International Journal of Pharmacy Research & Technology (IJPRT)

Impact of Levetiracetam Therapy on Seizure Control and Cognitive Outcomes in Children with Epilepsy

2026-07-01T11:14:29+00:00

Objective: Levetiracetam (LEV) is effective in seizure control and has a full spectrum of effects on cognitive development, neuropsychological, and behavioral outcomes in children with newly diagnosed epilepsy over 12 months.

Material and Methods: A prospective, multicenter, longitudinal, observational, cohort study was designed. Five tertiary epilepsy centres in Pakistan. Baseline and 6- and 12-month cognitive and behavioral assessments included the Wechsler Intelligence Scale for Children (WISC-V), the Neuropsychological Assessment, and the Child Behavior Checklist (CBCL). In addition, serum LEV trough concentrations and SV2A polymorphisms were evaluated.

Results: 342 patients were enrolled, with 310 patients having completed the 12-month follow-up. By 12 months, 74.2% of patients had ≥50% of their seizures reduced and 58.4% became seizure-free. Cognitive testing demonstrated an average or enhanced full-scale IQ and certain domains of cognition (p < 0.05). Behavioral assessments did, however, show statistically significant elevations of externalizing behavior from the CBCL (p > 0.05), with higher serum LEV levels and faster titration rates being correlated.

Conclusion: Levetiracetam is well-established as a very effective agent for the control of pediatric epilepsy and has a favorable cognitive-sparing profile. But it has a high risk of behavioral side effects, especially behaviors that are externalized. Routine behavioral monitoring with careful titration iskey to optimizing therapeutic outcomes.

Phytochemical Screening and Antibacterial Effect of Cardamom and Nutmeg Seed Extracts on Microbes Affecting Oral Health in Humans

2026-07-01T11:49:46+00:00

Background: Microorganisms associated with oral health, including Escherichia coli, Staphylococcus aureus, and Streptococcus mutans, can cause local and systemic infections in humans. The increasing prevalence of antibiotic-resistant strains necessitates the search for alternative antimicrobial agents from natural sources. Cardamom and nutmeg are medicinal plants known for their therapeutic properties and rich phytochemical composition.

Methods: Seed extracts of cardamom and nutmeg were subjected to qualitative phytochemical screening to identify major secondary metabolites. Antibacterial activity was evaluated against E. coli, S. aureus, and S. mutans using extract concentrations of 100, 75, 50, and 25 mg. The antimicrobial potential of the extracts was determined by measuring the zone of inhibition, and the minimum inhibitory concentration (MIC) against the test organisms was assessed.

Results: Phytochemical analysis confirmed the presence of flavonoids, alkaloids, tannins, terpenes, saponins, and phenolic compounds in both cardamom and nutmeg seed extracts. The antimicrobial assays demonstrated inhibitory activity of the extracts against all tested microorganisms, with varying degrees of effectiveness depending on the extract concentration and bacterial species. MIC findings further supported the antibacterial efficacy of both seed extracts.

Conclusion: The phytochemical constituents and antibacterial activity exhibited by cardamom and nutmeg seed extracts indicate their potential as natural antimicrobial agents against oral pathogens. These findings suggest that the extracts may serve as promising alternatives to synthetic drugs associated with adverse side effects. Further investigations are required to isolate the active compounds and validate their therapeutic applications.

Correlation between Sleep Duration, Body Mass Index and Gender in Medical Students

2026-07-01T12:03:50+00:00

Background: People suffering from sleep disorders do not get adequate or restorative sleep, and sleep deprivation is associated with a number of both physical and emotional disturbances. The wide range of health and cognitive issues due to sleep loss, make it important to get an adequate night’s sleep daily.

Aims and Objectives: To study the effect of sleep duration on body mass index (BMI) in male and female medical students.

Material and Methods: The present study was done in the Postgraduate Department of Physiology, Government Medical College Srinagar and Associated Hospitals. This study was done on 500 subjects and it was an Observational, Cross sectional study.

Results: Out of 500(100%) subjects, 4.4 % of short sleepers were underweight, 61.3 % were normal weight and 34.4% were overweight/obese. Thus the prevalence of overweight/obese among short sleepers was quite high at 34.4 % as compared to 11.7 % and 15.2 % among normal sleepers and long sleepers respectively. This increase in the percentage of overweight/obese among short sleepers was in significant relationship with CHI square of 36.28 with a P value <0.001. (Statistically significant). On gender analysis, the mean BMI in subjects with short sleep was found to be 23.75 in males and 22.64 in females. The association was found in both the sexes with the relation stronger in females (P-value<0.001) as compared to males (P-value of 0.032). The relationship between sleep duration and BMI shows a U shaped curvilinear pattern, where BMI increases in subjects with sleep duration below 6 hours and above 8 hours, however the association in our study was stronger for short sleep duration in comparison with longer sleep durations.

Conclusion: Our study suggests a clear association between short sleep duration and overweight/obesity. This association was found in both the sexes with the relationship stronger in females as compared to males. Increasing sleep time might be a novel approach to obesity prevention and should become the target of public health policy.

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Swine Flu and its Prevention Among Selected High School Students In Kuppam, Chittoor (District), A.P.

2026-07-02T09:56:29+00:00

Introduction: Swine influenza is a highly contagious respiratory disease of pigs caused by one of several swine influenza A viruses. Outbreaks are common in pigs year round and infection in humans is a result of close contact with infected animals. The H₁N₁ virus outbreak had previously occurred India during the 2009 flu pandemic. The virus killed 981 people in 2009 and 1763 in 2010. The mortality decreased in 2011 to 75. It claimed 405 lives in 2012 and 699 lives in 2013. In 2014, a total of 218 people died from the H₁N₁ flu, India recorded 837 laboratory confirmed cases in the year. The main aim of the study was to assess the effectiveness of structured teaching programme on knowledge regarding swine flu and its prevention among selected high school students in kuppam, Chittoor (district), A.P.

Methodology: A true experimental research approach is adopted to assess the knowledge regarding swine flu and its prevention was used and true experimental pre test and post test with control group design was used. In this study knowledge of high school students on swine flu and its prevention. Was dependent variables. Questionnaire was used to determine the effectiveness of structured teaching programme on swine flu and its prevention among high school students.

Results: After analysis of responses In experimental group 19(63%) were inadequate knowledge level, 11(37%) were in moderate knowledge level and in control group 17(57%) were in inadequate, 13(43%) were in moderate knowledge level. In pre test 19(63%) were inadequate knowledge level, 11 (37%) were in moderate knowledge level and in post test 7(23%) were in moderate level, 23 (77%) were in adequate knowledge level in experimental group.

Conclusion: It is concluded that by using Mc Nemar chi square test was used to compare the pre and post test knowledge level of the high school students, the P value is was 0.001which was statistically significant. The results shows that the post test knowledge scores are higher than the pretest knowledge scores in experimental group is found to be significant, i.e. the structured teaching programme was effective regarding swine flu and its prevention among high school students.

Effect of Vitamin D Supplementation on Clinical Outcomes in Patients with Allergic Rhinitis

2026-07-02T11:20:02+00:00

Background: Allergic rhinitis (AR) is aprevalent IgE-mediated inflammatory condition of the nasal mucosa, recognizedfor its substantial negative impact onpatients' quality of life. Vitamin

Serum Electrolyte and Acid–Base Abnormalities in Hepatic Encephalopathy Associated with Chronic Liver Disease

2026-07-02T11:36:56+00:00

Background: Hepatic encephalopathy (HE) is a severe neuropsychiatric complication of chronic liver disease (CLD) frequently associated with electrolyte and acid–base disturbances that may worsen disease severity and prognosis.

Aim: To evaluate serum electrolyte and acid–base abnormalities in patients with hepatic encephalopathy associated with chronic liver disease and assess their correlation with disease severity and outcomes.

Materials and Methods: This prospective observational study was conducted in the Department of General Medicine, Baba Raghav Das Medical College and Nehru Hospital, Gorakhpur, Uttar Pradesh, from January to December 2024. A total of 115 adult patients with hepatic encephalopathy associated with chronic liver disease were included. Hepatic encephalopathy was graded using the West Haven criteria. Serum sodium, potassium, calcium, and arterial pH were measured at admission and discharge. Statistical analysis was performed using SPSS version26.0.

Results: Most patients belonged to the 41–50 year’s age group (30.4%) and all were male. Alcohol-induced decompensated chronic liver disease was the predominant etiology (78.3%). Grade 2 HE was most common (37.4%). Significant associations were observed between etiology and diagnosis (p=0.005), admission calcium (p=0.009), admission pH (p=0.017), and all discharge biochemical parameters. Overall, 79.1% improved, while20.9% expired.

Conclusion: Electrolyte and acid–base abnormalities are important biochemical disturbances in hepatic encephalopathy. Early recognition, routine biochemical monitoring, and prompt management are essential to improve outcomes and reduce mortality.

Prevalence of obesity and hypertension in school going children aged 12 to 16 years-A cross sectional study

2026-07-02T13:13:49+00:00

Aim: To study the prevalence of obesity and hypertension in school going children aged 12 to 16 years.

Materials and methods: This cross-sectional study was conducted among 200 school-going adolescents aged 12–16 years. Participants were enrolled after obtaining informed consent from parents/guardians. Adolescents with genetic syndromes or chronic systemic illnesses were excluded. Demographic details, anthropometric measurements (height, weight, waist and hip circumference), and blood pressure were recorded using standardized protocols. Body mass index (BMI), waist-hip ratio, and waist circumference were assessed using Indian Academy of Pediatrics (IAP)-modified WHO growth charts and age- and sex-specific Indian reference standards. The association between obesity and hypertension was evaluated using appropriate statistical analysis.

Results: Among the 200 adolescents, 104 (52.0%) were males and 96 (48.0%) were females. Most participants were non-vegetarians (88.0%), consumed junk food (90.0%), were non-obese (82.0%), and had normal weight (78.0%). Hypertension was present in 32 (16.0%) participants, while 12 (6.0%) were pre-hypertensive. Hypertension was more common among males, overweight, and obese participants. However, no significant association was observed between hypertension and sex, dietary pattern, socioeconomic status, junk food consumption, or overweight status (p>0.05). Obesity showed a significant association with hypertension (p=0.021), with hypertensive cases being more frequent among obese participants (33.3%) than non-obese participants (4.9%).

Conclusion: These findings highlight the need for early screening, lifestyle modifications, and school-based interventions to prevent obesity and reduce the risk of hypertension and its long-term cardiovascular complications in adolescents.

Neurobehavioral Assessment of Newborns Using the Modified Brazelton Neonatal Behavioral Assessment Scale: Relationship with Gestational Age and Birth Weight

2026-07-03T07:42:24+00:00

Background: The neonatal period represents a crucial stage of brain maturation during which newborns adapt rapidly to life outside the uterus. Assessment of neonatal neurobehavior provides valuable information regarding neurological integrity, behavioural organization, and developmental maturity. The Modified Brazelton Neonatal Behavioral Assessment Scale (MNBAS) is a standardized instrument that evaluates multiple domains of neonatal behaviour, including habituation, orientation, motor performance, behavioural state regulation, autonomic stability, and primitive reflexes. Since gestational age and birth weight are important determinants of neurological maturity, understanding their influence on neonatal neurobehavior may facilitate early identification of infants at risk for developmental impairment.

Objectives:

Primary Objectives

To assess the neurobehavioral profile of newborns using the Modified Brazelton Neonatal Behavioral Assessment Scale.
To evaluate the relationship between neurobehavioral performance and gestational age.
To determine the association between birth weight and neurobehavioral assessment scores.

Secondary Objectives

To compare neurobehavioral performance according to gender.
To evaluate the influence of mode of delivery on neonatal neurobehavior.

Materials and Methods: A prospective hospital-based observational study was conducted over a one-year period in the Department of Paediatrics, Sree Mookambika Institute of Medical Sciences, Kulasekaram. Eighty eligible newborns were enrolled after obtaining informed parental consent. Neurobehavioral assessment was carried out within the first 72 hours after birth using the Modified Brazelton Neonatal Behavioral Assessment Scale under standardized environmental conditions. Maternal and neonatal clinical details, including gestational age, birth weight, gender, mode of delivery, Apgar score, and anthropometric measurements, were recorded. Data were analysed using appropriate descriptive and inferential statistical methods. A p-value less than 0.05 was considered statistically significant.

Results: Among the eighty newborns studied, term infants demonstrated significantly higher neurobehavioral scores than preterm infants. Newborns with normal birth weight performed better across most behavioural domains than low birth weight infants. Gestational age showed a significant positive correlation with the overall MNBAS score, while birth weight demonstrated a moderate positive correlation with neurobehavioral performance. No significant differences were observed with respect to gender or mode of delivery.

Conclusion: The Modified Brazelton Neonatal Behavioral Assessment Scale is a practical and reliable tool for evaluating neonatal neurobehavior in routine clinical practice. Increasing gestational age and birth weight are associated with improved neurobehavioral performance, emphasizing the importance of early behavioural assessment in identifying newborns who may benefit from developmental surveillance and early intervention.

Association of Moderately Increased Albuminuria in Nstemi with Timi Score of Nstemi

2026-07-03T12:55:47+00:00

Increasing evidence shows moderately increased albuminuria to be an important indicator in the future development of coronary artery disease. In moderately increased albuminuria, changes in extracellular matrix induce an increase in vascular permeability and causes endothelial dysfunction. This leads to influx of lipids into the vessel wall and development of atherosclerotic lesions. This study was done to investigate the association between moderately increased albuminuria in NSTEMI and TIMI score of NSTEMI.

Objective: To investigate the association between moderately increased albuminuria in NSTEMI and TIMI score of NSTEMI patients.

Methods: 195 patients admitted with NSTEMI fulfilling inclusion criteria were selected. Clinical data including patient demographics, risk factors for cardiovascular disease, clinical presentation, ECG and laboratory investigations including urinary albumin, urine creatinine, fasting blood glucose, renal function tests, lipid profile, and troponin I were recorded. Data were entered into Microsoft Excel and analysed using R statistical software.

Results: The distribution of urinary ACR categories differed across TIMI risk groups, with a shift toward higher levels of albuminuria in patients classified into intermediate and high-risk TIMI categories. Patients in the low-risk group (31.3%) were more frequently represented in the normal ACR category (42.6%), whereas moderately increased albuminuria (50.8%) predominated in the intermediate-risk group (37.4%). Severely increased albuminuria (6.7%) was more common among patients in the high-risk group (31.3%).

Conclusion: Moderately increased albuminuria was common in patients with NSTEMI. Patients with moderately increased albuminuria were more frequently classified into intermediate TIMI risk groups.

Evaluating the in Vitro Efficacy of Imipenem-Relebactam against Carbapenem-Resistant Gram-Negative Bacteria: A Comparative Analysis of Clinical Isolates

2026-07-03T13:46:58+00:00

Background: Antimicrobial resistance (AMR) is an increasing worldwide health issue with Gram-negative, carbapenem and colistin-resistant microorganisms. Gram-negative Rods (GNRs) resistance to carbapenems has emerged as a significant issue in medical facilities that gives rise to morbidity and mortality. Imipenem-relebactam (IMI-REL) a combination of the carbapenem, imipenem and the new release bactam-based, 2-lactamase inhibitor relebactam has demonstrated potential to defeat resistance in multidrug-resistant (MDR) pathogens.

Purpose: This study was intended to test the in vitro activity of IMI-REL against the carbapenem-resistant GNR isolates on clinical samples by the modified Kirby-Bauer disk diffusion test.

Methods: The study was a cross-sectional study conducted at the Armed Forces Institute of Pathology (AFIP), Rawalpindi, in June 2022 through January 2023. Total 210 clinical isolates of carbapenem-resistant GNRs were gathered and the susceptibility to IMI-REL was determined. The resistance rates were grouped in terms of patient age, gender and specimen type.

Findings: Of 210 isolates, 63.8 % were sensitive , 29 % resistant and 7.2 % intermediate sensitive to IMI-REL. The highest resistance was documented in isolates of invasive respiratory specimens. There was stratification analysis showed that resistance patterns varied significantly depending on the type of specimen.

Conclusion: IMI-REL showed considerable in vitro efficacy against carbapenem-resistant isolates of GNR, which suggests that the antibiotic can be used in the treatment of MDR infections, especially in severely ill patients. More clinical trials are necessary to support these findings and allow it to be used in the treatment plans.

Association Between Atopic Dermatitis and Bronchial Asthma: Evaluating the Atopic March in a Cross-Sectional Study

2026-07-04T08:05:02+00:00

Atopic dermatitis (AD) and bronchial asthmaare chronic inflammatory disorders that sharea common immunopathological basis drivenby type 2 immune responses. The concept ofthe “atopic march” describes the progression of allergic diseases from early-life skinbarrier dysfunction to respiratory a

Radiomic Features of Breast Lesions on MRI for Predicting Histopathological Grade in women with endometrial cancer

2026-07-04T08:07:24+00:00

Radiomic analysis derived frommagnetic resonance imaging (MRI) of breastlesions has emerged as a promising noninvasive approach for tumor characterizationand risk stratification. In patients with endometrialcancer,synchronous

Effectiveness of 3D Printed Anatomical Models in Teaching Pelvic Anatomy to Undergraduate Students: A Randomized Educational Intervention Study

2026-07-04T08:10:10+00:00

Pelvic anatomy is considered one of the mostchallenging topics in undergraduate anatomyeducation because of its complex spatialrelationships and deep anatomical location.Traditional teaching methods

Mental Health, Learning Behaviors, and Lifestyle Patterns Among Medical Students in the Digital Education Era: A Cross-Sectional Analytical Study

2026-07-04T08:12:10+00:00

The rapid transition toward digital educationhassignificantlytransformedmedicaltraining, altering learning behaviors, lifestyle
patterns, and psychological well-beingamong medical students.

Artificial Intelligence in Musculoskeletal Imaging of Inflammatory Arthritis: Current Applications and Future Directions: A Prospective Diagnostic Accuracy Study

2026-07-04T08:14:43+00:00

Inflammatory arthritis is a chronic immunemediated disorder characterized by persistentsynovial inflammation, progressive jointdestruction, functional impairment, andsubstantial healthcare burden. Early detectionofinflammatory activity

Comparison of Tear Film Parameters Before and After Corneal Refractive Surgery: A Prospective Longitudinal Study

2026-07-04T08:17:11+00:00

Corneal refractive surgery is widelyperformed for the correction of myopia,hyperopia, andastigmatism,offeringexcellent visual outcomes and patientsatisfaction.

Prevalence and Histopathological Characteristics of Endometrial Hyperplasia and Carcinoma in Women with Postmenopausal Bleeding: A Cross-Sectional Observational Study

2026-07-04T08:19:07+00:00

Postmenopausal bleeding (PMB) is aclinically significant symptom that often serves as an early indicator of endometrialpathology,includinghyperplasiaandcarcinoma. Timely evaluation is crucialbecause early-stage endometrial neoplasia

Prospective Cohort Study of Respiratory Muscle Dysfunction and Predictors of Prolonged Mechanical Ventilation in Critically Ill Adults

2026-07-04T08:22:56+00:00

Respiratory muscle dysfunctionasis increasinglycontributor to delayed liberation frommechanical ventilation among critically illpatients. However, thelongitudinal impact ofrespiratory muscle weakness on prolongedmechanical ventilation (PMV) and clinicaloutcomesremainscharacterized. This prospective cohort studyevaluated the prevalence of respiratorymuscle dysfunction and identified predictorsofprolonged mechanical ventilation incritically illadults admitted to intensive careunits (ICUs).

Mapping the Tribal Resistome: A Hospital-Based Surveillance of Multidrug-, Extensively Drug-, and Pandrug-Resistant Bacterial Pathogens in Bastar, Central India

2026-07-04T12:42:23+00:00

Background:Antimicrobial resistance (AMR) poses a significant threat to globalhealth,withextensively multidrug-resistant (MDR),drug-resistantpandrug-resistant (PDR) pathogens affectingclinical outcomes and healthcare delivery

Clinical and Imaging Profile of MOG Antibody–Associated Optic Neuritis in Indian Patients

2026-07-04T12:55:38+00:00

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has emerged as a distinct inflammatory demyelinating disorder of the central nervous system. Optic neuritis (ON) is one of the most common clinical manifestations of MOGAD and is characterized by unique clinical and radiological features. Early recognition is essential because visual outcomes and treatment responses differ from other forms of optic neuritis.

Methods: A retrospective observational study was conducted involving 30 patients diagnosed with MOG antibody-associated optic neuritis (MOG-ON). Demographic characteristics, clinical presentation, magnetic resonance imaging (MRI) findings, visual acuity at presentation and follow-up, treatment response, and recurrence profiles were analyzed. Descriptive statistics were used to summarize clinical and imaging characteristics.

Results: The mean age of patients was 27.8 ± 12.4 years, with a female predominance (60.0%). Unilateral optic neuritis was observed in 53.3% of patients, while 46.7% had bilateral involvement. Ocular pain (83.3%) and optic disc edema (66.7%) were common clinical findings. MRI demonstrated optic nerve enhancement in 90.0% and long-segment optic nerve involvement in 60.0% of patients. Visual outcomes improved substantially during follow-up, with 66.7% achieving visual acuity ≥6/12 compared to 10.0% at baseline. Complete visual recovery occurred in 60.0% of patients, and 86.7% exhibited steroid-responsive disease. Relapses occurred in 23.3% of patients during follow-up.

Conclusion: MOG antibody-associated optic neuritis in Indian patients is characterized by young age at presentation, frequent bilateral involvement, optic disc edema, characteristic MRI findings, and favorable visual recovery following treatment. Recognition of these features may facilitate early diagnosis and optimal management.

A Mixed Method Study to Assess the Risk and Experiences of Frontline Nurses Working in a Dedicated Covid Hospital at Bhubaneswar

2026-07-04T13:16:29+00:00

Introduction: The world is grappling with an ongoing COVID-19 pandemic that has shaken the mankind to the core and disrupted the lives of everyone. The aim of this study was to assess the risk and experience of nursing officer’s working in COVID-19 ward during COVID-19 second wave.

Methodology: A mixed method study was conducted in selected hospitals of Bhubaneswar, Odisha, to assess the impact of COVID-19 among 200 nursing officer’s working in COVID-19 wards. Questionnaire which includes demographic profile, DASS-21 and insomnia severity index were used for risk assessment like psychological distress of depression, anxiety, stress and insomnia, Interview guide used to assess experience of nursing officers while working in the COVID-19 Ward.

Results: Out of 200 nursing officer’s, 56 (28%) had mild level of depression, 54 (27%) had moderate level of depression and 5 (2.5%) had severe level of depression respectively. 76 (38%) had moderate level of anxiety, 50 (25%) had severe level of anxiety and 30 (15%) had mild level of anxiety respectively. 40 (20%) had mild level of stress, and 100(50%) had moderate level of stress respectively. 80 (40%) had Sub threshold insomnia, 70 (35%) had clinical insomnia (moderate severity), 50 (25.5%) had clinical insomnia (severe) respectively. Correlation between depression, anxiety, stress and insomnia shows positive correlation p-value is (p=0.000) are statistically highly significant.Selected demographic variables shows statisticallysignificant association between level of psychological distress of depression, anxiety, stress and insomnia. There are three main themes and each theme had 3-4 sub themes for the qualitative part in relation to experience of nursing officers.

Conclusion: The present study concluded that COVID-19 second wave had a significant psychological impact on nursing officers.

A Study To Evaluate The Risk Factors Of Childhood Obesity And To Determine The Effectiveness Of Video Assisted Teaching On Knowledge Regarding Childhood Obesity Among Obese Children Of Selected Schools At Rourkela

2026-07-04T13:26:01+00:00

Introduction: Childhood obesity among school-aged children is a growing global health concern, marked by excess body fat that begins early in life. It arises when children consume more calories than they expend—a result of unhealthy eating habits, sedentary routines, and environments that promote processed foods and screen-based leisure.The causes include a combination of family behaviours, school influences, genetic predispositions, and broader social and built environments. Despite growing incidence many schools lack consistent programs for monitoring body mass index, promoting nutritious meals, or ensuring adequate physical activity.

Methodology: A cross-sectional study to evaluate the risk factors of childhood obesity and to determine the effectiveness of video assisted teaching on knowledge regarding childhood obesity among obese children of selected schools at Rourkela. A mixed method research design was used a cross-sectional research design was adopted for assessing the obesity through BMI to evaluate the risk factors of obesity. Pre experimental research design was used for assessing the knowledge among school going children about obesity and risk factors.

Results: The findings related to prevalence of obesity 67(18.10%) of subjects were in underweight, 55(14.08%) of subjects were overweight and 17(4.59%) subjects were in obesity. Risk factors of the study shows that 30.8% having family history of obesity, 18.65% of children take medication for a long time, 20.91% of the children are not going to play outdoor game, 54.06% of children do not like to do daily exercise, 35.40% children like to eat outside food, 57.83% watching T.V. or mobile more than 2hours on a day, 53.78% like take junk foods, 38.11% children drink sugar, sweetened beverage daily, 23.52% not having good sleep at night, 21.35% were mentally disturb due to family problem. In relation to association between knowledge score and socio demographic variable there is significant association with no. of children in the family chi- value 19.84, df value 02,p <0.001, type of family chi value 10.24, df value 02, p <0.006, family history of obesity chi value 4.00, df value 01,p<0.0455.In relation to association between knowledge score & socio-demographic variable there is significant association with gender chi value 56, df value 02, p<0.00001, area of residence chi value 30.83,df value 04, p<0.00001, type of food chi value 23.88, df value 04, p<0.00008, family history of obesity chi value 10.60, df value 0.005, p<0.005.

Conclusion: In selected schools of Rourkela, overweight are more prevalent than obesity, and both are significantly linked to multiple risk factors. Additionally, socio-demographic characteristics influence both obesity rates and students’ knowledgelevels.

Microbial Proteolytic and Hydrolytic Enzyme Kinetics in Postmortem Liquefaction and Tissue Degradation: A Systematic Review for PMI Mapping

2026-07-04T13:31:44+00:00

Background: Estimating the postmortem interval (PMI) beyond the early algor-mortis window remains one of the least standardized areas of forensic pathology. As decomposition proceeds, host autolytic enzymes and a succession of microbial proteases, lipases, and other hydrolases drive the progressive liquefaction of soft tissue, and the kinetics of this enzymatic activity have been proposed as quantitative PMI markers.

Objective: This systematic review synthesizes evidence on microbial proteolytic and hydrolytic enzyme activity during postmortem tissue liquefaction and degradation, and evaluates its utility, alongside host-derived enzymatic and omics markers, for PMI mapping.

Methods: A structured search of PubMed-, Scopus-, Web of Science-, and Google Scholar-indexed literature was conducted for studies published between July 2000 and April 2026 addressing protein, lipid, or other macromolecule degradation kinetics in postmortem tissue, with emphasis on microbial enzymatic drivers. Eligible study types included animal and human cadaveric studies, proteomic/metabolomic PMI studies, and systematic reviews; entomological and pure skeletal-isotope PMI methods without an enzymatic/biochemical component were excluded.

Key findings: Twenty-eight studies met inclusion criteria. Host calpain-mediated proteolysis dominates the first hours to days postmortem in skeletal muscle, while microbial hydrolasesgenerated as gut and environmental bacteria proliferate and disseminatebecome the principal driver of tissue liquefaction from roughly the second day onward, producing characteristic byproducts such as hydrogen sulfide, ammonia, and biogenic amines. Multi-omics and machine-learning approaches integrating these markers now predict PMI to within approximately one to two days across a multi-week range, substantially outperforming classical methods beyond the first 72 hours.

Conclusion: Microbial enzyme kinetics offer a biologically grounded, decomposition-resistant complement to host-protein degradation and entomological methods for PMI mapping, but standardization of sampling, enzyme assay, and statistical modelling is required before broad forensic validation. Practical and research implications are discussed.

Predictors of Postoperative Hypocalcemia, Recurrent Laryngeal Nerve Injury, and Hospital Stay Following Total Thyroidectomy with Central Neck Dissection

2026-07-04T13:39:28+00:00

Background: Total thyroidectomy with central neck dissection is an established treatment for thyroid malignancies with central compartment involvement; however, postoperative hypocalcemia, recurrent laryngeal nerve injury, and prolonged hospital stay remain important causes of morbidity.

Objective: To identify predictors of postoperative hypocalcemia, recurrent laryngeal nerve injury, and prolonged hospital stay among patients undergoing total thyroidectomy with central neck dissection.

Methodology: This retrospective cohort study was conducted at Department of ENT, Bolan Medical Complex Hospital, Quetta from 1^st October 2025 to 31^st March 2026 and 210 patients undergoing total thyroidectomy with unilateral or bilateral central neck dissection for thyroid malignancies were included.

Results: The mean age of patients was 46.8±12.9 years, and 154 (73.3%) were female. Postoperative hypocalcemia occurred in 64 patients, while recurrent laryngeal nerve injury was observed in 18 patients. Patients with hypocalcemia had longer operative times (176.4±41.2 vs. 145.0±32.4 minutes; p<0.001), fewer preserved parathyroid glands (2.4±0.7 vs. 3.4±0.6; p<0.001), and more frequent bilateral central neck dissection (64.1% vs. 34.2%; p<0.001). Recurrent laryngeal nerve injury was associated with larger tumor size (4.1±1.8 vs. 2.7±1.3 cm; p<0.001), extrathyroidal extension (61.1% vs. 24.5%; p=0.001), longer operative time (201.7±44.6 vs. 150.2±35.3 minutes; p<0.001), and lower use of intraoperative nerve monitoring (38.9% vs. 68.8%; p=0.012). Preservation of fewer than three parathyroid glands (AOR=4.28, p<0.001), bilateral central neck dissection (AOR=2.74, p=0.004), and operative time >180 minutes (AOR=2.21, p=0.028) independently predicted hypocalcemia. Tumor size >3 cm (AOR=3.65, p=0.013), extrathyroidal extension (AOR=3.17, p=0.026), and absence of nerve monitoring (AOR=2.86, p=0.041) independently predicted RLN injury.

Conclusion: Postoperative complications following total thyroidectomy with central neck dissection are influenced by both disease-related and operative factors. Careful preservation of parathyroid glands, selective use of bilateral central neck dissection, routine intraoperative nerve monitoring, and strategies to reduce operative duration may help minimize postoperative morbidity and shorten hospital stay.

Clinicopathological Predictors of Cervical Lymph Node Metastasis and Recurrence in Patients Undergoing Surgical Management of Thyroid in Head and Neck Malignancies

2026-07-04T13:46:55+00:00

Background: Cervical lymph node metastasis is a major prognostic factor in thyroid and head and neck malignancies and is associated with increased recurrence and reduced survival.

Objective: To evaluate clinicopathological predictors of cervical lymph node metastasis and disease recurrence among patients undergoing surgical management for thyroid and head and neck malignancies.

Methodology: This retrospective cohort study was conducted at Department of ENT, Bolan Medical Complex Hospital Quetta from 1^st October 2024 to 31^st March 2025 and 210 patients with histopathologically confirmed thyroid or head and neck malignancies who underwent surgery with curative intent were included.

Results: The mean age of patients was 51.6±13.8 years with 126 (60%) were males. Cervical lymph node metastasis was identified in 97 (46.2%) patients and was significantly associated with younger age (48.2±12.9 vs. 54.5±14.1 years; p=0.001), larger tumor size (3.9±1.6 vs. 2.6±1.2 cm; p<0.001), advanced T stage, multifocality, lymphovascular invasion, perineural invasion, and extrathyroidal or extracapsular extension. Disease recurrence occurred in 42 (20%) patients and was significantly associated with cervical lymph node metastasis, positive surgical margins, larger tumor size, lymphovascular invasion, extrathyroidal or extracapsular extension, and advanced T stage. Multivariable analysis demonstrated that lymphovascular invasion (AOR=3.67, 95% CI: 1.89-7.11; p<0.001), tumor size >3 cm (AOR=2.84, 95% CI: 1.51-5.34; p=0.001), multifocality (AOR=2.21, 95% CI: 1.12-4.35; p=0.022), and extrathyroidal or extracapsular extension (AOR=2.95, 95% CI: 1.47-5.90; p=0.002) independently predicted cervical lymph node metastasis.

Conclusion: Clinicopathological features, including tumor size, multifocality, lymphovascular invasion, extrathyroidal or extracapsular extension, positive margins, and cervical lymph node metastasis, are significant predictors of recurrence in thyroid and head and neck malignancies.

Coronary Artery Dominance and the Pathology of Ischaemic Heart Disease: Dominance-Related Differences in Infarct Size and Collateral Circulation in a Cadaveric Series

2026-07-06T08:01:51+00:00

Background: Left coronary dominance has been linked to adverse outcomes in ischaemic heart disease, but direct anatomical evidence relating dominance to infarct size and collateral development is scarce. We examined these relationships in a cadaveric series.

Methods: Ninety-five formalin-fixed adult human hearts were dissected and classified by dominance. Atherosclerosis was graded, myocardial infarction was characterised by location, size (percentage of left ventricle), and histological age, and the collateral circulation was assessed. Infarct size was compared across dominance groups by ANOVA and categorical variables by the chi-square test.

Results: Coronary atherosclerosis was present in 75 hearts (78.9%) and myocardial infarction in 43 (45.3%). Infarcts were larger in left-dominant hearts than in right-dominant hearts (32.2 ± 8.3% vs 18.4 ± 5.4% of the left ventricle; ANOVA p<0.001), consistent with the greater myocardial territory subtended by the dominant circumflex. Collateral circulation was present in 47.8% of right-dominant, 66.7% of balanced, and 87.5% of left-dominant hearts, a gradient that approached but did not reach significance (p=0.054), likely reflecting the small left-dominant subgroup. Healed infarcts predominated (n=26).

Conclusions: Coronary dominance is associated with infarct size, left-dominant hearts sustaining larger infarcts, with a parallel trend toward greater collateral development. These direct anatomical findings support the adverse prognostic significance attributed to left dominance and the systematic consideration of dominance in ischaemic heart disease.

Visual Outcomes and Intraocular Pressure Control Following Manual Small Incision Cataract Surgery in Patients with Lens-Induced Glaucoma: A Prospective Analytic Study from a Tertiary Care Center in Rajasthan, India

2026-07-06T08:09:23+00:00

Background: Lens-induced glaucoma (LIG) is a vision-threatening secondary glaucoma associated with advanced cataract. Prompt surgical intervention is essential to reduce intraocular pressure (IOP), relieve symptoms, and restore visual function. Manual Small Incision Cataract Surgery (MSICS) remains a preferred treatment option in resource-limited settings because of its safety, effectiveness, and cost-efficiency.

Objective: To evaluate visual outcomes and IOP control following MSICS in patients with lens-induced glaucoma.

Methods: A hospital-based prospective analytic study was conducted in the Department of Ophthalmology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, from June 2024 to December 2025. Forty patients diagnosed with lens-induced glaucoma who underwent MSICS were included. Demographic characteristics, clinical presentation, preoperative findings, visual acuity, and IOP measurements were recorded. Patients were followed on postoperative day 1, week 1, month 1, and month 3. Statistical analysis was performed using SPSS version 26.

Results: The mean age of patients was 64.1 ± 8.9 years, with females accounting for 60% of cases. Phacomorphic glaucoma was the most common subtype (75%), followed by phacolytic glaucoma (20%). Mean IOP decreased significantly from 40.3 ± 6.2 mmHg at presentation to 19.5 ± 5.57 mmHg at three months postoperatively. Visual acuity improved substantially following surgery. At presentation, all patients had BCVA below 3/60, whereas at three months, 80% achieved BCVA of 6/36 or better. The majority of patients demonstrated satisfactory visual rehabilitation and effective IOP control.

Conclusion: MSICS is a safe and effective surgical modality for the management of lens-induced glaucoma. Early intervention provides significant improvement in visual acuity and long-term reduction of intraocular pressure, thereby minimizing the risk of irreversible glaucomatous damage.

Role of Oxidative Stress in Microvascular Dysfunction and Early Neurocognitive Changes

2026-07-06T12:10:58+00:00

Background: Oxidative stress plays a significant role in endothelial damage, microcirculatory dysfunction and early cognitive dysfunction. Further clinical assessment is needed to determine its associations with microvascular dysfunction and subtle cognitive changes.

Objective: To assess the association of oxidative stress biomarkers with microvascular dysfunction and early neurocognitive changes among adults with cardiovascular risk factors.

Methods: This prospective observational study was conducted from June 2024 to June 2025 at the Department of Medicine, Indus Medical College, Tando Muhammad Khan, Pakistan, in collaboration with the Department of Psychiatry, Lady Reading Hospital–Medical Teaching Institution, Peshawar, Pakistan. One hundred and twenty cardiovascular risk factor adults (40-70 years) were recruited. Oxidative stress markers, inflammatory markers, microvascular markers and neurocognitive function were measured. Data were analyzed using correlation and multivariable regression analysis.

Results: Microvascular dysfunction was observed in 71 participants (59.2%). The malondialdehyde, oxidized LDL, hs-CRP, and interleukin-6 levels were significantly higher and total antioxidant capacity, superoxide dismutase, and catalase levels were significantly lower in these participants. They also had decreased flow-mediated dilatation, longer capillary refill time, higher retinal microvascular abnormalities, and lower cognitive scores. Microvascular dysfunction was associated with early neurocognitive change. The factors independently associated with early change in neurocognition were elevated malondialdehyde, oxidized LDL, reduced flow-mediated dilation, and retinal microvascular abnormality.

Conclusion: There is a very significant relationship between oxidative stress, microvascular dysfunction and early neurocognitive decrease. The early detection of oxidative and microvascular markers may be useful in identifying individuals at risk for vascular cognitive impairment.

Assessment of Renal Function, Mineral Metabolism Disturbances, and Anti‑Platelet Therapy in Chronic Kidney Disease: Clinical Significance of Urea, Creatinine, Calcium, Phosphorus, Alkaline Phosphatase, and Platelet Modulation

2026-07-07T07:29:36+00:00

Introduction: Chronic kidney disease (CKD) is associated with biochemical disturbances and increased cardiovascular risk. Antiplatelet therapy is widely used in CKD, but its impact on outcomes remains uncertain.

Aim: To evaluate biochemical derangements in CKD patients and correlate them with antiplatelet therapy outcomes for prognostic stratification.

Materials and Methods: A prospective observational study was conducted in 100 CKD patients. Serum urea, creatinine, calcium, phosphorus, and alkaline phosphatase were measured. Patients were stratified into four groups: aspirin, clopidogrel, dual therapy, and no antiplatelet therapy. Clinical outcomes including cardiovascular events, bleeding, and hospitalization were analyzed. Statistical associations were assessed using chi-square test.

Results: Elevated serum urea (>45 mg/dL) was observed in 50% of patients, creatinine (>1.3 mg/dL) in 70%, hypocalcemia in 28%, hyperphosphatemia in 44%, and high ALP in 45%. Cardiovascular events occurred in 20% of aspirin and clopidogrel groups, 25% in dual therapy, and 40% in untreated patients. Dual therapy was associated with higher bleeding (30%) and hospitalization (50%). Elevated urea, creatinine, hypocalcemia, and hyperphosphatemia were significantly correlated with adverse outcomes (p<0.05).

Conclusion: CKD patients exhibit marked biochemical disturbances that strongly predict cardiovascular and bleeding complications. Antiplatelet monotherapy reduces cardiovascular risk compared to no therapy, while dual therapy increases bleeding. Integrating biochemical markers with pharmacological outcomes may enhance prognostic stratification and guide individualized management in CKD.

Study of Dyslipidemia in Pre- and Postmenopausal Diabetic Women

2026-07-07T08:02:43+00:00

Background: Menopausal transition in women with type 2 diabetes mellitus (T2DM) is associated with metabolic changes that may adversely affect lipid profile and increase the risk of vascular complications. This study compared lipid abnormalities, glycaemic parameters, and diabetes-related complications between premenopausal and postmenopausal women with T2DM.

Methods: A cross-sectional observational study was conducted over 18 months among 120 women with T2DM (60 premenopausal and 60 postmenopausal) attending a tertiary care teaching hospital in Kuppam, Andhra Pradesh. Clinical evaluation, anthropometry, fasting lipid profile, fasting and postprandial blood glucose, glycated haemoglobin (HbA1c), urine analysis, fundus examination, and electrocardiography were performed. Data were analysed using independent-sample t test and chi-square test, with p<0.05 considered statistically significant.

