International Journal of Research in Medical Sciences

COVID-19 mRNA vaccination: implications for the central nervous system

2025-11-06T06:51:22+0530

Background: Neuroinflammatory conditions involving the central nervous system (CNS) are on the rise and while the etiology is currently unknown the parallel rise in cases to mass COVID-19 vaccination is of particular interest. This study explores the association between the CNS infection rate and vaccination.

Methods: This is a retrospective study. Retrospective data were utilized from the U. S. centers for disease control and prevention (CDC) and the U.S. food and drug administration (FDA) vaccine adverse event reporting system (VAERS). Adverse events (AEs) encompassing CNS conditions following all vaccines were queried from January 1, 1990, through November 30, 2024. The timeframe for all vaccines except COVID-19 vaccines was 419 months and the timeframe for COVID-19 vaccines was 47 months (January 1, 2021, to November 30, 2024). Observed AEs are presented as odds ratios (ORs) by time which compare these events occurring after COVID-19 vaccination to those after influenza vaccination and to those after all other vaccines.

Results: Comparing COVID-19 vaccination to annual influenza vaccinations and all vaccines combined, the CDC/FDA’s safety signal thresholds were breached for the multiple outcomes. Data are expressed as OR, 95% confidence interval (CI), p value, Z score. All CNS categories reviewed produced a safety signal when comparing events after COVID-19 vaccination to influenza vaccination (referent). Thirty-nine events were categorized as CNS infection (29.4, 21.6-40.1, <000.1, 21.4); 11 events grouped as herpetic CNS Infection (171, 93.9-312, <000.1, 16.8); and 4 categorized as CNS abscess (107, 40.9-280, <000.1, 9.53). Similarly, CNS Infections, herpetic CNS infection, and CNS abscess categories also produced a safety signal when comparing events after COVID-19 vaccination to all vaccines combined (referent) (except COVID-19): 39 events categorized as CNS Infections (4.11, 3.03-5.57, <000.1, 9.09); 11 events grouped as herpetic CNS Infection (22.3, 15.4-32.4, <000.1, 16.4) and; 4 events noted as CNS abscess (17.8, 10.5-30.4, <000.1, 10.6). When comparing COVID-19 vaccination to influenza vaccination as well as all vaccines combined, 7 of 9 events in the uncommon neurological disease grouping exceeded safety thresholds for both comparisons.

Conclusions: All safety signals reported are concerning and support an immediate global ban on the COVID-19 vaccination program.

Heterophoria analysis of HIV/AIDS patients on highly active antiretroviral therapy in Northwestern Nigeria

2025-11-28T22:41:18+0530

Background: Despite the efficacy of highly active antiretroviral therapy (HAART) on HIV, there are other ocular side effects of HAART which are yet to be determined and characterized. The aim of the study was to determine and characterize the pattern of latent deviation of eyes among HIV/AIDS patients.

Methods: Consenting patients were recruited and grouped into two groups A and B. Group A were HAART naive, while group B were HAART experienced. These were further subdivided into four groups; comprising of B1: on HAART from 0>2½ years, B2: 2½>5 years, B3: 5>7½ years, and B4: 7½ >10 years.

Results: There were 400 participants aged 25-55 years with a mean age of 37.86±7.5 years. About 135 (33.8%) and 129 (32.3%) were Orthophoric for habitual phoria at near and far (HPN and HPF), while 207 (51.7%) and 218 (54.5%) were also Orthophoric for induced phoria at far and near (IPN and IPF) respectively. There was a statistically significant association between effect and HAART duration with induced lateral phorias at both distances (p=0.01), no association with CD4+ T-cells count, HAART Regimen and habitual lateral phorias at both distances (p=0.06 and p=0.95).

Conclusions: HIV/AIDS patients on HAART exhibit either convergence excess or divergence insufficiency as a binocular vision syndrome depending on the degree of deviation both at far and near distances. The effect and duration of HAART are statistically significant with induced lateral phorias at both distances (p=0.01).

Efficacy and safety of upadacitinib in the treatment of recalcitrant vitiligo

2025-11-28T22:45:06+0530

Background: Vitiligo is an acquired autoimmune disease resulting in depigmented patches of the skin, often leading to a significant psychosocial burden on patients. Building on recent advancements in understanding the immunological mechanisms in vitiligo pathogenesis, various potential treatment options such as JAK inhibitors are being clinically researched for vitiligo. In this study, upadacitinib was evaluated for its effectiveness and safety in treating recalcitrant vitiligo patients.

Methods: This study was a prospective randomized clinical trial, thirty patients of group A were treated with Upadacitinib, a dose of 15 mg once daily for 16 weeks. Thirty patients of group B were treated with low dose oral prednisolone (0.3 mg/kg body weight) daily for 16 weeks and the severity of vitiligo was measured using the Vitiligo Area Severity Index (VASI).

Results: The study shows that in Group A, the mean reduction of VASI score was lower in segmental vitiligo (1.24±0.43) and higher in acrofacial vitiligo (4.21±1.30). On the other hand, in Group B, the mean reduction of VASI score was almost similar in acrofacial vitiligo (2.17±0.35) and generalized vitiligo (2.23±0.44). The association between type of vitiligo and change in VASI score in Group A was statistically significant (0.002). At month 4, the VASI score was lower in group A (5.70±3.61) compared to group B (8.61±3.43), which was statistically significant (p=0.006).

Conclusions: The observed repigmentation with minor adverse effects in all vitiligo patients with upadacitinib suggests that upadacitinib could be a promising therapeutic option for this challenging condition.

Precipitating and aggravating factors of acne: a cross-sectional study in a tertiary care hospital

2025-11-28T22:45:05+0530

Background: Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous units, characterized by comedones, papules, pustules, nodules and scarring. It predominantly affects adolescents and young adults due to hormonal changes, increased sebum production, bacterial colonization (mainly Propionibacterium acnes) and genetic predisposition. Although not life-threatening, acne can lead to significant psychological distress and often requires medical or systemic therapy. To identify the precipitating and aggravating factors contributing to acne among patients attending a tertiary care hospital.

Methods: This descriptive cross-sectional study was conducted in the Department of Dermatology and Venereology, Combined Military Hospital (CMH), Dhaka, from March to August 2022. A total of 1200 acne patients aged 11–45 years were selected using purposive sampling. After informed consent, data were collected through structured interviews and clinical examinations. Patients with systemic illness, on hormonal therapy or under current acne treatment were excluded. Data were analyzed using SPSS version 22.

Results: Among 1200 participants, 59.1% were aged 16–20 years (mean age 20.58±5.18) and 77.5% were unmarried. The cheeks (85.8%) and forehead (75.8%) were the most affected sites. Oily skin (70.8%) and papular lesions (81.6%) predominated, with moderate severity in 59.2%. Pigmentation (71.6%) was the commonest sequela. Major aggravating factors included cosmetics (27.5%), topical steroids (26.6%), stress (24.1%), sunlight exposure (20%) and skin pricking (15%).

Conclusions: Acne is more prevalent among young females. Family history, cosmetic and steroid use, stress, sunlight and hormonal fluctuations are major precipitating and aggravating factors.

Outcome of decompression, correction and fusion for cervical spondylotic myelopathy with kyphotic deformity

2025-11-28T22:45:02+0530

Background: Cervical spondylotic myelopathy (CSM) with kyphotic deformity is a common degenerative spinal disorder that leads to progressive spinal cord compression and neurological deterioration. Objectives were to evaluate the outcome of decompression by laminectomy with correction by lateral mass fixation and fusion for CSM with kyphotic deformity.

Methods: Assessments were done pre-operatively and postoperatively at 1-, 2-, 3-, and 6-months using visual analogue score (VAS), modified Japanese orthopedic association (mJOA), Odom criteria, Nurick’s grading, and cervical curvature index. Data were analyzed using standard statistical methods via the statistical package for social sciences (SPSS) version 25 (IBM®, Armonk, USA). A p<0.05 was considered statistically significant.

Results: The mean VAS score significantly improved from 6.27±1.75 to 0.73±0.59 at 6 months. The mean mJOA score increased from 11.27±0.80 preoperatively to 16.53±0.74 at the final follow-up, indicating substantial neurological improvement. According to the modified Odom criteria, 33.3% of patients had excellent outcomes, 60.0% had good outcomes, and 6.7% had fair outcomes. Functional status measured by Nurick’s grading improved significantly, with 93.3% of patients in grade III preoperatively and 100% improving to either grade 0 or I by 6 months (p<0.001). The cervical curvature index showed marked radiological correction, improving from -8.24±2.59 preoperatively to 21.94±1.35 postoperatively (p<0.001).

Conclusions: Posterior decompression by laminectomy with lateral mass fixation and fusion is an effective and safe surgical technique for managing CSM with kyphotic deformity. It significantly improves neurological function, pain status, and cervical alignment.

Prevalence of anemia in pregnant women and its association with birth outcomes in Bhimpur block, Betul district, Madhya Pradesh

2025-11-28T22:43:26+0530

Background: Anemia Pregnant is an important and widely public health issue in the world and a leading cause of maternal morbidity and poor birth outcomes especially in low resources and tribal nations.

Methods: The sampling was done in the Bhimpur block of Betul district, Madhya Pradesh wherein 300 pregnant women were selected, and the study was conducted to estimate the prevalence and severity of anemia as well as its relationship with low birth weight (LBW) and preterm birth as adverse pregnancy outcomes.

Results: The hemoglobin level was measured with the help of hemoglobin meter, and anemia was determined according to WHO classification. It has been found that anemia was prevalent (64.7%), and most of the cases were mild (38.3%), moderate (24.7%), and only a small proportion of severe cases was observed (1.7%). LBW was found (27.5%) in a higher rate of 39.2% in anemic mothers and 11.8% in non-anemic mothers (p < 0.001). Anemia also revealed a dose-response relationship, with the higher the anemia, the higher the number of preterm births (p = 0.004), i.e., it is also found to be significant between the anemic and non-anemic women, with preterm births being higher in the former.

Conclusions: The results indicate that a continuously high prevalence of anemia in tribal pregnant women and its close relationship with unfavorable perinatal outcomes. Enhancement of culturally sensitive nutrition education, antenatal care and program execution through such initiative as Anemia Mukt Bharat is essential in the enhancement of maternal and new-born health.

Efficacy and safety of empagliflozin (SGLT2 inhibitor) in Bangladeshi patients with type 2 diabetes mellitus

2025-11-28T22:44:58+0530

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder requiring effective glycemic control to prevent complications.

Methods: This 8-month, randomized, open-label, interventional, single centered trial enrolled 86 Bangladeshi patients with poorly controlled T2DM (HbA1c ≥7.5%) on various antidiabetic regimens. Participants received Empagliflozin 10mg/25mg in addition to their ongoing therapy. Follow-ups at 6 weeks and 6 months evaluated glycemic control, lipid profile, renal parameters and adverse effects. Based on clinical response, the dosage was increased to 25 mg in selected cases. Statistical analyses included paired t-tests and Wilcoxon Signed Rank tests for normally and non-normally distributed variables.

Results: Hypertension was prevalent in 73.3% of cases, while chronic kidney disease (CKD), ischemic heart disease and dyslipidemia were observed in 12.8%, 14% and 37.2% of cases, respectively. Significant reductions in fasting blood sugar, postprandial blood sugar, systolic blood pressure (p<0.001 for all) and HbA1c (p<0.001) were observed at both 6-week and 6-month follow-ups. BMI reduction was significant at 6 months (p=0.03), while serum potassium increased significantly at both time points (p=0.02, p=0.01). Serum creatinine showed a significant decline at 6 months, while changes in LDL, triglycerides, HDL and total cholesterol were not statistically significant. Adverse effects were minimal, with 3.5% experiencing genital mycotic infections and 1.2% experiencing hypoglycemia.

Conclusions: Empagliflozin effectively improved glycemic control and systolic blood pressure reduction with minimal adverse effects in Bangladeshi T2DM patients while increasing serum potassium level.

Correlation of lipid profile with blood pressure in apparently healthy Sudanese individuals in Northern State, Sudan

2025-11-28T22:44:55+0530

Background: To assess the value of lipid profile on apparently healthy adult Sudanese based on the blood pressure values in Dongola town in the northern state. This study aims to correlate the lipid profile with the blood pressure to figure out their association with cardiometabolic disorders

Methods: a cross-sectional prospective study was carried out from January 2018 to November 2018 in Dongola on apparently healthy adult Sudanese.

Results: in this study 164 individuals have been tested, out of them 117 (71.34%) were females and males 47 (28.65%) respectively. Most of the study group were normal weight, females 63 (38.41%) and males 20 (12.19%) respectively. The arterial blood pressure values showed a significant positive correlation to both BMI and lipid profile (p-value≤0.05). Also, results revealed that fasting blood glucose has a strong positive correlation with lipid profile HDL and TG (p value≤0.05), TC and LDL (p value≥0.01).

Conclusions: Our results concluded that patients with hypertension are more likely than normotensive patients to exhibit dyslipidemia, including elevated TC, LDL, TG and reduced HDL cholesterol levels. Our results suggest that elevated BP may predict certain disturbances in lipoprotein metabolism.

Evaluating the effectiveness of problem-based learning in promoting rational prescribing among undergraduate medical students

2025-11-28T22:43:31+0530

Introduction: Rational prescribing is a core competency for future physicians, but traditional pharmacology teaching often emphasizes factual recall rather than clinical application. Problem-Based Learning (PBL) is a student-centered approach that has been proposed to enhance problem-solving skills and rational prescribing. To evaluate whether a PBL-based pharmacology module improves knowledge transfer, problem-solving ability, and attitudes toward learning compared to conventional teaching.

Methods: This interventional study included two groups of undergraduate medical students. The intervention group received a structured PBL module on drugs used in bronchial asthma, while the control group was taught through conventional lectures and tutorials. Both groups were assessed with problem-based multiple-choice questions on bronchial asthma (direct knowledge) and peptic ulcer (transfer of knowledge). Assessments were conducted at four weeks and again at two months. Student attitudes toward PBL were also collected via a structured questionnaire. Results: Students in the PBL group scored significantly higher than the control group in both assessments (p<0.01). While performance declined over time in both groups, PBL students consistently maintained superior outcomes. Feedback revealed positive attitudes toward PBL, with high ratings for problem-solving, motivation, teamwork, and overall satisfaction.

Conclusion: PBL is more effective than conventional teaching in enhancing rational prescribing skills and student engagement. However, sustained practice and curricular integration are recommended to maintain long-term benefits.

Association of angiographic severity of coronary artery disease and erectile dysfunction based on IIEF-5 score

2025-11-28T22:43:24+0530

Background: Erectile dysfunction (ED) is common in patients with coronary artery disease (CAD). Atherosclerosis is a shared mechanism for vasculogenic ED and CAD, suggesting a potential correlation. The objective was to evaluate the association of angiographic severity of coronary artery disease & erectile dysfunction based on IIEF-5 score.

Methods: This cross-sectional study was conducted at NICVD, Dhaka, on 60 patients with CAD and ED. Patients were divided into Group I (Gensini <20, n=30) and Group II (Gensini ≥20, n=30). ED was assessed using the IIEF-5 questionnaire, and IPA angiography was performed in the same setting.

