International Journal of Research in Medical Sciences

Impact of GLP-1 receptor agonists on cardiovascular risk reduction in patients with obesity without type 2 diabetes mellitus: a systematic review

2026-04-30T07:09:27+0530

Obesity has been established as an independent cardiovascular risk factor, driving low-grade systemic inflammation and endothelial dysfunction. Recently, GLP-1 receptor agonists (GLP-1 RAs) have demonstrated pleiotropic cardioprotective benefits, raising a paradigm shift regarding their preventive utility in patients without a diagnosis of type 2 diabetes mellitus (T2DM). To evaluate the current scientific evidence on the efficacy of GLP-1 RAs in reducing major adverse cardiovascular events (MACE) and improving risk biomarkers in overweight or obese patients without T2DM. A systematic literature review (2019-2026) was conducted in PubMed, Scopus, and Cochrane Library databases. Large-scale randomized clinical trials, meta-analyses, and mechanistic studies evaluating GLP-1 RA interventions (such as semaglutide and liraglutide) in non-diabetic populations were included, analyzing MACE incidence, lipid profiles, and inflammatory markers. Evidence demonstrates that GLP-1 RA therapy significantly reduces the incidence of MACE (non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death) in this population, with relative risk reductions approaching 20%. Crucially, independent of the magnitude of weight loss, consistent improvements are observed in endothelial function, a sharp decrease in high-sensitivity C-reactive protein (hs-CRP), optimization of the lipid profile, and reduction in systolic blood pressure. GLP-1 RAs transcend glycemic control and simple anthropometric intervention, positioning themselves as a primary cardiovascular risk-modifying therapy. Their application in obese patients without T2DM represents a critical advance toward cardiovascular prevention driven by comprehensive metabolic pharmacotherapy. control, positioning itself as a promising strategy for diabetes and obesity management.

Comparative evaluation of osseous bone splitting by piezosurgery and intramarrow penetration in localized intra-bony defects in patients with chronic periodontitis: a clinico-radiographical pilot study

2026-04-30T07:14:58+0530

Chronic periodontitis leads to intrabony defects that compromise tooth stability. Conventional treatments often show limited bone regeneration. Techniques like bone splitting by piezosurgery and intra marrow penetration (IMP) have emerged to enhance bone healing. This study aimed to explore their comparative effectiveness in promoting osseous regeneration and improving clinical outcomes in affected patients. 16 patients with probing depth ≥6 mm were selected and randomly underwent open flap debridement (OFD), followed by osseous bone splitting of the defect using piezosurgery (group A) and IMP (group B), with subsequent bone graft placement in the defect. Full mouth gingival index, plaque index, pocket probing depth and relative attachment level were assessed at baseline and 6 month visits. Defect base level (DBL), crestal bone level (CBL), intrabony defect depth (INTRA) and defect angle (ANG) were also analysed. Intragroup comparison shows statistically significant results in all clinical and radiological parameters in group A and group B (p<0.05). Intergroup comparison shows similar results in both the groups at 6 months interval. Both techniques of bone splitting using piezosurgery and IMP have shown promising results in the management of localized intra-bony defects in patients with chronic periodontitis.

Complex nasal reconstruction using first dorsal metacarpal artery free flap: a case report

2026-04-30T07:14:55+0530

The columella is a key structure for nasal aesthetics and function. Its reconstruction poses a surgical challenge due to limited access, the need for structural support, and the requirement for a precise match in skin color and thickness. The kite flap, supplied by the first dorsal metacarpal artery (FDMA), has proven useful in various facial defects; however, its application in columellar reconstruction remains scarcely documented. We report a 31-year-old woman who developed complete columellar necrosis secondary to an untreated post-traumatic septal hematoma. Clinical examination revealed total absence of the columella, including soft-tissue coverage and cartilaginous support. A two-stage nasal reconstruction was performed using a free FDMA (kite) flap combined with a costal cartilage graft. The postoperative course was favorable, with no vascular complications and complete flap integration. Donor-site healing was satisfactory. Objective measurements demonstrated improvement of the nasolabial angle from 70° preoperatively to 95° postoperatively, and an increase in columellar projection from 1.2 mm to 4.8 mm. These findings reflect successful restoration of nasal contour and structural support. The FDMA Kite flap is a reliable and aesthetically suitable microsurgical option for columellar reconstruction in cases of severe tissue loss. Its thinness, dependable vascularity, and low donor-site morbidity make it a valuable tool for complex nasal reconstruction.

Vitamin D-dependent rickets: challenges in diagnosis and management

2026-04-30T07:14:53+0530

Vitamin D-dependent rickets type II (VDDR-II) is a rare autosomal recessive disorder caused by mutations in the vitamin D receptor gene, leading to end-organ resistance to 1,25-dihydroxyvitamin D and poor response to conventional therapy. We report an adolescent female with genetically confirmed VDDR-II who presented with severe skeletal deformities, recurrent fractures, profound hypocalcaemia, secondary hyperparathyroidism, growth failure, and partial alopecia. Clinical, biochemical, radiological, and genetic evaluations confirmed the diagnosis. Despite intensive treatment with high-dose oral calcitriol and calcium supplementation, the patient required frequent intravenous calcium infusions to achieve partial biochemical stabilization, reflecting the resistant nature of the disease. Long-term follow-up demonstrated persistent growth impairment and fluctuating biochemical parameters closely related to treatment adherence. Notably, her sibling carrying the same vitamin D receptor mutation exhibited a significantly milder clinical phenotype, highlighting marked intrafamilial variability. This case illustrates the diagnostic and therapeutic challenges associated with VDDR-II and emphasizes the importance of early recognition, strict adherence to therapy, and multidisciplinary management to reduce complications and optimize outcomes.

A typical onset of multiple myeloma manifesting with persistent cytopenias and kidney dysfunction: a case report

2026-04-30T07:11:40+0530

Multiple myeloma is a clonal plasma cell neoplasm capable of producing severe multisystem compromise, including progressive anemia, renal dysfunction and immune suppression. Its initial presentation is often subtle and nonspecific, delaying diagnosis and treatment. Early recognition is critical to prevent irreversible organ injury. We present the case of a 48-year-old woman with a history of chronic kidney disease who was admitted due to persistent constitutional symptoms, transfusion-dependent anemia, nausea, marked asthenia, weight loss of 8 kilograms and recurrent vomiting. Initial laboratory findings revealed severe cytopenias, elevated creatinine levels and persistent electrolyte imbalance. Autoimmune studies were negative. Serum free light chain testing demonstrated a marked elevation of kappa chains, and bone marrow immunohistochemistry showed strong CD138 positivity in approximately 80 percent of the marrow cellularity, consistent with plasma cell neoplastic infiltration. Flow cytometry confirmed the presence of a clonal plasma cell population compatible with plasma cell dyscrasia. She was diagnosed with active multiple myeloma with renal involvement and severe hematologic compromise, requiring repeated transfusion support and chemotherapy initiation. This case illustrates an atypical and rapidly progressive presentation of multiple myeloma in a relatively young patient, initially masked by chronic kidney disease and constitutional symptoms. Persistent cytopenias combined with renal impairment should prompt early investigation for plasma cell disorders, as timely diagnosis remains essential to reduce morbidity and improve prognosis.

Solitary pulmonary nodule from metastatic endometrioid endometrial carcinoma: case report and histopathologic review

2026-04-30T07:09:55+0530

Endometrioid endometrial carcinoma is the most common subtype of endometrial cancer. Distant metastases are uncommon, and pulmonary involvement is rare, especially as a solitary pulmonary nodule. We report a case of pulmonary metastasis from endometrioid endometrial carcinoma, emphasizing the diagnostic value of histopathology, immunohistochemistry, and clinicopathological correlation. A 61-year-old woman with a history of FIGO grade 2 endometrioid endometrial carcinoma, treated with adjuvant radiotherapy and brachytherapy, underwent oncologic follow-up. One year later, computed tomography revealed a 35 x 22 mm lesion in the posterior basal segment of the right lower lobe. Right lower lobectomy was performed. Gross examination revealed a well-circumscribed cystic nodule containing yellow mucinous material. Microscopically, the lesion showed a malignant glandular proliferation composed of irregular glands with focal cystic dilatation and intraluminal mucin. These glands were lined by cuboidal to columnar cells exhibiting mild to moderate atypia, loss of polarity, and occasional mitotic figures. The adjacent lung parenchyma showed necrosis and mixed inflammatory infiltrates. Surgical margins were free of tumour. Immunohistochemically, the neoplastic cells were positive for CK7 and estrogen receptor and negative for CK20, CDX2, and SATB2, supporting the diagnosis of metastatic carcinoma without intestinal differentiation. In patients with a history of endometrioid endometrial carcinoma, a solitary pulmonary nodule should raise suspicion for metastasis. When immunohistochemical resources are limited, clinical, imaging, and pathologic correlation is essential for accurate diagnosis.

Arrhythmogenic cardiomyopathy: from concealed phase to refractory failure: a nine-year case study illustrating diagnostic evolution and biventricular progression

2026-04-30T07:09:42+0530

Arrhythmogenic cardiomyopathy (ACM) is a type of cardiomyopathy characterized by fibrofatty replacement of the right ventricular myocardium and associated with life-threatening arrhythmias. The criteria of the diagnosis of ACM are based on the estimates of structural changes in the right ventricular myocardium, electrocardiographic changes, fibrofatty dystrophy in the course of a histological investigation, and a family history of the disease. The diagnosis can be a challenging task as there are no pathognomonic clinical markers, which makes differential diagnosis of ACM with secondary myocardial pathology more difficult to perform. The article presents a nine-year-old case study of a young male patient with ACM, dominated by life-threatening ventricular arrhythmias and episode of resuscitated sudden cardiac death despite optimal medical therapy and cardioverter-defibrillator implantation.

A dynamic balance exercises programme to improve functional outcomes after total knee replacement in bilateral osteoarthritis knee: a case report

2026-04-19T09:10:06+0530

Osteoarthritis (OA) of the knee is a progressive degenerative joint disorder commonly affecting older adults, leading to pain, stiffness, reduced range of motion, and limitations in daily activities. When conservative management fails to provide adequate relief, total knee replacement (TKR) is frequently performed to alleviate pain and restore functional mobility. Despite surgical intervention, patients often experience postoperative challenges such as muscle weakness, impaired proprioception, and decreased balance, which may limit functional recovery. Dynamic balance, defined as the ability to maintain postural stability during movement, plays a critical role in safe ambulation and performance of daily tasks. The present case study aimed to evaluate the effect of a structured dynamic balance exercise program on functional outcomes following TKR in a patient with bilateral knee osteoarthritis. A review of relevant literature was conducted using electronic databases including MEDLINE, PubMed, and Google Scholar to establish the theoretical basis for the intervention. The rehabilitation program incorporated dynamic balance training along with conventional physiotherapy exercises over a defined treatment period. Functional outcomes were assessed before and after the intervention using standardized clinical measures. Post-intervention findings demonstrated noticeable improvements in balance performance, mobility, and overall functional independence. The results suggest that integrating dynamic balance exercises into postoperative rehabilitation may enhance functional recovery in patients undergoing TKR for bilateral knee osteoarthritis. Further research with larger sample sizes is recommended to support these findings.

Erythroderma as the first paraneoplastic manifestation of early-stage lung squamous cell carcinoma: a rare case report

2026-04-30T07:15:01+0530

Erythroderma is a severe inflammatory dermatosis affecting over 90% of the body surface area and commonly arises from pre-existing dermatoses or drug reactions. Paraneoplastic erythroderma is rare but clinically significant, especially in elderly patients, as it may precede the diagnosis of internal malignancy. Early identification and evaluation are essential for timely detection. An 85-year-old male with a 40 pack-year smoking history presented with rapidly progressive generalized erythema and scaling, without prior dermatologic disease or new medication exposure. Skin biopsy revealed subacute spongiotic dermatitis with dermal eosinophils. Given the unexplained presentation and patient’s risk factors, systemic evaluation was pursued. Imaging demonstrated a right lower-lobe perihilar mass, and bronchoscopy with biopsy confirmed moderately differentiated squamous cell carcinoma of the lung. Supportive dermatologic therapy was initiated and sequential chemo-radiation was planned. Improvement in the erythroderma paralleled initiation of cancer-directed therapy. Erythroderma can rarely be the first manifestation of lung squamous cell carcinoma. In elderly patients with unexplained erythroderma, especially those with smoking history, malignancy screening should be undertaken after exclusion of common causes.

