International Journal of Research in Medical Sciences

Characteristics and findings of digital subtraction angiography and magnetic resonance imaging in neurological patients: a cross-sectional study

Fritz Sumantri — 2024-12-31

Background: Stroke is a major health concern worldwide with significant rates of mortality and morbidity. Asian population suffers from increasing incidence of stroke. Various imaging modalities have been developed for the diagnosis of stroke and neurological diseases. This study aims to compare the use of digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) in neurological patients, underscoring particularly in ischemic stroke patients.

Methods: This cross-sectional descriptive study was performed from February to November 2023. Data was taken from medical records. All patients visiting the outpatient care unit of a hospital in Jakarta who underwent DSA and MRI were included in the study. The data taken included the patient’s name, medical record number, age, gender, MRI results, DSA results, and diagnosis. Diagnosis was established through history taking and physical examination.

Results: Of 500 subjects included in the study, most subjects were male (50.6%) aged 20 – 60 years old (75.6%) abnormal MRI and DSA results (84.6% and 90.6%, respectively). Ischemic stroke was the leading diagnosis (50.8%). MRI and DSA results showed 79.6% agreement of all cases.

Conclusions: Although MRI showed normal results, DSA could show abnormal results. This points out DSA superiority in detecting vascular abnormality compared to MRI.

Homicidal deaths due to weapons: an autopsy-based study

Din Islam Hossain — 2024-12-31

Background: Homicide, one of the oldest crimes in human civilization, involves the killing of one human being by another. Defined legally as the intentional destruction of human life, it is a leading cause of unnatural deaths worldwide. The crime involves two key elements: Mens rea (preplanning) and Actus reus (execution). Homicidal methods and patterns vary globally, influenced by factors such as weapon availability, motives, cultural and social influences, and socio-economic status. Violence is recognized as a global public health issue, contributing to significant mortality and disability, with approximately 520,000 people dying annually from interpersonal violence. The study aims to explore the types of injuries, weapons, and anatomical regions of the affected victim.

Methods: This retrospective observational study was conducted at the department of forensic medicine, Dhaka medical college and hospital, Dhaka, Bangladesh, focusing on 120 autopsied homicide cases involving definite weapons from January 2021 to December 2023. The study included all age groups, excluding accidental burn deaths, suspected homicidal poisonings, and decomposed bodies. Data were gathered from police inquest and post-mortem reports, analyzing injury types, weapons used, and their anatomical distribution. The findings were correlated with victims' age and gender. The ethics committee approved the study, and data were presented using SPSS for statistical analysis.

Results: The study analyzes violent incidents, focusing on participant demographics, weapon types, injury patterns, and homicide intentions. The highest participant age group is 21-30 years (33.33%), with males dominating at 84.17%. Knives are the most used weapon (51.67%), followed by blunt objects (38.33%). Head injuries are most common (44.17%), with intracranial hemorrhage (ICH) as the leading cause of death (48.33%). Non-intentional homicides constitute 60%, while 35.83% are deliberate. The study provides detailed insights into the nature and causes of homicides in the population studied.

Conclusions: The study in Dhaka, Bangladesh, reveals that young males are the primary victims of homicide, with knives and blunt objects frequently used. Head injuries, especially ICH, are the leading cause of death. The findings call for targeted interventions and further research into the factors driving non-intentional homicides.

Assessment of the knowledge and uptake of voluntary HIV testing and counselling services among mothers in Yenagoa, Bayelsa State

Faith A. Ngwu — 2024-12-31

Background: Voluntary counselling and testing (VCT) for HIV has proven to be an effective way to tackle the problem of HIV/AIDS. Many however do not utilize these services for various reasons which acts as an impediment in the delivery of the services. This study aimed to assess the knowledge, attitude and utilization of VCT-HIV services among pregnant women and mothers in Bayelsa State.

Methods: This was a hospital-based, descriptive analytic study among 301 adult mothers attending the antenatal and immunization clinics of the federal medical centre, Yenagoa, Bayelsa State. An interviewer-administered questionnaire having 6 sections was used to elicit data of the mothers’ knowledge, attitude and utilization of VCT-HIV services at the health facility as well as barriers affecting the utilization of the services. Descriptive and inferential analyses were conducted and the level of significance was set at 0.05.

Results: The 59.1% of respondents had heard about VCT-HIV. Most had adequate knowledge 268 (89.0%) and good attitude 270 (89.7%) towards VCT-HIV. About 197 (65.4%) had utilized VCT-HIV services in the past, and 241 (80.1%) were presently willing to use these services. Fear of knowing their HIV status, discrimination, family stigma, among others, were factors hindering utilization of these services. Age, level of education, preferred place for delivery, knowledge and attitude towards VCT-HIV were significantly associated with the uptake of these services.

Conclusions: there is the need for government to tackle issues of discrimination against HIV-infected persons as well as sustain the delivery of maternal healthcare through the primary healthcare initiative.

Frequency of low BMD and associated risk factors in patients with inflammatory bowel disease

Chinmoy Saha — 2024-12-31

Background: Low bone mineral density (BMD) is a known complication of inflammatory bowel disease (IBD), with several factors contributing to its occurrence. This study aims to assess the frequency of BMD and identify associated risk factors in patients with IBD. The aim of this study was to determine the frequency of low BMD and identify associated risk factors in patients with inflammatory bowel disease (IBD).

Methods: This cross-sectional study included 90 patients with established inflammatory bowel disease (IBD) at the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from June 2019 to September 2020. Patients aged 18 years and older, currently on IBD medication, were enrolled. Data on BMD, disease characteristics, and demographic factors were collected and analyzed using SPSS version 23.0.

Results: Among 90 IBD patients (mean age 31.8 years, 74.4% male, 35.6% with Crohn's), 40% were smokers. BMD results showed 34.4% normal, 40% osteopenia, and 25.6% osteoporosis. Low BMD was linked to lower BMI (20.25kg/m²) and vitamin D levels (17.45ng/ml), with regression analysis confirming vitamin D deficiency as the only independent risk factor.

Conclusions: Our study underscores the high prevalence of osteopenia and osteoporosis in Bangladeshi IBD patients, highlighting the critical need for regular monitoring and intervention focused on modifiable risk factors like BMI and vitamin D to safeguard bone health.

A comparative analysis of adiponectin and soluble CD36 levels between diabetic and non-diabetic metabolic syndrome patients

Mansura Khan — 2024-12-31

Background: Metabolic syndrome refers to a constellation of interrelated metabolic risk factors that promote the development of type-2 diabetes mellitus (T2 DM) and cardiovascular diseases (CVD). The purpose of this study was to compare the serum levels of adiponectin and soluble CD36 between diabetic and non-diabetic metabolic syndrome patients. The aim of this study was to compare the serum levels of adiponectin and soluble CD36 between diabetic and non-diabetic metabolic syndrome patients.

Methods: This cross-sectional analytical study, conducted at the Outpatient Department and Department of Immunology at BIRDEM General Hospital over 12 months, included 80 participants: 60 with metabolic syndrome (30 type-2 diabetic and 30 non-diabetic) and 20 healthy controls. Participants underwent clinical examinations, anthropometric measurements and blood tests for serum analysis of adiponectin and soluble CD36 using ELISA and immunonephelometry. Data were analyzed using nonparametric tests (Mann-Whitney U test, Levene's test) and correlation analyses (Pearson and Spearman) with p<0.05, using SPSS version 20.

Results: Metabolic syndrome patients had higher weight, BMI, waist circumference and blood pressure compared to healthy subjects. Adiponectin and soluble CD36 levels were significantly lower in metabolic syndrome patients, with differences between diabetic and non-diabetic groups. Adiponectin negatively correlated with waist circumference, blood pressure and triglycerides, while soluble CD36 positively correlated with waist circumference, diastolic blood pressure and triglycerides.

Conclusions: In conclusion, our study highlights that adiponectin and soluble CD36 levels are significantly altered in diabetic versus non-diabetic metabolic syndrome patients, suggesting their potential as biomarkers for metabolic syndrome.

Response of dasatinib in different phase of chronic myeloid leukaemia patients

Moshammat Naznin Begum — 2024-12-31

Background: Chronic myeloid leukemia (CML) is a stem cell disorder caused by a chromosomal abnormality that results in the formation of the Philadelphia chromosome. This abnormality leads to the production of the Bcr-Abl tyrosine kinase, which drives the uncontrolled proliferation of cells. Imatinib, a tyrosine kinase inhibitor (TKI), revolutionized the treatment of CML, but resistance and intolerance in some patients have necessitated alternative therapies such as Dasatinib, a potent multitargeted inhibitor of Bcr-Abl and Src-family kinases. This study was aims to assess the efficacy and safety of Dasatinib in CML patients who were either newly diagnosed or resistant/intolerant to Imatinib.

Methods: A prospective observational study was conducted at Dhaka Medical College & Hospital from July 2016 to June 2017. A total 31 patients with different phases of CML were included in this study. All patients were treated with Dasatinib 100 mg daily and monitored over 12 months. Molecular responses were assessed through quantitative PCR and hematologic responses were evaluated via complete blood counts.

Results: Among the 31 patients, two died and two discontinued treatment. Of the remaining 27, 23 (85%) achieved complete hematologic response (CHR), 12 (44%) achieved major molecular response (MMR) and 3 (11%) attained complete molecular response (CMR). All four chronic-phase CML (CML-CP) patients who received Dasatinib as frontline therapy achieved molecular response within one month of starting therapy. Responses were lower in more advanced disease stages, with two blast-phase patients dying.

Conclusions: Dasatinib demonstrated significant efficacy and safety in treating CML, particularly in chronic-phase patients and those resistant to Imatinib.

Relationship between stroke and compliance of antihypertensive medication

Debashis Roy — 2024-12-31

Background: Stroke is a leading cause of death and long-term disability globally, with hypertension being a key modifiable risk factor. Effective management of hypertension through medication compliance is crucial for reducing the risk of both initial and recurrent strokes. However, non-compliance with antihypertensive medication is a common challenge, particularly in resource-constrained countries like Bangladesh, where awareness and access to healthcare can be limited. This study aimed to investigate the relationship between antihypertensive medication compliance and the incidence of stroke, as well as the risk of stroke recurrence, in hypertensive patients admitted to Dhaka Medical College Hospital.

Methods: A descriptive cross-sectional study was conducted between March and August 2010, involving 100 stroke patients diagnosed clinically and confirmed by CT scan. Data on patients' hypertension status, medication adherence, and stroke history were collected through interviews and medical record reviews. Statistical analysis was conducted using SPSS software (Version 12) to explore the relationship between compliance and stroke occurrence.

Results: From 100 stroke patients, 65% were previously diagnosed with hypertension. Among these patients, 18 (27.7%) were compliant and 47 (72.3%) were non-compliant with their prescribed antihypertensive medication. The recurrence of stroke was significantly higher in non-compliant patients, with 66.67% experiencing a second stroke, compared to 33.33% among compliant patients.

Conclusion: There is a significant association between non-compliance with antihypertensive medication and both the onset and recurrence of stroke. Enhancing patient adherence to antihypertensive therapy through education and healthcare interventions is vital to reducing stroke-related morbidity and mortality.

Clinical outcomes of fractional erbium laser therapy in the treatment of mucosal lichen planus

Farjana Akhter — 2024-12-31

Introduction: Lichen planus is a chronic inflammatory condition affecting the skin and mucous membranes, with a prevalence of 1% to 2.2% in the general population. This study aims to evaluate the clinical outcomes of fractional erbium laser therapy for mucosal lichen planus, focusing on its efficacy in relieving symptoms and improving quality of life. The aim of the study was to evaluate the clinical effectiveness and safety of fractional erbium laser therapy in treating mucosal lichen planus.

Methods: This prospective observational study took place in the Department of Dermatology at Bangladesh Specialist Hospital, Dhaka, Bangladesh, from March 2021 to February 2023, involving 30 patients with mucosal lichen planus. Participants provided informed consent, and their lesion severity was assessed prior to administering fractional erbium laser therapy. Outcomes were measured and analyzed using SPSS version 22.0.

Result: Participants had a mean age of 58 ± 8.6 years, with 96.67% being female. After fractional erbium laser therapy, 90% achieved complete remission, and 83.33% reported no side effects. Pain scores dropped from 7.0 ± 1.5 to 2.3 ± 1.2, while lesion size decreased from 3.8±0.8 cm² to 1.0±0.5 cm². Satisfaction was high, with 80% highly satisfied, and follow-up indicated a 66.67% no recurrence rate of lesions.

Conclusion: Fractional erbium laser therapy is an effective and safe treatment for mucosal lichen planus, showing high remission rates, minimal side effects, and patient satisfaction.

A cross-sectional study assessing AI-generated patient information guides on common cardiovascular conditions

Mustafa Sibaa — 2024-12-31

Background: Patient education is essential for management of CVD as it enables in earlier diagnosis, early treatment and prevention of complications. Artificial intelligence is and increasingly popular resource with applications in virtual patient counselling. Thus, the study aimed to compare the AI generated response for patient education guide on common cardiovascular diseases using ChatGPT and Google Gemini.

Methods: The study assessed the responses generated by ChatGPT 3.5 and Google Gemini for patient education brochure on angina, hypertension, and cardiac arrest. Number of words, sentences, average word count per sentence, average syllables per word, grade level, and ease level were assessed using Flesch-Kincaid Calculator, and similarity score was checked using Quillbot. Reliability was assessed using modified DISCERN score. The statistical analysis was done using R version 4.3.2.

Results: The statistical analysis exhibited that there were no statistically significant differences between the responses generated by the AI tools based on different variables except for the ease score (p=0.2043), which was statistically superior for ChatGPT. The correlation coefficient between both the two tools was negative for the ease score (r=-0.9986, p=0.0332), the reliability score (r=-0.8660, p=0.3333), but was statistically significant for ease score.

Conclusions: The study demonstrated no significant differences between the responses generated by the AI tools for patient education brochures. Further research must be done to assess the ability of the AI tools, and ensure accurate and latest information is being generated, to benefit overall public well-being.

Postpartum depression associated with sex preference among rural Bangladeshi mothers

Tanjida Chowdhury — 2024-12-31

Background: Maternal depression, particularly postpartum depression (PPD), significantly impacts women’s well-being and can have long-term effects on child health, development, and behavior. The purpose of this study was to evaluate the association between postpartum depression and sex preference among rural Bangladeshi mothers. The aim of the study was to evaluate the association between postpartum depression and sex preference among rural Bangladeshi mothers.

Methods: This cross-sectional study, conducted in Banchanagar village, Laxmipur District, Bangladesh, from January to December 2014, focused on postpartum depression among rural mothers with children aged 0-12 months and its association with sex preference. A total of 219 postpartum women, aged 15-49 years, participated. Data were collected using a pre-tested, semi-structured questionnaire, including the Edinburgh postnatal depression scale (EPDS), with double data entry and analysis in SPSS.

Results: Of the 219 mothers, most had a wanted pregnancy (87.20%), with 60% experiencing complications during pregnancy. Most had no family history of depression, and a majority showed a low probability of depression. Over half considered the sex of the child, with most satisfied with it. Logistic regression showed that the sex of the child, the husband's views, and the mother’s satisfaction were significant factors influencing postpartum depression.

Conclusions: In rural Bangladesh, postpartum depression is notably higher among mothers who give birth to female children, driven by strong cultural preferences for male offspring and negative family reactions toward daughters.

Frequency of autoantibody formation in multi-transfused thalassemia patients at a tertiary care hospital: a cross-sectional study

A. B. M. Al-Mamun — 2024-12-31

Background: Autoantibodies are produced by the immune system against the body’s own proteins, such as red blood cells, particularly after transfusions. This phenomenon, known as erythrocyte autoimmunization, has been a recognized complication of repeated transfusions. The purpose of this study was to evaluate the frequency of autoantibody formation in multi-transfused thalassemia patients at a tertiary care hospital. The aim of the study was to detect the frequency of autoantibody formation in multi-transfused thalassemia patients at a tertiary care hospital.