Results: Mean IIEF-5 score was lower in severe CAD (Group II: 13.67±4.17 vs Group I: 15.93±3.14, p=0.021). Significant IPA stenosis (>50%) was more common in Group II (43.3% vs 20%, p=0.042). Spearman’s correlation showed a negative correlation between Gensini and IIEF-5 scores (ρ=-0.475, p=0.01) and a positive correlation with IPA stenosis (ρ=0.410, p=0.03). Logistic regression identified severe CAD (OR 9.13, 95% CI 1.37–60.99) and diabetes mellitus (OR 4.75, 95% CI 1.29–46.33) as predictors of IPA stenosis.

Conclusion: Severity of CAD is inversely associated with erectile function and positively correlated with IPA stenosis.

Risk profile of non-cicatricial alopecia in females

2025-11-28T22:43:21+0530

Background: Non cicatricial alopecia (NCA) is a common dermatological problem in female produces greater psychological distress. Understanding the risk factors and associations is essential for comprehensive assessments and effective management of various forms of hair loss. This study has been conducted with the aim to identify the possible risk profile of different types of NCA in female patients.

Methods: A descriptive type of observational study was conducted to find out the risk profile of NCA in females. About 355 females with NCA attending the outpatient department of dermatology and venereology department, Bangladesh medical university, Bangladesh during study period were the study population. Data was collected through face-to-face interviews and clinical examinations along with laboratory investigations on all patients.

Results: Among 355 female patients of NCA, age, duration of alopecia and family history of alopecia were significantly higher in patients with FPHL in comparison to patchy and diffuse pattern hair loss patients. Patients with diffuse alopecia had statistically significant association (p≤0.001) with CTD and history of taking OCP, oral steroid and hydroxychloroquine significantly more from the patients with other two patterns of NCA and the blood hemoglobin level was significantly lower in patients with diffuse alopecia.

Conclusions: Diffuse alopecia was the most common type NCA, which was associated with connective tissue diseases (CTD); history of taking OCP, oral steroid and hydroxychloroquine and lower blood hemoglobin level. Age, duration of alopecia and family history of alopecia were significantly higher in patients with female pattern hair loss (FPHL) of NCA.

Place of delivery and its determinants among women in rural and urban communities in Kano State, Nigeria

2025-11-28T22:42:13+0530

Background: Childbirth poses significant risks, particularly in Nigeria where many births occur outside health facilities and without skilled attendants, skyrocketing maternal morbidity and mortality. This study assessed and compared place of delivery and its determinants among women in urban and rural Kano State.

Methods: A cross-sectional study was conducted. A multistage sampling technique selected 292 urban and 300 rural women of reproductive age group. Quantitative data were analysed using SPSS 20.

Results: Overall, 32.1% of women delivered in health facilities, while 67.9% delivered at home. Hospital deliveries were higher in urban (39.7%) than rural areas (24.7%). Safety, avoidance of problems, and trust in health workers facilitate hospital delivery. Conversely, customs, quick labour, and fear of hospital staff were major reasons for home delivery. Mother’s education (Urban: aOR; 3.023 (95% CI; 1.459-6.264), p=0.003), (Rural: aOR; 2.311 (95% CI; 1.106-4.829), p=0.026) and spousal education level (Urban: aOR; 2.925 (95% CI; 1.357-6.306), p=0.006), (Rural: aOR; 2.183 (95% CI; 1.241-3.840), p=0.007) remained predictors in both areas with secondary and above likely to deliver in hospital. While occupation was significant in the urban communities (aOR; 2.392 (95% CI; 1.137-5.031), p=0.022), antenatal care visits in the rural communities (aOR; 2.427 (95% CI; 1.408 - 4.367), p=0.001).

Conclusions: The study found a high proportion of home deliveries with associated sociodemographic and socio-economic factors. Emphasis on hospital delivery and addressing sociodemographic and socioeconomic factors facilitating home deliveries is recommended.

Retroplacental hematoma: epidemiological profile and associated risk factors among Malagasy women at the Soavinandriana Hospital Center (CENHOSOA)

2025-11-28T22:42:11+0530

Background: Retroplacental hematoma (RPH) is a severe obstetric emergency that increases maternal and fetal morbidity and mortality. Data on RPH remain scarce in Madagascar. This study aimed to determine its prevalence and identify associated risk factors.

Methods: A descriptive and analytical case–control study was conducted in the Department of Obstetrics and Gynecology, Soavinandriana Hospital Center (CENHOSOA), Antananarivo, from January 2020 to December 2024. Sixty RPH cases and 120 controls (2:1 ratio) were analyzed. Data were retrospectively collected from medical records and analyzed using Epi Info 7.2. Associations were assessed using odds ratios (OR) with 95% confidence intervals (CI).

Results: Among 5,921 deliveries, 60 cases of RPH were identified (prevalence 1.01%). The mean age was 28.7 years (17-40). Farming was significantly associated with RPH (p=0.001; OR=5.75; 95% CI: 1.92-17.21). Lack of antenatal care (p=0.001; OR=6.51; 95% CI: 1.97-21.44), hypertension/preeclampsia (p=0.000; OR=5.68; 95% CI: 2.8-11.5), and abdominal massage during pregnancy (p=0.000; OR=13.57; 95% CI: 5.15-35.73) were major risk factors. Preterm delivery (<37 weeks) was significantly related to RPH (p=0.000; OR=7.97; 95% CI: 3.91-16.25). Cesarean section was required in 83.3% of cases (p=0.000; OR=23.57; 95% CI: 10.31-53.85).

Conclusions: RPH prevalence in this study was higher than reported in other regions. The main risk factors were abdominal massage, hypertensive disorders, absence of antenatal care, and low socioeconomic status. Strengthening antenatal follow-up and discouraging harmful traditional practices may reduce RPH-related complications.

Association of metabolic syndrome in patients with vitiligo

2025-11-12T10:23:08+0530

Background: Vitiligo can trigger inflammatory processes due to decreased number of melanocytes and their anti-inflammatory effects as well as oxidative stress. Metabolic syndrome includes hypertension, abdominal obesity, dyslipidemia, glucose intolerance, leading to cardiovascular disease, diabetes mellitus and stroke. Because of the systemic nature of vitiligo, metabolic syndrome or its component may be observed in vitiligo. To observe association of metabolic syndrome in patients with vitiligo.

Methods: This case control study included 54 vitiligo patients and 54 age and sex matched controls according to inclusion and exclusion criteria. Detailed history, physical examination and laboratory investigations were done in all participants and revised National Cholesterol Education Program Adult Treatment Panel III criteria were used for diagnosis of metabolic syndrome. Data were analyzed by using SPSS (Statistical Package for Social Sciences) Version 23.

Results: Metabolic syndrome was present in 20 (37.0%) patients with vitiligo and in 9 (16.7%) control subjects. Frequency of metabolic syndrome was significantly higher in vitiligo patient compared to control (p=0.017). Systolic blood pressure, diastolic blood pressure, fasting plasma glucose and mean serum triglycerides level were significantly higher in the patient group than that of control group, whereas serum high density lipoprotein cholesterol was significantly lower in the patient group than that of control group. There were no significant difference between cases and controls regarding waist circumference.

Conclusions: Presence of metabolic syndrome was higher in patients with vitiligo. Further large-scale studies are needed to establish it.

Relationship between QRS duration on admission electrocardiogram and angiographic severity of coronary artery disease in patients with acute anterior myocardial infarction

2025-11-28T22:42:08+0530

Background: Early risk stratification in myocardial infarction (MI) is crucial, but the prognostic role of admission electrocardiography (ECG) findings remains underexplored. This study evaluated the relationship between QRS duration and severity of coronary artery disease (CAD) in acute anterior MI (AMI).

Methods: A cross-sectional study was conducted at the Department of Cardiology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, from November 2019 to October 2020. One hundred patients with first anterior MI, admitted within 12 hours of chest pain onset and treated with thrombolysis, were enrolled. Patients were stratified into two groups: QRS≤100 ms (normal) and QRS >100 ms (prolonged). CAD severity was assessed using Gensini score, with ≥36 indicating moderate-to-severe disease.

Results: Patients with prolonged QRS duration were significantly more likely to have severe CAD, with an eightfold higher risk compared to those with normal QRS (95% CI: 3.2-19.3; p<0.001).

Conclusions: Prolonged QRS duration on admission ECG is strongly associated with severe CAD in acute anterior MI, suggesting its value for early risk stratification.

Antihypertensive prescribing patterns in type 2 diabetes patients with hypertension: a cross-sectional study

2025-11-28T22:42:03+0530

Background: The combination of type 2 diabetes mellitus (T2DM) and hypertension is associated with an increased risk for cardiovascular, renal and metabolic complications. Guidelines such as JNC 8, ADA, NICE advocate ACEIs, ARBs, CCBs and thiazide diuretics to be first-line antihypertensive drugs for diabetic patients based on evidence. Nevertheless, prescribing habits still differ among low-resource areas, one of which is Bangladesh. Objectives were to assess the prescribing pattern of antihypertensive drugs in hypertensive T2DM patients who come for treatment to tertiary hospitals in Bangladesh and also to evaluate the level of adherence with the international guideline-recommended therapies.

Methods: A cross-sectional study was carried out from August 2021 to July 2022 in a total of 246 hypertensive T2DM patients who received treatment in the OPDs of Sir Salimullah medical college and Mitford hospital (SSMCH) and BIRDEM. Data was obtained with the help of pretested questionnaire and analyzed through SPSS version 23.

Results: The average age of participants were 59.5±10.5 years, and 56% were women. Overweight and obesity were more than common (75.8% and 12.1%, respectively). Comorbidities were prevalent including chronic kidney disease (CKD) (37.6%), dyslipidaemia (33.1%) and ischemic heart disease (29.3%). The classes of β-blockers (23.2%) were the most commonly used, followed by ARBs (20.8%), CCBs (17.4%), diuretics (12.4%) and ACEI (9.7%). 42.4% of patients received combination therapy.

Conclusions: Prescriptions were characterized by inadequate compliance to established international standard with high rate of prescription of the non-guideline-favored beta blockers over ACEIs, ARBs and thiazide diuretics. Promotion of evidence-based prescriptive practices is required to optimize cardiovascular and renal outcomes in diabetic hypertensives in Bangladesh.

Descriptive retrospective study on dental implant failure by analyzing various factors: a 15-year study

2025-11-28T22:42:09+0530

Background: Dental implant failure remains a significant clinical challenge despite advances in implantology. Understanding the underlying causes and contributing factors is crucial for improving implant success and patient outcomes.

Methods: This descriptive retrospective study was conducted over 15 years from January 2010 to December 2024 at two specialized dental centers in Dhaka, Bangladesh Banasree Dental and Implant Center and German Dental and Implant Center. Clinical records of 261 patients, aged 20-90 years, who received a total of 510 implants were reviewed. Data were collected from clinical files, radiographs and follow-up records to evaluate implant characteristics, duration of survival and causes of failure.

Results: Of the 261 patients, 158 (61%) were male and 103 (39%) were female, with a male-to-female ratio of 1.5:1. Most patients were middle-aged or older. A total of 285 implants (55.9%) were placed in the maxilla and 225 (44.1%) in the mandible. The majority (95.49%) received initial treatment at other clinics. Implant survival duration ranged from 6 months to 3 years. The primary causes of implant failure were infection (peri-implantitis) in 40.2%, improper placement in 25.3%, insufficient bone density in 17.2%, mechanical issues in 10.3%, systemic health issues in 5.7% and excessive stress in 1.1%. Failures were more frequent in the maxilla (58.2%) and occurred predominantly within the first year (41.4%).

Conclusions: Infection and improper implant placement were the leading causes of dental implant failure, with higher risk observed in maxillary implants and early post-implantation periods. Rigorous surgical planning and follow-up are essential for minimizing failures.

Role of CT and MR enterography in the evaluation of inflammatory bowel disease

2025-11-06T06:51:23+0530

Background: Inflammatory bowel disease (IBD) requires accurate diagnosis and assessment of disease activity for effective management. CT Enterography (CTE) and MR Enterography (MRE) are key imaging modalities for evaluating small bowel involvement in IBD. This study compares their diagnostic performance in detecting IBD, assessing disease activity, and identifying complications.

Methods: A prospective observational study was conducted on 48 patients with suspected or confirmed IBD. All patients underwent both CTE and MRE, followed by ileo-colonoscopy within two weeks to maintain consistency in disease status. Endoscopy served as the reference standard. Sensitivity, specificity and accuracy were calculated for each modality, with statistical analysis performed using IBM SPSS version 29.0. Interobserver agreement was evaluated using Cohen’s kappa coefficient (κ).

Results: For diagnosing IBD, MRE showed a sensitivity of 86.6%, specificity of 92.7%, and accuracy of 89.65% (κ=0.73), while CTE demonstrated a sensitivity of 87.1%, specificity of 90.6%, and accuracy of 88.85% (κ=0.79). In detecting active disease, MRE achieved 84.5% sensitivity and 94.2% specificity (accuracy 89.35%, κ=0.76), whereas CTE showed 88.9% sensitivity and 83.7% specificity (accuracy 86.30%, κ=0.84). For chronic disease, MRE had 87.5% sensitivity and 91.2% specificity (accuracy 89.82%, κ=0.72), while CTE reported 88.3% sensitivity and 87.9% specificity (accuracy 88.10%, κ=0.77).

Conclusion: Both CTE and MRE provide high diagnostic accuracy for IBD. MRE is preferred in younger patients due to the absence of radiation, while CTE remains useful for rapid evaluation in acute or elderly cases.

Bidirectional relationship between anxiety and gastrointestinal symptoms: a case control study

2025-11-15T09:03:34+0530

Background: Many patients of anxiety manifest lot of gastrointestinal (GI) symptoms in the form of bloating, diarrhoea, heartburn and constipation. Conversely patients suffering from common GI diseases like irritable bowel syndrome have anxiety symptoms. Severity of one can aggravate the other condition. Gut and brain communicate through gut-brain axis. Gut microbiome and hypothalmo-pituitary-adrenal system and a host of metabolic products play an important role in this axis.

Methods: Thirty-eight patients with moderate-to-severe GI symptoms and anxiety were evaluated with appropriate scales for diagnosis and severity. The quality of life was also assessed in them. Thirty-eight healthy subjects with no GI symptoms and no/mild anxiety symptoms were similarly evaluated as control group.

Results: Key predictors of anxiety severity and GI symptoms severity were statistically analysed. There was a strong link between GI symptoms and anxiety severity and inverse relationship with the quality of life.

Conclusions: Evidence suggests a bidirectional relationship between gastrointestinal symptom severity and anxiety, mediated by the gut-brain axis.

Microvascular free flap reconstruction in head and neck cancer cases with vessel depleted necks and distorted anatomy due to prior intervention

2025-11-21T06:38:40+0530

Background: Microvascular reconstruction is crucial in head and neck oncoplastic surgery following ablative procedures. However, prior surgery, radiation or tumor recurrence often leads to a vessel-depleted neck, making free flap transfer technically challenging.

Methods: This prospective study included 30 patients undergoing microvascular reconstruction in a vessel-depleted neck over two years’ period. Preoperative imaging with doppler ultrasonography was performed for vessel mapping. Intraoperatively, meticulous dissection of ipsilateral vessels was attempted first. Free flaps used included anterolateral thigh, free fibula, and radial forearm, chosen for their long vascular pedicles.

