International Journal of Research in Medical Sciences

First and second dorsal metacarpal artery free flap in a degloving case

2025-12-31T06:30:49+0530

Digital degloving injuries are uncommon but represent a significant challenge in hand surgery due to the circumferential loss of coverage, bone exposure, and functional compromise. Although multiple reconstructive options have been described, none has become the gold standard, and in many cases the outcome ends in amputation. We report a 55-year-old male patient with a circumferential degloving injury of the left index finger, showing complete bone exposure of the middle and distal phalanges and partial exposure of the proximal phalanx. Surgical management consisted of debridement and resection of necrotic tissue, followed by reconstruction using two synchronous contralateral free Kite flaps to cover the dorsal and volar surfaces, in addition to a full-thickness skin graft to the residual radial wound. Postoperative evolution was satisfactory, with 90% graft integration and complete flap viability. At six months, the donor site exhibited full healing, preserved mobility, intact pinch function, and no residual pain. The synchronous use of double free Kite flaps constitutes an innovative, anatomically faithful, and low-morbidity alternative for managing circumferential digital injuries. This case expands the clinical spectrum of the kite flap and suggests new possibilities for application in complex microsurgical hand reconstruction.

A clinical case of a young patient with post-myocarditis atrial fibrillation and heart failure with reduced ejection fraction

2025-12-31T06:29:41+0530

A clinical observation of a 26-year-old patient with post-myocarditis atrial fibrillation and heart failure (HF) with reduced left ventricular ejection fraction (LVEF) is presented. In February 2025 the patient suffered from acute myocarditis, diagnosed based on magnetic resonance imaging. The outcome was post-myocarditis cardiosclerosis complicated by HF with LVEF 28%, followed by hospitalization in a cardiology hospital. During treatment, quadruple therapy (angiotensin receptor and neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist, sodium-glucose cotransporter type 2 inhibitor) was initiated and sinus rhythm was restored by electrical cardioversion. This therapeutic approach resulted in significant improvements, including a regression of congestive symptoms, a natriuretic peptide level from 2530 to 267 pg/ml, and an increase in LVEF from 28% to 65%. This clinical case highlights the complexity of not only the timely diagnosis of myocarditis but also the treatment of its consequences.

Mature cystic teratoma in a 12-year-old with situs inversus totalis: a case report in a Nigerian teaching hospital

2025-12-31T06:29:36+0530

Mature cystic teratomas are the most common benign ovarian tumors in children, adolescents, usually composed of mature tissues from all three germ layers. Situs inversus totalis (SIT) is a rare congenital condition characterized by complete mirror-image reversal of thoracic and abdominal viscera. Coexistence of these two entities is extremely rare, with only a handful of cases reported worldwide. We describe a 12-year-old girl who presented to the University of Medical Sciences Teaching Hospital, Ondo, Nigeria, with progressive abdominal swelling of eight months’ duration, associated abdominal pain, weight loss, anorexia, and early satiety. Clinical and radiological evaluation revealed a huge heterogeneous ovarian mass with incidental findings of dextrocardia, left-sided liver and gallbladder, and right-sided spleen, consistent with SIT. She underwent exploratory laparotomy which demonstrated a lobulated left ovarian mass measuring 30×28 cm, moderate ascites, and complete visceral reversal. Left oophorectomy was performed. Histopathology confirmed a mature cystic teratoma. Her postoperative recovery was uneventful, and she remained well at follow-up. Mature cystic teratomas are common ovarian tumors in young females, but their association with SIT is exceptionally rare. The reversed anatomy poses diagnostic and surgical challenges, and careful preoperative evaluation is crucial. Complete excision remains the treatment of choice, with an excellent prognosis. This case appears to be the first documented report from Nigeria and contributes to the scarce global literature on this unusual association. This case highlights the importance of considering rare anatomic anomalies in surgical planning and underscores the need for thorough reporting of such cases in sub-Saharan Africa.

From stroke mimic to genetic enigma: diagnostic challenges in neuronal intranuclear inclusion disease associated with FMR1 premutation

2025-12-31T06:30:49+0530

Neuronal intranuclear inclusion disease (NIID) is a rare progressive neurodegenerative disorder characterized by eosinophilic hyaline intranuclear inclusions in neurons, glial cells, and visceral organs. Recently, NIID has been genetically linked to GGC repeat expansion in the 5′-UTR of the NOTCH2NLC gene. Interestingly, overlapping imaging and clinical features have been observed with fragile X-associated tremor/ataxia syndrome (FXTAS), caused by fragile X messenger ribonucleoprotein 1 (FMR1) premutation. A 52-year-old male with long-standing diabetes and hypertension presented with multiple recurrent episodes of transient loss of consciousness over 12 years, mimicking vertebrobasilar transient ischemic attacks. He later developed transient quadriplegia and dysarthria with complete recovery within hours. Initial MRI showed diffusion restriction in the right corona radiata, reported as acute infarct. Repeat MRI and CT angiogram revealed diffusion restriction and FLAIR hyperintensities in the frontoparietal white matter at corticomedullary junctions, corpus callosum, and bilateral middle cerebellar peduncles. Skin biopsy showed intranuclear inclusions in sweat gland cells. Genetic analysis confirmed FMR1 premutation with 99 CGG repeats, establishing the diagnosis of FXTAS with overlapping features of NIID. This case emphasizes the diagnostic challenge in distinguishing NIID from FXTAS, both of which share overlapping clinical and MRI features. Genetic testing for FMR1 mutations should be considered in patients with stroke-like or episodic neurogenic events showing corticomedullary DWI hyperintensities and intranuclear inclusions on biopsy.

Tracing absolute lymphocytosis to T-large granular lymphocytic leukaemia in elderly: a flowcytometry based case report

2025-12-31T06:30:47+0530

T-cell large granular lymphocytic leukaemia (T-LGL leukaemia) is a rare, neoplastic proliferation of cytotoxic T cells, accounting for less than 5% of all chronic lymphoproliferative disease. Diagnosing T-LGLL can be challenging, particularly in distinguishing it from reactive lymphocytosis. Despite its indolent nature, T-LGL leukaemia remains incurable, highlighting the need for improved therapeutic strategies. The TRBC1 flow cytometric assay provides a rapid and reliable means of assessing T-cell clonality in patients with large granular lymphocytosis, facilitating diagnosis through detection of altered proportions of TRBC1⁺ αβ T cells. We report a case of T-LGL leukaemia with an immunophenotypic clonal T-cell, characterised as a CD4-/CD8+ T-cell, TCRαβ subset, exhibiting downregulation of CD5 and CD7, with expression of the NK Cell marker CD16.

Proximal renal tubular acidosis in Sjögren’s syndrome: diagnostic challenge and successful management

2025-12-31T06:30:45+0530

Proximal renal tubular acidosis (RTA) is a rare but important extra-glandular manifestation of Sjögren’s syndrome, often presenting diagnostic challenges due to its overlapping features with other renal and autoimmune disorders. This case report describes a 44-year-old woman with classic sicca symptoms and constitutional complaints including significant weight loss, prolonged fever, chronic cough, and oral dryness. She was found to have proteinuria, elevated creatinine, metabolic acidosis, severe hypocalcaemia, and electrocyte imbalances, markers suggestive of renal involvement. Serological work-up confirmed Sjögren’s syndrome, while detailed laboratory analysis recognized proximal (type 2) RTA accompanied by Fanconi syndrome, based on the detection of proteinuria, hypocalcaemia, hypokalaemia, and vitamin D deficiency. Differential diagnosis initially favoured plasma cell dyscrasias; however, polyclonal rather than monoclonal gammopathy, with a normal kappa-lambda ratio, established the autoimmune etiology. Hospital management included intravenous calcium gluconate, ongoing calcium and vitamin D supplementation, corticosteroids, azathioprine, sodium bicarbonate infusion, and potassium repletion, resulting in rapid symptomatic and metabolic improvement. The case highlights the complexity of distinguishing isolated proximal RTA from Fanconi syndrome and underscores the importance of early recognition and immunosuppressive management to prevent osteomalacia and progressive renal dysfunction. Regional and ethnic variability in RTA types further complicates diagnosis, confirming the need for high clinical suspicion and multidisciplinary evaluation. This report seeks to inform clinicians about the nuances of Sjögren’s-related renal disease and emphasizes individualized therapy tailored to the underlying autoimmune pathophysiology.

A unique perihilar renal vascular variation with fenestrated left renal vein: a case report

2025-12-31T06:29:33+0530

Each kidney is supplied by one renal artery and one renal vein which arises as a lateral branch of abdominal aorta and inferior vena cava respectively between the upper and lower margins of the first and second lumbar vertebrae. Here we report a case of fenestrated left renal vein, retro aortic vein and renal artery variation in a left-sided kidney emphasizing clinical, functional, and embryological perspectives of renal vascular variation. Precise knowledge of renal vascular anatomy and its variations are essential to prevent complications during surgical interventions, especially during kidney transplantation.

Efficacy of intratympanic steroid in the management of sudden sensorineural hearing loss: a prospective clinical study

2025-12-31T06:29:37+0530

Sudden sensorineural hearing loss (SSNHL) is a distressing otologic emergency that requires prompt management. Systemic corticosteroids have traditionally been the mainstay of treatment; however, concerns regarding systemic side effects and contraindications have led to increasing interest in intratympanic steroid (ITS) therapy. Objectives were to evaluate the efficacy of intratympanic dexamethasone in patients with SSNHL. It was a prospective, nonrandomized multicenter clinical trial. Patients diagnosed with unilateral SSNHL received intratympanic dexamethasone injections and were evaluated using serial pure tone audiometry. Hearing outcomes were assessed by changes in pure tone average (PTA). Clinically significant hearing improvement (>10 dB PTA gain) was observed in 83% of patients. Greater hearing recovery was noted in patients treated earlier after symptom onset. Intratympanic dexamethasone is a safe and effective treatment option for SSNHL and may be considered as a primary treatment modality, particularly when initiated early.

Microbial photoinactivation by blue light: advances and therapeutic perspectives in infections caused by multidrug-resistant pathogens

2025-12-31T06:29:40+0530

Blue light (400–470 nm) is emerging as a promising alternative to address the growing threat of antimicrobial resistance. Microbial inactivation by blue light is based on the production of reactive oxygen species (ROS), which are light-induced and mediated by photosensitizers, resulting in the destruction of microbial cells. The microbicidal efficacy of blue light against diverse pathogens has been demonstrated in in vitro and preclinical studies, achieving reductions in cell viability greater than 3 log₁₀ in multidrug-resistant bacteria. Furthermore, blue light has been reported to be harmless to host cells, which has spurred the development of clinical treatments, as well as protocols for food preservation and environmental disinfection. However, variability in parameters such as wavelength, dose, and endogenous chromophores limits standardization for clinical use. Therefore, future research will need to focus on optimizing its use in clinical practice, considering not only the effect on microorganisms but also on the exposed tissue. This review presents an up-to-date analysis of the mechanisms of action, experimental evidence, and clinical applications of blue light, emphasizing its potential as an alternative or adjunctive therapy in controlling infections caused by multidrug-resistant pathogens.

