International Journal of Research in Medical Sciences

Necrotizing enterocolitis in an extremely preterm infant born to a mother with type 1 diabetes mellitus: a case report with focused literature review

Thu, 30 Jul 2026 00:00:00 +0530

Necrotizing enterocolitis is a major cause of morbidity and mortality in very preterm infants. Maternal type 1 diabetes mellitus is strongly associated with prematurity, but its independent association with necrotizing enterocolitis remains uncertain. A 27-year-old woman with pregestational type 1 diabetes mellitus developed threatened preterm labour and later delivered a male infant at 27 weeks and 4 days of gestation weighing 880 g. The infant required intubation and surfactant therapy for extreme prematurity. During the neonatal course, he developed abdominal distension, bilious aspirates, worsening respiratory status, and mixed acidosis consistent with Bell stage IIA necrotizing enterocolitis. Management included bowel rest, gastric decompression, intravenous antibiotics, parenteral nutrition, close monitoring, and early surgical review. Feeds were later reintroduced using expressed breast milk, and the infant recovered without surgery, was discharged home, and remained well at follow-up, with appropriate growth and no recurrent gastrointestinal symptoms. Relevant cohort studies, meta-analyses, and guideline-level evidence regarding maternal type 1 diabetes mellitus, prematurity, and necrotizing enterocolitis were reviewed. Current evidence supports a strong association between maternal type 1 diabetes mellitus and prematurity, while evidence for an independent association with necrotizing enterocolitis remains inconsistent. This case emphasizes the importance of antenatal optimization, early neonatal stabilization, prompt recognition of intestinal disease, careful reintroduction of human milk feeding, and structured post-discharge follow-up.

Peripheral eosinophilia with eosinophilic gastroenteritis associated with semaglutide: a case report and literature review

Thu, 30 Jul 2026 00:00:00 +0530

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for the management of type 2 diabetes mellitus and obesity. Although generally well tolerated, gastrointestinal adverse effects are common, and rare immune-mediated complications have increasingly been reported. We describe the case of a 57-year-old woman with type 2 diabetes mellitus, treated with semaglutide, who presented with a four-month history of chronic epigastric pain, anorexia, and unintentional weight loss. Laboratory evaluation revealed marked peripheral eosinophilia, and endoscopic biopsies of the stomach and duodenum demonstrated extensive eosinophilic infiltration of the lamina propria, confirming a diagnosis of eosinophilic gastroenteritis. Secondary causes, including parasitic infection, allergic disease, and hematologic malignancy, were excluded. Given the temporal relationship between semaglutide initiation and symptom onset, the drug was discontinued. Over the following months, the patient's symptoms resolved and her eosinophil count normalized, with repeat biopsy confirming histological resolution. This case adds to a growing body of literature describing eosinophilic gastrointestinal and systemic reactions associated with GLP-1 RA therapy. Clinicians should maintain a high index of suspicion for drug-induced eosinophilic disorders in patients on GLP-1 RAs who present with persistent or atypical gastrointestinal symptoms, as early recognition and prompt drug discontinuation can prevent long-term morbidity and lead to complete clinical and histological recovery.

Comparative evaluation of radial ray defect associated with different syndromic conditions

Tue, 14 Jul 2026 00:00:00 +0530

Radial ray defect (RRD) is a rare congenital anomaly resulting from abnormal development of the preaxial structures of the upper limb. It encompasses a spectrum of malformations ranging from radial hypoplasia to complete absence of the radius and associated radial-sided structures. Although RRD may occur as an isolated defect, it is frequently associated with syndromic conditions and multisystem congenital anomalies. Two male fetuses, aged 24 and 17 weeks of gestation, presenting with bilateral RRDs were examined by detailed external inspection, anatomical dissection, and radiography. In case 1, bilateral upper limb anomalies were associated with vertebral defects, anal atresia, oesophageal atresia, and bilateral cystic renal dysplasia. The left radius was absent, whereas the right radius was markedly shortened and associated with thumb aplasia. The constellation of anomalies was suggestive of the VACTERL association spectrum. In Case 2, bilateral RRDs were accompanied by craniofacial dysmorphism, including a square-shaped face, broad mandible, prominent forehead, broad nasal base, reduced nasal height, and low-set ears. The left radius was absent, whereas the right radius exhibited partial hypoplasia. The phenotypic features demonstrated overlap with Holt-Oram syndrome. These cases highlight the broad anatomical spectrum and syndromic variability of RRDs. Comprehensive anatomical, radiological, and fetal autopsy examinations are essential for accurate phenotypic characterization and recognition of associated malformations. Early prenatal detection using three-dimensional ultrasonography, combined with clinical genetic evaluation, can facilitate accurate diagnosis, parental counselling, and multidisciplinary management.

Primary adrenal insufficiency secondary to ileocecal tuberculosis

Adesh Kumar, Debasmita Pal, Aditya Ojha — Thu, 30 Jul 2026 00:00:00 +0530

Ileocecal tuberculosis, the most common form of gastrointestinal tuberculosis, is usually caused by Mycobacterium tuberculosis, which is also the leading infectious cause of adrenalitis. Adrenal involvement can result in primary adrenal insufficiency, presenting with weakness, fatigue, hypotension, electrolyte imbalance, and hyperpigmentation. We present the case of a 43-year-old male with recurrent vomiting, fatigue, orthostatic dizziness, and generalized hyperpigmentation. His blood pressure was 100/80 mmHg, and laboratory tests showed low serum cortisol, elevated ACTH, hyponatremia, and hyperkalemia—findings consistent with primary adrenal insufficiency. Imaging revealed bilateral adrenal enlargement, a thickened ileocecal junction, and enlarged mesenteric lymph nodes. Colonoscopy demonstrated a terminal ileal stricture with granulomatous inflammation, and adrenal biopsy showed caseous necrosis. GeneXpert confirmed rifampicin-sensitive M. tuberculosis, indicating disseminated tuberculosis originating from the ileocecal region. The patient was started on standard anti-tubercular therapy with corticosteroid replacement for Addison’s disease. This case report highlights disseminated tuberculosis presenting as primary adrenal insufficiency secondary to ileocecal tuberculosis, an uncommon yet clinically significant association. Adrenal tuberculosis should be suspected with hyperpigmentation, electrolyte imbalance, and bilateral adrenal lesions; early diagnosis enables therapy, preventing adrenal crisis.

Acupuncture management of metabolic-allergic eosinophilia: a single-patient case report

Thu, 30 Jul 2026 00:00:00 +0530

Eosinophilia is a heterogeneous condition associated with allergic, metabolic, or idiopathic etiologies and is often accompanied by systemic inflammatory manifestations. Integrative approaches such as acupuncture have been explored for their potential immunomodulatory and anti-inflammatory effects. This case report describes the clinical and laboratory outcomes of acupuncture as a sole therapeutic intervention in a patient with metabolic–allergic eosinophilia. A 57-year-old male with a history of hypertension presented with pruritic erythematous lesions on the right leg, persistent phlegm, throat congestion, mild breathlessness, and generalized heaviness. Laboratory investigations revealed mild eosinophilia, markedly elevated immunoglobulin E (IgE), increased high-sensitivity C-reactive protein (hs-CRP) and homocysteine levels, hyperuricemia, hypertriglyceridemia, and vitamin D deficiency. Clinical examination showed cutaneous inflammation and phlegm accumulation. Traditional Chinese Medicine assessment indicated a Phlegm-Damp pattern with Qi stagnation involving the lung-spleen-liver axis. The patient underwent a two-week acupuncture protocol as the sole treatment, targeting LI4, LI11, SP9, ST36, LU7, BL13, BL20, BL23, and LR3. No concurrent pharmacological or alternative therapies were administered. The acupuncture sessions were well tolerated, with no adverse events reported. Following treatment, the patient experienced significant symptomatic improvement, including a reduction in pruritus, improved respiratory comfort, decreased phlegm, better sleep quality, and enhanced overall well-being. Post-treatment laboratory findings demonstrated reductions in IgE levels (from 996 to 612 IU/mL), eosinophil percentage (from 7.8% to 5.6%), triglycerides, uric acid, hs-CRP, and homocysteine. This case suggests that acupuncture may be a safe and potentially effective supportive therapy for metabolic–allergic eosinophilia, contributing to symptomatic relief and improvements in inflammatory, immunological, and metabolic parameters. Further well-designed controlled studies with larger sample sizes are necessary to validate these findings and clarify underlying mechanisms.

In-frame versus out-of-frame Duchenne muscular dystrophy deletions: a comparative case report highlighting genotype–phenotype correlation in the therapeutic era

Geerthana Balasubramaniam, Guhan Ramamurthy — Thu, 30 Jul 2026 00:00:00 +0530

Dystrophinopathies, including Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), are X-linked neuromuscular disorders caused by mutations in the DMD gene. We describe two male patients with dystrophinopathies due to large deletions in the DMD gene. Case 1 is a 23-year-old male with adult-onset proximal muscle weakness and preserved ambulation. Genetic analysis revealed an in-frame deletion of exons 45–48, consistent with Becker muscular dystrophy. Case 2 is a 7-year-old child presenting with early-onset progressive muscle weakness, a positive Gower’s sign, loss of ambulation, and markedly elevated creatine kinase levels. Multiplex ligation-dependent probe amplification (MLPA) identified an out-of-frame deletion spanning exons 46–57, confirming a diagnosis of Duchenne muscular dystrophy. Reading-frame status produced notably distinct clinical manifestations, despite the same gene and comparable mutational processes. The dystrophin reading-frame rule remains valid in this comparative case report, which also emphasises the importance of accurate molecular diagnosis for prognosis, genetic counselling, and treatment stratification in the era of precision medicine. To our knowledge, comparative genotype–phenotype case documentation from South Asian populations remains limited. This comparative case report adds valuable data from an underrepresented population.

Beyond bones and teeth: Langer–Giedion syndrome revealed through oral and psychiatric clues — a multisystem case report

Thu, 30 Jul 2026 00:00:00 +0530

Langer–Giedion syndrome (LGS), also known as trichorhinophalangeal syndrome type II (TRPS II), is a rare contiguous gene deletion disorder involving chromosome 8q24.11–q24.13, resulting in loss of the TRPS1 and EXT1 genes. The syndrome is characterized by distinctive craniofacial dysmorphism, multiple osteochondromas, skeletal abnormalities, intellectual disability, and dental anomalies. Psychiatric and neurodevelopmental manifestations remain underreported despite their significant impact on functioning and quality of life. We report a 19-year-old female who presented with dental pain and was subsequently found to have classical craniofacial, skeletal, oral, neurodevelopmental, and psychiatric features consistent with Langer–Giedion syndrome. Clinical examination revealed microcephaly, a bulbous nasal tip, prominent ears, multiple bony exostoses, short stature, hypodontia, malocclusion, and retained deciduous teeth. Developmental history demonstrated delayed motor milestones, while psychiatric evaluation revealed borderline intellectual functioning, social immaturity, and emotional dysregulation. Radiographic imaging demonstrated multiple enchondromas and impacted teeth. This case emphasizes the importance of recognizing oral and behavioural manifestations as diagnostic clues in rare genetic syndromes and underscores the necessity of multidisciplinary management incorporating psychiatric care.

A rare case of undifferentiated pleomorphic sarcoma of Gracilis muscle: role of histopathology and immunohistochemistry in diagnosis

Arsala Mulla, Preeti Jain, Khizra Sadiq — Thu, 30 Jul 2026 00:00:00 +0530

Undifferentiated pleomorphic sarcoma (UPS) is a high-grade soft tissue malignancy without identifiable differentiation, often presenting as a rapidly enlarging, painless mass in the extremities or other deep-seated locations in elderly population. A 72-year-old male presented with a progressively enlarging, painless mass in the right thigh of four months duration. Magnetic resonance imaging (MRI) revealed a multilobulated solid-cystic lesion located in the medial aspect of the right thigh, within the gracilis muscle plane. Radiologically, a differential diagnosis of myxofibrosarcoma versus intramuscular myxoma was considered. The patient subsequently underwent wide local excision of the lesion. Gross examination: A well-circumscribed soft tissue specimen measuring 14.5×9×4.5 cm was received. The external surface was bosselated. Cut section revealed a grey-white, fleshy solid tumor with focal areas of hemorrhage. Histopathological examination revealed a pleomorphic spindle cell tumor with interlacing fascicles and high mitotic activity. Areas of tumor necrosis are also identified. On immunohistochemical analysis, tumor cells retained nuclear expression of H3K27me3 in while being negative for lineage-specific markers (including epithelial, myogenic, neural, and melanocytic markers), thereby excluding specific lines of differentiation. UPS is a high-grade malignant mesenchymal neoplasm and remains a diagnosis of exclusion. A comprehensive evaluation incorporating histopathology and immunohistochemistry is essential to rule out other pleomorphic sarcomas and mimics, ensuring accurate diagnosis and appropriate management.

Successful placement of a tunnelled hemodialysis catheter in persistent left superior vena cava: a case report and literature review

Maulik Patel, Akash Dholakia — Thu, 30 Jul 2026 00:00:00 +0530

Persistent left superior vena cava (PLSVC) is the most common congenital thoracic venous anomaly and is often detected incidentally during central venous procedures. Its presence may complicate hemodialysis catheter placement because of the unusual venous anatomy and potential risk of catheter malposition or arrhythmia. We report the case of a 56-year-old man with end-stage renal disease secondary to diabetes mellitus and hypertension who required urgent hemodialysis. Ultrasound examination revealed thrombosis of the right internal jugular vein, necessitating left-sided vascular access. During tunneled hemodialysis catheter insertion, fluoroscopy demonstrated an unexpected guidewire course along the left mediastinal border. Contrast venography confirmed a PLSVC draining into a dilated coronary sinus and subsequently into the right atrium. Given the favorable drainage pattern, a cuffed dual-lumen tunneled hemodialysis catheter was successfully inserted under fluoroscopic guidance without procedural complications. The catheter achieved blood flow rates of 250–300 ml/min with satisfactory dialysis adequacy (Kt/V >1.2). No arrhythmia, catheter dysfunction, thrombosis, infection, or hemodynamic instability occurred during the procedure or throughout 3 months of follow-up. This case highlights the importance of recognizing an unexpected left-sided guidewire trajectory during venous access procedures and promptly confirming the anatomy before catheter advancement. When right atrial drainage is established, tunneled hemodialysis catheter placement through a PLSVC can provide safe and effective dialysis access in patients with limited vascular options.

An atypical metallic bezoar on imaging

Nidhi N. Thacker, Charmy Padhiyar, Ritesh D. Kamat — Thu, 30 Jul 2026 00:00:00 +0530

Laparoscopic fundoplication with mesh reinforcement is an established surgical treatment for gastroesophageal reflux disease and large hiatal hernias. Although long-term outcomes are generally favorable, delayed postoperative complications may occur, including wrap migration, recurrent hiatal hernia, mesh-related sequelae. We report a case of severe fundoplication failure with recurrent hiatal hernia complicated by metal bezoar-like intraluminal lesion with impregnated food particles on CT. This case highlights the importance of recognizing misleading intraluminal appearances on cross-sectional imaging to avoid diagnostic pitfalls and facilitate timely management.

The red herring in the cerebrospinal fluid: Aspergillus niger isolation in a 9-year case of recurrent lymphocytic meningitis

Thu, 30 Jul 2026 00:00:00 +0530

Invasive central nervous system (CNS) aspergillosis is classically a disease of the severely immunocompromised host, driven by rapidly progressive and often fatal infection. Aspergillus niger, an intrinsically rare neuropathogen even within this context, has scarcely been reported as a causative agent of meningitis. We report a 41-year-old man with chronic alcohol and tobacco use who presented with fever, headache, and photophobia two days after returning to Kerala, India, from Saudi Arabia. His records documented six identical meningitis episodes over nine years (2016, 2017, 2019, 2020, 2021, and 2025), each resolving completely with empirical antimicrobials and without neurological sequelae. Lumbar puncture revealed lymphocytic pleocytosis (85 cells/cumm, 98% lymphocytes), mildly elevated protein (59 mg/dL), and borderline-normal glucose (46 mg/dL). Extensive workup including Brucella serology, Weil-Felix test, TB PCR, Interferon-Gamma Release Assay, and autoimmune panels were negative. Unexpectedly, cerebrospinal fluid culture isolated Aspergillus niger. Empirical acyclovir and ceftriaxone were commenced; voriconazole was added following culture identification. The patient improved rapidly and was discharged, but was lost to follow-up before planned skull-base CT imaging could be completed. This case presents a compelling diagnostic dilemma: whether the isolate represents true invasive infection, periodic trans-cribriform antigenic seeding from a chronic sinus mycetoma, or an incidental finding superimposed on a benign recurrent meningitis syndrome such as Mollaret's meningitis or Neuro-Behçet's disease. It underscores the importance of integrating longitudinal clinical context when interpreting unexpected microbiological results, and of maintaining a broad differential rather than anchoring on a single laboratory finding.

Incidental detection of high-grade T cell non-Hodgkin lymphoma mimicking urinary bladder carcinoma: a diagnostic challenge

Shivangi S. Chaudhari, Sudhir B. Kavad — Thu, 30 Jul 2026 00:00:00 +0530

Non-Hodgkin lymphoma (NHL) is a heterogeneous group of lymphoid malignancies that can occasionally present with atypical clinical and radiological features, leading to significant diagnostic challenges. Incidental detection during evaluation for other suspected malignancies is uncommon. We report the case of a 65-year-old male who presented with radiological findings suggestive of a urinary bladder neoplasm with metastatic lymphadenopathy. The patient underwent cystoscopy with transurethral resection of bladder tumor (TURBT) and bilateral double-J (DJ) stenting. Histopathological examination of the bladder tissue revealed only chronic inflammatory changes consistent with cystitis, with no evidence of malignancy. Owing to persistent generalized lymphadenopathy, a biopsy of the right iliac lymph node was subsequently performed. Histopathological examination demonstrated features of a malignant lymphoid neoplasm, and immunohistochemistry confirmed a diagnosis of high-grade mature T-cell NHL, with tumor cells positive for CD3, CD4, CD5, and CD7 and a high proliferative index (Ki-67: 90-95%). PET-CT further supported the diagnosis by demonstrating widespread metabolically active lymphadenopathy consistent with a lymphoproliferative disorder. This case highlights an unusual presentation of high-grade T-cell NHL mimicking urinary bladder carcinoma with nodal metastasis and emphasizes the critical role of histopathological examination and immunohistochemistry in establishing the correct diagnosis when clinical and radiological findings are discordant. Early recognition of such atypical presentations is essential to avoid misdiagnosis, facilitate timely initiation of appropriate therapy, and improve patient outcomes.

