provide a practical model for enhancing quality maternity care in resource-constrained environments.

Secondary open-angle glaucoma and systemic manifestations in a patient with unrepaired tetralogy of Fallot

2026-09-30T09:57:27+0530

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. We report a rare case of secondary open-angle glaucoma in a 20-year-old male with longstanding, uncorrected TOF. The patient presented with 6 months of progressive bilateral vision loss. Ocular examination revealed prominent conjunctival vessel engorgement, elevated intraocular pressure, advanced glaucomatous optic neuropathy with increased cup-to-disc ratios, and significant retinal nerve fiber layer thinning. Notable systemic features included severe digital clubbing, skeletal deformities, congenital ear anomalies with hearing loss, short stature and hypogonadism. Prompt initiation of anti-glaucoma therapy successfully normalized intraocular pressure. This case underscores the importance of routine ophthalmic screening in patients with cyanotic congenital heart disease to detect and manage vision-threatening complications early.

Lithium toxicity following initiation of tirzepatide in a patient with bipolar I disorder

2026-09-30T09:57:12+0530

Lithium has a narrow therapeutic window, with a therapeutic range for maintenance of 0.6 to 1.2 mmol/l, and toxicity usually occurs at concentrations of 1.3 mmol/l or greater. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have seen a marked rise in use for both diabetes and weight management, and an emerging body of case reports has described lithium toxicity associated with their use, predominantly with semaglutide. A 31-year-old man with a ten-year history of bipolar I disorder. His maintenance psychiatric medications included lithium carbonate ER 900 mg by mouth at bedtime daily. Approximately three months prior to presentation, tirzepatide 10 mg/0.5 ml was initiated subcutaneously once weekly for weight management. His lithium level at the time of initiation was 0.9 mmol/l. Three months after initiation, he began reporting a general sense of not feeling well, along with brain fog, dizziness, and gait disturbance, with good oral fluid and food intake throughout this period and no recent dietary or fluid intake pattern changes. A lithium level obtained at that time was found to be elevated at 1.7 mmol/l. Lithium was reduced to 300 mg daily for two weeks, and tirzepatide was held. A repeat lithium level two weeks later was 0.8 mmol/l. Lithium was then restarted at the original dose of 900 mg daily, and tirzepatide was subsequently discontinued. This case adds to a growing body of literature describing lithium toxicity with GLP-1 RA use, and for occurring in the absence of the gastrointestinal symptoms typically implicated in this interaction. Clinicians should maintain a high index of suspicion for increased lithium levels in patients with GLP-1 RA, with proactive rather than symptom-triggered lithium monitoring.

Bedside intubation with AMBU bag ventilation improves outcome for respiratory muscle paralysis in neurotoxic snake bite: a case report

2026-09-30T09:55:04+0530

Neurotoxic snake envenomation can rapidly produce neuromuscular paralysis, bulbar dysfunction and life-threatening respiratory failure. Prompt airway protection, antivenom administration and ventilatory support are essential; however, mechanical ventilators are frequently unavailable in rural and resource-limited healthcare facilities. A 20-year-old man from rural Bangladesh presented approximately four and a half hours after a suspected Wall's krait bite to his right foot. His arrival was delayed by initial treatment from a traditional healer. On admission, he had altered consciousness, bilateral partial ptosis, excessive salivation and a positive broken-neck sign, indicating severe neurotoxicity. Although his initial oxygen saturation was 98% on room air, he rapidly developed worsening breathlessness, reduced consciousness, severe bradycardia and oxygen desaturation to 80%. Emergency bedside endotracheal intubation was performed, and ventilation was maintained manually using an AMBU bag. Neostigmine with atropine was administered, followed by three doses of polyvalent antivenom comprising a total of 30 vials. The patient was transferred approximately 55 km to a tertiary-care intensive care unit while continuous AMBU-bag ventilation was maintained. He subsequently received mechanical ventilation for approximately 72 hours. His neurological and respiratory functions gradually recovered, and he was successfully extubated on the fourth day. He remained clinically stable and was discharged without apparent neurological or respiratory complications. Immediate bedside intubation and continuous AMBU-bag ventilation can provide a lifesaving bridge to definitive mechanical ventilation in patients with neurotoxic snakebite-induced respiratory paralysis. Training healthcare professionals in manual ventilation and ensuring the availability of basic airway equipment may substantially reduce preventable snakebite mortality in resource-limited settings.

A tale of two entities: a rare presentation of hepatopulmonary syndrome associated with non-cirrhotic portal fibrosis

2026-09-17T07:04:39+0530

Hepatopulmonary syndrome (HPS) is traditionally associated with cirrhosis and advanced chronic liver disease, whereas its occurrence in non-cirrhotic portal fibrosis (NCPF) is distinctly uncommon. We report a 21-year-old woman with NCPF, portal hypertension, and autoimmune hemolytic anemia who presented with progressive dyspnea, fatigue, and dry cough. Examination revealed clubbing and marked orthodeoxia, with oxygen saturation decreasing from 89% supine to 81% upright. Room-air arterial blood gas analysis showed a PaO₂ of 71.9 mmHg with hypocapnia. Contrast-enhanced echocardiography demonstrated delayed microbubble transit into the left atrium via the pulmonary veins, confirming an intrapulmonary right-to-left shunt consistent with HPS. Abdominal imaging demonstrated non-cirrhotic portal hypertension (NCPH) with periportal fibrosis, splenomegaly, and extensive portosystemic collaterals, with preserved hepatic function. The patient underwent right-lobe living-donor liver transplantation and subsequently showed marked clinical and respiratory improvement. This case highlights that HPS may develop in NCPF despite preserved hepatic function and underscores the diagnostic importance of orthodeoxia and intrapulmonary shunting in unexplained hypoxemia.

Anesthetic management in a patient with Guillain-Barré syndrome undergoing open reduction and internal fixation for subtrochanteric femur fracture: a case report

2026-09-30T09:53:45+0530

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy associated with peripheral nerve involvement, autonomic dysfunction, and heightened sensitivity to anesthetic agents, making anesthetic technique selection challenging. We report a patient with a prior diagnosis of GBS (axonal variant, acute motor-sensory axonal neuropathy) confirmed on nerve conduction velocity studies, who presented with a subtrochanteric femur fracture requiring open reduction and internal fixation. Pre-operatively the patient had recovered neurologically with no residual paralysis but showed sinus tachycardia, mild anemia, low-grade fever treated with antipyretics, a Mallampati grade III airway, and grade 2 left ventricular diastolic dysfunction. Focused autonomic assessment revealed no active autonomic dysfunction. General anesthesia was precluded by the predicted difficult airway and the risk of succinylcholine-induced hyperkalaemia in denervated muscle, while epidural anesthesia was impractical due to positional limitations from fracture pain. Spinal anesthesia was administered using 0.75% hyperbaric ropivacaine via a 25G Quincke needle. Post-spinally the patient developed hypotension and tachycardia, attributed to multi-factorial hemodynamic compromise including spinal sympathectomy, anemia, febrile illness and diastolic dysfunction, and was managed with colloid and mephentermine. The intra-operative and post-operative course were otherwise uneventful, with no neurological deterioration. Neuraxial anesthesia is feasible in neurologically recovered GBS patients undergoing urgent non-obstetric surgery when general anesthesia is contraindicated. Thorough pre-anesthetic assessment, anticipation of disproportionate hemodynamic instability, and close post-operative monitoring are essential.

A wolf in sheep’s clothing: myositis mimicking motor neuron disease – a case report

2026-09-30T10:10:20+0530

Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of immune-mediated muscle disorders typically presenting with proximal muscle weakness and elevated creatine kinase levels. Atypical presentations, particularly in elderly individuals, may mimic motor neuron disease (MND), creating significant diagnostic challenges. We report a 72-year-old man who presented with a six-month history of progressive weakness beginning in the proximal lower limbs and later involving distal limbs and bulbar muscles. Examination revealed muscle wasting, spasticity, exaggerated reflexes, polyminimyoclonus, and neck flexor weakness, suggesting a mixed upper and lower motor neuron syndrome. Nerve conduction studies were normal, while electromyography demonstrated an irritable myopathic pattern without diffuse neurogenic denervation. Serum creatine kinase levels were normal. Autoimmune evaluation showed anti-thyroid peroxidase positivity, SSA/Ro52 positivity, rheumatoid factor positivity, hypocomplementemia, inflammatory polyarthritis, renal involvement, and interstitial lung disease. Whole-body muscle magnetic resonance imaging demonstrated diffuse symmetrical inflammatory changes, while FDG-PET CT excluded occult malignancy. The patient was treated with intravenous methylprednisolone followed by oral prednisolone and mycophenolate mofetil, resulting in marked clinical improvement. Idiopathic inflammatory myositis may rarely present with upper and lower motor neuron-like signs and mimic MND. Recognition of systemic autoimmune features, appropriate electrophysiological evaluation, and muscle imaging is essential to avoid misdiagnosis of a potentially treatable condition.

An unusual presentation of primary oesophagal melanoma in an elderly male: a case report

2026-09-30T10:03:50+0530

Primary malignant melanoma of the oesophagus (PMME) is a very rare and highly aggressive neoplasm, representing <0.2% of all oesophageal carcinomas. Malignant melanoma usually occurs in the skin but can sometimes arise from other non-cutaneous locations, such as mucosa, uvea, upper respiratory tract, gastrointestinal tract, and genitourinary tract. In particular, primary oesophageal melanoma is an extremely rare condition that is associated with a bad prognosis because of the aggressive nature of this tumour and late diagnosis. We present a rare case of an 85-year-old patient who had complaints of per rectal bleeding, vomiting, and shortness of breath. Physical and endoscopic examination found an oesophageal tumour. Histologic examination showed changes consistent with a malignant melanoma. PMME was diagnosed on the basis of the presence of typical histomorphological and immunohistological changes. Being extremely rare, PMME is a difficult disease for diagnosis and should be included in the differential diagnoses of melanomas of the oesophagus.

Recurrent unilateral dactylitis as an unusual presenting manifestation of polycythemia vera: a case report

2026-09-30T09:59:53+0530

Polycythemia Vera is a chronic myeloproliferative neoplasm characterised by clonal proliferation of erythroid, myeloid, and megakaryocytic cell lines. Typical clinical manifestations include headache, aquagenic pruritus, erythromelalgia, thrombotic events, and splenomegaly. However, atypical presentations may delay diagnosis. We report a rare case of recurrent unilateral dactylitis-like swelling as the presenting manifestation of polycythemia vera in a middle-aged woman. The patient was initially treated for presumed cellulitis because leucocytosis was interpreted in isolation, while the accompanying erythrocytosis and thrombocytosis were overlooked. Recurrent episodes prompted further evaluation, which demonstrated hypercellular bone marrow with panmyelosis and a positive JAK2 V617F mutation, confirming the diagnosis of polycythemia vera”. This case highlights the importance of careful interpretation of complete blood counts, detailed clinical history taking, and maintaining suspicion for haematological disorders in patients presenting with recurrent inflammatory digit swelling.

Neuropsychiatric systemic lupus erythematosus with normal CSF and EEG: a diagnostic challenge in the setting of antiphospholipid syndrome and vasculitis

2026-09-30T09:57:21+0530

Neuropsychiatric systemic lupus erythematosus (NPSLE) is a diagnostically challenging manifestation of SLE. We report a 56-year-old woman with known SLE, antiphospholipid syndrome, vasculitis, and seizure disorder who presented with refractory seizures, hallucinations, and altered sensorium. Despite entirely normal cerebrospinal fluid (CSF) analysis and electroencephalography (EEG), MRI brain revealed an old microhemorrhage in the right thalamocapsular region with diffuse cerebral atrophy, and anti-dsDNA-NcX IgG was positive. A diagnosis of NPSLE was established on this basis. She was treated with intravenous immunoglobulin, intravenous dexamethasone, intravenous cyclophosphamide, and antiepileptic agents, achieving sustained clinical remission at three-month follow-up. This case highlights that normal CSF and EEG do not exclude NPSLE, and that serological and neuroimaging findings must be interpreted together to reach a timely diagnosis and initiate appropriate immunotherapy.

Brucellar spondylodiscitis: a rare cause of back pain – a case report

2026-09-30T09:57:17+0530

Human brucellosis is one of the most common bacterial zoonotic infections worldwide and is caused by brucella species, which are facultative intracellular gram-negative coccobacilli. The disease can involve multiple organ systems, with osteoarticular manifestations being the most frequent focal complication. Among these, spinal involvement is clinically important because it often presents with nonspecific symptoms and can mimic other infectious or neoplastic disorders, leading to delayed diagnosis. We report the case of a 50-year-old man who presented with intermittent fever and persistent low back pain and was subsequently diagnosed with spinal brucellosis. Although the mortality associated with brucellosis is low, delayed recognition may result in significant morbidity, prolonged disability, and neurological complications. In regions where tuberculosis is highly prevalent, brucellar spondylitis is frequently overlooked because of its close clinical and radiological resemblance to tuberculous spondylitis. Therefore, spinal brucellosis should be considered in the differential diagnosis of patients presenting with fever and back pain, particularly in endemic areas, to facilitate timely diagnosis and appropriate treatment.

Ayurvedic management of diabetic peripheral neuropathy assessed by vibrotherm (the neuropathy analyser): a case report

2026-09-30T09:57:16+0530

Diabetic peripheral neuropathy (DPN) is the most prevalent type of diabetic neuropathy and is a major complication associated with diabetes mellitus. Chronic hyperglycaemia, plays a major role in the development of diabetic neuropathy leads to cellular injury through multiple mechanisms. This is a case of 58-years-old female who consulted in Kayachikitsa OPD of Vaidyaratnam Ayurveda College Hospital on 12 August 25 presented with progressively worsening Numbness, Pain, Tingling and burning sensation in both feet for 2 years. She has been diagnosed with a case of DPN (Prameha Upadrava) based on clinical findings, neurological examinations and presence of impairment of Vibration perception threshold and hot perception threshold. Treated with Sundibaladi kashayam 48 ml twice daily along with 6 gms of Nisha amalaki choornam, Nishakatakadi kashayam as toya kashayam for frequent use, Pramehaushadi tablet 1 tablet twice daily after food and Pada abhyanga with Sahacharadi tailam externally for a period of 90 days. The patient was assessed with HbA1c level, vibration and thermal perception threshold test by neuropathy analyser Vibrotherm, toronto clinical neuropathy score (TCNS) and monofilament test on 0th day and 91th day of treatment. Significant improvements were observed in parameters like Vibration perception threshold (VPT), Cold perception threshold (CPT) and hot perception threshold (HPT) and TCNS score following the treatment. It suggests that internal administration of ayurvedic medicaments based on principles of Prameha chikitsa and Prameha upadrava chikitsa is effective in relieving the symptoms of DPN.

Second toe-to-thumb transfer for reconstruction of a mutilated hand following firecracker blast injury – a case report

2026-09-30T09:54:12+0530

Firecracker blast injuries to the hand often result in severe mutilation with loss of the thumb, significantly impairing hand function. Restoration of thumb is critical for opposition and prehension. A 30-year-old right-hand dominant male presented with a mutilated right hand following a firecracker blast injury, with amputation of the thumb at the metacarpophalangeal joint, index finger amputation, and middle finger loss at the carpometacarpal level. Initial management included emergency debridement, skeletal stabilization, and soft tissue coverage using a groin flap. First web space deepening was performed at 6 months. Definitive reconstruction with a left second toe-to-thumb transfer was carried out one year after injury using a two-team approach. The postoperative course was uneventful with complete flap survival. At 1-year follow-up, the patient achieved functional opposition and was able to perform activities such as writing, holding objects, and riding a bike. Second toe transfer is a reliable option for thumb reconstruction in mutilated hands, even in delayed settings. A staged approach facilitates optimal functional outcomes.

Role of ardraka arkayoga in the management of bronchial asthma: a case report

2026-09-30T09:54:08+0530

Bronchial asthma is a chronic disease of the air passages characterized by inflammation and narrowing of the airways in which the airflow obstruction varies both spontaneously & with specific treatment. The prevalence of asthma has increased over time worldwide. The patient presented with episodes of cough, wheezing, dyspnea and chest tightness. The patient has consulted in the OPD of Kayachikitsa, Vaidyaratnam Ayurveda College, Ollur on 18 October 2025. He was diagnosed as a case of bronchial asthma from the typical clinical features, by physical examination and measuring FEV1. The patient underwent treatment for clearing the obstruction manifested in pranavaha srotas and thereby making vayu in its normal gathi. Ardraka arkayoga containing ardraka arka and madhu, indicated in swasa was administered to the patient for a period of 30 days. Arka kalpana was chosen since it is more palatable and having quick absorption. Assessment was made on 15th and 31st day of treatment. The results showed improvement in grading of cough from 2 to1, grading of wheezing from 2 to 0, grading of dyspnea from 1 to 0, FEV1 from 76% to 95%, FVC from 81% to 95% and PEFR from 73.86% to 88%. This case of Tamaka swasa is effectively managed with the help of arka kalpana eventhough it is mentioned as a krichra sadhya vyadhi.

Extrapontine myelinolysis in severe hypernatremia despite controlled sodium correction: a case report

2026-09-30T09:54:05+0530

Osmotic demyelination syndrome (ODS) is a condition characterized by sudden loss of myelin, typically triggered by rapid shifts in the body's osmotic balance. We report a 53-year-old male with recurrent carcinoma of the buccal mucosa who developed severe hypernatremia following sodium bicarbonate infusion. Despite careful and gradual correction of his elevated sodium levels, he subsequently developed quadriparesis, and MRI confirmed extrapontine myelinolysis. Supportive neurological, oncological, and hematological care was provided, but the patient ultimately succumbed to his illness. This case highlights that even cautious correction of sodium disturbances can precipitate ODS, particularly in patients with malignancy and metabolic stress, emphasizing the need for vigilant monitoring and individualized management.

A case report of post coronary artery bypass grafting Dressler’s syndrome presenting with cardiac tamponade

2026-09-30T09:54:02+0530

Dressler’s syndrome is an inflammatory complication following myocardial injury or cardiac surgery that may rarely progress to clinically significant pericardial effusion and cardiac tamponade. We report a case of a patient who developed delayed symptomatic pericardial effusion following coronary artery bypass grafting, with echocardiography demonstrating tamponade physiology requiring urgent pericardiocentesis and drainage. The patient was subsequently managed with anti-inflammatory therapy with clinical and echocardiographic improvement, highlighting the importance of recognizing PPS as a potentially life-threatening cause of delayed post- coronary artery bypass grafting pericardial effusion.

