International Journal of Research in Medical Sciences

Perforator flaps in soft tissue reconstruction: clinical outcomes in reconstructive plastic surgery

2025-09-30T07:22:37+0530

Perforator flaps constitute a significant advancement in soft tissue reconstruction within reconstructive plastic surgery, relying on perforator vessels that supply the skin and subcutaneous tissue without requiring large muscle or fascia volumes. This innovative approach allows for more refined and less invasive reconstructions, preserving muscular integrity and reducing functional deficits at the donor site. These flaps have become increasingly important in the management of complex defects resulting from oncologic resections, traumatic injuries, or chronic wounds particularly in anatomically complex regions. Advances in preoperative imaging and intraoperative navigation have enhanced the accuracy of flap planning and reduced complication rates. Additionally, the evolution of flap design-such as propeller, free-style, and supermicrosurgical flaps-has expanded reconstructive options. This systematic review aimed to evaluate recent innovations, surgical techniques, and clinical outcomes associated with perforator flaps across a range of reconstructive scenarios. A total of 30 studies were included, comprising clinical trials and observational research focusing on different anatomical sites (extremities, head and neck, breast, and trunk). The findings reveal a flap survival rate ranging from 93% to 98%, lower complication rates compared with conventional musculocutaneous methods, and high patient satisfaction. Nevertheless, heterogeneity in outcome measures and lack of randomized studies with large sample sizes underscore need for more standardized protocols and multicenter research to draw stronger conclusions.

Exploring the evolution of endocrowns: a bibliometric analysis (2010-2024)

2025-09-30T07:22:50+0530

The aim of this bibliometric analysis is to evaluate the global research trends and patterns in publications related to endocrowns, a conservative restorative option for endodontically treated teeth. Endocrowns have gained significant attention due to their ability to preserve tooth structure while providing adequate retention and aesthetics. This study analyzed the scientific output from various databases, including Scopus, Web of Science, and PubMed, focusing on publication trends, geographic distribution, most cited articles, prolific authors, and key journals publishing on the topic. A systematic search was performed using specific keywords such as "endocrown," "endodontically treated teeth," and "ceramic restorations." The data was then processed using bibliometric software to visualize collaborations, citation networks, and emerging trends in the field. Results show a steady increase in publications over the last decade, with notable contributions from Europe and Asia. The top-cited articles primarily discuss clinical outcomes, material choices, and long-term success rates of endocrowns. This analysis highlights the growing interest in endocrowns as a restorative solution and provides insights into future research directions, including advances in materials science and long-term clinical performance. The findings of this study serve as a comprehensive guide for researchers, clinicians, and academicians in understanding the evolution and current state of research on endocrowns.

Integration of nursing professionals, education and healthcare services: a strategic model to empower nurses and shape healthcare policy in India

2025-09-30T07:19:53+0530

Nurses form the backbone of India’s healthcare system, yet their contributions to health policy, education, and service integration remain underutilized. Effective integration of nursing professionals, education, and healthcare services is essential for advancing universal health coverage (UHC), reducing health disparities, and optimizing the quality of care. This review explores how aligning nursing education with service delivery and policy frameworks can empower nurses to lead reforms and shape healthcare policy in India. A comprehensive search of PubMed, BMJ Open, CINAHL, and PKP-indexed journals was conducted for studies published between 2005 and 2025. Inclusion criteria targeted empirical studies, national health reports, and review articles focused on the nursing profession’s involvement in health policy, service delivery, and education integration. Thematic analysis and narrative synthesis were applied using the IMRAD framework. Out of 2,341 records, 46 studies were included. Five central themes emerged: fragmentation between nursing education and practice; insufficient policy representation of nurses; gaps in clinical leadership development; potential of nursing integration models in public health; and global best practices adaptable for India. A nurse-led strategic model emphasizing vertical integration of academic curricula with national health priorities, community engagement, and digital health innovation showed promise in improving both workforce satisfaction and patient care quality. Reforming nursing education and embedding nurses in policymaking and service delivery is vital to strengthening India’s healthcare system. Strategic integration can empower nurses as key agents in shaping equitable, patient-centered health reforms.

Effects of Curcuma Aeruginosa Roxb. on selected biomarkers of renal and liver function following gentamicin-induced nephrotoxicity and hepatic damage in male Wistar rats

2025-09-30T07:21:15+0530

Background: This study investigated whether Curcuma aeruginosa Roxb. (CAE) could improve kidney and liver function in rats with gentamicin (GM)-induced injury.

Methods: Thirty animals were divided into five groups. All groups received 100 mg/kg of GM for seven days. One group served as a positive control, another received the standard drug metformin, and the remaining three groups received different doses of CAE (100, 200, and 300 mg/kg). Metformin and CAE were administered orally for 28 days. After the treatment period, blood and tissue samples (kidney and liver) were collected for the assessment of liver and renal function markers. Histological examinations were also performed using H and E stains. The data was analyzed using one-way ANOVA, with a p<0.05 considered significant.

Results: Both metformin and a low dose of CAE significantly reduced plasma levels of cystatin-C (Cys C) and urea compared to the control group. However, the moderate and high doses of CAE did not significantly affect Cys C levels. The low dose of CAE significantly lowered ALT and AST in both plasma and liver tissue compared to all other groups. Histological examinations showed significant improvement in the kidney and liver tissues of rats treated with the low dose of CAE.

Conclusions: In contrast, the tissues of rats treated with metformin and the moderate and high doses of CAE showed no significant recovery from the GM-induced injury. The results suggest that the protective effects of this plant on the liver and kidneys are not dose-dependent, as the lower dose was more effective.

A study of clinico pathological evaluation of acute scrotum and its management in adults in a tertiary care hospital

2025-09-30T07:21:14+0530

Background: The acute scrotum is a surgical emergency. It is defined as scrotal pain, swelling, and redness of acute onset. Scrotal abnormalities can be divided into three groups, which are extra-testicular lesion, intra-testicular lesion and trauma. Acute scrotal pain, once diagnosed, can be treated appropriately with either conservative or surgical measures. The appropriate management pathway is determined by proper history taking, clinical examination and investigations in a restricted time frame. Objectives were to evaluate clinical presentation, diagnosis, management, complications, and short-term outcomes of acute scrotum, including hospital stay and mortality.

Methods: A descriptive cross-sectional study was conducted at Dhaka medical college hospital from January to September 2013, including 210 adult patients (≥18 years) with acute scrotal pathology. Purposive sampling was used. Data on demographics, clinical features, investigations [complete blood count (CBC), urine routine examination (R/E), ultrasonography (USG)], management, and outcomes were collected prospectively. Statistical analysis was performed using SPSS, with results expressed as mean, standard deviation, and percentages.

Results: Among 210 patients with acute scrotum, acute epididymitis (24.28%) was the most common diagnosis, followed by epididymo-orchitis (13.80%) and testicular torsion (12.38%). Most patients were aged 21-30 years (27.76%) with normal body mass index (BMI) (85.07%). Scrotal swelling (79.52%) and fever (64.76%) were predominant symptoms, while only 15.23% presented within 6 hours. Surgical intervention was required in 53% of cases, with debridement (22.86%) being the most common. The mean hospital stay was 1.34 weeks, with 66.70% discharged within a week.

Conclusions: Acute scrotum requires urgent diagnosis and treatment; surgery for torsion and trauma, conservative care for infections ensures better outcomes.

Comparing surgical outcomes in end-bearing amputation stumps: a prospective cohort study of different surgical techniques

2025-09-30T07:18:41+0530

Background: Lower limb amputation outcomes are influenced by surgical technique, which impacts stump stability, prosthetic fitting, and complication rates. This study compared postoperative outcomes of fascia-to-fascia (including fascia-to-periosteum), myodesis, and myoplasty in below-knee amputations.

Methods: A five-year retrospective cohort study at two Nigerian tertiary centers included 96 adults who underwent unilateral below-knee amputation between January 2019 and December 2024. Data on patient characteristics, operative details, and outcomes were analyzed using Chi-square/Fisher’s exact tests and Kruskal-Wallis tests.

Results: Mean age was 46.9±12.8 years; 69.8% were male. Fascia to fascia achieved the best prosthetic fitting (48.4%) and stump stability (49.1%), with the lowest reoperation (6.7%) and infection rates (15.2%). Myodesis had the highest reoperation and infection rates, while myoplasty had the shortest surgery time and lowest pain. fascia-to-fascia (including fascia-to-periosteum), took longest to perform (125±15 minutes) and had the highest pain scores.

Conclusions: Fascia to fascia fixation appears superior for long term stump integrity and prosthetic function, which is particularly valuable in resource limited Nigerian settings. Nevertheless, its association with greater pain and longer operative time highlights the need for targeted strategies to optimise analgesia and surgical efficiency without compromising outcomes.

Feeding practices among children 6-23 months attending in an outpatient department of a tertiary level hospital in Dhaka

2025-09-30T07:20:00+0530

Background: As malnutrition is not considered a disease, it remains a hidden health problem and quietly steals energy, retards growth and development, and lowers body resistance to infection. This study aimed to assess the feeding practices among children aged 6-23 months attending the outpatient department (OPD).

Methods: This cross-sectional study was conducted among 125 purposively selected mothers having children of 6 months to 2 years of age who attended the outpatient department of Holy Family Red Crescent Hospital. Face-to-face interview was done through questionnaires. Analysis of data was done with SPSS version 21.

Results: Among 125 respondent’s majority (66.4%) had their first child at the age of between 18-22 years. Only some of them (35.2%) had antenatal check-ups during pregnancy and most (88.8%) of the mothers did not have postnatal care after the delivery of the last child. Regarding the reason for not taking PNC nearly all (91.0%) did not know PNC. Maximum (56.8%) knew about feeding colostrum after childbirth and most (88.8%) feed colostrum to their child and almost all (95.2%) of them were only breastfeeding their child for six months.

Conclusions: The study highlighted a gap in maternal knowledge regarding antenatal and postnatal checkups, underscoring the need to raise awareness in these areas. However, most mothers demonstrated adequate awareness of proper breastfeeding practices, including colostrum feeding and complementary feeding.

Increased blood level of urea and creatinine after chemotherapy in breast cancer patients

2025-09-30T07:21:12+0530

Background: Breast cancer is treated with surgery and often combined with chemotherapy, radiotherapy and or hormonal therapy or both. The treatment has some side effects such as hair loss, nausea, fatigue peripheral neuropathy, nephropathy etc. The objective of the study was to assess the nephrotoxic effects after treatment of breast cancer.

Methods: The infiltrating ductal carcinoma patients were treated with surgery, chemotherapy, with or without radiotherapy and hormonal therapy. The non-diabetic, non-cardiac post-menopausal breast cancer patients were further subdivided on the basis of nodes histopathology, with or without lymph node metastasis. Patients were subjected to different combination of disciplines of therapy including radiotherapy, chemotherapy and hormonal therapy. The blood samples were collected before and after chemotherapy. The blood was analyzed for urea and creatinine to assess the nephrotoxicity.

Results: There was a significant increase in blood urea and creatinine levels after the treatment as compared to before the start of therapy.

Conclusions: It is concluded that treatment of cancer (with chemotherapy, radiotherapy, hormonal therapy) lead to nephrotoxicity.

Assessment of glycemic control practices among patients with diabetes at Khadimpara Hospital

2025-09-30T07:18:45+0530

Background: Diabetes mellitus, a chronic condition characterized by elevated blood glucose levels due to insufficient or ineffective insulin, affects 537 million adults globally. Effective glycemic control is essential for preventing complications in patients with diabetes mellitus. This study aimed to assess glycemic control practices among diabetic patients attending Khadimpara Hospital, Sylhet.

Methods: This quantitative, cross-sectional study was conducted at Khadimpara 31-bed hospital, Sylhet, Bangladesh, from July to December 2024. A total of 221 patients diagnosed with diabetes mellitus (DM), aged 35 years or older, attending Khadimpara Hospital in Sylhet, were included in the study.

Results: The mean age of participants was 54.61±10.89 years, with the majority aged 51-60 years (34.4%). Females slightly outnumbered males (51.1% versus 48.9%). Nearly half (47.5%) had a normal BMI, while 34.8% were underweight. Most participants (73.8%) had a family history of diabetes, and the median duration of diabetes was five years (IQR 3-7). Regarding treatment, 54.3% had been on anti-diabetic medications for 1-5 years, and 86.9% reported diabetes-related complications. The most common management strategy (83.26%) was a combination of drug therapy, diet, and exercise. A statistically significant association was found between management approach and diabetes control (p=0.002), with combined interventions yielding the highest success rate (70.1%).

Conclusions: This study highlighted that most patients effectively manage diabetes mellitus through a combination of drug therapy, physical exercise, and diet control, with significant correlations observed between glycemic control and factors like gender, occupation, and family history.

Epidemiology of pain disorders among outpatients at Joypurhat Sadar Hospital

2025-09-30T07:18:40+0530

Background: Pain disorders represent a significant public health concern, especially in low-resource settings where data on their epidemiology are limited. Understanding the patterns and burden of pain among outpatients can inform appropriate management strategies and healthcare planning.

Methods: This cross-sectional study was conducted at the Department of Medicine, 250 Bed Sadar Hospital, Joypurhat, Bangladesh, between January and July 2024. A total of 200 adult outpatients presenting with various pain disorders were enrolled consecutively. Sociodemographic data, anthropometric measurements, clinical diagnoses and duration of pain were recorded. Data were analyzed using SPSS version 26.

Results: Most of the participants were female (77.5%) with a mean age of 37.7±12.6 years. Most were housewives (67.5%) and the predominant age group was 31-45 years (47.5%). The average BMI was 23.75±3.52. The most common diagnosis was mechanical low back pain (81.0%), followed by musculoskeletal chest pain (5.5%) and cervical spondylosis (4.0%). in terms of chronicity, 36.5% reported acute pain (<1 month), 34.0% had subacute pain (1–3 months) and 29.5% had chronic pain (>3 months).

Conclusions: Mechanical low back pain emerged as the most prevalent pain disorder among outpatients, with a substantial portion experiencing chronic symptoms. These findings highlight the need for early diagnosis, targeted intervention and resource-appropriate pain management strategies in district-level healthcare settings.

Nutrient deficiencies in patients with psychiatric disorders – investigating how low levels of omega-3s, B vitamins and magnesium affect mental health conditions like depression, schizophrenia and bipolar disorder

2025-09-30T07:18:43+0530

Background: Psychiatric disorders such as depression, schizophrenia and bipolar disorder are complex mental health conditions that significantly affect individuals' quality of life and functional ability. While their etiology is multifactorial, growing evidence suggests that nutritional factors play an important role in the onset and progression of these disorders. This study aims to explore the relationship between deficiencies in omega-3 fatty acids, B vitamins and magnesium and common psychiatric disorders, namely depression, schizophrenia and bipolar disorder.

Methods: This cross-sectional study was conducted from January 2022 to December 2022 at two tertiary care centers in Chattogram, Bangladesh: Chattogram Ma O Shishu Hospital Medical College and BGC Trust Medical College and Hospital. A total of 100 patients diagnosed with psychiatric disorders, including depression, schizophrenia and bipolar disorder, were enrolled from the outpatient and inpatient departments of psychiatry at both institutions. Data were analyzed using SPSS version 25.

Results: In this study, omega-3, B vitamin and magnesium deficiencies were observed in 61%, 58% and 47% of psychiatric patients, respectively. Deficiencies were most common among those with depression (72.9% omega-3, 66.7% B vitamins, 50% magnesium). Patients with longer illness duration (>5 years) showed higher deficiency rates, with 70.8% for omega-3, 79.2% for B vitamins and 62.5% for magnesium. Symptom severity was significantly higher in deficient patients, with mean scores of 26.5, 27.2 and 25.8 for omega-3, B vitamin and magnesium deficiencies, respectively (p<0.05).

Conclusions: This study demonstrates a high prevalence of omega-3 fatty acid, B vitamin and magnesium deficiencies among patients with psychiatric disorders, particularly those with depression and longer illness duration. These deficiencies were significantly associated with greater symptom severity, underscoring the critical role of nutritional status in mental health.

A multidimensional evaluation of patients with idiopathic intracranial hypertension: associations across symptoms, imaging, cerebrospinal fluid findings and medical history

2025-09-30T07:18:40+0530

Background: Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure without identifiable cause, predominantly affecting overweight women of reproductive age. Headache and visual disturbances are common but often show variable correlation with cerebrospinal fluid (CSF) pressure. This study aimed to evaluate the multidimensional associations among clinical symptoms, imaging, CSF findings and medical history in patients with IIH.

Methods: This cross-sectional study was conducted at the department of neuro medicine, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh, from July 2022 to June 2025. A total of 100 patients aged 18-50 years with a confirmed diagnosis of IIH and neuro-ophthalmic symptoms were included. Data were collected through clinical evaluation, lumbar puncture, imaging (MRI/MRV), fundal photography and visual field testing. Statistical analysis was performed using SPSS version 25.0.

Results: The mean age was 26.16±7.49 years, with a strong female predominance (92%). Most patients were overweight or obese. Headache (97%), visual impairment (88%) and cranial nerve palsy (50%) were the predominant symptoms. Papilledema was bilateral in 93% of cases. Elevated CSF opening pressure (>25 cm H₂O) was found in 75% of patients. Hormonal medication use was reported in 33% of cases. No significant association was observed between elevated CSF pressure and visual loss (p=0.02), double vision (p=0.96), or headache (p=0.53).

Conclusions: Symptom severity in IIH may not directly correlate with CSF pressure levels, underscoring the need for comprehensive, multidisciplinary assessment in clinical management.

Epidemioclinical aspects of breast cancer in women under 35 years at the oncology and palliative care department of Soavinandriana Hospital

2025-09-30T07:19:56+0530

Background: Breast cancer is rare among women under 35 years, but its incidence is increasing, particularly in low-resource settings. Young patients often present with aggressive disease and delayed diagnosis. This study aimed to describe the epidemioclinical features of breast cancer in this population.

Methods: A retrospective descriptive study was conducted from January 2014 to September 2024 at the oncology and palliative care department of Soavinandriana Hospital, Madagascar. 38 women under 35 years old with histologically confirmed breast cancer were included.

