International Journal of Research in Medical Sciences

Challenges in managing a transgender adolescent with attention-deficit/hyperactivity disorder and multiple psychiatric comorbidities: a case report

2025-10-31T09:23:07+0530

Transgender and gender-diverse (TGD) adolescents are individuals whose experienced gender differs from their biological sex. This group is particularly vulnerable to psychiatric disorders due to both biological factors and psychosocial stressors. Common comorbidities include attention-deficit/hyperactivity disorder (ADHD), mood, and substance use disorders. To date, numerous studies have examined the association between transgender incongruence and ADHD. However, the links with other psychiatric conditions, such as bipolar disorder, remain unclear. A 19-year-old transgender male presented with emotional instability, episodic mood swings, impulsivity, and difficulties related to gender identity. He came out to his friends as male at the age of 13. He had previously been diagnosed with depression, anxiety, and ADHD at the age of 16. The patient also experienced recurrent hypomanic episodes characterized by grandiosity and decreased need for sleep, followed by depressive phases marked by self-injurious behavior and suicidal ideation. He had a history of childhood sexual trauma perpetrated by a friend. Adopted in infancy, his relationship with his family deteriorated after he disclosed his gender identity. He was started on a mood stabilizer and an antipsychotic, with the addition of stimulants considered for later management. This case underscores the clinical challenges of managing psychiatric comorbidities in TGD adolescents, particularly the intersection of ADHD and bipolar disorder. Emerging neurobiological and psychosocial evidence suggests potential shared pathophysiological mechanisms between TGD status and psychiatric comorbidities, although definitive causal pathways remain uncertain. Comprehensive care must integrate individualized pharmacological strategies with psychosocial interventions to address the multifaceted influences.

Understanding amyloid light chain cardiac amyloidosis: a case study emphasising integrated diagnostic techniques

2025-10-31T09:28:11+0530

Cardiac amyloidosis, a manifestation of systemic amyloidosis, presents diagnostic challenges due to diverse clinical presentations. A 56-year-old woman with a history of hypertension presented with recurrent chest tightness, palpitations, decreased exercise tolerance, and nocturnal dyspnea. Diagnostic workup revealed reduced left ventricular function, thickened interventricular septum, and left atrial enlargement on echocardiography and electrocardiogram. Immunohistochemical staining confirmed AL amyloidosis in bone marrow biopsy specimens. Treatment involved supportive care and chemotherapy for plasma cell dyscrasia. Prompt identification and intervention for AL amyloidosis are crucial, highlighting the diagnostic role of electrocardiograms and echocardiograms. Management strategies included supportive care and chemotherapy for plasma cell dyscrasia. This case underscores the significance of timely recognition and intervention for cardiac amyloidosis, contributing to improved understanding and management approaches.

High-risk jejunal gastrointestinal stromal tumor: case report and comparative review of international guidelines

2025-10-31T09:25:28+0530

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, arising from interstitial cells of Cajal. Diagnosis and management have advanced through molecular testing, surgery, and tyrosine kinase inhibitors. Although usually seen in older adults, GISTs may occur in younger patients with atypical symptoms. We report a high-risk jejunal GIST and compare major international guidelines to inform management. A literature review and guideline comparison were conducted using recent recommendations from ACG, AGA, ESMO, BSG, ESGE, NICE, JSCO, and the Royal College of Pathologists. These were correlated with the clinical, imaging, surgical, and histopathological findings of a 40-year-old male patient. The patient presented with abdominal distension, obstructive symptoms, and a palpable mass. CT revealed a 14×13×11 cm well-circumscribed mass in the epigastric/mesogastric region. Surgery identified a jejunal tumor 30 cm distal to the ligament of Treitz, requiring en bloc resection and primary anastomosis. Histopathology confirmed a spindle-cell GIST (CD117+, DOG1+, CD34–, Ki-67: 5/50 HPF) with high-risk features. Postoperative recovery was uneventful. Guidelines consistently recommend R0 resection, immunohistochemical confirmation, mutational profiling, and long-term surveillance. Adjuvant imatinib is advised for high-risk disease. This case underscores the need for early recognition and guideline-based management of GISTs, particularly in patients with nonspecific symptoms and large abdominal masses. International concordance emphasizes imaging, endoscopic ultrasound with biopsy, immunohistochemistry, and molecular testing for risk stratification. Surgery remains the cornerstone of treatment, with adjuvant therapy in high-risk cases. Multidisciplinary care is essential to optimize outcomes.

CytoSorb hemoadsorption in rhabdomyolysis-induced acute kidney injury: a case report from a tertiary hospital in Bangladesh

2025-10-31T09:25:20+0530

Rhabdomyolysis is a serious clinical condition involving the breakdown of skeletal muscle, leading to the release of intracellular components into circulation. Among its complications, acute kidney injury (AKI) is the most critical, occurring in up to 50% of cases. This report presents the case of a 42-year-old male with schizophrenia and hypertension who developed rhabdomyolysis-induced AKI following a fall. He exhibited markedly elevated creatine phosphokinase (CPK) levels (360,000 u/l) and deteriorating renal function. In addition to supportive management, CytoSorb hemoadsorption was initiated. Over three sessions, CPK levels dropped to 174 u/l, and serum creatinine declined from 3.53 mg/dl to 2.16 mg/dl. This case demonstrates that CytoSorb therapy can be effective even in limited-resource settings where myoglobin assays are unavailable, offering a promising strategy for early intervention in rhabdomyolysis-induced AKI. Our experience suggests early initiation of hemoadsorption could serve as an effective adjunct in managing challenging cases where conventional therapies alone may be insufficient.

Juvenile dermatomyositis in an eleven-year-old boy: a case report and review of literature

2025-10-31T09:24:59+0530

Juvenile dermatomyositis (JDM) is a rare chronic autoimmune inflammatory condition characterized by systemic capillary vasculopathy and idiopathic inflammatory myopathy (IIM) that primarily affects the skin and musculoskeletal system, resulting in a characteristic rash and symmetric muscle weakness of the upper and lower proximal muscles, increased levels of serum muscle enzymes and myopathic electromyography. Dysphagia, respiratory problems, and aspiration pneumonia can occur due to the involvement of respiratory and oropharyngeal muscles in severe cases. Both immune dysfunction and environmental factors are thought to contribute to etiopathogenesis. It could be linked to genetics, an immune response to a virus, an adverse drug reaction, exposure to sunlight or internal malignancy. JDM is characterized by two periods of peak occurrence: one during infancy which is called juvenile DM (JDM), typically between the ages of 5 and 15, and another during maturity, typically between the ages of 40 and 60. Histologically, it is characterized by the presence of lymphocytic vascular inflammation and endothelial swelling. Management of JDM is complex and warrants a multidisciplinary approach including physiotherapists, dermatologists, specialist nurses and pediatric rheumatologists, with other specialists like cardiologist/pulmonologist. The long-term complications of JDM include prolonged and severe muscle weakness with muscle atrophy, cutaneous calcifications, scarring or atrophy, and lipodystrophy. Calcinosis cutis, a form of dystrophic calcification, is a late sequel of the disease and occurs in up to 40% of patients with this disorder, a major cause of morbidity. JDM has poor prognosis with one third of patients recovering without complication, one third develop disability and one third die. Herein, we reported a case of an 11-year-old boy who presented to us with facial puffiness & weakness in both limbs, classic clinical and histopathological features of Juvenile dermatomyositis (JDM). As early diagnosis and timely aggressive treatment are associated with better outcomes.

A rare case of Legionella bozemanae leading to necrotizing pneumonia in an immunocompromised patient: a case study

2025-10-31T09:20:37+0530

Legionella bozemanae is a rare organism of Legionella species that can cause mild fever to severe pulmonary pneumonia known as Legionnaires’ disease. It can also cause extra-pulmonary infections, particularly in immunocompromised patients although deadly outcome in immunocompetent has also been reported. Diagnosis is often delayed due to limitations of conventional methods such as culture, serology, and urinary antigen testing, making newer molecular methods more valuable for early detection. We report the case of a 68-year-old male with history of relapsed acute myeloid leukemia (AML) and Sweet’s syndrome who presented with worsening dyspnea to emergency department. For evaluation, CT chest and the Karius test were performed. Which confirmed L. bozemanae infection and lobar consolidation. Despite multiple courses of broad-spectrum antimicrobials, including fluoroquinolones (Levofloxacin), macrolides (Azithromycin), and beta-lactams (Amoxi-clav), his condition deteriorated. Repeat CT scan showed progressive bilateral consolidation with cavitation, this suggested progressing to necrotizing pneumonia. Invasive procedures were deferred due to profound pancytopenia. Escalation of antibiotics were done but the patient eventually succumbed to his illness. This case presents the diagnostic and therapeutic challenges of L. bozemanae infection in immunocompromised patient. Routine diagnostic methods often fail to identify this organism, whereas next-generation sequencing plasma cfDNA, was valuable in confirming the pathogen. However, treatment response was poor, likely because of profound immunosuppression and possible antimicrobial resistance, consistent with previously reported cases in the literature. L. bozemanae infection, though rare, should be considered in immunocompromised patients with progressive pneumonia unresponsive to standard therapy. Early use of advanced molecular diagnostics may facilitate timely diagnosis and treatment. Management may require combination antimicrobial therapy, as monotherapy has been associated with resistance and relapse. Aggressive management is recommended, as the infection can lead to lung tissue necrosis, as seen in our case.

Redo mitral valve surgery 15 years after bioprosthetic valve implantation in a patient with hepatic and cardiac comorbidities

2025-10-31T09:22:18+0530

Redo mitral valve surgery poses significant technical and clinical challenges, especially in patients having a third reoperation. These cases are associated with increased operative threat due to adhesions, previous sternotomies, and limited surgical exposure. With significant advancements in surgical techniques, perioperative care, and patient selection, successful outcomes can still be achieved. We report the case of a 47-year-old male with a complex cardiac history, including surgical atrial septal defect (ASD) closure and prior bioprosthetic mitral valve replacements, who presented with symptomatic structural valve deterioration and progressive heart failure. A third-time redo mitral valve replacement was performed via median sternotomy, using femoral cannulation. Intraoperative findings included extensive adhesions and prior prosthetic valve degeneration. The postoperative course was notable for transient low cardiac output and arrhythmia management; however, the patient eventually recovered well and was discharged on the 10th postoperative day.

Thyrotoxic periodic paralysis presenting as acute quadriparesis in a middle-aged male: a case report

2025-10-10T06:56:56+0530

Thyrotoxic periodic paralysis (TPP) is a rare, potentially life-threatening complication of hyperthyroidism characterised by acute flaccid paralysis due to hypokalaemia. We report the case of a 46-year-old man who presented with sudden-onset generalised weakness that progressed to quadriparesis over a few hours. Laboratory investigations revealed severe hypokalaemia (2.6 mmol/l) and thyrotoxicosis (FT3 8.76 pmol/l, FT4 32.71 pmol/l, TSH 0.01 µIU/ml), with elevated thyrotropin receptor antibody (TRAb 12.2 IU/l). Ultrasound revealed diffuse thyroid enlargement with increased vascularity. The patient received intravenous potassium supplementation, propranolol, and carbimazole and completely recovered within 24 hours. He was advised to avoid precipitating factors such as high-carbohydrate meals, alcohol, and strenuous activity, and was referred for definitive management of hyperthyroidism. This case highlights the importance of considering TPP in Asian males presenting with acute flaccid paralysis and hypokalaemia. Early recognition, cautious potassium replacement, and timely initiation of antithyroid therapy are essential to prevent serious complications and ensure complete recovery.

Ayurvedic intervention in Bell’s palsy: case report on therapeutic efficacy

2025-10-31T09:28:05+0530

Bell palsy is idiopathic, unilateral facial nerve palsy of acute onset leading to facial muscle weakness. Facial palsy is inflammation around the facial nerve and this pressure causes facial paralysis on the affected side. This is a case of A 46 year old male patient admitted in Kayachikitsa Department of Vaidyaratnam Ayurveda college, Ollur on 6^th December 2023 with pain on the right side of face, posterior of neck radiating to right shoulder associated with swelling since one month. He had a history of Bell’s palsy before one month. Patient felt difficulty in speaking, closing of the right eyelid and loss of taste. He underwent a treatment protocol of Arditha followed by Vatavyadhi Chikitsa. Ayurvedic preparations like Dhanadanayanadi kashayam, Pathyashadankam kashayam, Vaiswanara choornam, Gandarvahastha eranda thailam, Dhanwantaram tablet were given internally. Choorna pinda swedam, Thalam with Rasnadi choornam and Karuthavattu, Rasathailam application, Sahacharadi tailam for whole body. Sirovasthi with Mahamasha tailam and Rasa tailam in the ratio 3:1 ratio, Ksheera dhoomam, Nasya with Anutailam were done externaly. House Brackmann Grade scales for pain, facial movements, were used to evaluate the effectiveness of treatment. Patient-reported outcome measures such as Facial Disability Index were used to assess the quality of life. Significant improvement noted in management of symptoms and work ability also showed improvement. Although this particular case was krichrasadhya, it was effectively managed through ayurvedic therapies, showing its relevance in current scenario that emphasises the invasive approaches.

Pott’s puffy tumor due to bone wax in open hypophysectomy: unforeseen consequences

2025-10-31T09:25:24+0530

Pott's puffy tumor is a rare condition characterized by the accumulation of pus and granulation tissue beneath the periosteum of the frontal bone, typically resulting from an infection that spreads from the frontal sinuses. This condition often leads to localized demineralization and necrosis of the affected bone. Neurosurgical procedures involving craniotomy commonly breach the frontal sinus, making it susceptible to infections. While such postoperative infections are uncommon, they pose significant challenges in management. Various methods have been employed to reconstruct the anterior skull base following neurosurgical procedures, including cranialization and obliteration of the frontal sinus. However, incomplete removal of mucosa or the presence of bone wax within the sinus outflow tract can lead to complications such as cellulitis, abscess formation, chronic sinusitis, or the development of mucoceles and muco-pyoceles. In this report, we present two cases of open hypophysectomy where bone wax inadvertently obstructed the frontal sinus outflow tract, resulting in persistent infection and subsequent frontal osteomyelitis. The frontal sinusitis after craniotomy may be related to the inadequate sinus management, especially bone wax ramming the frontal sinus leading to frontal sinus mucosa secretion obstruction and poor drainage. Avoiding bone wax as an obliterating material and meticulous removal of mucosa with drilling of the underlying bone to remove mucosal imbrications and complete obliteration of the frontal recess is essential in both frontal sinus obliteration and cranialization.

Isolated polydactyly of hands and feet in neonates: a case report

2025-10-31T09:22:56+0530

Polydactyly is a common congenital limb anomaly characterized by the presence of extra digits on the hands, feet, or both. When it occurs without any associated syndromic or systemic abnormalities, it is referred to as isolated polydactyly. In neonates, this condition presents with a wide spectrum of manifestations, ranging from small soft-tissue projections to fully developed digits containing bones and joints, and it may occur unilaterally or bilaterally. Classification is typically based on the anatomical location of the extra digit—preaxial (thumb or big toe side), postaxial (little finger or little toe side), or central—with postaxial polydactyly being the most frequently observed type, particularly among certain ethnic populations. Isolated polydactyly commonly follows an autosomal dominant pattern of inheritance with variable expression, although sporadic cases are also frequently reported. Accurate and early diagnosis is critical to differentiate isolated polydactyly from syndromic forms, as this distinction plays a key role in determining clinical management strategies and providing appropriate genetic counselling to families. In cases involving non-functional or minimally developed extra digits, intervention may not be necessary; however, surgical removal is often considered during infancy or early childhood for functional or cosmetic reasons, especially when the anomaly may interfere with hand or foot function or affect the child’s psychosocial development. This case emphasizes the clinical importance of recognizing isolated polydactyly in the neonatal period and underscores the need for thorough clinical evaluation, precise classification, and a coordinated, multidisciplinary management approach involving pediatricians, geneticists, and surgeons. Early intervention and counselling are essential for addressing parental concerns, guiding developmental support, and ultimately enhancing the quality of life and long-term functional outcomes for affected children.

A rare occurrence of progressive encephalomyelitis with rigidity and myoclonus in a case of breast carcinoma on treatment: a case report

2025-10-31T09:22:51+0530

Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a subtype of Stiff-Person syndrome (SPS) and it is characterized by progressive muscle rigidity, painful spasms, and stimulus sensitive abnormal involuntary movements (myoclonus). PERM is distinct from classical SPS in view of its more rapid progression, additional neurological symptoms, and poorer prognosis. It is an autoimmune-mediated disorder of the central nervous system (CNS), particularly affecting inhibitory pathways and can present as a paraneoplastic syndrome. We present the case of a 65-year-old woman with metastatic breast cancer who initially presented with spasmodic abdominal contractions misdiagnosed as intractable hiccups. Her symptoms progressed to include jaw stiffness, dysarthria, dysphagia, and generalized myoclonus, requiring invasive mechanical ventilation. Investigations showed normal brain imaging, unremarkable cerebrospinal fluid analysis, and positive amphiphysin antibodies in paraneoplastic encephalitis panel thus confirming PERM. She was treated with methylprednisolone (500 mg/day for 5 days) followed by intravenous immunoglobulin (IVIG) (2 g/kg over 5 days), resulting in complete resolution of symptoms and ventilator weaning. This case highlights the importance of recognizing PERM in cancer patients and demonstrates the potential efficacy of immunotherapy in its management.