Reversible neurotoxicity associated with polymyxin B: a case report

Adesh Kumar, Debasmita Pal — Thu, 30 Jul 2026 00:00:00 +0530

Polymyxin B is a potent antibiotic used against multidrug-resistant Gram-negative infections such as Acinetobacter baumannii and Pseudomonas aeruginosa. It acts by disrupting the bacterial outer membrane, leading to cell death. Despite its effectiveness, its use is limited by a narrow safety margin and notable toxicities. The most common adverse effects are kidney injury and neurotoxicity, while symptoms such as fever, rash, headache, or chest tightness occur less often. Neurotoxic effects can range from mild paresthesia to severe neuromuscular impairment. This case describes a 60-year-old patient who developed perioral numbness, chest tightness, and headache shortly after receiving polymyxin B, highlighting the need for close monitoring even at therapeutic doses. This case is distinctive because the constellation of perioral numbness, chest tightness, and headache occurred in the absence of renal dysfunction, and symptoms resolved promptly with discontinuation of polymyxin B and supportive diuretic therapy. Such a presentation has not been widely described in prior reports, underscoring the need for vigilance even when dosing is within therapeutic ranges. Polymyxin B remains an important therapeutic agent for multidrug-resistant Gram-negative infections; however, its neurotoxic potential necessitates close observation during treatment. In our case, the patient developed transient neurological symptoms that improved following discontinuation of polymyxin B and supportive management with diuretics, including furosemide (Lasix). This highlights the importance of early recognition and prompt intervention to prevent serious toxicity while maintaining therapeutic efficacy.

LYRM7-associated mitochondrial complex III deficiency presenting as infantile hemiparesis with chronic cerebral infarction: a case report

Geerthana Balasubramaniam, Guhan Ramamurthy — Thu, 30 Jul 2026 00:00:00 +0530

Mitochondrial oxidative phosphorylation (OXPHOS) disorders are rare genetic diseases that primarily affect organs with high energy demands, especially the brain. Although stroke-like episodes are recognised manifestations, presentation as chronic cerebral infarction in infancy is uncommon. Variants in the LYRM7 gene causing mitochondrial complex III deficiency are extremely rare. We report an infant who presented with an acute-onset right-sided hemiparesis following a febrile illness and was found to have a chronic left middle cerebral artery territory cerebral infarction on neuroimaging. The child had delayed developmental milestones, elevated serum lactate, and magnetic resonance spectroscopy findings suggestive of mitochondrial dysfunction. Whole-exome sequencing identified a pathogenic homozygous variant in the LYRM7 gene, confirming mitochondrial complex III deficiency. Supportive management and multidisciplinary rehabilitation resulted in gradual improvement in motor function and developmental progress in follow-up. This case broadens the phenotypic spectrum of LYRM7-associated mitochondrial disease by presenting an unusual case. Recognition of mitochondrial disorders in infants presenting with stroke-like neurological deficits is essential for timely genetic diagnosis, appropriate management, family counselling, and long-term follow-up.

Clinical, laboratory and echocardiographic features of patients with ST-elevation myocardial infarction complicated by ventricular arrhythmias: an observational study

Thu, 30 Jul 2026 00:00:00 +0530

Background: Early malignant ventricular arrhythmias (VAs) during ST-elevation myocardial infarction (STEMI) significantly contribute to in-hospital mortality but appear to have little impact on long-term prognosis, likely because the arrhythmic substrate is reversed after revascularization.

Methods: The study included 91 patients with STEMI who were admitted to the Grodno State Cardiological Center for treatment between February 2024 and February 2025. Group 1 included 64 patients with STEMI, whereas Group 2 included 29 patients with STEMI and ventricular arrhythmias (sustained VT or VF). All patients underwent clinical, laboratory, and instrumental examinations, including coronary angiography. Statistical analyses were performed using STATISTICA 12.0 software.

Results: Among 29 patients with VAs, six had ventricular fibrillation treated with electrical cardioversion, three had sustained VT, and 20 had episodes of non-sustained VT. According to the results of coronary angiography, 24 patients had undergone percutaneous coronary intervention, and five patients had stenosis of the left main coronary artery; therefore, they underwent coronary artery bypass graft operation. Patients with STEMI and ventricular tachyarrhythmias were characterized by a higher prevalence of inferior localization of MI (p=0.001), higher WBCs counts (0.008), higher glucose levels (p=0.008), higher troponin levels (p=0.004), lower left ventricular ejection fraction in both M- and B-modes (p=0.001), and higher contractility index (p=0.001).

Conclusions: These results demonstrates that inflammatory markers, myocardial injury, compromised ventricular function, and metabolic disruptions depict that the pathophysiology of arrhythmias in STEMI patients, highlighting the significance of early observation and timely treatment program to decrease the arrhythmic risk.

Mental health status among intern doctors during COVID-19 pandemic in Bangladesh

Thu, 30 Jul 2026 00:00:00 +0530

Background: The COVID-19 pandemic has imposed substantial physical and psychological burdens on healthcare workers worldwide, with high levels of anxiety, depression and stress reported among physicians, especially frontline staff. Intern doctors in Bangladesh, who work long hours in high-risk and resource-limited settings, may be particularly vulnerable; however, data on this group remain limited. This study aimed to assess the prevalence and determinants of depression, anxiety and stress among intern doctors in Bangladesh during the pandemic.

Methods: This cross-sectional study included 317 intern doctors from public and private medical college hospitals, recruited through convenience sampling between April and July 2021. Data were collected using a structured questionnaire covering sociodemographic and work-related variables, along with the DASS-21 scale to measure depression, anxiety and stress. Statistical analysis was performed using SPSS, applying descriptive statistics, chi-square tests and binary logistic regression to identify factors independently associated with mental health outcomes, with p<0.05 considered significant.

Results: A high prevalence of psychological distress was observed: 73.2% of participants had depression, 69.4% had anxiety and 51.1% had stress, with many experiencing severe or extremely severe symptoms. Working in private hospitals was independently associated with higher odds of depression (OR 2.25), anxiety (OR 3.81) and stress (OR 2.31). Experiencing occupational stigma and working overtime were also significant contributors.

Conclusions: Intern doctors in Bangladesh experienced a substantial mental health burden during COVID-19. Targeted psychological support, improved workplace conditions and organizational interventions are urgently needed to safeguard their well-being.

Pattern and determinants of energy drink consumption among young persons in South-West Nigeria

Thu, 30 Jul 2026 00:00:00 +0530

Background: Energy drink (ED) consumption has become increasingly prevalent among young adults, particularly students, due to its perceived benefits in enhancing alertness and performance. These beverages are widely marketed and easily accessible, contributing to their growing popularity in both academic and social settings.

Methods: A descriptive cross-sectional study was conducted among 129 respondents using a structured, self-administered questionnaire. Data on sociodemographic characteristics, lifestyle factors, consumption patterns, and knowledge of health risks were collected. Statistical analyses, including chi-square tests and multivariable logistic regression, were performed at a 5% significance level to identify factors associated with regular consumption.

Results: The lifetime prevalence of ED consumption was high (86%), with 33.3% classified as regular users. Consumption was slightly higher among males and common across age groups. Taste (55.0%) and price (39.6%) were the main determinants of brand choice, with Fearless (49.6%) being the most consumed brand. Although 58.9% of respondents demonstrated high knowledge of health risks, unhealthy dietary habits (44.2%) and poor sleep patterns were prevalent. Significant predictors of regular consumption included unhealthy diet (AOR=3.25; 95% CI: 1.38-7.65) and consumption of certain brands, particularly monster (AOR=2.84; 95% CI: 1.12-7.25).

Conclusions: ED consumption is highly prevalent and influenced primarily by modifiable lifestyle factors. Targeted interventions focusing on dietary behavior, health education, and improved labeling practices are recommended to reduce habitual consumption and associated health risks.

Learning behaviors and preferences for lecture versus team-based learning among preclinical students in a Caribbean medical school

Dev K. Shah, Yuliya Modna, Nagadharshan Devendra, Julia Akcayli — Thu, 30 Jul 2026 00:00:00 +0530

Background: Medical students exhibit diverse learning behaviors that influence their engagement with instructional formats. This study investigated how preclinical students’ learning styles influence preferences for lectures versus team-based learning (TBL) and their impact on academic performance.

Methods: All preclinical students at Trinity Medical Sciences University were invited to participate voluntarily. Learning behaviors avoidant, participant, competitive, collaborative, dependent, and independent were classified using the Grasha-Riechmann questionnaire, while instructional preferences were assessed through a 14-item survey. GPA data were collected, and analyses performed using various statistics tests, and thematic analysis.

Results: A total of 108 students participated (mean age 24.9 years; 42.5% male, 57.5% female). dependent (27.8%) and independent (21.3%) were the most common learning behaviors, while competitive style was absent. Collaborative learners demonstrated a strong preference for TBL over lectures (p<0.001, d=1.816). Avoidant learners moderately favored TBL, whereas Independent and Participant learners showed comparable preferences, and Dependent learners displayed parity across formats. GPA differences across groups were not statistically significant, though small mixed-style cohorts (e.g., collaborative+dependent) had higher averages. Gender analysis revealed males more often exhibited independent and avoidant styles, while females favored dependent and participant behaviors, with mixed profiles more prevalent among female learners. Qualitative themes highlighted nuanced preferences: collaborative students valued frequent TBL, dependent learners preferred lecture-led curricula, and participant learners favored balanced approaches.

Conclusions: This study underscores that students’ instructional preferences vary by learning behavior and gender. Tailoring teaching strategies to these profiles can foster adaptive, inclusive curricula that enhance engagement, efficiency, and academic outcomes.

Sociodemographic profile and characteristics of whole blood donors in a multispecialist health centre in North Central Nigeria

Thu, 30 Jul 2026 00:00:00 +0530

Background: Blood donation is one of humanity's most noble contributions to medical services, providing invaluable and lifesaving benefits. Mobilising blood donors towards making blood and blood products readily available hinges on understanding the profile and characteristics of blood donors, the reason for this study.

Methods: The study was a cross-sectional study carried out between January 2024 and December 2024 involving 3,980 whole Blood donors recruited as walk-in donors in the Jos University Teaching Hospital blood bank or voluntary blood donors during the hospital's external donor drives. Donor recruitment forms were administered to potential blood donors, while the packed cell volume (PCV) was checked before donor blood collection was carried out.

Results: Three thousand, four hundred and fifty-nine (86.91%) males dominated the donor population, with the age group 26-35 accounting for 36.71%. There were more married individuals, 2,210 (55.53%), donating, while self-employed donors were the least. Donors who had previously donated were 2,668 (67.03%), while 1,312 (32.96%) were first-time donors. A history of high blood pressure was reported by 230 (5.78%). Breastfeeding mothers accounted for 0.90% of the donor population. Mean systolic and diastolic blood pressure were 121.73±15.81 and 78.11±9.77 mmHg, respectively, with a mean PCV of 42.98±3.16 percent.

Conclusions: The donor population showed some level of awareness by the profile and characteristics recorded. However, further advocacy and public awareness targeted at women, professionals, and the elderly, among other groups, will go a long way in improving donor recruitment, donor retention and availability of safe blood.

Association between smart device use and change in myopia in the OPD of a tertiary eye hospital

Mon, 06 Jul 2026 00:00:00 +0530

Background: Nowadays, children and adolescents are exposed to digital media from an early age. More and more aspects of modern life are thought to be affected by excessive screen time. Accordingly, the aim of this review is to document the effects of excessive screen time viewing on children and adolescents and change in myopia. A narrative review was performed in searchable databases.

Methods: Ninety-three patients will be included in the study after the patient/ ensuring written, informed consent from their legal guardians. All will undergo ophthalmological examination and data will be collected in a data record form. SPSS version 23 will be used for data analysis.

Results: The majority of participants were aged 11-15 years (34.4%), male (52.7%), and from urban areas (73.1%). Smartphones were the most commonly used device (61.3%). About 57.0% of participants reported screen time exceeding three hours per day. Mild myopia was observed in 44.1% of cases, moderate myopia in 36.6%, and severe myopia in 19.3%. A statistically significant association was found between increased daily screen time and higher severity of myopia (p<0.001).

Conclusions: Prolonged smart device use is significantly associated with increased severity of myopia, highlighting the need for preventive strategies to limit excessive screen exposure, especially among children and adolescents.

Knowledge and practice of nurses on care of elderly patients in a tertiary care hospital: a cross-sectional study

Pramila Dhakal, Shanti Awale, Mukti Nath Sankhi, Kumari Shanta Bhatta — Thu, 30 Jul 2026 00:00:00 +0530

Background: The elderly population is continuing to increase in Nepal, leading to the need for skilled and nursing care, particularly in hospital settings. Nurses are important healthcare providers for older adults, and their knowledge and practice related to older adults and care can enhance or reduce from quality of care of elderly. The purpose of this study was to assess the knowledge and practice of care in elderly patients. The study was conducted at tertiary care hospital, Nepal.

Methods: Between November 2023 and April 2025, a cross-sectional analysis study was done at tertiary care Hospital. Using non-probability methods, 218 nurses were included in the study. Researcher developed self-administered questionnaire was used for knowledge, and researcher developed observation checklist was used to assess the practice of nurses. Using SPSS version 16, we used descriptive and inferential statistics methods for data analysis.

Results: The results showed that 89.9% of the nurses had acceptable knowledge of elderly care, while 10.1% exhibited poor knowledge. For practice, only 63.3% of the immobilised elderly patients had their position changed regularly, and only 10% received pressure ulcer care. There was no association between sociodemographic characteristics and knowledge level.

Conclusions: While most of the nursing staff had adequate knowledge about the elderly care, their practice was low in providing care, most notably pressure ulcer prevention and catheter care. The authors suggested that education and consistent use of the guidelines are needed in the elderly care setting.

Serum calcium level among school-going adolescent girls in Bangladesh and their correlation with vitamin D level

Thu, 30 Jul 2026 00:00:00 +0530

Background: Calcium and vitamin D are essential for bone health during adolescence, a period of rapid bone mass accrual. Adolescent girls in Bangladesh are at increased risk of deficiency due to dietary factors and limited sunlight exposure. This study evaluated serum calcium levels among urban and rural school-going adolescent girls and examined the association between serum calcium and vitamin D status.

Methods: This cross-sectional study was conducted at the Department of Biochemistry, Sylhet MAG Osmani Medical College, Sylhet, from July 2017 to December 2018 among 140 school-going adolescent girls aged 10–19 years (70 urban, 70 rural). Sociodemographic, anthropometric, dietary and lifestyle data were collected using structured questionnaires. Data were analyzed using SPSS version 26.

Results: Urban girls had significantly higher mean serum calcium levels than rural girls (9.12±0.48 vs. 8.86±0.52 mg/dl; p=0.003) but lower vitamin D levels (19.4±7.2 vs. 22.8±8.1 ng/ml; p=0.010). Low serum calcium was observed in 11% of urban and 24% of rural girls. Vitamin D deficiency was more prevalent among urban girls (55.7%) than rural girls (40.0%). Vitamin D status was significantly associated with serum calcium levels (p=0.012), with sufficient vitamin D linked to normal serum calcium. Rural girls had greater sunlight exposure (43.8±18.7 vs. 21.6±12.4 min/day; p<0.001).

Conclusions: Hypocalcemia and vitamin D deficiency are common among Bangladeshi adolescent girls, with significant urban–rural differences. Improved nutrition, dietary counselling and promotion of outdoor activities are needed.

Gender differences in patients presenting with non-ST elevation acute coronary syndromes

Thu, 30 Jul 2026 00:00:00 +0530

Background: Although a role for gender-based differences in the development and associated complications of non-ST elevation acute coronary syndromes (NSTE-ACS) has been theorized, there is currently high uncertainty on the actual contribution of these factors in the epidemiology and clinical course of NSTE-ACS.

Methods: The retrospective study included 96 patients with NSTE-ASC, who were admitted to the Grodno Regional Clinical Cardiological Center (Belarus) for treatment over a period from January to Оctober 2025. Patients were divided into 2 groups according to their gender: group 1 included 49 male patients, while group 2 – included 47 female patients. All patients underwent clinical, laboratory, and instrumental studies. Statistical analysis was performed using STATISTICA 12.0.

Results: Female patients were significantly older (p=0.005); and more often had obesity (p=0.02). Female patients were significantly more diagnosed with unstable angina (p<0.001), while in male patients myocardial infarction (MI) diagnosis was more common. High-sensitive troponin I levels were comparable between two groups (p=0.12), as well as lactate dehydrogenase (p=0.09) and creatine phosphokinase MB (p=0.98). The results of coronary angiography show a tendency towards more extensive multivessel coronary artery disease in men (35% versus 17%, p=0.048).

Conclusions: These findings emphasize the importance of gender-specific approaches to the diagnosis and risk stratification of ACS. Larger, multicentre prospective studies incorporating additional biomarkers and long-term outcome data are needed to validate these results and to advance a more balanced approach to the gender-specific management of ACS.

Association of serum interleukin 15 level with vitiligo: a cross-sectional comparative study

Thu, 16 Jul 2026 00:00:00 +0530

Background: Vitiligo is a chronic autoimmune skin disorder characterized by the progressive destruction of melanocytes, leading to depigmented patches. Interleukin-15 (IL-15), a pro-inflammatory cytokine, has been implicated in the persistence of vitiligo by sustaining tissue-resident memory (TRM) T cells, which contribute to disease recurrence. Objective was to investigate the association of serum IL-15 levels with vitiligo and its severity.

Methods: A total of 60 participants, including 30 vitiligo patients and 30 healthy individuals were enrolled. Serum IL-15 levels were measured using enzyme-linked immunosorbent assay (ELISA). Disease severity was assessed using the vitiligo area scoring index (VASI).

Results: Vitiligo patients exhibited significantly higher serum IL-15 levels (41.98±32.16 pg/ml) compared to healthy individuals (15.19±8.82 pg/ml, p<0.001). IL-15 levels were positively correlated with disease severity, as patients with VASI scores >10 had the highest IL-15 levels (61.88±31.82 pg/ml, p=0.047). However, no significant correlation was observed between IL-15 levels and age (p=0.129), duration of disease (p=0.923), or age of onset (p=0.107). Receiver operating characteristic (ROC) analysis demonstrated that IL-15 levels ≥15.9 pg/ml had 80.8% sensitivity and 65.4% specificity in distinguishing vitiligo patients from healthy individuals (AUC=0.772, p=0.001).