Impact of fast pranayama (Bhastrika and Kapalabhati) on metabolic parameters in a patient with metabolic syndrome: a case report

2026-04-30T07:14:34+0530

Metabolic syndrome is a cluster of risk factors, including central obesity, dyslipidaemia, hyperglycaemia, and hypertension, all of which elevate the risk of cardiovascular disease and type 2 diabetes. Interest has grown in complementary practices such as yoga and pranayama for managing these risk factors. This case describes the impact of a three-month fast pranayama intervention, specifically Bhastrika and Kapalabhati, on metabolic health in a 43-year-old male IT professional with metabolic syndrome and type 2 diabetes who was undergoing oral hypoglycaemic therapy with metformin. The supervised practice was carried out six days per week for three months, and metabolic parameters were evaluated before and after the intervention. Notable improvements were observed across multiple domains: fasting plasma glucose decreased from 152 to 128 mg/dl, postprandial glucose from 214 to 186 mg/dl, and HbA1c from 7.6% to 6.8%. Triglyceride levels reduced from 280 to 210 mg/dl, while BMI and waist–hip ratio declined from 34.2 to 32.5 kg/m² and from 1.02 to 0.98, respectively. Blood pressure decreased from 134/86 mmHg to 124/80 mmHg, and the patient reported increased energy and overall well-being. These findings suggest that fast pranayama may offer meaningful adjunctive benefits in the management of metabolic syndrome and support the need for further controlled studies to validate its therapeutic potential.

Squamous cell carcinoma arising in a villous adenoma in the colon: a rare but real threat

2026-04-30T07:12:23+0530

Squamous cell carcinoma (SCC) of the colon is rare, with fewer than 100 cases, predominantly in males, usually presenting at advanced stages with poor prognosis. SCC arising in a villous adenoma of the colon is still rarer. The first case of primary SCC of the colon arising in a villous adenoma was reported by Lundquest et al. Metastasis from other sites like the lungs must be excluded before considering such a case as primary. Here a 54-year-old female presented with a three-month history of epigastric pain and altered bowel habits. A colonoscopy identified an ulcero-proliferative lesion in the ascending colon, which CT imaging confirmed as a neoplastic mass. Histopathological examination of colonoscopic biopsy was diagnosed as SCC. The patient subsequently underwent a right hemicolectomy, and a diagnosis of well differentiated SCC arising in a villous adenoma was given. Postoperative recovery was monitored, and the patient was scheduled for follow-up assessments to manage and detect any recurrence. SCC of the colon arising in a villous adenoma is rare, found mainly in the rectosigmoid region but occasionally in other areas, like the ascending colon. Due to its rarity, it is important to rule out secondary causes. Histological confirmation includes using immunohistochemistry such as p40/63, CK-AE1/AE3 and 34BE12 to confirm squamous cel differentiation. Primary SCC of the colon requires prompt surgery due to its aggressiveness. The effectiveness of chemoradiation is unclear, and increased surveillance is needed due to higher recurrence rates.

Unilateral high bifurcation of brachial artery: a cadaveric case report

2026-04-30T07:12:17+0530

The brachial artery is the chief artery irrigating upper limb. In standard conditions, the artery is continuation of axillary artery and commences at the lower border of the teres major muscle. The artery terminates at the level of neck of radius by dividing into radial and ulnar artery. But brachial artery undergoes multiple variations including high bifurcation into radial and ulnar arteries. The high division of brachial artery may take place in upper, middle and lower part of arm. The incidence of cranial bifurcation of brachial artery is reported to be 10.05%. The variation may affect the outcome of invasive procedures like catheterization, angiography, vascular and reconstructive surgeries. During routine dissection of right upper limb for first year MBBS students of 2025-26 batch, authors found brachial artery dividing into radial and ulnar arteries in upper arm. Rest of the course of radial and ulnar arteries as described in conventional literature. In the contralateral limb, there was no anomaly. The knowledge of high division of brachial artery will be of utmost use to cardiac surgeons carrying out catheterization for uneventful procedure, for radiologist to avoid misinterpretation of radiographs and for vascular surgeons to avoid complications.

Aggressive NUT carcinoma presenting as a nasal mass: a rare case report

2026-04-30T07:12:10+0530

Nuclear protein in testis (NUT) carcinoma is an exceptionally uncommon and highly aggressive carcinoma, refractory to treatment and has a devastating clinical course. NUT gene is expressed in non-germ cell tissues along with chromosomal rearrangement of the NUT gene on chromosome 15. These tumors are most commonly located in midline and near midline areas of the upper aero digestive tract and the mediastinum and can affect patients across a broad age range, including children. However, due to its low incidence, this is often misdiagnosed by the clinicians and pathologists. Here, we present a case report of NUT carcinoma in a 45- year- old female coming with chief complaints of nasal bleeding and nasal obstruction. This case report emphasizes the critical role of histopathological examination, supplemented by immunohistochemical analysis, in establishing a definitive diagnosis and underscores the diagnostic challenges posed by sinonasal undifferentiated tumors.

Premature myocardial infarction as the initial manifestation of JAK2 positive polycythemia vera in a young adult: a case report

2026-04-30T07:12:07+0530

Polycythemia vera is a clonal myeloproliferative neoplasm characterized by erythrocytosis and commonly associated with leukocytosis, thrombocytosis, and splenomegaly. Activating mutations in the JAK2 gene play a central role in its pathogenesis. Although typically a disease of older adults, polycythemia vera may present at a younger age with atypical and severe manifestations. We report the case of a 37-year-old Indian male who presented with massive splenomegaly and abnormal blood counts. Notably, the patient had a prior history of premature myocardial infarction requiring percutaneous coronary intervention at a young age, in the absence of conventional cardiovascular risk factors. Current evaluation revealed erythrocytosis, leukocytosis, thrombocytosis, and panmyelosis on bone marrow examination. Molecular testing confirmed the presence of a JAK2 mutation, establishing the diagnosis of polycythemia vera. The earlier myocardial infarction was retrospectively attributed to the underlying prothrombotic state associated with the disease. This case highlights that polycythemia vera may initially manifest as premature arterial thrombosis in young individuals. Awareness of such presentations is essential, as early diagnosis and appropriate management can prevent recurrent thrombotic complications and disease progression.

Paroxysmal nocturnal haemoglobinuria presented as acute kidney injury

2026-04-30T07:11:54+0530

Paroxysmal nocturnal hemoglobinuria (PNH) is rare disease, caused by acquired somatic mutations in PIG-A gene. Renal involvement in PNH varies from reversible acute kidney injury (AKI) to chronic irreversible damage. We are presenting a case of PNH in young female who presented as AKI. Final diagnosis was made by flowcytometry which showed evidence of PNH clone based upon analysis of a variety of GPI linked antibodies (FLAER, CD59) on monocytes, granulocytes and RBCs. PNH presenting as recurrent acute renal failure is extremely rare. We reported this case to highlight a rare, but potentially reversible cause of acute renal failure. These types of cases need high index of suspicion. Early diagnosis and treatment will help in preventing repeated episodes of AKI and thus chronic kidney disease.

Placenta accreta spectrum with placenta previa: anaesthetic challenges in a planned caesarean hysterectomy with emergency conversion to general anaesthesia

2026-04-30T07:11:29+0530

Placenta accreta spectrum (PAS) encompasses abnormal placental adherence and invasion (accreta, increta, percreta) and is strongly associated with placenta previa and prior uterine surgery. It remains a major cause of life-threatening obstetric haemorrhage. Antenatal diagnosis, delivery in a tertiary centre, multidisciplinary planning and meticulous anaesthetic preparation are essential for optimal outcomes. We report a 32-year-old gravida 3 para 2 abortion 1 at 35 weeks with placenta previa and antenatally confirmed PAS, scheduled for elective caesarean delivery with planned hysterectomy. Given her history of bronchial asthma, neuraxial anaesthesia was preferred, with full preparedness for immediate conversion to general anaesthesia. After establishing invasive monitoring and arranging adequate blood products, a subarachnoid block was performed using 2 mL of 0.5% hyperbaric bupivacaine with fentanyl 25 µg. Tranexamic acid 1 g IV was administered before incision. Following delivery, massive haemorrhage with haemodynamic instability occurred, necessitating urgent conversion to general anaesthesia. Induction was achieved with ketamine 2 mg/kg and atracurium, and aggressive resuscitation with vasopressors and transfusion was initiated. Haemostasis was secured by internal iliac artery ligation followed by hysterectomy. Estimated blood loss was 1.8 L; 4 units packed red blood cells and 2 units fresh frozen plasma were transfused. Postoperatively, the patient was electively ventilated in ICU suspecting airway oedema and extubated the next day. She was discharged on postoperative day 3. The neonate (3.1 kg) had Apgar scores of 8 and 10 at 1 and 5 minutes. This case underscores the need for individualised anaesthetic planning and readiness for rapid conversion in PAS.

Deep neck space infection with airway edema and sepsis in a non diabetic patient: a case report

2026-04-30T07:11:25+0530

Deep neck space infections (DNSIs) are serious clinical entities with the potential for rapid deterioration due to their anatomical proximity to critical cervical structures, making complications such as airway obstruction and sepsis particularly concerning. We present the case of a 55-year-old female who developed rapidly progressive bilateral swelling involving the parotid and submandibular regions, with extension to the chest and back. She had no history of diabetes mellitus or other significant comorbid illnesses. Her clinical course was marked by worsening laryngeal edema, respiratory distress, and features of sepsis, necessitating urgent airway stabilization. Surgical management with incision and drainage was performed, resulting in subsequent clinical improvement. This case demonstrates that severe DNSIs may arise even in the absence of traditional risk factors, and while contrast-enhanced computed tomography (CT) plays an important diagnostic role, priority should be given to airway security and timely clinical intervention in unstable patients.

Blood transfusion induced posterior reversible encephalopathy syndrome in a case of abnormal uterine bleeding-polyps with chronic very severe anaemia

2026-04-30T07:11:06+0530

Posterior reversible encephalopathy syndrome (PRES) is a rarely reported medical event across globe. Although PRES is primarily associated with pre-eclampsia, hypertension, auto-immune disorders and cytotoxic drug treatments, a rare fraction has been recently discovered due to transfusion of blood in rapid succession to the patients with chronic severe anemia. Postulated causation which is accepted overall; is due to hypoperfusion and vasogenic edema despite normal blood pressure. Pathology behind this disorder are endothelial dysfunction and breach of blood brain barrier. Cerebral lobes that are primarily affected are parietal and posterior occipital cortex which leads to headache, altered mental status, seizures, and visual disturbances. Its diagnosis is established only after proper clinicoradiological evaluation with aid of MRI. It is prudent to keep in mind about this rare clinical entity while assessing a patient in ward with visual disturbances, headache, and tonic-clonic seizures with normal blood pressure in the setting of chronic severe anemia and there is a history of multiple blood transfusions recently. Its prognosis is satisfactory with no report of fatality.

A rare presentation of familial polymastia with associated polycystic ovarian morphology: a case report with a one-year follow-up

2026-04-30T07:09:59+0530

Polymastia is a congenital anomaly resulting from incomplete embryological regression of the milk line. While relatively common, its familial occurrence and association with other morphological conditions present unique clinical scenarios. This report details a rare familial presentation of polymastia with concurrent polycystic ovarian morphology to highlight the need for holistic diagnostic evaluation. An 18-year-old female with a positive family history of polythelia presented with a left anterior axillary mass. Breast ultrasonography confirmed an accessory nipple with a distinct ductal system suggestive of left-sided polymastia. Abdominopelvic ultrasonography revealed bulky ovaries with tiny cysts (right ovary volume 6.61 CC, left ovary 9.69 CC), indicating polycystic ovarian morphology. The patient underwent complete surgical excision without complications. Histopathology demonstrated benign squamous epithelium with slight hyperkeratosis, pilosebaceous structures, smooth muscle, and breast lobules with ducts in the deep dermis, confirming no evidence of malignancy. At the one-year follow-up, the patient remained entirely asymptomatic with no recurrence and a satisfactory cosmetic outcome. This case emphasizes the clinical necessity of comprehensive systemic evaluation in patients with congenital anomalies. Surgical excision remains the definitive management for polymastia, successfully addressing cosmetic concerns and ruling out malignant changes.