Pulmonary lymphangioleiomyomatosis: a rare and challenging case report with unusual presentation of human melanoma black-45

2025-10-31T09:22:46+0530

Lymphangioleiomyomatosis (LAM) is a very rare disease that generally affects young women of reproductive health group. It is characterized by abnormal proliferation of smooth muscle like cells (LAM cells) in the lungs (pulmonary LAM) and extrapulmonary sites (extrapulmonary LAM). Patients usually present with spontaneous pneumothorax, hemoptysis and progressive dyspnea. There is a poor awareness, knowledge and records about this disease making it a difficult diagnosis. Herein this report presents a case of pulmonary LAM in a 63 years old female with h/o dyspnea and chest pain. Her imaging studies showed fibrosis and nodular lesions in both lungs suggesting metastatic lesions. Later on, after a lung biopsy the diagnosis of lymphangioleiomyomatosis was given and immunohistochemical staining was positive for spinal muscular atrophy (SMA), CD34 and negative for human melanoma black-45 (HMB45). HMB45 negative PLAM is very rare with only few instances in the literature making it a difficult diagnosis. Our patient was given mTOR inhibitors along with supportive and conservative management and she responded well to the treatment. This rare cystic lung disease can be devastating as it causes progressive lung damage. Limited options in the management of PLAM makes early diagnosis as key and there is also a need for high index suspicion with cystic lung disease in women.

Beyond the heart: unveiling paroxysmal nocturnal hemoglobinuria in a patient with rheumatic heart disease

2025-10-31T09:22:35+0530

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired clonal disorder caused by a PIGA gene mutation, leading to glycosylphosphatidylinositol (GPI) anchor deficiency and uncontrolled complement activation. It causes intravascular hemolysis (IVH), thrombosis, and systemic complications. Rheumatic heart disease (RHD), associated with severe valvular pathology, can cause hemolytic anemia. Herein this case reports a 46-year female with RHD-associated aortic stenosis, regurgitation, chronic anemia, jaundice, and hemoglobinuria. Investigations showed hemolysis with elevated lactate dehydrogenase, indirect bilirubin, and reticulocytosis. Chronicity and severity prompted further evaluation. Flow cytometry revealed a significant PNH clone (40.15% in RBCs, >89% in WBCs), confirming complement-mediated hemolysis coexisting with RHD. This case highlights the diagnostic complexity of overlapping hemolytic mechanisms and underscores the importance of considering PNH in unexplained anemia and hemolysis, with early evaluation critical for optimizing outcomes in such rare clinical scenarios.

The unseen threat: anti-PL7 anti-synthetase mediated interstitial lung disease

2025-10-31T09:22:26+0530

Anti-synthetase syndrome (ASS) is a rare autoimmune disorder within the spectrum of idiopathic inflammatory myopathies, defined by the presence of anti-aminoacyl-tRNA synthetase antibodies, most commonly anti-Jo1. Less frequent antibodies, such as anti-PL7, are associated with predominant pulmonary involvement and minimal muscle symptoms. Interstitial lung disease (ILD) is the most serious complication and may be the initial or sole presenting feature. Due to its rarity and atypical manifestations, anti-PL7-associated ASS can be underdiagnosed, especially in elderly patients presenting with unexplained ILD. Herein this case reports the case of a 74-year-old woman who presented with exertional dyspnea and a persistent dry cough for three months. Examination revealed Raynaud’s phenomenon, hyperkeratotic skin changes on the hands (mechanic’s hands), and digital ulceration. Imaging confirmed bilateral ground-glass opacities consistent with ILD. Autoimmune serology showed a positive ANA (1:320, speckled pattern) and anti-PL7 antibody, with no evidence of myositis. Based on Connors et al's criteria, a diagnosis of anti-synthetase syndrome was made. The patient received high-dose intravenous corticosteroids and cyclophosphamide, with limited clinical improvement. She was discharged on request on long-term oxygen support and oral steroids for outpatient follow-up. This case highlights the diagnostic challenge of ASS, especially when classical myositis features are absent. Anti-PL7-positive patients often present with isolated ILD, carrying a poorer prognosis compared to anti-Jo1-positive patients, and may not respond to standard immunosuppression. Early recognition of dermatologic signs and prompt antibody testing are essential for diagnosis. Aggressive initial therapy may be required, and biologic agents should be considered for refractory cases.

Brain trauma induced hyperfibrinolysis: a tale of two cases diagnosed on wheels of rotational thromboelastometry

2025-10-31T09:22:24+0530

Brain trauma including brain surgeries are medical emergencies which frequently cause abnormalities in the coagulation system which in turn leads to bleeding and poor outcomes. Routine coagulation tests often fail to diagnose these defects in the coagulation/fibrinolytic system in such critical emergencies. Viscoelastic tests are a rapid alternative which not only helps to diagnose these patients accurately but also at a much earlier time than routine coagulation tests. Here, we report two cases of brain surgeries who presented with bleeding in post operative period due to hyperfibrinolysis and they were correctly diagnosed and successfully treated with the help of rotational thomboelastometry whereas routine coagulation tests failed to do so.

Descending colon perforation due to accidental swallowing of dentures: an interesting case report

2025-10-31T09:22:15+0530

Ingesting foreign bodies is a common occurrence, particularly in children and in a few adults (Mentally incapable, alcoholics, and people wearing dentures). Swallowed dentures are a multidisciplinary problem that concerns various fields like surgery, endoscopy, anaesthesiology, dentistry, psychiatry, neurology, thoracic surgery, and emergency medicine. Hence, swallowed dentures are considered a unique type of foreign body apart from coins, batteries, and needles. Most foreign bodies pass through the intestines without a problem. The reported complications due to ingestion of swallowed dental prosthesis include trachea-oesophageal fistula and perforation of the colon. Here, we are reporting a case of a 40-year-old male patient presenting with descending colon perforation and on surgical exploration found to have a denture protruding from the colon.

A case report on fetal acrania

2025-10-31T09:21:04+0530

Fetal acrania is a rare but lethal congenital malformation within the acrania-exencephaly-anencephaly spectrum, characterized by complete absence of the cranial vault, meninges, and overlying scalp. The reported incidence is 1.4-2 per 1000 births in India, making it one of the most common neural tube defects after cardiac anomalies. Early detection through ultrasonography is crucial for counselling, prevention of maternal complications, and guiding reproductive planning. A 21-year-old primigravida presented at 16 weeks of gestation for routine antenatal care. She was unbooked case. Diagnosis of acrania was established by ultrasound, and the patient was managed with medical termination of pregnancy following counselling. Early sonographic diagnosis is vital for appropriate counselling and decision-making. Pre-conceptional folic acid supplementation remains the most effective preventive measure against neural tube defects.

Sheehan’s syndrome with delayed diagnosis

2025-10-31T09:20:59+0530

Sheehan’s syndrome is a rare but important cause of hypopituitarism, typically resulting from ischemic necrosis of the anterior pituitary gland following severe postpartum hemorrhage. Its presentation may be acute or delayed, often leading to diagnostic challenges, particularly in regions with limited obstetric facilities. This case reports the case of a 57-year-old woman who presented with chronic fatigue, dizziness, and hypotension. She had a history of severe postpartum hemorrhage decades earlier, followed by failure of lactation and amenorrhea. Evaluation revealed secondary hypothyroidism and adrenal insufficiency. Magnetic resonance imaging (MRI) brain demonstrated an atrophied pituitary with a thin rim of residual tissue. She was diagnosed with Sheehan’s syndrome and treated with hydrocortisone replacement, followed by levothyroxine titrated according to free T4 levels. At six-month follow-up, she was asymptomatic with complete resolution of clinical features. This case highlights the importance of considering Sheehan’s syndrome in women with unexplained hypothyroidism, hypotension, or amenorrhea with a history of postpartum hemorrhage. Cortisol replacement must always precede thyroid hormone therapy to avoid adrenal crisis. Early recognition and appropriate hormone replacement therapy ensure favorable long-term outcomes.

Goblet cell adenocarcinoma of the appendix: a rolling stone for long

2025-10-31T09:20:52+0530

Appendiceal goblet cell adenocarcinoma (GCA) is a rare and aggressive epithelial neoplasm comprising goblet-like mucinous cells primarily and variable neuroendocrine cells. It is an amphicrine neoplasm with features of epithelial and neuroendocrine tumours, but behaves aggressively like an adenocarcinoma variant. GCA has undergone multiple name changes in the past; therefore, there have been inconsistencies in nomenclature, classification, reporting, and understanding of the pathology of the disease. Although it typically presents with features of acute appendicitis, it may sometimes present with subtle symptoms of gastrointestinal discomfort. In late stages, they may present with intestinal obstruction or as a metastatic ovarian mass. Diagnosis is possible only on histopathologic examination, which reveals goblet cell infiltration in sheets, singly scattered form, complex cribriform pattern, discrete clusters, and tubules. Our case report aims to increase awareness about GCA and its differential diagnosis and emphasise the need for a larger, elaborate study to bring consistency in GCA reporting. We report a rare case of metastatic high-grade appendiceal GCA in a 65-year-old female presenting with complete intestinal obstruction.

Diabetes mellitus masking an ectopic Cushing syndrome in a young male: a case report

2025-10-31T09:20:49+0530

Ectopic adrenocorticotropic hormone (ACTH) secretion is a rare but important cause of Cushing syndrome, often associated with neuroendocrine tumors such as bronchial or gastrointestinal carcinoids. Its presentation can be subtle or atypical, delaying diagnosis and increasing morbidity. Herein this case report presents a 24-year-old male presenting with uncontrolled diabetes mellitus, polyuria, and weight loss (13 kg over 6 months). He exhibited proximal muscle weakness, broad purple striae, and extensive hyperpigmentation. Laboratory evaluation revealed markedly elevated 8 am serum cortisol 82 mcg/dl, midnight awake cortisol 211 mcg/dl, overnight dexamethasone suppression test (27.32 mcg/dl), plasma ACTH 320 pg/ml, and a non-suppressed (<50%) high-dose dexamethasone suppression test (16 mcg/dl). High-resolution computed tomography (HRCT) chest demonstrated multiple pulmonary nodules. Ga-68 DOTANOC PET-CT imaging revealed somatostatin receptor expression in bilateral lung nodules. Endobronchial biopsy confirmed atypical carcinoid tumor, Ki-67 index 4%. This case highlights the diagnostic complexity of ectopic ACTH syndrome, particularly in young adults presenting with rapidly worsening diabetes. The presence of significant pigmentation, proximal myopathy, and metabolic derangements were key clinical clues. Atypical carcinoid tumors exhibit intermediate biological behavior and require a multidisciplinary management approach including surgical resection, somatostatin analog therapy, and cortisol-lowering strategies. Ectopic ACTH syndrome should be considered in young patients with severe metabolic abnormalities, rapid weight loss, and hyperpigmentation. Early recognition and appropriate work-up can prevent complications and improve outcomes.

Accessory lobe of liver: intra-operative incidental finding: a rare case report

2025-10-31T09:20:47+0530

An accessory lobe of liver is a rare congenital anomaly, but is usually an incidental finding during abdominal surgeries. The condition is usually asymptomatic. Here, we report a case where the accessory liver lobe was an incidental finding during laparoscopic Cholecystectomy. An accessory liver lobe resection should be done to prevent complications and malignant transformation.

An aggressive clinical course of polycythemia vera with coexisting complications: a case report

2025-10-31T09:20:33+0530

Polycythemia vera (PV) is a myeloproliferative disorder characterized by rapid proliferation of red blood cells. It may present with symptoms of hyper viscosity. Complication of thrombosis is well recognized, but its rapid progress and coexistence of involvement of various organ sites simultaneously are not seen as often. We present a case of a 40-year-old female who was incidentally diagnosed with PV due to her presentation with extrahepatic portal venous obstruction (EHPVO). Her elevated platelet count prompted a bone marrow biopsy, leading to the finding of Janus kinase-2 (JAK2)-positive PV. Her condition rapidly progressed to decompensated chronic liver disease, likely triggered by the portal hypertension due to EHPVO. This was further complicated by her PV progressing to myelofibrosis, a rare complication of PV. This progression typically occurs after 10-15 years of diagnosis, but in this case, it was seen within 3 years, demonstrating the rapid course of her disease. This case is noteworthy for how differently PV can present. It highlights the importance of investigating patients for underlying blood malignancies when they present with clots without any identifiable cause. It also sheds light on how fast this disease can progress and shows the importance of early diagnosis and appropriate management to prevent several complications associated.

Global expert consensus on Takotsubo syndrome (part I): understanding clinical presentation, diagnostic criteria, and underlying mechanisms

2025-10-31T09:28:08+0530

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy or broken heart syndrome, is an acute, reversible form of left ventricular dysfunction that clinically mimics acute myocardial infarction but occurs without significant coronary artery obstruction. First identified in Japan in the 1990s, TTS is now recognized globally and accounts for approximately 1-2% of patients with suspected acute coronary syndrome. It predominantly affects postmenopausal women (mean age 58-75 years) and is typically triggered by intense emotional or physical stress. Clinically, TTS presents with sudden chest pain, dyspnea, and ECG changes such as ST-segment elevation or T-wave inversion. The leading pathophysiological hypothesis involves a catecholamine surge leading to myocardial stunning, microvascular dysfunction, and direct myocardial toxicity. Additional factors include neurohormonal, endothelial, and metabolic disturbances. Diagnosis is largely clinical, based on exclusion of coronary artery disease and confirmed via imaging modalities like echocardiography or cardiac MRI, which show characteristic regional wall motion abnormalities, often termed "apical ballooning." The Mayo Clinic Criteria remain the most widely accepted diagnostic framework, emphasizing transient ventricular dysfunction, absence of obstructive coronary lesions, ECG/biomarker abnormalities, and eventual recovery. Although the short-term prognosis is generally favorable, complications such as heart failure, arrhythmias, and thromboembolism may occur. Recurrence rates range from 5-15%, and psychological distress may persist. This review outlines the clinical presentation, diagnostic approach, and pathophysiological insights into TTS, highlighting recent consensus and advances essential for accurate diagnosis and long-term care.

Obesity and the role of artificial intelligence as a prediction tool

2025-10-31T09:22:40+0530

Obesity is one of the leading public health challenges worldwide, with a growing prevalence and a strong association with chronic noncommunicable diseases. Traditional methods for risk assessment and clinical management have shown limitations in addressing the multifactorial complexity of this condition. In this context, artificial intelligence (AI) emerges as an innovative tool capable of enhancing risk prediction and optimizing treatment strategies. This article reviews current AI approaches applied to obesity, ranging from predictive models based on clinical, genomic, and behavioural data to personalized digital interventions in nutrition, physical activity, and therapeutic adherence. Furthermore, the main advantages, limitations, and ethical challenges of clinical implementation are analyzed. Finally, recommendations are provided to guide the responsible integration of AI into medical practice, aiming to advance toward more predictive, preventive, and personalized medicine in obesity management.

Current management and controversies in acute cholecystitis: a narrative review of surgical and nonsurgical strategies, with emphasis on suspicion or incidental detection of gallbladder carcinoma

2025-10-31T09:20:26+0530

Acute cholecystitis (AC) is a frequent surgical emergency. Laparoscopic cholecystectomy (LC) remains the standard treatment, though debate continues over surgical timing, the role of percutaneous cholecystostomy (PC), and the management of incidental gallbladder carcinoma (GBC). This review analyzed data from randomized trials, meta-analyses, and large observational studies (1966–2023) on these key issues. Evidence supports early LC (within 24–72 hours) as the optimal approach, consistently reducing hospital stay by about 3–4 days (weighted mean difference: –3.07 to –4.1 days, p<0.00001) without increasing mortality or bile duct injury. Operative time is slightly longer (+9.29 minutes, NS). In high-risk patients (APACHE II ≥7), the CHOCOLATE trial demonstrated LC superiority over PC, with lower complication rates (12% versus 65%, p<0.001), fewer reinterventions, and shorter length of stay (5 vs. 9 days, p<0.001). A meta-analysis of 32 studies found PC followed by delayed LC reduced overall complications (RR 0.28, 95% CI 0.14–0.56) but increased biliary leakage when drainage was delayed. Large databases confirm PC alone yields higher mortality and longer hospitalization than LC. Incidentally detected GBC occurs in 0.25–0.89% of cholecystectomies. Registry data show re-resection significantly improves survival for pT2 (44.1 versus 12.4 months) and pT3 (23.0 versus 9.7 months) disease. Early LC is therefore preferred for most AC patients, while PC serves only as a bridge in unstable cases. For incidental GBC, timely re-resection remains essential for curative outcomes, though standardized timing and patient selection criteria require refinement.