Results: Among 2,087 breast cancer cases, 38 (1.82%) involved women under 35. The mean age was 30.7 years. Most patients were pauciparous (50%), had breastfed (73.7%), were non-smokers (81.6%), and had no family history of breast or ovarian cancer (76.3%). The upper outer quadrant was the most common tumor site (34.2%). Invasive carcinoma of no special type was predominant (78.9%). Grade II and III tumors accounted for 65.8%. More than 50% of patients were diagnosed at an advanced stage (IIB or higher). Immunohistochemical and staging data were frequently incomplete due to limited diagnostic resources.

Conclusions: Breast cancer in young Malagasy women is uncommon but presents aggressively and at advanced stages, underscoring the need for early detection strategies. Improved diagnostic access and tailored screening programs are essential.

Assessment of perceived adherence and barriers to the dietary recommendations among type 2 diabetic patients of Pakistan: a cross-sectional study

2025-09-30T07:19:48+0530

Background: Type 2 diabetes mellitus (T2DM) is one of the leading global health concerns, with Pakistan having the highest prevalence rate worldwide. International diabetes federation report 2025 suggests that 31.4% of population is diagnosed with diabetes. This ratio is expected to increase if no intervention is made timely. This study aims to evaluate how well patients with type 2 diabetes adhere to recommended diet and their perceived barrier in adhering to guidelines.

Methods: The cross sectional study was employed in Outpatient department of various hospitals of Punjab, Pakistan. Simple random sampling technique was used. Data was collected from 142 patients about their self-reported diagnosis, duration of disease, medicine adherence, dietary habits and perceived barriers. Perceived dietary adherence questionnaire (PDAQ-9) and Morisky medication adherence scale (MMAS-4) were used to access dietary and medicine adherence respectively. For barrier assessment, questions were taken from previous similar researches.

Results: Among 142 diabetic individuals, 3.52% participants showed good adherence, 38.7% poor adherence and 57.7% no adherence to recommended diet. 50.7% agreed to have lack of knowledge as barrier to recommendations. Chi square analysis showed positive correlation of dietary adherence with age (a=0.016, p<0.05) and lack of knowledge (a=0.036, p<0.05).

Conclusions: 3.52% of individuals having good dietary adherence is concerning and needs immediate plan of action by health governance to make pre-emptive measures to address the barrier. Awareness campaign regarding dietary habits and foods to avoid must be launched. National dietary guidelines should be made and communicated with patients during their follow up visits.

Donor site outcome after oral mucosa harvest for urethroplasty: a prospective study

2025-09-30T07:18:31+0530

Background: Congenital or acquired defects of the male urethra may be repaired utilizing varied substitute materials, such as genital or extragenital skin and oral mucosa (OM). Currently, the application of OM has emerged as the most dependable and favoured alternative to urethral reconstructive surgery. This study aimed to examine oral morbidity and patient satisfaction within a uniform cohort of patients who underwent oral mucosa harvesting with a standardised procedure.

Methods: The study was carried out in the Department of urology, Narayana medical college and hospital, Nellore between January 2023 to March 2025. 38 cases were included in the study, at the time of admission, detailed history, clinical examination and necessary radiological examination were done.

Results: The results showed that 2 (5%) of 38 patients had early oozing. 3 cases (7%) had accidental lip and cheek bites in whom harvest site was not closed. The graft site was sutured in 26 patients (68.42%). In 8 patients (21.05%) the graft site was left open. At one month only 1 patient (2.63%) was unable to whistle and he was able to do so by 3 months. 2 patients (5.26%) had parotid swelling during first week of surgery which subsided at 2 weeks with conservative treatment. 24 patients (63.15%) of 38 had restricted mouth opening only during first week.

Conclusions: Restricted mouth opening and Pain are the only long-term complications in our study which were not bother-some. Pain appears to be worse after suturing donor site. Bilateral buccal mucosal graft harvesting has no extra problems as compared to unilateral harvesting. Hence in case of long urethral stricture, two independent Strips are preferable than single strip involving lip.

Sheathless and fluoroscopy-free retrograde intrarenal surgery: a single center experience

2025-09-19T06:56:12+0530

Background: This study was done to evaluate the effectiveness and safety of minimally invasive approach to treating renal stones using sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy (FURSL).

Methods: A prospective study was conducted on 270 patients who underwent FURSL between January 2023 and March 2024. The procedure involved a semi-rigid ureteroscopic assessment with 6 and 8 Fr ureteroscope. A 7.5 Fr flexible URS was inserted into the PCS by side of guidewire sheathless and fluoroscopy-free, followed by the use of a holmium laser to fragment and dust stones in situ.

Results: The study population consisted of 270 patients including 170 males (62.96%) and 100 females (37.04%) with a mean age of 40.65 years (range: 3-70 years) were evaluated. The mean stone size was 17.23 mm (range: 8-41 mm). Complete stone-free status was achieved in 244 (90.37%) patients and clinically insignificant residual fragments (CIRF) in 4 (1.48%), while residual stones were still present in 22 (8.15%) patients. Postoperative complications occurred in 46 (17.4%) cases and were mostly minor, including fever in 34 (12.6%), pyelonephritis in 8 (3.0%), subcapsular hematoma in 2 (0.7%) and steinstrasse in 2 (0.7%). These complications were Clavien I-II, GI in 34 (12.6%) patients, GII in 10 (3.7%), and Clavien IIIb in 02 (0.7%). No major complications were observed. Stone size ≥2 cm, operative time ≥30 minutes, and lasing time ≥20 minutes were significantly associated with a higher rate of complications and lower stone-free rates (p<0.05).

Conclusions: Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management, especially for stones under 2 cm in diameter. This process is a feasible option for avoiding sheath complications, which can protect surgeons from the negative effects of radiation.

A morphometric study of variation in dens of second cervical vertebrae: corona dentis and its clinical implication

2025-09-03T19:22:35+0530

Background: Type-II odontoid fractures are often managed by anterior screw fixation, a technique that requires precise morphometric knowledge of the dens. The corona dentis, a bony spur at the odontoid apex, may artificially elongate measurements, leading to potential surgical complications if unrecognized.

Methods: Thirty dry human C2 vertebrae were studied using a digital vernier caliper. Morphometric parameters of the dens and vertebral body were recorded, including height, anteroposterior (AP) and mediolateral (ML) diameters, and dimensions of the corona dentis. Non-metric features such as dens tip shape, orientation, and transverse ligament groove morphology were assessed independently by two observers. Measurements were repeated to minimize intra-observer variability.

Results: Corona dentis was observed in 8 of 30 specimens (26.7%). The mean height of the dens without corona was 15.35±1.84 mm anteriorly and 15.65±1.70 mm posteriorly, whereas combined heights with corona averaged 18.95 mm and 19.25 mm, respectively. The corona itself measured 3.60±0.79 mm in height and 9.80±0.99 mm in width. The dens averaged 10.1±0.91 mm (AP) and 9.8±0.99 mm (ML). Non-metric analysis showed tapering tips in 40%, retroverted axes in 56.7%, and transverse-type ligament grooves in 60% of specimens.

Conclusions: The corona dentis is a relatively common anatomical variation that significantly increases apparent dens height. Failure to recognize this structure may result in overestimation of screw length during anterior odontoid fixation. Preoperative CT evaluation and careful apex identification are essential for safe surgical planning.

Application of the Sydney system for classification and reporting lymph node cytopathology: a retrospective analysis at a tertiary centre

2025-09-03T19:22:34+0530

Background: Lymph node fine needle aspiration cytology (LN FNAC) is a minimally invasive, safe, quick, inexpensive and reliable diagnostic technique for evaluating lymph node (LN) pathologies, but the existing classification systems exhibits inconsistencies leading to diagnostic discrepancies and challenges in interobserver reproducibility. The Sydney system provides a standardised, tiered categorisation to improve diagnostic precision of LN cytopathology. This study aimed to analyse diagnostic performance of the Sydney system and evaluate its applicability in a tertiary care setting.

Methods: The retrospective observational study was conducted at tertiary care institution in India with 630 LN cytopathological cases, reviewed and reclassified using the Sydney system and compared with available histopathological correlations. The risk of malignancy was calculated for each category. Diagnostic performance metrics including sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were evaluated with 95% CI.

Results: 630 LN FNAC samples were distributed as: L1, 19.7% (n=124); L2, 46.8% (n=295); L3, 1.1% (n=7); L4, 1.3% (n=8); L5, 31.1% (n=196). ROM increased progressively: L1, 0%; L2, 4.8%; L3, 66.7%; L4, 83.3%; L5, 98.5%. Diagnostic performance showed sensitivity 97.30%, specificity 93.02%, PPV 96%, NPV 95.24%, and accuracy 95.73%.

Conclusions: The Sydney system demonstrated high diagnostic accuracy and reliable risk stratification in a tertiary institution, reducing interobserver variability and enhancing patient management. Adoption of the Sydney system is recommended for standardised LN cytology reporting, with potential for ancillary techniques to refine indeterminate categories. This validation in a tertiary care institution supports the global applicability, particularly in high burden environments.

Evaluation of C-reactive protein/albumin ratio in women with polycystic ovarian syndrome and women without polycystic ovarian syndrome

2025-09-19T06:56:11+0530

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by hyperandrogenism, oligo-anovulation, and polycystic ovarian morphology. Emerging evidence suggests a role of chronic low-grade inflammation in PCOS pathophysiology. The C-reactive protein (CRP)/albumin ratio, reflecting both inflammation and nutritional status, may serve as a sensitive biomarker in PCOS.

Methods: A cross-sectional study was conducted over one year on 100 women aged 20–40 years attending the Obstetrics and Gynaecology department of Navodaya Medical College, Raichur. Group A included 50 women without PCOS, and group B included 50 women with PCOS (diagnosed by Rotterdam criteria). Serum CRP and albumin were measured, and the CRP/albumin ratio was calculated. Data were analysed using independent t-test, Chi-square test, and ROC curve analysis. A p-value <0.05 was considered statistically significant.

Results: Women with PCOS had significantly higher BMI and waist circumference (p<0.001). CRP levels were higher (4.8±1.4 mg/l versus 1.9±0.8 mg/l) and albumin levels lower (3.2±0.5 g/dl versus 4.1±0.4 g/dl) in PCOS compared to controls, resulting in a higher CRP/albumin ratio (2.8±1.2 versus 1.4±0.6, p<0.001). Elevated ratios were present even in lean PCOS cases. ROC curve analysis yielded an AUC of 0.89, with sensitivity 70% and specificity 84% at a cut-off >2.0.

Conclusions: CRP/albumin ratio is significantly elevated in PCOS, independent of obesity, and may serve as a simple, cost-effective marker of inflammation and metabolic dysfunction, aiding early diagnosis and risk stratification.

Effectiveness of vestibular rehabilitation among post-stroke pusher syndrome

2025-09-20T07:38:33+0530

Background: Pusher syndrome is a post-stroke neurobehavioral disorder characterized by a distorted perception of upright posture and active pushing toward the hemiparetic side, leading to impaired balance, increased fall risk, and delayed rehabilitation.

Methods: This randomized clinical trial included 36 post-stroke patients diagnosed with pusher syndrome. Participants were randomly assigned to two groups for an 8-week intervention, conducted twice weekly with two sessions per day. Group A received vestibular rehabilitation therapy (VRT) focusing on gaze stabilization, dynamic balance, and proprioceptive training. Group B performed trunk and core stability exercises. Outcome measures included the scale for contraversive pushing (SCP) and postural assessment scale for stroke patients (PASS), assessed pre- and post-intervention.

Results: Both groups demonstrated significant improvement; however, group A showed a greater reduction in SCP scores (6.09±0.19 to 2.89±0.17, p<0.001) and a greater increase in PASS scores (11.6±1.1 to 25.8±1.0, p<0.001) compared to group B. Between-group analysis confirmed that VRT was significantly more effective in reducing contraversive pushing and improving postural control.

Conclusions: VRT is more effective than trunk stability exercises in improving postural alignment, reducing contraversive pushing, and enhancing functional independence in post-stroke pusher syndrome. Incorporating vestibular strategies into stroke rehabilitation may optimize recovery.

Antibiotic usage in surgical prophylaxis: a prospective observational study in the surgical wards of a tertiary care hospital

2025-09-30T07:18:26+0530

Background: Surgical site infections (SSIs) are a leading cause of postoperative complications, particularly in resource-limited settings. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs when administered with appropriate antibiotic selection, timing, and duration. This study aimed to evaluate the SAP practices in elective surgeries and assess adherence to national and international guidelines.

Methods: A prospective observational study was conducted over six months at a tertiary care teaching hospital, including 293 patients undergoing elective surgical procedures in the departments of general surgery, orthopaedics, ENT, gynaecology, and obstetrics. Data on the choice of prophylactic antibiotics, timing relative to surgical incision, and duration of postoperative use were collected and compared with guidelines from the Indian council of medical research (ICMR), American society of health-system pharmacists (ASHP), and the world health organization (WHO).

Results: General surgery accounted for 51.9% of procedures, followed by orthopaedics (25%) and ENT (13.5%), with gynaecology and obstetrics together at 9.6%. Cefotaxime was the most frequently used antibiotic, particularly in obstetrics (100%) and general surgery (70.4%), whereas gynaecology predominantly used a cefotaxime-metronidazole combination (66.7%). SAP was administered within the recommended 60-minute window before incision in 80.7% of cases, with the highest adherence in obstetrics (100%). Discontinuation within 24 hours occurred in 77.8% of general surgery and 92.3% of orthopaedic cases, whereas extended use was common in obstetrics, ENT and gynaecology.

Conclusions: Although SAP timing was generally appropriate, the overuse of third-generation cephalosporin, the absence of cefazolin, and prolonged prophylaxis in some departments highlight the need for department-specific guideline adherence.

A cross-sectional study on the cardiac imaging methods including electrocardiograms and echocardiography of the heart in patients with COPD

2025-09-30T07:20:56+0530

Background: This study aimed to analyze electrocardiographic (ECG) and echocardiographic changes in patients with Chronic Obstructive Pulmonary Disease (COPD) and to correlate these findings with disease severity and duration. It also compared the diagnostic utility of clinical evaluation, ECG and echocardiography in detecting right ventricular (RV) dysfunction.

Methods: A cross-sectional observational study was conducted over one year in the medical wards of Sree Balaji Medical College and Hospital, Chennai. Fifty patients with clinically and spirometrically confirmed COPD were included using systematic random sampling. Detailed clinical history, including smoking habits and symptom duration, was recorded. All patients underwent spirometry, ECG and echocardiography. Disease severity was graded using the British Thoracic Society (BTS) criteria. Data were analyzed using Pearson’s correlation and Chi-square tests, with p <0.05 considered statistically significant.

Results: The mean age of the study population was 59.9±10.4 years, with a male predominance. The average disease duration was 5.71 years and mean smoking exposure was 23.2±3.6 pack-years. Severe COPD (FEV₁ < 40%) was common. ECG findings such as P pulmonale, right axis deviation, right bundle branch block, right ventricular hypertrophy and poor R-wave progression were associated with disease severity. Echocardiographic abnormalities included RV dilation, hypertrophy, pulmonary hypertension and cor pulmonale. Cor pulmonale was clinically evident in 36%, detected by ECG in 44% and confirmed by echocardiography in 54% of cases.

Conclusions: ECG and echocardiography serve as valuable tools for detecting RV dysfunction in COPD, with echocardiography demonstrating superior sensitivity.

A prospective study on outcome of dorsal versus ventral buccal mucosal graft urethroplasty for bulbar urethral stricture

2025-09-30T07:19:48+0530

Background: In urological practice, urethral stricture disease is a prevalent condition. In comparison to the other sites, the bulbar urethral stricture imposes a greater load. The buccal mucosal graft (BMG) has been considered an optimal kind of urethral replacement since 1941. A lifetime success rate of 92% is achieved with standard bulbar urethroplasty employing BMG. There exist several methodologies for BMG urethroplasty, namely dorsal, ventral, and lateral approaches, which depend on the discretion of the surgeon.

Methods: An observational study was done among 40 patients, divided into two groups each based on the procedure done. Age more than 18 years who are fit for the procedure, stricture length more than 2 cm on retrograde urethrogram (RGU) and patients who were willing to give informed consent were included in the study. Post operatively, all the patients were assessed at every 3-month interval up-to 18 months. The outcome parameters noticed were post voidal residual (PVR), Q_max, international prostate symptom score (IPSS) score.

Results: There was no difference between the pre-operative and post-operative Q_max, PVR, IPSS score between the study groups.

Conclusions: The findings of the present study concluded that there is no difference between dorsal and ventral onlay BMG urethroplasty in terms of increase in Q_max and decrease in PVR at the end of study period.

Buccal mucosa versus skin graft for two-stage redo hypospadias repair: our centre experience

2025-09-30T07:18:28+0530

Background: Repeated surgical interventions for significant problems arising from either partial or complete failure of hypospadias treatment are less likely to succeed due to extensive scarring, considerable shortening of the penis, and scarred, hypovascular skin over the penile area. We provide the outcomes of our surgical experience with staged reoperation utilizing buccal mucosa and skin grafts in the correction of hypospadias in patients with problems following multiple failed surgeries.

Methods: The study was carried out in the department of urology, Narayana Medical College and Hospital, Nellore between January 2023 to March 2025. Depending on the type of free graft used for urethroplasty, patients are divided into two groups. Group A-treated with buccal mucosa graft. Group B-treated with skin graft. Data were analyzed using SPSS version 26.0 statistical software.

Results: The results showed that regarding early complications, patients in the BMG group showed a numerically lower incidence of graft loss (0% vs. 20%), fistula (0% vs. 10%), infection (9.09% vs. 20%), and meatal stenosis (9.09% vs. 20%) compared to the skin graft group; however, these differences were not statistically significant (p>0.05). At the same time, there were no reported cases of graft contracture and urethral stricture. The incidence of donor site morbidity was greater in the skin graft cohort than in the BMG cohort.

Conclusions: Our findings indicated that BMG urethroplasty was associated with reduced occurrence of postoperative problems and donor site morbidity compared to skin graft urethroplasty. Furthermore, research is necessary to validate our findings and determine the subgroup of patients who are appropriate candidates for BMG urethroplasty.