Clinical adverse events following COVID-19 vaccination: a scoping review of observational studies

2025-12-31T06:29:30+0530

COVID-19 vaccination has been a central strategy to reduce severe disease and death during the pandemic. Although clinical trials demonstrated favorable safety profiles, real-world monitoring remains necessary to understand adverse reactions across diverse populations. Continuous post-authorization surveillance is essential to address concerns regarding vaccine safety and hesitancy. Objective of this study was to summarize observational evidence describing adverse reactions associated with COVID-19 vaccines in routine clinical and community environments. A scoping review was conducted following a structured methodological approach, including observational studies that evaluated post-vaccination adverse reactions. Eligible designs comprised cohort, registry-based and cross-sectional studies. Main outcomes included frequency, type, onset, severity and functional impact of adverse reactions. Eleven observational studies were included. The vaccines most frequently evaluated were Pfizer-BioNTech, Oxford-AstraZeneca, Moderna and Sinopharm. The most common reactions were local symptoms at the injection site, such as pain, tenderness and swelling, followed by systemic manifestations including fever, fatigue, headache, myalgia and chills. Most reactions appeared within the first 24 to 48 hours after vaccination, were mild or moderate in intensity and resolved spontaneously without medical intervention. Serious adverse events and fatal outcomes were uncommon, although isolated cardiovascular, neurological and allergic reactions were reported. Evidence from observational studies indicates that COVID-19 vaccines have a favorable real-world safety profile. Adverse reactions are predominantly mild, temporary and non-disabling. Continued transparent communication and post-marketing surveillance are necessary to maintain public confidence and ensure equitable uptake, particularly within vulnerable and underserved populations.

Current practices in influenza management and barriers to influenza vaccination in Nepal

2025-12-31T06:30:54+0530

Influenza is a viral infection affecting the respiratory tract, resulting in substantial morbidity and mortality. This review article explores the current practices in influenza management and the barriers to vaccination in Nepal. Influenza-associated respiratory deaths account for approximately 2% of all respiratory deaths globally, with higher mortality rates in low to middle income countries (LMICs) like Nepal. Vaccination remains the most effective preventive measure, yet Nepal lacks a formal seasonal influenza vaccination policy, with vaccines available only in the private sector. Current practices emphasize early diagnosis and antiviral treatment within 48 hours of symptom onset, though delayed diagnosis and poor adherence to treatment guidelines are common in Nepal. The article also discusses the vulnerability of specific populations, including children, pregnant women, individuals with chronic medical conditions, the elderly, and healthcare workers. It underscores the need for improved vaccination coverage and policy changes to reduce influenza-related morbidity and mortality in Nepal. Despite the availability of vaccines, certain barriers limit access to vaccination especially in LMICs like Nepal despite established cost effectiveness of influenza vaccination. Targeted vaccination campaigns and public health education are essential to increase awareness and acceptance.

Comparison of echocardiography and chest X-ray for initial diagnosis of heart failure: bibliographic review

2025-12-31T06:30:53+0530

Heart failure is a common pathology that continues to be one of the leading causes of cardiovascular death worldwide. Timely and accurate detection is essential to provide adequate treatment and improve the patient's clinical evolution. This review seeks to analyze the initial diagnostic potential of heart failure between transthoracic echocardiography versus chest X-ray, two tools commonly used in medical practice. For this purpose, studies published between 2000 and 2024 were reviewed, taking sensitivity, specificity, strengths and weaknesses of each diagnostic study as main indicators. The results indicate that transthoracic echocardiography offers a sensitivity between 80-95% and a specificity between 85-98%, whereas chest X-ray presents lower sensitivity data with 59-79% and a specificity close to 96%. Although transthoracic echocardiography proves to be more accurate for confirming the diagnosis of heart failure, chest X-ray retains its utility as an initial evaluation method due to its accessibility, speed, and low cost.

Managing irritable bowel syndrome via gut-brain axis modulation and antispasmodic - anxiolytic dual action: an Indian expert panel review

2025-12-27T08:48:10+0530

Irritable bowel syndrome (IBS) is a complex, multifactorial functional gastrointestinal disorder characterized by recurrent abdominal discomfort, altered bowel habits, and a high prevalence of psychological comorbidities, particularly anxiety. In the Indian clinical landscape, IBS remains underdiagnosed, largely due to symptom overlap with other gastrointestinal conditions and the lack of standardized diagnostic protocols. Anxiety significantly contributes to the exacerbation of IBS symptoms, primarily through dysregulation of the gut-brain axis. This manuscript explores the evolving paradigm of IBS diagnosis and management in India, with a particular focus on the therapeutic potential of antispasmodic-anxiolytic combinations. Among these, the fixed-dose combination of clidinium and chlordiazepoxide stands out for its dual mechanism of action, offering both peripheral antispasmodic and central anxiolytic effects. This makes it especially effective in managing IBS cases where psychological stress is a key aggravating factor. Unlike conventional monotherapies, this combination addresses both visceral hypersensitivity and the psychological dimensions of IBS, thereby enhancing symptom control in stress-amplified presentations. The manuscript also explores recent advancements in digital health tools, biomarker discovery, and precision medicine approaches that are reshaping IBS diagnostics and enabling more personalized treatment strategies. Insights from real-world clinical practice and patient profiling underscore the importance of individualized, multimodal management integrating pharmacologic interventions with lifestyle and behavioural therapies.

Optimizing outcomes in anal fissure treatment: Indian expert panel consensus on combination strategies

2025-12-11T06:26:45+0530

Anal fissures, defined as longitudinal tears in the anoderm, are a common cause of severe anorectal pain, especially during defecation. Despite the availability of both pharmacological and surgical treatments, certain challenges persist in effectively managing chronic anal fissures (CAFs). This manuscript reviews the unmet needs in the management of anal fissures like high recurrence rates, side effects from existing treatments, improper application of topical agents and poor compliance. It also presents the recommendations from an expert panel of surgeons from all over India, aimed at addressing these issues. While standard surgical treatment, such as lateral internal sphincterotomy, is highly effective, it carries the risk of side effects, including fecal incontinence, which can significantly impact quality of life. Consequently, chemical sphincterotomy has emerged as a leading non-invasive approach, with topical agents such as diltiazem and lidocaine serving as key components in the management of anal fissures. The experts recommended the combination of diltiazem and lidocaine for its superior efficacy in promoting healing and reducing anal resting pressure, with fewer side effects than agents like nifedipine and glyceryl trinitrate. This combination offers a promising alternative for patients seeking non-surgical management of anal fissures.

Consensus of expert through Indian perspective on the fixed-dose combination dapagliflozin and linagliptin combination in type 2 diabetes mellitus: CONSEPDT study

2025-12-31T06:32:05+0530

Effective management of type 2 diabetes mellitus (T2DM) increasingly demands a shift from a glucose-centric model to a comorbidity-centric approach, particularly in populations with high cardio-renal risk profiles. The fixed-dose combination (FDC) of dapagliflozin, a sodium-glucose co-transporter-2 inhibitor (SGLT2i), and linagliptin, a dipeptidyl peptidase-4 inhibitor (DPP4i), presents a synergistic, safe, and effective treatment option for patients with complex comorbidities. This combination not only improves glycemic control but also offers pleiotropic benefits, such as weight neutrality and reduced risk of hypoglycemia. Despite robust clinical evidence supporting its efficacy and safety, the absence of standardized, region-specific guidelines has led to inconsistent adoption in clinical practice across India. A consensus tailored to Indian clinical settings is necessary to ensure rational, evidence-based, and uniform use of this FDC. Such a framework will assist healthcare providers in making informed decisions, improving adherence, minimizing complications, and ultimately enhancing patient outcomes. The consensus aims to harmonize diabetes management by incorporating global evidence into local clinical practice.

Concept of obesity in Unani medicine: historical perspectives, etiology, pathophysiology and therapeutic approaches

2025-12-31T06:30:54+0530

Obesity is a chronic lifestyle disease caused by unhealthy dietary habits and inadequate exercise, remains a significant public health concern due to its widespread occurrence. This article explained obesity from both the Unani system of medicine and contemporary medical perspectives. The aim of this research is to bring together traditional and modern perspective to comprehensive understanding of obesity. A comprehensive literature review was conducted, to explore the historical context, etiopathogenesis, risk factors, signs, symptoms, complication and management strategies of obesity through the analyzing of authentic text books and manuscripts of Unani and contemporary scientific research. A search was conducted on Google Scholar, Sci Hub, PubMed and Scopus, using keywords such as Obesity, Mizāj, Temperament, Sū’-i-Mizāj, and Farbahi. This review found that imbalanced in diet and physical activity leads to Sū’-i-Mizāj Barid, which is responsible for obesity. The detailed concept of obesity as per both Modern and Unani perspectives have been described. Additionally, the therapeutic measures of obesity with reference to the Unani concept also mentioned that may play a pivotal role in the prevention and management of obesity. Both approaches emphasize the importance of dietary habits, physical activity and other factors related with obesity. By combining traditional and contemporary understandings, potential combinations of methods may provide more thorough and efficient ways for managing obesity. Focusing on natural remedies and lifestyle changes in Unani medicine offers a viable path for future research and treatment strategies.

Irritable bowel syndrome: a multidimensional review of pathophysiology, biomarkers, and tailored interventions

2025-12-31T06:30:51+0530

Irritable bowel syndrome is a chronic, functional gastrointestinal disorder characterized by recurrent abdominal pain and altered bowel habits without identifiable structural or biochemical abnormalities. It significantly impairs quality of life and remains a diagnostic and therapeutic challenge due to its multifactorial pathophysiology and symptom heterogeneity. This review synthesizes evolving evidence on the epidemiology, Rome-IV diagnostic criteria, and pathophysiological mechanisms including visceral hypersensitivity, gut-brain axis dysregulation, microbiota alterations, immune activation, and genetic factors. Special focus is placed on the neurobiology of IBS, highlighting structural and functional brain network changes, neurotransmitter involvement, and microbiota-gut-brain interactions. The manuscript also covers the overlap of IBS with other gastrointestinal and extra intestinal disorders, biomarker innovations, and the clinical value of positive diagnosis over exclusionary practices. A comprehensive, symptom-guided management strategy encompassing pharmacologic therapies, microbial modulation, dietary interventions, and psychological approaches is discussed. A structured approach to IBS begins with a confident diagnosis, followed by identification of underlying mechanisms through symptom assessment and pragmatic testing, and tailored treatment- such as probiotics (e.g. Bifidobacterium) for dysbiosis or antispasmodics (e.g. Mebeverine) for motility and pain, while tracking progress and adjusting therapy toward realistic symptom control goals. This integrative model underscores the necessity of personalized treatment to improve outcomes and patient satisfaction.