Redefining quality of life in renal replacement therapy: a patient centered perspective

2025-10-31T09:23:08+0530

Renal replacement therapy (RRT), encompassing hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation is essential for managing end stage renal disease (ESRD). As survival outcomes have improved, there is increasing recognition of the need to enhance quality of life (QoL) among patients undergoing RRT. However, widely used QoL assessment tools like ED-5D, SF-36 and KDQOL-SF often fail to capture the multifaceted psychosocial, emotional and existential dimensions of patients lived experiences. To better understand these limitations, we conducted a comprehensive review of PubMed indexed articles addressing QoL in RRT patients across different modalities. Our findings reveal that current tools inadequately reflect psychological distress, social role distribution and loss of autonomy and are inconsistently responsive across patient populations. Challenges such as fatigue, depression, physical decline and economic burden vary significantly and are often overlooked in standard metric. We propose a patient centered reframing of QoL assessment that includes domains such as purpose and identity, emotional and spiritual resilience, social integration, economic participation and digital empowerment. Incorporating these domains into clinical care and research design offers a more holistic approach to RRT, improving patient satisfaction, engagement and long term outcomes. This shift towards human centered metrics is essential for advancing patient centered nephrology care.

Impact of hormonal contraceptives and hormone replacement therapy on gastrointestinal health: a comprehensive review

2025-10-31T09:20:21+0530

Hormonal contraceptives and hormone replacement therapy (HRT) are widely used worldwide. While benefits are well established, exogenous hormones can affect the gastrointestinal (GI) system. These complications often nonspecific and delayed are underrecognized. In this review, we surveyed PubMed/MEDLINE/Embase through September 2025, assessing hormonal contraceptives or HRT in relation to GI/hepatobiliary outcomes. It was found that estrogen-containing contraceptives are most strongly linked to hepatocellular adenoma (HCA), with dose–duration dependence; lesions typically stabilize or regress after hormone withdrawal. Focal nodular hyperplasia showas no causal relationship and usually does not require contraceptive cessation once confidently diagnosed. Estrogen-induced cholestasis reflects down-regulation of canalicular transporters (e.g., BSEP, MRP2) and is more likely in genetically predisposed women, such as those with prior cholestasis of pregnancy. Estrogen increases biliary cholesterol; progestins reduce gallbladder contractility, together promoting lithogenesis – This effect is stronger with HRT than low dose combined contraceptives. Estrogen-associated pancreatitis occurs primarily via severe hypertriglyceridemia and is amplified by familial dyslipidemias, diabetes, or metabolic syndrome. Hormonal agents modulate motility and visceral sensitivity, contributing to nausea, bloating, and early satiety; symptom fluctuations may be greater with hormone-free intervals. Epidemiology consistently links combined oral contraceptives to Crohn’s disease in a dose- and duration-dependent fashion. Long-term hormonal therapy can influence GI health via hepatic, lipid, immune, and motility pathways. Absolute risks are low for most users, but individualized counselling, shared decision-making, and targeted monitoring improve safety while preserving therapeutic benefits. Further mechanistic and longitudinal studies are needed to refine risk stratification.

Role of inflammation in alcoholic liver diseases and its management

2025-10-31T09:25:01+0530

Alcoholic liver disease (ALD) weighs a heavy health burden in India with 76% increase in disability-adjusted life years (DALYs) through 1990 to 2016. This review examines the role of inflammation in its pathogenesis and management approaches for the same. The pathophysiology of ALD involves various mechanisms such as increased gut permeability, oxidative stress and activation of inflammatory cascade, where tumor necrosis factor-alpha (TNF-α) plays a central role. Due to these varied mechanisms, the clinical presentation also varies, ranging from asymptomatic fatty liver to severe cirrhosis. As such, the management strategies range from alcohol abstinence and nutritional support to pharmacological interventions. For inflammation-predominant ALD phenotypes such as alcoholic hepatitis, corticosteroids are often used as the primary therapy. Other agents, including S-adenosylmethionine (SAMe), pentoxifylline and N-acetylcysteine, show promise in targeting the inflammatory pathogenesis of ALD. SAMe is a more specific option for targeting inflammation, while N-acetylcysteine is best used where its potent anti-oxidant activity is desired. Ultimately, liver transplantation offers the terminal option for end-stage disease, with considerations for inflammation to subside before it can be done. This review highlights the complex inflammatory mechanisms underlying the ALD spectrum and discusses various multimodal approaches for incorporating various treatment strategies.

The hidden heart of autoimmunity: a scoping review of carditis in rheumatoid arthritis and IgG4-related disease

2025-10-31T09:24:42+0530

Cardiac involvement in autoimmune diseases is often more common and more serious than we tend to acknowledge. While most clinicians are familiar with the joint pain of rheumatoid arthritis or the organ swelling of IgG4-related disease, inflammation of the heart itself is frequently missed. This is partly because cardiac symptoms are subtle or mistaken for something else, and partly because cardiovascular issues simply aren’t top of mind when managing autoimmune patients. As a result, carditis whether it's myocarditis, pericarditis, or pancarditis remains underdiagnosed, underreported, and under-discussed, especially in the context of rarer conditions. This gap in recognition is particularly noticeable in IgG4-related disease, a condition known for causing fibrotic masses and multiorgan inflammation, but where cardiac involvement is poorly documented and often misclassified. Even in rheumatoid arthritis (RA), a disease much more common and much better studied, direct inflammation of the heart is often overshadowed by more visible symptoms like synovitis or systemic fatigue. Yet, evidence suggests that cardiac complications significantly contribute to both morbidity and mortality in autoimmune patients, often silently progressing until they become life-threatening. This scoping review sets out to bring more attention to this overlooked aspect of autoimmune disease. We aim to explore and organise the current literature on carditis in RA and IgG4-related disease, looking closely at how it presents, how it's diagnosed, what mechanisms might be driving it, and how it's treated. We’ve taken a wide lens to capture everything from well-documented case reports and cohort studies to emerging data on biomarkers and imaging techniques. In the end, this review is not just about summarising the science. It’s about bringing the heart back into the conversation, literally and figuratively when we talk about autoimmune diseases. Because if we want to improve outcomes for these patients, we need to start looking beyond the obvious and paying closer attention to what’s happening inside the chest.

Healing beyond borders: intellectual property, traditional knowledge, and the future of Unani medicine

2025-10-31T09:24:37+0530

There are unique issues and opportunities related to intellectual property in the development of modern Unani medicine. With increasing global interest in traditional and herbal medicines, Unani pharmaceutical companies face the challenge of continuously improving their products while staying true to traditional knowledge. Therefore, patent protection and compulsory licensing are essential in this transition process, balancing invention rights and public health concerns related to Unani treatments. Patents encourage innovation by providing exclusive rights for specific solutions and techniques, often attracting venture capital for development. However, these rights can also limit access, especially in poor regions where traditional cures are most needed. Compulsory licensing offers a viable alternative, allowing governments or authorized bodies to produce patented medicines without the patent holder’s consent in certain situations, such as in the public interest. In Unani medicine, compulsory licensing may be particularly useful for regulating patent-holding companies and ensuring they respond to societal needs by providing necessary treatments. This paper explores how patents and compulsory licensing influence Unani pharmaceuticals, focusing on how policy makers shape and enforce intellectual property rules to manage commercialization, access, and international market growth. It is crucial to balance the use of traditional Unani medicine to make it a practical, culturally sensitive, and affordable healthcare option for the global community.

Fear experienced by patients and their caregivers while performing tracheostomy suctioning: a comprehensive review

2025-10-31T09:23:11+0530

Tracheostomy suctioning is an essential procedure to prevent airway obstruction, yet it often triggers significant fear and anxiety in both patients and their caregivers. This comprehensive review analyzes the psychological and physical challenges associated with the procedure, drawing from peer-reviewed studies, case reports, and clinical guidelines. Patients frequently report profound fear linked to sensations of choking, breathlessness, pain, and a loss of control, which can contribute to long-term anxiety and depression. Concurrently, caregivers experience intense stress, fearing they might cause harm, complications like hypoxia or infection, or manage the procedure incorrectly due to inadequate training. This shared emotional burden can lead to burnout and negatively impact adherence to care. The findings confirm that fear associated with tracheostomy suctioning has significant psychological and clinical implications. Addressing these concerns through comprehensive caregiver training, patient reassurance, integrated psychological support, and adherence to standardized, gentle techniques is critical. Healthcare providers play a pivotal role in creating a supportive environment that empowers both patients and caregivers, ultimately reducing anxiety and improving the safety and efficacy of tracheostomy care.

Recent advances in computed tomography and magnetic resonance imaging techniques for cancer detection with artificial intelligence and machine learning integration

2025-10-31T09:21:02+0530

Cancer is one of the leading causes of death all over the world. The International Agency for Research on Cancer (IARC) estimated 20 million new cancer cases in 2022. However, detecting cancer is difficult because it shows symptoms in the final stage. Diagnostic imaging plays a vital role in the early detection of cancer. Advanced imaging technology includes X-ray mammography, ultra-low-dose computed tomography (ULDCT), and dual-source CT, which uses two X-ray sources and improves the resolution of images. Radiomics is another advanced approach that converts medical images into quantitative data and deep learning methods (DL) using Artificial intelligence (AI), which tremendously increases the accuracy of tumor detection. Several automated and semi-automated methods are proposed to detect pulmonary nodules using DL methods such as Conventional neural network (CNNs), which include ResNet-50, VGG16, and InceptionV3. In addition to techniques that involves ionizing radiation, this review also explains the magnetic resonance imaging (MRI) techniques for cancer detection. MRI uses radio-frequency (RF) pulses to form images with high spatial resolution. Diffusion-weighted imaging (DWI), functional magnetic resonance imaging (fMRI), and MR spectroscopy (MRS) are the MRI sequences generally used for cancer detection. The aim of this paper is to provide an overview of modern CT and MR imaging techniques integrating with AI and machine learning for cancer detection.

Periodontitis and malignancy: a growing concern

2025-10-31T09:20:57+0530

Periodontitis is an inflammatory disease affecting the supporting structures of the tooth resulting in tooth mobility and tooth loss. Periodontitis has been consistently associated with a higher risk for head and neck cancer. Possible mechanisms include the chronic inflammatory nature of the disease, epigenetic damage to the epithelial cells by periodontal pathogens and dysbiosis. The present review focuses on various pathways of spread of head and neck cancers and the role of various periodontal pathogens in initiating this carcinogenesis.

Chronic microplastic exposure: a growing threat to metabolic health in India

2025-10-31T09:22:48+0530

Microplastics have emerged as widespread environmental contaminants. These particles originate from the breakdown of larger plastic waste, which is now prevalent in ecosystems, including water, soil, air, and food sources, making human exposure inevitable. If current trends continue, global plastic pollution will reach alarming levels by 2050. Microplastics primarily enter the human body via ingestion, inhalation, as well as dermal contact, along with significant exposure occurring through contaminated water, food, and urban air pollution. Various studies indicate that microplastics can disturb gut microbiota, trigger systemic inflammation, hinder lipid metabolism, and encourage issues such as insulin resistance, obesity, and cardiovascular diseases. They also serve as vehicles for toxic substances, increasing their harmful effects. This review synthesizes current evidence by searching PubMed, PubMed Central, Scopus, and Google Scholar for studies published between 2010-2025 on microplastic exposure and metabolic health, focusing on India. The scenario in India is especially concerning due to high plastic consumption, poor waste management, and a significant rate of metabolic disorders; thus, further research in this field is crucial. This review highlights the pathways of microplastic exposure to humans, along with their potential to disrupt metabolic health, emphasizing the vulnerability among the Indian population. It calls for urgent, region-specific research to explore these health risks and advocates for stricter policies on plastic waste management to mitigate the growing public health crisis.

Enhanced surgical planning with 3D modeling in pediatric surgical oncology: management of complex abdominal tumors in a low-income country

2025-10-31T09:23:18+0530

Three-dimensional (3D) modeling has emerged as a valuable tool in pediatric oncologic surgery, particularly for complex abdominal tumors where precise anatomical planning is critical. It enables enhanced surgical visualization, improved team communication, and more accurate estimation of vascular structures and adjacent organs, thereby increasing the safety and feasibility of extensive resections. We present six pediatric cases of complex abdominal tumors, including a NOS hepatic tumor, myofibroblastic tumor, cholangiocarcinoma, hepatoblastoma, neuroblastoma, and a Frantz-Gruber tumor, where 3D reconstruction and printing were employed to support preoperative planning and intraoperative navigation. All patients underwent contrast-enhanced thoracoabdominal CT, angiography, and 3D modeling due to tumor size, anatomical complexity, and vascular involvement. Additionally, we performed a literature review to contextualize the clinical value of 3D modeling in pediatric surgical oncology. Six patients underwent complete resections without complications. One patient was deemed unresectable after a detailed 3D evaluation, and only one patient presented a postoperative complication. The models were used to assess tumor boundaries, vascular proximity, and residual liver volume. They also improved interdisciplinary coordination and communication with families. 3D modeling facilitates individualized surgical planning, enabling more accurate, safer, and potentially curative interventions in patients with complex tumors. It enhances communication across the surgical team, supports medical education, and minimizes potential complications. As this technology becomes more accessible, it has the potential to significantly improve outcomes in pediatric surgical oncology.

Brucella abortus and Brucella melitensis infections in humans: a case series highlighting diagnostic and epidemiological profile

2025-10-31T09:22:59+0530

Brucellosis is a major zoonotic infection caused by Brucella species, commonly acquired through contact with infected animals or ingestion of unpasteurized dairy products. Its varied clinical manifestations and nonspecific symptoms often delay diagnosis, complicating patient management. This case series describes the clinical, diagnostic, and epidemiological features of eight confirmed brucellosis cases from a tertiary care centre. Diagnosis was established using rose Bengal plate test (RBPT), serum agglutination test (SAT), enzyme-linked immunosorbent assay (ELISA) IgM antibody detection, and real-time PCR. Species identification was performed through conventional PCR targeting the IS711 gene, followed by Sanger sequencing. Clinical data, laboratory findings, risk factors, co-infections, and treatment outcomes were systematically documented. Of the eight cases, five were infected with B. abortus and three with B. melitensis. Joint pain was universal, with sacroiliitis in two patients and rheumatoid arthritis in another two. Most patients had normal haematological parameters, with mildly elevated inflammatory markers (CRP, ESR). Rural exposure, livestock contact, and consumption of animal products were the predominant risk factors in B. abortus cases. In contrast, B. melitensis cases occurred in urban residents with no direct animal exposure, suggesting foodborne transmission. Three patients presented with co-infections (Leptospira, dengue, malaria and salmonella), while two patients with underlying malignancies succumbed. All were treated with doxycycline and rifampicin for six weeks, as per WHO guidelines. This series emphasizes the persistence of brucellosis in rural India and the emergence of B. melitensis in urban settings. Early diagnosis, molecular species identification, and integrated one health interventions are critical to reducing disease burden.

Supporting caregivers of autistic children

2025-10-31T09:22:41+0530

I read with great interest the article by Abed et al on “Quality of life disparities among mothers of autistic children and mothers having normal children in Baghdad city-2024”. The study effectively demonstrated that mothers of autistic children face significantly poorer quality of life (QOL) compared to controls, with the greatest disparities noted in physical and psychological domains. These results highlight the immense caregiving burden borne by mothers, affecting their health, emotions, and daily functioning

Artificial intelligence in patient education: a case study on peripheral artery disease

2025-10-31T09:22:31+0530

The Gemini chatbot is a conversational artificial intelligence (AI) system developed by google and launched in December 2023. It functions as a multimodal large language model (LLM). This means it’s not limited to understanding and generating texts; it can process and respond to various types of information, including images audios and videos. Users can interact with it by typing or speaking prompts.

