International Journal of Research in Medical Sciences

Knowledge, attitudes and practices of mothers toward febrile seizures in children

2026-05-30T07:25:38+0530

Background: Febrile seizures are among the most common neurological emergencies in children and are a major source of parental anxiety. This study aimed to assess mothers’ knowledge, attitudes, and practices (KAP) regarding febrile seizures in Tuléar, Madagascar.

Methods: A cross-sectional KAP study was conducted in April 2023 among 400 mothers of children aged 1 to 5 years attending a primary health center and a university hospital. Data were collected using a structured questionnaire. Variables included sociodemographic characteristics, knowledge of febrile seizures, and reported attitudes and practices.

Results: The mean maternal age was 34.9±9.2 years, and 70% had previous exposure to febrile seizures. The most commonly recognized clinical signs were abnormal limb movements (85.75%), fever (85.25%), and loss of consciousness (85%). However, neurovegetative signs were less frequently identified (56%). Overall knowledge was considered adequate in 60.5% of participants but remained insufficient regarding causes (74%). While 85% of mothers reported immediate healthcare seeking, first-aid management skills were limited.

Conclusions: Despite relatively good recognition of clinical features and high healthcare utilization, significant gaps persist in understanding and home management of febrile seizures. Targeted health education programs adapted to the sociocultural context are essential to improve early management and reduce inappropriate practices.

Biochemical differences between diabetic and non-diabetic COVID-19 patients

2026-05-30T07:30:37+0530

Background: The COVID-19 pandemic presents a major global health challenge, with diabetes mellitus significantly increasing the risk of severe illness and mortality. This elevated risk is linked to the unique biochemical milieu of diabetes characterized by chronic inflammation, endothelial dysfunction, and metabolic dysregulation which interacts synergistically with SARS-CoV-2 infection. Understanding the distinct biochemical and hematological differences between diabetic and non-diabetic COVID-19 patients is crucial for improving clinical management and outcomes.

Methods: This hospital-based comparative study was conducted at the COVID19 unit of M. Abdur Rahim Medical College and Hospital, Dinajpur, Bangladesh, from September 2020 to June 2021. One hundred confirmed COVID-19 patients (50 diabetic, 50 non-diabetic) were enrolled. Demographic and clinical data were collected via questionnaire. Blood samples were analyzed for CRP, D-Dimer, and complete blood count at Popular Diagnostic Centre Limited, Dinajpur. Statistical analysis was performed using SPSS. Ethical approval and informed consent were obtained.

Results: The study of 100 patients (50 diabetic, 50 non-diabetic) showed diabetics had markedly higher CRP (161.02 vs. 54.78 mg/l) and D-dimer (5.71 vs. 1.52 mg/ml). Hematologically, diabetics had elevated WBC (14.12 vs. 10.33), neutrophils (75.20% vs. 65.68%), and ESR (85.06 vs. 54.58), but lower lymphocytes (17.48% vs. 24.74%). Comorbidities like dyspnea (62% vs. 30%) and symptoms like fever (92% vs. 84%) were more prevalent in diabetics.

Conclusions: Diabetic COVID-19 patients exhibit a more severe biochemical and clinical profile than non-diabetics, necessitating targeted monitoring and management.

Assessment of cryogenic safety practices, exposure and occupational hazards in embryology laboratories of IVF clinics in Abuja, Nigeria

2026-05-30T07:30:29+0530

Background: Assisted reproductive technology (ART) laboratories have cryogenic storage, which allows the long-term storage of gametes and embryos using liquid nitrogen in place of short-term storage. Although it is essential, cryogenic operations are known to create serious occupational hazards to the laboratory staff where there are no adequate safety measures. The study evaluated cryogenic safety practices, pattern of exposure, occupational hazards and compliance pattern among embryology laboratory staff in Abuja, Nigeria in vitro fertilizations (IVF) clinics.

Methods: A cross-sectional study of embryology lab staff in Abuja in selected IVF clinics was done in a descriptive study. The respondents filled a self-administered, structured questionnaire, which included data on cryogenic safety practices, exposure to cryogenic hazards and history of accidents. Frequencies and percentages were summarised using descriptive statistics. Principal component analysis (PCA) was used to identify underlying dimensions of cryogenic safety compliance across measured safety practices.

Results: The majority (90.24%) of respondents were directly involved in cryogenic storage, handling or supervision. 58.54% reported direct exposure to cryogenic liquids and 34.15% reported cryogenic related laboratory accidents. Principal component analysis identified two distinct dimensions of cryogenic safety compliance, reflecting procedural-behavioral practices and equipment monitoring activities.

Conclusions: High levels of staff exposure to cryogenic systems coexist with inconsistent engineering controls and uneven adherence to safety practices. The multidimensional compliance structure identified highlights the need for cryogenic safety management strategies that address both behavioral–procedural compliance and equipment monitoring practices in ART laboratories.

Comparative study of topical steroid misuse in urban and rural patients: public health implications

2026-05-30T07:30:27+0530

Background: Topical corticosteroids are widely used for a variety of dermatological conditions, but their irrational and unsupervised use has become a major public health concern, particularly in low- and middle-income countries. Misuse can lead to adverse effects such as tinea incognito, steroid-induced acne, skin atrophy, and other cutaneous complications. This study aimed to compare the prevalence, patterns, sources, potency, duration, and adverse effects of topical steroid misuse between urban and rural patients.

Methods: This cross-sectional comparative study was conducted from July 2025 to December 2025, in the dermatology outpatient department at Mymensingh Medical College Hospital, Mymensingh, Bangladesh to assess topical steroid misuse in urban and rural populations. A total of 102 patients were enrolled, divided into urban (n=52) and rural (n=50) groups.

Results: Urban patients mainly misused topical steroids for acne (34.6%), while rural patients primarily used them for fungal infections (44%, p<0.05). Pharmacists were the leading source of recommendation, particularly in rural areas (48% vs. 34.6%, p=0.04). Moderate-potency steroids were more common in urban patients, whereas super-potent steroids and longer duration of use (>3 months) were significantly higher in rural patients (36% and 68%, respectively, p<0.05). Adverse effects differed by setting, with tinea incognito more frequent in rural patients (44%, p=0.01) and steroid-induced acne more common in urban patients (30.8%, p=0.048); other complications showed no significant differences.

Conclusions: Topical steroid misuse is common across both urban and rural populations, with rural patients tending to use steroids for longer periods, depending more on pharmacists, and experiencing more fungal-related complications, whereas urban patients primarily misuse them for acne treatment and cosmetic purposes.

Comparison of outcomes and toxicities of concurrent chemo-radiation with weekly cisplatin versus weekly paclitaxel in locally advanced cervical carcinoma

2026-05-13T07:00:46+0530

Background: Cervical cancer remains a leading cause of cancer-related death among women. Concurrent chemoradiation with Cisplatin is the standard treatment for locally advanced disease, though outcomes remain suboptimal. Alternative non-platinum agents like Paclitaxel have been explored to improve efficacy and tolerability.

Methods: This quasi-experimental study was conducted at the Department of Radiotherapy, Rajshahi Medical College Hospital, from January 2022 to June 2023. Seventy patients with locally advanced squamous cell cervical cancer were equally assigned into two groups by purposive sampling. Arm A received weekly cisplatin (40 mg/m²) and Arm B received weekly paclitaxel (50 mg/m²), both with external beam radiotherapy followed by HDR brachytherapy. Patients were evaluated at weeks 4, 8, and 12 post-treatments. Data were analyzed using SPSS version 25.

Results: Of 70 patients, 68 completed treatment. Mean age was 48.46±8.80 years. Most patients were stage IIB (60.3%) and moderately differentiated (63.2%). Complete response was observed in 82.4% (Arm A) and 73.5% (Arm B), while partial response occurred in 14.7% and 20.6%, respectively (p>0.05). Hematologic toxicity and gastrointestinal side effects were higher in Arm B, whereas nausea, vomiting, and renal toxicity were more frequent in Arm A; differences were not statistically significant.

Conclusions: Weekly paclitaxel is not inferior to cisplatin in treatment response and may serve as an alternative when cisplatin is contraindicated, considering toxicity and cost.

Clinical and echocardiographic features of elderly patients with myocardial infarction

2026-05-30T07:29:25+0530

Background: Acute myocardial infarction (MI) is one of the leading causes of mortality worldwide. Elderly patients comprise a growing proportion of the MI population. We sought to characterize the clinical, anamnestic, laboratory, and echocardiographic data of elderly MI patients (>70 years).

Methods: We studied 104 patients with acute MI admitted to our regional cardiology center from January 2024 to November 2025. We divided the study population into two groups: 46 patients >70 years and 58 patients ≤70 years. We compared the clinical data, laboratory results, echocardiographic data, and results of coronary angiography between the study groups using non-parametric statistics.

Results: Elderly MI patients presented a higher proportion of females (45.7% vs. 15.1%, p=0.001), lower rates of obesity (23.9% vs. 44.8%, p=0.038), and reduced estimated glomerular filtration rate (67.8 vs. 79.8 ml/min/1.73m², p<0.05). Elderly MI patients presented reduced left ventricular dimensions in echocardiographic data but comparable ejection fractions. Elderly MI patients presented comparable vessel involvement in the results of coronary angiography but underwent less frequent stenting (41.3% vs. 63.7%, p=0.029) and bypass grafting (47.8% vs. 22.4%, p=0.011).

Conclusions: Despite having a similar coronary pathology elderly MI patients have different clinical and demographic data with different revascularization approaches. These findings emphasize the need for age-specific diagnostic and therapeutic strategies to optimize outcomes in this growing patient population.

Survival outcomes following decompressive craniectomy versus reconstructive cranioplasty: a comparative study

2026-05-30T07:30:35+0530

Background: Decompressive craniectomy is lifesaving for malignant cerebral edema after trauma or stroke. Subsequent cranioplasty restores cranial integrity and may improve neurological recovery; however, comparative outcome data from Bangladesh remain limited.

Methods: This comparative study was conducted at KPJ Specialized Hospital, Dhaka, Bangladesh, from September 2017 to December 2024. A purposive sample of 47 patients who underwent decompressive craniectomy was included and divided into two groups: the DC-only group (n=31) and the DC+CP group (n=16). Survival was the primary outcome measure. Data were analyzed using SPSS version 23.0.

Results: Patients in the DC+CP group were significantly younger than those in the DC-only group (p =0.009). A marked difference in survival was observed between groups: 93.8% (15/16) of patients in the DC+CP group were alive at follow-up, compared to 25.8% (8/31) in the DC-only group (p<0.001). Syndrome of the trephined was identified in 25.0% (4/16) of patients before cranioplasty. Following CP, 87.5% (14/16) demonstrated neurological improvement, and 68.8% (11/16) achieved good functional recovery (Glasgow Outcome Scale score 4–5). The overall CP-related complication rate was 18.8%.

Conclusions: Survival was substantially higher among patients who underwent cranioplasty following decompressive craniectomy. Despite inherent selection bias, cranioplasty was strongly associated with improved neurological and functional outcomes, underscoring its critical role in the continuum of care for severe neurotrauma and stroke.

Multiplex PCR assay findings of patients with clinically suspected acute viral encephalitis: an observational study in a tertiary care hospital

2026-05-30T07:30:34+0530

Background: Acute viral encephalitis is a life-threatening neurological emergency characterized by fever, seizures, and altered consciousness. Rapid identification of viral pathogens is essential for timely management, yet conventional diagnostic tools often have limited sensitivity. This study aimed to determine the multiplex PCR assay findings and describe the clinical, MRI, and CSF characteristics of patients with clinically suspected acute viral encephalitis in a tertiary care hospital.

Methods: This observational study was carried out at the Department of Neurology during December 2024 to November 2025 in Chittagong Medical College Hospital, Chattogram, Bangladesh of 100 patients irrespective of age and sex with clinically suspected acute viral encephalitis. Detailed clinical evaluation, routine laboratory tests, CSF biochemical and cytological analysis, and MRI imaging were performed. CSF samples were tested using a multiplex PCR panel for detection of common viral pathogens.

Results: The mean age of patients was 45.28±19.95 years, with nearly equal male (51%) and female (49%) distribution. Fever (100%), altered consciousness (97%), and confusion (81%) were the predominant clinical features. MRI abnormalities were observed in 53% of patients, mainly FLAIR/T2 changes (51%), restricted diffusion (51%), and hypoxic changes (43%). CSF analysis revealed a predominantly lymphocytic profile (median lymphocytes 98%) with preserved CSF/blood glucose ratio (median 0.555). Multiplex PCR detected viral pathogens in 32% of cases. The majority (68%) of patients were mPCR-negative.

Conclusions: Despite characteristic clinical, MRI, and CSF features, most cases remained mPCR-negative, highlighting the limitations of current diagnostic panels and the likelihood of undetected viral etiologies. Integrating broader molecular testing may improve diagnostic yield in resource-limited settings.

Gender-specific characteristics of acute myocardial infarction in the Grodno Region of the Republic of Belarus

2026-05-30T07:29:15+0530

Background: Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. Emerging evidence suggests significant gender-based differences in the pathophysiology, clinical presentation, and outcomes of MI. This study aimed to investigate gender-specific characteristics in clinical, laboratory, and angiographic parameters among patients with AMI in the Grodno Region of Belarus.

Methods: This prospective study included 100 patients (50 males, 50 females) admitted with a diagnosis of MI to the Grodno Regional Cardiological Center between January and December 2025. Clinical characteristics, laboratory parameters, and coronary angiography findings were analyzed. Statistical analysis was performed with STATISTICA 12.0.

Results: Female patients were significantly older than males at presentation (p<0.001). Inferior wall MI was more common in males (p<0.001), while females had a higher prevalence of diabetes mellitus (p=0.02) and anemia (p=0.03). Laboratory analysis revealed significantly higher creatinine, and estimated glomerular filtration rate in females, while males had higher glucose, and cardiac enzymes (AST, ALT, CPK-MB). Coronary angiography demonstrated a significantly higher rate of total coronary occlusion in males (p=0.001), despite similar distributions of affected vessels and revascularization strategies.

Conclusions: Significant gender-specific differences exist in the clinical presentation, laboratory profiles, and angiographic characteristics of patients with MI. Females present at an older age with a distinct comorbidity profile, while males exhibit a higher burden of total coronary occlusion. These findings underscore the need for gender-tailored approaches in the risk stratification and management of MI.

Patterns and management outcomes of urticaria in a tertiary hospital setting

2026-05-30T07:30:26+0530

Background: Urticaria is a common pruritic wheal disorder, with or without angioedema, classified as acute or chronic. Chronic urticaria often recurs, impairs quality of life, and requires stepwise antihistamine-based treatment. However, local data on disease patterns and treatment outcomes in Bangladesh remain limited.

Methods: This observational study was conducted at the Department of Dermatology and Venereology, Railway General Hospital, CRB, Chittagong, Bangladesh, from January to December 2025. A total of 125 consecutive patients with urticaria were enrolled. Cases were classified as acute or chronic, with chronic urticaria further categorized into chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU), or mixed. Disease severity was assessed using UAS7. Treatment patterns and 4-week outcomes were recorded.