Comparison between single point versus double point injection in supraclavicular block incidence: ulnar sparing

2025-09-30T07:23:14+0530

Background: This study compared the efficacy of single-point versus double-point injection techniques in ultrasound-guided supraclavicular brachial plexus blocks, focusing on success rate, procedural time, onset and duration of sensory and motor block, and complications.

Methods: Twenty patients (20-80 years) undergoing forearm surgery over one hour were randomized into two groups. Group D received 20 ml of 0.5% bupivacaine divided into two 10 ml injections (superior cluster and inferior corner pocket). Group S received the entire 20 ml in the superior cluster pocket. Ultrasound guidance was used to locate the brachial plexus. Sensory and motor blockade onset were assessed by pinprick test and Bromage scale. Procedural time was recorded from ultrasound scanning to drug administration completion. Duration of blockade and adverse events were also noted.

Results: Group D showed a significantly higher success rate (p<0.0001) and longer procedural time compared to group S. Onset of sensory and motor block was faster, and duration was significantly prolonged in group D.

Conclusions: Double-point injection results in faster onset, longer duration, and higher success rate of supraclavicular blocks compared to single-point injection, but requires more procedural time.

Tuberculosis and diabetes: bidirectional screening and management challenges in South Indian population

2025-09-30T07:23:02+0530

Background: The World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease have advocated for bidirectional screening testing TB patients for diabetes and vice versa—as a strategic approach to early detection and integrated management. Aim of the study is to evaluate the effectiveness, feasibility, and challenges of bidirectional screening for tuberculosis (TB) and diabetes mellitus (DM), and to identify barriers and opportunities for integrated management of coexisting TB and DM in high-burden settings.

Methods: This was a prospective, observational, cross-sectional study conducted to evaluate the implementation and challenges of bidirectional screening for tuberculosis (TB) and diabetes mellitus (DM) in a high-burden tertiary care setting. The study was carried out over a period of three years from February 2022 to January 2025.

Results: High undiagnosed DM in TB patients (27.2%) and TB in DM patients (15.3%), underscoring bidirectional screening gaps. TB and DM patients had poorer treatment outcomes (73.5% success vs. 85.7%, *p=0.03*). Systemic barriers: kit shortages (52%) and protocol inconsistencies (44%) dominated challenges. Age >45 and pulmonary TB doubled DM risk (OR>1.8, p<0.02).

Conclusions: Our study demonstrated a substantial prevalence of undiagnosed diabetes among TB patients and active TB among diabetic patients, both of which adversely affected treatment outcomes. Bidirectional screening is crucial for early detection, timely intervention, and improved clinical outcomes.

Pulmonary function tests in granite quarry workers in Kuppam, Andhra Pradesh

2025-09-30T07:21:18+0530

Background: Quarrying is the process by which rock, sand, gravel, or other minerals from the earth are removed to produce materials for construction work and other uses. During the process of quarrying, large amounts of dust particles of heavy metals, silica, and organic solvents are emitted from the earth’s surface. Kuppam region of Andhra Pradesh is famous for the green coloured granite stone which has global demand, which is specifically found in the Kuppam and surrounding villages, hence number of quarries are more and causing respiratory diseases of local quarry workers.

Methods: The study was conducted in the department of physiology with total of 50 quarry workers for more than or equal to 5 years duration of working, both gender is randomly selected between 25-55 years of age. 50 Apparently normal healthy individuals of both genders were chosen from 5 km away from the quarry area as the control group. Ethical approval for the study protocol was obtained from institutional ethical clearance committee (IECC). After inclusion and exclusion criteria, lung function tests were done in quarry and the normal healthy subjects.

Results: There was a statistically significant change in FEV1, FVC and PEFR among quarry workers.

Conclusions: Not only quarry workers but also nearby residing population were also at the risk of deterioration of lung function tests.

Evaluating HbA1c reduction with protocol-driven drug therapy in early type 2 diabetes: a prospective analysis

2025-09-30T07:22:55+0530

Background: Effective blood sugar control is critical to preventing complications in type 2 diabetes. While intensive drug therapy can improve glycemic outcomes, the long-term benefit of starting with aggressive regimens tailored to disease severity remains under investigation.

Methods: This study categorized patients with type 2 diabetes into three groups based on initial HbA1c levels: Group 1 (mild, 7–9%), Group 2 (moderate, 9–11%), and Group 3 (severe, >11%). Treatment was escalated accordingly: triple therapy for Group 1, quadruple therapy for Group 2, and quintuple therapy for Group 3. The medication regimen included pioglitazone, metformin, dapagliflozin, teneligliptin, and gliclazide. HbA1c levels were tracked to assess glycemic improvement and therapy simplification over time.

Results: All groups achieved significant reductions in HbA1c. Group 1 saw a 24.4% reduction, Group 2 a 29.0% reduction, and Group 3 a 51.7% reduction (p=0.001). Notably, many patients in Group 3 were able to simplify their medication regimens during follow-up, transitioning from five drugs to fewer agents while maintaining glycemic control (p<0.05).

Conclusions: Tailored intensive therapy based on initial glycemic severity leads to significant HbA1c improvement. Starting with robust combination therapy and later reducing drug burden may be an effective, sustainable strategy in managing type 2 diabetes.

Adjustment and coping skills among adolescent school children

2025-09-30T07:21:09+0530

Background: Adolescents often face adjustment difficulties that impact their emotional, social and educational development. Understanding their coping styles is essential for designing effective support systems.

Methods: The study sampled 207 high school students (143 boys, 64 girls) aged 10–19 from a Diwakar Model School of Ghaziabad. After obtaining informed consent and demographic details, participants were assessed using the Adjustment Inventory for School Students (AISS) and the Coping Orientation to Problems Experienced (COPE) inventory. Data was analyzed using descriptive statistics, Pearson correlations, Levene’s test and independent samples t-test.

Results: Findings indicated adjustment challenges across emotional, social and educational domains. Both boys and girls predominantly preferred problem-focused and emotion-focused coping strategies. No significant gender differences were observed, except in the educational adjustment domain.

Conclusions: Adolescents represent a psychologically vulnerable group. Their adjustment issues and coping preferences warrant careful attention from educators, counsellors and policymakers to foster healthier developmental outcomes.

Evaluation of causes of acute onset paraparesis in a tertiary care centre in South India

2025-09-30T07:22:48+0530

Background: Paraparesis is a complex condition that presents with unique challenges and people living with paraparesis can lead fulfilling lives with the right support and rehabilitation. This study aimed to determine the causes of acute onset paraparesis presenting to emergency department.

Methods: A hospital-based cross-sectional study done for a period of 12 months in 90 people attending a tertiary care hospital in Siddipet, Telangana. Patients aged less than 14 years, pregnant and lactating mothers and patients who were not willing to participate in the study were excluded. Preliminary data was recorded, followed by clinical examination and necessary relevant laboratory and radiological investigations were done.

Results: After complete evaluation, 33% of the people were found to have hypokalemic periodic paralysis, 30% were having Guillain Barre syndrome, 4% people were diagnosed with traumatic vertebral fractures and 3% of the people were found to have polymyositis. Rest of the people were having extramedullary Tumors, intervertebral disc prolapses, cauda equina syndrome, conus medullaris, paraneoplastic syndromes, neuromyelitis optica, transverse myelitis and multiple sclerosis.

Conclusions: Acute onset paraparesis must be evaluated swiftly starting with metabolic abnormalities which seem to be the most commonly encountered cause followed by imaging modalities, keeping in mind a few conditions related to spinal cord. Early detection and treatment are important to avoid grave consequences. It is imperative that atraumatic causes must also be taken into account besides the traumatic etiology, as there can be a significant improvement in their quality of life with timely medical attention and prompt treatment.

Effective management of peripheral vertigo due to benign paroxysmal positional vertigo with betahistine, in the real-world setting: an expert survey with ENT specialists in India

2025-09-30T07:22:47+0530

Background: Benign paroxysmal positional vertigo (BPPV) commonly causes peripheral vertigo and is treated with canalith repositioning maneuvers (CRM). Yet, a subset of patients continues to experience vertigo called residual dizziness after undergoing CRM. Objective was to understand the role of betahistine 48 mg per day in prevention of recurrent vertigo and prevention of residual dizziness in patients with BPPV based on expert perceptions.

Methods: Forty ear, nose and throat (ENT) specialists or otolaryngologists from diverse regions across India who were treating patients with peripheral vertigo were invited to participate in an online survey regarding their approach to treating peripheral vertigo in the real-world setting.

Results: 23 respondents (57%) reported that 10-25% of their patients had recurrence of vertigo. 24 respondents (60%) opined that both impaired vestibular compensation due to insufficient dose (less than 48 mg/day) and duration (less than 3 months) of betahistine and remnant otoliths cause recurrence of vertigo. 57% participants adopted this approach to prevent residual dizziness namely: 1) increase dose of betahistine to 48 mg/day and 2) increase the duration of use of betahistine to 3 months. 40% physicians opined that 75-90% reduction in vertigo episodes is seen with 48 mg per day of betahistine.

Conclusions: Betahistine is preferred to treat peripheral vertigo due to BPPV. Betahistine is prescribed in the dose of 48 mg per day for a duration of at least 3 months post repositioning manoeuvres effectively reduces vertigo, reduces recurrence and residual dizziness by facilitating vestibular compensation and improved vestibular blood supply.

Assessment of adverse drug reactions and intravenous incompatibilities in a tertiary care teaching hospital

2025-09-30T07:22:43+0530

Background: Adverse drug reactions (ADRs) and intravenous (i.v.) incompatibilities are significant concerns in clinical practice due to their potential to compromise patient safety and treatment efficacy. This study aimed to evaluate the prevalence, types, and consequences of ADRs and i.v. incompatibilities in prescriptions from tertiary care hospitals. The study also aimed to identify the most frequently implicated drugs and conditions associated with these issues and suggest recommendations for improving prescribing practices.

Methods: A prospective observational study was conducted over one year in a tertiary care hospital. Data were collected from 1000 patients across various age groups and genders in tertiary care settings. Detailed demographic information, prescribing patterns of high-risk medications, department-specific distribution, i.v. incompatibilities, and specific ADRs were analyzed. The assessment criteria included adherence to STGs, identification of deviations, and analysis of potential consequences.

Results: The study revealed a significant prevalence of unacceptable deviations from standard treatment guidelines, particularly with medications such as pantoprazole and rabeprazole with domperidone. High-risk medications like anticoagulants, antiplatelets, insulin, chemotherapeutic agents, opioids, and corticosteroids were frequently prescribed, with notable department-specific variations. I.v. incompatibilities were common with chemotherapeutic agents and insulin, while specific ADRs were associated with chemotherapeutic agents, insulin, anticoagulants, and corticosteroids.

Conclusions: The findings highlight the need for improved prescribing practices and strict adherence to guidelines, especially for high-risk medications. Implementation of targeted interventions, enhanced training for healthcare providers, utilization of electronic systems, robust pharmacovigilance programs, patient education, and department-specific protocols are recommended to enhance patient safety and treatment outcomes in tertiary care settings.

Genotyping and receiver operating characteristic-based evaluation of Paraoxonase-1 in stable chronic obstructive pulmonary disease: a case-control study from Central India

2025-09-30T07:22:33+0530

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, particularly in low- and middle-income countries like India. Oxidative stress is a key contributor to COPD pathogenesis, and the Paraoxonase 1 (PON1) enzyme plays a crucial antioxidant role. This case-control study from Central India investigated the association of PON1 gene polymorphisms-Q192R and L55M-with PON1 enzyme activity and lipid peroxidation marker malondialdehyde (MDA) in stable COPD patients.

Methods: Sixty COPD patients and 60 age and sex-matched healthy controls were enrolled. PON1 activity was measured spectrophotometrically, and genotyping was performed using PCR-RFLP. Receiver operating characteristic (ROC) analysis assessed the diagnostic performance of PON1 activity.

Results: COPD patients had significantly lower PON1 activity than controls (p<0.001). The RR genotype and R allele of the Q192R polymorphism were more frequent in COPD patients and associated with reduced enzyme activity (OR 2.7; p=0.02). L55M polymorphism showed no significant intergroup difference. An optimal PON1 activity cutoff of 118.2 U/l (Youden’s index) yielded 80% sensitivity and 86.7% specificity in distinguishing COPD from controls. Findings suggest the R allele and RR genotype as potential genetic risk markers for COPD, with decreased PON1 activity indicating impaired antioxidant defence.

Conclusions: This is the first report of PON1 polymorphism data in COPD patients from India, offering novel insights into gene-environment interactions and genetic susceptibility. Larger studies are needed to confirm these results and assess the role of PON1 genotyping in risk stratification and disease management.

Expert opinion survey on medication error awareness, reporting and its challenges among nursing leaders in India

2025-09-30T07:22:27+0530

Background: Medication errors (MEs) remain a significant concern in healthcare settings globally, particularly in India, where Nurses play a vital role in preventing MEs. This expert opinion survey explored the experience of nursing leaders in handling and reporting of MEs.

Methods: This expert opinion study was based on a descriptive survey conducted among 51 nursing leaders from top corporate hospitals in India. The survey consisted of 15 questions covering four key areas: (1) frequency and types of errors, (2) barriers to error reporting, (3) department-related factors, and (4) training/education. Responses were collected through an online self-administered questionnaire between June and November 2024.

Results: Most of the nursing leaders (96%) reported encountering MEs. Among them, 39.2% of respondents observed MEs weekly, while 19.6% encountered these errors daily. The common types of errors included prescribing errors (71%), dispensing errors (69%), wrong dosages (63%), and wrong timing (61%). Notably, 37% of nursing leaders perceived underreporting of MEs. Identified barriers to MEs reporting included extra time for documentation (47%), fear of blame (45%), lack of knowledge (47%), absence of anonymous reporting systems (33%), and inadequate information for reporting errors (31%). A significant proportion of respondents (86%) emphasized the need for more comprehensive training to improve ME reporting practices.

Conclusions: This survey highlighted the need for transformative changes in ME awareness and reporting in hospitals. Establishing blame-free, anonymous reporting systems and enhancing training are essential. Additionally, advanced technological solutions should be utilized to support nursing staff in improving patient safety via prevention of MEs.

A psychological aspect of globus pharyngeus

2025-09-30T07:21:17+0530

Background: Several psychological factors are included in globus pharyngues. The study aims to analyze psycho-social correlates of globus pharyngeus.

Method: This study is an observational study in individuals taken from various Delhi and NCR ENT clinics like Krishna Nagar ENT specialist Clinic (Delhi), Hargobind Enclave ENT specialist Clinic (Delhi), Santosh Medical Hospital (Delhi), Brij Vihar ENT specialist Clinic. (UP). ENT specialist has diagnosed individuals and they have undergone Endoscopies, treatment for Reflux for 3 weeks at least and still not recovered were taken for the testing. The adults 1from the age range of 18 years to 64 years according to National Institute of Health had participated in this study. After data collection Person Correlation was applied through SPSS.

Result: Total 100 Adults have participated in the research, results of correlation indicated that globus and depression found to be having no correlation (r =-0.115), Globus and Anxiety has an negative correlation (r= -0.330, p<0.01), Globus and Stress has an correlation (r=0.198, p<0.05) , Globus and Psychoticism has an correlation (r=0.282, p<0.01), Globus and Neuroticism it found to be having no correlation (r=0.139), Globus and Extraversion it found to be having no correlation (r=-0.196), globus and social support has an correlation (r=0.220, p<0.05).

Conclusion: Patients with Globus complain of pain without any physical illness these patients also have psychosocial problems. To concluded from the study, it shows that globus has high levels Anxiety, Stress, Psychoticism and low Social Support.

Gender differences in depression, anxiety, stress and quality of life among paramedical students

2025-09-30T07:21:16+0530

Background: Understanding the gender differences in depression, anxiety, stress and quality of life among paramedical students with special reference to the Indian context. To study the gender differences in depression, anxiety, stress and quality of life among paramedical students. The present study followed a cross-sectional study design and was conducted at a private medical university in Ghaziabad, Uttar Pradesh, India.

Methods: Purposive sampling technique was used to collect data from 218 paramedical students. Standardized tools General Health Questionnaire, Depression Anxiety Stress Scale and World Health Organization Quality of Life BREF were administered as physical forms. Ethical clearance and informed consent were obtained. Descriptive statistics (frequencies, mean and standard deviation) along with inferential statistics of t-test and Chi Square test were computed in the current study, to understand the gender difference in variables of study.

Results: Stress showed a statistically significant difference between male and female participants (χ²=11.151, p=0.025 significant) with females scoring a higher score as compared to males. No statistically significant difference were shown in depression, anxiety and quality of life between the genders despite slight score differences.

Conclusions: There is a gender difference as well as a relationship between depression, anxiety, stress and quality of life among paramedical students. These findings suggest the importance of how mental health differs in terms of gender and how it affects the quality of life among the students, specifically with reference to the Indian context.

Impact of depression, anxiety, and stress on adjustment of senior secondary school students

2025-09-30T07:21:13+0530

Background: Adolescence is a crucial developmental stage where personality traits, intelligence quotient (IQ) and emotional intelligence (EI) significantly influence academic achievement and psychological well-being. Despite widespread belief in IQ as a predictor of success, recent research emphasises the growing relevance of EI and personality in fostering social and academic competence.

Methods: A cross-sectional, correlational study was conducted across six secondary schools in Faridabad, India. A stratified random sample of 387 adolescents (aged 16–18 years) participated. Standardised tools were used: Raven’s Standard Progressive Matrices (RSPM) for IQ, Eysenck’s Personality Questionnaire (EPQ) and the Emotional Intelligence Scale (EIS). Statistical analyses included Pearson correlation, regression analysis and ANOVA.

Results: The results indicated that IQ had a negligible effect on emotional intelligence (EI). Nevertheless, some personality traits, especially psychoticism and neuroticism, significantly affected emotional regulation and social adaptability. There were differences between men and women in emotional intelligence. Women were better at empathy and social skills, while men were better at self-regulation. Regression models demonstrated that psychoticism influenced the relationship between IQ and emotional intelligence (EI).

Conclusions: This study shows that IQ isn't a great predictor of emotional intelligence and that personality factors are more important in molding social and emotional competence in teenagers. In order to improve academic resilience, self-esteem and stress control, the results support the implementation of interventions focused on emotional intelligence in educational settings. For teens to thrive academically, there must be an interdisciplinary approach to learning that prioritizes their emotional and cognitive development.