A rare case of late-presenting congenital diaphragmatic hernia in an adult patient

2026-04-30T07:09:57+0530

Congenital diaphragmatic hernia (CDH) refers to a true breach in the continuity of the diaphragm, allowing herniation of abdominal contents into the thoracic cavity. Usually, it presents in the neonatal stage. Adult presentations are rare. Most adult cases of diaphragmatic hernia are of traumatic etiology. Most adult CDH cases are asymptomatic and detected incidentally on imaging. Symptomatic adult CDH cases are uncommon. Bochdalek hernias are more common than the Morgagni type. Most of them are left-sided due to embryonic factors. We present an uncommon case of symptomatic, non-traumatic, left-sided CDH in an adult patient. A 20-year-old male presented with left hypochondriac pain for eight days and left-sided chest pain for three days in the absence of any trauma or comorbidities. On examination, the left chest showed reduced chest movement, diminished breath sounds, and gurgling on auscultation. Chest X-ray showed air-fluid levels in the left hemithorax and right mediastinal shift. Contrast-enhanced computed tomography showed an overdistended stomach in the left hemithorax. Upper midline laparotomy revealed an 8×7 cm defect in the posterior left hemidiaphragm, consistent with a Bochdalek hernia. The stomach and spleen were herniated into the left hemithorax. They were reduced into the peritoneal cavity, and the defect was repaired with primary closure. Diaphragmatic plication was done to reinforce the thinned left hemidiaphragm. This case underscores the importance of considering CDH in adults presenting with thoracoabdominal symptoms, especially in the absence of any trauma. Surgical exploration provides the most definitive diagnosis in cases of equivocal imaging in adult CDH patients.

Cryptogenic multiterritorial stroke with anti-U1 ribonucleoprotein positivity and steroid responsiveness: a diagnostic challenge

2026-04-30T07:09:19+0530

Acute ischemic stroke is most commonly caused by atherosclerotic, cardioembolic, or small vessel disease; however, in patients presenting with multiterritorial infarcts and inconclusive routine evaluation, alternative etiologies such as autoimmune mechanisms should be considered. We report the case of a 52-year-old male who presented with acute-onset vertigo followed by progressive imbalance and left-sided incoordination. Neuroimaging revealed multiple acute infarcts involving both anterior and posterior circulation. Cardiac and vascular evaluation did not identify a definitive source of embolism. Autoimmune workup demonstrated positive antinuclear antibodies with anti-U1 ribonucleoprotein (RNP)/Sm positivity raising suspicion of an underlying autoimmune-mediated process despite the absence of overt systemic features. The patient showed limited improvement with standard antiplatelet therapy but demonstrated marked clinical recovery following corticosteroid therapy, suggesting a possible inflammatory or immune-mediated mechanism. This case highlights the importance of considering autoimmune causes in patients with cryptogenic multiterritorial stroke and suggests a potential role for immunosuppressive therapy in selected cases.

Efficacy of single-stage laparoscopic common bile duct exploration versus sequential ERCP followed by cholecystectomy for the management of choledocholithiasis

2026-04-30T07:11:45+0530

Choledocholithiasis is one of the most frequent complications of cholelithiasis, and its optimal management remains a constant surgical challenge. Currently, there are two main strategies: single-stage laparoscopic common bile duct exploration (LCBDE) and the sequential approach consisting of endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy.To evaluate the comparative efficacy between the single-stage laparoscopic approach and sequential ERCP management in terms of technical success, complications, and hospital stay.A systematic review of scientific literature was conducted in indexed databases (PubMed, Scopus, Cochrane Library) using DeCS/MeSH descriptors. Studies published between 2020 and 2025 comparing both techniques in patients with confirmed choledocholithiasis were included.Evidence analysis indicates that the single-stage approach (LCBDE) offers similar efficacy in common bile duct clearance compared to sequential ERCP. However, LCBDE is associated with a significant reduction in total hospital stay and a lower rate of post-procedure pancreatitis. The sequential management, although more widespread, involves greater exposure to multiple anesthetic acts and an increase in overall operating costs. Single-stage laparoscopic common bile duct exploration is a safe and cost-efficient alternative for the treatment of choledocholithiasis. Its implementation should be promoted in centers that have the necessary equipment and surgeons with experience in advanced biliary tract techniques.

Comprehensive review of postmenopausal osteoporosis: molecular mechanisms, lifestyle interventions and pharmacological advances

2026-04-30T07:09:57+0530

Postmenopausal osteoporosis is a major public health concern characterized by decreased bone mineral density (BMD) and deterioration of bone microarchitecture, leading to increased fragility and fracture risk. The condition is primarily driven by estrogen deficiency following menopause, which disrupts the balance between bone resorption and bone formation. This review provides a comprehensive overview of the molecular and physiological mechanisms underlying postmenopausal osteoporosis, including the roles of osteoclast activation, inflammatory cytokines, oxidative stress, and key regulatory pathways such as RANK/RANKL/OPG and Wnt/β-catenin signaling. In addition to the biological mechanisms, the review examines important lifestyle factors that influence bone health, including nutrition, adequate calcium and vitamin D intake, physical activity, and fall-prevention strategies. Evidence supporting weight-bearing and resistance exercise as effective non-pharmacological interventions for maintaining or improving BMD is discussed. The article also reviews current pharmacological treatments for postmenopausal osteoporosis, including antiresorptive agents such as bisphosphonates and denosumab, as well as anabolic therapies such as teriparatide and romosozumab. In addition, the role of hormone replacement therapy (HRT) is considered as a therapeutic option for postmenopausal women. HRT can reduce bone loss by compensating for estrogen deficiency and has been shown to improve BMD and reduce fracture risk. Emerging therapeutic approaches and future directions in osteoporosis research are also highlighted. Understanding the complex interactions among hormonal changes, molecular pathways, lifestyle factors, and pharmacological therapies is essential for improving prevention strategies and optimizing clinical management of postmenopausal osteoporosis.

Cardiac magnetic resonance in ischemic cardiomyopathy: from tissue characterization to prognostic stratification

2026-04-30T07:09:45+0530

Ischemic cardiomyopathy (ICM), the most prevalent cause of heart failure globally, remains a significant contributor to cardiovascular morbidity and mortality. Despite advances in medical and interventional therapies, outcomes for patients with ICM remain suboptimal, underscoring the need for accurate diagnostic tools and effective risk stratification. Cardiac magnetic resonance imaging (CMR) has emerged as a powerful, non-invasive modality that provides detailed anatomical, functional, and tissue-level insights essential for managing this complex condition. A literature search was performed using PubMed, Embase, and the Cochrane Library to identify relevant studies published between January 2005 and January 2026. Search terms included combinations of “cardiac magnetic resonance,” “ischemic cardiomyopathy,” “late gadolinium enhancement,” “stress perfusion CMR,” “myocardial viability,” “prognosis,” and “revascularization.” Randomized controlled trials, cohort studies, systematic reviews, meta-analyses, and major society guidelines evaluating CMR in adult patients with suspected or established ischemic cardiomyopathy were included. This review explores the comprehensive role of CMR in the diagnosis, differentiation, and prognostication of ICM. It highlights CMR’s superiority in quantifying ventricular function and detecting myocardial ischemia using routine cine and perfusion sequences, while also emphasizing the emerging role of CMR speckle tracking—referred to as feature tracking (CMR-FT)—in the detection of ischemia and the assessment of myocardial viability. The review further evaluates the role of CMR in distinguishing ischemic from non-ischemic cardiomyopathies through advanced tissue characterization techniques, including parametric mapping and late gadolinium enhancement (LGE). Additionally, it discusses CMR’s utility in guiding revascularization decisions and predicting clinical outcomes based on scar burden and myocardial viability. Although certain limitations remain, such as accessibility and patient compatibility, CMR continues to represent the standard for non-invasive cardiac imaging in ICM, providing clinicians with critical information across all stages of patient care, however, the expanding applications of CMR must be interpreted within evolving evidence and guideline recommendations rather than generalized superiority claims.

Tuberculous meningitis: a comprehensive review of pathogenesis, clinical features and therapeutic strategies

2026-04-30T07:11:32+0530

Tuberculous meningitis (TBM) is the most severe form of tuberculosis affecting the central nervous system, associated with high mortality and long-term neurological disability. Diagnostic delays, limited drug penetration into the cerebrospinal fluid, and emerging drug resistance continue to complicate effective management.
This review aims to summarize current evidence (2020–2025) regarding therapeutic strategies for TBM, including standard antituberculosis therapy, optimized rifampin dosing, carbapenem use, fluoroquinolones, linezolid, corticosteroids, and aspirin as an adjunct treatment. Special emphasis is placed on drug-resistant TBM and pharmacokinetic considerations. A narrative review was conducted using articles published between 2020 and 2025 from PubMed, Scopus, Web of Science, and institutional sources. Key search terms included “tuberculous meningitis,” “CNS tuberculosis,” “rifampin pharmacokinetics,” “drug-resistant TBM,” “carbapenems,” “fluoroquinolones,” “linezolid,” and “adjunctive therapies.” Recent evidence supports the use of higher-dose rifampin to enhance central nervous system penetration. Carbapenems (meropenem and imipenem) and linezolid have shown clinical benefit, particularly in drug-resistant TBM. Moxifloxacin and levofloxacin offer additional therapeutic roles. Corticosteroids remain beneficial in reducing mortality in HIV-negative patients, while aspirin may reduce stroke risk and modulate inflammation. However, despite therapeutic advances, outcomes in multidrug-resistant TBM remain poor. Therapeutic advances, including optimized drug dosing and promising adjunctive agents, have improved TBM management. Nonetheless, early diagnosis, individualized pharmacologic approaches, and better strategies for drug-resistant disease remain critical priorities to reduce mortality and improve neurological outcomes.

Medication-induced electrolyte imbalances: a call for increased awareness and vigilance

2026-04-30T07:14:50+0530

Electrolyte imbalances are a significant concern in clinical practice, often caused by medications such as diuretics, cardiovascular drugs, chemotherapy agents, and antibiotics. These imbalances can lead to serious complications, including cardiac arrhythmias and increased mortality. Key electrolytes like sodium, potassium, calcium, and magnesium play crucial roles in maintaining fluid balance, nerve function, and muscle contraction. Medications can disrupt electrolyte balance, causing hyponatremia, hyperkalemia, hypomagnesemia, and other imbalances. Risk factors include pre-existing kidney disease, heart failure, and concomitant use of multiple medications. Treatment involves discontinuing the causative medication, correcting electrolyte imbalances, and managing underlying conditions. This review analyzes drug induced electrolyte disorders, their consequences, and treatment options. Understanding the mechanisms of drug-induced electrolyte imbalances can help clinicians manage complex cases and provide effective care.

The role of bone marrow adiposity in rheumatoid arthritis pathogenesis

2026-04-30T07:14:41+0530

Bone marrow adiposity (BMA) has historically been thought of as a passive energy reserve in the medullary cavity, new research indicates that it is actually a dynamic endocrine organ that affects immunological responses, bone remodeling, and hematopoiesis. Changes in BMA composition and behavior have been increasingly identified in rheumatoid arthritis (RA), an autoimmune disorder marked by joint damage and synovial inflammation. Immune dysregulation, decreased osteoblastogenesis, and osteoclast activation may be caused by dysregulated adipokine production, changed lipid metabolism, and compromised bone marrow microenvironment function. The physiological function of BMA, its changes in RA, and the mechanisms relating marrow fat to joint pathogenesis are all summarized in this paper. In addition, we go over cutting-edge imaging techniques for measuring BMA in vivo, provide an overview of clinical data regarding its involvement in the course of the disease, and investigate possible treatment approaches that target BMA modulation to enhance muscles and joints outcomes in RA. Gaining insight into this little-known facet of RA pathophysiology may pave the way for the development of biomarkers and focused therapeutic approaches.