Results: Of the patients, 58.4% were female and 51.2% were aged 20-39 years. Chronic urticaria accounted for 63.2% of cases, predominantly CSU (55.2%). Angioedema occurred in 30.4%, and generalized wheals in 73.6%. Triggers were unidentified in 32.0%, while stress (41.6%), foods (26.4%), drugs (22.4%), and infections (19.2%) were common. Atopy was present in 39.2% and thyroid disease in 12.0%. Moderate-to-severe UAS7 was observed in 54.4%, with 47.2% reporting sleep disturbance. All patients received second-generation antihistamines; 44.8% required up-dosing and 32.8% received short-term steroids. At 4 weeks (92.0% follow-up), 64.4% achieved complete or well-controlled status, 15.7% relapsed, and 12.0% reported adverse effects.

Conclusions: Chronic urticaria, mainly CSU, predominated with moderate-to-severe activity at presentation. Most patients achieved symptom control within 4 weeks using stepwise antihistamine therapy, though up-dosing was frequently required and some remained uncontrolled or relapsed.

Evaluation of fluid-related adverse events during therapeutic plasma exchange in Guillain-Barré syndrome

2026-05-30T07:29:29+0530

Background: Therapeutic plasma exchange (TPE) is used to treat moderate to severe Guillain-Barré syndrome (GBS), but it can cause fluid-related adverse events influenced by the type of replacement fluid, such as FFP or 5% albumin. Objectives were to evaluate and compare the frequency and severity of fluid-related adverse events during TPE in GBS patients receiving FFP or 5% albumin.

Methods: This cross-sectional study was conducted at BSMMU and NINS, Dhaka, from October 2021 to September 2022. Eighteen confirmed GBS patients undergoing TPE were equally divided into fresh frozen plasma (FFP) (n=9) and 5% albumin (n=9) groups, and 90 sessions were analyzed. Fluid-related adverse events were recorded and analyzed using SPSS version 22, with p<0.05 considered significant.

Results: A total of 22 adverse events were recorded (24.4% of sessions). Hypocalcemia was the most frequent complication (7.8%), followed by hypotension (6.7%), fever (5.6%), and allergic reactions (4.4%). Adverse events were numerically higher in the FFP group compared to the albumin group: fever (8.9% vs 2.2%), allergic reactions (6.7% vs 2.2%), hypotension (11.1% vs 2.2%), and hypocalcemia (11.1% vs 4.4%), though differences were not statistically significant (p>0.05). Most events were mild (72.7%), and no severe complications were observed.

Conclusions: Both FFP and 5% albumin were generally safe during TPE in GBS patients, though FFP showed a higher frequency of immediate fluid-related adverse events. Larger multicenter studies are needed to confirm these findings.

Electrocardiographic ventricular repolarization markers associated with obstructive coronary atherosclerosis in patients with coronary artery disease

2026-05-30T07:29:12+0530

Background: In patients with coronary artery disease (CAD), myocardial ischemia is manifested by an increase in the instability of cardiomyocytes which is potentially characterized by QT interval and T_peak - T_end interval duration. This highlights the relevance of this study, which was aimed at the evaluation of electrocardiographic ventricular repolarization parameters associated with obstructive coronary atherosclerosis in patients with CAD.

Methods: The study included 63 patients with CAD and stable angina class I-III, referred for coronary angiography. 26 (41%) patients didn’t have hemodynamically significant CAD (stenosis <50%) (group 1), and 37 (59%) patients had significant CAD (stenosis ≥50%) (group 2). At admission, a resting standard 12-lead ECG was recorded, taken at a paper speed of 50 mm/sec. Statistical analysis was performed using the STATISTICA 12.0.

Results: Patients of both groups were comparable in age, prevalence of hypertension, obesity, diabetes mellitus, and atrial fibrillation (p>0.05). Patients of group 2 were predominantly male (p=0.04) and more often suffered from myocardial infarction (p=0.03) than patients of group 1. QT interval duration was greater in patients of group 2 compared with group 1 (p=0.049), as well as T_peak - T_end interval duration (p=0.019).

Conclusions: Patients with significant obstructive CAD had greater values of QT interval and T_peak - T_end interval (p<0.05) in comparison with patients without coronary atherosclerosis. These parameters may be further used as potential ECG predictors of CAD and assist in risk stratification before coronary angiography.

Comparison of the efficacy and safety of the XELOX regimen versus the FOLFOX-4 regimen in metastatic colorectal carcinoma

2026-05-13T07:00:45+0530

Background: Colorectal cancer is a major cause of cancer-related mortality worldwide. Common regimens such as FOLFOX-4 and XELOX are widely used in metastatic colorectal carcinoma (mCRC), differing in toxicity profiles and administration methods.

Methods: This quasi-experimental study included 60 patients with histologically confirmed unresectable mCRC treated at BSMMU from April 2021 to March 2022. Patients were equally assigned to two groups: Arm A received XELOX (oxaliplatin+capecitabine) and Arm B received FOLFOX-4 (oxaliplatin+leucovorin+5-FU). Tumor response and toxicity were assessed using WHO and CTCAE v 5.0 criteria.

Results: The median age was 52 years, with 70% male participants. Baseline characteristics were comparable (p> 0.05). At 12 weeks, partial response rates were 46.7% in XELOX and 53.3% in FOLFOX-4, with no significant difference (p=0.605). After treatment completion, partial response was 40.0% and 46.7%, respectively, while progressive disease was higher in XELOX (33.3% vs 20.0%; p=0.668). Median progression-free survival was similar (7.8 vs 8.2 months; p=0.65). Grade 3–4 neutropenia was significantly higher in FOLFOX-4 (40.0% vs 0%, p=0.003), with febrile neutropenia observed only in this group. XELOX showed higher rates of diarrhea (40.0%) and hand-foot syndrome (23.3%).

Conclusions: Both regimens demonstrated comparable efficacy. XELOX had more gastrointestinal toxicity, whereas FOLFOX-4 showed higher hematological toxicity. XELOX may be a suitable alternative where outpatient convenience is preferred.

Assessment of prostate cancer knowledge and perception towards screening services and follow-up care among male non-medical staff at Epe General Hospital and Akodo General Hospital

2026-05-30T07:26:01+0530

Background: Prostate cancer has over the years emerged as a public health concern, as it has become the second common cancer and the fifth leading cause of death among men worldwide. Globally, 1.3 million new cases and 359, 000 related deaths were projected in 2018.

Methods: A cross-sectional analytical study design and simple random sampling technique was used to select 103 and 92 non-medical males in Epe and Akodo General Hospitals respectively using questionnaire adopted from previous study. Data was analyzed using Statistical Package for Social Sciences SPSS 23.0, interpreted using descriptive statistics: frequency tables, bar charts and converting same to percentages and X² was used to determine association.

Results: Results showed that pretest results from respondents in General Hospital (G.H.) Epe, as 74.3% indicated that they had not heard about prostate cancer. Interestingly, 37.6% of respondents recognized that maintaining a healthy lifestyle could reduce the risk of developing prostate cancer. 74.3% of participants in G.H. Epe indicated age as a risk factor for prostate cancer. 68% of participants were unaware of the significance of family history in relation to prostate cancer risk in Akodo G.H. 88.1% indicated smoking, obesity as risk factors, compared to 65.3% in Akodo. 91.7% of participants are familiar with PSA. In G.H. Epe (71.6%) are not well-informed about prostate cancer and the importance of early screening.

Conclusions: Individuals with good knowledge tend to have a more positive perception regarding prostate cancer, as indicated by the p value of 0.001.

In vitro and in vivo synergistic activity of antibiotic combinations against colistin-resistant Pseudomonas aeruginosa: a study from a tertiary care hospital in Bangladesh

2026-05-30T07:25:59+0530

Background: The emergence of colistin-resistant Pseudomonas aeruginosa poses a serious therapeutic challenge, particularly in low- and middle-income countries where treatment options are limited. Combination therapy is increasingly explored to improve clinical outcomes, but in vivo validation still remains insufficient.

Methods: A cross-sectional experimental study was conducted at a tertiary-care hospital in Bangladesh (2019). Clinical isolates of P. aeruginosa were identified and tested for antimicrobial susceptibility following CLSI guidelines. Colistin resistance was detected by agar dilution MIC testing and further confirmed by PCR. Molecular detection of colistin resistance–associated genes (pmr A, pmr B, pmr C, phoP, pho Q and mcr-1-5) was done by PCR. In vitro synergy of colistin–imipenem and colistin–amikacin combinations were evaluated by MIC reduction and fractional inhibitory concentration index (FICI). A murine infection model was used to assess the therapeutic efficacy.

Results: Among the 63 isolates of P. aeruginosa, 12 (19.05%) were identified as colistin-resistant. Multidrug resistance was observed among all the isolates, with high-level colistin MICs (≥4 µg/ml). Chromosomally mediated resistance genes (PMR and PHO systems) were only detected instead of any plasmid-mediated mcr genes. In vitro synergy testing demonstrated 100% synergistic activity for colistin–imipenem (FICI ≤0.5), whereas colistin–amikacin showed predominantly indifferent effects. In vivo, the combination of colistin–imipenem led to complete bacterial clearance from the mice with 100% survival, whereas the colistin–amikacin combination resulted in 100% mortality, similar to untreated controls.

Conclusions: The Colistin–imipenem combination demonstrates strong in vitro synergy and superior in vivo efficacy against colistin-resistant P. aeruginosa, highlighting its potential as a practical therapeutic option specially in resource-limited settings.

Exclusive breastfeeding practices among mothers delivering at a tertiary hospital in Antananarivo, Madagascar

2026-05-30T07:25:41+0530

Background: Exclusive breastfeeding (EBF) is a cost-effective intervention that significantly reduces infant morbidity and mortality. However, its practice remains suboptimal in many low- and middle-income countries. The aim of the study is to assess breastfeeding practices and maternal knowledge among mothers delivering at a tertiary hospital in Antananarivo, Madagascar.

Methods: A cross-sectional study was conducted from July to September 2024 at the maternity ward of the Centre Hospitalier de Soavinandriana. Mothers who initiated breastfeeding and consented to participate were enrolled. Data were collected at discharge and at one month postpartum. Statistical analyses were performed using Epi Info 7, with p < 0.05 considered significant.

Results: Among 106 mothers (mean age 29.3±4.7 years), early initiation of breastfeeding within one hour occurred in 41.5%. Exclusive breastfeeding was reported in 61.3% at discharge and declined to 48.1% at one month. Formula feeding was introduced in 34.0% of cases, and 27.4% of infants received non-breast milk liquids. Factors significantly associated with EBF at one month included early initiation (63% vs 37%, p < 0.001), vaginal delivery (52% vs 48%, p=0.03), and receipt of breastfeeding counseling (58% vs 42%, p=0.01). Mother–infant separation was negatively associated with EBF (29% vs 71%, p=0.002). Although 60.4% of mothers received breastfeeding information, only 46% correctly identified the recommended duration of EBF.

Conclusions: Despite moderate breastfeeding initiation rates, EBF declined substantially within the first month. Strengthening early initiation, counseling, and postnatal support is essential to improve breastfeeding outcomes.

Role of anemia in the severity and outcome of chronic heart failure

2026-05-30T07:25:58+0530

Background: Chronic heart failure is a major cause of morbidity and hospitalization worldwide. Anemia is frequently observed among heart failure patients and may worsen disease severity and clinical outcomes. However, limited data are available regarding this association in Bangladesh. This study aimed to evaluate the role of anemia in the severity and outcome of chronic heart failure.

Methods: This hospital-based observational study was conducted in the department of cardiology at Satkhira Medical College and Hospital from January 2025 to December 2025. A total of 180 patients with chronic heart failure were included. Data on demographic characteristics, anemia status, severity of heart failure according to New York Heart Association (NYHA) classification and clinical outcomes were collected using a structured data sheet.

Results: Among 180 patients with chronic heart failure, 107 (59.4%) had anemia. Most anemic patients had mild anemia (41.1%). Anemic patients were mainly in NYHA class III (43.0%) and IV (19.6%), whereas non-anemic patients were mostly in class II (38.4%) and I (23.3%). Significant differences were found for class I (p<0.001) and class III (p=0.032). Prolonged hospital stay was higher among anemic patients (40.2% vs. 23.3%, p=0.018), and clinical improvement was lower (57.0% versus 75.3%, p=0.012). Readmission and mortality were higher but not statistically significant.

Conclusions: Anemia is common among patients with chronic heart failure and is associated with greater disease severity and poorer clinical outcomes. Early identification and management of anemia may help improve the prognosis of heart failure patients.

Heart failure with reduced and mid-range ejection fraction: laboratory and instrumental profile

2026-05-30T07:25:43+0530

Background: Since the publication of the European Society of Cardiology Guidelines for the Diagnosis and Treatment of Heart Failure in 2016, a new class of HF has been defined - HF with mid-range ejection fraction (HFmrEF). Aim of the study was to establish clinical, anamnestic, laboratory and echocardiographic differences in patients with HF with reduced left ventricular ejection fraction (HFrEF) and HFmrEF.

Methods: The retrospective single-center study included 92 patients with HF who were admitted to the Grodno Regional Clinical Cardiological Center for treatment from January 2023 to June 2025. Group 1 included 48 patients with HFrEF (LVEF<40%), while Group 2 included 44 patients with HFmrEF (LVEF 41-49%). We analyzed demographics, comorbidities, treatment, laboratory results, and echocardiographic data.

Results: HFmrEF and HFrEF shared similar age, sex, and major comorbidities (p>0.05), yet displayed distinct clinical and instrumental profiles. HFmrEF showed a milder presentation better NYHA class, fewer pleural effusions, smaller chambers, and markedly lower NT-proBNP whereas HFrEF exhibited advanced remodeling (larger LA/LV dimensions and volumes), more wall-motion abnormalities, thinner systolic septum suggestive of a dilated/ischemic phenotype, higher NT-proBNP, and greater congestion. NT-proBNP level had significant correlations with echocardiographic parameters, including LVEF (R=-0.49, p<0.001).

Conclusions: These findings support: systemic phenotyping of HFmrEF to individualize therapy, broader adoption of SGLT2 inhibitors alongside ARNI optimization and prospective studies to define trajectories, subphenotype-specific responses (e.g. obesity-, ischemia-, AF- driven), and multimodal risk stratification.

Pattern and outcomes of neurosurgical interventions in Ado-Ekiti, Nigeria: a retrospective study

2026-05-30T07:25:42+0530

Background: Neurosurgical practice in resource-limited settings is often shaped by a high burden of trauma and delayed presentation. This study evaluated the indications, procedures, and outcomes of neurosurgical interventions in Ado-Ekiti, Nigeria.

Methods: This was a retrospective hospital-based study which covered an 18-month period from July 2024 to December 2025. A total of 86 patients who underwent neurosurgical procedures were included. Data on socio-demographic characteristics, clinical indications, types of procedures, postoperative complications, and outcomes were analyzed.

Results: Most patients were males (67.4%), with the highest proportion aged 18-40 years (39.5%). Over half presented through the emergency unit (53.5%). Traumatic brain injury was the most common indication for surgery (34.9%), followed by spinal cord compression (16.3%) and intracranial tumors (14.0%). The most frequently performed procedures were burr hole drainage (23.3%) and laminectomy (23.3%), followed by craniotomy (20.9%). Postoperative complications were observed in 39.5% of patients, with surgical site infection (10.5%) and seizures (8.1%) being the most common. At discharge, 62.8% of patients improved, while mortality was 14.0%. Good recovery on the Glasgow Outcome Scale was recorded in 46.5% of cases. No statistically significant association was found between procedure type and mortality outcome (χ²=1.79, p=0.878).