Conclusions: Serum IL-15 is found to be significantly elevated in vitiligo patients and is shown to correlate with disease severity. Future research should focus on longitudinal studies and therapeutic interventions targeting IL-15 to better understand its role in vitiligo pathogenesis and treatment.

Molecular detection and antimicrobial resistance pattern of carbapenem-resistant Klebsiella pneumoniae isolated from patients with lower respiratory tract infections

Thu, 30 Jul 2026 00:00:00 +0530

Background: Recently worldwide, carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has attracted a lot of attention because of the scarcity of effective drugs and the severity of the illness as well as the high death rate. This study was conducted to assess the antimicrobial susceptibility profiles and the molecular identification of CRKP isolates that were obtained from patients with lower respiratory tract infection (LRTI) at a tertiary care hospital in Sylhet, Bangladesh.

Methods: This cross-sectional study was conducted in the Department of Microbiology at Sylhet MAG Osmani Medical College, Sylhet, from July 2021 to June 2022. A total of 153 sputum samples were collected from adult patients (≥18 years) clinically diagnosed with LRTIs. Data were analyzed using SPSS version 26.

Result: Among 153 sputum samples from LRTI patients, 66.0% showed bacterial growth, with Klebsiella pneumoniae accounting for 20.9% of isolates. The mean age was 52.43±17.12 years with male predominance (69.3%). Of the Klebsiella pneumoniae isolates, 25.0% were carbapenem-resistant (CRKP), among which 75.0% produced carbapenemase and 50.0% harbored the KPC gene. Overall isolates showed high resistance to cephalosporins (up to 81.2%) and moderate sensitivity to carbapenems (around 72–75%) and amikacin (56.2%). CRKP isolates demonstrated marked multidrug resistance, with high resistance to most antibiotics, including carbapenems (75.0%).

Conclusion: In conclusion, one in every fourth KP isolate was CRKP, which highlighted the need for careful prescription of carbapenems for the therapy of infectious diseases with ESBL-producing KP. Among different genes conferring resistance to carbapenems, only the blaKPC gene was investigated in this study.

Factors associated with psychoactive substance use among youth in urban and rural local government areas of Kano State, Nigeria: a comparative cross-sectional study

Thu, 30 Jul 2026 00:00:00 +0530

Background: Substance use among youth remains a major public health challenge in Nigeria, with limited community-based data from northern regions. This study assessed the prevalence, types, and factors associated with psychoactive substance use among youth in urban and rural local government areas (LGAs) of Kano State, Nigeria.

Methods: A comparative cross-sectional study was conducted from December 2021 to March 2022 among 392 youth aged 15-24 years recruited from congregate settings in one urban and one rural LGA. Multistage sampling was used. Interviewer-administered questionnaires assessed socio-demographics and substance use. Data were analysed using SPSS version 20. Multivariable logistic regression identified factors associated with substance use, with significance set at p<0.05.

Results: The prevalence of psychoactive substance use was 77.8% overall (urban: 88.7%; rural: 67.0%). Commonly used substances included tobacco products (urban: 87.2%; rural: 65.5%), cannabis (urban: 86.2%; rural: 60.9%), tramadol (urban: 83.6%; rural: 66.5%), and alcohol (urban: 59.5%; rural: 56.3%). In urban LGA, independent factors associated with substance use were lower income (<₦ 50,000: aOR=20.41, 95% CI: 6.33-66.60, p=0.001), and earlier age at initiation (≤16 years: aOR=2.72, 95% CI: 1.34-5.52, p=0.005; 17-20 years: aOR=2.72, 95% CI: 2.00-3.71, p=0.001). In rural LGA, associated factors included no formal education (aOR=2.31, 95% CI: 1.11-4.83, p=0.026), student status (aOR=4.13, 95% CI: 1.68-10.19, p=0.002), and lower income (aOR=2.11, 95% CI: 1.43-3.11, p=0.001).

Conclusions: Prevalence of psychoactive substance use is high, particularly in urban areas. Strengthening substance use prevention programs, improving educational access, economic empowerment, and youth engagement initiatives may reduce substance use among at-risk youth.

Effects of bedtime smartphone use on sleep quality among medical students: a cross-sectional study

Thu, 30 Jul 2026 00:00:00 +0530

Background: Sleep is essential for physical, mental, and cognitive health, especially among medical students facing academic pressure. However, bedtime smartphone use is increasingly disrupting sleep quality through blue light exposure and psychological stimulation. This leads to delayed sleep onset, reduced sleep duration, and daytime dysfunction. Despite growing concerns, limited research exists in this area among Bangladeshi medical students, making it important to explore the relationship between smartphone use and sleep quality. Objectives were to assess effects of bedtime smartphone use on sleep quality and its patterns among medical students.

Methods: This cross-sectional study was conducted at a medical college in Sylhet Division from August to November 2025 among 100 medical students. Data were collected using a structured questionnaire covering smartphone use patterns and sleep quality (PSQI). Inclusion criteria included students aged 18-26 years using smartphones before sleep. Data were analyzed using SPSS v25, applying descriptive statistics and Chi-square test, with p<0.05 considered significant. Ethical approval and informed consent were obtained.

Results: Among 100 participants, most were aged 21-23 years (46%), with a mean age of 22.4±2.1 years; 52% were male and 72% were MBBS students. Bedtime smartphone use was mainly 1-2 hours (38%), with social media as the most common purpose (42%, p<0.001). Poor sleep quality was observed in 68%, and 36% slept 5-6 hours. Higher smartphone use was associated with worse sleep outcomes and increased daytime sleepiness (78%).

Conclusions: Bedtime smartphone use significantly disrupts sleep quality among medical students by affecting circadian rhythm and increasing cognitive stimulation.

Association of serum D-dimer levels with disease activity in chronic urticaria, psoriasis and urticarial vasculitis

Thu, 30 Jul 2026 00:00:00 +0530

Background: Chronic urticaria, psoriasis and urticarial vasculitis are common skin inflammatory diseases that frequently have systemic implications. D-dimers in serum, as a coagulation activation marker, have been suggested as biomarkers for systemic inflammation in different autoimmune diseases. Its use for the evaluation of disease activity in chronic urticaria, psoriasis and urticarial vasculitis is not well established but there are no data available on the same especially in South Asian countries like Bangladesh. There is an association between serum D-dimer level and the severity of chronic urticaria, psoriasis and urticarial vasculitis, indicating its consideration as a biomarker for activity or response to therapy.

Methods: A hospital-based cross-sectional study was carried out in 100 patients with chronic urticaria, psoriasis or urticarial vasculitis. The severity of the diseases was evaluated by UAS7 for chronic urticaria, PASI test in psoriasis and clinical evaluation in prematurely aged urticarial vasculitis. Serum D-dimer was detected and statistical analysis, consisting of one-way ANOVA and Pearson/Spearman correlation test, was executed.

Results: The D-dimer levels were higher in all groups, the highest of which was found for the patients with urticarial vasculitis 59.7 ng/ml), whereas they were 512.4 ng/ml and 468.9 ng/ml for those with chronic urticaria and psoriasis, respectively. D-dimer levels were positively correlated with the severity of disease in all conditions to a considerable extent (p<0.001).

Conclusions: Serum D-dimer level is associated with the severity of chronic urticaria, psoriasis and urticarial vasculitis, and thus may be considered as a potential biomarker for evaluating disease activity or treatment response.

Trend, causes and determinants of perinatal deaths in Ondo state: insights from maternal and perinatal death surveillance and response data 2021-2022

Isaac O. Aladeniyi, Rosena O. Oluwafemi — Thu, 30 Jul 2026 00:00:00 +0530

Background: Perinatal mortality remains a major public health challenge in Nigeria and it contributes substantially to under-five mortality. Maternal and perinatal death surveillance and response (MPDSR) systems provide opportunities to identify patterns, causes, and avoidable factors associated with these deaths. This study assessed MPDSR implementation and examined the trends, causes, and determinants of perinatal deaths in Ondo State, Nigeria, between 2021 and 2022.

Methods: A retrospective descriptive study was conducted using triangulated MPDSR data obtained from the electronic MPDSR platform, district health information system (DHIS-2), and health facility records in Ondo State. A four-phase review process involving desk review, stakeholder engagement, data mapping, facility-level record harvesting, and database validation was adopted. Data were extracted using National MPDSR tools and analysed with SPSS version 23 using descriptive statistics.

Results: A total of 365 and 392 perinatal deaths were notified in 2021 and 2022 respectively, of which 68 (18.6%) and 133 (33.9%) were reviewed. Most deaths occurred in health facilities. Home referrals accounted for 28 (41.2%) of reviewed cases in 2021 and 24 (18%) in 2022. Macerated stillbirths constituted a substantial perinatal deaths and while birth asphyxia, prematurity and sepsis were the leading causes of neonatal deaths. Delayed presentation, poor referral systems, socioeconomic barriers, and inadequate intrapartum monitoring were major contributory factors.

Conclusions: Structural and systemic barriers accounted for significant perinatal losses. Therefore, strengthening MPDSR systems, improving intrapartum care, regulating non-skilled birth practices, building the capacity of health workers and expanding equitable maternal and newborn services are essential to reducing preventable perinatal deaths.

Antibiotic resistance trends and diagnostic accuracy of Typhi Dot and Widal in enteric fever: a 2023-24 single-centre study from North India

Nishi, R. K. Meena, Lavanya Airen — Mon, 06 Jul 2026 00:00:00 +0530

Background: Antimicrobial resistance (AMR) in enteric fever is an emerging public health challenge in India. Early and accurate diagnosis, along with appropriate antibiotic therapy, is essential for reducing disease-related morbidity.

Methods: This retrospective, single-center observational study included all culture-confirmed enteric fever cases diagnosed at Moolchand K.R. Hospital, New Delhi, between August 2023 and September 2024. A total sample size of 45 patients with positive blood cultures for Salmonella Typhi or Salmonella Paratyphi was analyzed. Antimicrobial susceptibility testing was performed using the VITEK 2 compact system with GN and AST-N cards. Diagnostic performance of WIDAL and Typhi Dot tests was evaluated descriptively using blood culture as the reference standard.

Results: Forty-five culture-confirmed cases were analyzed (mean age 22.6±14.5 years; 51.1% female). S. Typhi accounted for 75.6% (34/45) isolates, while S. Paratyphi represented 24.4% (11/45). WIDAL was positive in 20.0% (9/45) cases and demonstrated a sensitivity of 20.6% (7/34), missing 79.4% of confirmed S. Typhi infections. Typhi Dot testing was performed in 25 patients, and all results were negative. Third-generation cephalosporins showed high susceptibility (97.8%), whereas resistance to fluoroquinolones was common. Multidrug resistance was identified in 2.2% (1/45) of isolates.

Conclusions: S. Typhi remained the predominant pathogen. Third-generation cephalosporins continue to be effective, although emerging multidrug resistance warrants ongoing surveillance and antimicrobial stewardship. Blood culture remains the diagnostic gold standard, while WIDAL and Typhi Dot demonstrated limited clinical utility.

Role of 108 ambulance services in road traffic accidents in Vijayapura, North Karnataka: a mixed methods study

Shamin Eabenson, M. R. Gudadinni, M. C. Yadavannavar, A. M. Rangoli — Mon, 06 Jul 2026 00:00:00 +0530

Background: Every year, traffic accidents claim more than 150,000 lives in India. Rather than being signs of systematic shortcomings in urban planning, enforcement and response, these are portrayed as individual incidents. Road trauma is one of India’s most underappreciated public health emergencies in the absence of combined visibility. The WHO estimates that 1.19 million people dies on Indian roads each year, making it a serious public health concern.

Methods: This study is a mixed method study. Both qualitative and qualitative study 108 ambulance drivers, emergency medical staff and road traffic accident victims admitted in BLDE(DU), Vijayapura. Key person interview, focus group discussion, in-depth interview technique.

Results: The time taken to shift the patient from site of accident to primary health care facility was ascertained and we found that, 105 (51%) cases it took 30 minutes to 1 hour, while 72 (34.9%) cases took less than 30 minutes and 29 (14.1%) took more than an hour to reach a health facility.

Conclusions: 51% cases it took 30 minutes to 1 hour, while 34.9% cases took less than 30 minutes and 14.1% took more than an hour to reach a health facility. The use of advanced machinery by traffic police to regulate traffic is the need of the hour: From hand held walkie talkies, signalling systems, crash barriers, reflective lights, AI cameras, automated traffic violation finding tools and software’s integrated to Chellan generation for fines.

Risk factors for cardiovascular diseases among people attending outpatient department of a tertiary care hospital

Davinder Kaur, Ifham Mujahid — Sat, 18 Jul 2026 00:00:00 +0530

Background: The rise in cardiovascular diseases (CVDs) has been particularly alarming in India, with a significant increase in both prevalence and mortality rates over the past few decades. Understanding the risk factors associated with cardiovascular diseases is crucial for developing effective prevention and intervention strategies.

Methods: After ethical approval, this cross-sectional study was conducted in outpatient department of Gian Sagar Medical College and Hospital of district Patiala, Punjab during October 2023 to November 2023. Two hundred patients were selected by non-probability sampling technique. Inclusion criteria were patients who were willing to participate and more than 25 years of age. The patients who were already diagnosed with hypertension and taking anti hypertension medicines were excluded from study. After extensive review, questionnaire was prepared which was divided into two parts: demographic performa and clinical proforma. Socio demo graphic data of patient includes variables that is age, gender, marital status, education, employment, socioeconomic status, history of smoking and alcohol, religion, and past history of heart disease, meal frequency, exercise, type of diet, oil consumption, salt and water consumption. Clinical variables are body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), comorbidity history, history of dyslipidaemia, and waist hip ratio were included. Tool got validated by experts from field of nursing and medicine. Reliability checked by Cronbach’s alpha and it was 0.80. Permission for data collection was taken from hospital administration. After obtaining consent from patient, data was collected from patients. Collected data was analysed by using statistical package for the social sciences (SPSS) version 21 for windows by using descriptive and inferential statistics. Findings were presented by tables and figures.

Results: The most significant risk factor identified was a lack of exercise, with 52.0% of the participants reported that they did not engage in regular physical activity. This was closely followed by pre-obesity/obesity, which affected 54.0% of the participants, and a higher waist-to-hip ratio, noted in 51.0% of the population. It was observed that while males are more prone to multiple risk factors, the fraction of females with a high number of risk factors is significant (p value of 0.000).

Conclusions: Particularly physical inactivity and obesity is the risk factor of developing cardiovascular diseases. The age and gender distribution data indicate that these risk factors are present even in younger populations and are more prevalent in females.

Late dysphagia, xerostomia and submucosal fibrosis following concurrent chemoradiotherapy for locally advanced head and neck squamous cell carcinoma: a prospective comparison of intensity-modulated radiotherapy and three-dimensional conformal radiotherapy

Nileshkumar Kucha, Tej P. Soni, Kavita Valiya, Dineshkumar Singh — Sat, 18 Jul 2026 00:00:00 +0530

Background: Late radiation-induced toxicities remain an important cause of long-term morbidity in survivors of locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Intensity-modulated radiotherapy (IMRT) offers improved dose conformity and normal tissue sparing compared with three-dimensional conformal radiotherapy (3D-CRT). This study compared late toxicity outcomes following definitive concurrent chemoradiotherapy delivered using IMRT versus 3D-CRT.

Methods: This prospective observational study enrolled patients with LA-HNSCC treated with definitive concurrent chemoradiotherapy between September 2017 and December 2018. Seventy-eight evaluable patients (39 IMRT, 39 3D-CRT) were analysed. Late xerostomia, dysphagia, and submucosal fibrosis were graded at 12 months using RTOG/EORTC late radiation morbidity scoring criteria.

Results: Clinically significant xerostomia (grade ≥2) occurred in 23.1% of patients treated with IMRT compared with 51.3% of those treated with 3D-CRT (p=0.019). IMRT was associated with a 55% reduction in the risk of xerostomia (RR 0.45, 95% CI 0.24-0.86). Grade ≥2 dysphagia was observed in 61.5% of patients in the IMRT group and 64.1% in the 3D-CRT group (p=1.000), while grade ≥2 submucosal fibrosis occurred in 30.8% and 43.6%, respectively (p=0.349). Patients treated with IMRT also had fewer treatment interruptions and lower rates of clinically significant weight loss.

Conclusions: IMRT was associated with a significantly lower incidence of late xerostomia than 3D-CRT in patients with LA-HNSCC undergoing definitive concurrent chemoradiotherapy. Although differences in dysphagia and submucosal fibrosis were not statistically significant, the overall toxicity profile favoured IMRT. These findings support IMRT as the preferred radiotherapy technique for reducing long-term treatment-related morbidity in head and neck cancer.

Anatomical variations in coronary artery origin, branching pattern, dominance and morphometry: a cadaveric study from Northeast India

Wed, 22 Jul 2026 00:00:00 +0530

Background: The coronary arteries exhibited significant anatomical variability in its origin, branching pattern, and dominance. Accurate knowledge of these variations is essential for the interpretation of coronary angiography and the planning of percutaneous coronary intervention, coronary artery bypass grafting, and aortic root surgeries. Cadaveric studies provide detailed anatomical information that is invaluable for clinical practice.

Methods: A descriptive cross-sectional study was conducted on 30 formalin-fixed adult human cadaveric hearts in the Department of Anatomy, Regional Institute of Medical Sciences, Imphal, from July 2025 to March 2026 after Institutional Ethics Committee approval. Coronary arteries were dissected to evaluate the position of the coronary ostia relative to the sinotubular junction, branching pattern, coronary dominance, myocardial bridging, and anomalies. The length of the left coronary artery (LCA) trunk was measured using a digital Vernier caliper, and data were analyzed using IBM statistical package for the social sciences (SPSS) statistics version 26.

Results: The LCA ostium was located below the sinotubular junction in 86.7% of hearts, while the right coronary artery (RCA) ostium was below the junction in 80.0%. The LCA exhibited bifurcation in 60.0%, trifurcation in 26.7%, and tetra- and pentafurcation in 6.7% each. The sinoatrial nodal, conus, posterior interventricular, and right marginal arteries arose from the RCA in 96.7%, 86.7%, 90.0%, and 30.0% of specimens, respectively. Myocardial bridging was present in 20.0%, and a third coronary artery in 3.3%. The mean LCA trunk length was 9.34±3.39 mm. Right coronary dominance was observed in 86.7% of hearts.