Hyperglycemia as a predictor of stroke severity and prognosis: evaluating short-term outcomes in acute stroke patients

2025-09-30T07:21:11+0530

Background: One of the leading causes of mortality and disability worldwide is stroke, with its burden increasing significantly, particularly in low- and middle-income countries (LMICs). Hyperglycemia independent of diabetic status has been correlated with a poor outcome after a stroke in severity, poor nervous system recovery, and mortality. However, the extent to which stress hyperglycemia independently impacts stroke prognosis remains debated. This study aimed to evaluate the relationship between glycemic status at admission and stroke severity, short-term neurological recovery, and mortality outcomes. Additionally, we assess whether random blood sugar (RBS) or glycated hemoglobin (HbA1c) correlates more strongly with stroke severity.

Methods: A hospital-based observational study was conducted on 80 acute stroke patients. Patients were categorized into euglycemic, diabetic, prediabetic, and stress hyperglycemic groups based on admission RBS and HbA1c levels. Stroke severity was assessed using the NIH Stroke Scale (NIHSS) on day 1 and day 7. The primary outcome was neurological recovery, and the secondary outcome was 7-day mortality.

Results: Hyperglycemia was significantly associated with higher NIHSS scores at admission and poorer recovery at day 7 (p<0.01). The mortality rate was highest in diabetic and stress hyperglycemic patients (20% each, p<0.01). A stronger correlation was found between RBS and stroke severity (r=0.81) than HbA1c (r=0.52).

Conclusions: Acute hyperglycemia is an independent predictor of stroke severity and poor short-term outcomes, emphasizing the need for early glucose monitoring and targeted intervention in stroke patients.

The effect of social media on body image, self-esteem, and social appearance anxiety among young adults

2025-09-30T07:21:10+0530

Background: Social media usage is growing rapidly among young adults, influencing body image, self-esteem, and appearance-related anxiety. Aim was to assess the relationship of social media usage with body image, self-esteem, and social appearance anxiety among young adults.

Methods: A cross-sectional study was conducted among 404 college students at Santosh Medical College and Hospital during the M.Sc. Clinical Psychology program. Purposive sampling was used. Tools included the social media use scale, Rosenberg self-esteem scale, body image satisfaction rating scale, and social anxiety questionnaire for adults (SAQ-A30). Data were collected using standardized procedures. Descriptive statistics (mean, standard deviation) were used to assess participant characteristics. Chi-square tests were used to examine the association between social media use and psychological variables. Data were analyzed using SPSS version 23 and MS Excel.

Results: There was a highly significant association between social media usage and all three psychological variables: body image dissatisfaction (χ²=297.99, p<0.01), low self-esteem (χ²=46.57, p=0.027), and social appearance anxiety (χ²=293.43, p<0.01). Social media usage (χ²=302.14, p<0.01) was strongly linked to poorer mental health outcomes.

Conclusions: The study highlights the psychological risks of high social media engagement among young adults. It reveals a significant relationship between social media use and body image dissatisfaction, low self-esteem, and high social appearance anxiety. Media literacy, mental health awareness, and promoting healthy online behaviour are essential for mitigating these effects.

Intolerance of uncertainty and adjustment among paramedical students: a cross-sectional study

2025-09-30T07:21:08+0530

Background: Working in the healthcare settings can be complex and ever-changing requiring adaptability and ability to manage stress in unclear circumstances. Paramedical students enter a field with a demanding nature of training and future professional responsibilities, needing high tolerance for uncertainty. As well as students may struggle to balance their studies with personal responsibilities and social life which can impact their ability to adjust. Therefore, the study is aimed to assess the relationship between intolerance of uncertainty (IU) and adjustment among paramedical students.

Methods: A cross-sectional study was conducted among 287 paramedical students from Santosh Deemed to be University in Ghaziabad, Uttar Pradesh, India. Data were collected using validated tools to measure their IU and adjustment. Analysis was done using SPSS and MS excel.

Results: The findings revealed that a considerable proportion (64.1%) of paramedical students exhibited high levels of IU. Analysis of adjustment levels showed that among males, the majority (62%) had overall unsatisfactory adjustment, while similar patterns were observed among females (50.3%). Chi-square analysis demonstrated a statistically significant relationship between IU scale (IUS) and adjustment levels in both genders. Chi-Square values for females (χ²=132.957) and males (χ²=110.467) were highly significant (p<0.01).

Conclusions: The findings highlight that a significant number of paramedical students experience high IU, which is strongly associated with poor adjustment to college life. These results emphasize the need to incorporate psychological support, uncertainty tolerance training, and adjustment strategies into paramedical education. Enhancing these areas may improve students’ well-being, academic performance, and future professional competence.

Effect of stress among school teachers

2025-09-30T07:21:07+0530

Background: Teachers are increasingly experiencing occupational stress, which may affect their psychological functioning and general health. In recent years, this concern has grown particularly among private school teachers, who face continuous academic, emotional, and administrative pressures. Understanding the nature and extent of stress in this population is crucial for identifying associated mental health patterns and guiding relevant psychological assessment. Aim was to evaluate the level of stress among private school teachers and examine its correlation with general health, personality traits, depression, anxiety, and psychological well-being. It was a cross-sectional study conducted in private schools in Ghaziabad, India.

Methods: The study included 375 full-time school teachers selected through purposive sampling. Standardized psychological tools used were the general health questionnaire (GHQ-12), Eysenck personality questionnaire (EPQ), depression anxiety stress scale (DASS-42), and Ryff psychological wellbeing scale. Data analysis was performed using SPSS-23. Descriptive statistics (mean and standard deviation) and Pearson correlation coefficients were used to assess associations between general health, personality traits, psychological well-being, and psychopathologies.

Results: Over 75% of teachers exhibited extremely severe levels of depression, anxiety, and stress. Approximately 67.6% showed moderate to severe general health concerns. High psychoticism (60.8%) and neuroticism (39.7%) scores were observed, with neuroticism significantly correlated with depression (r=0.160), anxiety (r=0.142), and stress (r=0.193), all at p<0.01. Only 32.8% of participants demonstrated high levels of psychological well-being.

Conclusions: The study reveals a substantial presence of psychological distress among private school teachers and significant associations with specific personality dimensions. These findings underline the importance of continued psychological evaluation and consideration of personality patterns when addressing teacher well-being.

Discrimination of two-point touch sense for the upper and lower extremity based on body mass index in young adults: an observational study

2025-09-30T07:21:05+0530

Background: To establish normative values for two-point discrimination (TPD) across 11 dermatome regions in the upper and lower limbs while examining the correlation between TPD and body mass index (BMI) and the influence of gender-based variations on sensory perception.

Methods: A cross-sectional observational study conducted with 200 healthy participants (100 males, 100 females) to measure TPD thresholds and analyse correlations with BMI. This study was carried out in a controlled clinical setting, ensuring minimal environmental interference in sensory assessment. Participants were tested in quiet, temperature-controlled conditions to maintain reliability. Normative values for TPD in upper and lower limb dermatome regions, Correlation between TPD and BMI assessed using Karl Pearson’s correlation test. Gender-based correlation differences evaluated using Karl Pearson’s correlation test.

Results: A statistically significant positive correlation (p<0.05) was observed between TPD and BMI, indicating higher BMI is associated with increased TPD values across multiple dermatome regions. No significant differences (p>0.05) in TPD were found between males and females, suggesting BMI influences sensory perception similarly across genders. Regional variations in TPD were noted, emphasizing differences in tactile acuity across limb areas.

Conclusions: This study successfully established reference values for TPD, providing critical insights into sensory perception variations based on BMI. The findings challenge previous assumptions by confirming BMI as a significant factor in tactile sensitivity. Standardized testing protocols are recommended for clinical applications and future research in neurophysiology and rehabilitation.

Concordance between trucut needle biopsy and surgical specimen for estrogen receptor, progesterone receptor and human epidermal growth factor receptor status in breast cancer

2025-09-30T07:21:04+0530

Background: Breast cancer is the most common malignancy among women worldwide, contributing significantly to cancer-related morbidity and mortality. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER2/neu) status are crucial for prognosis and treatment planning. Trucut needle biopsy is widely used for preoperative biomarker assessment; however, discrepancies with surgical specimen results may affect clinical decisions.

Methods: A cross-sectional study was conducted at Gandhi Medical College and Hamidia Hospital, Bhopal, from August 2022 to January 2024, including 32 cases of invasive ductal carcinoma. Immunohistochemistry was performed on trucut biopsies and surgical specimens to assess ER, PR, and HER2/neu expression. Concordance rates, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Statistical analysis used SPSS, with p<0.05 considered significant. Factors influencing discordance, including tumor heterogeneity, fixation techniques, and preanalytical variables, were evaluated.

Results: ER showed high concordance (90.6%), sensitivity (83.3%), specificity (100%), PPV (100%), and NPV (82.4%). PR demonstrated moderate concordance (78.1%), sensitivity (73.3%), specificity (82.4%), PPV (78.6%), and NPV (77.8%). HER2/neu showed moderate to low concordance (51.6%), sensitivity (64.7%), specificity (86.7%), PPV (84.6%), and NPV (68.4%). HER2/neu discordance was linked to intratumoral heterogeneity, staining variability, equivocal results requiring fluorescence in situ hybridization.

Conclusions: Trucut biopsy is highly reliable for ER and PR assessment but shows moderate reliability for HER2/neu, warranting confirmatory testing in borderline cases. Awareness of potential discrepancies and supplementary diagnostics can enhance preoperative accuracy and guide personalized breast cancer management.

Role of multi slice computed tomography in lung parenchymal pathologies

2025-09-30T07:21:03+0530

Background: Lung parenchymal pathologies cover a range of conditions such as interstitial lung diseases (ILD) bronchogenic carcinoma, pulmonary tuberculosis, aspergilloma, and many others. Multislice computed tomography (MSCT) has significantly aided in the diagnosis and management of lung parenchymal pathologies. Its high-resolution imaging capability and detailed cross-sectional view of the lungs help to detect and evaluate a wide range of pulmonary diseases with greater accuracy. Objective was to analyze the MSCT findings in patients with suspected lung parenchymal pathologies and assess its role in differential diagnosis and disease characterization.

Methods: An observational cross-sectional study was performed in 100 patients with clinical suspicion of lung parenchymal pathologies. All patients underwent MSCT and imaging findings were correlated with clinical data wherever available.

Results: The most common imaging features were consolidation (56%), cavitation (24%), ground-glass opacities (24%), fibrosis (23%). Infective pathologies accounted for the majority of findings, including consolidation, nodules, bronchiectasis, and cavitatory lesions. Neoplastic lesions were seen in 8% of cases, all showing advanced features such as lymphadenopathy and local invasion. Additional findings included pleural effusions (20%), pneumothorax (7%), and mediastinal involvement (58%). MSCT enabled accurate identification and characterization of various pathologies such as tuberculosis, bronchogenic carcinoma, ILD, aspergilloma, and allergic bronchopulmonary aspergillosis (ABPA).

Conclusions: MSCT plays a vital role in the early detection, accurate characterization, and staging of lung parenchymal diseases. Its high diagnostic yield enhances clinical decision-making and guides appropriate management strategies.

Impact of kangaroo mother care on phototherapy duration and hospital stay in term neonates with neonatal jaundice: a cross-sectional study from South India

2025-09-30T07:21:02+0530

Background: Neonatal jaundice affects about 60% of term and 80% of preterm infants, primarily due to immature bilirubin metabolism. Phototherapy is the standard treatment, but prolonged exposure can cause complications such as dehydration, hypocalcemia, and disrupted maternal-infant bonding. Kangaroo mother care (KMC), involving skin-to-skin contact, has emerged as a supportive intervention that may enhance bilirubin excretion and reduce phototherapy duration. Objective was to assess the effect of KMC on phototherapy duration and hospital stay in term neonates with hyperbilirubinemia.

Methods: A cross-sectional observational study was conducted from July 2023 to August 2024 at Sree Balaji Medical College and Hospital. A total of 120 term neonates (gestational age 37-42 weeks, birth weight >2500 gm) with jaundice requiring phototherapy were enrolled. Exclusion criteria included preterm birth, low birth weight, early-onset jaundice, hemolytic disease, or congenital anomalies. Infants were divided into two groups: group A (phototherapy only) and group B (phototherapy + KMC). Data were analyzed using SPSS v27.

Results: The mean phototherapy duration was significantly lower in the KMC group (46.22±2.56 hours) than in the phototherapy-only group (65.13±6.88 hours) (p=0.02). Hospital stays were also significantly shorter in the KMC group (p<0.05). No adverse events related to KMC were reported. Higher gestational age and maternal education were associated with better outcomes.

Conclusions: KMC is a safe, effective adjunct to phototherapy, reducing treatment duration and hospital stay while supporting mother-infant bonding.

Comparison between Bethesda and thyroid imaging reporting and data system scoring in patients of thyroid swelling at a tertiary care hospital

2025-09-30T07:21:01+0530

Background: Accurate diagnosis of thyroid swellings is crucial to differentiate benign from malignant lesions. The Bethesda system for reporting thyroid cytopathology (TBSRTC) and the thyroid imaging reporting and data system (TIRADS) are standardized tools used for cytological and ultrasonographic risk stratification, respectively. Objective was to compare the diagnostic performance of Bethesda and TIRADS scoring systems in evaluating thyroid nodules.

Methods: A prospective observational study was conducted over 18 months at a tertiary care hospital on 150 patients with thyroid swellings. All patients underwent ultrasound-based TIRADS scoring and FNAC using the Bethesda classification. The correlation of both scores with histopathological diagnosis was analyzed.

Results: Of 150 cases, 47 (31%) were malignant. TIRADS TR4-TR5 categories showed a strong correlation with Bethesda V-VI and histologically confirmed malignancies. Sensitivity, specificity, and diagnostic accuracy for TIRADS were 92.5%, 99.1%, and 97.3%, respectively. Combined TIRADS and Bethesda correlation further improved diagnostic confidence.

Conclusions: TIRADS scoring showed high concordance with Bethesda categories and histopathology. Combining both systems offers a robust preoperative risk stratification tool.

Academic stress and its clinical implications among college students

2025-09-30T07:20:58+0530

Background: Academic stress is increasingly recognized as a major mental health concern among undergraduate students worldwide, often leading to symptoms of depression, anxiety, and impaired general health. However, there is limited research focusing on students in nursing, paramedical, and allied health disciplines in India. This study aimed to assess the prevalence of academic stress and examine its relationship with depression, anxiety, stress, and overall general health among undergraduate students.

Methods: A cross-sectional study was conducted with 404 students from nursing, paramedical, and allied health sciences at Santosh medical college and hospital. Academic stress was measured using the academic stress scale (ASS), psychological symptoms were assessed with the depression anxiety stress scale-42 (DASS-42), and general health was screened with the general health questionnaire-12 (GHQ-12). Data were analyzed using descriptive statistics and Pearson’s correlation.

Results: A substantial 86.13% of students reported moderate to high academic stress levels. Correspondingly, moderate to extremely severe symptoms were reported by 61.4% for depression, 65.3% for anxiety, and 58.7% for stress. Furthermore, 70.8% of students scored above the clinical cutoff on the GHQ-12, indicating compromised general health. Significant positive correlations were found between academic stress and depression (r=0.75), anxiety (r=0.72), stress (r=0.70), and general health impairment (r=0.68) (p<0.05).

Conclusions: Academic stress is prevalent among undergraduate health science students and is strongly associated with poor psychological and general health outcomes. These findings highlight the need for early screening and tailored interventions in academic institutions to mitigate adverse mental health impacts and promote student well-being.

Prevalence and factors associated with diabetes-related distress among patients with type 2 diabetes mellitus in a South Indian secondary care hospital

2025-09-30T07:20:03+0530

Background: Diabetes related distress (DRD), though well known, is under-recognized in the Indian subcontinent. Existing literature is mostly from tertiary or teaching hospitals located in urban areas. The prevalence and determinants of DRD among non-urban settings is not well known. This study aims to fill this knowledge gap by investigating the same among patients with type 2 diabetes mellitus (T2DM) in a South Indian secondary care hospital.

Methods: 227 consecutive patients with T2DM were administered pre-validated diabetes distress scale questionnaire and their responses documented. The prevalence of distress in each of the four domains and as a whole was measured and the association with various factors were identified using appropriate statistical methods.

Results: 165 (72.7%), 164 (72.2%), 176 (77.5%) and 155 (68.3%) of patients experienced emotional distress, physician-related distress, regimen-related distress and interpersonal distress respectively. Overall, 165 (72.7%) had clinically significant diabetes-related distress in the study. Occurrence of hypoglycemic episodes (p 0.02), having high body mass index (BMI) (p 0.03) and non-adherence to a diet plan (p 0.03) were associated with increased distress in various domains.

Conclusions: Three out of four (165/227; 72.7%) adult patients living with T2DM reported experiencing DRD, a significantly higher prevalence than shown in previous studies. This highlights the need to incorporate DRD screening and management as part of routine care of T2DM. Prevalence of DRD was higher among patients who experienced hypoglycemia episodes in the month prior to the assessment. Scrupulous avoidance of hypoglycemia may help to reduce DRD among patients living with T2DM.

Relation between stress and gastrointestinal disorders

2025-09-30T07:20:02+0530

Background: This study investigated psychological influences in gastrointestinal (GI) disorders by analyzing relationships among stress, depression, anxiety, and somatization. Standardized scales were applied with 73 participants, revealing notable associations between stress and physical complaints. Findings highlight the significance of the brain-gut connection and recommend integrative therapeutic approaches. Aim was to evaluate the association between stress levels and general health, somatization, depression, anxiety, and illness perception among patients with gastrointestinal disorders.

Methods: This cross-sectional survey-based research distributed offline questionnaires to patients experiencing gastrointestinal symptoms to assess stress and its associations with general health, somatization, depression, anxiety, and illness perception. Data collection employed four standardized instruments: GHQ-12, SDC, DASS-42, and IPQ-R. Data were processed with Microsoft Excel and SPSS version 23, emphasizing descriptive and inferential methods. Descriptive analysis involved calculating mean and standard deviation for GHQ-12, SDC, DASS-42, and IPQ-R.