Conclusions: Neurosurgical interventions in Ado-Ekiti are predominantly driven by trauma-related conditions, with generally favorable outcomes. Improving early presentation and perioperative care may further enhance patient outcomes.

Pediatric facial trauma in a tertiary care hospital: an epidemiological overview in Mexico

2026-05-15T07:00:25+0530

Background: Pediatric facial trauma is a major public health concern because of its functional, aesthetic, and psychological impact on growing patients. Injury patterns vary according to age, sex, and trauma mechanism, with motor vehicle accidents (MVCs) and falls being the most common causes. Epidemiological data from Mexico remain limited.

Methods: A retrospective descriptive study was conducted on patients <18 years old with facial fractures treated at the Plastic and Reconstructive Surgery Service of the General Hospital of Mexico “Dr. Eduardo Liceaga” between January 2019 and January 2025. Demographic characteristics, trauma mechanisms, fracture location, and treatment modality were analyzed. All fractures were confirmed by computed tomography.

Results: Fourteen patients were included; 64.3% were male and 78.6% were students. MVCs were the most frequent mechanism of injury (35.7%), followed by falls from height (21.4%). Adolescents aged 16–20 years represented the most affected group (42.9%). Midface fractures were the most common injuries (42.9%), especially orbital floor and multiple fractures. Upper-third fractures involving the orbital roof and frontal region accounted for 14.3% each. Conservative treatment was performed in 57.1% of patients, whereas 42.9% required surgery. High-energy trauma was associated with more complex fractures.

Conclusions: Pediatric facial trauma predominantly affected male adolescents and was mainly associated with MVCs. Midface fractures were the most frequent injuries, emphasizing the importance of prevention strategies and optimized management protocols.

The Meek technique versus partial-thickness skin graft in major burns patients: experience in the National Center of Research and Care of Burns Patients in Mexico City

2026-05-15T07:00:23+0530

Background: The Meek technique, originated in the 1950s by Cicero Parker Meek is one of the most important techniques used in the treatment of major burns, particularly due to the scarcity of donor sites for single skin grafts. Despite advances in the care of burn patients, there is no universally effective treatment, particularly for major burn patients. Meek grafts exhibit reduced susceptibility to loss due to infection, favorable outcomes are achieved, with reported graft survival rates ranging from 86-95%, along with satisfactory functional and aesthetic outcomes. The modified Meek technique was associated with shorter operation times (p=0.04) and a greater expansion ratio (p=0.04). The Meek technique is considered a cornerstone in the treatment of extensive burns, particularly when donor sites are limited for conventional split-thickness skin grafts. Despite advances in burn care, there is still no universally effective treatment for patients with major burns.

Methods: A clinical, observational, cross-sectional study conducted from March 2022 to February 2024, comparing hospital length of stay (LOS), intensive care unit LOS, and outcomes in patients with major burn injuries. We compared these data between the Meek technique (n=11) and split-thickness skin grafting (STSG) (n=27).

Results: Among the patients, in the Meek group (n=11), 6 were male, while in the STSG group (n=27), 18 were male. The mean total body surface area (TBSA) for the Meek group was 63.9±17.9%, and for the STSG group, it was 63.6±19% (p=0.97). The mean LOS at the hospital for the Meek group was 41.1±18 days, while for the STSG group, it was 27.2±22 days (p=0.10). The LOS in the intensive care unit was 32.1±13.1 days for the Meek group and 19.4±11.2 days for the STSG group (p=0.04). A higher frequency of deaths was observed with the STSG technique compared to the Meek technique (59.3% versus 45.5%; p=0.03).

Conclusions: Preliminary results with the Meek technique are encouraging, showing a lower death rate in patients with severe burns. However, the prolonged LOS is a risk factor to consider in this group of patients.

Management of asthma in children under 36 months by physicians in university hospitals of Antananarivo, Madagascar

2026-05-30T07:25:40+0530

Background: Asthma is one of the most common chronic conditions in paediatrics. The main objective of this study was to describe the management of asthma in children under 36 months of age by doctors working in paediatric wards in Antananarivo hospitals.

Methods: This was a descriptive survey carried out in the form of a questionnaire among doctors practicing in the paediatric wards of Antananarivo Hospital Centers from February 2022 to February 2023.

Results: Fifty-two doctors were surveyed, giving a participation rate of 86.7%. Chest X-rays (88.5%) and allergy tests (32.6%) were the most frequently prescribed complementary examinations. For the treatment of an asthma attack, doctors prescribed salbutamol spray or nebulizer combined with corticosteroid. Inhaled corticosteroids were the most widely prescribed background treatment (75%), and all doctors practiced therapeutic education. The causes of under-diagnosis reported were confusion between bronchiolitis and asthma in infants, and the atypical presentation of the attack. The most common difficulties encountered were related to financial problems, parents' low level of education (94.9%) and inadequate technical facilities (66.7%).

Conclusions: To improve the management of asthma in children, it is necessary to provide continuing medical education, draw up a standardized management protocol for all paediatric departments, improve technical facilities and set up an asthma school for parents.

Use of ultrasonography as a novel tool of airway assessment in patients undergoing general anesthesia and surgery and its comparison with Cormack-Lehane classification: a prospective observational study

2026-05-15T07:00:34+0530

Background: Accurate preoperative prediction of difficult airway remains a challenge in anesthetic practice. Conventional bedside airway assessment tests have limited sensitivity and specificity. Ultrasonography has emerged as a non-invasive, bedside tool for airway evaluation. This study aimed to assess the role of ultrasonography in predicting difficult laryngoscopy and to compare ultrasonographic airway parameters with the Cormack-Lehane (CL) classification obtained during direct laryngoscopy.

Methods: This prospective observational study was conducted in adult patients undergoing elective surgery under general anesthesia. Preoperative airway assessment included ultrasonographic measurement of airway parameters. After induction of anesthesia, direct laryngoscopy was performed and the laryngeal view was graded according to the CL classification. The correlation between ultrasonographic findings and laryngoscopic grades was analyzed to evaluate the predictive value of ultrasound in identifying difficult laryngoscopy.

Results: Ultrasonographic airway measurements demonstrated a significant correlation with laryngoscopic grading. Patients with increased ultrasonographic airway parameters were more likely to have higher CL grades (Grade III-IV), indicating difficult laryngoscopy. Ultrasonography showed good sensitivity and specificity in predicting difficult airway when compared with conventional airway assessment methods.

Conclusions: Preoperative airway ultrasonography is a simple, non-invasive, and reliable tool for predicting difficult laryngoscopy. It can serve as a valuable adjunct to conventional clinical airway assessment and may improve perioperative airway management strategies.

Effectiveness of competency improvement module on primary school teachers' competency regarding early diagnosis and management of childhood learning disabilities: a pilot study

2026-05-22T06:50:12+0530

Background: Learning disabilities (LDs) affect a significant proportion of school-age children globally. Primary school teachers are ideally positioned for early identification and management; however, their competency in this domain remains inadequate. This pilot study evaluated the effectiveness of a Competency Improvement Module (CIM) on primary school teachers' competency regarding early diagnosis and management of childhood learning disabilities.

Methods: A quasi-experimental, non-randomized control group design was employed. Forty primary school teachers from District Reasi, Jammu and Kashmir, India, were allocated to an experimental group (n=20) and a control group (n=20). The experimental group received a structured CIM comprising 17 sessions. Competency was assessed using three validated instruments: a Structured Questionnaire, the Questionnaire on Teachers' Competence in Identifying Pupils with Learning Disabilities (QTCIPLD), and Structured Case Vignettes. Assessments were conducted at baseline, 21 days post-intervention (post-test 1), and 42 days post-intervention (post-test 2). Data were analyzed using repeated-measures ANOVA and independent t-tests.

Results: The experimental group demonstrated statistically significant improvements across all three competency domains post-intervention (p<0.001), with large effect sizes (Cohen's D: 2.33-4.13). Significant between-group differences were observed at both post-test time points. The demographic variables, such as monthly income and employment type, were significantly associated with competency gains among teachers.

Conclusions: The CIM is an effective, feasible intervention for enhancing primary school teachers' competency in early diagnosis and management of childhood learning disabilities. Findings support the large-scale implementation of structured teacher training programs.

Comparative study between bupivacaine plus fentanyl and bupivacaine plus dexmedetomidine for epidural caudal analgesia in pediatric patients: a double blind randomized controlled trial

2026-05-15T07:00:30+0530

Background: For postoperative pain following juvenile infraumbilical procedures, caudal epidural analgesia is frequently utilized. Analgesia is improved when bupivacaine is combined with adjuvants. In this study, the adjuvants fentanyl and dexmedetomidine are compared.

Methods: In this prospective, randomized, double-blind trial, sixty ASA I–II children (ages 1–8) were split into two groups: Bupivacaine and dexmedetomidine were administered to group BD, and bupivacaine and fentanyl were administered caudally to group BF. Every two hours for the duration of the day, pain was measured using the FLACC score. Rescue analgesia was given when FLACC≥4. Hemodynamic parameters and adverse consequences were observed.

Results: The groups' demographic characteristics were similar. After four hours, group BD's FLACC ratings were considerably lower than group BF's and group BD required rescue analgesia at a considerably lower rate than Group BF

Conclusions: Dexmedetomidine provides greater and longer-lasting postoperative analgesia with fewer rescue analgesic doses and less side effects than fentanyl in pediatric patients.

Medical negligence-perception among undergraduate medical students: a cross-sectional study from Vijayapura, North Karnataka, India

2026-05-15T07:00:12+0530

Background: Medical negligence is a grave concern both to patients and the medical fraternity. Lapses in concentration, stress, burnout, gross misconduct, lack of knowledge or application, sleeplessness, overwork, lack of continuing medical education can all lead to medical negligence. The trauma experienced by both the victim and the person causing the mistake is traumatic. Medical negligence should be minimised by the application of standard operating procedures, training, work scheduling and provision of support in time of need. Medical students, the future doctors of tomorrow have to cope with the stress they encounter during medical studies and practice. The dearth of knowledge about this issue needs to be studied to find out remedies and alleviate this problem altogether,

Methods: Cross-sectional study involving 151 medical students of BLDE DU Shri B M Patil Medical College and Research Centre, Vijayapura, North Karnataka, India. Convenience sampling method was used in this study.

Results: 151 medical students were part of this study; socio demographic profile indicates that the majority of the participants belonged to male gender 78 (51.7%) and 73 (48.3%) females. The majority of the participants were from urban areas 126 (83.4%) followed by rural 25 (16.6%). Most of the participants belonged to the age group 18-22 years, Knowledge Grading showed that 95 (62.9%) had good knowledge

Conclusions: Medical negligence and its causative factors need to be studied in detail to sensitize future doctors to bring a sea change to this situation.

Study of serum ferritin levels in patients of non-alcoholic fatty liver disease with and without metabolic syndrome

2026-05-30T07:30:44+0530

Background: Non-alcoholic fatty liver disease (NAFLD), defined as excessive deposition of fat >5% of liver weight is considered as liver manifestation of systemic metabolic dysregulation. Abdominal imaging is not able to determine which individuals with NAFLD have associated liver-cell death and inflammation (i.e., NASH), and specific blood tests to diagnose NASH are not yet available. Serum ferritin is a protein, expressed in an acute phase, elevated in the case of liver necrosis, inflammation. Therefore, this study aims to analyze the correlations between serum ferritin levels and NAFLD in patients with and without metabolic syndrome to explore a new biological marker for diagnosis and treatment.

Methods: A prospective study was performed among 100 cases of metabolic syndrome and 100 controls without metabolic syndrome, from November 2022-August 2024. Patients fulfilling inclusion criteria underwent ultrasonography for diagnosis and grading of NAFLD and their serum ferritin, clinical and lipid profiles were assessed in both the groups with and without metabolic syndrome.

Results: Serum ferritin levels were higher in cases across NAFLD grades compared to controls, and a strong positive correlation was observed between serum ferritin levels and NAFLD severity.

Conclusions: Patients with NAFLD exhibited a strong positive relationship between serum ferritin levels and NAFLD severity, suggesting that elevated ferritin levels may be an important marker for NAFLD progression. The findings underscore the importance of monitoring metabolic parameters and serum ferritin in assessing severity of NAFLD and adds value to the available armamentarium to tackle the syndrome.

Tobacco health hazards awareness among adults in Uttarakhand

2026-05-30T07:30:42+0530

Background: With Nearly eight million deaths annually, the tobacco epidemic is one of the greatest risks to global public health. According to NFHS-5, 4.6% of women and 337% of men in Uttarakhand use tobacco in some capacity.

Methods: A cross-sectional study was conducted among adults in, Uttarakhand, to evaluate their knowledge related to health hazards of tobacco use. Household Survey was conducted on eighty young adults in the age group of 18-24 years. Data were collected using structured questionnaires and analyzed to identify the knowledge gaps among young adults.

Results: Most (96.2%) of the adults recognized that tobacco consumption may cause serious health hazards. Approximately 83.75% of the adults were aware that tobacco consumption may lead to heart diseases, however the lack of information about the entire range of health effects of tobacco use is evident from the lesser awareness of other important illnesses such as stroke (42.5% unaware). Significant knowledge gap was seen in mental health hazards of tobacco use. Similarly, 23% of adults were ignorant about the harm that passive smoking does to the foetus. The fact that 57% of adults consume tobacco and believe it helps overcome stress suggests that tobacco use is still deeply entrenched socially and psychologically.

Conclusions: Although the participants demonstrated a good basic understanding of the health hazards associated with tobacco use, the majority were still consuming tobacco. Therefore, existing awareness activities need to be revised and implemented more effectively, alongside stricter enforcement of tobacco control laws.

Familial inheritance and maternal influence on type 2 diabetes transmission in the Muslim people attending a diabetic centre

2026-05-30T07:30:40+0530

Background: Diabetes mellitus is a complex metabolic disorder with strong genetic and familial components. Understanding patterns of family clustering and associated comorbidities provides valuable insights into disease onset and progression.

Methods: A dataset of 179 individuals was analysed, capturing family history across parents, siblings, children and extended relatives. Variables included age at diagnosis, duration of disease and presence of comorbidities. Descriptive statistics, correlation analyses, and frequency distributions were employed to identify familial aggregation and age-related trends.

Results: : Diabetes was more frequently reported in mothers (78 cases) than fathers (51 cases), with a weak correlation between parental diabetes (r≈0.11). Individuals with both parents affected demonstrated earlier onset and longer disease duration, highlighting additive genetic risk. Sibling clustering was also evident, reinforcing horizontal transmission patterns. Hypertension and gestational diabetes were common comorbidities, often overlapping with family clustering.

Conclusions: The findings highlight the significant role of family history in type 2 diabetes risk, with both vertical and horizontal familial clustering associated with earlier disease onset and longer duration. The coexistence of comorbidities suggests shared metabolic pathways within affected families. Although limited by its cross-sectional design and restricted population scope, this study provides important insights into familial aggregation and maternal influence in T2DM within a South Indian population, supporting the need for targeted screening and prevention strategies.

Wound healing effect of Parmelia perlata (Huds.) Ach. in albino Wistar rats: an in vivo study

2026-05-30T07:30:39+0530

Background: A wound is a disruption of soft tissue that heals with scar formation. Herbal medicines are widely preferred for wound management because of their cost-effectiveness and minimal side effects. In Unani medicine, Charela (Parmelia perlata), a lichen from Parmeliaceae family, found on rocks and tree trunks, is traditionally used for wound healing and other ailments. It contains several bioactive constituents, including Usnic acid, phenols, flavonoids, alkaloids, glycosides, steroid, tannins, vitamin A and C. Objective was to evaluate the wound healing activity of the ointments prepared from hydro alcoholic extract and powder of the Charela (Parmelia perlata) in albino Wistar rats.