Drugs and hepatotoxicity: a comprehensive review

2026-04-30T07:12:02+0530

Hepatotoxicity is a leading cause of acute and chronic liver disease worldwide. It denotes liver damage resulting from exposure to pharmaceuticals, chemicals, herbal preparations, or other foreign compounds. It is a major concern in clinical practice and drug development, as liver injury is a frequent cause of treatment discontinuation and drug withdrawal. Owing to its central role in metabolism and detoxification, the liver is particularly susceptible to toxic injury. The spectrum of hepatotoxicity ranges from mild, transient elevations in liver enzymes to severe acute liver failure. This review discusses the role of the liver in xenobiotic metabolism, mechanisms of hepatotoxicity, types of liver injury, implicated drugs, diagnostic approaches, management strategies, and preventive measures. Emphasis is placed on integrating mechanistic insights with clinical applications to aid in early detection, better therapeutic strategies, and reduction of morbidity and mortality associated with hepatotoxicity.

Photon-counting computed tomography: a next-generation imaging technology and its clinical impact

2026-04-30T07:11:12+0530

Photon-counting computed tomography (PCCT) is the radically new technology in the X-ray imager that makes it possible to directly detect and energy-discriminate a photon. PCCT, in contrast to traditional energy-integrating detector (EID) CT systems, uses semiconductor-based detectors that transform X-ray photons directly into electrical signals, which means that it has better spatial resolution and lower electronic noise, sufficient contrast-to-noise ratio, and improved dose efficiency. The main benefit of PCCT is that it has intrinsic spectral imaging capacity that enables it to obtain multi-energy data during a single scan, enabling a material to be decomposed accurately, better tissue characterization and beam-hardening and metal artifact reduction. Recent clinical and preclinical trials have shown that PCCT also has a broad diagnostic potential in a broad spectrum of uses such as neuroimaging, cardiovascular imaging, thoracic imaging, musculoskeletal examination and oncologic imaging. The enhanced spatial resolution allows the visualization of small structures of the anatomy to be better and the spectral information is possible to support quantitative imaging and the characterization of the lesion. These abilities can lead to the earlier detection of a disease, the increased confidence of the diagnostic results, and the optimal management of the patients. Though this has been advantageous, the common clinical use of PCCT is still hampered by issues of high costs of the systems, large volume of data, computational requirement and limited accessibility. However, these limitations are set to be overcome by the ongoing improvement in detector technology, image reconstruction algorithms and clinical validation studies. The review gives a summary of the principles underlying photon-counting CT as well as the comparison that has been given between PCCT and conventional CT technology, limitation of PCCT, and its future in diagnostic imaging.

Stem cell therapy for sensorineural hearing loss: A narrative review

2026-04-30T07:09:37+0530

Transplanting neural stem cells has drawn a lot of interest as a novel therapeutic approach for replacing specific cells that have been harmed by disorders like neurodegenerative diseases. Neural stem cell transplantation has a significant therapeutic impact on cell activation and regeneration as well as the restoration of damaged neurons in many organs. As stem cell research advances, stem cell therapy will become more important in treating inner ear diseases including sensorineural hearing loss. The invasive surgical procedure may result in severe hearing loss because of the unique structure of the cochlea. Therefore, several methods are chosen for neural stem cell implantation depending on the conditions and goals of the treatment. The methods for stimulating endogenous and exogenous stem cell differentiation in the inner ear are discussed in this review article. Although stem cell therapy still has many drawbacks, its potential to treat hearing loss has been widely acknowledged. This review attempts to provide a thorough overview of stem cell therapy for sensorineural hearing loss (SNHL), the difficulties encountered, and possible future prospects in this field by combining recent research and innovation.

Exploring the relationship between triglyceride-glucose index and peripheral neuropathy in Nigerian patients with type 2 diabetes: a comparison with other metabolic markers

2026-04-30T07:14:38+0530

Background: Diabetic peripheral neuropathy (DPN) is a common and disabling complication of type 2 diabetes mellitus (T2DM). The triglyceride–glucose (TyG) index, a surrogate marker of insulin resistance, has been associated with several diabetes-related complications, but its role in identifying DPN remains unclear. This study evaluated the relationship between the TyG index and DPN among Nigerian patients with T2DM and compared its performance with other metabolic markers.

Methods: This hospital-based cross-sectional study was conducted among adults with T2DM attending diabetes clinics in two tertiary hospitals in North-Central Nigeria. DPN was assessed using the Michigan Neuropathy Screening Instrument, 10-g monofilament and 128-Hz tuning fork. The TyG index, albumin–creatinine ratio (ACR), glycated haemoglobin (HbA1c), serum uric acid and apolipoprotein A-I (Apo A-I) were measured.

Results: The prevalence of DPN was 61.8% (n=63). DPN was associated with longer diabetes duration, higher hypertension prevalence, lower physical activity and worse renal indices. Participants with DPN had lower Apo A-I (p=0.013), higher urine albumin (p<0.001) and higher ACR (p<0.001). The TyG index did not differ significantly between groups (p=0.218) and showed poor diagnostic performance (AUC 0.427, p=0.218). By contrast, ACR (AUC 0.757, p<0.001) and Apo A-I (AUC 0.647, p=0.013) demonstrated better discriminatory ability.

Conclusions: TyG index showed poor diagnostic utility for DPN, whereas ACR and Apo A-I were significantly associated with neuropathy and provided superior discrimination. These findings support the use of renal and lipid-related markers alongside routine neuropathy screening.

Gender differences in patients with ST-elevation myocardial infarction

2026-04-30T07:12:41+0530

Background: Clinical and morphological features of myocardial infarction (MI) have significant gender differences, but for a long time this problem was not given much attention. In this regard, the issue of gender characteristics of the course and outcomes of MI has become more relevant.

Methods: The study included 100 patients with acute ST-elevation MI (STEMI) who were admitted to the Grodno Regional Cardiological Center (Belarus) for treatment from January to November 2024. Group 1 included 50 female patients, while Group 2 included 50 male patients. All patients underwent clinical, laboratory, and instrumental studies. Statistical analysis was performed using «STATISTICA 12.0».

Results: Female patients were significantly older than males (62.1±9.1 vs 57.6±9.2, p=0.017). Both groups were comparable in prevalence of hypertension and obesity (p>0.05), however females more often had diabetes mellitus (p=0.047). There were no intergroup differences in values of total cholesterol (p=0.23), triglycerides (p=0.54) and low-density lipoproteins (p=0.45), however high-density lipoproteins (HDL) were higher in females (p=0.034). Also, male patients with STEMI had higher troponin levels (p<0.001). Both volumetric parameters in M-mode and LV end-diastolic volume in B-mode showed significant differences (p<0.05), being greater in males.

Conclusions: Female patients with STEMI were characterized by higher prevalence of anterior MI and diabetes mellitus, as well as higher level of glucose and HDL. Male patients had higher levels of high sensitivity troponin levels, as well as larger LV volumes. All these parameters can potentially contribute to further investigations in treatment and prognosis in patients with MI.

Patterns of stroke subtypes among hypertensive patients: evidence from a hospital-based study in Bangladesh

2026-04-30T07:12:28+0530

Background: Stroke is a leading global cause of disability and death, with a disproportionately high burden in developing nations. Hypertension is the primary modifiable risk factor for both ischemic and hemorrhagic stroke subtypes.

Methods: A cross-sectional study was conducted from January to December 2015 at Sylhet M.A.G. Osmani Medical College Hospital. We enrolled 96 hypertensive patients admitted with a stroke diagnosis to the Department of Medicine and Neuromedicine. Data on demographics, clinical profiles, and stroke subtypes were collected via a structured questionnaire and analyzed using descriptive and inferential statistics.

Results: The mean age of participants was 60.0 ± 11.46 years, with the highest proportion (34.4%) in the 51–60year age group. Most participants were female (68.8%) and housewives (59.4%), belonging to a lower-middle socioeconomic class (55.2%). Ischemic stroke was the predominant subtype (70.8%), consistent with global and regional patterns of stroke distribution, followed by intracerebral hemorrhage (25%) and subarachnoid hemorrhage (4.2%). A significant association was found between age and stroke subtype (p=0.01). Uncontrolled hypertension, a major driver of stroke risk, was prevalent in 74% of patients, and 61.5% reported irregular use of antihypertensive medications.

Conclusions: Ischemic stroke is the most common subtype among hypertensive patients in this setting, heavily linked to uncontrolled blood pressure. These findings underscore the critical need for effective hypertension management, including regular medication adherence and early intervention, to mitigate the stroke burden in Bangladesh.

Demographic characteristics and risk factor profile of acute stroke patients

2026-04-30T07:11:16+0530

Background: Stroke is a major contributor to mortality and long-term disability worldwide, with a growing burden in low- and middle-income countries. Inadequate control of modifiable cardiovascular risk factors plays a central role in the rising incidence of stroke in these regions. Understanding the demographic profile and risk factor distribution among stroke patients is essential for effective prevention strategies. Hospital-based data provide valuable insight into existing gaps in risk detection and management. This study aimed to describe the demographic characteristics and risk factor profile of patients presenting with acute stroke in a tertiary care hospital.

Methods: This cross-sectional observational study included 100 patients with acute stroke admitted to a tertiary care hospital in Bangladesh. Demographic variables, residence and major cardiovascular risk factors were documented using structured data collection tools. Data were analyzed using SPSS version 22.

Results: Most patients were aged 51-60 years (47%), with a male predominance (71%). Urban residents comprised 61% of cases. Hypertension was the most common risk factor (65%), followed by smoking (49%) and heart disease (29%). Among hypertensive patients, only 21.6% were regularly treated, while 33.8% were newly diagnosed at admission. Diabetes mellitus was present in 18% of patients, with 38.9% newly diagnosed. Coexisting hypertension and diabetes were observed in 13% of patients.

Conclusions: Acute stroke patients exhibited a high prevalence of modifiable and inadequately controlled cardiovascular risk factors. Strengthening early detection and management of these risk factors is essential to reducing stroke burden.

Dysregulation of immunoglobulins and complement proteins in diabetic foot infections

2026-04-30T07:10:03+0530

Background: Diabetic foot infections (DFIs) continue to be a substantial contributor to morbidity, disability, and limb loss in resource-limited nations. Hyperglycemia is associated with impaired wound healing; however, the relationship between immune dysregulation and metabolic glitches in diabetic foot infections remains imperfectly characterized.

Methods: This cross-sectional analytical investigation recruited 55 patients with diabetic foot infections from a specialist diabetes care center in Eastern Sudan (2024–2025). Clinical factors, ulcer intensity (SINBAD score), fasting blood sugar (FBS), and glycated hemoglobin (HbA1c) were recorded. Plasma immunoglobulins (IgA, IgG, IgM) and complement (C3,C4) levels were measured and compared with reference values. Associations among immunological markers, glycemic indices, and ulcer intensity were analyzed using chi-square tests, correlation analyses, and regression models.

Results: The study consisted of 60% males and 40% females, with a mean age of 50.4±16.0 years and an average diabetes duration of 10.3±6.9 years. The majority exhibited advanced ulceration, with 52.7% receiving a SINBAD score of 6. The mean FBS and HbA1c levels were 191.0±71.9 mg/dl and 9.12±2.25%, respectively. Relative to reference values, IgA, C3, and C4 exhibited elevation (P<0.001), whereas IgM was reduced (P<0.001). Low IgM showed a linkage with increased HbA1c (P=0.030), whereas C3 was linked to FBS (P=0.049).

Conclusions: DFIs in Sudanese patients are accompanied by immune dysregulation, reduced IgM, and persistent complement signaling, linked to hyperglycemia. Assessing immunological markers alongside glycemic indices may expand the practical utility of prognostic evaluation in resource-limited settings.

Quality of the informed consent process in diabetic foot amputation surgery: a prospective multicenter study in Senegal

2026-04-30T07:10:02+0530

Background: Informed consent represents a fundamental ethical and legal requirement in surgical practice, particularly in mutilating procedures such as lower-limb amputation for diabetic foot. In low-resource settings, several structural and sociocultural factors may limit the quality of the informed consent process.