Results: All patients achieved successful flap survival, with no flap failures (100% survival). In all cases, ipsilateral vessels were usable despite prior surgery or radiotherapy. Contralateral dissection and vein grafting were not required in our series. End-to-side or end to end anastomosis to the internal jugular vein or its branches with corresponding arteries proved reliable. Prior radiotherapy did not adversely affect outcomes.

Conclusions: Microvascular reconstruction in vessel-depleted necks is surgically demanding but feasible with careful planning, patience, and detailed anatomical knowledge. Meticulous dissection and use of flaps with long pedicles allow consistently high success rates, minimizing the need for vein grafts or contralateral vessel exploration.

Agreement between arterial and venous electrolyte levels in patients admitted to intensive care unit: a retrospective study

2025-11-15T09:03:33+0530

Background: Electrolyte disturbances are common in critically ill patients and can significantly influence morbidity and mortality. Prompt detection is essential; however, serum electrolyte estimation using automated analyzers (AA) in central laboratories often suffers from delayed turnaround times. Point-of-care (POC) arterial blood gas (ABG) analyzers provide rapid results; however, their reliability compared to that of conventional autoanalyzers remains uncertain. This study aimed to evaluate the agreement between sodium and potassium levels measured in arterial and venous samples using the GEM 3500 (ABG) and Vitros 5600 (AA) analyzer, respectively.

Methods: A retrospective study was conducted on 200 intensive care unit (ICU) patients in a secondary healthcare hospital between January and June 2024. The electrolytes were reported from both arterial and venous blood samples sent to the clinical biochemistry laboratory on the same day and at the same time. GEM 3500 and Vitros 5600 analyzers are used, respectively. Both methods use the direct ISE method. Statistical analyses included the Wilcoxon signed-rank test, Spearman’s correlation, and Bland-Altman plots to assess correlation and agreement.

Results: The mean and standard deviation of sodium values (136.33±9.22 mmol/l in venous and 135.23±9.57 mmol/l in arterial blood) and potassium values (4.20±1.01 mmol/l and 4.01±0.97 mmol/l) were observed. The differences were statistically significant (p<0.001). Spearman’s correlation showed strong positive relationships (r=0.819 for sodium; r=0.844 for potassium, p<0.001). Bland-Altman analysis demonstrated that 97.5% of the sodium and 93.5% of the potassium values fell within the limits of agreement, suggesting good concordance.

Conclusions: Sodium and potassium measurements obtained from arterial samples using the ABG analyzer can be used interchangeably with serum values derived from venous samples analyzed on an automated chemistry analyzer for the management of critically ill patients.

Knowledge and attitude toward glaucoma among relatives of patients with established disease: a cross-sectional study at a tertiary eye care center

2025-11-28T22:41:20+0530

Background: Glaucoma is a leading cause of irreversible blindness worldwide. Relatives of glaucoma patients are at higher risk, yet their awareness and attitude toward the disease are often insufficient. The aim of the study was to assess the knowledge and attitude regarding glaucoma among first-degree relatives of patients attending a tertiary eye care center in India.

Methods: A cross-sectional study was conducted over six months at (tertiary eye care center). Two hundred fifty first-degree relatives of patients diagnosed with primary glaucoma were recruited. A structured, validated questionnaire assessed knowledge of glaucoma, risk factors, symptoms, and attitudes toward screening. Descriptive statistics and Chi-square tests were applied.

Results: Among 250 participants, 38% knew that glaucoma could cause irreversible blindness, and 45% recognized family history as a risk factor. Only 28% had previously undergone eye screening. Positive attitudes toward regular screening were observed in 52%. Higher education and prior exposure to glaucoma information were significantly associated with better knowledge and attitudes (p<0.05). Siblings of glaucoma patients showed higher awareness and more positive attitudes than parents or children. Younger participants (<40 years) demonstrated slightly better knowledge, though differences were not statistically significant.

Conclusions: Despite increased risk, knowledge and screening behavior among relatives remain suboptimal. Structured educational programs and targeted interventions in tertiary centers are essential to enhance awareness and early detection of glaucoma.

HbA1c test awareness, sociodemographic characteristics and lifestyle behaviour among type 2 diabetes mellitus patients

2025-11-28T22:41:19+0530

Background: Glycated hemoglobin (HbA1c) is a key biomarker for long-term glycemic control. The studies have shown that patients having an understanding of HbA1c values in diabetic patients is associated with better glycemic control and self-care practices. This study aims to assess HbA1c test awareness among type 2 diabetes mellitus (T2DM) patients and examine its association with sociodemographic and lifestyle factors.

Methods: This cross-sectional study was conducted among 230 type 2 diabetes mellitus patients using purposive sampling and the participants were recruited from outpatient and laboratory department of a hospital in Mangaluru, Karnataka, India. Awareness of HbA1c test was assessed using a structured questionnaire and analyzed in relation to demographic and lifestyle variables. Chi-square test were used for the analysis of data using statistical package for the social sciences (SPSS) software, and p<0.05 was considered statistically significant.

Results: Out of 230 participants, 56.5% were male and 43.5% were aged 50–69 years. Only a minority of participants (16.1%) were aware of the HbA1c test. The HbA1c test awareness was not significantly associated with age, gender, education, employment, income, smoking, alcohol use, medication adherence, or diet adherence.

Conclusions: Awareness of HbA1c test among T2DM patients was limited. Structured patient education and counseling programs focusing on HbA1c monitoring may empower patients to achieve better glycemic control and reduce the risk of diabetes-related complications.

A clinico-epidemiological study of non-venereal genital dermatosis and its association with serological markers

2025-11-28T22:45:11+0530

Background: Non-venereal genital dermatoses are non-sexually transmitted diseases which can be contagious diseases caused by viruses, fungi, bacteria and parasites or non-contagious including contact dermatitis, lichen sclerosus chronicus, fixed drug eruption, skin tags, vitiligo, papulosquamous disorders and others. The aim of the study was to describe the clinic-epidemiological pattern of non-venereal genital dermatosis among patients who attended the skin and STD clinic of Acharya Shri Chander College of Medical Sciences (ASCOMS) from 2007 to 2017 (10 years) and significance of serological tests in non-venereal genital dermatosis.

Methods: This descriptive study included 167 adults with non-venereal genital dermatoses who attended the clinic from January 2007 to January 2017. Patients diagnosed with venereal diseases were excluded.

Results: Of 308 patients (88 females, 79 males) visiting the STD clinic 167 patients were non-STD cases. Patient age ranged from 16-60 years. 20 different dermatoses were identified with Tinea cruris (36.5%) being most common followed by Furunculosis 7.8% and scabies (7.1%). Among 167 patients, 99 were found to be sero-positive to VDRL, HIV, HBS and HSV, out of which 32(19.2%) were VDRL positive followed by HSV 27 (16.2%) and HIV 9 (5.4%). It was found that most of the patients of Tinea cruris (27) were found to be VDRL reactive followed by HSV (2).

Conclusions: This study emphasizes the importance of recognizing common non-venereal genital dermatoses in the general population and highlights the value of routine serological testing. Asymptomatic or latent venereal infections may be missed without appropriate screening.

Integration of artificial intelligence and robotics in rehabilitation therapy: enhancing motor recovery after injury or stroke

2025-11-28T22:45:11+0530

Background: Artificial intelligence (AI) and robots are revolutionizing healthcare by delivering intelligent, adaptable, and patient-centric solutions. These technologies restore motor function, improve therapeutic precision, and adapt patient treatment regimens, making them vital for rehabilitation therapy. Recent advances in neuroscience, motor control, robotics, and AI-based algorithms have opened new doors in brain and motor rehabilitation. Invasive and non-invasive human-machine interfaces can reduce the long-term effects of strokes and spinal cord injuries. This research examines how AI and robotics can improve motor recovery after injury or stroke in rehabilitation therapy.

Methods: This study utilizes the quantitative research methodology. Data were gathered from different clinical trials and studies that specifically examined AI-assisted robotic rehabilitation therapy. Important indicators consist of the enhancement in motor function, rates of patient adherence, and the overall efficacy of therapy. A total of 19 participants were selected for this investigation. The standard of care group had ten participants and the robotic therapy group nine.

Results: The study showed that robotic therapy improved all evaluations more than the control group, proving that AI and robotic technology work in rehabilitation therapy.

Conclusions: The findings demonstrate that AI-integrated robotic therapy outperforms normal care in rehabilitation. Subsequent research endeavours may delve deeper into the enduring advantages and enhance the treatment regimens to optimize patient recuperation.

Exploring relationships between psychological factors and coping mechanisms in doctors of Delhi NCR: a correlational study

2025-11-28T22:45:09+0530

Background: The COVID-19 pandemic has posed substantial mental health challenges for healthcare professionals. While pandemic-related anxiety and fear of COVID-19 have been studied, less is known about how these factors relate to general psychological distress and coping styles among physicians in real-world settings.

Methods: This study is an observational, cross-sectional analysis involving N=100 physicians. Participants completed the General Health Questionnaire (GHQ) to assess general psychological distress and overall health status, the Coronavirus Anxiety Scale (CAS) to measure coronavirus-specific anxiety, the Fear of COVID-19 Scale (FCV-19S) to evaluate fear related to COVID-19 and the Coping Inventory to assess coping styles. Pearson correlations were computed to examine the inter-correlations among these variables.

Results: Coronavirus anxiety was strongly negatively correlated with perceived general health (r=-0.613, p<0.001), indicating that higher anxiety is linked to poorer health perception. Fear of COVID-19 showed a weak but significant positive correlation with general health (r=0.169, p=0.047), suggesting a nuanced relationship between health status and fear. No significant correlations were found between anxiety and coping strategies, nor between coping strategies and overall health, highlighting the complexity of coping mechanisms in this context.

Conclusions: The strong negative link between coronavirus-specific anxiety and perceived general health underscores the need for targeted mental health resources within healthcare settings to safeguard physicians’ overall well-being and job performance. Our findings support implementing balanced psychoeducational and resilience-building programs that promote vigilant but non-dysregulated emotional responses, thereby sustaining both physician health and quality of patient care in ongoing and future health crises.

A study of snakebite cases in a tertiary care hospital in South India, Telangana

2025-11-28T22:45:08+0530

Background: Snake bites pose a significant global health threat leading to substantial morbidity and mortality. According to WHO, approximately 11,000 deaths occur due to snake bite per annum in India. This study is done to know about common types of snakes in local areas, identify the clinical features, complications and mortality rates in snakebite victims attending RVM Charitable trust hospital.

Methods: A hospital-based cross sectional study done from 1st January 2024to 31st December 2024. Fifty patients enrolled during this period. Features during presentation and subsequent period were noted, anti-venom was given accordingly and outcome was recorded. Data was collected in a predesigned data sheet form and was analyzed accordingly.

Results: Among 50 snake bite patients, 70% were male and 56% cases were poisonous bites. The common victims were farmers (53%) and the bite was commonly encountered during rural foot walking (32%). Among 28 poisonous cases, 18 Poisonous cases developed neurological manifestations and 3 cases developed breathlessness which required mechanical ventilation support. Rest 10 Poisonous cases developed hematological manifestations and 6 cases developed Acute Kidney Injury of which 3 cases required hemodialysis support. Among the 28 venomous snake bite cases 25 (89%) recovered completely after getting polyvalent antivenom serum and 3 (11%) died after admission. Total 80% cases recovered with 10 vials of polyvalent antivenom serum. No reaction to anti-snake venom was noticed.

Conclusions: Snake bites cases are still a serious health problem for us. Treatment of poisonous snake bite with polyvalent antivenom serum is successful and safe. Awareness should be created among the rural people through mass media regarding the complications of snake bite and the need to visit a hospital as early as possible. Availability of snake venom kits should be made in rural health centres to identify the type of snake bite.

Integrative analysis of protein-protein interaction networks: linking cellular functions to cancer and diabetes mechanisms

2025-11-28T22:45:08+0530

Background: Protein-protein interactions (PPIs) are vital in regulating cellular functions, including signal transduction, metabolic control, and intracellular transport. In diseases such as diabetes and cancer, analyzing PPI networks provides valuable insights into underlying molecular mechanisms and potential therapeutic targets. Focusing on disease-specific subnetworks enables the identification of key proteins and their functional relationships.

Methods: A subset of the human PPI network associated with diabetes and cancer was analyzed to identify proteins involved in signaling, trafficking, and metabolism. Proteins such as ARF5, M6PR, FKBP4, CYP26B1, NDUFAF7, and FUCA2 were included in the dataset annotations. We utilized visualization techniques to generate PPI (protein-protein interaction) maps, isolate diabetes modules with key genes like INS, GCK, IGF1, PPARG, and GLUT4, and investigate their relationships with different cancer types using the adjusted p-value threshold.

Results: In this study, each protein contributed a unique aspect and function to the overall analysis. M6PR regulated the transport of lysosomal enzymes, while ARF5 played a role in Golgi-associated vesicle trafficking. Hormone receptor microtubule FCBP4, along with hormone-receptor microtubule dynamics, was involved in retinoic acid metabolism and germ cell development. NDUFAF7 played a crucial role in mitochondrial complex I assembly, while FUCA2 participated in glycoprotein catabolism. Furthermore, the diabetes-specific interaction modules revealed a core regulatory axis, which comprised INS, GCK, IGF1, PPARG, and GLUT4. These genes are significant insulin signaling and glucose metabolism genes. Beside that, notable associations were observed with endometrial, melanoma, and colorectal cancers.

Conclusions: Recording the interplay of metabolic pathways underscores the importance of ppi subnetworks in metabolic regulation, signal transduction, and associated disorders, which supports further drug target investigations in diabetes and cancer.

Antibiotic resistance trends and species distribution of coagulase negative Staphylococci in a tertiary hospital setting

2025-11-28T22:45:07+0530

Background: Coagulase-negative Staphylococci (CoNS) have emerged as significant opportunistic pathogens, especially in nosocomial settings. Their increasing resistance to commonly used antibiotics has heightened the need for species-level identification and susceptibility profiling. Aim of this study was to speciate clinical isolates of CoNS, determine their antibiogram and study biofilm formation.

Methods: In this cross-sectional study, 84 clinically significant CoNS isolates were identified by Standard biochemical tests and VITEK 2 system. Antibiotic susceptibility was determined by Kirby-Bauer disc diffusion method following CLSI (Clinical and laboratory standards institute) guidelines. Biofilm formation was assessed by tissue culture plate (TCP) method.

Results: A total 84 clinically significant CoNS isolates were identified from blood, pus, urine, sterile body fluids and catheter tips. Out of 84 isolates, S. epidermidis (46.43%) was the most common species, followed by S. haemolyticus (22.61%) and S. saprophyticus (10.71%). Majority of CoNS were isolated from blood culture (57.15%) followed by pus (21.42%) and urine (14.29%). High resistance was observed against penicillin (92.9%), followed by gentamicin (63.1%), and cotrimoxazole (61.9%). The 54.8% isolates were MRCoNS (Methicillin resistant coagulase negative Staphylococci), with 21.42% showing inducible clindamycin resistance (ICR) among the 84 CoNS. All MRCoNS were sensitive to vancomycin and linezolid. Biofilm production was noted in 61.90% of isolates.