Methods: Wound healing activity was evaluated using the excision wound model in albino Wistar rats divided into five groups (n=6). Group I served as untreated control, group II received ointment base (wax and Roghan Kunjad), group III received neomycin 0.5% ointment as standard treatment, group IV received ointment containing hydroalcoholic extract of Charela, and group V received ointment containing Charela powder. Treatments were administered until complete wound healing, which was evaluated based on the rate of wound contraction and period of epithelialization.

Results: Ointments formulated with the hydroalcoholic extract and powder of Charela (Parmelia perlata) demonstrated significant wound healing activity, evidenced by increased wound contraction and reduced period of epithelialization compared to the control group.

Conclusions: Ointments prepared from Hydro alcoholic extract and powder of Charela (Parmelia perlata) promote enhanced wound healing activity.

Burden and clinical characteristics of Scrub typhus in Deoghar: analysis of a hospital-based cohort

2026-05-30T07:30:38+0530

Background: Scrub typhus remains a significant cause of acute undifferentiated febrile illness in endemic regions, and transmission is modulated by ecological and seasonal forces. This study was done to characterise the epidemiological features, sex and age distribution, seasonal patterns, and clinical manifestations of suspected and laboratory-diagnosed Scrub typhus cases reported in 2025.

Methods: This was a cross-sectional observational study in 204 clinically suspected patients of Scrub typhus who were tested for the disease. Laboratory confirmation was done through serological testing. Demographic data, month-wise trends, clinical symptoms were obtained and evaluated to determine positivity rates and predictive clinical features.

Results: Of the 204 suspected cases, laboratory tests confirmed 47 (23% positivity). Men had a 24.37% positive rate, compared to 21.18% for women. Cases were seen at all ages, peaked at >15 years and were predominantly male in the ≥50s. From January to March, data were mostly monthly, indicating robust seasonality and a few positives. The monsoon (August) and post-monsoon (November) seasons in India had the largest number of positive incidences, with positivity rates being 41.0% and 34.1%, respectively, followed by a decline in December. The most frequent symptom in suspected and confirmed cases was fever with chills. Patients had increasing abdominal pain and vomiting, headaches and rarely myalgia or cough.

Conclusions: This study confirmed the seasonality, sex predilection of scrub typhus and clinical spectrum. Ongoing daily surveillance in high-hazard months may allow endemic residents to detect and treat epidemic disease sooner.

Effectiveness of attitude-directed interventions on student nurses' attitude and perceived barriers regarding community health nursing bag use: a quasi-experimental study in Kanpur, India

2026-05-30T07:30:36+0530

Background: The community health nursing (CHN) bag is an essential tool for delivering preventive, promotive, curative, and rehabilitative care at the community level. However, student nurses often exhibit negative attitudes and perceive significant barriers to its effective utilization, limiting the quality of field-based nursing care. Purpose: This study aimed to evaluate the effectiveness of attitude-directed interventions on student nurses' attitudes and perceived barriers regarding CHN bag utilization across selected nursing colleges in Kanpur, Uttar Pradesh.

Methods: A quasi-experimental, pre-test post-test control group design was employed with 80 student nurses recruited using non-probability purposive sampling. Data were collected using a 5-point Likert scale for attitude assessment and a structured ranking questionnaire for assessing perceived barriers. The experimental group received a structured teaching program comprising interactive lectures, demonstrations, and practical sessions.

Results: A statistically significant difference was found between experimental and control groups (p<0.05), indicating the effectiveness of attitude-directed interventions. Associations between demographic variables and attitude scores were analyzed across age, gender, academic year, course type, and previous exposure to CHN bag use.

Conclusions: Attitude-directed interventions significantly improve student nurses' attitudes toward CHN bag utilization and reduce perceived barriers. The findings support the integration of structured educational interventions in nursing curricula to enhance community health practice competency and professional preparedness.

Prevalence and correlates of metabolic syndrome among adults attending a tertiary care hospital in central India: a cross-sectional study

2026-05-30T07:30:35+0530

Background: Metabolic syndrome (MetS) is a major public health challenge worldwide, strongly associated with cardiovascular disease, type 2 diabetes mellitus, and premature mortality.

Methods: A hospital‑based cross‑sectional study was conducted among 400 adults aged 18–49 years attending the outpatient department. Sociodemographic characteristics, lifestyle factors, anthropometric measurements, blood pressure, and fasting biochemical parameters were collected using standardized methods. MetS was diagnosed according to the International Diabetes Federation criteria.

Results: The prevalence of MetS was 46.0%. Female sex, age 40–49 years, lower socioeconomic status, sedentary lifestyle, and poor diet quality were independent predictors in multivariable logistic regression analysis, while tobacco use was not significantly associated.

Conclusions: Nearly half of young and middle‑aged adults attending outpatient services were affected by MetS. Routine OPD‑based screening and timely lifestyle interventions are essential to prevent progression to cardiovascular disease and diabetes.

Oxidative stress and antioxidant imbalance in chronic renal failure: relationship with serum creatinine and selenium levels

2026-05-30T07:30:31+0530

Background: Chronic renal failure (CRF) is marked by progressive renal dysfunction and enhanced oxidative stress, contributing to cellular injury and disease progression. This study aimed to assess oxidative stress, antioxidant enzyme activities, and serum selenium levels in CRF patients and explore their relationship with renal function indices.

Methods: A cross-sectional case-control study was conducted on 46 patients with different degrees of CRF and 16 age- and sex-matched healthy controls. Renal function was assessed by serum creatinine, creatinine clearance, and estimated glomerular filtration rate (eGFR). Serum lipid peroxidation (MDA), superoxide dismutase (SOD), catalase, glutathione peroxidase, and selenium levels were estimated using standard biochemical methods. Data were analyzed using ANOVA and Pearson’s correlation.

Results: Serum creatinine increased progressively from 0.93±0.21 mg/dl in controls to 7.82±1.51 mg/dl in severe CRF (p<0.001). Lipid peroxidation was significantly elevated in all CRF groups (14.2-15.9 nm MDA/ml vs. 5.1±1.1 nm MDA/ml, p<0.01). SOD (2.2-2.8 IU/mg protein) and catalase (2.5-3.0 IU/mg protein) activities were significantly higher than controls (1.5 IU/mg protein; p<0.05), indicating compensatory antioxidant upregulation. Glutathione peroxidase and selenium levels showed mild, nonsignificant reductions (p>0.05). No significant correlations were observed between serum creatinine and oxidative or antioxidant parameters.

Conclusions: CRF is associated with sustained oxidative stress and adaptive elevation of SOD and CAT, alongside declining selenium and glutathione peroxidase activity. Persistent redox imbalance likely contributes to renal injury, underscoring the need for antioxidant-focused management in CRF.

Comprehensive assessment of medical soft skills: linking program and session outcomes

2026-05-30T07:30:30+0530

Background: Soft skills form an essential component of competency-based medical education, influencing communication, professionalism, emotional intelligence, and reflective capacity. Systematic evaluation ensures educational accountability and program refinement.

Methods: A cross-sectional evaluative study was conducted among 54 participants using structured 3-point and 5-point Likert-scale questionnaires. Descriptive statistics (mean±SD; percentages), chi-square test, one-way ANOVA, and Pearson correlation analysis were performed. Significance was set at p<0.05.

Results: Overall positive satisfaction ranged from 87%–92%. Faculty helpfulness received the highest agreement (94.4%; M=1.06, SD=0.23). One-way ANOVA demonstrated significant differences across session domains, F (6, 378) =3.94, p=0.001, η²=0.06. Strong correlations were observed between Emotional Intelligence and Critical Reflection (r=0.74, p<0.001), and Ethics and Emotional Intelligence (r=0.72, p<0.001). No significant (χ² (1, N) =54) = 1.62, p=0.203 association was found between participation and perceived usefulness.

Conclusions: The program demonstrated high effectiveness, strong internal coherence, and excellent faculty performance. Increased experiential components may further enhance psychological competency domains.

Changing trends in tracheostomy indications: a single-center observational study

2026-05-30T07:29:27+0530

Background: The indications for tracheostomy have evolved, shifting from emergency airway obstruction to prolonged mechanical ventilation in intensive care settings. Objectives were to analyze the changing trends in tracheostomy indications and evaluate patient outcomes in a tertiary care center.

Methods: A retrospective observational study of 40 patients who underwent tracheostomy. Data included demographics, indication, diagnosis, intubation-to-tracheostomy interval, complications, discharge condition, and follow-up outcomes.

Results: The mean age was 53.5±18.1 years. Prolonged intubation/ventilation remained the predominant indication (55%; n=22). The mean interval between intubation and tracheostomy was 7.8±4.2 days. No intraoperative complications occurred. Ward complications were seen in 15% (n=6). At discharge, 55% (n=22) were discharged with a tracheostomy tube. During follow-up, 20% (n=8) were decannulated, 10% (n=4) died, and outcomes were unknown in 40% (n=16).

Conclusions: Prolonged ventilation continues to be the leading indication for tracheostomy. The procedure demonstrates a strong safety profile. However, follow-up documentation remains inadequate and needs structured improvement.

A survey on the prevalence of acrophobia-induced symptoms among amateur trekkers

2026-05-30T07:29:26+0530

Background: Acrophobia, or fear of heights, is a specific phobia associated with significant psychological and physiological distress. Amateur trekkers are frequently exposed to elevated terrains that may trigger symptoms such as dizziness, anxiety, palpitations, and fear of falling. However, limited research has evaluated the prevalence and severity of acrophobia-induced symptoms among amateur trekkers using structured assessment tools.

Methods: A survey-based observational study was conducted among 50 amateur trekkers in the Loni area using simple random sampling. Data were collected using the self-developed and validated AcroTrek Survey Questionnaire, which assessed height-related discomfort, physiological reactions, psychological responses, and the impact on trekking experience. Responses were recorded on a 5-point Likert scale and analysed descriptively. Gender-related findings were interpreted in accordance with the Sex and Gender Equity in Research (SAGER) guidelines.

Results: All participants reported some degree of acrophobia-induced symptoms. The majority (74%) demonstrated moderate severity, while 12% had mild and 14% had severe symptoms. Symptoms were observed across all age groups. Although a higher number of female participants reported symptoms, findings were interpreted cautiously due to unequal gender distribution, following SAGER guidelines.

Conclusions: Acrophobia-induced symptoms are highly prevalent among amateur trekkers, predominantly at moderate severity levels. Early identification using structured screening tools such as the AcroTrek Questionnaire may enhance safety, confidence, and overall trekking experience.

Comparison of clinical profile and in hospital outcome of acute kidney injury in diabetic and non-diabetic hospitalized patients in tertiary care hospital: a prospective observational analytical study

2026-05-30T07:30:33+0530

Background: Diabetic and non-diabetic patients experience AKI of variable severity. Not much data exists about the comparison between these two with follow-up of the renal recovery. We here describe this study for bridging the knowledge gap.

Methods: Diabetic and non-diabetic patients having AKI were identified during the study period (n=66 each) at AIIMS Rishikesh in prospective manner. Patients were followed up and results were compared till the period of hospitalization.

Results: In Demographics, Diabetic patients were more in middle age (p-value-<0.001). diabetic patients had more underlying CKD than non-diabetic (p value-<0.001). severity of AKI, RRT requirement and outcomes were comparable in both groups. Out of 132, only 4 patients (3 diabetics and 1 non-diabetic) had mortality. Overall, AKI and its outcomes and mortality are comparable in diabetic and non-diabetic patients.

Conclusions: Primary objective being the in-hospital mortality rates is comparable between two groups and so is the need of renal replacement therapy and renal recovery at discharge. Most of the diabetic patients experiencing AKI episodes were in middle age to elder group, while non-diabetics have more of young and middle age predominance difference between them were statistically significant. In terms of AKI episodes, difference of prevalence of CKD and hypertension was more in diabetic group (p value <0.001).

The role of Rouvière’s sulcus and R4U line in safe laparoscopic cholecystectomy: a prospective observational study of 130 cases

2026-05-30T07:29:26+0530

Background: Bile duct injury (BDI) remains a serious complication of laparoscopic cholecystectomy (LC), most commonly due to misinterpretation of biliary anatomy. Rouvière’s sulcus (RVS) is an extra-biliary anatomical landmark that defines the plane of the common bile duct, while the R4U line delineates a safe zone for dissection. Identification of these landmarks may reduce the risk of BDI, particularly in difficult cholecystectomies.

Methods: This prospective observational study was conducted at a tertiary care center between March 2023 and March 2025. A total of 130 patients undergoing elective LC for symptomatic gallstone disease was included. RVS was identified intraoperatively and classified according to presence, type, orientation, and dimensions. In cases where RVS was absent, dissection was guided by the R4U line. Operative difficulty was graded using the modified Nassar scale. Outcomes assessed included achievement of the critical view of safety (CVS), bile duct injury, bile leak, conversion to open surgery, and need for subtotal cholecystectomy.

Results: Was identified in 106 patients (81.5%). The open type was the most common morphology (72.6%), with a predominantly horizontal orientation. CVS was achieved in all cases. No bile duct injuries were recorded. Bile leakage occurred only in patients undergoing subtotal cholecystectomy. Conversion to open surgery was required only in early cases of the study. With increasing adherence to RVS and R4U-guided dissection, difficult cases were successfully managed laparoscopically.

Conclusions: Rouvière’s sulcus is a reliable and consistent anatomical landmark for safe laparoscopic cholecystectomy. When absent, the R4U line provides an effective alternative guide. Routine identification and use of these landmarks may significantly reduce the risk of bile duct injury.

A retrospective multi-source clinical validation of Lenek intelligent radiology assistant: an artificial intelligence-based chest radiograph screening and triage system for high-burden pulmonary and cardiac conditions in India

2026-05-30T07:29:24+0530

Background: A critical radiologist shortage exists in India, leading to delayed chest radiograph (CXR) interpretation. This leads to disease progression, higher morbidity, and mortality. Artificial intelligence-based CXR interpretation by Lenek Intelligent Radiology Assistant (LIRA) is a promising solution. This study aims to establish the screening and triaging capabilities of LIRA by assessing its accuracy in detecting abnormalities and pathologies in CXRs from geographically diverse institutions.

Methods: We conducted a retrospective multi-source validation of the diagnostic accuracy of LIRA for the detection of general abnormalities, tuberculosis, consolidation, pleural effusion, pneumothorax, and cardiomegaly. De-identified chest radiographs were input into LIRA models. The obtained interpretations were compared to the established ground truth reporting for the calculation of sensitivity, specificity, and AUROC with 95% CI for individual pathologies across varying probability thresholds.

Results: LIRA demonstrated high sensitivity for general abnormality detection (AUROC 0.93-0.986, 84.4-97.1% sensitivity, 88.9-92.4% specificity) and tuberculosis triaging (Shenzhen and Montgomery: 88.5-89.7% sensitivity, 89.9-90.5% specificity; Jaypee: 98.7% sensitivity, 63.6% specificity). For consolidation (AUROC 0.884-0.895, 96.4-96.9% sensitivity, 70.8-77.1% specificity), pleural effusion (AUROC 0.942-0.967, 79.7-99.1% sensitivity, 81.2-87.7% specificity), pneumothorax (AUROC 0.87, 90.6-94.8% sensitivity, 79.5-82.7% specificity) and cardiomegaly (AUROC 0.883, 95.1% sensitivity, 81.6% specificity), the model exhibited commendable accuracy as well.