Anatomical diversity of brachial plexus with embryological and clinical perspectives: a review

2025-12-31T06:30:50+0530

The brachial plexus (BP) is the main neural source for the upper limb, and its anatomical variations are highly significant in clinical practice. It is a complex network of nerves that plays a crucial role in providing motor and sensory innervation to the upper limb. The clinical importance of the brachial plexus makes it essential for clinicians, surgeons, radiologists, and anaesthesiologists. Anatomical variations in its structure and connections with neighbouring nerves can complicate surgical procedures, diagnostic evaluations, and the management of nerve disorders. Variations in the upper limb nerves, such as the absence of certain nerves, interconnections, or unusual pathways, are common anatomical occurrences that can greatly affect clinical diagnosis and treatment. These variations may change innervation patterns or contribute to nerve compression syndromes, resulting in atypical clinical presentations. This review highlights the prevalence of upper limb variations and their clinical significance, stressing the importance of anatomical knowledge for accurate diagnosis and treatment. It also discusses the findings from recent studies and underscores the need for ongoing research to enhance diagnostic precision and surgical outcomes.

An integrative perspective on urine analysis: from humoural theory to biomarkers

2025-12-31T06:30:43+0530

Urine examination has served as an essential diagnostic tool across civilizations, reflecting the evolution of medical understanding from traditional to modern systems. In Unani medicine, Mu‘āyana’-i-Qārūra (Urine analysis) was a key diagnostic approach based on the Naẓariyya’-i-Akhlāṭ (humoural theory), aimed at identifying imbalances in the body’s temperament (Mizāj). Unani physicians meticulously observed features such as color, odor, clarity, froth, and sedimentation to interpret the state of humours and organ function, forming the basis for individualized treatment. In contrast, modern medicine employs advanced laboratory investigations, chemical assays, and imaging modalities to assess urinary composition and pathology with precision. This paper explores the historical context, methodologies, and diagnostic philosophy of urine examination in the Unani system, comparing them with contemporary scientific techniques. Integrating the personalized and qualitative diagnostic principles of Unani medicine with the quantitative precision of modern science may contribute to improved diagnostic accuracy and promote a more holistic, evidence-based approach to patient care.

Transformative role of artificial intelligence in promoting nurses’ mental resilience and quality of care delivery: from burden to balance

2025-12-31T06:30:44+0530

The transformative integration of artificial intelligence (AI) in nursing practice has emerged as a crucial innovation to mitigate occupational stress, enhance psychological resilience, and improve the overall quality of care delivery. As healthcare systems face mounting workloads, AI-driven technologies-such as machine learning, affective computing, and predictive analytics-offer meaningful pathways to achieve a balance between technological precision and human compassion. This systematic review critically synthesizes global evidence on AI’s role in promoting nurses’ mental resilience and optimizing patient-centered care outcomes. Following PRISMA 2020 and Joanna Briggs institute (JBI) guidelines, five major electronic databases-PubMed, Scopus, CINAHL, Web of Science, and Cochrane Library-were systematically searched for studies published between 2014 and 2024. A total of 78 studies met the inclusion criteria after rigorous screening, quality appraisal, and ROBINS-I/CASP bias assessment. Thematic and quantitative analyses revealed that AI interventions resulted in an average 28-35% improvement in resilience and a 22-32% enhancement in care quality. Among intervention types, simulation-based AI and affective computing yielded the highest combined benefits, while automation and predictive analytics consistently enhanced operational efficiency. Additionally, governance frameworks contributed indirectly to fostering ethical confidence and long-term trust in AI adoption. Overall, the findings underscore AI’s transformative potential in harmonizing innovation with empathy, empowering nurses toward sustainable well-being and professional excellence. When implemented responsibly, AI redefines modern nursing-from burden to balance-anchored in emotional intelligence, ethical stewardship, and evidence-based precision.

Compassion fatigue and resilience in palliative care nursing practice: systematic review

2025-12-31T06:30:56+0530

Palliative care nursing demands continuous compassionate engagement with patients and families experiencing end-of-life challenges. While this empathetic involvement enhances care quality, it also exposes nurses to significant emotional strain, often leading to compassion fatigue (CF) a state of emotional exhaustion, reduced empathy, and depersonalization. Conversely, resilience, defined as the psychological capacity to adapt positively in the face of adversity, serves as a protective factor mitigating CF’s adverse effects. This comprehensive review aimed to synthesize existing evidence on the prevalence, predictors, consequences, and mitigating strategies of CF, alongside the role of resilience among palliative care nurses. A systematic narrative review was conducted using databases including PubMed, CINAHL, Scopus, PsycINFO, and Web of Science (2010-2025), identifying 47 studies that met inclusion criteria. Findings revealed that 30-65% of palliative nurses experience moderate-to-high levels of CF, with contributing factors including emotional exposure, workload, moral distress, and inadequate support. Resilience consistently demonstrated a negative correlation with CF, buffering stress and promoting compassion satisfaction. Interventions such as mindfulness-based stress reduction (MBSR), reflective practice, peer support, and resilience training programs significantly improved coping outcomes. The review highlights resilience as a dynamic and trainable attribute essential for sustaining emotional well-being, professional satisfaction, and high-quality patient care. Institutional strategies emphasizing psychological support, education, and team cohesion are crucial for promoting resilient nursing practice in palliative settings.

Association of false-positive quadruple test and adverse pregnancy outcomes

2025-12-31T06:29:27+0530

Background: Aim of the study was to assess the relationship between false-positive quadruple test results and adverse pregnancy outcomes.

Methods: This retrospective case-control study was analysed data from 600 pregnant women who underwent second-trimester screening. The study compared 100 women with false-positive results (high risk group) to 500 women with true-negative results (low risk group). Odds ratios (OR) and adjusted OR (aOR) for various adverse pregnancy outcomes were calculated and compared between the groups.

Results: In this study, from 600 pregnant women in 2 groups. Some associations between high-risk group and adverse pregnancy outcomes can be found. The adjusted odds of developing gestational hypertension were significantly higher in the false-positive group (aOR 2.36, 95% CI: 1.07-5.18). Similarly, the risk of having a newborn with a low birth weight was also higher in this group (aOR 2.77, 95% CI: 1.06-7.24). No significant differences were observed between two groups regarding the rates of preeclampsia, gestational diabetes, fetal growth restriction and preterm labor.

Conclusions: Women with a false-positive quadruple test result have an increased risk of developing gestational hypertension and delivering a low-birth-weight newborn.

Success rate of dacryocystorhinostomy with and without silicone intubation: a comparative study

2025-12-05T12:38:26+0530

Background: Dacryocystorhinostomy (DCR) is the gold standard operation for nasolacrimal duct obstruction, (NLDO) creating a bypass between the lacrimal sac and nasal cavity to restore tear drainage and alleviate epiphora. The role of silicone intubation as a method of improving surgical outcomes is contentious, with conflicting evidence regarding whether it is effective and necessary.

Methods: The prospective comparative study was conducted at a tertiary care hospital in Dhaka, Bangladesh, from July 2019 to June 2024. Two hundred patients of chronic dacryocystitis were randomly placed in two groups: DCR with silicone intubation (n=100) and DCR without silicone intubation (n=100). Success was defined as freedom from epiphora, patent lacrimal passage on syringing, and no need for revision surgery. Data were analyzed using SPSS version 25, and statistical significance was established at p<0.05.

Results: The age was 30.41±7.41 years in the silicone group and 31.98±7.55 years in the non-silicone group, with female predominance (62% vs 58%). Success was higher in the silicone intubation group (96%) compared to the non-silicone group (88%). Failure was 4% in the silicone group and 12% in the non-silicone group. Binary logistic regression revealed that silicone intubation increased the chance of success by 5.26 times (95% CI: 1.24-22.34, p=0.024), and it was the most significant predictor of surgical success.

Conclusions: DCR with silicone intubation was more successful than DCR without intubation. High odds ratio supports the clinical benefit of routine silicone intubation for external DCR operations.

Prevalence, risk factors and quality of life impact of urinary incontinence in pregnancy at a northcentral Nigerian tertiary hospital

2025-12-31T06:30:42+0530

Background: Urinary incontinence during pregnancy is a distressing but often under-recognized condition with physical, psychological, and social consequences. Despite its impact, UI remains underreported and underexplored in Nigeria. This study aimed to determine the prevalence, risk factors, and quality-of-life impact of urinary incontinence among pregnant women attending antenatal care at a tertiary hospital in Northcentral Nigeria.

Methods: This was a cross-sectional study conducted among 959 pregnant women attending antenatal care at University of Abuja Teaching Hospital, Abuja. Eligible participants completed a structured questionnaire, including the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI-SF). Data were analysed using SPSS v25. Associations were tested with chi-square and logistic regression, with significance set at p<0.05.

Results: The mean age was 31.1±5 years, and the prevalence of UI was 14.1%. Stress urinary incontinence was most common (54.6%), followed by mixed (20.0%) and urge (18.5%). Most cases were mild (58.5%), though 15.4% were severe. Independent predictors included single marital status (aOR=2.76), occupation (civil servant aOR=2.21; business aOR=1.98), instrumental delivery (aOR=2.85), neonatal birthweight ≥3.6 kg (aOR=8.90), perineal injury (aOR=6.12), and chronic cough (aOR=4.21).

Conclusions: UI affects a notable proportion of pregnant women, predominantly as stress incontinence of mild severity. Key risk factors span sociodemographic, obstetric, and clinical domains. Incorporating routine screening, pelvic floor education, and preventive strategies into antenatal care could mitigate the burden and improve maternal quality of life.

Association of bone mineral density with sarcopenia indicators in the elderly population

2025-12-31T06:30:59+0530

Background: Osteoporosis and sarcopenia are age-related conditions that contribute to frailty, falls, and disability. The coexistence of osteopenia and sarcopenia, known as osteosarcopenia, is a growing concern. This study investigated the association between bone mineral density (BMD) and sarcopenia in elderly patients with osteoporosis.

Methods: A hospital-based cross-sectional study was conducted at Cumilla Medical College Hospital, Bangladesh, from January 2020 to January 2021. A total of 100 elderly patients (≥60 years) with osteoporosis were enrolled. BMD was assessed using dual-energy X-ray absorptiometry. Sarcopenia was evaluated using the EWGSOP2 criteria, hand grip strength, appendicular skeletal muscle mass index (ASMMI), and the Timed Up and Go test (TUG). Data were analyzed using SPSS version 20.