Methods: This cross-sectional study at the department of transfusion medicine, BSMMU, Dhaka, conducted from October 2017 to September 2018, included 384 thalassemia patients who received at least 10 units of red cell concentrate. Informed consent was obtained, and data collection involved patient interviews, clinical exams, and hematological tests. Statistical analysis using SPSS version 23.0 included Chi-square, Fisher’s exact, and t-tests, with significance set at p<0.05.

Results: In the study of 384 patients, 43.5% were under 10 years old, with a majority of 52.9% male. Coombs’ test showed 3.1% DCT positive, 7.5% ICT positive, and 4.2% positive for both. All 12 DCT-positive patients had a history of drug use, and 7.7% had undergone splenectomy.

Conclusions: In conclusion, regular blood transfusion in thalassemia patients is a key factor in autoimmunization, with lower antibody formation in females, younger patients, and those with blood group B, while Rh phenotype-matched blood and prestorage leukodepletion may help reduce autoantibody formation.

Factors associated with postnatal care seeking behavior among mothers of infants

Juthi Sarkar — 2024-12-31

Background: Postnatal period is a critical phase in the lives of mothers and newborn babies. Lack of appropriate care during this period could result in significant ill health and even death. Hence the study was carried out to identify the factors associated with postnatal care seeking behavior among mothers of infants.

Methods: This descriptive type of cross-sectional study was conducted at EPI centers of Sadar upazilla of Magura district from January to December 2023 among purposively selected 384 rural women of reproductive age who had at least one living child aged between 6 weeks to 10 months after obtaining ethical clearance from ethical review committee (ERC) of Dhaka Medical College.

Results: The average age of respondents was 24.28±3.52 years, with 84.1% aged 18-27 years. Among mothers, 59.6% completed primary education, while 10.2% reached secondary or higher education levels. Most (91.1%) were housewives, with 57% residing in joint families. While most of participants received ANC, only 35.5% sought PNC. The primary reasons for avoiding PNC included lack of awareness (28.9%) and financial constraints (23.7%). Significant associations were found between PNC utilization and mothers’ education, delivery complications, and decision-making authority within the family (p<0.05).

Conclusions: To improve utilization of postnatal care, national and local level action plan should be introduced to promote postnatal care delivery. PNC awareness campaign, motivation and economic empowerment programs for targeting mothers from the impoverished area need to be implemented.

Comparing the frequency of anemia in rheumatoid arthritis and axial spondyloarthritis patients and its relationship with hemogram parameters

Ebru Yilmaz — 2024-12-31

Background: To compare the frequency of anemia in rheumatoid arthritis (RA) and radiographic axial spondyloarthritis (r-axSpA) patients and to investigate its relationship with hemogram parameters used as inflammation markers.

Methods: The study included 87 RA patients and 116 r-axSpA patients. Characteristics of the patients, hemogram parameters (neutrophil-lymphocyte ratio 'NLR', platelet-lymphocyte ratio 'PLR', systemic immune-inflammation index 'SII', red blood cell distribution width 'RDW' and mean platelet volume 'MPV'), laboratory parameters (erythrocyte sedimentation rate 'ESR' and C-reactive protein 'CRP') and indices (Disease Activity Score in 28 Joints (DAS-28) for RA and the Bath Ankylosing Spondylitis (AS) Disease Activity Index (BASDAI) and AS Disease Activity Score with CRP (ASDAS-CRP) for axSpA) were recorded.

Results: The mean age for RA and r-axSpA patients was 55.8±12.0 and 43.8±10.1 years. Anemia was present in 47.1% of RA patients and 31.9% of r-axSpA patients and more prominent in RA patients (p=0.030). There was a significant female gender superiority in those with anemia in r-axSpA patients (p<0.001). ESR, PLR, SII and RDW values were significantly higher in patients with anemia in the RA (p=0.002, p=0.048, p=0.035, p<0.001, respectively), whereas only ESR was significantly greater in patients with anemia in the r-axSpA (p=0.012). There was no significant difference between disease activity and anemia in both disease groups.

Conclusions: Although the frequency of anemia was not affected by disease activity, female gender involvement was prominent. The increase in ESR and RDW values may reflect the possibility of developing anemia in rheumatic diseases.

Medical students’ perception of the use of artificial intelligence in medical education

Kininyiruchi Nelson Wobo — 2024-12-31

Background: Artificial Intelligence (AI) refers to technology that can efficiently perform tasks that typically require human intelligence, such as decision-making, teaching, object detection, and solving complex problems. As a veritable tool in medical education, this study was conducted to assess medical students’ awareness, perception and usage of AI in learning.

Methodology: This study was conducted at the Department of Paediatrics, University of Port Harcourt Teaching Hospital (UPTH). The subjects were one hundred and thirty-nine 5th-year medical students who had completed 3 months of Paediatrics and Obstetrics/Gynaecology clinical rotations. Data was collected using a semi-structured, open-ended questionnaire. Data were analysed using IBM SPSS Statistics version 26. Statistical significance was set at p value<0.05.

Results: 64 (46%) of the respondents are aware of AI. 57 (44%) of respondents applied AI during their clinical training. The most commonly used AI tool is Chatbots. 57(100%). The major limitations to AI use were unreliable internet connectivity (62%) and the high cost of AI hardware and software (53%). Most respondents (68%) expressed ethical concerns about the use of AI. There was a statistically significant relationship between awareness of AI and the use of AI in learning (p=0.0001)

Conclusion: This study demonstrates average awareness of AI's use and benefits among medical students. The major limitations to using AI were unlimited internet connectivity and the cost of AI tools. To maximize the benefits of AI in medical education in developing countries, medical schools need to increase their awareness and infrastructural capacity.

Prevalence, risk factors and management approaches for seborrheic dermatitis

M. Shahidul Islam — 2024-12-31

Background: Seborrheic dermatitis (SD) is a chronic inflammatory condition characterized by immune dysregulation, inflammation and disruption of the skin barrier. Despite its global prevalence, with studies indicating that up to 5% of the population may be affected, the study of the physical and emotional impact of SD on patients is limited. Furthermore, the prevalence of SD appears to be increasing over time. Therefore, this study aimed to determine the prevalence, risk factors and management approaches for seborrheic dermatitis.

Methods: This was a prospective study conducted in the Department of Skin and VD, Community Based Medical College Bangladesh, Mymensingh, Bangladesh during the period from June 2020 to June 2022. In our study, we included 150 patients with seborrheic dermatitis who visited the Department of Skin and VD at Community Based Medical College Bangladesh.

Results: Among 150 patients, 55% were male and 45% were female. Among all reported patients, 56 (71%) had a moderate level of SD, followed by mild (16%) and severe (13%). Among the HCP (Health care provider) suggested patients, 41% of them had moderate SD, followed by mild (40%) and severe (19%). Out of 150 patients, 50% of them were not allowed to miss their jobs due to the symptoms.

Conclusions: The findings of this study highlight the importance of a holistic care approach for managing seborrheic dermatitis. This approach should encompass not only the treatment of the physical signs and symptoms of the disease but also the psychological and social challenges that patients with seborrheic dermatitis face.

Clinical profile and underlying causes of recurrent pneumonia in young children

Tanusree Sen — 2024-12-31

Background: Recurrent pneumonia is a significant health concern in children, often associated with underlying medical conditions and substantial morbidity. Identifying risk factors, clinical profiles and underlying causes are essential for timely diagnosis and management.

Methods: This cross-sectional, prospective study was conducted at Bangladesh Shishu Hospital and Institute from January to June 2022, involving 50 children aged 2 months to 5 years with recurrent pneumonia. Data were collected on clinical symptoms, underlying conditions, physical findings, immunization status, radiographic, laboratory and specialized testing findings.

Results: Cough was present in 100% of cases, followed by respiratory distress (78%) and fever (66%). Congenital heart disease was the most common underlying condition (22%), followed by developmental delay (16%) and cystic fibrosis (10%). Respiratory distress was observed in 78% of patients, with crackles (66%) and wheezing (32%) as common auscultatory findings. Bronchopneumonia was the predominant chest x-ray finding (72%), while CT scans revealed consolidation in 48.6% of cases. Sweat chloride testing confirmed cystic fibrosis in 10% of cases and echocardiography identified congenital heart disease in 31.3%.

Conclusions: Recurrent pneumonia in children is frequently associated with congenital heart disease, developmental delay and cystic fibrosis. Radiographic findings, laboratory investigations and specialized testing are crucial for accurate diagnosis and management. Timely identification of risk factors and adherence to immunization schedules are essential to reduce disease burden.

Postoperative pain management in gynecologic laparoscopic surgeries

Mohammad Nurul Amin — 2024-12-31

Background: Postoperative pain management is crucial in gynecologic laparoscopic surgeries, as inadequate pain relief can delay recovery and affect patient satisfaction. This study evaluated the effectiveness of different postoperative pain management strategies in a cohort of female patients undergoing elective procedures. The primary objective was to assess the effectiveness of multimodal analgesia, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and regional anesthesia, on postoperative pain relief. Secondary objectives included evaluating side effects associated with these pain management strategies.

Methods: This cross-sectional observational study was conducted from July 2022 to June 2024 at the department of anesthesia, in different private clinics in Sylhet region, Bangladesh. A total of 60 adult female patients aged 18 to 65 years undergoing elective gynecologic laparoscopic surgeries were included. Data were collected using patient interviews and medical records, assessing pain levels using the visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively. Statistical analysis was performed using SPSS software.

Results: Among the 60 participants, the mean age was 35 years, with 55% undergoing laparoscopic hysterectomy and 45% laparoscopic cystectomy. At 1 hour postoperatively, the mean VAS score was 6.5±1.2, decreasing significantly to 2.2±0.9 by 24 hours (p<0.01). Pain management strategies included NSAIDs in 75% of patients, opioids in 50%, and regional anesthesia in 41.7%. The incidence of adverse effects varied: nausea was reported in 33.3% of opioid users compared to only 6.7% in NSAID users.

Conclusions: The findings indicate that implementing multimodal analgesia, particularly incorporating regional anesthesia, can enhance postoperative pain management in gynecologic laparoscopic surgeries. This approach not only improves pain relief but also minimizes the adverse effects commonly associated with opioid use.

Depression but not anxiety is associated with iron deficiency anemia for patients with stage 2-4 CKD

Ozant Helvaci — 2024-12-31

Background: Chronic kidney disease (CKD) is a global health challenge, often complicated by iron deficiency anemia (IDA), depression, and anxiety. While the impact of IDA on depression has been well-documented, its association with anxiety in non-dialysis-dependent CKD patients remains unclear. This study aimed to investigate the relationship between IDA and neuropsychiatric disorders, specifically depression and anxiety, in patients with non-dialysis-dependent CKD stages 2-4.

Methods: A cross-sectional study was conducted in the outpatient nephrology clinic at Gazi University Hospital, enrolling 200 patients with stable CKD (stages 2-4). Depression and anxiety were measured using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Statistical analysis included comparisons of BDI and BAI scores between anemic and non-anemic groups, along with subgroup analysis of iron-treated anemic patients.

Results: Anemia was present in 38% of patients, and anemic patients had significantly higher BDI scores (mean 13.4 vs. 9.0, p<0.001) than non-anemic patients, indicating a greater prevalence of depressive symptoms. No significant differences were found in BAI scores between the groups. However, anemic patients receiving iron supplementation had lower BDI and BAI scores compared to untreated anemic patients (p<0.001).

Conclusions: IDA was associated with a higher prevalence of depression but not anxiety in non-dialysis CKD patients. Iron supplementation may help mitigate depressive symptoms in this population. Further prospective studies are needed to explore the full potential of iron therapy in managing mental health outcomes in CKD patients.

Clinical outcomes of interim positron emission tomography-computed tomography scan-guided response-adaptive therapy in advanced Hodgkin's lymphoma: a tertiary cancer centre experience from South India

Vasanth Rooban Narasimman — 2024-12-10

Background: Hodgkin’s lymphoma (HL) is a highly curable malignancy, but some patients fail standard ABVD chemotherapy, requiring intensified treatment. Interim positron emission tomography-computed tomography scan (iPET-CT) using the Deauville scoring system allows response-adapted therapy, enabling de-escalation to AVD in good responders and escalation to dose-escalated BEACOPP (EB) in poor responders. This study evaluates iPET-guided therapy outcomes in HL patients at a tertiary care center in South India.

Methods: A retrospective study of 69 HL patients (aged 12-65 years) treated over 5 years was conducted. After two ABVD cycles, iPET-2 scans guided treatment: PET-negative patients (Deauville 1-3) received four additional AVD cycles, while PET-positive patients (Deauville 4-5) received four EB cycles. The primary endpoint was event-free survival (EFS); secondary endpoints included overall survival (OS), toxicities, and quality of life. Statistical analyses included Kaplan-Meier survival analysis and Cox regression.

Results: The cohort (median age: 38 years, 87% male) had predominantly advanced-stage disease (73.9%) and systemic B symptoms (81.2%). iPET identified 16% as PET-positive. Median OS was 73 months (95% CI: 67.77-78.23), and median EFS was 30 months (95% CI: 28.64-31.36). PET-negative patients showed significantly better 2-year EFS (81%) compared to PET-positive patients (50%; p<0.05). Toxicities were higher in the EB group, with grade 3-4 neutropenia in 85% of cycles.

Conclusions: iPET-CT-guided therapy effectively stratifies HL patients, improving outcomes in PET-positive poor responders while avoiding overtreatment in PET-negative patients. Despite higher toxicities, escalated BEACOPP was feasible and safe, highlighting the potential of response-adapted strategies in resource-limited settings.

Foreign body ingestion: distribution, its complication and management

Kalpana Sharma — 2024-12-13

Background: Foreign body ingestion can lead to severe complications, especially if the object becomes lodged in the oesophagus. Complications may include perforation, obstruction, and secondary infections. Early diagnosis using soft tissue neck and chest radiographs can help determine the location, type of foreign body and any associated abscess formation. In cases with complications, the primary treatment involves intravenous antibiotics followed by removal of foreign body.

Methods: This prospective observational study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery at Gauhati Medical College and Hospital, Guwahati. A total of 144 patients with foreign body ingestion treated in our hospital from September 2023 to August 2024 were included. Each patient underwent a thorough clinical assessment and radiographs of the soft tissue neck, chest, and abdomen (both lateral and anteroposterior views). A computed tomography (CT) scan was performed, if necessary, to confirm the presence of foreign body and to identify any potential complications.

Results: Among the 144 patients, 18 developed complications related to foreign body ingestion ranging from 6-60 years old with a male-to-female ratio of 2:1. The most frequent complication was retropharyngeal abscess, followed by oesophageal obstruction, respiratory obstruction, and oesophageal tear. Out of the 18 patients, one patient expired as a result of complications.

Conclusions: Foreign body ingestion can cause serious complications such as oesophageal obstruction, mucosal laceration and perforation, airway obstruction, and infections. Prompt identification and intervention are essential to manage these complications effectively and to reduce morbidity and mortality in affected patients.

A case control study of asymptomatic hyponatremia in patients with chronic kidney disease

Aditya K. Mishra — 2024-12-20

Background: This study has been conducted to assess the association between asymptomatic hyponatremia with cognitive dysfunction, bone health, quality of life and various inflammatory markers in non-dialysis chronic kidney disease patients.

Methods: A single centre hospital based observational case-control study conducted at a tertiary care hospital in eastern India. Non dialysis chronic kidney disease patients with (case) or without (control) asymptomatic hyponatremia were included in the study after proper assessment of inclusion and exclusion criteria. Relevant clinical and laboratory parameters were recorded. C reactive protein and interleukin 6 were measured and T score was assessed by dual-energy X-ray absorptiometry (DEXA) scan at lumbar vertebra (L1 to L4). For cognitive function assessment, Bangla adapted mental state examination (BAMSE) score was calculated and activities of daily living (ADL) score was also recorded.

Results: 38 patients in the control group and 37 patients in the case group came for follow-up visit. Significant positive correlation was found between serum sodium levels with the DEXA scan (T-scores). On the other hand, significant negative correlation was found between serum sodium with C-reactive protein (CRP) and interleukin-6 (IL-6) levels. Though BAMSE scores and ADL scores showed a positive correlation with serum sodium levels, the result was not statistically significant.