Conclusions: The diagnostic performance of LIRA was consistent across various pathologies and chest radiographs from diverse geographic locations, with particular strengths in abnormality detection and tuberculosis screening. The risk-stratified triaging and high sensitivity of LIRA make it a reliable adjunct solution to address radiologist shortages, reduce turnaround times, and support India's tuberculosis elimination goals.

Integrated model of digital health and clinic care pathway: a prospective observational study to manage glycated haemoglobin levels and time in range among Indian subjects with type 2 diabetes mellitus

2026-05-30T07:29:23+0530

Background: Good glycaemic control is difficult to achieve, especially with high glycated haemoglobin (HbA1c). The benefits of short-term dietary treatments and structured monitoring across severity levels are unknown. Severity-based category transitions may provide more clinically meaningful insight than mean HbA1c change alone.

Methods: To evaluate glycaemic change using a severity-stratified framework and to identify clinical and behavioral predictors of category improvement, with particular focus on baseline HbA1c, disease duration, and continuous glucose monitoring derived time-in-range. The analysis was performed on a cohort of 808 adults.

Results: To evaluate glycaemic change using a severity-stratified framework and to identify clinical and behavioral predictors of category improvement, with particular focus on baseline HbA1c, disease duration, and continuous glucose monitoring derived time-in-range. The analysis was performed on a cohort of 808 adults. At baseline, 23.4% were classified as controlled, 41.5% as uncontrolled, and 35.1% as severely uncontrolled. By 3–4 months, the proportion achieving glycaemic control had increased to 43.4%, corresponding to an absolute improvement of 20.0%. Overall mean HbA1c reduction was 1.34±1.79% (median 1.00%, IQR 0.20–2.15), with 68.0% achieving clinically meaningful improvement (≥0.5%; p<0.001).

Conclusions: Severity-stratified assessment provides clinically meaningful insight into real-world glycaemic outcomes. Structured monitoring combined with early metabolic feedback appears particularly effective in individuals with severe hyperglycaemia.

Bacteriological profile and antimicrobial susceptibility pattern of microorganisms isolated from surgical site infections at tertiary care center in Western India

2026-05-30T07:29:22+0530

Background: Among different types of hospital-acquired infections, Surgical site infections (SSIs) continue to be a major concern, due to prolonged hospitalizations, increased costs, and significant morbidity and mortality. Understanding the etiological agents behind these infections and their antimicrobial susceptibility patterns can greatly aid in the management of SSIs.

Methods: This prospective, single-center, laboratory-based study was carried out over nine months at a tertiary care teaching hospital. Pus-aspirates from 6575 patients suspected of developing SSIs were collected and analyzed according to the standard microbiological techniques. The antimicrobial susceptibility of isolated organisms was tested using Kirby-Bauer’s disc diffusion method or by the VITEK-2 compact system.

Results: The study concluded the SSI rate of 5.27%. Gram-negative organisms were the leading cause of SSIs (84%), with Klebsiella pneumoniae (22.87%) being the most common pathogen, followed by E. coli (21.14%) and Pseudomonas aeruginosa (17.94%). Nearly 42.38% of all Gram-negative isolates exhibited Carbapenem-resistance. All Gram-positive isolates were found susceptible to Vancomycin and Linezolid, and all Gram-negative isolates were colistin sensitive.

Conclusions: The present study provides crucial insights into local epidemiology and resistance patterns of SSI-causing microbes. The study also highlighted concerning resistance rates to commonly used antimicrobials, including β-lactams, cephalosporins, and aminoglycosides, with potentially alarming rates of Carbapenem resistance. Implementing strict infection control measures, rational use of antibiotics, and optimal pre-and post-operative care can potentially reduce the growing rates of SSIs.

Serological evidence of human brucellosis with female predominance in livestock-exposed communities of rural Haryana, India

2026-05-30T07:29:19+0530

Background: Human brucellosis is a neglected zoonotic infection transmitted through direct animal contact. It frequently eludes clinicians since its presentation is often non-specific and consequently leads to underdiagnosis. Haryana is predominantly an agrarian state with close human and livestock interactions. There is a dearth of systematic population-based data on human brucellosis. This study was aimed to determine the seroprevalence of brucellosis among febrile patients within livestock exposed population and identify associated risk factors.

Methods: A cross-sectional hospital-based study was conducted over 1 year, from November 2024 to November 2025, at a tertiary care centre in Budhera, Haryana. Individuals residing within 15 km of the hospital presenting with fever, headache or malaise, giving history of contact with livestock were included. Serum specimens were tested for anti-Brucella antibodies using Rose Bengal Plate Test (RBPT) and IgM enzyme-linked immunosorbent assays (ELISA). Structured interviews were used to collect data. Associations between risk factors and seropositivity were evaluated by multivariate analysis.

Results: Of 173 participants (mean age 32.95±18.55 years; 55.5% male), RBPT detected antibodies in 19 (10.98%) and ELISA in 22 (12.72%). Seropositivity was significantly associated with unpasteurised milk consumption, assisting animal birthing, handling foetuses and contact with animal excreta (OR 6.3-18.8, p<0.01). ELISA and RBPT showed substantial concordance (κ=0.91). Women involved in livestock care had disproportionately higher seropositivity.

Conclusions: Human brucellosis among febrile patients was primarily linked to domestic exposures to high-risk activities. Integrating exposure histories with clinical assessment, promoting pasteurisation of milk, enhancing animal vaccination and strengthening One Health surveillance are critical for early diagnosis in endemic areas.

A comparison of airway pressure changes in volume-controlled ventilation versus pressure-controlled ventilation with similar tidal volumes in laparoscopic surgery

2026-05-30T07:29:19+0530

Background: Whether pressure-controlled ventilation (PCV) is superior to volume-controlled ventilation (VCV) during laparoscopic surgery remains debatable. The strength and uniformity of the evidence on this topic have not been thoroughly examined, representing a significant gap in our knowledge of the comparative benefits of PCV versus VCV in laparoscopic surgery. The present study compared airway pressure changes between PCV and VCV using similar tidal volumes in patients undergoing laparoscopic procedures.

Methods: Seventy patients aged between 20 and 70 years, scheduled to undergo laparoscopic surgery and American Society of Anesthesiologists grades I-II, were randomly divided into two groups by computer-generated tables. Group A patients were given VCV after induction of pneumoperitoneum, while group B patients were given PCV after induction of pneumoperitoneum. Airway pressure changes and hemodynamic parameters were measured at 15-minute intervals until the end of the procedure. The primary objective was to compare peak pressure (P-peak) between the two groups, while the secondary objectives were to compare plateau pressure (P-plat), minute volume, and hemodynamic changes.

Results: The haemodynamic parameters were comparable at baseline and up to 75 minutes post-procedure. From the 15th minute onwards post-surgery, the mean P-peak, P-plat were significantly lower in the PCV group as compared with the VCV group till the 60th minute post-procedure. The mean minute volume and positive end-expiratory pressure were significantly lower in the VCV than the PCV group at the 30th and 45th minute.

Conclusion: The PCV is better than VCV in patients undergoing laparoscopic surgery.

Factors affecting glycemic control among patients with type-2 diabetes mellitus in Rajkot: a cross-sectional study

2026-05-30T07:29:17+0530

Background: Type-2 Diabetes Mellitus (T2DM) is a rapidly growing public health concern worldwide, particularly in developing countries like India. Despite advancements in treatment modalities, achieving optimal glycemic control remains a major challenge due to multiple influencing factors. The present study aimed to assess factors affecting glycemic control among patients with T2DM attending selected hospitals in Rajkot.

Methods: A descriptive cross-sectional research design was adopted for the study. A total of 70 participants were selected using a purposive sampling technique. Data were collected using a semi-structured interview schedule, the Diabetes Self-Management Questionnaire (DSMQ), and biophysical measurements.

Results: The findings revealed that a majority (87%) of participants had poor glycemic control. Significant factors influencing glycemic control included socio-demographic variables (age, education, and income), clinical factors (duration of diabetes and presence of co-morbidities) and behavioural factors including dietary control, physical activity, and medication adherence. Family support was also found to play a crucial role in diabetes management.

Conclusions: The study concludes that glycemic control is influenced by multiple socio-demographic, clinical, and lifestyle-related variables. Strengthening patient education, promoting self-management practices, and enhancing family involvement are essential to improve glycemic outcomes among T2DM patients.

A retrospective study on socio-demographic, clinicopathological, molecular subtypes and comorbidities of women with breast cancer

2026-05-30T07:29:16+0530

Background: Breast cancer is a heterogeneous disease influenced by demographic factors, tumor biology, and comorbid conditions. Understanding these characteristics is essential for improving early detection and management strategies.

Methods: We conducted a cross-sectional retrospective study using data from 120 women diagnosed with breast cancer. Demographic data (age, BMI), socioeconomic status, education level, clinical symptoms, radiologic findings, pathology reports, tumor grade, Modified Bloom-Richardson Score, molecular subtypes, comorbidities and presence of metastasis were obtained from patient charts and analysed descriptively.

Results: The majority of breast cancer patients were middle-aged; with the range of 36-55 years old. Many patients had high BMIs. The most common presenting symptom of breast cancer was a palpable breast lump. Histologically, invasive ductal carcinoma was the most common type, and the majority of the tumors were classified as high-grade and had high modified bloom-Richardson scores. The most common molecular subtype of breast cancer in our population was luminal A, followed by triple negative. Hypertension and Type 2 diabetes mellitus were the most common comorbidities in this population.

Conclusions: Breast cancer patients appeared to be diagnosed at a later stage than previously reported and the tumors were highly aggressive. The implications of our findings support increased public awareness, earlier detection, and targeted screening programs, particularly in rural and underserved populations.

Association between serum vitamin D levels and insulin resistance among adults

2026-05-30T07:29:16+0530

Background: Vitamin D is increasingly recognized for its role beyond bone metabolism, particularly in glucose homeostasis and insulin sensitivity. Deficiency of vitamin D has been implicated in the development of insulin resistance, a key pathophysiological mechanism underlying type 2 diabetes mellitus. Several studies have demonstrated a relationship between low Vitamin D levels and metabolic dysfunction. This study aimed to assess the association between serum vitamin D levels and insulin resistance among adults.

Methods: A hospital-based cross-sectional study was conducted among 120 adults aged 20-60 years. Serum 25-hydroxyvitamin D, fasting blood glucose, and fasting insulin levels were measured. Insulin resistance was calculated using HOMA-IR. Participants were categorized into vitamin D deficient and sufficient groups. Statistical analysis included descriptive statistics, independent t-test, Pearson correlation, chi-square test, and regression analysis.

Results: Vitamin D deficiency was observed in 56.7% of participants. Individuals with vitamin D deficiency had significantly higher fasting insulin and HOMA-IR values. A significant inverse correlation was found between vitamin D levels and insulin resistance (r = -0.52, p<0.001), consistent with previous studies. Regression analysis identified vitamin D as an independent predictor of insulin resistance.

Conclusions: Vitamin D deficiency is significantly associated with increased insulin resistance. Early identification and correction of Vitamin D deficiency may help reduce metabolic risk.

Clinicopathological profile and survival outcome of colorectal cancer: a retrospective study from a tertiary care centre in North-East India

2026-05-30T07:29:14+0530

Background: Colorectal cancer (CRC) is an emerging major health issue. The incidence in North-Eastern part of the country is higher compared to rest of the country. However, there is no formal screening program inspite of the alarming increased incidence. This study aims to analyze the clinicopathological characteristics, treatment pattern and outcome of CRC patients in a tertiary care hospital in North-East India.

Methods: A retrospective review was conducted for all patients with histopathologically confirmed CRC reported to Radiation Oncology Department, RIMS Imphal between January 2019 and December 2023. Data regarding demographic parameters, clinical presentations, tumor characteristics, treatment modalities and survival were collected and analyzed.

Results: A total of 212 cases with M:F ratio of 1.32:1 were studied. The mean age was 56.9 years with most commonly affected age group being 51-60 years. The most frequent symptoms were pain abdomen (37.01%), bleeding per rectum (34.41%), altered bowel habits (22.07%) and loss of appetite (6.49%). Rectum was most commonly affected (52.04%) followed by colon (33.67%) and rectosigmoid (14.28%). Adenocarcinoma was predominant (84.90%) followed by signet ring cell (7.07%), mucinous (7.07%) and squamous cell carcinoma (0.94%) with majority showing moderate differentiation (74.49%). Most patients were diagnosed at stage III (37.75%) followed by stage IV (27.55%). 2 years overall survival was 25.75%.

Conclusion: Colorectal cancer has male dominance and predominantly presents in advanced stages. The survival outcome is poor with limited curative option. These findings highlight the need for screening and public awareness.

Beyond awareness: a cross-sectional analysis of knowledge, attitude and practice gaps in thesis writing among postgraduates in a tertiary care institute

2026-05-30T07:26:06+0530

Background: Thesis writing is an integral component of postgraduate medical education in India. While academic institutions expect PGs to be proficient in research methodology and scientific writing, the actual level of knowledge, attitude and practice (KAP) among students remains under-explored. To assess the KAP related to thesis writing among postgraduate students and to identify gaps between these domains.

Methods: A cross-sectional study was conducted among 101 first-year postgraduate students at a tertiary care institute using a structured, validated questionnaire. The KAP domains were scored and analysed descriptively, with Spearman’s correlation applied to explore inter-domain relationships.

Results: Among 101 respondents, high correct response rates were observed for knowledge on thesis components (80.2%), study design types (82.2%) and research ethics (90.1%). However, awareness of referencing styles (39.6%) and reference management tools (30.7%) was poor. Despite 91.1% expressing willingness to seek thesis guidance and 86.2% believing thesis writing supports academic growth, only 10.9% had attended formal training and 35.6% used reference management software. Structured thesis planning was reported by 70.3%, but overall practical implementation lagged behind knowledge and attitude scores.

Conclusions: A clear gap exists between awareness and implementation of thesis-writing skills among postgraduates. Structured workshops, digital literacy training and mentorship are essential to enhance practical research capabilities and ensure high-quality academic output.

Correlation of bronchoalveolar lavage fungal culture with clinical spectrum and radiological features: a retrospective study

2026-05-30T07:26:05+0530

Background: Pulmonary fungal infections are an increasingly recognized cause of respiratory morbidity, particularly in immunocompromised individuals and patients with structural lung disease. Clinical and radiological features often overlap with tuberculosis and bacterial pneumonia, making diagnosis challenging. Bronchoalveolar lavage (BAL) based fungal culture and galactomannan assay are important diagnostic tools; however, their clinical relevance requires correlation with presentation and imaging findings.

Methods: This retrospective observational study was conducted in the department of respiratory medicine at tertiary care hospital from June 2025- November 2025. Patient (>18 years) with BAL positivity for fungal culture, galactomannan assay (GM) was included. Clinical characteristics, comorbidities, immunological status and radiological findings on chest radiograph and computed tomography were analyzed. Statistical analysis was performed using IBM SPSS version 25.0. Continuous variables were expressed as mean and categorial variables as percentages. Fischer’s exact test was used with p<0.05 considered statistically significant.