Dual-action hope: DeepSeek responses to Tirzepatide’s role in metabolic health

2025-10-31T09:21:06+0530

DeepSeek is an artificial intelligence (AI) platform introduced on January 2025. It is built on deep learning and natural language processing (NLP) technologies. Its core products include the DeepSeek-R1 and DeepSeek-V3 models.¹ A prominent feature of DeepSeek's framework is its support for offline deployment. This capability may enable healthcare institutions to adapt a local LLM (large language model) and operate the model without an internet connection, thereby enhancing data privacy and security.² DeepSeek has set tremendous path by lower computational costs compared to other proprietary LLMs, making AI more accessible to everyone. In medical education, educators can create case simulations for tutoring students. The model's ability to process and generate human-like text enables the development of realistic patient interactions, enhancing the training of future healthcare professionals.³ Having large updated database, doctors and patients can now use this as new tool to update themselves in new innovations in field of medicine

Discordance between histopathology and immunohistochemistry and pattern of lymphoma in northern part of Bangladesh

2025-10-31T09:28:00+0530

Background: Even in this modern era, many lymphoma patients are getting treatment based on histopathology diagnosis. The treatment plan and overall survival (OS) of lymphoma patients are adversely affected by either misdiagnosis or overdiagnosis. This study is intended to evaluate the degree of discordance between IHC and histopathological investigations, the pattern of lymphoma and various factors related to it.

Methods: This cross-sectional study was conducted in the Department of Hematology, Shaheed Ziaur Rahman Medical College Hospital, Bogura and private practice from 2019 to 2024 until 100 cases were available. Variation in diagnosis was assessed and factors such as cellular origin of lymphoma, status of CD20 positivity, any role of expert variation and justification of histopathology as a tool of treatment were assessed. Data were collected by reviewing investigation reports and documented in a checklist.

Results: Diagnostic discordance, regarding confirmed diagnosis, between histopathology and IHC was identified in 78% of patients. In 58% of cases, morphological diagnosis even failed to clarify broadly if it is malignant or not, if it is lymphoma whether it is HL or NHL. In 75% of lymphoma cases, peripheral lymph node involvement was found, about 10% of cases NHL involved bone marrow rather than peripheral LNs. CD20 was positive in 62% of lymphomas, 10% of HD and 72% of NHL.

Conclusions: Lymphoma is a potentially curable malignancy having a wide variety of treatment options depending on the type of disease. This typing is not possible without IHC. No lymphoma patient should be treated without IHC diagnosis.

Five-year survival rate from triple-negative breast cancer varies on follow up, platin agents and multidisciplinary team: a prospective analysis at tertiary level hospitals in Bangladesh

2025-10-31T09:24:54+0530

Background: Triple-Negative Breast Cancer (TNBC) is an aggressive subtype of breast cancer lacking ER, PR, and HER2, with high recurrence and mortality. This study evaluates survival outcomes and treatment impact in Bangladesh. The objective of this study was to assess the five-year survival rate of TNBC patients in Bangladesh, evaluate the impact of platin-based chemotherapy and MDT, and compare the outcomes of neoadjuvant and adjuvant treatments.

Methods: This prospective analysis was conducted on 165 TNBC patients from a cohort of 1672 breast cancer patients treated at two tertiary hospitals in Dhaka between January and December 2018. Patient data were collected prospectively, and follow-up was conducted every six months via phone or departmental database. Data on demographic characteristics, co-morbidities, treatment regimens, and survival outcomes were analyzed.

Results: Among the 165 TNBC patients, 37 (22.42%) died within the five-year follow-up period, with 52 (58.43%) surviving. Disease-Free Survival (DFS) was observed in 47 (52.81%) patients, and recurrence was recorded in 5 (5.62%). The survival rate varied significantly across different age groups: 59.62% survival in the 40-63 years age group, 32.69% in the 39 and younger group, and 7.70% in the 64 and above group. Notably, 91 (55.15%) patients received neoadjuvant chemotherapy (NACT), and 74.74% of them survived five years. The overall survival (OS) rate was highest in those treated with platinum-based agents, with a survival rate of 70.97%. The median survival time for those receiving MDT was 61.07%, compared to 19.79% for those treated without MDT. A significant correlation was found between treatment completion (p<0.05), chemotherapy regimen (p<0.01), and follow-up adherence (p<0.05) on survival outcomes.

Conclusions: This study highlights the importance of early detection, treatment completion, and MDT management in improving TNBC survival, particularly for those under 63 years.

Anatomical evaluation of supraorbital notch and supraorbital foramen morphology and supraorbital nerve distribution: a cadaveric study

2025-10-10T06:56:55+0530

Background: Peripheral nerve compression at trigger points is considered a cause of migraine and primary headaches. These trigger points are most commonly found in the sensory regions. In particular, compression of the supraorbital nerve by fascial bands or at the supraorbital foramen has been reported as a source of headache in the literature. This study aimed to evaluate the structures through which the supraorbital nerve passes to reach the innervation area.

Methods: Eleven female and 11 male cadaver heads fixed with formalin were dissected and the formation of the supraorbital nerve emerging the cranium was evaluated.

Results: Cadaveric sides were divided into four types based on the presence of a notch or foramen. Sides with only one notch constituted the majority at 45.4% (Type A).

Conclusions: In this study, in cases with only supraorbital notch, the distance of the notch to the midsagittal line was found to be 23.51±3.74 mm on the right side and 22.77±3.75 mm on the left side on average. In cases with only supraorbital foramen, the right side average was calculated as 20.50±4.30 mm and the left side average was calculated as 25.60±3.83 mm. These measurements are of considerable importance in procedures such as migraine botox or migraine surgery.

Management strategy of post-operative spinal infection

2025-10-31T09:24:48+0530

Background: This study aims to evaluate the outcomes of different management strategies in PSIs, with a focus on infections caused by S. epidermidis and TB organisms. Specific emphasis is placed on the role of antimicrobial and anti-TB drug therapies, as well as revision surgical procedures.

Methods: Analysis was conducted on 31 patients diagnosed with PSI at Bangladesh Medical University between 2015 and 2023. 14 patients received targeted antimicrobial therapy for pyogenic infections 5 patients received anti-TB therapy for tubercular infections. Revision surgical management, 7 patients underwent debridement only, 3 patients underwent debridement with fusion and 2 patients underwent debridement with fixation. Assessment were done at 1st, 3rd, 6th and 12th monthly by VAS, Odom Criteria, Nurick’s grading. Data were analyzed via the Statistical Package for Social Sciences (SPSS). A p value <0.05 was considered statistically significant.

Results: The mean VAS score significantly improved from 6.27±1.75 to 0.73±0.59 at 12 months (p < 0.001). According to the Modified Odom Criteria, 33.3% of patients had excellent outcomes, 60.0% had good outcomes and 6.7% had fair outcomes. Functional status measured by Nurick’s grading improved significantly, with 93.3% of patients in Grade III preoperatively and 87% improving to either Grade 0 or I by 12th months (p<0.001).

Conclusions: Effective management of PSIs depends on early diagnosis, appropriate antimicrobial or anti-TB therapy and timely surgical intervention. Staphylococcus epidermidis infections respond well to targeted antimicrobial therapy and debridement, whereas TB infections require prolonged anti-TB regimens and often more extensive surgical stabilization.

Osteoporosis and its relationship with sarcopenia in elderly patients

2025-10-31T09:21:09+0530

Background: Osteoporosis and sarcopenia are two chronic conditions that are associated with aging and leading to an increase in bone fragility and fracture susceptibility. The objective of this study was to find out the relationship between osteoporosis and sarcopenia in elderly patients.

Methods: This hospital-based cross-sectional descriptive study was conducted in the Department of Medicine, Cumilla Medical College Hospital, Bangladesh, from January 2020 to January 2021 in 100 elderly patients who are suffering from osteoporosis.

Results: A total of 100 elderly osteoporotic patients were studied. The median age was 66±7, 88% females. Regarding different co morbidities diabetes mellitus (DM), hypertension (HTN), ischemic heart disease (IHD), dyslipidemia, osteoarthritis (OA) and chronic kidney disease (CKD), 31 (31%), 23 (23%), 7 (7%), 9 (9%), 21 (21%) and 5 (5%) respectively. Among 100 cases, 71 (71%) patients were osteoporotic and 29 (29%) patients were severe osteoporotic, where vertebral compression fracture, femoral neck fracture and both are 18 (18%), 6 (6%) and 5 (5%) respectively. Sarcopenia is more common in severe osteoporotic patient and that is 72.4%. Hand grip strength 17.76±5.94 kg in right hand and 16±5.71 kg in left hand. Appendicular skeletal muscle mass (ASMM) index was 5.39±0.86 kg/m². Correlation of appendicular skeletal muscle mass (ASMM) index along with BMD of lumber spine (T-score) and BMD of femoral neck (T-score) were significant and the Pearson correlation coefficient were 0.264 and 0.356 respectively. Correlation between sarcopenia and osteoporosis was significant (p=0.008).

Conclusion: There is an intimate relationship between osteoporosis and sarcopenia. The prevalence of sarcopenia is higher in severe osteoporotic patient. Both conditions are significantly correlated to each other.

Comparison of early outcome of stapler versus hand sewn closure of duodenal stump after gastrectomy in gastric cancer

2025-10-31T09:20:31+0530

Background: Gastric cancer (GC) remains a major global health challenge, ranking as the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide. Surgery with gastrectomy remains the mainstay of curative treatment, but duodenal stump leakage (DSL) continues to be one of the most feared postoperative complications, associated with high morbidity and mortality. The choice between stapled and hand-sewn duodenal stump closure remains a debated topic, especially in resource-limited regions such as South Asia, where cost and accessibility are critical factors. The study aimed to compare the early outcomes of stapler versus hand-sewn closure of the duodenal stump after gastrectomy in gastric cancer patients.

Methods: This prospective comparative study included 40 gastric cancer patients undergoing elective gastrectomy, divided into stapler (n=20) and hand-sewn (n=20) duodenal stump closure groups. The study was conducted at Sylhet MAG Osmani Medical College and Hospital, Sylhet, Bangladesh, from July 2024 to June 2025. Patients with ASA class III–IV or prior neoadjuvant chemotherapy were excluded. Standardised operative and postoperative protocols were followed, and outcomes assessed included operative time, closure time, complications, hospital stay, and cost. Data were analysed using statistical package for the social sciences (SPSS) 26 with t-test, Chi-square, and multivariable logistic regression, considering p<0.05 as significant.

Results: Both groups were comparable in baseline demographics and type of gastrectomy. Stapler closure significantly reduced operative time (158±22 versus 177±25 min, p=0.007) and stump closure time (9±3 versus 18±5 min, p<0.001). Early postoperative complications, including duodenal stump blowout, were slightly lower in the stapler group but not statistically significant. Recovery was faster with stapler closure, with earlier oral intake (2.7±0.9 versus 3.8±1.2 days, p=0.009) and shorter hospital stay (8.2±2.0 versus 10.1±2.5 days, p=0.026). Stapler procedures incurred higher costs (p=0.01).

Conclusion: Stapled duodenal stump closure after gastrectomy offers faster surgery, earlier recovery, and shorter hospital stay than hand-sewn closure, without added complications. Despite higher costs, it represents a safe and effective option in selected gastric cancer patients.

Role of advanced magnetic resonance imaging techniques in the evaluation of glioblastoma multiforme

2025-10-31T09:20:45+0530

Background: Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults, often presenting with nonspecific clinical and radiological features that complicate early diagnosis. Advanced magnetic resonance imaging (MRI) techniques, including diffusion-weighted imaging (DWI), gradient-echo (GRE) sequences and magnetic resonance spectroscopy (MRS), may enhance diagnostic accuracy beyond conventional MRI.

Methods: This cross-sectional study was conducted in the Department of Radiology and Imaging, Sir Salimullah Medical College and Mitford Hospital, Dhaka, in collaboration with Neurosurgery and Pathology departments, from January 2018 to December 2019. A total of 31 patients with clinically suspected GBM were enrolled using purposive sampling. All patients underwent advanced MRI protocols, including DWI, GRE and MRS. MRI findings were compared with histopathological diagnoses, considered the gold standard.

Results: The mean patient age was 52.1±11.2 years, with most cases (41.9%) in the 51–60-year group. On DWI, partially restricted diffusion was observed in 51.6% of lesions, particularly among GBM cases (54.1%). Blooming artifacts on GRE were seen in 41.9% overall, including 37.5% of GBM. MRS consistently showed elevated choline, lactate and choline/creatinine ratio with reduced NAA and creatinine. A choline/creatinine ratio >2.5 distinguished GBM and anaplastic astrocytoma, while metastases showed ratios <2.5. Compared with histopathology, MRI achieved a sensitivity of 95.6%, specificity 75.0%, accuracy 90.3%, PPV 91.6% and NPV 85.7%.

Conclusion: Advanced MRI techniques provide significant diagnostic value in differentiating GBM from other intracranial tumors, with high sensitivity and accuracy when correlated with histopathology.

Regional cancer burdens: a retrospective analysis of demographic and diagnostic patterns in Bangladesh

2025-10-31T09:20:39+0530

Background: Regional cancer data from low and middle-income countries (LMICs) like Bangladesh remain limited, hindering evidence-based oncology planning. This study examines demographic and diagnostic patterns among cancer patients at two tertiary centers in northern Bangladesh to inform resource-sensitive cancer control strategies.

Methods: We conducted a retrospective analysis of 547 cancer cases diagnosed between 2019 and 2021 at two major tertiary care centers. Patient records were reviewed for age, sex, residential location and cancer type. Descriptive statistics were applied to explore demographic distributions and diagnostic trends over time.

Results: The 41–60 years age group consistently accounted for the majority of cases, followed by the 61–80 years group. Females represented a growing proportion of diagnoses, increasing from 60.64% in 2019 to 69.92% in 2021. Breast cancer was the most prevalent malignancy each year (37.35% in 2019; 45.71% in 2020; 42.28% in 2021). Colorectal, stomach, cervical and lung cancers followed in frequency, with lung cancer showing an upward trend in 2021 (12.20%). Geographic analysis showed the largest patient share from Sadar, with consistent contributions from Birgonj, Birol and Phulbari and steady representation from peripheral areas over the three years.

Conclusions: This study reveals stable demographic patterns and evolving cancer type distributions in a regional Bangladeshi population. The increasing female predominance and persistent burden of breast cancer highlight the need for gender-sensitive screening programs. The rising proportion of lung cancer and continued diagnostic insufficiency underscore the importance of strengthening cancer registries, decentralizing oncology services and improving access to care in remote areas of LMICs.

The effect of stress on cardiovascular system and its awareness among bank workers in Makurdi, Benue state

2025-10-31T09:20:35+0530

Background: Cardiovascular diseases (CVDs) remain the leading cause of global mortality, and stress is a key modifiable risk factor, particularly in occupational settings such as banking. This study assessed the effect of stress on the cardiovascular system and the level of awareness among bank workers in Makurdi, Benue State, Nigeria.

Methods: A descriptive cross-sectional study was conducted among 133 bank employees from five banks. Physical measurements including blood pressure, fasting blood sugar, and body mass index (BMI) were collected using standard instruments. A structured questionnaire was administered to assess lifestyle factors and awareness of cardiovascular risk factors. Chi-square tests were applied using statistical package for the social sciences (SPSS) version 26 to determine associations at a 5% significance level.

Results: The prevalence of hypertension was significantly higher among males (33.8%) compared to females (10.7%), and among older age groups (>40 years, 73.3%) versus younger groups (21–30 years, 28.7%). Longer job tenure (>10 years) was associated with higher prevalence of hypertension (32.1%). Significant associations were found between hypertension and lack of knowledge, overtime work, BMI and alcohol use (p<0.05). Additionally, diabetes mellitus and obesity were linked to job tenure and snacking habits. However, some variables, such as blood glucose level, smoking and exercise, showed no significant association with hypertension (p>0.05).

Conclusions: The study concludes that occupational stress contributes significantly to CVD risk factors among bank workers in Makurdi. Awareness levels of cardiovascular risk factors were generally low, underscoring the need for targeted interventions on stress management and cardiovascular health.

Elevated neutrophil elastase and myeloperoxidase mRNA expressions in patients with metabolic syndrome: a cross-sectional study

2025-10-31T09:20:29+0530

Background: Neutrophil-derived enzymes such as neutrophil elastase (NE) and myeloperoxidase (MPO) contribute to inflammation and vascular dysfunction. However, their expression in relation to metabolic syndrome (MetS) remains underexplored.

Methods: In this cross-sectional study, NE and MPO mRNA expression were evaluated in peripheral blood leukocytes of 44 adults. Among them 19 had MetS and 25 served as controls. Baseline metabolic parameters were compared between groups, and expression levels were analyzed using RT-qPCR.

Results: Individuals with MetS had significantly higher systolic blood pressure, waist circumference, triglycerides, and lipid ratios (TC: HDL-C, LDL-C: HDL-C), and lower HDL-C compared to controls. NE and MPO mRNA expression were significantly elevated in MetS (p=0.015 and p=0.029, respectively). Furthermore, both NE and MPO expression showed significant moderate positive correlations with MetS status.

Conclusion: Elevated NE and MPO gene expressions in peripheral blood leukocytes are associated with MetS, supporting their potential role as biomarkers of obesity-related dyslipidemia and inflammation. These findings highlight neutrophil activation as a possible molecular contributor to the pathogenesis of MetS.