Osseous metaplasia of the endometrium – an unusual etiology of secondary infertility in a nulliparous woman

2026-09-30T10:03:49+0530

The presence of bony tissue within the endometrium is an uncommon finding, usually uncovered during assessments for infertility. Most of the cases present with a clinical history of recurrent miscarriages, pelvic pain, dyspareunia, and menstrual irregularities, such as hypermenorrhea and dysmenorrhea. The other names of this rare entity are endometrial ossification, ectopic intrauterine bone, and heterotopic intrauterine bone formation. We present one such rare case with a review of the literature on a 21-year-old female presenting with secondary infertility. Endometrial osseous metaplasia should be considered in the differential diagnosis of intrauterine calcifications in women presenting with infertility or menstrual abnormalities. In the present case, ultrasonography demonstrated multiple linear calcifications with posterior acoustic shadowing in the lower endometrial cavity and endocervical junction. Hysteroscopy revealed four bony fragments, which were excised and sent for histopathological examination. The histopathological findings were consistent with endometrial osseous metaplasia. Hysteroscopic removal is considered the preferred treatment and may improve fertility by restoring the normal endometrial cavity.

Obstructive jaundice secondary to metastatic gastric adenocarcinoma

2026-09-30T09:53:47+0530

Cancer related obstructive jaundice is commonly associated with pancreatic biliary malignancies but is an uncommon manifestation of gastric carcinoma. The occurrence of malignant biliary obstruction in patients with previously treated gastric cancer is rare and generally indicates advanced metastatic disease with poor prognosis. A 39-year-old male with a history of gastric adenocarcinoma diagnosed in 2024, treated with total gastrectomy (pT4N3aM) and chemotherapy (FLOT regimen 8 cycles followed by FOLFIRI & Nivolumab 9 cycles), presented with progressive jaundice, dark coloured urine and abdominal distension. Laboratory investigations revealed elevated total bilirubin, alkaline phosphatase and gamma-glutamyl transferase. Contrast enhanced imaging demonstrated intrahepatic biliary radicle dilation, proximal common bile duct dilation, abrupt mid common bile duct narrowing suggestive of malignant stricture, pancreatic duct dilation, moderate ascites and bilateral hydronephrosis. Ascitic fluid analysis excluded spontaneous bacterial peritonitis. Right sided double-J ureteric stenting was performed for hydrouteronephrosis. Due to altered postoperative anatomy (gastrectomy), percutaneous transhepatic biliary drainage was undertaken. Cholangiography confirmed proximal common bile duct stricture and a self-expanding metallic stent (SEMS) was deployed percutaneously. Significant biliary decompression and symptomatic improvement was achieved. Malignant biliary obstruction due to metastatic gastric cancer is an uncommon clinical entity and associated with significant complications. In patients with altered anatomy after gastrectomy, percutaneous transhepatic biliary drainage with metallic stent placement provides effective palliation and symptomatic relief.

Artificial intelligence in psychiatry: transforming diagnosis, risk prediction and personalized mental healthcare – a narrative review

2026-09-30T09:57:08+0530

Artificial intelligence (AI) is transforming psychiatric practice by introducing innovative approaches to diagnosis, risk prediction, and personalized mental healthcare. Recent advances in machine learning (ML), deep learning (DL), natural language processing (NLP), digital phenotyping, neuroimaging analytics, and wearable technologies have enhanced the ability to analyze complex clinical, behavioral, and biological data, enabling earlier detection of mental disorders and more accurate prediction of treatment outcomes. AI-assisted clinical decision support systems facilitate the identification of individuals at risk of depression, schizophrenia, bipolar disorder, anxiety disorders, suicide, and relapse while supporting precision psychiatry through individualized treatment recommendations. Furthermore, digital health technologies allow continuous monitoring of patients in real-world settings, promoting timely interventions and improving continuity of care. Despite these promising developments, several challenges remain, including algorithmic bias, limited external validation, lack of explainability, data privacy concerns, ethical issues, and regulatory barriers that may affect clinical implementation. This narrative review synthesizes current evidence regarding the applications of AI in psychiatric diagnosis, predictive analytics, and personalized mental healthcare, while critically discussing technological advances, clinical benefits, implementation challenges, ethical considerations, and future research directions. The review highlights that AI should complement rather than replace psychiatrists, supporting evidence-based, patient-centered, and precision mental healthcare. Continued multidisciplinary collaboration, rigorous validation, transparent AI models, and robust governance frameworks are essential to ensure the safe, equitable, and effective integration of AI into routine psychiatric practice.

Aesthetic rehabilitation in implant prosthodontics: current concepts, digital advances and clinical perspectives – a narrative review

2026-09-06T08:13:52+0530

Aesthetic rehabilitation in implant prosthodontics is an integral component of contemporary dental practice, with treatment success determined not only by implant survival but also by restoration of natural function, appearance, and patient satisfaction. Predictable aesthetic outcomes require a prosthodontically driven approach involving comprehensive diagnosis, accurate three-dimensional implant positioning, and preservation of peri-implant hard and soft tissues. Factors such as smile line, periodontal phenotype, bone morphology, implant position, emergence profile, and restorative material selection influence the final aesthetic outcome. Thorough preoperative assessment facilitates identification of risk factors and individualized treatment planning. Digital technologies, including cone-beam computed tomography (CBCT), digital smile design, intraoral scanning, computer-aided design and manufacturing (CAD/CAM), and computer-guided implant surgery, have improved diagnostic accuracy, treatment planning, restorative precision, and interdisciplinary communication. The Pink Esthetic Score (PES) and White Esthetic Score (WES) provide standardized methods for evaluating peri-implant soft-tissue and prosthetic aesthetics. Soft-tissue augmentation, customized healing abutments, and immediate provisionalization may further enhance peri-implant tissue management and aesthetic outcomes in appropriately selected cases. However, complications such as mucosal recession, papillary deficiency, inadequate soft-tissue volume, and unfavourable emergence profiles remain challenging. Predictable aesthetic rehabilitation therefore requires an interdisciplinary, evidence-based approach integrating biological principles, prosthodontic concepts, and contemporary digital technologies to achieve functionally sound, biologically stable, and aesthetically harmonious implant-supported restorations.

A multi-disciplinary review on the diagnostic significance of body organ morphology in different body conditions (health and disease)

2026-09-30T10:09:13+0530

Body physique is simply known as the shape and size of the body. A range of factors influences a person’s physique, and lifestyle changes can cause shifts over time. Body physique plays an important role in the disease’s susceptibility, diseases diagnosis and therapeutic outcomes. This review aims to provide a comprehensive understanding of body physique presenting insight from traditional and Modern perspectives. A comprehensive literature review was conducted through an extensive analysis of classical manuscripts, standard textbooks, and published research articles from Unani, Ayurveda, Chinese, and contemporary biomedical sciences to explore the concept of body physique and constitutional typology. Relevant literature was systematically searched using electronic databases including PubMed, Google Scholar, and Scopus, employing keywords such as body physique, Mizāj, hayyate Aaza, Ayurvedic Medicine, Traditional Chinese Medicine, Prakriti, and somatotypes. Almost all traditional medicine poses a very strong belief on the importance of body physique as a reflection of internal balance and overall health. These traditional medical systems use this physical form for diagnosis, treatment and specific lifestyle recommendations. The review highlights the relationship between Mizāj/prakriti and body physique. This analysis of various systems of medicine reveals common insights, particularly in recognizing constitutional predispositions and their application to preventive and individualized care. Integrating ancient concepts with modern biomedical knowledge may lead to a more comprehensive understanding of the body, advancing methods to predictive diagnoses, personalized therapy, and lifestyle changes. Despite cultural and theoretical variances, all of these systems adhere to the principle that the body's outward shape reflects internal environment.

Quality beyond compliance: leveraging six sigma for clinical laboratory improvement

2026-09-30T10:09:28+0530

Clinical laboratories are the backbone of modern healthcare, providing crucial diagnostic services that guide patient management and treatment decisions. Accuracy and precision are vital factors for quality control in clinical laboratories. Six Sigma is a powerful quality management tool which enables laboratories to reduce process variability, minimize errors and evaluate analytical performance. This review highlights the various aspects of quality control, application of Six Sigma metrics in clinical laboratory practice. Sigma metrics helps in identification of analytical processes requiring improvement, risk-based quality control planning and implementing effective of internal quality control (IQC) protocols and improves operational efficiency.

Bedside data to clinical foresight: the emerging role of nurses in AI-enabled predictive care and early patient deterioration detection

2026-09-30T09:57:33+0530

Early recognition of patient deterioration remains a cornerstone of high-quality nursing care and is essential for preventing avoidable morbidity, mortality, and unplanned intensive care admissions. Despite advances in physiological monitoring, delays in recognizing subtle clinical changes continue to contribute to adverse patient outcomes. Artificial intelligence (AI) has emerged as a transformative technology capable of integrating large volumes of clinical, physiological, laboratory, and electronic health record (EHR) data to generate predictive insights that support timely clinical decision-making. AI-enabled predictive care systems, including machine learning algorithms, deep learning models, wearable sensor analytics, and early warning systems, provide nurses with opportunities to identify high-risk patients before overt clinical deterioration occurs. Rather than replacing nurses, these technologies augment clinical judgment by facilitating continuous risk assessment, prioritization of care, and proactive intervention. This narrative review explores the evolving role of nurses in AI-enabled predictive care and early patient deterioration detection. It examines the integration of bedside clinical observations with AI-driven predictive analytics, highlights current applications across acute and critical care settings, and discusses implications for nursing education, leadership, ethical practice, and interdisciplinary collaboration. The review also addresses challenges related to algorithmic bias, explainability, data quality, digital literacy, and governance while identifying future opportunities for human-centered AI implementation. Strengthening nurses' competencies in digital health and AI is essential for maximizing patient safety and ensuring equitable, evidence-based care in increasingly technology-enabled healthcare environments.

A conceptual framework of diet and its classification in Unani medicine

2026-09-30T09:57:32+0530

Diet (Ghidhā') occupies a central place in Unani medicine, serving not only as a source of nourishment but also as a fundamental means of preserving health and maintaining the body's temperamental balance (I‘tidāl-e-Mizāj). Classical Unani scholars regarded dietary regulation as the first line of both disease prevention and treatment. According to Unani principles, the human body undergoes continuous metabolic change (Taḥallul), resulting in the constant depletion of tissues that must be replenished through appropriate nutrition (Badal Mā Yataḥallal). Food is transformed through the process of Istihāla by Quwwat Ghādhiya into Akhlāṭ (humours), which provide nourishment and support physiological functions. Unani literature classifies diet using multiple parameters, including the nature of the humours produced, nutritional value (Quwwat-e-Taghdhiya), quality of Kaymūs (Chyme), rate of digestion (Hazm) and absorption (Nufūz), temperament (Kayfiyāt), and production of waste (Fuzūlāt). Foods are further categorized as Ghidhā', Dawā', Ghidhā' Dawā'ī, and Dawā' Ghidhā'ī, reflecting their nutritional and therapeutic aspects. This paper reviews the classical Unani concept of diet and its systematic classification, highlighting its relevance in maintaining temperamental balance (I'tidāl-e-Mizāj) and promoting health. By revisiting these traditional dietary principles, the study emphasizes their potential value in contemporary preventive healthcare and integrative medicine.

A correlation between gut—the second brain and homoeopathy

2026-09-30T09:57:09+0530

Talk of Irritable Bowel Disease (IBD). Irritable Bowel Syndrome (IBS), Coeliac Disease (CD), Colitis, Gastric Oesophageal Reflux Disease (GERD), Proctitis (acute and chronic), Metabolic Disorders (MD), Non-Communicable Diseases (NCD), Irregular Bowel Movement (IBM), Crohn’s Disease (CD), Colorectal Cancer (CC) and Irregular Peristalsis (IP) are the talk of the town these days. Besides these conditions/disease, there are risk factors for Insulin Resistance (IR), Cardio Vascular Disease (CVD), Chronic Typhoid Enteritis (CET), Fecal Obstruction Syndrome (FOS), Irregular Bowel Motility (IBM) and Chronic Inflammation (CI). All these Risk Factors (RF) and conditions/manifestations have become a part of the modern life as these do not yield only to medicines but these conditions need to be dealt with a multi-pronged approach. The article surfaces the multi-pronged approach through the alliance of homoeopathic therapeutics in the process of correcting the dysbiosis. Homoeopathy has been using the gut bacteria as medicines since a century now. These medicines are called as the Bowel Nosodes (BN) in homoeopathy. The article brings out a relation between the gut and the brain through the use of these nosodes and justifies the heading of this article. The highlight of this article is the common approach of ‘personalized nutrition’. It may be noted that while modern medicine sees the gut biome as a tool for this medicine, homoeopathy has been following this medicinal approach since the last 100 years. The article also focuses on two studies on gut micro-biome published in 2026 and relates the findings of the studies to the homoeopathic therapeutics.

The future of radiology education and training: a vision for future training models

2026-09-30T09:55:05+0530

This article discusses the history and future direction of radiology education and training. Beginning with the historical progression from Röntgen’s discovery to the digital era, it highlights the limitations of traditional apprenticeship models and the need for competency-based learning. Education today focuses on the incorporation of simulation, AI, VR/AR, and teleradiology, revolutionising how radiologists learn technical as well as decision-making skills. Some of the key issues are workforce shortages, differences in training, burnout and lagging adoption of innovations. The paper also explores evolving skill needs data analysis, communication, ethics, and collaboration as essential competencies for contemporary radiologists. It proposes a personalised and technology-driven curriculum supported by global collaboration, continuous faculty development, and standardised accreditation. In conclusion, the research provides that the future of radiology education is in integrating technological innovation with human-centred care, developing flexible, reflective professionals who can excel in an AI-integrated healthcare setting.

Reimagining community mental health nursing: integrating digital health, artificial intelligence, early intervention and recovery-oriented care – a narrative review

2026-09-30T09:54:12+0530

Community mental health nursing is undergoing a substantial transformation driven by digital health, artificial intelligence (AI), early intervention, and recovery-oriented approaches. This narrative review examines how these emerging domains can be integrated to strengthen accessible, proactive, person-centred community mental health services. Literature published primarily between 2020 and 2026 was explored through PubMed/MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and the Cochrane Library using MeSH terms and related keywords encompassing community mental health services, psychiatric nursing, telemedicine, digital health, AI, early intervention, recovery, peer support, and primary healthcare. The evidence indicates that telepsychiatry, mobile health applications, digital self-management platforms, and remote monitoring can improve service accessibility, continuity, engagement, and symptom management, although digital exclusion and adherence remain important challenges. AI-based machine learning, predictive analytics, and conversational agents demonstrate potential for early risk identification, personalized intervention, symptom monitoring, and clinical decision support. However, limitations related to external validation, algorithmic bias, transparency, privacy, and limited nursing-specific evidence require careful consideration. Recovery-oriented and peer-supported approaches remain essential for promoting autonomy, empowerment, social functioning, and meaningful participation. The review proposes a human-centred model in which AI and digital technologies augment, rather than replace, therapeutic nursing relationships and professional judgement. Future community mental health services should integrate technological innovation with ethical governance, digital inclusion, early intervention, interdisciplinary collaboration, and recovery-focused nursing practice.

Theranostics: integrating molecular imaging and targeted therapy for precision medicine across oncology and beyond

2026-09-30T09:55:01+0530

To review the principles, mechanisms, clinical applications, safety considerations, challenges and future perspectives of theranostics. Literature from peer-reviewed journals, clinical trials and authoritative sources was reviewed. Theranostics integrates molecular imaging and targeted therapy, demonstrating significant benefits in neuroendocrine tumors, prostate cancer, lymphoma and emerging non-oncologic diseases. Theranostics represents a cornerstone of precision medicine and is expected to expand further with advances in artificial intelligence, nanotechnology and novel radiopharmaceuticals.

Waja‘al-mafāṣil in Unani medicine: pathophysiological perspectives of mizāj and akhlāṭ and therapeutic approaches

2026-09-30T09:53:55+0530

Waja‘al-Mafāṣil (musculoskeletal disorders) is a group of ailments that includes muscles, bones, a group of nerves, ligaments and tendons. It is a kind of degenerative disorder that mostly occurs due to not following Asbāb Sitta Ḍarūriyya in their day-to-day life. The designation of diseases according to involvement of their respective organs: Niqris (Gout), ‘Irq al-Nasā (sciatica), Waja‘al-Warik (pain of hip joint) and Waja‘al-Mafāṣil (joint pain), having different manifestations of the same pathological entity. The etiopathogenesis of such diseases mainly revolves around the overwhelming of Akhlāṭ in the joint spaces. This build-up results in obstruction and distension, leading to pain. The most common etiological factor is Balgham (phlegmatic humour) or a mixture of Balgham and Ṣafrā’ (phlegm and yellow bile), and sometimes it may happen due to Khilṭ Sawda. The Balgham (phlegm) is often abnormal, thick, and purulent. With prolonged stagnation, this matter becomes increasingly viscous, sometimes hardening to the extent that it resembles stone. The works related to Waja‘al-Mafāṣil were meticulously reviewed, examined, scrutinised, scanned and summarised based on classical texts and published data in many reliable sources. Unani medicine has rich potential, and it has been focused on since the medicine was in a very primitive stage. It caters for prevention, protection, promotion, and empowerment, and performs the imbibed function. The available information emphasises to explore and develop a protocol for validation of existing knowledge in understanding the underlying pathology and the diagnosis of musculoskeletal conditions with their protocol of treatment.

Storytelling-based learning in nursing education: enhancing disease knowledge, clinical reasoning and professional competence among nursing students: a narrative review

2026-09-30T09:53:48+0530

Storytelling has returned as a purposeful teaching strategy in nursing education. It offers an alternative to didactic, fact-centred instruction by placing disease knowledge within lived clinical narratives. This narrative review synthesises current evidence on storytelling-based learning, including digital storytelling and narrative pedagogy and its influence on nursing students' disease knowledge, clinical reasoning and professional competence. PubMed/MEDLINE, CINAHL, Scopus, Embase, ERIC and Google Scholar were searched using Medical Subject Headings and free-text terms combined with Boolean operators. Primary studies, systematic reviews and theoretical papers published in English were included and synthesised narratively. The literature suggests that storytelling-based learning improves retention of pathophysiological and clinical content, strengthens critical thinking and clinical reasoning and supports empathy, communication, professional identity and humanistic caring ability. Digital and simulation-embedded narratives were particularly effective in engaging learners and encouraging reflective practice and narrative pedagogy helped students move from novice thinking toward more expert-like clinical judgement. The evidence is limited, however, by methodological heterogeneity, small samples and inconsistent outcome measures. Overall, storytelling-based learning appears to be a useful adjunct to traditional nursing curricula, linking theory with clinical practice while nurturing the humanistic side of care. Larger, adequately powered trials with standardised outcome measures are needed to establish its long-term effect on clinical competence and patient outcomes.