Results: 78 patients were included mean age 52.7 years. BAL fungal culture was positive in 48 patients, GM assay in 30, and both in 25 patients. Aspergillus species were the most common isolates (53.7%). Diabetes mellitus showed a significant association with fungal culture positivity(p=0.035). Consolidation was the most frequent radiological finding across all groups, while cavitary lesions were more common in patients positive for both GM and culture.

Conclusions: Aspergillus species predominate in pulmonary fungal infections and are commonly associated with diabetes, post- tubercular lung disease and characteristic radiological patterns. Integrated clinical, radiological and microbiological evaluation is essential for early diagnosis and appropriate management in tuberculosis-endemic region.

A randomized controlled trial to compare the outcome of mechanically ventilated patients between daily interruption of sedation versus continuous sedation

2026-05-30T07:26:02+0530

Background: This study is to Compare the Outcome of Mechanically Ventilated critically ill patients by daily interruption of sedation Versus continuous sedation.

Methods: The proposed study was a double-blinded, prospective randomized control trial done in critically ill mechanical ventilator patients in the critical care units, for 14 months. 52 adult patients were equally divided into 26 into each group were receiving mechanical ventilation and continuous infusions of sedative drugs. The interruption Group of Patients are named As Group “I” Patients They Received Injection Midazolam Infusion of 2 mg Per Hour, And the Continuous Group patients named has Group “C” Was Received Injection: Midazolam infusion of 2 mg per hour in continuous infusion during the period of mechanical ventilation. The interruption Group of patients the sedative infusions were interrupted until the patients were awake, daily. Sedative infusions for the continuous group of patients in the intensive care unit were only interrupted at the clinician’s discretion.

Results: The mean total duration of mechanical ventilation in hours (Group I) Interruption group is 79.46±28.96 while the mean total duration of mechanical ventilation in hours (Group C) continuous group is 174.26±84.91 The mean total number of hospitals stays in Group I is 16.42±3.12, while in Group C is 23.58±2.97.

Conclusions: Due interruption of sedation infusions helps to periodically evaluate the neurological status and sedation score of the patients, it can able to assess the neurological status of the patient intermittently, and hence extubation can be planned earlier. Therefore, this study concludes that the reduced duration of Mechanical ventilation and length of stay in intensive care units were significantly reduced in interruption group.

Evaluation of the correlation between serum magnesium and calcium levels and sleep quality among medical students: a cross-sectional study

2026-05-30T07:26:01+0530

Background: Sleep disturbances are highly prevalent among medical students due to academic stress and lifestyle factors. Magnesium and calcium play important roles in neuronal regulation and sleep physiology; however, their relationship with sleep quality remains unclear.

Methods: A cross-sectional study was conducted among 124 undergraduate medical students aged 18–26 years. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). Serum magnesium and calcium levels were measured using an automated biochemistry analyzer. Pearson or Spearman correlation tests were applied based on data distribution. A p<0.05 was considered statistically significant.

Results: The mean serum magnesium level was 2.59±0.40 mg/dl, and serum calcium was 8.88±0.33 mg/dl. The mean PSQI score was 5.80±3.64. No significant correlation was found between serum magnesium and PSQI (r=0.088, p=0.331) or serum calcium and PSQI (r=0.108, p=0.234). Additionally, no correlation was observed between serum magnesium and calcium (r=−0.011, p=0.906).

Conclusion: Serum magnesium and calcium levels do not significantly correlate with sleep quality among medical students. Sleep disturbances in this population are likely influenced more by psychosocial and lifestyle factors than by circulating mineral levels.

Patient satisfaction with comprehensive cataract surgical services in southern India: a multi-centre cross-sectional study

2026-05-30T07:26:04+0530

Background: Patient satisfaction is an important tool for healthcare providers to monitor and improve the quality of care, yet there is limited information on patient satisfaction with cataract surgical services in India.

Methods: This cross‑sectional study used a random sample from five not for profit eye hospitals in southern India. Patient satisfaction was assessed in three domains (i) provider communications, (ii) provider-patient interactions, and (iii) availability and accessibility. Data were collected using a structured questionnaire.

Results: A total of 322 patients provided interviews. The median ages were 62 and 59 years for males and females, respectively. The overall patient satisfaction was 96% (95% CI: 93.2-97.8%) but ranged from 79.2% for provider-patient interactions to 82.6% for provider communications. The self-rated patient satisfaction was 91.9% (95% CI: 88.4-94.7%). Female patients (62.1%, p=0.049) and those who travelled 50 km or less to reach base hospital (51.8%, p=0.026) were significantly more likely to report higher overall satisfaction. Similarly, female patients (62.5%, p=0.048) and those who opted to travel by vehicle provided by base hospital (69.9%, p=0.038) reported significantly higher self-rated satisfaction.

Conclusions: This study provides evidence supporting high levels of patient satisfaction with cataract surgical service provision in southern India. Female patients, those travelling for 50 km or less and availing free-of-cost transportation offered by base hospitals were more likely to report higher overall satisfaction. Employing staff that speaks the local language would enable better provider-patient communication and interactions leading to seamless service provision leaving patients more satisfied.

Clinical progression of opportunistic infections and their correlation with CD4 count in newly diagnosed HIV positive patients when attending tertiary care hospital

2026-05-30T07:26:00+0530

Background: HIV is a great threat faced by humanity in India. Opportunistic infections (OIs) arise due to progressive decline in CD4 count. HIV related OIs are the major causes of morbidity and mortality. The most prevalent OI reported in India is tuberculosis followed by candidiasis and diarrhoeal diseases. The study aimed to evaluate spectrum OIs in newly diagnosed HIV positive patients and their relation with CD4 count.

Methods: A prospective observational study was conducted over a period of 18 months from January 2021 to June 2022 at ART centre of a tertiary care hospital. All newly diagnosed HIV positive patients were clinically evaluated and monitored for absolute CD4 count by flow cytometer.

Results: A total of 117 newly diagnosed HIV patients were enrolled, of whom 100 patients completed two follow -up. Among these, 65% were males and 35% females. The mean CD4 cell count was 289.04 cells/mm³.OIs were observed in 57% of patients. Of these, at ART initiation,71.93% patients had OIs, while 24.56% and 3.51% developed during 1^st and 2^nd follow up respectively. Tuberculosis was found to be most prevalent infection among HIV patients. Of total OIs, 24.56% patients of pulmonary tuberculosis and 17.54% extrapulmonary tuberculosis, followed by Oral candidiasis (26.31%).

Conclusions: Tuberculosis was the most common OI in newly diagnosed HIV positive patients. OIs were more frequent in patients with lower CD4 counts. Early diagnosis, prompt initiation of treatment and periodic monitoring of CD4 count were key to manage HIV related OIs.

A cross-sectional study of quality of life among pediatric patients with epilepsy attending a tertiary care selected hospital at Vijayapur city

2026-05-30T07:25:43+0530

Background: Epilepsy is a common chronic neurological disorder in children associated with significant psychosocial morbidity. This study aimed to assess the health-related quality of life (HRQoL) among pediatric patients with epilepsy in a tertiary care setting and evaluate the correlation between child-reported outcomes and parental perceptions.

Methods: A descriptive cross-sectional study was conducted at a tertiary care center in South India, involving 106 pediatric patients (aged 6-18 years) with a confirmed diagnosis of epilepsy. HRQoL was assessed using the pediatric quality of life inventory (PedsQL) 4.0 generic core scales. Parental perceptions were evaluated through semi-structured interviews. Data were analyzed using the Chi-square test and Pearson’s correlation coefficient (p<0.05 considered significant).

Results: Overall, 66.0% (n=70) of participants reported poor HRQoL, 34.0% (n=36) reported moderate HRQoL, and none achieved a “good” rating. The lowest mean scores were observed in social functioning (6.13±2.31) and school functioning (6.24±2.34), while physical functioning scores were relatively higher (10.0±3.13). A strong positive correlation was found between child-reported HRQoL and parental perception (r=0.98, p<0.001). No statistically significant association was found between HRQoL and clinical variables such as seizure frequency or epilepsy type.

Conclusions: Pediatric epilepsy significantly impairs HRQoL, particularly in social and academic domains. The strong correlation between child and parent reports suggests that caregivers are highly attuned to the child’s struggles. Management should extend beyond seizure control to include psychosocial support and school-based interventions.

Prognostic significance of baseline hypoalbuminemia in lymphoma: a systematic review and meta-analysis

2026-05-30T07:30:41+0530

Lymphomas remain clinically heterogeneous diseases with variable outcomes despite advances in therapy. Reliable prognostic factors are essential to guide treatment planning. Serum albumin, a marker of both nutritional status and systemic inflammation, has been proposed as a simple biomarker of prognosis, but its role across lymphoma subtypes remains unclear. Objectives were to evaluate the association between baseline hypoalbuminemia and survival outcomes in patients with Hodgkin and non-Hodgkin lymphoma (HL). A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Cochrane Library, and ScienceDirect were searched through June 2025. Cohort studies reporting hazard ratios (HRs) for overall survival (OS) or progression-free survival (PFS) in relation to baseline serum albumin were included. Pooled HRs were calculated using random-effects models. Eight cohort studies with 1,633 patients were included. Hypoalbuminemia was significantly associated with worse OS (HR=2.16; 95% CI: 1.82-2.57; p<0.00001) and poorer PFS (HR=2.49; 95% CI: 1.80-3.45; p<0.00001). These associations remained consistent across lymphoma subtypes, age groups, and treatment contexts, with low to negligible heterogeneity. Notably, patients who achieved albumin recovery during treatment experienced superior outcomes compared with those who remained hypo-albuminemic. The findings underscore albumin’s value as a universally available, inexpensive biomarker that adds prognostic information beyond established indices. Its integration into clinical models may improve risk stratification and support more personalized management. Baseline hypoalbuminemia is a significant adverse prognostic factor in lymphoma. Incorporating serum albumin into routine assessment and considering serial monitoring may enhance prognostic accuracy and patient care.

Evaluation of Google Gemini’s advice for irritable bowel syndrome

2026-05-30T07:29:17+0530

An increasing number of patients now consult an artificial intelligence (AI) assistant before seeing a clinician. Large language model (LLM) chatbots have begun to shape how people look up health-related information. Google’s Gemini is a helpful personal AI assistant that drafts answers based on a user’s prompt and Google search, after which it applies safety checks. I evaluated Gemini’s counseling for irritable bowel syndrome (IBS), a common functional gastrointestinal (GI) disorder. The main objective here was to assess the safety and reliability of an AI’s guidance against established evidence.

Clear cell hidradenoma: a series of three cases

2026-05-30T07:30:42+0530

Described by various terms as clear cell hidradenoma, eccrine acrospiroma and clear cell myoepithelioma, clear cell hidradenoma is an uncommon adnexal tumor of eccrine or apocrine differentiation and common anatomic sites encountered are the head and neck region, trunk and extremities. It usually presents as a single papule, nodule or mass and are covered by intact skin or have ulcerative look. Occasionally, the development of brown, blue or red discoloration with superficial ulceration and serous discharge may mimic malignancy. Peak incidence of the disorder is fourth to eight decades, although all ages can be affected. On histopathology, tumour shows periodic acid–Schiff-positive clear cells and polyhedral cells. Recurrence rate is low if the lesion is completely excised. Here, we report three cases of clear cell hidradenoma presenting as a solitary nodule on the scalp, lower back and eyelid. The aim of this study is to create awareness about the various clinical presentations and morphological spectrum of this tumour as it can be a potential mimicker for some malignant tumours/metastasis particularly when it occurs in uncommon sites.

Botulinum toxin type A and progressive pneumoperitoneum for loss-of-domain hernia: a narrative review

2026-05-30T07:25:39+0530

The management of incisional hernias with loss of domain (LOD) represents a significant surgical challenge. Preoperative conditioning with botulinum toxin type A (BTX-A) and preoperative progressive pneumoperitoneum (PPP) has emerged as an effective strategy in specialized centers. To synthesize the available evidence on the pathophysiological basis, clinical and volumetric indications, and outcomes of the combined use of BTX-A and PPP in hernias with LOD. A narrative review of the literature was conducted through searches in PubMed, SciELO, and Scopus, including studies related to the pathophysiological basis, indications, technical aspects, and clinical outcomes of BTX-A and PPP in hernias with LOD. The combination of BTX-A and PPP produces elongation of the lateral abdominal muscles, reduces the hernia defect, and induces adaptive volumetric expansion of the abdominal cavity through progressive insufflations. When applied 15-30 days before surgery, these interventions allow primary fascial closure rates approaching or exceeding 95%. However, adequate patient selection based on volumetric and clinical criteria, while considering potential complications, is essential. The evidence available to date suggests that the combined use of BTX-A and PPP optimizes fascial closure in complex hernias, with high efficacy in experienced centers. However, the evidence remains limited to observational studies; therefore, protocol standardization and controlled clinical trials are required to increase the level of evidence and allow this sequential therapeutic method to become a standard of care in routine clinical practice.

Cell therapies for hematopoietic failure in trauma hemorrhagic shock

2026-05-30T07:29:13+0530

Traumatic hemorrhagic shock (T/HS) is clinically associated with hematopoietic failure (HF). HF in T/HS patients is characterized by an increase in the levels of norepinephrine, cytokines, granulocyte-colony stimulating factor and peripheral blood hematopoietic progenitor cells, as well as a decrease in the expression of erythropoietin receptors. Reducing cytokines, vascular dysfunction, tissue damage, apoptosis and HF may be possible with cell-based therapy. Regulatory T cells, mesenchymal stem cells, bone marrow mononuclear cells and induced pluripotent stem cell-derived hematopoietic progenitor cells are all cell-based treatments that have shown promise in improving the prognosis of patients with T/HS by ameliorating bone marrow malfunction or HF. Here, we discuss the latest cell-based therapy approaches for treating HF in T/HS patients.

Recurrent acute uncomplicated urinary tract infections in women: an epidemiological review of incidence, pathogenesis and psychological burden

2026-05-30T07:26:06+0530

Recurrent acute uncomplicated urinary tract infections in women pose a serious health issue on the global agenda due to their high prevalence, high occurrence rate of recurrence, and dramatic clinical and psychosocial implications. Though recurrent urinary tract infections are historically viewed as harmless, they impose significant financial burden on health-service providers and significantly reduce the quality of life. Most of the episodes can be traced to uropathogenic Escherichia coli, the recurrence of which is caused by multifactorial interactions including host susceptibility, bacterial virulence factors, behavioural determinants, and increased antimicrobial resistance. Recent studies have highlighted the significance of the intracellular bacterial reservoirs, biofilm formation, and dysbiosis of urinary and vaginal microbiota as a factor in the maintenance of recurrence. Other than these biological processes, women with recurrent acute uncomplicated urinary tract infections suffer considerable psychological distress including anxiety, fear of recurrence, stigma and social restrictions that are often underacknowledged in a normal clinical practice. To this end, this review summarizes the modern facts about the epidemiology, pathogenesis, determinants of risk, and psychological burden of recurrent urinary tract infections in women. It advocates the use of multidisciplinary and patient-centred therapeutic models that combine antimicrobial treatment with preventive, behavioural, and mental-health interventions in order to reduce recurrence and improve the long-term outcomes.