Conclusions: We conclude that asymptomatic hyponatremia in non-dialysis chronic kidney disease patients has significant association between DEXA scan T score and various inflammatory parameters like C reactive protein and interleukin 6. This may indicate possible role of prevention and treatment of this common electrolyte abnormalities to avoid effect of poor bone health and chronic inflammation in such a vulnerable population.

Efficacy of educational campaign on human leucocyte antigens screening for stem cell donation

Bharati Saikia — 2024-12-31

Background: Nearly all cells express the proteins known as human leukocyte antigens, or HLA. They aid in distinguishing our own cells from foreign substances and are principally in charge of the body's immunological response. It's interesting to note that every person inherits a distinct collection of antigens from their parents, with half coming from the mother and the other half from the father. This implies that these options can be programmed into youngsters from birth. This study aimed to evaluate how well undergrad students in particular colleges in greater Noida, Uttar Pradesh, are informed about HLA screening for stem cell donation.

Methods: Using convenience sample techniques, a pre-experimental study design is used to evaluate the awareness programme on HLA screening for stem cell donation.

Results: According to the study's findings, the majority of the sample (84%) had poor knowledge of stem cell donation during the pre-test, 16.0% had average knowledge, and 0% had good knowledge. During the post-test, however, the majority (61.0%) had good knowledge, with around 30.0% having average knowledge and only 9.0% having poor knowledge.

Conclusions: In summary, the majority of participants had low pre-test knowledge of HLA and stem cell donation; but, following an awareness presentation on the subject, most of them performed well on the post-test and had good understanding about HLA, DKMS, and stem cell donation. The awareness campaign was a success all around, and some of the participants are even eager to give.

Preoperative and intraoperative factors that influence development of systemic inflammatory response syndrome following percutaneous nephrolithotomy

Sandeep Reddy Donthiri — 2024-12-31

Background: Sepsis is one of the complications of PCNL. Various pre operative and intra operative factors are associated with its development. Sepsis initially starts with SIRS-Systemic Inflammatory Response Syndrome. Early diagnosis and treatment of SIRS also prevents the development of sepsis during the post operative period which markedly reduces the hospital stay and cost of care associated with the treatment and prevents mortality which can be attributed to septic shock. This study aimed to study the incidence of SIRS in the patients who underwent PCNL. Also, to study the pre operative and intra operative factors associated with development of SIRS in patients who underwent PCNL.

Methods: An observational study was conducted in the Department of Urology, Narayana Medical College and Hospitals, Nellore for 18 months from June 2021 to November 2022. A convenient sample of 100 were selected among the patients who underwent percutaneous nephrolithotomy procedure.

Results: 36% developed SIRS during the course of treatment. The association between development of SIRS and pelvic urine culture and sensitivity (P=0.018), stone culture and sensitivity (P=0.0004), requirement of blood transfusion (P=0.03) and operating time (P=0.0001) was statistically significant.

Conclusions: The patients with risk factors like positive pelvic urine culture and sensitivity, positive stone culture and sensitivity, requirement of blood transfusion and longer duration of surgery are to be carefully monitored and treated to prevent the development of SIRS.

Effect of total body fat on blood pressure in adolescents

Aaqib Husain Ansari — 2024-12-31

Background: Hypertension is a growing health concern among adolescents, with rising prevalence demanding a deeper understanding of its causes. Anthropometric factors are potential contributors to blood pressure variations, but their relationship with adolescent blood pressure remains unclear.

Methods: A cross-sectional study of 110 adolescents at King George's Medical College, Lucknow, from 20^th June 2023 to 1^st March 2024, examined the link between anthropometric parameters and blood pressure. Measurements followed standard protocols, and statistical analysis included correlation, linear regression, and multivariate methods.

Results: Participants averaged 15.98 years, with mean height, weight, and BMI of 164.92 cm, 61.98 kg, and 22.48 kg/m². Diabetes history was reported in 23.64%, and 27.27% had hypertension. Average waist and hip circumferences were 84.49 cm and 93.43 cm, with body fat at 21.33%. Mean systolic and diastolic pressures were 120.36 mmHg and 77.15 mmHg, with 9.09% showing elevated blood pressure. Males had higher physical measurements and systolic pressure, while females had higher body fat. Systolic pressure correlated with age, size, and BMI, while diastolic pressure linked to weight, BMI, and body fat.

Conclusions: Body measurements and fat levels significantly impact adolescent blood pressure. Higher body fat, waist circumference, and weight are linked to increased diastolic pressure, while systolic pressure correlates with age, height, and body size. Males tend to have higher systolic pressure and physical measurements, while females show higher body fat percentages. These findings highlight the importance of monitoring body composition to prevent hypertension and reduce cardiovascular risks in adolescents.

Comparative study of vicryl polyglactin (910) versus chromic catgut for episiotomy repair

Nazamdeep Kaur — 2024-12-31

Background: The aim of the study was to compare two different absorbable suture materials, namely vicryl rapide (no. 2-0) and chromic catgut (no.1-0) for episiotomy repair and evaluate their outcomes related to short term maternal post-partum morbidity.

Methods: The prospective randomized comparative study was conducted in the department of obstetrics and gynecology, Bebe Nanki Mother and Child Care Centre, Amritsar, for a period of 1 year, with 200 pregnant females admitted in the labour room who needed episiotomies for vaginal delivery and were randomly allocated for episiotomy repair with either vicryl polyglactin (910) (no. 2-0) or chromic catgut (no.1-0) with 100 patients in each group and various parameters like pain, swelling, tenderness, dyspareunia, wound discharge and dehiscence were assessed in each group at 24-48 hours, 10-14 days and 6 weeks postpartum.

Results: The sociodemographic characteristics were comparable in both groups. Compared to chromic catgut, the vicryl rapide group was associated with lesser pain (7% versus 21%), feeling of stitches (20% versus 38%) and swelling and tenderness (4% versus 12%). There was significantly less wound disruption (3% versus 12%), feeling of stitches (11% versus 21%) and wound discharge (1% versus 7%) in vicryl rapide group at 10-15 days. Residual pain and dyspareunia were also less in vicryl group at 6 weeks.

Conclusions: It can be concluded that vicryl rapide is a superior suture material than chromic catgut for repair of episiotomy as it results in lesser complications and improved wound healing.

Role of tranexamic acid in reducing blood loss in vaginal delivery

Harsimran Kaur — 2024-12-31

Background: Postpartum hemorrhage (PPH) remains a significant reason for maternal death, especially in developing nations like India, where it accounts for 23% of maternal deaths. This prospective study aimed to assess the effectiveness of tranexamic acid (TXA) in reduction of blood loss during vaginal deliveries.

Methods: This study was conducted at Bebe Nanki mother and child care centre in Amritsar, Punjab. 200 pregnant women were randomly assigned to two groups: Group A received 1g TXA intravenously alongside 10 IU oxytocin intramuscularly, while group B received only oxytocin. The measurement of blood loss was done up to 2 hours post-delivery along with various vital and hemodynamic parameters.

Results: The results showed reduction in blood loss in group A in comparison to Group B which was significant, with mean blood loss of 106.25 mL in group A vs 222.45 mL in group B (p=0.001). Hb and PCV declines were also significantly lower in group A. Fewer patients in group A required additional uterotonics (4%) or blood transfusions (2%) versus group B (26% and 4%, respectively). No significant adverse effects, such as thromboembolic events, were observed in either group. Mild post-delivery nausea and vomiting was seen in both groups, with slightly higher incidence in group A.

Conclusions: TXA combined with oxytocin significantly reduces postpartum blood loss without major side effects, supporting its use as an adjunct therapy in PPH management. Further studies are recommended to validate these findings and promote wider adoption in clinical practice.

Chemotherapy-induced adverse drug reaction of antineoplastic drugs among oncology patients in a tertiary care teaching hospital

Sabarinath Harshakumar — 2024-12-31

Background: The main objectives of the study were to assess the pattern of adverse drug reactions (ADRs) associated with the use of antineoplastic drugs along with their causality and severity. The study also aims to analyse the different stages of cancer, cycles of chemotherapy and the quality of life of the patients.

Methods: This prospective, cross-sectional and descriptive study was conducted among 100 patients of either sex for 6 months from April 2023 to October 2023. This study included patients above the age of 18 years who were clinically diagnosed with cancer and prescribed at least one antineoplastic drug.

Results: Most of the cancer patients belonged to stage 2 and were undergoing the third cycle of chemotherapy. Most common ADRs were alopecia, anemia and anorexia. The study revealed that 79% of ADRs were possible and nearly 21% were probable in nature. After the severity assessment, it was found that all of the ADRs were mild (level 1). It was also identified that quality of life (QoL) decreases with advancing stages of cancer.

Conclusions: Cancer, along with therapeutic agents, can impair a patient's quality of life, prompting the development of effective management strategies. Assessing the severity and causation of ADRs can help determine the right supportive care agent to improve patients' general well-being.

Unravelling the risk factors and treatment patterns of dyslipidemia in India (UNICORN study)

Mayur Mayabhate — 2024-12-31

Background: The UNICORN study aims to determine the risk factors and patient demographics for dyslipidemia and assess the efficacy of the prevalent therapies in managing dyslipidemia.

Methods: The UNICORN study employed a retrospective cross-sectional design, analyzing data from 9,998 patient health records retrieved from tertiary care centers across India. Demographic variables, lipid profile parameters, risk factors (smoking status, alcohol consumption and dietary habits) and healthcare-related variables (treatment history of medication, lifestyle interventions and lipid profiles) were extracted from medical records. Descriptive statistics and hypothesis testing were used to assess lipid profiles, comorbidities and treatment impact. Odds ratios and paired t-tests evaluated morbidity risk and treatment efficacy.

Results: Statins were prescribed to 99.19% of the patients. 61.61% of the population did not follow any particular diet. Lipid parameters were better in obese and overweight patients, compared to normal and underweight patients (p<0.001). Patients with hypertension (239.5 vs 223.4 mg/dl), coronary artery disease (240.5 vs 231.4 mg/dl), stroke (230.3 vs 236.3 mg/dl) and peripheral arterial disease (238.1 vs 234.1 mg/dl) showed significantly higher total cholesterol levels. The odds ratio (OR) reported a higher likelihood of newly diagnosed patients developing hypertension (OR=1.76), coronary artery disease (OR=1.65), heart failure (OR=1.76), stroke (OR=1.82) and peripheral arterial disease (OR=1.71).

Conclusions: Statins were used by the majority of the patients and improved the serum lipid levels. However, the improved lipid measures were still indicative of dyslipidemia, with the absence of complete resolution of the condition. Hypertension, coronary artery disease, stroke and peripheral arterial disease are risk factors and frequently associated comorbidities with an unclear causal relationship.

Preparing for tomorrows health challenges: lessons from a COVID-19 epidemic from tertiary healthcare setting in Delhi

Ambika Walecha — 2024-12-31

Background: The COVID-19 pandemic highlighted the fragility of healthcare systems, underscoring the urgent need for preparedness in managing medical emergencies. This study aims to evaluate the strengths and challenges within a tertiary care hospital, focusing on the lessons learned to improve future crisis management. This qualitative study investigates the strengths and limitations of Lady Hardinge medical college and associated hospitals during the COVID-19 pandemic. The findings aim to contribute to the development of a standardized preparedness plan for future epidemics and medical emergencies.

Methods: Ethical approval was obtained, and confidentiality was maintained. The research was conducted from August 2022 to December 2023 using purposive sampling. Data were collected through interviews and focus groups with hospital staff across all levels, including administrators, faculty, residents, nurses, paramedics, and support staff. Thematic analysis was used to identify key patterns and themes related to hospital preparedness and response strategies.

Results: Key themes emerged around service delivery challenges, communication issues between departments, resource management, and psychological concerns such as the need for acknowledgment. Insights from staff during the first and second waves of the pandemic revealed both weaknesses and strengths, providing valuable lessons for managing future emergencies.

Conclusions: The study emphasizes the importance of addressing the identified challenges to strengthen hospital systems for future crises. The findings offer essential guidance in developing effective preparedness plans to enhance healthcare resilience during emergencies.

A comparative study of mifepristone with dinoprostone for induction of labor in third trimester

Akshaya Sivadas — 2024-12-31

Background: Success of labor induction depends upon favourability of the cervix at the time of induction. Various methods have been tried for labor induction but the search for ideal induction agent continues. There is a paucity of literature regarding the safety and efficacy of Mifepristone as induction agent in live pregnancies. Our aim was to study the efficacy of tablet Mifepristone as a cervical ripening agent and to compare the feto-maternal outcome with Dinoprostone gel.

Methods: A total of 100 patients who required labor induction were enrolled and randomized to receive mifepristone and dinoprostone. 50 patients were given oral tablet Mifepristone 200mg and 50 patients were instilled with intracervical Dinoprostone 0.5mg gel. The outcome was assessed by improvement in bishop’s score, induction delivery interval, requirement of oxytocin, mode of delivery, and feto-maternal complications.

Results: The improvement in mean Bishop’s score after 24hours was more in Mifepristone group (2.78±1.28 to 7.22±2.02) than in Dinoprostone group (2.64±1.29 to 6.70±1.75) (p=0.173). The incidence of vaginal delivery and LSCS were 86% and 14% in Mifepristone group and 72% and 28% in Dinoprostone group, respectively (p=0.227). The requirement of mean dosage of oxytocin was lesser in Mifepristone group (2.26±0.71) as compared to Dinoprostone group (3.29±1.35) (p=0.001). NICU admission was required in 26% neonates in Dinoprostone group and 16% neonates in Mifepristone group (p=0.220).

Conclusions: Mifepristone is a safe and efficient cervical ripening agent with no significant adverse effects to both mother and fetus.

Are we ready to replace physical mock exam with an online mock exam? a survey-based comparison

Chaitanya Sabnis — 2024-12-31

Background: Mock exams have become an integral part of urology training, presently conducted in a real classroom (physical mock exam- PME). We conducted a mock exam in a virtual classroom (online mock exam- OME) for 130 urology residents. A survey was conducted to compare OME and PME.

Methods: Questionnaire was developed, consisting of 16 questions, of which two question were matrix, others had options. For the matrix questions the candidates had to rate the components of the PME and OME on a scale of 1 to 5.

Results: Out of the 130, 103 (86.55%) were eligible for analysis. Regarding, ease of understanding the question and fulfilling the expectations both modalities were rated highly (95.15% versus 93.2%, p=0.552 and 89.32 versus 83.5%, p=0.221). OME fared better than PME, with regards to the questions addressing; ease of understanding the explanation (p=0.000), fluency of interaction (p=0.000), ability to concentrate (p=0.002), feeling of involvement (p=0.000), logistic convenience (p=0.001), ability to network and ability to balance commitments (p=0.000). PME was superior in interacting with peers (p=0.000), and peer motivation helping them concentrate better (p=0.001). Out of the 103 respondents 79 (66.39%) recommended an OME for future.

Conclusions: Online platform can be effectively used to conduct a mock exam. It is not only noninferior to PME but also has many advantages. This survey shows OME has a potential to replace PME.

Key factors affecting psychosocial well-being in thalassemic children from eastern India: an institutional study

Rajib Saha — 2024-12-31

Background: Thalassemia syndromes, prevalent in Eastern India, significantly impact the psychosocial health of affected children. The challenges associated with chronic treatment and disease management underscore the need for comprehensive quality of life assessments.

Methods: This cross-sectional study was conducted at Bankura Sammilani Medical College and Hospital from July 2022 to June 2023. A sample of 371 thalassemic children aged 5-12 was analyzed using the Pediatric Quality of Life Inventory 4.0 Generic Core Scale. Socio-demographic data and psychosocial health were evaluated through parent interviews and clinical records. Statistical analyses included correlation and regression models to identify factors influencing psychosocial health.

Results: The mean psychosocial health summary score was 63 (SD=9.4), indicating significant psychosocial challenges. Key factors associated with better psychosocial outcomes included lower duration of blood transfusions, female gender, positive family history of thalassemia, and higher socioeconomic status. The regression analysis revealed that these factors collectively explained 21.3% of the variability in psychosocial health scores.