Ubiquitous analysis of thyroid disorders in reproductive age group females in rural field practice area of tertiary care hospital and its correlation with body mass index

2025-10-08T06:20:33+0530

Background: Thyroid is a vital hormone producing gland that plays a major role in regulating metabolism, growth and development in the human body. It also regulates body mass index (BMI) and other metabolic functions.

Methods: The present study was done on 200 females of reproductive age group in the field practice area of tertiary care hospital JIIU’s Indian institute of medical science and research, Jalna. Data collection involved general and thyroid examinations of subjects and blood sample collection for a thyroid profile. Body weight and height were also noted.

Results: Thyroid disorders and their prevalence among the overall study subjects show that 79% of the population has normal thyroid function, 11% have hypothyroidism, 4.5% have hyperthyroidism, 4% have goiter, 0.5% have thyroid adenoma, 0.5% have thyroid carcinoma, and 0.5% have thyroid cyst. The Thyroid disorders in the age group 15-24, 25-34, 35-44 and 44 and older years are 8%, 5.5%, 5% and 2.5% respectively.

Conclusions: Thyroid disorders are prevalent in reproductive age group females of rural Maharashtra commonest being subclinical hypothyroidism (SCH). Early diagnosis and treatment of thyroid disorders not only improve the quality of life of patients but also plays an important role in mitigating adverse maternal and fetal outcomes in the future. Further studies with larger sample sizes are needed to address the problem of thyroid disorders in rural areas.

Assessment of quality of life in patients undergoing maintenance hemodialysis in a tertiary care hospital

2025-10-14T06:45:42+0530

Background: The increasing prevalence of end-stage renal disease (ESRD) in India necessitates a deeper understanding of its impact on patient well-being. This study aimed to assess the quality of life (QOL) among hemodialysis (HD) patients in a North Indian setting using the kidney disease QOL-36 (KDQOL-36) instrument and to explore the associated demographic and clinical factors influencing their QOL.

Methods: We conducted an observational, cross-sectional study over two months (May-June 2024) at a tertiary care hospital in Jammu, India. A total of 100 patients aged 18-75 years, diagnosed with ESRD and undergoing maintenance HD for at least three months, were included after providing informed consent. Data was collected using a demographic questionnaire and the validated KDQOL-36 instrument. Statistical analysis was performed using SPSS ver 25.0.

Results: The study cohort comprised 100 patients (66% male) with a mean age of 58.08±12.3 years. The mean QOL scores indicated significant impairment across multiple domains: Physical component summary (PCS) was 41.19±8.24, mental component summary (MCS) was 42.52±7.84, symptom/problem list was 77.75±14.57, and effects of kidney disease was 56.56±16.48. The most profoundly affected domain was the burden of kidney disease, with an exceptionally low mean score of 24.00±15.24. A majority of patients reported that the disease interfered with their life (88%), felt like a burden to their family (74%), and were bothered by fluid (94%) and dietary (88%) restrictions.

Conclusions: This study highlights a profound impairment in the QOL among HD patients in North India, particularly concerning the overwhelming burden of the disease. The findings underscore the urgent need for renal healthcare systems in India to integrate routine QOL assessments into standard practice. Shifting towards a more holistic, patient-centered approach that includes targeted psychosocial support is crucial to alleviate the immense disease burden and improve overall well-being in this vulnerable population.

Association of interleukin-1β levels in type 2 diabetes mellitus patients

2025-10-17T08:42:00+0530

Background: Type 2 diabetes mellitus (T2DM) is a complex, non-communicable illness mainly marked by two main features: insulin resistance and chronic inflammation. Interleukin-1β (IL-1β) has been implicated in metabolic processes including insulin secretion and b-cell apoptosis. Increased levels of pro-inflammatory markers such as IL-1β, tumor necrosis factor-α and adipokines has been reported in T2DM patients. Recent studies have demonstrated a positive correlation between Interleukins in T2DM patients. The objective of the study was to find association of IL-1β in T2DM patients.

Methods: We conducted a cross-sectional study among T2DM patients visiting the OPD of Pulmonary Medicine. T2DM patients aged between 40 to 65 years of either sex were recruited. Biochemical investigations were performed in blood sample.

Results: We recruited 340 T2DM patients (162 males and 178 females) for the present study. Biochemical analysis viz. Plasma glucose and HbA1c reported 78 subjects with uncontrolled diabetes and 262 subjects with controlled diabetes. IL-1β levels were found to be significantly increased (p<0.001, t=21.76) in uncontrolled diabetics (55.23±9.11) in comparison with controlled diabetics (25.39±11.04).

Conclusions: Results suggests a highly significant and positive (p<0.001) association of IL-1β with glucose levels in T2DM patients.

Role of ultrasonography in the diagnosis of acute appendicitis in emergency cases

2025-10-25T09:35:31+0530

Background: Acute appendicitis remains one of the most common surgical emergencies worldwide, demanding prompt and accurate diagnosis to prevent complications such as perforation or peritonitis. While computed tomography (CT) offers high diagnostic accuracy, ultrasonography (USG) serves as a safer, more accessible alternative, particularly in emergency and resource-limited settings. This study aimed to evaluate the diagnostic accuracy of ultrasonography in acute appendicitis by correlating USG findings with histopathological results among patients presenting with suspected appendicitis in the emergency department.

Methods: A prospective observational study was conducted on 54 patients aged 8–60 years with clinical suspicion of acute appendicitis. All patients underwent graded compression ultrasonography using high-frequency linear and convex probes. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated using histopathological findings as the gold standard.

Results: The appendix was visualized in 79.6% of patients. USG diagnosed appendicitis in 41 of 43 positive scans, with 2 false positives and 4 false negatives. The overall diagnostic performance of USG was sensitivity 91.1%, specificity 77.8%, PPV 95.3%, NPV 63.6%, and accuracy 88.9%. Common sonographic findings included a non-compressible tubular structure >6 mm (75.9%), periappendiceal fat stranding (64.8%), and Doppler hyperemia (51.9%). Accuracy was higher in non-obese patients (92.3%) compared to obese individuals (81.8%), and pediatric cases showed superior sensitivity (95%).

Conclusions: Ultrasonography is a reliable, non-invasive, and efficient first-line imaging modality for diagnosing acute appendicitis in emergency settings. It demonstrates high sensitivity and accuracy comparable to CT when performed by skilled radiologists. Incorporating Doppler assessment and adopting a staged USG-CT approach in equivocal cases can further enhance diagnostic confidence while minimizing unnecessary radiation exposure.

Exploring the effectiveness of CADAVIZ in enhancing learning outcomes in undergraduate medical students

2025-10-31T09:20:54+0530

Background: Cadaver-based learning is fundamental to mastering human anatomy. However, accessing delicate, deep-seated regions such as the cerebellum is challenging. In this regard the virtual dissection table (VDT) is a useful supplement. This study investigates the effectiveness of CADAVIZ, a VDT, in enhancing anatomical understanding among undergraduate medical students.

Methods: After obtaining ethical approval and informed consent, 250 participants attended a standardized lecture on cerebellar anatomy followed by a pre-test to assess their baseline knowledge. The participants were then randomly assigned to three Groups: Group A attended practical session with a cadaveric specimen of the human cerebellum, Group B participated in an interactive session on cerebellar anatomy using CADAVIZ, and Group C engaged in practical sessions with both a cadaveric specimen and CADAVIZ. Lastly, post-tests were conducted to assess knowledge retention after the respective practical sessions.

Results: The mean pre-test score for Group A was 4.88±0.17 and the mean post-test score was 7.35±0.21, registering a mean percentage increase of 60.68±5.41%. Group B obtained a mean pre-test and post-test score of 4.73±0.19 and 7.75±0.15, respectively, reflecting a mean percentage increase of 78.92±5.27% (p=0.127). Group C, on the other hand, recorded a mean pre-test and post-test score of 3.99±0.13 and 6.96±0.16, respectively, yielding a mean percentage increase of 81.84±4.81% (p=0.005).

Conclusions: As compared to Group A, the percentage increase in Group C was significantly (p=0.005) higher, indicating that the blended learning with both cadaveric specimen and CADAVIZ enhanced anatomical learning more than a practical session with cadaveric specimen alone.

Correlation of serum C-reactive protein level with severity of preeclampsia

2025-10-31T09:20:22+0530

Background: Preeclampsia is a hypertensive disorder unique to pregnancy, characterized by elevated blood pressure and proteinuria after 20 weeks of gestation. It is associated with systemic inflammation and generalized endothelial dysfunction. C-reactive protein (CRP), a sensitive marker of inflammation, has been implicated in the pathophysiology of preeclampsia. This study aims to assess serum CRP levels in preeclamptic women and determine its correlation with disease severity.

Methods: A case-control study was conducted over a two-month period at the department of biochemistry and department of obstetrics and gynaecology, Gauhati medical college and hospital. A total of 60 pregnant women were enrolled-30 preeclamptic patients (15 mild, 15 severe) and 30 normotensive pregnant controls-based on strict inclusion and exclusion criteria. Serum CRP levels were measured using the Vitros 5600 integrated system. Data were analyzed using the independent t test and Pearson’s correlation coefficient. A p<0.05 was considered statistically significant.

Results: The mean serum CRP level in preeclamptic patients was significantly higher (14.63±1.99 mg/l) than in normotensive controls (5.98±1.86 mg/l) (p<0.001). Among the preeclamptic group, severe cases had significantly higher CRP levels (16.23±1.06 mg/l) compared to mild cases (13.03±1.28 mg/l) (p<0.001). CRP levels showed a strong positive correlation with both systolic and diastolic blood pressures (DBP) in both mild (r=0.97 and r=0.98, respectively) and severe (r=0.95 and r=0.93, respectively) preeclampsia groups.

Conclusions: Serum CRP levels are elevated in preeclampsia compared to normal pregnancy and increase further with disease severity.

Shielding design and calculation of a treatment room for a 15-MV versa HD LINAC at BMU, Dhaka, Bangladesh

2025-10-31T09:24:49+0530

Background: Effective shielding design is essential for ensuring radiation safety for both patients and healthcare staff in medical radiation therapy facilities, particularly with high-energy LINACs. This study investigates the shielding design and calculation for a 15-MV versa HD LINAC treatment room at Bangladesh Medical University (BMU), focusing on primary and secondary radiation barriers.

Methods: Shielding design and calculation were performed using empirical equations based on NCRP report no. 151 (2005). Maximum photon energy (15 MV) was considered for barrier design. Calculations for primary and secondary barrier thicknesses were performed using workload, use factor, and occupancy factor, with ordinary concrete (2.35 g/cm³) as the material. Radiation levels were measured at various gantry positions (0°, 90°, and 270°) with calibrated radiation detectors.

Results: The primary barrier thicknesses were calculated as 2.75 m for east and west sides, and 2.58 m for the roof. Secondary barrier thicknesses for the north, south, and roof sides were 1.02 m, 1.14 m, and 1.18 m, respectively. Radiation measurements at different gantry angles showed a maximum photon dose rate of 2.15 μSv/hr at the main entrance door, with values consistently below 10 μSv/hr at all locations. The standard deviation of dose rates ranged from 0.03 to 0.15 μSv/hr. Statistical analysis showed a p=0.04, indicating significant differences between radiation exposure at different gantry positions. The coefficient of variation (CV) was calculated as 0.23%, confirming low variability in the shielding performance across measurements.

Conclusions: The shielding design effectively meets safety standards, with radiation levels well below permissible limits, ensuring the safety of both hospital staff and patients.

Clinical characteristics and outcomes of rivaroxaban 2.5 mg in chronic coronary syndrome: insights from the RICCS India study

2025-10-31T09:28:10+0530

Background: The US Food and Drug Administration approved rivaroxaban 2.5 mg twice daily for the prevention of recurrent adverse cardiovascular events in patients with stable coronary heart disease and peripheral artery disease. This study aimed to understand the clinical characteristics and outcomes of Indian patients with chronic coronary syndrome (CCS) treated with rivaroxaban 2.5 mg, either as monotherapy or in combination therapy.

Methods: This retrospective, non-randomized, non-comparative, multi-center study was conducted across approximately 175 sites in India. Patients of either gender, aged >18 years, diagnosed with CCS, and who received rivaroxaban 2.5 mg were included. Patient data, including demographic details, medical history, and the treatment pattern of rivaroxaban 2.5 mg, were collected from the medical records and analyzed.

Results: A total of 1299 patients were included, with a median age of 62.00 years. Most patients were men (67.82%). The median systolic and diastolic blood pressures of the patients were 138.00 mmHg and 90.00 mmHg, respectively. Patients had a medical history of diabetes mellitus (41.72%), hypertension (38.95%), and cardiovascular disease (36.25%). Nearly 70% of patients received rivaroxaban 2.5 mg twice daily with low-dose aspirin (75 mg). The treatment duration was >3 months for 21.94% of patients, 1-3 months for 41.57%, and ≤1 month for 11.24%. Major bleeding events were reported in 24 patients (1.85%), while major adverse cardiovascular events occurred in 35 patients (2.69%).

Conclusions: This study provides real-world insights into clinical characteristics, treatment pattern, and outcomes of rivaroxaban 2.5 mg in patients with CCS in India.

Assessment of knowledge and perception about LGBTQ+ community in Indian medical students

2025-10-31T09:28:06+0530

Background: The LGBTQ+ community in India is underrepresented and face significant social challenges. The medical students and graduates in the country have limited educational material and training on the community’s healthcare needs. This can lead to bias in treatment and substandard patient care. The objective of this study was to assess the knowledge, education, and training, and perception of the LGBTQ+ community among Indian medical students and graduates.

Methods: A three-month cross-sectional survey-based study was conducted among Indian medical students and graduates using a Google form questionnaire to assess their knowledge, training, and perceptions about the LGBTQ+ community. The data were collected using Google sheets and analysed using Microsoft excel.

Results: Only 43% of the 546 participants had read about LGBTQ+ health in their medical school; however, 90% had used online platforms for learning. The majority agreed that more educational material was necessary, and nearly 90% perceived a need to bridge the knowledge gap on LGBTQ+ health concerns in the medical curriculum. Additionally, almost 90% of participants also felt that social support groups for the LGBTQ+ community were necessary, and educational institutions should provide sexual education for all orientations. Participants who had poor self-perceived knowledge about LGBTQ+ health had a significantly lower mean score on the knowledge assessment questionnaire than those who perceived their knowledge to be good.

Conclusions: Medical students and graduates in India need to receive adequate training and educational material on LGBTQ+ related health to improve their confidence in addressing healthcare issues and reduce bias towards the healthcare needs of the LGBTQ+ community.

Exploring self-esteem, body perception, stress and emotional regulation in women with PCOS: a comparative study of women with PCOS and the general population

2025-10-31T09:28:03+0530

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women of reproductive age, often associated with physical symptoms such as acne, hirsutism, and weight fluctuations, which may impact psychological well-being. Prior research suggests potential psychological consequences including low self-esteem, body dissatisfaction, stress, and emotional regulation difficulties.

Methods: A cross-sectional study was conducted with 102 women aged 18–45 years (51 with PCOS and 51 without), recruited from gynecology clinics, online forums, and universities. Participants completed standardized psychological measures: the General Health Questionnaire, Rosenberg Self-Esteem Scale, Body Shape Questionnaire, Perceived Stress Scale, and Emotional Regulation Scale. Independent samples t-tests and Pearson correlations were performed to assess between-group differences and variable interrelations.

Results: Findings revealed that women with PCOS reported significantly more negative body image and higher perceived stress compared to controls. No significant differences were found in self-esteem or emotional regulation. A significant negative correlation between emotional regulation and stress was observed among women with PCOS, indicating that better emotion regulation is linked to lower perceived stress.

Conclusions: The results emphasize the need for psychological support interventions targeting stress management and body image among women with PCOS. Although self-esteem and emotional regulation did not differ significantly between groups, improving emotional regulation may help manage stress. Future research should adopt longitudinal designs and include diverse samples to better understand psychological resilience and causal relationships in PCOS populations.

Comparison of day wise maturity and failure rates of radio-cephalic and brachiocephalic fistulas using Color Doppler ultrasound in chronic kidney disease patients

2025-10-31T09:27:58+0530

Background: Arteriovenous fistula is an autogenous connection between Artery and a vein which is created in patients of chronic kidney disease which need frequent hemodialysis as it allows adequate blood flow during the process and has high patency rates and lower complications.

Methods: This prospective study was conducted in tertiary care centre medical college in patients of age group 18-60 yrs. involving both genders with chronic kidney disease and hemodialysis with radio cephalic or brachiocephalic fistula.

