International Journal of Research in Medical Sciences

Modified fourth generation autologous cartilage transplantation for grade 2-3 knee osteoarthritis

Nandkumar Sundaram — 2026-03-30

Osteoarthritis (OA) of the knee poses a significant burden on physical mobility and quality of life, especially in middle-aged adults. This study evaluates the outcomes of a modified fourth-generation autologous cartilage transplantation technique developed to overcome limitations of traditional cartilage repair strategies. The major learning curve observed during this study was that patient preferred a minimally invasive and a shorter hospital stay technique over traditional TKR. The case series involves a cohort of 15 patients with Grade 2-3 knee OA, the case series showed significant improvements in pain relief, knee function, early mobilization, and patient satisfaction with no reported adverse events. Some patients had follow-up data extending up to 5 years, with results consistent with 6-month outcomes. Improved patient mobility score and improved patient satisfaction score noted. This technique offers a cost-effective, single-stage, arthroscopic alternative with promising short- and mid-term outcomes. Thus, this technique caters to the population at early osteoarthritis stage preventing an Early replacement.

Postural orthostatic tachycardia syndrome in patients with alcohol use disorder: a case series

Sumit Kumar — 2026-03-30

Postural orthostatic tachycardia syndrome (POTS) is an under-recognized complication of chronic alcohol use and withdrawal. Autonomic dysfunction secondary to alcohol-related neuropathy may manifest as POTS during or after the deaddiction process. This case series describes eight patients who developed POTS while undergoing detoxification and deaddiction treatment. We retrospectively reviewed medical records of four patients admitted to Dr. B. C. Roy Hospital for alcohol deaddiction during 2024-2025 who presented with POTS symptoms during their treatment. All four patients (4 males; mean age 34.25 years) with chronic alcohol use disorder (mean duration 12.4 years) developed orthostatic intolerance symptoms during detoxification or early recovery phase. Tilt table testing or active stand tests confirmed inappropriate tachycardia (≥30 bpm increase) upon postural change. Symptoms significantly impacted rehabilitation outcomes, requiring integrated management approaches. POTS represents an important autonomic complication in alcohol deaddiction patients that requires systematic evaluation and may impact recovery outcomes. Recognition and management of POTS should be integrated into comprehensive alcohol rehabilitation programs.

Epidemiological characterization of raw areas at the hospital general de México: a 4-year retrospective analysis

Jose B. Mendoza — 2026-03-30

Background: To identify the epidemiological characteristics of raw areas at the Hospital General de México.

Methods: An observational, cross-sectional and descriptive study was conducted to describe the presentation and management characteristics of raw areas at the Hospital General de México from January 1, 2022, to December 31, 2025. Variables included age, gender, occupation, affected area, wound classification and treatment. A non-probability sample was obtained from a 4-year retrospective review. Data were analyzed using descriptive statistics with the SPSS v26.0 statistical package.

Results: A total of 306 patients were selected. The predominant age group was 21 to 40 years (n=113, 36.9%), 200 (65%) were male and 103 (33.7%) were employees. Observed comorbidities included allergies in 54 (17.6%) and fractures in 29 (9.5%). The most affected areas were the head (n=76, 24.8%) and the right thigh (n=33, 10.8%). Wounds involving bone accounted for 110 cases (36.3%), while muscle involvement was seen in 107 (35.3%). Cultures identified Staphylococcus aureus in 97 (31.7%) and Pseudomonas aeruginosa in 91 (29.7%). Pain was reported by 205 (68%) patients. Initial treatment consisted of surgical cleansing and debridement in 206 (67.3%); definitive treatment included advanced dressing placement in 104 (34%) and skin graft harvesting and application in 89 (29.1%).

Conclusions: Male patients predominated, with the head being the most frequently affected area. Staphylococcus aureus and Pseudomonas aeruginosa were the most common pathogens. The primary initial treatment was surgical cleansing and the leading definitive treatment was advanced dressing placement.

Comprehensive evaluation of sensory taste acceptance, consumer preference and palatability factors in vitamin B (B1, B6 and B12): insights from a sensory analysis study

Fouzia Akhter — 2026-03-30

Background: Vitamins B1, B6 and B12 are essential for neurological and metabolic health, but their sensory properties may affect compliance. This study evaluated the sensory palatability and consumer response to a Vitamin-B supplement.

Methods: A cross-sectional sensory analysis was carried out over six months among 400 participants selected using standardized inclusion criteria at Central Hospital Limited, Dhaka, Bangladesh. Sensory attributes were evaluated using the Modified Mason and Nottingham 9-point scale. Consumer behavior outcomes and statistical analyses, including correlations and internal consistency, were conducted. Ethical approval and informed consent were strictly maintained according to the study protocol.

Results: The sample consisted mostly of females (70%) and participants aged 26–35 years. Prior vitamin-B use was reported by 64%. Sensory evaluation showed high acceptability, with odor (mean 7.23), appearance (6.87), aftertaste (7.41) and general approval (7.10) scoring positively. Overall palatability averaged 7.0±0.5, with 94–95% of responses falling within the “like” category, except for aftertaste, which showed more neutral ratings (29%). Consumer responses were highly favourable: 87.5% rated overall liking ≥7, 85.5% expressed definite purchase intent and 87% were willing to recommend the product. Strong correlations were observed between aftertaste and general approval (r=0.82) and palatability significantly predicted purchase intent (r=0.65, p<0.001). Sensory scale reliability was excellent (Cronbach’s α=0.89).

Conclusions: The Vitamin-B (B1, B6 & B12) showed high sensory acceptability, strong consumer satisfaction and solid purchase and recommendation intent. Aftertaste and odour strongly influenced overall approval. About 95% of participants genuinely liked the product, reflecting excellent sensory acceptance and consumer appeal.

Comparative analysis of central corneal thickness changes after cataract surgery at a tertiary hospital, North Central Nigeria

Saudatu U. Madaki — 2026-03-30

Background: Cataract surgery is the most frequently performed ophthalmic surgery to restore vision, so it is imperative for any surgeon performing cataract surgery to consider the health status of a cornea, most especially the central corneal thickness and document these parameters pre and post operatively for good visual outcome.

This study aims to assess the effect of conventional extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (MSICS) on central corneal thickness (CCT) in eyes of Nigerian adults with age-related uncomplicated cataract in order to obtain relevant information that will aid in improving cataract surgical outcome.

Methods: This was a hospital based prospective interventional study where all consecutive patients 40years and above with uncomplicated age-related cataract that presented to the hospital and fulfilled the inclusion criteria were recruited into the study until the minimum sample size was obtained. Two hundred and seventy-seven (277) cataract eyes of 269 patients were randomly selected and assigned to either MSICS or conventional ECCE with posterior chamber intraocular lens (PC IOL) implantation. Preoperatively the CCT was measured with a non-contact specular microscope. Post operatively these measurements were repeated at 1 week, 4 weeks and 12 weeks respectively.

Results: Of the 277 eyes studied, 263 (94.9%) were analysed. The mean age of patient for MSICS and ECCE was 64.03 (SD+11.2, range 40–95 years) and 62.69 (SD+10.48, range 42–94 years) respectively with male to female ratio of 1.9: 1. CCT increased in both groups at one week postoperatively but these values returned to preoperative values at 12 weeks after surgery.

Conclusions: The two cataract procedures induced a similar and transient increase in CCT postoperatively with return to normal values at 12 weeks.

Prevalence and clinical predictors of fibromyalgia in patients with rheumatoid arthritis

Aparna Deb — 2026-03-24

Background: Fibromyalgia (FM) is a common disorder in patients with rheumatoid arthritis (RA) and contributes to the inflation of disease activity scores because of a high symptom similarity. Objective of the study was to estimate the prevalence of FM in patients with RA and to identify clinical predictors.

Methods: A total of 150 RA patients were enrolled in this cross-sectional study. FM status was determined by WPI and SSS. Sociodemographic, clinical, laboratory and disease activity parameters were evaluated.

Results: The prevalence of fibromyalgia in patients with RA was 24%. The participants had a mean age of 52.02±12.13 years and were predominantly female at an 81.3% rate. Patients with both RA and FM presented with more swollen joint count, higher patient VAS scores, DAS28 scores, CDAI scores and SDAI compared to those without FM. Depression and fatigue were more common in FM-positive patients.

Conclusions: Nearly one fourth of patients with RA had FM diagnosed concurrently. Psychological and subjective disease components were strongly correlated with FM in this study, indicating that higher disease activity scores may not always represent an active inflammation.

Comparison of puncture outcome between prolonged occlusion flow mediated dilatation method and conventional method during distal radial artery cannulation in coronary intervention

M. Faizul Hafiz Chowdhury — 2026-03-30

Background: Distal transradial access is increasingly used for coronary angiography (CAG) and percutaneous coronary intervention (PCI), but radial artery cannulation can be technically demanding due to a steeper learning curve and smaller vessel caliber. Prolonged occlusion flow-mediated dilatation (PO-FMD) is a novel technique that may enhance distal radial artery (DRA) access by promoting vasodilatation. Aim was to compare the efficacy and vascular access-site complications of PO-FMD versus the conventional technique during distal transradial artery cannulation.

Methods: This cross-sectional analytic study was conducted at the department of cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, from March 2021 to February 2022. A total of 200 purposively selected patients with coronary artery disease (CAD) undergoing CAG with or without PCI via distal radial access were enrolled. Participants divided into 2 groups: Group I (PO-FMD, n=100) and II (conventional method, n=100). Efficacy outcomes included access time, procedural time, number of attempts, 1^st-attempt success rate, and crossover rate. Vascular access-site complications such as hematoma, radial artery spasm, and radial artery occlusion were also assessed.

Results: Crossover to another access site was significantly lower in group I compared to group II (5% vs. 15%, p=0.030). Access time was shorter with PO-FMD (58.8±10.1 seconds vs. 78.9±7.9 seconds; p=0.006). Group I demonstrated fewer attempts and a higher first-attempt success rate (p=0.015 and p=0.021, respectively). Radial artery spasm and occlusion were significantly reduced in the PO-FMD group (p=0.048 and p=0.039). No significant differences were observed in hematoma formation or total procedural time.

Conclusions: PO-FMD-mediated radial artery dilatation appears to be a safer and more effective technique than the conventional method for DRA cannulation.

Prevalence and risk factors of oral potentially malignant disorders among tobacco users in Bangladesh

Kulsum Nahar — 2026-03-30

Background: Oral potentially malignant disorders (OPMDs) are recognized precursors of oral cancer and are strongly linked to tobacco exposure. In Bangladesh, widespread use of smoked and smokeless tobacco, often combined with betel quid and areca nut, places a large population at increased risk of developing OPMDs. Objective was to determine the prevalence of OPMDs and identify associated risk factors among tobacco users in Bangladesh.

Methods: A cross-sectional study was conducted among 120 adult tobacco users. Data on socio-demographic characteristics, tobacco-use patterns, betel quid/areca nut consumption, and oral hygiene practices were collected using a structured questionnaire. Participants underwent clinical oral examinations for identification of OPMDs using standard diagnostic criteria. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression.

Results: The prevalence of OPMDs was 35%. The most common lesions were leukoplakia (15%) and oral submucous fibrosis (11.7%), with the buccal mucosa being the most frequently affected site. OPMDs were significantly associated with smokeless and dual tobacco use, longer duration and higher frequency of use, betel quid/areca nut consumption, and poor oral hygiene. Multivariable analysis identified these factors as independent predictors of OPMDs.

Conclusions: OPMDs are highly prevalent among tobacco users in Bangladesh. Targeted screening and integrated tobacco and areca nut cessation strategies are essential to reduce progression to oral cancer.

Clinical and echocardiographic features of patients with single-chamber and dual-chamber pacemakers

Liudmila Kalatsei — 2026-03-30

Background: The abnormalities in cardiac action potential generation and propagation may emerge at various levels in the electrical conduction system of heart, initiating from the sinoatrial node to the purkinje fibers which depolarize the ventricles. Thus, decline in this internal cardiac automaticity or propagation integrity, requires prompt use of pacemaker to initiate the cardiomyocytes to the baseline through excitation-contraction coupling. The aim of this study is to identify clinical and echocardiographic features of patients with single-chamber and dual-chamber pacemakers.

Methods: This retrospective study consist of 85 patients admitted to the Grodno Regional Clinical Cardiological Center (Belarus) for pacemaker implantation over a period of 2 years, from January 2024 to December 2025. The patients were divided into 2 groups according to the type of pacemaker implanted. Group 1 included 42 patients with single-chamber pacemakers, while Group 2 included 43 patients with dual-chamber pacemakers.

Results: This study consisted of 85 patients divided into single-chamber (SR, n=42) and dual-chamber (DR, n=43) pacemaker groups. The SR group was older (median 77 vs. 71.8 years, p=0.01). Sick sinus syndrome and second-degree AV block were more frequent in DR (60.4% and 27.9%, p<0.01), while third-degree AV block and persistent atrial fibrillation was prevalent in SR (57.1% and 80.9%, p<0.001). ESR and AST were lower, and RBC counts borderline higher in DR (p≤0.05). SR showed larger atrial diameters and more pleural effusion (p<0.01); ventricular function was similar.

Conclusions: This study explored the significant differences among patients with single-chamber and dual-chamber pacemakers in clinical, rhythm, laboratory, and echocardiographic parameters.

Frequency of comorbidities in patients with osteoarthritis and their impact on pain and physical function

Mohammed Taherul Islam — 2026-03-24

Background: Osteoarthritis (OA) is one of the commonest morbidities in older age population and the most common reason for restricted activity in their daily life. The prevalence of other disabling condition also rises with age and some common chronic condition can be found along with OA. The aim of this study was to identify frequency of comorbidities in patients with OA and impact of comorbidities on pain and physical function of the patients.

Methods: Self-reported comorbidities, clinical examinations and relevant investigations findings were recorded in a case record form. Depression and anxiety were measured by PHQ-9 and GAD-7 scale respectively. Pain of joint and physical function was measured by WOMAC questionnaire.

Results: The mean of the age, BMI (body mass index) and duration of pain was respectively 56.83 (±8.28) years, 26.01 (±4.1) kg/m² and 4.1 (±2.9) years. Male female ratio was 1:2.23. About one fifth of the patients (19.1%) reported no associated comorbid conditions and approximately three fourth of patients (70%) reported one or two comorbid conditions and another 11% reported three or more comorbid conditions. Of the comorbid conditions the most frequent was HTN (45.5%), followed by DM (20.9%), depression (20.9%) and anxiety (13.6%). The mean pain and physical function scores were 17.8±7.1 and 63.6±21.7 respectively.

Conclusions: In summary, the OA patients showed a high frequency of comorbid conditions including depression, which can impact the pain and physical function of those patients. Such results show the need for investigating and treating those comorbidities in OA patients.