Conclusion: The study emphasizes the critical influence of gender, family history, socioeconomic status, and transfusion duration on the psychosocial well-being of thalassemic children. Integrated care approaches combining medical treatment with psychological support are essential for improving quality of life. Early intervention strategies, family support programs, and tailored treatment plans that consider gender-specific needs are recommended to address the emotional and social challenges faced by these children.

A study on patients with alcohol dependence syndrome on tablet baclofen in a tertiary care hospital

Harshitha N. — 2024-12-31

Background: Many clinical trials indicate that baclofen, a gamma-aminobutyric acid agonist has efficacy for alcohol dependence to reduce the cravings of alcohol and it may also have certain common or rare ADRs. Aim was to evaluate tablet baclofen’s adverse effects and sociodemographic profile in the treatment of ADS.

Methods: This study was carried out in MVJ Medical College and Research Hospital Bangalore, India. The socio-demographic questionnaire and NADRP was administered to 100 patients who was on tablet baclofen with alcohol dependence syndrome that were diagnosed according to the ICD-10 diagnostic criteria, as well as 100 subject all of whom gave their informed consent. The data were analysed using Microsoft excel.

Results: As a result, this present data analysis revealing that alcohol addiction was more prevalent in the 36 to 50 age group, men among women. Primary school students were more addicted to alcohol, with non-professionals, rural areas, and nuclear families having higher addiction rates. Most alcohol dependence subjects have a tobacco history and comorbid mental and behavioral disorders. NADRP scales indicate no severe adverse drug reactions in alcohol dependence syndrome patients.

Conclusions: Results showed that ADS is more prevalent in the adults, married patients lack of education, occupation, and family size also contributed to addiction. Rural areas had higher alcohol addictions than urban ones, and nuclear families were more likely to abuse drugs. The study concluded that tab. baclofen is a rational medicine for treating ADS.

What strategies do cardiologists employ for heart failure management? Insights from Indian clinical practice

Kunal Khobragade — 2024-12-31

Background: Heart failure (HF) is a leading cause of morbidity and mortality in India, with ischemic heart disease (IHD) being a primary contributor, particularly in patients with reduced ejection fraction (HFrEF). Despite comprehensive guidelines, a gap exists between guideline-directed medical therapy (GDMT) and real-world practices.

Methods: A cross-sectional survey of 476 cardiologists across India was conducted from April to June 2023 to evaluate current therapeutic approaches for managing HFrEF. The study assessed alignment with established guidelines, including the American college of cardiology/American heart association (ACC/AHA) recommendations.

Results: HFrEF accounted for 40-60% of HF cases, typically diagnosed at advanced stages New York heart association (NYHA class III), with EF often reduced to 20-30%. While 94.5% of cardiologists supported NT-proBNP testing for HF management and 73.5% endorsed ARNi as first-line therapy, ARNi usage remained suboptimal at 20-60%. Most cardiologists (67%) preferred initiating quadruple therapy within 12-24 weeks of diagnosis, citing medication tolerance as a key barrier to achieving optimal treatment goals.

Conclusions: This study highlights substantial gaps in the adoption of guideline-recommended therapies for HFrEF in India. Improved strategies are needed to address barriers to GDMT implementation and ensure timely interventions to enhance patient outcomes.

Psychological determinants and its association with coronary artery disease: a prospective study

Nitinkumar Abdagire — 2024-12-31

Background: Psychological diseases like depression, anxiety and burnout are major public health problems of concern, as it is affecting both general as well as cardiac health. Therefore, present study aims to screen the patients for psychological determinants and its association with coronary artery disease.

Methods: The study is prospective, questionnaire based, observational study conducted on 166 patients having coronary artery disease based on conventional coronary angiography. Out of 166 participants, 132 were in conventional risk factors Group (comorbid condition group), and 34 in non-conventional risk factors group (without any comorbid condition group). Patients were screened for depression, anxiety and burn out using the patient health questionnaire (PHQ-9), generalised anxiety disorder (GAD-7), burnout self-test questionnaires respectively.

Results: The present study revealed majority of the participants had moderate anxiety, depression, and risk for burnout. Significant positive correlation was found between Syntax score and depression (P<0.05). No statistically significant difference was noted for anxiety, depression, and burnout score between comorbid group having conventional risk factors (patients having diabetes, hypertension and dyslipidaemia) and non-comorbid group with non-conventional risk factors (patients suffering from anxiety, depression and burnout without any comorbid conditions), suggesting major role of anxiety, depression, and burnout for the development of cardiovascular diseases.

Conclusions: Non-conventional risk factors add increased risk for the development of coronary artery disease; therefore, efforts should also be made to assess cardiac patients for psychological determinants and to improve patients psychological and social function.

Ophthalmic implications following orbital trauma

Kishorkumar Turadagi — 2024-12-31

Background: To study the epidemiology, clinico-radiological pattern of ocular injuries following orbital trauma.

Methods: A cross-sectional study was conducted for a period of 6 months, all the patients attending casualty with the history of orbital injuries were included in the study. Proper history and ophthalmological examination were done. The data were recorded in the form of various parameters like type of injury, time, place and severity of injury, site of injury, and radiological pattern of fracture.

Results: Out of 100 patients 68 patients had injuries due to road traffic accidents. Most of the victims were males (86%). The most vulnerable age group was 21-30 year (38%). Majority of the patients had lid laceration (n=43, 43%), followed by periorbital swelling with black eye in 40 patients (40%) and iris prolapse in 1 patient. Out of 40 orbital wall fracture 11 fractures were impure and 29 were pure orbital wall fracture. Most of them were orbital floor fracture and least was roof fracture.

Conclusions: Road traffic accidents can result in severe ocular trauma. Victims are usually adult males of productive age group. Frontal impacts during the accidents poses the greatest risk of orbito-facial trauma. Factors like open globe injury and multiple orbital wall fracture usually associated with poor prognosis. Use of helmet and seatbelt may reduce the risk of frontal impact and hence vision threatening ocular trauma.

A comparative study of catheter size effect after direct vision internal urethrotomy for small urethral strictures

Rohit Ajmera — 2024-12-31

Background: Urethral stricture disease is the most common cause of obstructive voiding symptoms in younger males and has always been a challenge for urologists. Optical urethrotomy (OU) has been considered as the standard therapy for anterior urethral and short segments strictures.

Methods: In our study 164 consecutive treatment naive and recurrent urethral stricture patients who underwent direct vision internal urethrotomy (DVIU) were retrospectively analyzed. 22Fr urethral catheters were placed for longer durations and small calibre catheters (14 or 16Fr) were preferred for shorter dwell times after DVIU. Catheter dwell times were grouped as <7 and ≥7 days.

Results: A total of 164 patients with a mean age of 54.51±11.8 (range: 17 to 85) years were enrolled in the study during the follow-up, 24 (14.6%) patients experienced recurrences during 6 month follow up. The mean postoperative duration of catheterization was 8.47±2.03 and 6.49±1.14 days, in 6 patients with 14/16 Fr and 18 patients with 20 Fr catheter respectively have recurrence with p=0.00802.5 patients with less than 7 days and 19 patients with >7 days had recurrence with p=0.0019.

Conclusions: Urethral stricture disease is disease of high recurrence. Factors responsible for recurrence of disease after treatment like-etiology, length of stricture, duration /size of catheter, open or endoscopic procedure. putting a small diameter catheter and short duration of catheterization help in reducing recurrence.

Study of serum uric acid level in chronic liver disease and its association with hepatic encephalopathy and LFT parameters

Atul Gupta — 2024-12-31

Background: Chronic liver disease (CLD) is a progressive condition associated with complications such as hepatic encephalopathy (HE), a neuropsychiatric manifestation linked to altered purine metabolism and serum uric acid (SUA) levels. While liver function tests (LFTs) evaluate liver health, the role of SUA in CLD, particularly its correlation with HE severity and LFT parameters, remains underexplored. To investigate serum uric acid levels in CLD patients and examine their correlation with HE severity and LFT parameters.

Methods: This cross-sectional study included 54 CLD patients aged 18-85 years from GSVM Medical college Kanpur, selected via random sampling. Clinical and biochemical data, including SUA levels and LFTs, were collected and analysed. Statistical analyses using ANOVA and Pearson correlation assessed associations between SUA, HE grades, and LFT parameters.

Results: Serum uric acid levels significantly correlated with HE severity (ANOVA: F=6.93, p<0.05), with mean SUA levels rising from 6.28 mg/dL in Grade 0 to 10.41 mg/dl in Grade 2 HE. SUA demonstrated significant negative correlation with serum albumin (r = -0.36, p<0.05) and positive correlations with PT-INR (r = 0.33, p<0.05) and creatinine (r = 0.55, p<0.05). No significant correlation was observed with bilirubin, SGOT or SGPT.

Conclusions: Elevated SUA levels are significantly associated with the severity of hepatic encephalopathy and key LFT parameters. SUA may serve as a valuable biomarker for assessing CLD progression and predicting complications like HE.

Correlation of serum homocysteine with HbA1c and kidney function in type 2 diabetic patients: insights from estimated glomerular filtration rate and renal impairment

Vineet Kumar — 2024-12-31

Background: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder associated with complications, particularly diabetic nephropathy (DN), a major cause of end-stage renal disease (ESRD). Early detection of DN is essential to prevent progression. Serum homocysteine (Hcy), a marker linked to oxidative stress and endothelial dysfunction, has shown potential in predicting vascular and renal complications. However, its relationship with glycemic control (HbA1c) and kidney function (eGFR) remains underexplored. This study examines these correlations in T2DM patients.

Methods: This cross-sectional study included 156 T2DM patients recruited from G.S.V.M. medical college, Kanpur (January 2023-April 2024). Serum Hcy, HbA1c, and eGFR were measured using standardized techniques. Pearson and Spearman correlations, along with multiple linear regression, were used to evaluate relationships while adjusting for confounders like age, diabetes duration, and lipid profile.

Results: Serum Hcy levels demonstrated a significant positive correlation with HbA1c (r=0.47, p<0.01), indicating an association with poorer glycemic control. Additionally, a negative correlation was observed between serum Hcy and eGFR (r=-0.52, p<0.001), suggesting that elevated homocysteine levels were associated with declining kidney function. These correlations remained significant after adjustments for confounders.

Conclusions: Elevated serum homocysteine is strongly associated with higher HbA1c and lower eGFR, suggesting its potential as a biomarker for glycemic control and renal impairment in T2DM. Routine homocysteine measurement could aid early DN detection and management. Further studies are needed to validate these findings.

Evaluation of ultrasound assisted peripheral nerve stimulator guided versus peripheral nerve stimulator guided lumbosacral plexus block for postoperative analgesia in patients undergoing lower limb surgery

Veena Chatrath — 2024-12-31

Background: The aim of the present study was to compare the efficacy of ultrasound (USG) assisted peripheral nerve stimulator (PNS) guided versus peripheral nerve stimulator (PNS) guided techniques of lumbosacral plexus block (LSPB) for postoperative analgesia.

Methods: This prospective, randomized, double-blind study was conducted on 60 ASA grade I-II patients of either sex, aged 20-60 years, undergoing unilateral lower limb surgery under spinal anaesthesia. On completion of surgery, group U (30 patients) received LSPB using USG assisted PNS guided technique and group P (30 patients) received LSPB using PNS guided technique, with 0.25% injection levobupivacaine (20 ml) + injection dexamethasone (4 mg) in lumbar plexus block and 0.25% injection levobupivacaine (20 ml) + injection dexamethasone (4 mg) in sacral plexus block.

Results: The mean procedure time of group U was significantly more (15.30±1.98 minutes) than that of group P (11.05±2.13 minutes) (p=0.001). The mean duration of postoperative analgesia was longer in group U (18.00±5.65 hours) as compared to group P (15.80±6.11 hours) (p>0.05). The mean number of doses of rescue analgesia with injection fentanyl in group U was 0.806±0.66 and in group P was 1.066±0.63 (p>0.05).

Conclusions: USG assisted PNS guided LSPB is a better choice as compared to PNS guided technique.

A study to assess the effectiveness of educational training for nurses regarding non-invasive positive pressure ventilation

Shanu Mehna — 2024-12-31

Background: The use of non-invasive positive pressure ventilation (NIPPV) has significantly increased in the last three decades, becoming an essential, cost-effective tool for managing respiratory failure. The study aimed to evaluate the impact of an educational training program in improving nurses' knowledge and attitude towards non-invasive positive pressure ventilation (NIPPV) therapy.

Methods: A quasi-experimental study with single group pre and post intervention conducted from 01 May 2023 to 30 June 2023 with 42 nurses, working at respiratory unit selected through enumerative sampling technique. The educational program followed the recommendation proposed by NIPPV guidelines and included six hours of theoretical and hands on training sessions. Nurses’ knowledge and attitude were assessed using a questionnaire developed by the researcher. Administrative approval was obtained from the authority and informed consent taken from all the participants.

Results: Study findings reveals that there was substantial improvement in the pre and post training overall knowledge scores of nurses regarding different aspects of NIPPV therapy (15.31±3.28-26.93±1.69, with mean difference 11.62±3.56, 95% CI- 10.51-12.73, t- 21.15 p<0.001 respectively). In terms of attitude, the proportion of participants with positive attitudes increased from 0% pre-training to 100% (p<0.001) post-training.

Conclusions: The educational program has proven to be a valuable asset to the nursing team in the respiratory unit. It has enhanced evidence-based practices and the quality of care, resulting in improved effectiveness, timeliness, and safety. The study findings confirm that the program effectively enriches nurses' knowledge and attitudes.

The interplay between nicotine metabolites and reproductive hormones in women beedi rollers occupationally exposed to tobacco dust

Spandhana Racharla — 2024-12-31

Background: Although beedi-rolling is a convenient, home-based occupation for many women from lower socio-economic backgrounds, the strenuous and time-consuming process exposes beedi-rollers to tobacco dust for prolonged periods. This study aimed to investigate the effects of long-term exposure to tobacco dust on beedi-rollers and to examine the impact of nicotine metabolites on hormonal levels.

Methods: The study included 320 beedi-rollers (BR) and 280 control subjects (NBR). Signed consent forms were collected from all participants before conducting face-to-face interviews and blood collection. Serum was isolated from the blood samples to estimate reproductive hormones and nicotine metabolites using ELISA and LC-MS, respectively.

Results: Significant differences in hormone and nicotine metabolite levels were observed between the BR and NBR groups. The BR group was further divided into two subgroups based on years of service. Anabasine and 4- Methylnitrosamino-1-3- pyridyl-1 butanone (NNK), levels were significantly higher in beedi-rollers with more than 10 years of service. Increased anabasine and Cotinine levels were significantly correlated with reduced reproductive hormone levels.

Conclusions: Long-term exposure to tobacco dust leads to elevated nicotine metabolite levels, which may disrupt hormonal function and levels. Further research with a larger sample size is needed to better understand the impact of nicotine metabolites on the reproductive health of beedi-rollers.

Prognostic role of serum uric acid levels in patients with decompensated chronic heart failure

Salvi Sharma — 2024-12-31

Background: Chronic heart failure (CHF) affects over 26 million people worldwide and is characterized by the heart’s inability to meet the body’s metabolic demands due to structural or functional abnormalities, resulting in high morbidity and mortality. Traditional biomarkers such as sST2, cardiac troponin, and natriuretic peptides are costly and not universally accessible, creating a need for affordable and accessible alternatives.

Methods: This study evaluated the prognostic role of serum uric acid levels in decompensated CHF by comparing outcomes such as hospitalization duration, ICU stay, and mortality between patients with high (>7 mg/dl) and low (≤7 mg/dl) uric acid levels. Conducted over 14 months at K.P.S. Post Graduate Institute, GSVM Medical College, Kanpur, the study included 126 patients selected through purposive sampling. Data collection involved physical exams, laboratory tests, echocardiography, and ECGs.

Results: Elevated serum uric acid levels were associated with reduced ejection fraction, prolonged hospital and ICU stays, and worse cardiac function. Patients with higher uric acid levels demonstrated poorer clinical outcomes, highlighting its potential role in risk stratification and prognosis.