Results: In our study out of 63 patients in 38 patients radio cephalic fistula was made in (60.3%), brachiocephalic in 11 patients (17.5%) and 14 cases were not fit for the surgery. In a comparison of day wise maturity of brachiocephalic and radio cephalic fistulas the maturity at day 1 for brachiocephalic fistula was ~37% and ~32% for radio cephalic fistulas.

On day 14; 8 of the 11 brachiocephalic fistula (72%) and 19 of the 38(50%) of the patients with radio cephalic had maturity. On day 42; 81% of the brachiocephalic fistula and radio cephalic fistula 27(71%) had maturity. Out of 11 total brachiocephalic 9 were mature at the end of study with failure rate of 18.2% and out of the 38-radio cephalic fistula 27 patients were mature with failure rate of 28.9%.

Conclusions: In our study involving 63 patients the most common fistula was radio cephalic fistula followed by brachiocephalic fistula, even though the brachiocephalic fistulas had an earlier maturity rate; long term complications of brachiocephalic fistula were more.

Graph-based learning for sleep microarchitecture: a hybrid graph autoencoder and graph attention network approach

2025-10-31T09:27:55+0530

Background: Sleep plays a vital role in cognitive function, memory consolidation, and overall neurological health. Analysis of sleep microarchitecture including features such as sleep spindles, K-complexes, slow waves, and EEG bandpower components provides critical insights into sleep disorders and genetic diseases. However, the complex interactions between sleep architecture and underlying genetic abnormalities remain underexplored. This study aims to investigate these interactions by leveraging advanced graph-based deep learning methods to uncover hidden relationships within EEG signals.

Methods: We developed a graph autoencoder (GAE) combined with a Graph attention network (GAT) to analyze polysomnography (PSG) data from the National Children's Hospital (NCH) dataset. EEG epochs were modelled as graph nodes, while edges were constructed based on bandpower similarity between epochs, enabling dynamic representation of sleep activity. The GAE learned latent embeddings that capture subtle patterns in sleep microarchitecture, and the GAT applied attention mechanisms to classify and interpret relationships between EEG events, sleep disorders, and genetic abnormalities. Three core analyses were conducted: (1) identifying differences in sleep microarchitecture across sleep disorders, (2) detecting EEG event changes associated with genetic disorders, and (3) exploring shared patterns linking sleep and genetic abnormalities.

Results: The model achieved classification accuracies of 92.4%, 91.2%, and 88.6% across the three tasks, respectively. The approach successfully identified distinct EEG event patterns in subjects with co-occurring sleep disorders.

Conclusions: This work presents a scalable, automated, and interpretable framework for analyzing the interplay between sleep microarchitecture, sleep disorders, and genetic disorders.

Neuropsychological dysfunction in schizophrenia: a study of executive functioning, vigilance and abstraction

2025-10-31T09:27:51+0530

Background: Schizophrenia is a chronic psychiatric disorder characterized by profound disturbances in cognition, perception and behaviour. This study examines neuropsychological dysfunctions in adult schizophrenic patients, specifically focusing on executive functioning, vigilance and abstraction. To assess deficits in neuropsychological domains among adult schizophrenic patients and compare them with healthy controls.

Methods: A prospective, matched control group design was used, comprising 30 adult schizophrenic patients and 30 healthy controls matched for socio-demographic variables. neuropsychological assessments included Bhatia’s short battery of performance test for intelligence, symbol cancellation test and the similarity Test. Descriptive statistics, t-tests and correlation analyses were used for data interpretation.

Results: Schizophrenic patients demonstrated significant impairments in executive functioning, vigilance and abstraction compared to healthy controls. Deficits were evident in working memory, cognitive flexibility, problem-solving, sustained attention and abstract reasoning, reinforcing the role of frontal lobe dysfunction in schizophrenia. Conclusions: The study highlights marked neuropsychological deficits in schizophrenia, emphasizing the need for targeted cognitive rehabilitation strategies. Addressing these impairments through structured interventions may improve functional outcomes and overall quality of life in patients.

Microalbuminuria as an indicator of sepsis and to predict mortality in patients admitted in intensive care unit

2025-10-31T09:27:46+0530

Background: Sepsis remains a major cause of morbidity and mortality worldwide. Early recognition is critical, but conventional diagnostic methods such as culture require more than 24 hours, delaying targeted therapy. Microalbuminuria, a marker of systemic endothelial dysfunction and capillary leak, may provide a rapid and non-invasive predictor of outcome. Objective of this study was to assess the role of microalbuminuria in predicting mortality among patients with sepsis admitted to the intensive care unit (ICU).

Methods: This prospective observational study was conducted in the ICU of Travancore Medical College, Kollam, from August 2022 to January 2024. A total of 122 adult patients with sepsis were enrolled after applying inclusion and exclusion criteria. Spot urine samples were collected within 6 hours of admission (ACR1) and at 24 hours (ACR2) to measure the albumin–creatinine ratio (ACR). The change in ACR (ΔACR = ACR1-ACR2) was calculated. Associations of ACR values with mortality and ICU stay were analysed using non-parametric tests, correlation studies, and ROC curve analysis.

Results: ACR2 was significantly higher among non-survivors than survivors (mean 284.3 vs. 77.0, p<0.001). Survivors showed a significant decline in ACR between 6 and 24 hours, while non-survivors had a significant increase. ΔACR correlated negatively with ICU stay duration (ρ = -0.303, p<0.001). ROC analysis identified ΔACR ≤21.5 as the optimal cutoff for predicting mortality, with sensitivity 83.9%, specificity 86.9%, and accuracy 86.2%.

Conclusions: Serial measurement of urine ACR, particularly ΔACR, within the first 24 hours is a simple, rapid, and cost-effective predictor of mortality in sepsis and can be especially valuable in resource-limited settings.

Correlation between pronated foot posture, movement quality and postural stability among college students: a pilot study

2025-10-31T09:25:32+0530

Background: Postural control and movement mechanics are significantly influenced by foot position. Pronated foot posture has been associated with reduced movement quality and impaired balance. It is characterized by medial arch collapse and foot eversion. College students may be more prone to these musculoskeletal abnormalities as a result of their lifestyle choices and extended periods of inactivity.

Methods: The 22 college students between the ages of 18 and 25 participated in a pilot cross-sectional study. The Flamingo balance test (FBT) was used to test static balance, the Y-balance test (YBT) was used to measure dynamic balance, the foot posture index-6 (FPI-6) was used to measure foot posture, and the functional movement screen (FMS) was used to evaluate movement quality. The association between postural stability, movement quality, and pronated foot posture was ascertained using Pearson's correlation coefficient.

Results: FPI-6 showed a strong negative correlation with FMS (r=-0.72, p<0.001 right; r=-0.599, p=0.003 left) and static balance (r=-0.75, p<0.001 right; r=-0.55, p=0.008 left). No significant correlation was observed with dynamic balance (p>0.05). FMS was positively correlated with static balance (r=0.648, p=0.001 right; r=0.621, p=0.002 left) but not with dynamic balance (p>0.05).

Conclusions: The study found that college students who have pronated foot posture have considerably worse static and dynamic balance as well as lower movement quality. Early detection and foot posture-focused remedial measures may enhance functional results and avert further musculoskeletal problems.

A comparative study between onlay and sublay mesh repair in the treatment of ventral hernias

2025-10-31T09:25:11+0530

Background: Ventral hernias, characterized by a defect in the anterior abdominal wall fascia, are commonly managed surgically using mesh reinforcement. Among the widely adopted techniques, onlay and sublay mesh placements differ in anatomical location and complication profiles. Despite being routine procedures, consensus on the superior approach remains elusive. Objectives were to compare the clinical outcomes of onlay versus sublay mesh repair in patients undergoing elective ventral hernia surgery.

Methods: This was a prospective interventional comparative study conducted at a tertiary care hospital from September 2019 to July 2021. A total of 90 patients were randomly allocated to undergo either onlay (n=45) or sublay (n=45) mesh repair. Parameters compared included duration of surgery, postoperative pain (VAS scores), incidence of early complications (surgical site infection, seroma, hematoma), duration of drain placement, hospital stay, and late complications (mesh infection, bowel obstruction, recurrence). Data were statistically analyzed for significance.

Results: The mean duration of surgery was significantly longer in the sublay group, while the onlay group had a higher incidence of early postoperative complications including seroma and wound infections. The sublay group demonstrated significantly shorter postoperative hospital stay and fewer late complications.

Conclusions: Although sublay mesh repair requires a longer operative time, it is associated with fewer complications, reduced postoperative morbidity, and quicker recovery. These findings support the adoption of sublay mesh placement as the preferred method in ventral hernia repair.

Evaluation of malnutrition in chronic kidney disease patients in a tertiary health care center at Uttarakhand: a single center, cross-sectional and observational study

2025-10-31T09:25:09+0530

Background: Malnutrition in CKD patients contributes to an increased risk of mortality and morbidity. This study aims to explore the prevalence of malnutrition among CKD dialysis dependent and not on dialysis patients at a tertiary health care center at Uttarakhand and examining the correlations between SGA score, biochemical markers, and anthropometric measures.

Methods: A cross-sectional and observational study was performed at Nephrology department, All India institute of medical sciences, Rishikesh from March, 2023 to July, 2024. It included 150 patients. Nutritional status was assessed with subjective global assessment score that included parameters like weight, dietary intake, gastrointestinal symptoms, functional capacity, subcutaneous fat, muscle wasting, oedema and ascites. Biochemical and anthropometric measures of patients were then correlated with SGA score.

Results: Prevalence of malnutrition in CKD patients in this study was 32%. GFR significantly predicted any presence of malnutrition for CKD patients not on dialysis. Blood urea, creatinine, triglycerides, total cholesterol, LDL, phosphorus were significantly associated with SGA Score (p<0.05). Weight, height, BMI, TSF and MAC decreased with increase in degree of malnutrition and it was statistically significant (p-<0.001, p-0.0031, p-<0.001, p-<0.001 and p-<0.001 respectively).

Conclusions: Malnutrition is prevalent among CKD patients. Prevalence of malnutrition increases with disease progression. Nutritional assessment is an important part of the holistic management of CKD. Biochemical and anthropometric parameters are reliable tools for monitoring and improving patient outcomes.

The spectrum of exudative pleural effusion: clinical and etiological insight

2025-10-31T09:25:05+0530

Background: Pleural effusion, an abnormal accumulation of fluid in the pleural space, is classified as transudative or exudative using Light’s criteria. This study aimed to evaluate the clinical and etiological profile of exudative pleural effusion in a tertiary care center in a high-tuberculosis-prevalence region.

Methods: This prospective study at Acharya Shri Chander college of medical sciences, Jammu (February 2024–January 2025), included 70 patients (14-85 years) with exudative pleural effusion. Demographics, clinical history, and investigations (X-ray, pleural/sputum analysis, CT) were recorded. Data were analyzed using excel and SPSS v20.0 with chi-square and Fisher’s exact tests.

Results: The cohort was predominantly male (94.3%, p<0.001) with a mean age of 71.6±5.6 years. Common symptoms included cough (87.1%), dyspnea (77.1%), and fever (75.7%), with cough significantly associated with tuberculosis (p=0.02). Mean symptom duration was 2.7±1.2 weeks. Right-sided pleural effusion was most frequent (47.1%), followed by left-sided (27.1%) and bilateral (25.7%). Consolidation (22.9%) was significantly associated with pneumonia (p=0.01). Pleural fluid was exudative in 98.57% of cases, with malignant cells in 1.4%. Sputum analysis (n=53) showed AFB growth (35.84%) or CBNAAT positivity (50.94%), strongly associated with tuberculosis (p<0.001). Pulmonary tuberculosis was the leading etiology (74.3%), followed by pneumonia (8.6%), lung malignancy (1.4%), and undetermined causes (15.7%).

Conclusions: Pulmonary tuberculosis is the leading cause of exudative pleural effusion in this cohort, with symptoms and imaging consistent with infection. The low malignancy rate, unlike Western data, highlights the need for region-specific diagnostics.

Effect of postural variation on near visual function in myopic subjects

2025-10-31T09:25:04+0530

Background: Near visual tasks demand sustained accommodation and convergence, which may vary with body posture. This study examined the effect of sitting, standing and supine positions on amplitude of accommodation (AA) and near point of convergence (NPC) in myopic individuals.

Methods: A cross-sectional study was conducted on 60 optometry undergraduates aged 19–30 years with mild to moderate myopia. Comprehensive eye examinations were performed and AA and NPC were assessed in three postures. AA was measured monocularly using the push-up method with a Royal Air Force ruler and NPC was measured binocularly with a pen torch and 0.30 logMAR (6/12) letters. Each test was repeated thrice per posture and mean values were analyzed using one-way ANOVA.

Results: Mean AA in the right eye was 8.48±2.94 D (sitting), 7.89±2.74 D (standing) and 7.38±2.17 D (supine), with no significant difference (p=0.077). NPC averaged 5.38±1.15 cm (sitting), 5.38±1.15 cm (standing) and 5.15±1.45 cm (supine), also not significant (p=0.53).

Conclusions: While posture did not significantly influence AA or NPC, a trend toward better accommodative response was seen in the sitting position. These findings indicate that sitting may provide greater visual comfort for myopes during near tasks, highlighting posture’s potential role in visual performance.

A study on the pattern of antibiotic resistance on different infective organisms in a tertiary care hospital

2025-10-31T09:25:03+0530

Background: A serious problem for global health, antibiotic resistance raises morbidity, mortality, and medical expenses. A clear understanding of local resistance patterns is required to maximize empirical therapy and infection control. Objectives of the study was to identify infective organisms and determine their antibiotic resistance profiles in a tertiary care hospital. To assess the resistance patterns across various antibiotic classes.

Methods: A cross-sectional study was conducted in a tertiary care center. Clinical specimens (pus, urine, sputum, blood, and tissue) were obtained and processed using standard microbiological culture techniques. Isolates were identified, and antibiotic susceptibility testing was performed via the disc diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: As a result, the present data analysis releaving that the culture positive was seen more in the 46-65 age range and with a higher propotion of females. The majority of the isolated organisms were Escherichia coli (23%), Staphyloccus aureus (21%), Klebisella pneumonia (21%), Pseudomonas aeruginosa (11%). The sample that grew organisms were pus (65), urine (13), sputum (17), blood (3), tissue (2).

Conclusions: The prevalence of drug-resistant infections, particularly in patients aged 46–65 and among females, underscores the importance of routine antimicrobial surveillance. E. coli’s high cefuroxime resistance and maintained amikacin susceptibility highlight the need for evidence-based empirical therapy. Strengthening hospital-based antibiotic stewardship programs is recommended to curb the spread of resistance.

Exploring the interplay of body image, quality of life, self-esteem, and psychological well-being on eating attitudes in adolescents

2025-10-31T09:25:02+0530

Background: This study explores the associations between body image, quality of life (QOL), self-esteem, and psychological well-being with eating attitudes in adolescents. These psychological factors are theorized to influence the development of disordered eating.

Methods: A cross-sectional study was conducted with 100 adolescents aged 13-18 from private schools in Jaipur. Data collection used standardized tools: GHQ-12, EAT-26, BSQ-34, KIDSCREEN-27, and Rosenberg Self-Esteem Scale. Pearson correlations and independent t-tests were conducted using SPSS to explore relationships and group differences.

Results: Significant negative correlations were found between eating attitudes and both body image (r = -0.477, p<0.001) and QOL (r = -0.372, p<0.001). No significant correlations were found with self-esteem or psychological well-being. Likewise, t-tests showed significant differences in body image and QOL between problematic and non-problematic eaters, but not in self-esteem or well-being.

Conclusions: Body image and QOL significantly influence adolescents’ eating attitudes. Interventions should focus on these factors to prevent disordered eating, though self-esteem and general well-being may play a more indirect role.

Association of body mass index and psychological stress in medical students: a cross-sectional study

2025-10-31T09:24:56+0530

Background: Stressful life circumstances have many known negative implications on personal health. Medical students are especially exposed to very stressful life which may impact their health and behaviour. So, This study aimed to analyze the association between psychological stress and BMI in medical students in Sikkim.

Methods: This cross-sectional study measured BMI and stress in 132 MBBS students from Sikkim, India between the age group of 18-26 years. The relation between them was analyzed using the student t-test and Pearson’s correlation. P value<0.05 was taken as significant.

Results: Higher grades of BMI were associated with higher values of total stress, but the P value (0.85) was not significant. BMI and weight were also higher in groups with greater severity of stress (mild, moderate and severe), but the associations were not significant (p=0.035).

Conclusions: This study shows no significant association between stress and BMI in medical students. However, higher BMI values were seen with increased total stress and the degree of stress. Further studies with larger sample sizes and diverse regions may provide a conclusive association between stress and BMI. Universities must adopt measures to minimize stress and stress-associated changes in BMI in medical students. Psychological and stress-related counselling should be given to at-risk students to prevent eating disorders.