Conclusions: Species-level identification and antibiotic resistance profiling of CoNS is crucial in clinical settings to avoid treatment failures. The high prevalence of MRCoNS and biofilm producers necessitates strict infection control and antibiotic stewardship.

A cross-sectional study on elevated levels of serum amylase as a predictive factor for appendiceal perforation in patients with acute appendicitis

2025-11-28T22:45:04+0530

Background: Acute appendicitis is a common surgical emergency, and appendiceal perforation can lead to serious complications. Early identification of perforation is critical to improving outcomes. Serum amylase has been suggested as a potential marker for perforated appendicitis, but its diagnostic accuracy remains under-investigated. This study aimed to evaluate the diagnostic utility of elevated serum amylase levels as a predictive factor for appendiceal perforation in patients with acute appendicitis.

Methods: An observational study was conducted at Hi-tech medical college and hospital, Bhubaneswar, from December 2023 to February 2025. Sixty-four patients diagnosed with acute appendicitis and undergoing appendectomy were included. Preoperative serum levels of amylase and lipase were measured. Postoperative histopathological examination confirmed the diagnosis of perforated or non-perforated appendicitis. Statistical analysis was performed using chi-square test, t-test, and ROC curve.

Results: Among the 64 patients, 28 had perforated appendicitis, and 36 had non-perforated appendicitis. The mean serum amylase level was significantly higher in the perforated group (72.1±27.3 mg/dl) compared to the non-perforated group (30.1±11 mg/dl) (p<0.0001). No significant difference was observed between groups regarding serum lipase.

Conclusions: Elevated serum amylase levels were associated with perforated appendicitis in patients with acute appendicitis. Serum amylase demonstrated high diagnostic accuracy and could serve as a predictive marker for appendiceal perforation. Further studies are warranted to validate these findings and explore the clinical utility of serum amylase in the early diagnosis of perforated appendicitis.

A descriptive study on coverage of hepatitis B vaccination among final year MBBS students in a private medical college, Bengaluru urban of India

2025-11-28T22:45:01+0530

Background: Hepatitis B is one of the most common infections seen in all age and all around the world with high mortality and morbidity. Healthcare workers (HCW) are at risk of contracting the hepatitis B virus (HBV) from infected patients. Hence his study was conducted with an objective to study the coverage and factors affecting hepatitis B vaccination among medical students.

Methods: The descriptive study was carried out among final year MBBS students of B. R. Ambedkar medical college, Bengaluru by adopting convenient sampling technique. A total of 72 students had given consent for the study.

Results: Majority of the students 86% seem to have a good knowledge regarding hepatitis B and 97.2% have responded that it is necessary to get vaccinated. But on the other side only 33.3% students have been vaccinated with a minimum of single dose against hepatitis B. Top 3 reasons for not being vaccinated are lack of motivation, no need felt and never thought of vaccination.

Conclusions: This study reveals that only 33.3% have been vaccinated with a minimum of single dose and 66.6% students are not vaccinated against hepatitis B. After the completion of analyses, the students were briefly educated on the necessity of vaccination, completion of course and the complications that could be avoided in future by volunteering to get vaccinated. Following this event, we saw the 91.7% of students who are motivated or have changed their perception towards vaccination. This shows the importance of health education and counselling.

Mobile phones and minds: linking usage to stress and academic performance in undergraduates

2025-11-28T22:44:57+0530

Background: Mobile phones have become ubiquitous among students, providing easy access to communication and information. However, excessive use has been associated with negative outcomes, including decreased academic performance and increased psychological stress. Understanding the relationship between mobile phone usage, stress and academic achievement is essential to promote healthy study habits and overall well-being among undergraduate students.

Methods: This cross-sectional study included 110 first-year Allied Health and Physiotherapy students from JN Medical College, Belagavi, who provided informed consent. Participants completed a structured questionnaire detailing demographic information, mobile phone usage patterns and study habits. Academic performance was assessed using self-reported grades and recent examination scores, while stress levels were evaluated using a standardized stress assessment scale.

Results: Students reporting higher daily mobile phone usage exhibited significantly lower academic performance compared with those with limited usage (p<0.05). Additionally, frequent mobile phone use was associated with elevated stress levels, suggesting a direct relationship between screen time, psychological stress and learning outcomes. Students who managed mobile phone usage effectively demonstrated better academic scores and lower stress, highlighting the potential impact of controlled use on educational achievement and mental health.

Conclusions: Excessive mobile phone usage among undergraduates is linked to poorer academic performance and higher stress levels. Awareness and strategies to regulate mobile phone use may help improve learning outcomes and reduce stress in this population.

Longitudinal impact of sodium-glucose co-transporter-2 versus dipeptidyl peptidase-4 inhibitors on weight and body mass index in type 2 diabetes: a 12-month comparative analysis

2025-11-28T22:43:28+0530

Background: Obesity and elevated body mass index (BMI) are strongly associated with poor glycaemic control and increased cardiometabolic risk in type 2 diabetes mellitus (T2DM). Beyond glycaemic efficacy, contemporary antidiabetic agents are increasingly evaluated for their effects on weight and metabolic outcomes. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors are widely prescribed, yet comparative long-term data on their impact on weight and BMI in Indian populations remain limited.

Methods: This 12-month observational study included 200 T2DM patients 100 each receiving SGLT-2 or DPP-4 inhibitors. Assessments were conducted at baseline and at 3, 6, 9, and 12 months. Primary outcomes were changes in body weight and BMI, analysed using SPSS v31.0 with paired t-tests, repeated measures ANOVA, and Bonferroni/Sidak post hoc tests. Statistical significance was set at p<0.05.

Results: Patients on SGLT-2 inhibitors exhibited consistent and significant reductions in both parameters: mean body weight declined from 91.61±4.09 kg to 77.63±4.61 kg (Δ=-13.98 kg, p<0.001), and BMI from 29.57±2.68 to 23.13±2.09 (Δ=-6.44, p<0.001). Conversely, DPP-4 users showed negligible changes (Δ=+0.14 kg and -0.10, both p>0.3). The SGLT-2 group’s weight loss was progressive and sustained throughout 12 months. Although gender distribution was similar (p=0.744), younger age in the SGLT-2 group may have influenced outcomes.

Conclusions: SGLT-2 inhibitors produced significant, durable reductions in weight and BMI versus DPP-4 inhibitors, highlighting their dual metabolic advantage in comprehensive T2DM management.

Effect of structured physical activity on intelligence in underperforming school students

2025-11-28T22:43:22+0530

Background: Poor academic performance in some children often stems from lack of concentration. Traditional measures like extra classes and repeated tests show questionable effectiveness. Exercise, however, may offer an alternative, as it enhances cognitive skills and academic performance. This study aims to examine the effect of structured physical activity (SPA) on intelligence in underperforming school students.

Methods: This experimental study was conducted among VI-X standard students from schools in Komarapalayam, Namakkal district. Eligible participants were 11-15 years old, full-time students from middle or low socio-economic groups. From 220 screened students (168 boys, 52 girls), 50 were selected. After obtaining parental consent, they were randomly allocated into two groups: SPA, n=25; 15 boys, 10 girls and general PA (GPA, n=25; 17 boys, 8 girls). The intervention was integrated into the school curriculum. Outcomes measured were intelligence (Bhatia battery test) and endurance, assessed at baseline and at alternate weeks over an 8-week period. Data analysis was performed using SPSS 26.0, with p<0.05 considered statistically significant.

Results: The result of the study shows considerable significance in both groups, where there is a remarkable improvement in the SPA group with t value of 7.67 (p<0.005), compared with GPA with t value of 8.44 (p<0.005).

Conclusions: This study concluded that SPA improves the activity on intelligence in underperforming school students when it was compared with regular PA.

Phenotypic changes in Salmonella typhi: observations during the recent upsurge in typhoid cases in Vadodara, Gujarat

2025-11-28T22:43:20+0530

Background: Salmonella enterica serotype typhi is a causative agent of enteric fever (typhoid). The study was aimed at seeing why the S. typhi showing in vitro susceptibility to ceftriaxone required longer treatment for defervescence. We observed phenotypic change characterized by bipolar staining (safety-pin appearance) in the bacilli. We also observed bacilli forming elongated (filamentous forms). We hypothesize a possible association between this structural change in the cell-wall and the resistance pattern of S. typhi.

Methods: The study was conducted in a rural hospital with tertiary care facilities. Blood cultures were performed in cases of all the patients with suspected sepsis. The blood cultures were performed on an automated BACT/Alert 3D system. Identification and drug susceptibility of the bacterial isolates are done on VITEK 2. The study comprised 25 blood culture-positive typhoid cases in the last three months.

Results: We observed that gram-stained smears made from positive blood culture bottles revealed conspicuous changes in staining pattern of the bacilli. The bacilli showed Bipolar staining (safety pin appearance) of Salmonella enterica serotype typhi under the oil immersion objective.

Conclusion: This is the first observational study to investigate the phenotypic change in the staining properties of S. typhi. We hypothesize that this change in staining pattern is associated with structural changes in the bacterial cell wall, which is responsible for S. typhi altered response to antibiotic therapy.

Towards smear-free anemia diagnosis: evidence from a high-volume laboratory

2025-11-28T22:43:19+0530

Background: Objectives of the study were to evaluate whether peripheral smear (PS) examination is essential in all cases of moderate anemia, or if automated hematology analyzer parameters—particularly RBC indices, red cell distribution width (RDW), and reticulocyte count—can provide reliable diagnostic information.

Methods: This retrospective audit was conducted in the hematology laboratory of a tertiary care teaching hospital over six months. A total of 707 consecutive cases of moderate anemia (hemoglobin 8–10 g/dl) were included. Cases were classified by automated RBC indices into microcytic, macrocytic, normocytic normochromic (NCNC), or dimorphic categories. Peripheral smears were reviewed independently by two hematopathologists. RDW and reticulocyte count were analyzed for additional diagnostic utility. Concordance between analyzer-based and smear-based classifications was evaluated using contingency tables and Chi-square testing (χ²=504, df=24, p<0.001). One-way ANOVA with post-hoc Tukey analysis assessed differences in RDW values across anemia subtypes.

Results: Microcytic anemia demonstrated the highest concordance between analyzer and smear findings (83.8%), followed by macrocytic (56%), dimorphic (40.8%), and NCNC anemia (17.5%). Hemolytic anemia showed no concordance. Elevated RDW values effectively flagged hidden mixed morphologies, while reticulocyte counts were useful in distinguishing regenerative states. Dimorphic anemia exhibited significantly higher RDW compared to both microcytic and macrocytic anemia (p<0.05).

Conclusion: Selective smear review, guided by RBC indices, RDW, and reticulocyte counts, ensures diagnostic accuracy while reducing workload. Universal smear policies are impractical in high-volume laboratories, and targeted approaches provide an evidence-based balance between accuracy and efficiency.

Detection and differentiation of Brucella abortus and Brucella melitensis by multiplex real-time polymerase chain reaction in patients with pyrexia of unknown origin at a tertiary care centre in Northern India

2025-11-28T22:43:17+0530

Background: Brucellosis is a neglected zoonotic disease caused by Brucella spp., posing serious public health and economic challenges, especially in low- and middle-income countries. The disease presents with nonspecific symptoms, and conventional diagnostic methods are often time-consuming and less accurate. Multiplex real-time polymerase chain reaction (m-RT PCR) has emerged as a rapid and reliable diagnostic tool for detecting and differentiating Brucella species. The prevalence, clinical characteristics, and risk factors of human brucellosis among patients with pyrexia of unknown origin (PUO) and to perform molecular characterization of Brucella species using m-RT PCR at King George’s Medical University, Lucknow.

Methods: A total of 315 PUO patients were enrolled between January 2023 and March 2025. Blood samples were collected, sera separated, and DNA extracted using the QIAamp DNA Mini Kit. Multiplex RT-PCR assays targeting the bcsp31 and IS711 genes were performed with species-specific probes to detect Brucella spp., B. abortus, and B. melitensis. Clinical, demographic, and laboratory data were analyzed.

Results: Out of 315 samples, 30 (9.5%) were positive by m-RT PCR-24 (80%) for B. abortus and 6 (20%) for B. melitensis. Most positive cases were adults (70%) and rural residents (73.3%), with housewives (33.3%) and students (26.7%) being the most affected.

Conclusions: Human brucellosis is endemic in Uttar Pradesh, with B. abortus as the predominant species. M-RT-PCR offers a rapid, sensitive, and specific diagnostic method, emphasizing the need for public awareness and a One Health approach for effective control.

Tobacco consumption pattern and dependence in an urban slum community of Mumbai

2025-11-28T22:42:14+0530

Background: Globally India ranks as second highest in terms of tobacco users. As per the GATS survey, 11% of all adults smoke and 21% of all adults are using the smokeless form of tobacco. The aim of the study is to assess the level of dependence on tobacco in the urban slum population aged 18 years and above in Mumbai.

Methods: A descriptive cross-sectional study amongst 100 adults aged 18 years and above, selected sequentially from the sampling frame of tobacco users in the urban slum of Mumbai.

Results: Amongst the 100 respondents 63 were males and 37 were females, 48% were aged 55 years or older and only 12% were below 35 years of age. All females in the study used smokeless form of tobacco, whereas 74.6% of the males used smokeless form of tobacco. 51% respondents reported the age of initiation of tobacco as 20-24 years and 34% reported a family member using tobacco products. Less than Rs. 200 per month was being spent on purchasing tobacco products by 77% of the respondents. High dependency score in Fagerstrom Test for Nicotine Dependence (FTND) was observed in 26.3% and 51.2% of smokers and smokeless tobacco users respectively.

Conclusions: In the urban slum of Mumbai, smokeless form of tobacco is more prevalent than smoke form of tobacco and is highly addictive both in males and females. Family influence played a major role in initiation of tobacco use among females as compared to males.

Correlation between mean thrombocyte volume and microalbuminuria in type 2 diabetes mellitus patients

2025-11-28T22:42:14+0530

Background: The determination of microalbuminuria is beneficial in detecting cases of type 2 diabetes mellitus (T2DM), which can result in renal and cardiovascular diseases. A few studies correlating mean thrombocyte volume (MTV) with microalbuminuria have shown positive results; however, data remain limited in the Indian population. The present study evaluated the association between MTV and microalbuminuria in patients with (T2DM).

Methods: This hospital-based cross-sectional study was conducted from February 2023 to January 2024 in Maharashtra, India. Sixty patients of either sex, aged 18 years or older, with a duration of T2DM greater than four years and diagnosed according to American Diabetes Association criteria, were included. The duration of diabetes mellitus (DM), HbA1c, and urine microalbumin were noted. The primary objective was to determine the relationship between MTV and microalbuminuria, while the secondary objectives were to assess the associations between MTV and the duration of T2DM and between MTV and HbA1c. The sample size was statistically powered to detect a significant correlation between MTV and microalbuminuria, aligning with findings from prior research.

Results: The mean MTV was significantly elevated in patients with a duration of diabetes greater than ten years, HbA1c >7%, and urine microalbumin levels >30 mg/g. A significant positive correlation of 0.936, 0.552, 0.875 and 0.433 was observed between MTV and urine microalbumin levels, the duration of DM, HbA1c and age, respectively.

Conclusions: MTV serves as a simple and cost-effective marker for assessing glycemic control and early detection of renal involvement in T2DM. The study reinforces the potential role of MTV as a supportive tool for monitoring disease progression and guiding preventive care in diabetic patients.