Results: The mean age was 66±7 years, and 88% of the patients were female. Sarcopenia was present in 61% of patients and was more prevalent in patients with severe osteoporosis (72.4%). The mean lumbar spine and femoral neck T-scores were -3.29±1.04 and -3.09±1.56, respectively. The functional parameters included grip strength of 17.76±5.94 kg (right hand), walking speed of 0.65±0.12 m/s, and TUG of 13.5±3.2 seconds. Significant positive correlations were observed between ASMMI and BMD at the lumbar spine (r=0.264) and femoral neck (r=0.356) (p=0.008).

Conclusions: Reduced BMD was significantly associated with impaired sarcopenia indicators in elderly patients. Early identification and management of osteoporosis and sarcopenia are essential for preventing frailty and improving patient outcomes.

Correlation of duration of diabetes mellitus with bone mineral density in postmenopausal women

2025-12-31T06:30:58+0530

Background: Osteoporosis and type 2 diabetes mellitus commonly coexist in postmenopausal women, both increasing morbidity and fracture risk. Despite often normal or elevated bone mineral density, individuals with T2DM face a paradoxically higher fracture risk. This study aimed to assess the correlation between the duration of T2DM and BMD in postmenopausal women.

Methods: This cross-sectional study was conducted in the Medicine Department of Sir Salimullah Medical College and Mitford Hospital from July 2023 to June 2024. A total of 120 postmenopausal women with T2DM were enrolled according to predefined criteria. Data were analyzed using SPSS 22.0, with a p<0.05 considered statistically significant.

Results: Duration of diabetes demonstrated a significant negative correlation with BMD. T-scores showed strong inverse relationships at both the femoral neck (r =-0.649, p<0.001) and lumbar spine (r=-0.724, p<0.001). Similarly, Z-scores were negatively correlated at the femoral neck (r=-0.521, p<0.001) and lumbar spine (r=-0.540, p<0.001). Comparison of treatment modalities revealed no significant differences: women on oral agents had femoral neck and lumbar spine T-scores of -2.51±0.96 and -3.12±1.50, while those on oral agents plus insulin had scores of -2.94±1.17 and -3.54±1.52, respectively (p>0.05).

Conclusions: Longer duration of T2DM is significantly associated with lower BMD in postmenopausal women, particularly at the femoral neck and lumbar spine. Treatment modality did not significantly influence BMD outcomes.

Shear bond strength of orthodontic brackets bonded with four different orthodontic adhesives: an in vitro study

2025-12-31T06:30:57+0530

Background: The fundamental requirement of an orthodontic adhesive is clinically acceptable bond strength between orthodontic brackets and tooth surface without any failure. Bond strength has a massive influence in the success of orthodontic treatment. The study aimed to evaluate and compare the shear bond strength of four different orthodontic adhesives.

Methods: This in-vitro study was conducted at the Department of Orthodontics and Dentofacial Orthopaedics, Dhaka Dental College & Hospital. Eighty extracted human premolars of 30 participants were randomly divided into four groups and bonded with 0.018-inch stainless steel edgewise brackets: Group 1-37% phosphoric acid + Enlight; Group 2-37% phosphoric acid + Transbond XT; Group 3 - Xeno V+ self-etch adhesive; Group 4 - ESPE universal self-etch primer + Transbond Plus color change adhesive.

Results: Transbond XT exhibited the highest shear bond strength (14.45 MPa), followed by Enlight (7.80 MPa), Xeno V+ (6.73 MPa), and Transbond Plus (4.25 MPa). ANOVA revealed a significant difference among the groups, and post hoc Bonferroni tests confirmed significant pairwise differences. Regarding adhesive remnant index (ARI) scores, score 0 was most frequent in the Transbond Plus group (35%), score 1 in Transbond XT (60%), score 2 in Xeno V+ (55%), and score 3 in Enlight (35%). Chi-square analysis showed a significant difference (p<0.001) in ARI distribution among groups.

Conclusions: This study showed that clinically acceptable bond strength was observed for Transbond XT, Enlight, and Xeno V+, with Transbond XT exhibiting the highest shear bond strength, followed by Enlight, Xeno V+, and Transbond Plus.

Cultural and linguistic adaptation of Bangla version of vitiligo impact scale-22

2025-12-31T06:29:28+0530

Background: Vitiligo is known to have a major psychosocial effect on sufferers. “Vitiligo impact scale 22 (VIS 22)” is a newly developed specific scale to measure the quality of life (QoL) in vitiligo patients. As a psychometric evaluation of the Bangla version of VIS-22 has not yet been in Bangladesh. This study aimed to develop a culturally adapted Bangla version of English VIS-22 in Bengali-speaking vitiligo patients of Bangladesh.

Methods: The original English version of the VIS-22 questionnaire was translated into Bangla following established cross-cultural procedures as recommended. The adapted Bangla version of VIS-22; and the Bangla version of SF-36 were administered and VASI was calculated.

Results: The scale demonstrated a good internal consistency (Cronbach’s alpha=0.83) and significant test-retest reliability (by Pearson correlation 0.98 and by paired sample statistics 0.073). I-CVI for each item was 1. Construct validity assessing factor analysis-principal component analysis with the distribution of varimax rotation of VIS-22 Bangla ranged from 0.14 to 0.88 and six components were extracted. Criterion validity was assessed by comparing it with the VASI score which revealed Pearson correlation between VASI score and VIS-22 score was .30 which signifies a positive relationship. Correlation between the domains of SF-36 and VIS-22 Bangla was found between 0.45 to 0.60 in Pearson’s measurement.

Conclusions: The adapted Bangla version of VIS-22 appears to be an acceptable, reliable, and valid instrument for measuring the QoL in Bengali-speaking patients of vitiligo.

Evaluation of larvicidal effects of five different tropical plant extracts against filarial vector Culex quinquefasciatus

2025-12-31T06:29:34+0530

Background: The aim of the study was to assess the larvicidal activity of leaf extracts of Sphaegneticola trilobata, Syzygium cumini, Averrhoa carambola, Tamarindus indica and Citrus maxima.

Methods: The 3rd and 4th instar larva of Culex quinquefasciatus were tested to evaluate larval mortality after 24-hour exposure to different plant leaf extracts. Larvicidal activity of S. trilobata leaf extract, S. cuimini, A. carambola, T. indica, Culex quinquefasciatus, and C. maxima leaf was observed at different concentrations of distilled water (1250-10000 ppm), acetone (250-850 ppm), methanol (2000-3500 ppm) and 50% ethanol (3000-5000 ppm).

Results: Larval mortality was checked after 24h of exposure and lethal concentrations at LC50 of S. trilobata were 4183.866 ppm, 486.109 ppm, 2478.026 ppm, 3541.842 ppm respectively and at LC90 were 11717.896 ppm, 908.933 ppm, 3321.521 ppm, 4892.513 ppm respectively. Lethal concentrations of S. cuimini at LC50 were 9045.301 ppm, 476.714 ppm, 1797.028 ppm, 2825.363 ppm respectively and at LC90 were 14411.664 ppm, 1070.723 ppm, 2433.824 ppm, 4211.212 ppm respectively. And, for A. carambola lethal concentrations at LC50 were 8405.722 ppm, 927.011 ppm, 2080.519 ppm, 4977.002 ppm respectively and at LC90 were 13438.102 ppm, 1455.087 ppm, 3020.974 ppm, 6165.633 ppm respectively. For T. indica, application dosage was 7038.103 ppm, 565.073 ppm, 1739.942 ppm, and 3876.449 ppm. Again, for Culex quinquefasciatus larvae, the larvicidal LC50 values of C. maxima leaf extract at the application dosage are 2931.936 ppm, 633.329 ppm, 1306.784 ppm, and 1710.784 ppm respectively.

Conclusions: These results indicate the potential of the phytochemicals derived from experimental plants.

Clinicopathological association of CD44 and PD-L1 expression in epithelial ovarian carcinoma: a hospital-based cross-sectional study from AIIMS Patna

2025-12-08T07:01:55+0530

Background: Epithelial ovarian carcinoma (EOC) is the most lethal gynecological malignancy, often presenting at advanced stages. Molecular markers such as CD44, a stem cell-associated adhesion molecule, and PD-L1, an immune checkpoint regulator, have been implicated in tumor progression, chemoresistance, and immune evasion. Understanding their expression patterns and correlation with clinicopathological features may aid prognostic stratification and therapeutic decision-making. Aim was to assess CD44 and PD-L1 expression in EOC and analyze their association with clinicopathological parameters.

Methods: A hospital-based cross-sectional study was conducted over 5 years (2018-2023) in the department of pathology, AIIMS Patna. A total of 132 histologically confirmed cases of EOC were included. Immunohistochemistry (IHC) for CD44 and PD-L1 was performed, and expression was scored semi-quantitatively. Associations with age, histological subtype, tumor grade, stage, and lymph node involvement were evaluated. Statistical analysis was performed using chi-square and logistic regression.

Results: CD44 positivity was observed in 79/132 cases (59.8%), while PD-L1 was expressed in 62/132 cases (47.0%). Co-expression of both markers was found in 38 cases (28.8%). High CD44 expression was significantly associated with high-grade serous carcinoma (p=0.01), advanced FIGO stage (p=0.03), and lymph node metastasis (p=0.04). PD-L1 positivity correlated with advanced stage (p=0.02) and presence of ascites (p=0.03). Co-expression was linked to poor differentiation and advanced disease. Multivariate analysis showed CD44+/PD-L1+ tumors had 2.6-fold higher odds of lymph node metastasis.

Conclusions: CD44 and PD-L1 are frequently expressed in EOC and show significant association with adverse pathological features. Their combined expression may serve as a prognostic biomarker and highlight potential candidates for targeted and immune checkpoint therapies in ovarian carcinoma.

Incidence of peripheral arterial disease in diabetic foot

2025-12-08T07:01:54+0530

Background: Diabetic foot infections (DFIs) are a major cause of morbidity and lower-limb amputations in individuals with diabetes mellitus. Peripheral arterial disease (PAD) significantly increases the risk of non-healing ulcers and adverse outcomes, yet often remains underdiagnosed. This study aimed to determine the prevalence of PAD in patients with DFI and to evaluate its association with clinical profile and outcomes.

Methods: A hospital-based descriptive observational study was conducted among 100 adults with DFI. Clinical data were collected using a structured proforma. The severity of foot lesions was graded using the Wagner classification. Ankle–brachial pressure index (ABI) was measured for all participants, and arterial Doppler was performed when ABI was abnormal. Microbiological culture results and need for amputation were recorded. Statistical associations were assessed using Chi-square test.

Results: PAD was detected in 60% of patients, with moderate disease being most common. PAD prevalence was significantly higher in older individuals, those with longer diabetes duration, and patients with poor glycaemic control (p<0.05). Overall, amputation rate was 34% (34/100), with significantly higher rates in PAD patients (38.3%) vs non-PAD (27.5%) (p<0.05). Gram-negative organisms predominated in wound cultures, with Pseudomonas (24.0%) and Proteus (17.0%) as the most common isolates.