Conclusions: Serum uric acid is a valuable, low-cost prognostic marker for CHF, offering potential utility in early diagnosis and management. Its incorporation into clinical practice could improve outcomes and facilitate timely, affordable interventions, addressing the growing global burden of CHF. These findings underscore the need for further research to explore its integration into clinical workflows.

Incidence of homologous recombination deficiency among high grade serous ovarian carcinoma patients from a tertiary care center in India

Uddiptya Goswami — 2024-12-31

Background: Ovarian cancer (OC) is the 9th most prevalent cancer overall in India and the 3rd most common among women, following breast and cervical cancers. According to GLOBOCAN 2022, there were 47,333 new OC cases and 32,978 deaths. Epithelial ovarian cancer (EOC) represents 90% of OC cases, of which 70% are high-grade serous ovarian cancer (HGSOC). Unfortunately, most patients are diagnosed at advanced stages III-IV. Homologous recombination deficiency (HRD) is a phenotype that is characterized by the inability of a cell to repair DNA double-strand breaks using the HRR pathway, leading to genomic instability and further malignant transformation. The Cancer Genome Atlas (TCGA) has reported HR deficiency in nearly 50% of HGSOC cases.

Methods: This retrospective observational study evaluated 62 HGSOC patients treated at Apollo Cancer Centre Chennai from January 2021 to January 2024. Clinical data were collected from medical records. Formalin-fixed, paraffin-embedded (FFPE) tissue samples were obtained from patients undergoing surgery or biopsy and tested for HRD status. The data was analyzed and represented.

Results: In the study population of 62 patients, 15 patients (24%) had HR deficiency (HRD positive).8 (13%) patients had poor quality FFPE tissue. Out of the 15 HRD-positive patients, six patients were TBRCA1, and four patients were TBRCA2. Five patients had GSS of more than 42.

Conclusions: There is a significant population of HR-deficient HGSOC, comparable with the published literature. Thus, it serves as a predictive biomarker in ovarian cancers with deficiencies in DNA repair mechanisms.

Comparative study on the effectiveness of case-based learning over small group discussion in pediatrics among 8th semester MBBS students

Bindu Gopalakrishnan Santhakumari — 2024-12-31

Background: Case based learning (CBL) is a new teaching learning method in medical education. The goal of this method of teaching is to prepare students for clinical practice through the use of authentic clinical cases. It links theory to practice through the application of knowledge to the cases. Hence it is effective for students who have already acquired foundational knowledge. The study was conducted to compare CBL and the traditional method of small group discussion (SGD) in Pediatrics among 8th semester MBBS students.

Method: This quasi-experimental study was done among 8th semester MBBS students (n=83) of Government Medical College in south Kerala. The students were divided into two groups. One group was taught by CBL and the other by SGD. Pre-tests containing 10 multiple choice questions were conducted prior to each session. After three sessions, they were crossed over so that the two groups were exposed to both types of teaching learning methods. Post tests were conducted after 3rd (post test1) and 6th (post test2) sessions and the results were analysed.

Results: There was no statistically significant difference in the post test scores between CBL and SGD groups (p value 0.696 for post test1 and p value 0.908 for post test2). However, the learners agreed that CBL had helped them in making concepts clear, stimulated active learning and improved their skills in case analysis.

Conclusion: CBL can be used as a teaching learning method in Pediatrics to complement the traditional methods of teaching like SGD.

Gastrointestinal function and quality of life in postoperative patients of pancreatoduodenectomy

Veronica Masabanda Celorio — 2024-12-31

Pancreaticoduodenectomy (PD) is a complex, high-risk procedure with insufficient data on long-term quality of life and gastrointestinal function. Therefore, it is necessary to determine the level of quality of life and functional outcomes in these patients. In the following study, we present a case series analysis, establishing a direct relationship between post-surgical evolution and its impact on quality of life and gastrointestinal function, using two questionnaires: Short Form 36 and Gastrointestinal Symptom Rating Scale. Out of 15 patients the prevalence of pancreaticoduodenectomy in women was 69%, with a mean age of 53 years. The average follow-up period was 3.47 years. When applying the Short Form 36, they rated their general health at 68.67 points, emotional well-being at 78 points, and social well-being at 73 points. Regarding the Gastrointestinal Symptom Rating Scale, 100% reported pain and indigestion, some experienced gastroesophageal reflux, diarrhea, steatorrhea, and constipation; none of these symptoms limited daily life. Patients undergoing pancreaticoduodenectomy experience changes in their quality of life; likewise, gastrointestinal function alterations are common. Those who survive the underlying pathology and PD have quality of life and gastrointestinal function close to normal values, with improvements possible through symptom treatment, psychological support, social assistance, and physical rehabilitation.

Modified inverted-L glabellar flap for coverage of nasal dorsum defects: a case series

Jose de Jesus Orozco Grados — 2024-12-31

Nasal reconstruction, particularly of the nasal dorsum, presents significant challenges due to the intricate aesthetic subunits and complex vascular supply. Traditional techniques often face limitations in terms of coverage and aesthetic outcomes. This study aims to enhance reconstructive outcomes by employing advanced flap designs, specifically the Inverted-L and modified frontonasal or glabellar flaps, to address these limitations. This study presents a single-surgeon retrospective case series involving sixteen patients diagnosed with isolated Basal Cell Carcinoma on the nasal dorsum. Between 2019 and 2021, patients underwent wide lesion resections with clear margins, followed by flap coverage using the Inverted-L or modified frontonasal flap. The flap design was planned to avoid the supratrochlear artery and ensure optimal vascular supply. Postoperative care included the use of medical-grade silicone sheets for scar management, and patients were monitored for two years for any recurrences or complications. The patient cohort included a diverse age range with no long-term flap compromise or dehiscence reported. The mean follow-up period was 24 months (range, 6 months to 3 years). Minor complications involved the removal of absorbable internal stitches in three cases due to granuloma and pustule formation. All patients achieved satisfactory aesthetic results with no tumor recurrence or significant adverse events. This case series demonstrates the efficacy of the Inverted-L flap in nasal dorsum reconstruction, offering significant improvements in both aesthetic and functional outcomes. The technique allows for versatile flap manipulation while maintaining robust vascular support, crucial for optimal healing and minimal scar visibility.

Clinical profile and outcome of viral encephalitis patients in a tertiary care hospital

Naseeb N. N. — 2024-12-31

Early detection and management of viral encephalitis patients presenting with various symptoms result in better outcomes. This study seeks to address gaps in timely diagnosis and management to reduce long-term neurological deficits. To study the clinical profile and outcomes of viral encephalitis patients admitted to a tertiary care hospital.

Retrospective, observational study of 30 patients admitted at Travancore Medical College Hospital from April 2023 to May 2024. Fever, altered sensorium, and seizures were the most common presentations. Recovery was slower among immunocompromised patients, particularly those with chronic kidney disease. Common etiologies included Dengue, Herpes Simplex Virus (HSV), and Varicella Zoster Virus (VZV). Viral encephalitis remains a significant neurological emergency. Early recognition and management improve outcomes and reduce morbidity.

The impact of artificial intelligence in general surgery: enhancing precision, efficiency, and outcomes

Sergio M. S. Fuentes — 2024-12-31

The integration of artificial intelligence (AI) into general surgery has brought significant advancements in surgical precision, postoperative complication prediction, and intraoperative assistance. Despite its potential, AI faces challenges regarding its broad implementation in clinical practice. This systematic review aims to assess the impact of AI on clinical outcomes in general surgery, including diagnostic accuracy, complication prediction, and surgical error reduction. A systematic review was conducted using PubMed, Scopus, and Web of Science databases, focusing on studies published between 2020 and 2024. Inclusion criteria required studies that evaluated AI’s role in general surgery with a sample size of at least 50 patients. Studies reporting both qualitative and quantitative outcomes, including complication prediction and intraoperative assistance, were included. Ten studies were selected, involving a total of 12,580 patients undergoing various surgical procedures such as hepatectomies, colectomies, and cholecystectomies. AI significantly improved complication prediction accuracy (25% improvement over traditional methods) and reduced intraoperative errors by 18%. Additionally, AI-assisted surgeries showed an average reduction of 30 minutes in surgical time, from 150 to 120 minutes in complex cases. AI has proven to be a valuable tool in general surgery, particularly in complex procedures where precision and complication prediction are critical. However, further studies are needed to validate AI models across diverse populations and healthcare settings to ensure widespread adoption.

Associations between smartphone use and mental disorders in college students: a systematic review

Renata Maria Silva Santos — 2024-12-31

Smartphones are now ubiquitous in the daily lives of undergraduate students, but their excessive use may be related to psychological problems and to the development of mental disorders. To verify the influence of smartphone use on the development of mental disorders in university students, a systematic review of the literature was conducted, according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) and registered in PROSPERO under number CRD42023401060. The search was carried out in June 2024 with the descriptors: “smartphone”, “university students”, “college students” and “mental disorders”, in the PubMed, PsycInfo and Scopus databases. Of the 48 studies included, most found associations between excessive use of smartphones and the presence of mental disorders in university students. Only two articles observed improvement in anxiety, depression and stress associated with smartphone use and one study found no associations. Depression, anxiety, and stress were the main mental disorders found among university students. The excessive use of smartphones is associated with the presence of psychological problems in university students. Constant smartphone availability and online studies favours the development of psychopathologies in university students. The findings in this review strengthen the evidence of the need to develop strategies to live in a healthy way with the digital world.

Advances in flap surgical techniques and regenerative approaches for reconstruction of extensive defects in cutaneous squamous cell carcinoma: a systematic review of functional and aesthetic outcomes

Diego Román Zapata Ospina — 2024-12-13

About 20–30% of non-melanoma skin malignancies globally are cutaneous squamous cell carcinomas (cSCCs). Achieving the best functional and cosmetic results in complex and Long-term instances that need rebuilding is extremely difficult. Though they lack a thorough assessment of their efficacy but recent developments in flap surgery and regenerative medicines present encouraging alternatives. We only included papers which are published between 2000-2024 were included in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) -guided systematic review. Data were taken from 45 studies with 3,560 individuals (9 RCTs, 20 cohort studies, and 11 case series). Functional recovery, cosmetic satisfaction, and the rates of complications for both regenerative (such as platelet-rich plasma [PRP] and bioengineered scaffolds) and advanced flap techniques like perforator and free tissue flaps were evaluated. The Newcastle-Ottawa scale and the ROB 2 tool were used to evaluate the risk of bias. Compared to pedicled flaps (7.2/10, p<0.01), perforator flaps showed a 96.5% success rate and better functional recovery (mean mobility score: 8.5/10). Although free tissue transfers had a greater rate of complications (18%) but they produced the greatest aesthetic satisfaction scores (85%). Regenerative techniques enhanced wound healing by 25% and decreased infection rates by 15% (p=0.04). Graft survival was increased to 90% with bioengineered scaffolds as opposed to 75% without them. Complication rates were 20% overall but in high-risk instances, regenerative treatments reduced them to 10%. After all research, we can conclude that for cSCC reconstruction, the combination of regenerative procedures and sophisticated flap techniques minimizes problems while optimizing functional and aesthetic results. Free tissue transfers are favored for cosmetic reasons however perforator flaps are excellent for functional recovery. Regenerative methods like PRP and scaffolds can enhance surgical outcomes and durability.

Impact of neuroanatomical alterations identified by advanced imaging on the diagnosis and management of schizophrenia: a systematic review of psychosocial interventions and pharmacological therapies

Rebeca Rosas Hernández — 2024-12-13

We aim to systematically evaluate neuroanatomical alterations identified through advanced imaging on the diagnosis and management of schizophrenia. Neuroimaging advancements of magnetic resonance imaging (MRI), positron emission tomography (PET) and diffusion tensor imaging have made it possible to reveal in-depth structural and functional abnormalities such as reduced grey matter in the prefrontal cortex and hippocampus or ventricular enlargement and disrupted white matter tracts such as in schizophrenia case. Key symptoms such as disordered behaviour, hallucinations, and cognitive deficiencies are correlated with these alterations. Morphological features are also associated with neurotransmitter dysregulation specifically about dopamine and glutamate. The review also looks at pharmacological treatments like antipsychotics and psychosocial methods like cognitive behavioural therapy emphasising their varying effectiveness in treating the complex symptomatology of schizophrenia. Although there is potential for individualized treatment when neuroimaging results are integrated with clinical techniques but there are still obstacles to putting these insights into practice, especially in areas with low resources.

Integration of high-resolution imaging and minimally invasive ablation in the resection of thyroid microcarcinomas: evaluation of surgical precision and functional outcomes

Mauricio Zuluaga Zuluaga — 2024-12-31

Since high-resolution imaging and minimally invasive ablation techniques have emerged, their integration in medical field has marks a significant advancement in oncology including thyroid microcarcinomas (TMCs) management. TMCs are small but potentially aggressive tumors. TMCs require precise intervention to balance oncologic control and thyroid function preservation. Such as the detailed ultrasonic MRI and CT scan has improved TMC’s diagnostic ability and especially, the surgery planning. They are now making it possible to map tumors and the tumor margins in real time. Technological advances to minimally invasive ablation approaches such as radiofrequency and microwave ablation (MWA) have now shifted to offer localized cancer tissue destruction with less complications than the classical thyroidectomy. These techniques produce superior functional outcomes such as voice preservation and reduced hypoparathyroidism rates as well as high procedural success rates of more than 90%. Combining sophisticated imaging and ablation increases precision while resulting in recurrence rates as low as 2-5% in low-risk individuals. Despite these developments some challenges such as operator dependency and expensive costs that limit accessibility. Evidence supports the use of these approaches as an alternative to traditional surgery for certain patients showing importance of competent operators and technological infrastructure. This paradigm shift not only improves TMC treatment, but it also necessitates additional study to maximize long-term outcomes and increase accessibility. Ethical adherence and rigorous methodologies ensure reliable evaluations of safety efficacy, and functional outcomes. Evidence supports the integration of these techniques as an alternative to conventional surgery for select patients, emphasizing the need for skilled operators and technological infrastructure. This Transformation not only refines TMC management but also warrants continued research to optimize long-term outcomes and broaden accessibility.

Different machine learning language models for cardiovascular disease risk prediction: a systematic review

Alisha Lakhani — 2024-12-31

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, prompting the urgent need for accurate and efficient predictive tools. This systematic review evaluates the efficacy of various machine learning algorithms in predicting cardiovascular disease risk by analyzing multiple studies that employed diverse techniques, including support vector machines, decision trees, and neural networks. The results consistently demonstrate that machine learning algorithms outperform traditional risk assessment models in predicting critical outcomes such as myocardial infarction, heart failure, and stroke, with advanced methods like gradient boosting and deep learning models showing superior accuracy. The review highlights the potential of these technologies to enhance clinical decision-making and improve patient outcomes, while also recognizing challenges such as implementation barriers and the need for validation across broader populations. Furthermore, the review underscores the transformative potential of machine learning in cardiovascular risk assessment, emphasizing the necessity for continued validation and adaptation to diverse patient groups. These findings affirm the growing role of artificial intelligence in revolutionizing cardiovascular care through early diagnosis and precise risk stratification, while also addressing the strengths and limitations of AI-based tools.

The role of cognitive and personality factors in youth deliberate self-harm: a systematic review

Audifax Kpeno — 2024-12-31

This systematic review aims to investigate the relationship between cognitive factors, emotional tendencies, and personality traits contributing to deliberate self-harm (DSH) behaviour among youth. This systematic review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. Literature searches were conducted in March 2024 using Scopus, PubMed, and Google Scholar, focusing on "deliberate self-harm," "youth," "cognitive factors," and "personality profiles." The search was limited to articles in English from medicine, psychology, and social sciences, published in the U. S., Canada, Australia, the U. K., and New Zealand. Articles were selected based on their relevance to youth DSH and related cognitive constructs, excluding those focused on suicidal ideation. A narrative synthesis was performed, and study quality was assessed using the Cochrane risk of bias tool. A total of 21 articles were identified and included in the final review. Emotional regulation emerges as crucial in preventing DSHing behaviours, with early detection facilitated by screening for impulsivity, sensation-seeking, and emotional dysregulation. Prevention strategies targeting specific cognitive patterns and personality traits associated with self-harm are informed by insights from this review, drawing from diverse studies. Limited yet promising evidence underscores the need for further research to elucidate these relationships. Additionally, significant correlations between specific online behaviors and DSH among youth are noted. Understanding these cognitive constructs and personality traits can offer timely support and guidance in clinical practice, potentially leading to more effective, personalized interventions for reducing DSH behaviour among youth. Prospero registration no.: crd42024525239.