Enhancing microbiological culture accuracy: clinical audit on the role of direct microscopy and the Bartlett scoring system in diagnostic correlation of sputum samples

2025-11-28T22:42:13+0530

Background: Lower respiratory tract infections (LRTIs) represent a significant clinical burden necessitating accurate microbiological diagnosis to guide targeted antimicrobial therapy. The quality of sputum specimens substantially influences the validity of culture results and diagnostic reliability. The Bartlett scoring system (BS) is a standardized, objective tool for assessing sputum specimen quality. However, its clinical utility in predicting culture positivity within tertiary care settings remains inadequately characterized in existing literature.

Methods: A clinical audit was conducted on 212 consecutive sputum samples from patients with suspected LRTIs collected during September and October 2023 at a tertiary care center. All specimens were subjected direct microscopy examination with concurrent assessment using the Bartlett scoring system. Samples that met quality criteria (BS≥2) were processed for culture using standard microbiological techniques. Culture positivity rates were correlated with Bartlett scores to determine the association between sample quality assessment and microbiological yield.

Results: Among the 212 sputum samples analyzed, specimens with higher Bartlett scores demonstrated significantly increased culture positivity rates, establishing a positive correlation between sample quality assessment and microbiological diagnostic yield. Samples classified as high-quality (BS≥2) demonstrated superior diagnostic utility compared to lower-quality specimens. The Bartlett scoring system, when applied systematically in conjunction with direct microscopy, facilitated objective specimen selection and enhanced laboratory processing efficiency.

Conclusions: This audit demonstrates that the scientific utility of Bartlett scoring system serves as a valuable objective tool for assessing sputum quality and predicting culture positivity.

Exploring Deferoxamine-B for resensitization and antimicrobial resistance mitigation in drug resistant Klebsiella pneumoniae and Staphylococcus aureus: an in vitro study

2025-11-28T22:42:12+0530

Background: The rising incidence of antimicrobial resistance (AMR) in pathogens like Klebsiella pneumoniae and Staphylococcus aureus is a major global concern. Resistance mechanisms such as extended spectrum β-lactamases (ESBLs), metallo β-lactamases (MBLs), and methicillin resistance limit treatment options. Iron-chelating siderophores like DFO-B may disrupt bacterial iron metabolism and potentially resensitize resistant strains to antibiotics.

Methods: This in vitro cross-sectional study assessed the adjunctive effect of DFO-B with selected antibiotics against clinical isolates of MDR K. pneumoniae and S. aureus. Isolates were identified, and antibiotic susceptibility was determined using disc diffusion and micro broth dilution. Synergy between DFO-B and antibiotics was evaluated by disc diffusion enhancement and MIC reduction assays.

Results: Among 100 K. pneumoniae isolates, 54% were multidrug-resistant and 46% extensively drug-resistant; 83% produced ESBLs and 70% showed MBL activity, with high resistance to third-generation cephalosporins. DFO-B alone showed no antibacterial effect and did not enhance antibiotic activity, displaying indifferent interactions and mild antagonism with imipenem in ESBL producers. Among 128 S. aureus isolates, tigecycline showed 100% susceptibility in both MSSA and MRSA, with no additional effect from DFO-B. Cefdinir and ampicillin showed higher resistance in MRSA, but their activity improved in the presence of DFO-B, with cefdinir showing a marked increase in MRSA susceptibility and ampicillin showing modest improvement.

Conclusion: DFO-B did not enhance antibiotic activity against MDR K. pneumoniae, but it showed some potential to increase susceptibility in selected S. aureus strains. These results highlight the complex role of siderophore-mediated iron chelation in AMR and the need for further research to optimize such combination therapies.

Diagnostic significance of micronucleus evaluation in breast fine needle aspiration cytology

2025-11-28T22:42:11+0530

Background: Breast cancer is one of the most common malignancies among females in India. Micronucleus (MN) scoring, a marker of chromosomal instability, has shown potential in evaluating breast lesions cytologically. The International Human Micronucleus Project confirmed that MN assays are simple and minimally invasive indicators of genomic instability, with higher scores correlating with malignancy. To compare MN scores across benign, borderline and malignant breast lesions, correlate MN scores with Robinson’s cytological grading in malignant cases and evaluate the diagnostic utility of MN scoring in fine needle aspiration cytology (FNAC).

Methods: A cross-sectional study was conducted in the Department of Pathology of Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research from December 2023 to February 2025 on 100 breast FNAC samples. Smears were alcohol-fixed, H&E-stained and classified per the Yokohama System. Robinson’s cytological grading was applied to malignant cases and MN scoring was performed on 1000 cells per case. Statistical analysis was done using SPSS version 20, with p<0.05 considered significant.

Results: Among 100 cases (age 19–62 years), there were 50 benign, 10 atypical, 10 suspicious and 30 malignant lesions. Mean MN scores were 0.53±0.45, 2.8±0.85, 6.4±2.1 and 21.9±5.9, respectively (p=0.000). Significant differences were found between most groups, except benign versus atypical (p=0.15). MN scores increased with Robinson’s grades I–III, showing significant correlation (p=0.04).

Conclusions: Micronucleus scoring, reflecting genomic instability, serves as a simple, cost-effective adjunct cytological marker enhancing diagnostic accuracy and prognostication in breast malignancy.

Titagen® for total wellness: results from a randomised, placebo controlled clinical study on adults for osteoarthritis, improvement in skin, nail and health

2025-11-28T22:42:09+0530

Background: Fish collagen has been vital in functional food with natural bioactive compounds to offer potential therapeutic benefits. Titan biotech limited (TBL) has studied Titagen® as a nutraceutical to evaluate improvement in in adults looking to improve skin, hair, nail health and osteoarthritis.

Methods: Two randomised, double blinded, placebo controlled clinical studies were conducted on Titagen® of TBL. 48 adults were studied in each of the studies for a period of 90 days. Study 1 (SHN study) was conducted on adults looking to improve skin, hair and nail health with Titagen® dose of 5g per day for 3 months-assessed, using assessments and questionnaire to evaluate skin improvement, hair growth and nail health. Study 2 (OA study) was conducted on adults with osteoarthritis with Titagen® dose of 10 g per day for 3 months-evaluated using assessments and questionnaires.

Results: Results showed that Titagen® was better than placebo with statistically significant results in skin health (59.72% vs -51.39), 60 second hair comb test (27.15% vs 2.35%), hair health (18.06% vs -43.06%), nail health (62.50% vs -33.33%), Western Ontario and McMaster universities arthritis index (WOMAC) parameters (39.73% vs 1.72%), pain VAS (70.86% vs 4.21%), quality of life questionnaire (20.83 scores vs 7.31 scores), global impression of change scale results (2.75 vs 4.40). There were no adverse events related to Titagen® and is deemed safe for daily consumption.

Conclusions: The clinical studies proved 5 g Titagen® for 90 days improved skin, hair and nail health, 10 g Titagen® for 90 days reduced pain, stiffness in joints and improved quality of life living with osteoarthritis.

Fine needle aspiration cytology of breast lumps: how reliable is it? A correlative study with histopathology

2025-11-28T22:42:08+0530

Background: Breast carcinoma is one of the most common malignancies in women. Palpable breast lesions are one of the commonest presentations in general and surgical practice. To study the spectrum of benign and malignant breast lesions and the efficacy of FNAC as a diagnostic tool by correlating with histopathological findings.

Methods: The present study was carried out among 250 patients who presented to ACPM medical college and hospital during a 5-year period from January 2018 to January 2023. All cases that presented with a palpable breast lump were evaluated with FNAC and the lesions were categorised as C1-C5 as per National Health Service Breast screening programme (NHSBSP) reporting criteria. Every patient subjected to FNAC with an adequate result, underwent a definitive surgical procedure. All specimens so obtained were subjected to histopathology. The results thus obtained were matched with those of FNAC and a correlation was sought based on statistical tests. In 243 cases cytohistopathological correlation was obtained.

Results: A total of 250 cases was studied which included 170 benign cases (68%), 52 malignant cases (20.8%), 21 proliferative lesions with atypia (8.4%) and 7 inadequate aspirates (2.8%). The diagnostic accuracy of FNAC in this study was 98.77%.

Conclusions: Aspiration cytology can be done as a first line procedure but cannot be considered as a substitute for histopathology.

Comparing the efficacy and renal safety of metformin and imeglimin in diabetic rats

2025-11-28T22:42:06+0530

Background: Diabetic kidney disease (DKD) represents a significant cause of end-stage kidney disease and is closely linked to substantially higher rates of cardiovascular morbidity and mortality. As a result, there is a need for therapies that can prevent DKD, improve patient compliance, reduce side effects, and be cost-effective.

Methods: Healthy male albino rats (150-200 g) were screened, and hyperglycemia was induced in 24 rats, and after one week, hyperglycemia was confirmed. The rats were then divided into four groups (Groups 1, 2, 3, and 4) (n=6). Group 1 was designated as diabetic control group, while nephrotoxicity was induced in the remaining rats. Group 1 and Group 2 (toxic control group) were treated with vehicle. Group 3 (metformin group) was treated with metformin, and Group 4 (imeglimin group) received imeglimin, both at a dose of 180 mg/kg/day for two weeks.

Results: On day 21, there was a significant reduction in serum urea and creatinine levels in Group 3 (p<0.05 and p<0.05, respectively) and Group 4 (p<0.001 and p<0.001, respectively) when compared with Group 1. Also, both Groups 3 and 4 showed a significant reduction in serum urea (p<0.001, p<0.001) and creatinine (p<0.001, p<0.001) levels when compared with Group 2. However, the glycemic control by imeglimin did not significantly differ from that of metformin on day 21.

Conclusions: Imeglimin was more effective in improving renal function parameters, demonstrating greater renal safety compared to metformin.

Clinical study of conservative and surgical management of blunt abdominal trauma: a prospective observational study

2025-11-28T22:42:06+0530

Background: Blunt abdominal trauma represents a significant cause of morbidity and mortality, particularly in developing countries. The management approach has evolved from primarily surgical to selective non-operative management in hemodynamically stable patients.

Methods: A prospective observational study was conducted at a tertiary care center over 18 months, including 50 patients with blunt abdominal trauma. Data were collected on demographics, clinical presentation, management approach, and outcomes. Statistical analysis was performed using chi-square test and Student's t-test.

Results: The study included 40 males (80%) and 10 females (20%), with mean age of 35.2 years. Road traffic accidents accounted for 50% of cases, followed by assault (38%) and falls (12%). Surgical management was required in 31 patients (62%), while 19 patients (38%) were managed conservatively. The overall mortality rate was 10% (5 patients), with 90% achieving complete recovery. Mesenteric tears were the most common intraoperative finding (60% of surgical cases). Significant associations were found between outcome and clinical features including abdominal distension (p=0.026), vomiting (p=0.045), and associated injuries (p=0.023).

Conclusions: Blunt abdominal trauma predominantly affects young males, with road traffic accidents being the leading cause. While surgical intervention remains necessary in the majority of cases, selective non-operative management can be safely applied in hemodynamically stable patients with appropriate monitoring. Early recognition and prompt intervention are crucial for optimal outcomes.

Impact of screen time on sleep quality among undergraduate medical students in Patna, Bihar: a cross-sectional study

2025-11-28T22:42:02+0530

Background: Digital screens have become omnipresent in the lives of young adults, especially medical students, raising concerns about the influence of extended screen exposure on sleep quality. Growing evidence suggests screen time, particularly near bedtime, adversely affects sleep parameters, potentially diminishing cognitive and academic performance. The objective of this study was to assess the association between total screen time and sleep quality among undergraduate medical students in Patna, Bihar, India.

Methods: A cross-sectional study was conducted in June 2025 among 510 undergraduate medical students from seven medical colleges in Patna. Data was collected using a pre-tested, semi-structured Google Forms questionnaire, which included socio-demographic details, screen use patterns, and the Pittsburgh sleep quality index (PSQI) for sleep assessment. Descriptive and inferential statistics were analyzed with statistical package for the social sciences (SPSS) trial version 25.

Results: The mean participant age was 22.4 years; 59.9% were male. Most students reported 2–4 hours (44.9%) followed by 5–8 hours (29.6%) of screen time per day. Only 16.3% reported sleeping more than 7 hours per night. Use of screens within 1 hour before sleep was reported by 46.7% of participants. PSQI scores showed that 68.2% of students experienced poor sleep quality (global PSQI >5). Extended and late-night screen time was significantly associated with higher PSQI scores, indicating poorer sleep.

Conclusion: High levels of screen exposure, especially at night, are associated with significantly reduced sleep quality among medical students. Responsible digital hygiene and structured interventions are crucial to prevent sleep disturbances in this vulnerable population.

Uterine smooth muscle tumours and the role of Ki67 expression in determining their biological behaviour

2025-11-28T22:42:02+0530

Background: Uterine smooth muscle tumours include leiomyoma, intravenous leiomyoma, metastasizing leiomyoma, smooth muscle tumour of uncertain malignant potential (STUMP) and leiomyosarcoma (LMS). Diagnosis primarily relies on histopathological features. In cases with overlapping morphological findings, immunohistochemical markers can help in differentiating benign and malignant lesions. This study evaluates the role of Ki67 immunohistochemical expression in determining the biological behaviour of uterine smooth muscle tumours.

Methods: In this study a total of 58 cases of uterine smooth muscle tumours were analysed. Gross findings were observed. The microscopic evaluation was done on formalin fixed paraffin embedded sections and haematoxylin and eosin-stained slides. This was followed by Ki67 staining by immunohistochemistry and was graded depending on percentage of nuclear expression. Association of Ki67 grade with gross and microscopic findings were determined.

Results: Among 58 tumours, 52 (90%) were leiomyomas, 3 (5%) STUMPs, and 3 (5%) LMS. Most patients were between 41 and 50 years of age, with menorrhagia being the most common presenting complaint. Ki67 expression was low (86.2%) in all leiomyomas, consistently high in LMS and showed variable levels in STUMP. Ki67 levels demonstrated a significant association with mitotic activity, necrosis and cytologic atypia (p<0.05), but did not correlate with tumour size and secondary changes.

Conclusions: Combining histopathology with Ki67 immunostaining improves diagnostic efficacy in uterine smooth muscle tumours and thus contributes to a more effective clinical management.

Exploring healthcare providers’ perspectives on type 1 diabetes management in rural and resource-limited settings

2025-11-28T22:42:00+0530

Background: Type 1 diabetes mellitus (T1D) is a chronic autoimmune condition requiring lifelong insulin therapy and comprehensive care. In India, especially in rural and resource-limited settings, challenges in availability of insulin, provider training, patient education, and psychosocial support persist. Most studies emphasize patient experiences; however, healthcare providers’ perspectives remain underexplored.

Methods: A mixed-methods cross-sectional study was conducted among 82 healthcare providers, including endocrinologists, nurses, diabetes educators, and primary care physicians. Data were collected using structured questionnaires (quantitative) and semi-structured interviews/focus group discussions (qualitative). Quantitative data were analyzed using descriptive statistics, while qualitative transcripts underwent thematic analysis. Findings were integrated through convergent analysis.