Conclusions: PAD is highly prevalent among hospitalized patients with DFI and is strongly associated with ulcer severity and poor clinical outcomes. Routine ABI-based vascular assessment is essential for early detection and timely intervention to improve limb salvage.

Polycystic ovarian syndrome: affecting quality of life and awaiting cure

2025-12-18T06:53:45+0530

Background: The increasing number of polycystic ovarian syndrome (PCOS) patients in gynaecology outdoor especially younger adults, with long term health implications prompts us to study the condition. The syndrome not only has a vast impact on physical health but also affects psychosocial aspects of life. The study aimed to analyse the characteristics and presenting complaints in subjects with PCOS.

Methods: It was an observational study conducted at a secondary care centre over a period of one year. Chi square goodness of fit test was used to analyse the results.

Results: The study showed an increased incidence in younger adults with menstrual irregularity as the most common complaint and an increased body mass index (BMI) amongst most patients. Inability to conceive without treatment was also very important presenting feature.

Conclusions: We should increase our efforts to find a preventive strategy and if possible, a cure to this syndrome.

Fixed-dose formulation of nifedipine and lidocaine for the treatment of anal fissures: results from a prospective, multicenter, single-arm and post-marketing observational study

2025-12-05T12:38:24+0530

Background: Anal fissures are a common cause of severe anorectal pain and impaired quality of life, most often affecting individuals aged 15-40 years. Combination therapy with nifedipine and lidocaine has shown promise for symptom relief and healing, yet Indian clinical data remain scarce, highlighting the need for real-world evaluation of this fixed-dose combination (FDC).

Methods: This prospective, multicenter, single-arm, open-label, post-marketing observational study evaluated the effectiveness and safety of FDC of nifedipine and lidocaine in Indian patients with acute or uncomplicated chronic anal fissures. The primary effectiveness endpoint was improvement in pain management. Secondary endpoints evaluated improvement in fissure healing, number of rescue medications required, global effectiveness and tolerability to therapy. Safety was evaluated by monitoring adverse drug reactions (ADRs).

Results: Fifty patients (male: female, 39:11), with a mean (SD) age of 43.5 (16.1) years were enrolled. Pain intensity decreased significantly from a mean (SD) of 6.6 (0.8) at baseline to 3.7 (1.4) and 1.2 (1.5), respectively at week 3 and 6. At Week 6, 93.0% of patients achieved complete re-epithelialization, with no requirement for rescue medication. The treatment was well tolerated with no incident of ADRs.

Conclusions: The study demonstrated statistically significant pain reduction along with improvements in fissure healing over 6 weeks of treatment with the FDC in Indian patients. The complementary actions of nifedipine and lidocaine contributed to both symptomatic relief and sustained healing, with no ADRs reported. These findings support its effectiveness, acceptability, and suitability as a non-surgical treatment option in routine clinical practice.

Comparative study of cervical cytology in HIV-infected and non-HIV-infected women

2025-12-31T06:30:59+0530

Background: Cervical cancer remains a major preventable cause of morbidity and mortality among women worldwide, with HIV-infected women demonstrating a substantially higher susceptibility to persistent HPV infection and cervical dysplasia. This study compares cervical cytological findings in HIV-positive and HIV-negative women using Pap smear screening.

Methods: A six-month retrospective study was conducted on 200 Pap smears (100 HIV-positive, 100 HIV-negative) reported according to the 2014 Bethesda System. Unsatisfactory smears were excluded and cytological patterns were analyzed and compared.

Results: HIV-positive women showed a markedly higher prevalence of cervical abnormalities. Squamous epithelial abnormalities (SEA) were observed in 17% of HIV-positive women compared to 5% of HIV-negative women. Non-squamous abnormalities, including infectious etiologies such as bacterial vaginosis, candidiasis and trichomonas, were also significantly higher in the HIV-positive cohort (34% vs 12%). NILM rates were substantially lower among HIV-infected women (49% vs 79%).

Conclusions: HIV infection is strongly associated with increased cervical cytological abnormalities, underscoring the need for early, routine and targeted cervical screening, including Pap and HPV testing, in HIV-positive women to enable timely intervention and reduce the risk of cervical cancer.

Anemia and its determinants among adults in central India: a cross-sectional study

2025-12-31T06:30:58+0530

Background: Anemia remains a major public health problem in India despite national control programmes. Its multifactorial causes include nutritional deficiencies, chronic illnesses, and sociodemographic factors. Limited data are available on the interplay of anemia with nutritional status and hematological variations in central India.

Methods: A cross-sectional study was conducted among 392 participants. Demographic and anthropometric details were recorded, and BMI was classified using WHO Asian cut-offs. Hematological parameters (Hb, MCV, MCH, MCHC, hematocrit) were measured using an automated analyser. Anemia was defined and graded using WHO criteria and further classified morphologically. Statistical analysis included Chi-square test, Student’s t-test, ANOVA, and Pearson’s correlation. A p value <0.05 was considered significant.

Results: The mean hemoglobin level was 12.64±1.49 gm/dl. The prevalence of anemia was 36%, with 0.3% severe, 12.8% moderate, and 23% mild cases. Morphologically, microcytic anemia (24%) and hypochromic anemia (53.6%) predominated. Anemia was significantly associated with age (p=0.012), highest among participants <18 years (43.2%). No significant association was found with sex or BMI, though underweight individuals had the highest prevalence (43.8%). Mean hemoglobin was significantly higher in males (13.38 gm/dl) than females (12.22 gm/dl, p<0.001). Hemoglobin correlated positively with both BMI (r=0.159, p=0.002) and age (r=0.202, p<0.001).

Conclusions: Anemia affects more than one-third of the studied population, with microcytic and hypochromic patterns suggesting iron deficiency as a major cause. Younger individuals and those with low BMI are most vulnerable. The findings highlight the dual burden of malnutrition- anemia and undernutrition coexisting with rising overweight, obesity, and elevated blood sugar. Targeted interventions addressing both ends of the nutritional spectrum are urgently needed.

Comparison of control oocytes and oocyte with mild and dark severe coarse granules in the perivitelline space: insights on IVF-ICSI cycle outcomes: a retrospective cohort analysis

2025-12-31T06:30:56+0530

Background: Coarse granules in the perivitelline space (PVS) have been associated with impaired oocyte quality and reduced success rates in assisted reproductive technologies. However, their precise impact on IVF-ICSI cycle outcomes remains unclear. This study aims to evaluate the correlation between PVS granularity and embryological as well as clinical outcomes.

Methods: This retrospective cohort study analyzed 161 women undergoing IVF/ICSI cycles at Nova IVF Fertility Centre, Madurai, between January 2022 and March 2025. Oocytes (n=2300) were classified into three groups based on the presence of PVS granules: Group A (Control oocytes), Group B (Moderate granules), and Group C (Dark severe granules). Statistical analyses assessed differences in oocyte maturation, fertilization, embryo development, implantation, and live birth rates.

Results: Group C exhibited significantly higher AMH levels (p<0.008) and increased oocyte retrieval rates (p<0.039). However, fertilization efficiency, cleavage rates, and implantation rates were significantly lower in both Group B and Group C. ROC analysis identified MII oocytes (AUC=0.683) and fertilization rates (AUC=0.674) as the strongest predictors of implantation success. The clinical pregnancy rate was highest in Group A (79.3%) and lowest in Group C (40.2%) (p<0.000). Despite a comparable live birth rate between Groups A and C, ongoing pregnancy rates were significantly lower in Group C (13.4%).

Conclusions: Dark severe granules in PVS negatively impacts oocyte competence and IVF success. Optimizing ovarian stimulation protocols and incorporating advanced embryo selection techniques may improve ART outcomes for patients with granular oocytes.

A comparative study of rFSH, HMG, and FSH-HMG stimulation protocols on embryo quality and outcomes across first and second IVF-ICSI cycles

2025-12-31T06:30:55+0530

Background: Optimization of ovarian stimulation is crucial for improving oocyte quality, embryo development, and implantation outcomes in IVF/ICSI cycles. This study compared clinical and embryological results of three stimulation regimens recombinant FSH (rFSH), human menopausal gonadotropin (HMG), and a combined rFSH-HMG protocol-across two consecutive IVF/ICSI cycles to evaluate potential improvements over time.

Methods: A retrospective analysis was conducted on 120 women who underwent two IVF/ICSI cycles between 2021 and 2024. Participants were grouped into rFSH (n=67), HMG (n=33), and rFSH-HMG (n=13). Stimulation characteristics and embryological outcomes, including oocyte retrieval, MII oocyte yield, fertilization, and blastocyst formation, were compared between cycles. Statistical analysis included t-tests, chi-square tests, Mann-Whitney U tests, and ROC curve analysis to determine predictive value for fertilization and blastocyst development.

Results: Baseline demographics and hormonal parameters showed no significant differences between groups. In the second cycle, the rFSH group demonstrated significantly higher oocyte retrieval, MII oocyte yield, fertilization, and blastocyst formation (p<0.05). ROC analysis showed rFSH-HMG had the strongest predictive value for blastocyst formation (AUC=0.963), followed by HMG (0.880) and rFSH (0.774).

Conclusions: Second-cycle IVF/ICSI outcomes improved across several embryological parameters, suggesting beneficial effects of prior stimulation or clinical adjustments. rFSH showed consistent improvement, while rFSH-HMG was the strongest predictor of blastocyst formation. Recognizing cycle-to-cycle dynamics may enhance individualized stimulation strategies and improve reproductive success.

Spinal anaesthesia versus general anaesthesia for laparoscopic cholecystectomy: a comparative study

2025-12-31T06:30:52+0530

Background: Anaesthesia involves analgesia, unconsciousness, relaxation and suppression of body reflexes. This state can be achieved either by Spinal or General Anaesthesia (GA). In G.A all the four parameters are fulfilled, where as in Spinal Anaesthesia the patient need not be unconscious. This study aimed to compare the effectiveness general anaesthesia to that of spinal anaesthesia in laparoscopic cholecystectomy.

Methods: A period-based study was conducted among 100 patients. Group 1- who received spinal anaesthesia and Group 2- who received general anasthesia. Demographic data, hemodynamic parameters, operation time, visual analog scale (VAS) scores at postoperatively, patient-surgeon satisfaction, side effects, and hemodynamic changes were inquired and recorded.