The combined effects of blood lead exposure and chronic psychosocial stress on cardiovascular, inflammatory and cardiometabolic biomarkers among U. S. adults: a survey-weighted analysis of NHANES 2013-2014

2026-09-30T09:54:59+0530

Background: Lead exposure remains a public health concern, with low-level exposure associated with adverse cardiovascular and inflammatory outcomes. Depressive symptoms may influence cardiovascular responses to environmental toxicants through overlapping biological pathways. This study examined whether depressive symptom burden modified associations between blood lead exposure and cardiovascular, inflammatory, and cardiometabolic biomarkers among U. S. adults.

Methods: A cross-sectional analysis was conducted using NHANES 2013-2014 data. The analytic sample included 5,924 adults with available blood lead, patient health questionnaire-9 (PHQ-9), outcome, and covariate data. Survey-weighted multivariable linear regression models accounted for the NHANES complex sampling design and examined interactions between blood lead concentration and PHQ-9 score for mean systolic and diastolic blood pressure (SBP and DBP), pulse rate, white blood cell count, and low-density lipoprotein cholesterol. Models were adjusted for age, sex, race/ethnicity, body mass index (BMI), and poverty-income ratio (PIR).

Results: A statistically significant interaction between blood lead concentration and PHQ-9 score was observed for mean SBP (β=-0.201, p=0.047). No significant interactions were observed for DBP, pulse rate, white blood cell count, or low-density lipoprotein cholesterol (all p>0.05).

Conclusions: Depressive symptom burden modified the association between blood lead concentration and SBP but not the other biomarkers examined. These findings support considering environmental and psychosocial factors jointly when evaluating cardiovascular effects of lead exposure. Longitudinal studies are needed to confirm this interaction and clarify its underlying mechanisms.

Evaluation of diagnostic outcomes and management of healthcare personnel with positive tuberculin skin tests referred for latent tuberculosis infection assessment at Prince Sultan Military Medical City: a retrospective cohort study

2026-09-18T06:46:49+0530

Background: Healthcare workers (HCWs) are at increased risk of latent tuberculosis infection (LTBI) due to occupational exposure. However, the diagnostic outcomes, agreement with confirmatory testing, and treatment adherence in this population remain underexplored. This study aimed to evaluate the proportion of TST-positive HCWs diagnosed with LTBI, assess TST-IGRA agreement, and determine treatment initiation and completion rates.

Methods: We conducted a retrospective cohort study of 64 HCWs with positive TST results who were referred to the ID clinic at PSMMC from January to December 2025. Data were abstracted from electronic medical records. LTBI diagnosis was defined as positive interferon-gamma release assay (IGRA) or initiation of LTBI treatment. Agreement between TST and IGRA was tested with Cohen's kappa. We used univariate and multivariable logistic regression to identify predictors of LTBI.

Results: Of the 64 participants, 40.6% (n=26) were diagnosed with LTBI. IGRA testing was performed in 32.8% (n=21). The agreement between TST and IGRA was poor (kappa=-0.095, p=0.329). Treatment was initiated in 80.8% (21/26) of diagnosed cases, and completion among those who started was 42.9% (9/21). In univariate analysis, nationality (p=0.031), department (p=0.043), and TST size (p=0.014) were significantly associated with LTBI. However, multivariable regression failed to identify independent predictors (overall model p=0.225).

Conclusions: Over one-third of referred HCWs were diagnosed with LTBI. TST showed poor agreement with IGRA, highlighting the need for confirmatory testing. Treatment completion rates were suboptimal, suggesting enhanced adherence support strategies are required.

Post-relaparotomy morbidity and mortality patterns following gynecological and obstetrical surgeries: a tertiary care hospital experience

2026-09-20T09:14:52+0530

Background: Relaparotomy following obstetrical and gynecological surgery is an uncommon but serious event associated with substantial maternal morbidity and mortality. Early identification of postoperative complications and timely surgical intervention are essential to improve outcomes. This study aimed to evaluate the morbidity and mortality pattern among patients undergoing relaparotomy following gynecological and obstetrical surgeries.

Methods: This hospital-based prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital, over six months (November 2018 to April 2019). A total of 48 patients who required relaparotomy after obstetrical or gynecological abdominal surgery were included by consecutive sampling. Demographic characteristics, primary surgery, indications and timing of relaparotomy, operative findings, postoperative complications, treatment requirements and final outcomes were recorded and analyzed.

Results: Among 48 patients, 39 (81.3%) underwent relaparotomy following obstetrical surgery and 9 (18.8%) following gynecological surgery. Caesarean section was the commonest primary procedure (64.6%). Hemoperitoneum or ongoing intra-abdominal hemorrhage was the leading indication for relaparotomy (33.3%), followed by sepsis/peritonitis (16.7%) and hematoma (14.6%). Overall, 60.4% of relaparotomies were performed within 24 hours. Major post-relaparotomy morbidities included sepsis (25.0%), hemorrhagic shock (20.8%), wound infection (18.8%) and acute kidney injury (14.6%). Blood transfusion was required in 81.3% and ICU/HDU admission in 31.3% of patients. Six patients died, giving an overall mortality rate of 12.5%.

Conclusions: Relaparotomy was associated with considerable morbidity and mortality, predominantly due to hemorrhage and sepsis. Vigilant postoperative monitoring, early recognition of complications, prompt re-exploration and adequate critical-care support are essential to improve patient outcomes.

Seroprevalence and the factors associated with Helicobacter pylori infection among adolescent students in Tiko municipality, Southwest region of Cameroon

2026-09-30T09:59:51+0530

Background: Helicobacter pylori, a gram-negative oncogenic coccobacillus, and micro-aerophilic bacterium requires environments containing oxygen at a low partial pressure. Although many carrier individuals are asymptomatic, long-term exposure to this bacterium can contribute to the pathogenesis and progression of peptic ulcers, chronic gastritis and stomach cancers in adulthood.

Method: A school based cross-sectional study was carried among 180 adolescents chosen conveniently. Descriptive and multivariate logistic regression analyses were performed to determine the factors associated with this infection.

Results: The 180 participants were aged 17.27 ± 1.48 years on average. Of these, blood sample from 96 (53.3%) tested positive for H. pylori antibodies. Three factors were significantly associated with this sero-prevalence. Compared to individuals consuming 3-4 meals daily, those taking only 1-2 meals per day had approximately 2.5 times higher odds of infection (aOR= 2.48, 95% CI 1.347-4.588, p = 0.004). Participants using a pit toilet system had higher odds of infection relative to those using a flushing system (aOR = 1.93, 95% CI 1.042-3.597, p = 0.037). Additionally, alcohol consumption was associated with higher odds of H. pylori infection (aOR = 1.98, 95% CI 1.083-3.636, p = 0.027). Conclusion: H. pylori sero-prevalence was found to be high and associated with low dietary frequency, pit toilets use, and the consumption of alcohol. Hence, health interventions targeting nutrition, environmental sanitation, and behavioural change would contribute to reduce the risk of exposure of adolescent population to H. pylori infection.

Bacterial etiology and multidrug resistance patterns in hospital-acquired pneumonia: predominance of Gram-negative pathogens

2026-09-30T10:03:51+0530

Background: Hospital-acquired pneumonia (HAP) is a major nosocomial infection and is increasingly complicated by multidrug-resistant (MDR) pathogens. Center-specific data on bacterial etiology and susceptibility patterns are essential to optimize empiric therapy and antimicrobial stewardship. Objective was to determine bacterial etiology and MDR burden in HAP, and to describe organism-specific antibiotic susceptibility patterns, emphasizing Gram-negative predominance.

Methods: This cross-sectional study enrolled 100 adult inpatients with HAP (onset ≥48 hours after admission) in the department of respiratory medicine, Bangladesh Medical University, Dhaka, over 12 months, from August 2024 to August 2025. Sputum, induced sputum, or bronchoalveolar lavage specimens were cultured following quality screening, and antimicrobial susceptibility testing was performed by disc diffusion. Results were summarized using frequencies and percentages; MDR was defined as non-susceptibility to at least one agent in three or more antimicrobial classes.

Results: Bacterial growth was obtained in 78.0% of cases, with single-organism isolation in 68.0% and polymicrobial growth in 10.0%. A total of 89 isolates were recovered, predominantly Gram-negative (93.3%). Leading pathogens were Klebsiella spp. (33.7%), Pseudomonas aeruginosa (31.5%), and Acinetobacter spp. (24.7%). Overall MDR prevalence was 87.8%. Cephalosporin susceptibility was low among major Gram-negative organisms, while carbapenem susceptibility was moderate; colistin susceptibility varied across species.

Conclusions: HAP in this cohort was dominated by MDR Gram-negative pathogens with limited susceptibility to commonly used antibiotics, supporting the need for local antibiograms and stewardship-guided empiric therapy.

Timeliness and guideline concordance of post-exposure prophylaxis following occupational blood and body fluid exposures at Prince Sultan Military Medical City: a retrospective timestamp-based cohort study (2024-2025)

2026-09-12T06:51:34+0530

Background: Healthcare workers (HCWs) are at increased risk of acquiring bloodborne infections through occupational exposure to blood and body fluids (BBFEs). Prompt post-exposure prophylaxis (PEP) is essential to reduce the risk of transmission yet delays and inconsistent adherence to institutional protocols remain significant concerns. To determine the median exposure-to-reporting delay, the proportion of HCWs reporting within the institutional target of ≤24 hours, assess adherence to PEP guidelines, and identify predictors of delayed reporting.

Methods: A retrospective cohort study was conducted at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia, from January 2024 to December 2025. All HCWs who reported occupational BBFEs with complete exposure and reporting timestamps were included. Data were extracted from occupational health and electronic health records. The primary outcome was exposure-to-reporting delay in hours. Logistic regression identified predictors of delayed reporting (>24 hours).

Results: Among 145 HCWs (mean age 32.6±7.1 years; 74.5% female), the median exposure-to-reporting delay was 504.30 hours (IQR: 1463.88), with only 39.3% reporting within ≤24 hours. Needlestick injuries comprised 88.3% of exposures. HIV PEP was indicated in 47 cases (32.4%), of which 26 (55.3%) were initiated. HBIG was administered in 4 cases (2.8%). Follow-up attendance declined from 37.9% in 6 weeks to 4.1% in 12 months. Delayed reporting was significantly associated with initiation of HIV PEP (p=0.003), HBIG administration (p<0.001), and infectious disease consultation (p<0.001). No demographic or occupational factors predicted delayed reporting.

Conclusions: Substantial gaps exist in the occupational exposure management pathway at PSMMC, with prolonged reporting delays, suboptimal PEP initiation, and poor follow-up adherence. Reporting delays appear systemic rather than attributable to individual HCW characteristics. Urgent improvements in reporting systems, documentation, and follow-up reminders are needed to protect HCWs from preventable infections.

Clinical audit of a respiratory intensive care unit – evaluating outcomes via the acute physiology and chronic health evaluation II system

2026-09-30T10:10:00+0530

Background: The acute physiology and chronic health evaluation II (APACHE II) score is widely used to assess illness severity and predict mortality in critically ill patients. This study evaluated its usefulness for mortality prediction in a respiratory intensive care unit (RICU).

Methods: A prospective observational study included 80 consecutive RICU admissions over six months at a tertiary-care hospital. APACHE II scores were calculated using the worst physiological values recorded during the first 24 hours of admission. Predicted mortality was compared with observed mortality, and associations with age, sex, APACHE II score, and diagnostic category were assessed.

Results: Of 80 patients, 54 survived and 26 died, giving an observed mortality of 32.5%. Mean age was 42.1±20.642.1/pm 20.642.1±20.6 years, mean APACHE II score was 12.43±10.812.43/pm 10.812.43±10.8, and mean predicted mortality was 23.9%. Non-survivors were older and had significantly higher APACHE II scores than survivors (p=0.0001, p=0.0001, p=0.0001 and p=0.001, p=0.001, p=0.001, respectively). Mortality increased with advancing age and higher APACHE II score categories, reaching 80% among patients with scores of 30–34 and >34. Male patients had higher observed mortality than female patients (44.68% versus 15.15%; p=0.006, p=0.006, p=0.006). Respiratory and trauma cases had the highest observed mortality (66.66% each).

Conclusions: APACHE II is a useful tool for early risk stratification of RICU patients. Higher APACHE II scores and older age were strongly associated with mortality; however, the score underestimated overall mortality in this cohort. Periodic local validation is recommended.

Role of 2D shear wave elastography in differentiating malignancy from focal liver lesions as compared to multiphasic contrast enhanced computed tomography

2026-09-17T07:04:40+0530

Background: Liver cancer is the third most common cause of cancer mortality worldwide. A precise evaluation of benign and malignant liver lesions is very important for the patients. In the present study, we aim to evaluate the use of SWE in the differentiation of malignant from benign focal liver lesions and to determine the SWE characteristics of common liver lesions as compared to multiphasic computed tomography (CT) scan.

Methods: Diagnostic test evaluation observational study where sensitivity, specificity, PPV and NPV of both modalities 2D SWS and multiphase contrast-enhanced-computed tomography (CECT) are compared. 63 patients with focal liver lesions were evaluated by both modalities with HPE as gold standard.

Results: Overall sensitivity, specificity, PPV, NPV and accuracy of multiphasic CECT is 89.74%, 50.00%, 10.28%, 99.39% and 98.71% respectively. Overall sensitivity, specificity, PPV, NPV and accuracy of 2D SWS is 94.59%, 56.25%, 12.13%, 99.39% and 58.55% respectively.

Conclusions: 2D SWS is a useful modality and is capable of evaluating stiffness changes in the liver associated with solid focal liver lesions, which helps in distinguishing benign from malignant lesions and also in their sub-categorization, i.e., differentiating focal nodular hyperplasia from hemangioma and differentiating hepatocellular carcinoma, with high sensitivity and accuracy. Overall performance of both CECT and 2D SWS did not show much difference statistically. However, both modalities complement each other and shortcoming of one modality can be overcome with the help of other thereby leading to better diagnostic evaluation.

Clinicopathological profile of male breast cancer: an institutional experience from Western Bihar, India

2026-09-09T06:55:56+0530

Background: Male breast carcinoma (MBC) is rare (~1% of breast diagnoses) and often presents at advanced stages due to limited awareness, screening guidelines, and medical guidance. Data from Bihar, India, remains scarce. This study assessed institutional accrual alongside demographic, clinical, histological, and stage profiles at Netaji Subhas Medical College and Hospital (NSMCH), Bihta, Patna.

Methods: An ambispective observational cohort study (January 2019 to December 2025) histopathologically confirmed primary male breast cancer (MBC) cases were included (retrospective: 2019–2023; prospective: 2024–2025). Age, symptoms, histological subtype, and AJCC 8th Edition (pTNM) stage were recorded. Data were analyzed using descriptive statistics with exact binomial and Poisson confidence intervals.

Results: Over seven years, 36 patients were identified (mean accrual: 5.14 cases/year), predominantly aged 60–84 years. Painless breast lump was the chief symptom in 28 patients (77.7%). Invasive ductal carcinoma (no special type) was the predominant variant (33 cases, 91.7%). Advanced Stage III or IV disease was present in 27 patients (75.0%) at initial diagnosis.

Conclusions: MBC in western Bihar primarily affects older men and usually presented at advanced stages through symptom-driven detection, dominated by invasive ductal carcinoma. Improving public awareness, screening efficiency, rapid histopathological diagnosis, referral networks, and regional cancer registration is essential.

Clinico-laboratory spectrum of dengue fever and predictors of severe dengue infection: a study from a tertiary care hospital in Mumbai

2026-09-12T06:51:40+0530

Background: Dengue is a rapidly spreading arboviral infection that can progress from flu-like illness to life-threatening severe forms. Since early prediction of severity is difficult, identifying clinical and laboratory predictors is essential for proper management.

Methods: A total 200 patients of either gender and of age ≥18 years with confirmatory diagnosis of dengue fever by dengue NS1 ELISA and/or RT-PCR were enrolled in this study from August 2017 to November 2018. Detailed clinical history was documented.

Results: Of 200 patients, 89% had non-severe (group A) and 11% had severe (group B). Common age group affected in both the groups were 18-30 years. In non-severe dengue, 7.3% patients presented with signs of bleeding as compared to 63.6% in severe dengue. Signs of plasma leakage were only seen in severe dengue (68.2%). Hepatomegaly was predominantly associated with severe dengue (90.9%) as compared to non-severe dengue (10.1%). Splenomegaly was noted from 31.8% patients with severe dengue as compared to only 1.7% patients with non-severe dengue. Secondary dengue infection was present in 2.2% of non-severe cases and 18.2% of severe cases. All patients with severe dengue had significantly higher viral load (≥1000 copies/ml) as compared to 78.7% patients with non-severe dengue.

Conclusions: The possible predictors of severe dengue may include young age with symptoms like rash, vomiting, lethargy and dyspnoea having signs of bleeding, plasma leakage and organomegaly. In addition, laboratory findings supporting severity are secondary infection, high viral load, thrombocytopenia, high haematocrit, raised liver enzymes and increased serum creatinine.

Drug-eluting balloon angioplasty: redefining percutaneous coronary intervention

2026-09-06T08:13:38+0530

Background: Drug-eluting balloon (DEB) angioplasty has emerged as an effective alternative to stent-based coronary revascularization, offering comparable efficacy without the long-term complications associated with permanent metallic implants. Sirolimus-based drug-coated balloon platforms offer distinct mechanistic advantages through inhibition of the mammalian target of rapamycin (mTOR) pathway, enabling selective suppression of smooth muscle cell proliferation while preserving endothelial integrity. Herein, we report the clinical outcomes of a prospective cohort of 59 patients treated with sirolimus-DEB angioplasty.

Methods: We prospectively enrolled 59 consecutive patients undergoing sirolimus-Drug eluting balloon angioplasty for coronary artery disease at a single center over a two-year period (2023-2025). Primary endpoints were technical and procedural success. Secondary endpoints included major adverse cardiovascular events (MACE), restenosis, and target lesion revascularization (TLR) at 6-12 months of follow-up.

Results: The mean age of the cohort was 59.1±10.7 years; 40 (67.8%) were male and 19 (32.2%) were female, with male predominance. Clinical presentations included acute coronary syndromes in 29 (49.2%) and chronic coronary disease in 30 (50.8%). Sirolimus DEB was deployed in 56 of 59 cases (94.9%). Technical and procedural success was achieved in 59 of 59 cases (100%), with all procedures achieving Thrombolysis in myocardial infarction 3 flow and residual stenosis <30%. In-hospital MACE occurred in 1 of 59 patients (1.7%), attributable to refractory cardiogenic shock in the setting of anterior myocardial infarction with severe left ventricular dysfunction; no procedure-related mortality or major bleeding was recorded. At 6-12-month follow-up, available in 56 of 59 patients (94.9%), 53 of 56 (94.6%) were symptom-free with zero TLR and zero late MACE.