Physical fitness in Belarusian children with chronic gastritis

Halamba Osini Senara Rathnasiri — 2026-03-30

Background: Chronic gastritis is a common pediatric condition characterized by inflammation of the gastric mucosa. Its potential impact on children’s growth and physical development remains underexplored. This study aimed to assess the relationship between chronic gastritis and physical development in Belarusian children, focusing on height and body mass index (BMI) compared to WHO growth standards.

Methods: A retrospective cross-sectional review was conducted on 100 pediatric patients diagnosed with chronic gastritis in 2023 at Grodno Regional Clinical Pediatric Hospital, Belarus. Growth indicators were analyzed using AnthroPlus software, with Z scores for height-for-age and BMI-for-age calculated and compared against WHO reference values.

Results: Among the 100 children (76% female, mean age 13 years), height-for-age z-scores demonstrated a rightward shift, indicating taller stature compared to WHO standards. Conversely, BMI-for-age z-scores showed a leftward shift, reflecting lower BMI values. This disproportionate growth pattern tall stature with lean body composition was more pronounced in girls and persisted across age groups, particularly in middle and high school children.

Conclusions: Chronic gastritis in children appears to negatively influence physical development by reducing BMI, despite an unexpected trend toward increased height. These findings highlight the importance of monitoring growth trajectories and addressing nutritional and metabolic factors in pediatric patients with chronic gastritis. Further multi-center studies are needed to validate these results and clarify underlying mechanisms.

Clinical and laboratory features of patients with postoperative pneumonia after cardiac surgery

Kalatsei Liudmila — 2026-03-30

Background: Following cardiothoracic surgery, postoperative pneumonia (POP) represents a major clinical sequela. This study compared clinical and diagnostic features among the patients who developed POP and those with an uncomplicated recovery.

Methods: In a retrospective single-centre analysis, 95 patients who had open-heart surgery were divided into group 1 (POP, n=53) and group 2 (no major complications, n=42). We analysed demographics, comorbidities, laboratory results, and echocardiographic data.

Results: While baseline characteristics were similar, group 1 had a significantly higher prevalence of anaemia (98% versus 70%, p<0.001) and postoperative pneumothorax (17% versus 2%, p=0.020). Laboratory findings showed markedly elevated inflammatory biomarkers, including C-reactive protein and procalcitonin (p<0.001), in group 1. Echocardiography revealed a lower left ventricular ejection fraction (57.3% versus 62.8%, p=0.037) and more frequent pericardial effusion (p=0.026) in these patients.

Conclusions: POP is associated with a distinct profile featuring significant anaemia, elevated specific infection biomarkers, slightly impaired left ventricular function, and increased pulmonary complications. The study thus underscores potential focuses for improving both patient assessment before surgery and diagnosis after the procedure.

Determinants of birth weight abnormalities at a university hospital in Mahajanga, Madagascar: a prospective case-control study

Raveloharimino N. Henintsoa — 2026-03-30

Background: Birth weight abnormalities, including low birth weight and macrosomia, represent a major public health problem due to their neonatal and long-term consequences. Identifying the associated factors helps guide prevention strategies adapted to the local context of the neonatology department of the University Hospital Center of Mahajanga, Madagascar.

Methods: This was a prospective descriptive and analytical case-control study conducted from 19 March to 19 September 2024, in the neonatology department of the University Hospital Center of Mahajanga, Madagascar. Seventy-four newborns presenting with birth weight abnormalities were compared with 222 controls with normal birth weight. Sociodemographic, obstetric, and maternal factors were analyzed.

Results: The hospital incidence of birth weight abnormalities was 9%. The identified risk factors were gestational hypertension (OR=9.84; 95% CI: 4.21–21.02), fewer than four antenatal care visits (OR=4.73; 95% CI: 2.01–10.12) and single marital status (OR=2.79; 95% CI: 0.98–7.99). Conversely, maternal age between 18 and 35 years (OR=0.42; 95% CI: 0.21–0.84), iron and folic acid supplementation (OR=0.34; 95% CI: 0.16–0.72), normal maternal body mass index (OR=0.51; 95% CI: 0.27–0.95) and secondary or higher education level also reduced the risk (OR=0.31; 95% CI: 0.15–0.66) had a protective effect.

Conclusion: Birth weight abnormalities at the University Hospital of Mahajanga are mainly influenced by modifiable maternal determinants. Strengthening antenatal care and early management of hypertensive disorders could significantly reduce their frequency.

Impact of environmental factors on adverse events in whole blood donation

Roni Roy — 2026-03-30

Background: Whole blood for transfusion is essential in medical treatment; for surgeries, trauma treatment and managing diseases like anemia and cancer. However, the adverse reactions (ARs) such as vasovagal syncope, dizziness and fainting are still concerning for donor safety. Reactions are influenced by age, sex and general health status; however, the impact of environmental factors temperature, humidity and air quality are not well studied. The aim of this study was to examine environmental factors affecting the incidence and severity of adverse events during whole blood donation.

Methods: Total of 170 voluntary whole blood donors were included in the study. Donor demographic, health and reporting records were obtained from the center during the study period. Environmental factors such as temperature, humidity and air quality were collected from monitoring stations located nearby the locality. Bivariate analyses using chi-square tests and logistic regression were performed to evaluate the relationship between environmental factors and adverse events.

Results: Adverse events were observed in 15% of donors (12% mild and 3% severe). High temperatures (>25 C), relative humidity >60%, and AQI >70 were associated significantly with the increased rate of adverse events. High temperatures were significantly associated with more serious reactions, particularly in male donors, whereas high relative humidity was correlated with mild reactions among women.

Conclusions: Environmental factors have greatly influenced on the incidence and severity of adverse reactions with whole blood donation. These results indicate the importance of adjusting environmental parameters such as temperature, humidity and air quality in blood donation centers for donor safety and comfort.

Management of erosive/ulcerative oral lichen planus by diode laser therapy with corticosteroid or topical therapy: a randomized controlled trial

Abdullah Al Mamun Khan — 2026-03-30

Background: Oral lichen planus (OLP) is a chronic inflammatory mucosal disorder, with erosive and ulcerative forms causing significant pain, discomfort and impaired quality of life. Although topical corticosteroids are considered first-line therapy, recurrence and adverse effects remain common. Low-level laser therapy has emerged as a promising adjunctive modality due to its anti-inflammatory and biostimulatory effects. This study evaluated the effectiveness of diode laser–assisted combined therapy compared with topical corticosteroid therapy alone in symptomatic OLP.

Methods: This randomized controlled clinical trial included 60 patients (45 females, 15 males; age 35–65 years) diagnosed with erosive or ulcerative OLP attending two dental centers in Dhaka between 2019 and 2025. Participants were randomly allocated into two groups (n=30 each). Group 1 received combined therapy comprising low-level red diode laser (630 nm, 1.5 J/cm², 10 mW, 120 seconds, 15 sessions) with 0.1% triamcinolone acetonide, while group 2 received topical corticosteroid alone. Pain was assessed using the visual analog scale (VAS). All patients were followed for 12 months. Data were analyzed using statistical package for the social sciences (SPSS) version 25.

Results: Combined therapy produced superior outcomes, with 100% of patients reporting nil pain, complete healing and no recurrence. In the topical therapy group, 60% achieved nil pain while 40% reported mild pain and recurrence. Mild adverse effects occurred in 10% of patients receiving corticosteroids alone.

Conclusions: Diode laser–assisted combined therapy is a safe and more effective treatment modality than topical corticosteroid alone for managing erosive and ulcerative OLP, providing better pain relief, faster healing and reduced recurrence.

Evaluation of triple assessment performance against NICE breast cancer standards: a prospective breast clinic audit assessing guideline compliance and diagnostic outcomes in a rural hospital in Bangladesh

A. B. M. Abdullah — 2026-03-30

Background: Breast cancer is a leading cause of mortality worldwide, and early detection is crucial for improving survival. The National Institute for Health and Care Excellence (NICE) breast cancer diagnostic standards provide a structured pathway, but their implementation in resource-constrained, rural settings remains challenging. This study aims to evaluate compliance with NICE diagnostic standards and assess the outcomes of the triple assessment pathway (clinical examination, imaging, and histology) in a rural breast clinic in Bangladesh.

Methods: A prospective audit was conducted on 150 patients attending the breast clinic at Bangladesh Korea Friendship Hospital from February to July 2025. Demographic data, compliance rates with triple assessment, diagnostic outcomes, and delays were recorded. The association of resource constraints with compliance and outcomes was evaluated using appropriate statistical tests.

Results: Compliance with NICE standards for clinical examination, imaging, and histology was 87%, 76%, and 58%, respectively, with an overall pathway compliance of 73%. Diagnostic outcomes revealed malignancy in 39.5% of patients and benign conditions in 48.6%. The mean time from referral to final diagnosis was 24 days. Inadequate diagnostic tools (p=0.032) and medical facilities (p=0.045) were significantly associated with lower compliance and poorer diagnostic performance.

Conclusions: The triple assessment pathway can be implemented in a rural setting, but significant compliance gaps exist due to resource and staffing limitations. Addressing these barriers is essential to improve diagnostic accuracy and ensure timely breast cancer diagnosis in similar contexts.

Opioid-free anaesthesia using continuous dexmedetomidine and lignocaine infusion in elective spine surgery and its effect on patient recovery at a referral neuroscience hospital, Dhaka

M. Anwarul Mamun — 2026-03-30

Background: Opioid anaesthesia, though useful in pain control in spine surgery, is associated with adverse effects like respiratory depression, nausea, and vomiting after the surgery, and slow recovery. Opioid-free anaesthesia with dexmedetomidine and lignocaine has been an emerging prospect to improve perioperative care with the elimination of opioid-induced complications.

Methods: This prospective observational study was done among 60 ASA I-III patients aged 18-65 years having elective spine surgery in a referral neuroscience hospital in Dhaka. Anaesthesia was induced with dexmedetomidine (1 μg/kg for 10 min), lignocaine (1.5 mg/kg), propofol (2 mg/kg), and rocuronium for relaxation. Maintenance was by continuous infusion of dexmedetomidine (0.4-0.7 μg/kg/h) and lignocaine (1-2 mg/kg/h), topped up by sevoflurane and non-opioid analgesics. Outcome variables were hemodynamic stability, postoperative pain score, opioid consumption, recovery parameters, and complications.

Results: 100% of patients were hemodynamically stable during intraoperative time without MAP or heart rate variability ≥20% from baseline. No hypotension or bradycardia intervention was required. Postoperatively, 63.3% of patients experienced mild pain (VAS 0-3), and 15% required rescue opioids. Early extubation (≤10 minutes) succeeded in 93.3% of patients, 56.7% of patients had ≤12 hours of ICU stay, and 46.7% were discharged within 3 days. PONV occurred in only 10% of the patients, without any respiratory depression. Hemodynamic stability showed moderate negative correlations with extubation time (r=-0.34, p=0.01), ICU stay (r=-0.29, p=0.03), and rescue opioid requirement (r=-0.36, p=0.008).

Conclusions: Opioid-free anaesthesia with continuous infusion of dexmedetomidine and lignocaine offers excellent hemodynamic stability, analgesia, and recovery profile for elective spine surgery with minimal side effects, being safe and effective as compared to traditional opioid-based techniques.

Depression as a determinant of pain severity and functional limitation in patients with knee osteoarthritis: a cross-sectional study

Mohammad Imtiaz Sultan — 2026-03-26

Background: Knee osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide. Psychosocial factors especially depression-could greatly affect pain perception and functional outcomes in people who are affected. Objectives were to assess the prevalence of depressive symptoms and their relationship with pain severity and functional limitation in knee OA patients.

Methods: This is a hospital-based cross-sectional study that included 110 adult patients with primary knee OA diagnosed according to American College of Rheumatology Criteria. Depressive symptoms were assessed by the patient health questionnaire-9 (PHQ-9). A cut-off score of ≥10 was considered clinically significant depression. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) assessed pain intensity and physical function. Continuous variables were summarized as mean±SD. Group comparisons were performed with independent t tests and correlations assessed using Spearman’s coefficient.

Results: The prevalence of clinically significant depressive symptoms was 20.9%. Patients with depression had mean WOMAC pain (19.2±8.1 vs 17.1±7.4; p=0·001) and function (67.5±22·5 vs 62.1±21·4; p<0·001) scores significantly higher than non-depressed patients. There was a positive correlation between PHQ-9 scores and WOMAC pain (r=0.33, p=0·002). PHQ-9 scores correlated positively also to function (r=0.41, p<0 ·001). A stepwise increase in pain and disability was observed according to the severity of depression.

Conclusions: Depressive symptoms are common for knee OA patients and significantly associated with high pain intensity level and functional limitation. Routine psychological screening can be performed using validated tools such as the PHQ-9, which may improve comprehensive management of OA.

Impact of tooth wear on oral health symptoms and quality of life: a population-based study

Mir Abeed Rahman — 2026-03-30

Background: Tooth wear is an increasingly prevalent oral health condition with a multifactorial etiology, affecting functional performance as well as psychological and social well-being. The aim of the study was to determine the prevalence of tooth wear, identify associated behavioral risk factors, and assess its impact on oral health–related quality of life (OHRQoL).

Methods: A cross-sectional study was conducted at the dental unit of Chattogram Maa-O-Shishu Hospital Medical College between July and November 2025. A total of 150 patients attending the outpatient department were recruited. Data were collected using structured interviewer-administered questionnaires covering sociodemographic characteristics, oral health behaviors, clinical symptoms, and OHRQoL indicators. Statistical analyses were performed using SPSS version 25. Chi-square tests and logistic regression analyses were applied to evaluate associations between tooth wear and potential risk factors.

Results: The prevalence of tooth wear among participants was 85.3%. Significant associations were observed between tooth wear and aggressive tooth brushing (p<0.001), betel nut chewing (OR=3.54, p=0.013), and clenching or grinding of teeth (p=0.031). Participants with tooth wear reported significantly greater difficulties in social interaction (p=0.028), smiling or laughing (p=0.047), and performing major work activities (p=0.003) compared to those with no or minimal wear. Localized tooth sensitivity (70.6%) and fractured teeth (50.0%) were the most commonly reported clinical conditions.

Conclusions: Tooth wear was highly prevalent and had a significant negative impact on functional and psychosocial aspects of OHRQoL. Aggressive tooth brushing and betel nut chewing emerged as key modifiable risk factors, underscoring the need for targeted preventive strategies and early behavioral interventions.

Prevalence and associated factors of peripheral neuropathy in type 2 diabetic patients in Antananarivo: a three-year cross-sectional study

Rija E. Raherison — 2026-03-30

Background: Diabetic peripheral neuropathy (DPN) is common, causing functional disability and impaired quality of life for patients. The aims of this study were to determine the prevalence of DPN and its associated factors in type 2 diabetics seen at the Soavinandriana Hospital Center.

Methods: This was a descriptive and analytical cross-sectional study, conducted on a 3-years period. The diagnosis of DPN was made based on a DN4 questionnaire score ≥4 and/or impaired sensitivity to 10 monofilament and/or a reduction or absence of the Achilles reflex.