Results: The mean operation time was 37.08 minutes for Group 1 and 42.12 minutes in group 2. The mean VAS was 1.4 at 4 hours,1.8 at 8 hours and 12 hours and 0.7 at 16 hours in Group 1.In group 2, it was 2.3 at 4 hours and at 16 hours it was 2.7. Pateint satisfaction was more in Spinal Anaesthesia group as compared to General anaesthesia group whereas surgeons satisfaction was more in Group 2. Mean Heart Rate was found to be 87.1 and 88.2 in group 1 & group 2 respectively. 76.2 and 87.6 in group 1 and 2 respectively at 180 min. The result is significant at p <0.05. Mean Systolic BP was found to be 122.5 and 132.4 in group 1 and 2 respectively at 180 min. The result is significant at p <0.05.

Conclusions: Spinal anesthesia may be associated with less postoperative pain and postoperative nausea and vomiting compared with general anesthesia. Patients receiving spinal anesthesia had shorter discharge time and better satisfaction. Difference in mean HR and Systolic BP was found to be statistically significant.

Study comparing rapid diagnostic test with conventional method in diagnosis of spontaneous bacterial peritonitis in liver cirrhosis

2025-12-31T06:30:51+0530

Background: Spontaneous bacterial peritonitis (SBP) is a severe and frequent complication of liver cirrhosis with ascites. Conventional diagnostic methods such as manual polymorphonuclear leukocyte (PMN) count and ascitic fluid culture are time-consuming, delaying treatment. Rapid diagnostic tests based on leukocyte esterase activity offer a simple bedside alternative. This study aimed to assess the diagnostic accuracy of a rapid reagent strip test compared with the conventional method in detecting SBP.

Methods: A hospital-based observational study was conducted among 104 patients with liver cirrhosis and new-onset ascites admitted to a tertiary care center between August 2022 and August 2024. Ascitic fluid from each patient was analyzed by both conventional PMN count and leukocyte esterase reagent strip testing. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using SPSS v24.

Results: SBP was detected in 15 (14.4%) patients by the conventional method and in 23 (22.1%) using the rapid test. The rapid diagnostic test demonstrated a sensitivity of 100%, specificity of 91.01%, PPV of 65.21% and NPV of 100%.

Conclusions: The leukocyte esterase reagent strip test provides a rapid, inexpensive and reliable alternative for early bedside diagnosis of SBP in cirrhotic patients. Its excellent sensitivity and high NPV make it particularly useful in resource-limited and emergency settings for timely initiation of treatment.

Etiological patterns, clinical outcomes and management of acute intestinal obstruction: a prospective study from a tertiary care center

2025-12-31T06:30:48+0530

Background: Acute intestinal obstruction represents one of the most prevalent surgical emergencies worldwide, significantly impacting healthcare systems and patient outcomes. This study aimed to comprehensively analyze the causes, clinical presentations, management approaches and outcomes of acute intestinal obstruction in a tertiary care setting in Maharashtra, India.

Methods: A prospective observational study was conducted over twelve months (2022-23) at Shri Bhausaheb Hire Government Medical College and Hospital, Dhule. Eighty-two consecutive patients with acute intestinal obstruction were enrolled after informed consent. Comprehensive clinical evaluation, laboratory investigations, imaging studies and surgical findings were systematically recorded. Primary outcomes included etiology identification, management approach (conservative versus surgical) and in-hospital mortality. Secondary outcomes comprised postoperative complications and hospital length of stay.

Results: The cohort comprised 82 patients with mean age of 48.7±22.3 years and slight male predominance (51.2%). Age distribution showed bimodal pattern with peaks in middle-aged adults (41-50 years, 26.8%) and elderly patients (71-80 years, 17.1%). Adhesions emerged as the predominant cause (35.4%), followed by obstructed hernia (15.9%), malignancy (8.5%) and tuberculous stricture (7.3%). Conservative management succeeded in 24 patients (29.3%), while 58 patients (70.7%) required surgical intervention. Postoperative complications occurred in 29.3%, with septicemia most common (8.5%). Overall mortality was 8.5%, exclusively in the surgical group. Mean hospital stay was 12.3 days.

Conclusions: This study demonstrates significant epidemiological transition with adhesions becoming the predominant cause of acute intestinal obstruction, replacing historically dominant obstructed hernias in developing countries. Early diagnosis, appropriate management selection and timely intervention remain critical determinants of outcome. The substantial morbidity and mortality emphasize the need for enhanced preventive strategies and optimized perioperative care protocols.

Echocardiographic evaluation of wall motion abnormality and systolic left ventricular dysfunction in acute myocardial infarction within 1st week of hospitalization

2025-12-31T06:29:26+0530

Background: Acute myocardial infarction is a leading cause of morbidity and mortality, commonly resulting in left ventricular systolic dysfunction. Early echocardiographic assessment helps identify wall motion abnormalities, guide prognosis, and optimize timely management during the first week of hospitalization. The objective was to find out cardiac wall motion abnormality and ejection fraction by echocardiography and its correlation with clinical features and ECG findings in patients of AMI.

Methods: One hundred (100) cases of acute myocardial infarction were studied in cardiology unit of RMCH from July 2008 to December 2008. Mean age (±SD) was 50.22±11.59 years (range 25-80 years). It was an observational study. All selected patients were interviewed with a preformed questionnaire and were observed up to 7 days in hospital.

Results: 88% of them were males and 12% of them were females. Males were mostly smokers (89.77%) and females were mostly hypertensive (75%). Most patients could reach in hospital within 4-12 hours of onset of symptoms due to acute left ventricular failure and cardiogenic shock. Anterior wall (49%) hypokinesia and mild systolic LV dysfunction were revealed in echocardiography among the survivors.

Conclusions: This study is a hospital-based study and most of the patients came from rural areas of Rajshahi and nearby districts (85%). Incidence of AMI was seen common among farmers who were mostly smokers. Systolic LV dysfunction was common in most patients where anterior wall involvement was present.

A comparative evaluation of hyperbaric levobupivacaine versus hyperbaric ropivacaine in parturients for elective caesarean section under spinal anaesthesia: a randomized clinical study

2025-12-31T06:30:46+0530

Background: Spinal anaesthesia is the most preferred and widely used anaesthetic technique for elective lower-segment caesarean section, which offers less exposure to the potentially depressant drugs of general anaesthesia and allows early bonding between the mother and newborn as the mother is awake throughout the procedure. Levobupivacaine and Ropivacaine, are the two new long-acting amino amide local anesthetics available for clinical use. This study aimed to clinical efficacy, safety and haemodynamic changes of spinal anaesthesia with 0.5% hyperbaric Levobupivacaine versus 0.5% hyperbaric Ropivacaine.

Methods: The study groups were divided into two, named group L and group R. The total sample size was 132 (66 patients in each group). Patients in Group L received 2.4 ml of 0.5% hyperbaric Levobupivacaine and Patients in Group R received 2.4 ml of 0.5% hyperbaric Ropivacaine.

Results: Group R showed a quicker onset of sensory block and a faster 2-segment regression. On the other hand, Group L displayed a shorter duration of motor block. Both drugs showed promise for use in lower segment caesarean section with no significant side effects. The sensory and motor characteristics of both drugs are similar.

Conclusions: The intrathecal hyperbaric Ropivacaine showed a faster onset of sensory block, while hyperbaric Levobupivacaine led to earlier motor block regression in elective lower segment caesarean section.

A comparative assessment of nutritional eye health literacy as a preventive tool among gainfully employed and homemaker women in urban India

2025-12-31T06:30:46+0530

Background: Nutritional eye health literacy (NEHL) contributes significantly to the prevention of diet‑related ocular disorders, especially in urban populations where micronutrient deficiencies and digital exposure are increasingly reported. This study compared NEHL between employed and homemaker women in India and evaluated a machine‑learning model for predicting high NEHL.

Methods: A cross‑sectional study was conducted among 300 Delhi‑NCR women aged 25–55 years. A validated 35‑item NEHL questionnaire was used. A logistic regression model with a 70/30 train–test split predicted high NEHL. Performance metrics included accuracy, sensitivity, specificity, precision, F1 score and AUC.

Results: Employed women exhibited significantly higher NEHL scores (75.8±8.2) versus homemakers (66.9±9.5; p<0.001). The predictive model performed strongly (accuracy 82%, sensitivity 78%, specificity 85%, precision 81%, F1 score 79%, AUC 0.88).

Conclusions: Employed women demonstrated better NEHL. The predictive model reliably identified individuals at risk of low NEHL. Targeted interventions are recommended for homemakers.

Diagnostic accuracy of serum-ascites albumin gradient in esophageal varices in cirrhosis

2025-12-31T06:29:42+0530

Background: Chronic liver disease (CLD) is the major global health concern. Portal hypertension leads to Esophageal Varices (EVs), when bleeds have a high mortality rate. Early diagnosis and treatment of EVs improves patient outcome and decrease mortality. The serum ascites albumin gradient (SAAG) has been used as a biomarker for detecting portal hypertension. In this study, we aimed to assess the diagnostic accuracy of SAAG in predicting EVs in cirrhotic patients.

Methods: This was an observational cross-sectional study, conducted at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi. 75 cirrhotic patients were enrolled, SAAG was calculated and Upper GI Endoscopy was performed to screen for EVs. Diagnostic performance of SAAG was assessed using specificity, sensitivity, positive predictive value, negative predictive value and receiver operating characteristic curve (PPV, NPV and ROC) analysis.

Results: The patient demographics showed a predominance of males (82.67%) with alcohol being the main cause of CLD. A strong positive correlation was found between SAAG and EVs grade. SAAG value of >1.4g/dL predicted varices with a sensitivity of 93.65%, specificity of 100%, AUC of 0.968 (p value <0.0001) and diagnostic accuracy of 94.67%. SAAG value of >1.8g/dL predicted high-risk varices with a sensitivity of 100%, specificity of 88.68% (p value <0.0001), AUC of 0.992, PPV of 78.6% (95%CI:59.0-91.7%) and diagnostic accuracy of 92.00%.

Conclusions: The study shows that SAAG is a reliable marker for predicting EVs in cirrhotic patients and can be used for early identification of at-risk patients, facilitate in timely and effective management to prevent serious complications.

Attitudes and practices toward stray dog management for rabies prevention among adults in an urban field practice area: a community based cross-sectional study

2025-12-31T06:29:41+0530

Background: Rabies is a fatal viral disease predominantly transmitted through dog bites. Although 100% vaccine preventable, India bears a heavy burden causing an estimated 18,000-20,000 deaths annually and accounting for around 36% of global rabies fatalities. Stray dogs remain the primary reservoir, underscoring the urgent need for effective stray-dog and bite-prevention strategies. This study was done to assess the attitudes and practices of adults in an urban field practice area towards stray-dog management for prevention and control of rabies in the community.

Methods: This cross-sectional survey in an urban field practice area of a medical college included 380 adults (≥18 years) using convenience sampling across five zones. Over 18 months, investigators used a validated, multi-language questionnaire. Data were analyzed in SPSS 23 with chi-square tests (α=0.05).