Conclusion: Sirolimus-eluting balloon angioplasty demonstrates excellent safety and efficacy in this single-center prospective cohort. The 59/59 (100%) technical success rate, 58/59 (98.3%) uneventful procedural course, and 1/59 (1.7%) MACE rate compare favorably with published benchmarks and support the continued adoption of sirolimus-based drug-coated balloon technology for percutaneous coronary revascularization in appropriately selected patients.

Evaluating the association between inflammatory markers and glycemic control status in type 2 diabetes mellitus patients: a tertiary care centre experience

2026-09-25T06:48:49+0530

Background: Type 2 diabetes mellitus is a chronic, multifactorial metabolic disease in which systemic inflammation plays a key role in the pathogenesis of insulin resistance. This study aimed to compare serum concentrations of ferritin, hs-CRP, IL-6, TNF-α, and IFN-γ between type 2 diabetes mellitus patients and matched healthy controls, and to determine their correlation with glycated haemoglobin (HbA1c) and fasting insulin levels.

Methods: A case-control study was conducted comprising 50 patients with type 2 diabetes mellitus and 50 age- and sex-matched healthy controls under fasting conditions. Serum levels of HbA1c, fasting insulin, ferritin, hs-CRP, IL-6, TNF-α, and IFN-γ were measured. Intergroup comparisons were evaluated using the Mann–Whitney U test, and correlations with HbA1c and insulin were assessed using Spearman's rank correlation.

Results: Serum levels of ferritin, hs-CRP, IL-6, and TNF-α were significantly higher in type 2 diabetic patients than in healthy controls (p<0.001), whereas IFN-γ levels showed no significant intergroup difference (p=0.515). Serum ferritin demonstrated a statistically significant positive correlation with both HbA1c (rho=0.38, p=0.007) and fasting insulin (rho=0.33, p=0.021). In contrast, serum hs-CRP (rho=0.13, p=0.368 with HbA1c; rho=0.19, p=0.193 with insulin), IL-6 (rho=-0.01, p=0.952 with HbA1c; rho=-0.11, p=0.462 with insulin), TNF-α (rho=0.11, p=0.448 with HbA1c; rho=0.13, p=0.364 with insulin), and IFN-γ (rho=0.20, p=0.154 with HbA1c; rho=0.09, p=0.538 with insulin) showed no significant correlation with either HbA1c or fasting insulin levels (p>0.05).

Conclusions: Chronic systemic inflammation is pronounced in type 2 diabetes mellitus. Among the evaluated inflammatory biomarkers, serum ferritin uniquely correlates with both glycemic control and circulating insulin levels, highlighting its practical clinical utility in monitoring subclinical metabolic decompensation, while acute-phase cytokines reflect tonic inflammatory activation rather than direct glycemic fluctuations.

Clinicopathological spectrum of renal biopsies at a tertiary care hospital in South India: a cross-sectional study

2026-09-25T06:48:48+0530

Background: Renal biopsy provides definitive tissue-based diagnosis in patients with suspected intrinsic renal disease, and its spectrum varies geographically and by referral pattern. Data from South Indian tertiary-care centers remain limited. This study evaluated the clinical presentation, biochemical profile, and histopathological spectrum of renal biopsies at a tertiary-care hospital in Davangere, Karnataka.

Methods: This hospital-based cross-sectional study included 30 consecutive patients undergoing native percutaneous renal biopsy between July 2022 and June 2023. Demographic, clinical, and laboratory parameters were recorded, biopsies evaluated by light microscopy, and histopathological diagnoses assessed descriptively against presenting renal syndromes.

Results: Mean age was 39.9±16.3 years; 17 (56.7%) were male. Pedal edema was present in 25 (83.3%) and hematuria in 15 (50.0%); 13 (43.3%) had diabetes and 9 (30.0%) hypertension. Asymptomatic microscopic hematuria/proteinuria, macroscopic hematuria, and nephrotic syndrome each accounted for 6 (20.0%), while nephritic syndrome, rapidly progressive glomerulonephritis, and acute kidney injury each accounted for 4 (13.3%). Membranous nephropathy was the commonest diagnosis (9, 30.0%), followed by IgA nephropathy (6, 20.0%); diabetic nephropathy and acute tubular injury/necrosis each accounted for 4 (13.3%). Six patients (20.0%) had nephrotic-range proteinuria, and among 13 diabetic patients, only 4 had diabetic nephropathy while 9 had other renal lesions.

Conclusions: The renal biopsy spectrum in this cohort was heterogeneous, with membranous nephropathy and IgA nephropathy the most frequent diagnoses. The frequent occurrence of alternative renal lesions among diabetic patients highlights the value of biopsy when the clinical diagnosis does not adequately explain the renal presentation. These findings provide locally relevant clinicopathological data from South India.

Silent but not harmless: asymptomatic hypertension, medication non-adherence and complications in a Rural Punjab outreach population

2026-09-30T09:53:47+0530

Background: Hypertension is often symptomless and consequently can go diagnosed until it accelerates and causes medical emergencies. This study determined the prevalence of hypertension, presence of symptomless cases, adherence to antihypertensive medications, complications and awareness among adults residing in outreach camps in two rural villages in Sangrur, Punjab.

Methods: This was a descriptive cross-sectional study undertaken between 2024 to 2026, to evaluate adults 18 years and above, residing in outreach camps in Mehlan and Kheri. Descriptive statistics and chi-square/Fisher’s exact test were done. In a univariate analysis, lack of adherence was assessed against other variables. Logistic regression was done to evaluate the effect of independent variables. A p value of less than 0.05 was taken as significant.

Results: Of the 300 participants, 182 (60.7%) had hypertension. Of these, 90 (49.5%) were previously undiagnosed. Of the 92 hypertensive patients, 27 (29.3%) were non-adherent to their medication. Of the 92 hypertensive patients, 106 (58.2%) had at least one medical complication. In the univariate analysis, lack of adherence was not significant (OR=2.29, 95% CI=0.92, 5.74). After controlling for other variables (AOR=3.16, 95% CI=1.04, 9.59), lack of adherence and old age (≥60 years) were significantly associated with medical complications.

Conclusions: The study participants were largely hypertension diagnosis and medication adherence. As such, there is justification for large scale hypertension diagnosis and medication adherence interventions in similar rural setups. The findings are applicable to other rural areas of Punjab. The study revealed inadequate diagnosis and treatment of hypertension among outreach camp participants.

Decoding Candida-speed and accuracy in species identification: a study from a tertiary care hospital in Western Vidarbha

2026-09-30T09:53:45+0530

Background: Candida infections encompass a clinical spectrum ranging from superficial mucocutaneous lesions to life-threatening disseminated candidemia in immunocompromised hosts. Over the years, clinical distribution of Candida species has significantly evolved, shifting from the traditional dominance of Candida albicans to an increasing isolation rate of diverse non-albicans Candida (NAC) species. This study was conducted to isolate Candida spp. from various clinical specimens, to speciate and study the distribution of Candida albicans and non-albicans Candida spp. among various clinical specimens.

Method: A total of 464 samples were included in the study form January 2024 to June 2025. Samples included urine, blood, sputum, high vaginal swab, pus etc. Demographic details of patients were recorded. KOH, gram staining, germ tube techniques were done preliminarily. Culture on Sabourauds dextrose agar, morphology identification by Dalmau plate method and CHROM agar identification was done.

Results: Out of 464 Candida spp. isolated, highest infection (40.5%) seen in the 41-60 years age group, with female preponderance. The highest number of Candida isolates were obtained from urine samples 37.7% (n=175), followed by 28.2% (n=131) from sputum. non-albicans Candida spp. was 244 (53%) as compared to Candida albicans 220 (47%). C. troplicais predominated from all clinical samples and was commonest NAC spp. from urinary and respiratory tract.

Conclusion: The rise of non-albicans Candida species underscores a global shift toward higher drug resistance. Precise speciation is essential to identify these distinct resistance profiles, allowing clinicians to start appropriate empirical and target therapy.

Evaluation of plasma leakage and its clinical spectrum in pediatric dengue patients in a tertiary care hospital of Bangladesh

2026-09-30T09:54:10+0530

Background: Dengue is a major public health problem in Bangladesh and plasma leakage is the hallmark of severe disease in children. Early recognition is essential for timely intervention. To evaluate the prevalence, clinical spectrum and associated factors of plasma leakage among pediatric dengue patients admitted to a tertiary care hospital in Bangladesh.

Methods: This retrospective observational study included 130 children aged ≤17 years with NS1-confirmed dengue admitted to the Department of Pediatrics, Delta Medical College and Hospital, from Jun-2025 to May-2026. Children referred after intravenous fluid replacement elsewhere or presenting with multi-organ failure were excluded. Hospital records were analyzed using SPSS, applying the chi-square and independent-samples t-tests.

Results: Among 130 children, 65.4% were male and 35.2% were aged 10–17 years. Plasma leakage (pleural effusion and/or ascites) was identified in 6.9% of patients and abnormal ultrasonographic findings in 10.8%. According to WHO classification, 64.6% had dengue without warning signs, 24.2% had dengue with warning signs and 11.1% had severe dengue. Persistent vomiting was the only clinical feature significantly associated with plasma leakage (21.4% vs. 5.2%, χ²=5.123, p=0.024). Hemoglobin and hematocrit were higher in children with plasma leakage, but the differences were not statistically significant.

Conclusions: Plasma leakage occurred in a small proportion of hospitalized pediatric dengue patients, with persistent vomiting the only clinical feature significantly associated with it. Careful monitoring of warning signs and early ultrasonographic assessment may facilitate prompt detection of plasma leakage.

Predictive value of pre-induction cerebroplacental ratio for caesarean delivery due to foetal distress following induction of labour: a prospective observational study

2026-09-30T09:53:44+0530

Background: Induction of labour is a commonly performed obstetric intervention when delivery is considered safer than continuation of pregnancy. Traditional parameters like the amniotic fluid index, estimated foetal weight and modified bishop score have been used to identify the development of foetal distress. This study focuses on the Cerebroplacental Ratio derived from Doppler assessment of the middle cerebral and umbilical arteries which provides information regarding foetal adaptation and the risk of foetal compromise during labour.

Methods: A prospective observational study was conducted over 12 months among 305 antenatal women with singleton, cephalic pregnancies beyond 32 weeks of gestation undergoing induction of labour. Pre-induction Cerebroplacental ratio (CPR), amniotic fluid index (AFI), estimated foetal weight (EFW), and Modified Bishop Score were assessed within 24 hours before induction. The predictive performance of CPR was compared with AFI, EFW and Modified Bishop Score using appropriate statistical and diagnostic measures.

Results: Among 305 women undergoing induction of labour, 213 (70%) had normal vaginal delivery and 92 (30%) underwent caesarean section. A CPR ≤1.1 was significantly associated with caesarean delivery and adverse neonatal outcomes. CPR ≤1.1 was also significantly associated with Apgar score <7 at 1 and 5 minutes. Among the parameters studied, CPR showed the highest sensitivity (45.54%), positive predictive value (58.08%) and diagnostic accuracy (39.02%) for adverse outcome.

Conclusion: Pre-induction cerebroplacental ratio was found to be a better predictor of adverse perinatal outcome compared with AFI, estimated foetal weight and Modified Bishop Score in women undergoing induction of labour.

Temporal trends and demographic disparities in mortality from chronic renal failure with cerebrovascular disease as a contributing cause – a retrospective, population-based observational study in the United States, 1999-2020

2026-09-30T10:10:07+0530

Background: Chronic renal failure (CRF) is a major cause of mortality worldwide. However, most studies focus on CRF alone and overlook the contribution of coexisting conditions.

Methods: A retrospective population-based study was conducted using the CDC wonder multiple cause of death database from 1999-2020. Deaths among U.S adults aged ≥25 years with chronic renal failure (ICD-10: n18) as the underlying cause and cerebrovascular disease (ICD-10: i60-i69) as a contributing cause were identified. Mortality trends were analyzed by sex, race, urbanization status, and place of death. Age-adjusted mortality rates and annual percentage changes were calculated using joinpoint regression analysis.

Results: A total of 22,719 deaths were identified, corresponding to a crude mortality rate of 5.1 per million population. The age adjusted mortality rate (AAMR) increased significantly from 2013-2020 (annual percentage changes (APC) +2.9%). Females accounted for 52.1% of deaths and males for 47.9%. Most deaths occurred among whites (68.7%) and black individuals (27.0%). Metropolitan areas accounted for 81.7% of deaths, while inpatient facilities represented the most common place of death (52.3%). Mortality increased among black populations from 2005 (APC +2.6%) and among whites from 2012 (APC +3.1%).

Conclusions: Mortality associated with CRF and cardiovascular disease (CVD) increased after 2013, with substantial disparities across racial, sex, and urbanization groups.

Study of the efficacy of a single 600 µg oral misoprostol dose for full uterine evacuation in cases of blighted ovum and missed abortions

2026-09-30T10:09:57+0530

Background: Missed abortions are common and represent a signifiant gynaecological emergency workload. The conventional method of uterus evacuation by vacuum aspiration is associated with morbidity and mortality. The search for a non-invasive method with high success rate and patient acceptability has led to the use of prostaglandins in varied conditions.

Methods: Present study was conducted with 50 cases. Patients who complained of amenorrhoea lasting fewer than 12 weeks and had ultrasonographic evidence of blighted ovum and/or missed abortions were included in this prospective trial. The study comprised patients who had been diagnosed with blighted ovum or missed abortion by ultrasonography, had amenorrhoea for fewer than 12 weeks, and were willing to receive medical treatment. The trial excluded patients with undiagnosed vaginal bleeding, amenorrhoea lasting longer than 12 weeks, incomplete or inevitable abortion, asthma, a history of medication responses to prostaglandins, signs of pelvic infection and/or sepsis, haemodynamic instability, or shock.

Results: 24.8 years mean maternal age and 8.4 weeks mean gestational age was observed. 56% cases were observed with surgical evacuation. Most of the cases i.e. 84% cases were seen with lower abdominal pain. Statistically no significant difference was observed in Hb.

Conclusions: When treating a blighted ovum with oral misoprostol 600 µg, their efficacy is nearly the same. Oral misoprostol is a useful treatment for blighted ovum.

Effectiveness of three-dimensional myofascial release on pain, disability and functional performance in physiotherapy students with forward head posture: a pre and post experimental study

2026-09-30T10:09:51+0530

Background: Forward head posture (FHP) is one of the most common postural abnormalities among young adults and physiotherapy students due to prolonged smartphone use, poor ergonomics, and sedentary lifestyle. FHP is associated with pain, neck disability, reduced mobility, and impaired functional performance. Three-dimensional myofascial release (3D-MFR) is a multidirectional fascial release technique designed to reduce fascial restrictions and improve postural alignment. The aim was to find out the effectiveness of 3D-MFR on pain, disability and function with FHP in physiotherapy students of Srinivas Institute.

Methods: A pre- and post-experimental study was conducted among 27 physiotherapy students aged 18-25 years with forward head posture at Srinivas University, Mangaluru. Participants underwent 3D-MFR intervention targeting suboccipital muscles, upper trapezius, levator scapulae, pectoralis major and minor, and sternocleidomastoid muscles. Outcome measures included numeric pain rating scale (NPRS), neck disability index (NDI), craniovertebral angle (CVA), tragus-to-wall test, and global rating of change (GROC) scale. Statistical analysis was performed using Wilcoxon signed-rank test and paired sample t-test.

Results: Significant improvements were observed in all outcome measures following intervention. NPRS (p=0.006), NDI (p<0.001), CVA (p<0.001), tragus-to-wall test (p<0.001), and GROC scores (p<0.001) demonstrated statistically significant improvement after 3D-MFR intervention.

Conclusions: Three-dimensional myofascial release was effective in reducing pain, improving disability, correcting forward head posture, and enhancing functional performance among physiotherapy students with FHP.

Computed tomography derived imaging surrogates as pre-operative predictors of gall bladder pathologies in cases of cholecystic mural thickening

2026-09-30T10:09:20+0530

Background: Diffuse or focal wall thickening wall is a common manifestation of most gall bladder pathologies. Identification of features to differentiate malignant from benign causes is hence of prime importance in clinical practice.

Methods: Contrast enhanced computed tomography (CT) scan was performed on 100 patients who revealed a gallbladder wall thickening (>5 mm) on screening sonography. The imaging features were charged with the intent of radiomic analysis and post-operative histopathologic correlation was done.

Results: The average wall thickness was 22.28±12.51 mm in malignancies and 13.5±6.6 mm in benign conditions with the difference being highly significant (p<0.05). The gallbladder wall thickening was a common feature (76.2%) in benign group while wall thickening with associated focal mass lesion was common (59.5%) in malignant group. Morphologically inhomogeneous lesions were more prone to develop malignancy (53%) compared to benign lesions in which homogeneous wall thickening (52.4%) was common. Type I (39.2%) and type II (39.2%) was seen in malignant conditions, while type I pattern was also seen in xanthogranulomatous cholecystitis (66.7%). Type V was common in benign cases (23.8%).

Conclusions: Amongst the charted radiomic features wall thickening and pattern of wall thickening were the most significant with sensitivity and specificity of 59.49% and 76.19% respectively. The next most common feature was pattern of enhancement on post contrast CT scan.

Clinical study on infections with special reference to tubercular infection in post-kidney transplant recipients from Western India

2026-09-30T10:09:09+0530

Background: Infections remain a major cause of morbidity and mortality following kidney transplantation. The spectrum of infectious complications differs between developing and developed countries, with tuberculosis (TB) continuing to pose a significant challenge in endemic regions such as India. Data on post-transplant infections from western India are limited. Objectives were to evaluate the spectrum of infections, with special reference to tuberculosis, among kidney transplant recipients and assess their impact on graft and patient outcomes.

Methods: This retrospective and prospective observational study was conducted at the department of nephrology, Goa Medical College, Goa, India. Sixty-two kidney transplant recipients transplanted between August 2018 and August 2025 were included. Demographic, transplant-related, infectious, tuberculosis-related, graft, and patient outcome data were analyzed. Risk factors for post-transplant tuberculosis were assessed using univariate analysis.

Results: Of 62 recipients, 48 (77.4%) developed at least one infectious episode, accounting for 84 infectious events. Urinary tract infection was the most common infection (32.1%), followed by lower respiratory tract infection (26.2%) and tuberculosis (10.7%). Tuberculosis occurred in 9 recipients (14.5%), with extrapulmonary disease predominating (55.6%). Two-thirds of cases developed within two years of transplantation. Low socioeconomic status (OR 18.67, p=0.002) and chronic allograft nephropathy (OR 4.74, p=0.04) were significantly associated with post-transplant tuberculosis. Chronic graft dysfunction occurred in 30.6% and overall mortality was 29%. Mortality among tuberculosis patients was 88.9%.