Conclusions: Coronary arteries exhibited significant anatomical variability, particularly in the location of the coronary ostia and branching pattern of the LCA. These findings provide clinically relevant anatomical data that may improve the safety and accuracy of coronary imaging and surgical and interventional procedures.

Forty-eight-hour mortality in the emergency department: a record-based analysis of patterns and causes from a South Indian tertiary care centre

Thu, 30 Jul 2026 00:00:00 +0530

Background: Early mortality within 48 hours of emergency department (ED) admission is a key indicator of acute care quality. Limited Indian data exist on its epidemiology, especially regarding contributory factors in both medico-legal (MLC) and non-medico-legal (non-MLC) deaths. To determine the 48-hour mortality rate in the ED, describe demographic and clinical profiles, identify the duration of ED stay prior to death, and evaluate causes and contributing factors to early mortality.

Methods: This retrospective record-based study was conducted at a tertiary care center in South India over two years (January 2019–January 2021). All 132 patients who died within 48 hours of ED admission were included. Demographic and clinical parameters, cause of death, referral-to-death interval, and contributory factors (organizational, disease-related, human error) were analyzed descriptively and comparatively across MLC and non-MLC cases.

Results: Out of 96,560 emergency department visits, 132 patients died within 48 hours of ED arrival, corresponding to a mortality rate of 1.37 per 1,000 ED visits. Most patients (58%) died within 6 hours of admission. Cardiac causes (51.5%) and sepsis (26.8%) were predominant in non-MLC deaths, while trauma (60%) was the leading cause in MLC. Over 60% of patients died within 1–6 hours of referral from other centers. Disease-related causes accounted for 65.7% of MLC and 41.2% of non-MLC deaths, followed by organizational delays and human errors.

Conclusion: Early ED mortality is driven by both clinical severity and systemic delays. Stratified analysis of MLC and non-MLC cases reveals opportunities to strengthen prehospital referral systems, triage protocols, and resource allocation in emergency care.

A study to assess the dietary intake among antenatal mothers attending selected CHCs at district Ambala

Ambika Kanwar — Thu, 30 Jul 2026 00:00:00 +0530

Background: Maternal nutrition plays a crucial role in determining pregnancy outcomes and the health of both mother and fetus. Inadequate dietary intake during pregnancy is associated with complications such as anemia, low birth weight, preterm birth, and maternal morbidity. Despite national nutritional programs, maternal undernutrition remains a significant public health issue in India.

Methods: A quantitative non-experimental descriptive study was conducted among 100 antenatal mothers aged 18-40 years attending selected community health centers (CHCs) in District Ambala, Haryana. Convenient sampling technique was used. Data were collected using a structured tool consisting of socio-demographic variables, food frequency questionnaire (FFQ), and 24-hour dietary recall checklist. Dietary intake was assessed based on calorie and nutrient adequacy.

Results: The study revealed variability in dietary intake among antenatal mothers. A considerable proportion of participants exhibited inadequate nutrient intake, particularly in iron, protein, and micronutrients. Based on FFQ scoring, a significant number of mothers had fair to poor diet quality. Associations were observed between dietary intake and socio-demographic variables such as education, socioeconomic status, and antenatal visits. Food quality also showed a significant relationship with dietary intake.

Conclusions: The study highlights the need for targeted nutritional education and interventions among antenatal mothers. Strengthening antenatal counselling services and improving awareness regarding balanced diet can significantly enhance maternal and fetal outcomes.

Retrospective analysis of the effects of high versus extra-high whey protein intake on muscle strength and nutritional status in adults aged 45–65 years

Thu, 30 Jul 2026 00:00:00 +0530

Background: Age-related muscle decline often begins in middle age, affecting strength, functional performance and nutritional status. Protein supplementation supports muscle mass and strength, but comparative data on high versus extra-high protein intake in adults aged 45–65 years are limited. This study evaluated the effects of high (HP) and extra-high whey protein (XHP) supplementation on muscle strength, anthropometry and nutritional outcomes in this transitional age group.

Methods: A retrospective analysis was conducted using medical records of participants who received HP or XHP supplementation for at least 60 days. Inclusion required complete documentation of demographic details, clinical history, anthropometrics, nutritional assessment (mini nutritional assessment short form (MNA-SF)) and handgrip strength. Extracted data included weight, BMI, waist and hip circumference, mid-upper arm and calf circumference and muscle strength at baseline and follow-ups over two months.

Results: HP supplementation led to significant increases in weight and BMI (p<0.05), whereas XHP protein intake was associated with reductions in these parameters. between groups in waist and hip circumference, MUAC and calf circumference emerged from 30 days onward (p<0.05). Handgrip strength improved in both groups initially, but XHP supplementation produced superior functional gains 45 and 60 days (p<0.05).

Conclusions: High-protein supplementation with whey protein provided dose-dependent benefits. Moderate intake supported anabolic recovery, while higher intake improved lean body mass and muscle strength. These findings highlight the therapeutic role of dietary protein in enhancing muscle quality, metabolic health and functional performance, helping prevent and manage sarcopenia and age-related muscle decline.

A retrospective observational study of ocular firecracker injuries during Diwali in the year 2023 encountered at a tertiary care hospital in Ahmedabad, Gujarat, India

Thu, 30 Jul 2026 00:00:00 +0530

Background: Firecrackers are used worldwide to express festive mood inspite of the fact that they can cause severe mental and physical morbidity. Consequently, ocular injuries caused by firecrackers have become a national problem in different countries. The aim was to study the demographic pattern, clinical features, management and prognosis of the patients with firecracker-related ocular injuries during Diwali.

Methods: This institution-based retrospective study was done on patients who attended eye emergency and outpatient department (OPD) of tertiary care center in Ahmedabad, Gujarat. The parameters studied were the age and sex of the patients, severity of injury with respect to active and passive participants, management, severity of injury and visual outcome with respect to type of firecrackers.

Results: A total of 30 patients attended eye OPD and emergency during our study period, of which 91% were male and 9% were female. All of them were of variable age group. All patients were examined on the day of injury. Patients less than 20 years of age were most commonly affected. Visual acuity varied from 6/9 to no perception of light. The most common firework involved was the crackers.

Conclusions: Careless and indiscriminate use of firecrackers may sometimes lead to serious ocular damage. In India, use of fireworks is quite common during various festivals, particularly during Diwali, thus fireworks-related ocular injuries are important causes of blindness. This retrospective study revealed the presentation and outcome of ocular injuries due to firecrackers in this area of mixed culture during this festive week.

Evaluation of the National Medical Commission-Mandated Family Adoption Programme as a community-based learning tool among second-professional MBBS students in central India: a cross-sectional study

Shiwani Lilhore, Tinku Verma, Mahendra Chouksey — Thu, 30 Jul 2026 00:00:00 +0530

Background: Community-based medical education is widely recognized as a critical approach for enabling medical students to understand social determinants of health and primary healthcare delivery. In India, NMC introduced the FAP to integrate community-oriented experiential learning into undergraduate medical education while simultaneously addressing community health needs. The main objective of the programme was to encourage medical students to actively participate in community health and well-being and to provide real-world experience in dealing with socio-economic and health-related issues.

Methods: A cross-sectional descriptive study was conducted by the department of community medicine at a tertiary care medical college in central India during July 2024-September 2024. Seven villages were randomly selected under the family adoption programme. Anthropometric measurements, blood pressure assessment, hemoglobin estimation, and random blood sugar testing were performed following standard protocols.

Results: Out of 200 sanctioned MBBS seats, 188 students participated in the programme. A total of 563 households comprising 3,391 individuals were covered. High blood pressure was observed in 12.9 of men and 6.9 of women and high blood sugar was observed in 3.2 of them. At the age of less than five, a quarter of the children (29.4) was found to be shorter than ought to have been, and a fifth (20.7) of the weight. The prevalence of anemia was higher in the adult population (15-49 years old) where 60.0 per cent of women and 37.0 per cent of men were afflicted.

Conclusions: The family adoption programme informed numerous individuals in the society and provided the undergraduates of the medical fields with a practical learning opportunity.

Proportion and clinico-mycological profile of fungal sinusitis in a tertiary care hospital

Judit D., Deepika K., Gayathri Bhaskaran, J. Jayalakshmi, Vijay R. — Thu, 30 Jul 2026 00:00:00 +0530

Background: Rhinosinusitis is the inflammation of the nose and sinus cavities, which affects about 20% of the population. Earlier considered to be primarily affecting immunocompromised individuals, now increasingly being reported in immunocompetent patients as well. This was a prospective study aimed at evaluating the clinical and mycological profile of fungal sinusitis.

Methods: The collected samples were subjected to three methods: KOH mount, LPCB mount, and fungal culture.

Results: Out of 128, males were 53.5% and females were 46.4%. The fungal sinusitis contributed to 25%, with a mean age of 46.5 years. A significant association between fungal sinusitis and diabetes mellitus (p<0.0001) was noted. The common factors were agricultural occupation (53%) and monsoon season (35.7%). Nasal obstruction (64.2%) was the predominant symptom. CT scan revealed frequent maxillary and ethmoid involvement. Culture positivity was seen in 21.4%, of which the histopathology correlation was seen in 46.4% of the cases. The fungi isolated were Aspergillus spp., Rhizopus spp., Fusarium spp., and Curvularia spp. Complications like osteomyelitis, adenoiditis, and facial palsy were noted in 21%, and mortality was 3.5%.

Conclusions: A higher incidence was noted in middle-aged females, diabetics, and during the monsoon season. Maxillary and ethmoid sinuses were the most frequently affected. Aspergillus species were the predominant pathogens. Early diagnosis and treatment are essential, and it is crucial to employ a combination of diagnostic methods to reach a conclusive result rather than relying solely on a single technique.

Reducing negative appendectomies: a prospective comparative study of the RIPASA and Alvarado scoring systems in the emergency setting in an Indian population cohort

Thu, 30 Jul 2026 00:00:00 +0530

Background: Acute appendicitis is the most common surgical emergency worldwide, with a reported lifetime prevalence of approximately 7–12%. Clinical scoring systems offer a rapid, cost-effective adjunct to diagnosis, yet conventional tools such as the Alvarado score exhibit suboptimal sensitivity, particularly in Asian populations. The RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) score, incorporating six additional parameters including age, sex duration of symptoms, was developed specifically to address this limitation.

Methods: A prospective observational comparative study was conducted in the Surgery Department of KPC Medical College and Hospital, Kolkata, India, from December 2022 to June 2024 (18 months). Fifty-one adult patients (aged ≥12 years) presenting with right iliac fossa pain were prospectively enrolled. Both the Alvarado and RIPASA scores were applied at presentation. Definitive diagnosis was established by histopathological examination (HPE) of appendectomy specimens or clinical follow-up. Diagnostic performance metrics sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) overall accuracy were calculated using standard 2×2 contingency tables. Statistical significance was assessed by chi-square test and z-test (SPSS v27).

Results: RIPASA demonstrated superior sensitivity (83.3% vs 66.7%), specificity (80.0% vs 66.7%), NPV (66.7% vs 45.5%) accuracy (82.35% vs 66.66%) compared to Alvarado. The chi-square statistic for RIPASA was 18.60 (p<0.0001) versus 4.80 (p=0.029) for Alvarado. The potential negative appendectomy rate with the RIPASA cut-off was 66.7% lower than with the Alvarado system.

Conclusions: The RIPASA score is a superior clinical diagnostic tool for acute appendicitis in the emergency setting, particularly in Asian populations. Its adoption in Indian emergency departments has the potential to significantly reduce negative appendectomy rates, associated morbidity healthcare costs.

Relationship between self-esteem and self-efficacy among female cricketers: a cross-sectional survey

Jeevitha Palanisamy, Krishna N. S., Yamuna C. — Thu, 30 Jul 2026 00:00:00 +0530

Background: Self-esteem, defined as an individual’s subjective evaluation of their own worth, is a key construct in sports psychology, influencing motivation, performance, and psychological resilience. Cricket, as a team sport that requires both strategic decision-making and individual skill execution, demands optimal levels of self-esteem and self-efficacy. Despite its importance, there is a lack of research focusing on these psychological constructs among female cricketers. Therefore, this study aimed to examine the relationship between self-esteem and self-efficacy among female cricketers.

Methods: A quantitative cross-sectional study was conducted among female cricket players in Tamil Nadu. A total of 50 participants were recruited using a convenient sampling method. Data were collected through structured questionnaires administered to eligible participants. The collected data were analysed to assess levels of self-esteem and self-efficacy, and to determine the relationship between these variables.

Results: The findings revealed a moderate positive correlation between self-esteem and self-efficacy (r=0.500, p<0.001), indicating statistical significance. Among the participants, 30% demonstrated low self-esteem, 66% had self-esteem within the normal range, and only 4% exhibited high self-esteem.

Conclusions: This study identified a significant positive relationship between self-esteem and self-efficacy among female cricket players. Overall, participants demonstrated predominantly moderate levels of both self-esteem and self-efficacy.

Learning curve in laparoscopic cholecystectomy: a prospective observational study

Sudhir B. Kavad — Thu, 30 Jul 2026 00:00:00 +0530

Background: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. However, mastering laparoscopic skills requires structured training and experience. Evaluation of operative time, intraoperative complications, conversion rate, and hospital stay helps define the learning curve in laparoscopic.

Methods: A prospective observational study was conducted on 36 consecutive elective laparoscopic cholecystectomy cases. Parameters assessed included operative time, intraoperative complications, conversion to open surgery, need for senior assistance, and duration of hospital stay. Sequential case analysis was performed to assess improvement in surgical performance over time.

Results: The overall mean operative time was progressive reduction in later cases. Conversion to open surgery occurred in 8.33% of cases, predominantly in early cases. Intraoperative complications were more frequent during the initial cases and declined with increasing experience. The requirement for senior assistance decreased progressively. The mean hospital stay was 2-3 days, with shorter stays observed in later cases.

Conclusions: A definite learning curve exists in laparoscopic cholecystectomy, with significant improvement in operative time, reduction in complications, and decreased conversion rates. Supervised training and gradual exposure to increasing case complexity are essential for safe skill acquisition.

Hematological and biochemical alterations across stages of chronic kidney disease: a tertiary care based observational study

Deepkumar Valand, Meetkumar Patel, Himani Shah — Thu, 30 Jul 2026 00:00:00 +0530

Background: Chronic kidney disease (CKD) is associated with progressive hematological and biochemical abnormalities that increase morbidity and mortality. Anemia, electrolyte imbalance, metabolic acidosis, and inflammation worsen with declining renal function. Objectives were to describe the hematological and biochemical profile of CKD patients; to compare parameters between early (stages 1-3) and advanced CKD (stages 4-5); and to assess correlations between glomerular filtration rate (GFR) and selected laboratory variables.

Methods: This observational study included 380 adults with CKD stages 1-5 attending a tertiary care hospital. Data collected included demographics, body mass index (BMI), CKD stage, and laboratory parameters (hemoglobin, blood cell counts, serum creatinine, uric acid, electrolytes, calcium, bicarbonate, GFR, C-reactive protein (CRP), and blood urea nitrogen). Anemia was graded as severe (<8 g/dL), moderate (8-9.9 g/dL), mild (10-10.9 g/dL), or absent (≥11 g/dL). Independent-samples t-tests compared CKD stages 1-3 vs 4-5, and Pearson’s correlation assessed associations with GFR (p<0.05).

Results: Most patients were male, aged 41-60 years, and stage 5 CKD constituted over half of the cohort. Nearly 40% were overweight or obese. Anemia affected almost three-quarters of patients, with severe and moderate anemia seen in approximately one-fifth and one-third, respectively. Advanced CKD showed significantly lower hemoglobin, calcium, and bicarbonate, and higher creatinine levels. GFR correlated positively with hemoglobin, calcium, and bicarbonate, and negatively with creatinine and CRP.

Conclusions: CKD patients exhibited a high burden of anemia, metabolic acidosis, hypocalcemia, and inflammation, worsening with disease progression. Early identification and management of these abnormalities may improve outcomes.

Assessment of radiation protection knowledge and practices among radiation workers in a radiology imaging department

Thu, 30 Jul 2026 00:00:00 +0530

Background: Radiation protection is an essential component of radiology practice to minimize unnecessary occupational exposure among healthcare workers. Despite established safety standards, differences may exist in awareness and compliance with radiation protection principles among students and staff working in radiology departments. Objective was to assess the knowledge and practices related to radiation protection among radiation workers in a radiology imaging department.

Methods: A cross-sectional descriptive study was conducted over a period of five months among 168 radiation workers in the radiology imaging department of Mahatma Gandhi Medical College and Hospital, Jaipur. Data were collected using a structured 20-item questionnaire distributed through Google forms and direct circulation. Participants included students and staff members. Data were analyzed using frequencies, percentages, and group comparisons.

Results: Among 168 participants, 75.6% were students and 24.4% were staff members. Awareness regarding ALARA was high (89.3%), and 98.2% correctly identified TLD badges as radiation monitoring devices. However, only 28.6% correctly knew the minimum lead equivalence of aprons. Regular TLD badge use was reported by 85.7%, lead apron use by 83.9%, and attendance in radiation protection training by 68.5%.

Conclusions: The study demonstrated good overall awareness regarding basic radiation safety principles, but gaps remain in technical knowledge and training participation. Continuous education programs and strict compliance monitoring are recommended to strengthen radiation safety culture.

Assessment of knowledge, attitude and practice regarding nutritional care and sarcopenia in oncology: a cross-sectional pilot survey

Thu, 30 Jul 2026 00:00:00 +0530

Background: Malnutrition and sarcopenia are highly prevalent in cancer patients and are associated with poor clinical outcomes. Despite increasing awareness, their assessment and management remain inconsistent in routine oncology practice. To assess the knowledge, attitude and practice (KAP) of healthcare professionals regarding nutritional care and sarcopenia in oncology settings.

Methods: A cross-sectional survey was conducted among 18 clinicians using a structured questionnaire covering knowledge, attitude and practice domains. Responses were analyzed using descriptive statistics and domain-wise scores were calculated.

Results: The findings demonstrated moderate knowledge levels, with variability in understanding of sarcopenia definitions, diagnostic tools and biomarkers. Attitude toward nutrition was highly positive, with most participants acknowledging the importance of early nutritional intervention and routine screening. However, clinical practice lagged behind, with low adoption of structured screening tools such as SARC-F and handgrip strength, limited routine nutritional assessment and inconsistent tracking of body composition.