Results: Of 73 respondents, SDC showed 6.8% had marked somatic concerns. These findings emphasize the overlap between psychological stress and physical outcomes, as patients with GI symptoms often present emotional struggles through somatic complaints.

Conclusions: Stress was significantly correlated with the somatization disorder checklist (GI).

Personality correlates of job stress and organisational citizenship behaviour among hospital professionals

2025-09-30T07:20:02+0530

Background: Understanding the role of personality in occupational stress and organisational citizenship behaviour (OCB) is crucial in healthcare environments, where professionals often face high-pressure situations. In Indian healthcare settings, research on how personality dimensions impact stress levels and prosocial workplace behaviours remains limited. Aim was to examine the correlation between big five personality dimensions (extraversion, agreeableness, conscientiousness, openness and neuroticism), occupational stress, and OCB among hospital professionals.

Methods: A cross-sectional study was conducted among 254 full-time employees from Santosh Hospital in Ghaziabad, Uttar Pradesh, India using purposive sampling. Participants included doctors, nurses, technical, and non-technical (administrative) staff. Standardized tools- the big five inventory (BFI), occupational stress index (OSI), general health questionnaire (GHQ-12), and organisational citizenship behaviour checklist (OCB-C)- were administered as physical forms. Descriptive statistics and inferential statistics (Pearson correlation) were performed.

Results: Neuroticism was positively correlated with occupational stress (r=0.201**) and negatively with OCB (r=–0.170**), indicating a dual relationship. OCB was significantly associated with extraversion (r=0.142*), agreeableness (r=0.187**), and conscientiousness (r=0.145*). Psychological distress (GHQ scores) correlated negatively with extraversion, agreeableness, conscientiousness, and openness. The mean OCB score was 64.24 (SD±12.51), suggesting moderate prosocial workplace behaviour (* = p<0.05, ** = p<0.01).

Conclusions: Personality dimensions significantly influence both job stress and OCB. These findings underscore the importance of personality in healthcare context, specifically Indian healthcare scenario among doctors, nurses, technical and non-technical/administrative staff.

An observational study to determine the efficacy of FOGSI gestosis score as a predictor of pre-eclampsia and Ecosprin prophylaxis as a preventive intervention

2025-09-30T07:20:00+0530

Background: FOGSI gestosis score is a simple risk model devised for preeclampsia screening and prediction. Each risk factor is given score of 1, 2 or 3 based on severity. A total score of ≥3, implies ‘at risk’ for developing preeclampsia warranting closer monitoring and management. Also, Ecosprin prophylaxis in these high-risk pregnancies can reduce the incidence of early onset preeclampsia as well as maternal and neonatal morbidity and mortality.

Methods: This prospective OBSERVATIONAL study was conducted at GMC Amritsar, involving 100 pregnant women at ≤24 weeks of gestation (Group A), screened using gestosis score. Participants identified as high-risk (score ≥3) received prophylactic Ecosprin and monitored until 6 weeks postpartum for maternal and neonatal outcomes which were compared with 145 unbooked, already known cases of preeclampsia/eclampsia (group B).

Results: Among 100 participants screened as per gestosis score, 29% were high risk and 71% low risk. Preeclampsia developed in 31% of high-risk versus 4.2% of low-risk participants (IRR=8.98, p=0.0002). Significant predictors included anaemia, primigravida status, BMI>30 and MAP>85 mmHg. Preterm birth, FGR, unfavourable APGAR score and perinatal mortality were more common in the high-risk group. The score demonstrated 82.35% sensitivity, 82.69% specificity, 43.75% PPV, 96.63% NPV, and 82.64% accuracy in predicting Preeclampsia, indicating good screening potential.

Conclusions: Gestosis score is low cost, noninvasive screening tool for predicting preeclampsia and adverse pregnancy outcomes, particularly in resource-constrained settings. Early Ecosprin prophylaxis significantly reduces the incidence and severity of complications in high-risk pregnancies.

Induction of labour: a comparative study of dinoprostone gel versus vaginal misoprostol versus sequential intracervical Foley’s catheter followed by vaginal misoprostol versus concurrent intracervical Foley’s and dinoprostone gel

2025-09-30T07:19:59+0530

Background: Induction refers to the stimulation of contractions prior to the spontaneous commencement of labour, whether or not the membranes have already ruptured. Induction of labour is needed when risks outweigh the benefits of pregnancy continuation and there is no contraindication for vaginal delivery.

Methods: This was a randomized control trial which included low risk pregnant women at term gestation. Eligible patients were divided into 4 groups by randomisation in ratio of 1:1:1:1 with 25 patients in each group i.e. vaginal misoprostol (25 µgm) (group A) versus intracervical dinoprostone gel (group B) versus sequential intracervical Foley’s catheter followed by vaginal misoprostol (group C) versus concurrent intracervical Foley’s and dinoprostone gel.

Results: Use of dinoprostone gel for cervical priming is a more efficacious method among women needing labour induction with bishop score <6 compared to vaginal misoprostol, concurrent intracervical foley’s as well as sequential intracervical Foley’s and vaginal misoprostol. It is associated with higher rates of vaginal delivery (84%, p value 0.001), shortened induction delivery interval (14.38±7.16 hours, p value 0.178) and least risk of fetal distress/MSL.

Conclusions: Use of dinoprostone gel for cervical priming is a more efficacious method as it is associated with higher rates of vaginal delivery, more predictable response, shortened IDI and least risk of fetal distress/MSL. It should be preferred over tablet vaginal misoprostol especially for nulliparous women.

A clinical study of plasma homocysteine levels in chronic kidney disease at a tertiary care center

2025-09-30T07:19:57+0530

Background: Chronic kidney disease (CKD) is associated with progressive loss of renal function and elevated plasma homocysteine levels, which may increase cardiovascular risk. This study aimed to assess the association between renal function decline and homocysteine levels in CKD patients.

Methods: A single-center, prospective observational study was conducted over 18 months involving 50 CKD patients. Demographic, clinical, and biochemical data including plasma homocysteine, serum creatinine, blood urea nitrogen (BUN), urea, glomerular filtration rate (GFR), and albumin levels were collected. Patients were stratified by homocysteine levels (normal <15 µmol/l, elevated >15 µmol/l), and associations with renal parameters were analyzed.

Results: Elevated homocysteine was observed in 38 (76%) patients. Patients with elevated homocysteine had significantly higher plasma homocysteine levels (21.98±7.52 µmol/l) compared to the normal group (12.22±1.83 µmol/l, p=0.001). Serum creatinine was higher in the elevated group (8.30±4.68 mg/dl) versus normal (4.68±2.17 mg/dl, p=0.001). Similarly, BUN (57.89±15.41 mg/dl versus 42.18±6.22 mg/dl, p=0.001) and urea (121.58±32.37 mg/dl versus 88.58±13.06 mg/dl, p=0.001) were elevated. The mean GFR was significantly lower in the elevated homocysteine group (11.68±6.30 ml/minute) compared to the normal group (16.44±7.93 ml/minute, p=0.03). Significant correlations were found between homocysteine and serum creatinine (r=0.305, p=0.03), BUN (r=0.335, p=0.01), urea (r=0.345, p=0.01), and GFR (r= -0.412, p=0.01).

Conclusions: Elevated homocysteine levels may serve as a useful biomarker and potential therapeutic target to mitigate cardiovascular risk and disease progression in CKD.

An observational study on the influence of latissimus dorsi length on upper limb reaction time in recreational volleyball players

2025-09-30T07:19:56+0530

Background: Reaction time is a critical determinant of athletic performance, particularly in sports like volleyball that demand rapid upper limb responses. The latissimus dorsi muscle, essential for upper limb mobility and postural stability, may influence neuromuscular responsiveness through its length and flexibility. This observational study aimed to investigate the relationship between latissimus dorsi muscle length and upper limb reaction time in recreational volleyball players aged 18-25 years.

Methods: Eighty recreational volleyball players aged 18-25 years were recruited. Participants with a normal lumbar lordotic angle and disabilities of the arm, shoulder, and hand (DASH) scores indicating no significant upper limb disability were included. Lumbar lordosis was assessed using the flexicurve method, latissimus dorsi muscle length was measured using an inch tape, and upper limb reaction time was evaluated via the ruler drop test. Data were analyzed using SPSS version 23.0, with Spearman’s correlation employed to assess associations.

Results: A weak positive correlation was observed between right latissimus dorsi length and right upper limb reaction time (r=0.222, p<0.05), while a moderate positive correlation was found between left latissimus dorsi length and left reaction time (r=0.313, p<0.05). These findings suggest that increased muscle length is associated with slightly prolonged reaction times.

Conclusions: This study found a significant weak-to-moderate positive correlation between latissimus dorsi length and upper limb reaction time. These results suggest that muscle flexibility may influence neuromuscular performance and highlight the need for further research into flexibility training to enhance athletic performance.

Study of knowledge and perception of hand hygiene among nursing staff in a tertiary care hospital

2025-09-30T07:19:52+0530

Background: Health care-associated infections (HAIs) are a major cause of morbidity and mortality, significantly impacting hospitalized patients. Poor hand hygiene among healthcare workers is a primary contributor to these infections, leading to longer hospital stays, increased antibiotic resistance, and substantial financial burdens. Nurses, being the largest group of healthcare workers with extensive patient contact, play a crucial role in preventing HAIs through proper hand hygiene. This study aimed to assess nurses' knowledge and perceptions of hand hygiene to inform strategies for promoting effective practices.

Methods: This cross-sectional, questionnaire-based study was conducted at a tertiary care hospital, involving 234 nursing staff. Participants provided verbal consent. The study utilized the WHO hand hygiene knowledge questionnaires. Scores were converted to percentages and categorized as good (>75%), moderate (50-75%), or poor (<50%). Incomplete questionnaires were excluded. Data was kept confidential, validated by a pilot test, and analysed using SPSS version 23.

Results: The study included 234 predominantly female (92.73%) and young (62.39% aged 20-30) nursing staff; 96% had received formal hand hygiene training. Regarding knowledge, 62.82% had moderate knowledge, 32.90% had poor knowledge, and only 4.27% demonstrated good knowledge. For perception, a significant majority (80.34%) showed good perception, with 12.39% moderate and 7.26% poor. Gaps were identified in understanding germ sources and the effective use of hand rubs/washes.

Conclusions: The study findings highlight the critical need for tailored, ongoing training programs focusing on practical demonstrations, clarification of germ sources, and effective application methods.

Evaluation of cardiac autonomic dysfunction using electrocardiography in type 2 diabetes mellitus patients: a case-control study

2025-09-30T07:19:52+0530

Background: Type 2 diabetes mellitus (T2DM) is associated with a high risk of cardiovascular complications, including cardiac autonomic neuropathy (CAN), which significantly increases morbidity and mortality. Electrocardiography (ECG) offers a non-invasive method to detect cardiac dysautonomia early. This study aimed to evaluate ECG changes in T2DM patients and correlate them with cardiac autonomic dysfunction.

Methods: A cross-sectional observational study was conducted on 50 T2DM patients and 50 age- and gender-matched healthy controls. Standard 12-lead ECG was performed to assess heart rate, RR interval, PR interval, QRS duration, QRS axis, and QTc interval. Cardiac autonomic function was evaluated using heart rate variability (HRV) parameters and clinical autonomic tests. Statistical analysis was performed to compare ECG parameters and prevalence of ischemic and conduction abnormalities between groups.

Results: T2DM patients exhibited significantly higher mean heart rates (86.9±10.81 versus 78.78±11.26 beats/minute; p=0.001), prolonged PR interval (162.40±31.72 versus 138.20±16.98 msec; p=0.001), increased QRS duration (70.98±12.72 versus 65±8.63 msec; p=0.007), and prolonged QTc interval (410.63±43.80 versus 329.20±29.74 msec; p=0.001) compared to controls. Additionally, ischemia (20% versus 4%; p=0.01), infarction (22% versus 6%; p=0.02), and conduction blocks (14% versus 2%; p=0.02) were significantly more prevalent in T2DM patients. HRV analysis indicated reduced autonomic function in the diabetic group.

Conclusions: T2DM is associated with significant ECG abnormalities reflecting cardiac dysautonomia and increased cardiovascular risk. ECG can serve as a valuable tool for early detection of CAN in diabetic patients, enabling timely intervention to reduce adverse outcomes.

Evaluating upper versus lower calyceal access in percutaneous nephrolithotomy: a prospective comparative study in complex renal calculi

2025-09-30T07:18:43+0530

Background: Percutaneous nephrolithotomy (PCNL) is the preferred modality for managing complex renal calculi, yet the optimal calyceal access upper or lower remains debated due to varied outcomes and complication profiles.

Methods: The research included 100 patients undergoing PCNL for treatment of complex renal stones. A division of patients occurred into two distinct groups: those accessing the upper calyces with n=46 and those accessing the lower calyces with n=54. Medical staff evaluated stone size together with operative time and haemoglobin drop and stone clearance and hospital stay duration.

Results: Finding shows operative durations (84.35 min vs. 84.66 min, p>0.05), baseline stone sizes (39.07 mm vs. 39.41 mm, p>0.05), haemoglobin decline (1.58 vs. 1.57 gm%, p>0.05) and hospital stay (3.80 vs. 3.67 days, p>0.05) were similar for both groups. Though the variation was not statistically noteworthy (p>0.05), the upper calyceal group (86.96%) had a greater total stone clearance rate than the lower (75.93%).

Conclusions: Regarding operative time, safety and recuperation, upper and lower calyceal access in PCNL produced similar clinical results. Upper calyceal access, on the other hand, indicated a tendency toward improved stone clearance, implying possible clinical preference in certain complicated situations.

Predictors of mortality in heart failure patients: a retrospective cohort study at a tertiary care hospital in Vadodara

2025-09-30T07:18:42+0530

Background: Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, particularly in low- and middle-income countries. Understanding the factors contributing to mortality in HF patients can inform clinical decisions and improve patient outcomes. This study aims to identify the predictors of mortality in HF patients admitted to a tertiary care hospital in Vadodara, Gujarat.

Methods: This retrospective cohort study included 250 consecutive HF patients admitted to SSG Hospital, Vadodara, between January 2022 and December 2023. Patient data, including demographic characteristics, clinical features, comorbidities, left ventricular ejection fraction (LVEF), laboratory values and mortality outcomes, were collected from hospital records. Multivariable logistic regression was used to identify independent predictors of mortality. Kaplan-Meier survival curves were generated to analyze survival rates over the study period.

Results: The cohort consisted of 250 patients, with a mean age of 62.7±10.5 years. Males accounted for 58.9% of the cohort. Overall mortality was 29.3% during the follow-up period. Predictors of mortality included lower LVEF (OR 2.7, 95% CI 1.8-4.2, p<0.001), elevated NT-proBNP levels (OR 3.2, 95% CI 2.0-5.1, p<0.001) and chronic kidney disease (OR 2.5, 95% CI 1.6-4.0, p=0.002). Kaplan-Meier analysis revealed a significant difference in survival rates between patients with LVEF<40% and those with LVEF≥40% (p<0.001).

Conclusions: This study identified several key predictors of mortality in HF patients, including reduced LVEF, elevated NT-proBNP levels and chronic kidney disease. These findings underscore the need for close monitoring and management of these high-risk factors to improve survival outcomes in HF patients.

Prevalence of adverse events due to self-administration errors among patients in a tertiary care hospital: a cross-sectional study utilizing the SAME tool

2025-09-30T07:18:37+0530

Background: Self-administration medication errors (SAMEs) are a growing concern in outpatient care, especially among patients with chronic conditions requiring complex medication regimens. Despite perceived competence, many patients may be at risk of medication mismanagement, leading to adverse outcomes.

Methods: A cross-sectional study was conducted among 237 patients with chronic diseases. The SAME tool, a 10-item validated instrument (Cronbach’s α=0.814), was used to identify self-administration errors and stratify patients into risk categories. Sociodemographic and clinical data, including pill burden and comorbidities, were analyzed for associations with error prevalence.

Results: The prevalence of self-administration medication errors was 31.6%. Forgetting doses (22.4%) was the most frequent error, followed by wrong dose (11.0%) and wrong medication intake (10.1%). Multimorbidity and higher pill burden (≥6 pills/day) were significantly associated with higher error rates (p<0.05), while age and gender showed no significant correlation. Patients were classified as high risk (17.7%), moderate risk (61.2%), and low risk (21.1%) for medication errors.

Conclusions: Self-administration medication errors are common, especially among patients with multiple conditions and complex regimens. The SAME tool is effective for identifying at-risk individuals. Targeted interventions focusing on medication literacy and regimen simplification are crucial to enhance adherence and safety in outpatient care.

Study of clinical profile of acute kidney injury in medical intensive care unit in a tertiary care center: a prospective study

2025-09-30T07:18:33+0530

Background: Acute kidney injury (AKI) is a condition characterized by a sudden decline in renal function, which can lead to long-term complications including chronic kidney disease and increased mortality. In critically ill patients, particularly in intensive care units (ICU), AKI poses a significant health burden. The aim of the study was to evaluate the clinical profile of AKI in the medical ICU of a tertiary care center.

Methods: A prospective observational study was conducted over one year in the MICU of tertiary hospital. The study included 100 patients aged over 18 years, who developed AKI as per the acute kidney injury network (AKIN) criteria. Data on patient demographics, co-morbidities, clinical presentation, etiology, and treatment outcomes were recorded. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26.0.

Results: The majority of patients (62%) were aged between 18-40 years, with a male predominance (64%). Sepsis (30%), snake bites (23%) and drug induced (19%) were the leading causes of AKI. Of the patients, 54% were diagnosed with stage 3 AKI, and 31% required renal replacement therapy (RRT). The mortality rate was 26%, with significant associations found between RRT requirement, hyperkalaemia, metabolic acidosis, and increased mortality.

Conclusion: Sepsis especially pneumonia and snakebite were the predominant etiological factors for AKI. Comorbidities, stage of AKI, RRT, along with complications like hyperkaleamia and metabolic acidosis, are the key predictors of poor outcomes and higher mortality rate. This emphasizes the importance of early detection, effective management strategies and continuous monitoring to reduce mortality and improve patient outcomes in the ICU setting.