Methods: A prospective descriptive and analytical multicenter study was conducted from April to December 2022 in three teaching hospitals in Dakar, Senegal. Adult patients hospitalized for surgical management of diabetic foot were included. Data were collected using structured questionnaires completed by physicians and patients to evaluate socio-demographic characteristics, clinical data, and the quality of the informed consent process. The perceived quality of informed consent was categorized as favorable (excellent or average) or unfavorable (poor). Statistical analysis was performed using the Chi-square test with a significance level set at p<0.05.

Results: A total of 109 patients were included with a mean age of 62.1±9.1 years. Most patients (92.7%) reported understanding their diagnosis. However, several deficiencies were identified in the consent process: insufficient information about complementary investigations (78.9%), prosthetic rehabilitation (61.5%), and lack of confidentiality during counselling (82.6%). Only 25.7% of patients reported complete satisfaction with the consent process. Interview duration longer than five minutes (p<0.001), clarity of information (p<0.001), physician empathy (p<0.001), and counselling conducted in a private consultation room (p=0.001) were significantly associated with a favorable perception of informed consent.

Conclusions: The informed consent process for diabetic foot amputation remains suboptimal despite a generally positive physician-patient relationship. Improving communication, ensuring confidentiality, and allocating sufficient consultation time may significantly enhance the quality of informed consent in surgical practice.

Clinical and echocardiographic features in patients with different phenotypes of heart failure

2026-04-30T07:09:47+0530

Background: Despite the advancements in heart failure (HF) management, a gap remains in distinguishing the clinical and echocardiographic profiles among the different phenotypes of HF, particularly in HF with mid-range ejection fraction (HFmrEF). The aim of the current study was to establish clinical and echocardiographic differences in patients with HF with reduced and mid-range left ventricular ejection fraction (LVEF).

Methods: The study included 80 patients with chronic HF with LVEF less than 50% who were divided into two groups: HF with reduced ejection fraction (HFrEF) (n=45) and HFmrEF (n=35). All patients underwent clinical, laboratory, and instrumental studies, including transthoracic echocardiography. Statistical analysis was performed using «STATISTICA 12.0».

Results: Patients of both groups were predominantly male (p>0.05), comparable in age prevalence of atrial fibrillation and diabetes mellitus (p>0.05). Patients with HFmrEF more often suffered from hypertension (p=0.04) and stable angina class 3 (p=0.010). Laboratory markers in both groups had no significant differences except for NT-proBNP levels (p=0.031), which were higher in patients with HFrEF. Patients with HFrEF had higher linear and volumetric parameters of both atria and ventricles (p<0.05), which demonstrated undeniable correlation between LVEF and other heart diameters and volumes.

Conclusions: Our study showed that patients with HFmrEF have significant differences from HFrEF (higher incidence of hypertension, lower NYHA class and NT-proBNP levels). This highlights that the further study of clinical and laboratory characteristics of HFmrEF should be conducted.

Hematological evaluation of splenectomized and non-splenectomized transfusion dependent patients with thalassemia

2026-04-30T07:11:14+0530

Background: Thalassemia is a group of blood disorders caused by decreased or absent synthesis of globin chains, with β-thalassemia leading to ineffective erythropoiesis, severe anemia, and the need for lifelong transfusions. Frequent transfusions can cause iron overload, and many transfusion-dependent patients require splenectomy to manage hypersplenism, though the procedure carries potential risks and its benefit on transfusion reduction remains debated. The aim of the study was to compare the hematological profile and iron overload status between splenectomized and non-splenectomized transfusion-dependent patients with thalassemia.

Methods: This cross-sectional comparative study at the department of transfusion medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from December 2021 to October 2022, included 60 transfusion-dependent thalassemia patients (30 splenectomized, 30 non-splenectomized). Sociodemographic, nutritional, clinical, transfusion, and laboratory data (CBC, PBF, serum ferritin) were collected and analyzed using SPSS version 24 (p < 0.05).

Results: Among 60 patients, splenectomized individuals were more often underweight (76.7% versus 46.7%), had higher hemoglobin (7.26 versus 6.78 gm/dl), MCV (75.64 versus 69.99 fl), WBC (12.24 versus 9.31 ×10³/l), platelets (556 versus 210 ×10³/L), and ferritin (5843.98 versus 3253.32 ng/mL), while non-splenectomized patients required more frequent transfusions ≤4 weeks (83.3% versus 40%) and had more severe anemia (63.3% versus 36.7%).

Conclusions: Splenectomy in transfusion-dependent thalassemia improves hemoglobin and blood counts but does not reduce iron overload, highlighting the need for continued monitoring and management.

Health related quality of life and related factors among children with transfusion dependent thalassemia: a cross-sectional study in Chattogram, Bangladesh

2026-04-30T07:09:24+0530

Background: Transfusion-dependent thalassemia (TDT) is a chronic inherited disorder requiring lifelong transfusions and iron chelation. Despite improved survival, complications and treatment burden reduce health-related quality of life (HRQoL). Evidence from Bangladesh using disease-specific tools is limited. This study assessed HRQoL and its associated factors among children with TDT in Chattogram.

Methods: A cross-sectional study was conducted among 400 children (6–18 years) at two tertiary hospitals in Chattogram. HRQoL was measured using the Bangla-translated TranQol questionnaire (physical, emotional, family and school/career domains). Sociodemographic and clinical data were collected via interviews and records. Data were analyzed using non-parametric tests, correlation and hierarchical multiple linear regression in SPSS v27, with p<0.05 considered significant.

Results: Most participants were aged 10–15 years (58.0%) and male (68.5%), with HbE thalassemia as the predominant type (70.0%). Mean serum ferritin was high (2082.6±1353.7 ng/ml) and 54.5% received iron chelation therapy. Physical health had the lowest HRQoL score (6.07/24), followed by family (11.32/36), emotional (14.13/36) and school/career (9.45/16). Sociodemographic and family factors explained 31.8%, 26.1%, 16.6% and 24.6% of variance across domains, respectively (all p<0.001). Age at diagnosis and residence were consistent significant predictors.

Conclusions: Children with TDT in Bangladesh experience substantial multidimensional impairment in HRQoL. Early age at diagnosis, iron overload and socioeconomic constraints significantly influence outcomes. Integrating routine HRQoL assessment and strengthening psychosocial and financial support mechanisms are essential to improve holistic thalassemia care.

Determinants of blood pressure control: a survey on Cilnidipine–Telmisartan use in uncontrolled hypertension

2026-04-09T07:08:47+0530

Background: Uncontrolled hypertension remains a major public health challenge, often complicated by poor medication adherence and multiple comorbidities. Fixed-dose combinations such as Cilnidipine and Telmisartan (CILTEL) have been proposed to improve blood pressure (BP) control through complementary mechanisms and simplified dosing. Objectives were to assess physicians’ perceptions, attitudes, and prescribing patterns regarding CILTEL in the management of uncontrolled hypertension, and to identify factors associated with achieving ≥80% BP reduction.

Methods: A cross-sectional, questionnaire-based survey was conducted among 788 physicians across various regions and practice settings. Data were collected via structured personal interviews. Descriptive statistics summarized demographic and professional characteristics. Multivariate logistic regression identified independent predictors of achieving ≥80% BP reduction.

Results: The majority of physicians reported high satisfaction with CILTEL for patients with uncontrolled hypertension, citing improved BP control and better adherence as key benefits. Multivariate analysis revealed that good patient adherence (OR=1.91), absence of major comorbidities (OR=2.03), and longer duration of therapy (OR=1.83) were significant predictors of BP target achievement. Physicians also highlighted the convenience of a fixed-dose regimen in reducing pill burden and enhancing patient compliance.

Conclusions: CILTEL is perceived by physicians as an effective and well-tolerated option for uncontrolled hypertension, particularly when adherence is optimized and comorbidity burden is low. Its fixed-dose nature supports improved compliance, potentially translating into better long-term cardiovascular outcomes.

Poultry farms as reservoirs of antibiotic-resistant Klebsiella pneumoniae: a “one health” concern

2026-04-17T06:40:54+0530

Background: The emergence and spread of antibiotic-resistant bacteria have been largely attributed to the indiscriminate use of antibiotics in poultry farming, posing significant risks to human, animal, and environmental health. Increasing evidence links Klebsiella pneumoniae with multidrug resistance, highlighting its role as an emerging opportunistic pathogen. The present study aimed to isolate and evaluate antibiotic-resistant bacteria from chicken (Gallus gallus domesticus) droppings and assess their potential eco-health implications.

Methods: Droppings were collected from a poultry farm located in Mavelikkara, Kerala, India. Microorganisms were isolated and characterized using standard microbiological protocols. Molecular identification of the isolates was carried out following established procedures. Confirmation of antibiotic-resistant strains was performed using species-specific polymerase chain reaction analysis.

Results: Two antibiotic resistant strains of Klebsiella pneumoniae PB-01(PX376439) and PB-02(PX376441) strains were identified. Both strains exhibited resistance to commonly used antibiotics, including ampicillin, streptomycin, and erythromycin.

Conclusions: Poultry farms may act as reservoirs of antibiotic resistance genes, facilitating their spread beyond ecological boundaries. This is supported by the isolation of multidrug-resistant Klebsiella pneumoniae from chicken fecal samples collected from the farm. The findings highlight the importance of integrated surveillance and prudent antibiotic stewardship to limit the spread of antibiotic resistance within the One Health framework.

Impact of transfusion history on hepatitis B virus seropositivity among thalassemic and hemophilic patients

2026-04-30T07:10:04+0530

Background: Patients with thalassemia and hemophilia require repeated blood transfusions, which increase the risk of transfusion-transmitted infections, including hepatitis B virus (HBV). Despite routine donor screening, previous exposure to HBV may still occur, particularly in multi-transfused populations. To assess the impact of transfusion history on hepatitis B virus seropositivity among thalassemic and hemophilic patients.

Methods: This cross-sectional analytical study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from March 2021 to August 2023. A total of 50 multi-transfused patients (25 thalassemia and 25 hemophilia) were enrolled. HBsAg and Anti-HBc were tested and transfusion history, demographics and vaccination status were analyzed using SPSS.

Results: All participants were negative for HBsAg. Anti-HBc (total) positivity was detected in 22.0% of patients, including 24.0% of hemophilia patients and 20.0% of thalassemia patients. Demographic factors, transfusion burden, transfusion interval, type of blood component and hepatitis B vaccination history showed no statistically significant association with Anti-HBc positivity (p>0.05). However, a significant association was observed between Anti-HBc positivity and a history of receiving transfusions from multiple centers (p=0.001).

Conclusions: Although active HBV infection was not detected, a substantial proportion of multi-transfused patients had evidence of previous HBV exposure. Receiving transfusions from multiple centers was the most important risk factor for HBV seropositivity, highlighting the need for standardized and high-quality transfusion practices across all centers.

Fostering medical education: an affable approach to small group discussion in conventional settings

2026-04-30T07:15:04+0530

Background: Competency-based medical education (CBME) marks a paradigm shift in Indian medical education, emphasizing active and learner-centric strategies over traditional didactic methods. The National Medical Commission (NMC) has recommended expanding small group discussion (SGD) hours to strengthen this learner-driven model. However, microbiology education in India remains largely lecture-driven. This study aimed to evaluate the implementation and effectiveness of four distinct SGD techniques-flipped classroom, escape room, distribute-discuss-develop (3D), and mind-mapping-in promoting engagement and deep learning among undergraduate medical students.

Methods: A cross-sectional study was conducted among phase II MBBS students (n=150) at a tertiary medical college. Participants were divided into ten groups. Four SGD modalities were implemented: a flipped classroom on immunoprophylaxis, a game-based escape room on atypical pneumonia, a 3D poster session on viral encephalitis, and mind mapping on transfusion transmitted infections. Faculty used validated checklists for performance scoring and Google forms for feedback.

Results: Overall participation was 100%. Quantitative analysis revealed that the Escape room received the highest median enjoyment score (5/5, IQR=4-5) and was preferred by 72% of learners. Faculty observed improved articulation and peer teaching behaviors during 3D and mind mapping sessions. Faculty evaluation scores showed a median of 8 (IQR=7-9) across all techniques.

Conclusions: Incorporating varied SGD modalities into the microbiology curriculum is feasible and effective. Techniques like flipped classrooms and escape rooms enhance academic engagement and promote core competencies such as communication and teamwork.