Conclusions: Despite favorable attitudes, a significant gap exists between knowledge and implementation of nutritional care in oncology. Targeted education and integration of structured screening tools are essential to improve clinical outcomes.

Serum lactate levels as a marker of clinical severity in malaria: a prospective observational study

Bablu Mehta, Darbari Lal, Nihar Behera, Grishma Vekariya — Thu, 30 Jul 2026 00:00:00 +0530

Background: Malaria remains a major cause of morbidity and mortality in tropical countries. Severe malaria is associated with microcirculatory dysfunction, tissue hypoxia, and metabolic derangements. Serum lactate may serve as an early marker of disease severity and prognosis. Objectives were to evaluate serum lactate levels in patients with malaria and assess their association with disease severity and clinical outcomes.

Methods: This prospective observational study included 100 adult patients with laboratory-confirmed malaria admitted to a tertiary care hospital. Clinical evaluation and laboratory investigations, including serum lactate estimation at admission, were performed. Disease severity was classified according to WHO criteria. Clinical outcomes were categorized as favorable or adverse.

Results: Of the 100 patients, 48% had Plasmodium vivax infection, 42% had Plasmodium falciparum infection, and 10% had mixed infection. Patients with severe malaria had significantly higher serum lactate levels than those with uncomplicated malaria (4.5±1.2 vs. 1.6±0.4 mmol/l; p<0.001). Elevated lactate levels were associated with hypotension, severe anemia, metabolic acidosis, renal dysfunction, altered sensorium, hepatic dysfunction, thrombocytopenia, and hypoglycemia. Adverse outcomes occurred in 45% of patients, including ICU admission (22%), prolonged hospital stay (18%), and mortality (8%). Serum lactate levels were significantly higher in patients with adverse outcomes than in those with favorable outcomes (4.5±1.2 vs. 1.6±0.4 mmol/L; p<0.001).

Conclusions: Serum lactate is significantly associated with disease severity and adverse clinical outcomes in malaria. Early lactate estimation may help identify high-risk patients and guide timely management.

Clinicohistopathological study of lichenoid interface dermatitis

Simran Mehra, Shweta Grover, Vineet Relhan, Anupam Varshney — Thu, 30 Jul 2026 00:00:00 +0530

Background: Lichenoid interface dermatitis (LID) represents a heterogeneous group of inflammatory dermatoses characterized by immune-mediated basal keratinocyte injury and interface inflammation, often posing diagnostic challenges due to overlapping clinical and histopathological features. The study was done to evaluate the clinicohistopathological features of LID, to identify the spectrum of clinical and microscopic findings, and to assess histopathological features useful in subtyping variants of lichenoid interface dermatoses.

Methods: This was hospital-based observational study conducted in the Department of Pathology, Muzaffarnagar Medical College and Hospital, from March 2024 to September 2025. A total of 70 skin biopsy specimens clinically suspected and histopathologically diagnosed as LID were included. Biopsies were processed routinely, and 4-5 μm sections were stained with hematoxylin and eosin. Detailed histopathological evaluation was performed and correlated with clinical data. Statistical analysis was carried out using SPSS version 17/20, and results were expressed as percentages.

Results: Out of the total of 70 cases, female preponderance was noted with male to female ratio as 1:1.33. Most patients belonged to the 31-40 years group of which most of the cases were diagnosed as classic lichen planus (44.3%). Most common site reported in the present cohort was lower limbs. Clinico-pathological concordance was seen in 80% of the cases.

Conclusions: Meticulous histopathological examination, coupled with clinical correlation, is essential for precise diagnosis and subtyping, thereby fulfilling the study objectives and reinforcing the central role of histopathology in managing lichenoid interface dermatoses.

Prevalence and antimicrobial susceptibility pattern of Stenotrophomonas maltophilia isolated from peritoneal fluid cultures of dialysis patients

Shinu Krishnan, Anusha Murali, Asalatha Ratheesh Babu, Anila Gopal — Thu, 30 Jul 2026 00:00:00 +0530

Background: Stenotrophomonas maltophilia (S. maltophilia) is an important cause of nosocomial infections, particularly in immunocompromised patients, such as patients with indwelling catheters. Blood stream infections are a leading cause of morbidity among patients undergoing dialysis. Prevalence and Antimicrobial Susceptibility pattern of Stenotrophomonas maltophilia isolated from peritoneal fluid cultures of Dialysis Patients.

Methods: This single-center, retrospective, case–control study was conducted between April 2025 and January 2026. Patients who were undergoing dialysis at a tertiary care hospital, south Kerala and were diagnosed with S. maltophilia were included in this study. The demographic data, clinical characteristics and initial treatment data of the patients were analyzed to determine the risk factors for peritoneal dialysis- related S. maltophilia peritonitis.

Results: A total of 370 peritonitis cases were recorded during the study period. Seven patients with S. maltophilia peritonitis and 21 controls (three controls to one case) were included in this study. The incidence of S. maltophilia peritonitis was significantly more frequent among patients with diabetes mellitus compared with controls (80.0% vs. 20.0%, p=0.004) and among patients with higher white blood cell counts in the dialysate after appropriate antibiotic therapy 2561/µl (349–4654/µl) vs. 20/µl (20–23/µ), p<0.001) than among the control patients. Although all the patients were treated with appropriate antibiotics following the identification of S. maltophilia, they had a significantly higher rate of catheter removal than the controls (80.0% vs. 0.0%, p=0.0003).

Conclusions: Diabetes mellitus may be an important risk factor for S. maltophilia peritonitis in patients undergoing peritoneal dialysis.

Clinico-epidemiological profile of chronic kidney disease patients attending a tertiary care hospital in Goa, India

Thu, 30 Jul 2026 00:00:00 +0530

Background: Chronic kidney disease (CKD) is a major public health problem associated with substantial morbidity and mortality. While diabetes mellitus and hypertension remain the leading causes of CKD, increasing attention is being directed toward chronic kidney disease of unknown etiology (CKDu). In Goa, particularly the southern taluka of Canacona, systematic hospital-based data on CKD are limited.

Methods: This cross-sectional study was conducted at Goa Medical College between May 2023 and April 2024. Consenting adults (>18 years) with CKD, defined according to KDIGO 2024 criteria, were enrolled. Demographic, socioeconomic, clinical, biochemical, radiological, and etiological data were collected. CKDu was defined as CKD in the absence of diabetes mellitus, long-standing hypertension sufficient to explain kidney disease, or any other identifiable cause after standard evaluation. Statistical analysis was performed using SPSS version 26.

Results: Among 345 patients, 243 (70.4%) were male, with a mean age of 55.0±14.3 years. Hypertension (93.6%) and diabetes mellitus (60.9%) were the most common comorbidities. Anemia was present in 84.6% of patients, and CKD–mineral and bone disorder abnormalities were frequent. Diabetic kidney disease and hypertensive nephropathy were the predominant etiologies. CKDu was identified in 27 patients (7.8%), with marked clustering in Canacona taluka (20 cases).

Conclusions: CKD in Goa is predominantly driven by diabetes and hypertension. However, clustering of CKDu cases in Canacona suggests a potential hotspot warranting focused surveillance and environmental investigations.

Biochemical correlation of serum insulin, high-sensitivity C reactive protein and lipid tetrad index with thyroid-stimulating hormone levels in patients with hypothyroidism

Mandayal Jamatia, Avdhesh Kumar Sharma, Rimpy Charak — Thu, 30 Jul 2026 00:00:00 +0530

Background: Hypothyroidism is a prevalent endocrine disorder associated with insulin resistance, dyslipidemia, chronic low-grade inflammation, and an increased risk of cardiovascular disease. Thyroid hormone deficiency adversely affects glucose and lipid metabolism, contributing to metabolic dysfunction. This study investigated the relationship between thyroid-stimulating hormone (TSH) levels and markers of insulin resistance, systemic inflammation, and atherogenic risk in patients with hypothyroidism.

Methods: A hospital-based cross-sectional analytical study was conducted among 70 patients with hypothyroidism attending a tertiary care teaching hospital in Indore, Madhya Pradesh, India. Based on thyroid function tests, participants were categorized as having overt or subclinical hypothyroidism. Serum triiodothyronine (T3), thyroxine (T4), TSH, fasting insulin, high-sensitivity C-reactive protein (hs-CRP), and lipid profile were measured using standard laboratory methods. Insulin resistance was assessed using the homeostatic model assessment for insulin resistance (HOMA-IR), while atherogenic risk was evaluated using the lipid tetrad index (LTI). Correlation analysis was performed to examine associations between TSH and study variables.

Results: Serum TSH demonstrated significant positive correlations with fasting insulin (r=0.42, p<0.01), hs-CRP (r=0.38, p<0.01), and LTI (r=0.44, p<0.001). Compared with patients with subclinical hypothyroidism, those with overt hypothyroidism had significantly higher fasting insulin, HOMA-IR, hs-CRP, and LTI values. Insulin resistance was identified in 58.6% of participants.

Conclusions: Higher TSH levels are associated with insulin resistance, systemic inflammation, and increased atherogenic risk in hypothyroidism. These findings highlight the importance of comprehensive metabolic assessment for improved cardiovascular risk stratification and timely clinical intervention.

Student perceptions of small and large group discussions as active learning strategies in undergraduate medical education: a cross-sectional study from Gwalior (M.P)

Shiwani Lilhore, Tinku Verma, Mahendra Chouksey — Thu, 30 Jul 2026 00:00:00 +0530

Background: Competency-based medical education focuses on the active learning interventions that improve communication, critical thinking, and the engagement of the learner. In undergraduate medical education, SGD and LGD are common interactive methods of teaching; even so, little evidence has been found about the perceptions of students regarding their efficacy in the framework of Indian CBME. To assess students’ perceptions regarding the content, delivery, and effectiveness of SGD and LGD, to evaluate their perceived impact on communication and analytical skills, and to identify areas for improvement.

Methods: The study was a cross-sectional feedback study carried out among undergraduate MBBS students (Batch 2021) in the Department of Community Medicine in a tertiary care medical college in Gajra Raja Medical College Gwalior (M.P). A pre-established, pre-tested feedback questionnaire will be administered after SGD and LGD sessions that will take place in July 2024. The descriptive statistics was used to analyze data of 162 complete responses and reported in terms of frequencies and percentages.

Results: Most of the respondents felt that the group meetings were suitable, informative, and interesting. The majority of students indicated that they had developed better skills in walking into groups, relating with peers, building relationships, and critical thinking.

Conclusion: Small and large group discussions were considered as good active learning competencies that increased cognitive and interpersonal abilities of undergraduate medical students.

Mites, monsoon and multisystem mayhem: clinico-demographic profile of scrub typhus at a tertiary care centre in upper Assam

Thu, 30 Jul 2026 00:00:00 +0530

Background: Scrub typhus, caused by Orientia tsutsugamushi and transmitted via larval trombiculid mite bites, is a re-emerging public health threat in Northeast India. Data from upper Assam remain sparse. This study characterises the clinico-demographic profile of confirmed scrub typhus patients at a tertiary hospital in Dibrugarh.

Methods: A hospital-based, cross-sectional observational study was conducted at the Department of Medicine, Assam Medical College and Hospital (AMCH), Dibrugarh over one year (October 2024–September 2025). Eighty patients with confirmed scrub typhus (IgM ELISA and/or quantitative real-time PCR) were enrolled. Demographic, clinical, laboratory, and radiological data were analysed using descriptive statistics and Chi-square tests.

Results: The 31–40-year age group was most affected (33.75%; mean age 40.25±14.74 years). Male predominance was significant (67.5%; M: F=2.08:1; p=0.002). Three-quarters of patients (76.25%) were from rural backgrounds, and farmers comprised the largest occupational group (37.5%). Fever (100%), headache (92.5%), and jaundice (45%) were the commonest symptoms. Eschar was detected in 35% of patients. Near-universal transaminase elevation (100%), thrombocytopenia (96.25%), hypoalbuminaemia (97.5%), and elevated creatinine (87.5%) reflected multi-organ tropism. Peak incidence occurred in March–April (42.5%). Mortality was 8.75%.

Conclusions: Scrub typhus in upper Assam disproportionately affects rural male farmers with a distinctive spring-season peak. Multi-organ involvement is the rule. Early IgM ELISA-based diagnosis and prompt doxycycline initiation remain paramount. Community awareness and vector control are essential to reduce the regional disease burden.

Tropical-infection-precipitated acute-on-chronic liver failure: a distinct, lower-mortality phenotype in a Northeast Indian cohort

Ponn Karthikeyan Saravanamuthu, Anup Kumar Das, Rashmi Rajkakati, Aparna Sonowal — Thu, 30 Jul 2026 00:00:00 +0530

Background: Leptospirosis and scrub typhus are endemic tropical infections in northeast India capable of precipitating acute-on-chronic liver failure (ACLF). Both are doxycycline-responsive. Whether tropical-precipitated ACLF represents a distinct, lower-mortality phenotype amenable to targeted therapy is unknown.

Methods: Seventy consecutive adults with EASL-CLIF ACLF were prospectively enrolled at a tertiary teaching hospital in Northeast India (October 2024-September 2025). Leptospirosis was diagnosed by IgM ELISA and/or compatible clinical syndrome; scrub typhus by Orientia tsutsugamushi IgM ELISA or Weil-Felix titre ≥1:160. All clinically suspected tropical infections received empirical doxycycline 100 mg twice daily alongside standard broad-spectrum antibiotics. Tropical-precipitated versus non-tropical-precipitated subgroups were compared for severity, inflammatory markers, and 28-day mortality.

Results: Tropical infection precipitated 17 of 70 ACLF episodes (24.3%)- 10 leptospirosis (14.3%), 6 scrub typhus (8.6%), and 1 mixed Leptospira-Orientia infection (1.4%). The tropical subgroup had a higher proportion of grade 1 ACLF (41.2% versus 7.5%; p=0.003), lower admission PCT (2.54 versus 6.73 ng/ml), and significantly higher admission creatinine (5.91 versus 3.19 mg/dl; p=0.018). Twenty-eight-day mortality was 35.3% in the tropical subgroup versus 62.3% in non-tropical patients (OR 0.33; 95% CI 0.11-1.05; p=0.091). Compared with alcohol-precipitated ACLF specifically, tropical-precipitated mortality was significantly lower (35.3% versus 73.9%; OR 0.19, p=0.024).

Conclusions: Tropical-infection-precipitated ACLF is a distinct phenotype with lower presentation severity and a clinically important mortality advantage over alcohol-precipitated ACLF. Empirical doxycycline in ACLF patients with suspected leptospirosis or scrub typhus in endemic regions deserves routine inclusion in management protocols.

The study of antibiotics prescription pattern in pre, intra and post operative period to patients who later developed surgical site infections in a tertiary care centre

Vaibhav B. Chavhan, Jugalkishor B. Jaju, Asha D. Jadhav — Thu, 30 Jul 2026 00:00:00 +0530

Background: AMR has emerged as major public health problem all over world which can be controlled in paying great attention to judicious use of them. In 2012, ICMR started ASP to reduce SSIs by doing right antimicrobial prophylaxis and emphasised to prevent drug resistance. We aimed to see pattern of antibiotics prescribed in pre, intra and post-operative period to patients, who later developed SSIs.

Methods: After local IEC-DHR approval, data is collected using retrospective descriptive type study Design. All patients’ medical records who undergone surgeries performed in general surgery, obstetrics-gynaecology, Orthopaedics departments and later developed SSIs in post-operative period are included. Duration of study is 6 months. Only antimicrobials used are recorded and data is analysed using MS Excel.

Results: In total 71 case records, females found more. 19-30 years of age patients are more. Antimicrobials of Third generation cephalosporins are used most frequently in Pre, Intra and post-op period. Inj. Ceftriaxone was prescribed more commonly as ‘Monocef’. Half of Antimicrobials are prescribed with Generic names and match DDD recommended by WHO. Average duration of post-operative treatment was 12-13 days. Antibiotics were prescribed till discharge to all.

Conclusions: In the study, case records of patients who later developed surgical site infections are studied to know demographic profile. Prescription pattern is most commonly polypharmacy and FDCs were preferred. I.V. was used more than P.O. Treatment modifications are done in 1/4th cases after microbiological reports of swabs of infected sites and this need to be increased.

A comparative study on the block characteristics in spinal anaesthesia with premixed or succedent administration of hyperbaric bupivacaine and fentanyl in lower segment caesarean section

Thu, 30 Jul 2026 00:00:00 +0530

Background: Caesarean section (CS) is a lifesaving procedure when there is both or either maternal and fetal problem and the rate of CS had increased dramatically. Objectives were to compare between premixed and succedent administration of intrathecal hyperbaric Bupivacaine and Fentanyl on the block characteristics of spinal anesthesia among parturient women undergoing lower segment CS.

Methods: The study groups divided into two. The total sample size was 60, 30 patients in each group. In group A, all the patients were given 2 ml of hyperbaric Bupivacaine (0.5%) using a 5 ml syringe followed by 0.5 ml (25 mcg) Fentanyl citrate in a 2 ml syringe intrathecally at L3-4 space and in the group B, all the patients were given 2 ml of hyperbaric Bupivacaine (0.5%) plus 0.5 ml (25 mcg) Fentanyl citrate premixed in a 5 ml syringe intrathecally at L3-4 space.

Results: The mean time of onset of sensory block was significantly shorter in group A when compared to group B. The time to achieve maximum sensory block level and time to complete motor blockade was significantly shorter in group A when compared to group B. There was no significant difference between the groups in terms of hemodynamic changes and attainment of maximum sensory block levels and requirement of vasopressor.

Conclusions: There were no significant differences in the time to reach sensory block level T6, degree of motor blockade, Apgar score and complications. The time to achieve maximum sensory block level was significantly shorter in group A when compared to group B.

Comparing C-peptide and HbA1c levels in obese patients with and without type 2 diabetes

Thu, 30 Jul 2026 00:00:00 +0530

Background: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by either insufficient insulin production by the pancreas or the body's inability to utilize it. HbA1c level of 6.5% was recommended for diagnosing diabetes. C-peptide is a byproduct of insulin synthesis has been widely studied as a diagnostic biomarker for DM. Obesity is a major risk factor for the development of type 2 DM (T2DM) and is associated with insulin resistance. With the increasing global burden of obesity and diabetes, our study investigates the relationship between HbA1c and C-peptide levels in obese individuals with and without diabetes. Objectives were to assess and compare HbA1c and C-peptide levels among obese individuals with diabetes and without diabetes and to evaluate the correlation between these parameters within each group.