Conclusions: Infectious complications remain highly prevalent after kidney transplantation in western India. Tuberculosis continues to be associated with substantial graft dysfunction and mortality, highlighting the need for early diagnosis, vigilant surveillance, and prompt management.

Role of high-performance liquid chromatography in detection of hemoglobinopathies: a cross-sectional study

2026-09-30T10:09:04+0530

Background: Hemoglobinopathies are a group of inherited disorders affecting the public health in many parts of the world, particularly in South Gujarat region for structure or production of haemoglobin (Hb). Hemoglobinopathies are disorders having high mortality ratio in regions with high prevalence carrier state. Objectives were to determine the frequency of hemoglobinopathies in south Gujarat community by using high performance liquid chromatography (HPLC) test, to study haemoglobin disorder among all ages and gender wise distribution of haemoglobinopathies, to study the incidence of haemoglobinopathies in different castes in patients and to compare the results of present study with the results of other authors similar studies.

Methods: Total 740 cases were observed on Bio-Rad D-10 HPLC, a platform for screening haemoglobin variant and hemoglobinopathies. Cases that were diagnosed over one year at SMIMER hospital, Surat and were taken for study. Each case evaluated with clinical features, hematological parameters and its geographical pattern.

Results: The cases included a series of hemoglobinopathies like sickle cell disease (SCD), sickle cell trait (SCT) HbS, beta-thalassemia trait/major/minor and intermedia, HbE disease and other rare diseases etc. Common clinical condition included low Hb, fever, cold, joint pain, abdominal pain, splenomegaly. Family study was taken into consideration for accurate diagnosis.

Conclusions: Studying spectrum of hemoglobinopathies diagnosed by HPLC helps improving the prevalence and distribution of various haemoglobin disorders. It gives accurate quantitative measurements. Early diagnosis and management of hemoglobinopathies improve quality of life and reduce the risk of morbidity.

A community cross-sectional study to assess the awareness and perception among women regarding contraceptive methods in Gautam Budh Nagar, U.P.

2026-09-30T10:08:56+0530

Background: Pregnancy and childbirth carry risks for both morbidity and mortality. Couples who use contraceptives to avoid pregnancy may face some health risks, but there are also important non-contraceptive health benefits. The present study aimed to assess the awareness and perception among women regarding contraceptive methods.

Methods: A community based cross-sectional study was conducted in the year 2023 and non-probability purposive sampling technique was chosen to recruit 200 the women of age between 18-28 years. A structured questionnaire was adopted to gather data. Descriptive statistics like Frequency, percentage, mean and standard deviation and inferential statistics of chi square and Karl Pearson correlation coefficient was used in the study.

Results: Among the 200 women, 39.1% are between the ages of 25 and 26, 89.6% are Hindu, 52.5% are from nuclear families, 48.5% have secondary education, 85.6% are housewives, 41% have an annual income between 10,000 and 15,000, and 45.5% have learned about contraception from the media whereas 25.7% learnt from friends. 20.5% of women scored a sufficient level of awareness. According to the perception score, 74.5% have a favourable perception. The correlation coefficient turned out to be (r)= 1.00, which shows that there was a positive relationship between level of awareness and level of perception.

Conclusions: All women of reproductive age should understand about contraception so they are better prepared to make wise and healthy decisions. Improving awareness and perception regarding the use of contraception in rural communities necessitates enhancing access to and education regarding reproductive health among adolescents.

Association of psychosocial factors with postpartum depressive symptoms among mothers in urban slums of Mumbai

2026-09-30T10:08:52+0530

Background: Postpartum depression affects mothers emotional well-being, bonding with her baby, and ability to cope after childbirth. This study aimed to assess postpartum depressive symptoms among mothers in the urban slums of Mumbai and examine its links with self-esteem, perceived social support and Maternal age.

Methods: The present study adapted quantitative method, cross sectional, correlational research design with 151 women between 4 weeks to 1 year postpartum were assessed using a pre-tested questionnaire. Hindi validated tools like Edinburgh postnatal depression scale, Rosenberg self-esteem scale, and multidimensional perceived social support scale were used, data were analyzed to determine the prevalence of postpartum depressive symptoms and its association with the opted factors.

Results: Research focused on how maternal age, self-esteem, and perceived social support associate with postpartum depression (PPD) in 151 mothers residing in urban slums of Mumbai. Around 56.3% of these mothers depicted symptoms of PPD, highlighting that a large number were at average to high risk. This study showed that mothers with lesser self-esteem had considerably higher levels of depressive symptoms. Support from family and partners also aided in lowering depressive symptoms, while support from friends and maternal age highlighted no significant difference. The strongest predictor overall was self-esteem, making up about 22% of the variation in depression scores. These findings emphasized the importance of establishing self-esteem and enhancing family and partner support networks for new mothers in low-income communities.

Conclusions: These findings highlight the need for targeted psycho social interventions to mitigate PPD risks among urban slum mothers, informing scalable public health strategies in low-resource settings.

Observational study to assess efficacy and safety of Bifidobacterium longum W11 + fructo-oligosaccharide combination in patients with irritable bowel syndrome

2026-09-30T10:08:47+0530

Background: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder. Synbiotics, combinations of probiotics and prebiotics offer a promising therapeutic approach, particularly formulations involving Bifidobacterium longum W11 and fructo-oligosaccharides (FOS). To assess the improvement in global IBS symptoms compared to baseline.

Methods: A prospective, single-arm, open-label observational study was conducted involving 50 patients with IBS (predominantly IBS-D and IBS-M subtypes). Participants received a daily oral dose of Bifidobacterium longum W11 (5 billion CFU) and FOS (2.5 gm) for 30 days. Clinical outcomes were assessed using the irritable bowel syndrome symptom severity scale (IBS-SSS), and patient-reported stool frequency and consistency verbal feedback. Evaluations were performed at baseline, day 15, and day 30. Continuous variables are summarized using N, mean, SD, median, minimum, and maximum/range. Categorical variables were presented as number of patients and N (%) based on exposed participants.

Results: The study showed significant symptom relief; IBS-SSS scores dropped 75.6% (362.6 to 90.4, p<0.001) by day 30, with major improvements in abdominal pain (−93-94%), distension (−74%), bowel habit dissatisfaction (−65%), and QoL interference (−63%). Severity shifted from predominantly severe to mild/normal. Stool normalized in all patients, frequency reduced from 5 to 2 per day (p<0.001), and no adverse events occurred.

Conclusions: The synbiotic combination of Bifidobacterium longum W11 and FOS demonstrated significant clinical benefits by helping to reduce IBS symptoms, normalizing stool patterns, and improving quality of life over a 30-day period.

Patterns, management and outcomes of chest trauma in a rural tertiary care hospital in North Kashmir: a prospective observational study

2026-09-30T10:08:43+0530

Background: Chest trauma remains a critical cause of morbidity and mortality, especially in rural and resource-limited settings. The heterogeneity in injury mechanisms and limitations in emergency infrastructure often pose major challenges in timely diagnosis and management. In North Kashmir, civilian trauma accounts for the majority of cases, while conflict-related injuries contribute a smaller but clinically relevant subset.

To analyze the clinical profile, modes of injury, types of chest injuries, management strategies and outcomes of patients presenting with chest trauma at a rural tertiary care hospital GMC Baramulla in North Kashmir over a five-year period.

Methods: This is a Prospective observational study of 430 patients presenting with chest trauma from July 2020 to July 2025 from GMC Baramulla. Data on demographics, type of trauma, injury patterns, treatment modalities, complications and hospital stay were analyzed using descriptive statistics and expressed as frequencies and percentages using standard statistical software.

Results: Blunt trauma accounted for 90.6% of cases, predominantly affecting males (74.4%). Road traffic accidents were the leading cause (46.5%), followed by falls (42.7%). Rib fractures and pulmonary contusions were the most common injuries. Most patients were managed conservatively (53.4%), while 30.2% required intercostal tube drainage and 15.8% underwent thoracotomy. Major morbidities included bronchopleural fistula (1.3%) and empyema (0.2%). More than half of the patients (58.1%) were discharged within five days.

Conclusions: In rural healthcare settings, structured protocols and timely interventions can effectively manage chest trauma with favorable outcomes. Strengthening trauma systems and referral pathways can further improve care delivery.

Association of transfusion burden with serum ferritin among patients with transfusion-dependent thalassemia: a cross-sectional study from Bangladesh

2026-09-30T09:54:06+0530

Background: Regular red-cell transfusion is essential for patients with transfusion-dependent thalassemia (TDT) but causes progressive iron loading. Where MRI-based tissue iron assessment is not routinely available, serum ferritin remains a practical marker. This study evaluated the association between transfusion burden and serum ferritin in patients with TDT.

Methods: This cross-sectional study included 150 patients with TDT at Sirajganj Medical College Hospital, Bangladesh, from July 2025 to June 2026. Transfusion exposure, pre-transfusion hemoglobin, thalassemia phenotype, chelation adherence, splenectomy status, and serum ferritin were assessed. Associations were examined using Spearman correlation and multivariable linear and logistic regression.

Results: Mean age was 17.06±6.87 years; 60.7% were male. Median annual transfusion burden was 144.08 ml/kg/year (IQR 126.95–161.41) and median ferritin was 1965.00 ng/mL (IQR 1329.28–2723.51); 31.3% had ferritin ≥2500 ng/mL. Annual transfusion burden correlated positively with ferritin (coefficient=0.231, p=0.004). After adjustment, each additional 10 ml/kg/year was associated with 5.9% higher ferritin (B=0.057, 95% CI 0.030–0.083; p<0.001) and 27% higher odds of ferritin ≥2500 ng/mL (aOR 1.27, 95% CI 1.08–1.50; p=0.004). Poor chelation adherence was strongly associated with ferritin ≥2500 ng/mL (aOR 6.92, 95% CI 2.84–16.85; p<0.001).

Conclusions: Greater transfusion burden and poor chelation adherence were independently associated with higher serum ferritin. Tracking transfusion volume, serial ferritin, and chelation adherence may improve iron-overload monitoring in resource-constrained TDT care.

Study of different aspects of polyendocrine metabolic ovarian syndrome in females of reproductive age group

2026-09-30T10:08:33+0530

Background: PMOS is most common hormonal disorder in females of reproductive age group. In PMOS many pearl sized cysts are formed in the ovaries. These cysts contain immature eggs. High LH, low FSH, high Testosterone in PMOS causes changes in physical appearance, irregularity in menstrual cycle and if not treated in time, leads to diabetes and strokes, obesity, mood disorder, endometrial cancer and sleep apnoea. The aim of the present study was to find out the clinical features, biochemical and hormonal profile of patients with PMOS.

Method: An observational, comparative study was conducted in the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynaecology, Govt. Medical College and Hospital, Amritsar after taking approval from institutional ethical committee. The study group included 25 patients clinically diagnosed as patients of polycystic ovary disease, between age group 14-35 years. 25 age and sex matched healthy volunteers were included as control. Result: Levels of LH, Prolactin, Testosterone were increased significantly in PMOS patients whereas changes in TSH were not significant. The FSH was significantly lower in the study group. Levels of Insulin and C-peptide were raised in PCOS patients.

Conclusion: From present study it is observed that PMOS patients are usually overweight, have menstrual irregularities, difficulty in conception, have oily skin, acne, hirsutism, hyperandrogenaemia, insulin resistant and have altered LH to FSH ratio, patients also have sleep disturbances, mood swings. The present study concludes that PMOS not only affect the physical quality of life, but it also affects mental and social life.

Influence of anemia on levels of glycosylated hemoglobin/HbA1C

2026-09-30T09:59:54+0530

Background: Glycated hemoglobin (HbA1c) is the standard biomarker for assessing long-term glycemic control in patients with diabetes mellitus. However, several hematological conditions, particularly iron deficiency anemia (IDA), may influence HbA1c values independently of blood glucose levels, potentially leading to inaccurate assessment of glycemic status.

Methods: This case-control study included 60 participants comprising 30 diabetic patients with anemia (cases) and 30 diabetic patients without anemia (controls). HbA1c was measured by high-performance liquid chromatography (HPLC), plasma glucose, hemoglobin concentration, and other hematological parameters were assessed. Statistical analyses were performed to compare the two groups. Following ethical guidelines, informed consent was obtained from all participants.

Results: HbA1c levels were significantly higher in diabetic patients with anemia compared with non-anemic diabetic patients, despite comparable plasma glucose levels. These findings suggest that iron deficiency anemia may falsely elevate HbA1c values, likely due to prolonged red blood cell survival, allowing greater glycation of hemoglobin.

Conclusions: Iron deficiency anemia significantly affects HbA1c levels in diabetic patients and may lead to misinterpretation of glycemic control if HbA1c is used to monitor. Routine screening and appropriate management of anemia should be done to improve the accuracy of HbA1c interpretation. In patients with anemia, alternatives of glycemic control, such as fructosamine or continuous glucose monitoring (CGM), should be considered. Further research is warranted to evaluate the effects of anemia and to assess changes in HbA1c following anemia correction, thereby enhancing diabetes monitoring.

A prospective, two arm, observational study to analyze the factors predicting the role of double J stenting technique in management of acute pyelonephritis

2026-09-30T10:03:32+0530

Background: Acute pyelonephritis is a severe urinary tract infection with variable presentation, ranging from mild illness to septic shock. While most patients respond to antimicrobial therapy, some require early urological intervention such as Double J (DJ) stenting. Identifying predictors for intervention is crucial. Aim was to assess factors determining the need for DJ stenting and analyse the clinical profile and predisposing factors in patients with acute pyelonephritis.

Methods: This prospective study was conducted over one year at a tertiary care centre and included 60 patients diagnosed with acute pyelonephritis. Patients were divided into Group A (conservative management) and Group B (DJ stenting). Clinical features, laboratory parameters, imaging findings, and treatment outcomes were analysed. Statistical analysis used chi-square and unpaired t tests, with p<0.05 considered significant.

Results: Most patients were aged 51-70 years, with female predominance (61.7%). Age, gender, diabetes, and comorbidities did not differ significantly between groups. Significant predictors of DJ stenting included chills (p=0.004), flank pain (p=0.035), lower urinary tract symptoms (LUTS) (p=0.009), nausea/vomiting (p=0.045), high-grade fever >100.4°F (p=0.001), persistent tachycardia (p=0.001), tender palpable kidney (p=0.001), pyuria (p=0.0001), thrombocytopenia (p=0.001), hyponatremia (p=0.004), and HbA1c >9% (p=0.001). Elevated creatinine, total leukocyte count, and positive blood and urine cultures were also significantly associated with stenting (p=0.001).

Conclusions: Multiple adverse clinical and laboratory parameters predict failure of conservative management. Patients with three or more poor prognostic factors may benefit from early DJ stenting, potentially improving outcomes and preventing complications.

Quality of life and its determinants among pulmonary tuberculosis and multidrug-resistant tuberculosis patients receiving DOTS therapy in Lucknow District, Uttar Pradesh: a cross-sectional study

2026-09-30T10:01:52+0530

Background: Tuberculosis (TB) continues to be a major public health challenge in India despite substantial progress under the National Tuberculosis Elimination Programme (NTEP). While treatment outcomes are commonly assessed using bacteriological and clinical indicators, the impact of TB on patients’ quality of life (QoL) remains inadequately explored. Multidrug-resistant tuberculosis (MDR-TB) further compounds the physical, psychological, and social burden experienced by patients. Objectives were to assess the quality of life among pulmonary tuberculosis (PTB) and multidrug-resistant tuberculosis (MDR-TB) patients and to identify determinants influencing QoL in Lucknow district, Uttar Pradesh.

Methods: A cross-sectional analytical study was conducted among 214 tuberculosis patients receiving treatment under urban DOTS centres of Lucknow district. The study period was September 2014 to October 2015. Of the total participants, 157 were PTB patients and 57 were MDR-TB patients. Data regarding socio-demographic characteristics, treatment history, psychosocial issues, stigma, and healthcare-related factors were collected using a structured questionnaire. Quality of life was assessed using the medical outcomes study short form-36 (SF-36). Multiple linear regression analysis was performed to identify predictors of QoL.

Results: PTB patients demonstrated significantly better QoL scores compared with MDR-TB patients (42.7±18.8 versus 34.6±17.8). Physical health was more adversely affected than mental health in both groups. Significant differences were observed between PTB and MDR-TB patients in physical functioning, role physical, bodily pain, general health, vitality, and social functioning. Poor social relationships emerged as the strongest predictor of reduced QoL among PTB patients, whereas unsatisfactory DOTS centre services were the strongest predictor among MDR-TB patients.

Conclusions: Tuberculosis significantly impairs quality of life, with MDR-TB patients experiencing a greater burden. Psychosocial support, stigma reduction, strengthening DOTS services, and improving patient-provider interactions should be integrated into TB control strategies to enhance patient-centred outcomes.

Beneath the bark: mapping dog bite patterns and injury severity – a cross-sectional study at rural health training centre Santhpur, Bidar, Karnataka

2026-09-30T10:03:28+0530

Background: Rabies is a vaccine-preventable, zoonotic, viral disease that invariably affects the central nervous system, with dogs responsible for virus transmission in up to 99% of human cases. India remains endemic for rabies and accounts for approximately 36% of global rabies deaths. Objectives were to describe the pattern and severity of injuries among patients presenting with dog bite complaints to rural health training centre.

Methods: A prospective cross-sectional study was conducted from February 2026 to May 2026 at RHTC Santhpur, Bidar. All 63 patients presenting with dog bite complaints were enrolled and data were collected using a structured questionnaire covering socio-demographic profiles, bite characteristics, wound categorization, and post-exposure management. Analysis was performed using Microsoft Excel 2022.

Results: Of the 63 patients, 46 (73%) were male. The most affected age group was 6-25 years (42.86%). The majority of bites occurred in the evening (38.1%) and stray dogs accounted for (52.4%) of bites. Unprovoked bites were predominant (77.78%). Lower limbs were the most commonly bitten site (71.4%). Category II wounds predominated (85.7%), while category III wounds constituted (14.3%). First aid with soap and water was performed by (98.4%) of victims. However, only (11.1%) of category III patients received rabies immunoglobulin (RIG).

Conclusions: Dog bites predominantly affect young, productive-age males, with a near-equal burden from stray and pet dogs. The critical gap in RIG availability for category III patients represents a serious public health concern requiring urgent systemic intervention.

Effect of neural mobilization of musculocutaneous nerve on spasticity of elbow flexors in post-stroke patients: a pilot study

2026-09-30T10:03:49+0530

Background: While neural mobilization shows promise, its effect on the musculocutaneous nerve remains underexplored. This pilot study evaluated the clinical effectiveness of musculocutaneous nerve mobilization on elbow flexor spasticity in chronic post-stroke individuals.