Results: Among the 289 DT2 patients, the prevalence of DPN was 28.7%. Risk factors for DPN were age 60-69 years [OR=1.83 (1.06-3.19), p=0.0139], dyslipidemia [OR=3.31 (1.47-3.49), p=0.0009], microalbuminuria [OR=6.98 (3.85-12.9), p<0.0001], diabetes duration ≥10 years [OR=2.80 (1.42-5.52), p=0.0011], glycated hemoglobin level ≥7% [OR=2.25 (1.03-5.85), p=0.0287], presence of nephropathy [OR=13.2 (6.82-26.2), p<0.0001], retinopathy [OR=2.71 (1.42-5.15), p=0.0009], carotid atherosclerosis [OR=2.73 (1.57-4.79), p=0.0001], lower limb arteriopathy [OR=2.27 (1.21-4.23), p=0.0047] and ischemic heart disease [OR=3.41 (1.72-6.82), p=0.0001].

Conclusions: The frequency of DPN was 28.7%. Associated factors were advanced age, the presence of other cardiovascular risk factors, a long duration of diabetes and its poor control, and the presence of other degenerative diabetes complications. Better control of diabetes and associated cardiovascular risk factors with multidisciplinary care are essentials to avoid or limit their occurrence.

Comparative study between skin staples and conventional sutures for skin closure in elective abdominal surgery

Bidyut Chandra Debnath — 2026-03-30

Background: Skin closure is a crucial step in surgical procedures, as it directly affects wound healing, postoperative infection risk, and the aesthetic quality of the incision. The purpose of the study is to compare skin staples and conventional sutures for skin closure in elective abdominal surgery with respect to closure time, postoperative outcomes, and cosmetic results.

Methods: This prospective comparative study at the Department of General Surgery, Enam Medical College and Hospital, Dhaka, Bangladesh (March 2022–February 2023) included 60 elective abdominal surgery patients (30 staples, 30 sutures). Primary outcome was skin closure time; secondary outcomes were surgical site infection, pain, hospital stay, and cosmetic results. Data were analyzed using independent samples t-tests and chi-square tests (p<0.05).

Results: Sixty patients (30 per group) showed comparable baseline characteristics (p>0.05). Skin closure time was significantly shorter with staples than sutures (2.4±0.7 versus 9.8±2.5 minutes; p<0.001). Surgical site infection, postoperative pain, and hospital stay were similar between groups (p>0.05). Cosmetic outcome was significantly better with sutures (73.3% versus 40.0%; p=0.030).

Conclusions: Skin staples offer faster skin closure, whereas conventional sutures provide better cosmetic outcomes, with no significant difference in postoperative complications.

The effectiveness of HeartMath biofeedback intervention to improve blood glucose levels among type 2 diabetes mellitus patients

Balasingham Arasabalan — 2026-03-30

Background: Biofeedback interventions are widely used among naturopathic practitioners to treat and manage various health conditions, such as mental health-related disorders, hypertension, and diabetes mellitus. The aim of the study was to evaluate the efficacy of the biofeedback HeartMath emWave Pro intervention in patients with type 2 diabetes mellitus (T2DM).

Methods: A total of 25 adults [male (n=14) and female (n=11)] participants (age: 51.32±4.13 years) were recruited in this quasi-experimental pilot study. Heart rate variability (HRV) and breathing analysis were trained and measured using HeartMath emWave Pro during biofeedback training. Blood glucose parameters [haemoglobin A1c (A1c)], fasting blood glucose, and post-prandial blood sugar) were measured pre- and post-intervention using a biochemistry auto-analyzer. Data were analyzed via the Wilcoxon Signed Rank test and Spearman correlation.

Results: Post-intervention findings revealed a significant difference in HbA1c, fasting blood sugar, post-prandial blood sugar, and cortisol (all, p<0.05). Post intervention, thyroid-stimulating hormone (TSH) (r=-0.408) and breathing (r=0.465) showed significant correlation with HRV (all, p<0.05).

Conclusions: These findings suggest that HeartMath biofeedback training may improve blood glucose control in individuals with T2DM.

Influence of psychological and symptom burden on disease activity scores in patients with rheumatoid arthritis

Mohammad Imtiaz Sultan — 2026-03-30

Background: Joint disease activity indices such as DAS28, CDAI, and SDAI are important for the treatment of rheumatoid arthritis (RA). Yet, indices are influenced by subjective components, which are likely to be reflective of impaired psychological and symptom burden with the former possibly confounding true calculation of inflammatory activity. Objective was to assess the impact of psychological factors and symptom burden on composite disease activity scores in patients with RA.

Methods: This cross-sectional analytical study selected 150 patients who fulfilled the criteria for diagnosis of RA by the ACR/EULAR in 2010. Clinical assessment comprised tender joint count and swollen joint count, patient global assessment, physician global assessment, ESR, and CRP. Depression and fatigue were measured by clinical examination and patient self–report. Disease activity was assessed based on DAS28, CDAI, and SDAI.

Results: The mean age was 52.02±12.13 years, and 81.3% were women. In the 36.0% and 48.0% of patients, depression and fatigue were detected, respectively. The average value of DAS28 was 4.28±1.25 (mean±SD)." Depressed patients also had a higher DAS28 (4.82±1.19 versus 3.97±1.18, p<0.001), CDAI and SDAI scores. Similar results were observed for individuals reporting fatigue (p<0.001). VAS-patient correlated most closely with DAS28 (r=0.49, p<0.001), and ESR and CRP demonstrated weak but not significant degree of correlation.

Conclusions: Psychosocial and symptom burden strongly contribute to the composite disease activity measures in RA. Disease activity scores must be interpreted in the context of psychosocial factors to prevent misclassification and unnecessary treatment step-up.

Native collagen type II and Aflapin® in the management of hip and knee osteoarthritis: a single-centre prospective observational study

Vaibhav Maheshwari — 2026-03-10

Background: Osteoarthritis (OA) affects over 595 million people worldwide, with cases rising by 132% from 1990. Standard NSAID therapy offers only symptomatic relief and has safety limits, driving interest in alternatives. Native type II collagen and Aflapin provide complementary immunomodulatory and anti-inflammatory effects. This study evaluates their combined efficacy and safety in hip or knee OA over 12 weeks.

Methods: Adults (≥40 years) with confirmed hip or knee OA receiving native collagen type II 40 mg + Aflapin 100 mg as routine treatment were enrolled after consent. Key exclusions were recent corticosteroid/NSAID or intra-articular therapy, major comorbidities, obesity, pregnancy, or any other investigational drug use. Efficacy and safety were assessed via 100 mm VAS for pain and stiffness and a 5-point Likert scale for global OA status at weeks 4 and 12.

Results: A total of 100 subjects (mean age 58.6 years; 57% female) were enrolled. Significant improvements in pain, stiffness, and overall OA status were observed by weeks 4 and week 12, with all subjects reporting pain relief and 99% showing reduced stiffness by week 12. No rescue medication was needed, and three minor adverse events (AEs) (headache, bloating, mild gastritis) resolved without treatment.

Conclusions: Native collagen type II 40 mg + Aflapin 100 mg significantly improved joint pain, stiffness, and overall OA status by Week 4, with further gains by Week 12. No rescue medication was needed, and only mild, self-limiting AEs occurred. The combination was well tolerated and effective for knee or hip OA symptom relief.

Harnessing baicalein to mitigate antibiotic resistance: resensitizing norfloxacin against urinary multidrug-resistant Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa

Akhila K. P. — 2026-03-24

Background: According to the World Health Organization (WHO) Priority Pathogen List — 2024, multidrug-resistant pathogens will emerge and spread rapidly in the coming years. This has to be countered by the urgent development of novel antibiotics for their effective management. Restoring and enhancing the potency of existing antibiotics by combining with bioactive compounds is a novel strategy to be further studied. The purpose of our study is to determine the synergistic effect of one of the active ingredients from Chinese skullcap, baicalein with norfloxacin on multi-drug resistant uropathogens.

Methods: The present cross-sectional study was undertaken at School of Medical Education (SME), Kerala, India, during the period of November 2023 to November 2024. Based on the calculated FICI values, results were interpreted as Synergy (FICI≤0.5), Additive (0.5<FICI≤1), Indifferent (1<FICI≤4), Antagonistic (FICI>4). The data were analysed using Microsoft Excel software (Windows 2010). Chi-square test was performed using IBM statistical package for the social sciences (SPSS) Statistics 24 to evaluate significant differences (p value <0.05) among the parameters examined in this study.

Results: A total of 150 drug-resistant strains of E. coli, K. pneumoniae and P. aeruginosa were isolated from urinary tract infections (UTIs). Resistance to norfloxacin was observed in 64% of E. coli, 68% of K. pneumoniae, and 74% of P. aeruginosa isolates. Notably, baicalein resensitized 56.3% of E. coli, 70.6% of K. pneumoniae, and 75.7% of P. aeruginosa strains to norfloxacin, as determined by the checkerboard assay and these findings were statistically significant.

Conclusions: This study emphasizes the need for ongoing surveillance of antimicrobial resistance in common urinary pathogens and also suggests that natural compounds like baicalein may resensitize existing antibiotics like norfloxacin against resistant strains, warranting further research into the underlying mechanisms and potential clinical applications.

A randomized prospective study to evaluate the efficacy of ultrasonic shears (Harmonic scalpel®) and monopolar electrocautery in dissection of gall bladder from the gall bladder bed during laparoscopic cholecystectomy

Chetan Mahala — 2026-03-26

Background: Laparoscopic cholecystectomy is the gold-standard treatment for symptomatic gallstones. Advances in technology have made it faster and safer. Ultrasonic shears enable dissection and vessel sealing via cavitation and coaptation, though their safety and efficacy as a sole instrument require further validation.

Methods: A prospective randomized controlled study was conducted in 100 patients with symptomatic gallstones, divided into two groups: laparoscopic cholecystectomy using ultrasonically activated shears or monopolar electrocautery. Operative time, gallbladder removal, blood loss, postoperative pain scores, analgesic requirement, hospital stay, and complications were compared.

Results: Patients who had a laparoscopic cholecystectomy with ultrasonic shears experienced less pain and a quicker procedure (44.18±14.03 minutes versus 54.48±16.34 minutes; p<0.001) and gallbladder removal from the gallbladder bed (9.66±4.54 minutes versus 14.18±4.67 minutes; p<0.001). They had a lower risk of gallbladder perforation (4 versus 13) and a shorter hospital stay. Additionally, on the first postoperative day, fewer analgesics were needed. The study population included 85% females and 15% males, presented in demographic analysis.

Conclusions: There is no risk of serious injuries or leaks while using an ultrasonically triggered scalpel during a laparoscopic cholecystectomy. In terms of quicker and safer operation, lower related morbidity, less pain, and an earlier return to home, it performs better than electrocautery.

Prevalence of asymptomatic malaria in patients of a secondary care hospital presenting with non-febrile symptoms

Pritam Priyansu Purohit — 2026-03-30

Background: Malaria remains a major public health problem in endemic regions such as Odisha, India, where asymptomatic infections can sustain transmission and hinder elimination efforts. This study assessed the prevalence of asymptomatic malaria among afebrile patients in a secondary care hospital and compared the diagnostic performance of peripheral blood smear (PBS) and rapid diagnostic tests (RDT).

Methods: An observational cross-sectional study was conducted at a secondary care hospital in Gopalpur, Odisha, from January 2021 to March 2022. A total of 300 OPD and inpatient cases from Medicine, Surgery, and Obstetrics & Gynecology departments were enrolled. Inclusion criteria included residence in Odisha for ≥10 years, absence of fever in the preceding month, and no malaria diagnosis in the previous six months. All participants underwent PBS and RDT testing. Positive cases were reconfirmed externally, and treatment was provided as per national guidelines.

Results: Of the 300 participants (171 males, 129 females), none were positive on PBS, while 46 cases (15.3%) were detected by RDT. Plasmodium vivax accounted for 59% of cases, P. falciparum for 30%, and mixed infections for 11%. Although 44% reported previous malaria treatment, only 30% completed the full regimen, and radical therapy with primaquine was administered in 10.8% of cases.

Conclusions: A substantial burden of asymptomatic malaria was observed in this hospital-based population. The poor sensitivity of PBS and inadequate treatment adherence highlight the need for sensitive diagnostic tools, active surveillance, and improved therapeutic compliance to support malaria elimination in endemic regions.

Observational study of use of harmonic scalpel vs electrocautery in dissection and removal of gallbladder from gallbladder bed in laparoscopic cholecystectomy

Rohan Shrotri — 2026-03-30

Background: The harmonic scalpel uses ultrasonic vibrations at a high frequency to cut tissue and coagulate blood vessels. Electrocautery uses electrical current to generate heat, which cuts tissue and coagulates blood vessels. Both energy sources are used for dissection of gallbladder with each having their own merits and demerits.

Objectives: To assess the outcomes and complications of using harmonic Scalpel vs electrocautery for laparoscopic cholecystectomy.

Methods: Observational retrospective study, conducted at a tertiary healthcare center (Sassson General Hospital, Pune). Data collection over 24 months (December 2022-December 2024), enrolled 100 patients diagnosed with cholelithiasis. The key outcomes measured - the average operating time, the average frequency of lens cleaning, the average VAS score on POD 1, the average length of stay postoperatively, duration of drain and number of complications.

Results: The average operating time using electrocautery vs harmonic scalpel was 55.67 vs 41.52 minutes, average frequency of lens cleaning 5 vs 3.24 times, average VAS score on post operative day 1 to be 4.321 vs 3.264,average length of stay post-surgery to be 3.58 vs 2.38 days ,average duration of drain to be 2.681 vs 2.324 days ,number of gallbladder perforations to be 5 vs 2.

Conclusions: The harmonic scalpel demonstrated improved patient outcomes for operating time, length of stay, duration of drain, drainage volume, postoperative pain and overall complications compared to electrocautery.

Comparison of effect of intravenous tramadol and low dose ketamine in the attenuation of post spinal anaesthesia shivering following caesarean section: a double blinded randomised trial

Merlin Marita Loving — 2026-03-30

Background: Intraoperative shivering is a common complication in patients undergoing caesarean section under spinal anaesthesia (SA). Various pharmacological agents including tramadol and ketamine have been used for the management of intraoperative shivering.

Methods: This double-blinded randomized trial included a total of 72 patients scheduled for elective caesarean section under SA. Patients were randomly assigned to one of two groups: Group T (received tramadol 0.5 mg/kg intravenous) and group K (received ketamine 0.2 mg/kg intravenous). The primary outcome measure was the cessation of shivering after study drug administration. Secondary outcome measures included hemodynamic changes and adverse effects of study drugs.