Resection of a nasal arteriovenous malformation with favourable aesthetic outcome: a case report

Melissa De A. Hidalgo — 2024-12-06

This case report details the management of a high-flow arteriovenous malformation (AVM) in a 13-year-old male, a rare condition in pediatric patients. The AVM, located on the left nasal wing, initially presented as a progressively enlarging purple nodule with recurrent bleeding. Initial treatment included embolization on 11 November 2022, which halted growth and led to partial involution. Despite this, renewed bleeding urged further intervention. The patient’s significant medical history, including chronic cardiopathy, added complexity to his care. A two-step treatment approach, including transcatheter embolization followed by surgical resection, achieved approximately 95% devascularization. The post-operative course showed satisfactory recovery with no complications. This case highlights the effectiveness of a multidisciplinary approach in managing complex facial AVMs and underscores the need for ongoing monitoring and individualized treatment strategies.

Immediate pelvic defect reconstruction with unilateral gracilis flap in a postoperative patient with vulvar carcinoma

Jose B. Mendoza — 2024-12-18

Vulvar cancer is a rare malignancy that primarily affects postmenopausal women. Squamous cell carcinoma is the most common histological type. Clinical presentation can be variable and non-specific, and treatment involves a combination of surgery and radiotherapy. This article presents a clinical case of a 61-year-old patient with squamous cell carcinoma of the vulva, treated with chemotherapy, brachytherapy and radiotherapy, who experienced recurrence. A pelvic exenteration and immediate reconstruction were performed using a unilateral gracilis flap, with satisfactory results. A 2-year follow-up showed no complications.

Obstructive jaundice as the initial manifestation of hepatocellular carcinoma in a patient with previously unknown chronic hepatitis B infection: a case report and literature review

Joaquin Blanco — 2024-12-31

Hepatocellular carcinoma (HCC) is the most common liver neoplasm, accounting for 90% of cases, with hepatitis B and C infections being the main risk factors for its development. Diagnosis is primarily based on imaging studies, serology, and histology. Clinically, it presents with right upper quadrant pain and B symptoms, with jaundice occurring in 19-40% of cases. However, the onset of obstructive jaundice as the initial symptom occurs in approximately 1-12% of cases. We present the case of a 65-year-old male with a recent diagnosis of diabetes mellitus, who presented with progressive jaundice, documenting suggestive imaging findings of hepatocellular carcinoma with portal involvement and a positive viral panel for hepatitis B. Pathology report confirmed a differentiated hepatocellular carcinoma.

Presentation of a cutaneous fistula due to mesh migration in a postoperative incisional hernia patient

Samuel Hernández — 2024-12-31

Incisional hernias are a frequent complication after abdominal surgery, ranging from 5-20% and up to 30% in patients with risk factors. Currently, hernia repair with mesh placement is recommended because it helps tension-free closure; however, there are complications such as surgical site infection, seroma, recurrence, fistula and mesh migration. We present the case of a 42-year-old female patient with mesh migration into the abdominal cavity secondary to incisional hernia repair. After reintervention with mesh remove, the patient had a favorable evolution, without complications and was discharged 48 hours after surgery. Currently the gold standard for incisional hernia repair is tension-free with mesh placement, however, this is not safe since there are several complications ranging from surgical site infection to mesh migration; the mesh migration represents a low percentage and its treatment is always surgical, but we must individualize it with each patient. In this case, we present an infrequent complication of open repair with mesh placement of an incisional hernia; however, it should be considered in the postoperative follow-up.

Disseminated histoplasmosis in a patient with NADPH oxidase deficiency: a case report

Mohd Mujtaba Akib Bhuiyan — 2024-12-31

Neutrophil nicotinamide adenine dinucleotide phosphate (NADPH) Oxidase plays a pivotal role in the production of reactive oxygen species and defect of its different subunit leads to the development of chronic granulomatous diseases. The defect of different sub-units of neutrophil NADPH oxidase affects different organs1.In endemic region, histoplasmosis is often seen in host with defective cell mediated immunity. Host with primary immunodeficiency with disseminated histoplasmosis is rare. Host with primary immunodeficiency due to Neutrophil NADPH Oxidase is even rarer2.One such presentation was seen in a 49 years old man who presented to us with recurrent attacks of histoplasmosis involving different organs which was treatment refractory. We report this case so that physicians can consider correlation between primary immunodeficiency and treatment refractory disseminated histoplasmosis in a seemingly immunocompetent patient.

Hemobilia, an uncommon case in a patient with severe acute cholangitis: a case report

Erik Martinez-Garcia — 2024-12-31

Hemobilia is an uncommon cause of upper gastrointestinal bleeding and it is usually associated with hepatobiliary trauma. We present a 71-year-old female patient with type 2 diabetes mellitus and hypertension, who was admitted to the emergency department due to clinical features of a severe acute cholangitis and hemodynamic instability. She required an external drainage through a T-tube in the common bile duct and admission to the intensive care unit in order to improve clinical conditions for a definitive treatment. Afterwards we performed an open cholecystectomy with a satisfactory postsurgical outcome and decided to discharge her. However, she was readmitted due to melena and bleeding through the T-tube, which developed a hypovolemic shock treated with crystalloid fluids and blood transfusion.

It is still in discussion what is the best treatment option. Since the objective is to preserve the integrity of the bile duct, only 5% of the cases will require a major intervention. It is important to individualize every case.

Spinal cord infarction a rare complication of acute aortic intramural hematoma: a clinical case report and review of literature

Munthir A. Alahmed — 2024-12-31

Aortic intramural hematoma is a rare and very serious condition, it can rapidly progress and lead to severe complications if there is a delay in the diagnosis and starting appropriate management. In this case report we are presenting a male 67 years old presented to the emergency department complaining of sudden severe worsening of his lower back pain, associated with left lower limb weakness for which he is unable to walk. A case report of spinal cord infarction secondary to acute aortic intramural hematoma (IMH) type A Standford classification. It represents an unusual clinical presentation of acute aortic IMH. Surgical management done resulting in a successful outcome.

Cerebral venous sinus thrombosis secondary to acute viral meningitis from cytomegalovirus and Epstein-Barr virus in immunocompetent patients: a case report

Muriel Amon-Tanoh — 2024-12-31

Cerebral venous sinus thrombosis (CVST) represents about 0.5% to 3% of all stroke cases, with a higher prevalence among younger populations. The estimated incidence is around 3 to 4 cases per million in adults and 7 cases per million in children. In tropical areas, there is often a notable association between infectious diseases and strokes. In sub-Saharan Africa, infections are identified as significant risk factors for cerebral venous thrombosis. Human cytomegalovirus (CMV) and Epstein-Barr virus (EBV), both ubiquitous members of the herpesvirus family, are typically asymptomatic; however, they can, in certain instances, contribute to the development of thromboembolic diseases (TED), particularly in immunocompromised individuals. The incidence of CVST linked to CMV or EBV in immunocompetent individuals without other risk factors is uncommon. This study presents two cases: the first involves a 15-year-old immunocompetent adolescent who experienced a rapid decline in alertness, while the second case pertains to a 43-year-old man who presented with sudden-onset headaches. Magnetic resonance venography (MRV) revealed extensive CVST on the left side in the first case and a sub occlusion of the left transverse sinus in the second. Analysis of cerebrospinal fluid isolated EBV and CMV through PCR, with positive serological results. The clinical outcome was favorable due to anticoagulant treatment combined with symptomatic management of the infections. The risk of CVST should not be overlooked in patients with symptoms related to CMV and EBV infection regardless of immune status and MRV should be considered to rule out this possibility.

A case of dysphagia and microcytic anemia successfully treated with heme iron polypeptide

Rajesh Makadia — 2024-12-18

A 40-year-old female presented to the oncologist with complaints of dysphagia (pain while swallowing) for the past month. Apart from this symptom, she had no other significant clinical complaints. Physical examination and imaging did not reveal any obvious findings, except for a few non-specific left supraclavicular lymph nodes. Blood tests revealed anemia, for which she was prescribed heme iron polypeptide (HIP). Follow-up over six months showed significant improvement in her hemoglobin levels and resolution of symptoms. This case highlights the efficacy and gastrointestinal tolerability of HIP in managing anemia.

Hemoglobin D-Punjab heterozygous encountered in Assam: a case report

Tanushree Debnath — 2024-12-31

Hemoglobin (Hb) D-Punjab is a haemoglobin variant with a point mutation in beta globin gene. A case of Hb D was encountered during screening of Hb variants among undergraduate students. With a prevalence rate of 2% in India, Hb D is generally rare in the Northeast region of India. Among the 200 screened cases, one Hb D heterozygous was detected by analysing the blood sample of the subject with an automated haematology analyser for complete blood count (CBC) and by using high performance liquid chromatography (HPLC) based Hb typing method. The haematological parameters were done in cell counter with Hg % 15.1 g/dl, mean corpuscular volume (MCV) 95 fl and mean corpuscular hemoglobin (MCH) 32.2 pg. The platelet value was high and high mean corpuscular hemoglobin concentration (MCHC) was obtained and the HPLC based haemoglobin typing was done with A2-2.9, A0-53.3, F- <0.8 area percentage and unknown window with 38.2 area percentage (retention time 3.86). Hb D Punjab heterozygous case has been reported in this report as prevalence of Hb D Punjab is very rare in the state of Assam.

Elongated uvula: diagnosis and management of a rare condition: case report

Harshitha N. — 2024-12-31

Elongated uvula is a rare condition where the uvula extends into the oropharynx, causing discomfort such as throat irritation, choking during swallowing, and nocturnal dyspnea. This case study discusses a male patient in his 50s presenting with these symptoms, aiming to highlight the diagnostic process and treatment outcomes. The patient presented with throat irritation, choking sensation while swallowing, and nocturnal dyspnea. Clinical examination by a primary care physician revealed an elongated uvula, which was confirmed through CT imaging. Routine investigations, including CT-PNS scanning and polysomnography (PSG), were conducted. The patient underwent a uvulectomy under local anesthesia in an outpatient setting. Postoperative follow-up assessments were conducted to monitor symptom relief and any complications. CT imaging confirmed the diagnosis of an elongated uvula measuring 54 mm. PSG indicated fragmented sleep architecture. The uvulectomy procedure was performed successfully without complications. The patient reported significant relief from throat irritation and improved swallowing function postoperatively. Follow-up at 1 month showed sustained improvement in symptoms. This case highlights the importance of considering uvulectomy for patients with symptomatic elongated uvula. Accurate diagnosis is essential to differentiate it from other conditions like asthma. Uvulectomy is an effective treatment that can significantly improve symptoms and quality of life for appropriately selected patients. Proper patient selection and preoperative evaluation are crucial for achieving optimal outcomes.

Anal fistula associated mucinous adenocarcinoma with anal fissure: a case report

Nikita Tompe — 2024-12-31

Perianal abscesses and anal fistulas are interconnected phases of an infectious process. Persistent irritation and inflammation around an anal fistula can cause cellular changes that increase the risk of cancerous transformation. A long-standing anal fistula, persisting for over 10 years, has been recognized as a potential precursor to fistula-associated mucinous adenocarcinoma (FAMC). A 67-year-old male patient presented with complaints of intense anal pain and a palpable tumor last year. Examination revealed a gluteal abscess, fistula-in-ano and an anal fissure. The patient gave a history of perianal abscess and anal fistula treated three years ago with fistulectomy, pus drainage, and lateral anal sphincterotomy. MRI revealed a horseshoe-shaped, multiseptate abscess in the intersphincteric plane (1 to 9 o’clock, predominantly left-sided), displacing the anal canal to the right, with three intersphincteric fistulas connected to the tumor. Histopathological examination revealed well to moderately differentiated mucinous adenocarcinoma in the distal aspect of the fistula suggesting a direct link between the chronic inflammatory process and development of malignancy. FAMC is a rare but serious complication of chronic anal fistulas. The diagnosis was made three years after treating a perianal abscess, indicating that epithelial dysplasia and carcinogenesis may have begun before the abscess developed. Consequently, FAMC can arise from anal fistulas in fewer than 10 years. This case underscores the importance of careful monitoring of patients with a history of perianal abscesses or anal fistulas for signs of malignant transformation, as early detection can significantly impact prognosis and treatment outcomes.

Neuroendocrine tumour of a larynx in 70-year-old man: a rare entity and a diagnostic challenge

Nida Shabbir — 2024-12-31

Neuroendocrine tumours of the larynx are rare yet neuroendocrine tumors is the second most common larynx tumour. According to the World Health Organization (WHO) 2022 classification, neuroendocrine tumours (NET) can be classified into well-differentiated, moderately differentiated and poorly differentiated. Well-differentiated NETs (typical carcinoids) of the larynx are rare and largely published as case reports. We present a case of a 70-year-old male with a history of hoarseness of voice for 1 year. Grossly, the tumour was globular and encapsulated. Based on histopathological features and immunohistochemistry results, the final diagnosis of a well-differentiated Neuroendocrine tumour was rendered. For carcinoid tumours of the larynx, conservative surgical resection is the preferred treatment without elective neck dissection. This tumour has a favourable prognosis, rare recurrences, and minimal metastasis.

Amyloidogenic occipital mass obscuring plasmacytoma: a rare presentation and review of literature

Tripti Verma — 2024-12-31

Solitary plasmacytoma of bone are a spectrum of plasma cell disorder which are defined by presence of clonal plasma cell in the bone including skull. The occurrence of true plasmacytoma of skull with large amyloid deposits in young patient is a rare presentation. We present case of 25-year-old man with a 3-month history of a slowly growing mass in the occipital region associated with headache. Neurological examination was within normal limits. Magnetic resonance imaging revealed a large extra-axial mass, the inner table of the skull were partially destroyed by the tumour, but the dura was not involved. The tumour removed and the skull defect was reconstructed followed by radiotherapy. Histopathological examination confirmed plasmacytoma with amyloidosis, positive for amyloid P component on immunohistochemistry. Laboratory investigations revealed no systemic myelomatosis. After 2 years of close follow up patient had no signs of recurrence or progression to multiple myeloma. The different management stratagies for the two entities of plasma cell disorder spectrum i.e. solitary plasmacytoma of bone and multiple myeloma necessitates there differentiation by thorough clinical, radiological and hematological studies. Surgical treatment followed by radiotherapy is an effective treatment option.

Huge multinodular goiter with retrosternal extension, a challenge to both surgeon and anesthetist: a case report

Benazeer H. Mohammad — 2024-12-31

Retrosternal goitre, defined as over 50% of the thyroid mass extending below the thoracic inlet, is a rare presentation of goitre. These cases are particularly observed among females in their 5th and 6th decades. Symptoms like breathlessness, facial flushing, and dysphagia, alongside complications like superior vena cava syndrome, increase morbidity. Surgery is the management of choice. While most cases are managed surgically via a cervical approach, some require thoracic intervention due to airway and neurovascular compression, including displacement of critical vessels like the subclavian and carotid arteries. We present a case of 63-year-old female with a huge euthyroid multinodular goiter with no pressure symptoms. Contrast enhanced computed tomography (CECT) neck was suggestive of bilateral enlargement of thyroid nodules, with left sided lobe also getting an additional supply from left brachiocephalic artery. Surgery of retrosternal goitre commonly involves a cervical approach, but thoracotomy maybe needed in cases of malignancy, redo thyroid surgery, or mediastinal goitres. Careful dissection to avoid damage to recurrent laryngeal nerve (RLN) and mediastinal structures is required, especially when nodules extend into the thorax. Tracheomalacia and vocal cord dysfunction, are rare but serious complications. Anesthesia challenges include difficult airway management due to tracheal deviation. Awake fibreoptic intubation is preferred, and patients may require intubation for 24 hours postoperatively due to anticipated airway edema. Large, long-standing retrosternal goitres require thorough preoperative surgical and anesthetic workup, often necessitating ear, nose and throat (ENT) and thoracic surgery backup, with CECT with angiograph aiding operative planning.