Results: Among participants, 85% identified irregular insulin supply and affordability as major barriers, while 78% reported low patient awareness and literacy. Insufficient provider training (70%) and lack of systematic follow-up (65%) were also highlighted. Only 30% reported regular interdisciplinary coordination, and just 20% addressed psychosocial issues during consultations. Qualitative themes reinforced these findings, highlighting four domains: (1) systemic care barriers (supply shortages, workload, inadequate infrastructure), (2) patient engagement challenges (low literacy, stigma, myths), (3) limited team-based care (poor referrals, lack of formal coordination), and (4) neglected psychosocial support (absence of counseling, unmet family needs).

Conclusions: Providers face significant systemic, educational, and psychosocial challenges in managing T1D in rural India. Strengthening provider training, ensuring insulin availability, enhancing patient education, establishing multidisciplinary networks, and integrating psychosocial services are critical to improve outcomes.

Psychiatric manifestations in ulcerative colitis: a North Indian cohort study

2025-11-28T22:41:59+0530

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes results in gastrointestinal and other health issues. Psychiatric problems are being recognized more often but are still often missed, particularly in India. Aim of the study was to examine the demographics, disease characteristics, and psychiatric symptoms of UC patients in North India.

Methods: A prospective observational study of 100 UC patients was carried out from September 2021 to September 2023. Demographics, disease extent, severity, and psychiatric outcomes were recorded, and all patients were assessed for depression and anxiety using PHQ-9 and GAD-7 scores.

Results: The mean age of the study cohort was 38.6±12.4 yrs, with 58% being male. Pancolitis was found in 48% of the patients. Clinically significant depression (PHQ-9 ≥10) and anxiety (GAD-7 ≥10) were seen in 28% and 26%, respectively. Sleep disturbances affected 44% of the patients, and fatigue was reported by 47%. Steroid-related psychiatric events occurred in 3%.

Conclusions: Psychiatric symptoms are common in UC and can negatively impact quality of life. Comprehensive care requires regular screening and a team-based approach.

Epidemiology of lung cancer in a central India population: a single tertiary cancer centre 5-year prospective study

2025-11-28T22:45:03+0530

Background: Globally, there have been varied changes in trends of lung cancer epidemiology depending on the geographic region, gender, histological subtype, and incidence. Also, there is a dearth in our current understanding of the changing epidemiological trends of lung cancer among Indian patients. Indian epidemiological data on lung cancer are limited, particularly in the central region.

Methods: We conducted a 5-year prospective study (January 2020-December 2024) at the Department of State Cancer Institute, Jabalpur (Madhya Pradesh), to evaluate the demographic and clinico-radiological profiles of primary lung cancer in Central India. Cases with confirmed histological or cytological diagnoses were reviewed, collecting data on demographics, risk factors, residence, histological subtype, and stage at presentation.

Results: A total of 546 patients (median age: 58.4 years; male-to-female ratio: 3.9:1) were included, with 60% smokers and 68.5% from rural areas. Most of the patients presented with non-small-cell carcinoma (NSCLC), with squamous cell carcinoma being the most common histological subtype (49.6%), followed by adenocarcinoma (34.6%), undifferentiated carcinoma (2.5%), and large-cell carcinoma (1.8%). Small-cell lung carcinoma accounted for 9.5% of cases. Over half of the patients (57.4%) presented with stage IV disease at diagnosis. Common metastatic sites included the pleura, liver, brain, bone, and adrenal glands, with bone metastases more commonly observed in smokers.

Conclusions: A significantly high proportion of lung cancer patients in Central India are smokers. Passive smoking is also a risk factor in our region. Squamous cell carcinoma remains the predominant subtype.

Acanthamoeba keratitis: prevalence, diagnosis, treatment and future trends: a systematic review

2025-11-28T22:42:01+0530

Acanthamoeba keratitis (AK) is a rare but severe corneal infection caused by free-living Acanthamoeba species. It is increasingly recognised as a significant cause of visual morbidity, especially among contact lens users. This systematic review follows preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines and analyses studies published between January 2000 and January 2025, focusing on AK prevalence, diagnostics, treatment, and innovations. Our search across databases, including PubMed and Scopus, identified 20 peer-reviewed studies. Findings reveal a 35-50% increase in global AK incidence since 2000, particularly affecting Europe, East Asia, and North America, with 85-90% of cases linked to contact lens wear and the T4 genotype being the predominant strain. Advancements in diagnostics, such as polymerase chain reaction (PCR) testing (with over 95% sensitivity) and in vivo confocal microscopy (IVCM) (with 85-90% sensitivity), have improved early detection. Emerging technologies, including metagenomics sequencing and artificial intelligence (AI)-driven imaging, have further enhanced diagnostic accuracy, achieving a specificity of over 93%. Current treatments rely on a combination of biguanides and diamidines, but prolonged therapies often lead to recurrence, with 20-25% of severe cases requiring keratoplasty. Innovations such as nanocarrier drug delivery, photodynamic therapy (PDT), and genotype-specific antimicrobials are promising. While advancements in the diagnosis and treatment of AK have improved, challenges in reducing the disease burden and improving long-term outcomes remain. The future of AK management hinges on integrating molecular diagnostics and AI into clinical practice, supported by public education on safe contact lens hygiene practices.

Hearing risk in the digital age: a systematic review on recreational audio device use among youth

2025-11-28T22:45:02+0530

Prolonged use of personal listening devices (PLDs) like earphones and headphones among young people has become a global concern due to the risk of hearing damage. This systematic review, which included 15 studies, found that such use is associated with early signs of auditory damage, particularly at high frequencies. While the quality of evidence varied, with some studies having a low risk of bias and others showing moderate concerns due to issues like selection and detection bias, key risk factors were consistently identified. These included the duration of listening, the volume level, and the use of earphones in noisy environments. The findings highlight the pressing need for standardised research and public health initiatives to promote safer listening practices among individuals aged 12-30.

Publish or perish: exploring nurse academicians’ perspectives on academic publishing

2025-11-28T22:43:26+0530

Academic publishing is a vital component of nursing scholarship, essential for faculty promotion, knowledge dissemination, and international recognition. Despite its importance, nurse academicians face multiple challenges such as limited mentorship, heavy workloads, language barriers, and financial constraints that impede scholarly engagement. This study aimed to clarify the concept of nurse academicians’ perspectives on academic publishing using Walker and Avant’s eight-step concept analysis framework. A systematic literature search was conducted across PubMed, Scopus, CINAHL, and Web of Science for studies published between 2015 and 2024. Both MeSH terms and free-text keywords were used, and fifteen empirical studies met the inclusion criteria. Data were extracted and appraised using a 15-item quality checklist, with findings synthesized into defining attributes, antecedents, consequences, and empirical referents. Three key attributes emerged: motivational drivers (career advancement, scholarly identity), barriers (workload, language difficulties, financial constraints, predatory publishing), and facilitators (mentorship, institutional support, collaboration). Antecedents included research competence, supportive culture, and funding availability. Consequences encompassed enhanced productivity and recognition but also risks such as burnout and unethical practices. Empirical referents such as publication count, H-index, and faculty surveys provided measurable indicators. A model case illustrated how mentorship, motivation, and resources interact to shape publishing perspectives. In conclusion, this analysis distinguishes perspectives from mere productivity, offering conceptual clarity and practical insights. Strengthening mentorship, redistributing workloads, providing writing and language support, and ensuring financial assistance are crucial for enhancing scholarly publishing in nursing. These findings inform institutional policy, nursing education, and global research collaboration.

Genetic modulator of stress resilience and blood pressure regulation: insights from polymorphic variation

2025-11-12T10:23:07+0530

Neuropeptide Y (NPY) is a remarkably conserved neuropeptide distributed throughout the central and peripheral nervous systems, where it exerts broad influence over stress regulation and cardiovascular stability. While chronic stress typically contributes to increased blood pressure, a subset of individuals maintain normal levels despite similar stress exposure, suggesting the involvement of protective genetic factors within the NPY pathway. Variations in the NPY gene, particularly functional promoter polymorphisms such as rs16147 C>T and related haplotypes, appear to shape individual differences in stress responsiveness, sympathetic activation and emotional resilience. High-expression alleles are generally linked with reduced norepinephrine release, lower blood pressure and greater psychological stability under stress, whereas low-expression variants tend to enhance sympathetic tone and heighten vulnerability to anxiety and stress-related hypertension. Experimental studies reinforce the concept of NPY as a central sympathoinhibitory regulator, acting mainly through presynaptic Y₂ receptors within autonomic control centers. Recognizing these genetic influences offers valuable insight into why stress affects individuals so differently and opens new avenues for precision medicine. Genotypic profiling may ultimately aid in tailoring interventions for hypertension, anxiety and post-traumatic stress disorder. Moreover, pharmacological strategies targeting the NPY system such as Y₂ receptor agonists or agents that modulate epigenetic regulation, represents promising directions for future therapy. Continued longitudinal and translational research is essential to confirm causal mechanisms and to establish NPY as a clinically useful biomarker and therapeutic target in stress-related cardiovascular and neuropsychiatric disorders.

The role of childhood trauma in the development of psychopathology via neurocognitive pathways

2025-11-28T22:45:10+0530

Childhood trauma is a potent risk factor for a wide range of psychopathological outcomes. This review synthesizes evidence on how trauma experienced in childhood (before age 12) impacts neurocognitive development and in turn elevates risk for later psychopathology. A comprehensive literature search was conducted focusing on cognitive, behavioral, and neurobiological effects of early trauma, with special emphasis on Indian research alongside international findings. Childhood trauma is associated with broad cognitive difficulties, including attentional bias toward threat, memory processing impairments (e.g., fragmented or overgeneral memories), executive function deficits, and emotion regulation problems. These trauma-induced neurocognitive alterations often mediate the link between early adversity and diverse psychopathological outcomes such as posttraumatic stress, anxiety, depression, and dissociation. Neurobiologically, trauma-exposed children show dysregulation of stress response systems (e.g., HPA axis) and structural and functional brain changes in regions subserving emotion and cognition (e.g., amygdala, hippocampus, prefrontal cortex). Indian studies mirror global findings, with high prevalence of child trauma and evidence of similar neurocognitive sequelae. Childhood trauma can derail neurocognitive development in ways that confer transdiagnostic psychopathology risk. These findings underscore the need for early identification and intervention for trauma-exposed children, culturally informed research (particularly in India), and dimensional frameworks (e.g., RDoC) to understand trauma-related cognitive profiles. Early interventions targeting cognitive and emotional regulation skills may mitigate the progression from childhood trauma to later mental health disorders.

Exploring Actinomycetes metabolites in cancer therapy

2025-11-28T22:45:00+0530

Cancer poses a serious threat to human health, with its incidence and mortality rates rapidly increasing worldwide. Current therapies often fall short of clinical needs, particularly due to challenges such as tumor resistance to chemotherapy and severe toxic side effects. Therefore, there is an urgent need to develop highly effective anticancer drugs with low toxicity. Natural products derived from microorganisms serve as a vital source of valuable pharmaceuticals and therapeutic agents. Among them, actinomycetes represent a rich reservoir for the discovery of numerous medicinal natural products and play a crucial role in the development of new microbial drugs. In particular, actinomycetes of the genus Streptomyces have attracted significant global attention due to their ability to produce a wide range of bioactive secondary metabolites. The potential of these Gram-positive bacteria to synthesize diverse compounds with potent biological activities makes them ideal candidates for anticancer drug discovery. This review article focuses on the natural products secreted by actinomycetes, their biological functions and their possible roles in anticancer activity.

Cryotherapy in endodontics: a comprehensive review of applications, mechanisms, and future perspectives

2025-11-28T22:43:32+0530

Cold temperatures, therapeutically used in cryotherapy, are a valuable adjunct in endodontics. It is reviewed in terms of its history, principles, techniques, clinical uses, and evidence base. Mechanisms include vasoconstriction, reduced metabolism, modulation of nerves (analgesia), and anti-inflammatory effects. Cold saline irrigation, cryoprobes, external cold packs and cryogenic instrument treatment are standard methods. Cold saline irrigation (2.5–4°C) is strongly evidenced to reduce postoperative pain after root canal treatment (RCT). It may also enhance the success of local anaesthesia, especially in inflamed teeth. However, it is encouraging in its role in vital pulp therapy and regenerative endodontics, but more research is needed. The fatigue resistance of NiTi files may be improved by cryogenic treatment. Temperature and duration must be carefully controlled for safety, patient screening (including contraindications such as cold hypersensitivity), and proper technique. For pain, it is effective; however, further research is needed for other applications and protocol optimisation. Cryotherapy overall improves patient comfort and may enhance outcomes, aligning with modern endodontic principles.

Early and guided physiotherapy in head and neck cancer: a narrative review of clinical interventions

2025-11-28T22:43:29+0530

Head and neck cancer (HNC) patients frequently experience pain, fatigue, dysphagia, and psychological distress because of oncologic treatment. Physiotherapy has emerged as a key rehabilitative strategy to address these sequelae, particularly when initiated early and delivered through therapist-guided protocols. Objective: This narrative review aims to synthesize evidence from clinical trials and structured programs evaluating early and guided physiotherapy interventions in HNC, focusing on their impact on symptom management and functional recovery. A comprehensive literature search was conducted across five databases (PubMed, Scopus, Web of Science, Cochrane Library, and ScienceDirect) for studies published between 2010 and 2025. A total of 396 records were identified, with 304 screened by title and abstract. After full-text assessment of 141 articles, 13 studies met the inclusion criteria. Data were extracted on intervention type, timing, therapist involvement, and outcomes related to pain, fatigue, swallowing function, and quality of life. Early physiotherapy interventions, particularly those involving therapist supervision, demonstrated consistent improvements in fatigue, mobility, swallowing function, and emotional well-being. Multimodal approaches combining aerobic and resistance training were especially effective. Therapist-guided delivery enhanced adherence, safety, and individualized care. Early and guided physiotherapy offers significant benefits for HNC patients, supporting its integration into multidisciplinary cancer rehabilitation. Future research should focus on standardized protocols, long-term outcomes, and scalable delivery models.

A narrative review of digital screen time and sleep quality among young adults in India

2025-11-28T22:43:17+0530

In India, the digital revolution has transformed daily life patterns, with smartphone penetration and internet usage reaching historic levels. However, this digital transformation has raised significant concerns about adverse health effects, particularly regarding sleep quality. This narrative review synthesizes evidence from 30 studies published between 2010 and 2025 to explore the complex relationship between digital screen time and sleep quality among young adults aged 18–35 years in India. A comprehensive literature search was conducted across multiple databases including PubMed, Scopus, and Web of Science, and this review was synthesised. The findings reveal that young adults in India spend an average of 4–6 hours daily on digital devices, with smartphones accounting for the majority of screen exposure. Excessive screen time was consistently and significantly associated with multiple dimensions of sleep impairment, including delayed sleep onset, reduced sleep duration, poor overall sleep quality, and irregular sleep schedules. Notable gender differences emerged, with men more likely to engage in prolonged gaming sessions and women spending more time on social media, leading to distinct patterns of sleep disturbances. India-specific cultural and social factors, including academic pressure, professional demands, late-night entertainment consumption patterns, and social connectivity norms, further exacerbated the problem. The review concludes that excessive screen time represents a growing public health concern in India with implications extending beyond sleep to encompass mental health, academic and professional performance, and overall well-being.