Results: The study compared the effects of intravenous tramadol and ketamine for treating intraoperative shivering during caesarean section under SA. Among 72 patients, tramadol 0.5 mg/kg was used in 36 patients and ketamine 0.2 mg/kg in 36 patients. The time to cessation of shivering was less with group T (2.59±0.54 s) than with group K (7.77±1.13 s). The recurrence rate of shivering with group T was significantly less (8.3%) as compared to group K (58.3%) with comparable hemodynamic parameters. No adverse effects were seen in both groups except for sedation among some in the ketamine group.

Conclusions: Tramadol offers rapid onset and less recurrence rate of shivering with no sedation as a side effect when compared to ketamine. More studies of different dose ranges of the study drugs in different surgeries need to be conducted in order to cement its position as an efficient anti-shivering agent.

Metabolic risk in drug-resistant tuberculosis: prevalence of type 2 diabetes and its association with disease severity

Amita Mason — 2026-03-30

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a global health challenge, further complicated by the co-prevalence of Type 2 Diabetes Mellitus (T2DM), particularly in drug-resistant TB (DR-TB) cases. This dual burden worsens clinical severity, leads to poor treatment outcomes, and prolongs infectivity. This study assessed the prevalence of T2DM among DR-TB patients and evaluated clinical-radiological correlations, alongside the relationship between HbA1c and 7-point glucose profiles.

Methods: A cross-sectional study of 104 microbiologically confirmed DR-TB patients. Diabetes was diagnosed using ADA criteria. Demographics, clinical features, radiology, HbA1c, and 7-point glucose profiles were analyzed.

Results: T2DM prevalence was 41.3% in DR-TB patients, with significant associations found between T2DM, older age, and higher BMI. Radiological abnormalities included infiltrates (32.7% upper, 32.7% middle zones), consolidation (30.8%), and cavities (20.2%). No significant association was found between diabetes and radiographic extent (p> 0.05). HbA1c demonstrated a strong positive correlation with mean 7-point glucose values (r=0.579; p=0.03).

Conclusions: T2DM is highly prevalent among DR-TB patients. Routine screening and integrated TB–diabetes care are essential. HbA1c remains reliable for diagnosis and monitoring even during active TB disease.

Prevalence of extended spectrum beta lactamases and Metallo beta lactamases among Escherichia coli isolates in a tertiary care hospital, Thiruvananthapuram

Thuhina P. — 2026-03-30

Background: Antimicrobial resistance in Escherichia coli, particularly due to extended-spectrum β-lactamases (ESBL), Amp C β-lactamases, and Metallo-β-lactamases (MBL), poses a major therapeutic challenge. This study aimed to determine the prevalence of these resistance mechanisms among clinical E. coli isolates and to assess their antibiotic susceptibility patterns.

Methods: A hospital-based cross-sectional study was conducted on 130 non-duplicate E. coli isolates obtained from urine, blood, sterile body fluids, and aspirates over six months in a tertiary care hospital in south India. Identification was performed using standard microbiological techniques. Antimicrobial susceptibility testing was carried out by Kirby-Bauer disc diffusion following CLSI guidelines. ESBL, Amp C, and MBL production was detected using phenotypic screening and confirmatory disc synergy tests.

Results: ESBL production was detected in 67 (51.5%) isolates, MBL in 9 (7%), and AmpC in 6 (4.6%). Co-production of ESBL and MBL was observed in 2 (1.5%) isolates, while no isolate produced all three enzymes. The highest resistance was observed to ampicillin (96.1%), ceftriaxone (91.5%), and ciprofloxacin (77.6%). Colistin (100%) and tigecycline (98.4%) showed the highest susceptibility. ESBL-producing isolates were most susceptible to colistin (100%), tigecycline (97%), and carbapenems (68-73%), whereas MBL producers retained susceptibility mainly to colistin and tigecycline.

Conclusions: The high prevalence of ESBL-producing E. coli and the emergence of MBL producers underscore the urgent need for continuous surveillance, rational antibiotic use, and strengthened antimicrobial stewardship programs to limit the spread of multidrug-resistant organisms.

Metabolic cardiovascular risk profiles: a comparative study of khat-chewing and non-chewing women using hormonal contraception in Dhamar District, Yemen

Amat Al-Qader F. Al-Anesi — 2026-03-30

Background: The concurrent use of khat (Catha edulis) and hormonal contraceptives (HC) is common among Yemeni women, yet its combined effect on novel metabolic cardiovascular risk markers is poorly understood. This study compared the impact of khat chewing on serum homocysteine (Hcy), c-reactive protein (CRP), the atherogenic index of plasma (AIP), and lipid profiles in HC.

Methods: A comparative cross-sectional study was conducted in Dhamar District, Yemen. One hundred women using HC were divided into 50 khat chewers and 50 non-chewers. Fasting blood samples were analyzed for Hcy, CRP, and lipid profiles, with calculation of AIP and (TC/HDL, LDL/HDL) ratios.

Results: Khat-chewing women exhibited a significantly more adverse metabolic profile. Key findings included elevated diastolic blood pressure (75.80±12.14 versus 68.40±11.13 mmHg, p=0.002), higher homocysteine (7.81±2.55 versus 6.77±2.53 µmol/l, p=0.04), elevated CRP (4.88±1.25 versus 4.26±1.32 mg/l, p=0.01), lower HDL-C (46.58±8.06 versus 49.96±8.35 mg/dl, p=0.04), higher triglycerides (159.99±41.44 versus 141.17±19.58 mg/dl, p=0.005), and a substantially higher AIP (0.38±0.12 versus 0.30±0.094, p<0.001). A dose-response relationship was observed, with heavy use linked to greater disturbances. A significant interaction was found between khat and contraceptive type on atherogenic ratios.

Conclusions: Among Yemeni women using hormonal contraception, khat chewing is a significant risk factor for an adverse cardiovascular profile, including hypertension, a pro-inflammatory and pro-thrombotic state, and atherogenic dyslipidemia. The harmful metabolic effects of khat were found to be modified by the type of contraceptive used. These effects also intensify with chewing duration, underscoring the critical need for targeted screening and personalized contraceptive counselling for khat-using women.

Observational study of IAC Yokohama reporting system of breast cytology along with histopathological correlation at tertiary care hospital

Jahnavi N. Rana — 2026-03-30

Background: The International Academy of Cytology (IAC) Yokohama system categorizes FNAC reports into five clearly defined categories with each category is associated with an estimated Risk of Malignancy (ROM) and corresponding clinical management guidelines. The present study is undertaken to evaluate and categorise breast FNAC lesions and correlate these findings with subsequent histopathological diagnoses to assess the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM of FNAC under the IAC Yokohama reporting framework.

Methods: Total 322 cases of cytologically diagnosed breast lesions were included in this observational cross-sectional study at Department of Pathology, Government Medical College, Majuragate, Surat, Gujarat during the period from January 2023 to June 2024 and correlated with corresponding paraffin-embedded sections, where applicable and biopsy follow up was available.

Results: ROM was highest in Category 4 and Category 5 category (100%), followed by Category 3 (60%) and Category 2 (0%). In present study, sensitivity was 100%, specificity was 96.49%, positive predictive value (PPV) was 93.55% negative predictive value (NPV) was 100% and Diagnostic Accuracy was 97.33%, evaluated by considering cases with category of Atypical (C3), Suspicious of Malignancy (C4) and Malignant (C5) as positive in cytological screening test.

Conclusions: IAC Yokohama System represents a simple system that allows greater diagnostic clarity and, consequently, better communication between pathologists and treating clinicians, with clear benefits for patient management.

Epidemiology, clinicopathological profile, treatment patterns and survival outcomes of non-Hodgkin lymphoma: a 10-year single-institution retrospective study

Dorafiona Swer — 2026-03-30

Background: Non-Hodgkin lymphoma (NHL) is a heterogeneous group of malignancies with wide variation in clinical presentation and outcomes. Data from resource-limited settings on clinicopathological characteristics, treatment patterns, and outcomes remain limited.

Methods: This retrospective study included 692 patients with histologically confirmed NHL treated at a tertiary government hospital over a 10-year period. Demographic details, clinicopathological features, treatment modalities, and outcomes were extracted from medical records and radiotherapy registers using a predefined data collection form. Analyses were performed using descriptive statistics based on available data without imputation.

Results: The median age at diagnosis was 55.5 years, with a male predominance (male-to-female ratio ~1.2:1). Diffuse large B-cell lymphoma was the most common histological subtype, accounting for 56.3% of patients with documented histology. Ann Arbor staging was available in 422 patients, of whom 67.3% presented with advanced-stage disease (stage III–IV). Chemotherapy was administered in 60.1% of patients, predominantly using CHOP-based regimens. Radiotherapy was delivered with radical or consolidative intent in a substantial proportion of patients, while others received palliative radiotherapy. At last follow-up, 16.8% of patients were alive, 20.1% had died, and a significant proportion were lost to follow-up or had undocumented survival status. Kaplan-Meier survival analysis was not performed due to inconsistent documentation of follow-up dates.

Conclusions: This large single-institution study demonstrates a high burden of advanced-stage NHL at presentation in a low-resource setting, with diffuse large B-cell lymphoma as the predominant subtype. Outcomes were influenced by delayed presentation, limited access to targeted therapies, and substantial loss to follow-up. Strengthening early diagnosis, access to comprehensive oncologic care, and follow-up systems is essential to improve outcomes in similar settings.

Clinical bacterial isolates and antibiotic susceptibility patterns in surgical site infections among gyneoncology patients at a government cancer hospital

Shailesh M. Salve — 2026-03-30

Background: Surgical site infections (SSIs) are a significant cause of morbidity in gyne-oncology patients due to immunosuppression, complex surgeries, and cancer-related treatments. These infections are often polymicrobial, involving both gram-positive and gram-negative organisms with biofilm formation contributing to treatment resistance. SSIs prolong hospitalization, delay cancer therapy, and increase healthcare costs. Understanding the bacterial profile and antibiotic susceptibility pattern of SSIs in gyne-oncology patients is essential to guide effective antimicrobial therapy and improve surgical and oncologic outcomes.

Methods: The study was carried out in the department of microbiology, Government Cancer Hospital during the period from January 2025 to December 2025. A total 100 samples from surgical sites from gyne-oncology were collected and processed for culture, identification as per standard recommended procedures and antibiotic susceptibility testing were carried out on isolates as per clinical laboratory standard institute (CLSI) guidelines.

Results: A total of 100 specimens were cultured, of which 53 showed bacterial growth. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus species were the most commonly isolated organisms. A high level of resistance to multiple antibiotics was observed among both Gram-negative and Gram-positive bacteria.

Conclusions: The present study highlighted the microbiological pattern of isolates in gyne-oncology patients. There is a clear need for ongoing monitoring of multidrug-resistant organisms (MDROs), along with the development of appropriate antimicrobial treatment strategies and the strengthening of antibiotic stewardship initiatives.

Efficacy of an ayurvedic therapeutic protocol in the management of gridhrasi/sciatica: a prospective open-label clinical study

Nitesh Kumar Kaser — 2026-03-30

Background: Sciatica is a common neuromusculoskeletal disorder characterized by radiating pain along the sciatic nerve, often accompanied by functional disability and impairment of quality of life. Sciatica has been described in Ayurveda under a similar condition known as gridhrasi, which is classified as a severe vatavyadhi and mahagada. The widespread conventional analgesic use has suboptimal long-term results, and hence, there is a need to find complementary therapeutic interventions. This study was done to evaluate the clinical efficacy of an Ayurvedic treatment, namely vatanashini vati, kati basti with vishnu taila, and patra pinda sweda, in patients diagnosed with gridhrasi (sciatica).

Methods: This open-label, prospective clinical study enlisted 30 patients diagnosed with gridhrasi (sciatica), recruited from the Government Ayurvedic hospital. Patients were administered oral medication vatanashini vati and external therapies for two months. Outcome measures included subjective symptoms like pain, pricking sensation, stiffness, tingling, and functional parameters, such as the Straight Leg Raising test and gait. The Wilcoxon signed-rank test was used for statistical analysis.

Results: All the assessed parameters showed a statistically significant posttreatment improvement, p<0.001. Pain intensity, stiffness, and paresthesia were considerably reduced, and functional mobility improved in the majority of treated patients. No serious adverse events were reported.

Conclusions: The studied Ayurvedic protocol has shown promising symptomatic and functional improvement in patients with gridhrasi (sciatica). These results indicate a role of Ayurveda-based interventions as possibly safe and effective complementary intervention strategies in sciatica management. Larger trials are needed.

Type 2 diabetes risk among families of diabetic individuals in Kerala: a community-based study

Sabari Aparna — 2026-03-30

Background: Family members of individuals with type 2 diabetes mellitus (T2DM) are at increased risk of developing diabetes due to shared genetic predisposition and lifestyle factors. Early identification of high-risk individuals using simple screening tools can facilitate timely preventive interventions. Objectives were to assess the risk of type 2 diabetes among first-degree family members of persons with diabetes using the Indian diabetes risk score (IDRS) and to describe associated sociodemographic and lifestyle characteristics.

Methods: A community-based cross-sectional study was conducted among 100 first-degree family members of persons with diabetes from selected urban and rural areas of Kerala. Data were collected using a pre-tested structured questionnaire capturing sociodemographic variables, physical activity, and family history of diabetes. Waist circumference was measured using standard procedures. Diabetes risk was assessed using the IDRS. Data were analysed using descriptive statistics and are presented as frequencies, percentages, means, and standard deviations.

Results: Among the participants, 54% were classified as having moderate risk and 26% as having high risk for developing diabetes according to IDRS. Higher risk scores were more frequently observed among older age groups, females, individuals with sedentary lifestyles, and those with increased waist circumference. Participants residing in urban areas and those belonging to higher socioeconomic strata showed a higher proportion of high-risk scores.

Conclusions: A substantial proportion of first-degree relatives of persons with diabetes were found to be at moderate to high risk of developing T2DM. Community-based screening using the IDRS is a feasible and cost-effective approach for early identification of high-risk individuals and for guiding targeted lifestyle modification strategies.

A study on the etiology and clinical profile of patients presenting with inflammatory arthritis in a tertiary care hospital, Bhilai, Chhattisgarh

Prarthana M. Suryavamshi — 2026-03-30

Background: Inflammatory arthritis encompasses a range of autoimmune conditions that significantly impact patients’ quality of life. This study aimed to analyse the demographic characteristics, clinical presentations, laboratory findings, and disease patterns in patients diagnosed with inflammatory arthritis.

Methods: This was a prospective observational study involving 200 patients diagnosed with inflammatory arthritis The study was conducted in the department of medicine, Jawaharlal Nehru Hospital and Research Center, Bhilai, Chhattisgarhat a tertiary centre. The patients were clinically evaluated by detailed history in the form of a questionnaire and thorough general, systemic and musculoskeletal examination and underwent laboratory investigations to establish the etiology. Statistical analysis was done using SPSS program.