Results: Postmenopausal women had a significantly longer duration of diabetes than premenopausal women (5.89±5.86 vs 3.46±3.08 years; p=0.011). LDL cholesterol (94.98±35.44 vs 81.05±32.82 mg/dL; p=0.027), VLDL cholesterol (44.11±21.92 vs 34.86±20.66 mg/dL; p=0.019), and TC/HDL ratio (5.96±1.71 vs 4.87±1.86; p=0.039) were significantly higher among postmenopausal women, whereas total cholesterol, triglycerides, and HDL cholesterol showed no significant differences. Nephropathy (16.7% vs 5.0%; p=0.047) and microvascular complications (31.7% vs 20.0%; p=0.016) were significantly more common in postmenopausal women.

Conclusions: Postmenopausal women with T2DM exhibited a more atherogenic lipid profile and a higher burden of diabetic complications than premenopausal women. Routine lipid screening and early management of dyslipidaemia and vascular complications may reduce long-term cardiovascular risk and improve clinical outcomes in this high-risk population.

A Comparative Study of Conventional Versus Mitomycin C Augmented External Dacryocystorhinostomy

2026-07-07T08:09:14+00:00

Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of chronic epiphora and recurrent dacryocystitis in adults. External dacryocystorhinostomy (DCR) remains the gold standard surgical procedure for treating nasolacrimal duct obstruction. However, postoperative fibrosis and closure of the osteotomy site may compromise long-term surgical success. Mitomycin C (MMC), an antifibrotic agent, has been used as an adjunct during DCR to reduce scar formation and improve ostium patency.

Methods: A hospital-based randomized interventional study was conducted in the Department of Ophthalmology, Jawaharlal Nehru Medical College, Ajmer, from June 2024 to May 2025. Eighty patients diagnosed with chronic dacryocystitis secondary to nasolacrimal duct obstruction were randomly allocated into two groups. Group A (n=40) underwent conventional external DCR, while Group B (n=40) underwent external DCR with intraoperative application of 0.2 mg/ml MMC for 5 minutes. Patients were followed on postoperative day 1, day 14, 3 months, and 6 months. Anatomical success was assessed by syringing patency and functional success by fluorescein dye disappearance test (FDDT).

Results: At 6 months, anatomical success was achieved in 92.5% of patients in the conventional DCR group and 97.5% in the MMC group. Functional success rates were similarly 92.5% and 97.5%, respectively. Postoperative complications were minimal in both groups. Granulation tissue formation was observed in only one patient in the MMC group. No revision surgery was required in either group.

Conclusion: External DCR is a highly effective procedure for managing nasolacrimal duct obstruction. Adjunctive intraoperative MMC demonstrated slightly higher anatomical and functional success rates with a comparable safety profile. MMC may be considered a useful adjunct in external DCR to improve long-term surgical outcomes.

Effect of Nitrous Oxide–Oxygen Mixture versus Oxygen Alone on Propofol Induction Dose, Induction Time, and Haemodynamic Response to Laryngoscopy: A Randomised, Single-Blinded Trial

2026-07-07T17:35:52+00:00

Background and Aims: Propofol is awidely used induction agent but producesdose-related cardiovascular depression.Nitrous oxide (N₂O), through its analgesic and second-gas effects, may reduce propofolrequirements

MRI-Based Grading of Lumbar Disc Degeneration and Its Correlation with Functional Disability Scores: A Cross-Sectional Analytical Study

2026-07-08T06:53:02+00:00

Lumbar disc degeneration (LDD) is a majorcause of chronic low back pain and functionaldisability worldwide, significantly impactingquality of life and productivity. Magnetic resonance imaging (MRI) is the goldstandard for evaluating structural discchanges, while functional disability

Are Routine Wound Swabs Indicated Before Split-Thickness Skin Grafting? - A Retrospective Observational Study

2026-07-08T09:28:17+00:00

Background: Bacterial contamination is traditionally considered an important determinant of skin graft survival. While quantitative tissue cultures have demonstrated a relationship between bacterial burden and graft take, routine wound swab cultures are commonly performed even in clinically clean wounds. The benefit of this practice remains unclear.

Methods: A retrospective observational study was conducted between January 2023 and December 2024 in a tertiary care centre. Adult patients aged 18–50 years with clinically clean wounds measuring ≥15 × 10 cm and presenting 15–28 days after trauma were included. Patients were divided into two groups: Group A underwent routine pre-operative wound swab culture followed by culture-specific antibiotics, while Group B underwent grafting without routine wound swabs. All wounds were surgically debrided prior to split-thickness skin grafting. Graft take was assessed on postoperative days 2, 5, and 8.

Results: A total of 271 patients were analysed (Group A: 133; Group B: 138). Nearly half of clinically clean wounds (48.9%) in Group A showed no bacterial growth. Mean graft take was comparable between Group A and Group B (72.4% vs 73.7%; p = 0.299). No statistically significant association was observed between routine wound swabbing and graft take.

Conclusion: Routine wound swab cultures do not improve graft take in clinically clean wounds. Meticulous surgical debridement remains the most important determinant of successful skin grafting.

Macular Thickness among Different Refractive States (Emmetropia, Myopia, and Hypermetropia): An Optical Coherence Tomography-Based Comparative Study

2026-07-08T09:33:20+00:00

Background: Refractive errors are among the most common causes of visual impairment worldwide and may influence retinal morphology, particularly macular thickness. Optical Coherence Tomography (OCT) provides a reliable and non-invasive method for quantitative assessment of retinal architecture.

Objective: To compare macular thickness among emmetropic, myopic, and hypermetropic individuals using OCT and evaluate the association between refractive error severity and retinal thickness.

Methods: A hospital-based analytical study was conducted in the Department of Ophthalmology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, from June 2024 to May 2025. A total of 180 participants were enrolled and equally divided into emmetropic (n=60), myopic (n=60), and hypermetropic (n=60) groups. All subjects underwent visual acuity assessment, refraction, fundus examination, and OCT evaluation. Mean macular thickness and central retinal thickness were compared among groups.

Results: Mean macular thickness was significantly lower in myopic eyes (279 ± 8.17 µm) compared with emmetropic (291 ± 1.49 µm) and hypermetropic eyes (294 ± 1.49 µm) (p<0.001). Similarly, central retinal thickness was lowest in myopic eyes (235 ± 13.6 µm) compared with emmetropic and hypermetropic eyes (246 ± 3.0 µm and 246 ± 3.24 µm, respectively) (p<0.001). Increasing myopia was associated with progressive retinal thinning.

Conclusion: Refractive status significantly influences OCT-derived macular thickness measurements. Myopic eyes demonstrate reduced macular and central retinal thickness, while hypermetropic eyes tend to show relatively thicker retinal architecture. Consideration of refractive status is essential for accurate interpretation of OCT findings.

Prevalence and Predictors of Gastrointestinal Motility Disorders in Patients with Diabetes Mellitus

2026-07-08T09:42:49+00:00

Background: Gastrointestinal motility disorders are common but often under-recognized complications of diabetes mellitus and may affect nutrition, glycemic stability, and quality of life.

Objective: To determine the prevalence and predictors of gastrointestinal motility disorders in patients with diabetes mellitus.

Methodology: This cross-sectional analytical study was conducted at Department of Biochemistry, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from 1^st October 2025 to 31^st March 2026 including 190 patients with diabetes mellitus.

Results: Gastrointestinal motility disorders were present in 92 (48.4%) patients. The most common manifestations were gastroesophageal dysmotility/reflux symptoms in 44 (23.2%), suspected diabetic gastroparesis in 38 (20.0%), constipation/colonic dysmotility in 34 (17.9%), and diabetic enteropathy in 26 (13.7%). Patients with motility disorders had higher age (57.8±10.9 vs. 50.8±11.4 years), longer diabetes duration (11.6±5.1 vs. 6.8±4.2 years), higher body mass index (30.7±4.9 vs. 28.1±4.2 kg/m²), and higher HbA1c (9.4±1.7% vs. 7.8±1.3%). HbA1c ≥9% was the strongest predictor of gastrointestinal motility disorders (aOR 3.92; p<0.001), followed by peripheral neuropathy (aOR 3.48), diabetes duration >10 years (aOR 3.11), autonomic neuropathy (aOR 2.94), female gender (aOR 2.26), and body mass index ≥30 kg/m² (aOR 2.18).

Conclusion: Gastrointestinal motility disorders are highly prevalent in diabetic patients and are significantly associated with poor glycemic control, longer diabetes duration, neuropathy, obesity, and female gender.

Impaired Antioxidant Defense and Enhanced Lipid Peroxidation in Osteoporosis: Evaluation of Sod, Cat, Gsh, Gpx, Mda, and Nitric Oxide

2026-07-08T12:17:40+00:00

Objective: To examine the status of antioxidant defense enzymes (SOD, CAT, GSH, GPx), and oxidative stress biomarkers (MDA, NO) in postmenopausal females with osteoporosis.

Materials & Methods: 73 clinically diagnosed osteoporotic females were recruited for the study with a comparison of 20 healthy females of similar ages. Serum samples were obtained during the fasting period and analyzed by standard spectrophotometric, colorimetric and enzymatic methods of superoxide dismutase (SOD), catalase (CAT), glutathione (GHS), glutathione peroxidase (GPx), malondialdehyde (MDA) and nitric oxide (NO). One-way ANOVA was used to analyze data and p values < 0.05 were considered statistically significant.

Results: Osteoporotic patients exhibited significantly depleted antioxidant defenses: SOD (0.12±0.10 vs. 0.47±0.16 nmol/mL), CAT (0.78±0.49 vs. 4.13±0.80 μmol/mol), GSH (2.39±0.97 vs. 9.88±1.16 mg/dL), and GPx (0.21±0.07 vs. 0.63±0.32 IU/mL; all p < 0.001). Conversely, lipid peroxidation and nitrosative stress markers were markedly elevated: MDA (3.81±0.95 vs. 1.34±0.30 nmol/mL) and NO (15.62±1.62 vs. 11.28±1.34 μmol/L; both p < 0.001).

Conclusion: There is a significant decrease of the antioxidant defense system and increase in lipid peroxidation in osteoporosis. The marked reduction in SOD, CAT, GSH and GPx levels along with the increased levels of MDA and NO highlight that oxidative stress is an important mediator of bone resorption. The use of targeted antioxidant modulation could be a promising strategy for adjunctive treatment.

Postoperative Pain in Mesh versus Non-Mesh Inguinal Hernia Repair: A Comparative Retrospective Study from a South Indian Tertiary Care Centre

2026-07-09T11:21:23+00:00

Background: Inguinal hernia repair remains one of the most frequently performed elective general surgical procedures, with mesh-based (tension-free) and non-mesh (tissue-based) techniques representing the two principal approaches. While mesh repair is associated with lower recurrence, its relationship with acute and chronic postoperative pain compared with non-mesh repair remains debated, particularly in Indian tertiary-care populations.

Objective: To compare acute and chronic postoperative pain, analgesic requirement, functional recovery, and complications between mesh and non-mesh inguinal hernia repair, and to identify predictors of chronic post-herniorrhaphy pain.

Methods: This retrospective comparative observational study included 220 patients (110 mesh, 110 non-mesh) undergoing elective open unilateral inguinal hernia repair over a 3-month period. Pain was assessed using the Numerical Rating Scale (NRS, 0–10) at 24 hours, 48 hours, 7 days, 1 month, and 3 months. Analgesic consumption, return to activity, complications, and quality of life (EQ-5D-3L) were recorded. Predictors of chronic pain were identified using multivariate logistic regression, and receiver operating characteristic (ROC) analysis evaluated the predictive value of the 24-hour NRS score.

Results: Mean NRS scores were significantly lower in the mesh group at 24 hours (4.1 ± 1.2 vs 5.3 ± 1.4, p<0.001), 48 hours, and 7 days. Analgesic consumption (42.6 ± 12.3 mg vs 58.9 ± 15.7 mg morphine-equivalent) and return to normal activity (9.8 ± 3.2 vs 13.4 ± 4.1 days) favoured the mesh group. However, chronic pain at 3 months was numerically higher after mesh repair (16.4% vs 10.9%, p=0.21). NRS ≥5 at 24 hours independently predicted chronic pain (odds ratio 3.4, 95% CI 1.9–6.1), with an area under the ROC curve of 0.78.

Conclusion: Mesh repair confers a clear advantage in acute pain control, analgesic sparing, and early functional recovery, without a statistically significant excess of chronic pain in this cohort. Early pain severity is a strong predictor of chronic post-herniorrhaphy pain and may guide targeted follow-up.

A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOME OF MANAGEMENT OF ARTHRITIS OF HIP BY TOTAL HIP REPLACEMENT

2026-07-09T12:22:58+00:00

Background and Objectives: Osteoarthritis (OA)of the hip is a degenerative joint disease thatcauses wear and tear of the articular cartilage,leading to pain, stiffness, and limited mobility. It is prevalent among middle-aged and elderlyadults. Hip OA may be primary or secondary;secondary OA is more common in India

Knowledge, Attitude and Practice Patterns Regarding Medico-Legal Affairs among Indian Ophthalmologists: A Cross-Sectional Survey

2026-07-10T08:38:57+00:00

Background: To assess the knowledge, attitude, and practice (KAP) regarding medico-legal affairs among Indian ophthalmologists and identify areas requiring improvement to strengthen medico-legal preparedness in routine ophthalmic practice.

Methods: A prospective cross-sectional questionnaire-based survey was conducted among 160 ophthalmologists practicing in government and private healthcare institutions in Rajasthan and neighboring regions. A structured pre-validated questionnaire evaluated participants’ demographic characteristics and their knowledge, attitude, and practice regarding medico-legal issues, including informed consent, documentation, medical negligence, emergency care, medico-legal case (MLC) management, police notification, record keeping, professional liability, and communication following complications. Data were analyzed using SPSS version 25.0. Categorical variables were summarized as frequencies and percentages.

Results: Among the 160 participants, junior residents constituted the largest group (43.8%), followed by consultants (37.5%). Most respondents were practicing in government hospitals (73.1%). Overall, participants demonstrated satisfactory medico-legal awareness. A majority correctly identified the need for police notification in grievous ocular injuries (82.5%), mandatory written informed consent before surgery (83.1%), maintenance of medico-legal records (81.9%), and preservation of OPD records (95.6%). Nearly all respondents supported transparent disclosure and communication with patients following complications (98.1%). However, important knowledge gaps were identified regarding eye donation in medico-legal cases, statutory limitation periods, liability associated with equipment failure, and the scope of legal protection provided by informed consent.

Conclusion: Indian ophthalmologists demonstrated generally satisfactory knowledge, positive attitudes, and appropriate medico-legal practices. Nevertheless, deficiencies in selected legal domains indicate the need for structured medico-legal education, regular continuing medical education programs, standardized institutional protocols, and enhanced legal awareness to reduce medico-legal risk and improve patient safety.

Imaging Spectrum of High Altitude Cerebral Edema: MRI Findings and Proposed Severity Classification

2026-07-10T08:56:14+00:00

Purpose: To evaluate the spectrum of magnetic resonance imaging (MRI) findings in patients with high-altitude cerebral edema (HACE) presenting in the Leh–Ladakh region and to assess the distribution and severity of cerebral involvement.

Materials and Method: This retrospective study included 18 patients diagnosed with HACE between 2021 and 2024 in the Leh–Ladakh region. MRI examinations were reviewed for the pattern and extent of cerebral involvement, including corpus callosal lesions, white matter abnormalities, diffusion restriction, and hemorrhagic changes on gradient recalled echo (GRE)/susceptibility-weighted imaging (SWI) sequences.

Results: The most common MRI finding was isolated involvement of the splenium of the corpus callosum, observed in 44.4% (8/18) of patients. Diffuse corpus callosal involvement was seen in 27.8% (5/18), while isolated periventricular white matter abnormalities were identified in 16.7% (3/18). Mixed involvement of the corpus callosum and cerebral white matter was present in 11.1% (2/18) of cases. Diffusion restriction, indicative of cytotoxic edema, was demonstrated in approximately 88.9% (16/18) of patients. Microbleeds on GRE/SWI sequences were detected in 22.2% (4/18) of patients and were more commonly associated with extensive disease. The corpus callosum, particularly the splenium, was the most consistently affected structure.

Conclusion: HACE demonstrates a broad spectrum of MRI manifestations ranging from isolated reversible splenial lesions to extensive white matter involvement with hemorrhagic changes. The corpus callosum, especially the splenium, is the most frequently involved structure. Recognition of these characteristic imaging patterns can facilitate early diagnosis, guide timely therapeutic intervention, and improve outcomes in individuals exposed to high-altitude environments.

A Study on Adherence to Medication and Quality of Life Assessment among Patients with Depression and Bipolar Disorder in a Government Tertiary Care Teaching Hospital

2026-07-10T09:08:53+00:00

Background: Medication adherence is a key determinant of successful treatment outcomes in patients with depression and bipolar disorder. Poor adherence is associated with relapse, hospitalization, and impaired quality of life (QoL). This study assessed medication adherence and its association with QoL among patients with depression and bipolar disorder receiving psychiatric care.

Methods: A prospective analytical study was conducted among 100 adult patients (50 with bipolar disorder and 50 with depression) attending the Psychiatry Department of Government Teaching General Hospital, Eluru, between February and May 2026. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS), while quality of life was evaluated using the WHOQOL-BREF questionnaire. Assessments were performed at baseline and during follow-up visits. Correlation analysis, comparison of means, and binary logistic regression were used to identify factors associated with medication adherence. Statistical significance was considered at p<0.05.

Results: Mean QoL scores improved significantly from 56.56±16.42 at baseline to 100.55±13.99 at the seventh week. Medication adherence scores also increased significantly from 6.71±1.86 to 7.51±1.77, with the proportion of adherent participants rising from 70% to 84%. Medication adherence demonstrated a significant positive correlation with QoL throughout follow-up (r=0.493 to 0.637. Adherent participants consistently had significantly higher QoL scores than non-adherent participants. Multivariable logistic regression identified bipolar disorder as an independent predictor of medication adherence (AOR=5.959; 95% CI: 1.390–25.542).

Conclusions: Medication adherence improved significantly during follow-up and was strongly associated with better quality of life. Patients with bipolar disorder demonstrated higher odds of adherence than those with depression. Regular patient education, adherence reinforcement, and structured follow-up may enhance treatment outcomes and quality of life among individuals with severe mental illness.

Red Blood Cell Alloimmunization in Multi-Transfused Patients: A Prospective Study of Antibody Screening and Identification

2026-07-10T10:27:28+00:00

Background: Red blood cell (RBC) transfusion is an indispensable therapeutic intervention for patients with chronic hematological disorders requiring repeated transfusions, including β-thalassemia major, sickle cell disease, aplastic anemia, myelodysplastic syndrome, and chronic kidney disease. Although transfusion improves survival and quality of life, repeated exposure to foreign erythrocyte antigens may result in the development of alloantibodies. Red cell alloimmunization complicates future transfusion therapy by causing delays in locating compatible blood, increasing the risk of hemolytic transfusion reactions, and contributing to transfusion failure. Early antibody screening and identification therefore play an essential role in ensuring safe transfusion practices. Objectives: To determine the prevalence of red blood cell alloimmunization among multi-transfused patients, identify the spectrum of clinically significant alloantibodies, evaluate demographic and clinical factors associated with alloimmunization, and assess the importance of routine antibody screening before transfusion. Materials and Methods: A prospective observational study was conducted among 100 multi-transfused patients attending the Department of Transfusion Medicine over a 24-month period. Patients receiving three or more packed red blood cell transfusions were enrolled. Blood samples were subjected to ABO and Rh typing, antibody screening using the indirect antiglobulin test, and antibody identification with commercially available reagent cell panels whenever screening was positive. Demographic details, underlying diagnoses, transfusion history, and laboratory findings were recorded. Statistical analysis was performed using SPSS version 25, with p < 0.05 considered statistically significant. Results: Among 100 enrolled patients, RBC alloantibodies were detected in 14% of cases. Females demonstrated a higher alloimmunization rate than males. The most frequently identified antibodies belonged to the Rh blood group system, particularly anti-E and anti-c, followed by antibodies against the Kell system. Patients receiving more than 20 transfusions exhibited significantly higher alloimmunization rates than those receiving fewer transfusions (p < 0.05). Increasing transfusion burden and longer duration of transfusion therapy were independently associated with alloantibody formation. Conclusion: Red blood cell alloimmunization remains a significant complication among multi-transfused patients. Routine antibody screening and identification, combined with extended antigen matching for clinically significant blood group antigens, can substantially reduce alloimmunization and improve transfusion safety.

Infant and Young Child Feeding Practices as Determinants of Severe Acute Malnutrition Among Under-Five Children

2026-07-10T15:13:05+00:00

Objective: To examine the relationshipbetween infant and young child feeding practices and severe acute malnutrition inunder five children

Association Between Serum Vitamin D Levels and Clinical Severity of Plantar Fasciitis: A Cross-Sectional Study

2026-07-10T15:17:00+00:00

Plantar fasciitis is the most common causeof chronic heel pain, accounting for nearly80% of painful heel disorders encounteredin orthopedic practice. The condition ischaracterized by degeneration of the plantarfascia resulting from repetitive mechanical stress, microtears, and chronicinflammation. Recent evidence suggests

A comparative study of local anaesthetic agent levobupivacaine and ropivacaine in ultrasound guided erector spinae plane block in patients undergoing laparoscopic cholecystectomy

2026-07-10T18:02:01+00:00

Introduction: Laparoscopiccholecystectomy is frequently associatedwith moderate to severe postoperative pain,necessitating effective multimodal analgesia.The erector spinae plane block (ESPB) hasemerged as an effective regional technique,but the optimal local anesthetic agent for thisblock remains underexplored.

Comparison of hemodynamic changes in patients undergoing laparoscopic cholecystectomy using rocuronium and vecuronium for intubation and maintenance under general anaesthesia

2026-07-10T18:04:55+00:00

BackgroundLaparoscopic cholecystectomy is thestandard minimally invasive treatment forsymptomatic gallbladder disease. General
anaesthesia is preferred because it ensures airway protection, controlled ventilation

Clinical Profile and Outcomes of Scrub Typhus with Multi-Organ Dysfunction Syndrome (MODS)

2026-07-10T18:08:38+00:00

Background: Scrub typhus is a re-emergingzoonotic disease caused by Orientia tsutsugamushi and has become an importantcause of acute undifferentiated febrileillness in India. Delayed diagnosis

A STUDY TO COMPARE DEXMEDETOMIDINE, TRAMADOL AND PETHIDINE IN THE PREVENTION OF INTRAOPERATIVE SHIVERING AFTER SPINAL ANAESTHESIA

2026-07-10T18:44:13+00:00

Background:-Shivering is a common and distressing experience to patients which occurs either during orimmediately after the surgery. It is defined as an involuntary, repetitive activity of skeletalmuscles 1.Spinal anaesthesia impairs the thermoregulatory system by inhibiting vasoconstriction, and results in redistribution of core heat to the periphery from the trunk.

A prospective study to compare pericapsular nerve group (PENG) block versus fascia iliaca compartment block (FICB) for pain control in hip surgeries

2026-07-10T18:47:42+00:00

Background:-Regional anesthesia techniques provide good postoperative analgesia leading to higher patient
satisfaction and better outcomes. Fascia Iliaca compartment block (FICB) is a routinely usedanalgesic technique for hip surgeries but it does not provide enough analgesia. Hence, a novelblock called Pericapsular nerve group (PENG) block is studied.

Effect of a 5-minute Educational Video Versus Conventional Verbal Counselling on Preoperative Anxiety in Patients Undergoing Elective Surgery: A Prospective Randomized Controlled Study

2026-07-10T18:49:49+00:00

Background:-Preoperative anxiety is experienced by a substantial proportion of patients undergoing elective surgery and
is associated with increased perioperative stress responses, higher anaesthetic requirements, postoperativepain, prolonged recovery, and reduced patient satisfaction. Conventional preoperative counselling is usuallyprovided verbally; however, the quality and consistency of information may vary between healthcareproviders. Short educational videos offer standardized information and may improve patient understandingwhile reducing anxiety.

A Comparative Evaluation of Hemodynamic Stability, Safety Profile, and Postoperative Outcomes of PENG Block and Supra-Inguinal Fascia Iliaca Compartment Block in Peri-Articular Hip Surgeries

2026-07-11T07:40:42+00:00

Background: Effective postoperativeanalgesia following peri-articular hipsurgeries is essential for early mobilization,functional recovery, and patient satisfaction.The Pericapsular Nerve Group (PENG) blockhas emerged as a motor-sparing regional
analgesic technique that specifically targetsthe sensory innervation of the anterior hip capsule, whereas the Supra-Inguinal

Evaluation of Automated Hematology Analyzer (DXH 800) Flags in Detection of Plasmodium vivax: A Comparative Study with Peripheral Blood Smear

2026-07-11T07:50:05+00:00

Malaria remains a major parasitic disease in endemic regions. Peripheral blood smear (PBS) examination is the gold standard for diagnosis; however, it is time-consuming and observer dependent. Automated hematology analyzers such as DXH 800 provide rapid screening and generate abnormal flags that may indicate malaria (World Health Organization et al. [1]). This study evaluates 50 confirmed cases of Plasmodium vivax and correlates analyzer findings with PBS. All cases showed analyzer flag positivity. One case initially missed on smear was later detected after analyzer alert. The study emphasizes the importance of automated systems as adjunct tools in malaria, detection.

Hepatic Dysfunction in Dengue Virus Infection: Spectrum, Severity, and Prognostic Implications

2026-07-11T08:12:09+00:00

Background: Liver involvement is a well-recognised complication of dengue virus infection, yet its frequency, pattern, and relationship to disease severity remain incompletely characterised in adult populations from endemic regions. Objective: This retrospective study evaluated the nature and extent of hepatic biochemical disturbances across the clinical spectrum of dengue illness and identified markers associated with adverse outcomes. Methods: Records of 196 laboratory-confirmed adult dengue cases with complete liver function test (LFT) data were examined. Cases were categorised as dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) according to standard WHO criteria. Hepatic parameters assessed included serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), serum albumin, and the international normalised ratio (INR). Results: Elevated transaminases were the predominant abnormality, with AST and ALT exceeding the upper limit of normal in 95.4% and 91.8% of patients respectively. A disproportionate rise in AST relative to ALT was consistently observed (mean AST 328.4 ± 44.1 U/L vs. ALT 202.7 ± 29.5 U/L; p = 0.021). Hyperbilirubinaemia (22.1%), hypoalbuminaemia (27.6%), and elevated ALP (34.2%) were less frequent. Patients with DSS showed significantly greater derangement across all hepatic parameters versus DF patients. Bilirubin, ALT, and ALP were markedly elevated in the setting of haemorrhage, secondary infection, and among non-survivors. Conclusions: Transaminase elevation is near-universal in dengue infection, with preferential AST rise serving as an early diagnostic pointer. Hyperbilirubinaemia and elevated ALP and ALT are associated with haemorrhagic complications, re-infection, and mortality, suggesting their utility as prognostic biomarkers in dengue management.

Association of Multidrug-Resistant Bacterial Infections with Histopathological Severity, Antibiotic Outcomes, and Community-Level Risk Factors in Surgical Wound Infections

2026-07-11T13:04:49+00:00

Background: Multidrug-resistant (MDR) organisms increasingly complicate surgical wound infections and may worsen tissue damage, delay healing, and reduce antibiotic effectiveness.

Objective: To determine the association of MDR bacterial infections with histopathological severity, antibiotic outcomes, and community-level risk factors in surgical wound infections.

Methods: This cross-sectional analytical study included 120 patients with surgical wound infections from January 2024 to January 2025 at the Department of Pathology, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan, in collaboration with the Department of Microbiology, Sharif Medical and Dental College, Lahore, Pakistan. Wound specimens were cultured, antibiotic susceptibility was assessed, and tissue samples were examined histopathologically. Clinical outcomes and risk factors were analyzed.

Results: MDR bacterial infection was identified in 68 patients (56.7%), while 52 patients (43.3%) had non-MDR infection. MDR infection was significantly associated with diabetes mellitus (50.0% vs 23.1%; p=0.003), prior antibiotic use (66.2% vs 25.0%; p<0.001), delayed presentation (58.8% vs 25.0%; p<0.001), poor hygiene (55.9% vs 21.2%; p<0.001), and previous hospitalization (45.6% vs 19.2%; p=0.003). Severe histopathological involvement was more frequent in MDR cases than non-MDR cases (41.2% vs 13.5%; p=0.001). MDR infections showed lower favorable antibiotic response (38.2% vs 76.9%; p<0.001), higher repeat debridement (42.6% vs 15.4%; p=0.001), and longer hospital stay (9.6 ± 3.4 vs 6.1 ± 2.7 days; p<0.001).

Conclusion: MDR surgical wound infections were common and were associated with severe tissue injury, poor antibiotic response, and adverse clinical outcomes.

Role of Micronutrients in Maintaining Bone Health and Reducing Long-Term Health Risks among Postmenopausal Women

2026-07-11T13:34:05+00:00

Objective: To assess the contribution of micronutrients to bone health and the prevention of long-term health risks in post-menopausal women.

Methods: This cross-sectional analytical study was conducted from January 2024 to August 2025 at the Department of Gynaecology and Obstetrics, KRL Hospital, Islamabad, Pakistan, in collaboration with Shaikh Zayed Medical College, Rahim Yar Khan, Pakistan. A total of 130 postmenopausal women were enrolled. Demographic, dietary, clinical history, serum micronutrient, and bone mineral density were measured. The levels of serum vitamin D, calcium, magnesium, zinc, alkaline phosphatase, and parathyroid hormone (PTH) were determined. Bone mineral density was evaluated using dual-energy X-ray absorptiometry.

Results: The mean age was 59.4 ± 7.1 years, and the mean duration since menopause was 9.2 ± 5.6 years. Vitamin D deficiency was found in 78 (60.0%) women, calcium insufficiency in 52 (40.0%), magnesium deficiency in 44 (33.8%), and zinc deficiency in 49 (37.7%). Osteopenia was present in 55 (42.3%) participants, while osteoporosis was observed in 39 (30.0%). Osteoporosis was significantly more frequent among women with vitamin D deficiency (42.3%), calcium insufficiency (46.2%), magnesium deficiency (45.5%), and zinc deficiency (44.9%). A single micronutrient deficiency was independently associated with osteoporosis, with an adjusted OR of 4.18 (95% CI: 1.81–9.67, p<0.001).

Conclusion: Micronutrient deficiencies were common among postmenopausal women and were significantly associated with osteoporosis and long-term skeletal health risks.

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy Using Clinical, Sonographic and Biochemical Parameters: A Retrospective Study

2026-07-13T10:00:38+00:00

Background: Laparoscopic cholecystectomy (LC) is the gold standard for the surgical management of gallbladder disease. A subset of cases, however, proves technically difficult, resulting in prolonged operative time or conversion to open cholecystectomy. Preoperative identification of such cases allows more informed surgical planning, resource allocation, and patient counselling.

Aim: This study aimed to preoperatively predict difficult laparoscopic cholecystectomy and the likelihood of conversion to open cholecystectomy (OC) using a combination of clinical parameters, sonographic findings, and biochemical markers. The secondary objective was to correlate the composite clinico-sonographic scoring with intraoperative findings.

Methods: A retrospective study was carried out on 88 patients who underwent elective laparoscopic cholecystectomy at PESIMSR Hospital, Kuppam, over a period of 18 months. Clinical parameters, ultrasonographic findings, and biochemical markers were recorded and statistically correlated with intraoperative findings and total duration of surgery.

Results: The majority of patients were female (67.1%), with a mean age of 41 years. Prolonged surgery (>2 hours) was associated with male gender, presence of comorbidities, prior abdominal surgery, elevated alkaline phosphatase (ALP), and abnormal total leukocyte count (TLC). Sonographic features, including gallbladder wall thickening, pericholecystic fluid, multiple calculi, and a distended gallbladder, correlated significantly with increased surgical difficulty. Only one patient (1.1%) required conversion to open surgery.

Conclusion: Preoperative assessment combining clinical, sonographic, and biochemical parameters is an effective and reproducible strategy for predicting difficult LC. Systematic use of this composite approach can aid surgical planning, improve patient counselling, and help minimise intraoperative and postoperative complications.

The Role of Artificial Intelligence in Addressing Antimicrobial Resistance: Challenges, Opportunities, and Strategic Interventions

2026-07-13T10:54:55+00:00

AIMR is an emerging global health problem which affects the efficacy of critical medicines and treatment failure in clinical and public-health settings. This review provides insights into the current role of AI in tackling antimicrobial resistance across the four A's of surveillance, diagnostics, antimicrobial stewardship and drug discovery, as well as in the integration of One Health. The paper reviews the evidence, using a narrative review format and a scoping review approach with principles, synthesizing evidence from the global burden studies, clinical microbiology, machine learning research, stewardship literature and antimicrobial innovation frameworks. The review highlights the potential of using AI to enhance the use of AMR response, such as identifying resistance trends at an earlier stage, forecasting risk of resistance at the patient level, speeding up interpretation of diagnostics, improve antimicrobial prescribing, and broaden the exploration of new antimicrobials. But adoption of AI is still hindered by siloed health data systems, scarce external validation, algorithmic bias, poor interoperability of AI systems, regulatory ambiguity and poor infrastructure within health systems. The paper concludes that AI should be used as a clinically informed decision-making support infrastructure, not as a substitute for the knowledge and experience of a clinical team, laboratory capacity, or public-health stewardship.

Effect of Pre-Prosthetic Surgical Alveoloplasty on Post-Prosthetic Mucosal Pathologies, Denture Retention, and Stability in Complete Denture Patients: A Systematic Review and Meta-Analysis

2026-07-13T11:21:00+00:00

Background: Pre-prosthetic surgical alveoloplasty is widely taught and practised as a means of optimising the alveolar ridge before complete denture fabrication, yet the degree to which it measurably improves post-prosthetic mucosal health, retention, and stability compared with denture fabrication without alveoloplasty has not been systematically established.

Objectives: This systematic review aimed to evaluate the effect of pre-prosthetic surgical alveoloplasty, relative to no alveoloplasty, on post-prosthetic mucosal pathology, denture retention, and denture stability in adult complete denture patients.

Methods: PubMed, Embase, the Cochrane Library, Web of Science, and Scopus were searched from January 2010 to June 2026 for randomised controlled trials and comparative cohort studies. Two reviewers independently screened records, extracted data, and assessed methodological quality using RoB 2 and ROBINS-I. A random-effects meta-analysis was planned a priori, with heterogeneity to be quantified using the I² statistic and publication bias to be assessed via funnel plot and Egger's test where a sufficient number of studies permitted.

Results: The search identified 118 records, of which 9 underwent full-text review. No randomised controlled trial or comparative cohort study directly comparing alveoloplasty with no alveoloplasty for mucosal pathology, retention, or stability outcomes met inclusion criteria; all excluded full texts lacked a concurrent non-surgical comparator or did not measure the outcomes of interest. Consequently, quantitative meta-analysis could not be performed for any outcome domain. A narrative synthesis of indirect and descriptive evidence, including single-arm case series and cross-sectional prevalence data, is presented in place of pooled effect estimates, following Synthesis Without Meta-analysis (SWiM) reporting guidance.

Conclusions: No controlled comparative evidence currently exists to confirm or refute the clinical benefit of pre-prosthetic alveoloplasty for post-prosthetic mucosal health, retention, or stability. Current practice rests on biomechanical rationale and uncontrolled case series rather than comparative trial evidence, representing a substantial evidence gap that adequately powered comparative studies should address.

A Study on Solitary Nodule of Thyroid Gland: Evaluation of Risk Factors Associated With Occurrence of Malignancy, Diagnostic Modalities and Management at a Tertiary Care Hospital

2026-07-13T12:36:18+00:00

Background: A solitary thyroid nodule is a single, discrete swelling within an otherwise normal thyroid gland, encountered frequently in surgical practice. Although 80–90% of such nodules are benign, a solitary nodule carries a higher individual risk of malignancy (11–20%) than a nodule within a multinodular goitre (~5%), which makes systematic clinical, cytological and histopathological evaluation essential for rational management.

Aim: To study the incidence of malignancy in solitary thyroid nodules, to evaluate the risk factors associated with malignant transformation, and to correlate fine needle aspiration cytology (FNAC) with final histopathological examination (HPE) at a tertiary care teaching hospital.

Methods: This prospective observational study was conducted in the Department of General Surgery at a tertiary care teaching hospital over a two-year period. Seventy-nine patients above 12 years of age with a clinically palpable thyroid swelling who consented to surgical management were enrolled. Detailed history, clinical examination, thyroid function tests, ultrasonography and FNAC were performed in all patients, who subsequently underwent thyroidectomy with histopathological correlation of the resected specimen.

Results: The mean age of presentation was 42.65 ± 13.91 years (range 17–72 years), with marked female preponderance (94.94%; male:female = 1:19). Swelling of more than 24 months' duration was seen in 55.75% of patients. FNAC classified 82.28% of nodules as benign, 10.13% as suspicious of malignancy and 7.69% as suspicious follicular neoplasm. On final histopathology, colloid goitre (72.15%) was the commonest diagnosis, followed by papillary carcinoma (11.39%), lymphocytic thyroiditis (10.13%) and follicular carcinoma (6.33%); no anaplastic carcinoma was recorded. The overall malignancy rate was 17.72%, and FNAC showed a sensitivity of 91.8% and specificity of 98.3% against histopathology.

Conclusion: Solitary thyroid nodules in this cohort predominantly affected middle-aged women and were mostly benign, but nearly one in six harboured malignancy, chiefly papillary carcinoma. FNAC remains a reliable first-line triage tool, but its imperfect sensitivity for follicular lesions justifies histopathological confirmation of all resected specimens, and a low threshold for surgery in nodules with suspicious cytology or high-risk clinical features.

EFFECT OF ROCURONIUM ON MEASURED EXPIRATORY TIDAL VOLUME BEFORE AND AFTER CHECKING MASK VENTILATION IN PATIENTS WITH NORMAL AIRWAYS; A RANDOMIZED DOUBLE BLIND INTERVENTIONAL STUDY

2026-07-14T06:19:43+00:00

Background: Facemask ventilation is one ofthe fundamental skills required during induction of anaesthesia. Especially in cases ofdifficult tracheal intubation, it is an importantalternative to ensure adequate oxygenationuntil the patient’s airway can be secured

Pterygium Surgery Using Anchored Conjunctival Rotation Flap Vs Conjunctival Autograft – A Comparative Study

2026-07-14T07:27:57+00:00

Background: Pterygium is a common ocular surface disorder characterized by fibrovascular proliferation of conjunctival tissue onto the cornea, often resulting in irritation, cosmetic concerns, induced astigmatism, and visual impairment. Conjunctival autograft is widely regarded as the standard surgical treatment; however, anchored conjunctival rotation flap surgery has emerged as an alternative technique with potential advantages in surgical efficiency and graft stability. This study compared the efficacy, safety, and postoperative outcomes of anchored conjunctival rotation flap and conjunctival autograft techniques in the management of primary pterygium.

Methods: A hospital-based analytical comparative study was conducted at the Department of Ophthalmology, Jawaharlal Nehru Medical College, Ajmer, from June 2024 to May 2025. Eighty patients with primary pterygium were enrolled and equally divided into two groups: conjunctival autograft (Group A, n=40) and anchored conjunctival rotation flap (Group B, n=40). Demographic characteristics, surgical duration, postoperative astigmatism, complications, and recurrence rates were evaluated during follow-up visits up to one year. Statistical analysis was performed using SPSS version 26.0, with p<0.05 considered statistically significant.

Results: Baseline demographic and clinical characteristics were comparable between the groups. Mean surgical duration was significantly shorter in the rotation flap group (27.4±5.4 minutes) compared with the autograft group (30.25±5.3 minutes) (p=0.020). Both groups demonstrated significant reduction in postoperative astigmatism, with a significant intergroup difference observed at three months (p=0.026). Recurrence occurred in 5.0% of patients in the autograft group and 8.1% in the rotation flap group. Postoperative complications were mild and self-limiting in both groups.

Conclusion: Both conjunctival autograft and anchored conjunctival rotation flap techniques are safe and effective for primary pterygium surgery. The anchored conjunctival rotation flap technique offers shorter operative time with comparable clinical outcomes, making it a reliable alternative to conjunctival autografting.

Functional Outcome of Displaced Transverse Patellar Fracture Treated With Tension Band Wiring: A Prospective Interventional Study

2026-07-14T07:34:39+00:00

Background: Displaced transverse fractures of the patella disrupt the extensor mechanism of the knee and usually require surgical fixation to restore articular congruity, knee function, and early mobilization. Tension band wiring (TBW) remains the standard treatment for these fractures because it converts tensile forces into compressive forces at the fracture site during knee flexion. However, functional recovery and postoperative complications continue to vary among patients.

Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Geetanjali Medical College and Hospital, Udaipur, India, between April 2024 and October 2025. Forty adult patients with displaced transverse patellar fractures underwent open reduction and internal fixation using the AO tension band wiring technique. Functional outcome was assessed using the Böstman scoring system during serial follow-up visits up to 24 weeks. Demographic characteristics, operative details, postoperative complications, and sequential improvements in pain, range of motion, stability, and overall function were analyzed using appropriate statistical methods. A p-value <0.05 was considered statistically significant.

Results: The majority of patients were 41–50 years old (72.5%), and males accounted for 60% of the study population. Road traffic accidents were the most common mechanism of injury (45%). Most procedures were completed within 70–90 minutes (82.5%). Immediate postoperative complications were uncommon, with surgical site infection and swelling each occurring in 2.5% of patients, while late complications included restricted knee motion (7.5%) and implant failure (2.5%). The mean total Böstman score was 26.63 ± 5.14. Excellent functional outcomes were achieved in 47.5% of patients, good outcomes in 37.5%, and poor outcomes in 15%, resulting in an overall satisfactory outcome rate of 85%. Significant improvements were observed in pain, range of motion, stability, and functional performance throughout the 24-week follow-up period (p<0.01).

Conclusion: Tension band wiring provides reliable fixation for displaced transverse patellar fractures, resulting in satisfactory functional recovery, low complication rates, and significant improvement in knee function. The technique remains an effective, reproducible, and cost-effective surgical option for appropriately selected patients.

A Comparison of Insulin Sensitivity and Lipid Profile in Tobacco Chewers and Non-Tobacco Chewers Participants

2026-07-14T10:28:27+00:00

Background: Tobacco chewing is a prevalent habit in many populations and has been implicated in metabolic disturbances, including insulin resistance and dyslipidemia. This study aimed to compare insulin sensitivity and lipid profile parameters between tobacco chewers and non-tobacco chewers.

Methods: A cross-sectional study was conducted among 100 participants, divided into two groups: 50 regular tobacco chewers and 50 age- and sex-matched non-tobacco chewers. Fasting blood glucose, fasting serum insulin, and lipid profile parameters (total cholesterol, triglycerides, low-density lipoprotein [LDL], and high-density lipoprotein [HDL]) were measured. Insulin resistance was assessed using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Statistical analysis was performed using independent t-test, with p < 0.05 considered significant.

Results: Tobacco chewers showed significantly higher fasting blood glucose (110 ± 13 mg/dL in tobacco chewers. 93 ± 11mg/dL, p < 0.01) in non-tobacco chewers, fasting insulin levels (19.5 ± 4.5 µIU/mL vs. 11.5 ± 2.9 µIU/mL, p < 0.01), and HOMA-IR values (4.3 ± 1.1 vs. 2.6 ± 0.7, p < 0.001) compared to non-chewers. Lipid profile analysis revealed significantly elevated total cholesterol (212.5 ± 27 mg/dL vs. 171.20 ± 20.7 mg/dL), triglycerides (181. ± 30 mg/dL vs. 129.3 ± 25 mg/dL), and LDL (128 ± 17 mg/dL vs. 105.4 ± 14 mg/dL), along with reduced HDL levels (38 ± 5 mg/dL vs. 58.9 ± 6 mg/dL) in tobacco chewers (p < 0.05 for all).

Conclusion: Tobacco chewing is significantly associated with reduced insulin sensitivity and an adverse lipid profile. These findings highlight the increased risk of metabolic disorders, including type 2 diabetes mellitus and cardiovascular disease, among tobacco users. Preventive strategies and awareness programs are essential to reduce tobacco consumption and its associated metabolic risks.

A Comparative Study of Fentanyl with Ropivacaine versus Dexmedetomidine with Ropivacaine for Epidural Anaesthesia in Lower Limb Orthopaedic Surgery: A Randomized Controlled Trial

2026-07-14T11:46:23+00:00

Epidural anaesthesia has become a cornerstone of modern anaesthesia practice, offering effective intraoperative and postoperative pain relief, particularly for abdominal and lower limb surgeries.[1] It facilitates early mobilization, reduces postoperative pain, and improves recovery, resulting in shorter hospital stays and better patient outcomes.[2]

Comparative Outcomes in Endobag versus Direct Extraction of Gall Bladder Specimen in Laproscopic Cholecystectomy from a Tertiary Care Hospital

2026-07-14T11:59:43+00:00

Aims & Objectives: To evaluate and compare the incidence of spillage and contamination during endo bag extraction and direct extraction. To assess the operative time difference between the two techniques.

Materials and Methods:

SAMPLE: Patient admitted in the Institute of General Surgery, Rajiv Gandhi Government General Hospital and who underwent laparoscopic cholecystectomy during the period August 2024 to March 2025.

Sample Size: 132 STUDY: Prospective cohort study

Inclusion Criteria: Patient above 18 years of age Patients diagnosed with symptomatic gallbladder disease requiring laparoscopic cholecystectomy (e.g., cholelithiasis, chronic cholecystitis). Patients who provide informed consent to participate in the study

Exclusion Criteria: Complicated Gallbladder Disease: Cases with acute cholecystitis, empyema, or gangrene of the gallbladder, where emergency intervention is necessary. Previous Abdominal Surgery: Patients with a history of major abdominal surgeries leading to significant adhesions, which may impact gallbladder retrieval. Conversion to Open Surgery: Patients requiring conversion from laparoscopic to open cholecystectomy during the procedure

Results

In our study 132 cases were included who underwent laparoscopic cholecystectomy and there were 66 patients in Group A, where direct extraction of gall bladder was done and 66 cases in Group B, where endobag extraction was done. The age range of the patients were in the range 20 – 75 years. Male: female ratio was found to be 1:1 in our study. Around 85% patients in the study had comorbidities. In around, 53.79% cases the extraction was done through epigastric port while 46.21% cases it was done through umbilical port. The mean operative time in Group A was found to be 81.03 min and in group B it was 77.3 min and the p value was 0.04 which showed that direct extraction consumed more time than endobag extraction. Group B had significant decrease in stone spillage, bile spillage, port site spillage, port site infection, port site hernia when compared to Group A

Assessment of Rational Prescribing Awareness and Influencing Factors among Clinicians in North-West Maharashtra: A Cross-Sectional Study

2026-07-14T12:10:56+00:00

Background: Rational prescribing is essential for safe and cost-effective healthcare; however, pharmaceutical marketing and institutional factors may influence prescribing behavior. Data from tertiary care settings in North-West Maharashtra remain limited.

Methods: A cross-sectional, non-interventional survey was conducted among clinicians practicing in tertiary care outpatient departments in North-West Maharashtra. A pre-validated digital questionnaire assessed awareness of rational prescribing, influencing factors, exposure to pharmaceutical promotion, and institutional support mechanisms. The calculated minimum sample size was 103; 122 complete responses were analyzed. Associations were assessed using the Chi-square test, and multivariate logistic regression identified independent predictors of moderate-to-high perceived commercial influence. A p-value <0.05 was considered statistically significant.

Results: Most clinicians demonstrated moderate-to-high awareness of rational prescribing principles. Clinical efficacy, safety, and cost were the most commonly reported determinants of prescribing decisions, although a substantial proportion acknowledged pharmaceutical marketing influence. Fewer years of clinical experience and exposure to pharma-sponsored educational activities were independently associated with higher perceived commercial influence (p <0.05), while availability of prescription audits showed a protective effect.

Conclusion: Despite adequate awareness, commercial exposure and limited institutional oversight significantly influenced prescribing behavior. Strengthening audit systems and promoting independent continuing medical education may enhance rational prescribing practices.

Manifestations and Myocarditis in Hospitalized Adults with Scrub Typhus: A Prospective Cohort Study from South India

2026-07-14T12:17:32+00:00

Background: Scrub typhus is an important cause of acute febrile illness in South India and may produce cardiovascular involvement through endothelial injury, vasculitis and systemic inflammation. However, the burden and clinical impact of myocarditis in adult scrub typhus remain insufficiently characterized.

Materials and Methods: This prospective cohort study included 50 hospitalized adults with confirmed scrub typhus in a tertiary care centre in South India. Demographic details, clinical features, laboratory parameters, illness severity scores, electrocardiographic findings, cardiac biomarkers, echocardiographic parameters, treatment requirements and outcomes were recorded. Myocardial injury was defined by elevated troponin T, while myocarditis was presumed when myocardial injury was associated with global left ventricular systolic dysfunction.

Results: The mean age was 49.41 ± 16.1 years, with female predominance. Fever was universal, breathlessness occurred in 64%, and eschar was present in 40%. The cohort had severe systemic illness, with ICU admission in 60%, ventilatory support in 60%, vasoactive support in 56%, and mortality of 10%. Myocardial injury was observed in 31 patients (62%), myocardial dysfunction in 15 (30%), myocarditis in 11 (22%), diastolic dysfunction in 11 (22%), and pericardial involvement in 26 (52%). Patients with myocarditis had higher SOFA scores, more cardiovascular failure, greater inotropic and ventilatory requirement, and longer hospital stay. Mortality was comparable between groups.

Conclusion: Cardiac involvement is common in hospitalized scrub typhus. Systematic assessment with cardiac biomarkers and bedside echocardiography is useful, especially in patients with shock, respiratory failure or high SOFA score.

Clinical Profile, Etiological Spectrum, and Three-Month Outcomes of Hyponatremia in Hospitalized Geriatric Patients: A Prospective Longitudinal Observational Study

2026-07-14T12:46:37+00:00

Background: Hyponatremia is the most common electrolyte disorder among hospitalized older adults and is associated with increased morbidity, mortality, prolonged hospitalization, and poor clinical outcomes. Data on its clinical profile and outcomes in South Indian geriatric patients remain limited.

Objectives: To evaluate the clinical profile, etiological spectrum, and three-month outcomes of hyponatremia among hospitalized geriatric patients.

Materials and Methods: A prospective longitudinal observational study was conducted in the Department of General Medicine, PES Institute of Medical Sciences and Research, Kuppam, from March 2024 to September 2025. Fifty-seven patients aged ≥60 years with serum sodium <130 mEq/L were enrolled. Clinical features, etiological factors, laboratory findings, treatment, serial serum sodium levels, complications, and outcomes were recorded. Data were analyzed using IBM SPSS Statistics version 23.0. A p-value <0.05 was considered statistically significant.

Results: Acute hyponatremia (82.5%) and hypervolemic hyponatremia (57.9%) were the predominant presentations. Drug-induced hyponatremia (29.8%), infections (28.1%), and SIADH (28.1%) were the leading etiologies. Mean serum sodium increased significantly from 122.03 ± 6.37 mEq/L at admission to 136.24 ± 2.95 mEq/L at discharge and 139.95 ± 2.48 mEq/L at three months (p<0.001). Recovery was observed in 86.0% of patients at discharge and 96.5% at three months, with mortality in one patient (1.8%).

Conclusion: Hyponatremia in hospitalized geriatric patients was predominantly acute and hypervolemic, with drug-induced causes, infections, and SIADH accounting for most cases. Early etiological evaluation, medication review, and individualized management resulted in significant improvement in serum sodium concentrations and favorable three-month outcomes.

Hepatic Hydatid Disease: A Case Series of Three Patients Managed Surgically

2026-07-14T13:09:48+00:00

Background: Hydatid disease is a parasitic zoonosis caused by the larval stage of Echinococcus granulosus(Jarvis, 2025). The liver is the most commonly affected organ, accounting for approximately 60–70% of cases(Derbel et al., 2012). Although many patients remain asymptomatic for prolonged periods, enlarging cysts may cause symptoms and complications requiring surgical intervention(Bayrak & Altıntaş, 2019).

Case Presentation: We present a series of three patients diagnosed with hepatic hydatid cysts. A 42-year-old male presented with right upper abdominal pain and was found to have an 8 × 7 cm cyst in segment VI. A 35-year-old female presented with abdominal fullness and was diagnosed with a 7 × 6 cm cyst in segment IV. A 50-year-old male presented with abdominal pain and nausea and was found to have a 9 × 8 cm cyst in segment III. All patients underwent preoperative albendazole therapy followed by open surgical management consisting of cyst evacuation with omentoplasty or drainage.

Results: All three patients underwent successful surgical treatment without intraoperative complications. Postoperative recovery was uneventful, and all patients received postoperative albendazole therapy. No recurrence was observed during follow-up.

Conclusion: Hepatic hydatid disease remains a significant health problem in endemic regions(Bachar et al., 2025). Early diagnosis through imaging and timely surgical intervention combined with antiparasitic therapy provides excellent outcomes(Bachar et al., 2025; Nunnari, 2012).

Development and Validation of an Imaging-Based Prediction Model for Stone-Free Outcomes after Flexible Ureteroscopy

2026-07-14T13:18:21+00:00

Objective: To devise and externally validate a complete, imaging-based predictive nomogram for estimating the probability of stone-free status (SFS) after flexible ureteroscopy (fURS) for upper urinary tract calculi using advanced parameters from non-contrast computed tomography (NCCT).

Material And Methods: Retrospective study, which comprised 850 consecutive patients with renal and proximal ureteral stones from January 2023 to December 2025. The cohort was randomly divided into a training set (n=600) and an external validation set (n=250). Advanced imaging parameters such as stone volume, maximum Hounsfield units (HU), skin to stone distance (SSD), infundibulopelvic angle (IPA), and renal pelvic area were extracted from pre-operative NCCT. A multivariate logistic regression model was created and presented as a nomogram.

Results: The overall SFS rate was 78.8% (670/850). LASSO and multivariate analyses showed that stone volume, maximal HU, SSD, IPA, and severe hydronephrosis were independent predictors of SFS (all p < 0.05). The imaging-based nomogram demonstrated excellent discrimination in both the training cohort (AUC = 0.865, 95% CI: 0.832-0.898) and the validation cohort (AUC = 0.841, 95% CI: 0.795-0.887).

Conclusion: The imaging-based prediction model newly developed and validated, is an accurate tool for predicting stone-free results following fURS. This will enable the use of advanced NCCT morphological and densitometric parameters for preoperative counseling and for optimizing surgical decision-making in endourology.

Metformin and Insulin in the Treatment of Gestational Diabetes- A Retrospective Case-Control Study

2026-07-15T07:36:49+00:00

Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy associated with increased maternal and neonatal complications. Insulin has traditionally been considered the standard pharmacological treatment; however, metformin has emerged as an effective oral alternative due to its ease of administration, lower cost, and improved patient compliance. This study aimed to compare maternal glycemic control and pregnancy outcomes among women with GDM treated with metformin and insulin.

Methods: A retrospective case-control study was conducted in the Department of Obstetrics and Gynaecology, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India, from January 2025 to June 2026. A total of 150 women diagnosed with GDM were included and divided into two groups: 75 women treated with metformin and 75 women treated with insulin. Maternal characteristics, glycemic parameters, pregnancy complications, mode of delivery, and neonatal outcomes were collected from medical records and compared between the groups. Statistical analysis was performed using IBM SPSS version 25.0, with p-value <0.05 considered statistically significant.

Results: The baseline maternal characteristics, including age, BMI, and gravidity, were comparable between the groups. Both metformin and insulin achieved similar glycemic control, with no significant difference in fasting blood glucose, postprandial blood glucose, or HbA1c levels. Maternal complications such as pregnancy-induced hypertension, preeclampsia, polyhydramnios, and preterm labour were slightly lower in the metformin group but were not statistically significant. Caesarean delivery rates were lower among women receiving metformin (36.0%) compared with insulin (42.6%). Neonatal outcomes including birth weight, APGAR score, neonatal hypoglycemia, NICU admission, and respiratory complications were comparable between both groups. A trend toward fewer neonatal complications was observed in the metformin group.

Conclusion: Metformin demonstrated glycemic efficacy and maternal-neonatal outcomes comparable to insulin in the management of gestational diabetes mellitus. Due to its oral administration, cost-effectiveness, and favorable safety profile, metformin can be considered a suitable alternative to insulin in appropriately selected women with GDM.

Assessment of Vitamin D Deficiency in Lactating Women Attending a Tertiary Care Hospital

2026-07-15T08:12:27+00:00

Background: Vitamin D deficiency is a major public health concern affecting women of reproductive age worldwide. Lactating women are particularly vulnerable because of increased maternal nutritional demands and inadequate dietary intake, which may adversely affect both maternal health and breast milk vitamin D content. Early identification of vitamin D deficiency is essential for preventing maternal osteomalacia, osteoporosis, and impaired infant skeletal development.

Objectives: To assess the prevalence of vitamin D deficiency among lactating women attending a tertiary care hospital and to evaluate its association with demographic, nutritional, and biochemical parameters.

Materials and Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, ESIC Medical College, Kalaburagi, from November 2022 to October 2023. A total of 100 lactating women were enrolled after obtaining informed consent. Demographic details, dietary habits, sunlight exposure, anthropometric measurements, and obstetric history were recorded. Serum 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus, alkaline phosphatase, haemoglobin, and other relevant biochemical parameters were estimated. Vitamin D status was classified according to the Endocrine Society guidelines. Statistical analysis was performed using SPSS version 25.0, and a p-value <0.05 was considered statistically significant.

Results: The mean age of participants was 27.1 ± 3.9 years. Vitamin D deficiency (<20 ng/mL) was observed in 58% of women, while 24% had insufficiency and only 18% had sufficient vitamin D levels. Vitamin D deficiency was significantly associated with lower sunlight exposure (p=0.012), vegetarian diet (p=0.041), higher BMI (p=0.026), prolonged lactation (p=0.048), lower serum calcium (p=0.003), and lower hemoglobin levels (p=0.014). No significant association was observed with maternal age.

Conclusion: Vitamin D deficiency is highly prevalent among lactating women attending a tertiary care hospital. Routine screening of high-risk mothers, nutritional counseling, adequate sunlight exposure, and appropriate vitamin D supplementation should be incorporated into postpartum care to improve maternal and infant health outcomes.

A Study on Determination of Gestational Age by Ultrasonographic Femur Length Estimation

2026-07-15T08:20:26+00:00

Background: Accurate estimation of gestational age (GA) is fundamental to optimal antenatal care, guiding decisions regarding fetal growth assessment, timing of delivery, and management of high-risk pregnancies. Ultrasonography has become the standard method for fetal dating, and femur length (FL) is one of the most reliable biometric parameters, particularly during the second and third trimesters.

Objectives: To determine gestational age using ultrasonographic femur length estimation and evaluate its correlation and accuracy in comparison with gestational age calculated from the last menstrual period (LMP).

Materials and Methods: A prospective observational study was conducted among 200 pregnant women with singleton pregnancies attending the Department of Radiodiagnosis, Kodagu Institute of Medical Sciences, Madikeri, from January 2024 to June 2025. Femur length was measured using standard obstetric ultrasonographic techniques. Gestational age estimated from femur length was compared with gestational age based on LMP and composite fetal biometric parameters. Data were analyzed using SPSS version 25.0. Pearson correlation and Student's t-test were applied, with p<0.05 considered statistically significant.

Results: The mean maternal age was 26.8 ± 4.3 years, and 54% were multigravida. Mean femur length was 52.8 ± 14.7 mm. Gestational age estimated by femur length closely agreed with LMP-derived gestational age (28.4 ± 6.2 vs. 28.6 ± 6.3 weeks; p=0.184). Femur length demonstrated a very strong positive correlation with gestational age (r=0.984, p<0.001). Accurate gestational age estimation within ±1 week of LMP was observed in 82% of cases, with an overall diagnostic accuracy of 95.5%.

Conclusion: Ultrasonographic femur length is a highly reliable and accurate parameter for determining gestational age during the second and third trimesters. It demonstrates excellent correlation with gestational age derived from LMP and composite fetal biometric measurements and should remain an integral component of routine obstetric ultrasonography.

Association of Cesarean Study with Chronic Low Back Ache in Multiparous Women – A Hospital Based Study

2026-07-15T08:25:23+00:00

Background: Chronic low back ache is a common musculoskeletal complaint among women after childbirth and can significantly impair quality of life. The increasing rate of cesarean section has raised concerns regarding its long-term effects on maternal musculoskeletal health. This study aimed to evaluate the association between previous cesarean section and chronic low back ache in multiparous women.

Methods: A hospital-based observational study was conducted at the Department of Obstetrics and Gynaecology, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, from April 2024 to March 2025. A total of 200 multiparous women were included, comprising 100 women with a history of one or more cesarean sections and 100 women with previous vaginal deliveries. Demographic details, obstetric history, prevalence and severity of chronic low back ache, functional disability, and associated risk factors were assessed using a structured questionnaire, clinical examination, the Visual Analog Scale (VAS), and the Oswestry Disability Index (ODI). Statistical analysis was performed using IBM SPSS Statistics version 25.0, with p < 0.05 considered statistically significant.

Results: The baseline demographic and obstetric characteristics were comparable between the two groups. Chronic low back ache was significantly more prevalent among women with previous cesarean section than those with vaginal delivery (61.0% vs. 39.0%, p = 0.002). Women in the cesarean group had significantly higher pain severity and greater functional disability scores. Obesity (BMI ≥30 kg/m²) and multiple cesarean sections were significantly associated with chronic low back ache. Women with previous cesarean section had 2.45 times higher odds of developing chronic low back ache compared with women who had only vaginal deliveries.

Conclusion: Previous cesarean section is significantly associated with chronic low back ache in multiparous women. Early identification of at-risk women, along with postpartum physiotherapy, core strengthening exercises, and weight management, may help reduce long-term musculoskeletal morbidity and improve maternal quality of life.

A Prospective Observational Study on Osteoporosis in Postmenopausal Women Attending Opd

2026-07-15T08:33:00+00:00

Background: Osteoporosis is a major public health problem among postmenopausal women due to estrogen deficiency, leading to accelerated bone loss, decreased bone mineral density (BMD), and an increased risk of fragility fractures. Early diagnosis and identification of risk factors are essential for timely intervention and prevention of fracture-related morbidity.

Objectives: To determine the prevalence of osteoporosis among postmenopausal women attending the outpatient department and to evaluate the association of osteoporosis with demographic, clinical, and biochemical risk factors.

Materials and Methods: A prospective observational study was conducted among 100 postmenopausal women attending the Outpatient Department of Kodagu Institute of Medical Sciences, Madikeri, Karnataka, from February 2024 to January 2025. Detailed demographic and clinical data were collected. Bone mineral density was assessed using Dual-Energy X-ray Absorptiometry (DEXA) at the lumbar spine and femoral neck. Osteoporosis was diagnosed according to the World Health Organization (WHO) criteria based on T-scores. Data were analyzed using SPSS version 26.0, and a p-value <0.05 was considered statistically significant.

Results: The mean age of participants was 56.3 ± 6.8 years. Osteopenia was observed in 41% of women, while osteoporosis was diagnosed in 35%. The prevalence of osteoporosis increased significantly with advancing age (p=0.008) and duration since menopause (p=0.002). Vitamin D deficiency was present in 44% of participants and showed a significant association with osteoporosis (p=0.012). Low physical activity and inadequate dietary calcium intake were the most common modifiable risk factors.

Conclusion: Osteoporosis and osteopenia are highly prevalent among postmenopausal women. Advancing age, prolonged duration since menopause, Vitamin D deficiency, inadequate calcium intake, and sedentary lifestyle significantly contribute to reduced bone mineral density. Routine DEXA screening and preventive strategies should be encouraged for early diagnosis and fracture prevention.

Robotic-Assisted Versus Conventional Laparoscopic Hysterectomy for Benign Gynaecological Conditions: A Systematic Review and Meta-Analysis of Clinical Outcomes, Perioperative Efficiency, and Complications

2026-07-15T13:17:13+00:00

Background: Robotic-assisted laparoscopic hysterectomy (RALH) has been increasingly adopted for benign gynaecological indications, yet its comparative value relative to conventional laparoscopic hysterectomy (CLH) remains debated, given its higher acquisition and operative cost.

Objectives: This systematic review and meta-analysis aimed to compare RALH and CLH with respect to operating time, estimated blood loss, conversion rate, length of hospital stay, complication rates, return to normal activity, and cost among adult women undergoing hysterectomy for benign gynecological disease.

Methods: PubMed, Embase, the Cochrane Library, Web of Science, and Scopus were searched from January 2010 to June 2026 for randomized controlled trials and comparative cohort studies. Data were extracted independently by two reviewers, risk of bias was assessed using RoB 2 and ROBINS-I, and random-effects meta-analysis was performed where heterogeneity was substantial. Heterogeneity was quantified using the I² statistic, and publication bias was evaluated through funnel plot inspection and Egger's test.

Results: Nine comparative studies (two randomized trials and seven cohort studies) met the inclusion criteria, collectively encompassing several hundred thousand women when the largest contributing national cohort is included. Pooled analysis demonstrated no statistically significant difference between RALH and CLH in operating time, conversion rate, or complication rates. A non-significant trend favored RALH for estimated blood loss and length of hospital stay, while cost was consistently and significantly higher with RALH, exceeding CLH by approximately US$1,600 to US$2,500 per case in the United States cohorts.

Conclusions: Current evidence does not demonstrate clinically meaningful superiority of RALH over CLH for benign hysterectomy, while cost remains substantially higher for the robotic approach. Adoption decisions should weigh institutional cost structures, surgeon proficiency, and case complexity rather than assumed clinical superiority.

Mucosal Hyperplasia and Antifungal Efficacy of Modified Versus Conventional Soft Denture Liners: A Systematic Review and Meta-Analysis

2026-07-15T13:26:24+00:00

Background: Soft denture lining materials are frequently colonised by Candida albicans, contributing to denture stomatitis and, in chronically affected patients, inflammatory papillary hyperplasia of the denture-bearing mucosa. Incorporation of antifungal or antimicrobial agents into soft liners has been proposed as a strategy to reduce fungal colonisation and improve mucosal health relative to conventional, unmodified liners.

Objectives: This systematic review aimed to evaluate the antifungal efficacy of modified versus conventional soft denture liners against Candida albicans, and to characterise the available evidence on mucosal response, including inflammatory papillary hyperplasia and denture stomatitis severity, and on liner mechanical properties associated with antimicrobial modification.

Methods: A targeted literature search identified in vitro and clinical studies comparing antimicrobial-modified soft denture liners with unmodified controls. Twenty-two unique records were identified and screened; twelve studies met inclusion criteria and were assessed in full text, with all twelve confirmed eligible and included in narrative synthesis. Quantitative synthesis was performed descriptively where studies reported directly comparable antifungal-efficacy data; formal statistical meta-analysis was not performed, given substantial heterogeneity in modifying agent, liner base material, and outcome metric across the included literature.

Results: Twelve studies were included: eleven in vitro (bench) studies and one randomised clinical trial. Modifying agents included silver nanoparticles, chitosan, plant-derived compounds (garlic, neem, tea tree oil), and synthetic pharmacological agents (nystatin, chlorhexidine, ketoconazole, miconazole, itraconazole). Silver nanoparticle-modified silicone liners demonstrated concentration-dependent antifungal efficacy ranging from 16.3% to 52.5%. Plant-derived and chitosan-based modifications consistently inhibited C. albicans growth in vitro. Chlorhexidine diacetate produced a dose-related antifungal effect and measurable drug release, whereas chlorhexidine hydrochloride showed no inhibitory effect, indicating that antifungal efficacy is salt-form dependent for at least one agent. Mechanical property data from a cluster of related in vitro studies indicated that most antifungal agents at minimum inhibitory concentration preserved liner hardness and tensile strength, with the exception of miconazole and itraconazole, which reduced tensile strength and, for miconazole, increased hardness at 14 days. In the single identified clinical trial, nystatin- and chlorhexidine-modified liners achieved complete absence of mycelial Candida on palatal cytological smears by day 14, compared with persistence of mycelial forms in patients receiving an unmodified liner. No included study reported inflammatory papillary hyperplasia as a graded clinical outcome.

Conclusions: Antimicrobial modification of soft denture liners consistently reduces Candida albicans colonisation relative to conventional liners across the available in vitro and limited clinical evidence, with agent- and concentration-dependent effects on liner mechanical integrity. The evidence base for mucosal hyperplasia specifically remains critically underdeveloped, and well-designed clinical trials using standardised hyperplasia grading are needed before firm clinical recommendations can be made regarding this specific outcome.

Quality of Life Among Patients Receiving Treatment for Multidrug-Resistant Tuberculosis in Raichur District: A Cross-Sectional Assessment

2026-07-16T05:04:20+00:00

Background: Multidrug-resistanttuberculosis is associated with prolongedtreatment, adverse drug reactions,psychological distress, social stigma,nutritional impairment, and financialdifficulties. These factors may substantially reduce patients’ quality of life despitecontinued clinical and microbiologicalmanagement. Assessment of quality of life istherefore important for identifying domains

Association Between Subclinical Hypothyroidism and Diabetic Nephropathy Among Patients With Type 2 Diabetes Mellitus: A Cross Sectional Study

2026-07-16T05:49:00+00:00

Background:-Thyroid dysfunction is a common finding inpatients with type 2 diabetes mellitus (T2DM),the most common anomaly being subclinicalhypothyroidism (SCH). SCH may beimplicated in the development and progression of diabetic microvascular complications,particularly diabetic nephropathy, emergingevidence suggests. However, data from SouthIndia are limited

Video laryngoscope versus Macintosh laryngoscope for tracheal intubation in anticipated difficult airways (Mallampati III–IV): a prospective randomized controlled trial

2026-07-16T06:02:35+00:00

Background: Airway management is acrucial aspect of anaesthetic practice, and failed tracheal intubation can result inserious complications such as hypoxemia,aspiration, and cardiovascular instability.The Macintosh laryngoscope

A Study on Functional Outcome of Proximal Femur Nailing Without Distal Locking In Intertrochanteric Fracture Cases

2026-07-16T08:19:24+00:00

Background: Intertrochanteric fractures are common injuries in the elderly and are associated with significant morbidity and loss of mobility. Proximal femur nailing (PFN) is widely accepted for their management; however, the necessity of distal locking in selected fracture patterns remains controversial. This study evaluated the functional outcomes of PFN without distal locking in intertrochanteric fractures.

Materials and Methods: This prospective hospital-based observational study was conducted in the Department of Orthopaedics, ESIC Medical College and Hospital, Kalaburagi, Karnataka, from June 2025 to May 2026. A total of 30 adult patients with AO/OTA 31-A1 and 31-A2 intertrochanteric fractures underwent PFN without distal locking. Patients were followed for 12 months. Clinical, radiological, and functional outcomes were assessed. Functional outcome was evaluated using the Harris Hip Score (HHS), while secondary outcomes included operative duration, blood loss, time to fracture union, time to full weight-bearing, hospital stay, and postoperative complications.

Results: The mean age of the patients was 66.2 ± 9.1 years, and 60% were males. Slip and fall was the most common mechanism of injury (63.3%). The mean operative duration was 56.7 ± 8.5 minutes, mean blood loss was 92.4 ± 18.9 mL, and mean hospital stay was 5.6 ± 1.3 days. Radiological union was achieved in 29 patients (96.7%) with a mean union time of 13.1 ± 2.0 weeks. The mean Harris Hip Score at final follow-up was 89.3 ± 8.2. Excellent functional outcomes were observed in 50.0% of patients, good outcomes in 33.3%, fair outcomes in 13.3%, and poor outcomes in 3.4%. Overall, 83.3% of patients achieved excellent or good functional results. Postoperative complications were minimal, with one case each of superficial infection, delayed union, and varus collapse, and no cases of implant failure, screw cut-out, nonunion, or reoperation.

Conclusion: Proximal femur nailing without distal locking is a safe and effective treatment for selected intertrochanteric fractures, providing high union rates, satisfactory functional outcomes, shorter operative time, and a low complication rate. Careful patient selection and meticulous surgical technique are essential for achieving optimal results.

Analysis of Serum Vitamin D levels in Pediatric Patients with Autism Spectrum Disorder

2026-07-16T08:59:04+00:00

Background:-Autism spectrum disorder also calledASD is identified as issues with communicationand show repetitive behavior. Causes of ASDare complex and are not fully understood,however, they are thought to be multifactorial with genetic components and someenvironmental factors. One such environmentalfactor may be Vitamin D, which is aneurosteroid hormone. ASD and otherneurodevelopmental disorders have a growingamount of evidence for the involvement ofneurosteroids and neuroimmunomodulation

Evaluating the Efficacy of Intramuscular Iron Treatment in Pediatric Patients with Severe Iron Deficiency Anemia: A Pilot Study

2026-07-16T09:05:03+00:00

Background: Iron deficiency anemia (IDA)is a common public health problem among children, particularly in low- and middleincome countries. Oral iron therapy is theconventional treatment for IDA; however,poor absorption, gastrointestinal side effects

COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK VERSUS TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN INGUINAL HERNIA REPAIR

2026-07-16T12:14:25+00:00

Background: Effective postoperative painmanagement following inguinal hernia repair facilitates early mobilization, reducesopioid consumption, and improves patientrecovery.

CORRELATION OF THE DOSE INDEX AND COPD ASSESSMENT TEST (CAT) SCORE IN PREDICTING RECURRENT EXACERBATIONS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2026-07-16T12:16:20+00:00

Background: Chronic obstructivepulmonary disease (COPD) is a majorcause of morbidity and mortalityworldwide, with acuteexacerbationscontributing significantly to diseaseprogression, recurrent hospitalizations,impaired quality of life, and increasedhealthcare costs. Accurate assessment ofdisease severity and prediction of futureexacerbations are essential for optimizingpatient management. This study evaluatedthe relationship between the DOSE Indexand CAT score and their ability to predictclinical outcomes in patients with acute exacerbation of COPD.

Incidence and Early Management of Post-Cholecystectomy Bile Duct Injury

2026-07-16T13:35:18+00:00

Background: Bile duct injury (BDI) is an uncommon but potentially devastating complication of cholecystectomy that carries substantial risk of long-term morbidity when recognition or repair is delayed¹, and outcomes are strongly influenced by injury grade, timing of diagnosis, and the expertise of the treating team².

Objectives: To determine the incidence of bile duct injury among patients undergoing cholecystectomy at a tertiary care centre, and to describe the clinical profile, management strategies and outcomes of the affected patients.

Methods: This retrospective observational study analysed a masterchart of 150 consecutive patients who underwent open or laparoscopic cholecystectomy at this tertiary care centre over the study period. Patients who developed bile duct injury were identified from this cohort, and data on their Strasberg classification, timing and mode of presentation, procedure performed, postoperative complications, hospital stay, and follow-up outcome were extracted and analysed descriptively.

Results: Of the 150 patients who underwent cholecystectomy, the mean age was 46.8 ± 15.5 years, with a female preponderance (68.0%), and the index procedure was performed laparoscopically in 84.0%. Bile duct injury occurred in 4 of 150 patients, an overall incidence of 2.7%. Among these four patients, Strasberg type E2 injury was the commonest (2 of 4, 50.0%), with one type E1 and one type D injury (25.0% each). Injury was recognised intraoperatively in 1 patient; among the remaining three, diagnosis was most often made between postoperative days 4–7 (2 of 4, 50.0%). Jaundice and bile leak were the leading modes of clinical presentation. Roux-en-Y hepaticojejunostomy was performed in 2 of 4 patients (50.0%), with primary repair and ERCP with stenting used in one patient each. One patient (25.0%) developed a postoperative bile leak that resolved with conservative management; the mean hospital stay among the four affected patients was 10.5 ± 3.2 days. At follow-up, all four patients (100%) had normal liver function tests and patent biliary drainage; three (75.0%) were classified as fully recovered and one (25.0%) recovered after a secondary endoscopic intervention.

Conclusion: Bile duct injury occurred in a small minority of patients (2.7%) undergoing cholecystectomy at this centre. Structured, early referral-based management tailored to Strasberg grade was associated with excellent recovery and low morbidity in all affected patients, reinforcing the case for prompt recognition and centralised repair of this complication.

Study of Microalbuminuria as a Marker in Patients with Septicemia-A Prospective Study in a Tertiary Care Teaching Centre

2026-07-17T08:04:22+00:00

Background: Sepsis remains a major cause of ICU mortality worldwide. Early risk stratification is crucial for improving outcomes. We investigated urinary albumin-to-creatinine ratio (UACR) as a non-invasive biomarker of endothelial dysfunction in sepsis.

Methods: Prospective observational study of 89 ICU patients with sepsis admitted to a tertiary care center. Serial UACR measurements were performed at admission (spot), 24 hours, and 48 hours. Additional biomarkers (CRP, lactate) and clinical outcomes were recorded. Statistical analysis used Mann-Whitney U test.

Results: At baseline (spot UACR), values were comparable between survivors and non-survivors (51.11 vs 51.25 mg/g, p=1.0). By 24 hours, non-survivors showed higher UACR (128.66 vs 106.9 mg/g, p=0.0275). At 48 hours, UACR was significantly elevated in non-survivors (174.08 vs 100.35 mg/g, p<0.001), exceeding the discriminatory power of CRP and lactate. Serial UACR monitoring showed progressive divergence between survivors and non-survivors over time. Demographics showed 60.7% survival rate; older age groups (70-79 years) had highest mortality (67%). Gram-negative organisms predominated (65% of cultures).

Conclusions: UACR at 48 hours is a powerful, non-invasive prognostic marker in sepsis. Serial monitoring is superior to single baseline measurements. UACR reflects systemic endothelial dysfunction and serves as a practical alternative to conventional biomarkers, particularly in resource-limited settings.a

Combined Diagnostic Utility of ACR-TIRADS, Fine Needle Aspiration Cytology and Histopathology in the Evaluation of Thyroid Nodules: A Prospective Study

2026-07-17T11:30:16+00:00

Background: Thyroid nodules are a common clinical problem, with malignancy occurring in approximately 4.5–6.5% of cases. High-resolution ultrasonography, combined with the American College of Radiology–Thyroid Imaging Reporting and Data System (ACR-TIRADS), has emerged as an effective tool for stratifying malignancy risk and guiding the need for fine-needle aspiration cytology (FNAC). Despite its increasing use, limited Indian data exist correlating ACR-TIRADS scores with final histopathology.

Aim: To evaluate the combined diagnostic performance and correlation of ACR-TIRADS, Fine Needle Aspiration Cytology (FNAC), and histopathological examination in patients with thyroid nodules.

Materials and Methods: This prospective observational study included 120 consecutive patients who underwent thyroidectomy after preoperative ultrasonography using ACR-TIRADS at a tertiary care centre in South India. Ultrasound features including composition, echogenicity, margins, shape, and echogenic foci were used to categorize nodules from TR1 to TR5. FNAC was selectively performed, and histopathology served as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Statistical significance was determined using Chi-square test (p < 0.05).

Results: Of 120 nodules, 98 (81.7%) were benign and 22 (18.3%) malignant. Malignancy rates increased progressively with higher TIRADS categories. TIRADS demonstrated high sensitivity and NPV but lower specificity, reflecting overlap of suspicious sonographic features between benign and malignant lesions. The correlation between TIRADS score and histopathological outcome was statistically significant (p = 0.001).

Conclusion: Although ACR-TIRADS provides effective risk stratification of thyroid nodules, definitive diagnosis cannot be established by ultrasonography alone. FNAC serves as an essential intermediate diagnostic modality, while histopathological examination remains the gold standard. The combined use of TIRADS, FNAC, and histopathology provides the highest diagnostic accuracy and should be adopted for comprehensive evaluation of thyroid nodules.

Development and Validation of a Gas Chromatographic Method for Determination of Residual Solvents in Propofol API

2026-07-17T11:38:35+00:00

Objective: To develop and validate a simple, sensitive, and reliable Headspace Gas Chromatography method coupled with Flame Ionization Detection (HS-GC-FID) for the determination of residual solvents in Propofol Active Pharmaceutical Ingredient (API) in accordance with International Council for Harmonisation (ICH) guidelines.

Methods: Chromatographic separation was achieved using a DB-624 column with nitrogen as the carrier gas under optimized temperature programming conditions. N-Methyl-2-pyrrolidone (NMP) was used as the diluent for the preparation of standard and sample solutions. The residual solvents analyzed in the study were isopropyl alcohol (IPA) and cyclohexane. The developed method was validated as per ICH Q2(R2) guidelines for specificity, linearity, precision, accuracy, limit of detection (LOD), limit of quantification (LOQ), and robustness.

Results: The developed method demonstrated good specificity with well-resolved peaks and no interference at the retention times of IPA and cyclohexane. Excellent linearity was observed over the studied concentration range with correlation coefficients (R²) of 0.9904 and 0.9908 for IPA and cyclohexane, respectively. Precision studies showed low %RSD values, indicating good repeatability of the method. Accuracy studies demonstrated acceptable recovery results within the specified limits. The obtained LOD and LOQ values confirmed adequate sensitivity for trace-level analysis of residual solvents. Robustness studies indicated that minor deliberate variations in chromatographic conditions did not significantly affect the analytical performance of the method.