Expert opinion on the burden, etiology, and management of respiratory tract infection with a special focus on cefpodoxime in Indian settings

2025-10-31T09:24:47+0530

Background: To assess clinician-reported practices in managing respiratory tract infections in Indian settings, with a focus on antibiotic use and experiences with cefpodoxime, including infection prevalence, treatment choices, dosing patterns, and clinical outcomes.

Methods: The cross-sectional study used a 23-item questionnaire to gather the expert opinion among clinicians in managing respiratory tract infections, with a focus on antibiotic use and experiences with cefpodoxime in Indian settings. The study covered various aspects such as infection prevalence, treatment choices, dosing patterns, clinical outcomes, and common infection types. Data visualization, including bar charts, was performed using Microsoft Excel 2013.

Results: The study involved 1,243 clinicians practicing across various settings in India. Cefpodoxime was preferred as the first-line anti-infective for upper respiratory tract infections by approximately 74% of clinicians, with 65% selecting a dose of 10 mg/kg/day. It was prescribed in 11-25% of chronic bronchitis cases by nearly 52% of respondents, in less than 10% of bone and joint infections by 51%, and in 25-50% of ENT infections by 43%. For skin and soft tissue infections, 42% reported using it in less than 10% of cases. Diarrhoea was identified as the most common adverse effect by 50% of clinicians, while approximately 51% considered its broad-spectrum activity to be the main advantage.

Conclusions: This study provides a detailed analysis of the clinical use of cefpodoxime, highlighting its frequent use in upper respiratory and ENT infections, with relatively limited use in chronic bronchitis, bone and joint, and skin and soft tissue infections.

Genotyping and antifungal susceptibility profile of Candida albicans isolated from various clinical samples from tertiary care hospital

2025-10-31T09:24:46+0530

Background: Genotyping Candida albicans helps identify outbreaks, sources, and virulent and drug-resistant strains. PCR can identify Candida albicans isolates as A, B, or C based on transposable group I introns in 25S rDNA. The length of the amplified product divides C. albicans isolates into genotypes A, B, and C. Objective of this study was to determine Candida albicans genotypes and antifungal susceptibility in candidiasis patients using PCR.

Methods: HIV-positive vaginal and oropharyngeal swabs yielded 126 Candida albicans isolates. Germ tube development, chlamydospore formation, CHROM agar color, sugar fermentation, and auxanographic plate technique with sugar discs identified all C. albicans isolates phenotypically. E-test tested antifungal susceptibility. Genotyping was done using PCR. The Phenol: Chloroform method extracted genomic DNA from all C. albicans isolates. The primer pairs and sequence encompassed the 25Sr DNA transposable intron. 5'-ATA AGG GAA GTC GGC AAA GAT CCG TAA-3' and CA-INT-R (reverse): 5'-CCT TGG CTG TGG TTT CGC TAG ATA GTA GAT-3'.

Results: Out of all the 126 profiles, PCR examination of the 25S rDNA transposable group I intron indicated 68.3% genotype A, 10.3% genotype B, and 21.4% genotype C isolates. Genotype A had 16.3% fluconazole resistance, genotype B 7.7%, and genotype C 3.7%. Genotype A strains were resistant to caspofungin, amphotericin B, flucytosine, and voriconazole at 3.5%, 5.8%, 8.1%, and 8.2%. While genotype B and C strains were sensitive.

Conclusions: C. albicans genotyping advances drug resistance research. C. albicans molecular typing helps design infection control methods by studying its epidemiology and pathophysiology.

Common parlance English in an Indian medical undergraduate institution: teaching-learning methods for improvement

2025-10-31T09:24:45+0530

Background: Author’s experience/ Capstone Project (T2TM, Harvard University) approval.

Methods: Harrison’s Textbook of Internal Medicine was the vocabulary source. COCA corpus was purchased for ranking ‘usage frequency’ of words. Background (MCQ.1) versus summative (MCQ.2) assessment has already been published – ‘teaching learning methods’ applied meanwhile is elaborated hereby. After MCQ.1, in sensitisation, 5 glossary options were explained/ offered. Monthly improvement of 1000 COCA ranks were aimed through 5 monthly interim tests (MCQ.T.1-5). MCQ.2 was taken after 6 months. All 7 tests were followed by feedback enucleation. Finally, dictionaries were rated by the participants through 7 questions. Data normality (Shapiro Wilk test) without outliers (Tukey’s fence/ QQ plot) was affirmed. Repeated measure ANOVA was applied. After 6 months, 5000 ranks betterment was expected in MCQ.2 apropos MCQ.1 – in outcome, there was no underfitting/ overfitting (no significant bias/ variance).

Results: Sphericity (Mauchly’s test) was 0.85 – so adjusted F-tests (Greenhouse Geisser [e_GG = 0.8497]/ Huynh Feldt [e_GG = 0.8888] correction) were used. Effect size (h²) was 0.0035 (observed) and 0.0201 (partial). Despite monthly increase of usage frequency rank by 1000, participants’ ‘scores’ were not significantly different in the 5 monthly MCQ.Ts. Dictionary market was not congruent with post-awareness choices.

Conclusions: By such a 6-month training, improvement of at least 5000 COCA ranks can be achieved. Dictionaries require in-depth awareness before purchase. Dictionaries D.4 and D.5 could think of lowering the prices.

Exploring the relationship between craniovertebral angle, hand grip strength and handwriting performance in students

2025-10-31T09:24:40+0530

Background: With the increasing reliance on mobile phones for communication, gaming, and internet use, musculoskeletal issues have become more prevalent, especially among students. Prolonged neck flexion, often associated with forward head posture (FHP), may compromise upper extremity function. Hand grip strength is considered a reliable indicator of upper limb integrity, while handwriting performance reflects fine motor coordination both potentially influenced by postural alignment. This study aimed to examine the relationship between craniovertebral angle (CVA), handwriting performance with hand grip strength among students.

Methods: An observational study was carried out over a 12-month period (June 2023–May 2024) at a tertiary care hospital in Southern Karnataka. A total of 77 students participated. CVA was measured using digital photogrammetry, hand grip strength with a handheld dynamometer, and handwriting performance through standardized writing tasks. Statistical analysis, including Pearson’s correlation, was conducted using statistical package for the social sciences (SPSS) version 21.0 to evaluate the relationships among the variables.

Results: The analysis found a weak, negative correlation between grip strength and handwriting (r=-0.06, p=0.606), indicating a lack of statistical significance. There was no significant correlation between CVA and hand grip strength, nor between hand grip strength and handwriting performance.

Conclusion: The findings suggest that in this student population, there is no significant association between craniovertebral angle, hand grip strength, and handwriting performance. However, generalizability is limited due to the homogeneous age group and restricted sample diversity.

Impact of dietary patterns on non-alcoholic fatty liver disease: a case-control study at a tertiary care hospital in western India

2025-10-31T09:24:34+0530

Background: Non-alcoholic fatty liver disease (NAFLD) is a growing concern worldwide, particularly in India, due to lifestyle changes and dietary habits. Diet plays a significant role in the onset of NAFLD, yet the specific dietary patterns contributing to this condition vary across populations. This study aims to assess the association between dietary patterns and NAFLD across different populations.

Methods: We conducted a case-control study at a tertiary care hospital in Vadodara, Gujarat, involving 200 participants (100 cases with NAFLD and 100 matched controls without NAFLD). Dietary intake was assessed using a modified 24-hour dietary recall method. To identify common dietary patterns, principal component analysis (PCA) was performed using the open-source statistical software R. Multivariable logistic regression was performed to estimate the odds ratios (ORs) for NAFLD risk, adjusting for confounders such as age, sex, BMI, physical activity, and smoking status.

Results: The study, involving 200 participants (100 with NAFLD and 100 controls), revealed that high intake of processed foods and low fiber intake were significantly associated with an increased risk of NAFLD. Specifically, high consumption of processed foods was linked to a 3.4-fold increased risk of NAFLD (Odds Ratio [OR] 3.4; 95% Confidence Interval [CI]: 2.1-5.6). Similarly, low fiber intake was associated with a 2.7-fold increased risk (OR 2.7; 95% CI: 1.7-4.5). These results highlight the strong impact of dietary patterns on the risk of NAFLD.

Conclusions: This study highlights that a Western dietary pattern is strongly associated with an increased risk of NAFLD, while adherence to a traditional diet appears protective. Dietary modifications could serve as a potential strategy for NAFLD prevention in at-risk populations.

Optimizing blood utilization: insights from a tertiary care hospital in Hubballi, Northern Karnataka, India

2025-10-31T09:24:31+0530

Background: Blood transfusion is a cornerstone of modern medical care. With the shift from whole blood to component therapy, especially in resource-limited settings, optimizing blood utilization is essential to ensure availability, minimize wastage, and improve patient outcomes.

Methods: To analyze the utilization patterns of blood and its components at a tertiary care center in Hubballi, Karnataka, over a three-year period, with an emphasis on usage trends, demographic distribution, and discard rates. A descriptive, observational study was conducted at the blood centre of Karnataka Medical College and Research Institute, Hubballi, India from January 2021 to December 2023. Data were extracted from blood bank records, including type of components used, patient demographics, clinical indications, and reasons for discards. Trends were compared with national and international studies.

Results: A total of 45,514 units were collected, and 44,139 units utilized. Component therapy accounted for 78% of transfusions, with packed red blood cells (39%), fresh frozen plasma (29%), and platelets (10%). Whole blood usage remained at 22%. Female recipients constituted 57% of transfusions, primarily in reproductive age groups. The discard rate was 3.02%, mainly due to transfusion-transmitted infections and donor-related issues.

Conclusion: The study highlights a favorable shift toward component therapy, though whole blood use still exceeds national benchmarks. Strengthening clinician awareness, donor screening, and inventory practices, along with regular audits, is vital for enhancing transfusion efficiency and safety.

Guillain–Barre syndrome - clinical profile, diagnosis and recovery in a tertiary care setting

2025-10-31T09:23:21+0530

Background: Guillain–Barre syndrome (GBS) is an autoimmune disease and a recognized cause of generalized progressive paralysis worldwide. The present study was aimed to document the clinical finding, diagnostic challenges, and management outcome amongst the patients with GBS during the hospital stay.

Methods: A retrospective analysis of 22 cases diagnosed as GBS was conducted. Medical records and the data related to age, sex, antecedent illness, muscle power graded by the Medical Research Council scale, functional scores, details of intensive care unit complications and need for ventilation were obtained.

Results: GBS seems to affect all age groups with male preponderance. The male-to female ratio was 2.5:1. Maximum number of patients (50 %, n=11) were in the age group of 60 years and above. The next common age group was 13-30 years in which 31.8% (n=7) patient. Nearly 72% patients (n=16) had history of preceding illness. Paraparesis as a common clinical feature 54.5% (n=12). The majority (n=20) 90.9% were found to be of AMSAN followed by AIDP variants (n=2) 9.09%. About 59.09% patient (n=13) improved at the time of discharge on their F-scores with mild disability.

Conclusions: GBS remains a neurologic emergency that requires early recognition and prompt management to improve patient outcomes. Our study highlights the diverse clinical presentations and underscores the importance of supportive care and timely initiation of immunotherapy. While most patients show favourable recovery with appropriate treatment, residual deficits and complications can persist, emphasizing the need for ongoing rehabilitation and follow-up. Increased awareness among clinicians, especially in primary care and emergency settings, is crucial for early diagnosis. Further research is warranted to explore predictive markers of prognosis and optimize long-term care strategies.

Circadian patterns of peak expiratory flow in healthy male individuals from different age groups

2025-10-31T09:23:14+0530

Background: The human respiratory system exhibits circadian variation, with peak expiratory flow rate (PEFR) typically lowest in the early morning and highest in the evening. This study aimed to assess diurnal variations in PEFR across different age groups and evaluate the influence of aging on this physiological rhythm.

Methods: A cross-sectional study was conducted on 145 healthy male volunteers aged 18–50 years, divided into two groups: 18-30 years (n=78) and 31-50 years (n=67). PEFR was recorded at four time points (7:00 AM, 12:00 PM, 7:00 PM, and 10:00 PM) over two days using mini-Wright’s peak flow meters. Data were analyzed using unpaired t-test, ANOVA, and Tukey’s post hoc test.

Results: Both groups exhibited significant diurnal variation in PEFR (p<0.0001), with morning troughs and evening peaks. The younger group consistently showed higher PEFR values at all-time points (p<0.0001) and a greater amplitude of variation. The largest increase occurred between 7 AM and 7 PM. No significant differences were observed between 12 pm and 10 pm in either group, indicating a plateau after the evening peak. BMI was comparable between groups, ruling it out as a confounder.

Conclusions: PEFR demonstrates a clear circadian pattern in healthy adult males, with aging associated with reduced values and diminished amplitude of variation. These findings underscore the importance of considering time-of-day and age in pulmonary function assessment. Clinically, they support time-based monitoring and interventions, particularly in conditions like asthma, where diurnal variation is exaggerated.

Cytomorphological spectrum and tissue reaction patterns in parasitic infections

2025-10-31T09:23:03+0530

Background: Parasitic infections are prevalent in endemic regions and often present as subcutaneous swellings. Fine-needle aspiration cytology (FNAC) provides a rapid and minimally invasive diagnostic option. Objective was to evaluate the cytomorphological features and tissue reaction patterns in parasitic lesions diagnosed by FNAC.

Methods: An ambispective study of 40 FNAC-confirmed parasitic infection cases conducted over two years. Cytological smears stained with May-Grünwald-Giemsa were evaluated for parasitic elements and background response.

Results: Among 40 cases, cysticercosis (n=30) was most common, followed by hydatid cyst (n=6), filariasis (n=3), and leishmaniasis (n=1). Cysticercosis cases showed bladder wall fragments (83.3%), calcareous spherules (16.7%), and suppurative inflammation (76.7%). Hydatid cysts revealed scolices/hooklets and lamellated membranes; filariasis showed microfilariae and embryonated eggs with inflammatory backgrounds. Leishmaniasis demonstrated amastigotes in a subacute inflammatory background.

Conclusions: FNAC remains a valuable diagnostic tool for identifying parasitic lesions based on cytological hallmarks and associated tissue responses.

Comparison of thoracic epidural analgesia and ultrasound guided erector spinae plane block for post operative pain control following laparoscopic cholecystectomy: a randomized clinical trial

2025-10-31T09:23:02+0530

Background: Effective management of postoperative pain is a cornerstone of modern perioperative care, critically influencing patient recovery and overall outcomes. Over the past several decades, significant advancements in regional anesthesia techniques have transformed the landscape of perioperative analgesia.

Methods: The study groups were divided into two, named group A and group B. The total sample size was 80 (40 patients in each group). In Group A, Thoracic epidural analgesia was given at T8-T9 epidural space via paramedian approach using 7.5ml of 0.75% Ropivacaine diluted with 7.5ml of Normal saline and 7.5mcg Dexmedetomidine, and in the Group B, Erector spinae plane block was given bilaterally at T9 transverse process level using 7.5ml of 0.75% Ropivacaine diluted with 22.5ml of Normal saline and 7.5mcg of Dexmedetomidine.

Results: Duration of analgesia was more in the Thoracic Epidural Analgesia (TEA) group with 894±115.93 mins. There was no significant difference in the dosage of rescue analgesic, however the TEA group needed lesser rescue dosages than those in ESPB group. Pain scores were similar across both groups at all time intervals. Hemodynamic parameters varied early on, with TEA maintaining higher heart rates and MAP values initially. Side effects were comparable between the groups.

Conclusions: This randomized clinical trial comparing Thoracic Epidural Analgesia (TEA) and Ultrasound-Guided Erector Spinae Plane Block (ESPB) for post-operative pain control following laparoscopic cholecystectomy found that TEA demonstrated a significantly longer duration of analgesia compared to ESPB.

Enteric opportunistic parasites in HIV positive patients and associated risk factors

2025-10-31T09:23:00+0530

Background: Depletion of CD4+ T-cells following HIV infection leads to immune system collapse, leaving patients susceptible to opportunistic infections. In developing countries like India, parasites cause diarrhoea in over 90% of HIV patients. This study was conducted to identify the enteric opportunistic parasitic diseases that affect HIV-positive patients and associated risk factors. This study also focuses on the identification of Cryptosporidium species by conventional methods and comparing them with ELISA.

Methods: A cross-sectional study was carried out in the Department of Microbiology, GMCH, Aurangabad, from January 2023 to June 2024. Total 104 stool samples of HIV-positive patients were collected. Proper history was obtained to identify the risk factors. The samples were subjected to direct wet mount, concentrated using formalin-ether method, followed by modified Ziehl-Neelsen staining, Auramine O fluorescent staining, and ELISA.