Methods: Eighteen chronic stroke survivors with elbow flexor spasticity were randomly assigned to Group A (experimental, n=9) or Group B (control, n=9). Group A received musculocutaneous nerve mobilization plus concurrent physiotherapy; Group B received structured elbow flexor stretching plus concurrent physiotherapy. Both interventions were delivered 5 times weekly for 6 weeks (45 minutes/ session). Outcome measures included surface electromyography (sEMG) root mean square difference (RMSD) of the biceps and brachialis, the Modified Ashworth Scale (MAS), and goniometric range of motion (ROM) for elbow flexion and extension lags.

Results: Both groups demonstrated statistically significant within-group improvements across all clinical and objective metrics (p<0.05 for MAS; p<0.001 for sEMG and ROM). Between-group analyses did not reach statistical significance for any outcome measure (p>0.05). However, Group A demonstrated a distinct clinical trend toward superior outcomes, achieving greater mean reductions in Biceps sEMG (7.57 μV to 4.80 μV vs. Group B: 8.36 μV to 6.68 μV) and greater decreases in flexion (15.22)^∘ with 15.22° and (7.33)^∘ with 7.33°.

Conclusion: Musculocutaneous nerve mobilization is a safe, clinically valuable intervention for post-stroke elbow spasticity. Though between-group statistical significance was limited by the pilot sample size, the technique showed superior descriptive clinical trends compared to stretching.

A smartphone-based assessment of hearing impairment among medical students of a medical college, Bidar: a cross-sectional study

2026-09-30T10:03:47+0530

Background: Hearing loss is increasingly prevalent among young adults, often due to frequent use of personal audio devices. Early assessment is essential for identifying hearing impairment and implementing preventive strategies. This study evaluated hearing levels among medical students using the hearWHO application. Objective was to estimate the prevalence of hearing impairment using a smartphone-based tool and to assess the associated factors among medical students.

Methods: A cross-sectional study was conducted among 140 medical students selected through stratified random sampling. Each academic year (1^st, 2^nd, 3^rd, and final year) constituted a stratum. Hearing was assessed using the hearWHO application, with scores categorized as >75 (excellent), 50-75 (moderate), and <50 (low hearing).

Results: Total 140 study participants were included. On assessment with hearWHO application, 28 (20%) were in the score category of >75, 109 (77.9%) in score category 50-75 and 3 (2.1%) in score category <50. Among the earphone users, 85 (60.7%) did not adhere to volume alert notification.

Conclusions: Most students had moderate hearWHO scores, while a small proportion exhibited low scores suggestive of hearing impairment. These findings highlight the importance of regular auditory assessment and preventive strategies, particularly among personal listening device users, for early detection and timely intervention.

Real-world practice perspectives of Indian clinicians on dual antiplatelet therapy optimization post percutaneous coronary intervention and utilization of aspirin clopidogrel fixed dose combination in secondary prevention: INDI PROLONG STUDY

2026-09-30T10:03:46+0530

Background: Background: Dual antiplatelet therapy (DAPT) is post-percutaneous coronary intervention (PCI) to prevent thrombotic events. However, optimal duration and agent choice remain debated, particularly in Indian practice. This study explored real-world clinician perspectives on DAPT optimization and the use of aspirin–clopidogrel fixed-dose combinations (FDCs).

Methods: The INDI-PROLONG study was an anonymous, cross-sectional PAN India survey conducted between June 15 and August 15, 2024. A total of 301 clinicians, including cardiologists, consulting physicians, diabetologists, and other specialists, participated. The survey assessed DAPT prescription patterns, preferred regimens, determinants of duration, and perceptions of aspirin–clopidogrel FDCs.

Results: Of 301 clinicians, 259 (86.1%) routinely prescribed DAPT post-PCI. For high thrombotic risk patients, 165 (54.8%) favored >12 months of therapy, while 136 (45.2%) recommended 12 months. Clopidogrel + aspirin was most preferred (57.8%), followed by ticagrelor + aspirin (23.9%) and prasugrel + aspirin (15.6%). Clopidogrel was prescribed to 25–50% of eligible patients by 137 (45.5%) clinicians. Key factors influencing duration included bleeding risk (48.8%), guideline recommendations (39.5%), adherence (36.5%), and thrombotic risk (32.2%). Switching from ticagrelor to clopidogrel was mainly due to bleeding (56.5%) and adverse reactions (30.6%). Cardiologists favored prolonged therapy, while consulting physicians preferred standard 12-month durations. Regional variation was noted, with northern India showing a higher preference for extended DAPT.

Conclusion: Indian clinicians demonstrate varied DAPT strategies, balancing efficacy, safety, and accessibility. Clopidogrel + aspirin remains the dominant choice. Findings highlight the need for India-specific guidelines to optimize DAPT duration and agent selection based on real-world evidence.

Endoscopic microdebrider-assisted versus conventional curette adenoidectomy in paediatric adenoid hypertrophy: a randomized controlled study

2026-09-30T09:59:52+0530

Background: To compare the clinical and endoscopic outcomes of endoscopic microdebrider-assisted adenoidectomy with conventional curette adenoidectomy in paediatric patients with symptomatic adenoid hypertrophy.

Methods: This prospective randomized controlled study was conducted in 50 children aged 5–15 years with symptomatic adenoid hypertrophy. Patients were randomly allocated into two groups of 25 each. Group A underwent endoscopic microdebrider-assisted adenoidectomy, whereas Group B underwent conventional curette adenoidectomy. Clinical symptoms, endoscopic adenoid grading, and nasal airway patency were assessed preoperatively and at postoperative days 15 and 30. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p<0.05 considered statistically significant.

Results: Complete resolution of mouth breathing, snoring, recurrent upper respiratory tract infections, and otologic symptoms was observed in all patients undergoing microdebrider-assisted adenoidectomy, whereas residual symptoms persisted in the conventional curette group. Endoscopic evaluation demonstrated complete conversion to Grade I adenoid tissue in all patients in Group A, while residual Grade II hypertrophy was observed in 44% of patients in Group B. Mean nasal airway patency improved from 39% to 92% in the microdebrider group compared with 32% to 80% in the conventional group. Both groups showed statistically significant postoperative improvement (p<0.05), with significantly better outcomes in the microdebrider-assisted group.

Conclusions: Endoscopic microdebrider-assisted adenoidectomy provides superior symptomatic relief, greater improvement in nasal airway patency, and more complete removal of adenoid tissue than conventional curette adenoidectomy. The technique is safe, effective, and offers important clinical advantages in the surgical management of paediatric adenoid hypertrophy.

A descriptive study to assess the knowledge, attitude and perception about autism spectrum disorder in children among the mother(s) of age group 25 to 35 years in Bisrakh Community, Noida, U.P.

2026-09-30T10:03:46+0530

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties in communication, social interaction, and behaviour, usually appearing during early childhood. In India, increasing numbers of children are being diagnosed with ASD, while limited awareness, inadequate services, and delayed diagnosis remain major concerns. This study aimed to assess knowledge, attitude, and perception regarding ASD among mothers aged 25-35 years in the Bisrakh Community, Noida, Uttar Pradesh.

Methods: Non-experimental descriptive research design was employed with 30 mothers’ recruited by using non – probability convenient sampling. Data were collected using a 5-point Likert scale for perception and attitude assessment and a structured questionnaire for assessing knowledge.

Results: More than half of the mothers (53.33%) had poor knowledge regarding ASD, while 46.67% had average knowledge. None demonstrated good or excellent knowledge. Regarding perception, 43.32% of mothers agreed or strongly agreed with positive statements, while 40% disagreed or strongly disagreed and 16.66% were uncertain. Attitudes were mixed, with 43.34% reporting satisfaction, 20% remaining neutral, and 36.66% expressing dissatisfaction. Overall, the findings indicate a mixed attitude among mothers regarding ASD.

Conclusions: The study concludes that mothers in the Bisrakh Community had inadequate knowledge regarding Autism Spectrum Disorder (ASD), although most demonstrated a generally positive perception and a mixed attitude towards the disorder. These findings highlighted the need for targeted awareness and educational interventions to improve mothers’ knowledge and promote more positive attitudes towards ASD, which may facilitate early identification and timely intervention for affected children.

Effect of anuloma viloma pranayama on cardiorespiratory parameters in apparently healthy young adults

2026-09-30T09:59:50+0530

Background: Alternate nostril breathing (anuloma viloma pranayama) has been reported to influence autonomic balance and improve cardiorespiratory function. The present study was conducted to assess the effect of regular anuloma viloma practice on selected cardiorespiratory parameters in healthy young individuals.

Methods: This study was carried out in the department of physiology, King George’s Medical University, Lucknow, after institutional ethics committee approval. A total of 52 apparently healthy young adults aged 18-26 years with BMI 18.5-22.9 kg/m² were enrolled. Participants were divided into two groups. During the experimental phase, subjects practiced anuloma viloma for 10 minutes daily for 4 weeks, while the control phase involved no breathing intervention. Pulse rate, systolic blood pressure, diastolic blood pressure and PEFR were assessed. Statistical analysis was done using SPSS 21.0.

Results: Baseline cardiac and respiratory parameters of both groups were comparable. After intervention, group A showed significantly lower pulse rate, systolic blood pressure and diastolic blood pressure compared with group B. PEFR was significantly higher in the intervention group.

Conclusions: Regular practice of anuloma viloma pranayama produced favourable cardiorespiratory changes in apparently healthy young adults, with reduction in pulse rate and blood pressure, along with improvement in peak expiratory flow rate (PEFR).

Diagnostic utility of the Paris system for urine cytology with histopathological correlation

2026-09-30T09:59:50+0530

Background: Urothelial carcinoma (UC) is the second most common malignancy in the urogenital system. Urinary cytology is a non-invasive, cost-effective screening and monitoring technique for UC.

Methods: In this retrospective study, conducted from over a period of one year, 62 urine cytology sample s were evaluated utilizing. The Paris system (TPS) for reporting urinary cytology and correlated with histopathological findings where available.

Results: Urine cytological cases were divided in 5 categories as per TPS. The majority (46.77%) were negative for high-grade urothelial carcinoma (NHGUC), while 35.48% were unsatisfactory/non-diagnostic, indicating inadequate samples. 6.45% of cases were diagnosed as high-grade urothelial carcinoma (HGUC), and 4.83% were suspicious for high-grade urothelial carcinoma (SHGUC). Atypical urothelial cells (AUC) made up 6.45% of cases. No any case of low-grade urothelial neoplasm was found. Out of 62 total cases, histological correlation was available in 13. On histopathology 8 cases confirmed as UC which were diagnosed cytologically as HGUC (2 cases), SHGUC (1 case), AUC (3 cases) and NHGUC (2 cases). Two cases were nondiagnostic on cytology due to low cellularity were later reported as Sarcomatoid urothelial carcinoma with squamous component and Low-grade urothelial carcinoma each on histology. Remaining biopsies were inadequate where only necrosis and/or few atypical cells noted.

Conclusions: The study highlights the effectiveness of urine cytology in detecting high-grade lesions but emphasizes the challenges posed by unsatisfactory samples and the need for a multi-modal diagnostic approach, including cystoscopy and histopathology, to enhance diagnostic accuracy. The TPS framework offers a structured method for interpreting urinary cytology, critical for improving patient outcomes in urothelial carcinoma detection.

Frailty, multimorbidity and adverse hospitalization outcomes: a cross-sectional study of geriatric patients in a low-resource setting

2026-09-30T10:03:51+0530

Background: As the global population ages, frailty has emerged as a critical predictor of adverse hospitalization outcomes. In low-resource settings like Bangladesh, socioeconomic barriers frequently lead to Discharge Against Medical Advice (DAMA), yet the specific role of frailty in driving these premature discharges remains poorly understood.

Methods: A cross-sectional study was conducted at Sir Salimullah Medical College Mitford Hospital, Dhaka, involving 250 inpatients aged ≥ 50 years. Frailty was assessed using the 9-point Clinical Frailty Scale (CFS), categorized into three tiers: Low Risk/Vulnerable (CFS 2-4), Moderately Frail (CFS 5-6), and Severely/Terminally Frail (CFS 7-9). Multimorbidity and hospitalization outcomes (mortality, length of stay, and DAMA) were analyzed using Pearson's Chi-square and binary logistic regression.

Results: High levels of frailty were observed, with 60% of the cohort classified as moderately to severely frail. Multimorbidity was prevalent, led by diabetes (53.6%), hypertension (50.0%), and anemia (49.6%). The DAMA rate was alarmingly high at 61.6%. Logistic regression identified moderate frailty as a primary predictor of DAMA (AOR = 2.66, 95% CI: 1.26-5.64, p = 0.011), while severe frailty did not reach statistical significance (p = 0.313). Patients identified home health monitoring (81.2%) and financial support (57.2%) as the most critical needs to reduce future hospitalizations.

Conclusions: Moderate frailty serves as a critical tipping point where clinical needs and caregiver burden intersect, significantly increasing the risk of DAMA. Addressing geriatric outcomes in Bangladesh requires integrating clinical frailty assessments with socioeconomic support and home-based care strategies to mitigate premature hospital discharge.

Relationship between serum ferritin levels and hepatic and renal function parameters in patients with transfusion-dependent β-thalassemia major: a hospital-based cross-sectional study

2026-09-30T10:01:42+0530

Background: Transfusion-dependent β-thalassemia major requires lifelong blood transfusions, resulting in iron overload and hepatic and renal complications. Serum ferritin is widely used as a surrogate marker of body iron stores. This study evaluated serum ferritin levels and their association with hepatic and renal function parameters in patients with transfusion-dependent β-thalassemia major.

Methods: This hospital-based cross-sectional study included 100 patients with transfusion-dependent β-thalassemia major. Demographic data were recorded, and serum ferritin, liver function tests, and renal function parameters were analyzed using laboratory methods. Data were analyzed using descriptive statistics and Pearson’s correlation analysis.

Results: The mean serum ferritin level was 2701.48±1393.83 ng/ml, with 46% of patients exhibiting ferritin concentrations >2500 ng/ml. Hepatic abnormalities included elevated AST (72%), ALT (60%), bilirubin (55%), and ALP (33%). Renal assessment revealed reduced estimated glomerular filtration rate (eGFR) in 35% of patients, while elevated serum creatinine and blood urea nitrogen were observed in 17% and 13%, respectively. Serum ferritin showed weak but statistically significant negative correlations with ALT (r=−0.227, p=0.023) and total bilirubin (r=−0.273, p=0.006), whereas no significant correlation was found with serum creatinine.

Conclusions: Patients with transfusion-dependent β-thalassemia major demonstrated substantial iron overload with frequent hepatic and renal biochemical abnormalities. Regular monitoring of serum ferritin together with liver and renal function tests may facilitate early detection of organ involvement and optimization of iron-chelation therapy.

Beyond Google: association between pre-consultation AI chatbot use and healthcare-seeking behaviour among adult outpatients in a cross-sectional study

2026-09-30T09:59:49+0530

Background: Artificial intelligence (AI) chatbots are increasingly used by the public to obtain health-related information before consulting healthcare professionals. Although these tools have improved access to health information, their association with healthcare-seeking behaviour remains insufficiently explored, particularly in real-world outpatient settings. This study aimed to assess the association between pre-consultation AI chatbot use and healthcare-seeking behaviour among adult outpatients.

Methods: A quantitative observational cross-sectional study was conducted among 350 adult outpatients attending two selected healthcare facilities. Data were collected using a structured interviewer-administered questionnaire. Descriptive statistics were used to summarize participant characteristics and AI chatbot use. Associations between pre-consultation AI chatbot use and healthcare-seeking behaviour were analysed using the Chi-square test, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated.

Results: Of the 350 participants, 230 (65.7%) reported using an AI chatbot before consulting a doctor. ChatGPT was the most frequently used platform, and obtaining quick health information was the most common reason for AI chatbot use. AI chatbot users had significantly higher odds of practising self-medication than non-users (OR=5.01; 95% CI: 2.48-10.14; p<0.001). However, no statistically significant association was observed between AI chatbot use and delayed doctor consultation (OR=0.79; 95% CI: 0.50-1.23; p=0.290).

Conclusions: Pre-consultation AI chatbot use was common among adult outpatients and was significantly associated with self-medication but not with delayed medical consultation. These findings suggest that AI is increasingly influencing patients’ healthcare decisions before professional consultation. Promoting digital health literacy and encouraging the responsible use of AI as a supportive information resource may help reduce inappropriate self-medication while supporting informed healthcare-seeking behaviour.

Comparison of the immediate effects of Buteyko breathing technique, stacked breathing technique and conventional therapy on the peak expiratory flow rate and dyspnea level in asthmatic patients

2026-09-30T09:59:48+0530

Background: Asthma is a chronic inflammatory airway disease characterized by airflow limitation and recurrent symptoms that may persist despite standard medical treatment. Breathing retraining techniques have been increasingly used as adjunctive interventions to improve respiratory function. This study compared the immediate effects of the Buteyko breathing technique (BBT), stacked breathing technique (SBT), and conventional therapy on peak expiratory flow rate (PEFR) and dyspnea in individuals with bronchial asthma.

Methods: A quasi-experimental study was conducted among 63 clinically stable adults with bronchial asthma (20–50 years). Participants were allocated into three groups (n=21 each): BBT with conventional therapy, SBT with conventional therapy, or conventional therapy alone. Each participant received a single 30–45-minute intervention. PEFR and dyspnea were assessed before and immediately after treatment using a peak flow meter and the modified Borg dyspnea scale. Data were analyzed using appropriate parametric and non-parametric statistical tests, with significance set at p<0.05.

Results: All groups demonstrated significant post-intervention improvements in PEFR and dyspnea. The BBT group showed the greatest increase in PEFR (mean difference: 30.0 l/min) and the largest reduction in dyspnea (mean difference: 1.42), followed by the SBT and conventional therapy groups. Between-group comparisons confirmed significantly better outcomes with BBT.

Conclusions: BBT, when combined with conventional therapy, produced greater immediate improvements in expiratory flow and dyspnea than SBT or conventional therapy alone, supporting its use as an adjunct in bronchial asthma rehabilitation.

Comparative evaluation of serum homocysteine, CYFRA 21-1 and leptin in newly diagnosed oral squamous cell carcinoma: a hospital-based observational study

2026-09-30T09:59:47+0530

Background: Oral squamous cell carcinoma (OSCC) is the predominant malignancy of the oral cavity and is associated with morbidity and mortality. Identification of circulating biomarkers reflecting disease-associated biochemical alterations may facilitate early detection and clinical risk assessment. This study evaluated serum homocysteine, cytokeratin 19 fragment antigen 21-1 (CYFRA 21-1), and leptin concentrations in patients with newly diagnosed OSCC and healthy controls.

Methods: This hospital-based comparative observational study included 126 participants: 63 histopathologically confirmed, treatment-naïve patients with OSCC and 63 age- and sex-matched healthy controls. Serum homocysteine was determined using an automated biochemical analyser, whereas CYFRA 21-1 and leptin were estimated by enzyme-linked immunosorbent assay. Between-group comparisons were performed using Student’s independent t-test, and associations among biomarkers were assessed using Pearson’s correlation analysis. A p value <0.05 was considered statistically significant.