Unusual distal migrations of ventriculoperitoneal shunts: a six-patient pediatric case series with literature review

2025-11-28T22:43:29+0530

Distal migration of ventriculoperitoneal (VP) shunts to atypical sites is an uncommon but potentially serious complication. This retrospective case series presents six pediatric patients (aged 0-3 years) with unusual distal shunt migrations managed at a tertiary neurosurgical center between 2018 and 2025. Three infants exhibited scrotal migration through a patent processus vaginalis (PPV), two children presented with transanal extrusion following bowel perforation, and one infant had vaginal extrusion. Management included shunt revision with PPV ligation, shunt removal with antibiotic therapy, and definitive cerebrospinal fluid (CSF) diversion procedures, including endoscopic third ventriculostomy (ETV). All patients recovered without long-term morbidity. This study highlights the clinical importance of early recognition and prompt management of distal catheter migration, emphasizing preventive strategies, including optimizing catheter length and surgical correction of a PPV.

NTM beyond the lungs: a case series of non-tuberculous mycobacterial infection at extrapulmonary sites

2025-11-28T22:44:54+0530

Background: In this case series, the results of documented non-tuberculous mycobacteria (NTM) infections, which have emerged as important pathogens, mainly among individuals with immunocompromised status have been studied. The report showcases the clinical presentation, diagnostic modality, treatment as well as outcome and results regarding the 8 patients who were diagnosed with NTM infection at extrapulmonary locations via molecular techniques.

Methods: It involves retrospective analysis of patients who were diagnosed with NTM infection at the Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, in the last 2 years, who were diagnosed using molecular tests. The specific details of clinical presentation, diagnostic methods and treatment regimens, along with outcomes, were reviewed retrospectively and summarized.

Results: The outcomes comprised 8 patients (5 females and 3 males) between 19 and 79 years. The signs and varied symptoms included fever, headache, cough and weakness. The confirmatory diagnosis was followed by Polymerase chain reaction (PCR) for NTM, biopsy from the site, such as abdominal and vertebrae and pleural fluid analysis. Most patients showed significant clinical improvement after the diagnosis and appropriate treatment.

Conclusions: This case series highlights the diverse clinical manifestations of NTM infections at extrapulmonary sites, emphasizing the importance of early diagnosis and appropriate management. Clinicians should maintain a high index of suspicion for NTM infections, especially in atypical presentations and immunocompromised patients.

Fibromatosis colli: a case series of three infants

2025-11-28T22:43:28+0530

Fibromatosis colli is a rare, benign fibrous lesion of the sternocleidomastoid muscle in infancy. It typically presents as a firm; non-tender neck swelling within the first few weeks of life and is strongly associated with birth trauma. We report a series of three infants with fibromatosis colli, emphasizing the role of clinical evaluation, ultrasonography, and fine-needle aspiration cytology (FNAC) in diagnosis, with physiotherapy as the mainstay of management. A four-week-old male presented with a left cervical swelling following breech delivery. Ultrasound showed fusiform thickening of the left sternocleidomastoid, and FNAC confirmed fibromatosis colli. He was managed conservatively with physiotherapy. A six-week-old female presented with right-sided neck swelling after a forceps-assisted delivery. Ultrasound revealed an ellipsoid enlargement of the right sternocleidomastoid, and FNAC showed spindle fibroblastic cells. She responded well to physiotherapy with near-complete resolution at three months. A three-week-old male had bilateral sternocleidomastoid thickening with restricted neck movement after prolonged labor. Ultrasound confirmed bilateral fusiform thickening, and FNAC ruled out malignancy. Physiotherapy led to gradual improvement over 4 months. Early recognition of fibromatosis colli is crucial to avoid unnecessary investigations and parental anxiety. Timely physiotherapy results in spontaneous regression in most cases, while surgery is reserved only for refractory cases.

Comparative efficacy of aloe vera in the treatment of oral lichen planus: a systematic review and meta-analysis of randomized controlled trials

2025-11-28T22:43:30+0530

Oral lichen planus (OLP) is a chronic immune-mediated disorder that negatively affects oral function and quality of life. Corticosteroids are the standard therapy but may cause adverse effects with prolonged use. Aloe vera, a natural agent with anti-inflammatory and wound-healing properties, has been proposed as a safer alternative. Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Scopus, Cochrane Library and Google Scholar was performed up to September 2025. Eligible studies were RCTs comparing Aloe vera (gel, paste or mouthwash) with placebo, corticosteroids or other therapies. Primary outcomes included post-treatment Visual Analogue Scale (VAS) pain scores and Thongprasom clinical scores; secondary outcomes were treatment response and lesion size reduction. A random-effects model was used to calculate pooled mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI). Nine RCTs involving 752 patients met the inclusion criteria. Aloe vera was associated with a significantly higher overall treatment response (RR=1.34, 95% CI 1.12–1.61; I²=28%). No significant differences were found for VAS pain scores (MD=−0.01, 95% CI −0.19 to 0.16; I²=90%), Thongprasom clinical scores (MD=−0.49, 95% CI −1.36 to 0.38; I²=96%) or lesion size (MD=0.81, 95% CI −0.57 to 2.19; I²=99%). Aloe vera demonstrates a favourable safety profile and may enhance overall treatment response in oral lichen planus compared with placebo or corticosteroids. However, its benefits on pain relief and lesion healing remain inconsistent across studies. Future multi-center RCTs with standardized Aloe vera formulations, longer follow-up and biomarker-based outcomes are warranted to confirm its clinical utility as a reliable adjunct or alternative to corticosteroids in OLP management.

Ocular surface squamous neoplasia misdiagnosed as corneal opacity and dry eye: a case report

2025-11-28T22:43:31+0530

Ocular surface squamous neoplasia (OSSN) represents a spectrum of ocular surface epithelial neoplasms ranging from conjunctival intraepithelial neoplasia (CIN) to invasive squamous cell carcinoma. We report a case of a 75-year-old man initially misdiagnosed with corneal opacity and dry eye, whose symptoms persisted despite lubricant therapy. Detailed ophthalmic examination revealed a suspicious lesion extending across the temporal cornea with sentinel vessels and corneal invasion. Histopathological analysis confirmed high-grade intraepithelial dysplasia consistent with CIN, while immunohistochemistry for p16 was negative. The patient underwent surgical excision with wide margins, adjunctive cryotherapy, and postoperative topical 5-fluorouracil therapy. This case illustrates the diagnostic challenges of OSSN due to its ability to mimic benign ocular surface conditions. Prompt recognition, appropriate histopathological confirmation, and timely treatment are essential to prevent progression and preserve vision. Clinicians should maintain a high index of suspicion for atypical or persistent ocular surface lesions, particularly in elderly patients with risk factors such as ultraviolet exposure and diabetes.

Treatment of posttraumatic hemobilia in penetrating abdominal wound injury

2025-11-28T22:43:19+0530

This case report details a rare occurrence of traumatic hemobilia in a 29-year-old male following a penetrating stab wound to the abdomen. After initial surgical treatment, the patient developed severe right hypochondrial pain, prompting further investigation that revealed hemobilia. Magnetic resonance imaging (MRI) showed a blood-filled gallbladder and thrombotic masses obstructing the hepatic ducts, leading to a laparotomy that confirmed a liver wound with hemobilia. Postoperative complications included hemorrhagic drainage from the common bile duct, which was addressed through selective angiography that identified a false aneurysm in the liver artery. Successful angioembolization achieved hemostasis, allowing for a smooth recovery without further invasive procedures. This case highlights the effectiveness of X-ray endovascular methods in managing traumatic hemobilia, demonstrating their minimally invasive nature, quicker recovery times, and reduced complications. It advocates for the integration of endovascular techniques in complex trauma management to improve patient outcomes.

Paracecal appendicitis in a rare anatomical position: a case report describing a modified laparoscopic approach

2025-11-28T22:42:15+0530

Anatomical variations of the appendix, such as a paracecal adherent position, are uncommon and may complicate both diagnosis and surgical management. While laparoscopic appendectomy remains the gold standard, this variant poses challenges in mobilization, vascular control, and cecal protection. We describe a 47-year-old female presenting with acute appendicitis, where contrast-enhanced computed tomography (CT) revealed a retrocecal appendix with paracecal adherence. At laparoscopy, necrotizing appendicitis in an unusual paracecal position was confirmed. A modified surgical strategy was applied, combining retrograde appendectomy with a lateral-to-medial dissection. This approach facilitated early vascular control, safe mobilization of the appendix, and secure division of the base without the use of staplers or endoloops. The operative time was 60 minutes, with minimal blood loss, and the patient had an uneventful recovery, being discharged on postoperative day three. Paracecal adherence represents a rare but technically demanding variant. Our combined retrograde and lateral-to-medial approach provided advantages in hemostasis, cecal protection, and operative efficiency. Compared to conventional methods, it minimized the risk of bleeding and avoided cecal injury, while also being cost-effective. This case highlights the feasibility and safety of a modified laparoscopic technique for paracecal adherent appendicitis. Broader validation in larger cohorts is warranted, but this strategy may represent a valuable alternative for surgeons encountering rare anatomical variants.

Diabetic myonecrosis: a rare complication of poorly controlled diabetes

2025-11-28T22:42:07+0530

Diabetic myonecrosis is a rare complication of poorly controlled diabetes that can be overlooked. This case report describes a 58-year-old man with type 2 diabetes who presented with severe pain and swelling in his right anterolateral thigh for one month. Despite antibiotics, his symptoms persisted. Laboratory tests revealed a normal white blood cell count, elevated blood glucose levels, an elevated erythrocyte sedimentation rate, and elevated C-reactive protein levels. Magnetic resonance imaging revealed diffuse oedema in the anterior thigh muscles, strongly suggesting muscle necrosis. The patient was diagnosed with diabetic myonecrosis based on clinical presentation, basic investigations and imaging findings. He was managed with rest, pain control, and improved glycemic control. This case highlights the importance of considering diabetic myonecrosis in patients with poorly controlled diabetes who present with acute muscle pain and swelling. Early recognition and appropriate management are crucial for avoiding unnecessary interventions and improving outcomes. Increased awareness of this complication is needed among clinicians to ensure prompt diagnosis and treatment.

A clinical case of multiple myeloma complicated by renal amyloidosis

2025-11-28T22:42:05+0530

Multiple myeloma is a hematological malignancy effecting multiple organ systems. One of the commonly effected organs are the kidneys leading to renal amyloidosis and nephrotic syndrome. This article describes a clinical case of a patient presenting with end-stage renal failure. It mainly discusses the investigations used to come to a clinical diagnosis of multiple myeloma and renal amyloidosis and the treatment strategies used in managing the patient.

Association of achalasia and Down syndrome in an adult patient: a case report

2025-11-28T22:42:04+0530

Achalasia is a rare primary esophageal motility disorder caused by degeneration of inhibitory neurons in the myenteric plexus, resulting in impaired lower esophageal sphincter (LES) relaxation and absent peristalsis. Adult-onset achalasia in individuals with Down syndrome is exceedingly uncommon and may be underrecognized due to subtle or atypical symptom expression. This case, reported adult with Down syndrome and achalasia, highlights the importance of early recognition and multidisciplinary care. We report a 63-year-old man with genetically confirmed Down syndrome presenting with progressive dysphagia to solids, postprandial regurgitation, intermittent retrosternal discomfort, and a 10 kg weight loss over six months. Oral intake was markedly restricted, and communication limitations hindered symptom reporting. Upper endoscopy revealed retained semi-solid food and resistance at the LES without mucosal lesions. High-resolution manometry (HRM) confirmed type II achalasia with 100% failed peristalsis and panesophageal pressurization. The patient underwent laparoscopic Heller myotomy with anterior (180°) Dor fundoplication. Intraoperative findings included tissue laxity, gastroesophageal junction fibrosis, and a 1.5 cm hiatal hernia, which was repaired. Recovery was uneventful. At one-year follow-up, the patient achieved complete resolution of dysphagia, normalized oral intake, sustained weight gain (BMI 17.8 to 23.1 kg/m²), and absence of reflux. Adult-onset achalasia in Down syndrome is rare but clinically significant. Diagnosis and timely laparoscopic intervention provide durable symptom relief and nutritional improvement. This case emphasizes the importance of clinical vigilance and multidisciplinary care for optimal outcomes in this population.

Ectopic pregnancy in a non-communicating rudimentary uterine horn: a ticking bomb in a closed room

2025-11-15T09:03:35+0530

Unicornuate uterus with rudimentary horn is a rare Müllerian anomaly occurring in 2.5-13% of cases, resulting from incomplete midline unification of Müllerian ducts during organogenesis. Pregnancy in a non-communicating rudimentary horn occurs in approximately 1 in 76,000-150,000 pregnancies and poses significant risks, including uterine rupture and severe haemorrhage. A 26-year-old woman presented at 8 weeks of gestation with her first pregnancy. Ultrasound revealed a right non-communicating horn pregnancy of 7 weeks with a gestational sac diameter of 24.9 mm and absent cardiac activity. β-hCG was 1,35,066 IU/l. MRI confirmed a unicornuate uterus with a non-communicating uterine horn pregnancy showing yolk sac presence and fetal pole absence. The patient was treated with systemic methotrexate 70 IU. Following an inadequate initial response (β-hCG: 89,344 IU/l after 7 days), a second dose was administered. Subsequently, β-hCG showed a declining trend: 1400, 457, 268.25, and 54 IU/l over consecutive weeks, confirming successful treatment. The patient later conceived naturally, achieving left horn intrauterine pregnancy and is currently at 24 weeks gestation with normal antenatal progress including normal nuchal translucency and anomaly scan. Early diagnosis and management of ectopic pregnancy in non-communicating uterine horns prevents fatal maternal complications. High clinical and radiological suspicion is essential for timely diagnosis. Systemic methotrexate represents an effective conservative treatment option, allowing preservation of fertility and subsequent successful pregnancy outcomes in the functional uterine horn.

A rare case of double lumen in the fallopian tube

2025-11-28T22:44:59+0530

Mullerian duct anomaly is seldom reported in the literature. Isolated congenital anomalies of the fallopian tubes are uncommon and are often overlooked due to the limited data available about this entity. Various other anatomical variations to mention are accessory tubes, sacculations and atresia or segmental deletion of different regions of the tube. The double lumen fallopian tube was observed in a 45-year-old female admitted for complain of menorrhagia for one year. The patient had undergone hysterectomy with right tubal ligation and specimen was send for histopathology section. Histopathological examination revealed double lumen in right fallopian tube. Due to the limited data available and lack of awareness about this entity, it is often overlooked. This report presents a rare anatomical variation in the form of double lumen fallopian tube on the right side.