A systematic review on the comparative effectiveness of positional release technique and active release technique in improving hamstring flexibility among athletes

2026-05-30T07:29:21+0530

Hamstring tightness is a common musculoskeletal issue among athletes, leading to reduced performance and increased risk of injury. Manual therapy techniques such as positional release technique (PRT) and active release technique (ART) are widely used, but comparative evidence remains fragmented. This review aims to systematically map and synthesize available evidence on the comparative effectiveness of PRT and ART in improving hamstring flexibility among athletes. Review was conducted following PRISMA guidelines. Database searched included PubMed, Scopus, and Web of Sciences. Eligible studies included randomized controlled trials (RCTs), quasi experimental trials and comparative physiotherapy interventions. Risk of bias was assessed using the Cochrane RoB 2 tool, and study quality was appraised using the JBI critical appraisal checklist. Seven studies (2017-2026) met inclusion criteria. Both PRT and ART demonstrated significant improvements in hamstring flexibility. ART showed superior short-term gains in dynamic flexibility, while PRT was more effective in sustained pain reduction. Evidence suggests complementary roles of PRT and ART. ART may be preferable for athletes requiring rapid flexibility gains while PRT may benefit from those with chronic tightness and pain. Further high-quality RCTs are warranted.

Physiotherapy management in patients with pulmonary tuberculosis: a systematic review

2026-05-30T07:29:21+0530

Physiotherapy approaches like pulmonary rehabilitation, respiratory exercises, airway clearance methods, chest physiotherapy, organized physical training have been progressively included in PTB treatment. These interventions are designed to improve lung function, facilitate sputum clearance, boost physical conditioning, regain functional independence. To find various physiotherapy interventions for patients with pulmonary tuberculosis. A systematic review was carried out descriptively in accordance with PRISMA guidelines. Electronic databases such as PubMed, Google Scholar were explored using terms associated with pulmonary tuberculosis and physiotherapy treatments. research published over the past decade was included. Qualifying designs included randomized controlled trials, quasi-experimental studies, observational studies, and systematic reviews. Following the review of 50 records and the elimination of duplicates, 10 studies satisfied the inclusion criteria for qualitative synthesis. Studies in the review showed that physiotherapy methods—like pulmonary rehabilitation, breathing exercises, chest physiotherapy, effective coughing strategies, airway clearance techniques, organized exercise training—greatly enhanced lung function measures (FEV1, FVC), exercise capacity (6-minute walk distance), sputum clearance, fatigue levels, and overall physical well-being. Furthermore, decreases in dyspnoea, anxiety, respiratory rate, and symptom burden were noted, enhancements in quality of life and functional independence. Physiotherapy treatment acts as a beneficial complement to medical therapy in pulmonary tuberculosis. It improves respiratory effectiveness, functional ability, and life quality while lessening symptoms and physical deterioration. Additional rigorous randomized controlled trials are required to develop standardized protocols and enhance treatment results.

Lenacapavir: a long-acting human immunodeficiency virus prevention strategy with the potential to transform global human immunodeficiency virus control

2026-05-30T07:29:14+0530

Recent advancements in the prevention of HIV emphasize the need for newer strategies that can address the continuous gap in global HIV control. The incidence of HIV remains significantly high in certain populations, especially among young women, mobile communities, and individuals facing stigma-related barriers to care. While daily pre-exposure prophylaxis has been proven to be effective, limitations such as adherence to treatment and pill fatigue still pose challenges. Lenacapavir has been shown to be promising in this regard as a long-acting prevention modality that merits prompt consideration. Innovative approaches that are in line with real-world behavioral and structural challenges are an urgent requirement as the global community works to maintain the momentum of HIV elimination.

Linguistic malady in medical literature: the horrible homonyms

2026-05-30T07:30:38+0530

As a medical student for 10 years, and then as a teacher for 25 years-the author has found and felt the semantic confusions (i.e. ambiguity about words and their meanings) in medical students/literature widespread. It is a commentary-correlating confusing realities from various standard sources of scientific medical literature. Suggesting some approaches for improvement.

Total colectomy: indications and outcomes in colorectal pathology

2026-05-22T06:50:14+0530

Colorectal cancer remains one of the leading causes of cancer-related morbidity and mortality worldwide. The presence of synchronous tumors poses a significant challenge in surgical management, often requiring more extensive resections to achieve adequate oncological control. Total colectomy is considered a viable option in selected patients with multifocal or extensive colonic disease, as it allows complete removal of the affected organ and reduces the risk of metachronous lesions. We present the case of a 62-year-old female patient with no significant family history, who presented with weight loss, anemia, and changes in bowel habits. Colonoscopy revealed two synchronous lesions located in the ascending colon and sigmoid colon. Histopathological analysis confirmed moderately differentiated mucinous adenocarcinoma in both sites. Imaging studies showed no evidence of distant metastasis. The patient underwent total colectomy with ileorectal anastomosis. The postoperative course was uneventful, with adequate recovery and no evidence of complications. Final pathology reported tumors staged as T3N0M0 and T2N0M0, with negative surgical margins and no lymph node involvement. At follow-up, the patient demonstrated good clinical evolution and satisfactory functional outcomes. This case highlights the importance of recognizing synchronous colorectal cancer and selecting an appropriate surgical strategy. Total colectomy provides an effective oncological approach in such cases, offering complete disease control and reducing the likelihood of future colonic malignancies.

Atypical presentation of prosopometamorphopsia in concurrent postpartum mood disorder and bipolar II disorder: a case report

2026-05-30T07:30:32+0530

Women are at an increased risk of being diagnosed with bipolar II disorder, and bodily fluctuations related to pregnancy can significantly alter the severity of symptoms. Hormonal changes may warrant severe perinatal and postpartum mood disturbances in this population and lead to the development of symptoms related to psychosis, such as visual hallucinations. Prosopometamorphopsia is a rare disorder related to the visual perception of faces. While it is most commonly attributed to organic neurological causes like tumors, some cases of prosopometamorphopsia have been linked to mood or psychotic disorders. A 38-year-old female diagnosed with bipolar II disorder and postpartum mood disturbance reported paranoia and symptoms of prosopometamorphopsia beginning in mid-pregnancy and continuing multiple months postpartum. MRI suggested the presence of a pituitary microadenoma. This case describes the atypical presentation of an extremely rare visual perception condition concurrent with postpartum mood disturbance and bipolar II disorder, possibly related to the presence of a pituitary adenoma. Though literature has reported instances of visual hallucinations stemming from pituitary adenoma, the etiology of the patient’s perceptual issues is unclear. Despite a lack of patient background and relevant research findings, this unique case prompts further exploration of potential neurobiological and hormonal connections among pituitary adenoma, perinatal/postpartum mood disturbance, and prosopometamorphopsia.

Liver abscess as a complication of intrahepatic gallbladder perforation in a septuagenarian: a case report and literature review

2026-05-30T07:30:29+0530

Acute cholecystitis is a common complication of gallstone disease; however, gallbladder perforation with intrahepatic abscess formation is a rare and potentially life-threatening entity. We report the case of a 67-year-old man with long-standing type 2 diabetes mellitus, end-stage renal disease on peritoneal dialysis, and hypertension who presented with nonspecific constitutional symptoms and minimal abdominal findings. Laboratory evaluation revealed leukocytosis and abnormal liver function tests. Computed tomography demonstrated acute cholecystitis with intraluminal gas and adjacent hypodense lesions in hepatic segments VII and VIII, concerning for pyogenic liver abscesses secondary to gallbladder perforation. Exploratory laparotomy confirmed complicated acute cholecystitis with dual gallbladder perforation, including posterior extension into the hepatic parenchyma with intrahepatic abscess formation. Due to severe inflammation and unsafe biliary dissection, subtotal fenestrating cholecystectomy was performed as a bailout procedure with abscess drainage. Histopathology confirmed acute ulcerated cholecystitis with mucosal necrosis and intramural gallstones. The postoperative course was uneventful. This case highlights the diagnostic challenge of intrahepatic gallbladder perforation in high-risk patients and supports early cross-sectional imaging and operative source control when severe inflammation precludes safe definitive dissection.

Maxillary second molar with additional mesiobuccal root

2026-05-15T07:00:15+0530

Maxillary molar (MM) teeth often have three separate roots. These teeth may present a single-root or two-root morphology depending on the fusion between the roots, while additional roots are very rare. The reporting of this case aims to present a case of maxillary second molar with additional mesiobuccal roots in A 42-year-old female patient presented to the dental clinic complaining of pain and bad halitosis in her mouth. The patient’s medical history was obtained and revealed no significant abnormalities. Vital signs were recorded as follows: blood pressure 125/65 mmHg, heart rate 65 beats/min, body temperature 36.2 °C, and respiratory rate 18 breaths/min. Clinical examination showed that tooth #26 had an occluso-mesial restoration. A periapical X-ray of tooth #26 revealed a previously endodontically treated tooth with substandard root canal treatment. Cone beam computed tomography (CBCT) was taken for further evaluation for tooth #26, and incidentally it was found that tooth #27 had four roots. The extra root was located in the mesiobuccal area and was named an additional mesial root (MB2 root). It was separated in the middle to apical third of the mesial root. The previous case report shows a rare case of extra root in maxillary second molar, this report done to increase the awareness of such cases and to avoid complications during dental treatment.

Acute abdomen due to ileal perforation with an unexpected appendiceal mucocele: an intraoperative diagnostic challenge

2026-05-30T07:25:50+0530

Acute abdomen secondary to intestinal perforation is a life-threatening surgical emergency that requires prompt diagnosis and intervention. Appendiceal mucocele is a rare entity that is frequently discovered incidentally and may carry significant clinical implications due to the risk of pseudomyxoma peritonei if rupture occurs. We report the case of an 82-year-old female who presented with a 2-day history of diffuse abdominal pain, nausea, decreased bowel movements, leukocytosis, metabolic acidosis, and signs of peritoneal irritation. Computed tomography demonstrated free intraperitoneal air and fluid collections suggestive of intestinal perforation. Emergency exploratory laparotomy revealed fecal peritonitis secondary to distal ileal perforation with transmural necrosis. Intraoperatively, an incidental dilated appendix consistent with appendiceal mucocele was also identified. Surgical management included small bowel resection with terminal ileostomy and appendectomy. Histopathological examination confirmed ischemic ileal perforation and appendiceal mucocele. This case highlights the diagnostic complexity of acute abdomen and emphasizes the importance of meticulous intraoperative exploration, as unexpected findings may alter surgical management and influence outcomes. Careful recognition and treatment of incidental appendiceal mucocele are essential to prevent complications such as pseudomyxoma peritonei.

From clinical complaints to radiological revelation: case study of cecal adenocarcinoma with multiorgan involvement

2026-05-30T07:25:50+0530

Colorectal cancer (CRC) is the third most common malignancy in the world, with adenocarcinoma accounting for the vast majority of cases. A 60-year-old male complained about the presence of a tumour like palpable mass in the right iliac region with general weakness and weight loss. Patient was eventually transferred to the oncology department for further investigations and treatment. Initial colonoscopy evaluations combined with the anatomical difficulty of visualizing the cecum. A barium enema demonstrated narrowing at the cecum, suggestive of obstruction. Radiological imaging proved decisive in this case, revealing the full extent of local invasion and distant metastasis. Histopathological and cytological findings established the diagnosis of metastatic adenocarcinoma. This case underscores the diagnostic and therapeutic challenges associated with right‑sided colorectal cancers with late presentation, particularly cecal adenocarcinoma, which progress silently until an advanced stage. This case illustrates the importance of multi-disciplinary approach in oncology involving internal medicine for timely diagnosis and treatment.

Inguinal swelling in a young lady: a case report

2026-05-30T07:25:42+0530

Ultrasonography, specifically high-resolution ultrasound is considered as the first-line imaging modality for evaluation of groin pathology. Ultrasonography can accurately distinguish a mass lesion either it is solid, cystic or complex (both solid and cystic). Here we report an inguinal swelling of a young lady evaluated by ultrasonography. A 29-year-old female patient came to Institute of Nuclear Medicine and Allied Sciences (INMAS), Cumilla for ultrasound of right inguinal region with the complaints of right inguinal swelling and occasional pain for 02 months. The swelling was firm, non-tender, didn't disappear on lying position. She had no associated fever, nausea, vomiting. High-resolution ultrasonography was performed to evaluate the swelling and an elongated, thin-walled cystic lesion was seen with internal echoes, extending from deep inguinal ring to labia majora. Doppler study shows no vascularity within the lesion. No peristalsis or change of shape or change in fluid amount seen on valsalva and augmentation. Sonological findings suggest right sided encysted hydrocele of the canal of Nuck. The cystic lesion was completely surgically removed, and histopathological examination verified an encysted hydrocele of the canal of Nuck with a smooth postoperative recovery. She was released in stable condition and stayed asymptomatic during follow-up with no signs of recurrence. Hydrocele of the canal of Nuck is rare in middle aged patient. High-resolution ultrasound plays vital role to diagnose confidently and to differentiate other pathological differentials in inguinal swelling specially from inguinal hernia and inguinal lymphadenopathy.

Axillary primary mucin producing epithelial malignancy - rarely encountered site

2026-05-30T07:26:03+0530

The most common skin malignancy in the axilla is Basal cell carcinoma. Primary mucin producing epithelial carcinoma in the axilla can closely resemble metastatic mucinous carcinoma, most often originating from the breast, but also from the gastrointestinal tract, lung or ovary. Axilla is a rare site for primary mucin-producing epithelial carcinoma of skin. Thorough clinical examination histopathological examination with IHC and other ancillary investigations are necessary to confirm the diagnosis and to rule out metastatic mucinous carcinoma. We present a rare case of primary mucin producing epithelial carcinoma of axillary skin in an elderly male patient which was present since two and half year, without any complication. Which was diagnosed by histopathological examination, complete clinical examination and radiological examination and confirmed with IHC marker. Which presented to us as a lesion mimicking benign cyst. Which was managed by wide local excision of the lesion and lymph node dissection till level II.

Osteocartilaginous choristoma of bilateral palatine tonsil

2026-05-30T07:31:38+0530

Choristoma is defined as the presence of normal tissues in abnormal anatomical locations. This entity is extremely rare, with only few cases reported in the literature. We hereby report a case of tonsillar osteocartilagenous choristoma in a 37-year-old male who presented at our hospital ENT outpatient department (OPD) with bilateral tonsillitis. He underwent bilateral tonsillectomy surgery and we received the specimen at Pathology department. Grossly both the tonsils were enlarged with cut surface showing chalky white firm to hard areas. The histopathological examination revealed unexpected presence of mature cartilage and bone surrounded by lymphoid follicles along with areas of calcification in both tonsils. Osseous and cartilaginous choristoma are the most frequently observed choristoma in oral cavity. However cartilaginous choristoma of oral cavity is commonly seen in the tongue, buccal mucosa and soft palate. This case report shall create awareness about occurrence of choristoma at rare sites like the palatine tonsil; among pathologists and clinicians.