Results: Rheumatoid arthritis was the most prevalent condition (59.5%), followed by SLE (14%), Sjögren’s syndrome (6.5%), mixed connective tissue disease (6%), and ankylosing spondylitis (5.5%). Most patients were in the age group of 41-50 years (35%), with a female predominance (87.5%). The most common symptoms included joint pain (89%) and morning stiffness (89%). Laboratory findings revealed that 66.50% of patients had a positive ESR and 22.5% had a positive CRP. Among patients with rheumatoid arthritis, the most common extra-articular manifestation was anemia (57.98%).

Conclusions: Rheumatoid arthritis emerged as the most common type of inflammatory arthritis, followed by SLE predominantly affecting middle-aged females. Early diagnosis and appropriate management strategies, including lifestyle modifications and targeted therapies, are essential to improving patient outcomes. Increased awareness and early screening programs can help in the timely identification and treatment of these conditions.

Enhancing batting skills in young female cricketers via simulator

Catherine Shalini Raja — 2026-03-30

Background: This research explored the potential of an advanced cricket simulator- integrating cutting-edge technology- to transform traditional training methods for young female cricket players. The system features an LED-based display for realistic bowler animations, a programmable bowling machine, and a machine vision replay for detailed feedback. This setup creates an immersive, data-rich environment that sharpens batsmen’s timing, anticipation, and decision-making through lifelike simulations of real bowlers. The primary aim was to evaluate the effectiveness of this individualized digital simulator, combined with performance and fitness analytics, in boosting batting skills among young female athletes. Specific objectives included enhancing key fitness metrics: reaction time, shot perfection, and footwork efficiency.

Methods: Thirty college-level female cricket players, aged 18-22 from the Coimbatore region, met the inclusion criteria and participated. The simulator quantitatively assessed reaction time, shot perfection, and footwork efficiency. Participants underwent pre-testing before a 4-week matrix training protocol, followed by post-testing to measure improvements.

Results: Post-intervention data showed significant gains across all parameters. The matrix training protocol delivered outstanding enhancements in reaction time, shot perfection, and footwork efficiency for all 30 players.

Conclusions: The individualized advanced digital cricket simulator, with its integrated performance and fitness analysis, markedly improved batting skills, reaction time, footwork efficiency, and shot perfection in young female cricket players. Additionally, it boosted players’ speed and dynamic balance, offering a promising tool for optimized training.

A multicenter and post-marketing surveillance study to evaluate the safety and effectiveness of a sodium alginate-based raft-forming antacid oral suspension in Indian patients with heartburn and indigestion

S. R. Ramakrishnan — 2026-03-30

Background: This study evaluated the safety and effectiveness of a sodium alginate-based raft-forming antacid oral suspension in Indian patients with heartburn and indigestion.

Methods: This multicenter post-marketing surveillance study, conducted across five centers in India, included adult patients with heartburn and indigestion prescribed a sodium alginate-based antacid suspension (10-20 ml after meals and at bedtime) for 7 days. Patients were evaluated on day 8 (±2). Effectiveness was assessed by adequate symptom relief, improvement in RDQ frequency and severity scores, reduction in symptom duration, and improvement in night-time symptoms. Safety was evaluated based on reported adverse drug reactions and global tolerability assessments by patients and investigators.

Results: Of 319 enrolled patients, 297 completed the study. After 7 days, adequate relief was reported by 95.6% for heartburn and 96.6% for indigestion. RDQ frequency and severity scores significantly improved (both ~74-76% reduction; p<0.0001), with marked reductions in daily symptom duration and nighttime episodes. Only one non-serious, unrelated ADR was reported, and tolerability was rated “good” by ~90% of patients and investigators.

Conclusions: The sodium alginate-based raft-forming antacid oral suspension provided effective relief of heartburn and indigestion, reflected by greater than 95% adequate relief rates, over 74% reductions in RDQ scores and marked decreases in symptom duration, with an acceptable safety and tolerability profile during the course of the study.

Spatial mapping and analysis of anaemia cases in Gadag district, Karnataka: a GIS-based study

Duragappa Nayak — 2026-03-30

Background: Anaemia is one of the chronic public health problems in India and it is associated with inequities in healthcare service, nutrition status and socioeconomic status. Knowledge of geographic distribution of anemia can help for the identification of high-risk areas, where focused interventions can be implemented. This study aimed to map and analyse the spatial distribution, clustering patterns and hotspots of laboratory confirmed anaemia cases in the Gadag District.

Methods: A retrospective cross-sectional study on 4,040 cases of laboratory-confirmed anaemia has been carried out using secondary data. Spatial clustering was analysed using the average nearest neighbour (ANN) test; Global and Local Moran's I tested for spatial autocorrelation along with hotspots and cold areas of anaemia patients.

Results: Significant clustering was detected by the ANN test (p<0.001). Different hotspots were identified by using Local Moran's I and Getis-Ord Gi tools mainly in the Shirahatti, Laxmeshwar and Mundargi taluks, whereas Global Moran's I did not detect any significant autocorrelation.

Conclusions: The spatial distribution of anaemia in the Gadag District is non-random, spatially heterogeneous, with well-defined hotspot zones. The use of GIS based surveillance at district level planning will help in early detection and targeted management of anemia.

Optimizing neonatal care: streamlined positive blood culture reporting via laboratory automation with BacT/ALERT 3D

Premjith Lal U. A. — 2026-03-30

Background: Sepsis presents a potentially life-threatening medical condition marked by a systemic inflammatory response throughout the body, triggered by various pathogenic organisms found in the bloodstream. Neonatal sepsis stands as the third primary contributor to neonatal mortality. Blood culture methods have evolved significantly from conventional techniques involving bottles of nutrient broths cultured in incubator and subsequent subculture based on visual assessments to modern automated systems. These automated instruments, which are continuously monitored and enhanced the efficiency of blood cultures. One of the widely employed blood culture systems in numerous diagnostic microbiology laboratories is the BacT/ALERT 3D system developed by BioMérieux Inc.

Methods: This is a hospital-based observational study we were trying to evaluate the time to positivity (TTP), identification and antimicrobial susceptibility patterns of causative organism in blood culture. One thirty-nine matched pairs of blood cultures from neonates were evaluated by the BacT/ALERT 3D system.

Results: Out of 139 blood samples that were processed 40 (28.77%) were positive. The median time to detection in the BacT/ALERT 3D system for isolates was found to be on an average of 11.8 hours in our study. Gram-negative isolates were found most common cause of sepsis, accounting for 75%, compared to gram-positive isolates, which accounted for 25%. Among the identified isolates, Klebsiella pneumoniae and Escherichia coli were the most prevalent, responsible for 25% each.

Conclusions: Neonatal septicemia poses a life-threatening emergency. The BacT/ALERT 3D system is more sensitive, rapid, higher efficiency in detecting prevalent bloodstream pathogens.

PNF stretching and its immediate impact on hamstring flexibility and agility

Royline Fathima Pinto — 2026-03-30

Background: Hamstring muscle is the most common muscle that goes into tightness due to changes in the active lifestyle. Hamstring tightness in college students can result from a combination of factors, including prolonged periods of sitting during lectures and study sessions, insufficient physical activity, poor posture. Hamstring tautness is often an indicator of muscle weakness, which may affect the performance. The aim of the study was to assess the immediate effects of PNF stretching on hamstring flexibility and agility in lower extremity.

Methods: This study was conducted at Tejasvini Physiotherapy College. The participants recruited were students from the college aged between 18-25 years both male (n=30) and females (n=30). The hamstring flexibility was checked using active knee extension test in pre and post-test and the performance was assessed by using agility test (t-test and Illinois test). In post-test PNF contract relax agonist contract (CRAC) stretch was given to all the participants and their performance was rechecked. Data were analysed by SPSS 16.0 and the effect of pre and post PNF contract relax agonist contract was estimated by using paired t-test.

Results: Using paired t-test, the PNF CRAC stretch made an average of hamstring flexibility of 8.3 and 8.0 in right and left of males, 8.0 and 9.0 in right and left of females. Following the intervention, the agility t-test and Illinois test shows a 0.4 and 0.5 in males and 0.5 and 0.6 in females.

Conclusions: The current study showed a statistically significant improvement in hamstring flexibility scores of agility test following PNF CRAC stretch.

A cross-sectional study on stigma among people living with HIV attending anti-retroviral therapy center in Jaya Arogya Group of Hospital, Gwalior, Madhya Pradesh

Sourav Mandal — 2026-03-30

Background: AIDS stigma exists in a variety of ways, including ostracism, rejection, discrimination, and avoidance of HIV-infected people. Some people are rejected by family and community, whereas others face poor treatment in healthcare and educational settings, erosion of their rights, and psychologic damage. All these limit access to HIV testing, treatment, and other HIV services.

Methods: A hospital-based cross-sectional design conducted over a twelve-month period. The study focused on 380 HIV-positive participants within the 25 to 35 years of age. Assessments were performed using a structured questionnaire and the Berger stigma scale to access the overall stigma. Data were analysed using SPSS v27, with p<0.05 considered significant.

Results: Out of 380 participants, 135 (35.5%) reported mild levels of stigma, 116 (30.5%) experienced moderate levels, while 129 (34.0%) reported severe stigma.

Conclusions: Stigma remains a pervasive and significant challenge for PLHIV. Among the subscales of the Berger stigma scale, public attitude stigma registered the highest mean score (45.62±10.41), indicating that external societal prejudice and misconceptions are more dominant than internalized shame or disclosure concerns.

Vitamin D3 status in pre-menopausal and post-menopausal type 2 diabetes mellitus women

Jessica Maurya — 2026-03-30

Background: Type 2 diabetes mellitus (T2DM) is a metabolic condition that arises from either total or partial deficiency of insulin. It is a multifactorial disorder characterised by abnormal glucose metabolism, persistent high blood glucose levels, and altered insulin release. Recent study suggest that vitamin D may play a protective role against malignancies, cardiovascular conditions, diabetes, osteoporosis, and various other bone-related diseases. Numerous studies have highlighted a high prevalence of vitamin D deficiency among postmenopausal women, with some suggesting an association with diabetes and metabolic syndrome. Therefore, we aim to assess serum vitamin D₃ status in T2DM pre-menopausal and post-menopausal women.

Methods: We conducted a cross-sectional study with 104 T2DM pre-menopausal and 104 T2DM post-menopausal women visiting the OPD of Obstetrics and Gynecology. Study population age ranging between 25 to 70 years were recruited and biochemical analysis was done.

Results: Mean age (mean±SD) of pre-menopausal and post-menopausal women was recorded as 33.03±5.89 years, and 57.23±8.72 years, respectively. Fasting blood glucose levels in pre-menopausal and post-menopausal women were 199.89±61.69 and 195.09±68.85, respectively, similarly HbA1c values in pre-menopausal and post-menopausal women were 8.70±2.01 and 8.63±2.23, respectively. Serum vitamin D₃ levels (mean±SD) were recorded as 43.64±17.91 and 37.08±16.26 in pre-menopausal and post-menopausal women, respectively. A statistically significant (p<0.002) decrease in serum vitamin D₃ level was found in post-menopausal women as compared to pre-menopausal women.

Conclusions: Results of our study shows statistically significant decrease in serum vitamin D₃ levels in post-menopausal T2DM women as compared to pre-menopausal T2DM women.

Relative adrenal insufficiency in non-critically ill liver cirrhosis

Dipen Agarwal — 2026-03-30

Background: Endocrinopathy like adrenal insufficiency (AI) is being increasingly recognised in patients with liver cirrhosis. It is characterized by a relative decrease in serum cortisol level with respect to increasing stress as occurs in sepsis & has been associated with increased morbidity and mortality. This study aimed to find the prevalence of Adrenal insufficiency and low HDL in non-critically ill chronic liver disease (CLD) patients i.e. patients without sepsis, bleed or dehydration.

Methodology: A cross-sectional study including 100 non-critically ill CLD patients aged 20 -80 years. Model for end stage liver disease (MELD) scores and the Child Turcotte Pugh scores (CTP) were used to assess the severity of liver disease. Basal cortisol level was measured & after one hour of short synacthen test (SST), peak and delta cortisol levels were measured in order to assess adrenal function. Biochemical parameters including HDL levels were also assayed.

Results: This study included 76 male and 24 female CLD patients. Prevalence of AI was highest in females of age 41-60 years. Alcohol (61%) was the most common etiology, followed by MASLD and HBV. Prevalence of AI was 55.6%, 60.5% and 65.9% in CTP class A, B and C respectively. Prevalence of AI in the high MELD (>15) group was 66.7% and 50% in the low MELD (<14) group. Low HDL and AI were reported in CTP classes B and C.

Conclusion: Adrenal insufficiency is common in patients with non-critically ill chronic liver disease; which increases with severity of disease; and whose HDL levels are low.

Correlation between HbA1c and high sensitivity C-reactive protein in type 2 diabetes mellitus patients: a cross-sectional study at tertiary care hospital in western Rajasthan

Nitasha Sharma — 2026-03-30

Background: Type 2 diabetes mellitus (T2DM) is associated with chronic low-grade inflammation, increasing cardiovascular risk. High-sensitivity C-reactive protein (HSCRP) is a reliable inflammatory biomarker. This study aimed to evaluate the correlation between HbA1c and HSCRP and its association with lipid profile in T2DM patients.

Methods: This cross-sectional study was conducted at Government Medical College and Bangur Hospital, Pali, Rajasthan, over one year. A total of 123 patients aged 18-75 years with T2DM were included. Patients were categorized into controlled (HbA1c<7.5%) and uncontrolled (HbA1c≥7.5%) groups. HbA1c, HSCRP, and lipid profile were measured using standard laboratory methods. Statistical analysis was performed using SPSS version 25, and Pearson’s correlation was applied.

Results: Among 123 patients, 50.4% had controlled and 49.6% had uncontrolled diabetes. Mean HSCRP levels were significantly higher in the uncontrolled group (4.86±2.37 mg/L vs 2.63±0.43 mg/L; p<0.001). Uncontrolled diabetes was associated with significantly higher total cholesterol and triglycerides and lower HDL levels (p<0.001). A strong positive correlation was observed between HSCRP and HbA1c (r=0.961, p<0.001), triglycerides (r=0.889), and total cholesterol (r=0.731), while a negative correlation was seen with HDL (r=−0.827).

Conclusions: Poor glycemic control is strongly associated with increased systemic inflammation and adverse lipid profile. HSCRP can serve as an important marker for cardiovascular risk assessment in T2DM patients.

Comparison of exercise induced bronchospasm using peak expiratory flow rate in obese and non-obese young females

Siddhi Sunil Pagar — 2026-03-30

Background: Obesity significantly alters respiratory mechanics, increasing susceptibility to Exercise-Induced Bronchospasm (EIB) a reversible airway constriction during or after physical activity which often limits exercise participation. This study aimed to compare EIB prevalence and severity using Peak Expiratory Flow Rate (PEFR) between obese and non-obese young females.