Conclusion: The validated HS-GC-FID method was found to be simple, precise, accurate, robust, and suitable for routine quality control analysis of residual solvents in Propofol API, ensuring compliance with pharmaceutical safety and regulatory requirements.

Challenges in the Application of ITART Clinical Diagnostic Criteria Among Patients with Suspected Dermatophytosis Infection: A Cross Sectional Study from a Tertiary Care Centre

2026-07-17T14:28:37+00:00

Background: The Indian Associationof Dermatologists, Venereologists andLeprologists Task Force AgainstRecalcitrant Tinea (ITART) proposedstandardized clinical criteria for thediagnosis and classification of dermatophytosis. Although thesecriteria have improved uniformity

B SCAN ULTRASONOGRAPHY IN PREOPERATIVE EVALUATION OF POSTERIOR SEGMENT IN DENSE CATARACT-A CROSS SECTIONAL STUDY

2026-07-18T06:10:42+00:00

Background: In patients with dense ormature cataract, fundus view maybeobscured or not visible at all .In these cases,
B scan ultrasonography before surgery cangive vital information regarding the status ofvitreous ,retina, choroid and sclera B scan ultrasonography is one of the most efficient

The Brother Who Betrayed: A Rare Case of Strangulated Ileal Obstruction Due to Perforated Meckel's Diverticulum in a Post-Gastrectomy Patient – A Case Report

2026-07-18T07:24:59+00:00

Background: Small bowel obstruction (SBO) is a common surgical emergency. In patients with a history of major abdominal surgery, postoperative adhesions account for 60–75% of cases and are routinely presumed to be the underlying etiology. However, congenital anomalies such as Meckel's diverticulum can occasionally complicate in adulthood, mimicking adhesive intestinal obstruction and posing a significant diagnostic challenge.

Case Presentation: A 66-year-old male with a history of subtotal gastrectomy with Roux-en-Y reconstruction for gastric carcinoma presented with clinical and radiological signs of acute mechanical small bowel obstruction. Given his surgical history, adhesive bands were highly suspected. Emergency exploratory laparotomy, however, revealed a perforated Meckel's diverticulum forming a constricting fibrous band around the distal ileum, leading to closed-loop strangulation, compromised bowel viability, and a localized mesenteric hematoma. Segmental ileal resection with a double-barrel ileostomy was performed. The postoperative course was uneventful.

Conclusion: This case highlights that previous abdominal surgery should not automatically rule out rare congenital etiologies like Meckel's diverticulum in adults presenting with SBO. Maintaining a broad differential diagnosis and performing a meticulous intraoperative exploration are critical to avoiding diagnostic delays and mitigating bowel ischemia.

A Comparison of a Single Point versus Two-Point Injection Technique to Block Sciatic Nerve by Posterior Approach Using Sono Guidance: A Randomized Controlled Trial

2026-07-20T08:02:21+00:00

Background: Sciatic nerve blocks are essential for effective pain management in lower limb surgeries. This study compares the efficacy and duration of analgesia between single-point and two-point ultrasound-guided injection techniques for sciatic nerve blocks.

Methods: This randomized controlled trial was conducted at Dr. Sampurnanand Medical College, involving 100 patients undergoing below-knee surgeries. Participants were allocated to either the single-point injection group (SP) or the two-point injection group (DP) through randomization. The primary outcomes measured were the time to perform the block, onset times of sensory and motor blockade, duration of analgesia, and procedural complications.

Results: The time to perform the block was shorter in the SP group (9.97 ± 1.03 minutes) compared to the DP group (15.69 ± 1.49 minutes; p<0.001). However, the DP group exhibited faster onset of sensory (11.14 ± 1.62 minutes) and motor blockade (15.73 ± 1.44 minutes) and a longer duration of analgesia (421.80 ± 34.39 minutes), all statistically significant compared to the SP group.

Conclusion: The two-point injection technique, while more time-consuming, enhances the effectiveness of sciatic nerve blocks by providing a quicker onset and prolonged duration of analgesia compared to the single-point technique. These findings suggest that the two-point technique may be preferable for surgeries requiring extended postoperative pain management.

Patient-Reported Chemotherapy-Related Toxicities in Patients with Solid Malignancies: A Prospective Observational Study

2026-07-20T08:06:51+00:00

Background: Chemotherapy remains a cornerstone in the management of solid malignancies but is frequently associated with treatment-related toxicities that adversely affect patients' quality of life and treatment adherence. Patient-reported outcomes provide a more comprehensive assessment of symptom burden than clinician-reported evaluations and facilitate timely identification of adverse events.

Objective: To evaluate the frequency, severity, and overall burden of patient-reported chemotherapy-related toxicities among patients with solid malignancies receiving systemic chemotherapy.

Methods: A prospective observational study was conducted in the Department of Radiation Oncology at SMS Medical College, Jaipur. Fifty adult patients with histologically confirmed solid malignancies receiving chemotherapy were enrolled. Patient-reported toxicities were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Demographic characteristics, clinical variables, chemotherapy intent, and toxicity profiles were analyzed using descriptive statistics, while associations between cancer type and common toxicities were evaluated using the Chi-square test.

Results: The majority of participants were aged 40–60 years (66.0%), and 54.0% were male. Breast cancer (32.0%) was the most common malignancy, followed by colorectal (28.0%), stomach (26.0%), and head and neck cancers (14.0%). Fatigue (88.0%) was the most frequently reported toxicity, followed by loss of appetite (78.0%), nausea (54.0%), and diarrhea (50.0%). Grade 1–2 toxicities predominated, while Grade 3 toxicities occurred in 30.0% of patients. Significant associations were observed between cancer type and the occurrence of diarrhea (p=0.014), mucositis (p=0.009), and vomiting (p=0.043).

Conclusion: Patient-reported outcomes revealed a substantial burden of chemotherapy-related toxicities, with fatigue and appetite loss being the most prevalent symptoms. Routine incorporation of patient-reported toxicity monitoring may facilitate earlier symptom recognition, improve supportive care, and optimize treatment outcomes in patients with solid malignancies.

The Significance of Octreotide in the Treatment of Mild to Moderate Acute Pancreatitis.

2026-07-20T18:00:55+00:00

Background:-Acute pancreatitis is a potentially life-threatening inflammatory disease of the pancreas with clinical manifestations ranging from mild self-limiting disease to severe systemicillness with multiorgan failure.[1] Octreotide, a long-acting somatostatin analogue,inhibits pancreatic exocrine secretion and has been used as an adjunct in themanagement of acute pancreatitis.[2]

PHENOTYPIC DETECTION AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF EXTENDED-SPECTRUM BETA LACTAMASE PRODUCING GRAM-NEGATIVE BACILLI

2026-07-21T07:20:14+00:00

Background: Globally, antimicrobialresistance emerges as one of the major public health threats. Excessive orinappropriate use of antimicrobials inhealthcare settings over the last fewdecades has been acontributing factor inthe emergence of drug resistance

DIAGNOSTIC ACCURACY OF E-FAST IN DETECTING PNEUMOTHORAX IN TRAUMA PATIENTS AND ITS COMPARISON WITH MULTIDETECTOR COMPUTED TOMOGRAPHY

2026-07-21T07:22:16+00:00

Background: Traumatic pneumothorax isa common and potentially life-threateningconsequence of chest trauma that requiresprompt diagnosis and management toprevent respiratory compromise andprogression to tension pneumothorax. Although multidetector computedtomography (MDCT) is considered the gold standard for diagnosing pneumothorax

The Staining Effect of Mouthwash Containing Silver Nitrate Mouthwash on Dental Enamel: A Comparative Study

2026-07-21T07:33:23+00:00

This in-vitro study evaluated and compared the enamel staining potential of a 0.011% w/v silver nitrate solution and an ionic silver based mouthwash (SilvOral®️ supplied by ALPINIA pharmaceuticals) on extracted human premolars. Forty teeth without caries were randomly allocated to three groups: silver nitrate (n=20), ionic silver mouthwash (n=20) and distilled water control (n=20). Colorimetric measurements (ΔE, L, C, H*) were taken by Vita Easyshade®️ spectrophotometer at baseline (T1), after 24h immersion (T2) and after brushing (T3). Results found that the silver nitrate group was significantly discolored with the mean ΔE value of 10.9 in T2, with a great variation towards dark shades (C3-C4), a decrease in lightness (mean L*=-1.2). In contrast, in the mouthwash group, lighter Vita shades (A3-A4) were maintained, higher lightness values (mean L* = +8.4) were achieved and lower perceptible change of color was registered (mean ΔE = 6.3). It was found that while the stain caused by silver nitrate was largely permanent, the mouthwash group was able to partially reverse the stain (ΔE of 4.8) after brushing. Analysis of variance (ANOVA, p < 0.05) confirmed the color stability was significantly better with the mouthwash. These results indicate that the ionic silver mouthwash has lower and greater reversible enamel discoloration than silver nitrate and support it to have a safer esthetic profile for clinical application.

A Comparative Study of Efficacy of Sphincterotomy in Open Haemorrhoidectomy

2026-07-21T07:42:17+00:00

Background: Open Milligan–Morgan haemorrhoidectomy remains an effective operation for advanced haemorrhoidal disease, although postoperative pain, urinary retention, bleeding and delayed recovery continue to affect patient comfort and resource use. Internal sphincter spasm is considered an important contributor to pain after excisional haemorrhoidectomy. Lateral internal sphincterotomy may reduce resting sphincter pressure and improve early recovery, but its clinical value must be assessed against procedure-related morbidity.

Aim: To compare early postoperative outcomes following open haemorrhoidectomy with and without lateral internal sphincterotomy in patients with grade III or IV haemorrhoids.

Methods: This observational comparative clinical study was conducted in the Department of General Surgery at a tertiary-care centre in Visakhapatnam from May 2024 to April 2025. Sixty consenting adults with clinically and proctoscopically diagnosed grade III or IV haemorrhoids were analysed in two equal groups: Group A underwent open Milligan–Morgan haemorrhoidectomy, whereas Group B underwent open haemorrhoidectomy with lateral internal sphincterotomy. Postoperative pain was measured using a 0–10 visual analogue scale on days 1, 3 and 7. Urinary retention, postoperative bleeding, duration of hospitalization and wound-healing time were recorded. Continuous variables were compared using an independent t-test or Mann–Whitney U test, and categorical variables using the chi-square test; p<0.05 was considered statistically significant.

Results: Baseline age, sex and haemorrhoidal-grade distributions were descriptively similar between groups: mean age was 45.3 ± 7.6 years in Group A and 44.9 ± 8.1 years in Group B, and each group included 21 patients with grade III and nine with grade IV disease. Mean VAS scores were lower in Group B on day 1 (3.5 vs 6.6), day 3 (2.5 vs 5.0) and day 7 (1.5 vs 3.5), with p<0.001 for every comparison. Mean hospital stay was 3.0 versus 4.0 days, and mean wound-healing time was 14.0 versus 18.0 days, respectively (both p<0.001). Urinary retention occurred in 2/30 patients in Group B and 8/30 in Group A (Pearson χ² p=0.038). Any postoperative bleeding occurred in 4/30 and 9/30 patients, respectively; this difference was not statistically significant on two-sided Fisher’s exact testing (p=0.209).

Conclusion: Open haemorrhoidectomy with lateral internal sphincterotomy was associated with lower postoperative pain, less urinary retention, shorter hospitalization and faster wound healing. Postoperative bleeding did not differ significantly between the groups.

When Size Matters: Splenectomy for Massive Splenomegaly in Tyrosine Kinase Inhibitor-Resistant Chronic Myeloid Leukemia: A Case Report

2026-07-21T10:47:10+00:00

Background: The advent of tyrosine kinase inhibitors (TKIs) has significantly reduced the need for splenectomy in chronic myeloid leukemia (CML). However, massive, symptomatic splenomegaly remains a challenging clinical scenario in selected patients with treatment-resistant disease.

Case Presentation: A 40-year-old male with a three-year history of chronic myeloid leukemia presented with progressive abdominal distension and dyspnea on exertion for six months. He had developed resistance to first-line Imatinib therapy and was receiving second-line Dasatinib. Clinical examination and imaging revealed massive splenomegaly with minimal ascites. Following correction of anemia, the administration of preoperative vaccinations, and multidisciplinary evaluation, an e please let me know which book you would like to proceed with from these options. This is the updated poster.lective open splenectomy was successfully performed. The patient experienced significant symptomatic improvement after surgery.

Conclusion: Massive splenomegaly secondary to TKI-resistant CML continues to pose unique surgical challenges. Careful patient selection, meticulous preoperative preparation, and appropriate surgical technique can result in favorable outcomes.

TO FIND OUT THE INCIDENCE OF CAESAREAN DELIVERY ON MATERNAL REQUEST (CDMR)

2026-07-21T12:33:19+00:00

Background: There has been a notableincrease in the global prevalence of Caesarean deliveries over the last fewdecades, where Caesarean delivery onmaternal request (CDMR) stands out as oneof the major reasons for this increasingtrend. There has also been an increase

COMPARISON OF EFFICACY AND SAFETY OF ISOBARIC LEVOBUPIVACAINE WITH DIFERENT ADJUVANTS LIKE CLONIDINE VS DEXMEDETOMIDINE IN SEGMENTAL THORACIC SPINAL ANAESTHESIA FOR OPEN CHOLECYSTECTOMY CASES- A RANDOMIZED CASE CONTROL STUDY

2026-07-21T14:59:34+00:00

Background: Thoracic segmental spinalanaesthesia (TSSA) is increasingly beingused as an alternative to general anaesthesia
for upper abdominal surgeries because itprovides effective surgical anaesthesia,excellent postoperative analgesia, and enhanced recovery. Intrathecal α₂-adrenergicagonists such as clonidine anddexmedetomidine are commonly used asadjuvants to improve the quality and durationof spinal anaesthesia.

A CLINICAL COMPARATIVE STUDY OF 8 mg AND 10 mg OF 0.5% HYPERBARIC BUPIVACAINE AND COMBINATION OF EACH WITH 12.5 μg OF FENTANYL FOR SPINAL ANAESTHESIA IN CAESAREAN SECTION

2026-07-22T15:45:39+00:00

INTRODUCTION:-Spinal anaesthesia is commonly employedfor caesarean delivery. Bupivacaine is thecommonly used local anaesthetic forcaesarean delivery. Intrathecal Bupivacainealone may be insufficient to providecomplete analgesia despite the high sensoryblock. The use of neuraxial opioids has gained popularity over the last few years;

Comparison of Dexmedetomidine and Fentanyl as Adjuvants to Bupivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial

2026-07-22T16:25:20+00:00

Background: Adjuvants added to local anaesthetics in supraclavicular brachial plexus block hastenthe onset and prolong the duration of sensory–motor blockade and post-operative analgesia.Dexmedetomidine, a selective α₂-adrenoceptor agonist, and fentanyl, a lipophilic μ-opioid receptoragonist, are both used perineurally, but head-to-head data under real-time ultrasound guidance remain limited.

Development and Validation of a Stability Indicating RP-HPLC Method for Quantitative Estimation of Apixaban in Tablet Dosage Form

2026-07-23T10:50:51+00:00

Objective: The present study aimed to develop and validate a simple, accurate, precise, and stability-indicating RP-HPLC method for the quantitative estimation of Apixaban in tablet dosage form.

Methods: Chromatographic separation was achieved using a Phenomenex ODS-3 C18 column (250 mm × 4.6 mm, 5 µm). The mobile phase consisted of Methanol (70:30 v/v) at a flow rate of

1.0 mL/min. Detection was carried out at 249 nm using a UV detector. The developed method was validated according to ICH Q2(R1) guidelines for specificity, linearity, accuracy, precision, robustness, LOD, LOQ, and system suitability.

Results: The developed method showed satisfactory chromatographic performance with good peak symmetry and acceptable retention time. Validation studies demonstrated excellent linearity, accuracy, and precision within the selected concentration range. The method was found to be robust and stability-indicating, capable of separating Apixaban from its degradation products.

Conclusion: The developed RP-HPLC method is simple, rapid, accurate, precise, and suitable for routine quality control analysis of Apixaban in pharmaceutical dosage forms.

Clinical Profile, Indications and Outcomes of Therapeutic Phlebotomy: A Retrospective Study from a Tertiary Care Teaching Hospital

2026-07-23T11:05:49+00:00

Background: Therapeutic phlebotomy is a well-established treatment modality for conditionsassociated with iron overload and increased red cell mass. It remains the first-line treatment forhereditary hemochromatosis and polycythaemia vera and has applications in secondary polycythaemia and porphyria cutanea tarda

Utility of Point of Care Ultrasound in Predicting the Severity for Patients with Dengue Fever – A Prospective Cross-sectional Study.

2026-07-23T11:07:41+00:00

Background: Dengue infection exhibits awide clinical spectrum, ranging from mildself-limitingillnesstosevere dengueassociated with plasma leakage, shock, andmortality. Early identification of patients atrisk for severe disease remains a clinical challenge, particularly in resource-limitedand high-burden settings. Point-of-careultrasound (POCUS) has emerged as abedside tool capable of detecting

TO STUDY THE EFFECT OF MAGNESIUM SULPHATE NEBULISATION IN PREVENTION OF POST-OPERATIVE SORE THROAT FOLLOWING I-GEL INSERTION FOR GENERAL ANAESTHESIA

2026-07-23T11:37:06+00:00

Background: Post operative sore throat(POST) is a frequent complaint with I-gel for GA. Irritationand inflammation of the airway are considered to be the causes of Post operative sore throat(POST). Postoperative sore throat (POST) is a well-recognised complication that remainsunresolved in patients following I-gel insertion for general anaesthesia. . Avoiding POST symptoms is a major priority for these patients because preventing postoperative complications contributes to patient satisfaction.

Expanding Frontiers of Intracranial Neuromodulation in Pediatric Drug-Resistant Epilepsy: A Retrospective Cohort Study

2026-07-23T12:27:36+00:00

Background: Pediatric drug-resistant epilepsy remains a major therapeutic challenge and is associated with substantial impairment in neurodevelopment, cognition, behavior, and quality of life. When resective epilepsy surgery is not feasible, intracranial neuromodulation with deep brain stimulation or responsive neurostimulation may offer meaningful seizure reduction. However, pediatric data remain limited, particularly in low- and middle-income settings.

Objective: To evaluate the single-center experience with DBS and RNS in children with DRE, with emphasis on seizure outcomes, safety, and neurocognitive changes following treatment.

Methods: This retrospective observational cohort study was conducted at multiple tertiary care centers across Pakistan. Medical records of pediatric patients aged 3 to 18 years with DRE who underwent DBS or RNS implantation between January 2020 and December 2025 were reviewed. Eligible patients had at least 12 months of postoperative follow-up and were not considered candidates for resective surgery after multidisciplinary evaluation. Data collected included demographic characteristics, seizure outcomes, responder rates, postoperative complications, and available neurocognitive assessments.

Results: A total of 30 pediatric patients met the inclusion criteria, including 14 treated with DBS and 16 with RNS. The mean age at implantation was 11.0 years overall, with mean ages of 12.29 years in the DBS group and 9.88 years in the RNS group. Mean seizure reduction was 57.73% in the DBS group and 57.31% in the RNS group. Responder rates, defined as at least reduction in seizure frequency, were 64.29% for DBS and 68.75% for RNS. Overall complications occurred in 7 of 30 patients , with infection and lead migration being the most common adverse events; device failure occurred in 1 patient . No mortality was observed. In the subgroup with available neurocognitive follow-up, mean IQ scores increased modestly from 81.35 to 83.82 in the DBS group and from 82.85 to 86.83 in the RNS group.

Conclusion: Intracranial neuromodulation appears to be a feasible and clinically meaningful palliative treatment option for selected pediatric patients with DRE who are not candidates for resective surgery. In this single-center cohort, both DBS and RNS were associated with substantial seizure reduction and acceptable safety profiles, with stable to modestly improved neurocognitive performance in the assessed subgroup. Larger prospective multicenter studies are needed to better define patient selection, comparative effectiveness, long-term safety, and developmental outcomes.

CT-Based Anatomical Mapping of Renal Vascular Variations and it impact on Preoperative Planning in Urological Surgery

2026-07-23T13:15:13+00:00

Objective: To evaluate renal vascular variations using contrast-enhanced CT angiography and determine their role in preoperative planning for urological surgery.

Materials and Methods: A cross-sectional observational study was conducted in the Department of Radiology in collaboration with the Department of Urology at a tertiary care teaching hospital over a six-month period. A total of 200 adult patients undergoing contrast-enhanced multidetector CT angiography for renal evaluation were included using a non-probability consecutive sampling technique. CT images were assessed for renal arterial and venous anatomy, including accessory renal arteries, early arterial branching, multiple renal veins, retroaortic left renal vein, circumaortic left renal vein, and other vascular anomalies. Data were analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Statistical significance was considered at a p-value of <0.05.

Results: The mean age of the participants was 46.8 ± 13.2 years, with 118 (59.0%) males and 82 (41.0%) females. Renal vascular variations were identified in 74 (37.0%) patients. Accessory renal arteries were the most common arterial variation, observed in 48 (24.0%) patients, followed by early arterial branching in 12 (6.0%) and multiple accessory arteries in 4 (2.0%). Normal venous anatomy was present in 168 (84.0%) patients, whereas multiple renal veins, retroaortic left renal vein, circumaortic left renal vein, and late venous confluence were detected in 9.0%, 4.0%, 2.0%, and 1.0% of cases, respectively. CT findings resulted in modification of the anticipated surgical approach in 22.0% of patients and indicated increased operative difficulty in 7.0%. No statistically significant association was found between renal vascular variations and either age (p = 0.611) or gender (p = 0.284).

Conclusion: Contrast-enhanced multidetector CT angiography is a reliable and effective imaging modality for identifying renal vascular variations before urological surgery. CT-based anatomical mapping provides valuable information for individualized surgical planning, facilitates recognition of clinically significant vascular anomalies, and may help reduce operative complications while improving surgical outcomes.

The Diagnostic Yield of Multiphasic CT in Ovarian Cancer Staging among Women of Different Socioeconomic Strata

2026-07-23T13:55:16+00:00

Objective: To determine the diagnostic yield of multiphasic computed tomography (CT) in ovarian cancer staging among women of different socioeconomic strata.

Methods: This descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Shaukat Omar Memorial Hospital, Fauji Foundation, from 1^stApril 2026 to 30 June 2026.

A total of 153 women with suspected ovarian malignancy were enrolled through consecutive non-probability sampling. Demographic, clinical, and socioeconomic data were recorded using a structured proforma. Participants were categorized into low-, middle-, and high-income socioeconomic strata based on monthly household income. All patients underwent multiphasic contrast-enhanced CT of the abdomen and pelvis, and radiological staging was compared with the final surgical and histopathological findings, which served as the reference standard. Data were analyzed using SPSS version 28. Associations were assessed using the Chi-square test and one-way ANOVA, with p≤0.05 considered statistically significant.

Results: The mean age of participants was 52.8 ± 11.6 years. Serous epithelial carcinoma was the most common histopathological subtype (68.6%), while Stage III was the predominant FIGO stage (43.1%). Overall, 64.0% of women presented with advanced-stage disease (Stages III–IV). Multiphasic CT demonstrated a sensitivity of 93.6%, specificity of 50.0%, positive predictive value of 95.7%, negative predictive value of 40.0%, and an overall diagnostic accuracy of 90.2%. Diagnostic accuracy was significantly higher among women in the high socioeconomic stratum (97.1%) compared with the middle (91.8%) and low (84.5%) socioeconomic strata (p=0.033).

Conclusion: Multiphasic CT demonstrated high diagnostic accuracy for preoperative ovarian cancer staging. Socioeconomic status was significantly associated with diagnostic performance, highlighting the need for equitable access to timely diagnostic imaging to optimize staging and treatment planning.

Cross Sectional Assessment of Perioperative Antibiotic Prophylaxis and Adherence to Institutional Guidelines in Surgical Patients

2026-07-23T16:07:54+00:00

Background: Perioperative antibiotic prophylaxis is an important measure for preventing surgicalsite infections. Its effectiveness depends on appropriate indication, antimicrobial selection, dose,route, timing, intraoperative redosing, and duration. Despite the availability of institutional guidelines, inappropriate prophylactic antibiotic use remains common and contributes to adversedrug effects, increased treatment costs, and antimicrobial resistance.

Cross sectional Evaluation of Adverse Drug Reactions Associated with Perioperative Medications in Surgical Patients

2026-07-23T16:10:15+00:00

Background: Perioperative medications are essential for anaesthesia, infection prevention, paincontrol, haemodynamic stability and postoperative recovery. However, the simultaneousadministration of multiple drugs may increase the risk of adverse drug reactions, ranging frommild nausea and allergic manifestations to serious cardiovascular or respiratory complications. Systematic evaluation of perioperative ADRs is important for identifying high-risk medications, preventable factors and vulnerable patient groups

Clinicopathological and Toxicological Evaluation of Drug-Induced Liver Injury in Medico-Legal Autopsy Cases

2026-07-24T07:19:46+00:00

Background: Drug-induced liver injury is a difficult diagnosis in medico-legal autopsy practice because exposure history, premortem biochemical data, histology, and toxicological findings may be incomplete or non-specific.

Objective: To evaluate the clinicopathological and toxicological features of drug-induced liver injury in medico-legal autopsy cases and determine its contribution to death.

Methods: This multicentre retrospective analytical study included 200 medico-legal autopsy cases examined at the Department of Forensic Medicine, King Edward Medical University, Lahore, and the Department of Forensic Medicine and Toxicology, Dera Ghazi Khan Medical College, from January 2024 to October 2025. Demographic data, exposure history, autopsy findings, liver histopathology, and multi-matrix toxicological results were reviewed. Cases were classified as probable, possible, or unlikely drug-induced liver injury through multidisciplinary assessment.

Results: The mean age was 41.8 ± 15.2 years, and 118 cases (59.0%) were male. Paracetamol was the most frequently implicated agent, followed by antituberculous drugs, multidrug exposure, antiepileptics, antibiotics, and herbal preparations. Toxicological analysis was positive in at least one specimen in 166 cases (83.0%), with liver tissue showing the highest detection rate. Centrilobular or confluent necrosis was the predominant histopathological pattern. Overall, 108 cases (54.0%) were classified as probable and 62 (31.0%) as possible drug-induced liver injury. It was the primary cause of death in 79 cases (39.5%) and a contributory in 68 (34.0%).

Conclusion: Postmortem diagnosis of drug-induced liver injury requires integrated interpretation of exposure history, autopsy findings, histopathology, toxicology, and exclusion of competing causes, rather than isolated findings.

Impact of Pathophysiology, Pharmacological Therapy with Physiotherapy Outcomes and Anesthesia-Related Factors on Musculoskeletal and Orthopedic Disorders

2026-07-24T07:29:23+00:00

Background: Musculoskeletal and orthopedic disorders are associated with complex pathophysiological changes and are frequently managed with pharmacological therapies and anesthesia-related interventions. These factors may influence disease severity, perioperative complications, pain control and functional outcomes.

Objective: To assess the impact of pathophysiological alterations, pharmacological therapy, anesthesia-related factors on clinical characteristics and functional outcomes among patients with musculoskeletal as well as orthopedic disorders.

Methodology: A hospital-based cross-sectional study was conducted among patients diagnosed with musculoskeletal and orthopedic disorders. Data regarding demographic characteristics, underlying pathophysiological conditions, pharmacological treatment patterns, anesthesia-related factors and clinical outcomes were collected using a structured questionnaire and medical records. Descriptive statistics and appropriate inferential analyses were performed to determine associations between variables, with statistical significance set at p<0.05.

Results: Among the study participants, inflammatory and degenerative pathophysiological changes were common which were significantly associated with pain, severity and functional limitations. Analgesics, non-steroidal anti-inflammatory drugs, corticosteroids and other therapeutic agents were frequently prescribed. Anesthesia-related factors, including type of anesthesia and perioperative analgesic use demonstrated significant associations with postoperative pain control and recovery outcomes. Patients receiving optimized pharmacological and anesthetic management exhibited better functional status and fewer complications.

Conclusion: Pathophysiological alterations, pharmacological therapy and anesthesia-related factors have a significant impact on clinical presentation and functional outcomes in musculoskeletal and orthopedic disorders. Comprehensive multidisciplinary management may contribute to improved recovery and reduced morbidity in affected patients.

The Influence of Postoperative Pain Management on Recovery in Gallbladder Surgery

2026-07-24T07:39:42+00:00

Aim: To assess the impact of postoperative pain management on recovery in Gallbladder Surgery.

Materials and Methods: The hospital based prospective observational study was conducted in the Department of Surgery. A total of 100 patients undergoing elective laparoscopic cholecystectomy for symptomatic gallbladder disease were included in the study.

Results: A total of 100 patients were included, with a mean age of 46.2 ± 12.3 years; most were females (62.0%) and aged 41–50 years (30.0%). Symptomatic cholelithiasis (70.0%) was the most common indication for surgery, while hypertension (24.0%) was the most frequent comorbidity. IV paracetamol plus NSAIDs (40.0%) was the most commonly used postoperative analgesic regimen. Patients receiving TAP block with paracetamol had the lowest postoperative pain scores, and pain decreased progressively over the first 24 hours in all groups. The mean time to first ambulation, oral intake, and hospital stay were 8.2 ± 2.3 hours, 6.9 ± 1.9 hours, and 2.3 ± 0.7 days, respectively, with all showing significant positive correlations with postoperative pain (p < 0.001). Postoperative nausea and vomiting occurred in 24.0% of patients, 30.0% required rescue analgesia, and 66.0% reported high satisfaction, which was significantly associated with lower pain scores (r = −0.49, p < 0.001).

Conclusion: Effective postoperative pain management improved recovery after gallbladder surgery by promoting earlier ambulation and oral intake, shortening hospital stay, and reducing rescue analgesic requirements. Multimodal analgesia, particularly TAP block with paracetamol, provided superior pain relief and was associated with better patient satisfaction.

Clinical Comparison of Incremental Layering Technique and Bulk-Fill Technique in Posterior Composite Restorations

2026-07-24T07:54:51+00:00

Background: Direct resin composite is always the preferred material for posterior tooth restoration, and can be placed in either the traditional incremental layering technique or the newer bulk-fill technique.

Objective: To clinically evaluate and compare the incremental layering method and the bulk-fill method regarding their postoperative sensitivity, marginal adaptation, and restoration success in posterior composite restorations.

Materials and Methods: Randomized clinical trial conducted at the Department of Operative Dentistry, Islamic International Dental Hospital Islamabad, Pakistan, for a period of 9 months from September 2025 to May 2026. A total of 120 posterior teeth were selected and randomly divided into two groups (n = 60), one group (Group A) restored with an incremental layering technique and the other group (Group B) restored with the bulk-fill technique. Data was analyzed using SPSS (version 25), and a p-value of <0.05.

Results: Sensitivity at 1 week was significantly lower in the bulk-fill group than in the incremental group (8.3% vs 18.3%, p=0.041), but this difference was smaller at 1 month and 6 months. At 6 months, there was no difference between the two groups in terms of marginal adaptation or marginal discoloration (p>0.05), and the overall clinical success rate at 6 months was 96.7% for bulk-fill and 95.0% for incremental restorations (p=0.65).

Conclusion: The bulk-fill technique resulted in significantly less early postoperative sensitivity than the incremental layering technique, with marginal adaptation and short-term clinical success being similar for the two techniques.

Risk Factors for Surgical Site Complications Following Combined General and Plastic Surgical Abdominal Wall Reconstruction

2026-07-24T08:00:29+00:00

Objective: This study aims to identify and quantify patient-specific, operative, and specialty-specific risk factors for SSOs following combined AWR.

Materials and Methods: A retrospective cohort study was conducted on 512 patients who underwent combined general and plastic surgical AWR for complex ventral hernias. Data on demographics, comorbidities, operative details, and postoperative outcomes were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A p-value of less than 0.05 was considered statistically significant.

Results: The overall SSO rate was 23.4% (n=120), with an SSOPI rate of 11.7% (n=60). Multivariate analysis revealed that a Body Mass Index (BMI) > 35 kg/m² (OR 2.84, p=0.002), active smoking (OR 2.15, p=0.011), preoperative HbA1c > 7.5% (OR 1.98, p=0.024), and operative time > 300 minutes (OR 2.45, p=0.008) were independent risk factors for SSOs. Furthermore, the use of anterior component separation (OR 3.12, p=0.004) and the absence of intraoperative indocyanine green (ICG) angiography for flap assessment (OR 2.67, p=0.015) significantly increased the risk of wound dehiscence.

Conclusion: Combined AWR is associated with a substantial risk of SSOs. Modifiable risk factors such as smoking, glycemic control, and intraoperative flap perfusion assessment must be rigorously optimized to mitigate complications in this high-risk population.

From Calculators to Datastatpro: The Progression of Data Analysis in the Digital Era

2026-07-24T10:34:47+00:00

Introduction: Since the inception of manual calculation with the help of mechanical computing machines, major technological advancements have transformed the field of data analysis, including the emergence of standalone digital analytical platforms such as DataStatPro. The purpose of this paper is to examine the progression of data analysis from manual and mechanical approaches to modern digital and AI-assisted analytical systems.

Methods: This paper uses a historical narrative review approach to synthesise key developments in data analysis technologies, including mechanical computation, personal computers, statistical software, open-source tools, big data platforms and artificial intelligence-assisted systems. As this is a conceptual review, no primary data collection or inferential statistical testing was performed.

Results: Initial statistical problems and data processing were done by hand, and early computational machines were used to solve automated computations with low processing depth and speed. This was transformed with the advent of advanced computers and then personal computers, such as tablets and laptops. It is now possible to use powerful software such as the Statistical Analysis System (SAS), Statistical Package for Social Sciences (SPSS), now known as Statistical Product and Service Solutions, and Stata to conduct richer and more efficient analyses. The pace of this growth has been compounded by recent advancements in artificial intelligence, big data technology and open-source tools, which have made it possible to automate analysis, improve reproducibility and support intricate modelling.

Conclusions: Modern data analysis has shifted from isolated computational procedures to integrated end-to-end analytical systems that meet the needs of modern data-driven research and decision-making. AI-assisted analytical systems make use of automation, learning algorithms and subject expertise to accelerate data processing with reduced human error. They enhance decision-making by transforming complex datasets into reproducible, interpretable and actionable insights.

Clinical Profile and Surgical Outcome of Buccal Mucosa Carcinoma in a Rural Tertiary Care Setting: A Retrospective Study

2026-07-24T10:50:34+00:00

Background: Oral squamous cell carcinoma of the buccal mucosa presents significant clinical challenges in rural populations where smokeless tobacco use is endemic. This study aimed to evaluate the clinicopathological profile, surgical outcomes and factors influencing advanced-stage presentation in a rural tertiary care setting in Andhra Pradesh.

Methods: A retrospective observational study was conducted on 45 patients undergoing surgical resection for biopsy-proven primary buccal mucosa carcinoma. Clinical and demographic variables, risk habits, TNM staging at presentation, and surgical outcomes were extracted from institutional records. Statistical associations with clinical stage (Early [I–II] vs. Advanced [III–IV]) were evaluated using Pearson Chi-Square and Fisher’s Exact tests.

Results: The cohort exhibited a distinct female preponderance (62.2%, n=28). Male patients presented with advanced disease at a significantly higher rate than females (76.5% vs. 46.4%, P 0.048). Patients with mixed habits (betelnut products with smoking or alcohol) predominantly presented with advanced disease (75.0%, n=9/12), as did exclusive betel leaf consumers (63.6%, n=7/11), though this association did not reach statistical significance (P 0.356). Advanced stage disease (57.8%) required complex composite resections and major flap reconstructions; the postoperative complication rate was 13.3%, with a mortality rate of 4.4%.

Conclusion: Buccal mucosa carcinoma in this rural cohort is characterized by a high proportion of advanced-stage disease, driven by endemic betelnut product consumption and mixed risk habits. The significant delay in male presentation identifies them as a uniquely vulnerable subgroup, underscoring the need for targeted, community-level screening and tobacco cessation initiatives.

Think–Pair–Share as an Active Learning Strategy in Anatomy

2026-07-24T10:56:13+00:00

Background: Anatomy is a foundational subject in medical education. While structured lectures continue to be the backbone of teaching, they are increasingly supplemented with active learning strategies to enhance engagement and understanding. Active learning strategies such as Think–Pair–Share (TPS) encourage peer interaction, critical thinking, and improved conceptual understanding. The Kirkpatrick model provides a structured framework to evaluate educational interventions across multiple outcome levels.

Aim and Objectives: To implement Think–Pair–Share as an active learning strategy in first-year MBBS Anatomy and to evaluate its effectivenes.

Methods: An interventional educational study was conducted among 150 first Year MBBS students. The study was conducted in the department of Anatomy at Apollo Institute of medical Sciences and research, Hyderabad for a period of 3 months.

Think-pair-Share was implemented during selected anatomy topics. Students first thought individually, then discussed in pairs and finally shared responses with larger group. Small group discussions were also conducted during Osteology sessions to reinforce active learning. Kirkpatrick Level 1 (Reaction) was assessed using a written student feedback. Level 2(Learning) was evaluated using pre- and post-tests comprising multiple-choice questions.

Statistical Analysis: Data was entered in Microsoft Excel and analyzed descriptively. Pre and post test scores were expressed as mean +/- standard deviation. A p value of <0.05 was considered statistically significant.

Results: Most students reported high satisfaction and active engagement with the Think Pair Share method. The mean pretest score was 6.38 ± 2.13 which significantly increased to 7.56 ± 1.87 in the post test. Paired t test showed a statistically significant improvement .Post-test scores showed a marked improvement compared to pre-test scores,indicating enhanced learning. Faculty observations revealed improved confidence, correct use of anatomical terminology, and increased participation in later sessions. Improved performance was also noted in assessments.

Conclusion: Think–Pair–Share is an effective active learning strategy in Anatomy teaching. Evaluation using the Kirkpatrick model demonstrated positive outcomes supporting its integration into undergraduate medical education.

Association of Serum Calcium and Magnesium Levels in Infants Born to Early and Late Onset Gestational Diabetic Mothers Admitted In Tertiary Care Hospital

2026-07-24T12:36:35+00:00

Background: Gestational diabetes mellitus (GDM) is significant health concerns affecting maternal and neonatal outcomes worldwide, babies born to mothers with gestational diabetes are at increased risk of metabolic imbalances, like hypoglycemia, hypocalcaemia and hypomagnesaemia. Adequate levels of serum calcium and magnesium are crucial for various physiological functions, including bone development, muscle function, and neuromuscular stability in newborns. Studies suggest that gestational diabetes may impact these mineral levels in infants, potentially leading to complications such as hypocalcaemia and hypomagnesaemia.

Objective: This study aims to compare serum magnesium levels and its association with serum calcium level in infants born to mothers with early GDM and late GDM, providing insights into the impacts of maternal diabetes on newborns.

Methodology: This retrospective cohort study was conducted at the jjm medical College Davangere . Total 105 infants within 72 hours of birth were selected from the pediatrics departments. Serum levels of magnesium and calcium were measured. Data were analyzed using t-tests and chi-square tests to assess differences between infants of late onset GDM and early onset GDM mothers and to understand correlation between these two parameters in IDMs.

Results: The study revealed that hypomagnesaemia and hypocalcaemia were higher in infants of PGDM mothers compared to GDM mothers. Association of hypomagnesaemia and hypoglycemia were significant in early GDM infants than in late GDM infants (90% vs. 35.29% p=0.001, 60% vs. 43.1% p=0.010).

Conclusion: Infants of early onset GDM mothers are at a higher risk of hypomagnesaemia and hypocalcaemia. In order to improve neonatal outcome of those admitted in NICU, these findings help in the individualized and timely prenatal care depending on the type of maternal diabetes

Prevalence of Thyroid Dysfunction in Patients with Gallstone Disease: A Cross-Sectional Study from a Tertiary Care Hospital in South India

2026-07-24T13:07:26+00:00

Background: Gallstone disease (GSD) is a common hepatobiliary condition in India, and emerging evidence suggests thyroid dysfunction, particularly subclinical hypothyroidism, may contribute to its pathogenesis through altered lipid metabolism, delayed biliary emptying, and reduced gallbladder motility. Indian studies have reported thyroid dysfunction in 17-42% of gallstone patients, yet thyroid screening is not routinely performed in this population.