Results: In this study, 87.1% of the 380 participants reported that stray dogs posed problems in their community, with common concerns including attacks/bites (57.4%), barking/nuisance (22.4%) and environmental spoilage (12.4%). While 71.8% opposed removing and killing stray dogs, 70.3% supported removing them from streets and sheltering them. Just over half (52.4%) endorsed sterilisation and release, and only 9.7% had ever filed a municipal complaint. Additionally, 73.2% believed the government alone is responsible for stray-dog population control.

Conclusions: The study found only 38.9% of participants had heard of rabies, with over half of them scoring “poor” on awareness. Despite prevalent stray-dog issues, 73.2% believed only government agencies are responsible. We recommend urgent IEC efforts, proactive dog-population control, community engagement, and a multidisciplinary “one health” approach.

Anorectal manometry in disorders of defecation: a retrospective study

2025-12-31T06:29:40+0530

Background: Prevalence of Chronic Constipation (CC) in India is around 12-30%. Diagnosis of Fecal Evacuation Disorder (FED) requires specialized investigations like Anorectal Manometry (ARM), Balloon Expulsion Test (BET), MR defecography. High resolution ARM is considered first line diagnostic tool for chronic constipation as it measures pressure exerted by the muscles of anus and rectum. This study aimed to evaluate the characteristics of anorectal pressure in a cohort of Indian patients with CC and fecal incontinence and types of FED in patients with CC and age distribution (in young and elderly).

Methods: The present retrospective study was conducted from January 2022 to May 2024 at department of gastroenterology, Yashoda hospitals, Secunderabad, India. A total of 266 patients who presented with CC or Fecal incontinence were included in the study. Sigmoidoscopy or full-length colonoscopy, BET and ARM were done in all the patients. Mean resting and squeeze pressure and other parameters were measured by ARM. Data was compiled and observations tabulated.

Results: Among 266 patients, 136 were young with mean age 21.93±10.54 years and 130 with mean age 60.43±11.87. Gender distribution was 59% men and 41% women. Mean resting anal pressure was 57.06±23.11 mg, mean squeeze pressure was 98.36±35.96 mmHg. In present study, type I dyssynergic defecation was most common with 76 (29%) patients followed by type II 46 (17%).

Conclusions: The present study showed that 65% with constipation subjected for ARM had dysynergic defecation (DD) and type I DD was most common followed by type II. Similar trend was observed in both young and elderly patients.

A study of sciatic nerve in relation to piriformis muscle in South Indian population

2025-12-31T06:29:39+0530

Background: The sciatic nerve (SN) is the largest nerve in the body, emerging from the pelvis beneath the piriformis muscle (PM) and dividing into the tibial nerve (TN) and common peroneal nerve (CPN). The long course and proximity to the PM make the SN susceptible to multiple injuries and compression, especially in the gluteal area and posterior thigh.

Methods: This study aimed to assess the anatomical variations of the SN course by analysing 68 lower limb specimens. The dissection focused on the gluteal region and back of the thigh, with special attention to the level and nature of the SN’s bifurcation. The SN and PM were exposed by retracting the gluteus maximus muscle. The level of SN division and its relation to PM were recorded, photographed and classified into five groups.

Results: The findings showed a wide range of variations in SN bifurcation, with the most common type of SN bifurcation occurring at the lower end of the posterior thigh, found in 72.05% of specimens. The least common was the pelvic bifurcation before exiting the gluteal region in 2.94% of specimens. The study also revealed rare variations, such as the reunion of split divisions in 8.82% of specimens.

Conclusions: The variations in the division of the SN are crucial for clinical and surgical procedures involving the gluteal and posterior thigh regions. Such anatomical insights can reduce iatrogenic injuries and improve procedural outcomes.

Impact of vegetarian and non-vegetarian diets on glycaemic control in type 2 diabetes mellitus patients: a cross-sectional study

2025-12-31T06:29:38+0530

Background: Effective management of type 2 diabetes mellitus (T2DM) requires lifestyle modification alongside pharmacological therapy. Although vegetarian diets have been associated with a lower diabetes burden in Western populations, evidence regarding their effect on glycemic control among Indian patients with T2DM is limited. This study evaluated the association between dietary pattern (vegetarian versus non-vegetarian) and glycemic control in T2DM patients receiving oral hypoglycemic agents (OHAs).

Methods: This cross-sectional study was conducted at a secondary care hospital in Alwar. 200 adults with T2DM were included (115 vegetarians, 85 non-vegetarians). Dietary classification was based on self-reported intake over the preceding 12 months. Fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and glycated hemoglobin (HbA1c) were measured. Baseline demographics, body mass index (BMI), and medication adherence were recorded. Multivariate regression analysis was performed to assess independent association between diet and glycemic control after adjusting for confounders.

Results: Vegetarian patients had significantly lower mean FBS (137.11±25.35 mg/dl versus 161.75±33.93 mg/dl), PPBS (180.24±34.07 mg/dl versus 241.15±52.55 mg/dl), and HbA1c levels (7.47±0.71% versus 8.72±1.42%) compared to non-vegetarians (p<0.001 for all). BMI was comparable between groups (p=0.089). Multivariate analysis showed a vegetarian diet to be independently associated with better glycemic control (OR=2.31; 95% CI: 1.48–3.62; p<0.001). Medication adherence also significantly influenced HbA1c (p=0.012).

Conclusion: Vegetarian diet was associated with improved glycemic control in patients with T2DM, independent of BMI. These findings support dietary modification as an important adjunct to medical therapy, although larger, region-specific studies are needed to guide definitive dietary recommendations.

A prospective study on evaluation of Mannheim peritonitis index in cases of spontaneous hollow viscus perforation at a tertiary health care center

2025-12-31T06:29:37+0530

Background: Spontaneous hollow viscus perforation leading to peritonitis remains a significant surgical emergency with high mortality despite advances in medical care. The Mannheim Peritonitis Index (MPI) is a prognostic scoring system designed to assess disease severity and predict outcomes. This study aimed to evaluate the prognostic value of MPI in predicting mortality and morbidity in patients with spontaneous hollow viscus perforation.

Methods: A prospective observational cross-sectional study was conducted at a tertiary care center in Maharashtra, India, over 18 months (April 2023 to August 2025). Ninety-seven patients with spontaneous hollow viscus perforation were enrolled. MPI scores were calculated for each patient based on eight risk factors including age, gender, organ failure, malignancy, preoperative duration, origin of sepsis, type of peritonitis, and exudate characteristics. Statistical analysis was performed using Chi-square test, Fisher's exact test, and Pearson correlation coefficient.

Results: The overall mortality rate was 11.3% (11/97). Patients with MPI score >26 showed significantly higher mortality (9/41, 21.9%) compared to those with MPI ≤26 (2/56, 3.6%) (p=0.00). Significant mortality predictors included age >50 years (p=0.01), presence of malignancy (p=0.02), organ failure (p=0.00), preoperative duration >24 hours (p=0.04), and purulent/fecal exudate (p=0.03). MPI showed positive correlation with hospital stay (r=0.463, p=0.01) and mortality (r=0.429, p=0.00). Patients with MPI >26 had prolonged hospitalization (85.4% stayed >15 days.

Conclusions: MPI is a reliable, simple, and effective prognostic tool for risk stratification in patients with spontaneous hollow viscus perforation. It accurately predicts mortality and hospital stay duration, enabling early identification of high-risk patients who require aggressive management and intensive care support.

Sero-prevalence of transfusion transmissible infections among 59,434 blood donors over a period of 5 years in a tertiary care institute in Himachal Pradesh

2025-12-31T06:29:35+0530

Background: Blood transfusion is the cornerstone of modern health services. Each blood component transfused has a potential risk of transfusion transmissible infections. Frequent assessment of the prevalence of these infections among blood donors is essential to assess the risk and to improvise the testing methods accordingly. This study was undertaken in Department of Immunohematology and Blood Transfusion, Indira Gandhi Medical College (IGMC), Shimla to assess the sero-prevalence and trends of human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV), among blood donors who donated blood from 2020 till 2024.

Methods: Enzyme-linked immunosorbent assay (ELISA) testing for HIV, HBsAg and HCV was carried out on all blood samples from voluntary and replacement blood donors and results were recorded in Microsoft Office Excel sheet.

Results: Out of 59,434 blood units collected, 558 units tested positive for HIV, HBsAg and HCV. The individual sero-positivity rates were 0.44% (263 cases) for HCV, 0.41% (241 cases) for HBsAg, 0.08% (50 cases) for HIV. There were 2 cases of co-infections of HBsAg with HCV, 1 case of co-infection of HIV with HBsAg and 1 case of co-infection of HIV with HCV. A rising trend of HIV and dual sero-positivity among blood donors was noted in the study.

Conclusion: The alarming rise in the prevalence of transfusion transmissible infections (especially dual positivity) among blood donors’ stresses upon the need for strict adherence to donor selection criteria and using better screening technologies like chemiluminescence immunoassay (CLIA) and nucleic acid amplification testing (NAT) to detect window phase infective blood.

Glasgow coma scale components as predictors of outcomes in conservatively managed head injury patients: a prospective observational study

2025-12-31T06:29:35+0530

Background: Traumatic brain injury remains a leading cause of mortality and morbidity worldwide. The Glasgow Coma Scale (GCS) serves as a fundamental tool for assessing neurological status and predicting outcomes in head injury patients. To assess individual components of the Glasgow Coma Scale and identify which parameter demonstrates the most favorable outcome in conservative management and to compare GCS scores at admission, discharge, 3 months and 6 months post-injury.

Methods: This study was conducted at a tertiary care center in over 18 months. 164 patients aged 18-60 years with head injuries managed conservatively were enrolled. GCS scores were recorded at admission, discharge, 3 months and 6 months. Statistical analysis was performed using paired t-tests and chi-square tests, with significance set at p<0.05.

Results: Majority were males (90.9%) with a mean age of 35.2 years. Road traffic accidents accounted for 45.7% of injuries. At admission, 56.7% had severe head injury (GCS 3-8), 41.5% moderate (GCS 9-12) and 1.8% mild (GCS 13-15). Overall mortality was 7.9%. By 6 months, 91.5% achieved near-normal function (GCS 13-15). Paired t-tests revealed significant improvement in all GCS components: eye response (+1.66 points, p<0.001), verbal response (+2.23 points, p<0.001) and motor response (+2.44 points, p<0.001).

Conclusions: Conservative management yields excellent outcomes in appropriately selected head injury patients. The motor component of GCS demonstrates superior prognostic value and should be emphasized in clinical decision-making.

Cardiovascular manifestation in hypothyroid patient: a cross-sectional study

2025-12-31T06:29:25+0530

Background: Hypothyroidism exerts widespread physiological effects, including significant cardiovascular alterations. Both overt and subclinical hypothyroidism can impair cardiac function, although the severity and pattern of abnormalities may differ. The aim of the study was to evaluate the spectrum of cardiovascular manifestations among hypothyroid patients attending a tertiary care hospital.