A challenging case of severe sickle cell crisis: a case report on vaso occlusive crisis in sickle cell disease with multi organ failure

2025-11-28T22:44:56+0530

Sickle cell disease involves recurrent hemolysis and vaso occlusive crisis, which occurs mainly due to abnormal Hemoglobin S polymerization and sickling of erythrocytes. These sickled erythrocytes are prone for damage in micro capillaries, escalating into vaso occlusive crisis presenting as acute pain episodes and recurrent hospitalisations. Severe vaso occlusive crisis can precipitate multi organ dysfunction and failure, significantly increasing morbidity and mortality. This report presents a 19-year-old male with known sickle cell disease who developed a severe vaso occlusive crisis complicated by multi organ failure, including acute chest syndrome, renal impairment, and liver dysfunction. The patient presented with generalized joint pain, chest discomfort, dyspnea, and oliguria. Clinical evaluation revealed pallor, mild icterus, hypoxemia, and hemodynamic instability. Investigations demonstrated bilateral pulmonary infiltrates, pleural effusions, and deranged liver and renal function tests. Management included aggressive intravenous hydration, oxygen therapy, blood transfusion, hydroxyurea, broad spectrum antibiotics, anticoagulation, and supportive care. Despite clinical deterioration necessitating intensive care and non-invasive ventilation, the patient responded favourably to multidisciplinary intervention, with gradual resolution of organ dysfunction and return to baseline status. This case underscores the critical importance of early recognition, prompt resuscitation, and comprehensive management in sickle cell disease patients with vaso occlusive crisis and evolving multi organ failure. Timely intervention can be lifesaving and is essential for improving outcomes in high-risk sickle cell disease populations.

Comprehensive management of rotator cuff tendinopathy in diabetic patients with Ayurveda and myofascial release

2025-11-28T22:44:54+0530

Shoulder disorders are markedly more common in individuals with diabetes than in the general population. Rotator cuff tendinopathy, a form of persistent tendon pain and dysfunction from mechanical loading, arises when tendon regeneration fails, leading to structural disorganization, thickening, and potential rupture. Its etiology involves intrinsic factors such as aging, altered tendon biology, vascular compromise, and overload, as well as extrinsic factors including impingement from structural variations, soft-tissue tightness, muscle imbalance, and overuse, all of which contribute to compromised tendon integrity and function. A 49-year-old male patient who is a known case of Diabetes mellitus was admitted to Kayachikitsa IPD of Vaidyaratnam Ayurveda College, Ollur on 09 July 2024 with bilateral shoulder joint pain more at right side with stiffness and limited range of motion. He underwent a treatment protocol of vatavyadhi and myofascial release with an effort to keep diabetes under control. The patient got relief from pain (VAS score 6 to 1) and stiffness and range of movements were improved. There is remarkable functional restoration (SPADI 57.69 to 10). In rotator cuff tendinopathy of diabetic patients, a combined use of pramehahara oushadha, vatavyadhi chikitsa and myofascial release can be effective.

Midgut malrotation presenting as duodenal obstruction in an adult: a rare entity!

2025-11-28T22:44:52+0530

Intestinal malrotation is a congenital anomaly of the small bowel with an incidence of 1 in 500 live births, mostly presenting in infancy. Presentation in adults is rare. A 46 -year-old male presented with acute pain in abdomen, obstipation and bilious vomiting. The patient was vitally stable with insignificant clinical examination and normal hematological investigations. On abdominal CT, abnormal right sided small bowel loops with pulled up caecum in the midline, fibrotic bands extending from the DJ flexure towards the caecum, and Whirlpool sign relating to the superior mesenteric vein were seen. The patient was managed conservatively initially, and subsequently a Ladd’s procedure was performed. Post operative course was uneventful. Though rare after childhood, symptomatic midgut malrotation may present in adults. Thus, high index of suspicion in patients presenting with non-specific abdominal pain and recurrent bilious vomiting, allows early recognition and management of this rare cause of small bowel obstruction.

A rare gastric and peritoneal metastasis of cervical squamous cell carcinoma-an unusual breach and homing

2025-11-28T22:44:52+0530

Gastric metastasis is rare with a reported incidence of less than 1% with only a very few case reports in the literature to date. Gastric metastasis most commonly arises from malignant melanoma. We present a case of a 58-year-old female, a case of metastatic poorly differentiated squamous cell carcinoma of cervix. Radiology showed a circumferential asymmetric enhancing wall thickening in antrum of stomach and peritoneal carcinomatosis. Endoscopy showed circumferential thickening in proximal antrum, biopsy of stomach and peritoneum showed carcinoma-possibly poorly differentiated squamous cell carcinoma which on immunohistochemistry (IHC) was confirmed to be HPV associated poorly differentiated squamous cell carcinoma. The patient was started on palliative chemotherapy and is on follow-up.

Post-operative rehabilitation following posterior superior labral repair to improve shoulder function in a manual labourer: a case study

2025-11-28T22:44:51+0530

This case study presents the post-operative physiotherapy rehabilitation of a 28-year-old male bike mechanic following arthroscopic repair of a type III superior labrum anterior to posterior (SLAP) lesion in the right shoulder. The rehabilitation program focused on restoring shoulder mobility, strength, and functional stability through a structured, phase-wise physiotherapy approach including passive and active-assisted range of motion exercises, neuromuscular stimulation, scapular stabilization, proprioceptive neuromuscular facilitation, and progressive strengthening. Over an eight-week period, the patient demonstrated significant improvements in pain, range of motion, and muscular strength, with the disabilities of the arm, shoulder and hand (DASH) score improving from 82% to 14%, the University of California, Los Angeles (UCLA) shoulder rating scale from 14/35 to 31/35, and pain on the numerical pain rating scale (NPRS) reducing from 9/10 to 2/10. The patient achieved full return to work without restrictions. This case highlights the importance of early, structured, and individualized physiotherapy intervention in optimizing post-surgical outcomes and restoring functional independence following superior labral repair.

Giant mature cystic teratoma of the ovary mimicking a 36-week pregnancy in a 14-year-old female

2025-11-28T22:43:27+0530

A dermoid cyst is a mature cystic teratoma, most common benign germ cell tumor of the ovary. It arises from totipotent germ cells and can contain well-differentiated tissues from all three germ layers. It is one of the most common benign ovarian neoplasms, occurring in a wide range of sizes. Early diagnosis is essential to prevent potential complications such as torsion, rupture, internal haemorrhage or malignant transformation. Most commonly seen in reproductive age group (20-40 years). Large mature cystic teratoma of ovary exceeding 10cm is extremely rare teratoma. Here we are presenting the case of giant mature cystic teratoma of ovary in 14-year adolescent female, which was mimicking 36weeks pregnancy. Patient had complaints of abdominal distension with decrease appetite and weakness since 2months. On per abdominal examinations there was a lump, which was mimicking 36weeks pregnancy. Which was managed with exploratory laparotomy and left salpingo-oophorectomy and kept her on regular follow up.

Penile strangulation by a plastic bottle neck: a novel technique for non-metallic foreign body removal

2025-11-28T22:43:25+0530

Penile strangulation is a rare urological emergency requiring immediate intervention to prevent ischemia, necrosis, and functional loss. We reported a 35-year-old male who presented with penile incarceration caused by a rigid plastic bottle neck. The patient’s unsuccessful self-removal attempts partially fragmented the object. A novel extraction technique using a Gigli saw guided over an artery forceps under local anaesthesia enabled safe removal without significant complications. A multidisciplinary approach involving surgical, urological, and psychiatric evaluation ensured complete recovery. This report highlights a simple, low-cost, and reproducible technique for managing non-metallic penile constricting objects and underscores the importance of early intervention and holistic care in such emergencies.

Primary neuroendocrine tumor of liver-a rare case report

2025-11-28T22:43:25+0530

The primary neuroendocrine tumor of the liver (PNET) is an exceptionally rare diagnosis, representing only 0.3% of all neuroendocrine tumors (NET). Due to its infrequency, accurate differentiation from other hepatic masses and exclusion of occult primary NETs are imperative. Establishing a definitive diagnosis of liver PNET often requires a comprehensive follow-up to rule out alternative primary causes. The liver is a frequent site for neuroendocrine metastases, and notably, primary neuroendocrine liver tumors typically demonstrate a more favorable prognosis compared to hepatocellular carcinoma and other malignant hepatic lesions. This paper reports on the case of a 74-year-old female patient who presented with pain in the right upper quadrant of the abdomen for two months. Following a triphasic CT scan and liver mass biopsy, the diagnosis of PNET was confirmed based on biopsy reports and immunohistochemistry (IHC). The patient underwent multimodality treatment; however, further intervention was deferred due to the patient's poor general condition. Instead, the patient was placed on the best supportive care.

A rare case of ophiasis pattern of alopecia areata in a child: a case report with Unani insights

2025-11-28T22:43:23+0530

Alopecia areata is a T cell–mediated autoimmune disease targeting hair follicles. Ophiasis is a rare subtype of alopecia areata with a snake-like hair loss pattern across the occipital, temporal, and parietal scalp. A 3-year-old Indian boy presented with a 4-month history of patchy scalp hair loss. Clinical and trichoscopic examination confirmed rare pattern of ophiasis type of alopecia areata. Ophiasis pattern of alopecia areata is considered one of the most challenging forms to treat, owing to its chronic and relapsing nature as well as its poor response to conventional therapies. In this context, the present paper attempts to provide a foundational perspective on the management of ophiasis through the Unani system of medicine.

Fatal neonatal septicemia with meningitis due to Escherichia coli in a full-term baby: an unusual presentation

2025-11-28T22:43:23+0530

Neonatal meningitis carries the risk of long-term debilitating squeal with very high mortality. With the use of antibiotics, the mortality due to neonatal meningitis has significantly reduced in developing countries, with India reporting incidence rates of 0.5 per 1000 with mortality ranging from 16-34%. Diagnosis of neonatal meningitis is based on clinical presentation, gestational age, causative agent, and geographical location. Early empiric antibiotic therapy may often obscure the diagnosis of the causative agent. We report a fatal case of neonatal meningitis in a 39-day-old baby. The child was initially treated for hyperbilirubinemia and mild fever. The child presented with a fever for 4 days and episodes of convulsion. The child was put on ampicillin and gentamicin empirically. The CSF was suggestive of pyogenic meningitis. The Gram-stained smear of the CSF sediments revealed Gram-negative bacilli suggestive of E. coli (Enteric-like gram-negative bacilli). E. coli was isolated from blood as well as CSF and was a phenotypically ESBL (CTX-M like) producer. The antibiotic was changed to meropenem and amikacin. Despite appropriate antibiotic therapy, the patient rapidly deteriorated and died on the third day of admission. Treatment of bacterial meningitis due to E. coli in neonates has changed over the years due to the emergence of antibiotic resistance patterns of E. coli. Resistance to third-generation cephalosporin has evolved in E. coli due to ESBL production. Neonatal meningitis due to E. coli, particularly in full-term babies, is reported rarely. We report a case of fatal meningitis due to ESBL-producing E. coli in a full-term baby.

Basal cell carcinoma in a patient at two rare sites: a case report

2025-11-28T22:43:22+0530

Basal cell carcinoma (BCC) is a locally aggressive cutaneous tumor frequently linked to aberrations in the Hedgehog signaling pathway. It typically occurs on sun-exposed areas; however, rare presentations in non-sun-exposed sites have been documented. A 61‐year‐old female presented with a five-year history of a non-healing ulcer on the right leg. Initially misdiagnosed as Lupus vulgaris, repeated biopsies revealed features consistent with infiltrative BCC and, subsequently, a morpheaform subtype with squamous differentiation. In addition, metastasis was noted in the inguinal region. Radiological studies and histopathological evaluations confirmed the diagnosis. This case underscores that BCC may present at atypical, non-sun-exposed sites and can demonstrate local aggressive behavior with regional metastasis. Early recognition and prompt surgical management are essential to prevent further local invasion and metastasis.

A case report of rifampicin-induced dual adverse drug reaction: pancytopenia and hyperpigmentation

2025-11-28T22:43:18+0530

Rifampicin is a first-line anti-tuberculosis (TB) drug widely used for its potent bactericidal activity. Although generally well tolerated, it can occasionally lead to uncommon adverse drug reactions (ADRs). Among these, pancytopenia and hyperpigmentation are extremely rare and may complicate therapy or cause unnecessary medication non-compliance. We report a case of a middle-aged female receiving anti-TB therapy (ATT) for past one week. She developed pancytopenia and brown patchy hyperpigmentation following rifampicin single regimen re-administration. Rifampicin was promptly withdrawn, and supportive management was provided. Progressive improvement in both hematological parameters and cutaneous pigmentation was observed after discontinuation. Rifampicin-induced pancytopenia results primarily from idiosyncratic or immune-mediated marrow suppression, whereas hyperpigmentation is believed to occur due to increased melanin production or dermal drug deposition. The visible change in the skin caused considerable distress and fear of continuing treatment, necessitating empathy and appropriate counseling to gain the individual’s trust. Health-care professionals should maintain a high index of suspicion for rare rifampicin-induced reactions presenting with simultaneous hematologic and dermatologic features. Early recognition, prompt drug withdrawal, and empathetic patient counseling are vital for favorable outcomes. Reporting even minor adverse effects contributes to pharmacovigilance and enhances awareness of such uncommon presentations.

Low alkaline phosphatase levels: a potential indicator of Wilson disease

2025-11-28T22:42:10+0530

A young adult female patient presented with complaints of jaundice, intermittent vomiting, and weight loss. Upon examination, pedal oedema and abdominal distension were observed. Laboratory investigations indicated macrocytic anaemia, hemolysis, prolonged prothrombin time, mixed hyperbilirubinemia, elevated aspartate/alanine transaminase (AST/ALT), and a normal alkaline phosphatase (ALP). The investigations repeated showed an increase in bilirubin, AST, and ALT. However, the levels of ALP and the ALP: total bilirubin ratio (ALP:TB ratio) were found to be very low. This raised the suspicion of Wilson disease, and further laboratory workup was initiated. Urine (24-hour) and serum copper levels were elevated, while serum ceruloplasmin levels were lower. Based on this, the diagnosis of acute on chronic liver failure (ACLF) related to Wilson disease was made. The levels of ALP and the ALP:TB ratio remained low until the sixth day. This report demonstrates the clinical relevance of low levels of ALP and ALP: TB ratio and its diagnostic utility in establishing the diagnosis of Wilson disease.

Occupational brucellosis in a veterinary assistant following exposure during management of bovine dystocia: a case report

2025-11-28T22:42:04+0530

Brucellosis remains a significant occupational zoonosis in India, particularly affecting workers in the veterinary and livestock sectors who frequently interact with infected animals and reproductive tissues. The disease is caused by gram-negative intracellular coccobacilli of the genus Brucella, with B. abortus being the predominant species associated with bovine brucellosis. Veterinary personnel performing high-exposure procedures such as dystocia management, placentectomy and handling of aborted materials face the greatest risk due to the heavy bacterial load present in reproductive tissues. We describe a case of acute brucellosis in a 34-year-old veterinary assistant who developed undulant fever, arthralgia, generalized myalgia, malaise and sacroiliac pain after unprotected exposure to reproductive secretions during manual management of bovine dystocia in a herd experiencing multiple late-term abortions. Herd screening revealed widespread Brucella abortus positivity. Initial evaluation showed leukopenia and a false-positive Widal test, leading to misdiagnosis as enteric fever. Persistent fever and musculoskeletal symptoms led to further investigation, and Brucella IgM ELISA returned strongly positive, confirming acute infection. The patient received WHO-recommended therapy with doxycycline and rifampicin for six weeks, resulting in full recovery without relapse over three months of follow-up. This case highlights the occupational risks faced by veterinary personnel, diagnostic challenges caused by nonspecific symptoms and serological cross-reactivity, and the critical need for strengthened biosafety practices and One-Health–oriented surveillance systems to reduce the burden of brucellosis in endemic regions.