Aim: To determine the prevalence of thyroid dysfunction, particularly hypothyroidism, among patients diagnosed with gallstone disease at a tertiary care hospital.

Methods: This cross-sectional observational study was conducted over 18 months at the Department of General Surgery, PES Institute of Medical Sciences and Research (PESIMSR), Kuppam. Seventy-nine adults with ultrasound-confirmed cholelithiasis were recruited by convenience sampling. Patients with known thyroid disease, prior thyroidectomy, or thyroid-altering medication were excluded. Serum T3, T4, and TSH were estimated for all participants, and data were analysed using SPSS v23.0, with chi-square and ANOVA tests applied as appropriate (p<0.05 significant).

Results: The majority of participants were female (65.82%) and aged 41-50 years (26.58%). Overall, 82.28% of patients were euthyroid, 11.39% had subclinical hypothyroidism, and 6.33% had overt hypothyroidism. Thyroid dysfunction was more prevalent among females (23.08% combined) than males (7.41%), and was most frequent in the 41-50 year age group. Uncomplicated gallstone disease carried the highest burden of thyroid dysfunction (20.64%) compared with gallstones with common bile duct stones (10.0%) and acute calculous cholecystitis (0%).

Conclusion: Nearly one in five patients with gallstone disease demonstrated some form of thyroid dysfunction, predominantly subclinical hypothyroidism among middle-aged women. Routine thyroid function screening in gallstone patients, particularly in high-risk subgroups, may aid early detection and holistic management.

COMPARATIVE STUDY OF CT ANGIOGRAPHY VERSUS DUPLEX ULTRA SONOGRAPHY IN ASSESSMENT OF LOWER LIMB PERIPHERAL ARTERIAL OCCLUSIVE DISEASES (PAOD)

2026-07-25T04:53:37+00:00

Introduction: Currently, CT angiography (CTA) and Duplex ultrasonography (DUS) arewidely used non-invasive imaging modalities for evaluating PAOD. CTA involves radiationexposure and the use of iodinated contrast. On the other hand, DUS is a safer, widely available, radiation-free technique, but its accuracy may vary. There is a need to evaluatewhether DUS can serve as a reliable

Comparative Safety and Adverse Drug Reaction Profiles of Four Antibiotics in Paediatric Enteric Fever: A Prospective Pharmacovigilance Cohort Study

2026-07-25T05:00:49+00:00

Background: Safety comparisons among antibiotics used for paediatric enteric fever are limited, and adverse symptoms may be influenced by the infection, treatment route, and intensity of follow-up

Comparative Effectiveness of Cefixime, Ceftriaxone, Aztreonam and Azithromycin in Culture-Confirmed Paediatric Enteric Fever: A Prospective Observational Cohort Study

2026-07-25T05:04:25+00:00

Background: Contemporary head-to-head evidence for antibiotics used in paediatric enteric fever islimited and treatment selection in routine care is influenced by illness severity, route, and susceptibility.

SPOT URINE PROTEIN-TO-CREATININE RATIO AS AN EARLY PREDICTOR OF DENGUE HAEMORRHAGIC FEVER AND DENGUE SHOCK SYNDROME: A PROSPECTIVE OBSERVATIONAL STUDY

2026-07-25T05:11:00+00:00

Background: Diabetic retinopathy (DR) is a leading microvascular complication of diabetesmellitus and a major cause of preventable blindness. Chronic hyperglycaemia drives its progression, but which routinely available glycaemic index best reflects DR severity is uncertain

ASSOCIATION OF DIABETIC RETINOPATHY SEVERITY WITH FASTING BLOOD GLUCOSE, POSTPRANDIAL BLOOD GLUCOSE AND GLYCATED HAEMOGLOBIN (HBA1C): A HOSPITAL-BASED CROSS SECTIONAL STUDY

2026-07-25T05:13:19+00:00

Background: Diabetic retinopathy (DR) is a leading microvascular complication of diabetesmellitus and a major cause of preventable blindness. Chronic hyperglycaemia drives itsprogression, but which routinely available glycaemic index best reflects DR severity is uncertain.

Objectives: To examine the association of fasting blood glucose (FBG), postprandial bloodglucose (PPBG), HbA1c and diabetes duration with the severity of DR.

TO STUDY THE CLINICAL PROFILE OF CIRRHOTIC PATIENTS BEFORE AND AFTER FFP TRANSFUSION ESPECIALLY WITH REGARDS TO BLEEDING TENDENCIES

2026-07-26T11:10:11+00:00

Background: Inappropriate use not onlyleads to a wastage of limited resources depriving more needy patients, but alsoleads to an increased healthcare cost andincreased risk of transfusion relatedcomplications.

VARIATION IN PLATELET INDICES IN HYPERTENSIVE DISORDERS OF PREGNANCY: A CROSS-SECTIONAL STUDY FROM A TERTIARY CARE HOSPITAL IN NORTH BENGAL

2026-07-27T05:09:47+00:00

Background: Hypertensive disorders ofpregnancy (HDP) are considered one of theleading causes of maternal and perinatalmorbidity and mortality worldwide. Plateletindices such as platelet count (PC), meanplatelet volume (MPV), platelet distributionwidth (PDW), and platelet-large cell ratio(P-LCR) have been proposed as simplehematological markersforearlyof disease severity

Dissociation between Sensory and Motor Blockade Durations in Supraclavicular Brachial Plexus Regional Anesthesia: A Comparative Analysis of Perineural Dexmedetomidine versus Dexamethasone as Adjuvants to Ropivacaine

2026-07-27T11:26:46+00:00

Background: Supraclavicular brachial plexus block is widely used for anesthesia and postoperative analgesia in upper-limb surgeries because of its high success rate and excellent perioperative pain control. The addition of adjuvants to long-acting local anesthetics has become an effective strategy to improve block quality, prolong analgesia, and reduce postoperative opioid consumption. Among the various adjuvants, dexmedetomidine, a highly selective α₂-adrenergic agonist, and dexamethasone, a long-acting corticosteroid, have consistently demonstrated favourable effects on peripheral nerve blockade. However, direct comparisons have largely focused on overall block duration rather than the differential effects on sensory and motor blockade, an outcome that has important implications for postoperative recovery and early mobilization.¹–⁶

The present study aimed to compare the efficacy of perineural dexmedetomidine and dexamethasone as adjuvants to ropivacaine in supraclavicular brachial plexus block, with particular emphasis on the dissociation between sensory and motor blockade durations.

Methods: The current study was conducted in ninety adult patients with American Society of Anesthesiologists (ASA) physical status I and II undergoing elective upper-limb surgery under supraclavicular brachial plexus block. Patients received supraclavicular brachial plexus block using 30 mL of 0.5% ropivacaine combined with either dexmedetomidine 50 μg or dexamethasone 8 mg (total volume 32 mL).

The primary outcome was the duration of sensory blockade. Secondary outcomes included onset of sensory blockade, onset and duration of motor blockade, duration of postoperative analgesiaand sensory–motor dissociation nanalysis.

Results: Baseline demographic characteristics, ASA physical status, body weightand duration of surgery were comparable between the two groups. Dexmedetomidine produced significantly earlier onset of both sensory and motor blockade compared with dexamethasone. Furthermore, sensory block duration, motor block duration, and postoperative analgesia were significantly prolonged in the dexmedetomidine group (P<0.05).⁷–¹²

Although both sensory and motor blockade were prolonged with dexmedetomidine, sensory blockade demonstrated a proportionately greater extension than motor blockade, suggesting a favorable sensory–motor dissociation profile. No serious neurological complications or major adverse events were observed.¹³–¹⁵

Conclusion: Both dexmedetomidine and dexamethasone are effective adjuvants to ropivacaine for supraclavicular brachial plexus block. Dexmedetomidine provides faster block onset, prolonged postoperative analgesia, and superior sensory blockade while maintaining an acceptable safety profile. The observed sensory–motor dissociation may represent an additional clinical advantage by extending analgesia without proportionately delaying motor recovery.

A Comparative Study Between Divide and Conquer, Stop and Chop, and Direct Chop Techniques Used In Phacoemulsification: A Prospective Comparative Study

2026-07-27T13:02:57+00:00

Background: Phacoemulsification is the gold standard surgical procedure for cataract extraction. The technique used for nuclear fragmentation significantly influences surgical efficiency, ultrasound energy utilization, endothelial preservation, and postoperative recovery. Divide and Conquer, Stop and Chop, and Direct Chop are among the most commonly employed nucleotomy techniques.

Methods: This prospective comparative study was conducted in the Department of Ophthalmology, JLN Medical College and Hospital, Ajmer. A total of 150 patients with immature senile cataract undergoing phacoemulsification were enrolled and equally allocated into three groups: Divide and Conquer (Group A, n=50), Stop and Chop (Group B, n=50), and Direct Chop (Group C, n=50). Patients were evaluated preoperatively and postoperatively on days 7, 14, and 28. Outcome measures included best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), macular thickness, phaco power percentage, and total phacoemulsification time.

Results: Baseline demographic and clinical characteristics were comparable among the groups. Significant postoperative improvement in BCVA was observed in all groups without significant intergroup differences. Direct Chop demonstrated the shortest mean phaco time (5.29 ± 2.16 seconds), followed by Stop and Chop (12.66 ± 2.76 seconds) and Divide and Conquer (21.06 ± 4.72 seconds) (p<0.05). Mean phaco power was significantly higher in the Divide and Conquer group. Postoperative corneal edema, assessed by CCT, was greatest in the Divide and Conquer group and least in the Direct Chop group. Macular thickness remained comparable across all groups throughout follow-up.

Conclusion: All three nucleotomy techniques provided excellent visual outcomes following phacoemulsification. However, Direct Chop demonstrated superior surgical efficiency with reduced ultrasound energy usage, shorter phaco time, and better corneal preservation, suggesting it may be the preferred technique in routine cataract surgery.

Thromboprophylaxis in Pregnancy and the Puerperium: Physiology, Evidence, Guideline Discordance and Research Gaps: A Narrative Review

2026-07-27T14:34:00+00:00

Venous thromboembolism (VTE) is a leading direct cause of maternal death and among the most preventable. Pregnancy satisfies every element of Virchow's triad-a progressive procoagulant shift with suppressed fibrinolysis, mechanical venous stasis, and endothelial injury at delivery-and risk peaks in the puerperium rather than during gestation. Yet the translation of this well-characterised physiology into prophylaxis policy has proved remarkably contentious.

Study of Suicidal Deaths among Adolescent Age Group

2026-07-27T19:26:29+00:00

Background: Suicide among adolescents is a major public health and medicolegal concernworldwide. Adolescence (10–19 years) is a period of rapid physical, psychological, and socialdevelopment during which individuals are particularly vulnerable to emotional distress andsuicidal behaviour. Understanding the demographic profile and methods of suicide amongadolescents is essential for developing effective preventive strategies and strengthening mental health services

EVALUATION OF PERCEIVED STIGMA AMONG PATIENTS ATTENDING A TERTIARY CARE PSYCHIATRIC CENTRE

2026-07-27T19:29:12+00:00

Background: Perceived stigma is amajor barrier to treatment seeking,adherence, and rehabilitation among individuals with mental illness.Objective: To evaluate perceived stigma among patients attending atertiary care psychiatric centre andidentify factors associated with stigma.

Comparison of Transconjunctival versus Subciliary Approach for the Management of Infraorbital Rim Fractures

2026-07-28T08:14:00+00:00

Background: Infraorbital rim fractures are commonly associated with zygomaticomaxillary complex and orbital fractures. Surgical exposure is essential for accurate reduction and fixation.The transconjunctival and subciliary incisions are the two most widely used approaches, each with reported advantages and drawbacks.

Aim and objectives: To compare the transconjunctival and subciliary approaches for management of infraorbital rim fractures.

Materials and Methods: Twenty patients with infraorbital rim fractures were divided equally into two groups treated by the transconjunctival (Group A) or subciliary (Group B) approach. Duration of fracture exposure, ectropion, entropion, scar formation, periorbital oedema, and postoperative pain were assessed on postoperative day 1, at 1 week, and at 1 month. Data were analysed using the independent Student's t-test (SPSS v29; p<0.05 significant).

Results: Mean fracture exposure time was 14.00±1.15 minutes in transconjunctival group (Group A) versus 12.60±0.69 minutes (Group B) (p=0.004). Scar score at 1 month was significantly higher in Group B (1.90±0.87) than Group A (0.00±0.00) (p<0.001), whereas periorbital oedema at 1 week was significantly lower in Group B (p=0.008). Ectropion, entropion, and postoperative pain showed no significant intergroup difference.

Conclusion: Both approaches provide satisfactory surgical access; however, the transconjunctival approach offers superior cosmetic outcome with a concealed scar and is the preferable technique for management of infraorbital rim fractures.

Comparison of Conventional Titanium Linear Miniplate versus 3d Rectangular Grid Plate for the Fixation of Mandibular Angle Fracture – A Prospective Clinical Study

2026-07-28T08:22:48+00:00

Background: Mandibular angle fractures are among the most common facial fractures and remain challenging because of unfavourable biomechanical forces and high complication rates. Conventional titanium linear miniplates are widely used; however, three-dimensional (3D) rectangular grid plates have been introduced to provide enhanced biomechanical stability and minimize postoperative complications.

Aim: To compare the clinical efficacy of conventional titanium linear miniplates and 3D rectangular grid plates in the management of mandibular angle fractures.

Materials and Methods: A prospective randomized clinical study was conducted on 20 patients aged 18–60 years with isolated mandibular angle fractures. Patients were equally allocated into two groups: Group I underwent open reduction and internal fixation (ORIF) using a conventional titanium linear miniplate (n=10), while Group II received fixation with a 3D rectangular grid plate (n=10). Clinical parameters including fracture stability, occlusion, operative time, mouth opening, postoperative pain, and swelling were evaluated at 1 week, 1 month, and 3 months postoperatively.

Results: Both groups achieved complete fracture stability, satisfactory occlusion, and uneventful fracture healing during the follow-up period. No statistically significant differences were observed between the groups with respect to fracture stability, occlusion, pain, or swelling. However, the 3D rectangular grid plate group demonstrated significantly shorter operative time and greater postoperative mouth opening at 3 months. No cases of plate fracture, screw loosening, malunion, or non-union were observed in either group.

Conclusion: Both the conventional titanium linear miniplate and the 3D rectangular grid plate provided effective and reliable fixation for mandibular angle fractures with comparable fracture stability and clinical outcomes. However, the 3D rectangular grid plate offered the advantages of significantly shorter operative time and improved postoperative mouth opening, making it an effective alternative for the management of mandibular angle fractures.

Retromandibular Transmasseteric Anteroparotid Approach versus Retromandibular Transparotid Approach for Open Reduction and Internal Fixation of Mandibular Condylar Fractures: A Comparative Clinical Study

2026-07-28T08:30:05+00:00

Background: Mandibular condylar fractures are among the most common mandibular fractures and present significant functional and surgical management challenges. Open reduction and internal fixation (ORIF) has become the preferred treatment for displaced mandibular condylar fractures over closed reduction, owing to superior anatomical restoration and earlier functional rehabilitation. Among the various surgical corridors described, the retromandibular approach remains popular; however, concerns regarding facial nerve injury and parotid gland morbidity have led to the development of modified access routes such as the transmasseteric anteroparotid (TMAP) technique. Aim: To compare the efficacy of the retromandibular transmasseteric anteroparotid (TMAP) approach and the retromandibular transparotid approach for ORIF of mandibular condylar fractures.

Materials and Methods: Twenty patients with sub-condylar fractures, with or without associated mandibular fractures, were randomly allocated into two equal groups of ten. Group A underwent ORIF via the TMAP approach, and Group B via the transparotid approach, both using a 2 mm delta plate and 2×8 mm screws. Exposure time, occlusal derangement, maximal interincisal opening, protrusive and lateral excursive movements, facial nerve function (House–Brackmann grading), and parotid fistula formation were assessed preoperatively and postoperatively at 1 day, 1 week, 4 weeks, and 3 months.

Results: The mean exposure time was significantly shorter in Group A (18.7 ± 3.1 minutes) than Group B (21.9 ± 2.1 minutes; p = 0.008). Both groups showed comparable, statistically significant improvement in maximal interincisal opening, protrusive movement, and lateral excursion over time (p < 0.001), with no significant intergroup differences at any interval. All patients in both groups achieved normal occlusion and Grade I (House–Brackmann) facial nerve function by 3 months. One patient (10%) in Group B developed a parotid fistula, which resolved conservatively; none occurred in Group A.

Conclusion: Both the TMAP and transparotid approaches are safe and effective for ORIF of mandibular condylar fractures, providing comparable functional and occlusal outcomes with complete facial nerve preservation. The TMAP approach offers the additional advantages of significantly reduced exposure time and freedom from parotid fistula complications, making it a favorable alternative to the conventional transparotid technique.

Early Hemodynamic and Sedative Effects of Perineural Dexmedetomidine Versus Dexamethasone in Supraclavicular Brachial Plexus Block

2026-07-28T09:39:35+00:00

Background: Perineural adjuvants are commonly added to local anaesthetics during supraclavicular brachial plexus block to improve block quality and prolong analgesia. While both dexmedetomidine and dexamethasone are effective, comparative data regarding their early hemodynamic and sedative effects remain limited. This study compared the early hemodynamic changes and sedation profiles of perineural dexmedetomidine and dexamethasone when used as adjuvants to ropivacaine.

Methods: In this study, 80 ASA I–II patients aged 18–60 years undergoing elective upper-limb surgery under supraclavicular brachial plexus block received 30 mL of 0.5% ropivacaine with dexamethasone 8 mg, or dexmedetomidine 50 µg. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), peripheral oxygen saturation (SpO₂), and Ramsay Sedation Score (RSS) were recorded from baseline to 45 minutes after block administration.

Results: Baseline demographic and clinical characteristics were comparable between groups. The dexmedetomidine group demonstrated significantly lower SBP and DBP from 3 minutes onward (P<0.001) and lower heart rate at 15 and 30 minutes (P<0.001), although all values remained within physiological limits. MAP was significantly lower only at 45 minutes (P=0.006). Ramsay Sedation Scores were significantly higher in the dexmedetomidine group at 30 minutes (3.13±0.34 vs. 2.00±0.00; P<0.001) and 45 minutes (2.63±0.55 vs. 2.00±0.00; P<0.001), indicating cooperative sedation. Peripheral oxygen saturation remained above 98% in both groups throughout the study, with no episodes of respiratory depression, clinically significant hypotension, or bradycardia requiring intervention.

Conclusion: Perineural dexmedetomidine provides superior conscious sedation with modest, clinically acceptable reductions in heart rate and blood pressure compared with dexamethasone, while maintaining excellent respiratory safety. It is a valuable adjuvant when mild intraoperative sedation and patient comfort are desired during supraclavicular brachial plexus block.

Incidence of Perianal Fistula and Its Clinical Spectrum Following Perianal Abscess: A Prospective Observational Study

2026-07-28T10:21:04+00:00

Background: Perianal abscess is a common anorectal condition arising from cryptoglandular infection, and a substantial proportion of patient’s progress to fistula-in-ano despite adequate incision and drainage. Reported incidence rates of fistula formation vary widely (20-56%), and the factors that predict progression remain incompletely defined, particularly in Indian settings.

Aim: To estimate the incidence of perianal fistula in patients with perianal abscess, to assess its clinical spectrum, and to identify factors associated with fistula development.

Methods: This prospective observational study included 92 patients with perianal abscess managed by incision and drainage at a tertiary care hospital. Patients were followed up for the development of fistula-in-ano, and demographic, clinical, microbiological, and postoperative variables were analysed for their association with fistula formation using the chi-square test (p<0.05 significant).

Results: Fistula-in-ano developed in 40.2% (37/92) of patients. Recurrent abscess (53.2% vs 26.7%, p=0.02), abscess depth ≥3 cm (70.8% vs 6.8%, p<0.001), pus volume ≥15 ml (45.5% vs 13.3%, p=0.01), fecal organisms on culture (69.2% vs 18.9% with skin flora, p=0.0001), and delayed wound healing beyond 30 days (57.7% vs 27.8%, p=0.04) were significantly associated with fistula formation. Age, sex, occupation, education, residence, addiction, comorbidities, and antibiotic choice showed no significant association.

Conclusion: Fistula-in-ano is a common sequela of perianal abscess, occurring in two-fifths of patients, and its development is driven predominantly by disease severity and microbiological profile rather than demographic factors. Early identification of deep, recurrent, or fecal-flora-associated abscesses may help target patients for closer follow-up.

Tick Infestation of the Eyelid: Two Case Reports

2026-07-28T11:31:13+00:00

Background: Tick infestation of the eyelid is an uncommon ophthalmic condition that may mimic benign eyelid lesions and delay diagnosis. Prompt recognition and complete removal are essential to prevent local complications and the transmission of tick-borne diseases.

Case Presentation: We report two female patients, aged 55 and 70 years, who presented with painful, erythematous swelling of the upper eyelid associated with a brownish wart-like lesion. Slit-lamp examination revealed attached ticks, identified clinically as a soft tick in the first case and a hard tick in the second. Both ticks were carefully removed intact using blunt toothless forceps without rupture. The specimens were sent for microbiological evaluation, and laboratory investigations were performed to assess possible systemic involvement. Both patients received prophylactic antibiotic therapy and were advised regarding symptoms of tick-borne illnesses. No systemic manifestations were observed at presentation.

Conclusion: Eyelid tick infestation is a rare but clinically significant condition that requires a high index of suspicion. Careful slit-lamp examination, complete tick removal, and appropriate follow-up are crucial to minimize ocular and systemic complications. Awareness of this uncommon presentation can facilitate early diagnosis and successful management.

IMPACT OF CAP THICKNESS IN SMALL INCISION LENTICULE EXTRACTION (SMILE) SURGERY ON OCULAR SURFACE AND VISUAL ACUITY

2026-07-29T08:41:33+00:00

Objective: to assess the tear film byschirmer test, TBUT, OSDI score inpatients undergoing SMILE refractivesurgery with cap thickness of 120µm and140µm and to study the visual acuity inpatients undergoing SMILE refractive surgery with cap thickness of 120µm and140µm.

Clinical profile of granulomatous mastitis at a tertiary care Hospital Kashmir

2026-07-29T08:49:31+00:00

Background: Chronic granulomatous mastitis(CGM) is a rare benign inflammatory breastentity characterized by lobulo-centricgranulomas. The nonspecific manifestationsand varied demographic features of thiscondition, as well as similarities in presentationwith other breast conditions, pose substantialdiagnostic and treatment challenges (1). Aim: the study was aimed to evaluate differentclinical presentations and treatment approachesfor granulomatous mastitis in resource limitedsetting.

Clinical and Biochemical Profile of Patients with Non-Alcoholic Fatty Liver Disease: A Clinical Study

2026-07-29T10:35:17+00:00

Background: Non-alcoholic fatty liver disease (NAFLD) is becoming recognised as a significant metabolic liver condition associated with obesity, diabetes mellitus, dyslipidaemia, and cardiovascular risk. It has a silent clinical presentation, and biochemical abnormalities can be variable depending on the severity of the disease.

Objective: To evaluate the clinical and biochemical traits of patients with non-alcoholic fatty liver disease and determine the relationship between metabolic abnormalities and ultrasonographic severity.

Methods: This cross-sectional research was carried out at Rashid Latif Khan University Medical College in Lahore, Pakistan, from January to November 2025. A total of n=120 individuals diagnosed with non-alcoholic fatty liver disease by ultrasonography were included. Demographic data, clinical manifestations, anthropometric measurements, coexisting conditions, hepatic function assessments, glycaemic indicators, and lipid profiles were recorded. The extent of hepatic steatosis was evaluated using ultrasonography as mild, moderate, or severe.

Results: The mean age was 47.9 ± 11.6 years, and 55.0% were male. 43.3% of the patients were obese, 44.2 percent had diabetes mellitus, 40 percent had hypertension, and 52.5 percent had dyslipidaemia. The most common symptom was fatigue, and 35.8% were asymptomatic. 47.5% had steatosis grade I, 36.7% had steatosis grade II, and 15.8% had steatosis grade III. The severity of steatosis was significantly associated with higher BMI, WC, ALT, AST, FbS, HbA1C, and TG, and lower HDL-C.

Conclusions: There was a strong association of non-alcoholic fatty liver disease with metabolic dysfunction. The ultrasonographic severity was associated with progressive obesity, glycaemic control, dyslipidaemia, and hepatocellular damage. These findings provide evidence for the practice of early metabolic screening for metabolic risk factor management.

Automation in Microbiology to Reduce Turnaround Time for Patients Better Outcome: Narrative Review

2026-07-29T11:10:23+00:00

Automation has revolutionized and changed clinical and diagnostic microbiology by improving laboratory reporting, reducing turnaround time, enhancing diagnostic accuracy and minimizing human error. Modern microbiology laboratories has increasingly employed automated systems for specimen processing and culturing, microbial and organism identification. Automated blood cultures and antimicrobial susceptibility testing (AST), molecular diagnostics and gene detection has become easier and rapid. Technologies such as total laboratory automation (TLA), matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and artificial intelligence (AI) have transformed traditional workflows. Despite these advances challenges includes high implementation costs, infrastructure requirements. Workforce training remain significant barriers, particularly in low- and middle-income countries. This narrative review discusses the evolution, applications, advantages, limitations and future perspectives of automation in microbiology.

Prognostic Value of Serum Lactate Levels in Predicting Outcomes in Perforated Duodenal Ulcer: A Retrospective Observational Cohort Study

2026-07-29T11:20:20+00:00

Background. Perforated duodenal ulcer (PDU) carries a mortality of up to 30%. Serum lactate is a rapid, inexpensive marker of tissue hypoperfusion. We assessed its value in predicting outcome after PDU repair.

Predictors of Postoperative Complications Following Emergency Laparotomy: A Prospective Cohort Study

2026-07-29T11:47:04+00:00

Background:-Emergency laparotomy is a surgical procedurethat is used in saving lives in wide range of acute abdominal conditions such as perforationperitonitis, intestinal obstruction, abdominaltrauma, mesenteric ischemia and intra-abdominalsepsis. Despite advances in surgical technique,anaesthesia, perioperative care and critical caresupport, emergency laparotomy remains

Excessive Daytime Sleepiness, Morning Tiredness, and Prognostic Biomarkers in Patients with Chronic Coronary Syndrome

2026-07-29T13:39:35+00:00

Background: Sleep-related breathing disorders (SRBD) are related to cardiovascular outcomes in patients with chronic coronary syndrome (CCS). Whether SRBD-related symptoms are associated with prognostic biomarkers in patients with CCS is not established.

Methods: Associations between frequency (never/rarely, sometimes, often, always) of self-reported SRBD-related symptoms (excessive daytime sleepiness [EDS]; morning tiredness [MT]; loud snoring; multiple awakenings/ night; gasping, choking, or apnea when asleep) and levels of biomarkers related to cardiovascular prognosis (high-sensitivity C-reactive protein [hs-CRP], interleukin 6 [IL-6], high-sensitivity cardiac troponin T [hs-cTnT], N-terminal pro B-type natriuretic peptide [NT-proBNP], cystatin C, growth differentiation factor 15 [GDF-15] and lipoprotein-associated phospholipase A₂ activity) were assessed at baseline in 15,640 patients with CCS on optimal secondary preventive therapy in the STABILITY trial. Cross-sectional associations were assessed by adjusted linear regression models testing for trends with the never/rarely category serving as reference.

Results: EDS was associated (geometric mean ratio, 95% confidence interval) with increased levels of IL-6 (often 1.07 [1.03–1.10], always 1.15 [1.10–1.21]), GDF-15 (often 1.03 [1.01–1.06], always 1.07 [1.03–1.11]), NT-

proBNP (always 1.22 [1.12–1.33]), and hs-cTnT (always 1.07 [1.01–1.12]). MT was associated with increased levels of IL-6 (often 1.05 [1.01–1.09], always 1.09 [1.04–1.15]), and GDF-15 (always 1.06 [1.03–1.10]). All symptoms were to some degree associated with higher levels of hs-CRP and loud snoring was also associated with decreased levels of NT-proBNP and hs-cTnT.

Conclusions: In patients with CCS, stepwise increased frequency of SRBD-related symptoms, such as EDS and MT, were associated with gradually higher levels of IL-6 and GDF-15, each reflecting distinct pathophysiological pathways.

Effects of Nd:YAG Laser Posterior Capsulotomy on Intraocular Pressure, Best-Corrected Visual Acuity, and Central Macular Thickness in Posterior Capsular Opacification

2026-07-30T07:39:00+00:00

Background: Posterior capsular opacification (PCO) is a common complication of cataract surgery that can happen weeks to months later and results in decreased vision. Nd:YAG laser capsulotomy is the common treatment for PCO, although it can cause transient changes to the eye.

Objective: To study intraocular pressure, best-corrected visual acuity and central macular thickness after Nd:YAG laser posterior capsulotomy for clinically significant posterior capsular opacification.

Methods: Fifty-eight eyes of fifty-eight participants were included in this prospective observational study. Intraocular pressure (IOP) was measured by Goldmann applanation tonometry, best-corrected visual acuity (BCVA) was measured by Snellen chart and converted to logMAR, and central macular thickness (CMT) was measured by Spectral Domain Optical Coherence Tomography. All assessments were done prior to and at one hour, one week, and one month after capsulotomy.

Results: At baseline, mean IOP was measured at 14.6 ± 2.1 mmHg and at one hour post intervention was measured at 17.3 ± 3.4 mmHg (p < 0.001) with a return to 14.4 ± 2.2 mmHg at the one month follow up. Mean BCVA logMAR improved from 0.64 ± 0.22 to 0.14 ± 0.11 (p < 0.001) with 89.6% achieving 6/12 or better vision. Mean CMT was measured at 242.5 ± 18.4 µm with a statistically significant increase at one week post intervention to 250.7 ± 22.1 µm (p = 0.002) and a return to 243.9 ± 18.8 µm at one month. There was no significant increase in IOP, Cystoid Macular Oedema or other adverse events reported.

Conclusion: Nd:YAG laser posterior capsulotomy significantly improved vision. Post operative changes in IOP and CMT were mild, temporary and resolved by one month.

Clinical Profile and Management of Firecracker-Induced Ocular Trauma: A Hospital Based Observational Study

2026-07-30T07:49:24+00:00

Purpose: To describe the demographic profile, pattern of ocular injuries, clinical presentation, and management of patients presenting with firecracker-related ocular injuries during festive season in the year 2025 at a tertiary eye care centre.

Methods: A retrospective observational study was conducted on patients presenting with firecracker-related ocular injuries during festive season in the year 2025 to a tertiary eye care centre. Demographic characteristics, involvement as a bystander or participant, type of firecracker, mode of arrival, time interval between injury and presentation, presenting visual acuity, ocular findings, and management were retrieved from medical records and analysed using descriptive statistics.

Results: A total of 57 patients were included in the study. The mean age was 21.8 ± 15.4 years (range, 2.5–60 years), with the highest proportion of injuries occurring in the 11–20-year age group (35.1%). Males accounted for 84.2% of the patients. Bystanders constituted 66.7% of the injured individuals, while 33.3% were active participants. Bijli crackers were the most common type of firecracker involved (24.6%). Most patients (75.4%) presented within 4 hours of injury, and 80.7% presented directly to the tertiary eye care centre. At presentation, 43.9% of eyes had a visual acuity of 6/12 or better, whereas 22.8% had vision between 3/60 and perception of light, and 1.8% had no perception of light. Corneal epithelial defects/abrasions were the most common ocular finding (40.4%), followed by hyphema (22.8%) and vitreous haemorrhage (14.0%). Most patients (86.0%) were managed conservatively, while 14.0% required surgical intervention.

Conclusion: Firecracker-related ocular injuries during festive season in the year 2025 predominantly affected young males and frequently involved bystanders. Corneal injuries were the most common ocular finding, although serious anterior and posterior segment injuries were also encountered. These findings underscore the importance of public awareness, supervision during festive celebrations, and preventive measures to reduce avoidable ocular morbidity associated with firecracker use.

Correlation between Visual Acuity and OCT Biomarkers in Patients with Neovascular AMD

2026-07-30T07:58:26+00:00

Background: Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss among older adults. Optical coherence tomography (OCT) enables detailed assessment of retinal morphology and provides valuable biomarkers that may correlate with visual function. Identifying structural predictors of visual acuity is essential for prognosis and treatment planning.

Methods: A hospital-based observational cross-sectional analytical study was conducted on 62 eyes diagnosed with neovascular AMD. Demographic and clinical data were recorded, and all patients underwent comprehensive ophthalmic examination, including best-corrected visual acuity (BCVA) assessment and spectral-domain OCT imaging. OCT biomarkers evaluated included central retinal thickness (CRT), intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), hyperreflective foci (HRF), subretinal hyperreflective material (SHRM), ellipsoid zone (EZ) disruption, and external limiting membrane (ELM) disruption. Correlation and multivariable regression analyses were performed using SPSS, with p < 0.05 considered statistically significant.

Results: The mean age of the participants was 68.5 ± 8.2 years, and 58.1% were males. The mean BCVA was 0.82 ± 0.32 logMAR. IRF (64.5%), SRF (58.1%), and EZ disruption (54.8%) were the most common OCT biomarkers. Poorer BCVA showed significant positive correlations with CRT (r = 0.41), IRF (r = 0.48), PED (r = 0.32), HRF (r = 0.37), SHRM (r =0.44), EZ disruption (r = 0.56), and ELM disruption (r = 0.52) (all p < 0.05). Multiple regression analysis identified EZ disruption (β = 0.36) as the strongest independent predictor of poor visual acuity, followed by IRF, SHRM, CRT, and age.

Conclusion: OCT biomarkers demonstrated significant associations with visual acuity in patients with neovascular AMD. Among these, ellipsoid zone disruption, external limiting membrane disruption, and intraretinal fluid were the strongest predictors of visual impairment. Comprehensive OCT biomarker evaluation may improve prognostic assessment and support individualized management of neovascular AMD.

Clinical Profile, Surgical Outcomes, and Postoperative Complications Following Total Thyroidectomy: A Prospective Observational Study from a Tertiary Care Centre in Southern India

2026-07-30T09:25:25+00:00

Background: Total thyroidectomy has become an increasingly preferred procedure for a wide range of benign and malignant thyroid disorders, but hypocalcemia, recurrent laryngeal nerve (RLN) injury, and haemorrhage remain important sources of morbidity, and institution-specific prospective data from southern India are limited.

Aims: To evaluate the clinical profile, surgical outcomes, and postoperative complications in patients undergoing total thyroidectomy, and to identify risk factors associated with these complications.

Methods: A prospective observational cohort study was conducted in the Department of General Surgery of a tertiary care hospital in Kuppam, India, over 18 months. Eighty-six consecutive adult patients undergoing total thyroidectomy were enrolled after preoperative thyroid function testing, ultrasonography, and FNAC. Postoperative complications were systematically monitored, and data were analysed in SPSS v23.0 using the chi-square test, independent t-test, and binary logistic regression.

Results: The mean age was 38.41 ± 10.47 years with marked female predominance (83.7%). Colloid goitre (36.1%) and multinodular goitre (30.2%) were the commonest FNAC diagnoses. Mean operative time was 104.41 ± 14.85 minutes and mean blood loss 104.70 ± 21.08 ml. The overall postoperative complication rate was 24.4%, transient hypocalcemia being the commonest complication (10.5%), followed by permanent hypocalcemia (3.5%) and temporary RLN injury (4.7%); no permanent RLN injury, respiratory obstruction, or thyroid storm occurred. Central neck dissection was significantly associated with postoperative hypocalcemia (odds ratio 9.13, 95% CI 1.65–50.59, p = 0.011).

Conclusion: Total thyroidectomy is a safe procedure with an acceptable complication profile in a tertiary care setting. Central neck dissection is an independent risk factor for postoperative hypocalcemia, underscoring the need for meticulous parathyroid preservation and vigilant postoperative monitoring.

Early Laboratory Predictors of Sepsis-Associated Acute Kidney Injury and Short-Term Clinical Outcomes in Emergency Department Patients

2026-07-30T09:30:21+00:00

Objective: The objective of this study was to identify early laboratory and microbiological markers for SA-AKI and 28-day mortality in emergency department patients who were admitted with sepsis, focusing on the pathology and microbiology parameters.

Material and Methods: Prospective observational cohort study in the tertiary care ED. Patients of age who fulfilled the Sepsis-3 criteria were recruited as adults. Blood and urine samples were taken within 6 hours of triage. Routine biochemistry, novel biomarkers (Neutrophil Gelatinase-Associated Lipocalin [NGAL], Kidney Injury Molecule-1 [KIM-1] and Interleukin-6 [IL-6]), and comprehensive microbiological analysis (two sets of blood culture time to positivity, MALDI-TOF MS identification) were measured.

Results: 168 of the 420 enrolled patients (40%) had sepsis-associated acute kidney injury (SA-AKI). At baseline, NGAL, KIM-1, IL-6 and the ratio of Neutrophils to Lymphocytes (NLR) were all significantly higher in the SA-AKI patients, as was the time to blood culture positivity (TTP). NGAL (OR 4.12), IL-6 (OR 2.85), TTP < 12 hours (OR 3.45), and Gram-negative bacteremia (OR 2.10) were all independent risk factors for SA-AKI (all p < 0.05). Overall, the biomarker panel had an AUC of 0.91 for SA-AKI prediction. There was a strong association between shorter TTP and higher levels of IL-6, and both with 28-day mortality.

Conclusion: Early integrated laboratory and microbiological profiling using NGAL, IL-6 and blood culture TTP enables very accurate and rapid prediction of SA-AKI and early mortality in ED sepsis patients and enables prompt targeted intervention.

Correlation of Multidrug-Resistant Bacterial Infections with Histopathological Severity in Chronic Osteomyelitis

2026-07-30T09:39:55+00:00

Objective: This study aimed to assess the microbiological profile of chronic osteomyelitis (COM) and also to check the correlation between the severity of bone tissue and the presence of multidrug-resistant (MDR) bacterial infection.

Material and Methods: A prospective observational study was done in 150 patients who were diagnosed with COM clinically and radiologically over a 24-month period. Bone biopsy and sequestrectomy specimens were cultured, Bone biopsy and sequestrectomy specimens were cultured, identified by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS), and antimicrobial susceptibility testing (AST) was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. A modified histopathological severity scoring system (necrosis, inflammatory infiltrate, fibrosis, osteoblastic activity, and new bone formation) was used. Data was analyzed statistically using Chi square test, Mann Whitney U test and Spearman's correlation test.

Results: Among the 128 culture-positive cases, 84 (65.6%) were infected with MDR organisms, mainly MRSA (32.1%) and ESBL-producing enterobacteria (28.5%). The mean of the histopathological severity score was significantly elevated in the MDR group (14.2 ± 1.8) than in the non-MDR group (11.2 ± 2.8) (p < 0.001). Severe bone necrosis was also strongly correlated with MDR infections (r = 0.68, p < 0.001), as well as dense fibrotic replacement (r = 0.72, p < 0.001).

Conclusion: The association between MDR bacterial infection and higher histopathologic severity of chronic osteomyelitis with high bone necrosis and fibrosis score is significant. Combining microbiological AST and histopathological grading offers a holistic perspective on disease severity and helps to inform aggressive surgical and antimicrobial therapy.

PREVALENCE AND CLINICAL CHARACTERISTICS OF ASTHMA COPD OVERLAP AMONG PATIENTS ATTENDING A TERTIARY CARE HOSPITAL

2026-07-30T09:59:34+00:00

Background: Asthma and chronicobstructive pulmonary disease (COPD) arecommon chronic airway disorders withdistinct clinical and pathologicalcharacteristics. However, a substantialproportion of patients exhibit overlapping features of both conditions, referred to asasthma–COPD overlap

The Impact of Hybrid Learning on Psychological Wellness, Academic Performance, and Health Behaviors Among Medical Students

2026-07-30T12:16:36+00:00

Hybrid learning, combining traditional faceto-face teaching with digital educationplatforms, has become a widely adoptedinstructional model in medical education. While it offers flexibility and improvedaccess to learning resources, its impact onpsychological wellness, academicperformance, and health behaviors remains

Patterns of Nodal Metastasis and Their Impact on Survival After Modified Radical Mastectomy: A Prospective Cohort Study

2026-07-30T12:23:55+00:00

Axillary lymph node involvement remainsone of the most important prognosticindicators in breast cancer and plays a criticalrole in determining disease recurrence,therapeutic planning, and long-term survival.Despite advances in systemic therapy and
molecular profiling, the extent and pattern ofnodal metastasis continue to influenceoutcomes following modified radical mastectomy (MRM).