A case report on sarcoidosis: the great-mimicker

Megha Majumder — 2024-12-31

Sarcoidosis is a rare multi-systemic disease of idiopathic etiology with a low incidence and the hallmark histologic feature of non-caseating granulomas. Sarcoidosis can involve any organ system. Thus, the manifestations at presentation are highly variable. Our case features a 55-year-old female who presented with complaints of abdominal pain, anorexia, weight loss, and a history of infrequent dry cough with lymphoma, tuberculosis, and lung carcinoma, the initial differentials in mind. In due course, investigations revealed bilateral renal calculi and hypercalcemia, which eventually led to the diagnosis of sarcoidosis. Hypercalcemia and renal dysfunction in sarcoidosis are relatively rare, affecting less than 10% of patients at presentation. In its acute phase, the consequences of hypercalcemia are reversible, and its prompt treatment subsequently reduces the risk of irreversible renal dysfunction, highlighting the importance of strong suspicion for a disease like sarcoid - the Great Mimicker.

Phenylephrine causes anuria in a patient with benign prostatic hyperplasia

Pratap Kumar Sahu — 2024-12-31

Phenylephrine is classified as an alpha-adrenergic agonist and used as a nasal decongestant. Benign prostatic hyperplasia (BPH) is a common progressive disease in males over the age of 40, leading to urethral constriction. Alpha-1A (α1A) receptor blockers such as Silodosin are commonly prescribed to manage BPH symptoms. They relax the smooth muscle around the bladder exit, in the lower urinary tract and prostate gland to facilitate the passage of urine in BPH. However, when combined with alpha-adrenergic agonists such as Phenylephrine, this mechanism may be disrupted. This case report highlights contraindication of Phenylephrine in patients with BPH. It may induce anuria in patients with BPH. We present a case report of a diabetic, hypertensive and hypothyroidism patient with BPH suffering from anuria due to administration of an over-the-counter medicine containing Phenylephrine. Caution should be taken while prescribing Phenylephrine in BPH patients on medication with alpha-1A (α1A) receptor blockers.

Juvenile chronic myeloid leukemia: a case report

Praveen Kumar Pandey — 2024-12-31

Chronic myeloid leukemia (CML) accounts for 2-3% of leukemias in children under 15 and 9% in adolescents aged 15-19. The diagnosis of CML in children, adolescents, and young adults has several differences compared to that in adults. Juvenile myelomonocytic leukemia (JMML)/ juvenile CML is a rare, malignant myelodysplastic/ myeloproliferative neoplasm (MPN) overlap haemopoetic disorder that presents in infants and toddlers and it must be differentiated from other disorders that can show similar presentation in this age group. JMML is very uncommon and the diagnosis is often difficult to establish. The disease has a rapid course and has a median survival of less than 10 months when untreated or undertreated. In this case report we present a case of a 7-year-old male patient with gingival enlargement and swelling along with mobility of mandibular anterior teeth with various associated systemic factors in which various hematological, biochemical, and radiographic investigations were carried out to differentiate CML from other systemic conditions.

A case report on late onset linear discoid lupus erythematosus on the face mimicking linear morphoea

Ananthu B. Piloly — 2024-12-31

50-year-old female with no known comorbidities presented to the dermatology OPD with complaints of slowly progressive asymptomatic skin coloured linear atrophic plaque over left side of face since, 5 years. Cutaneous examination revealed well demarcated, linear atrophic plaque with hidebound skin over left side of face extending from scalp margin to tip of the nose, involving the lateral wall of nose along the lines of Blaschko. Dermoscopic examination showed structureless areas and loss of follicles as well as eccrine openings. Laboratory investigations including ANA-IFA were negative. A clinical diagnosis of linear morphoea (En- coup de sabre) was made. Further investigation with punch biopsy was performed from the lesion site which gave a histopathological diagnosis of Discoid Lupus Erythematosus and was confirmed with direct immunofluorescence study. Full physical examination, review of systems and laboratory workup showed no features to suggest systemic lupus. She was managed with hydroxychloroquine and sun protective measures. Linear discoid lupus erythematosus can clinically mimic linear morphoea, but histopathological examination provides distinctive features that aid in accurate diagnosis and differentiation between the two conditions. This case gave us valuable insight into keeping DLE as a differential for linear morphoea on the face.

Ventricular bigemini in a patient with serologically positive dengue hemorrhagic fever

Salini N. R. — 2024-12-31

Dengue epidemic is a major health problem in India. In expanded dengue syndrome major organs involvement and atypical manifestations have been increasingly reported. Cardiac involvement in dengue ranges from benign arrhythmias to fatal fulminant myocarditis. ECG changes usually secondary to myocarditis. Most common ECG abnormality Is bradycardia. Other ECG findings are ST segment depressions and elevation T wave abnormalities, sinus pauses ventricular ectopics, ventricular trigeminy, atrial fibrillation, heart blocks such as first-degree block and Mobitz type I second-degree AV block and bundle branch blocks. Most of the cardiac abnormalities are transient, but sometimes it can aggravate pre-existing conditions and even be fatal. So, assessing cardiac involvement in dengue patients is important for appropriate management. We are reporting a 55-year-old patient with dengue haemorrhagic fever presenting with ventricular bigeminy symptoms and markers indicative of cardiac compromise which improved after 1 week.

Synchronous ovarian granulosa cell tumor and carcinoma endometrium due to excess estrogen secretion: a rare presentation

Shubha Supriya Asaithambi — 2024-12-31

Granulosa cell tumor (GCT) is a low malignant potential ovarian tumor accounting for 70% of all sex cord stromal tumor. It is an estrogen secreting tumor, hence diagnosed in early stages, associated with 20-30% concomitant lesion in endometrium including 5% of invasive adenocarcinoma. Through this case report we present the synchronous occurrence of ovarian and endometrial malignancy of a 52-year-old female, P3L2A0 who presented with irregular menstrual bleeding since 2 months along with literature review. Imaging showed endometrial lesion with synchronous left ovarian lesion with a normal CA-125. Underwent total abdominal hysterectomy with bilateral salphingo-oophorectomy and post op histopathology showed FIGO stage IC GCT of left ovary and Endometrioid carcinoma of endometrium, grade1, FIGO stage IA, low risk with P-53 negative by IHC. In view of ovarian tumor FIGO stage IC GCT, she received adjuvant chemotherapy. Hence, presence of synchronous endometrial lesion with suspicious ovarian mass at presentation should suspect the diagnosis of estrogen secreting GCT with endometrial lesion.

Ursodeoxycholic acid induced skin eruption: a case report

Anna James — 2024-12-31

This case report discusses a rare adverse reaction associated with ursodeoxycholic acid (UDCA), highlighting its potential impact on patient management and treatment outcomes. UDCA, commonly used for gallstone dissolution and liver disease, occasionally induces skin eruptions, though mechanisms remain unclear. A 23-year-old male with a history of jaundice and fatty liver presented with a right inguinal hernia. He was prescribed UDCA (300 mg), among other medications, post-surgical intervention. Twelve hours later, he developed sharply demarcated, dusky red plaques on his hands, suggestive of a type IV delayed hypersensitivity reaction. The Naranjo score indicated a probable association between UDCA and the skin eruption. Discontinuation of UDCA led to gradual resolution of symptoms. This case underscores the importance of recognizing and managing rare adverse reactions to UDCA, such as dermatological manifestations. While typically non-life-threatening, these reactions can necessitate treatment discontinuation, potentially compromising therapeutic efficacy. Vigilant monitoring and further research are essential to elucidate underlying mechanisms and optimize patient care strategies.

Understanding the complexity of Miller-Fisher syndrome: a case report

Parvathy Ramachandran Satheebai — 2024-12-31

Miller-Fisher syndrome is a rare neurological disorder characterized by a clinical trial of ophthalmoplegia, ataxia and areflexia. It is a variant of Gullian Barrie syndrome. A variety of other symptoms and signs beyond the triad has been reported. Here we report a case of a 58-year-old male patient with atypical presentation of Miller-Fisher syndrome. He had a history of upper respiratory tract infection 3 weeks prior. After hospital admission, he abruptly developed unsteadiness while walking, diplopia and dysphagia. Clinical evaluation along with antiganglioside antibody made the diagnosis of Miller-Fisher syndrome. After immunotherapy was initiated, the patient improved gradually and later discharged to home. To diagnose a case of Miller-Fisher syndrome, a high index of clinical suspicion and ruling out other aetiologies should be made. Timely effective intervention either plasmapheresis or IV Immunoglobulin can completely reverse the symptoms.

Carcinoma ex pleomorphic adenoma of the parotid gland: a case with difficult diagnosis

Sridhar Reddy Dandala — 2024-12-31

Carcinoma ex pleomorphic adenoma (CXPA) is carcinoma arising from a primary or recurrent benign pleomorphic adenoma. It might be non-invasive or invasive. It often poses a diagnostic challenge to clinicians and pathologists. Pathological assessment is the gold standard for diagnosis. Treatment for CXPA often involves an ablative surgical procedure, which may be followed by radiotherapy. We report to you a 63-year-old female who came to the ENT OPD with a complaint of swelling in the front of the right ear for 6 months and pain over swelling for 2 weeks. The patient was advised for USG-guided FNAC, which was suggestive of a benign cystic parotid lesion. The patient was planned for superficial parotidectomy and the tumor was surgically excised. The frozen section was suggestive of a benign salivary gland tumor and the histopathology report concluded of a non-invasive carcinoma ex pleomorphic adenoma. The patient was advised to undergo radiotherapy after the surgery. During the follow-up, the patient showed signs of Frey’s syndrome. Carcinoma ex pleomorphic adenoma is difficult to diagnose; clinicians and pathologists should work together to diagnose it and pathological assessment is the gold standard for the diagnosis.

Pneumococcal pneumonia complicating secondary bacteremia in an immunocompromised patient: a case report

Sangeeta Datta — 2024-12-31

Pneumococcal pneumonia is a significant global public health issue, contributing to considerable morbidity and mortality, as well as placing a strain on healthcare systems. Here, we present the case of a 46-year-old female who was admitted to our hospital with a sudden onset of shortness of breath and right-sided substernal chest pain on the day of admission, accompanied by fever and a productive cough. She displayed an increased respiratory rate and diminished vesicular breath sounds, with bilateral scattered rhonchi. Blood tests and chest radiological findings suggested an infectious etiology. Ultimately, Streptococcus pneumoniae was isolated through microbiological culture from both sputum and blood samples, showing similar antimicrobial sensitivity, and appropriate management was initiated. She was discharged after five days of hospitalization, with an uneventful recovery. Appropriate antimicrobial stewardship and pneumococcal vaccination are essential to combat this infection.

A baffling referral from dermatology- aleukemic leukemia cutis with literature review

Shruthi Swamy — 2024-12-31

Aleukemic leukemia cutis (ALC) is a rather uncommon condition that is characterized by leukemic cell invasion into the skin which primarily precedes the peripheral blood and marrow infiltration by leukemic cells. We present a 35-year-old male with maculopapular skin lesions with a normal bone marrow and peripheral smear. Skin lesions were positive for leukemic cells. Bone marrow infiltration was identified 1 month after the skin diagnosis which showed Acute Myeloid leukemia with Monocytic differentiation. The patient succumbed to tumor lysis syndrome before initiation of treatment. ALC portends a very poor prognosis. Prompt diagnosis with skin biopsy is essential to improve survival in ALC.

Schwannoma of the colon: a case report and literature review

Manar Mohammed Alshahrani — 2024-12-31

Tumours that originate from the Schwann cells are known as schwannomas. Schwannomas are generally rare, but the rarest are perhaps those of the colon and rectum. The areas of the body that ordinarily experience more schwannomas include such organs as the head, neck, arms, and limbs. Although they are mostly usually harmless, malignant degeneration may appear without surgery. The current case study is a male, 40 years of age, who reported abdominal pain and recurrent vomiting and was admitted for elective Esophagogastroduodenoscopy (EGD) and colonoscopy. There was no family history of inflammatory bowel disease or cancer, and he had no prior abdominal surgeries. A physical examination revealed mild tenderness in the right lower quadrant. Results of the examinations indicate normal mucosa and vasculature in visualized parts. One polyp ascending around 1 cm was removed completely by cold snare after elevation by an adrenaline base secured by one clip. Another polyp in the transverse colon, around 1 cm, was removed completely by a hot snare base secured by one clip. Following a routine biopsy test that revealed a polypoid lesion consisting of bland spindle cells with an elongated shape. Upon histological testing, a schwannoma was found. Immunohistochemistry revealed that the tumor was negative for EMA, cluster of differentiation (CD)117, calertinin, and synaptophysin, and positive for S100 and vimentin, with a Ki-67 proliferative index of 3%. There was no lymph nodes implicated. Schwannomas may present difficult biopsy investigations, and a reliable diagnosis of this sickness requires immunohistochemistry. Unlike gastrointestinal stromal tumors, Schwannomas contain vimentin and the S100 protein but are negative for CD117. The likelihood of tumor aggressiveness increases significantly in cases recording a Ki-67 score of ≥5%. As a result, the recommended treatment for schwannomas is oncological drastic surgical excision.

Comparison of urethral-sparing versus non urethral-sparing techniques of robot-assisted simple prostatectomy: a systematic review and meta-analysis of sexual, functional, and surgical outcomes

Noka Yogahutama — 2024-12-31

Simple prostatectomy (SP) with urethral preservation offers various benefits. Recent advancements in technology have made urethral-sparing robot-assisted simple prostatectomy (US-RASP) more feasible. This systematic review compares the efficacy of US-RASP to non-urethral-sparing robot-assisted simple prostatectomy (Non-US-RASP). A systematic literature search was conducted on PubMed, Scopus, ProQuest, Cochrane Library, and ScienceDirect, following PRISMA 2020 guidelines up to September 2024. Meta-analyses of sexual, functional, and surgical outcomes were performed using Review Manager version 5.4. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS). Six observational studies involving 615 patients were included (332 US-RASP versus 283 non-US-RASP). US-RASP significantly improved sexual outcomes, with higher 6-month ejaculatory preservation (OR 31.77, 95% CI: 13.28 to 76.02, p<0.001) and a higher 12-month MSHQ-EjD SF score (MD 6.38, 95% CI: 5.90 to 6.85, p<0.001). Surgical outcomes favored US-RASP with shorter catheterization time (MD -2.67, 95% CI: -4.63 to -0.71, p=0.008) and reduced length of stay (MD -1.39, 95% CI: -2.51 to -0.28, p=0.01). However, US-RASP was associated with a higher 12-month PVR score (MD 14.00, 95% CI: 12.33 to 15.68, p<0.001). This meta-analysis suggests that US-RASP is an effective alternative to Non-US-RASP, demonstrating better sexual and surgical outcomes despite a higher PVR. However, these findings should be confirmed with a well-designed larger randomized trial.

The impact of anxiety and depression symptoms on people with multiple cardiovascular risk factors

Karla V. Arévalo — 2024-12-31

Typical cardiovascular risk factors are mainly related to lifestyle. New research suggests that psychological factors, especially anxiety and depression, are closely linked to cardiovascular factors. Anxiety and depression have shown an abysmal increase in the number of people who suffer from them in recent years. Different factors are related to their appearance, among which the social, work, emotional and environmental environment stand out. Multiple studies mention their relationship with cardiovascular risk factors, although there are multiple mechanisms associated with psychological and cardiovascular factors, to date there is no way to measure them. The impact of psychological stress on the development of different cardiovascular factors and its effect on the autonomic nervous system causing its inflammation must be investigated and requires much interest. As such, tools are required to be able to evaluate the biological pathways that link anxiety/depression with the risk of developing cardiovascular diseases.