Results: The parasites identified include Cryptosporidium (34), Cyclospora cayetanensis (1), Strongyloides stercoralis (1), and Entamoeba (1). The risk factors associated with opportunistic infections were high HIV viral load, low CD4 count, shorter duration of ART, chronic diarrhea, and occupation. Auramine O staining was identified as superior to wet mount and modified Ziehl-Neelsen staining for identification of Cryptosporidium spp.

Conclusions: Clinicians can fight AIDS more successfully with proper knowledge about opportunistic infections. Since the spectrum of opportunistic infections varies with geography, their pattern in a particular area is of utmost importance. Understanding the risk factors and optimal diagnostic techniques for opportunistic infections helps in prompt treatment, contributing to delaying the progression to AIDS.

Trends analysis of birth weight of newborn babies born to mothers of different ethnicities of Tripura: a facility-based observational study

2025-10-31T09:22:54+0530

Background: There is little known about the ethnic disparity, which is one of the social determinants of low birth weight in India. This issue was not extensively studied, especially in North-east India. The study aimed to analyse the birth weight trends of newborn babies born to different ethnicities in Tripura.

Methods: A cross-sectional study was conducted in the West Tripura District of Tripura, capturing birth records from 2017 to 2022 among mothers who went through institutional normal vaginal delivery. A 1520 delivery case record form was used to record all birth events, and they were analysed using both descriptive and inferential statistics. Ethical approval was taken from the Institutional Ethics Committee, AGMC, Tripura.

Results: In total, 1520 delivery cases were recorded as normal vaginal delivery. The mean birth weight (kilogram) of newborn babies among Tribal mothers is 3.14±0.46 kgs, Bengali communities’ mothers is 2.83±0.38 kgs, and Tea tribe mothers is 2.76±0.42 kgs. The difference in the mean birth weight of newborns among different ethnicities is found to be statistically significant (p-value 0.008). There was a declining trend in the year 2020-2021 (post-COVID era). The low-birth-weight rate was higher among the tea tribe and the Bengali communities than among Tribal babies (p-value 0.000).

Conclusions: The low birth weight was comparatively lower among the tribal community than the tea tribe and the Bengali community. The study suggested taking specific interventions against low birth weight, targeting the marginalized population.

Investigation of the possible association of LRP5 gene polymorphisms with osteoporosis in an Indian subpopulation of Malda, West Bengal: a case-control study

2025-10-31T09:22:39+0530

Background: The involvement of low-density lipoprotein receptor-related protein 5 (LRP5) in bone-related diseases with low bone mineral density like osteoporosis is scientifically well established. This study aims to explore the relationship between two LRP5 gene polymorphisms viz. rs3736228 (A1330V) and rs41494349 (Q89R) and the risk of osteoporosis in an Indian subpopulation.

Methods: This case-control study included 61 patients with osteoporosis, and 30 healthy controls from Malda Medical College and Hospital. The SNP analysis was performed by PCR-RFLP method with DraIII and AvaII enzymes for rs3736228 (A1330V) and rs41494349 (Q89R) respectively. The data is validated with DNA sequencing. The results are statistically evaluated.

Results: The distribution of the A1330V and Q89R genotypes in this population was as follows: AA 81.97%, AV 18.03%, and VV 0.00%; QQ 100%, QR 0.00%, and RR 0.0 0%. No homozygous mutant for A1330V and heterozygous or homozygous mutant for Q89Rare detected in this population. Both the polymorphisms in this population are in Hardy-Weinberg equilibrium. The genotype distributions of rs3736228 showed difference between the osteoporotic patients and control groups [odds ratio (OR):1.98, 95% confidence interval (CI): 0.51 to 7.71, p=0.374]. DNA sequencing of exon 18 not only confirms the presence of A1330V in Indian population but also identifies a novel mutation.

Conclusions: The odds ratio (OR) suggests a positive trend toward an association between the A1330V variant and osteoporosis risk. Exon 18 of LRP5 demands special scientific attention. No variation is detected for rs41494349 in the study population.

Clinical and immunological outcomes in HIV-2 and HIV-1 and 2 co-infections at a tertiary care centre in Maharashtra

2025-10-31T09:22:20+0530

Background: HIV-2 and HIV-1 and 2 co-infections are rare but clinically significant subtypes with varying response to treatment and progression of disease exist. Not much data from central India especially Maharashtra is available regarding their immunologic courses. The objective was to examine the sociodemographic characteristics, baseline and follow-up CD4 trends, and antiretroviral therapy (ART) outcomes in HIV-2 and HIV-1 and 2 dually infected patients.

Methods: Retrospective analysis was conducted among 27 patients co-infected with HIV-2 or HIV-1 and 2 who were attending a tertiary ART centre in Maharashtra. Baseline and most recent CD4 counts and ART regimen were analysed. Demographic data, and treatment outcomes like alive on ART, died, transfer out, stopped, and opted out were described using descriptive statistics.

Results: Tenofovir-lamivudine-dolutegravir (TLD) was prescribed in the majority of patients. Mean CD4 baseline count of survivors on ART was 352.3 cells/µl, and recent CD4 improved to 519.3. High mortality was observed in those on protease inhibitor-based regimens (ZL+LPV/r, TL+LPV/r).

Conclusion: TLD-based ART produced better immunological outcome. Protease inhibitor-containing regimens needed in HIV-2, could be associated with poor prognosis in patient on ART.

Microbiological profile of central line-associated bloodstream infections at a tertiary care facility

2025-10-31T09:20:56+0530

Background: High-risk and critically ill patients admitted to the ICU often require catheter insertion for administering fluids, blood products, medications, and performing hemodynamic monitoring. Healthcare-associated infections (HAIs) are common in the ICU due to prolonged hospital stays. Central line-associated bloodstream infections (CLABSI) are significant healthcare-associated infections that necessitate surveillance to decrease their occurrence. This study aims to identify the etiological agents and AST patterns of CLABSI in the Medicine ICU.

Methods: A hospital-based surveillance study was conducted from January to December 2023 in the medicine ICU. Blood samples were collected from suspected patients, processed, organisms isolated, and their antibiotic susceptibility tested following our department’s SOPs. CLABSI was diagnosed as per the AIIMS guidelines. CLABSI rates were calculated monthly as part of an HIC surveillance. IPC measures were implemented to reduce the CLABSI rate under surveillance.

Results: Out of 628 blood samples received from the medicine ICU, 178 (28.3%) were positive by culture, and 450 were sterile. Of the 178 positive samples, 65 (10.35%) cases were HAI BSI, with 19 (3.02%) being CLABSI HAI and 46 (7.32%) non-CLABSI HAI. Among CLABSI HAI, Gram-negative bacteria (GNBs) are the most common organisms, accounting for 68.4% of isolates, while Gram-positive bacteria (GPBs) contribute 31.6%.

Conclusions: Excessive use of invasive procedures increases the risk of MICU patients becoming colonized with highly resistant bacteria. Identifying the range of bacteria causing BSI helps clinicians apply proper management strategies and antibiotic policies to improve patient outcomes.

Effect of pre and post badminton match on shoulder rotators strength and range of motion in recreational badminton players

2025-10-31T09:20:46+0530

Background: Badminton is recognized as the fastest racquet sport, with shuttle speeds during match play ranging from 50–75 m/s and post-smash velocities exceeding 100 m/s. Singles competition demands high levels of fitness, while doubles require sustained aggression and rapid reflexes. Players rely on aerobic endurance, agility, strength, speed, and precision. The biomechanics of badminton involve six rapid motion phases, with acceleration lasting just 0.05 seconds being the most injury-prone. Identifying early signs of shoulder dysfunction is essential to prevent long-term damage. This study aims to evaluate the effect of a single badminton match on shoulder rotator strength and range of motion (ROM) in recreational male players.

Methods: A total of 44 recreational male badminton players participated in the study. Shoulder rotator strength and ROM were assessed both before and after match play. Strength was measured using a handheld dynamometer, and ROM was evaluated using a goniometer. A p value of <0.01 was considered statistically significant.

Results: Post-match analysis revealed a significant decrease in internal rotator ROM and strength, alongside an increase in external rotator ROM. External rotator strength also showed a notable reduction. These changes were statistically significant (p<0.001), indicating acute biomechanical alterations following match play.

Unpaired t-test analysis revealed statistically significant differences in shoulder internal and external rotation ROM (p<0.001), internal rotator strength (p<0.001) and external rotator strength (p<0.05) between pre- and post-match assessments.

Conclusion: Post-match findings indicated a decrease in shoulder internal rotation ROM and external rotator strength, alongside an increase in external rotation ROM and internal rotator strength. These changes highlight the acute impact of match play on shoulder function and underscore the need for targeted conditioning and recovery strategies.

Stent-free Endo-DCR: success of the posterior based mucosal flap technique

2025-10-31T09:20:26+0530

Background: Endoscopic Dacryocystorhinostomy (Endo-DCR) is an established surgical procedure for nasolacrimal duct obstruction (NLDO). While silicone stenting is frequently employed to maintain ostial patency, concerns regarding associated complications and costs have spurred interest in stent-free techniques. This study evaluates the efficacy of the posterior-based mucosal flap technique for stent-free Endo-DCR.

Methods: This prospective observational study was conducted at Nandkumar Singh Chouhan Government Medical College, Khandwa, Madhya Pradesh, between July 2023 and July 2025. One hundred and fifty adult patients (165 eyes) diagnosed with primary acquired NLDO were included after obtaining institutional ethics committee approval and informed consent. All participants underwent stent-free Endo-DCR utilizing the posterior-based mucosal flap technique. Primary outcome measures were anatomical success (patent syringing and endoscopic visualization) and functional success (resolution of epiphora and dacryocystitis) assessed at 1, 3, 6 and 12 months post-operatively. Intraoperative and postoperative complications were also meticulously recorded.

Results: The mean age of the cohort was 51.2±11.8 years (range: 23-82 years), with a female preponderance (72.0% females). The overall anatomical success rate was 87.9% and the functional success rate was 85.5% at 12 months follow-up. Minor postoperative complications, predominantly mild synechiae formation (8.5%), were observed, none of which necessitated surgical revision during the study period. The symptomatic re-obstruction rate requiring revision surgery was 2.4%.

Conclusions: The posterior-based mucosal flap technique for stent-free Endo-DCR demonstrates robust anatomical and functional success rates with a low complication profile in the patient population of Madhya Pradesh. This approach offers a safe, effective and potentially more economical alternative to stented DCR, particularly relevant for improving access to care in resource-constrained regions.

Aflatoxin contamination in food crops in Kenya: a systematic review

2025-10-31T09:25:14+0530

Aflatoxins, a group of toxic secondary metabolites produced by Aspergillus flavus and A. parasiticus fungi species, is a sub-chronic and multifaceted agricultural productivity and public health problem in sub-Saharan Africa. The health impacts of aflatoxin exposure are severe and long-term. Characterization of aflatoxin forms is a valuable aspect of this challenge because different forms; aflatoxin B1, B2, G1, and G2 which vary in toxicity and occurrence according to environmental factors and processing conditions. This systematic review bridges the existing gaps by aggregating evidence of levels and extent of aflatoxin contamination of maize, wheat, sorghum, and groundnuts in Kenya from 2010 to 2025. This systematic review employs a narrative synthesis to analyze aflatoxin infestation of maize, wheat, sorghum, and groundnuts in Kenya based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA 2020) standards. The search includes a number of electronic databases and grey literature sources. The four studies indicate that aflatoxin infestation of Kenyan maize remains a significant public health and food security concern, with infestation levels frequently being higher than the regulatory limit (10 µg/kg). The results quantify high infestation in the Rift Valley and Meru County, respectively, as well as associate extreme infestations in Eastern Kenya with associated health dangers like HCC. Regional disparities, driven by moisture, and problems such as broken kernels, insect damage, and excessive moisture levels continue to emerge as contamination drivers. These findings underscore the need for specific interventions to address the environmental and human-related causes of aflatoxin accumulation in maize.

Aerobic exercises and ambulatory blood pressure monitoring in resistant hypertension population: a systematic review

2025-10-31T09:20:43+0530

Resistant hypertension associated with increased risk of morbidity and mortality. Here our aim was to systematically evaluate and sum up evidence on the impact of aerobic exercise on ambulatory blood pressure (ABP) in resistant hypertension population. This systematic review followed PRISMA guidelines, and we explored PubMed, Cochrane Library, SCOPUS, and Science Direct for apropos studies. This systematic review included randomized controlled trials and crossover trials focusing on resistant hypertension population undergoing aerobic exercise compared to routine management. The primary outcome was blood pressure (BP) control, which was measured using 24-hour ambulatory blood pressure monitoring (ABPM). Secondary outcome were office blood pressure and adverse effects. Three authors independently selected studies, extracted data, and assessed the risk of bias. The conflicts were resolved by consensus. This systematic review summarizes findings of six randomized controlled trials with 187 participants assessing the impact of exercise on ambulatory blood pressure in resistant hypertension population. Aerobic training was associated with significant reduction of 5-10 mmHg in 24- hour ambulatory BP. Similar pattern was observed in day time BP, while night time BP were less pronounced. Office BP showed inconsistent changes. Exercise interventions, particularly supervised programs and light-to-moderate intensity activities, also improved cardiorespiratory fitness and physical performance. In studies exercise intervention were usually safe and well tolerated without serious adverse events. Moderate evidence supports the addition of aerobic exercise to usual care in resistant hypertension population. However small number of participants and heterogenicity in methodology and outcome limiting the strength of findings.

Association between adolescent obesity and subclinical cardiac dysfunction: a systematic review and meta‑analysis

2025-10-31T09:27:53+0530

Rising rates of adolescent obesity raise concerns about early cardiac changes that may silently progress to dysfunction. Sensitive imaging techniques can detect subclinical cardiac impairment in youth, even when standard echocardiography appears normal. We conducted a comprehensive systematic review and meta‑analysis to evaluate the association between adolescent obesity and subclinical cardiac dysfunction, focusing on measures such as myocardial relaxation velocity (e′), e′/a′ ratio, global longitudinal strain (GLS), ventricular mass changes, right ventricular (RV) strain, and metabolic modulators like insulin resistance and leptin. Database searches (PubMed, PMC, JACC, AHA Journals, ScienceDirect) up to July 2025 identified 24 studies (n=2,200 adolescents, ages 10–19). Among them, 16 provided sufficient numeric data for meta‑analysis. Studies used tissue Doppler imaging (TDI), speckle-tracking echocardiography (STE), and MRI. Random-effects models yielded standardized mean differences (SMD) for e′, e′/a′, and GLS; heterogeneity assessed via I²; bias via funnel plots. Obese adolescents consistently exhibited reduced e′ (SMD=–0.75; p<0.00; I²=52%), reduced e′/a′ ratio (SMD=–0.60; p<0.001; I²=48%), and lower GLS (SMD=–0.68; p<0.001; I²=55%). Most studies also reported increased left ventricular mass, concentric remodeling, and impaired RV strain. Metabolic factors (insulin resistance, elevated leptin, dysglycemia) correlated with worse strain outcomes. Adolescent obesity is linked to measurable subclinical biventricular cardiac dysfunction, detectable via advanced echocardiographic techniques. These abnormalities often precede overt disease, underscoring the need for early detection and targeted intervention to halt progression.

Zinc supplementation for reducing duration and severity of acute diarrhoea in children: a meta-analysis

2025-10-31T09:20:25+0530

Acute diarrhoea remains a major cause of morbidity and mortality among children under five years, particularly in low- and middle-income countries, despite widespread use of oral rehydration therapy. Zinc supplementation has been endorsed by international health authorities as an adjunct therapy, yet variations in its reported efficacy necessitate an updated synthesis of available evidence. This meta-analysis evaluated the impact of zinc supplementation on the duration and severity of acute diarrhoea in children aged 0–59 months. A systematic literature search was conducted in PubMed, Embase, and Web of Science databases for randomized controlled trials published between January 2000 and June 2025 comparing zinc supplementation with placebo or standard treatment. Fifteen eligible trials comprising 8,423 participants were included, and pooled estimates were calculated using a random-effects model. Zinc supplementation significantly reduced the mean duration of diarrhoea by 0.72 days (95% CI: −1.04 to −0.40) and decreased the risk of diarrhoea persisting beyond seven days (RR=0.65; 95% CI: 0.50–0.85). Furthermore, the risk of diarrhoea-related hospitalization was lower in the zinc group (RR=0.74; 95% CI: 0.60–0.92). Moderate heterogeneity (I²=62%) was observed across studies, likely reflecting variations in population characteristics, zinc formulations, and baseline nutritional status. These findings confirm that zinc supplementation effectively reduces both the duration and severity of acute diarrhoea in young children and supports existing World Health Organisation (WHO) recommendations for its routine use in diarrhoeal disease management. Broader integration of zinc supplementation into national child health programs, especially in resource-limited settings, could substantially reduce the global burden of childhood diarrhoeal disease.