Frequency of Peripheral Retinal Lesions in Patients Evaluated for Corneal Refractive Surgery

2026-07-30T12:26:44+00:00

This prospective, noninterventional, experimental cohort studyinvestigates the distribution, characteristics,and anatomical location of peripheral retinallesions in myopic candidates undergoingthorough preoperative assessment for cornealrefractive procedures, aiming to refine patient safety protocols and lower theincidence of postoperative complications.

Diagnostic Accuracy of BI-RADS-Based Sonomammographic Assessment of Palpable Breast Masses: Correlation with Histopathology

2026-07-30T12:29:22+00:00

Palpable breast masses remain oneof the most common clinical presentationsencountered in breast imaging clinics andsurgical practice. Accurate differentiationbetween benign and malignant lesions isessential to facilitate timely interventionwhile minimizing unnecessary invasive procedures. The Breast Imaging Reportingand Data System (BI-RADS)

Histological Footprint of Helicobacter Pylori: Insights from the Updated Sydney Grading System

2026-07-30T12:33:40+00:00

Background: Helicobacter pylori is a common chronic bacterial infection associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. Histopathological examination of gastroduodenal biopsies remains the gold standard for its detection and assessment of mucosal changes.

Aim: To determine the prevalence of H. pylori in gastroduodenal biopsies, evaluate associated histopathological changes using the Updated Sydney Classification, and correlate bacterial density with histological findings.

Materials and Methods: This prospective observational study included 122 gastroduodenal biopsy specimens collected over two years. Sections were stained with Hematoxylin and Eosin and modified Giemsa stain. Histopathological parameters were graded according to the Updated Sydney Classification.

Results: H. pylori was detected in 68 (55.7%) cases, with higher prevalence in gastric (58.4%) than duodenal (48.5%) biopsies. Chronic gastritis was the most frequent lesion. Moderate bacterial density was the commonest finding (41.9%), followed by severe (35.5%) and mild (22.6%) density. Active chronic gastritis was present in 51.6% of cases, and H. pylori density showed a significant association with neutrophilic activity (p=0.0094).

Conclusion: H. pylori infection was strongly associated with chronic gastritis and active inflammation. Routine histopathological evaluation using H&E, modified Giemsa staining, and the Updated Sydney Classification provides reliable detection and standardized grading, supporting its routine use in gastric biopsy reporting to guide clinical management and improve patient outcomes.

A PROSPECTIVE OBSERVATIONAL STUDY TO ASSESS FACTORS INFLUENCING MORBIDITY AND MORTALITY FOLLOWING EMERGENCY ABDOMINAL SURGERY IN A TERTIARY CARE HOSPITAL

2026-07-30T12:55:43+00:00

Background: Emergency abdominalsurgery constitutes a major component ofsurgical practice and is associated withsignificantly higher morbidity andmortality compared to elective procedures.Rapid clinical deterioration, delayed presentation, and the presence ofunderlying comorbidities contribute to pooroutcomes in these patients

Cognitive Impairment and its Association with Glycemic Control among Patients with Type 2 Diabetes Mellitus

2026-07-31T07:26:33+00:00

Background: Cognitive impairment is increasingly recognized as an important complication of type 2 diabetes mellitus. Hyperglycaemia over time, recurrent hypoglycaemia, vascular comorbidities, and exposure to metabolic abnormalities, may play a role in causing memory, attention, and executive function deficits. But a lot of people who get diabetes treatment don't have cognitive function checked routinely.

Objective: To determine the frequency of cognitive impairment and evaluate its association with glycaemic control among patients with type 2 diabetes mellitus.

Methodology: A cross-sectional study was conducted in the Department of Neurology, PIMS Islamabad and Department of Neurology/Medicine Khyber Teaching Hospital, Peshawar, from January 2025 to June 2025 in hospital setting. Patients with type 2 diabetes mellitus were recruited using consecutive non-probability sampling to achieve a total of 85 patients. Demographic data, diabetes duration, treatment history, comorbidities and diabetic complications were noted. The glycated haemoglobin (HbA1c) was used to assess glycemic control, and HbA1c <7% was considered as good glycemic control, whereas HbA1c ≥7% was considered as poor glycemic control. Cognitive function was assessed with the Montreal Cognitive Assessment and a score of less than 26 was defined as cognitive impairment. Appropriate comparative tests, correlation analysis and binary logistic regression were used to assess associations.

Results: The mean age of the participants was 56.82 ± 9.74 years, and the mean duration of diabetes was 10.24 ± 6.08 years. The mean HbA1c level was 8.31 ± 1.47%, while 54 (63.5%) patients had poor glycaemic control. Cognitive impairment was identified in 38 (44.7%) patients, including 28 (32.9%) with mild and 10 (11.8%) with moderate impairment. Cognitive impairment was significantly more frequent among patients with HbA1c ≥7% than among those with HbA1c <7% (57.4% versus 22.6%, p = 0.002). HbA1c demonstrated a significant inverse correlation with the MoCA score (r = −0.48, p < 0.001). Poor glycaemic control, increasing age and longer duration of diabetes remained independent predictors of cognitive impairment.

Conclusion: Cognitive impairment was common among patients with type 2 diabetes mellitus and was significantly associated with poor glycaemic control. Routine cognitive screening, particularly among older patients and those with longstanding or poorly controlled diabetes, may support early detection and safer individualized management.

D-Test Method for Inducible Clindamycin Resistance in Staphylococcus Aureus from Clinical Samples of Children at a Tertiary Care Hospital

2026-07-31T07:36:12+00:00

Background: Inducible clindamycin resistance in Staphylococcus aureus is an evolving problem, which may cause treatment failure if not routinely detected by the D-test.

Objective: To investigate the frequency of inducible clindamycin resistance in Staphylococcus aureus from various clinical specimens by D-Test.

Methodology: The cross-sectional study was conducted from September 2023 to December 2023 in the Department of Microbiology, Children Hospital and University of Child Health Sciences, Lahore. The samples were taken and cultured on blood agar and MacConkey agar. Gram staining, catalase and coagulase tests were performed for the identification of Staphylococcus aureus (S.aureus). Isolates from all the samples were tested for antibiotic sensitivity by using Kirby Bauer’s disc diffusion method. The cefoxitin (30 µg) disc was used to detect methicillin-resistance. D-Test was conducted by putting the discs of Clindamycin and Erythromycin at a distance of 15-26mm (edge to edge) on Mueller Hinton agar and D-Test results were recorded. SPSS-23 was used for statistical analysis. The frequencies and percentages were computed; Chi square test and Fisher's Exact Test were used to find the association with p value of <0.05 considered significant.

Results: Out of 164 Staphylococcus aureus 117(71.3%) were Methicillin resistant Staphylococcus aureus (MRSA) and 47(28.7%) were Methicillin sensitive Staphylococcus aureus (MSSA). Out of 164 Staphylococcus only 14(8.5%) were D-Test positive i.e.inducible clindamycin resistance. Of these 14 D-Test positive 12(85.7%) were MRSA and only 2(14.3%) were MSSA

Conclusion: Inducible clindamycin resistance is seen in Staphylococcus aureus, mostly MRSA. D-Test should be included as part of routine microbiology laboratory practice to get an idea about efficacy of Clindamycin in infections caused by S.aureus.

Spectrum of CT Findings and Etiological Profile of Non-Traumatic Acute Abdomen in Adults: A Hospital-Based Cross-Sectional Study

2026-07-31T08:50:27+00:00

Background: Non-traumatic acute abdomen comprises a wide spectrum of abdominal disorders requiring prompt diagnosis for appropriate treatment. Clinical presentation frequently overlaps among different diseases, making accurate etiological identification challenging. Multidetector computed tomography (MDCT) has become the preferred imaging modality because it provides comprehensive evaluation of abdominal organs and accurately characterizes the underlying pathology. Understanding the spectrum of CT findings in patients presenting with acute abdomen is valuable for improving diagnostic pathways and guiding clinical decision-making.

Objective: To evaluate the spectrum of multidetector computed tomography findings and determine the etiological profile of non-traumatic acute abdomen in adult patients presenting to a tertiary care hospital.

Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Radiodiagnosis, Mahavir Institute of Medical Sciences, Telangana, from March 2024 to December 2025. A total of 187 adult patients with suspected non-traumatic acute abdomen underwent MDCT following clinical evaluation and conventional imaging. Demographic characteristics, clinical presentation, CT findings, etiological categories, and their association with patient characteristics were analyzed.

Results: Among 187 patients, the mean age was 45.09 ± 12.32 years, and males constituted 52.94% of the study population. Inflammatory disorders were the most common CT diagnosis (45.99%), followed by obstructive (28.88%), renal (8.02%), biliary (6.95%), perforation (5.35%), and vascular disorders (4.81%). Right lower quadrant pain represented the most frequent site of abdominal pain (21.93%). Significant associations were observed between patient age and CT-based etiological categories (ANOVA, p<0.001), as well as between pain location and underlying pathology (Chi-square, p<0.001).

Conclusion: MDCT effectively characterizes the diverse spectrum of diseases responsible for non-traumatic acute abdomen. Inflammatory and obstructive conditions accounted for nearly three-quarters of all diagnoses, while CT accurately demonstrated clinically significant associations between demographic characteristics, pain localization, and disease etiology, highlighting its importance in comprehensive emergency abdominal evaluation.

Diagnostic Accuracy and Clinical Impact of Multidetector Computed Tomography in Adult Patients with Non-Traumatic Acute Abdomen: A Cross-Sectional Study

2026-07-31T08:59:09+00:00

Background: Non-traumatic acute abdomen is a frequent emergency presentation encompassing a broad spectrum of conditions ranging from self-limiting inflammatory disorders to life-threatening surgical emergencies. Although ultrasonography (USG) and plain abdominal radiography are commonly employed as first-line imaging modalities, their diagnostic performance is often limited. Multidetector computed tomography (MDCT) has emerged as an important imaging tool for establishing an accurate diagnosis and guiding timely management.

Objective: To evaluate the diagnostic accuracy of MDCT in adult patients presenting with non-traumatic acute abdomen and to assess its impact on subsequent clinical management.

Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Radiology, Mahavir Institute of Medical Sciences, Telangana, between March 2024 and December 2025. A total of 187 adult patients presenting with non-traumatic acute abdomen underwent MDCT following inconclusive, negative, or clinically insufficient conventional imaging. CT diagnoses were compared with operative findings or final discharge diagnoses. The influence of MDCT on patient management was also evaluated.

Results: The mean age of the study population was 45.09 ± 12.32 years, with a slight male predominance (52.94%). Ultrasonography was inconclusive in 58.29% of patients, while abdominal radiographs were normal in 71.12%. MDCT demonstrated diagnostic concordance with the final diagnosis in 97.33% of cases. CT findings altered clinical management in 55.08% of patients, most commonly by changing conservative treatment to urgent surgical intervention. Management modification was significantly associated with underlying etiology (χ²=41.75, p<0.001).

Conclusion: MDCT demonstrated excellent diagnostic accuracy and substantially influenced therapeutic decision-making in adults with non-traumatic acute abdomen. Its high concordance with final diagnosis and significant impact on surgical triage support its routine use when conventional imaging is inconclusive or insufficient.

To Investigate the Effect of Losartan Treatment on Serum Uric Acid Levels among Patients with Essential Hypertension

2026-07-31T09:04:48+00:00

Background: Hypertension is one of the most common health problems all over the world. Losartan, an antihypertensive medication, is used in the management of hypertension as well as for elevated serum uric acid. It effectively reduces uric acid levels by inhibiting renin, thus counteracting its effects.

Materials & Methods: 110 patients were included in this study from outpatient department of Medicine of Saraswathi Institute of Medical Sciences, Hapur, U.P., during the period of 2 years. Informed consent and a questionnaire were obtained. Losartan (25mg/50mg) was prescribed according to baseline tests and examination, and results were noted at one, three, and six months. Data was entered in excel sheet and analyzed using SPSS software v29.

Results: The study cohort (n=110) mainly included middle-aged to older adults, with the highest proportion (39.1%) in the 41–50 years group and a mean age of 49.85±8.55 years. There were 60 males and 50 females. Most participants (85) received 50 mg once daily, while 25 received 25 mg.

Repeated measures ANOVA showed highly significant effects (p < 0.001). Both doses produced similar reductions in systolic and diastolic blood pressure at 6 months, with a rapid decline at 1 month followed by a plateau.

Serum uric acid decreased significantly in both groups (from ~7.0 mg/dL to 5.9 mg/dL), with no difference between doses. This indicates a strong, dose-independent uricosuric effect.

Conclusion: Losartan is highly efficacious and effective, 80% of the patients experienced no side effects. Future randomized and longer-term studies will clarify whether the uric- lowering effect translates into fewer gout flares and better long-term cardiovascular/renal outcomes.

LATERAL NASAL OSTEOTOMY IN RHINOPLASTY: EXTERNAL AND INTERNAL APPROACH

2026-07-31T09:35:36+00:00

Background: Rhinoplasty is becoming acommonly performed procedure to improve nasalaesthetics. Different techniques havebeen developed to reduce the complicationswhich include hemorrhage, periorbitaledema, ecchymosis, excessive damage tonasal mucosa, and asymmetry.

Morphological Assessment of Megakaryocytes in Bone Marrow Aspirates in Different Hematological Conditions: A Descriptive Observational Study from a Tertiary Care Centre in Jaipur

2026-07-31T10:35:36+00:00

Background: Megakaryocytes play a pivotal role in thrombopoiesis, and alterations in their morphology provide valuable diagnostic information in a wide spectrum of hematological disorders. Although bone marrow aspiration is routinely performed for the evaluation of cytopenias and hematological malignancies, the diagnostic significance of megakaryocyte morphology across different disease entities remains underexplored.

Methods: A descriptive observational study was conducted in the Department of Pathology, SMS Medical College, Jaipur, including 150 consecutive bone marrow aspiration specimens from patients with various hematological disorders. Bone marrow aspirates were evaluated for marrow cellularity, megakaryocyte number, and qualitative morphological alterations. Morphological abnormalities were categorized as dysplastic, non-dysplastic, or mixed. Clinical findings and hematological diagnoses were correlated with megakaryocyte morphology using appropriate statistical analysis, with a p-value <0.05 considered statistically significant.

Results: Of the 150 cases, 100 (66.7%) were neoplastic and 50 (33.3%) were non-neoplastic disorders. Hypercellular marrow was observed in 55.3% of patients. Altered megakaryocyte morphology was identified in 90.0% of cases, with mixed morphological changes being the most frequent pattern (45.3%). Hypolobulated megakaryocytes (50.0%), immature forms (36.7%), and micromegakaryocytes (35.3%) were the predominant abnormalities. Dysplastic megakaryocyte features were significantly more common in neoplastic disorders than in non-neoplastic disorders (87.0% vs. 48.0%, p<0.001). Megakaryocyte number also demonstrated significant variation across different hematological diagnoses.

Conclusion: Systematic evaluation of megakaryocyte number and morphology during bone marrow aspiration provides important diagnostic information and significantly improves differentiation between reactive and neoplastic hematological disorders. Megakaryocytic assessment should be considered an integral component of routine bone marrow examination.

Utilization of Scatter gram Patterns in the Mindray BC-6800 Hematology Analyzer for Early Diagnosis of Dengue Infection: A Novel Automated Analyzer-Based Study

2026-07-31T10:42:38+00:00

Background: Dengue is a rapidly emerging mosquito-borne viral infection that poses a major public health challenge in tropical countries. Early diagnosis is crucial for timely supportive management and prevention of complications. Automated hematology analyzers provide scatter gram patterns that may serve as valuable adjuncts for the early identification of dengue infection. This study aimed to evaluate lymphocyte scatterogram patterns generated by the Mindray BC-6800 hematology analyzer in laboratory-confirmed dengue cases and assess their association with severe thrombocytopenia.

Methods: This retrospective observational study was conducted at Sree Balaji Medical College and Hospital, Chennai, India. Patients presenting with acute febrile illness between September and November 2021 with laboratory-confirmed dengue infection by NS1 antigen and/or anti-dengue IgM/IgG serology were included. Hematological parameters, including platelet count, and lymphocyte scatter gram patterns obtained from the Mindray BC-6800 automated hematology analyzer were analyzed.

Results: A total of 102 patients with confirmed dengue infection were included. Eighty (78.4%) patients demonstrated atypical lymphocytosis with varying degrees of thrombocytopenia. A characteristic figure-of-eight lymphocyte scatter gram pattern was consistently observed in patients with atypical lymphocytosis and severe thrombocytopenia. This distinctive pattern was absent in patients without significant hematological abnormalities and served as an early indicator of severe dengue-related changes.

Conclusion: The figure-of-eight scatter gram pattern identified on the Mindray BC-6800 analyzer is a promising laboratory marker associated with atypical lymphocytosis and severe thrombocytopenia in dengue infection. Recognition of this characteristic pattern may facilitate early clinical suspicion, expedite confirmatory testing, and support timely initiation of appropriate patient management. Further prospective multicentre studies are warranted to validate its diagnostic and prognostic utility.

Clinical Presentation, Management, and Short-Term Outcomes of Diabetic Foot Ulcers in a Tertiary Care Hospital: A Prospective Observational Study

2026-07-31T11:58:12+00:00

Diabetic foot ulcer (DFU) is one of the mostdisabling complications of diabetes mellitus, and has emerged as a leading cause of hospitalization,lower-limb amputation, and disability worldwide.Diabetic foot disease is emerging as a burden indeveloping countries due to increasingprevalence of diabetes, late presentation

Comparative Effectiveness of Vacuum-Assisted Closure Therapy versus Normal Saline Dressing in the Healing of Diabetic Foot Ulcers

2026-07-31T18:43:17+00:00

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus, carrying a lifetime risk of approximately 25 percent among people with diabetes and representing a leading cause of lower-limb amputation. Wound bed management is central to DFU care, and negative pressure wound therapy delivered through vacuum-assisted closure (VAC) has emerged as an alternative to traditional normal saline (NS) gauze dressing.

Artificial Intelligence in Surgical Decision-Making: A Comprehensive Review of Applications Across the Preoperative, Intraoperative, and Postoperative Continuum

2026-07-31T18:49:09+00:00

Background: Artificial intelligence (AI) and machine learning (ML) are increasingly embedded across the surgical care pathway, moving beyond early risk-scoring tools toward real-time intraoperative guidance, automated complication prediction, and clinical decision support for multidisciplinary oncologic planning. Whether this expanding footprint translates into genuinely improved surgical decision-making-as opposed to impressive but clinically unvalidated model performance-remains an open and actively debated question.

Surgical Site Infection: A Review of Epidemiology, Risk Factors, Prevention, and Management

2026-07-31T18:56:09+00:00

Surgical site infections (SSIs) remain among the most common healthcare-associated infections and a leading cause of postoperative morbidity, prolonged hospitalization, and increased healthcare costs.This paper reviews the current literature on the epidemiology, microbiology, risk factors, and prevention strategies associated with SSIs. Evidence indicates that SSIs account for a substantial
proportion of hospital-acquired infections and that approximately half of these cases may be preventable through evidence-based, bundled interventions.

Robotic-Assisted Surgery versus Conventional Laparoscopic Surgery: A Comprehensive Comparative Analysis of Perioperative, Oncologic, Functional, and Economic Outcomes Across Surgical Specialties

2026-07-31T19:01:00+00:00

Background: Robotic-assisted surgery (RAS) has expanded rapidly across nearly every surgical subspecialty since its introduction, marketed on the premise of superior dexterity, three-dimensional visualization, and ergonomic advantage over conventional laparoscopic surgery (LS). Whether these theoretical advantages translate into superior patient-centered outcomes remains contested,
particularly given the substantially higher costs and longer operative times consistently associated with RAS.

Our Experience of Stoppa's Repair: A Prospective Study of 50 Cases

2026-07-31T19:07:36+00:00

Background: Stoppa's repair, also known as Giant Prosthetic Reinforcement of the Visceral Sac (GPRVS), is a tension-free, sutureless preperitoneal mesh repair based on the hydrostatic principle of Pascal. It offers single-mesh coverage of all potential hernial orifices in the lower abdomen through a single midline incision.

Enhanced Recovery After Surgery (ERAS) Protocol versus Conventional Postoperative Laparotomy Surgery: A Systematic Review

2026-07-31T19:12:30+00:00

Background: Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based perioperative care pathway originally developed for elective colorectal resection and now extended to elective and emergency laparotomy more broadly. Conventional postoperative care, characterized by prolonged fasting, routine nasogastric decompression, delayed mobilization, and opioid-based analgesia, remains widespread despite accumulating evidence favoring the enhanced recovery approach.

Predictors of Chronic Groin Pain (Inguinodynia) Following Inguinal Hernia Repair: A Prospective Observational Study

2026-07-31T19:17:24+00:00

Background: Chronic groin pain (inguinodynia) is among the most significant long-term complications following inguinal hernia repair, with reported incidence rates of 10–30%. Despite improvements in surgical technique and mesh technology, its etiology remains multifactorial and incompletely understood.

Prospective Study of the Mannheim Peritonitis Index in Mortality and Complications, with ROC Validation

2026-07-31T19:20:51+00:00

Background: Secondary peritonitis is a surgical emergency, and reported mortality runs anywhere from 6% to 60% depending on the cause and the patient's condition. The Mannheim Peritonitis Index (MPI) combines clinical and operative findings into a single prognostic score, but it has been validated in only a limited number of populations. We assessed how accurately the MPI predicts mortality and
postoperative complications in patients undergoing emergency laparotomy for secondary peritonitis.

Accommodation and Vergence in Young Adults with Myopic Anisometropia

2026-07-31T19:25:12+00:00

Background: Myopia is a common refractive error, and anisometropia may impair binocular vision due to unequal refractive status between the eyes. This study compared binocular vision parameters in young adults with isometropic and anisometropic myopia.

CLINICAL SPECTRUM, ETIOLOGY AND ASSOCIATED FACTORS OF ACUTE KIDNEY INJURY IN HIV-INFECTED PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY

2026-08-04T03:05:08+00:00

Background: Acute kidney injury (AKI) ischaracterised by a rapid decline in renalfunction and is associated with pooroutcomes. People living with HIV are at increased risk of AKI through HIVdependent factors, HIV-independent factors

A STUDY OF INCIDENCE, ETIOLOGICAL FACTORS, CLINICAL PROFILE AND OUTCOME AMONG PATIENTS WITH METABOLIC ENCEPHALOPATHY

2026-08-04T03:10:19+00:00

Background: One of the most commoncauses of morbidity and death in intensivecare units is metabolic encephalopathy,especially in patients who are elderly,immunocompromised, severely ill or haveconcomitant diseases. Therefore, we aimto investigate the prevalence, etiology,clinical characteristics, and outcome ofmetabolic encephalopathy patients admitted to tertiary care institution duringthe study period.

Role of Closed Suction Drain in Preventing Postoperative Seroma and Surgical Site Infection Following Open Lichtenstein Mesh Repair of Large Complicated Inguinoscrotal Inguinal Hernias: A Prospective Comparative Study

2026-08-04T03:23:41+00:00

Background: Large, complicated inguinoscrotal inguinal hernias present a distinct reconstructivechallenge because of the extensive dissection of the distal sac and scrotal component required duringopen Lichtenstein mesh repair. This dissection creates substantial dead space, and reported rates ofpostoperativescrotalseroma or haematoma after Lichtenstein hernioplasty forcomplete/inguinoscrotal hernias range from 5% to over 20%, with surgical site infection (SSI)frequently arising secondarily in these collections.

Predictors of Mortality and Leak Rate Following Omental Patch Repair (Graham Patch) for Perforated Peptic Ulcer: A Prospective Observational Study

2026-08-04T03:26:26+00:00

Background: Perforated peptic ulcer is a common surgical emergency, and omental patch (Grahampatch) repair remains the standard operative approach for most perforations. Despite its widespread use, suture line leak and postoperative mortality continue to occur, and reliable clinical predictorsare needed to guide risk stratification

Assessment of Risk Factors Associated with Surgical Site Infection Following Elective Gastrointestinal Surgery: A Prospective Cohort Study

2026-08-04T04:28:36+00:00

Background: Surgical site infection (SSI)remains the most common health-care–associatedinfection after gastrointestinal (GI) surgery andcontinues to prolong hospitalisation and increasecosts, particularly in low- and middle-income settings. Robust local data on modifiable

Risk Factors Influencing Conversion from Laparoscopic to Open Cholecystectomy: A Retrospective Cohort Study from a Tertiary Care Hospital

2026-08-04T04:34:45+00:00

Background: Laparoscopic cholecystectomy(LC) is the gold-standard treatment forsymptomatic gallstone disease. Despiterefinements in technique and instrumentation, aproportionofprocedures still require conversion to open cholecystectomy (OC).Early identification of patients at higher risk ofconversionfacilitatesinformed consent

Clinical Predictors of Difficult Laparoscopic Cholecystectomy in Patients with Symptomatic Cholelithiasis: A Prospective Observational Study

2026-08-04T04:39:11+00:00

Background: Laparoscopic cholecystectomy(LC) is the standard treatment for symptomaticcholelithiasis, but a proportion of cases provetechnically difficult, leading to prolonged operative time, higher complication rates andoccasional conversion to open surgery

Assessment of Postoperative Seroma Formation Following Modified Radical Mastectomy: Risk Factors, Management Strategies, and Clinical Outcomes

2026-08-04T04:43:22+00:00

Background: Breast carcinoma is the mostfrequently diagnosed malignancy amongwomen in India, and modified radicalmastectomy (MRM) remains the mostcommonly performed surgical procedure inlow-andmiddle-income settings. Postoperative seroma is the most frequentcomplication following MRM

Association between Body Mass Index and Left Brachial-Ankle Pulse Wave Velocity in Young Adult Females: A Cross-Sectional Study

2026-08-04T05:53:19+00:00

Background: Pulse wave velocity (PWV) is a validated, non-invasive index of arterial stiffness, and obesity, commonly assessed using body mass index (BMI), is a recognised determinant of vascular stiffening and cardiovascular risk. Data describing this relationship in young, apparently healthy women from India remain limited.

Objective: To assess the association between BMI and left brachial-ankle pulse wave velocity (L-baPWV) in young adult females.

Methodology: A cross-sectional study was conducted among 200 healthy female students aged 18-25 years in the Department of Physiology, BPS Government Medical College for Women, Khanpur Kalan, Sonepat. Anthropometric parameters were recorded and BMI was calculated. L-baPWV was measured by a non-invasive periscope and categorised as ≤ 1056 cm/s and ≥ 1057 cm/s. The Chi-square test was used to test the association between BMI category and L-baPWV category.

Results: The mean age of participants was 21.33 ± 1.81 years and mean BMI was 22.20 ± 3.68 kg/m². Of the 200 participants, 28 (14%) were underweight, 127 (63.5%) had a normal BMI and 45 (22.5%) were overweight. Elevated L-baPWV (≥ 1057 cm/s) was present in 60.71% of underweight participants compared with 30.71% of those with normal BMI and 28.89% of overweight participants. This association between BMI and L-baPWV was statistically significant (χ2 = 9.950, df = 2, p = 0.007).

Conclusion: A significant association was found between BMI and left brachial-ankle pulse wave velocity, with a higher proportion of underweight young women showing increased peripheral arterial stiffness. BMI, at both extremes, deserves attention as a correlate of early vascular changes even in apparently healthy young women.

Ethnobotanical Survey and Traditional Knowledge of Ayurvedic Plants for Gynecological Disorders in Jammu Region, J&K: Linking Folk Claims to Scientific Validation

2026-08-04T06:24:21+00:00

Background: The Jammu Division of Jammu & Kashmir, a transitional Himalayan zone encompassing subtropical plains, mid-hills and temperate forests, harbours a rich reservoir of ethnomedicinal knowledge that local Vaidyas, Hakims, Gujjar and Bakerwal communities, and elderly rural women have traditionally applied to gynecological complaints. While this folk knowledge is widely practiced, it has rarely been systematically documented alongside laboratory-based validation.

Objective: This study aimed to (i) document, through a structured ethnobotanical survey, the traditional knowledge of Ayurvedic medicinal plants used for gynecological disorders in the Jammu region, and (ii) link these folk claims to scientific validation through phytochemical and antioxidant profiling of the identified species.

Methods: Semi-structured interviews and questionnaire-based field surveys were conducted with traditional healers, herbal practitioners, and knowledgeable villagers across representative districts of Jammu Division (Jammu, Kathua, Udhampur, Reasi, Rajouri, Poonch and Doda), documenting local names, plant parts used, modes of preparation, dosage, and the specific gynecological indications treated. Twelve Ayurvedic medicinal plants identified through this survey and cross-verified among multiple informants were authenticated, collected, and sequentially extracted with hexane, ethyl acetate, methanol and water. Qualitative phytochemical screening, quantitative estimation of total phenolic (TPC), flavonoid (TFC), alkaloid (TAC) and saponin (TSC) content, and antioxidant assays (DPPH, FRAP) were performed, followed by correlation, regression and principal component analysis (PCA).

Results: Informants consistently reported the use of these twelve species for dysmenorrhea, menorrhagia, leucorrhea, infertility, menstrual irregularities, vaginal infections, postpartum weakness, hormonal imbalance and uterine inflammation. Methanolic extracts gave the highest yields (mean 10.7%) and the greatest phenolic, flavonoid and alkaloid recovery, while aqueous extracts were richest in saponins and tannins, mirroring traditional decoction-based preparation. Vitex negundo, Cinnamomum zeylanicum and Punica granatum showed the highest phenolic/flavonoid content and antioxidant capacity (DPPH IC₅₀ 45-52 µg/mL; FRAP 458-490 µmol Fe²⁺/g), Asparagus racemosus and Foeniculum vulgare were saponin-dominant, and Berberis lyceum and Cissampelos pareira were alkaloid-dominant. Antioxidant activity correlated strongly with TPC (r = 0.91–0.93, p < 0.01). PCA and hierarchical clustering grouped the species into three chemotypic clusters that aligned closely with the folk-use categories reported during the survey (antioxidant/anti-inflammatory, fertility/adaptogenic, and uterotonic/hormonal regulatory).

Conclusion: The close correspondence between informant-reported indications and species-specific phytochemical/antioxidant signatures demonstrates that the ethnomedicinal knowledge of Jammu Division is not anecdotal but chemically coherent. The findings provide a scientific rationale for prioritizing these plants for standardization, quality control and further pharmacological and clinical validation, while underscoring the need to conserve both the plant resource and the associated traditional knowledge.

Incidence and Spectrum of Postoperative Complications Following Modified Radical Mastectomy: A Retrospective Study

2026-08-04T06:32:00+00:00

Background: Modified radical mastectomy remains an essential surgical procedure for locally advanced breast cancer, but is associated with wound-related, lymphatic, and functional postoperative complications.

Objective: To determine the incidence, spectrum, and predictors of postoperative complications following modified radical mastectomy.

Methodology: This retrospective descriptive study was conducted at Shalamar Hospital Lahore, from-April 2025 to April 2026. Medical records of 85 patients who underwent primary unilateral modified radical mastectomy for breast carcinoma were reviewed. Demographic, clinical, tumour-related, operative, and postoperative data were retrieved using a structured proforma. Patients were followed through available records for three months after surgery. The primary outcome was the occurrence of any postoperative complication.

Results: The mean age was 52.8 ± 10.9 years, and 54 (63.5%) patients were postmenopausal. Diabetes mellitus was present in 19 (22.4%) patients, hypertension in 27 (31.8%), anaemia in 29 (34.1%), and neoadjuvant chemotherapy had been received by 23 (27.1%). Stage III disease was documented in 50 (58.8%) patients. The mean operative duration was 133.6 ± 23.7 minutes, the mean intraoperative blood loss was 258.0 ± 81.0 mL, and the mean drain-retention duration was 8.6 ± 2.4 days. 29 (34.1%) patients developed at least one postoperative complication. Seroma was the most frequent complication, occurring in 15 (17.6%) patients.

Conclusion: Postoperative complications occurred in approximately one-third of patients undergoing modified radical mastectomy, with seroma and prolonged drain output being the most common.

Knowledge, Attitudes, and Practices among Lactating Mothers on Breastfeeding and Weaning Attending the Immunization Clinic at District Hospital, Sagar (M.P)

2026-08-04T06:48:43+00:00

Background: Optimal breastfeeding and appropriate weaning practices are critical determinants of infant growth, development, and survival. Despite global and national recommendations, suboptimal practices persist due to knowledge gaps, socio-cultural beliefs, and inadequate counselling. Objectives: To assess the knowledge, attitudes, and practices (KAP) regarding breastfeeding and weaning among lactating mothers attending an immunization clinic at a district hospital in Sagar, Madhya Pradesh.

Methods: A cross-sectional descriptive study was conducted among 200 lactating mothers attending the immunization clinic over a period of three months. Data were collected using a pretested semi-structured questionnaire. Descriptive statistics and appropriate inferential tests were applied.

Results: Among participants, 82% were aware of early initiation of breastfeeding and 72% knew about exclusive breastfeeding (EBF) for six months. However, 18% believed colostrum should be discarded. Only 60% initiated breastfeeding within one hour, and 65% practiced exclusive breastfeeding. Complementary feeding at six months was correctly practiced by 62% of mothers.

Conclusion: Although knowledge and attitudes were generally favourable, actual practices were suboptimal. Strengthening counselling services and addressing cultural misconceptions are essential to improve infant feeding practices.

Cross-Sectional Study to Track Antibiotic Consumption and its Appropriateness in an Intensive Care Setting of a Tertiary Care Hospital using Aware Tool of World Health Organization (WHO)

2026-08-04T06:56:01+00:00

Background & Objectives: Incorporating AWaRe classification metrics provide a structured approach to evaluating antibiotic consumption and guiding future interventions for better antibiotic stewardship in healthcare facilities. The study aimed to quantify antibiotic consumption and assess its appropriateness in an intensive care unit of a tertiary care hospital in South India using the WHO's AWaRe tool.

Methods: This study was conducted in a South Indian ICU over 2 months, including prescriptions with at least one antibiotic for patients admitted within 2 weeks. Around 100 prescriptions were included based on ICU admission statistics. An AWaRe tool by WHO was used to analyze antibiotic consumption and appropriateness.

Results: 201 antibiotics were prescribed, with an average of 2 antimicrobials per patient. 78.6% administered parenterally, 21.4% orally. 29% cases had clinical samples sent for Culture & Sensitivity testing. Only 29% cases showed escalation or de-escalation of antimicrobials based on clinical response.

Interpretations & Conclusions: The study highlighted the empirical nature of antibiotic prescriptions, limited microbiological guidance, and inadequate adjustments based on clinical responses. These findings emphasize the need for improved guidelines and practices to optimize antibiotic use in intensive care settings, ensuring appropriateness and effectiveness in patient care.

Comparison of Short-Course Magnesium Sulfate and Standard Pritchard Regimen for Prevention of Recurrent Seizures in Eclampsia: A Prospective Comparative Study

2026-08-04T07:01:22+00:00

Background & Objectives: Eclampsia is a life-threatening obstetric emergency characterized by generalized tonic-clonic seizures in women with pre-eclampsia and remains a major cause of maternal morbidity and mortality. Magnesium sulfate is the standard anticonvulsant for preventing recurrent seizures; however, the conventional Pritchard regimen requires prolonged administration and close monitoring. This study compared the effectiveness and safety of a short-course magnesium sulfate regimen with the standard Pritchard regimen in women with eclampsia.

Methods: This prospective randomized interventional study was conducted in the Department of Obstetrics & Gynaecology, Pt. JNM Medical College and Dr. BRAM Hospital, Raipur, India, from August 2021 to December 2022. One hundred women with eclampsia were randomly allocated to receive either short-course magnesium sulfate (n=50) or the standard Pritchard regimen (n=50). The primary outcome was recurrent seizures, while secondary outcomes included magnesium toxicity, maternal complications, duration of ICU and hospital stay, and recovery parameters.

Results: No recurrent seizures occurred in either group (0% vs. 0%; p=0.943). Magnesium toxicity (0% vs. 12%; p=0.0352) and injection-site pain (10% vs. 92%; p<0.0001) were significantly lower with the short-course regimen. Maternal complications were comparable between groups (p>0.05). Women receiving the short-course regimen had shorter ICU and hospital stay, earlier breastfeeding and oral feeding, and lower healthcare resource utilization (all p<0.05).

Interpretation & Conclusions: Short-course magnesium sulfate is as effective as the standard Pritchard regimen in preventing recurrent seizures while reducing treatment-related toxicity, improving recovery, and decreasing healthcare resource utilization, making it a practical alternative for managing eclampsia, particularly in resource-limited settings.

Clinico-Pathological Profile and Surgical Margin Status in Patients Undergoing Wide Local Excision for Oral Squamous Cell Carcinoma

2026-08-04T07:09:39+00:00

Background: Oral squamous cell carcinoma (OSCC) is the most frequent cancer of the oral cavity. Its morbidity and mortality rate is high. The standard surgical treatment is the excision of the tumor with adequate margins. Opportune assessment of the surgical margins and the clinico-pathological characteristics of OSCC aids in the development of a treatment plan and estimation of prognosis.

Objective: The aim was to assess the clinico-pathological features and the status of surgical margins of patients who underwent wide local surgical excision for OSCC.

Methods: This cross-sectional study was carried out on 220 patients between ages 20 to 80 years old who had histopathological diagnosis of OSCC and had undergone wide local excision at a Swat Medial College Teaching Hospital Saidu Sharif Swat in the 12 months. Participants were selected using a non-probability sampling method. Using a pre-tested structured check list, the following were documented: age, sex, site of the tumor, size of the tumor, the TNM stage, histological grade, and status of the lymph nodes along with perineural and lymphovascular invasions. Also documented was the status of the surgical margin. This was categorized as clear (≥5 mm), close (1-4 mm), or involved (<1 mm). For analyses, version 26.0 of the SPSS software was utilized. Summarizing of data was done using descriptive statistics. Associations were evaluated using the chi-square test, with p<0.05 considered to be statistically significant. Results: The mean age of participants was 54.9 ± 12.3 years, and males made up 69.1% of the population. The most common site was buccal mucosa (42.3%), followed by tongue involvement (27.7%). The majority of the tumors were moderately differentiated (56.4%) and were of Stage III–IV (61.8%). Complete Surgical margins were obtained in 176 (80.0%) patients, while 31 (14.1%) had close margins, and in 13 (5.9%) patients, margins were involved. Advanced tumor stage, larger tumor size, poor histological differentiation, and lymph node metastasis had a significant statistical correlation with close/involved surgical margins (p< 0.05).

Conclusion: Though most patients with oral squamous cell carcinoma had advanced-stage disease, the majority had clear surgical margins after wide local excision. The adverse clinico-pathological features were significantly related to margin clearance, thereby showing the importance of early diagnosis and precise surgical margin planning for better results in patients.

Frequency and Distribution of Common Oral Mucosal Lesions (Aphthous Ulcers, Geographic Tongue) Among Dental Patients

2026-08-04T07:15:53+00:00

Oral mucosal lesions (OMLs) can show different patterns based on demographics, oral hygiene, and other risk factors. OMLs need to be detected early for diagnosis and management for the risk of prognosis. This cross-sectional study investigated the occurrence of oral mucosal lesions with an emphasis on aphthous ulcers and geographic tongue, in patients of a tertiary care dental hospital with a dental outpatient population. 300 patients above the age of 18-35 were targeted in this study in a time span of six months with the use of non-probability, consecutive sampling. The data collection methods involved a clinical expert examination and the development of a survey tool based on the (WHO) guide to the oral health survey 2013. The data were analyzed statistically by the application of descriptive and inferential statistics using SPSS version 26.0. The study reported the presence of oral mucosal lesions in 160 (53.3%) of the participants, while 140 (46.7%) were found to be lesion free. The study cited the presence of aphthous ulcers (16.3%) and geographic tongue (11.7%) as the most common lesions, while traumatic ulcer (8.0%), fissured tongue (6.7%), oral candidiasis (4.3%), frictional keratosis (3.0%), leukoplakia (2.0%) and lichen planus (1.3%) were noted to be less common lesions. The lesions in the tongue (36.3%) and buccal mucosa (26.2%) were frequently found. The study also noted the prevalence of oral mucosal lesions to be higher in the female population in comparison to the male population (p = 0.039). This study observed the frequent occurrence of common oral mucosal lesions in the young adult dental patient population. The study also noted the frequent occurrence of aphthous ulcers and geographic tongue. Every dental visit should include a routine oral mucosal examination for the purpose of early detection and better patient care.