Clinical and etiological findings of musculotendinous injuries after physical exercise

Adonis A. Gavilanez — 2024-12-31

The pathogenesis of sports injuries is complex and difficult to identify clearly. Recent theories bring to light new mechanisms related to the production of muscle pain and tendinopathies. The accumulation of lactate can cause fatigue and muscle pain. Apparently, the lactate anion is an excellent fuel for myocardial fibre. Its accumulation of lactic acid after performing intense physical exercise can prevent the excitability of the sarcolemma induced by the increase in the concentration of the interstitial potassium ion. The identification of sports and physical activity that can cause damage to our body has become necessary, due to the increase in the incidence of joint injuries generated by physical activity in people who routinely practice exercise and in athletes, in order to prevent future injuries. Articles related to the different mechanisms involved in the different musculoskeletal injuries related to the practice of exercise have been selected.

Management of insomnia in India: expert consensus insights with a focus on zolpidem

Jagadish Anjanappa — 2024-12-12

Insomnia is a global health concern affecting 10%-30% of the population. In India, the prevalence of insomnia among adults is 33%, with older adults being notably affected - urbanization, lifestyle changes, and increasing stress levels are factors that lead to insomnia. Despite its widespread impact, few people affected by insomnia seek treatment due to societal stigma and sparse data on the disorder. Benzodiazepines (BDZs), particularly alprazolam, which were once favored for insomnia treatment, are no longer recommended due to side effects, including addiction and dependence risks. Zolpidem, a selective agonist of BDZ (ω) receptors containing α-1 subunits, has emerged as a viable alternative, often used in conjunction with cognitive behavioral therapy (CBT). Currently, zolpidem is the preferred first-line pharmacotherapy for the treatment of insomnia as it does not alter sleep architecture, prevents daytime sleepiness, has a non-addictive nature, and its abrupt discontinuation does not induce dependence, withdrawal symptoms, or trigger rebound insomnia. This expert opinion manuscript aims to elucidate the treatment landscape for insomnia in India, with a focus on the use of zolpidem. Insights were derived from advisory board meetings involving 33 Indian physicians from diverse specialties. Discussions centered on the current status of insomnia in India, clinical experiences with zolpidem, and emerging pharmacotherapeutic options. In conclusion, valuable insights into the management of insomnia and related disorders, with a focus on pharmacotherapy using zolpidem, were gained. Zolpidem provides effective treatment when compared with BDZs and other drugs. However, it must be prescribed judiciously based on patient-specific factors.

Darwinizing cough and its modern triggers: newer management approach to cough associated with allergy, asthma, upper airway cough syndrome

Agam Vora — 2024-12-31

Cough is a crucial defensive reflex of the respiratory system, essential for expelling irritants and secretions. It can present as acute or chronic cough, often exacerbated by allergic conditions such as allergic rhinitis (AR) and upper airway cough syndrome (UACS). Effective management of cough focuses on addressing the underlying aetiology while simultaneously offering symptomatic relief. Fixed-dose combinations (FDCs) are becoming an increasingly effective approach to enhance patient adherence and streamline treatment. Non-sedating antihistamines, like Bilastine, have demonstrated efficacy in alleviating AR and associated cough, making them an ideal choice for cough syrup formulations. The combination of Bilastine with Dextromethorphan and Phenylephrine provides a suitable treatment option for cough related including UACS, asthma, and respiratory allergies. This formulation is particularly well-suited for pediatric patients aged six and older, offering effective relief from throat irritation without sedation, being well-tolerated, and minimizing risks of cardiovascular and hepatotoxic effects. Pulmonologist, Otolaryngologist, Physician and paediatrician opinions have been gathered to review current practices and provide insights into effective management strategies. This review delves into the pathophysiology and clinical significance of cough, particularly in relation to respiratory allergies, highlighting its complexities and the need for ongoing research to refine treatment strategies and improve patient outcomes.

Diagnosis and management of bone cysts

Deepak Channarayapattana Devaraju — 2024-12-31

Bone cysts are benign, fluid-filled lesions primarily occurring in the metaphyseal regions of tubular and flat bones, such as the humerus and femur. These lesions are commonly seen in children and adolescents during periods of rapid bone growth. While often asymptomatic, bone cysts are typically discovered incidentally or after a pathological fracture due to weakened bone structure. Radiographic imaging plays a pivotal role in diagnosis, revealing well-defined, lytic lesions with thin cortical margins. Management of bone cysts has evolved to emphasize minimally invasive techniques, including intralesional steroid or bone marrow injections, as well as curettage with bone grafting. These approaches aim to promote healing, prevent recurrence, and restore bone integrity. In some cases, internal fixation may be required for structural support. The prognosis is generally favourable, with high rates of healing and functional recovery, especially with timely intervention.

Current challenges and Indian perspectives in the diagnosis and management of bipolar disorders

G. Prasad Rao — 2024-12-31

Bipolar disorders (BDs) are episodic illnesses characterised by alternating episodes of mania or hypomania and depression, or mixtures of manic and depressive features. BDs present many diagnostic and therapeutic challenges because of their varying clinical course, symptoms, severity and the presence of comorbidities. They severely burden healthcare systems, particularly in low-income and middle-income countries. In India, managing bipolar disorder is challenging, due to inadequate resources, poor knowledge about the disorder or its treatment, and limited access to healthcare facilities. These disorders impact a large portion of the Indian population, thus highlighting an urgent need to effectively facilitate better diagnosis and management of mental disorders across the country. A careful assessment of previous manic or hypomanic episodes and early identification of comorbidities helps predict disease course and treatment options. Treatment of BDs usually combines medications and psychotherapy. In Indian clinical settings, the first-line treatment for BDs includes pharmacotherapy with mood stabilisers, such as divalproex, lithium, anticonvulsants, and antipsychotics. Psychotherapy, along with lifestyle approaches are useful adjuncts. To reinforce the overall management of BDs, focused group discussions were conducted among 87 psychiatrists across nine cities in India, to gather insights about the burden, diagnostic challenges, and treatment approaches. This review discusses expert insights on optimal diagnostic and treatment approaches for BDs, focusing on psychiatric and non-psychiatric comorbidities, prevalent among Indian patients with type I and II bipolar disorders. It also covers lithium adverse effects, divalproex-place in therapy, and the use of anti-depressant a risk factor for rapid cycling.

Expert opinion on challenges in the diagnosis and treatment of OCD in India

Kishan Porandla — 2024-12-31

Obsessive-compulsive disorder (OCD) is considered as a significant cause of disability worldwide, ranking among the top 10 causes. The diagnosis of OCD is often delayed due to the reluctance of patients to share their symptoms. OCD is also associated with the presence of other comorbid psychological conditions like anxiety, depression, and schizophrenia among others, which adds to the challenge of accurate diagnosis. Delayed diagnosis and the presence of comorbid conditions have a poor prognosis. Hence, an increased awareness about identifying symptoms of OCD among doctors and the general public is important. Even though clinical practice guidelines outline the management for OCD, challenges in appropriate management exist. This review elaborates the challenges associated with the diagnosis and management of OCD in India and presents insights from experts which can help doctors in early diagnosis and appropriate management of this debilitating condition.

Artificial intelligence in scientific writing: opportunities and ethical considerations

Anil Sharma — 2024-12-31

Scientific writing is a major consideration when writing a research paper, as it encompasses all aspects of the research. With the rise of digitalization, new opportunities have emerged for the development of Artificial intelligence (AI)-driven tools and algorithms designed to analyze the vast amounts of data being uploaded. It has allowed researchers and practitioners to more efficiently access and evaluate a vast array of scientific papers. This capability facilitates the connection of related studies from the past, identifies research gaps, and speeds up the processes of literature review, evidence generation, and knowledge discovery. Despite these advancements, AI tools are subject to ethical considerations, regulatory approval, compliance with data protection regulations, journal guidelines, transparency, and public perception. Some text prompts are used to instruct AI tools to generate effective information. Fostering trust and transparency with AI tools in scientific writing includes operationalizing frameworks, addressing discrepancies, reducing plagiarism, and generating new innovative ideas. Future trends suggest that AI capabilities will keep advancing and developing, underscoring the need for ethical considerations and the need to balance AI automation with human expertise. However, it cannot replace the creativity and critical thinking skills that are crucial for scientific writing and research. The key objective of this review is to discuss and assess various AI-based tools and algorithms, focusing on their key features and how they can support researchers and authors in enhancing their writing skills.

Diverse ambulatory profiles in cerebral palsy: in-depth review

Namrata Sant — 2024-12-31

The estimation of ambulation prognosis in cerebral palsy children poses a challenge for parents, caregivers, neurologists, and pediatric rehabilitation specialists despite its status as the primary cause of chronic disability in this demographic. Currently, a scale is developed for predicting ambulation in these children, making it imperative to anticipate their ambulatory potential. Research indicates that a child's gross motor skill development, such as achieving neck control by nine months, independent sitting by two years, crawling, and meeting other developmental milestones by thirty months, in addition to factors like postural reactions, cognitive abilities, infantile reflexes, and auditory and visual functions, serve as predictive indicators of ambulation. Moreover, even favourable upper limb functions in cerebral palsy contribute to prognosis of ambulation. The primary cause of chronic disability in pediatric population is cerebral palsy, and it can be challenging for pediatric rehabilitation specialists, neurologists, and parents to predict a child's prognosis for walking. The ambulation chart is available, which is developed by researcher, A Thai, who provided guidance on this matter. It is yet unknown how valid and reliable this tool is to serve as a predictor of ambulation in patients with cerebral palsy. To develop a suitable method for predicting ambulation in cerebral palsy that takes into account all the variables except those listed above, more research in this area is required.

Role of clarithromycin in the management of multiple infection

Pradyut Waghray — 2024-12-31

Clarithromycin, a second-generation semisynthetic macrolide antibiotic, is known for its broad-spectrum antibacterial activity, favorable pharmacokinetic profile, and stability at gastric pH, along with significant anti-inflammatory and immunomodulatory effects. It demonstrates superior efficacy and fewer side effects compared to other macrolides, making it a potent therapeutic option for various bacterial infections. Clarithromycin is approved for use in combination therapy to eradicate Helicobacter pylori and for treating mild to moderately severe respiratory infections such as acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP) including infections from Chlamydia, Mycoplasma spp., acute streptococcal pharyngitis, and skin and soft tissue infections. Apart from its usual listed uses, clarithromycin is used in multiple other infections, including upper respiratory tract infections (URTIs) like pharyngitis in penicillin-allergic patients, chronic pharyngitis related to gastroesophageal reflux disease (GERD), sore throat, acute laryngitis, and chronic rhinosinusitis. It is also effective for lower respiratory tract infections (LRTIs) related to chronic obstructive pulmonary disease (COPD), Mycobacterium avium complex (MAC) infections, bronchiectasis, and various other conditions including COVID-19, systemic lupus erythematosus (SLE), bronchiolitis obliterans syndrome post-lung transplant, and H. influenzae infections. During the COVID-19 pandemic, concerns about antimicrobial resistance from the overuse of antibiotics, including azithromycin, highlighted clarithromycin as a preferable alternative due to its superior pharmacodynamics and lower resistance risk. While clarithromycin has a favorable safety profile, it is associated with potential adverse effects such as cardiovascular risks and gastrointestinal disturbances. Its role as a reserve antibiotic highlights its importance in managing resistant infections and in situations where first-line treatments are ineffective or contraindicated.

Real world use of T3 to alleviate symptoms of hypothyroidism during preparation of radioactive iodine ablation: experts viewpoint

P. R. K. Bhargav — 2024-12-31

Thyroid carcinoma is a common endocrine malignancy with most of the cases being diagnosed as differentiated thyroid cancer. Thyroidectomy is the cornerstone of treatment for thyroid carcinoma. Adjuvant therapy with radioactive iodine after surgical resection of all known primary tumor tissue and metastatic foci is advocated. The preparation for radioactive iodine ablation requires elevation of thyroid stimulating hormone to 30 mIU/l for ensuring uptake of I-131 by thyroid follicular cells. In the Indian setting, there are specific challenges in preparation for radioactive iodine ablation including the high cost of recombinant TSH injection which may preclude its use in most patients. The practical approach adopted by Indian endocrinologists, endocrine surgeons and nuclear medicine physicians in the preparation of post-thyroidectomy thyroid cancer patients for radioactive iodine ablation in the real-world setting needs to elaborated and chronicled for providing guidance specific for the constraints encountered in the Indian scenario. Thyroid hormone withdrawal is affected by cessation of levothyroxine for 4 weeks prior to radioactive iodine ablation leading to profound hypothyroidism. This can be addressed by appropriate use of liothyronine (LT3) to substitute levothyroxine after its withdrawal. LT3 administration of 20 mcg twice or thrice a day (40 to 60 mcg/day in divided doses) is the best practice during THW. The duration of LT3 replacement following cessation of levothyroxine, is for 2-3 weeks and then 10-14 days off LT3. These practices are corroborated by evidence from literature and recommendations from guidelines elucidating the use of liothyronine during the period of thyroid hormone withdrawal.

Cancer-new therapies aligned with Homoeopathy

Tridibesh Tripathy — 2024-12-31

Cancer is a disease that everyone fears & it is obvious that people are fearful about cancer. The current article discusses various therapeutic interventions of cancer such as R-Cu therapy, CAR-T cell therapy, chronotherapy from the modern system of medicine. It also discusses the homoeopathic intervention in cancer that has medicines on the lines of the R-Cu therapy, CAR-T cell therapy, CRISPR & especially the chronotherapy. The article suggests a treatment protocol based on homoeopathic system of therapeutics aligning with the interventions mentioned above. The application of homoeopathy based on its essential medicine (EM) properties, properties that help the system to cover the masses backed up by a national policy are also discussed in the article. The article aspires that the homoeopathic therapeutic system plays a significant role in dealing with the current non communicable disease menace like cancer in the national level.

Embracing the digital revolution: exploring the acceptance and potential of artificial intelligence in physiotherapy

Riyas Basheer K. B. — 2024-12-31

Recently, there has been significant discussion about artificial intelligence (AI) and Large Language Models (LLMs) as they relate to teaching and learning. To date, literature exists about the role of AI in Physical Therapy treatment, but not Physical Therapy education. This review will identify the benefits of adapting AI into Physical Therapy education to better prepare the healthcare providers of tomorrow. Survey research shows that AI can improve access to information, increase productivity, and reduce errors. However, most also feel ill-informed on the topic. A majority agreed that AI concepts should be included in Physical Therapy education. While valid concerns exist about AI sources giving false information, as well as the potential to use these services to plagiarize work, tools are already in existence to mitigate these issues. Potential benefits of AI in physical therapy education include the ability to produce examples, provide different explanations, and assist in assessing student learning while providing immediate feedback on performance. With the scope of AI rapidly expanding, we believe it is imperative for physical therapy educators to have access to current information about its potential benefits, uses, and limitations. While many professionals do not currently possess much knowledge on the topic, there is a growing consensus as to the role it will play in our profession in the future. While discussions of AI can raise more questions than answers, preparation now will reduce the need for urgent adaptations in the future.

Role of radiologist with the advent of artificial intelligence in medical imaging

Anitha Boregowdanapalya — 2024-12-31

Artificial intelligence (AI) has rapidly emerged as a transformative tool in healthcare, particularly in radiology, where it offers substantial opportunities to enhance diagnostic precision and workflow efficiency. AI, defined as an artificial entity capable of recognizing patterns, processing data, and executing tasks, has revolutionized traditional imaging practices by automating analyses and reducing subjectivity. While radiologists traditionally rely on expertise and visual assessment to detect and monitor abnormalities, this approach can be limited by variability, fatigue, and bias. AI complements radiologists by providing objective, quantitative assessments, enabling early detection of diseases, lesion classification, and image segmentation with greater speed and accuracy. AI's integration into radiology workflows supports risk stratification, personalized treatment planning, and predictive analytics, thus enhancing clinical decision-making and patient care. Despite its potential, AI’s current performance remains task-specific, requiring human oversight to ensure accuracy and reliability, especially in ambiguous cases. Challenges such as algorithm bias, ethical considerations, and regulatory hurdles must be addressed to ensure generalizability, transparency, and patient trust. Radiologists play a pivotal role in validating AI tools and advocating for their responsible implementation, ensuring that AI enhances clinical workflows without compromising the essential human connection in healthcare.