Methods: A total of 100 adults with newly diagnosed or previously known overt or subclinical hypothyroidism were enrolled. Patients with secondary hypothyroidism, major comorbidities, congenital or structural heart disease, chronic systemic illnesses, pregnancy, or relevant drug exposures were excluded. Clinical examination, ECG, and echocardiography were performed by trained cardiology specialists. Data were analyzed using SPSS-24.

Results: The mean age of the patients was 38.89±9.98 years, and 81% were female. Overt hypothyroidism was present in 67% of participants. Common cardiovascular symptoms included dyspnoea (21%), ankle swelling (16%), and chest pain (4%). Bradycardia (36%), hypertension (27%), pedal edema (19%), and diminished heart sounds (23%) were notable clinical signs. ECG abnormalities included bradycardia (41%), low-voltage complexes (38%), flat or inverted T waves (25%), and ST-segment changes (26%). Echocardiographic findings showed LVDD (21%), RWMA (20%), pericardial effusion (12%), systolic dysfunction (9%), and reduced ejection fraction (11%). ST-segment changes (p=0.021) and systolic dysfunction (p=0.022) were significantly more frequent in overt hypothyroidism.

Conclusions: Cardiovascular manifestations are common in hypothyroidism, with overt cases demonstrating more pronounced structural and functional abnormalities. Early detection and appropriate management are essential to prevent long-term cardiac complications.

Cervical pap smear study: a cytohistological correlation in patients of tertiary care centre

2025-12-31T06:29:32+0530

Background: The second most prevalent disease in Indian women and a leading source of morbidity and death is cervical cancer. The Pap smear is a quick, low-cost and effective screening technique for early detection of benign and malignant cervical lesions. The objectives of this study were to analyze the cytomorphological patterns of cervical smears, ascertain the frequency of abnormalities in epithelial cells and use histopathological correlation to evaluate the Pap test's diagnostic accuracy.

Methods: From January to December of 2022, this retrospective study was carried out in the pathology department of Gandhi Hospital in Telangana. The Bethesda Reporting System for Cervical Cytology, 2014 was used to analyze and classify conventional Pap smears from women ages 20 to 80. Histopathological findings and abnormal epithelial findings were associated and the diagnostic accuracy, sensitivity, specificity and predictive values were computed.

Results: Out of 4,848 satisfactory smears analyzed, epithelial cell abnormalities constituted 1.63% of all cases. The most common abnormality was ASCUS, which was followed by LSIL. Approximately two-thirds of abnormal lesions occurred in women over 40 years of age. Cytological findings demonstrated good concordance with histopathological diagnoses, with an overall diagnostic accuracy of 79.68%.

Conclusions: A safe, easy, non-invasive and reasonably priced way to identify precancerous and cancerous cervical abnormalities is through Pap smear screening. By enabling early detection and prompt treatment, routine screening in sexually active women can dramatically lower the incidence of cervical cancer.

Immunohistochemical expression of BCL-2 in colorectal cancer and its association with clinicopathological parameters: a cross-sectional study from an Indian tertiary care center

2025-12-31T06:29:32+0530

Background: Colorectal cancer (CRC) is among the leading causes of global cancer mortality and is steadily increasing in India. Despite advances in multimodal therapy, treatment resistance and recurrence remain major challenges. BCl-2, an anti-apoptotic protein, has emerged as a potential biomarker of tumor aggressiveness and therapeutic response. Objectives were to evaluate BCl-2 immunoexpression in CRC tissues and correlate expression levels with key clinicopathological features.

Methods: A cross-sectional observational study was conducted on 60 histopathologically confirmed CRC cases. Formalin-fixed paraffin-embedded samples were stained using standard immunohistochemistry protocols. BCl-2 expression was scored based on percentage of positively stained tumor cells. Clinical data and pathological variables, including tumor location, histological subtype, grade, stage, and lymph node involvement, were recorded. Statistical significance was evaluated using chi-square/Fisher’s exact test (p<0.05).

Results: BCl-2 positivity was identified in 96.7% of CRC cases, with 46.7% demonstrating strong cytoplasmic staining. A significant association was observed between BCl-2 expression and tumor location (rectum) as well as histological subtype (adenocarcinoma NOS). Although higher BCl-2 expression was noted in moderately differentiated tumors, this relationship did not reach statistical significance. No significant associations were found with tumor grade, stage, lymph node status, age, or sex.

Conclusions: BCl-2 is frequently expressed in colorectal carcinoma, indicating its role in tumor survival; however, its limited correlation with clinicopathological parameters suggests it is not an independent prognostic marker. Further studies integrating additional apoptotic and molecular markers are needed to clarify its prognostic and therapeutic value.

A comparative study of socio demographic and clinical characteristics of heroin injectors and heroin chasers: a comparative study done in a tertiary care de-addiction center of Kashmir, India

2025-12-31T06:29:31+0530

Background: Heroin use has intensified into a major public health concern in Kashmir, accompanied by a rising prevalence of high-risk routes of administration, particularly injecting. However, regional research comparing injectors and chasers remains scarce. This study examined the socio-demographic and clinical differences between heroin injectors, heroin chasers, and healthy controls in a tertiary de-addiction centre in Kashmir.

Methods: A cross-sectional comparative study was conducted among 50 heroin injectors, 50 heroin chasers, and 30 healthy controls recruited through purposive sampling. Participants aged ≥18 years meeting DSM-5 criteria for Opioid Use Disorder were assessed after withdrawal stabilization using a semi-structured socio-demographic and clinical questionnaire. Data analysis was performed in SPSS-21 using descriptive statistics, chi-square tests, and independent t-tests, with statistical significance set at p<0.05.

Results: Injectors were significantly younger, less educated, and more frequently engaged in unskilled or unstable occupations than chasers and controls (p<0.001). Injectors showed earlier onset of heroin use, longer illness duration, and more treatment attempts. Both groups had comparable legal involvement (25%). High-risk behaviors were far more common among injectors: 80% reused needles, 72% shared needles, 50% were hepatitis-positive, and 34% reported overdose. Medical complications such as abscesses and skin infections occurred only among injectors.

Conclusions: Heroin injectors represent a high-risk subgroup with greater addiction severity and substantially elevated medical and behavioural harms. These findings highlight the need for targeted harm-reduction interventions, early identification of injecting-related risks, and preventive strategies to reduce transition from chasing to injecting within the Kashmir region.

Effect of pre-administration of 50 ml and 100 ml 6% hydroxyethyl starch for reduction of pain on propofol injection: a randomized controlled study

2025-12-31T06:29:30+0530

Background: Propofol is the drug of choice for induction of anaesthesia but causes pain on intravenous injections. Colloids can prevent contact activation by propofol. This randomized controlled study compared the effects of pre-administration of 50 ml and 100 ml 6% Hydroxyethyl Starch (HES) in attenuating propofol injection pain.

Methods: 180 patients undergoing elective surgery under general anaesthesia were randomized into 3 groups. Group A (Patients received 50 ml HES), Group B (Received 100 ml HES) and Group C (Received 50 ml normal saline). Study drug was administered immediately before administration of propofol. Pain was assessed 15 seconds after administration of propofol using a four-point Verbal Rating Score (VRS). Descriptive statistics, chi-square test, ANOVA and Post hoc Bonferroni test were applied and p<0.05 was considered statistically significant.

Results: There was a significant reduction in occurrence of pain in group A and B compared to group C (p=0.000). The mean pain score was also significantly higher in group C compared to group A and B (p=0.000). On post hoc Bonferroni test for intergroup comparison, there was no significant difference in the pain scores between group A and B (p=1.000), whereas both groups had a significantly lower pain scores compared to group C (p=0.000 and 0.000 respectively).

Conclusions: Both 50 ml and 100 ml 6% hydroxyethyl starch pre-administration equally and significantly reduces pain on propofol injection.

A phase 3, randomized, open-label, multicentre study to evaluate the efficacy and safety of diltiazem plus lidocaine fixed-dose combination gel versus diltiazem gel in Indian patients with anal fissure

2025-12-31T06:29:29+0530

Background: Anal fissures cause significant pain and morbidity, requiring prompt and effective treatment. This study aims to evaluate the efficacy and safety of a fixed-dose combination (FDC) gel containing diltiazem and lidocaine compared to diltiazem gel alone in the treatment of anal fissures.

Methods: In this randomized, open-label, phase 3 study, eligible Indian patients (n=326) of either sex, aged 18 to 64 years, were randomly allocated (1:1) to the test (FDC diltiazem and lidocaine) or reference (diltiazem) group. Patients were asked to apply ~1 g of test or reference product, intra-anally, thrice-a-day, for 40±2 days. The assessment time points were day 1, 5, 10, 25, and 40.

Results: There was a significant reduction in pain scores between the test group and the reference group at the assessment time points. The least-squares mean difference in the mean anal pain intensity reduction from Baseline to day 10 between test and reference groups was ─.1 (95% confidence interval: ─9.18, ─3.02; p=0.0001). More patients in the test versus reference group had pain relief at 0.5 hours after first treatment application on day 1 (60.7% versus 48.8%; p=0.0302). Proportion of patients with partial healing of anal fissure was significantly higher at day 5 (64.2% versus 46.5%; p=0.0015) and day 10 (92.5% versus 81.5%; p=0.0036) in the test versus reference group) treatment-emergent adverse events occurred in four patients in the test group and in eight patients in the reference group.

Conclusions: In this large, phase 3 multicentric study, the FDC of diltiazem and lidocaine demonstrated superior pain intensity reduction and early onset of pain relief with an acceptable safety profile as compared with diltiazem gel alone in Indian patients with anal fissure.

A small step towards empowering communities: assessing and educating stroke symptoms, risk factors and treatment access: a cross-sectional study in two villages of South India

2025-12-31T06:29:27+0530

Background: Stroke is a major preventable cause for disability and death. It has a host of modifiable risk factors. Management of stroke is getting revolutionised. The benefits of these recent advances are not passed to the public more so to the rural folks because there is lack of awareness of stroke symptoms and therapeutic options available for them.

Methods: In a door-to-door survey, subjects were randomly selected to take a questionnaire based on the stroke awareness questionnaire published in the literature. Measures were taken to prevent group answering. Subsequently all subjects in small groups were explained details of stroke symptoms, related risk factors and the various treatment options available to them in the vicinity. The data so acquired was tabulated and analysed statistically.

Results: Most of the subjects were aware of stroke symptoms and risk factors associated with it. But they preferred local native medicines and were not aware of recent treatment modalities.

Conclusions: Most of subjects in the rural area were unaware of recent treatment modalities for stroke in spite of being aware of its manifestations and associated risk factors. There is strong need to educate rural population about stroke treatment.