Clinicopathological mimics of accessory breast tissue: a case series with cytological and histological correlation

2025-09-30T07:21:00+0530

Axillary swellings in young women present a broad differential diagnosis, from benign developmental anomalies such as accessory breast tissue (ABT) to neoplastic lesions including fibroadenoma and phyllodes tumor. This case series reports eight patients with varied clinical and pathological findings. Six women aged 19–28 years presented with unilateral or bilateral axillary swellings, with initial clinical impressions ranging from lipoma and lymphadenopathy to soft tissue tumors. Fine needle aspiration cytology (FNAC) was performed in all cases, followed by surgical excision and histopathological confirmation in most. Diagnoses included ABT in four patients, lactating adenoma in one, bilateral lipomas in one, benign phyllodes tumor in one and fibroadenoma in one. FNAC aided in narrowing the differential diagnosis, but definitive identification relied on excision and histopathology. Recognition of ABT and its mimickers is important, as these lesions can undergo physiological and pathological changes similar to normal breast tissue and misdiagnosis may lead to unnecessary anxiety or inappropriate management. This series highlights the value of correlating clinical, cytological and histopathological findings to ensure accurate diagnosis and optimal treatment of axillary swellings in young women.

Non-hemorrhagic stroke following venomous snakebite: a case series

2025-09-30T07:18:41+0530

Snakebite envenomation remains a major public health issue in India, causing nearly 50,000 deaths annually. Hemotoxic venoms, particularly from viper bites, are well recognized for inducing coagulopathy and hemorrhagic complications; however, ischemic stroke following envenomation is a rare but important clinical entity. We present a case series of three patients who developed non-hemorrhagic ischemic strokes after Russell’s viper bites. All three had evidence of systemic envenomation with prolonged clotting times and received prompt treatment with anti-snake venom and fresh frozen plasma. Despite correction of coagulopathy, each developed focal neurological deficits. Neuroimaging revealed acute infarcts: right corona radiata infarct in Case 1, left middle cerebral artery territory infarction in Case 2, and multiple embolic infarcts in Case 3. All patients were managed with antiplatelet therapy, neuroprotective agents, and supportive care, with gradual neurological improvement. This series highlights that neurological deterioration after snakebite is not always attributable to neurotoxic effects or intracranial hemorrhage and should prompt evaluation for ischemic stroke. Early recognition, timely neuroimaging, and institution of stroke-specific management are critical in improving outcomes. Clinicians should maintain a high index of suspicion for ischemic stroke in snakebite victims presenting with new-onset focal deficits, as prompt intervention may prevent long-term morbidity and disability.

Knee deep in innovation: advancing osteoarthritis therapy through regenerative medicine and precision interventions

2025-09-30T07:19:49+0530

Knee osteoarthritis (KOA) is a complex, heterogeneous illness that includes abnormal joint remodelling, chronic inflammation, mechanical strain, and metabolic dysregulation. It is not just a disease of cartilage loss. Its increasing prevalence highlights the critical need for disease-modifying approaches beyond palliation, particularly in older and obese individuals.

Exploring the role of DeepSeek artificial intelligence in patient education and diagnosis for chronic kidney disease: promise and precautions

2025-09-30T07:19:47+0530

The integration of artificial intelligence (AI) into healthcare is revolutionizing how patients access medical information.

Meningeal abnormalities: a radiologist's guide to comprehensive imaging and differential diagnosis

2025-09-10T07:02:14+0530

Meningeal abnormalities encompass a wide spectrum of pathological conditions affecting the protective layers of the central nervous system the dura mater, arachnoid mater, and pia mater. These abnormalities may arise from infectious, neoplastic, inflammatory, traumatic, or post-surgical origins and often present with non-specific clinical symptoms such as headache, seizures, or altered mental status. As such, neuroimaging plays a pivotal role in their evaluation, providing critical information for accurate diagnosis and effective management. This article serves as a comprehensive guide for radiologists, offering a structured approach to the imaging and differential diagnosis of meningeal diseases. It begins with a review of the normal meningeal anatomy, including recent discoveries about the glymphatic system and the fourth meningeal layer, and proceeds to detail the utility of key imaging modalities, particularly magnetic resonance imaging (MRI) and computed tomography (CT), in assessing meningeal pathology. Emphasis is placed on distinguishing between pachymeningeal and leptomeningeal involvement based on enhancement patterns, as well as identifying hallmark imaging signs such as dural thickening, nodular lesions, and enhancement distribution. Common and rare disease entities including meningitis, meningioma, dural metastases, neurosarcoidosis, and carcinomatous meningitis are explored through detailed imaging features and differential considerations. The article also highlights advanced techniques including contrast-enhanced 3D FLAIR, dynamic contrast-enhanced MRI, and emerging applications of artificial intelligence in meningeal evaluation. Through illustrative case examples and a systematic diagnostic framework based on current evidence, this guide aims to enhance radiologists' diagnostic accuracy and clinical confidence, ultimately contributing to more timely and informed management of patients with meningeal abnormalities.

Gut microbiota changes and its potential relations with thyroid disorders

2025-09-30T07:23:00+0530

The human intestinal flora is composed of more than 1200 species of anaerobic and aerobic bacteria, along with bacteriophages, viruses and fungi, essential for several processes including digestive and non-digestive, being of vital importance for health, including digestive balance and immunological, hormonal and metabolic homeostasis. Micronutrients, generally trace elements (copper, iodine, iron, selenium, zinc) and vitamins (A, C, D and E), interact with the bacterial flora to generate an adequate immunological metabolism of the host. Multiple studies on the functioning of the gut microbiota (GM) have revealed an association between microbiota alterations and various pathological disorders, such as encephalitis due to antibodies against the N-methyl-D-aspartate receptor (NMDAR), anxiety, depression, early-onset cancer, type 1 diabetes, and type 2 diabetes. According to recent studies, the thyroid microbiota (TM) could play a fundamental role in the triggering of thyroid gland diseases, among which autoimmune diseases play an important role. Not only environmental triggers and predisposing genetic background cause autoaggressive damage, which affects the cellular and humoral networks of the immune system, but the GM interacts with distant organs through signals that may be part of the bacteria themselves or their metabolites. The objective of this review is to describe the current knowledge about the microbiota in the metabolism of thyroid hormones and the pathogenesis of thyroid diseases, as well as its participation in the appearance of benign nodules. and papillary cancer.

Dystrophic epidermolysis bullosa: a comprehensive review of therapeutic strategies and the role of skin grafting in wound management and tissue regeneration

2025-09-30T07:20:01+0530

Dystrophic epidermolysis bullosa (DEB) is a severe inherited disorder caused by COL7A1 mutations, leading to deficient type VII collagen (COL7), chronic wounds, and fibrosis. Skin grafting-autologous, allogeneic, or bioengineered-offers potential for wound stabilization. This review evaluates grafting efficacy, limitations, and future directions. A systematic literature analysis (PubMed, Embase, Cochrane) highlighted clinical trials and mechanistic studies. Autologous grafts reduce wound burden but face donor-site fragility; allogeneic grafts provide temporary coverage but risk rejection. Bioengineered substitutes (e.g., gene-corrected autografts) show promise for COL7A1 restoration. While grafting remains palliative, gene-edited (e.g., CRISPR-Cas9) and tissue-engineered approaches may transform DEB care, necessitating multicenter trials for protocol standardization.

Links between vitamin D receptor gene polymorphisms and coronary artery disease: a review of evidence

2025-09-30T07:18:44+0530

Vitamin D receptor (VDR) serves as a nuclear receptor, playing a significant role in mediating the physiological effects of vitamin D through the regulation of gene expression. Polymorphisms in the VDR gene have the potential impact on receptor activity through modifications in gene transcription, mRNA stability and protein function. Within the extensive array of single-nucleotide polymorphisms (SNPs) identified in the VDR gene, which exceeds 470, four specific variants have captured significant scientific attention: FokI (rs2228570), ApaI (rs7975232), BsmI (rs1544410) and TaqI (rs731236). The examination of these polymorphisms has been conducted within the framework of various diseases, such as malignancies, diabetes mellitus, myocardial infarction and coronary artery disease (CAD). Numerous studies indicate a possible links between these genetic variants and an increased risk of developing CAD; however, discrepancies in findings across various populations and research methodologies persist. This review will thoroughly overview the existing literature regarding the links between VDR polymorphisms and CAD.

Effects of probiotics on neurodegenerative diseases

2025-09-30T07:18:36+0530

Neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis, represent a growing public health challenge due to their high prevalence and the lack of curative therapies. In this context, research on the gut–brain axis has highlighted the crucial role of the intestinal microbiota in modulating neurological processes and in the pathophysiology of these disorders. Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer health benefits to the host, have shown potential neuroprotective effects. Preclinical and clinical studies have demonstrated that probiotics may modulate neuroinflammation, reduce oxidative stress, improve blood–brain barrier integrity, and regulate the production of neurotransmitters such as serotonin, GABA, and dopamine. In Parkinson’s disease, the administration of Lactobacillus and Bifidobacterium strains has been associated with improvements in gastrointestinal symptoms and reductions in systemic inflammatory markers. In Alzheimer’s disease, probiotic supplementation has been linked to benefits in cognitive parameters and decreases in inflammatory biomarkers. Likewise, in multiple sclerosis models, probiotics appear to modulate immune responses by promoting an anti-inflammatory profile. Although current findings are promising, the heterogeneity of probiotic strains, variability in study designs, and the limited number of controlled clinical trials highlight the need for further research to establish standardized protocols. Incorporating probiotic-based therapies may represent a complementary approach in the prevention and management of neurodegenerative diseases within the framework of personalized and interdisciplinary medicine.

The evolving role of nurses in extracorporeal membrane oxygenation therapy

2025-09-30T07:18:25+0530

Nurses managing extracorporeal membrane oxygenation (ECMO) have shifted from operating under a perfusionist-led framework to assuming full responsibility for ECMO care. This transition reflects a growing demand for sustainable, team-based ECMO delivery models. To review the evolving role of nurses in ECMO therapy, with emphasis on clinical responsibilities, education, training and leadership, this narrative review synthesizes findings from original studies and program evaluations describing nurse-led ECMO models, nursing competencies and educational initiatives. Nurses now monitor circuits, adjust settings, manage anticoagulation and lead emergency responses. Structured training programs, simulation exercises and competency validation have facilitated this role expansion. Studies report improved ECMO capacity, patient safety and program efficiency. Nurse-led ECMO models enhance resource use, team integration and care quality. Investment in training and interprofessional collaboration is vital for sustaining and expanding nursing roles in ECMO programs.

Rising gastrointestinal malignancies in North India: a comprehensive review

2025-09-18T06:53:59+0530

Gastrointestinal (GI) malignancies, including cancers of the esophagus, stomach, colorectal region, gallbladder and liver, pose a significant public health challenge in North India, with rising incidence driven by unique regional factors. This comprehensive review synthesizes current literature to analyze the epidemiology, risk factors, clinical characteristics and management challenges of GI cancers in North India. Esophageal cancer, predominantly squamous cell carcinoma, exhibits high incidence in areas like Mizoram, while gastric cancer is prevalent in the Kashmir Valley. Colorectal cancer is increasing due to urbanization and lifestyle changes and gallbladder cancer is a major concern in the Ganges River belt. Liver cancer, primarily hepatocellular carcinoma, is linked to chronic hepatitis infections. Key risk factors include dietary habits (e.g., smoked meats, high-fat diets), tobacco use, Helicobacter pylori infection, hepatitis B and C and environmental carcinogens. Advanced-stage diagnosis, limited access to diagnostic tools and inadequate region-specific research hinder effective management. Preventive strategies, such as H. pylori eradication, hepatitis B vaccination and lifestyle modifications, alongside enhanced screening and genomic research, are critical for reducing the burden. This review underscores the need for collaborative efforts to improve early detection, treatment access and region-specific guidelines to address this growing epidemic.

Chronic myeloid leukemia from pathophysiology to treatment-free remission: new perspectives

2025-09-30T07:18:35+0530

Chronic myeloid leukemia (CML) is one of the most common leukaemia’s occurring in the adult population. The course of CML is divided into three phases: the chronic phase, the acceleration phase and the blast phase. CML is a chronic myeloproliferative neoplasm characterized by the presence of the chimeric BCR-ABL1 gene, resulting from the chromosomal translocation t (9;22) (q34;q11), which encodes a constitutively active tyrosine kinase. The advent of tyrosine kinase inhibitors (TKIs) has revolutionized the management of CML, significantly improving patient survival and quality of life. Recent studies have shown that a subgroup of patients can maintain deep remission even after treatment discontinuation, a phenomenon known as treatment-free remission (TFR) . This narrative review synthesizes the current evidence on the pathophysiology of CML, therapeutic advances with TKIs and the clinical and prognostic criteria associated with TFR, providing an integrated view that can guide clinical practice and future research.

Causes, prevalence and treatment of myopia: a review

2025-09-30T07:23:11+0530

The aim of this work is to investigate the causes, prevention strategies, and prevalence of myopia, a common refractive error increasingly recognized as a global public health concern. A comprehensive literature review was conducted using major academic databases, including PubMed, Google scholar, and Web of Science, with selected keywords to identify relevant studies on myopia’s etiology, prevention, and treatment. Evidence indicates that myopia arises from an interplay of genetic predisposition and environmental influences. Individuals with a family history of myopia are at higher risk; however, lifestyle factors, particularly prolonged near work and limited outdoor activity, significantly contribute to onset and progression. The prevalence of myopia varies widely across regions, with rapid increases noted in many parts of the world, especially in urbanized settings. Preventive strategies, such as encouraging outdoor time for children and limiting excessive near work or screen use, have shown promise in reducing risk. For individuals with established myopia, several management options exist, including orthokeratology (ortho-k) lenses, multifocal contact lenses, and other optical interventions, which aim to slow disease progression. Addressing myopia requires both public health initiatives to promote preventive lifestyle changes and early clinical interventions to manage its impact. By understanding its multifactorial causes and employing evidence-based prevention and control strategies, it is possible to mitigate the growing burden of myopia and preserve long-term visual health.

Inflamed and unrewarded: a narrative review exploring neuroinflammation and its impact on the brain’s reward mechanisms

2025-09-30T07:22:41+0530

Depression is associated with dysfunction in the brain’s reward system, contributing to symptoms like anhedonia. Emerging evidence suggests that neuroinflammation plays a key role in disrupting dopaminergic pathways. This review explores how pro-inflammatory cytokines affect reward circuitry and assesses the potential of anti-inflammatory treatments. A narrative review was conducted using studies from 2000 to 2025. Databases searched included PubMed and Google Scholar. Keywords focused on depression, neuroinflammation, reward systems, cytokines, and treatment strategies. Studies in adults examining neural and behavioural outcomes were included. Pro-inflammatory cytokines (e.g., IL-6, TNF-α) impair dopamine function and alter connectivity in the mesolimbic pathway. These changes are linked to core depressive symptoms. Anti-inflammatory agents—such as TNF inhibitors, NSAIDs, and probiotics—have shown promise in alleviating symptoms, particularly in patients with high inflammation. Neuroinflammation plays a critical role in the pathophysiology of depression through its detrimental impact on dopaminergic reward pathways. Targeting inflammation presents a promising strategy for treating depression, particularly subtypes characterised by elevated immune activation. Future research should aim for biomarker-driven stratification to optimise individualised therapeutic approaches.

Advances in the understanding and management of immune thrombocytopenia: a review of pathophysiology, risk factors, and treatment strategies

2025-09-30T07:22:38+0530

An autoimmune disease known as immune thrombocytopenia (ITP) in which the immune system destroys platelets and the platelet count drops below 100,000/µl. The pathogenesis of ITP involves peripheral platelet destruction, impaired platelet production, and other mechanisms. Risk factors of ITP include environmental exposures, demographic factors, and genetic predispositions, all contributing to autoimmune responses. Diagnostic tests for ITP include complete blood count for low platelet counts, peripheral blood smear for platelet morphology, advanced autoantibody tests. Bone marrow examination for ruling out hematologic disorders, and spleen tissue analysis to understand platelet destruction and guide treatments. Treatment of ITP includes first-line therapies includes Corticosteroids, Intravenous immunoglobulin, anti-D immunoglobulin, second line therapies includes Rituximab, thrombopoietin receptor agonists, splenectomy and other therapies includes immuno-suppressants, and Fostamatinib. Some studies assessing response criteria in ITP patients. Recent advancement in ITP treatment involves spleen tyrosine kinase inhibitors, Bruton tyrosine kinase inhibitors, plasma cell-targeting agents, complement pathway, neuraminidase, and monoclonal antibodies. Also, in non-coding RNAs, CRISPR-associated protein 9 system, and Chimeric antigen receptor T-cell therapy. Recent research in ITP, animal models, includes in various species, mimic human ITP. This study concludes the understanding of ITP with various mechanisms and its advance therapies and treatment with ongoing latest research.

The gut-vascular axis in diabetes: exploring impaired blood flow, cardiovascular disease, and peripheral arterial complications

2025-09-30T07:22:30+0530

The gut-vascular axis-a dynamic, bidirectional interface between the gut microbiota and vascular system-has emerged as a pivotal regulator of metabolic homeostasis and cardiovascular health, especially in the context of type 2 diabetes mellitus (T2DM). This comprehensive review delineates how microbial dysbiosis, compromised intestinal barrier function, and microbial metabolite imbalances contribute to chronic inflammation, endothelial dysfunction, and vascular complications such as atherosclerosis, coronary artery disease (CAD), and peripheral arterial disease (PAD). Key microbial metabolites such as short-chain fatty acids (SCFAs), trimethylamine-N-oxide (TMAO), and secondary bile acids influence insulin resistance and vascular remodeling. The manuscript also highlights the indirect modulatory roles of SGLT2 inhibitors and GLP-1 receptor agonists on gut microbial dynamics and vascular integrity. Current evidence underscores significant inter-individual variability in microbiota profiles, necessitating personalized therapeutic strategies. Despite compelling preclinical data, translational research in human cohorts remains limited. The review further explores cutting-edge microbiome-based therapeutic strategies, including probiotics, fecal microbiota transplantation (FMT), and engineered microbial therapeutics, while identifying critical research gaps in the development of microbiota-targeted interventions for diabetic vascular disease. Overall, the gut-vascular axis is positioned as a promising frontier in precision medicine for metabolic and cardiovascular complications in diabetes.