Methods: This study was included 30 obese diabetic and 30 obese non-diabetic participants recruited over 3 months. Blood samples were collected for estimating HbA1c and C-peptide. Ethical approval was obtained prior to the study. Data were analyzed using Jamovi software.

Results: HbA1c and C-peptide levels were significantly higher in obese individuals with diabetes compared to non-diabetic obese controls (p<0.001). A strong positive correlation was observed between HbA1c and C-peptide levels in both groups, with a stronger association in diabetics (r=0.94) compared to non-diabetics (r=0.88); both correlations were statistically significant.

Conclusions: Higher levels and strong positive correlation between HbA1c and C-peptide-especially in diabetics-suggests increased insulin secretion in response to poor glycemic control and insulin resistance.

Molecular screening of β-thalassemia mutations among anaemic children and the influence of consanguinity: a hospital-based cross sectional study from South India

Pushkala S., Srilakshmi S., Valarmathi S., Sivaranjani E., Veeralakshmi M. — Thu, 30 Jul 2026 00:00:00 +0530

Background: β-thalassemia is the most common inherited haemoglobin in India, affecting 3-4% of the population. Mutations in the β-globin gene cause defective haemoglobin synthesis and chronic anaemia. Consanguineous marriage increases the risk of homozygosity for autosomal recessive disorders. Early molecular diagnosis is essential for differentiating inherited haemoglobinopathies from nutritional anaemia and for implementing preventive strategies. This study aimed to detect β-thalassemia mutations among anaemic children and evaluate the association between parental consanguinity and mutation positivity.

Methods: A hospital-based cross-sectional study was conducted between September 2021 and October 2022 among 40 children with severe anaemia, haemoglobin <8 g/dL. Demographic and clinical information, including parental consanguinity, was collected. Molecular screening for β-thalassemia mutations was performed using Real-Time PCR with the SNP Biotech Beta Thalassemia Kit on the 7500 AB systems. Statistical analyses included Chi-square test, odds ratio (OR), relative risk (RR), and 95% confidence intervals (CI).

Results: Of 40 children, 13 (32.5%) tested positive for β-thalassemia mutations. Mutation positivity was 33.3% among consanguineous families and 31.2% among non-consanguineous families. Statistical analysis showed no significant association between consanguinity and mutation positivity (χ²=0.019, p=0.890). Odds ratio analysis indicated slightly higher odds among consanguineous families (OR=1.10; 95% CI: 0.28-4.27).

Conclusions: β-thalassemia mutations were identified in a substantial proportion of severely anaemic children. Although prevalence was marginally higher in consanguineous families, comparable rates in non-consanguineous families highlight the widespread carrier burden. Molecular screening is valuable for early diagnosis, family screening, genetic counselling, and prevention of severe β-thalassemia.

Clinical and laboratory profile of Kyasanur forest disease in a tertiary care hospital in Goa

Chitralekha Nayak, Ruth Viegas, Edwin Gomes — Thu, 30 Jul 2026 00:00:00 +0530

Background: Kyasanur Forest Disease (KFD), a tick-borne viral hemorrhagic fever once confined to the Western Ghats of Karnataka, India, has spread to adjacent states, including Goa, in recent years. This study aimed to analyze the clinical profiles of confirmed adult KFD cases at a tertiary care hospital.

Methods: A retrospective observational study was conducted in the Department of Medicine, Goa Medical College, from June 2016 to June 2017. Case records of all RT-PCR-confirmed adult KFD cases were reviewed for demographic, clinical and laboratory data and analyzed using descriptive statistics.

Results: Fifty-seven confirmed adult cases were analyzed (mean age 41.65 years; 63.16% female). The majority of cases arose from Sawantwadi and Dodamarg talukas of Sindhudurg District, Maharashtra, with a seasonal peak in March-April. Fever was universal, followed by myalgia (52.6%), vomiting (52.6%), and diarrhea (50.8%). Lower respiratory tract involvement occurred in 35.1% and pneumonia in 8.8%. Neurological complications were observed in 17.5% of patients, including meningoencephalitis, cerebellitis, and quadriparesis. Hemorrhagic manifestations occurred in 17.5%. Leucopenia was present in 94.7%, with marked leucopenia (<2000 cells/mm3) in 52.6%. Thrombocytopenia was noted in 70.2% and elevated transaminases in 91.2%. Renal involvement was rare (1.75%). One patient died due to pneumonia.

Conclusions: KFD presents with diverse early manifestations, predominantly gastrointestinal, respiratory, hemorrhagic involvement with neurological impairment in some cases associated with marked leucopenia and elevated liver enzymes which may mislead clinicians. Further detailed clinical and epidemiological aspects of KFD need to be explored for better understanding of the disease.

Reference intervals and 24-hour temporal stability of 82 hematological parameters, including research-use-only parameters, on the Mindray BC-780 analyser in adults from Gujarat, Western India

Thu, 30 Jul 2026 00:00:00 +0530

Background: The advent of advanced hematology analysers, such as the Mindray BC-780, has expanded the range of routinely reported and research-use-only (RUO) parameters, necessitating the need for accurate, population-specific reference intervals (RIs). This study aimed to define age- and gender-specific RIs for 82 parameters in a healthy adult population from Gujarat, western India, and to assess their temporal stability at room temperature (RT).

Methods: A cross-sectional study was conducted involving 1,376 healthy adults aged 18-94 years. Parameters were stratified by age and gender, and RIs were established using appropriate statistical methods, following CLSI guidelines. Temporal stability was evaluated by analysing samples at baseline (immediately after collection) and after storage at RT for 4, 8, 12, and 24 hours.

Results: Most parameters were non-normally distributed. Precision analysis revealed excellent reproducibility in 75 parameters. Stability testing showed 72 parameters remained stable over 24 hours at RT. Significant age- and gender-based differences were found in 47 parameters, requiring subgroup-specific reference intervals. RBC, HGB, and HCT decreased with age, while MCV and macro% increased; females showed lower RBC and HGB but higher PLT and PDW. Comparison with national and international studies demonstrated variation in a few parameters, emphasising the need for localised RIs.

Conclusions: This study establishes comprehensive, population-specific RIs for routine and RUO hematology parameters and confirms the temporal stability of most parameters at RT. The findings support the adoption of region-specific RIs to enhance diagnostic accuracy and clinical decision-making.

Comparison of conventional radiograph with low-dose computed tomography of sacroiliac joints in patients with proven sacroiliitis

Rupa Sarkar, Debraj Sen — Thu, 30 Jul 2026 00:00:00 +0530

Background: Sacroiliitis is central to diagnosing axial spondyloarthritis (axSpA), yet conventional radiography suffers from anatomical superimposition and low sensitivity for early structural change. Low-dose computed tomography (LDCT) provides cross-sectional detail at a radiation dose comparable to plain radiography. Aim was to evaluate LDCT versus conventional sacroiliac (SI) joint radiography in assessing sacroiliitis.

Methods: This prospective, observational, cross-sectional study enrolled 30 consecutive adults with proven sacroiliitis at a tertiary centre. All underwent pelvic radiography (SAPA view) and LDCT of the SI joints (Philips Brilliance iCT 256-slice; 120 kV, 30 mAs; effective dose ~1 mSv). Two blinded radiologists independently scored 60 SI joints using a modified European image-quality system covering technical parameters (joint-margin and soft-tissue delineation, superior/inferior visualisation, absence of superimposition) and pathological parameters (joint-space change, erosions, sclerosis, soft-tissue content). Chi-square/Fisher’s exact and unpaired t-tests were used; p<0.05 was significant.

Results: Mean age was 33.1±8.7 years; 96.7% were male; axSpA accounted for 90.0% of diagnoses. LDCT was significantly superior to radiography for soft-tissue delineation (98.3% versus 18.3%), superior/inferior joint margins (98.3% versus 55.0%), absence of superimposition (100% versus 36.7%), and iliac-margin erosion detection (86.7% versus 55.0%) (all p<0.001). Mean total imaging score was 7.6±1.3 for LDCT versus 4.3±1.8 for radiography (p<0.001), with consistent superiority across all subgroups; scores correlated strongly (r=0.742, p<0.001).

Conclusions: LDCT delivered substantially superior image quality and structural-lesion detection than radiography at a comparable dose and should be integrated into diagnostic algorithms for suspected sacroiliitis, particularly when radiographs are inconclusive.

Periodontitis in diabetic patients: prevalence, glycemic associations and renal implications-a cross-sectional study

Thu, 30 Jul 2026 00:00:00 +0530

Background: Diabetes mellitus is associated with multiple systemic complications, including periodontal disease. The bidirectional relationship between diabetes and periodontitis is well established, and emerging evidence suggests periodontal disease may contribute to diabetic nephropathy progression through shared inflammatory mechanisms. This study evaluated the prevalence and severity of periodontitis in diabetic patients and assessed its associations with glycemic control and renal function.

Methods: This observational, cross-sectional study enrolled 203 diabetic patients at IPGMER and SSKM Hospital, Kolkata, India (February 2014–August 2015). Periodontal status was assessed using the community periodontal index (CPI) and classified as no, low-grade, or high-grade periodontitis. Clinical parameters including HbA1c, fasting and postprandial plasma glucose, urine albumin-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) were recorded. Statistical analysis used was statistical package for the social sciences (SPSS) (p<0.05).

Results: Periodontitis prevalence was 85.2%, with high-grade disease in 52.7% and low-grade in 32.5% of participants. Patients with HbA1c ≥8% had significantly greater periodontal severity (p<0.0001). Severe periodontitis was independently associated with higher albuminuria (ACR: 810.94 versus 96.13 mg/g; p=0.0014) and reduced eGFR (73.89 versus 93.13 ml/min/1.73 m²; p=0.0018). Diabetes duration, smoking, and BMI were also significantly associated with periodontal severity.

Conclusions: Periodontitis is highly prevalent in diabetic patients and significantly associated with suboptimal glycemic control and renal dysfunction. These findings support integrating periodontal evaluation into routine diabetes management. Prospective studies are needed to determine whether periodontal treatment can mitigate diabetic complications.

The impact of a comprehensive clinical pharmacist counseling intervention program on patients with chronic illness in India: a quasi-experimental study

Mehul Soni, Bhoomi Soni, Narendra B. Parihar, Mahendra S. Rathore, Medha Mathur — Thu, 30 Jul 2026 00:00:00 +0530

Background: Chronic conditions such as cardiovascular disorders, diabetes mellitus, respiratory disorders, and cancer continue to be predominant cause to morbidity and mortality globally. Suboptimal adherence to prescribed medication represents a critical obstacle to achieve optimal therapeutic outcomes and effective disease management. Objective of the study was to assess the effect of a comprehensive clinical pharmacist counseling intervention program (CPCIP) on medication adherence, knowledge, attitudes, practices (KAP), and patient satisfaction among individuals with chronic illnesses in a tertiary care hospital in India.

Methods: The quasi-experimental study was conducted with pre and post interventions among patients with chronic diseases at a tertiary care hospital. Clinical pharmacists delivered systematic counseling regarding medication adherence, lifestyle modifications, and disease management strategies. Along with that, the Morisky medication adherence scale (MMAS-8), a validated KAP scale, and satisfaction questionnaires were used before and after the ‍‌‍‍‌‍‌‍‍‌intervention.

Results: This study evaluated the CPCIP intervention improved adherence and KAP scores with patient satisfaction, the mean MMAS-8 score significantly increased post intervention from 3.05±1.10 to 5.55±0.95 (p<0.001). The three domains KAP also demonstrated an improvement while patients reported satisfaction level 8.62±0.84 out of 10 scale. There were positive correlations were found among satisfaction, adherence scores, and KAP improvements.

Conclusions: The CPCIP effectively enhanced adherence, patient understanding, and satisfaction. Integrating pharmacist-led counseling within routine healthcare services can supports effective chronic disease management, reduce complications, and healthcare burden while improving overall healthcare outcomes in patients with chronic illness in India.

Cardiovascular manifestations in HIV-infected patients: a cross-sectional study from a tertiary care hospital

Nayana Rajan, Anita Paritekar — Thu, 30 Jul 2026 00:00:00 +0530

Background: Human Immunodeficiency Virus (HIV) infection is associated with various cardiovascular manifestations, many of which remain asymptomatic and contribute significantly to morbidity. The present study was conducted to evaluate the prevalence and spectrum of cardiovascular manifestations among HIV-infected patients and to assess their association with CD4 counts and antiretroviral therapy adherence.

Methods: This hospital-based cross-sectional study included 100 HIV-positive patients admitted to a tertiary care hospital between October 2019 and April 2021. Detailed clinical evaluation along with laboratory investigations including CD4 count, electrocardiography, chest radiography and two-dimensional echocardiography were performed in all patients. Coronary angiography was performed in selected patients when clinically indicated.

Results: Cardiovascular abnormalities were observed in 48% of patients, of which 64.5% were asymptomatic. Diastolic dysfunction was the most common echocardiographic abnormality (36%), followed by systolic dysfunction (23%), dilated cardiomyopathy (11%) and pericardial effusion (9%). Lower CD4 counts and anemia were significantly associated with cardiovascular involvement.

Conclusions: Cardiovascular manifestations are common in HIV-infected patients and often remain clinically silent. Routine cardiac evaluation, particularly echocardiography, may help in early detection of cardiac involvement in these patients.

Sutureless and glue-free conjunctival autografting versus sutured autografting for primary pterygium: a prospective comparative study

Shivangi Sahu, Shiva Shrivastava, Ankit Shah — Thu, 30 Jul 2026 00:00:00 +0530

Background: Pterygium recurrence remains a major challenge following surgical excision. Although conjunctival autografting is the preferred treatment, suturing is associated with postoperative discomfort and suture-related complications. This study compared the outcomes of sutureless and glue-free conjunctival autografting with sutured conjunctival autografting in primary pterygium.

Methods: A prospective, observational, comparative hospital-based study was conducted at a tertiary-care centre in Madhya Pradesh, India, from February 2021 to February 2022. A total of 50 patients with primary nasal pterygium were included and divided into two groups: (i) sutureless and glue-free conjunctival autografting (n=25), and (ii) sutured conjunctival autografting (n=25). Patients were evaluated preoperatively and followed up at 2, 4, and 6 weeks postoperatively.

Results: Most patients i.e. 15 (30.0%) were aged 31-40 years. Males comprised 23 (46.0%) patients of the study population. Majority i.e. 32 (64.0%) patients resided in rural areas. Progressive pterygium was observed in 46 (92.0%) patients, with grade 2 being the most common presentation as observed in 36 (72.0%) patients. At the 6-week follow-up, visual acuity of 6/9-6/6 was achieved in 20 (80.0%) patients in the sutureless group and 17 (68.0%) patients in the sutured group. Graft oedema was observed in 2 (8.0%) and 1 (4.0%) patients, while graft displacement occurred in 2 (8.0%) and 1 (4.0%) patients in the sutureless and sutured groups, respectively. Pain was less frequent in the sutureless group at follow-up. Recurrence was observed in 2 (8.0%) patients in the sutureless group and 1 (4.0%) patients in the sutured group.

Conclusions: Sutureless and glue-free conjunctival autograft technique is easy, safe, effective.

Zinc deficiency as a key risk factor for pneumonia in early childhood: a hospital-based case-control study

Linda Jacob, Carol Sara Cherian — Thu, 30 Jul 2026 00:00:00 +0530

Background: Pneumonia remains the leading infectious cause of under-five mortality globally. Zinc deficiency impairs immune function and is prevalent among children in low- and middle-income countries. This study examined the association between serum zinc status and pneumonia in hospitalised children aged 6-59 months at a tertiary care centre in Kerala, India.

Methods: A prospective hospital-based case-control study was conducted from May 2023 to November 2024. Thirty children with WHO-defined pneumonia (cases) were compared with 30 age- and sex-matched healthy controls. Serum zinc was measured by atomic absorption spectrometry. Zinc deficiency was defined per IZiNCG criteria as <65 µg/dl. Logistic regression estimated the odds of pneumonia per 1 µg/dl decrease in serum zinc.

Results: Mean serum zinc was significantly lower in cases than controls (54.0±11.6 µg/dl versus 76.8±13.6 µg/dl; mean difference 22.8 µg/dl, 95% CI 16.2-29.3; p<0.001). Zinc deficiency was present in 86.7% of cases (33.3% severe, 53.3% mild) versus 26.7% of controls (p<0.001). Each 1 µg/dl decrease in serum zinc was associated with 1.15-fold greater odds of pneumonia (OR 1.15, 95% CI 1.07-1.24; p<0.001). No significant associations were found with anthropometric indices, disease severity, or length of hospital stay.

Conclusions: Low serum zinc was strongly associated with childhood pneumonia, even among children with normal growth parameters, consistent with the ‘hidden hunger’ phenomenon. Prospective multi-centre studies are needed to confirm these findings.

Acute coronary syndrome in chronic kidney disease: clinical characteristics and stage-wise associations from a tertiary care centre in Western India

Thu, 30 Jul 2026 00:00:00 +0530

Background: Cardiovascular disease is the leading cause of morbidity and mortality among patients with chronic kidney disease (CKD). Acute coronary syndrome (ACS) in CKD is often associated with atypical presentations, diagnostic challenges and adverse outcomes. Data from western India regarding the clinical profile of CKD patients presenting with ACS remain limited.

Methods: This ambispective observational study was conducted at Goa Medical College, Goa. Adult patients with CKD presenting with ACS between September 2019 and August 2025 were included. Demographic characteristics, comorbidities, clinical presentation, cardiac biomarkers, echocardiographic findings and ACS subtype were assessed. Associations between CKD stage and clinical variables were analysed using the Chi-square test and analysis of variance.

Results: A total of 220 patients were included. The mean age was 66.5±9.1 years and 53.2% were male. Hypertension (87.3%), diabetes mellitus (71.8%) and dyslipidemia (66.8%) were common. NSTEMI was the predominant ACS subtype (60%), followed by unstable angina (37.7%) and STEMI (2.3%). Nearly half of patients (45.9%) had atypical presentation. Advancing CKD stage was significantly associated with NSTEMI/STEMI presentation (p<0.001), higher troponin variability (p=0.004), dialysis dependence (p=0.002), higher Killip class (p=0.002) and lower left ventricular ejection fraction (p<0.001).