Results: Serum homocysteine and CYFRA 21-1 concentrations were significantly higher in OSCC patients than in controls (22.87±7.24 vs 12.53±3.01 µmol/l and 4.09±1.40 vs 0.81±0.51 ng/ml, respectively; both p<0.001). Conversely, serum leptin concentrations were significantly lower in OSCC patients (4.16±3.17 vs 11.04±5.83 ng/ml; p<0.001). Homocysteine demonstrated a significant positive correlation with CYFRA 21-1, whereas leptin showed significant inverse correlations with both biomarkers.

Conclusion: Newly diagnosed OSCC was characterized by elevated serum homocysteine and CYFRA 21-1 and reduced leptin concentrations. This differential biomarker profile supports their potential utility as complementary circulating markers in OSCC and warrants further prospective investigation.

Enhancing competency based practical assessment in diploma medical laboratory technology: a prospective comparative study of objective structured practical examination and conventional assessment

2026-09-30T09:57:35+0530

Background: Competency-based education emphasizes acquisition of practical skills alongside theoretical knowledge. Conventional practical examinations in diploma in medical laboratory technology (DMLT) programs may be affected by subjectivity, examiner variability and limited assessment of procedural competencies. Objective structured practical examination (OSPE) offers a standardized approach to practical assessment. This study compared OSPE with conventional practical assessment among DMLT students.

Methods: This prospective educational interventional pilot study was conducted among 50 second-year DMLT students in the department of pathology of a tertiary care teaching institution from May 2025 to October 2025. Following routine teaching on peripheral blood smear preparation, students underwent conventional practical assessment followed one week later by a five-station OSPE. Performance was compared using paired Student’s t-test, and student perceptions were assessed using a structured feedback questionnaire.

Results: The mean OSPE score was significantly higher than the conventional practical examination score (35.2=/- 4.8 vs 29.6 +/- 2.1; p<0.001). Forty- two (84%) students scored higher in the OSPE, five (10%) achieved comparable scores and three (6%) scored lower. Students reported favourable perceptions regarding fairness, objectivity, transparency, confidence and educational value.

Conclusion: OSPE provided an objective and structured method for assessing practical competencies among DMLT students and was associated with better performance and favourable learner perceptions. Its use may strengthen competency- based practical assessment in laboratory education.

Transforming maternal health services through quality improvement: a five-year experience from a rural community health centre in Northern India

2026-09-30T09:57:34+0530

Background: Improving maternal health remains a major public health priority in low- and middle-income countries. Strengthening antenatal care, institutional delivery, emergency obstetric services, and quality improvement (QI) is particularly important in rural settings. This study evaluated the association of integrated QI interventions with institutional delivery services and maternal healthcare utilization at Community Health Centre (CHC) Faridpur, Uttar Pradesh, India.

Methods: A retrospective QI study used routinely collected health management information system (HMIS) data, institutional delivery registers, and programme records from April 2022 to July 2026. Interventions included high-risk pregnancy surveillance, strengthened antenatal care, maternal anaemia management, telephonic beneficiary follow-up, emergency obstetric preparedness, and continuous staff capacity building. Trends in institutional deliveries, normal deliveries, and Caesarean sections were analysed descriptively.

Results: Institutional deliveries increased from 2,404 in FY 2022–23 to 2,809 in FY 2025–26, while Caesarean sections increased from 36 to 177. During April–July FY 2026–27, 810 institutional deliveries, including 48 Caesarean sections, were recorded. These changes occurred alongside strengthened clinical governance, community engagement, and maternal service utilization.

Conclusions: A structured package of QI interventions was associated with increased institutional deliveries and strengthened emergency obstetric services at a rural CHC. This integrated, low-resource approach may provide a practical framework for strengthening maternal healthcare in similar rural settings.

Comparison of the effects and efficacy of 0.5% hyperbaric levobupivacaine with fentanyl versus 0.5% hyperbaric bupivacaine with fentanyl for subarachnoid block in elderly patients undergoing elective surgeries

2026-09-30T10:22:40+0530

Background: Spinal anesthesia is widely used in elderly patients undergoing lower abdominal or lower limb surgeries. Bupivacaine is associated with cardiovascular and central nervous system toxicity, prompting the adoption of levobupivacaine, its S(–)-enantiomer, as a safer alternative to bupivacaine.

Methods: A randomised, double-blind study was conducted amongst 80 ASA grade I/II patients aged 60-75 years scheduled for elective infraumbilical and lower limb surgeries. Patients were randomly assigned to group L (levobupivacaine 0.5%, 3 ml + fentanyl 25 µg) and group B (bupivacaine 0.5%, 3 ml + fentanyl 25 µg).

Results: The onset of sensory block was significantly faster in group B (2.66±0.56 minutes) than in group L (3.25±0.68 minutes; p<0.001). However, sensory block duration was prolonged in group L (303.38±20.44 minutes) compared to group B (263.13±14.55 minutes; p<0.001). Similarly, motor block occurred earlier in group B (2.59±0.61 minutes) than in group L (3.15±0.56 minutes; p<0.001), but the motor block lasted longer in group L (172.88±19.44 minutes) than in group B (144.63±15.25 minutes; p<0.001). Group L demonstrated superior haemodynamic stability. Conversely, side effects were more frequent in group B.

Conclusions: Compared to hyperbaric bupivacaine with fentanyl, hyperbaric levobupivacaine with fentanyl provided a longer duration of sensory and motor blockade, enhanced haemodynamic stability, and fewer adverse effects. Levobupivacaine thus appears to be a safer and more effective option for older adult patients undergoing elective surgeries.

Species-specific hematological derangements and recovery kinetics in Plasmodium vivax and Plasmodium falciparum malaria: a comparative clinical study

2026-09-30T09:57:31+0530

Background: Malaria remains a major public health concern, yet comparative evidence on species-specific hematological alterations and recovery following treatment is limited. This study compared hematological derangements and recovery kinetics in patients with Plasmodium vivax and Plasmodium falciparum malaria.

Methods: A comparative observational study included 100 laboratory confirmed malaria patients (50 P. vivax, 50 P. falciparum). Diagnosis was established by peripheral smear microscopy and rapid diagnostic tests. Hemoglobin, red blood cell count, platelet count, hematocrit, white blood cell count, and red cell indices were evaluated before and after standard antimalarial therapy using an automated hematology analyzer.

Results: P. falciparum infection produced significantly greater reductions in hemoglobin, erythrocyte count, platelet count, and hematocrit than P. vivax (p<0.05). Thrombocytopenia was the most frequent hematological abnormality, whereas white blood cell counts showed no significant interspecies difference. Although hematological parameters improved after treatment in both groups, recovery was consistently faster and more complete in P. vivax, while delayed normalization persisted in P. falciparum.

Conclusions: Malaria species significantly influence both the severity of hematological abnormalities and the pace of recovery. Serial hematological assessment offers a simple, economical, and clinically valuable approach for species-specific risk stratification, treatment monitoring, and prognosis, particularly in resource limited endemic settings.

Effectiveness of a modified ABCDE bundle on ICU psychosis among cardiac postoperative patients at a selected tertiary care hospital, Coimbatore

2026-09-30T09:57:30+0530

Background: Intensive care unit (ICU) delirium is a common postoperative complication among cardiac surgery patients and is associated with prolonged mechanical ventilation, increased hospital stays, higher healthcare costs, and poor clinical outcomes. Evidence regarding modified ABCDE bundle interventions specifically designed for cardiac postoperative patients remains limited. This study evaluated the effectiveness of a modified ABCDE bundle in reducing ICU delirium among adult cardiac postoperative patients.

Methods: A true experimental, pretest-posttest control group design study was conducted among 30 adult cardiac postoperative patients admitted to the Cardio-Thoracic Intensive Care Unit of a tertiary care hospital in Coimbatore, Tamil Nadu. Participants were allocated into an intervention group (n=15), which received the modified ABCDE bundle in addition to routine care, and a routine care group (n=15). ICU delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive statistics and paired and unpaired t tests were used for data analysis.

Results: Baseline characteristics were comparable between groups. Post-intervention, the intervention group demonstrated significantly lower mean ICDSC scores than the routine care group (1.20±1.469 vs. 5.33±2.809). The intervention group also showed a greater reduction in delirium severity following implementation of the modified ABCDE bundle.

Conclusions: The modified ABCDE bundle was effective in reducing ICU delirium among adult cardiac postoperative patients and may be incorporated into routine nurse-led postoperative ICU care to improve patient outcomes.

Analysis of glycemic trends in elderly patients with diabetes mellitus with continuous glucose monitoring

2026-09-30T09:58:12+0530

Background: Glycemic control is critical in elderly diabetics, considering their increased vulnerability to hypo- and hyperglycemic events. Continuous Glucose Monitoring (CGM) offers real-time, 24-hour insights into glucose fluctuations by measuring interstitial glucose levels over 14 days. CGM summarizes glycemic variability using metrics such as time above range (TAR), time in range (TIR), and time below range (TBR), enabling better detection of patterns compared to isolated blood glucose measurements. This study aimed to investigate glycemic variability in elderly diabetics using CGM. Also, to evaluate CGM’s relevance in identifying hypo- and hyperglycemia, and provide evidence for the benefits of CGM in diabetes management.

Methods: A six-month observational study at tertiary care hospital in Pune enrolled elderly diabetics on CGM. Data was transmitted by patients periodically. Insulin therapy was remotely titrated in real time as per patient requirement.

Results: The study had a mean age of 70.72 years, with 76% males. Hypoglycemic episodes were reported in 8% of patients, 64.7% of which were asymptomatic and 35.3% symptomatic. In those experiencing early morning hyperglycemia, 48% patients showed Dawn’s and 32% Somogyi’s phenomenon. 76% of patients had fasting hyperglycemia, while 64% had postprandial hyperglycemia. Following remote insulin titration over 14 days, TAR decreased by 7.1% and TIR increased by 8.7%.

Conclusions: CGM provides a comprehensive, dynamic assessment of glycemic patterns in elderly, surpassing traditional glucose monitoring. Study demonstrates that remote titration of insulin and OHAs based on CGM data significantly improves glycemic control while reducing the risk of hypo- and hyperglycemia. Findings underscore the clinical value of CGM in elderly diabetes care, enabling personalized therapeutic decisions and enhancing safety in a population highly susceptible to glucose fluctuations. Integrating CGM into standard management protocols can optimize outcomes and mitigate complications.

Relationship between electronic health record documentation burden, job satisfaction and burnout among staff nurses at KG Hospital, Coimbatore

2026-09-30T09:57:20+0530

Background: Electronic health record (EHR) systems have become an essential component of healthcare delivery, improving the quality and accessibility of patient information. However, increasing documentation requirements may contribute to documentation burden, influencing nurses’ job satisfaction and burnout. This study aimed to assess the relationship between EHR documentation burden, job satisfaction, and burnout among staff nurses at KG Hospital, Coimbatore.

Methods: A hospital-based quantitative descriptive correlational study was conducted among 100 registered staff nurses selected using a non-probability convenience sampling technique. Data were collected using a self-structured demographic questionnaire, a Self-Structured EHR documentation burden scale, the McCloskey/Mueller satisfaction scale (MMSS), and the Maslach burnout inventory-human services survey (MBI-HSS). Data were analysed using Microsoft Excel. Descriptive statistics, Chi-square test, and Pearson’s correlation coefficient were used for data analysis. A p value of <0.05 was considered statistically significant.

Results: The majority of the participants had a moderate level of EHR documentation burden (90%) and burnout (64%), whereas 69% reported a high level of job satisfaction. EHR documentation burden showed a very weak negative correlation with job satisfaction (r=−0.076) and a weak positive correlation with burnout (r=0.252). Job satisfaction demonstrated a moderate positive correlation with burnout (r=0.451). Significant associations were observed between area of working and EHR documentation burden, experience in using EHR and job satisfaction, and formal EHR documentation training and burnout (p<0.05).

Conclusions: The study found that EHR documentation burden was associated with job satisfaction and burnout among staff nurses. Optimizing EHR documentation processes, improving system usability, and providing continuous EHR training may help reduce documentation burden and support nurses' professional well-being.

Antibiotic prophylaxis versus empirical therapy in routine abdominal hysterectomy in tertiary care hospital

2026-09-30T09:57:28+0530

Background: Surgical site infection remains an important cause of postoperative morbidity after abdominal hysterectomy. Although antibiotic prophylaxis is widely recommended, empirical postoperative antibiotic therapy is still commonly practiced in many tertiary care settings. This study aimed to compare the clinical outcomes of antibiotic prophylaxis and empirical therapy in routine abdominal hysterectomy.

Methods: This comparative study included 88 women undergoing routine abdominal hysterectomy in the Department of Obstetrics and Gynaecology, Chittagong Medical College Hospital. Participants were divided into two groups of 44 patients each. Group-A received antibiotic prophylaxis with intravenous ceftriaxone 1 g, administered 30 minutes before surgery. Group-B received the same preoperative dose followed by intravenous ceftriaxone 1 g 12-hourly for 72 hours and oral cefixime 400 mg twice daily for 7 days. Patients were followed for 30 days. Outcomes included superficial surgical site infection, postoperative complications, further antibiotic requirement, wound condition and duration of hospital stay.

Results: Superficial surgical site infection occurred in 5 patients (11.4%) in Group-A and 7 patients (15.9%) in Group-B, with no statistically significant difference (p=0.534). Postoperative complications were observed in 43.2% of Group-A and 36.4% of Group-B patients (p=0.513). Further antibiotic use was required equally in both groups, 8 patients (18.2%) each (p=1.000). Healthy wound condition during follow-up was observed in 88.6% and 86.4% of patients, respectively (p=0.747). Mean hospital stay was 6.75±4.27 days in Group-A and 8.18±6.42 days in Group-B (p=0.221).

Conclusions: Single-dose antibiotic prophylaxis showed comparable clinical outcomes to empirical postoperative therapy in routine abdominal hysterectomy and may support rational antibiotic use.

Atherogenic index of plasma as a marker of severity in pre-eclampsia

2026-09-30T09:57:19+0530

Background: Pre-eclampsia is a major hypertensive disorder of pregnancy associated with endothelial dysfunction, metabolic disturbance and adverse maternal-perinatal outcomes. The atherogenic index of plasma (AIP), derived from fasting triglyceride and high-density lipoprotein cholesterol values, may provide an integrated measure of atherogenic burden.

Methods: This hospital-based comparative cross-sectional study included 312 third-trimester pregnant women: 156 with pre-eclampsia and 156 normotensive pregnant women. Clinical parameters, biochemical markers, fasting lipid profile, AIP and fetomaternal outcomes were compared. AIP was categorized as low (<0.10), intermediate (0.10-0.24) and high risk (>0.24), and its associations with severity and delivery/neonatal outcomes were evaluated among women with pre-eclampsia.

Results: Women with pre-eclampsia had significantly higher BMI, blood pressure, random blood sugar, serum creatinine, LDH, total cholesterol, triglycerides and LDL-C, with lower HDL-C (all p<0.001, except gestational age). Mean AIP was higher in pre-eclampsia (0.39±0.13 versus 0.15±0.14; p<0.001), with high-risk AIP in 84.0% versus 23.7% of controls. High-risk AIP occurred in 98.2% of severe and 76.2% of mild pre-eclampsia (p=0.001). AIP correlated inversely with birth weight (ρ=-0.759) and 5-minute Apgar score (ρ=-0.699), while adverse outcomes were concentrated in the high-risk category.

Conclusions: Third-trimester pre-eclampsia was associated with higher AIP, greater disease severity and less favourable fetomaternal outcomes. AIP may serve as a low-cost adjunct marker for severity and short-term risk stratification, although prospective multivariable validation is required.

Head and neck cancer dominance and emerging multi-site burden: a three-year hospital-based cancer registry analysis from central India (2022-2024)

2026-09-30T09:57:15+0530

Background: Cancer registries provide epidemiological information for regional public health planning. Central India has a unique cancer burden driven by high tobacco use and limited early-detection infrastructure, yet the hospital-based cancer registries (HBCRs) data from this region remain scarce. This study characterised the site-specific distribution, sex-based disparities, age-group variation, and state-wise referral patterns of confirmed malignant cases at Cancer Hospital and Research Institute (CHRI), Gwalior, over three years (January 2022 – December 2024), to identify priority sites for region-specific cancer control interventions.

Methods: A retrospective descriptive study was conducted on 25,692 Outpatient Department (OPD) records from CHRI, Gwalior, a regional cancer centre serving Madhya Pradesh (MP), Uttar Pradesh (UP), and adjacent states. International Classification of Diseases -10 (ICD-10) was used to classify malignant cases (n = 20,062). They were analyzed by sex, cancer site, age group, state and year of registration.

Results: Among the 20,062 malignant cases, males constituted the majority (n=12,394; 61.78%) versus females (n=7,665; 38.21%). Mouth (n=5,255; 26.04%) and tongue (n=2,746; 13.69%) were the most common sites. Gallbladder cancer ranked third overall (8.11%) with marked female predominance. Breast (7.42%) and cervical (5.74%) cancers predominated among females. Patients aged ≥50 years had the largest disease burden, though oral cancers appeared as early as 19-35 years.

Conclusions: Head and neck cancers accounted for 46.59% of all malignant cases (9,347 /20,062), with the oral cavity and tongue representing the most frequently affected sites. The co-existing burdens of gallbladder, breast, and cervical cancers highlight the need for region-specific, multi-site cancer screening programmes.

Utilizing images-based self-directed learning to promote anatomy learning during neuroanatomy module

2026-09-30T09:54:02+0530

Background: Anatomy education is fundamental to medical training, yet conventional approaches such as cadaveric dissection may be constrained by limited resources, large class sizes, faculty shortages, and ethical considerations. Image-based learning incorporating radiological images and interactive three-dimensional models may serve as a useful adjunct by enhancing conceptual understanding and student engagement. This study evaluated medical students’ perceptions of image-based identification sessions across cognitive, affective, and psychomotor domains.

Methods: A cross-sectional study was conducted during the 2022-2023 academic year among 137 second year (MD2) medical students at the College of Medicine and Health Sciences, National University, Sohar, Oman. Ethical approval was obtained, and informed consent was secured in English and Arabic. Students completed pre- and post-tests and a 12-item questionnaire administered through Google Forms. Items assessed the three learning domains using a five-point Likert scale. Data were analysed descriptively.

Results: Students reported positive perceptions across all three domains. In the cognitive domain, 81% agreed or strongly agreed that image-based sessions improved understanding and recall of anatomical concepts. In the affective domain, 83% reported enhanced enjoyment, confidence, and motivation for active participation. In the psychomotor domain, 79% indicated improved clarification of anatomical concepts, information-processing skills, and self-directed learning. Overall, approximately 80% considered the sessions effective and satisfactory.