Cytological diagnosis of rare variant of anaplastic thyroid carcinoma: case report

2026-05-30T07:30:43+0530

Anaplastic thyroid carcinoma (ATC) is an exceptionally rare and highly aggressive malignancy, accounting for merely 1-2% of all thyroid cancers (TC). Despite its low incidence, ATC is notorious for its fulminant clinical course and dismal prognosis. Among the histological subtypes of ATC, the osteoclastic variant represents an exceedingly rare morphologic entity. It is characterized by the presence of numerous multinucleated osteoclast-like giant cells interspersed within the undifferentiated malignant component, raising diagnostic challenges and often necessitating thorough histopathological evaluation for confirmation. The advent and widespread utilization of fine-needle aspiration cytology (FNAC) has markedly transformed the diagnostic landscape of thyroid nodules. FNAC allows for early identification of undifferentiated and aggressive neoplastic processes, facilitating prompt clinical decision-making. Herein, we present a case of ATC with osteoclast-like giant cells in an elderly female patient. The diagnosis was initially suggested by cytological features observed on FNAC and subsequently confirmed on histopathological examination of the resected specimen. This case underscores the critical role of cytopathology in the early recognition of rare ATC variants and highlights the need for heightened clinical suspicion in rapidly evolving thyroid masses.

Medical thoracoscopy in thoracic endometriosis: a diagnostic tool in a rare scenario

2026-05-30T07:30:40+0530

Medical thoracoscopy is a tool employed in the evaluation of pleural effusions when initial diagnostic thoracocentesis and standard conventional therapies prove to be ineffective. Thoracic endometriosis (TE) is an uncommon form of extra pelvic endometriosis, characterized by endometrial cells in thoracic cavity which can be parenchymal, pleural and diaphragmatic. TE typically manifest as catamenial pneumothorax followed by catamenial hemothorax, catamenial hemoptysis and occasionally as pulmonary nodules. We present a case involving a 29 year old female experiencing secondary infertility and recurrent right sided chest pain and dyspnea since three months. Chest radiography revealed right hydropneumothorax. As her symptoms correlated cyclically with menstruation, a high suspicion of TE was made and later confirmed on histopathology by medical thoracoscopy.

Acute aortic intramural hematoma as a cause of acute abdominal pain: case report and review of literature

2026-05-30T07:30:33+0530

A middle aged male patient with sudden onset of severe upper abdominal pain was diagnosed as acute aortic intramural hematoma (IMH) by CT scan and treated conservatively in view of Type B IMH with prompt recovery. AAS (Acute Aortic Syndrome) needs to be considered in any acute abdominal pain, especially when the diagnosis is doubtful. There are three components of AAS namely aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), AD being more common. Aortic dissection is primarily categorized by Stanford classification (Type A: involves the ascending aorta; Type B: involves only the descending aorta) or the more comprehensive DeBakey classification. It presents as sudden, severe, tearing chest or back pain, requiring immediate treatment. The IMH has similar symptoms and is also classified by Stanford into Type A and Type B. Type A may need surgical treatment, whereas Type B IMH may be managed conservatively. CT angiography is usually the investigation of choice.

Pheochromocytoma crisis presenting as refractory cardiogenic shock: anaesthetic and critical care challenges

2026-05-30T07:30:30+0530

Pheochromocytoma is a rare catecholamine-secreting tumour of the adrenal medulla with heterogeneous clinical manifestations. Pheochromocytoma crisis is an uncommon but life-threatening presentation frequently complicated by cardiovascular collapse and multi-organ dysfunction. A 30-year-old male presented with undifferentiated shock, metabolic acidosis, acute heart failure, and renal failure. He was later diagnosed with pheochromocytoma-induced cardiogenic shock, likely worsened by inappropriate β-blocker therapy without prior α-blockade. Management required advanced critical care support, mechanical ventilation, renal replacement therapy, staged endocrine optimization, and definitive adrenalectomy. This case highlights the importance of maintaining a high index of suspicion for pheochromocytoma in patients with unexplained cardiogenic shock and labile hemodynamics, particularly when preceded by episodic headaches and inappropriate β-blocker exposure. Early imaging and multidisciplinary management are crucial for optimal outcomes.

Radiological evidence of regeneration in bilateral humeral head avascular necrosis following bone marrow aspirate concentrate augmented core decompression: a case report

2026-05-30T07:29:28+0530

Avascular necrosis (AVN) of the humeral head is an uncommon but potentially debilitating orthopaedic condition characterized by compromised blood supply to the subchondral bone, leading to bone ischemia, structural collapse, and progressive joint dysfunction. In early stages, the disease may remain asymptomatic or present with mild shoulder pain; however, with disease progression functional impairment is evident. Early diagnosis and timely intervention are essential to prevent joint collapse and arthroplasty. Regenerative strategies using Orthobiologics aim to enhance bone repair, restore vascularity, and preserve joint integrity. We report the case of a 60-year-old female presenting with bilateral humeral head AVN without subchondral collapse. The patient underwent percutaneous core decompression (PCD) augmented with autologous bone marrow aspirate concentrate (BMAC) under fluoroscopic-guided suprascapular nerve block. At eight months post-intervention, the patient demonstrated significant clinical and radiological improvement. Pain, measured using the visual analogue scale (VAS), decreased from 8/10 pre-procedure to 1/10 post-procedure. Functional outcomes assessed by the Constant-Murley shoulder score (CMS) improved from 36 (right) and 42 (left) pre-procedure to 85 (right) and 81 (left) post-procedure. Follow-up magnetic resonance imaging (MRI) revealed marked resolution of subchondral altered marrow signal intensity in both humeral heads, indicating structural recovery without evidence of cortical collapse. Early-stage humeral head AVN without subchondral collapse can be effectively managed using PCD combined with autologous BMAC augmentation. This minimally invasive regenerative approach may promote biological repair, alleviate pain, and restore function, thereby serving as a joint-preserving alternative to arthroplasty in selected patients.

Unusual case of recurrent bony pain and swelling in a child: a case report

2026-05-30T07:29:24+0530

Prolonged fever in children is a vexing problem. High grade fever with multiple joint pain and swelling can be seen in infections, inflammatory conditions, connective tissue disorders and malignancies. Peri articular pain and fever can be seen in enthesitis, osteomyelitis and malignancy whereas articular pain can be seen in hereditary arthropathies, infectious and inflammatory conditions. Arthritis is defined as presence of pain, swelling, rednness, warmth and diminished range of motion. Involvement of more than four joints is taken as polyarthritis. Tuberculosis is an important differential diagnosis in this situation. Here we present a case of a 11-year-old boy with complaints of prolonged fever of 5 months duration with progressive pain, swelling and restriction of mobility of multiple joints. Investigations to rule out inflammatory arthritis, malignancy and infections were done in this child which were initially not pointing to a specific diagnosis. At times, even after best efforts, microbiological diagnosis cannot be established and we have to resort to advanced imaging, techniques and rely on a constellation of clinical and radiological, cytological and microbiological clues to clinch the diagnosis.

Hepatic non-caseating granulomas mimicking malignancy: a diagnostic dilemma of mixed infection

2026-05-30T07:29:20+0530

Hepatic granulomas present a diagnostic challenge due to their diverse etiologies, including infections, autoimmune disorders, and malignancies. In endemic regions, lesions with lymphadenopathy and metabolic activity on imaging often raise suspicion of malignancy or tuberculosis. We report a case of a 54-year-old female presenting with significant weight loss and multiple hepatic lesions with mesenteric lymphadenopathy, initially suggestive of malignancy. Histopathology revealed non-caseating granulomas, while microbiological investigations were negative. A multidisciplinary panel evaluation highlighted peripheral eosinophilia as a key clue, raising suspicion of a parasitic or mixed infectious etiology. Empirical antiparasitic therapy resulted in rapid resolution of hepatic lesions and normalization of eosinophil counts. This case emphasizes the importance of considering infections as malignancy mimics and highlights the role of clinical acumen and multidisciplinary evaluation in endemic settings.

A rare neuro-ophthalmological presentation of Nine syndrome: clinical radiological-anatomical correlation

2026-05-30T07:29:18+0530

Nine syndrome is a very rare neuro-ophthalmological entity resulting from combined involvement of the abducens nucleus or paramedian pontine reticular formation (PPRF), the medial longitudinal fasciculus (MLF), the facial colliculus, and the corticospinal tract. This constellation produces the combination of horizontal gaze palsy, internuclear ophthalmoplegia, ipsilateral facial palsy, and contralateral hemiparesis/ hemianesthesia/ hemiataxia together constitute Nine syndrome (7^th nerve+1 and 1/2 syndrome+1/2 hemiparesis/ hemianesthesia/ hemiataxia). Our objective was to present a case of nine syndrome providing a comprehensive clinical examination, detailed radiological evaluation and anatomical correlation to explain the neurological findings. This case highlights the importance of recognizing characteristic neuro-anatomical correlations in pontine stroke syndromes. We report a case of a 57-year-old male who presented with sudden-onset left hemiplegia, dysarthria, and binocular diplopia. Neurological examination revealed right horizontal conjugate gaze palsy, right internuclear ophthalmoplegia, right lower motor neuron facial palsy, and left hemiplegia-clinically consistent with nine syndrome. MRI brain revealed an acute right paramedian pontine infarct with basilar artery aneurysm. The patient was managed with antiplatelet therapy, high-intensity statin, glycemic control, and supportive care. Clinical improvement was noted over the following days. This case highlights the importance of recognizing combined cranial nerve and long-tract signs in localizing pontine lesions. Nine syndrome, though rare, should be considered in patients presenting with horizontal gaze palsies and contralateral hemiparesis and aggressive vascular risk-factor management is critical for preventing recurrence.

Industrial compressed air injury resulting in caecal perforation and tension pneumoperitoneum: a rare non-iatrogenic barotrauma

2026-05-30T07:26:03+0530

The widespread use of compressed air equipment in industrial settings has led to an increase in severe injuries resulting from misuse. Air compressor abuse is one of the non-iatrogenic causes of colonic barotrauma and typically occurs when coworkers engage in joking or horseplay. High-pressure compressed air is capable of penetrating clothing and can cause bowel injury. Injuries due to compressed air range from mucosal tear to perforation to abdominal compartment syndrome. Although the caecum is considered the most vulnerable segment, the sigmoid and rectosigmoid junction are the most common sites of perforation in industrial barotrauma cases. We report a case of extensive pneumoperitoneum caused by caecal perforation secondary to the forceful injection of compressed air through the perineum while playful joke in young male patient. The patient had one caecal perforation and multiple serosal tears throughout the colon, which were successfully managed with resection and creation of a double-barrel ileo-ascending stoma, along with primary repair of the serosal tears.

Nonketotic hyperglycaemia associated hemichorea-hemiballismus in an elderly woman with type 2 diabetes mellitus

2026-05-30T07:25:58+0530

Hyperglycaemia-induced chorea, also referred to as Diabetic Striatopathy (DS), is a rare but clinically significant neurological complication of uncontrolled diabetes mellitus. It is most frequently associated with non-ketotic hyperglycaemia and manifests as hemichorea or hemiballismus, occasionally progressing to generalised choreiform movements. Although uncommon, DS is increasingly recognized as the second most frequent cause of hemichorea- hemiballismus after basal ganglia cerebrovascular events and the most common metabolic etiology of this syndrome. The condition is typically characterized by severe hyperglycaemia in the absence of ketosis accompanied by either choreiform movements or radiological abnormalities of the basal ganglia on CT or MRI. However, normal neuroimaging does not exclude the diagnosis and clinical suspicion remains paramount. Misdiagnosis is common, particularly when basal ganglia hyper density on CT mimics intracerebral haemorrhage leading to unnecessary interventions and delayed treatment. We present the case of a 71-year-old woman with long-standing type 2 diabetes mellitus and chronic kidney disease who developed acute onset hemichorea in the setting of profound hyperglycaemia. Despite unremarkable neuroimaging, the diagnosis of DS was established based on clinical features and metabolic derangements. The patient demonstrated partial improvement with strict glycaemic control and symptomatic therapy, though abnormal movements persisted beyond three months. This case underscores the importance of recognizing DS even in the absence of classical imaging findings. Early diagnosis and prompt initiation of glycaemic control, supplemented by symptomatic pharmacotherapy, when necessary, can significantly improve outcomes. Greater awareness among clinicians is essential to prevent misdiagnosis and ensure timely management of this rare but reversible complication of diabetes mellitus.

Polyserositis as an early presentation of systemic lupus erythematosus in an elderly patient: diagnostic challenges and clinical implications

2026-05-30T07:25:57+0530

Systemic lupus erythematosus (SLE) is an autoimmune disorder with multisystem involvement, predominantly affecting young women. Diagnosis after the age of 50 years is rarely encountered, and late-onset SLE frequently presents with atypical features that differ markedly from classic manifestations. Polyserositis-defined as simultaneous inflammation of the pleura, peritoneum, and pericardium-is an uncommon and often under recognised presentation of SLE, particularly in elderly patients. We report a 70-year-old woman with no known comorbidities who presented with bilateral symmetric polyarthritis (small joint predominant), non-scarring alopecia, moderate pleural and pericardial effusion, ascites, bilateral pitting pedal oedema, and proteinuria. On investigation, ANA was strongly positive (3+, titre 1:720) with positivity for anti-dsDNA, anti-nucleosome, anti-Smith, and anti-U1RNP antibodies, along with low complement levels (C3 and C4), fulfilling ACR criteria for SLE. Infectious and malignant aetiologies were systematically excluded. The patient was initiated on pulse methylprednisolone followed by oral prednisolone, mycophenolate mofetil, diuretics, and albumin transfusion, with marked clinical improvement. At two-month follow-up, proteinuria had reduced significantly (900 mg/day to 190 mg/day) and repeat chest imaging confirmed bilateral clear lung fields. This case highlights the importance of including SLE in the differential diagnosis of unexplained polyserositis in elderly patients, where classical mucocutaneous features may be absent. Polyserositis in SLE may indicate severe systemic inflammation requiring careful therapeutic monitoring. Increased awareness, application of evidence-based guidelines, and early rheumatology referral are key to timely diagnosis and improved outcomes in this patient group.

Aorto to alveoli: catastrophic antiphospholipid syndrome masquerading as multisystem failure

2026-05-30T07:25:51+0530

Catastrophic Antiphospholipid Syndrome (CAPS) is a rare, fulminant variant of antiphospholipid syndrome, characterized by rapid multi-organ involvement due to widespread thrombosis. We report a 65-year-old male, with prior comorbidities such as diabetes, hypertension, dyslipidemia, cerebrovascular accident and coronary artery disease who presented with complete thrombosis of the distal abdominal aorta and common iliac vessels. During hospital stay, he developed acute respiratory distress, right-sided haemothorax with massive pleural effusion, diffuse alveolar haemorrhage, acute kidney injury with microscopic haematuria, and neurological deterioration requiring mechanical ventilation. Initial autoimmune workup was negative for ANA, ANCA, and anti-GBM antibodies. However, β2-glycoprotein IgG was strongly positive, and anticardiolipin antibody was borderline positive, raising suspicion of CAPS. Given the constellation of multiorgan dysfunction with diffuse alveolar haemorrhage and vascular thrombosis, a diagnosis of catastrophic APS was considered. The patient underwent aggressive multimodal therapy including pulse corticosteroids, anticoagulation, renal replacement therapy, immunomodulators, and ventilatory support. Plasma exchange/IVIG was planned in case of further worsening. With multidisciplinary management and intensive supportive care, the patient showed gradual recovery, and was discharged in a stable condition. This case highlights the diagnostic challenge of CAPS, which often masquerades as vasculitis, sepsis, or other autoimmune diseases. It also underlines the management hurdles, requiring timely recognition, multidisciplinary coordination, and combined immunosuppression and anticoagulation. Despite its rarity, CAPS should be considered in patients with rapidly progressive multiorgan thrombosis, as early diagnosis and intervention can be life-saving.