Prescription audit of tertiary care centre using world health organization core prescribing indicators: an observational study

2026-04-30T07:12:00+0530

Background: Rational use of medicines is a cornerstone of effective healthcare delivery. Inappropriate prescribing practices can lead to polypharmacy, increased healthcare costs, ADRs and poor patient compliance. DUS, using World Health Organization (WHO) prescribing indicators, are essential tools for evaluating prescription patterns and promoting rational drug use, especially in tertiary care settings where patient load and disease complexity are high. Analyse prescription patterns using WHO drug use indicators. Assess the extent of polypharmacy & use of generic versus brand-name drugs. Commonly prescribed drugs & their combinations.

Methods: A prospective, observational study was conducted in all OPDs of a tertiary care centre. A total of 1,050 prescriptions were analysed over a study period from March 2024 to August 2025.

Results: The average number of drugs per prescription was 5.84. 81.54% of drugs were prescribed by generic name. Antibiotics were prescribed in 15.72% of encounters, while injections were used in 1.81%. NSAIDs, particularly paracetamol and diclofenac, often co-prescribed with proton pump inhibitors. Antihypertensive and antidiabetic medications were commonly used due to the high burden of comorbid conditions.

Conclusions: The study reveals a high level of polypharmacy in the OPD setting, though prescribing practices largely adhered to rational drug use principles. The high rate of generic prescribing and limited use of injections reflect appropriate prescribing behaviour. Continuous prescription auditing and periodic training programs are recommended to further improve rational drug use and minimize unnecessary polypharmacy.

Short-term outcomes following massive small bowel resection: our experience of 23 cases

2026-04-30T07:14:47+0530

Background: Short bowel syndrome (SBS) is a condition where a significant portion of the small intestine is lost/ absent, either congenitally or secondary to surgical resection. Complications arising due to the short length of the remnant bowel account for the high morbidity and mortality. In this case series, we describe our experience with 23 patients who underwent major intestinal resection.

Methods: Retrospective data were retrieved from departmental records from January 2017 to June 2024 of patients who underwent major small bowel resection at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry with a remnant small bowel length of <200cm.

Results: After excluding patients with incomplete records, data from 23 patients were analyzed. Mesenteric ischemia due to thrombosis of the superior mesenteric artery or vein was the most common etiology behind massive bowel resection. Most of the patients required intensive care in the immediate postoperative period, with ventilator support. The wound related complications included superficial and deep surgical site infection (52.2%), wound dehiscence (21.7%), and stomal necrosis (26.1%). Dyselectrolytemia, in the form of hyponatremia, was common in Type I (90%) and Type II SBS (80%), whereas it had a lower incidence in Type III SBS (28.6%), p value = 0.023. Early postoperative mortality occurred in 5 patients.

Conclusions: The present case series shows the high morbidity and mortality associated with massive small bowel resection. Early initiation of enteral feeds, with or without parenteral supplementation, may help prevent dependence on parenteral nutrition and is associated with lower morbidity and mortality.

Detection of ESBL and MBL among uropathogenic Escherichia coli in a tertiary care hospital in Maharashtra

2026-04-30T07:14:43+0530

Background: Urinary tract infection (UTI) is one of the most common infections worldwide. Although the spectrum of etiological agents causing UTI has remained relatively constant, their antimicrobial susceptibility patterns have changed over time due to the emergence of resistant strains. Escherichia coli, a gram-negative bacillus, is the most common uropathogen. Antimicrobial resistance mediated by extended-spectrum β-lactamases (ESBL) and metallo-β-lactamases (MBL) in E. coli contributes significantly to prolonged hospital stay and increased treatment costs in patients with UTI.

Methods: All urine samples received from inpatients and outpatients in the microbiology laboratory were processed for microscopy and cultured on Blood agar and MacConkey agar. Isolates were identified based on colony morphology and standard biochemical tests. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method according to CLSI guidelines. ESBL production in E. coli was detected by the cephalosporin/clavulanate disk test and MBL production by the imipenem/EDTA disk test.

Results: Of the 2234 urine samples processed, 845 yielded significant growth. E. coli was the most common isolate (41.89%). The uropathogenic E. coli (UPEC) strains showed more resistance to ampicillin (96.78%) and cephalosporins (93.55%) and comparatively less resistance to imipenem (11.93%) and nitrofurantoin (13.55%). ESBL and MBL production were observed in 55.81% and 10.65% of E. coli isolates, respectively.

Conclusions: The increasing prevalence of ESBL- and MBL-producing E. coli among uropathogens is a major concern. Judicious and rational use of antimicrobial agents, guided by local susceptibility patterns, is essential to reduce treatment costs, limit morbidity and curb the further spread of resistance in UTI cases.

Autologous serum as an alternative to fibrin glue for conjunctival autograft fixation in sutureless pterygium surgery

2026-04-30T07:10:01+0530

Background: Pterygium is a common ultraviolet (UV)-related ocular surface disorder. Although conjunctival autografting lowers recurrence, the optimal graft fixation method remains debated. Autologous serum offers a cost-effective alternative to fibrin glue in sutureless pterygium surgery. Objectives were to compare the efficacy of autologous serum and fibrin glue for conjunctival autograft fixation in sutureless pterygium surgery.

Methods: This prospective randomized comparative interventional study was conducted at the Department of Ophthalmology, Dhaka Medical College Hospital, from January to July 2020. Sixty patients with primary nasal pterygium were randomly allocated into two groups: Group A (autologous serum) and group B (fibrin glue), with 30 patients in each group. Operative time, graft adherence, postoperative symptoms, complications, and recurrence at 3 months were evaluated. Data were analyzed using SPSS version 22, and p<0.05 was considered statistically significant.

Results: The mean surgical time was 23.11±1.69 minutes in group A and 24.41±1.19 minutes in group B (p=0.084). Complete graft adherence on the first postoperative day was observed in 96.7% of group A and 100% of group B. Postoperative symptoms were present in 50.0% and 60.0% of patients, respectively (p=0.463). Recurrence at 3 months occurred in 3.3% of group A and none in group B (p=1.000). No statistically significant differences were found between groups.

Conclusions: Autologous serum is a safe, effective, and economical alternative to fibrin glue for conjunctival autograft fixation in sutureless pterygium surgery.

Prevalence of Acinetobacter spp. in lower respiratory tract infections and its antimicrobial susceptibility pattern in a tertiary care hospital

2026-04-30T07:14:30+0530

Background: Acinetobacter spp. are regarded as commensal microbes of human skin and respiratory tract; however, they may cause serious infections, such as endocarditis, urinary tract infections (UTI), pneumonia, wound infections, especially in individuals with impaired host defenses. This study aimed to determine the prevalence and antimicrobial susceptibility pattern of Acinetobacter spp. isolated from lower respiratory tract (LRT) specimens in a tertiary care hospital in Jaipur, Rajasthan, India.

Methods: A total of 1031 lower respiratory tract (LRT) samples, including sputum, bronchoalveolar lavage (BAL), endotracheal tube (ET)/ aspirate and pleural fluid, were collected from inpatients and outpatients. Acinetobacter spp. were isolated and identified using standard microbiological techniques and antimicrobial susceptibility testing was performed.

Results: Out of 801 (77.69%) culture-positive samples, 136 (16.98%) were identified as Acinetobacter spp. The highest isolation rate was observed in ET samples (80.15%), followed by sputum (16.91%), BAL (2.21%) and pleural fluid (0.74%). The majority of Acinetobacter spp. were isolated from patients in the medical ICU (29.37%) and the critical care unit (26.98%). Antimicrobial susceptibility testing revealed high resistance rates to cefotaxime (99.26%), ceftriaxone (97.79%) and other antibiotics. Colistin was the only antibiotic to which all isolates were susceptible.

Conclusions: The high prevalence of multidrug-resistant Acinetobacter spp. in LRT infections poses a significant challenge for clinicians. Implementing strict infection control measures, judicious use of antibiotics and regular monitoring of antimicrobial susceptibility patterns are essential to prevent the spread of these resistant pathogens in healthcare settings.

Digital media use among children under five: an insight into socio-demographic factors and immediate behavioural outcomes

2026-04-30T07:14:27+0530

Background: With advancement and increasingly accessibility of digital technology, digital devices have become integral part in every household. Sociodemographic factors influence digital media use, yet data from tertiary care settings in India remain limited. This study provides important insights into how various sociodemographic factors influence children's screen time and its association with behavioral problems.

Methods: An observational study was conducted among under five children attending a tertiary care hospital. Parents were interviewed using a structured questionnaire about sociodemographic characteristics, availability & usage of digital devices and behavioral issues observed. Data were analyzed using SPSS.

Results: The study included 384 children aged below five years. The mean age was 29.4 months, with male predominance (57%). The median number of family members was 5, 80% of households had two or more digital devices. The mean screen-time was 72.3 minutes per day and 49.2% of children had excessive screen time while only 32.4% consumed educational content. 58.7% of parents had not set time limits for screen usage. Younger age, higher socioeconomic class, lower paternal education, early initiation of screen exposure, greater access to devices, were all significantly associated with excessive screen-time. 14.8% of all participants exhibited behavioral changes associated with screen use.

Conclusions: Excessive screen time is highly prevalent among under five children. It is strongly influenced by sociodemographic factors and is linked to behavioral problems. A balanced approach to screen time in early childhood can reduce negative outcomes.

Status of serum magnesium and calcium in type 2 diabetes mellitus patients

2026-04-30T07:12:37+0530

Background: Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by persistently elevated blood sugar levels, resulting from inadequate insulin secretion, ineffective insulin action or both. Several studies have revealed association of hypomagnesaemia with poor glycemic control and various long-term complications of diabetes mellitus. Cohort studies have been found to be associated with higher serum Calcium levels with an increased risk of T2DM. Therefore, we aim to assess serum Mg and Ca status in Type 2 diabetes mellitus patients.

Methods: We conducted a case-control study with normal healthy population and T2DM patients visiting the OPD of Medicine. Normal healthy population and T2DM patients aged between 40 to 70 years of either sex were recruited and biochemical analysis was done.

Results: Total 80 participants (40 control and 40 T2DM patients) were recruited for the study. The mean age of the normal healthy population and T2DM patients was 53.07±10.79 and 55.72±9.86 years respectively. Non-significant change in BMI was observed in T2DM patients (26.49±4.35) as compared to normal healthy control (25.77±3.72). Significant increase (p<0.001) in fasting blood glucose and HbA1c was recorded in T2DM patients (222.55±75.63, 8.28±2.43 resp.) as compared to normal healthy control (92.33±8.53, 5.19±0.72 resp.). We observed non-significant decrease in serum Mg level and serum Ca level in T2DM patients (2.05±0.45, 8.68±0.76 resp.) as compared to normal healthy control (2.11±0.23, 8.99±0.77 resp), while Mg/Ca ratio was found unchanged in T2DM patients as compared to normal healthy control.

Conclusions: The study reveals a non-significant decrease in serum Mg and Ca in T2DM patients as compared to normal healthy population.

A study on clinical correlation and ultrasound biomicroscopic findings among cases of blunt ocular trauma

2026-04-30T07:12:35+0530

Background: Blunt ocular trauma is a significant cause of ocular morbidity and may result in a wide spectrum of anterior segment abnormalities that are not always detectable on routine clinical examination. Ultrasound biomicroscopy (UBM) is a high-resolution imaging technique that allows detailed visualization of anterior segment structures. The present study aimed to evaluate the correlation between clinical examination findings and ultrasound biomicroscopy findings in patients with blunt ocular trauma.

Methods: This descriptive cross-sectional observational study included 80 patients aged ≥12 years with closed-globe blunt ocular trauma presenting to a tertiary care teaching hospital between August 2022 and January 2024. All patients underwent comprehensive ophthalmic evaluation including visual acuity assessment, slit-lamp examination, intraocular pressure measurement, gonioscopy, fundus examination and ultrasound biomicroscopy using 35–50 MHz probes.