Methods: This comparative experimental study involved 60 female participants (age >19 years), divided into two cohorts based on Body Mass Index (BMI): Group A (Obese, n=30) and Group B (Non-obese, n=30). Pulmonary function was measured via PEFR at baseline and immediately following a standardized 400-meter run to identify airway obstruction consistent with EIB.

Results: Post-exercise, the obese group exhibited a substantial decline in lung function, with mean PEFR dropping from 373.1 L/min to 342 L/min (an 8.3% decrease). Conversely, the non-obese group showed minimal change, moving from 388.8 L/min to 375.2 L/min (a 3.5% decrease). Notably, 40% of obese participants met the diagnostic criteria for EIB, compared to only 10% of the non-obese cohort.

Conclusions: EIB is significantly more prevalent and severe in obese young females. These findings suggest that respiratory symptoms often attributed to general deconditioning in obese individuals may actually stem from underlying EIB. Addressing this airway hyper-responsiveness is crucial for improving physical activity tolerance in this population.

Maternal risk factors among antenatal women in relation to socio-demographic, clinical and lifestyle factors: a community-based cross-sectional study

Ashwini L. H. — 2026-03-30

Background: Maternal risk factors such as anemia, hypertension, diabetes and abnormal body mass index (BMI) remain major contributors to adverse pregnancy outcomes in India. Early identification of these conditions through community-based antenatal screening is essential for timely intervention. Objectives were to identify maternal risk factors among antenatal women and to compare women with and without complications based on socio-demographic, clinical and lifestyle factors.

Methods: A community-based cross-sectional study was conducted using routinely collected data from a one-day antenatal care camp held at an Urban Primary Health Centre (UPHC), Buddhanagara. All pregnant women attending the camp with complete records were included by universal sampling. Socio-demographic variables were compared between women with and without maternal risk factors such as anemia, hypertension, diabetes and abnormal body mass index (BMI). Data were analyzed using descriptive statistics and Chi-square test.

Results: A total of 61 antenatal women were included. The prevalence of anemia, hypertension, diabetes and abnormal BMI was 85.2%, 6.6%, 8.2% and 77.0% respectively. Maternal risk factors were significantly associated with increasing age, lower educational status, unemployment and higher parity. Women with identified complications were more likely to require referral to higher health facilities.

Conclusion: Maternal risk factors were common among antenatal women and showed significant association with socio-demographic characteristics. Community-based antenatal screening camps play a crucial role in early detection and referral of high-risk pregnancies.

Prospective study of bacteriological profile of indoor patient of respiratory diseases at tertiary care centre

Abhishek Chandra — 2026-03-30

Background: Respiratory tract infections (RTIs) are a major cause of morbidity among hospitalized patients and are frequently associated with bacterial pathogens and antimicrobial resistance. Knowledge of the local bacteriological profile and antibiotic susceptibility pattern is essential for guiding appropriate empirical therapy and improving clinical outcomes.

Methods: This prospective observational study was conducted over a period of one year from 20 January 2025 to 30 December 2025 at Rajarshi Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh. A total of 102 indoor patients admitted with respiratory diseases were included. Respiratory samples, predominantly sputum, were collected and processed using standard microbiological techniques. Bacterial isolates were identified, and antibiotic susceptibility testing was performed. Data were analysed using the descriptive statistics and expressed as frequencies and the percentages.

Results: Among the 102 patients studied, males constituted the majority. Gram-negative organisms were predominantly isolated. E. coli was the most common organism, followed by K. pneumoniae and P. aeruginosa. Most isolates showed higher sensitivity to broad-spectrum antibiotics such as carbapenems, aminoglycosides, and higher-generation cephalosporins, while resistance to commonly used first-line antibiotics was observed in several cases.

Conclusions: Gram-negative bacteria were the predominant pathogens among indoor patients with respiratory diseases. Regular monitoring of bacteriological patterns and antibiotic susceptibility is essential to guide rational antibiotic therapy and to curb the growing problem of antimicrobial resistance in tertiary care settings.

Clinical outcomes of neoadjuvant dual HER2 blockade with pertuzumab/Sigrima and trastuzumab/Vivitra biosimilars: real-world evidence in HER2-positive breast cancer in India

Priya Mehta — 2026-03-30

Background: HER2-positive breast cancer is an aggressive subtype with a high risk of recurrence. Neoadjuvant chemotherapy (NACT) combined with dual HER2 blockade improves pathological complete response (pCR) rates in clinical trials; however, real-world evidence on biosimilars Sigrima™ and Vivitra™ in India remains limited.

Methods: This retrospective study analysed 571 HER2-positive breast cancer patients enrolled in the ANAYA Care programme. All patients received dual HER2 blockade with Sigrima™ (petuzumab biosimilar) and Vivitra™ (trastuzumab biosimilar), with 495 undergoing NACT. Data on demographics, disease stage, treatment setting, financial assistance, pCR outcomes, and adverse events were collected. pCR was evaluable in 242 patients.

Results: Most patients were aged 46-60 years, with stage II disease being most common, followed by stage III and stage I. The majority were treated in private hospitals, with additional representation from government and trust centres. Financial assistance supported chemotherapy access in 194 patients. Among evaluable patients, 182 achieved pCR, yielding a rate of 75.2%. Treatment was well tolerated, with ~90% reporting no adverse events. Observed toxicities were primarily mild to moderate, including nausea, fatigue, stomatitis, cytopenias, and liver enzyme abnormalities; serious events were rare.

Conclusions: Dual HER2 blockade with Sigrima™ and Vivitra™ demonstrated high efficacy and favourable tolerability in this real-world Indian cohort. These findings support their use as a practical and effective neoadjuvant treatment option in routine clinical practice.

A comparative study of honey-betadine dressing and paraffin gauze dressing on skin graft donor site

Bhargavi V. Voorakalli — 2026-03-30

Background: Honey has long been used in Indian medicine for its anti-inflammatory, antibacterial and wound-healing properties. Split-thickness skin grafting is a common reconstructive method in surgery, yet there is no universally accepted, standardized dressing for donor sites that is simple, affordable and effective. This study evaluates honey as a donor site dressing to establish scientific evidence for its benefits.

Methods: A prospective randomized controlled trial was conducted at MGM Hospital, Navi Mumbai, from April 2025 to September 2025. Postoperative patients undergoing split-thickness skin grafting for healed ulcers were allocated into two groups: honey–betadine dressing or paraffin gauze dressing at the donor site.

Results: In the honey–betadine group, complete epithelialization occurred in 60% by day 7, 26.6% by day 10 and 6.6% by day 14. In contrast, only 33.3% of the paraffin gauze group healed by day 10, with 73.3% achieving complete healing by day 14 or later. Pain assessment revealed that in the honey–betadine group, 73.3% reported only mild or moderate pain, compared with 26.6% in the paraffin gauze group, where higher proportions experienced severe or very severe pain.

Conclusions: An ideal donor site dressing should be readily available, cost-effective, hydrating, antibacterial, infection-preventive, and promote rapid healing with minimal discomfort. Honey fulfils these criteria, demonstrating faster epithelialization, better pain outcomes and improved patient comfort compared with paraffin gauze.

Effectiveness of demonstration-based breastfeeding technique on breastfeeding performance among postnatal women: a pilot study

Preety Alagh — 2026-03-30

Background: Breastfeeding is a key strategy for promoting child health and survival. Proper positioning and effective attachment are essential for successful exclusive breastfeeding, as they ensure efficient milk transfer and prevent common breastfeeding problems. Therefore, this randomized controlled pilot study evaluated the effect of demonstration-based breastfeeding technique on breastfeeding performance among postnatal women.

Methods: After receiving ethical clearance, 180 antenatal women participated in this single-blind trial. Random allocation of antenatal women was carried out using computer-generated random code numbers after meeting inclusion and exclusion criteria. In the study, antenatal women allocated to the intervention group received a structured demonstration on breastfeeding techniques, supplemented with an informational brochure at 37 weeks of gestation, whereas the control group received standard care with no additional intervention. Breastfeeding performance was assessed on the third postnatal day by using a standardized bristol breastfeeding tool among the intervention and control group. Descriptive and inferential statistics were used to analyze the data.

Results: A statistically significant difference in mean breastfeeding performance score was observed between the intervention and control group, indicating that structured demonstration of breastfeeding technique improved breastfeeding performance during the postnatal period.

Conclusions: The findings highlight the value of practical breastfeeding education in enhancing breastfeeding technique, which may contribute to a significant reduction in lactation failure and minimize problems related to breastfeeding.

Acute autoimmune hemolytic anemia with transient aplastic crisis likely triggered by Parvovirus B19 infection in an adolescent: a case report

Wafa Manaf — 2026-03-07

Autoimmune hemolytic anemia (AIHA) is an uncommon but potentially life-threatening disorder characterized by immune-mediated destruction of red blood cells. Parvovirus B19 infection is a well-recognized cause of transient aplastic crisis due to suppression of erythroid precursors, and the simultaneous occurrence of immune hemolysis with marrow suppression presents a diagnostic challenge. We report the case of a 13-year-old boy who presented with fever, jaundice, and dark-colored urine. Laboratory evaluation revealed severe anemia (hemoglobin 5.5 g/dl), indirect hyperbilirubinemia, and a positive direct antiglobulin test confirming AIHA. Notably, the reticulocyte count was inappropriately low for the degree of hemolysis, suggesting transient marrow suppression. Extensive autoimmune and infectious investigations were largely negative except for equivocal parvovirus B19 IgM serology. The patient showed significant clinical and hematological improvement following packed red blood cell transfusion and corticosteroid therapy. This case highlights the importance of considering Parvovirus B19 infection in AIHA patients presenting with reticulocytopenia, as early recognition and appropriate supportive management are essential to prevent serious complications.

Unusual case of bladder hernia presenting with abdominal pain

Faisal S. Bhutta — 2026-03-30

Urinary bladder hernias are rare and often underdiagnosed causes of lower abdominal and groin pain with or without urinary symptoms, particularly in elderly men with urinary symptoms presenting in emergency departments. This case highlights the importance of recognizing bladder herniation as a differential diagnosis in the emergency department for such presentations particularly elderly men with vague lower abdominal pain with or without urinary symptoms. It could also present with or without lump in groin. This case is 39-year-old male presented with chronic lower abdominal and groin pain. Frequency of micturition ultimately diagnosed as an inguinal bladder hernia. Bladder involvement occurs in 1–4% of inguinal hernias, though preoperative diagnosis remains rare (≤7%) due to non-specific symptoms. This case underscores the importance of considering bladder herniation in patients with known hernias who develop urinary symptoms or persistent pain. Computed tomography (CT) cystogram confirmed the diagnosis, and open hernioplasty with mesh repair resolved symptoms without recurrence. Early recognition and tailored surgical intervention prevent complications like obstruction or strangulation.

Immediate radical cholecystectomy for suspected gallbladder cancer identified intraoperatively: a case report

Samantha Dennis Ordóñez-Hernández — 2026-03-30

Gallbladder cancer (GBC) is the most common malignancy of the biliary tract and is associated with poor prognosis due to its aggressive biological behavior and frequent diagnosis at advanced stages. Preoperative diagnosis remains challenging, and a significant proportion of cases are detected incidentally or suspected only during surgery performed for presumed benign gallbladder disease. For tumors staged T1b or higher, current international guidelines recommend radical cholecystectomy with hepatic resection of segments IVb and V and regional lymphadenectomy to achieve adequate oncological control. However, the optimal timing of extended resection when malignancy is suspected intraoperatively remains controversial. We report the case of a 78-year-old woman undergoing evaluation for gastroesophageal reflux disease in whom abdominal ultrasonography revealed a gallbladder fundal lesion suspicious for malignancy. Contrast-enhanced thoracoabdominopelvic computed tomography showed no evidence of distant metastases or invasion of adjacent structures. The patient was scheduled for laparoscopic cholecystectomy with the possibility of extended resection depending on intraoperative findings. During laparoscopy, macroscopic features highly suggestive of malignancy were identified, prompting conversion to open surgery and immediate radical cholecystectomy with non-anatomical resection of liver segments IVb and V and regional lymphadenectomy. Histopathological examination confirmed invasive biliary-type gallbladder adenocarcinoma staged as pT2N0M0 (stage IIA) with negative surgical margins (R0). The postoperative course was uneventful, and adjuvant systemic therapy was initiated. Immediate radical cholecystectomy during index surgery may represent a feasible and oncologically sound approach when GBC is suspected intraoperatively.

Kikuchi-Fujimoto disease: a two-case series of necrotizing histiocytic lymphadenitis mimicking other pathologies: a care compliant case report

Abhishek Reddy N. — 2026-03-30

Kikuchi-Fujimoto disease (KFD) is a rare, benign, and self-limiting cause of cervical lymphadenitis. It is often misdiagnosed as tuberculosis or lymphoma. A histopathological examination is crucial for a definitive diagnosis. We report two female patients with cervical lymphadenopathy. Case 1: A 67-year-old woman had a 3-week history of painful swelling in her right neck. Imaging and FNAC did not provide clear results. An excision biopsy showed necrotizing histiocytic lymphadenitis. Case 2: A 29-year-old woman had a 1-month history of painless swelling in her right neck and evening fever. Histopathology after an excision biopsy confirmed KFD. Both patients received conservative management with symptom relief and showed complete recovery. KFD should be included in the differential diagnosis of persistent cervical lymphadenopathy, especially in women, to prevent unnecessary treatment with antibiotics or cancer therapies.

Rare case report of ruptured splenic artery pseudoaneurysm: a complication of chronic pancreatitis

Santosh Kumar Pandey — 2026-03-30

Splenic artery pseudoaneurysm is a rare complication of chronic pancreatitis. It is a life-threatening complication that can be fatal if missed both clinically and radiologically. While the diagnosis of chronic pancreatitis is straight forward, identifying associated vascular complications like splenic artery pseudoaneurysm can be challenging, often leading to diagnostic dilemma. The same can result in fatal complications and delayed treatment, thus contributing to both morbidity and mortality. We present the case of 37-year-old male who presented to us with two weeks history of left upper abdominal pain in the background of chronic pancreatitis. The patient was managed conservatively using microcoil embolization and was discharged in stable condition. Our case report aims to highlight the importance of recognizing this infrequent complication of chronic pancreatitis in the setting of acute abdomen. The case report also emphasises the role of newer imaging techniques and interventions in its prompt diagnosis and management.

Tubercular thyroiditis: a case report

Santosh Kumar Pandey — 2026-03-30

Tuberculosis of the thyroid gland is a rare disease even in countries in which tuberculosis (TB) constitutes an endemic disorder. The diagnosis is often difficult as the clinical presentation has no distinct characteristics. We report a case of 29-year-old woman who presented following an eventful course over two weeks with a bilateral diffuse swelling of the thyroid gland. Ultrasonography disclosed colloid nodules with abscess over left neck region. Thyroid function tests were initially normal followed by phases of hyper and hypothyroidism in the absence of significant symptoms. There was no evidence of tuberculosis in any other organ. FNAC of abscess and thyroid parenchyma revealed necrotizing epithelioid granulomas with positive ZN staining for AFB. The diagnosis of thyroid tuberculosis was therefore made. The patient was put on Category II ATT with stormy but favourable outcome. Although rarely encountered, tuberculosis should be kept in mind in the differential diagnosis of nodular lesions of the thyroid in our country.