ROLE OF ULTRASONOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT THYROID NODULES: CORRELATION WITH FINE NEEDLE ASPIRATION CYTOLOGY

2026-08-04T08:50:23+00:00

Background: Thyroid nodules are most frequentlyencountered in clinical practice. Thyroid nodulesare abnormal growths of thyroid cells that formmasses within the thyroid gland. Although the majority are benign, differentiating malignant frombenign nodules is essential for appropriatemanagement, to avoid unnecessary

Effectiveness of a Video-Assisted Teaching Programme on Knowledge and Behaviour Regarding the Impact of Mobile Phone Usage on Mental Health and Academic Performance among School Students: A Pre-Experimental Study

2026-08-04T09:45:40+00:00

Background: The widespread use of mobile phones among adolescents has created new opportunities for learning and communication; however, excessive use may negatively influence mental health, psychological well-being, sleep patterns, and academic functioning. School-based health education programmes may help students develop awareness and adopt healthier digital habits. Objectives: The study aimed to assess baseline knowledge and behaviour regarding the impact of mobile phone usage among school students, evaluate the effectiveness of a video-assisted teaching programme on improving knowledge and behavioural practices, and determine the association between study outcomes and selected socio-demographic variables. Materials and Methods: A quantitative pre-experimental one-group pre-test–post-test design was adopted among 60 students studying in Classes IX and X at Government Higher Secondary School, Goria, Kanke, Ranchi, Jharkhand. Participants were selected using a non-probability purposive sampling technique. Data were collected using a structured knowledge questionnaire and behaviour rating scale before and after administration of the video-assisted teaching programme. Data were analysed using descriptive and inferential statistics, including paired t-test, Chi-square test, and Pearson’s correlation coefficient. Results: Before the intervention, 56.7% of students had inadequate knowledge and 48.3% demonstrated negative behavioural practices related to mobile phone usage. Following the video-assisted teaching programme, a significant improvement was observed in knowledge and behaviour scores. The mean knowledge score increased from 7.12 ± 2.48 in the pre-test to 15.82 ± 2.31 in the post-test (t = 18.96, p < 0.001). Similarly, the mean behaviour score improved from 38.64 ± 9.72 to 64.18 ± 10.26 (t = 16.42, p < 0.001). No significant association was found between knowledge or behaviour scores and selected socio-demographic variables. Conclusion: The video-assisted teaching programme was effective in improving knowledge and promoting healthier behavioural practices regarding mobile phone usage among school students. Integrating digital health education into school health programmes may support adolescent mental health promotion and responsible technology use.

A Comparative Study of Fibrin Glue and Suture Closure for Compromised Scleral Flaps in Manual Small-Incision Cataract Surgery (SICS)

2026-08-04T09:59:21+00:00

Background: Compromised scleral flaps, resulting from extension or buttonholing during manual small-incision cataract surgery (SICS), can lead to wound leakage, shallow anterior chamber, postoperative astigmatism, and increased risk of endophthalmitis. Conventionally, these defects are managed using sutures, which may cause postoperative discomfort and require subsequent removal. Fibrin glue has emerged as a biological tissue adhesive that may provide effective wound closure while minimizing suture-related complications. This study compared the safety and efficacy of fibrin glue with X-shaped infinity sutures for the management of compromised scleral flaps during SICS.

Methods: A prospective, comparative, single-centre study was conducted among 30 patients aged 55–65 years with compromised scleral flaps encountered during SICS. Patients were equally divided into two groups: Group A (n=15) underwent wound closure using fibrin glue, while Group B (n=15) received X-shaped infinity sutures. All surgeries were performed by a single surgeon using a standardized technique. Postoperative evaluation over six months included wound integrity, anterior chamber depth, intraocular pressure, inflammation, surgically induced astigmatism (SIA), and patient comfort.

Results: Both groups were comparable with respect to baseline demographic and ocular parameters. No statistically significant differences were observed in postoperative inflammation or surgically induced astigmatism during the six-month follow-up. Mean SIA at six months was 1.73 ± 0.77 D in the fibrin glue group and 1.76 ± 1.23 D in the suture group. Patients treated with fibrin glue experienced no postoperative discomfort, whereas five patients in the suture group developed foreign body sensation and conjunctival hyperaemia requiring suture removal.

Conclusion: Fibrin glue is a safe and effective alternative to X-shaped infinity sutures for managing compromised scleral flaps during manual SICS. It provides secure wound closure, minimizes postoperative discomfort and suture-related complications, preserves astigmatic outcomes comparable to sutures, reduces inflammation, and shortens surgical time. Fibrin glue may therefore be considered a valuable option for the management of extended or buttonholed scleral flaps during cataract surgery.

Knowledge Attitude and Practice Regarding Use of Artificial Intelligence among Medical Students - A Comparative Study

2026-08-04T10:04:57+00:00

Background: Artificial Intelligence (AI) is described as “the theory and development of computer systems capable of performing tasks ordinarily requiring human intellect, such as visual perception, speech recognition, decision-making, and language translation”. AI can simulate cognitive abilities for real-world problem solving and the development of machine learning and human-like reasoning. It can mimic cognitive operations, such as image recognition, speech recognition, and annotation generation. It is important for physicians to understand the potential of AI and the issues associated with it to make informed decisions and provide comprehensive treatment. The application of AI in healthcare can lead to exquisite improvement in providing healthcare. This study research was done to help gain knowledge about importance of AI and how various aspects of AI can be utilized for the improvement of healthcare among Undergraduate (UG) medical students. This will afford insights into the influence of artificial intelligence platforms on various facets of health care, encompassing physical, mental, and social well-being.

Objectives

To assess the Knowledge, Attitude and Practice on Artificial intelligence among undergraduate medical college
To compare Knowledge, Attitude and Practice on Artificial intelligence among 1^st ,2^nd ,3^rd and 4^th year undergraduate medical college

Methods: A cross sectional comparative study was conducted among the medical college students. A total of 100 medical college students participated in the study. Knowledge, Attitude and Practice on Artificial intelligence among undergraduate medical college students was assessed using a pretested semi structured questionnaire. Comparison was done among 1^st ,2^nd ,3^rd and 4^th year undergraduate medical college students. Independent sample t test will be used for finding the mean difference between the groups.

Results: Among the 100 medical students, a total of 25 study participants each from the 1^st, 2^nd, 3^rd, and 4^th year of medical college were selected by random sampling method. The age group representation was predominantly 17–20 years (44%), followed by 21–22 years (45%), with smaller proportions in the 23–25 years range (11%).The study participants were almost evenly split, with 51% female and 49% male. Overall, 47% of participants had solid very solid knowledge of AI, 48% had good knowledge on AI and 5% had very basic knowledge on AI. The average knowledge score across the 4 years of medical students was 2.59. The average attitude score across the 4 years of study participants was 3.85. only 4% of study participants are very confident of using their AI skill in practice.

Conclusions: Despite moderate knowledge and positive attitudes, actual implementation and use of AI in healthcare practices are minimal. Implementing health and technology strategies can accelerate the practical use of AI in healthcare and institutions.

Comparative Immunohistochemical Expression of HER2/neu in Intestinal-type and Diffuse-type Gastric Adenocarcinoma: A Cross-Sectional Study

2026-08-04T10:31:37+00:00

Background: Human epidermal growth factor receptor 2 (HER2/neu) is a well-known predictive marker of targeted therapy in gastric adenocarcinoma. Local data on the comparison of HER2 expression in intestinal-type and diffuse-type gastric adenocarcinoma are limited.

Objective: To compare the immunohistochemical expression of HER2/neu in intestinal and diffuse-type gastric adenocarcinoma.

Methods: This was a cross-sectional comparative study carried out at Prime Teaching Hospital, Peshawar, from 1st November 2025 to 30th April 2026. Using non-probability consecutive sampling, 106 gastric adenocarcinoma cases, 53 intestinal-type and 53 diffuse-type, were enrolled, all of which were histopathologically confirmed. The independent samples t-test, Chi-square test, and Fisher's exact test were used to compare clinicopathological characteristics and HER2 expression. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived, and values less than 0.05 were deemed statistically significant.

Results: The mean age of the participants was 58.6 ± 11.4 years, and 64.2% of participants were male. The overall HER2 positivity (IHC 3+) was 13.2%. There was a significant difference in the percentage of HER2 positivity between intestinal-type and diffuse-type gastric ADC (22.6% versus 3.8%, respectively; p < 0.001). Patients with intestinal-type tumors had 7.12-fold higher odds of HER2 positivity (OR = 7.12, 95% CI: 1.49–34.01, p = 0.009). HER2 positivity was also significantly associated with lymphovascular invasion (p = 0.043).

Conclusion: HER2/neu overexpression was significantly associated with intestinal-type gastric adenocarcinoma, supporting routine HER2 testing to identify patients who may benefit from targeted anti-HER2 therapy.

Impact of Artificial Intelligence-Assisted Feedback on Clinical Reasoning Skills among Postgraduate Medical Trainees

2026-08-04T10:55:14+00:00

Background: Clinical reasoning is an important competency in postgraduate medical education, but traditional feedback systems can be slow and intermittent due to faculty workload and the time available for supervision. In case-based learning, feedback can be immediate, individualized and structured with the support of systems supported by artificial intelligence.

Objective: To determine the impact of artificial intelligence-assisted feedback on clinical reasoning skills among postgraduate medical trainees.

Methods: The study was a prospective quasi-experimental comparative study carried out at Rawal Institute of Health Sciences Islamabad, from January 2025 to June 2025. In total, there were 76 postgraduate medical trainees, half of whom received feedback via artificial intelligence (38 trainees) and the other half received it from the faculty (38 trainees). Both groups answered clinical cases and had pre- and post-test clinical reasoning assessments. The main outcome was the difference from the overall clinical reasoning score. Secondary outcomes were diagnostic accuracy, generation of differential diagnosis, selection of investigations, planning for management, diagnostic errors, time to complete the case, confidence and satisfaction. Analysis of the data was done by suitable descriptive and inferential statistical tests, and the p-value of < 0.05 was taken as statistically significant.

Results: Baseline clinical reasoning scores were comparable between the AI-assisted and conventional-feedback groups (61.8 ± 7.4 versus 62.3 ± 7.1; p = 0.766). After the intervention, the mean score was significantly higher in the AI-assisted group than in the conventional group (78.6 ± 6.8 versus 70.4 ± 7.3; p < 0.001). The mean improvement was 16.8 ± 6.1 points in the AI group compared with 8.1 ± 5.7 points in the conventional group. The AI-assisted group also demonstrated greater diagnostic accuracy, fewer diagnostic errors, shorter case-completion time, and higher confidence and satisfaction scores.

Conclusion: Artificial intelligence-assisted feedback was associated with greater improvement in clinical reasoning performance than conventional feedback. It may be used as a supplementary educational strategy under appropriate faculty supervision.

Effectiveness of Competency-Based Assessment versus Traditional Assessment in Postgraduate Residency Training

2026-08-04T11:17:13+00:00

Background: Assessment is an integral part in the process of post-graduate medical training, because it defines the process and readiness of the resident for independent clinical work. Traditional assessment techniques focus on written tests and viva voce/viva voce at the end of rotation while competency-based assessment focuses on multiple observations in the workplace, with structured feedback and a demonstration of pre-established clinical skills. In the postgraduate residency training program, this study examined the competency based assessment and traditional assessment methods.

Methods: A prospective comparative study was conducted at the Rawal Institute of Health Sciences, Islamabad from January 2025 to June 2025. The total number of residents included was 76, with an equal number in each group of postgraduates. Thirty-eight residents were competency assessed and 38 were traditionally assessed. The outcomes were overall assessment scores, clinical knowledge, clinical and procedural skills, communication, professionalism, clinical decision-making, patient management, competency achievement, pass rate and resident satisfaction. Data were analysed using appropriate descriptive and inferential statistical tests and a p value of < 0.05 was set as the criteria to be statistically significant.

Results: Residents assessed through the competency-based approach achieved a significantly higher mean overall score than those assessed traditionally (78.6 ± 6.9 versus 71.3 ± 7.5; p < 0.001). The competency-based group also obtained significantly higher scores in clinical skills, procedural competence, communication, professionalism, clinical decision-making and patient management. The mean improvement from baseline was 13.4 ± 5.8 points in the competency-based group and 7.1 ± 5.2 points in the traditional group (p < 0.001). Competency achievement was observed in 86.8% and 65.8% of residents, respectively (p = 0.031), while final pass rates were 92.1% and 73.7% (p = 0.034). Residents receiving competency-based assessment also reported greater satisfaction, more useful feedback and lower assessment-related stress.

Conclusion: Competency-based assessment was more effective than traditional assessment in improving clinical performance, competency achievement and residents’ learning experiences. Its implementation may strengthen postgraduate residency training, although adequate faculty preparation, time and institutional support are required.

Clinicodemographic Profile of Patients Admitted With Acute Appendicitis: A Hospital-Based Cross-Sectional Study

2026-08-04T11:26:34+00:00

Background: Acute appendicitis is one of the most common surgical emergencies worldwide, yet its clinical presentation, diagnostic pathway, and disease severity vary across populations. Locally generated clinicodemographic data can help refine diagnostic pathways and anticipate complicated disease.

Objective: To describe the clinicodemographic profile, diagnostic workup, operative findings, and outcomes of patients admitted with acute appendicitis, and to compare clinical and laboratory parameters between complicated and uncomplicated disease.

Methods: This hospital-based cross-sectional study included 200 consecutive patients admitted with a clinical diagnosis of acute appendicitis over a 12-month period. Demographic details, symptom duration, clinical signs, Alvarado score, laboratory parameters, imaging findings, operative details, and histopathological outcomes were recorded. Diagnostic performance of the Alvarado score, ultrasonography, and computed tomography was assessed against the final histopathological diagnosis. Complicated (gangrenous/perforated) and uncomplicated appendicitis were compared using the chi-square and independent-samples t-test as appropriate.

Results: The mean age was 28.6 ± 11.4 years with a male-to-female ratio of 1.4:1. Migratory right iliac fossa pain was present in 71.0% and fever in 47.0% of patients. Ultrasonography demonstrated a diagnostic accuracy of 81.8%, rising to 96.2% with computed tomography in equivocal cases. Histopathology confirmed acute appendicitis in 92.0% of specimens (negative appendectomy rate 6.0%), with gangrenous or perforated appendicitis in 35.0% of confirmed cases. Symptom duration beyond 48 hours, an Alvarado score ≥7, and elevated C-reactive protein were significantly more frequent among patients with complicated appendicitis (all p<0.001).

Conclusion: Acute appendicitis in this cohort predominantly affected young adults with a male preponderance and typical clinical features. Delayed presentation and elevated inflammatory markers were strongly associated with complicated disease, underscoring the value of early clinical recognition and judicious imaging in reducing perforation-related morbidity.

IMPACT OF INHALER THERAPY ADHERENCE ON CLINICAL OUTCOMES IN PATIENTS WITH ASTHMA AND COPD: A PROSPECTIVE COHORT STUDY

2026-08-04T15:28:33+00:00

Background: Adherence to inhaler therapyis central to disease control in asthma andchronic obstructive pulmonary disease(COPD), yet suboptimal adherence remains common and is associated with poorsymptom control and increased healthcareutilization.

Histological Impact of Aqueous Extract of Neem Leaves (Azadirachta Indica) on the Portal Triad of Adult Albino Rats

2026-08-05T06:50:25+00:00

Introduction: Neem is a common ingredient of most herbal medicines used throughout the world as a house hold cure for hypertension and diabetes along-with different skin disorders.

Objective: To evaluate the effects of aqueous extract of neem leaves on the light microscopic features of portal triad in hepatic lobules of adult albino rats.

Material & methods: Rats in groups B and C received 40 mg/kg and 100 mg/kg of aqueous Neem extract via orogastric tube for 20 days, while group A rats were given simply distilled water (20 ml/kg). All of the rats were sacrificed at the conclusion of the experiment, and their livers were removed for histopathological analysis.

Statistical Analysis: All the data obtained was analyzed by using SPSS V 26. Comparison for inflammation and congestion in portal triad among groups was performed by using chi-square test. P-value ≤ to 0.05 was taken as significant.

Results: No inflammation seen in the portal triads among control group but it was observed that 13 animals in group B and 10 in group C had inflammation in portal triad.

Conclusion: It was concluded that hepatocytes of adult albino rats were found to be significantly harmed by high dosages of aqueous neem leaf extract.

The Role of Cerebroplacental Ratio in Monitoring Fetal Well-Being and Predicting Adverse Outcomes in Healthy and High-Risk Pregnancies in Pakistan

2026-08-05T07:01:27+00:00

Objective: To assess the role of the cerebroplacental ratio (CPR) in determining fetal well-being across healthy and high-risk pregnancies in Pakistan, with a focus on its predictive value for adverse perinatal outcomes such as fetal growth restriction (FGR), preterm birth, and neonatal intensive care unit (NICU) admission.

Study Design: Prospective observational study.

Place and Duration of Study: The study was conducted at the Obstetrics Department of Agha Khan Hospital Hyderabad and Civil Hospital Hyderabad, between July 2024 and December 2024.

Methodology: A total of 64 pregnant women were enrolled and divided equally into four groups of 16 participants: Group 1 (Healthy pregnancies), Group 2 (Pre-eclampsia), Group 3 (Eclampsia), and Group 4 (Diabetes Mellitus). Doppler ultrasound was used to measure the pulsatility indices (PI) of the middle cerebral artery (MCA) and the umbilical artery (UA). The cerebroplacental ratio (CPR) was calculated as the ratio of MCA PI to UA PI. A CPR value of less than 1.0 was considered abnormal and indicative of fetal compromise. Data on perinatal outcomes, including preterm birth, FGR, neonatal Apgar scores, NICU admission, and mode of delivery were collected. Data were analyzed using SPSS Version 25. Statistical significance was defined by a p-value of less than 0.05.

Results: High-risk pregnancies showed significantly lower mean CPR values compared to healthy pregnancies. The mean CPR values were: 1.8 ± 0.3 in the healthy group, 0.85 ± 0.15 in pre-eclampsia, 0.82 ± 0.18 in eclampsia, and 0.95 ± 0.2 in diabetes mellitus (p < 0.001). Adverse perinatal outcomes were more prevalent in high-risk groups. Preterm birth occurred in 37.5% of pre-eclampsia cases, 43.75% of eclampsia cases, and 31.25% of diabetic pregnancies, compared to 6.25% in the healthy group. FGR was observed in 31.25%, 37.5%, and 25% of the pre-eclampsia, eclampsia, and diabetes groups, respectively, while it was absent in the healthy group. NICU admission rates were 25%, 31.25%, and 18.75% in pre-eclampsia, eclampsia, and diabetes groups, respectively, compared to 3.1% in healthy pregnancies. The cesarean delivery rate was highest in eclampsia (62.5%), followed by pre-eclampsia (56.25%) and diabetes mellitus (43.75%), compared to 12.5% in healthy pregnancies. Logistic regression analysis indicated that a CPR below 1.0 was strongly associated with an increased risk of preterm birth (odds ratio: 4.5) and FGR (odds ratio: 3.8).

Conclusion: The cerebroplacental ratio is a crucial tool for predicting adverse perinatal outcomes in high-risk pregnancies. Its integration into routine antenatal care enables early detection of fetal compromise and supports timely clinical interventions, thereby reducing perinatal morbidity and mortality in resource-constrained healthcare settings in Pakistan.

Feeding Practices and Their Correlation with Nutritional Status of Children Aged 6–24 Months in Rural Sagar, Madhya Pradesh: A Community-Based Cross-Sectional Study

2026-08-05T07:16:35+00:00

Background: Complementary feeding practices are a key modifiable determinant of undernutrition in children aged 6–24 months. Madhya Pradesh reports among the highest rates of minimum dietary diversity failure in India, yet rural, block-level correlational data from Sagar district are scarce.

Objectives: To assess complementary feeding practices and to determine their correlation with the nutritional status of children aged 6–24 months in rural Sagar.

Methods: A community-based cross-sectional study was conducted among 425 children aged 6–24 months in the rural field practice area of Sagar, using multistage random sampling. Complementary feeding practices were assessed using WHO/UNICEF (2021) IYCF indicators via a pre-tested questionnaire and 24-hour dietary recall; nutritional status was classified using WHO Child Growth Standards. Analysis was performed using SPSS v26, with chi-square test, odds ratio, and multivariate logistic regression.

Results: Minimum Dietary Diversity was met by 31.1% and Minimum Acceptable Diet by only 22.6% of children. Overall, 35.1% of children were stunted, 19.1% wasted, and 30.8% underweight. Inadequate dietary diversity (χ²=15.80, p<0.001; OR=2.61, 95% CI: 1.63–4.18), inadequate meal frequency (p<0.001; OR=2.28), and failure to achieve MAD (p<0.001; OR=4.09) were significantly associated with stunting. On multivariate analysis, MAD not achieved (AOR=2.92), inadequate MDD (AOR=2.14), maternal illiteracy (AOR=1.96), and lower socioeconomic status (AOR=1.71) independently predicted stunting.

Conclusion: A high burden of undernutrition coexists with poor complementary feeding practices in rural Sagar. Strengthening dietary diversity and meal frequency through Anganwadi/ASHA-led IYCF counselling under POSHAN 2.0 is warranted.

Clinical Audit of Pediatric Advanced Life Support (PALS) Guideline Adherence during Emergency Resuscitation

2026-08-05T07:42:07+00:00

Background: Pediatric emergencies can progress rapidly to respiratory failure, shock, and cardiopulmonary arrest.

Objective: To assess adherence to Pediatric Advanced Life Support guidelines during emergency resuscitation in the Pediatric Emergency Department and identify areas requiring quality improvement.

Study Design: Clinical audit.

Place and Duration of Study: Pediatric Emergency Department, Liaquat University Hospital, Hyderabad, from July 2021 to December 2021.

Methodology: Ninety-six consecutive resuscitation events involving children aged one month to 18 years were assessed using a structured checklist based on Pediatric Advanced Life Support recommendations. The evaluated criteria included timely recognition of deterioration, initiation and quality of cardiopulmonary resuscitation, oxygenation and ventilation, rhythm recognition, vascular access, epinephrine administration, defibrillation, assessment of reversible causes, teamwork, documentation, and post-resuscitation care.

Results: The mean overall adherence score was 61.4 ± 14.2%. High adherence was observed in 19 (19.8%) events, moderate adherence in 43 (44.8%), and low adherence in 34 (35.4%). Immediate cardiopulmonary resuscitation was initiated in 65 (67.7%) events. The recommended compression rate, appropriate compression depth, and interruptions below 10 seconds were achieved in 52 (54.2%), 47 (49.0%), and 43 (44.8%) events, respectively. Correct epinephrine dosing was documented in 60 (62.5%) events, while recommended dosing intervals were followed in 49 (51.0%).

Conclusion: Adherence to Pediatric Advanced Life Support guidelines was suboptimal, particularly regarding chest-compression quality, medication timing, communication, documentation, and debriefing.

Effectivity of Hepatitis B Vaccination

2026-08-05T10:13:23+00:00

Introduction: Hepatitis B poses a significant health problem worldwide. Hepatitis B vaccine as a part of universal immunization, is both cost-effective and efficacious with minimal side effects. The Hepatitis B virus (HBV) vaccine is exceptionally effective, providing 98–100% immunity in healthy individuals who complete the standard 2-to-3-dose series. It is one of the most successful public health interventions, drastically reducing pediatric infections worldwide and providing long-term protection that lasts at least 30 years. The reported side effects of the Hepatitis B vaccine include soreness, redness, or swelling at the injection site, headache, fatigue, and a low-grade fever.

Aim of Study To determine effectivity of hepatitis B vaccination in spouses of Hepatitis B patients and Health care workers.

Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of three years from 1^st July, 2023 to 30^thJune, 2026. At our department, as a policy matter, we mandatory screen spouses and other family members for HBV and HCV infection in patients of chronic hepatitis B and C. Moreover, we also have mandatory fully vaccinated all health care workers against hepatitis B. Hence, we tried to check effectivity of HBV vaccination in these two groups, at-least after three years of HBV vaccination. This time period was given for adequate exposure for risk of counteracting hepatitis B infection. Only those spouses were enrolled in the study who were having normal sexual relationships after HBV vaccination. Moreover, only those healthcare workers were enrolled who were having clinical postings after HBV vaccination. Our institute has high footfall of HBV and HCV patients who are treated in various specialities and super-specialities. Moreover, our department is model treatment centre under National viral hepatitis control program and on daily basis 70-80 HBV and HCV patients come for treatment which require endoscopy and indoor admission in many cases. Thus, our 25 staff members are continuously exposed to HBV and HCV infection. In total, total 500 spouses and 500 health care workers were screened with HbsAg test after at least in three years of HBV vaccination. The written informed consent was taken before enrolling in the study and data pertaining to them was analysed.

Observation and Results: Out of total one thousand participant in study group, 500 were health care workers and 500 were spouses of HBV patients. All had received three doses of HBV vaccination. The challenge faced was in certain husbands of HBV infected females who had strong ego. They felt, that they do not need advice of their spouses, as they are main head of family. Hence with persistent efforts took full dose of HBV vaccine. Out of these 1000 participants, none was found to be HbsAg positive after a gap of 3-5 years of complete course of HBV vaccination.

Conclusion: India is having intermediate prevalence of HBV. Hepatitis B vaccination is strongly indicated in health care workers and high -risk groups. The vast majority of vaccinated healthcare workers and spouses of HBV patients remain protected against HBV infection decades after the primary immunization cycle. These results give strong motivation for mandatory HBV vaccination in all health care workers and high-risk groups, including spouses and family members of HBV patients.

Optimal Staging and Single-Stage Arthroscopic Management Protocols for Combined ACL/PCL or Posterolateral Corner Injuries: A Prospective Clinical Study

2026-08-05T10:28:14+00:00

Background: Combined anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posterolateral corner (PLC) injuries are technically demanding and may result in persistent multidirectional instability, stiffness, and loss of activity. The preferred timing of reconstruction and the role of single-stage treatment remain debated.

Objective: To evaluate functional recovery, objective stability, range of motion, complications, and timing associations following protocol-based single-stage management of combined ACL/PCL or cruciate-PLC injuries.

Methods: This prospective, single-centre interventional study included 40 adults with ACL+PCL, ACL+PLC, PCL+PLC, or ACL+PCL+PLC injuries. All underwent single-stage arthroscopic cruciate reconstruction, with PLC repair or reconstruction when indicated, followed by structured phase-based rehabilitation. Lysholm, subjective International Knee Documentation Committee (IKDC), and Tegner scores were compared before surgery and at final follow-up using the Wilcoxon signed-rank test. Spearman correlation assessed associations between injury-to-surgery interval and final outcomes.

Results: Mean age was 30.75±8.75 years, and 27 (67.5%) patients were men. Road traffic or motorcycle trauma accounted for 19 (47.5%) injuries. Mean injury-to-surgery interval was 5.35±2.60 weeks, and mean follow-up was 19.95±2.84 months. Lysholm score improved from 29.15±5.61 to 88.15±5.18, subjective IKDC from 31.10±5.30 to 84.68±5.32, and Tegner score from 2.00±0.78 to 6.45±1.47 (all p<0.001). Objective IKDC grade A or B was achieved in 34 (85.0%) patients. Nine (22.5%) patients had a recorded complication, most commonly arthrofibrosis. Longer time to surgery correlated with lower postoperative Lysholm (ρ=-0.699), IKDC (ρ=-0.681), and Tegner scores (ρ=-0.669), and with greater motion loss (all p<0.001). In the exploratory ≤6-week versus >6-week comparison, the earlier group had better final scores but was also substantially younger and had higher baseline function.

Conclusion: Protocol-based single-stage treatment produced substantial functional improvement and acceptable objective stability at short- to mid-term follow-up. The observed timing relationships were confounded and do not establish an optimal operative threshold or superiority over staged reconstruction.

Inhaler Technique Errors and Their Association with Asthma Control among Adult Patients: A Cross-Sectional Study

2026-08-05T10:36:48+00:00

Background: Incorrect inhaler technique can reduce pulmonary drug deposition and contribute to persistent symptoms despite appropriate prescribing. This study assessed the frequency and pattern of inhaler technique errors and examined their association with Asthma Control Test (ACT) scores among adults with asthma.

Methods: In this cross-sectional study, 100 adults using a pressurised metered-dose inhaler (pMDI), dry-powder inhaler (DPI), or pMDI with spacer demonstrated their usual technique. Device-relevant errors were recorded with a predefined checklist. Asthma was classified as controlled (ACT 20-25), partly controlled (ACT 16-19), or uncontrolled (ACT 5-15). Chi-square, Spearman rank correlation, and Mann-Whitney U tests were used as appropriate.

Results: The mean age was 48.06±13.46 years. At least one technique error was observed in 87 patients (87.0%), and the mean error count was 3.10±2.17. Failure to hold the breath after inhalation was the most frequent error (n=79). Mean ACT score was 18.19±4.97; 44 patients had controlled asthma, 20 partly controlled asthma, and 36 uncontrolled asthma. Error count had a strong inverse correlation with ACT score (rho=-0.991, p<0.001). Asthma-control distribution differed significantly across error categories (chi-square=119.00, p<0.001). Patients with prior inhaler education had fewer errors and higher ACT scores than those without prior education (both p<0.001).

Conclusion: Inhaler technique errors were frequent and closely associated with poorer ACT-based asthma control. Direct observation, correction of device-specific errors, and repeated teach-back education should form part of every asthma review.

Breast-Feeding Practices in HBV and HCV Patients

2026-08-05T11:09:24+00:00

Introduction: Chronic hepatitis B (HBV) & C Virus (HCV) infection are important cause of cirrhosis of liver for which effective treatment is available but still significant number of patients require liver transplantation when it reaches end stage liver disease. Breastfeeding is highly recommended for mothers with Hepatitis B (HBV) and Hepatitis C (HCV), provided proper immunoprophylaxis is administered. Breast milk itself does not significantly increase transmission risk, and the nutritional benefits far outweigh the potential for infection. Mothers with high viral loads often receive antiviral medications Tenofovir during the third trimester to reduce the risk of transmission. All infants born to HBsAg-positive mothers must receive the Hepatitis B vaccine and Hepatitis B Immune Globulin (HBIG) within 12-24 hours of birth. With proper vaccination and HBIG, breastfeeding is completely safe and not a contraindication.

Aims and Objectives: To determine hurdles faced and implementation of breast- feeding program in HBV & HCV pregnant patients.

Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of four years from 1^st June, 2023 to 31^st May, 2026 during which 200 confirmed pregnant patients each of HBV & HCV were enrolled in the study and were enquired about challenges faced regarding breast feeding and following of practice of breast feeding. All these 400 pregnant patients delivered in hospital surroundings. All newborns borne to HBV pregnant patients received mandatory 0.5 ml intravenous hepatitis B immunoglobulin, along with zero dose HBV vaccination, followed by complete source of vaccination. Out of these 200 HBV patients, 60 (30%) received antiviral treatment with tenofovir 300 mg, in view of raised levels of HBV DNA, HbeAg and transaminases, as per scientific guidelines. All 400 HBV and HCV pregnant females were motivated for breast feeding on every follow-up. Hence data pertaining to these total 400 patients was used in final analysis.

Results: Out of the 200 HBV pregnant patients, 196 (98%) breast fed for six months or more, 2 patients (1%) lactation did not occur, and 2 patients (1%) intentionally never breast fed due to pressure of family members due to fear of transmission of HBV infection to new born. Hence, these 4 newborns, out of 200 were given top feed. Out of the 200 HCV pregnant patients, 197 (98.5%) breast fed for six months or more, in 1 patient (0.5%) lactation did not occur, and 2 patients (1%) intentionally never breast fed due to pressure of family members due to fear of transmission of HCV infection to new born. Hence, these 3 newborns, out of 200 were given top feed.

Conclusion: The HBV and HCV patients are already terrified regarding their illness, course & side effects of treatment, familial transmission and social stigma associated with the illness. The pregnant females having HBV and HCV infection are more worried for their newborn, then for themselves. The main worry is transmission to the newborn during pregnancy and after delivery, especially by breast feeding and close contact with mother. The main precipitant are family members, relatives and society at large. Hence, all manoeuvres should be done to break all challenges and myths associated with breastfeeding in HBV and HCV infected mothers.

A Prospective Histopathological Study of Renal Changes in Cases of Flame Burns Brought to Government Medical College Mortuary, Kadapa, Andhra Pradesh

2026-08-05T11:18:21+00:00

Background: Burn injuries remain a major public health problem and are associated with significant morbidity and mortality worldwide. Acute kidney injury is one of the most important systemic complications following severe flame burns and contributes substantially to mortality. Histopathological examination of renal tissue provides valuable insights into the pathological alterations associated with burn injury and their relationship with survival duration.

Objectives: To identify the histopathological changes in kidneys among fatal flame burn cases and to correlate these findings with post-burn survival.

Materials and Methods: A prospective observational autopsy-based study was conducted in the Department of Forensic Medicine in collaboration with the Department of Pathology, Government Medical College, and Kadapa. Thirty consecutive flame burn fatalities fulfilling the inclusion criteria were enrolled. Following medico-legal autopsy, both kidneys were preserved in 10% neutral buffered formalin, processed routinely, and stained with hematoxylin and eosin for microscopic examination. Histopathological changes were recorded and analyzed using descriptive statistics.

Results: Thirty flame burn cases were included, comprising 15 males and 15 females with a mean age of 43.2 years. Congestion was the most frequent histopathological finding (73.3%), followed by cloudy degeneration (66.7%), acute tubular necrosis of proximal convoluted tubules (63.3%), distal tubular necrosis (46.7%), interstitial inflammatory infiltration (43.3%), tubular casts (20.0%), and pyelonephritis (6.7%). The majority of significant renal changes were observed in patients surviving between 4 and 7 days following burn injury.

Conclusion: Renal histopathological alterations are common following fatal flame burns. Congestion, cloudy degeneration, and acute tubular necrosis constitute the predominant pathological changes. Histopathological evaluation of kidneys provides valuable evidence regarding systemic burn injury and may aid in understanding mechanisms contributing to mortality.

Morphological Evaluation of the Acetabulum in Adult Indian Dry Hip Bones: Implications for Total Hip Arthroplasty and the Role of Three-Dimensional Printing

2026-08-05T11:36:45+00:00

Background: The acetabulum, the bony socket of the hip joint, displays significant population-level morphological variation. Current acetabular implants for total hip arthroplasty (THA) are largely dimensioned on Caucasian and East Asian anthropometric data. Simultaneously, three-dimensional (3D) printing has emerged as a transformative technology for producing patient-specific implants, surgical guides, and anatomical models. Population-specific morphometric data combined with 3D printing offer a paradigm shift in THA planning and implant design for the Indian population. Objectives: To perform comprehensive morphometric analysis of the acetabulum in adult Indian dry hip bones and to evaluate the role and applications of 3D printing technology in THA planning, implant fabrication, and surgical training within the Indian clinical context. Materials & Methods: One hundred and twenty adult dry hip bones (78 male, 42 female; 62 right, 58 left) of confirmed Indian origin were studied from multi-institutional osteology collections. Eleven morphometric parameters were measured using digital verniercallipers, an acetabulometer, and goniometers. Literature on 3D printing applications in THA was systematically reviewed using PubMed, Scopus, and MEDLINE databases (2010–2024). Results: Mean acetabular transverse diameter was 45.8 ± 4.1 mm (males 47.3 ± 3.8 mm; females 43.6 ± 3.2 mm). Mean acetabular depth was 22.3 ± 2.6 mm. Elliptical morphology predominated (54.2%). Significant sexual dimorphism was observed across all linear measurements (p < 0.001). Comparison with published Caucasian data revealed consistently smaller diameters in Indian specimens. 3D printing applications reviewed included patient-specific acetabular cups, surgical cutting guides, pre-operative simulation models, and porous titanium ingrowth surfaces. Conclusion: The Indian acetabulum is morphometrically distinct from Western counterparts, with smaller diameters, greater ellipticity, and higher acetabular inclination in females. These population-specific data, when combined with 3D printing technology, enable manufacture of anatomically optimised acetabular implants, improving prosthetic fit, primary stability, and long-term osseointegration. Wider adoption of CT-derived 3D printing workflows in Indian orthopaedic practice is strongly recommended. Keywords: Acetabulum, morphometry, dry hip bone, Indian population, total hip arthroplasty, 3D printing, additive manufacturing, patient-specific implant, acetabular cup, sexual dimorphism.

Nasal Carriage of Methicillin-Resistant Staphylococcus aureus (MRSA) among Healthcare Workers in a Tertiary Care Hospital in New Delhi, India

2026-08-06T06:15:01+00:00

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen with a high prevalence among healthcare workers (HCWs), posing a risk of transmission to vulnerable patients. Colonized HCWs are often asymptomatic but serve as reservoirs for hospital and community-associated infections. This study aims to determine the nasal carriage rate of MRSA among HCWs at HAHC Hospital, analyze its antimicrobial resistance profile, and detect the presence of mecA and PVL genes. A cross-sectional study at HAHC Hospital, Jamia Hamdard, New Delhi, India, collected nasal swabs from 250 HCWs and MBBS students, culturing isolates to identify and test S. aureus for antimicrobial susceptibility. MRSA screening was performed using the cefoxitin disc diffusion method, and polymerase chain reaction (PCR) was used for mecA and PVL gene detection. The prevalence of S. aureus nasal carriage was 31.6% (79/250), with MRSA accounting for 5.6% (14/250). The MRSA rate among S. aureus carriers was 17.7% (14/79). The highest MRSA carriage was observed in nursing staff (16.7%; 5/30), followed by doctors (6.4%), laboratory technicians (5.8%), and MBBS students (3.7%). Housekeeping staff showed no MRSA carriage. MRSA isolates exhibited 100% resistance to levofloxacin and cefoxitin, followed by ciprofloxacin (78.5%), erythromycin (64.2%), clindamycin (57.1%), and gentamicin (42.8%). The mecA gene was detected in 13 out of 14 MRSA isolates, while the PVL gene was absent. Significant MRSA nasal carriage among nursing staff and final-year MBBS students underscores the urgent need for infection control, regular screening, and delocalization strategies.

COMPARISON OF CONVENTIONAL AND BISPECTRAL INDEX GUIDED PROPOFOL INDUCTION DURING GENERAL ANAESTHESIA FOR ABDOMINAL SURGERIES

2026-08-06T06:27:43+00:00

Background: Propofol is the mostcommonly used intravenous inductionagent for general anaesthesia.Conventional weight-based dosing maylead to over- or under-dosing because ofinter individual pharmacokinetic and pharmacodynamic variability, resulting inhaemodynamic instability and delayedrecovery. Bispectral Index (BIS)

A Retrospective Epidemiological Study of Hearing Loss in Gims Teaching Hospital, Gulbarga

2026-08-06T06:29:22+00:00

Introduction: Hearing impairment remains a significant yet overlooked public health issue in developing countries, despite the fact that about half of all instances could be prevented or detected early. The present study is carried out to know the prevalence of hearing loss in the region of Gulbarga district, Karnataka state, India.

Methodology: A retrospective cross-sectional study of hearing impairment was caried out in GIMS teaching hospital, Gulbarga from October 2021 to October 2023. Records of patients visiting ENT OPD with complaints of hearing loss including complete systemic, otological and audiological assessment were compiled and assessed.

Results: In our study, total of 3839 individuals were studied in different age groups, majority of the hearing impairment population (17.8%) belonged to age group of 21-30years. An alarming 86% of the population suffered from bilateral hearing loss, with male preponderance. When comparison was done between conductive, mixed and sensorineural, sensorineural weighed more. A summating 54% of the population was leading a life with disability.

Conclusion: Given the serious health and social consequences of hearing impairment, its prevalence is a cause of concern. Early detection and timely intervention have the potential to ameliorate this burden. Hence, making it important to include audiological assessment in routine health checkup and create awareness among the general public.

DIAGNOSTIC PERFORMANCE OF RED CELL DISTRIBUTION WIDTH IN PREDICTING THE SEVERITY OF NEONATAL SEPSIS

2026-08-06T07:09:45+00:00

Background: Neonatal sepsis is a severe, lifethreatening condition that arises from a systemicinflammatory response to infection in newborns. It isa significant contributor to neonatal morbidity and mortality, particularly among preterm and low-birthweight infants.

A Clinico-Epidemiological Profile and Etiological Spectrum of Fever of Unknown Origin in Children Age 1–17 Years: A Prospective Observational Study from a Tertiary Care Centre in North India

2026-08-06T08:20:38+00:00

Background: Fever of unknown origin (FUO) remains a major diagnostic challenge in paediatric practice because of its diverse etiologies and variable clinical manifestations. Contemporary prospective data from North-Western India are limited.