Results: Males constituted the majority of cases 80% (n=64), with the highest proportion of patients belonging to the 20–29-year age group 36.3% (n=29). the most common mechanisms of injury were road traffic accidents 33.3% (n=23) and sports injuries 27.5% (n=19). Gonioscopy detected angle recession in 12.5% (n=10) of patients. Ultrasound biomicroscopy identified additional anterior segment abnormalities including zonular dehiscence 22.5% (n=18), lens subluxation 20% (n=16), lens dislocation 7.5% (n=6), cyclodialysis 5% (n=4) and iridodialysis 4.8% (n=4). Ultrasound biomicroscopy also detected occult anterior segment abnormalities that were not evident on routine clinical examination.

Conclusions: Ultrasound biomicroscopy is a valuable adjunctive imaging modality in the evaluation of blunt ocular trauma. It enables detailed assessment of anterior segment structures and facilitates the detection of subtle traumatic abnormalities that may be missed during routine clinical examination, thereby aiding in appropriate management and prognosis.

Comparison of serum homocysteine levels in transfusion-dependent β-thalassemia patients with regular and irregular folic acid supplementation

2026-04-30T07:10:01+0530

Background: Transfusion-dependent β-thalassemia (TDT) patients have increased folate requirements due to chronic erythropoietic stress. Inadequate folate intake may result in elevated serum homocysteine, a recognized risk factor for vascular complications. This study aimed to compare serum homocysteine levels between TDT patients with regular and irregular folic acid supplementation and to assess correlations with duration of supplementation and age.

Methods: This cross-sectional comparative study was conducted at the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, between March 2023 and February 2024. Forty TDT patients were categorized into regular (n=20) and irregular (n=20) folic acid supplementation groups. Fasting serum homocysteine levels were measured using chemiluminescent immunoassay. Data were analyzed using SPSS version 27.0.

Results: Mean serum homocysteine was significantly lower in the regular supplementation group (5.19±1.04 µmol/l) compared with the irregular group (13.68±5.47 µmol/l; p<0.001). Hyperhomocysteinemia (≥15 µmol/l) was observed exclusively among irregularly supplemented patients (30%). A negative correlation was identified between duration of supplementation and homocysteine level, while age showed a modest positive trend with homocysteine among irregular users.

Conclusions: Irregular folic acid supplementation is associated with significantly elevated serum homocysteine levels in transfusion-dependent β-thalassemia patients. Sustained adherence to supplementation may reduce metabolic risk and should be emphasized in routine clinical management.

Evaluating the landscape of PD-L1 testing and treatment approaches in gastrointestinal and lung cancer: a questionnaire-based study among Indian oncologists

2026-04-30T07:12:32+0530

Background: Lung and gastrointestinal (GI) cancers together account for a major proportion of India’s cancer burden, with most cases diagnosed at advanced stages. Despite the proven efficacy of immune checkpoint inhibitors (ICIs), access and biomarker-guided implementation remain limited. This study assessed the current landscape of PD-L1 testing and immunotherapy (IO) practices among Indian oncologists treating patients with lung and GI malignancies.

Methods: A cross-sectional, questionnaire-based survey was conducted among 63 practicing oncologists across India from February 2025 to April 2025. The 23-item questionnaire collected information on PD-L1 testing practices, immuno-oncology (IO) usage, and barriers to adoption. Data were analyzed using descriptive statistics.

Results: Most respondents (73.02%) had over 10 years of clinical experience. PD-L1 testing was most frequent in non-small cell lung cancer (NSCLC) and less consistent in GI malignancies. Immunotherapy use was highest in NSCLC (44.44% common use in first-line) and hepatocellular carcinoma (36.51%), but infrequent in colorectal and biliary tract cancers. High PD-L1 expression guided IO use in most cases, while actionable mutations and performance status also influenced treatment choice. Cost was the predominant barrier, with 56-70% of patients deferring IO due to financial constraints. Key unmet needs included affordable access to IO (95.24%), predictive biomarkers (58.73%), and India-specific clinical guidelines (57.14%). Experienced oncologists were more likely to consider IO re-challenge after progression (p=0.03).

Conclusions: PD-L1 testing and IO adoption remain inconsistent across India, primarily due to cost, infrastructure, and limitations in biomarker availability. Strategic measures such as subsidized access, standardized testing, and context-adapted guidelines are essential to advance equitable precision immunotherapy in Indian oncology practice.

Fetomaternal outcomes in eclampsia at a tertiary care centre: a prospective observational study

2026-04-30T07:12:14+0530

Background: Eclampsia remains one of the most severe hypertensive disorders of pregnancy and continues to contribute substantially to maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries.

Methods: This hospital-based cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care centre in Nepal from July 2024 to July 2025. All women presenting with antepartum, intrapartum, or postpartum eclampsia beyond 28 weeks of gestation and up to seven days postpartum were included. Women with chronic hypertension, epilepsy, metabolic disorders, renal disease, or infectious causes of seizures were excluded. A total of 114 women were enrolled using non-probability convenient sampling. Maternal demographic details, clinical characteristics, management, and outcomes were recorded. Neonatal outcomes including birth weight, Apgar scores, NICU admission, and perinatal mortality were assessed. Data were analysed using SPSS version 25 with descriptive statistics.

Results: The incidence of eclampsia was 3.39%. Most women were young (≤20 years, 42.98%), primigravida (72%), and unbooked (94.74%). Antepartum eclampsia was the most common presentation (93.85%). Vaginal delivery occurred in 48.24% and caesarean section in 46.49% of cases. Maternal complications were observed in 38.60%, with acute renal failure being the most frequent. Two maternal deaths were reported. Among neonates, 25.43% were preterm and the perinatal mortality rate was 21.05%, with prematurity being the leading cause.

Conclusions: Strengthening antenatal surveillance, early referral, and timely management are crucial to improving outcomes in resource-limited settings.

A study of prescribing pattern in type-1 and type-2 diabetes in a tertiary care centre

2026-04-30T07:12:01+0530

Background: Diabetes mellitus is a chronic metabolic disorder with rising global prevalence, necessitating evidence-based prescribing to prevent complications. Understanding prescribing patterns provides insights into guideline adherence, drug utilization, and rational therapy. This study aimed to evaluate and compare prescribing patterns among Type-1 and Type-2 diabetes patients in a tertiary care hospital, assess rationality of prescriptions, and analyze combination therapies.

Methods: A prospective, observational study was conducted over 18 months (March, 2024 to August, 2025) in a tertiary care hospital. Prescriptions from 506 patients (T1DM = 49, T2DM = 457) were collected and analyzed. Data included demographics, drug class, dose, frequency, regimen, combination therapy medications. Descriptive statistics were used for analysis.

Results: Insulin therapy was prescribed universally in T1DM, predominantly basal-bolus regimens. In T2DM, metformin was the most frequently prescribed (72.92%), followed by sulfonylureas, SGLT2 inhibitors, and DPP-4 inhibitors. Dual and triple combination therapies were common. The use of generic drugs prefers more over the brands. Polypharmacy was seen in 32.30% of the study population.

Conclusions: Prescribing patterns largely adhered to evidence-based guidelines. Rational use of combination therapies and newer antidiabetic agents was observed. Reinforcing guideline-based prescribing can improve patient outcomes.

Clinical and lifestyle risk determinants of undiagnosed diabetes and pre-diabetes in a blood donor population

2026-04-30T07:10:00+0530

Background: Diabetes and its related complications constitute a major public health challenge due to their high prevalence, healthcare costs, and associated morbidity and mortality. Therefore, this study aimed to identify clinical and lifestyle factors associated with undiagnosed diabetes and pre-diabetes among blood donors in Bangladesh.

Methods: This cross-sectional study at the department of transfusion medicine, Bangladesh Medical University (BMU), Dhaka, enrolled 135 healthy blood donors aged 18-60 years. Participants were assessed for BMI, physical activity, family history of diabetes, FINDRISC score, and HbA1c, with blood analyzed using an automated analyzer (Capillary 3 Octa/Variant II). Data were analyzed in SPSS 24.0 using Chi-square tests (p<0.05).

Results: Among 135 blood donors, 83% were 25-44 years and 91.1% male. BMI showed 51.8% overweight and 17.8% obese. FINDRISC scores were mainly 7-11 (52.6%) and 12-14 (25.9%). Glycemia: 49.6% normal, 41.5% prediabetic, 8.9% diabetic. Dysglycemia was higher with obesity (41.7%), overweight prediabetes (57.1%), inactivity (p=0.029), and positive family history (73.2-75%; p<0.001). FINDRISC scores correlated with risk, with 58.3% diabetes in the 15-20 group (p<0.001).

Conclusions: Higher BMI, low physical activity, positive family history, and elevated FINDRISC scores are associated with undiagnosed dysglycemia among apparently healthy blood donors.

A cross-sectional study to assess the impact of dietary and lifestyle behaviour on menstrual patterns in medical students of GRMC Gwalior city, Madhya Pradesh, India

2026-04-30T07:11:51+0530

Background: Menstrual health is an important indicator of reproductive well-being. Medical students are particularly vulnerable to menstrual irregularities due to stress and lifestyle factors. To assess menstrual patterns and their association with dietary and lifestyle factors among female medical students.

Methods: A cross-sectional study was conducted among 183 female undergraduate medical students at Gajra Raja Medical College, Gwalior, from November 2024 to January 2025. Data were collected using a structured questionnaire covering sociodemographic details, menstrual history, BMI, diet, physical activity, stress, and sleep. Dysmenorrhea severity was assessed using the Visual Analogue Scale. Statistical analysis was performed using Jamovi 2.6.26, with Chi-square test and p<0.05 considered significant.

Results: Most participants (70.2%) attained menarche at 12–15 years. Normal BMI was observed in 56.9%, while 70.7% reported no physical exercise and 80.1% experienced stress. Irregular menstrual cycles were present in 53.6% of students. Significant associations were found between menstrual irregularity and BMI (p=0.003), physical activity (p=0.023), study duration (p<0.001), and dysmenorrhea (p<0.001). Junk food consumption and stress were not significantly associated.

Conclusion: Menstrual irregularities are common among medical students and are significantly associated with modifiable lifestyle factors such as BMI, physical inactivity, and prolonged study duration. Early lifestyle interventions are essential to improve menstrual health.

Mean platelet volume in acute ischemic stroke: a hospital based cross sectional study

2026-04-30T07:11:49+0530

Background: Platelet activation is a key mechanism underlying acute ischaemic stroke. Mean platelet volume (MPV), routinely reported in complete blood counts, reflects platelet size and functional activity and has been proposed as a marker of thrombotic tendency.

Methods: This hospital-based cross-sectional study enrolled adults with neuroimaging-confirmed acute ischaemic stroke admitted to a district hospital in Karnataka, India. Clinical characteristics, vascular risk factors, laboratory indices including MPV, and stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS) were documented and analysed.

Results: Among 134 patients studied, males accounted for 89 (66.4%), and the largest age group was 56-65 years, 51 (38.1%). Hypertension was present in 101 (75.4%), diabetes mellitus in 80 (59.7%), smoking in 60 (44.8%), alcohol use in 54 (40.3%), and coronary artery disease in 48 (35.8%). MPV values were significantly elevated in patients with these risk factors and showed a positive correlation with NIHSS score.

Conclusions: Increased MPV is associated with acute ischaemic stroke and with greater neurological severity. MPV may be a simple and economical adjunct marker for early risk stratification.

Pills over pesticides: the rising burden of pharmaceutical poisoning among young adults in urban south India

2026-04-30T07:10:03+0530

Background: Acute pharmaceutical poisoning represents an emerging public health challenge in urban India, with limited contemporary data on clinical profiles and outcomes. This study aimed to characterize the epidemiological patterns, clinical presentations, and determinants of complications in patients with acute drug poisoning.

Methods: We conducted a prospective observational study over six months (June-December 2024) at a tertiary care center in Chennai, India. Adult patients (≥18 years) admitted with acute pharmaceutical poisoning were enrolled. Primary outcomes included organ dysfunction and in-hospital mortality. Secondary outcomes comprised length of stay and complication patterns. Multivariable logistic regression identified independent predictors of organ dysfunction.