Conclusions: ACS in CKD is characterised by a high burden of cardiovascular risk factors, frequent atypical presentation and predominance of NSTEMI. Advanced CKD is associated with greater cardiac dysfunction and more severe ACS manifestations, highlighting the need for early cardiovascular evaluation and intervention in this population.

Assessment of cardiac autonomic functions and anxiety sensitivity scale in different phases of menstrual cycle in young females

Gulnaaz Khanam, Shraddha Singh, Mohammed Ubaidullah, Dileep Kumar Verma — Thu, 30 Jul 2026 00:00:00 +0530

Background: The menstrual cycle, a reproductive rhythm marked by bleeding and ovulation, is a dynamic biological process where hormones quietly reshape multiple systems in the body with their fluctuations. Cardiovascular control, emotional reactivity and stress responsiveness are the changes which become relevant in young women. Objectives were to measure heart rate variability (HRV) and anxiety sensitivity in different phases of menstrual cycle and establish their correlation.

Methods: This study was a comparative (observational) consisting of 48 healthy females’ participants aged 18-32 years. Cardiac autonomic function was assessed using HRV analysis on day 2, day 10, and day 21 of the menstrual cycle While anxiety sensitivity was assessed using the anxiety sensitivity index-3 (ASI-3), an 18-item scale, containing items specifying different concerns someone could have regarding their anxiety. The total ASI-3 score was analysed and compared across the menstrual phases to observe variations in anxiety sensitivity. Correlation between HRV parameters and anxiety sensitivity scores was also assessed to study the relationship between cardiac autonomic function and anxiety sensitive.

Results: Both time-domain and frequency-domain HRV parameters, remained largely stable across follicular, and luteal phases. No statistically significant phase-wise differences were observed. In contrast, anxiety sensitivity exhibited a statistically significant variation across menstrual cycle phases, reflecting meaningful phase-related psychological fluctuation. However, this variation in anxiety sensitivity was not accompanied by corresponding changes in resting HRV parameters, and no consistent association was identified between anxiety sensitivity categories and cardiac autonomic indices across phases.

Prevalence and patterns of dyslipidaemia and glycaemic abnormalities among patients of heart failure at a tertiary care hospital in Eastern India

Soham Biswas, Pinaki Sarkar, Tushar Kanti Patra — Thu, 30 Jul 2026 00:00:00 +0530

Background: Dyslipidaemia and diabetes mellitus are highly prevalent in India. Both are risk factors of various cardiovascular diseases which may progress to heart failure. Heart failure is a leading cause of morbidity and mortality throughout the world. This study aimed to estimate the prevalence of different patterns of dyslipidaemia and glycaemic abnormalities among the heart failure patients of different severity.

Methods: A descriptive, cross-sectional study was done on 492 clinically diagnosed heart failure patients categorised according to severity based on NYHA classification. Serum lipid profile, fasting plasma glucose and HbA1c % were evaluated. Data were analysed using standard statistical software.

Results: The different patterns of dyslipidaemia detected were hypercholesterolaemia (32%), increased LDL cholesterol (34%), decreased HDL cholesterol (52%) and hypertriglyceridaemia (26%). Prevalences of pre-diabetes and diabetes mellitus were 33 % and 29 % respectively. No patient had NYHA class I symptoms. Prevalence of hypercholesterolaemia among NYHA class II, III and IV patients were 28 %, 33 % and 40 % respectively whereas prevalence of hypertriglyceridaemia were 21%, 28% and 30% in the respective classes. Diabetes mellitus was present in 7%, 39%, and 50% of NYHA class II, III, and IV patients, respectively.

Conclusions: The commonest form of dyslipidaemia was low HDL cholesterol, detected in almost half of the patients, followed by elevated LDL cholesterol. Hyperglycaemia was detected in almost two-thirds of the patients. Pre-diabetes was slightly more prevalent than diabetes mellitus. Prevalence of dyslipidaemia and diabetes mellitus increased with the severity of heart failure.

A histomorphological study of central nervous system tumors in pediatric age group at tertiary care teaching hospital

Bansri B. Patel, Dhruv R. Parmar, Shreyas D. Patel — Thu, 30 Jul 2026 00:00:00 +0530

Background: Central nervous system (CNS) tumors are the second most common malignancies in children after acute lymphoblastic leukemia and constitute a significant cause of morbidity and mortality. Their histopathological classification is essential for diagnosis, treatment planning and prognostication. The present study was undertaken to evaluate the histomorphological spectrum of pediatric CNS tumors in a tertiary care teaching hospital.

Methods: A retrospective observational study was conducted in the Department of Pathology, B. J. Medical College and tertiary care teaching hospital, Ahmedabad, from March 2022 to July 2024. A total of 100 CNS biopsy specimens from pediatric patients aged 0-12 years were included. Clinical, demographic, radiological and histopathological data were collected and analyzed. Tumors were classified and graded according to histomorphological features.

Results: Among the 100 cases studied, males constituted 59% and females 41%, with a male-to-female ratio of 1.4:1. The highest number of cases (34%) occurred in the 0-4 years age group. Supratentorial tumors accounted for 54% of cases, followed by infratentorial tumors (40%) and spinal tumors (6%). Gliomas were the most common tumor category (36%), followed by embryonal tumors (24%) and ependymal tumors (10%). Among gliomas, low-grade astrocytoma (44.4%) and pilocytic astrocytoma (27.8%) were predominant subtypes. Medulloblastoma represented 66.6% of embryonal tumors. Most tumors belonged to lower WHO grades, while all embryonal tumors classified as grade 4.

Conclusions: Gliomas were the most frequently encountered pediatric CNS tumors, with a predominance of supratentorial location and male preponderance. Histopathological evaluation remains indispensable for accurate classification and grading, thereby facilitating optimal management and prognostic assessment of pediatric CNS tumors.

Evaluation of drug utilization and prescribing practices in osteoarthritis patients: insights from a prospective observational study

Thu, 30 Jul 2026 00:00:00 +0530

Background: Osteoarthritis (OA) is a common chronic musculoskeletal disorder associated with pain, disability, and frequent medication use. Objective of the study was to evaluate prescribing patterns, WHO prescribing indicators, comorbidities, and treatment practices in OA patients.

Methods: A six-month prospective observational study included 270 OA patients at a tertiary care hospital in Gujarat, India. Demographic, clinical, and prescribing data were analyzed using WHO prescribing indicators and two-way ANOVA.

Results: Females constituted 73.7% of patients, and knee OA was most common (90.7%). Combination therapy (66.2%) was prescribed more often than monotherapy. Oral NSAIDs were the most frequently used drugs, followed by tramadol-acetaminophen. Hypertension was the leading comorbidity. BMI and comorbidities were significantly associated with OA severity (p=0.0091 and p=0.0003, respectively). Generic prescribing (3.62%) and essential medicine use (4.69%) were low.

Conclusions: NSAIDs remain the primary treatment, but high polypharmacy and poor adherence to rational prescribing indicators emphasize the need for guideline-based prescribing to improve patient outcomes.

Impact of hemorrhoidectomy with lateral internal sphincterotomy on resting anal pressure in grade III and IV haemorrhoids with elevated anal pressure (>90 mmHg): a prospective observational study

Thu, 30 Jul 2026 00:00:00 +0530

Background: Grade III and IV hemorrhoids commonly present with pain, bleeding and prolapse, often associated with elevated resting anal pressure. This study assessed postoperative changes in anal pressure and their relationship with disease grade, surgical procedure and outcomes.

Methods: This 18-month prospective study included 79 patients with Grade III–IV hemorrhoids and elevated resting anal pressure, evaluating postoperative pressure changes and their association with symptoms, disease severity and hemorrhoidectomy type.

Results: The mean age was 44.6±12.4 years; 67.1% were male, with most patients aged 31–40 years. Perianal pain was present in all patients, followed by bleeding (n=44) and prolapse (n=34). Grade III and IV hemorrhoids were seen in 43% (n=34) and 57% (n=45), respectively; 53.2% underwent open and 46.8% stapler hemorrhoidectomy. Preoperative VAS scores were similar between groups (p=0.898). Median VAS significantly decreased from 6 (IQR 5–7) preoperatively to 2 (IQR 1–2) on POD1 and 1 (IQR 0–1) on POD7 (p<0.001). On POD1, 84.8% had mild pain, 11.4% no pain and 3.8% moderate pain; by POD7, 36.7% were pain-free and 63.3% had mild pain. Complications included bleeding (n=17), urinary retention (n=12) and faecal incontinence (n=3). Mean resting anal pressure decreased from 122.9±7.50 mmHg preoperatively to 83.4±7.42 mmHg at 1 week and 90.9±7.63 mmHg at 2 months (p<0.001), with recurrence in only two stapler hemorrhoidectomy patients at 3 months.

Conclusions: Grade III–IV hemorrhoid surgery significantly reduces symptoms and resting anal pressure, with both open and stapler hemorrhoidectomy showing similar efficacy, low complications and minimal recurrence.

Effectiveness of a structured AETCOM training intervention on knowledge, attitude and communication practices among medical interns in Maharashtra: an interventional study

Preeti Pawde, Prashant Solanke, Satishkumar Dhage — Thu, 30 Jul 2026 00:00:00 +0530

Background: Attitude, ethics and communication are key attributes in doctor-patient relationship and to strengthen them, National Medical Commission (NMC) introduced the Attitude, Ethics and Communication (AETCOM) module within Competency-Based Medical Education (CBME). Evidence on its impact among medical interns in Maharashtra is limited. This study evaluates interns’ baseline knowledge, attitudes and communication practices regarding AETCOM and examines the module’s effectiveness in improving them.

Methods: An interventional study was conducted among 180 medical interns from three medical colleges in Maharashtra from December 2025 to May 2026. Baseline assessment was carried out using a validated Knowledge-Attitude-Practice (KAP) questionnaire and Kalamazoo Essential Elements Communication Checklist–Adapted (KEECC-A). A structured 12-hour AETCOM training was delivered over four weeks, with post-intervention evaluation done six weeks later. The difference in means of pre-intervention and post-intervention scores were analysed for statistical significance using ‘paired t-test’(‘p’ value<0.05 considered significant).

Results: The mean knowledge score increased significantly from 18.6±4.2 to 27.9±3.1 (p<0.001). Mean attitude score improved from 62.4±8.7 to 79.6±6.4 (p<0.001). Mean communication practice score increased from 58.3±10.2 to 91.4±12.1 (p<0.001). Female interns demonstrated marginally higher post-test scores than males, though the difference was not statistically significant (p>0.05).

Conclusions: The structured AETCOM module demonstrated significant effectiveness in improving knowledge, professional attitude and communication practices among medical interns in Maharashtra.

Surgical outcome of canal wall down mastoidectomy with or without cavity obliteration

Thu, 30 Jul 2026 00:00:00 +0530

Background: Canal wall down (CWD) mastoidectomy is commonly used to treat chronic otitis media with cholesteatoma. Cavity obliteration may improve postoperative outcomes by reducing cavity-related complications. Aim of the study was to compare surgical outcomes of CWD mastoidectomy with and without cavity obliteration.

Methods: This prospective longitudinal observational study was conducted at Sir Salimullah Medical College Mitford Hospital, Dhaka, from July 2023 to June 2024. Eighty patients with active squamous chronic otitis media undergoing CWD mastoidectomy were enrolled. Group I had no obliteration; group II underwent obliteration using vascularized periosteo-temporofascial swing, bone dust, and cartilage. Outcomes included cavity discharge, giddiness, epithelialisation, wax formation, hearing, meatal stenosis, residual cholesteatoma, and facial nerve palsy.

Results: Mean age was comparable (27.92±8.23 versus 27.28±8.19 years; p=0.724), with male predominance in both groups. At three months, dry cavity was achieved in 95.0% of group II versus 72.5% of group I (p=0.015). Persistent giddiness was lower in group II (2.5%) than group I (20.0%). Complete epithelialisation occurred in 90.0% of group II versus 60.0% of group I (p=0.004). Wax formation was lower in group II (5.0%) than group I (20.0%). Postoperative hearing was significantly better in group II (45.82±5.38 dB versus 48.22±4.07 dB; p=0.027), with greater hearing gain (10.22±5.42 dB versus 7.95±3.68 dB; p=0.031). Meatal stenosis and residual cholesteatoma were less frequent in group II, and no facial nerve palsy occurred.

Conclusions: Cavity obliteration in CWD mastoidectomy provides better postoperative outcomes, including improved cavity healing, reduced complications, and superior hearing improvement.

Artificial intelligence-driven predictive analytics for early detection and risk stratification of cardiovascular disease

Thu, 30 Jul 2026 00:00:00 +0530

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, necessitating improved approaches for early detection and risk stratification. Traditional cardiovascular risk assessment models often demonstrate limited predictive accuracy because they rely on a restricted number of clinical variables and linear statistical relationships. Artificial intelligence (AI)-driven predictive analytics has emerged as a promising solution capable of processing large, complex, and multidimensional healthcare datasets to improve cardiovascular risk prediction and clinical decision-making. This systematic review aimed to evaluate the effectiveness of AI-based predictive models for the early detection and risk stratification of CVD. A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, Embase, CINAHL, IEEE Xplore, and the Cochrane Library for studies published between January 2015 and December 2025. A total of 130 studies involving approximately 12.8 million participants met the eligibility criteria and were included in the review. The findings demonstrated that machine learning (ML) and deep learning (DL) models consistently outperformed conventional cardiovascular risk prediction tools, achieving area under the receiver operating characteristic curve (AUC) values ranging from 0.80-0.99 across various cardiovascular conditions. The strongest evidence was observed in the prediction of coronary artery disease, heart failure, atrial fibrillation, stroke, and major adverse cardiovascular events. Electronic health records, electrocardiography, medical imaging, wearable devices, and multimodal datasets were the most commonly utilized data sources. Despite their promising performance, challenges related to external validation, interpretability, algorithmic bias, and clinical implementation remain.

Nurse-led care clinics: transformative healthcare model or modern branding buzzword? A critical systematic review

Thu, 30 Jul 2026 00:00:00 +0530

Healthcare systems worldwide are increasingly challenged by rising chronic disease burdens, workforce shortages, escalating healthcare costs, and growing demands for accessible, high-quality care. In response, nurse-led care clinics (NLCCs) have emerged as innovative healthcare delivery models designed to enhance service accessibility, continuity of care, and patient outcomes. This critical review examines whether NLCCs represent a transformative healthcare model or primarily function as a contemporary healthcare branding strategy. A comprehensive review of published literature was conducted using evidence from primary care, chronic disease management, cardiovascular services, oncology, mental health, community healthcare, and advanced nursing practice settings. The findings indicate that nurse-led clinics consistently achieve clinical outcomes comparable to physician-led services while demonstrating high levels of patient satisfaction, improved self-management, enhanced continuity of care, and increased healthcare accessibility, particularly among underserved populations. Evidence also suggests potential economic benefits through reduced hospital admissions, lower emergency department utilization, and improved chronic disease management. However, significant variability exists in clinic structures, scope of practice, regulatory frameworks, and operational definitions, limiting direct comparisons across studies. Furthermore, some claims regarding the transformative impact of nurse-led care may exceed the strength of available evidence, highlighting the need for standardized evaluation frameworks. Overall, the review concludes that NLCCs are more than a healthcare branding phenomenon and possess substantial potential to improve healthcare quality, equity, and sustainability when supported by appropriate policy, education, and organizational infrastructures. Future research should focus on long-term outcomes, cost-effectiveness, and implementation strategies across diverse healthcare systems.

The vanishing diagnosis: a comprehensive review of late-onset hypopituitarism due to Sheehan syndrome in resource-limited settings, diagnostic nosography and persistent barriers to endocrine care

Thu, 30 Jul 2026 00:00:00 +0530

Sheehan syndrome (SS), or postpartum pituitary necrosis, is a preventable consequence of obstetrical hemorrhage. Although its incidence has declined in high-income countries, it persists as a major cause of maternal morbidity in low-resource regions, often with diagnostic delays of decades. This review critically analyzes the epidemiological shift of SS, delineates mechanisms permitting delayed presentation, and explores factors contributing to diagnostic oversight in developing nations. We performed a narrative synthesis of literature from 2015-2025, including case series, cross-sectional studies, and reviews on hypopituitarism and neuroimaging, with emphasis on chronic glucocorticoid and thyrotrophin deficiency as clinical masqueraders. In areas with high home-delivery rates, SS prevalence may reach 3% among parous women over 20 years. Mean diagnostic delay ranges from 10-20 years, with extremes up to 50 years postpartum. Common findings include partial empty Sella on magnetic resonance imaging (MRI) and panhypopituitarism, with normocytic normochromic anemia and hyponatremia from adrenal insufficiency as predominant laboratory features. In developing nations, SS serves as a silent marker of obstetric disparities. Its nonspecific symptoms-chronic asthenia, hyponatremia, secondary hypothyroidism-are often misattributed to aging, malnutrition, or psychiatric illness. A high index of suspicion, combined with targeted hormonal assays and appropriate imaging, remains essential to reduce preventable morbidity from this overlooked endocrinopathy.

Early marriage and reproductive health outcomes: demographic trends (1990-2025) and regional analysis of the Nakhchivan Autonomous Republic

Gultakin Aliyeva, Elsuna Aliyeva, Samangul Tarverdiyeva — Thu, 30 Jul 2026 00:00:00 +0530

Early marriage remains an important social and public-health determinant affecting adolescent girls’ education, reproductive autonomy, and pregnancy outcomes. This manuscript examines the long-run pattern of early marriage between 1990 and 2025 and synthesizes evidence on maternal and neonatal risks associated with adolescent pregnancy, with special attention to the Nakhchivan Autonomous Republic as a regional case study within Azerbaijan. The analysis combines descriptive demographic trend data, comparative evidence from the World Health Organization (WHO), UNICEF, and peer-reviewed literature, and a GIS-style district-level visualization prepared for academic discussion rather than official prevalence reporting. Across the literature, adolescent pregnancy is consistently linked with higher risks of anemia, hypertensive disorders of pregnancy, low birthweight, preterm birth, and selected severe neonatal conditions. The regional perspective suggests that rurality, educational inequality, and persistent gender norms remain key pathways through which early marriage may continue to affect reproductive health. The findings support multisectoral policies that combine girls’ education, community-level norm change, and improved access to respectful adolescent-responsive maternal care.