Pyomyositis caused by Salmonella enterica: a rare case report

B. Vijay Kumar — 2026-03-30

Pyomyositis is characterized as a primary bacterial infection of skeletal muscle, with Staphylococcus aureus being the most prevalent causative agent. In contrast, pyomyositis attributed to Salmonella enterica is an uncommon occurrence, typically observed in immunocompromised individuals, and often presents diagnostic challenges due to atypical laboratory findings. We report a such rare case involving an 82-year-old male who presented with severe bilateral thigh pain and difficulty in ambulation and a history of diabetes. He was admitted with provisional diagnosis of myositis. Laboratory evaluations indicated marked leukocytosis, elevated inflammatory markers, and hypoalbuminemia. These elevated inflamatory markers and MRI findings collectively suggested the possibility of pyomyositis with myonecrosis. Automated blood culture bactifast confirmed the presence of Salmonella enterica. In light of the diagnosis of pyomyositis caused by Salmonella enterica, prolonged intravenous antimicrobial therapy and supportive care were commenced. Following the appropriate administration of antibiotic treatment, the patient gradually exhibited symptomatic improvement and achieved hemodynamic stability. Early imaging and prompt initiation of aggressive antimicrobial therapy are essential for achieving favorable outcomes.

Case report on Mauriac syndrome-revisiting a rare complication of a common condition

Manan A. Salodkar — 2026-03-30

Mauriac syndrome is a rare complication of poorly controlled type 1 diabetes mellitus, characterized by growth retardation, hepatomegaly, delayed puberty, and cushingoid features. We describe a 9-year-old girl with long-standing diabetes and poor glycemic control who presented with short stature, abdominal distension and dyslipidemia, with imaging findings suggestive of glycogen accumulation. These features established the diagnosis of Mauriac syndrome; a condition infrequently encountered today due to advances in insulin therapy. However, the case underscores that this syndrome still occurs in settings with limited resources and suboptimal treatment adherence. Early recognition is crucial, as improved glycemic control can reverse most clinical and biochemical abnormalities. This case report emphasizes the need for vigilance in diabetic children with growth failure or delayed puberty, and highlights the importance of education, monitoring, and multidisciplinary care in prevention of complications.

Right subclavian artery injury along with right pleural injury-inadvertent complication of internal jugular vein catheterisation and its management

Kalyani Dnyaneshwar Aher — 2026-03-30

Internal jugular vein catheterization is a commonly performed and generally safe procedure; however, it may be associated with rare but potentially fatal complications. Common complications of internal jugular vein catheterization include arterial puncture (involving the carotid artery or subclavian artery), hematoma, pneumothorax, hemothorax, chylothorax (due to thoracic duct injury, especially with left internal jugular vein catheterization), and cardiac tamponade. This case highlights the successful management of a right hypertensive pleural effusion resulting from central venous catheter misplacement in the right pleural cavity, leading to hypovolemic shock and right subclavian artery injury-an extremely rare but serious complication of right internal jugular vein catheterization.

Contralateral obstructive uropathy unveils eosinophilic solid and cystic renal cell carcinoma: a typical yet rare entity with rare presentation

Sonal T. Raut — 2026-03-30

The World Health Organization (WHO) 2022 kidney tumour classification has introduced a novel and uncommon type of renal cell carcinoma (RCC) known as eosinophilic solid and cystic renal cell carcinoma (ESC-RCC). ESCRCC is an under‑recognized, emerging new entity of sporadic renal neoplasms, with an approximate incidence of 0.2% of renal tumours. Approximately 70 cases have been reported in the literature till date. ESCRCC are usually seen in adult females, with a low stage and indolent behaviour, and rare incidence of recurrence or metastasis. They typically have solid and cystic morphology with very characteristic microscopy of abundant eosinophilic cytoplasm and prominent basophilic granules. They consistently harbor TSC1 or TSC2 mutations in tumour which is a proposed molecular marker for this entity. We presented hereby a case study in 56-year female with symptoms of contralateral obstructive uropathy for which patient underwent radiology and found out this tumour in opposite kidney. Uncommon gross presentation of extensive subcapsular haemorrhage and advanced TNM stage was noted in our case.

Orbital cellulitis secondary to primary varicella zoster infection in a child: a rare but serious complication

Amal Prazad — 2026-03-30

Varicella zoster virus (VZV) infection is generally a self-limiting childhood illness; however, secondary bacterial complications may result in significant morbidity. Orbital cellulitis is a rare but vision-threatening complication of varicella, usually arising from bacterial superinfection following disruption of the cutaneous barrier. We report the case of a 7-year-old child who developed unilateral orbital cellulitis three days after the onset of primary varicella infection. Prompt recognition and aggressive combined antiviral and broad-spectrum intravenous antibiotic therapy resulted in complete clinical recovery. This case highlights the importance of early identification of red-flag symptoms in varicella and underscores the need for vigilant monitoring for invasive bacterial complications.

Rhabdomyolysis induced acute kidney injury after dengue infection

Pratim Sengupta — 2026-03-30

Rhabdomyolysis is the breakdown of striated skeletal muscle tissue, leading to the release of cellular elements such as myoglobin, creatine kinase, aldolase, lactate dehydrogenase, and electrolytes into the blood circulation. It’s usually caused by trauma or certain medications, but it can also happen during viral infections like dengue fever, though this is rare and serious. We describe a case of a 33-year-old man with dengue fever who was admitted to the hospital with high fever, nausea, vomiting, and dark urine. Investigations showed high levels of creatine phosphokinase (CPK) and abnormal liver enzymes, suggesting rhabdomyolysis and acute liver injury. Regardless of treatment with fluids and antibiotics, his kidney function got worse, needing hemodialysis. After discharge, he had high blood pressure and required more dialysis sessions. With good care, his kidneys started working better, and the catheter used for dialysis was removed. Rhabdomyolysis from Dengue infection is hard to diagnose and treat. The virus can directly harm muscle cells and cause immune reactions that release harmful substances like myoglobin, which may cause acute kidney injury. Early detection of high CPK levels is crucial to prevent kidney injury. Treatment involves giving fluids carefully to protect the kidneys from myoglobin damage without causing fluid overload, which is critical in helping patients recover. Monitoring CPK levels in Dengue patients is vital to diagnose rhabdomyolysis early and protect the kidneys. This approach can improve outcomes and guide better treatment decisions for patients with this rare but severe complication.

Undergraduate medical education in Nigeria: a critical reassessment of regulatory frameworks, pedagogical practices and systemic reform

Bruno Basil — 2026-03-30

This review critically examines the evolution, challenges, and reform prospects of undergraduate medical education in Nigeria, aiming to identify the structural, policy, and operational factors that influence its quality and effectiveness. Its foundation was established during the colonial era, with early medical schools focused primarily on training auxiliary health workers, and was later strengthened by the mandates of the Medical and Dental Council of Nigeria (MDCN) and the National Universities Commission (NUC), which continue to define accreditation, professional standards, and curriculum frameworks. Despite this institutional base, medical training faces persistent challenges, including chronic underfunding, inadequate infrastructure, faculty shortages and low motivation, outdated curricula, and overlapping regulatory oversight, all of which reduce instructional quality, limit clinical exposure, and weaken graduate competence. By reviewing historical records, policy documents, and contemporary literature, this paper highlights how traditional educational models have not adapted sufficiently to Nigeria’s changing healthcare needs. Recent reform efforts, however, show promise, including the introduction of competency-based curricula, blended learning, simulation-driven clinical training, and community-oriented education programs that follow international best practices. The analysis emphasizes that lasting improvement requires addressing foundational deficits in governance, funding, and infrastructure alongside curriculum and pedagogical innovations. The review concludes that harmonized regulatory standards, sustained political commitment, and strategic investment in modern teaching and learning approaches are essential to developing a medical education system in Nigeria that is effective, responsive, and aligned with national healthcare priorities.

Severe manifestations of Streptococcus pyogenes: a narrative review

Orestes Andre Hurtado-Mosquera — 2026-03-30

Streptococcus pyogenes is a pathogen capable of causing a wide spectrum of diseases, ranging from mild infections to severe invasive conditions. This narrative review focused on two of its most serious manifestations: meningitis and streptococcal toxic shock syndrome (STSS). A systematic search was conducted in PubMed, Scopus and ScienceDirect for articles published in recent years in both English and Spanish. Studies addressing severe presentations in the pediatric population were included. S. pyogenes meningitis, although a rare disease, carries a high mortality rate (up to 75%) if not treated early. STSS, on the other hand, constitutes a medical emergency with variable mortality rates ranging from 5% to 56%, influenced by factors such as the EMM genotype and the expression of superantigens. Both conditions often present nonspecific symptoms, complicating initial diagnosis. Diagnostic and therapeutic delays can be decisive in unfavorable outcomes. Invasive forms of S. pyogenes infection require early suspicion, prompt intervention and aggressive clinical strategies to reduce mortality. Initial underestimation can be fatal; therefore, continuous medical education and active surveillance are essential.

Pain and its management: a precise summary

Debadrita Ghosh — 2026-03-30

Pain may be portrayed as an unpleasant, subjective, sensation, that may be resulting from a sudden ‘tissue damage’. ‘Pain management’; implemented for patients should involve both ‘pharmacologic’ and ‘nonpharmacologic’ protocols. Medical therapies, such as mind-body practice, acupuncture, massage therapy, and music therapy, have been well appreciated for their roles in pain management. Since recent past, numerous studies have emphasized upon the effect of hypnosis, acupuncture, and music therapy in reduction of pain. Mindfulness meditation, yoga, qigong, and massage therapy, although may not bear the potential of completely reducing the pain, but can still offer adequate relief from persistent anxiety and phenomenal mood changes, which may be commonly associated with pain. Recent screening tools and brief intervention techniques can be effective in helping clinicians identify, stratify and manage both patients already living with chronic pain and those who are at risk of developing chronic pain from acute pain. Frequent assessment and re-assessment are key to ensuring treatment is appropriate and safe, as well as minimizing and addressing side effects. Therefore, in clinical practice, it is always suggested for the practitioners; to earnestly consider the various burdens and risks to patients, consequent patient preference, and the presence or absence of better alternatives while opting for an integrative medical therapy.

Diagnosis and management of intrahepatic cholestasis of pregnancy: current practices and future directions

Sunita Chandra — 2026-03-30

Intrahepatic cholestasis of pregnancy (ICP) is a reversible, pregnancy-specific liver disorder characterized by impaired bile flow and maternal hypercholanemia, classically presenting in the late second or third trimester with pruritus on normal skin and resolving after delivery. Global prevalence is up to ~2%, with higher rates reported from India (≈3–4.5%), reflecting genetic (e.g., ABCB4/ABCB11/ATP8B1 variants), hormonal, and environmental contributions. Diagnosis is based on clinical and biochemical criteria, with pruritus and elevated non-fasting total bile acids confirming cholestasis and stratifying fetal risk. Adverse perinatal outcomes (preterm birth, meconium-stained liquor, fetal asphyxia, neonatal respiratory distress, and stillbirth) track with TBA in a concentration-dependent manner, with risk increasing ~1–2% for each µmol/l above 40 µmol/l in severe disease and rising markedly at ≥100 µmol/l. Management prioritizes maternal symptom relief and bile-acid reduction with ursodeoxycholic acid (UDCA- the first drug approved by CDSCO based on an Indian Phase 3 trial; 10–15 mg/kg/day, titrated), while cholestyramine may be considered for refractory cases; vitamin K is reserved for prolonged cholestasis or coagulopathy. Because conventional fetal surveillance (CTG/ultrasound) does not reliably avert sudden compromise, outcome modification relies on timely, TBA-guided delivery (typically by 40 weeks for 19–39 µmol/l, 38–39 weeks for 40–99 µmol/l, and 35–36 weeks for ≥100 µmol/l), balancing stillbirth prevention against prematurity; antenatal corticosteroids are used solely for lung maturation. Postpartum reassessment confirms resolution and guides counseling on recurrence risk and the use of progestin-only contraception. Emerging work on transporter biology, biomarkers, and optimized second-line therapy is poised to refine individualized, bile-acid–guided care and further improve perinatal outcomes.

Linagliptin in type 2 diabetes mellitus: glycemic control and beyond

Ritesh Agrawala — 2026-03-30

Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder requiring comprehensive strategies to achieve sustained glycemic control and reduce complications. Linagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4i), provides effective glycemic control with a low risk of hypoglycaemia and weight neutrality. Its once-daily dosing without the need for renal or hepatic dose adjustment makes it suitable for patients with multiple comorbidities. Large clinical trials, including CARMELINA and CAROLINA, have established its cardiovascular and renal safety. Beyond monotherapy, combination therapy with dapagliflozin, a sodium-glucose co-transporter-2 inhibitor (SGLT2i), demonstrates synergistic benefits. This combination improves glycemic parameters, supports weight reduction, and enhances cardiorenal outcomes. Phase III trials show that fixed-dose combinations of dapagliflozin and linagliptin achieve superior HbA1c reduction and improved postprandial glucose control compared with monotherapy, with favourable safety and tolerability.

Recent advances in physiotherapy management of multiple sclerosis: a scoping review

Khushboo C. Valodwala — 2026-03-30

Multiple sclerosis (MS) is a chronic immune-mediated neurological disorder leading to progressive disability, fatigue, and reduced quality of life. Physiotherapy plays a crucial role in maintaining function and participation. Over the last decade, rehabilitation has evolved toward technology-assisted and neuroplasticity-based interventions. Objective was to map and summarize recent advances in physiotherapy management of multiple sclerosis. A scoping review was conducted according to PRISMA-ScR guidelines. Electronic databases (PubMed, Scopus, Web of Science, and PEDro) were searched for studies published between 2014 and 2025. Studies investigating physiotherapy or rehabilitation interventions in MS were included. Pharmacological-only studies were excluded. A total of 40 records were identified; 30 full texts were assessed and 18 studies were included. Major intervention categories were: combined exercise therapy, high-intensity interval training, virtual reality rehabilitation, exergaming, telerehabilitation, wearable-guided therapy, and cognitive-motor dual-task training. Technology-assisted rehabilitation demonstrated comparable or superior outcomes to conventional therapy in mobility, balance, and fatigue management. Physiotherapy management of MS has shifted from compensatory care to neurorestorative and technology-integrated rehabilitation. Hybrid care models combining in-person and remote therapy appear most effective for long-term management.