Results: Among 80 patients (mean age 36.8±11.2 years, 55% female), intentional self-harm accounted for 92.5% of cases. Benzodiazepines (17.5%) and NSAIDs (13.8%) were most frequently implicated. The majority (76.3%) presented 7-24 hours post-ingestion. Organ dysfunction occurred in 22 patients (27.5%), with no mortality observed. Independent predictors of organ dysfunction included delayed presentation >24 hours (OR 15.2, 95% CI 2.1-109.8, p=0.007) and ingestion >40 tablets (OR 8.9, 95% CI 2.8-28.4, p<0.001). Median length of stay was 5 days (IQR 4-6). All patients survived to discharge.

Conclusions: Acute pharmaceutical poisoning predominantly affects young urban adults through intentional self-harm, replacing traditional pesticide poisonings. Early presentation and limiting ingested quantities are critical determinants of outcomes. These findings support the need for enhanced mental health services, medication safety measures, and public health interventions targeting pharmaceutical poisoning prevention.

Domain-specific prevalence of learning disability among government and non-government school children

2026-04-30T07:09:58+0530

Background: Learning disability is a neurodevelopmental disorder characterized by persistent difficulties in acquiring academic skills despite adequate intelligence and educational opportunities. Educational environments may influence the pattern and prevalence of learning disability. However, comparative evidence across different school systems remains limited. This study aimed to determine the prevalence of learning disability among school children in government and non-government schools. Additionally, to examine the relationship between Intelligence Quotient (IQ) and learning disability diagnostic inventory (LDDI) domains along with perceptual deficits.

Methods: A cross-sectional observational study was conducted among 240 school children aged between 8-12 years. Learning disability were assessed using the LDDI, while intelligence was evaluated using Raven’s Coloured Progressive Matrices (CPM). Descriptive statistics were used to estimate prevalence across domains and school types. Correlation analysis was performed to examine the association between IQ and LDDI domains, with statistical significance considered at p<0.05.

Results: Domain specific prevalence of learning disability was observed. Listening disability was the most prevalent domain, affecting (30%) students in government and (16%) of non-government school students, followed by speaking (27% and 12.5% respectively). Among perceptual deficits, position in space (11.6% and 10%) and eye-hand coordination (4-6%) were most frequently observed. Overall, government school students showed a relatively higher prevalence. A significant association was observed between learning disability domains and Intelligence quotient scores (p<0.05)

Conclusions: The study highlights the domain-specific prevalence of learning disability among school children and emphasizes the importance of early screening, targeted educational strategies and school-based interventions to improve learning outcomes.

Improving attendant hand hygiene in the paediatrics department: a quality improvement initiative

2026-04-30T07:09:56+0530

Background: Healthcare-associated infections remain a major cause of morbidity and mortality in paediatric inpatient settings. While hand hygiene interventions have traditionally focused on healthcare workers, patient attendants and caregivers represent a potential but under-addressed source of pathogen transmission. This project assessed whether a low-cost, behaviourally informed intervention could improve hand hygiene compliance among paediatric patient attendants in a tertiary-care hospital setting.

Methods: This prospective, before-and-after quality improvement initiative was conducted in paediatric wards of a government tertiary-care hospital in India. Baseline and post-intervention data were collected using brief, anonymized self-reported assessments of attendant hand hygiene behaviour. The intervention consisted of multilingual educational posters and improved access to alcohol-based hand sanitizer dispensers, implemented using plan–do–study–act cycles. The primary outcome was the proportion of attendants reporting sanitizer use before touching the child. Sanitizer consumption was monitored as a supporting process measure.

Results: At baseline, 47.7% (31/65) of attendants reported using sanitizer before patient contact. Following the intervention, compliance increased to 71.4% during the initial nursery-focused phase and was sustained after expansion to the entire paediatric ward, with pooled post-intervention compliance of 70.6% (137/194). The difference between pre- and post-intervention compliance was statistically significant. Ward-level sanitizer consumption increased progressively during the post-intervention period.

Conclusions: Improving access to hand hygiene resources combined with simple visual messaging was associated with sustained improvements in reported hand hygiene compliance among paediatric patient attendants.

Safety and efficacy of ZOLSOMA tablets in patients with insomnia

2026-04-30T07:09:43+0530

Background: Insomnia is difficulty falling asleep or staying asleep, even when a person has the chance to do so. Pharmacological management often relies on hypnotics such as zolpidem; however, high doses are linked to adverse effects. Combining zolpidem with melatonin, a circadian regulator with mild hypnotic activity, may enhance sleep quality while minimizing side effects. Aim of the study was to evaluate the safety and efficacy of a fixed-dose combination (FDC) of zolpidem and melatonin (ZOLSOMA-5) in patients with insomnia.

Methods: This open-label, single-arm, multicentre, prospective study was conducted between October 2021 and October 2024. Participants received ZOLSOMA-5 for 30 days. Efficacy was assessed using the Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI). Safety was evaluated using Epworth Sleepiness Scale (ESS) and based on adverse effects.

Results: Of 312 enrolled patients, 300 completed the study. Mean PSQI scores in intention-to-treat (ITT) set significantly decreased from 15.19±2.75 at baseline to 5.73±5.58 on day 30 (p<0.001). ISI scores reduced from 20.57±5.00 at baseline to 7.18±5.45 on day 30, respectively (p<0.001). ESS scores improved from 6.99±6.68 at baseline to 4.48±4.70 on day 30 (p<0.001). A total of 45 patients (14.4%) reported 60 adverse events (AEs), most commonly dizziness and nausea, the majority were mild and transient.

Conclusions: The FDC of ZOLSOMA-5 demonstrated significant improvement in sleep quality, reducing insomnia severity, and alleviating daytime sleepiness, with a favourable safety profile. The combination appears to be a safe and effective short-term therapeutic option for insomnia, including in patients with psychiatric comorbidities.

Clinical profile and etiological spectrum of malignant pleural effusion: a hospital-based observational study

2026-04-30T07:09:33+0530

Background: Malignant pleural effusion (MPE) is a common manifestation of advanced malignancy and is associated with significant morbidity. It results from direct or metastatic involvement of the pleura and often indicates poor prognosis. Aim of the study was to evaluate the clinical profile, etiological spectrum, and cytological characteristics of malignant pleural effusion.

Methods: This hospital-based observational study was conducted on 89 patients diagnosed with malignant pleural effusion from May 2012 to December 2014. Detailed clinical evaluation, radiological assessment, and pleural fluid analysis were performed. Effusions were classified using Light’s criteria. Statistical analysis was performed using the Chi-square test with statistical package for the social sciences (SPSS) version 25.0. A p value of <0.05 was considered statistically significant.

Results: The mean age of patients was 59.06±15.53 years with a nearly equal gender distribution. The most common presenting symptom was cough (61.2%), followed by breathlessness (22.41%). Lung carcinoma was the most frequent primary malignancy (43.8%), followed by breast (15.7%) and ovarian malignancies (14.6%). Adenocarcinoma (28.1%) was the most common histopathological type. Pleural fluid cytology was positive for malignant cells in 68.5% of cases.

Conclusions: Malignant pleural effusion is most commonly associated with lung carcinoma and typically affects older adults. Pleural fluid cytology remains a crucial diagnostic tool for identifying malignant involvement of the pleura.

Comparative in vitro antibacterial and antifungal efficacy of chemical, herbal and probiotic mouthrinses against Streptococcus mutans and Candida species

2026-04-30T07:09:29+0530

Background: Dental caries and oral candidiasis are predominant biofilm-associated infections, primarily driven by Streptococcus mutans and Candida species. While mechanical plaque removal is fundamental, mouthrinses are widely used as adjunctive treatments. This study evaluated and compared the in vitro antibacterial and antifungal efficacy of commercially available chemical, herbal and probiotic mouthrinses against key oral pathogens.

Methods: 15 commercial mouthrinses, comprising five each of chemical, herbal and probiotic formulations were tested against S. mutans MTCC 457, Candida albicans MTCC 227 and clinical isolates of C. albicans, C. tropicalis and Pichia kudriavzevii. Antibacterial and antifungal activity was assessed using the agar well diffusion method. Zones of inhibition were measured following 24 - 48 hours of incubation at 37°C with positive controls penicillin or fluconazole.

Results: Chemical mouthrinses demonstrated the strongest antimicrobial activity, where Hexidine produced the largest mean ZOI, followed by Colgate maXFresh PLAX. Herbal formulations such as Himalaya active fresh and K. P. Namboodiri’s Herbal Fresh showed moderate efficacy. Probiotic mouthrinses displayed limited and selective activity, primarily against S. mutans and non-albicans Candida spp., with Perfora probiotic rinse demonstrating the highest mean ZOI. Several products in each category produced no measurable ZOI.

Conclusions: Chlorhexidine based mouthrinses remain the gold standard for rapid, broad-spectrum microbial reduction. Herbal formulations provide a moderate, phytochemical dependent alternative with a safer profile, while probiotic mouthrinses offer limited but selective antimicrobial effects.

Study of serum uric acid levels in patients with acute coronary syndrome and its correlation with clinical features and Killip classification in patients attending tertiary care hospital in Kumaon region of Uttarakhand

2026-04-30T07:09:20+0530

Background: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. Serum uric acid has been suggested as a potential biomarker associated with oxidative stress and cardiovascular risk. This study aimed to evaluate the role of serum uric acid as a prognostic marker in patients with ACS and to assess its association with the Killip classification.

Methods: This prospective study was conducted in the Department of Medicine at Government Medical College and Dr. Susheela Tiwari Hospital, Haldwani, from January 2020 to September 2021. A total of 100 patients with confirmed ACS were included based on clinical presentation, ECG changes and elevated cardiac biomarkers. Serum uric acid levels were measured on day 1 and day 3 of admission. Patients were classified according to the Killip classification and clinical outcomes including mortality, complications and duration of hospital stay were recorded.

Results: Among the 100 patients, the mean age was 60.97±10.8 years and 63% were males. Hyperuricemia (>8 mg/dl) was observed in 30% of patients on day 1 and 24.49% on day 3. Higher uric acid levels were significantly associated with increased mortality, higher Killip class and greater disease severity (p<0.0001). Patients with hyperuricemia also showed higher prevalence of dyspnoea, hypertension, positive troponin levels, STEMI presentation and cardiovascular complications. Additionally, the duration of hospital stay was significantly longer among patients with elevated uric acid levels.

Conclusions: Elevated serum uric acid levels are significantly associated with increased severity, complications and mortality in patients with ACS. Serum uric acid may serve as a simple and useful prognostic biomarker for risk stratification in ACS patients.

A study of central corneal thickness and psychological wellbeing: a menstrual cycle correlation

2026-04-30T07:09:13+0530

Background: Hormonal changes during the menstrual cycle can influence ocular physiology. Prior studies report mid-cycle increases in central corneal thickness (CCT) and modest intraocular pressure (IOP) changes. Mean CCT may rise ~5–6% at ovulation, whereas IOP differences are generally minor. These cyclical changes may affect clinical ocular measurements. This study aims to investigate variations in central corneal thickness (CCT) across different phases of the menstrual cycle and examine the potential associations between these variations and psychological factors such as stress, anxiety and depression.

Methods: Sixty healthy women (18–30 years) with regular 28–32-day cycles were recruited. Examinations were conducted in the early menstrual phase, midcycle and late luteal phase. Central corneal thickness was measured by pachymetry; IOP by Goldmann applanation tonometry; and visual acuity by a standardized logMAR chart. Psychological status was assessed at each phase using the depression, anxiety and stress scale (DASS-21). Correlation analyses were performed to explore associations between CCT and psychological scores. All measurements were taken in the morning to minimize diurnal variation.

Results: CCT was lowest in the early menstrual phase (530.6±8.9 µm), peaked at mid-cycle (561.3±10.1 µm) and decreased in the luteal phase (535.4±9.5 µm), with statistically significant differences (p<0.001). IOP and visual acuity remained stable throughout the cycle. DASS-21 scores were highest during the luteal phase (depression: 8.9±3.1, anxiety: 9.4±3.3, stress: 10.2±3.5) and CCT correlated negatively with anxiety (r=–0.51, p=0.002) and stress (r=–0.46, p=0.004).

Conclusions: Menstrual cycle-related hormonal changes cause temporary mid-cycle increases in CCT, while IOP and vision remain stable. Additionally, CCT variations are inversely related to psychological distress, highlighting the importance of considering both menstrual phase and emotional status in clinical ocular assessments.