Beyond the gastric lesser curvature: a comprehensive multidisciplinary review of Dieulafoy’s lesion pathophysiology, emerging diagnostic challenges and modern therapeutic strategies in the endoscopic era

Sergio San Sebastian Cruz Dominguez, Andrea del Carmen Maldonado Rojas — Thu, 30 Jul 2026 00:00:00 +0530

Dieulafoy's lesion is a rare but serious cause of acute gastrointestinal bleeding, characterized by a persistent submucosal artery protruding through a small mucosal defect. Its intermittent bleeding and normal-looking mucosa make diagnosis challenging. This review synthesizes evidence on epidemiology, pathophysiology, diagnostic approaches, and hemostatic treatments for Dieulafoy's lesions across the GI tract, emphasizing the shift from surgery to endoscopic first-line therapy and multidisciplinary management. A narrative synthesis of recent literature, including large case series, systematic reviews, and practice guidelines from major gastroenterology societies, was performed. Dieulafoy's lesion predominantly affects males (2:1 ratio) in their 5th-7th decades. While classically located in the proximal stomach, extragastric sites are increasingly recognized. It accounts for 1-2% of all acute GI bleeds and up to 6.5% of nonvariceal upper GI bleeding. Current guidelines recommend mechanical endoscopic methods (band ligation or hemoclipping) over epinephrine injection or thermal therapy alone. Primary hemostasis success approaches 90%, with mortality dropping from over 80% historically to about 8.6% today. Rebleeding remains a concern, warranting repeat endoscopy, embolization, or deep enteroscopy. Dieulafoy's lesion requires high clinical suspicion in recurrent severe GI bleeding with unremarkable mucosa. Urgent endoscopy with mechanical hemostasis has transformed outcomes. Future research should address underdiagnosis and treatment standardization for anatomically challenging locations.

Concept of Umoor-e-tabiya in pediatric physiology: an integrative review of al-Arkān, al-Mizāj and Akhlāṭ

Danish, Saiyeda Zainab Fatima, Sudhanshu, M. Sohail — Thu, 30 Jul 2026 00:00:00 +0530

The Unani system of medicine conceptualizes human physiology through a set of seven fundamental natural principles known as Umūr Ṭabī‘iyya (Umoor-e-tabiya), which govern growth, development, and maintenance of health. Childhood represents a unique physiological phase characterized by rapid growth, high metabolic activity, and distinct constitutional attributes, yet the interpretation of Umūr Ṭabī‘iyya in the context of modern pediatric physiology remains inadequately explored. This review aims to critically examine the Unani concepts of al-Arkān (elements), al-Mizāj (temperament), and Akhlāṭ (humours) and interpret their relevance to pediatric physiological processes. A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar for contemporary biomedical literature, alongside classical Unani texts and authoritative reference works, focusing on pediatric physiology, growth, metabolism, and constitutional assessment. Relevant data were extracted and synthesized using a narrative and integrative approach, correlating classical Unani principles with established concepts in modern pediatric science. The review demonstrates that the Unani designation of childhood as a Ḥārr Raṭb (hot and moist) state closely parallels modern understanding of elevated basal metabolic rate, high total body water content, tissue plasticity, and developmental homeostasis in children. The humoral predominance of Dam and Balgham is shown to correspond with contemporary insights into pediatric hematology, immunity, and fluid physiology. This integrative synthesis supports the view that Umūr Ṭabī‘iyya represents an early systems-based physiological framework that remains conceptually relevant to modern pediatrics. Incorporating these principles may enrich integrative pediatric assessment, education, and individualized healthcare approaches.

Vertebral body changes that make spinal anesthesia difficult in geriatric patients

Thu, 30 Jul 2026 00:00:00 +0530

Spinal anaesthesia techniques are important, because age-related structural and degenerative alterations to the spine sometimes make it difficult to deliver spinal anaesthesia to the elderly population. The current understanding of age-related changes in the vertebral column that affect successful administration of spinal anaesthesia is thoroughly examined in this review. Our review focuses on the adverse effects of osteoporotic degenerative changes in older individuals, including reduced disc height, calcified ligaments, osteophyte formation, and narrowed interspinous spaces. These changes collectively complicate landmark identification and needle insertion and increase the risk of traumatic or failed spinal anaesthesia. Even though spinal anaesthesia is frequently a better option for older patients than general anaesthesia, age-related anatomical changes in the vertebral column present serious technical difficulties that can result in block failure and potentially requiring alternative or adapted approaches. The effectiveness of a number of adaptive techniques, including paramedian approaches, ultrasound-guided neuraxial blocks, and the use of alternate access sites in the sacral or lower lumbar spine, is analyzed further in this review. This review article additionally examines the challenges of delivering spinal anaesthesia to geriatric patients with altered spine structure, and investigates future directions in this field and notes a few limitations.

Smart biomaterials in periodontology: a narrative review

Sarita Parihar, Kajol Kumari Rajak, Aishwarya Pandey — Thu, 30 Jul 2026 00:00:00 +0530

Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the supporting structures of teeth, including gingiva, periodontal ligament, cementum and alveolar bone. Conventional periodontal therapies primarily focus on infection control and repair; however, complete regeneration of lost periodontal tissues remains a major clinical challenge. Recent advances in biomaterial science, nanotechnology, tissue engineering and regenerative medicine have led to the emergence of smart biomaterials, which possess the ability to respond dynamically to biological, chemical or physical stimuli within the periodontal microenvironment. These intelligent biomaterials can provide controlled drug delivery, antimicrobial action, immunomodulation, enhanced wound healing and targeted tissue regeneration. Smart biomaterials used in periodontology include stimuli-responsive hydrogels, nanoparticles, nanofibers, bioactive membranes, injectable scaffolds and stem cell-based matrices. These materials respond to various stimuli such as pH, temperature, enzymes, light, magnetic fields and inflammatory mediators, thereby improving therapeutic efficacy and minimizing adverse effects. In addition to periodontal regeneration, smart biomaterials have shown promising applications in guided tissue regeneration, peri-implantitis management, local drug delivery and bone tissue engineering. This narrative review discusses the concept, classification, mechanisms, applications, advantages, limitations and future perspectives of smart biomaterials in periodontology. The review also highlights emerging trends such as exosome-based therapy, 3D printing, nanotechnology, biosensor-integrated scaffolds and personalized regenerative approaches. Smart biomaterials represent a transformative advancement in modern periodontology and may significantly improve the predictability and success of regenerative periodontal therapy in the future.

The role of biomarkers in modern endodontic diagnosis

Trishala, Pragya Pandey, Ramesh Bharti, Promila Verma — Thu, 30 Jul 2026 00:00:00 +0530

Biomarker-based diagnostics represent an emerging frontier in precision endodontics, offering biologically informed approaches for the detection, monitoring, and management of pulp inflammation. Unlike conventional pulp testing methods that rely on subjective pain responses or thermal/electrical stimuli, biomarkers provide objective molecular and cellular insights into pulp health. Various biological markers-such as cytokines (IL-1β, TNF-α), neuropeptides (Substance P, CGRP), matrix metalloproteinases, and microRNAs-demonstrate distinct profiles in reversible versus irreversible pulpitis, enabling early detection and targeted interventions. Clinical applications include non-invasive analysis of dentinal fluid, gingival crevicular fluid, and saliva, often combined with advanced biosensors and point-of-care devices to improve diagnostic accuracy. Innovations in omics technologies, microfluidics, and artificial intelligence facilitate high-throughput biomarker analysis and predictive modeling of disease progression. Despite promising developments, challenges remain in standardization, sensitivity, cost-effectiveness, and clinical translation. Ongoing research into longitudinal monitoring and multi-marker panels holds potential for personalized pulp therapy. As biomarker-guided diagnostics evolve, interdisciplinary collaboration will be essential to integrate molecular insights into routine endodontic practice, enhancing early intervention and patient-specific care.

Chronic Cannabis indica exposure and neurodegenerative vulnerability: a review of observational evidence

Saikat Dhang, Ayeshik Chakraborty — Thu, 30 Jul 2026 00:00:00 +0530

Neurodegenerative diseases are marked by the gradual loss of neurons due to factors such as protein toxicity, oxidative stress, and inflammation, resulting in declining cognitive and motor abilities. Alzheimer’s disease (AD), Parkinson’s disease (PD), and related dementias contribute significantly to global morbidity and mortality. Identifying modifiable risk factors is essential. This retrospective review synthesises available clinical and observational evidence exploring the association between chronic Cannabis indica exposure and neurodegenerative outcomes. A retrospective review of published observational studies and clinical records was conducted. Data sources included neurology and psychiatry case records and peer-reviewed literature reporting chronic Cannabis indica use and neurodegenerative outcomes. Primary outcomes were cognitive impairment, dementia syndromes, Parkinsonian features, and neuroimaging evidence of neurodegeneration. Chronic cannabis use was consistently associated with structural and functional brain alterations, particularly in CB1-rich regions such as the medial temporal cortex, orbitofrontal cortex, insula, and hippocampus. Neuroimaging studies reported reduced gray matter volume and altered white matter integrity, with functional connectivity changes. Evidence also suggests chronic exposure disrupts glutamatergic and GABAergic signaling and contributes to cognitive deficits in learning, executive function, memory, and attention. In dementia and Parkinson’s cohorts, cannabis abuse was linked with increased emergency visits and higher pain burden. Observational evidence indicates a potential neurodegenerative vulnerability associated with chronic Cannabis indica use. Prospective longitudinal studies with standardized exposure metrics are required to clarify causality and inform public health policy.

Areca nut and betel quid without tobacco are neither harmful nor carcinogenic: scientific evidences

Keshava Bhat S., Mythri Sarpangala, Sukesh Bhat — Thu, 30 Jul 2026 00:00:00 +0530

Arecanut, the seed of Areca catechu palm, is the most popular chewing substance in most parts of the world. This nut is also called betel nut in several countries as it is invariably chewed along with the leaf of betel (Piper betle) vine and lime (calcium hydroxide). This chewing mixture is popularly called betel quid. Lots of scientific papers and reports highlight arecanut chewing as carcinogenic to humans. If such observations are really true, the results should be repeatable and consistent in other identical studies. Strangely, several researchers could not arrive at that conclusion in similar studies. Such research papers are retrieved and presented in this review. While going through several reports which highlighted arecanut chewing as dangerous or carcinogenic, it was observed that in most of such papers the conclusions were drawn hastily and lots of lacunae observed in the methodology. Most important one is that in several such studies, data were collected on mixtures of chewing substances such as betel quid, pan masala, gutkha, etc but the authors wrongly titled the paper as arecanut or betel nut chewing as if all such chewing mixtures contain only arecanut. Contamination and adulteration of arecanut, the dosage of arecanut extract used in such experiments were some of the other factors for this ambiguity. These findings underscore the need for specific interventions to address the issue more scientifically.

PCOS/PMOS Polycystic ovarian syndrome/polyendocrine metabolic ovarian syndrome: the syndrome vs. homoeopathy of AYUSH

Thu, 30 Jul 2026 00:00:00 +0530

Women’s health is an integral part of public health & in that the most critical group is the reproductive age group of 15-49 years. This article discusses a condition that spans across the women in the reproductive age group. First, it discusses the issue of misnomer of the condition known as polycystic ovarian syndrome (PCOS). As a result of the misnomer, the condition did not get adequate attention of Research and Development (R&D) since it was named in 1935. After a span of 81 years of misdiagnosis, poor treatment, poor focus and follow up, the condition was renamed as Polyendocrine Metabolic Ovarian Syndrome (PMOS). So, the last eight decades, it was a clear case of undignified approach to women’s health. As the issue of PCO/PMOS is complex both clinically & culturally, the issue comes under the domain of Community Medicine & Public Health (CMPH). With the renaming not only health policies are impacted but also the approach has to be relooked. As it needs a holistic approach, the approaches that were followed till date in endocrinology will not hold adequacy in future clinical approaches. It is here that Homoeopathy of AYUSH ministry of India steps in with the holistic approach. As it is a metabolic issue that has a hormonal angle. Homoeopathy fits in the bill as it has properties of cost effective, clinical effective & zero side effects to deal with the menace of Non-Communicable Diseases (NCD). PCO/PMOS is one such condition. Dealing with it effectively means impacting women’s health positively.

Unraveling complex autoimmunity: a case series of rheumatologic overlap syndromes

Prasanta Dihingia, Karthik Ilangovan — Thu, 30 Jul 2026 00:00:00 +0530

Overlap syndromes represent a complex interplay of multiple connective tissue diseases coexisting within a single patient, posing significant diagnostic and therapeutic challenges due to overlapping clinical, serologic, and immunologic features that defy classification into a single disease entity. We report a case series of ten patients evaluated at a tertiary care rheumatology unit in Northeast India, illustrating the heterogeneity of this clinical entity. The cohort included overlaps of systemic sclerosis with rheumatoid arthritis, Sjögren's syndrome with polymyositis, systemic lupus erythematosus with rheumatoid arthritis, systemic lupus erythematosus with Sjögren's syndrome, and systemic sclerosis with polymyositis, with organ involvement ranging from interstitial lung disease and pulmonary arterial hypertension to lupus nephritis, neuropsychiatric lupus, and lupus enteritis. Nine of the ten patients were female, and diagnosis relied on comprehensive autoantibody profiling alongside clinical evaluation. Management with corticosteroids, mycophenolate mofetil, cyclophosphamide, and hydroxychloroquine, guided by dominant organ involvement, achieved favourable outcomes in most patients; two patients with treatment non-adherence progressed to fatal complications. These cases emphasize the importance of maintaining a high index of suspicion for overlap syndromes in patients with multisystem autoimmune manifestations. Early recognition, detailed immunologic profiling, and multidisciplinary management are essential to prevent irreversible organ damage, guide personalized therapy, and optimize long-term outcomes in this challenging and increasingly recognized domain of clinical rheumatology.

Dengue and typhoid co-infection: a case series from a tertiary care hospital in rural South India

Thu, 30 Jul 2026 00:00:00 +0530

Dengue and typhoid are important febrile illnesses endemic to India. A significant increase in incidence of these infections is observed during the monsoon season due to the vector borne and water borne origin respectively. When fever persists/symptoms are overlapping, co-infections with these two diseases should be suspected. Such co-infective conditions present with a clinical dilemma to diagnose and to provide optimum care and treatment. To avoid such dilemma, diagnosis should be made by considering clinical details, lab reports and radiological reports where applicable, keeping seasonality and endemicity in mind. In this case series, we present 4 cases of dengue and typhoid co-infection with an intent to create awareness regarding the early diagnosis and prompt treatment to improve patient condition and prevent mortality and morbidity. Diagnosis of dengue is made by taking relevant clinical details and NS1 antigen/IgM antibody positive status into consideration. Diagnosis of typhoid is made by considering relevant clinical details, widal test positive status with titer >1:80 for TO and TH.

Cerebral injury in diabetic ketoacidosis: multifactorial pathogenesis beyond sodium and osmolality shifts and implications for clinical management

Adesh Kumar, Debasmita Pal, Soham Deshpande — Thu, 30 Jul 2026 00:00:00 +0530

Background: Cerebral injury is the leading cause of mortality in pediatric diabetic ketoacidosis (DKA). Historically attributed to rapid osmotic shifts during fluid resuscitation, emerging evidence suggests that intrinsic disease severity and biochemical derangements play a primary role. The objective of this study was to systematically review and meta-analyze the association between intrinsic non-osmotic markers and cerebral injury in children with DKA.

Methods: Following PRISMA 2020 guidelines, we searched PubMed, Embase, and Scopus. We performed a random-effects meta-analysis on human clinical studies evaluating non-osmotic risk factors.

Results: Five human studies (n=1,528) met the inclusion criteria. Meta-analysis demonstrated a significant association between intrinsic severity markers- specifically low partial pressure of arterial carbon dioxide (pCO2) and elevated blood urea nitrogen (BUN)-and cerebral injury (Pooled OR=1.55; 95% CI 1.04-2.30; p=0.031).

Conclusions: Cerebral injury in DKA is primarily driven by biochemical derangements present at admission. Clinical protocols should prioritize early identification of high-risk metabolic profiles.

Dietary glycemic load and risk of diabetic retinopathy: a systematic review and meta-analysis

Ayub Ali, Deepshikha, Yogita Nagar — Thu, 30 Jul 2026 00:00:00 +0530

Diabetic retinopathy (DR) is a leading cause of preventable blindness globally. While chronic hyperglycemia is a well-established determinant of DR, dietary carbohydrate quality reflected by glycemic index (GI) and glycemic load (GL) may independently influence microvascular damage. Objectives of the study were to evaluate published evidence examining the association between dietary GL and the prevalence or progression of DR. A PRISMA 2020-compliant systematic review was conducted. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to March 2025. Observational and interventional studies assessing dietary GI/GL and reporting DR outcomes were included. Data were narratively synthesized; where appropriate, meta-analytic methods using random-effects models were described. Fourteen studies met inclusion criteria, comprising cross-sectional and longitudinal cohort designs. Most studies reported a positive association between higher dietary glycemic load and increased DR risk or progression. Evidence suggested that diets characterized by refined carbohydrates and high glycemic load were associated with worse retinal outcomes, independent of HbA1c in several cohorts. Available evidence suggests dietary glycemic load may represent a modifiable risk factor in diabetic retinopathy. High-quality longitudinal studies and randomized dietary interventions are needed to confirm causality and inform clinical dietary recommendations.

A meta-analysis on the effectiveness of nursing education programs

Thu, 30 Jul 2026 00:00:00 +0530

Nursing education is very crucial in training qualified healthcare practitioners who can address the needs of the contemporary healthcare systems. As teaching methodologies have developed, several teaching strategies including traditional teaching in the classroom, learning through simulations, e-learning, and blended learning have become popular. Nevertheless, the success of these programs is inconsistent in various studies which makes it necessary to conduct an overall assessment. To examine the effectiveness of nursing education programs on a large scale, this research lies on secondary data gathered in the form of published research articles, journals and reports of reputable databases, which include PubMed, Google Scholar and World Health Organization (WHO). The research is directed at comparing the learning outcomes, clinical skills development, and student satisfaction in the various teaching methods. The results show that technology and modern techniques of learning, especially simulation and blended learning are more effective than the traditional techniques. Statistical analysis shows that there is a great enhancement in student performance and acquisition of skills in different studies. The findings also indicate the differences in effectiveness based on the nature of educational intervention applied. The research concludes that education programs in nursing that include new and digital teaching methods have a great impact on the results of education. It highlights the importance of ongoing improvement, introduction of the latest technologies, and evidence-based teaching to provide high-quality nursing education.