Metabolic, neurological and endocrine safety profiles of atypical antipsychotics: focus on quetiapine, olanzapine and risperidone: an updated review

Mudasir Manzoor Dar — 2026-03-30

The atypical antipsychotics (second-generation antipsychotics, SGAs) are commonly used in the treatment of schizophrenia, bipolar disorder and other mental illnesses because they have fewer extrapyramidal side effects than first-generation agents. Nonetheless, their growing utilization has brought to light serious safety issues, especially in metabolic, neurological and endocrine spheres. This review aims at comparing three widely used SGAs, which are Quetiapine, Olanzapine, and Risperidone, with comparison in their pharmacological and safety profiles. Olanzapine presents the greatest metabolic risk often leading to weight gain, dyslipidaemia and insulin resistance. Quetiapine exhibits less sensitive metabolic responses accompanied by reduced pyramidal and prolactin increase rates at low off-label doses but is risky. Risperidone is an effective treatment of psychotic and bipolar disorders, but it is closely linked to hyperprolactinemia and dose-related extrapyramidal symptoms. The review also points out that there is now emerging evidence on changes in gut microbiota and changes in pharmacogenetic variations that affect individual response to drug and drug adverse effects. In general, the results highlight the importance of identifying unique antipsychotic treatment, regular checks of metabolic, endocrine indicators to ensure optimal safety and treatment. It is recommendable that future studies concentrate on genetic predictors, new formulations (e.g. olanzapine-samidorphan), and microbiome-targeted interventions as a way of reducing adverse effects.

The nexus of mental health, climate change and artificial intelligence: a narrative review of emerging evidence and clinical implications

Alvin Joseph — 2026-03-30

Climate change has emerged as a major global determinant of mental health, contributing to a growing burden of psychological distress. Concurrently, artificial intelligence (AI) offers novel approaches to enhance mental health assessment, monitoring, and intervention, particularly in contexts where access to care is limited. This narrative review synthesizes current evidence on the mental health impacts of climate change and critically examines the potential role of AI-driven technologies in addressing climate-related psychological disorders. A comprehensive narrative review of peer-reviewed literature published between 2015 and 2025 was conducted using major academic databases. Relevant studies addressing climate-related mental health outcomes and AI applications in mental healthcare were analysed thematically. Four key themes were identified: direct and indirect mental health consequences of climate change, including eco-anxiety, depression, and climate-related post-traumatic stress disorder; emerging AI applications in mental health, such as machine learning–based neuroimaging, digital phenotyping using wearable biosensors, and conversational AI platforms; implementation challenges, including algorithmic bias, data privacy and ethical concerns, and digital inequities; and pathways for integrating climate-sensitive, AI-supported mental health interventions into healthcare systems, particularly in vulnerable populations within low- and middle-income countries such as India. Interdisciplinary collaboration among climate scientists, mental health professionals, and digital health innovators is essential to develop equitable, culturally sensitive, and evidence-based interventions. Future research should prioritize longitudinal studies, bias-mitigation strategies in AI systems, and policy frameworks linking climate adaptation with mental health resilience.

Advances in malignant hyperthermia: pathophysiology, diagnosis and management

Shaistha Banu — 2026-03-30

Malignant hyperthermia (MH) is a rare genetic disorder triggered by volatile anaesthestics and depolarizing muscle relaxants like sevoflurane, desflurane, and succinylcholine. It is mainly associated with pathogenic variants in the RYR1 and CACNA1S genes that disrupt calcium regulation in skeletal muscles, causing uncontrolled calcium release from the sarcoplasmic reticulum and a hypermetabolic crisis with rhabdomyolysis, muscle rigidity, hypercapnia, hyperthermia, and multiorgan failure. Since its first clinical description in the 1960s, clinical signs such as tachycardia, rising end-tidal CO₂ (ETCO₂), and sudden hyperthermia remain essential for detection. Diagnosis relies on invasive muscle contracture tests like the Caffeine-Halothane contracture test (CHCT) and in vitro contracture test (IVCT). Next-generation sequencing (NGS) identifies mutations in RYR1, CACNA1S, and related excitation–contraction coupling genes. Despite incomplete genotype-phenotype correlations, mechanisms including oxidative stress and sodium-calcium channel dysregulation improve understanding of MH susceptibility. Management requires immediate cessation of triggering agents, intravenous dantrolene, and supportive care including cooling, correction of acidosis, electrolyte control, and monitoring of cardiac and renal complications. Patients should be monitored for recurrence within 24 hours and receive genetic counselling, medical alert identification, and family screening due to autosomal dominant inheritance. Emerging research explores CRISPR/Cas9 correction of RYR1 mutations, antisense oligonucleotide therapy to suppress mutant transcripts, and antioxidants N-acetylcysteine and Trolox to reduce reactive oxygen species-mediated muscle injury; animal studies show improved calcium regulation but human trials are needed. Preventive measures include temperature and ETCO₂ monitoring, regional anaesthesia in obstetrics, and total intravenous anaesthesia, when necessary, supported by collaboration among anaesthesiologists, geneticists, intensivists, and surgeons.

Effectiveness of hand-arm bimanual intensive therapy in neurological training: a comprehensive scientific literature review

Ismail Hazim — 2026-03-30

Hand-arm bimanual intensive therapy (HABIT) is an intensive rehabilitation approach designed to improve bimanual coordination and functional hand use in individuals with neurological impairments. Unlike constraint-induced movement therapy, HABIT emphasizes simultaneous bilateral practice of meaningful tasks, leveraging neuroplasticity principles to drive functional recovery. This scoping review synthesizes evidence from eight randomized controlled trials and high-quality protocols to evaluate the effectiveness, feasibility and innovations in HABIT and HABIT including lower extremities (HABIT-ILE) across cerebral palsy and stroke populations. A multi-phase search strategy was conducted across PubMed, Google Scholar and SciSpace, yielding 177 unique records. After screening and eligibility assessment, eight studies were included. Methodological quality and risk of bias was appraised and summarised. In unilateral cerebral palsy, HABIT consistently improved assisting hand assessment (AHA) scores, dexterity and caregiver-reported outcomes, with stronger effects observed in early interventions. HABIT-ILE demonstrated additional benefits for lower extremity function without compromising upper limb gains. In bilateral cerebral palsy, HABIT improved dialy functioning and dominant-hand dexterity, while large multisite trials confirmed feasibility across a wide severity spectrum. In stroke populations, HABIT delivered in the acute phase produces superior motor recovery compared to conventional rehabilitation, supporting its adaptability beyond paediatric contexts. Home-based HABIT models showed promise for dexterity and goal attainment, though bimanual performance gains were less robust. HABIT demonstrate consistent efficacy in enhancing functional outcomes across cerebral palsy and stroke, with early intensive delivery yielding the most clinically meaningful improvements. Evidence supports HABIT as a scalable, neuroplasticity-driven intervention, though heterogeneity in dosage, delivery models and outcome measures underscores the need for standardized protocols and exploration of adjunctive innovations such as neuromodulation and virtual reality.

Integrating knowledge, psychological support and digital health interventions: nursing innovations in diabetes management

Chisla Unnati Pravinbhai — 2026-03-30

Diabetes mellitus remains one of the most significant global public health challenges, requiring comprehensive and sustained management strategies beyond pharmacological treatment. Increasing evidence highlights the importance of integrating structured patient education, psychological support, and digital health technologies within nursing practice to improve clinical and psychosocial outcomes. This narrative review synthesizes contemporary evidence on nursing innovations that combine knowledge enhancement, behavioral and emotional support, and technology-enabled care in diabetes management. Literature from PubMed, Scopus, CINAHL, and Web of Science published between 2013 and 2025 was reviewed. Findings indicate that structured diabetes self-management education improves glycaemic control, enhances self-efficacy, and promotes adherence to therapeutic regimens. Psychological interventions, including cognitive behavioral therapy and motivational interviewing delivered by nurses, significantly reduce diabetes distress and depressive symptoms while contributing to improved metabolic outcomes. Digital health strategies such as telemonitoring, mobile health applications, continuous glucose monitoring, and SMS-based support facilitate remote engagement and sustained self-management. Integrated multicomponent nurse-led models demonstrate superior reductions in HbA1c, improved quality of life, and decreased hospitalization rates compared to single-domain interventions. These findings support the adoption of comprehensive, technology-enabled, and psychologically informed nursing approaches to address the complex demands of chronic diabetes care.

Interrelationship between rheumatoid arthritis and diabetes mellitus: current insights and perspectives

Prakash Sigedar — 2026-03-30

Rheumatoid arthritis (RA) and diabetes mellitus (DM) are chronic, systemic conditions with significant global health burdens. Emerging evidence suggests a bidirectional relationship between these diseases, with shared pathophysiological mechanisms, including chronic inflammation, immune dysregulation, and metabolic disturbances. This review explores the current insights into the interrelationship between RA and DM, emphasizing the role of pro-inflammatory cytokines, insulin resistance, and genetic predispositions. Additionally, it examines the impact of therapeutic interventions for RA on glycemic control and vice versa, highlighting challenges and opportunities in clinical management. Understanding these interactions is crucial for developing integrated treatment strategies, improving patient outcomes, and addressing the broader implications of coexisting RA and DM. This review article aims to provide a comprehensive perspective on the evolving knowledge in this field and to identify areas for future research.

Trans-alveolar extraction: a spectacular oral surgical approach

Debadrita Ghosh — 2026-03-30

Dental caries’ has significantly become a widespread disease, raising a serious global concern. In certain cases, when caries or other oral symptoms like root resorption, tooth ankylosis seem to happen beyond care; ‘dental extraction’ becomes inevitable. But, in various cases like retained roots; hypercementosis; impaction; bony sclerosis; where simple extraction is unable to eradicate the distress; “complicated exodontia” or “trans alveolar extraction” ranges the highest accord. A ‘trans alveolar extraction is a surgical approach’ to successful tooth removal necessary; when a tooth or root cannot be extracted with standard forceps methods, often, because of fracture or other difficulties. The particular "open" or "surgical" technique involves making incisions and exposing the tooth and the underlying jawbone; with the purpose of removing the tooth fragment. It may also owe to alarming post-operative complications, and over-time, studies have evaluated its incidence and management, while effective research highlighting patient demographics, the diagnostic tools like indices for surgical difficulty, and post-operative care with agents like topical ozone therapy is still in progress. This paper chiefly imparts special mention to ‘complicated exodontia’-the otherwise typically established oral surgical procedure.

Nursing shift handover methods and their impact on patient safety

Kavitha N. K. — 2026-03-30

Nursing shift handover is a critical patient safety practice that underpins continuity of care, clinical accountability, and risk mitigation in complex healthcare environments. Communication failures during handover remain a leading contributor to preventable adverse events, including medication errors, patient falls, pressure injuries, and delayed recognition of clinical deterioration. This systematic review synthesises current evidence on nursing shift handover methods and their impact on patient safety outcomes in inpatient settings. A comprehensive systematic search of major databases, including PubMed, Scopus, CINAHL, Embase, and the Cochrane Library, was conducted following PRISMA 2020 guidelines. Studies published between 2008 and 2025 evaluating bedside nursing handover, structured communication frameworks such as SBAR/ISBAR, integrated verbal–written systems, and electronic handover tools were included. Quantitative, qualitative, and mixed-methods studies were synthesised using a narrative approach due to methodological heterogeneity. Findings indicate that structured and standardised handover interventions are consistently associated with improvements in communication quality, handover completeness, and shared situational awareness. Bedside nursing handover demonstrates additional benefits through real-time patient verification and engagement, contributing to reductions in falls, medication administration errors, and pressure injuries in several settings. Electronic and integrated handover systems enhance information continuity but require robust governance to prevent data inaccuracy and over-reliance on documentation. Overall, this review underscores nursing shift handover as a high-impact, nurse-led safety intervention. Embedding structured, patient-centred, and context-sensitive handover models within organisational safety frameworks has the potential to substantially strengthen patient safety and quality of care.

Confocal reflectance microscopy versus digital dermoscopy for the diagnosis of melanoma in equivocal lesions: a systematic review

Elisa María Jurado Jara — 2026-03-10

The diagnosis of melanoma in clinically or dermoscopically equivocal melanocytic lesions is difficult and gives rise to many unnecessary excisions. This review compares in vivo reflectance confocal microscopy or confocal reflectance microscopy (RCM of CRM) and digital dermoscopy in the diagnosis of melanoma in equivocal lesions. We conducted a systematic review of PubMed, Embase, Cochrane Central and Web of Science (according to PRISMA) until 30 January 2026. Eligible studies were direct comparisons of RCM and digital dermoscopy in adults with equivocal lesions and had histopathology as the reference standard. Data extraction and quality appraisal using the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) instrument were performed in duplicate. Where studies were homogenous enough for the statistical analysis, we used a bivariate random-effects model to pool sensitivity and specificity; or used a structured narrative synthesis otherwise. Fifteen (2007-2020) studies were included in which referral cohorts of equivocal lesions were included. In data pooled from the similar studies sensitivity of RCM was about 91% {[95% confidence intervals (CI) 88-94%]} with specificity almost at 69% (95% CI 62-76%). Digital dermoscopy demonstrated the same sensitivity, approximately 88% (95% CI 83 92) but significantly worse specificity, approximately 34% (95% CI 2841). Heterogeneity was high and was determined by referral setting, reader experience, device type and algorithm use. Studies consistently found that the number needed to excise was reduced from approximately 3.7 by dermoscopy alone to near 1.1 by RCM guided excision. For lesions that are still equivocal even after being clinically and assessed by dermoscopy, the RCM substantially improves specificity but at the cost of a high sensitivity. RCM is a useful second-level test in specialist environments but operator education, cost, and poor penetration depth limit the broader use of this modality.

Imaginative pedagogical approaches in nursing education: moving beyond traditional teaching methods

N. Muruganandan — 2026-03-30

Nursing education is undergoing a paradigm shift in response to increasing healthcare complexity, rapid technological advancement, and evolving expectations of professional competence. Traditional teacher-centred instructional models are increasingly insufficient to prepare nursing graduates for contemporary clinical practice. This review synthesises current evidence on imaginative pedagogical approaches that move beyond conventional teaching methods in nursing education. A comprehensive literature search was conducted across major electronic databases, and studies were systematically screened using PRISMA guidelines, resulting in the inclusion of 30 eligible studies. The review examines a range of innovative pedagogies, including simulation-based learning, flipped classrooms, virtual and augmented reality, gamification and serious games, problem-and team-based learning, interprofessional education, and competency-based education. Findings consistently demonstrate that these approaches enhance knowledge acquisition, clinical skills, critical thinking, learner engagement, confidence, and readiness for practice when compared with traditional didactic methods. Simulation and flipped learning emerged as the most robustly supported strategies, while immersive digital technologies showed promising but still emerging evidence. Key challenges identified include faculty preparedness, resource constraints, assessment standardisation, and equity of access. The review underscores the need for strategic curricular integration, sustained faculty development, supportive regulatory frameworks, and rigorous evaluation of long-term outcomes. Imaginative pedagogical approaches represent a critical opportunity to strengthen nursing education and align graduate competencies with the demands of modern healthcare systems.