Conclusions: Image-based identification sessions were positively perceived and supported learning across cognitive, affective, and psychomotor domains. While not a replacement for cadaveric dissection, image-based learning represents an effective adjunct that can support blended, student-centred anatomy curricula, particularly in resource-constrained educational settings.

Impact of comorbidities and preoperative vascular assessment on outcomes of arteriovenous fistulas in patients on haemodialysis: a retrospective cohort study

2026-09-30T09:57:14+0530

Background: End-stage renal disease is a major global health problem, and hemodialysis remains the most common renal replacement therapy. Arteriovenous fistula (AVF) is considered the gold-standard vascular access due to its superior patency and lower complication rates. However, AVF success depends on multiple factors, including vascular anatomy and patient comorbidities. Despite careful planning, a significant proportion of fistulas fail to mature or lose function over time. This study aimed to evaluate the impact of comorbidities and preoperative vascular assessment on AVF outcomes and to determine the relationship between vessel diameter and AVF success.

Methods: A retrospective cohort study was conducted at AIIMS Rishikesh including 150 adult chronic kidney disease (CKD) patients who underwent AVF creation. Data regarding demographics, comorbidities, duplex ultrasound findings, surgical details, complications, and patency outcomes were collected and analyzed statistically.

Results: The mean age was 48.2 years, with male predominance. Overall primary AVF success was 68.7%. Larger arterial and venous diameters were significantly associated with higher success rates, especially when both were ≥2 mm. Primary patency declined from 78% at 3 months to 45.1% at 12 months. Early thrombosis and failure to mature were the leading causes of primary failure. Diabetes and coronary artery disease (CAD), cerebrovascular accident (CVA), peripheral arterial disease (PAD) significantly reduced AVF success.

Conclusions: Preoperative vessel diameter is the strongest predictor of AVF success, while diabetes and systemic vascular disease negatively affect outcomes, emphasizing the importance of vascular assessment and comorbidity optimization.

A cross-sectional study on knowledge, attitudes, practices and barriers regarding generic medicines and Jan Aushadhi initiatives among healthcare professionals and students in Hyderabad, India

2026-09-30T09:57:13+0530

Background: Generic medicines are therapeutically equivalent to branded medicines and are promoted through government programmes such as the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) to reduce the economic burden of healthcare. However, misconceptions and concerns regarding their efficacy and acceptance may limit their use. This study assessed the knowledge, attitudes, practices, and barriers regarding generic medicines and Jan Aushadhi initiatives among healthcare professionals and students in Hyderabad, India.

Methods: A cross-sectional study was conducted among 300 healthcare professionals and healthcare students in Hyderabad using a pre-validated structured questionnaire. The questionnaire assessed knowledge, attitudes, practices, and perceived barriers related to generic medicines and Jan Aushadhi initiatives.

Results: Participants demonstrated reasonable awareness of generic medicines and PMBJP; however, preference for branded medicines remained high among both healthcare professionals and patients. A major barrier was the perception that lower-cost medicines are less effective than branded medicines. Concerns regarding the availability and acceptance of generic medicines also contributed to their limited use.

Conclusions: Despite reasonable awareness, preference for branded medicines and misconceptions regarding the efficacy of lower-cost medicines remain important barriers to the wider use of generic medicines. Targeted educational and awareness programmes are needed to address misconceptions, improve confidence in generic medicines, and promote the rational use of cost-effective medicines.

Prescribing patterns and health-related quality of life in patients with chronic kidney disease: a cross-sectional study

2026-09-30T09:57:07+0530

Background: Chronic kidney disease (CKD) is associated with multimorbidity, polypharmacy, and impaired health-related quality of life (HRQoL). This study evaluated prescribing patterns using World Health Organization (WHO) core prescribing indicators and HRQoL using the RAND 36-item health survey 1.0 among patients with CKD.

Methods: A cross-sectional observational study was conducted among 162 adults with CKD in India. Prescribing patterns were assessed using WHO core prescribing indicators, and HRQoL was evaluated using the RAND-36 questionnaire. Associations between prescribing burden, patient characteristics, and physical component summary (PCS) and mental component summary (MCS) scores were analysed.

Results: The mean number of drugs per encounter was 12.77±3.68. Generic prescribing (38.64%) and essential medicines list (EML) adherence (61.57%) were below WHO benchmarks, while injection prescribing (29.23%) exceeded recommendations. Cardiovascular agents were the most frequently prescribed drug class (34.26%). HRQoL was impaired across all domains (PCS: 30.23±6.57; MCS: 35.30±5.30). Advancing CKD stage was associated with lower PCS and MCS (both p<0.001). Older age was associated with lower PCS (p<0.001), whereas higher medication burden was associated with lower MCS (p=0.034). Medication burden was also associated with greater comorbidity burden (p=0.007) and longer hospitalisation (p<0.001).

Conclusions: Patients with CKD experienced substantial polypharmacy, suboptimal adherence to WHO prescribing indicators, and impaired HRQoL. These findings highlight the need for rational prescribing, medication review, and routine patient-reported outcome assessment.

Drug utilization pattern, drug-related problems and associated risk factors in patients with hepatic impairment: a prospective observational study at a tertiary care teaching hospital

2026-09-30T09:57:06+0530

Background: Because the liver drives the clearance of most medicines, any decline in hepatic function reshapes drug handling and leaves patients open to drug-related problems (DRPs). We set out to map the drug utilization pattern, characterise the DRPs, and identify the risk factors linked to hepatic impairment in admitted patients.

Methods: A sample of 60 inpatients with hepatic impairment was studied prospectively over six months (February to August 2025) in the medicine ward of a tertiary care teaching hospital. Demographic, clinical, and prescription details were captured on structured forms. Severity was graded by the Child-Pugh score, prescribing quality was benchmarked against WHO core indicators, and DRPs were categorised by the Cipolle-Strand-Morley framework. Categorical associations were tested by chi-square, with the exact test for sparse cells; significance was set at p<0.05.

Results: Most patients were men (95.0%); the 41-60-year band was largest (45.0%) and moderate disease (Child-Pugh B) prevailed (76.7%). Altogether 714 drugs were prescribed (mean 11.9 per patient); antibiotics (19.2%) and proton-pump inhibitors (13.2%) led non-hepatospecific classes, and ursodeoxycholic acid (16.1%) the hepatospecific agents. Generic prescribing reached only 25.6%, while 74.9% featured on the WHO Essential Medicines List. Fifty DRPs occurred in 42 patients (70.0%), chiefly drug-drug interactions (40.0%) and adverse drug reactions (20.0%). Comorbidity was significantly associated with DRPs (exact test, p=0.024), and alcohol overconsumption was the leading risk factor (88.3%).

Conclusions: Prescribing leaned on antibiotics, acid suppressants, and hepatospecific agents, yet weak generic prescribing and a heavy comorbidity-driven DRP load mark clear openings for pharmacist-led optimisation and structured alcohol-abstinence counselling.

Strengthening cervical cancer prevention through district-wide HPV vaccination: an implementation case study from Bareilly district, Uttar Pradesh, India

2026-09-30T09:57:04+0530

Background: Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer, one of the leading cancers among women in India. Introduction of HPV vaccination under India's universal immunization programme (UIP) represents an important step towards achieving the World Health Organization (WHO) strategy for cervical cancer elimination. Although vaccine efficacy is well established, published evidence describing district-level implementation experiences remains limited. To describe the planning, implementation, operational performance, and lessons learned from the district-wide HPV vaccination programme in Bareilly district, Uttar Pradesh.

Methods: A retrospective descriptive implementation case study was conducted using programme data collected from 28 February 2026 to 4 August 2026. Data were obtained from district HPV vaccination monitoring reports, session reports, beneficiary registers, microplans, vaccine stock records, supervisory reports, and electronic vaccine intelligence network (eVIN) records. Indicators included session completion, beneficiaries vaccinated, vaccine utilization, and reconciliation between administrative and eVIN records.

Results: A total of 3,865 vaccination sessions were planned and 3,863 (99.95%) were conducted. Overall, 25,276 adolescent girls received HPV vaccination. eVIN documented 24,897 vaccine doses utilized, giving an absolute difference of 379 doses (1.5%) between administrative vaccination records and eVIN utilization. CHC Faridpur achieved complete implementation, with 152 of 152 planned sessions conducted, 2,478 beneficiaries vaccinated, and zero difference between beneficiary records and eVIN utilization.

Conclusion: The Bareilly implementation demonstrates that large-scale HPV vaccination can be integrated within routine immunization infrastructure through strong leadership, detailed microplanning, intersectoral collaboration, supportive supervision, and digital vaccine logistics monitoring. The operational experience may inform implementation in similar districts.

Assessment of chemotherapy-induced cognitive impairment in cancer patients

2026-09-30T09:54:11+0530

Background: Chemotherapy-induced cognitive impairment (CICI) is a well-established side-effect of cancer treatment, which can impact memory, attention, executive function and quality of life. There have been reports of cognitive impairment in chemotherapy-treated patients, but there is limited data in the Indian population. This study was conducted to assess the prevalence of CICI and identify factors associated with cognitive impairment among patients undergoing chemotherapy.

Methods: A cross-sectional observational study was performed among 160 adult cancer patients receiving chemotherapy treatment at a tertiary care center. The functional assessment of cancer therapy – cognitive function (FACT-Cog, version 3) questionnaire was used to measure cognitive function. A structured case record form was used to gather the demographic and clinical information. Descriptive statistics, correlation analysis and multivariable logistic regression were used for statistical analysis to find independent predictors of cognitive impairment.

Results: Among 160 participants, 57 (35.6%) had chemotherapy induced cognitive impairment. Cognitive function was significantly associated with advanced cancer stage and number of chemotherapy cycles and was an independent predictor of cognitive impairment in multivariable analyses. Type 2 diabetes mellitus was associated with lower odds of cognitive impairment, although this finding requires further investigation.

Conclusions: Cognitive impairment was common among patients who were receiving chemotherapy. Greater treatment exposure and advanced disease stage were independently associated with cognitive impairment, highlighting the importance of routine cognitive assessment during cancer treatment. Further prospective multicenter studies are needed to confirm these findings and improve the management of chemotherapy-induced cognitive impairment.

Ageing of abrasions by gross and histopathological examination – study among dead bodies brought to modern mortuary, King George Hospital, Visakhapatnam

2026-09-30T09:54:09+0530

Background: Dating injuries has important medico-legal implications. Abrasion age estimation in routine forensic practice relies mainly on gross examination, while histopathology provides objective microscopic evidence. However, their correlation remains insufficiently studied in India. To estimate the age of abrasions by gross and histopathological examination and correlate gross changes with microscopic findings.

Methods: This prospective observational study was conducted from August to December 2021 at Andhra Medical College, Visakhapatnam. Sixty-four medicolegal autopsy cases with known times of injury and death were included. A total of 118 abrasion samples underwent gross and histopathological examination using haematoxylin and eosin staining.

Results: The study included 51 males (79.68%) and 13 females (20.31%), with most aged 21–40 years (39.06%). Road traffic accidents accounted for 76.56% of cases and graze abrasions were most common (57.62%). Grossly, bright red discolouration was observed up to 6 hours, reddish scab up to 38 hours, brownish scab up to 115 hours, dark brown scab up to 140 hours and black scab from 140–290 hours. Vascular congestion was the earliest microscopic change (25 minutes), followed by oedema, inflammatory cell infiltration, fibroblast formation, granulation tissue, collagen formation and regression. Good correlation was observed.

Conclusions: Combined gross and histopathological examination may improve abrasion age estimation in medicolegal practice.

Clinico-etiological profile of ascites among adult patients attending a tertiary care hospital: a hospital-based cross-sectional study

2026-09-30T09:54:07+0530

Background: Ascites is a common manifestation of several diseases and an important cause of hospitalization. Portal hypertension secondary to chronic liver disease remains the leading cause worldwide, although the etiological spectrum varies geographically. In India, tuberculosis, malignancy, and systemic disorders also contribute substantially. This study evaluated the clinical, laboratory, and etiological profile of adults presenting with ascites at a tertiary care hospital in Western India.

Methods: A hospital-based cross-sectional study was conducted among 267 consecutive adults with ascites admitted to the Department of Medicine at a tertiary care hospital in Vadodara, Gujarat, over one year. Demographic characteristics, clinical presentation, laboratory parameters, ultrasonographic findings, and ascitic fluid analysis were recorded using a structured proforma. Data were analyzed using descriptive and inferential statistics, with p<0.05 considered statistically significant.

Results: Among 267 participants, mean age was 53.7 ± 13.2 years and 181 (67.8%) were males. Chronic liver disease with portal hypertension was the commonest etiology (174; 65.2%), followed by malignancy (31; 11.6%), tuberculous peritonitis (24; 9.0%), congestive heart failure (17; 6.4%), nephrotic syndrome (11; 4.1%), pancreatitis (6; 2.2%), and miscellaneous causes (4; 1.5%). High-SAAG ascites was present in 191 (71.5%) patients and was significantly associated with portal hypertensive causes (p<0.001).

Conclusion: Chronic liver disease remains the predominant cause of ascites, while tuberculosis and malignancy remain important non-cirrhotic etiologies. Clinical evaluation combined with ascitic fluid analysis, particularly SAAG, facilitates accurate etiological diagnosis and appropriate management.

Phenotypic detection of presumptive AmpC β-lactamase production among cefoxitin screen-positive gram-negative bacilli in a tertiary care teaching hospital

2026-09-30T09:54:04+0530

Background: AmpC β-lactamase-mediated resistance among Gram-negative bacilli is an increasingly important therapeutic challenge because it reduces the effectiveness of several β-lactam antibiotics and limits treatment options. In resource-limited laboratories, reliable phenotypic methods remain essential for the routine evaluation of cefoxitin screen-positive isolates for presumptive AmpC β-lactamase production.

Methods: This prospective descriptive observational study was conducted at a tertiary care teaching hospital in Western Uttar Pradesh, India, from January to December 2025. A total of 2,860 clinical specimens yielded 1,486 clinically significant, non-duplicate Gram-negative isolates. Cefoxitin screen-positive isolates (inhibition zone diameter ≤18 mm) were evaluated using the Cefoxitin–Cloxacillin Double Disk Synergy Test (CC-DDST), Phenylboronic Acid Disc Test (PBA), and Disk Approximation Test (DAT) in accordance with CLSI M100, 35th edition (2025). Frequencies, percentages, and 95% confidence intervals were calculated.

Results: Among the 1,486 Gram-negative isolates, 626 (42.1%; 95% CI: 39.6–44.6%) were cefoxitin screen-positive. Escherichia coli (40.6%) and Klebsiella pneumoniae (28.6%) were the predominant cefoxitin screen-positive isolates. CC-DDST identified the highest proportion of presumptive AmpC β-lactamase-positive isolates (303/626; 48.4%; 95% CI: 44.5–52.3%), followed by PBA (285/626; 45.5%; 95% CI: 41.6–49.4%) and DAT (206/626; 32.9%; 95% CI: 29.3–36.7%).

Conclusions: A considerable proportion of Gram-negative isolates were cefoxitin screen-positive. Among the evaluated phenotypic methods, CC-DDST showed the highest positivity rate for presumptive AmpC β-lactamase production and appears to be a practical and cost-effective method for routine evaluation of cefoxitin screen-positive Gram-negative isolates in laboratories where molecular diagnostic facilities are unavailable.

Effect of menstrual phase-wise training versus conventional training on speed, agility, power and psychological well-being in female sprinters: a comparative study

2026-09-30T09:53:54+0530

Background: The menstrual cycle phase is increasingly acknowledged as a determinant of female athletic performance; nevertheless, data for phase-tailored training of sprint-specific attributes is still scarce. This study examined the effects of a menstrual phase-wise training (MPWT) program versus conventional training (CT) on speed, agility, power, and psychological well-being in female sprinters.

Methods: This comparative research randomly assigned 60 female sprinters (18-28 years) either MPWT (n=30) or CT (n=30) for six weeks. MPWT suggested phase-specific exercise-rest and breathing exercises during menstruation, strengthening during the follicular phase, resistance range-of-motion exercise during ovulation, and endurance running during the luteal phase; CT maintained normal sport-specific training. Measurements speed (30 m sprint test), agility (Edgren side-step test), power (vertical leap, jump height, Harman average and peak power) and psychological well-being (BBC subjective well-being scale) were examined pre- and post-intervention.

Results: Groups were similar at baseline. After the intervention, MPWT provided considerably bigger gains than CT for lower-limb power (vertical jump/jump height, p=0.009; Harman average power, p=0.001; Harman peak power, p=0.001) with medium to large effect sizes. There were no significant differences between groups in speed or agility. There was a substantial drop in psychological well-being within the MPWT group (p=0.0001) and no significant difference was seen across groups (p=0.05).

Conclusions: A six week menstrual phase-wise training program provided a selective benefit of power-specificity against conventional training in female sprinters. There were no improvements in speed or agility and an unsolved deficit in psychological well-being. Larger trials are needed before menstrual cycle-informed training may be suggested for everyday practice.

Perception, attitude and knowledge of anatomical structures observed in the dissection hall-MLS students, national university: dissection based anatomy learning in MLS students

2026-09-30T09:54:58+0530

Background: Cadaveric dissection remains an important component of anatomy education, but evidence on its value for allied health students is limited. This study assessed medical laboratory science (MLS) students’ perceptions, attitudes, self-reported knowledge, and satisfaction regarding dissection hall-based anatomy learning.

Methods: A descriptive cross-sectional survey was conducted among 41 MLS students at the National University, Sultanate of Oman, during 2025. Data were collected using a 12-item, five-point Likert-scale questionnaire. Descriptive statistics, Wilcoxon signed-rank, Friedman, post-hoc Wilcoxon, and Spearman correlation tests were used. Statistical significance was set at p<0.05.

Results: Students showed highly favorable perceptions (mean 4.22±0.43) and attitudes (4.07±0.52) toward dissection-based learning. Satisfaction was moderately positive (3.56±0.74), while knowledge scores were comparatively lower (3.31±0.67). Perception and attitude were significantly higher than knowledge (p<0.001). Agreement was highest for perception (88.6%) and attitude (81.3%), but only 48.8% for knowledge. No significant correlations were found among the study domains.

Conclusions: The findings indicate that students value dissection and demonstrate positive attitudes, but these favorable responses do not necessarily translate into comparable perceived knowledge gains. Structured preparation, guided identification, faculty facilitation, and post-dissection reinforcement may help strengthen learning outcomes. Cadaveric dissection remains a valuable component of MLS anatomy education. A structured, learner-cantered, and blended approach may better convert positive dissection experiences into anatomical knowledge and competence.