Nursing approach to myocardial infarction

2025-09-30T07:20:59+0530

Myocardial infarction (MI) is still a primary cause of death and disability globally, needing early, professional, and comprehensive healthcare measures. Nurses have an important role in all phases of MI treatment, from emergency response and acute clinical management to rehabilitation, education, and long-term follow-up. This study focuses on nurses' numerous tasks, which include fast evaluation, ECG monitoring, medication administration, emotional support, patient and family education, and multidisciplinary care coordination. Nurses in critical care settings help to prevent problems while also contributing considerably to quality improvement and evidence-based procedures. Nurse-led cardiac rehabilitation and follow-up clinics have shown improved outcomes and decreased recurrence. Furthermore, nurses promote patient autonomy, make ethical decisions, and participate in cardiovascular research. Addressing issues including intense workload, fatigue, and patient nonadherence is critical to improving nursing care. Following a MI, a thorough, patient-centered, and evidence-informed nursing strategy is required to improve survival, improve rehabilitation, and promote lifestyle modification.

Scar management in pediatric patients: a current review

2025-09-30T07:18:34+0530

Pediatric patients are particularly vulnerable to trauma and surgical interventions, both of which frequently result in cutaneous scarring. Although the complete prevention of injuries is not feasible, scar formation and long-term sequelae can be mitigated through evidence-based interventions. Current literature highlights that optimal scar management begins intraoperatively, with meticulous attention to reducing wound tension by aligning incisions along relaxed skin tension lines and achieving early closure under minimal stress. Postoperative strategies should be initiated within 2 to 3 weeks following wound closure and typically involve the use of silicone-based therapies (gels or sheeting) in combination with manual scar massage. Nevertheless, emerging evidence indicates that topical modalities alone may be insufficient in cases of erythematous or immature hypertrophic scars, where laser therapy has demonstrated superior outcomes. Pathological scar evolution—including atrophic scars, post-inflammatory hyperpigmentation, hypertrophic scars, and keloids—necessitates multimodal therapeutic approaches tailored to scar phenotype. For instance, atrophic scars may benefit from retinoid application and dermabrasion, whereas hyperpigmented lesions respond more favorably to retinoids, hydroquinone, and selective laser therapies. Hypertrophic scars and keloids require more intensive protocols, incorporating pressure therapy, intralesional corticosteroids, and laser-based interventions. In cases where pathological scarring persists beyond 12 months despite conservative and adjunctive therapies, surgical excision remains an appropriate intervention. Importantly, current evidence supports a stepwise, algorithmic approach to pediatric scar management, integrating preventive strategies, topical and device-based therapies, and surgical revision as clinically indicated.

Global prevalence and etio-pathogenesis of autism: a review

2025-09-30T07:18:33+0530

Autism spectrum disorder (ASD) is a complicated neurobehavioral disorder, characterized by lack of social communication, presence of restricted and repetitive behaviors and lack of verbal development. The condition is believed to stem from cerebral malfunctioning resulting from a complex interplay of environmental, genetic and epigenetic variables. The level and number of symptoms vary from individual to individual and hence the clinical findings cannot be generalized. Prevalence of ASD has risen over the years which is possibly due to increased diagnosis, reporting and awareness. Autistic individuals are observed to have certain physiological challenges as abnormalities in the gut-brain axis with a focus on gut dysbiosis. This current review was prepared using PubMed, Google Scholar and other sources. It presents data on the primary streams about the etio-pathogenesis and global prevalence of ASD. However, it is observed that there is no specific cure for ASD. Timely intervention results in significant enhancements in social communication abilities, cognitive and adaptive functions.

Rising trend of oral cancers in India: a comprehensive review

2025-09-18T06:53:58+0530

Oral cancer, encompassing malignancies of the lip, tongue, buccal mucosa and oropharynx, is a major public health concern in India, accounting for approximately one-third of the global burden with 77,000 new cases and 52,000 deaths annually. This comprehensive review examines the rising trend of oral cancers in India, focusing on epidemiology, risk factors, clinical characteristics, diagnostic challenges, management strategies and preventive approaches. The age-standardized incidence rate is 10.4 per 100,000, with higher prevalence among men and in regions like Uttar Pradesh, Bihar and the north eastern states. Key risk factors include tobacco use (smoked and smokeless), betel quid chewing, alcohol consumption, HPV infection and genetic predispositions, with squamous cell carcinoma dominating (>90% of cases). Advanced-stage diagnosis, limited access to screening and advanced diagnostics and reliance on Western treatment protocols contribute to poor outcomes. Preventive strategies, such as tobacco cessation, HPV vaccination and community-based screening, show promise in reducing incidence. This review emphasizes the need for region-specific research, affordable diagnostics and enhanced healthcare infrastructure to address the growing burden of oral cancers in India.

The usefulness of various subjective and objective measures of circadian phase in sleep medicine diagnostics

2025-09-30T07:19:50+0530

Circadian rhythm sleep disorders (CRSDs)can be difficult to diagnose as they usually present with a wide array of complaints ranging from insomnia to excessive sleepiness or impairment in the quality of life. Malalignment of the endogenous circadian clock to the external day-night cycle leads to these disorders. There are various subjective and objective methods for assessing these disorders. Both individual subjective and objective measures of circadian phase have their own merits and limitations and a combination of both- especially sleep logs and questionnaires along with actigraphy usually suffice for diagnosing most cases. Dim light melatonin onset (DLMO) and core body temperature (CBT) minimum are also very useful in some cases. Recent advances in the knowledge of neurobiology and genetics of the circadian rhythm should hopefully lead us to improved diagnostic tools and provide us with evidence base practical guidelines for diagnosis and treatment of CRSDs.

Circadian Rhythm Sleep Disorders (CRSDs)can be difficult to diagnose as they usually present with a wide array of complaints ranging from insomnia to excessive sleepiness or impairment in the quality of life. Malalignment of the endogenous circadian clock to the external day-night cycle leads to these disorders. There are various subjective and objective methods for assessing these disorders. Both individual subjective and objective measures of circadian phase have their own merits and limitations and a combination of both- especially sleep logs and questionnaires along with actigraphy usually suffice for diagnosing most cases. Dim light melatonin onset(DLMO) and Core body temperature(CBT)minimum are also very useful in some cases. Recent advances in the knowledge of neurobiology and genetics of the circadian rhythm should hopefully lead us to improved diagnostic tools and provide us with evidence base practical guidelines for diagnosis and treatment of CRSDs.

Fungal pseudoaneurysm in pediatric patients: presentation of two cases

2025-09-20T07:38:33+0530

Pseudoaneurysms are a rare and serious complication of infective endocarditis (IE), especially in patients with previous cardiac surgery. They can lead to serious complications, such as rupture, compression of cardiac structures or fistulization. The incidence is not exact, although it is known that certain congenital heart defects and surgical procedures can increase the risk of developing it. We present the cases of two patients who underwent surgery for the treatment of their congenital heart disease, presenting as a complication the development of infectious pseudoaneurysm: the first is a 2-year-old female patient, with a diagnosis of tetralogy of fallot, who underwent surgical correction at 22 months of age; 4 months after correction, he went to our hospital where a transesophageal echocardiogram showed loss of continuity at the level of the right sinus of Valsalva secondary to a 46×44 mm pseudoaneurysm, which generated obstruction of the outflow tract of the right ventricle, so it was decided to undergo the Bentall bono procedure. The second case is a 12-year-old female patient with a diagnosis of pulmonary atresia with ventricular septal defect (VSD), a rastelli procedure was performed at 12 months, presenting with fever, cough in fits and a pulsatile mass of 6×7 cm in the upper third of the wound wound. A transthoracic echocardiogram was performed, observing loss of continuity at the level of the pulmonary artery secondary to a 60×75 mm pseudoaneurysm, which causes dynamic obstruction at the level of LVST. Complete resection of the pseudoaneurysm capsule was performed, a bovine pericardium patch (Peri-Guard) was placed, and a mediastinal cavity was cleaned, and due to high suspicion of mediastinitis, it was decided to submit to the Molina protocol.

An unusual presentation of inverted papilloma in the nasopharynx

2025-09-30T07:20:57+0530

Inverted papilloma is a benign epithelial ingrowth into the underlying stroma of the nasal cavity and paranasal sinuses. Even though inverted papilloma is a common lesion within the nasal cavity, it rarely presents primarily in the nasopharynx. This patient presented with clinical features of a nasopharyngeal mass, which on imaging of nose and paranasal sinuses revealed a well-defined polypoidal soft tissue density lesion seen arising from the posterolateral wall of nasopharynx. Total surgical excision of the mass was done and histopathological examination was indicative of inverted papilloma with features suggestive of carcinoma in situ. The importance of early identification of this lesion lies in the fact that the tumor is well known for its invasiveness, tendency to recur and association with malignancy. Hence this requires close surveillance and regular follow up with endoscopy and imaging. This case is rare of its type due to its unusual presentation as an isolated nasopharyngeal mass without extension to nasal cavity.

Facial reconstruction following basal cell carcinoma: repair using a paramedian forehead flap-a case report

2025-09-30T07:23:06+0530

Basal cell carcinoma (BCC) is the most common malignant cutaneous neoplasm, primarily affecting sun-exposed areas, with the nasal region being one of the most frequently involved sites. Here this report presents the case of a 68-year-old male presenting with an ulcerated lesion on the nasal tip, clinically consistent with nodular ulcerative BCC. A wide local excision was performed, and intraoperative frozen section analysis confirmed tumor-free margins. Reconstruction of the resulting full-thickness nasal defect was accomplished using a two-stage interpolated paramedian forehead flap. The postoperative course was uneventful, yielding an outcome that was both aesthetically satisfactory and functionally robust, with no evidence of recurrence during short-term follow-up. This case highlights the importance of meticulous oncologic resection and tailored reconstructive planning in managing complex nasal defects caused by skin cancer.

Breast reconstruction after radical mastectomy for giant phyllodes tumor: a case report

2025-09-30T07:19:58+0530

We present the case of a 40-year-old woman with a giant phyllodes tumor in the left breast, detected after breastfeeding and progressively growing over two years. In August 2023, a biopsy confirmed the diagnosis, and in March 2024, a radical mastectomy was scheduled, as negative surgical margins could not be guaranteed with a conservative approach. The initial intervention included vacuum-assisted closure (VAC) therapy to manage infection risk and prepare the wound for later reconstruction. Thirty days later, breast reconstruction was performed using a latissimus dorsi flap, which was elevated, dissected, and placed over the thoracic defect. The surgery was completed without complications, and the patient had a satisfactory recovery, being discharged three days postoperatively. At the three-month follow-up, the flap showed good integration and favorable evolution. This case highlights the importance of timely breast reconstruction in patients undergoing radical mastectomy for phyllodes tumors and the effectiveness of the latissimus dorsi flap as a reconstructive option in complex scenarios.

Steroid sensitive nephrotic syndrome as a potential contributor to pediatric-onset psychosis: a case-based hypothesis

2025-09-30T07:19:54+0530

Steroid-sensitive nephrotic syndrome (SSNS) is a type of primary glomerulopathy that results in multiple complications, including edema and hyperlipidemia. Most existing studies indirectly attribute psychiatric manifestations in SSNS to corticosteroid therapy, while its etiological role in neuroinflammation remains rarely discussed. This article aims to explore this association through a unique case report. An investigation of available English-language literature providing insight into pathophysiology of SSNS, neuroinflammation, and psychosis was done. Information collected was reviewed and analysed for quality and relevance. We present a rare case of a 13-year-old male with SSNS, who exhibited escalating oppositional behavior, emotional dysregulation, and aggression, resulting in a parental request for discontinuation of steroids and immunosuppressants. Despite cessation of medication, symptoms progressed to worsening of psychosis with multiple psychiatric hospitalizations, raising concerns for a potential link between SSNS and neuropsychiatric origin. Collateral history revealed discontinuation of immunosuppressant therapy in early childhood, indicating its limited significance in the current presentation. This case elucidates the potential correlation between SSNS and psychosis in pediatric patients from a pathophysiological and neuropsychiatric point of view, necessitating further investigations into its underlying mechanism.

Colon cancer presenting as an abdominal wall abscess: a case report

2025-09-30T07:18:39+0530

Colorectal cancer is one of the most common malignancies worldwide. However, its initial presentation as an abdominal wall abscess is extremely rare, occurring in only 0.3% to 4% of cases. Such atypical presentations may delay diagnosis and treatment, increasing morbidity. We present the case of a 58-year-old male with a history of comorbidities and chronic alcohol use. He developed progressive right flank swelling and localized pain following blunt trauma. Clinical evaluation and contrast-enhanced CT imaging revealed a cecal mass with infiltration into adjacent muscles and a purulent collection. The patient underwent CT-guided drainage followed by open debridement. Colonoscopy and biopsy confirmed adenocarcinoma and a right hemicolectomy with lymphadenectomy was performed. Histopathological analysis revealed a poorly differentiated adenocarcinoma pT4bN1M0, with infiltration into the appendix, ileum and pericolonic tissues, as well as angiolymphatic and perineural invasion. One of 27 lymph nodes was positive for metastasis. Postoperative recovery was uneventful and the patient was referred for adjuvant chemotherapy. Although rare, colorectal cancer should be considered in the differential diagnosis of patients presenting with abdominal wall abscesses, especially when risk factors or systemic symptoms are present. Cross-sectional imaging and colonoscopy are critical for early identification. Timely surgical intervention and oncologic resection with adequate lymphadenectomy significantly improve prognosis. This case highlights the importance of recognizing unusual manifestations of colorectal cancer to avoid delays in diagnosis and optimize patient outcomes.

A case of toxic epidermal necrolysis in a paediatric patient with mycoplasma pneumoniae infection

2025-09-30T07:18:36+0530

Toxic Epidermal Necrolysis (TEN) is a rare, life-endangering emergency condition with a high mortality rate. While medications are recognized as common trigger factors, infections like Mycoplasma pneumoniae are also increasingly being recognized as other potential triggers, particularly in the paediatric population. A 6-year-old boy presented with fever, sore throat and tender skin lesions that rapidly progressed from erythema, macular rash to multiple vesicles, flaccid bullae and erosion, affecting more than 70% of total body surface area. Epidermal necrolysis affects more than 30% of the total body surface area including genital, oral and conjunctival mucus membranes. A diagnosis of Toxic Epidermal Necrolysis was established. Laboratory tests confirmed Mycoplasma pneumoniae infection and a chest Х-ray revealed pneumonia. For management of TEN, IVIG, followed by Methylprednisolone pulses were in combination. This was combined with antibacterial therapy and supportive care. The patient made a complete recovery with no complications after 36 days under Intensive Care. This case underscores Mycoplasma pneumoniae as a paediatric TEN trigger. It also serves to highlight the efficacy of combined immunotherapy and multidisciplinary care and the importance of early intervention in minimizing complications, especially in such severe cases.

Abdominal sepsis due to rupture of a giant pancreatic pseudocyst: a life-threatening complication

2025-09-30T07:19:57+0530

Giant pancreatic pseudocysts (>10 cm) are uncommon sequelae of severe pancreatitis and are associated with a higher risk of complications, including infection, hemorrhage, and, rarely, spontaneous rupture. This latter complication is life-threatening and requires urgent diagnosis and intervention. Although endoscopic approaches have become standard in stable patients, the role of surgical management remains pivotal in critically ill individuals. We report the case of a 22-year-old female with a history of severe acute pancreatitis and a previously drained pancreatic pseudocyst who presented with clinical signs of sepsis and acute peritonitis. Imaging revealed rupture of a large infected pseudocyst into the lesser sac with associated intra-abdominal collections. Emergency exploratory laparotomy was performed, followed by transgastric drainage and open cystogastrostomy. A comprehensive review of the current literature on diagnosis and management strategies for ruptured pseudocysts was also conducted. Intraoperative findings confirmed the presence of purulent intra-abdominal collections secondary to rupture of the giant pseudocyst. Approximately 450 ml of infected fluid was drained, and a cystogastrostomy was successfully created. The patient’s postoperative course was favorable, with resolution of sepsis, gradual recovery of gastrointestinal function, and discharge with complete clinical improvement. The review highlights the importance of early imaging-based diagnosis and the selection of appropriate intervention based on clinical severity. Spontaneous rupture of giant pancreatic pseudocysts is a rare but life-threatening event that necessitates high clinical suspicion and prompt surgical management, particularly in unstable patients. While minimally invasive techniques are first-line for selected cases, open surgical drainage remains essential for effective source control in critical scenarios. This case contributes to the limited literature on surgical resolution of ruptured pseudocysts and underscores the importance of individualized, multidisciplinary approaches in optimizing outcomes.

Navigating the storm: a young woman’s battle with refractory lupus nephritis complicated by pulmonary tuberculosis: a detailed case report

2025-09-20T07:38:34+0530

Systemic lupus erythematosus (SLE) is an autoimmune disease that is commonly treated with high dose of corticosteroids and other immunosuppressive medications. Patients with SLE are thus more likely to become infected with a variety of pathogens, including Mycobacterium tuberculosis. There are no established guidelines for treatment of tuberculosis in SLE patients with high disease activity due to a lack of relevant studies and management based on physician expertise. This article presents a case report of a 31 years old female with underlying SLE and refractory lupus nephritis previously treated with IV methylprednisolone pulse therapy and 6 doses of cyclophosphamide and Rituximab presented with Fever, cough with expectoration, pain abdomen and loose stools for a 15 days duration. Mini-BAL CBNAAT detected TB. She was treated with intravenous methylprednisolone and anti-tuberculous therapy, but the result was a fatal outcome.

Influence of proprioceptive neuromuscular facilitation on pulmonary gas exchange in a mechanically ventilated class I obese patient with acute respiratory distress syndrome: a case report

2025-09-18T06:53:58+0530

Acute respiratory distress syndrome (ARDS) is a severe and life-threatening condition characterized by impaired oxygen exchange, reduced lung elasticity, and persistent hypoxemia, and although advances in mechanical ventilation have improved outcomes, oxygenation often remains suboptimal, necessitating supportive adjunctive therapies. This case report examined the effects of proprioceptive neuromuscular facilitation (PNF)-based respiratory physiotherapy in a 52-year-old male patient with ARDS associated with class I obesity on mechanical ventilation. Targeted PNF interventions, including anterior basal lifts and intercostal muscle stretching, were delivered over seven days, with oxygen saturation (SpO₂) monitored by pulse oximetry and arterial oxygen pressure (PaO₂) and PaO₂/FiO₂ (P/F) ratio measured through arterial blood gas analysis on the 3^rd, 5^th, and 7^th days of ventilation. Progressive improvements in SpO₂, PaO₂, and P/F ratio were observed, reflecting enhanced pulmonary compliance and better gas exchange efficiency. These findings suggest that PNF-based respiratory physiotherapy may represent a valuable adjunct to conventional ARDS management in mechanically ventilated patients, though further research with larger samples is needed to validate its effectiveness in critical care.

Effectiveness of repetitive transcranial magnetic stimulation on hypomimia induced sialorrhea among Parkinsons: a case study

2025-09-12T07:12:39+0530

Excessive drooling (sialorrhea) in Parkinson’s disease (PD) affects quality of life, often linked to hypomimia. Conventional treatments have limitations, while repetitive transcranial magnetic stimulation (rTMS) shows promise but remains understudied for sialorrhea. A 74-year-old male with PD underwent rTMS and exercise therapy for eight weeks. Pre-treatment scores were 63 in sialorrhea clinical scale for PD and 7 on the Radboud oral motor inventory for PD (ROMP), improving to 48 and 5. Surface electromyography (SEMG) showed increased zygomaticus major activity (10.5 µV to 16.2 µV) and corrugator supercilii (17.3 µV to 22.7 µV), suggesting rTMS may improve sialorrhea and orofacial function in PD.

Beneath the surface: unravelling a frontal epidermoid cyst–a case study

2025-09-30T07:22:59+0530

Epidermoid cysts are rare, benign congenital lesions that account for a small percentage (0.3–1.8%) of primary intracranial tumors. These cysts arise from ectodermal cells that become trapped during the early closure of the neural tube in embryonic development. But their occurrence in the frontal lobe is extremely rare, with about 20 cases reported in literature. A 42-year-old male with a history of hypertension presented with generalized tonic-clonic seizures. magnetic resonance imaging (MRI) of the brain revealed a right frontal lobe lesion with mass effect, characterized as a non-enhancing intra-axial lesion. This imaging led to a preoperative diagnosis of low-grade glioma. The patient underwent a right frontal craniotomy with total microsurgical excision of the lesion and duroplasty under general anesthesia. Histopathological analysis of the lesion confirmed it to be an epidermoid cyst. Intracerebral epidermoid cysts, especially those located in the frontal lobe, are exceedingly rare and pose diagnostic challenges due to their similarity to more common brain lesions such as gliomas. Advanced imaging techniques, particularly diffusion-weighted MRI, are crucial in differentiating these cysts from other intracerebral tumors. Complete surgical resection is the definitive treatment, effectively preventing recurrence. The rarity of frontal lobe epidermoid cysts underscores the importance of thorough diagnostic and surgical strategies in managing this unique case.

Revolutionizing full-mouth rehabilitation: digital integration of Hobo’s philosophy with CAD/CAM multilayered zirconia crowns: a case report

2025-09-30T07:22:53+0530

Severe occlusal wear disrupts function, aesthetics, and occlusal harmony. Hobo’s twin-stage philosophy offers a structured approach to full-mouth rehabilitation. Integrating this with CAD/CAM technology enhances precision and clinical outcomes. A 28-year-old male with generalized tooth wear and compromised function underwent full-mouth rehabilitation. Vertical dimension was increased by 2 mm following occlusal splint evaluation. Hobo’s twin-stage technique was applied using a semi-adjustable articulator. Digital impressions and CAD/CAM workflows facilitated the fabrication of multilayered zirconia crowns.The patient showed excellent adaptation to the increased vertical dimension. Functional occlusion with canine guidance and posterior disclusion was achieved. The final restorations demonstrated precise fit, esthetics, and occlusal stability, with high patient satisfaction. Digital integration of Hobo’s twin-stage protocol with CAD/CAM zirconia restorations offers a predictable, efficient, and esthetically superior solution for managing severe tooth wear.

C3GN associated with deletion in CHFR1 and CHFR3 genes: a case report

2025-09-30T07:22:28+0530

C3GN is a unique abnormality that commonly occurs due to an abnormal alternative path of the complement complex. This is distinguished by precipitation of mainly the C3 factor of complement along with minimal deposit of immunoglobulin in the mesangial, subepithelial, and subendothelial areas of glomeruli. It is seen that most of the mutations that are pathogenic happen in C3, complement factor B (CFB), complement factor H (CFH), complement factor I, along with CFHR5. Some other associations are also found that could lead to this disorder, such as autoantibodies against C3 nephrotic factor, C5 nephritic factor, anti-CFB autoantibodies, along with anti-CHF antibodies. Atypical HUS occurs due to abnormality in different components of the alternate pathway, such as complement factor F, and autoantibodies against anti-CFH caused by CFHR 1 and 3 deletions. Here we narrate a rare occurrence of C3GN related to mutation in CFHR1 and 3 in a young female and her mother who presented to us for renal transplant as prospective recipient with her mother as donor.

Integrative ayurvedic approach in post-ischemic stroke rehabilitation with special reference to Pakshaghata: a case report

2025-09-30T07:21:16+0530

Ischemic stroke, comprising approximately 85% of all strokes globally, is a major cerebrovascular disorder. In Ayurveda, a similar condition is identified as Pakshaghata, categorized under Vatavyadhi. It results from aggravated Vata dosha, which governs motor and sensory functions, invading the shareera dhamani and leading to hemiplegia, speech loss and pain. A 67-year-old male patient, known case of hypertension for 2 years with poor medication adherence, presented with weakness and pain over the right upper and lower limbs, difficulty in walking without support and restricted right upper limb movement since 1½ months. A cerebrovascular accident occurred on 21/04/24 during nocturnal hours, with subsequent right-sided hemiparesis, facial deviation and slurred speech. CT revealed a chronic lacunar infarct in the right corona radiata, while MRI indicated an acute infarct in the left posterior capsulo-ganglionic region. The patient was admitted to the Kayachikitsa IPD on 14/06/24 with spasticity, hemiplegic gait, muscle weakness, exaggerated reflexes and an extensor plantar response. Following 14 days of integrative Ayurvedic treatment, the patient regained the ability to walk without support and raise the right upper limb, reflecting enhanced motor function and quality of life. VAS score reduced from 9 to 0, Ama assessment score dropped from 6 to 0 and NIHSS score improved from 8 to 6 indicating reduced stroke severity. This case demonstrates the potential role of conservative Ayurvedic interventions in post-stroke rehabilitation.

Ayurvedic insights into the early pathogenesis and management of ankylosing spondylitis: a case report

2025-09-30T07:21:09+0530

Ankylosing spondylitis is a chronic seronegative inflammatory arthritis that mainly affects the sacroiliac joints and spine, potentially leading to spinal fusion. Conventional treatments like NSAIDs, DMARDs, and TNF-α inhibitors help manage pain and inflammation but do not provide a cureIn this case 37year old male patient admitted in kayachikitsa inpatient department of vaidyaratnam ayurveda college, ollur on 02/01/24 with pain and restricted movements of neck, swelling with pain on right knee joint and low back ache. He was diagnosed as ankylosing spondylitis (Sandhigata vata) as per Modified New York Criteria for Ankylosing spondylitis (AS) and including the clinical presentation, physical examination, laboratory tests. He underwent treatment protocol of vatavyadhi chikitsa. Ayurvedic preparations like chitrakadi kashayam, maharasnadi kashayam, chandrapraba gulika, vettumaran gulika, shaddharanam choornam were given internally. Dhanyakizhi, lepanam, dhanyamla dhara, abhyangam were given as external therapy. Visual analogue scales for pain, range of movements, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score using ESR (ASDAS-ESR), AMA assessment tool were used to evaluate the effectiveness of the treatment. After the treatment patient got relief of pain, considerable improvement in range of motion of cervical spine, swelling and pain on right knee joint reduced. This case study highlighted that within 2 weeks restricted movements of neck got considerable improvement and ankylosing spondylitis disease activity score using ESR (ASDAS-ESR) decreased significantly by conservative ayurvedic management only.

Central hexadactylia of the foot: a rare case presentation

2025-09-30T07:21:06+0530

Polydactyly is congenital duplication type of anomaly of fingers and toes. Its embryogenesis is associated with a disturbance of the anterior-posterior axial development of the limb. Classified in pre-axial, central and post-axial. Classification depends on location of duplication. Details of the case-3 years old, female. Examination findings were single supernumerary toe over metatarsal bone. Extra toe is inclined to transverse arch of foot. Bony structure of supernumerary digit with Y-shaped bifurcation of second metatarsal bone proximal to head of metatarsal. For right upper limb type IV radial club hand. For Left upper Limb-Wassel Type 5 Radial polydactyly. Foramen ovale L to R shunt was also found in 2D Echo. Central polydactyly is a very rare phenotypic presentation. Patient in our case was operated with excision of the supernumerary digit. On dissection, anomalous tendons were found with digital nerve and artery. Tendons were removed, digital nerve incised and digital arteries coagulated. This case is a rare variety. Extra toe dorsally oriented, metatarsal angulated to transverse arch of foot. No metatarsal widening. This case does not fit into the classifications described.

Effective short term Siddha treatment of filiform warts using Rasaganthi Mezhugu

2025-09-30T07:19:55+0530

Filiform wart is a non-cancerous, contagious and outwardly growing skin lesion caused by the Human Papillomavirus (HPV). It is characterized by slender, finger-like projections from the squamous epithelium, a condition known as papillomatosis. These lesions are most commonly observed on the neck, eyelids, and fingers. If left untreated, filiform warts may spread to other parts of the body. The virus prompts the skin to produce an excess of keratin leading to the formation of long, narrow growths. Conventional treatments for warts include immunotherapy, laser therapy, phytotherapy, and topical medications. However, these methods are often time-consuming, expensive and may require multiple or repeated sessions due to recurrence. Warts may reappear if HPV remains in the surrounding skin. In the Siddha system of medicine, warts are referred to as Marul, classified under Thol Noikal (skin disorders). One effective remedy recommended is Rasagandhi Mezhugu (RGM), traditionally used for treating various skin ailments. A recent case study documented the successful treatment of a 36-year-old male patient with 19 filiform warts on his neck. He was administered 500 mg of RGM internally for 15 consecutive days following the intake of curd rice. No external applications were used. Within two weeks, the hyperkeratinized projections began to shrink, detach and completely disappear. The treatment reported no adverse effects and no recurrence of the warts till date. This case highlights the therapeutic potential of Rasagandhi Mezhugu in managing filiform warts caused by HPV. The outcome demonstrates its efficacy and safety as a natural alternative for wart treatment.

Post-operative rehabilitation following posterior cruciate ligament reconstruction on manual labourer

2025-09-30T07:19:54+0530

Injuries to the posterior cruciate ligament (PCL) are less common than injuries to the anterior cruciate ligament (ACL), but they make the knee much less stable and functional. Post-operative complications such as stiffness, muscle inhibition, and gait dysfunction often require an intensive and structured rehabilitation program. This case study highlights the role of comprehensive physiotherapy following delayed PCL reconstruction and medial meniscus repair. A 32-year-old male was done with imaging after his motorcycle accident, it revealed that a near-complete PCL tear, medial meniscus tear. He underwent arthroscopic PCL reconstruction and meniscus repair followed by 3 months immobilized in a brace at 30-degree flexion. After that the patient came with a complaint of a swelling, reduced range of motion (ROM), muscle wasting, inability to flex or extend his left knee. The patient went through a 12-week rehab program that included manual therapy, electrotherapy (faradic and Russian current), progressive strength training, gait training, and cryotherapy. Significant improvements were recorded over 12 weeks: pain reduced from 8/10 to 2/10 numerical pain rating scale (NPRS), active knee flexion improved from 40° to 128°, extensor lag resolved from 27° to 0°, and IKDC score increased from 40.2%/100% to 85.1%/100%. Muscle strength across the quadriceps, hamstrings, and gluteal muscles also showed notable gains while achieving all the short- and long-term goals. This case illustrates the importance of delayed referral, week-wise rehabilitation, and individualized physiotherapy for optimal recovery following PCL reconstruction. The integration of neuromuscular stimulation, targeted strengthening, and functional re-training proved effective in restoring joint mechanics and return to daily activities. Delayed mobilization and immobilization complications underscore the need for timely, evidence-based rehabilitation protocols.

A rare case of refractory active antibody mediated rejection who had recurrence of immunoglobulin a nephropathy in the form of crescentic glomerulonephritis

2025-09-30T07:19:51+0530

Immunoglobulin A nephropathy is one of the most common recurrent glomerulonephritis after kidney transplantation. Recurrence rate is around 30% at 10 years after transplant. Rarely, rapid deterioration of renal function may occur suggestive of presence of crescents. Presence of donor specific antibodies can predict poor transplant outcomes. Compliance to immunosuppressive medications will prevent development of donor specific antibodies and prolong allograft survival. Authors hereby report a case of refractory active antibody mediated rejection who developed recurrent Immunoglobulin A nephropathy 3 years after renal transplantation.

A rare case of membranous nephropathy with crescent who responded to intravenous cyclophosphamide

2025-09-30T07:19:51+0530

Crescent formation is a rare complication of primary membranous nephropathy. It is a sign of severe glomerular injury and can lead to rapid deterioration of renal function. Primary membranous nephropathy and crescents have a lower remission rate and poor prognosis. Crescentic transformation can be associated with ANCAs or anti-GBM antibodies. Early detection and prompt management reduces the chances of progression to end stage kidney disease. Authors hereby report a case of primary membranous nephropathy with crescent who had negative ANCA and anti-GBM antibodies who responded to cyclophosphamide and achieved stabilization of GFR.

Gq1b IgG-positive myeloradiculoneuropathy with spinal cord demyelination and autonomic dysfunction

2025-09-30T07:18:45+0530

Here, we present a case of a 43-year-old woman who developed acute-onset progressive weakness in both lower limbs, with a distinct sensory level at D3-D4, and bowel/bladder incontinence, demonstrating an unusual overlap of central and peripheral nervous system involvement. Magnetic resonance imaging (MRI) revealed linear hyperintensities from C6 to D3 spinal levels while nerve conduction studies confirmed peripheral demyelination, creating a diagnostic challenge. Serological testing identified strongly positive GQ1b IgG antibodies with equivocal GQ1D reactivity, while comprehensive panels ruled out neuromyelitis optica, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and paraneoplastic aetiologies. The patient showed dramatic improvement following IVIG therapy, supporting an antibody-mediated pathophysiology affecting both spinal cord and peripheral nerves. This case showcases the heterogeneity of presentation of GQ1b-associated disorders by demonstrating its potential to cause concurrent central demyelination and peripheral neuropathy. Our findings underline the importance of considering atypical presentations in anti-ganglioside antibody disorders, where immunotherapy may be effective. This type of presentation of anti GQ1b reactive disease is rarely documented in the existing literature.

Refractory Strongyloides stercoralis hyperinfection syndrome in a chronic alcoholic: a clinical challenge

2025-09-30T07:18:39+0530

Strongyloides stercoralis is an intestinal nematode capable of causing persistent autoinfection, often leading to asymptomatic or mild gastrointestinal illness. However, in immunocompromised individuals, including those with chronic alcohol use and malnutrition, it can escalate into life-threatening hyperinfection syndrome. We report a diagnostically and therapeutically challenging case of a 56 years old male with a history of chronic alcoholism and malnutrition who presented with profuse diarrhea, generalised weakness and pellagrous dermatitis. Stool microscopy confirmed S. stercoralis infection and oral ivermectin therapy was initiated. Despite initial symptomatic improvement, the patient developed progressive respiratory distress, abdominal distension and cardiovascular instability, culminating in multi-organ dysfunction syndrome (MODS) and death. Notably, peripheral eosinophilia-a classic marker of helminthic infection was absent, underscoring the diagnostic complexity in such immunocompromised hosts. This case highlights the critical need for heightened clinical suspicion of Strongyloides hyperinfection in high-risk populations such as chronic alcoholics, even in the absence of eosinophilia. Early diagnosis, aggressive management and consideration of atypical risk factors are essential to improving outcomes in this under recognized, but potentially fatal condition.

Prompt diagnosis and treatment of cutaneous mucormycosis: a challenging complication in post-renal transplant patients

2025-09-30T07:18:38+0530

A 52 years old male cadaveric renal transplant recipient developed cutaneous mucormycosis, presenting with febrile toxicity and a rapidly growing black lesion. Diagnosis was confirmed by biopsy and treatment began with liposomal amphotericin B. Owing to the high mortality associated with mucormycosis, isavuconazole, a non-nephrotoxic antifungal, was added to Amphotericin B. The patient underwent surgical debridement and his condition subsequently stabilized, accompanied by improved renal function. He was discharged on a combination of isavuconazole and other medications, with good wound healing and a creatinine level of 1.6 mg/dl at one-month follow-up. This case highlights prompt diagnosis and treatment and maintenance with isavuconazole as a viable alternative for mucormycosis in transplant patients with renal impairment.

A case of acute necrotising encephalitis in an adult with H1N1 pneumonia

2025-09-30T07:18:35+0530

Acute necrotising encephalitis is a severe and rapidly progressive neurological disorder seen after Respiratory or Gastrointestinal tract viral infections mostly affecting children and very rarely affecting adults with only few case reports published worldwide. Common organisms implicated in the etiology are influenza, Enteroviruses, COVID-19, It was reported in adult patients after influenza and COVID-19 pneumonia. Diagnosis requires a high index of suspicion with clinical and radiological evidence precisely MRI findings with characteric features. Treatment has to be initiated early with high dose steroids and IVIG where indicated because this condition is associated with a very high mortality. ANEC can mimic sepsis with a cytokine storm and hence awareness of this entity is very crucial for early diagnosis and treatment initiation. We report the case of a middle aged man presenting with altered mental status after H1N1 influenza and diagnosed with ANEC based on the characteristic MRI and CSF findings after excluding other causes with biochemical and imaging workup.