Objectives: To evaluate the clinico-epidemiological profile and etiological spectrum of fever of unknown origin among children age 1–17 years admitted to a tertiary care centre.

Methods: A hospital-based prospective observational study was conducted in the Department of Paediatric Medicine, Sir Padampat Institute of Neonatology and Paediatric Health, SMS Medical College, Jaipur, from June 2024 to May 2025. Eighty children fulfilling the predefined criteria for fever of unknown origin were enrolled. Demographic characteristics, clinical features, laboratory investigations, imaging findings, and final diagnoses were recorded using a standardized protocol. Statistical analysis was performed using SPSS version 26.0.

Results: The mean age of participants was 6.93 ± 5.15 years, with children age 1–5 years accounting for 53.75% of cases. Males predominated (61.25%). The mean duration of fever was 33.05 ± 13.6 days. Poor activity and appetite (81.25%) and weight loss (51.25%) were the most frequent presenting features. Anaemia was the commonest haematological abnormality (66.25%). Infectious diseases represented the predominant etiological group (83.75%), followed by malignancies (8.75%), undiagnosed cases (5.0%), and connective tissue diseases (2.5%). Tuberculosis (47.5%) and brucellosis (25.0%) were the leading final diagnoses. Thrombocytopenia, leukopenia, neutropenia, and pancytopenia showed significant associations with malignant disorders.

Conclusions: Infectious diseases, particularly tuberculosis, remain the principal cause of paediatric fever of unknown origin in this region. A structured, stepwise diagnostic approach supported by targeted laboratory investigations facilitates early diagnosis and appropriate management while reducing unnecessary investigations and empirical antimicrobial therapy.

Prevalence of Drug Resistance in Neonatal Sepsis- A Prospective Study

2026-08-06T08:37:59+00:00

Background: Infections are the single largest cause of neonatal deaths globally. The emergence of Methicillin resistant Staphylococcus aureus (MRSA) and extended spectrum β– lactamases (ESBLs) in neonatal intensive care unit patients is increasing. This study aims to find out the bacteriological profile in neonatal sepsis and study their antimicrobial susceptibility pattern.

Method: A total of 360 suspected neonatal septicaemic cases admitted in SSIMS & RC at NICU were enrolled. Blood sample was collected for blood culture. The isolates were identified by standard biochemical tests and susceptibility performed using the disc diffusion methods as per Clinical laboratory Standard Institute (CLSI) recommendations. Staphylococcus aureus were tested for Methicillin resistance using Cefoxitin disc (30μg), ESBL was detected using combined disc method.

Results: Out of 360 cases 160 were bacteriologically positive, Klebsiella was the most common organism isolated (21%), followed by Staphylococcus aureus (20%) Acinetobacter (15%), Pseudomonas (13%). Maximum sensitivity was seen by Linezolid, Erythromycin for Gram positive organisms and Gram negative organisms were sensitive to Piperacillin/ Tazobactum, Imipenem, Levofloxacin, Meropenem. MRSA was detected in 53% isolates, ESBL production was majorly seen in E.coli, followed by Klebsiella.

Conclusion: Klebsiella spp. and Staphylococcus aureus were the commonest bacteria causing neonatal sepsis in this centre. Multidrug resistance among the isolates was common. Early diagnosis and institution of specific antibiotics after studying the sensitivity pattern will help in reducing neonatal morbidity and mortality and prevent emergence of drug resistant strains.

A Prospective Study of Sepsis among Newborns and It's Etiology in a Tertiary Care Hospital

2026-08-06T08:51:51+00:00

Background: Neonatal sepsis is a worldwide problem with the prevalence at 1 to10 per 1000 live birth and one of the indicator for measuring the health status of a nation. According to WHO there are about 5 million neonatal death per year with 98% occurring in developing countries. Antimicrobial resistance is a growing threat worldwide. Blood culture is considered as the gold standard technique for diagnosis of neonatal septicemia.

Objectives

To know the various bacteria causing neonatal septicemia and their antibiogram.
To detect drug resistance among the isolated bacteria

Method: A Prospective study was done over a period of 2 year. Blood samples for culture were collected aseptically before starting antibiotic therapy and subcultures were performed. The isolates were identified by standard biochemical tests and antibiogram of the isolates were studied.

Conclusion: Knowledge of likely causative organism causing neonatal septicemia can help in instituting prompt and appropriate therapy which in turn reduce morbidity and mortality.

Closed Intramedullary Nailing Vs. Percutaneous Plating for Distal Tibia Metaphyseal Fractures

2026-08-06T09:53:29+00:00

Background: Distal tibial metaphyseal fractures are difficult orthopedic injuries due to the fact that they are relatively soft tissue-deficient and hard to fix without compromising the fracture biology.

Objective: The clinical, radiological, and functional results of closed intramedullary nailing versus percutaneous plating of distal tibial metaphyseal fracture.

Materials and Methods: The study was a prospective comparative study at the Khyber Teaching Hospital Peshawar from September 2025 to February 2026. A total of 80 patients with extra-articular distal tibial metaphyseal fractures were randomly divided into two groups: intramedullary nailing and percutaneous plating.

Results: The intramedullary nailing group had a significantly lower blood loss, shorter hospital stay, and lower operative time. There was no difference in the rate of fracture union or functional results, but plating had slightly better alignment and more superficial wound complications and implant irritation.

Conclusion: Both methods are effective, but intramedullary nailing is more efficient in the operation and has a quicker recovery.

Anatomical Variations of the Axillary Nerve and Their Impact on Proximal Humerus Fracture Surgery

2026-08-06T11:17:22+00:00

Background: The axillary nerve is associated with the surgical neck of the humerus and is especially susceptible on operative treatment of the proximal humerus fracture. Changes in its location, branching configuration and relation to adjacent structures can increase the risk of intra-operative injury and negatively impact post-operative shoulder function. This study was conducted to find the incidence of specific anatomical variations of the axillary nerve and to assess their relevance to the surgical and functional results in patients who have had surgery for the proximal humerus.

Methodology: This is a prospective observational study that took place between January 2025 and June 2025 at Rawal Institute of Health Sciences, Islamabad. Patients with patients of displaced proximal humerus fractures who were managed by surgery were all included consecutively, total 85 patients. Demographic data, fracture-related and operative data were recorded. The course, branching pattern and relationships of the axillary nerve was determined intraoperatively. Patients were grouped into either a normal or variant axillary nerve anatomy. The neurological status, duration of the operation, blood loss, range of the shoulder, Constant–Murley shoulder score, and complications were assessed postoperatively. Data were analyzed statistically by appropriate comparative tests and multivariable logistic regression and p value < 0.05 was considered statistically significant.

Results: The mean age of the patients was 52.8 ± 13.6 years, and 49 (57.6%) were male. Anatomical variations of the axillary nerve were identified in 26 (30.6%) patients. Multiple branching was the most frequent variation, observed in 10 (11.8%) patients, followed by a low-positioned nerve in 7 (8.2%), a high-positioned nerve in 5 (5.9%) and accessory or communicating branches in 4 (4.7%). The mean nerve-to-acromion distance was significantly shorter in patients with anatomical variations than in those with normal anatomy. Postoperative axillary nerve dysfunction occurred in 11 (12.9%) patients and was significantly more frequent in the variation group than in the normal-anatomy group, 30.8% versus 5.1% (p=0.002). Patients with anatomical variations also had longer operative duration, greater blood loss, more frequent modification of the surgical approach, lower Constant–Murley scores and reduced shoulder abduction. Anatomical nerve variation independently increased the likelihood of postoperative nerve dysfunction.

Conclusion: Anatomical variations of the axillary nerve are common and may significantly influence the complexity and outcome of proximal humerus fracture surgery. Awareness of these variations, careful intraoperative identification and individualized surgical planning may reduce the risk of nerve injury and improve postoperative shoulder function.

Prevalence and Predictors of Restrictive Lung Dysfunction among Patients with Type 2 Diabetes Mellitus

2026-08-06T11:32:17+00:00

Objective: Type 2 Diabetes Mellitus (T2DM) is a systemic disease, and the lungs are a target organ of the disease. This study was aimed to find out the prevalence of Restrictive Lung Dysfunction (RLD) in T2DM patients and to identify its independent clinical and biochemical predictors.

Material and Methods: A cross-sectional observational study of 450 adult patients of T2DM attending a tertiary care endocrinology clinic was conducted. The definition of RLD was a Forced Vital Capacity (FVC) < 80% of the predicted value and normal FEV1/FVC ratios. Multivariate logistic regression analysis was used to determine the independent risk factors for RLD.

Results: RLD was identified in 34.2% (n=154) of the participants. Multivariate analysis revealed that prolonged duration of diabetes (OR = 1.15, 95% CI: 1.08-1.22, p < 0.001), poor glycemic control (HbA1c > 8.0%) (OR = 2.45, 95% CI: 1.55-3.88, p < 0.001), presence of diabetic nephropathy (OR = 2.10, 95% CI: 1.25-3.52, p = 0.004), and increased body mass index (OR = 1.08, 95% CI: 1.02-1.14, p = 0.008) were independent predictors of RLD.

Conclusions: Restrictive lung dysfunctions is common among patients with T2DM. Significant independent risk factors include poor glycemic control, long duration of diabetes, diabetic nephropathy, and obesity. Lung function screening should be routinely performed in T2DM patients, particularly those with long duration of diabetes and microvascular complications as a part of their comprehensive management.

A PROSPECTIVE OBSERVATIONAL STUDY OF PLATELET RICH PLASMA AS MODALITY OF TREATMENT OF OSTEOARTHRITIS

2026-08-06T12:11:04+00:00

Introduction: Osteoarthritis is adegenerative, chronic disease that affects upto 80% of the population over 75 years ofage. A recent report indicates that kneeosteoarthritis is likely to become the fourthmost crucial aetiology of physical limitation in women and the eighth most in men. Inmiddle-aged persons, osteoarthritis maycause a major burden in lost time at work

A PROSPECTIVE COMMUNITY BASED STUDY TO EVALUATE THE PREVALENCE AND RISK FACTORS FOR OSTEOPOROSIS AMONG MENOPAUSAL AND PREMENOPAUSAL WOMEN

2026-08-06T12:13:46+00:00

Introduction: Osteoporosis is defined as asystemic skeletal muscle diseasecharacterized by low bone mass leading to
an increase in bone fragility andsusceptibility to fractures. It is a major global health problem associated withsignificant morbidity, mortality, andsocioeconomic burden.

A PROSPECTIVE STUDY OF RELATIONSHIP BETWEEN AGE AND BMI ON OSTEOARTHRITIS IN GERIATRIC FEMALES IN A TERTIARY CARE HOSPITAL

2026-08-06T12:17:35+00:00

Introduction: Osteoarthritis (OA) is adisease with truly formidable impact. As themost common form of arthritis, it accounts for more dependency in walking, stairclimbing, and other lower extremity tasksthan any other disease; especially in theelderly. Musculoskeletal health is oftenoverlooked on the public health agenda

RETROSPECTIVE STUDY OF PATTERNS AND CHARACTERISTICS AND OUTCOME OF ROAD TRAFFIC INJURED PATIENTS IN A TERTIARY CARE HOSPITAL

2026-08-06T12:22:00+00:00

Introduction: Road traffic accidents are ahuman tragedy. Nearly 1.3 million peopledie every year on the world’s roads and upto 50 million people suffer non-fatal injuries, with many sustaining a disability asa result of their injury

CLINICO-EPIDEMIOLOGICAL PROFILE OF CUTANEOUS ADVERSE DRUG REACTIONS: A RETROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE TEACHING HOSPITAL IN KARNATAKA, INDIA

2026-08-06T12:42:18+00:00

Background: Cutaneous adverse drugreactions (CADRs) represent one of themost frequently encountered adverse drug
reactions in clinical practice, accounting fora significant proportion of dermatologicalconsultations and hospital admissions (1,2). Their clinical spectrum ranges from mildself-limiting eruptions to life-threatening

HISTOPATHOLOGICAL INSIGHTS INTO HYPERPIGMENTED SKIN LESIONS – A CLINICOPATHOLOGICAL STUDY

2026-08-06T17:32:19+00:00

Background: Hyperpigmentary disordersare a common dermatological concern thatcan cause considerable cosmetic,psychological, and emotional distress toaffected individuals and their families.These disorders encompass a broadspectrum of conditions, including
infectious, inflammatory, autoimmune, lymphoproliferative, and sclerosingdiseases. Owing to their diverse etiologies

Beyond the Incision: Predicting Surgical Site Infection After Orthopaedic Surgery: A Multicentre Cohort Study

2026-08-06T17:34:58+00:00

Background: Surgical site infection (SSI) remains one of the most serious complications followingorthopaedic surgery, leading to increased morbidity, repeated surgical interventions, prolongedhospitalization, and higher healthcare costs. Early identification of modifiable risk factors is essential for improving patient outcomes.

Individualized Homoeopathic Management of Chronic Relapsing Alopecia Areata with Phosphorus LM Potencies: A Case Report

2026-08-07T05:48:59+00:00

Alopecia areata is a chronic autoimmune disorder characterized by non-scarring hair loss with an unpredictable relapsing course. Conventional treatment options may promote hair regrowth, but recurrence is common after treatment discontinuation. This case report describes the individualized homoeopathic management of a 30-year-old male with a 14-year history of recurrent alopecia areata involving the scalp, eyebrows, beard, axillae, and limbs. Constitutional assessment revealed marked thirst for cold water, increased appetite and desire for cold drinks, sweets and salty foods, disturbed sleep, fear of thunderstorms and darkness, and poor memory. Based on the totality of symptoms, Phosphorus was prescribed in sequential LM potencies. During follow-up, progressive reduction in hair fall, gradual regrowth of scalp and eyebrow hair, absence of new alopecic patches, and improvement in general well-being were observed without reported adverse effects. Although therapeutic efficacy cannot be established from a single case, this report provides descriptive clinical evidence supporting further investigation of individualized homoeopathic treatment in alopecia areata.

Phenotypic Variations and Birth Weight Trends in Neonates of Gestational Diabetic Mothers- Hospital Based Cohort Study

2026-08-07T06:25:14+00:00

Background: Gestational diabetes mellitus (GDM) represents a significant metabolic challenge during pregnancy, directly impacting fetal growth and development. While the classical phenotype of the infant of a diabetic mother is large for gestational age (LGA), birth weight alone may not capture the full extent of metabolic alterations.

Methods: A hospital-based cohort study was conducted on 105 neonates born to GDM mothers admitted to a neonatal intensive care unit (NICU) to assess phenotypic categories and immediate clinical outcomes. These findings were comparatively analysed against recent literature to identify changing trends in neonatal assessment.

Results: In the current clinical cohort, infants exhibited varied phenotypes: 33.3% were LGA, 53.3% were average for gestational age (AGA), and 13.3% were small for gestational age (SGA). High rates of short-term morbidities were observed, notably hypoglycaemia (64.8%) and respiratory distress syndrome (50.5%).

Conclusion: The phenotypic presentation of infants of GDM mothers is a spectrum ranging from growth restriction to macrosomia. Recent trends indicate a paradigm shift from relying solely on standard birth weight percentiles toward direct body composition analysis to better predict neonatal complications.

Development and Validation of Matrix Interference Method for Estimation of Miconazole Nitrate, Clobetasol Propionate in Combined Pharmaceutical Dosage Form

2026-08-07T06:52:30+00:00

Background: Matrix interference caused by excipients and preservatives can affect the accuracy and reliability of analytical methods used for the estimation of active pharmaceutical ingredients (APIs) in combined pharmaceutical dosage forms. Therefore, evaluation of matrix effects is essential for ensuring accurate quantitative analysis.

Aim: The present study aimed to develop and validate a simple, rapid, and economical UV spectrophotometric method for evaluating matrix interference in a topical formulation containing Miconazole Nitrate, Clobetasol Propionate, and Chlorocresol.

Methods: Standard and sample solutions were prepared using methanol and analyzed by UV spectrophotometry at the respective λmax values of Miconazole Nitrate (272 nm), Clobetasol Propionate (239 nm), and Chlorocresol (283 nm). Matrix interference was assessed using the standard addition method and recovery studies at 80%, 100%, and 120% levels. The method was validated according to ICH Q2 (R1) guidelines for linearity, accuracy, precision, specificity, limit of detection (LOD), and limit of quantification (LOQ).

Results and Discussion: The developed method demonstrated excellent linearity with correlation coefficients (R²) greater than 0.999 for all analytes. Assay values for Miconazole Nitrate and Clobetasol Propionate were found to be 99.37% and 100.20%, respectively. Recovery studies showed satisfactory results, indicating negligible matrix interference. Precision studies exhibited %RSD values below 2%, confirming good repeatability and reproducibility. Low LOD and LOQ values indicated adequate sensitivity of the method.

Conclusion: The validated UV spectrophotometric method was found to be accurate, precise, sensitive, and suitable for routine quality control analysis of combined pharmaceutical dosage forms with minimal matrix interference.a

Oral Tramadol versus Oral Paracetamol for Prevention of Peri Anaesthetic Shivering During Transurethral Resection of the Prostate Under Spinal Anaesthesia: A randomised prospective interventional observer blinded study

2026-08-07T07:14:02+00:00

Background: Peri anaesthetic shivering iscommon during transurethral resection of theprostate(TURP) performed under spinal anaesthesia, particularly in elderly patients.Evidence comparing oral tramadol with oralparacetamol for prophylaxis is limited.

Radiating Petals: A Case of Planum Sphenoidale Meningioma Presenting with Seizures and Anosmia, Resected via Suprabrow Keyhole Craniotomy

2026-08-07T08:47:32+00:00

Background: Planum sphenoidale meningiomas are uncommon anterior skull-base tumors that classically present with anosmia, seizures, and behavioral change once they reach sufficient size to compress adjacent neurovascular structures.

Case Presentation: We report a 44-year-old woman who presented with seizures, progressive anosmia, and behavioral change that progressed to altered sensorium refractory to anticonvulsant therapy (Glasgow Coma Scale 6/15). Contrast-enhanced magnetic resonance imaging (MRI) demonstrated a large extra-axial anterior cranial fossa mass (6.2 × 5.9 × 4.5 cm) involving the cribriform plate, nasal cavities, olfactory groove, orbital roof, sella, and clinoidal triangle. The patient underwent a suprabrow keyhole craniotomy through a 4 × 1 cm bone window, with complete microsurgical excision of the tumor. Histopathology confirmed a WHO Grade 1 meningioma, and the patient had an uneventful recovery with a favorable cosmetic outcome.

Conclusion: Multi-structural extension of planum sphenoidale meningiomas can produce a combination of seizures, anosmia, and behavioral disturbance. The suprabrow keyhole craniotomy is a safe, effective, and cosmetically favorable alternative to conventional transcranial approaches for complete excision of these tumors.

Correlation between Screen Time and Internal Assessment Scores among First-Year MBBS Students: A Cross-Sectional Analytical Study

2026-08-07T09:36:44+00:00

Background: Smartphone use has become an integral part of medical education, providing access to educational resources while simultaneously increasing exposure to recreational digital media. Excessive screen time has been associated with reduced academic performance, impaired concentration, and behavioral changes among university students. However, the influence of different types of screen time on academic achievement among undergraduate medical students remains insufficiently explored.

Objective: To evaluate the correlation between smartphone screen time and Internal Assessment (IA) scores among first-year MBBS students and to compare screen use patterns across different academic performance categories.

Methods: A cross-sectional analytical study was conducted among 250 first-year MBBS students who provided informed consent. Weekly smartphone screen-time data were obtained from the Digital Wellbeing application. Total, educational, and recreational screen times were recorded and correlated with mean IA scores using Pearson's correlation analysis.

Results: Total daily screen time demonstrated a strong negative correlation with IA scores, whereas educational screen time showed a significant positive correlation. Recreational screen time was strongly associated with lower academic performance. Students with lower IA scores exhibited the highest recreational and total screen time.

Conclusion: Excessive recreational smartphone use is associated with poorer academic performance, whereas educational smartphone use appears beneficial. Encouraging responsible and purpose-oriented smartphone use may improve academic outcomes among medical students.

Umbilical Cord Blood Biomarkers as Predictors of Meconium Aspiration Syndrome: A Prospective Cohort Study

2026-08-07T10:13:49+00:00

Background: Early identification of neonates at risk of meconium aspiration syndrome (MAS) may facilitate timely monitoring and respiratory support.

Objective: To evaluate umbilical cord-blood lactate and acid–base parameters for predicting MAS among neonates born through meconium-stained amniotic fluid.

Methods: This prospective cohort study included 72 neonates. Cord-blood pH, PCO₂, PO₂, bicarbonate, oxygen saturation, base excess, and lactate were measured immediately after delivery. Neonates were followed for development of MAS, respiratory-support requirements, and in-hospital outcome.

Results: MAS developed in 19 neonates (26.4%). Compared with non-MAS neonates, affected neonates had higher lactate (5.40 vs 2.60 mmol/L), lower bicarbonate (15.03 vs 22.18 mEq/L), more negative base excess (−10.76 vs −4.57 mEq/L), and lower 1- and 5-minute Apgar scores (all p<0.001). Cord-blood pH, PCO₂, PO₂, and oxygen saturation did not differ significantly. Lactate showed the highest discrimination for MAS (AUC 0.81), followed by pH (0.75) and base deficit (0.71).

Conclusion: Cord-blood lactate may be a useful early adjunct for predicting MAS.

Comparison of ease of nasogastric intubation with or without application of Reverse Sellick’s manoeuvre using a cold nasogastric tube in anaesthetized, intubated adult patients. A prospective, randomized, open label, parallel assignment study

2026-08-07T10:23:49+00:00

Background: Insertion of a nasogastric tube (NGT) in anaesthetized and endotracheally intubated patients can be technically difficult because of tube coiling, kinking, and impaction at the upper airway structures. Various techniques have been proposed to improve the success of NGT placement, including cooling the tube to increase its rigidity and the use of Reverse Sellick’s manoeuvre to facilitate esophageal entry.

Aim: To determine the success rate of nasogastric intubation with a cold NGT with Reverse Sellick’s manoeuvre by a doctor in training in adult human participants with endotracheal tube in-situ.

Methods: This prospective, randomized, open-label trial included 130 adult patients undergoing general anaesthesia who required NGT insertion. Participants were randomly assigned to either the cold NGT group (Group C, n=65) or the cold NGT with Reverse Sellick’s manoeuvre group (Group RS, n=65). The primary outcome was successful placement on the first attempt. Secondary outcomes included second-attempt success, overall success rate confirmed by radiography, procedure duration, and insertion-related complications.

Results: The first-attempt success rate was higher in Group RS than in Group C (70.8% vs. 58.5%), although the difference was not statistically significant (p=0.140). Group RS demonstrated significantly greater second-attempt success (84.2% vs. 55.6%; p=0.040) and overall success rates (95.4% vs. 81.5%; p=0.010). The mean insertion time was significantly shorter in Group RS (36.6±17.1 seconds) compared with Group C (47.6±21.5 seconds; p=0.002). In addition, insertion-related complications, particularly kinking and overall adverse events, occurred less frequently in the Reverse Sellick’s group.

Conclusion: From a clinical perspective, the combination of improved success rates, reduced procedure time, and lower complication rates makes this technique particularly useful in the operating room setting, where efficiency and patient safety are paramount. Fewer attempts and shorter insertion times may also reduce mucosal injury and bleeding.

CORRELATION BETWEEN CORRECTED QT INTERVAL AND SEVERITY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A CROSS-SECTIONAL STUDY

2026-08-07T13:43:22+00:00

Background: Chronic obstructivepulmonary disease (COPD) is a progressiverespiratory disorder associated with systemiccomplications,particularly cardiovasculardisease. The corrected QT (QTc) interval, amarker of ventricular repolarization, hasbeen implicated in arrhythmogenesis andsudden cardiac death, and may be prolonged in patients with severe COPD.

A CROSS SECTIONAL AND COMPARATIVE STUDY OF STIGMA IN MBBS MEDICAL STUDENTS TOWARDS MENTALLY ILL PATIENTS IN A TERTIARY CARE HOSPITAL

2026-08-08T05:00:39+00:00

Introduction: Mental illness poses atremendous challenge to global publichealth. The prevailing statistics show that itaffects millions of people worldwide,making it an overwhelming health system.Not only do they degrade an individual's quality of life but they also make themsusceptible to stigma, discrimination, andsocial isolation. In India, mental disorders

Comparison of Perineural Versus Intravenous Dexamethasone as an Adjuvant to Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block: A Prospective Randomized Controlled Study

2026-08-08T05:13:29+00:00

BACKGROUND: Supraclavicularbrachial plexus block provides effectiveanaesthesia and postoperative analgesia forupper-limb surgery, but the duration ofbupivacaine analgesia is limited.Dexamethasone can be administeredperineurally or intravenously, and the optimal route remains uncertain.

Bacterial Vaginosis Prevalence: Is It Really Common?

2026-08-08T06:04:09+00:00

Background: Bacterial vaginosis is a common vaginal dysbiosis that may cause abnormal vaginal discharge, malodour and irritation, although some affected women remain asymptomatic. Clinical symptoms alone cannot reliably distinguish bacterial vaginosis from intermediate vaginal flora or other genital tract conditions.

Objective: To determine the prevalence and distribution of Nugent-defined bacterial vaginosis among symptomatic women and assess its association with age, pregnancy status and parity.

Methods: This retrospective, record-based cross-sectional study was conducted at a tertiary-care hospital in Riyadh, Saudi Arabia. Electronic clinical and laboratory records of symptomatic women undergoing vaginal swab examination from 1 September 2023 to 31 August 2024 were reviewed. Gram-stained vaginal smears were classified using the Nugent scoring system as normal flora (score 0–3), intermediate flora (score 4–6) or definite bacterial vaginosis (score 7–10). Data were analysed using IBM SPSS Statistics version 30. Categorical variables were compared using the Pearson chi-square test, with p<0.05 considered statistically significant.

Results: A total of 1,645 vaginal swab specimens were evaluated. The mean age of the women was 28 years, and 252 (15.3%) were pregnant. Definite bacterial vaginosis was identified in 196 women, giving a prevalence of 11.9% (95% CI: 10.4%–13.6%). Intermediate vaginal flora was observed in 920 (55.9%) women, while 529 (32.2%) had normal flora. Overall, 1,116 (67.8%) women had altered vaginal flora. Nugent score distribution differed significantly across age groups (χ²=119.77, p<0.001), with the highest prevalence of definite bacterial vaginosis among women aged 38.1–48 years (24.2%). Definite bacterial vaginosis was more frequent among pregnant than non-pregnant women (28.2% vs 9.0%), with a prevalence ratio of 3.14 (95% CI: 2.42–4.07; p<0.001). Parity was not significantly associated with Nugent score category (p=0.273).

Conclusion: Definite bacterial vaginosis was present in approximately one in eight symptomatic women, whereas intermediate vaginal flora was the predominant microbiological abnormality. Pregnancy and age were significantly associated with Nugent score distribution, while parity showed no significant association. Laboratory confirmation using Nugent scoring may improve diagnostic accuracy and reduce unnecessary empirical antimicrobial treatment.

An Observational Study to Analyze the Impact of Static and Dynamic Balance, Agility and Change of Direction Speed In Young Athletes

2026-08-08T06:11:07+00:00

Background: Athletic performance in youth sports is shaped by a wide spectrum of neuromuscular and biomechanical factors, among which static balance, dynamic balance, agility, and change of direction speed (CODS) hold a foundational place. These performance components serve as the building blocks of nearly every skill executed in sport - from simple posture control to complex movement sequences requiring strength, coordination, precision, and rapid adaptation. Together, they influence how efficiently a young athlete can maintain bodily control, adjust to external demands. This study was designed to examine the interrelationship between static balance, dynamic balance, agility, and change of direction speed (CODS) in young athletes aged 12–18 years.

Objective: The objective of the study is to i) evaluate static balance performance in young athletes, ii) assess dynamic balance abilities during functional movement tasks, iii) measure agility performance in young athletes iv) assess change of direction speed (CODS) during pre-planned directional tasks.

Methods: 60 Recreational and competitive athletes are participated who are involved in the sports with agility and balance (for example, badminton, football, basketball, and athletics) for at least 3 days per week during the last 6 months. Participants proceed to the testing site, fill in a demographic and screening form.

Outcome measure: Stork Stand Test, “Y” shape, Hexagon Agility Test, T-test is used for measuring pre and post intervention evaluation.

Results: This data suggests that most athletes in the study possessed reasonably good directional speed and movement efficiency, likely due to regular participation in sports requiring rapid directional changes.

Conclusion: A strong relationship was observed between agility and change of direction speed, indicating that athletes who are more agile also tend to perform better in COD tasks. Age-related analysis showed that older athletes demonstrated superior dynamic balance, agility, and COD performance, likely due to improved neuromuscular coordination, strength, and movement efficiency with growth and maturation. Static balance showed minimal improvement with age, suggesting that dynamic movement control continues to develop throughout adolescence.

Comparison of Transcutaneous Bilirubin with Serum Bilirubin in Pre-Term Neonates Before, During, and After Phototherapy

2026-08-08T06:21:35+00:00

Objective: To assess the agreement between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) measurements before, during, and after phototherapy in preterm neonates with unconjugated hyperbilirubinemia.

Study Design: Prospective observational method-comparison study.

Place and Duration of Study: Neonatal Intensive Care Unit, Dr Sulaiman Al Habib Hospital, Al Rayyan, Riyadh, Saudi Arabia, from May to October 2024.

Methodology: A total of 199 preterm neonates with unconjugated hyperbilirubinemia requiring phototherapy were enrolled. Paired TcB and TSB measurements were obtained before phototherapy, during phototherapy, and 12 hours after its discontinuation. TcB was measured from the protected forehead using a Dräger JM-105 bilirubinometer, while TSB was determined from venous blood samples using an automated biochemical analyser. Quantitative variables were presented as mean ± standard deviation, while categorical variables were expressed as frequencies and percentages. Paired-samples t-tests were used to compare TcB and TSB values at each assessment stage. Subgroup analyses were performed according to gestational age and birth weight, with p<0.05 considered statistically significant.

Results: A total of 199 jaundiced preterm neonates were evaluated. Before phototherapy, the mean paired difference between TSB and TcB was −16.00 ± 19.64, indicating that TcB tended to overestimate TSB (t=−11.491, p<0.001). During phototherapy, the mean difference increased to 45.49 ± 25.86, demonstrating substantial underestimation of TSB by TcB (t=24.817, p<0.001). Twelve hours after phototherapy discontinuation, the mean difference decreased to 5.81 ± 21.27 but remained statistically significant (t=3.853, p<0.001). The wide standard deviations indicated considerable interindividual variability in the agreement between the two methods.

Conclusion: TcB measurements showed significant differences from TSB before, during, and after phototherapy. The greatest discrepancy occurred during phototherapy, when TcB substantially underestimated serum bilirubin levels. TcB may support non-invasive bilirubin screening and follow-up, particularly after phototherapy, but it should not replace TSB measurement when treatment decisions are required in preterm neonates.

A Comparative Study to Analyze the Influence of Quadriceps Flexibility and Vmo Strengthening Using Lunges with Resistance Band Versus Wall Ball Squats With Combined Exercises on Dynamic Patellofemoral Pain Syndrome in Athletes

2026-08-08T06:32:18+00:00

Background: Patellofemoral syndrome (PFS), or alternatively referred to as patellofemoral pain syndrome (PFPS) or “runner knee syndrome is one of the most common causes of anterior knee pain in clinical and sports medicine practice. It is noted by diffuse, ill-localised pain around or behind the patella, which is usually exacerbated by knee loading exercises in flexed position like running, climbing stairs, squatting, and sitting. Clinical tests focus on posture, alignment, bulk of the muscles (e.g., vastus medialis atrophy), local tenderness, range of movement, and strength of the quadriceps and hip muscles. The PFS treatment is largely conservative and aims to manage pain, repair biomechanical dysfunction, and restore function. The first line of treatment consists of activity modification, temporary use of non-steroidal anti-inflammatory drugs (NSAIDs), and modalities such as ice to relieve symptoms during the acute stage. Nevertheless, structured rehabilitation programs are most often associated with long-term improvement. The therapeutic exercise geared toward enhancing strength, flexibility, and neuromuscular control of the knee and hip has always been found to be the most effective. In this study resistance-band lunge training and wall ball squats combined with therapeutic exercises has been introduce to reduce pain and improve function.

Objective: The objective of the study is to i) evaluate the effect of resistance-band lunge training, ii) evaluate the effect of wall ball squats combined with therapeutic exercises, iii) compare the outcomes between the two intervention programs to determine which approach is more effective.

Methods: 30 athletes diagnosed with the patellofemoral pain syndrome (PFPS) by orthopedic OPD or physiotherapy department were initially assessed for the inclusion or exclusion criteria. Prior to the treatment procedure patient are oriented to the study. Participants are divided into 2 groups and both groups assessed for the pre test parameter.

Outcome measure: VAS (Visual Analog Scale), and Kujala Questionnaire Scale is used for measuring pre and post intervention evaluation.

Results: The results illustrate that pain reduction and functional improvement do not always follow the same trajectory, and different exercise strategies may target different aspects of patellofemoral pain syndrome. Thera-band lunges proved to be an excellent choice for rapidly reducing pain, while wall ball squats and associated neuromuscular exercises were more effective for developing overall functional capabilities needed for sports and higher-level activities. Although both groups improved, the study’s outcomes suggest that an optimal rehabilitation approach may blend elements from both interventions-using pain-reducing strategies early on and gradually transitioning into functional strengthening and neuromuscular control exercises as pain subsides.

Conclusion: The findings of the present investigation clearly demonstrate that both interventions produced substantial improvements in pain and functional outcomes by the end of the intervention period.

Effectiveness of Quadriceps Flexibility and Vmo Strengthening Using Wall Ball Squats with Specific Exercises on Dynamic Patellofemoral Pain Syndrome in Athletes: An Observatonal Approach

2026-08-08T06:39:51+00:00

The primary objective of the present study is to evaluate the effectiveness of quadriceps flexibility and VMO Strengthening using wall ball squats with specific exercises on dynamic patella-femoral pain syndrome in athletes. Pre and post evaluation was performed on 15 participants using the VAS (Visual Analog Scale), Kujala Questionnaire Scale. Findings suggest Wall-ball squats offer a highly stable closed-chain position that minimizes anterior shear forces, promotes symmetrical co-contraction, and allows progressive loading without inducing excessive irritability. These characteristics likely facilitated smoother functional adaptation and higher overall performance scores. By offering controlled sagittal-plane strengthening, wall-ball squats may have better addressed the demands of functional mobility. Data suggest that the application of wall ball squats with specific exercises is effective intervention for treating dynamic patella-femoral pain syndrome in athletes.

Relationship of Balance with Agility and Change of Direction Speed in Young Athletes

2026-08-08T06:54:04+00:00

The primary objective of the present observational study was designed to examine the interrelationship between static balance, dynamic balance, agility, and change of direction speed (CODS) in young athletes aged 12–18 years. Pre and post evaluation was performed on 60 participants using the Stork Stand Test, “Y” shape, Hexagon Agility Test, T-test. The findings demonstrated that dynamic balance, particularly the posteromedial and posterolateral reach components of the Y-Balance Test, showed the strongest associations with both agility and COD performance. Static balance showed moderate but significant relationships with agility and CODS.

Inflammatory Effects of Microplastic Exposure: A Review of Il-6 and Cytokine Responses

2026-08-08T11:22:35+00:00

Background: Plastic particles have become a prevalent environmental contaminant with growing evidence of harmful impacts on human health. Plastic particles smaller than 5mm in diameter are called Microplastics (MPs). Human exposure occurs through contaminated food, drinking water, and inhalation of airborne particles, leading to the accumulation of MPs in several tissues, such as blood, lungs, placenta, and liver, which cause immunological dysregulation, oxidative stress, and chronic inflammation in the organism. Interleukin-6 (IL-6) receives considerable attention among inflammatory mediators for its important role in regulating immune responses and the pathophysiology of chronic inflammatory diseases.

Method: To identify peer-reviewed articles published primarily between 2015 and 2026, a thorough literature search was conducted in PubMed, Scopus, ScienceDirect, Google Scholar, and Web of Science. Among the search terms were inflammation, oxidative stress, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), mitogen-activated protein kinase (MAPK), and environmental pollution. A comprehensive evaluation and synthesis of original research papers, systematic reviews, and meta-analyses evaluating the molecular mechanism of MP-induced inflammation and IL-6 signaling were conducted

Review findings: MP exposure causes oxidative stress, mitochondrial dysfunction, and immunological dysregulation, which raises the production of IL-6 and other proinflammatory cytokines, according to experimental and epidemiological research. Animal and cell culture studies have repeatedly shown elevated IL-6 concentrations, and new human data now prove a link between MP exposure and systemic inflammation. Other cytokines, such as Interleukin-1 beta (IL-1β) and tumour necrosis factor-alpha (TNF-α), are often dysregulated by MP exposure. The oxidative stress pathway, NF-κB, MAPK, and toll-like receptor (TLR) are all activated in these inflammatory reactions. However, significant variation in polymer type, particle size, experimental design, exposure concentration, and analytical techniques makes risk evaluation more difficult and restricts direct comparison between studies.

Conclusion: According to available data, IL-6 plays an essential role as a key mediator connecting exposure to microplastics to chronic inflammation and the emergence of inflammatory disorders; however, there are significant gaps in understanding of the dose-response relationship, long-term impact on human health, environmentally relevant exposure limits, and standardised analytic techniques for microplastic identification. To clarify the role of MPs in chronic inflammatory disorders and to support evidence-based public health policies, future research should focus on harmonised exposure protocols, large-scale longitudinal epidemiological studies, and mechanistic investigations that integrate molecular biology, toxicology, and clinical research.

Dry Needling versus Corticosteroid Injection forLateralEpicondylitisinRural Patients: A Retrospective Comparative Study

2026-08-08T12:18:14+00:00

Introduction: Lateral epicondylitis is a common degenerative tendinopathy causing pain and functional disability, particularly among manual workers. Dry needling (DN) and corticosteroidinjection (CSI) are frequently used after failure of conservative treatment, but comparative evidencein rural populations is limited.

Clinical Outcomes of Titanium Elastic Nailing System versus Dynamic Compression Plating in Adolescent Femoral Shaft Fractures: A Retrospective Cohort Study

2026-08-08T12:22:45+00:00

Introduction: The optimal surgical management of adolescent femoral shaft fractures remainscontroversial because Titanium Elastic Nailing System (TENS) and Dynamic Compression Plating (DCP) differ in biomechanics, indications, and complication profiles.

Assessment of Hypokalemia Frequency and Hospital Stay Duration Among Patients with Hepatic Encephalopathy

2026-08-09T11:28:07+00:00

Objective: To determine the frequency andseverity of hypokalemia in patients with hepatic encephalopathy and its associationwith the length of hospital stay.

Clinical Spectrum and Frequency of Cutaneous Hyperpigmentation in Patients with Megaloblastic Anemia

2026-08-09T11:30:20+00:00

Objective: To identify the prevalence andclinical spectrum of cutaneoushyperpigmentation in patients withmegaloblastic anemia (MA) and to assess its correlation with hematological andbiochemical severity.

Evaluation of Neutrophil Gelatinase-Associated Lipocalin (NGAL) as a Biomarker for Early Prediction of Bacterial Sepsis in Patients with Fever in the Emergency Department

2026-08-09T11:33:21+00:00

Background:-It is a very serious condition known asbacterial sepsis, which has a high incidenceand death rates; the prognosis worsens withlate diagnosis and treatment. The difficultyin recognizing sepsis patients arises from thelack of reliable diagnostic markers. The
recently studied ‘neutrophil gelatinase associated lipocalin’ has proven to be useful

Comparative Evaluation of Buprenorphine and Tramadol as Adjuvants to Ropivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block for Humeral Procedures

2026-08-09T14:08:31+00:00

Background and Aim: Supraclavicularbrachial plexus block is an effective regionalanaesthetic technique for upper-extremitysurgery. Ropivacaine provides effectiveblockade, but the duration of a singleinjection block may be limited. Adjuvants such as buprenorphine and tramadol havebeen used to enhance block characteristics

Pre-Operative Serum Albumin as a Predictor of Post Operative Outcome in Emergency Bowel Anastomosis: An Observational Study in Victoria Hospital, Bengaluru

2026-08-10T06:00:57+00:00

Introduction: Hypoalbuminemia is associated with increased postoperative morbidity and mortality in patients undergoing major abdominal surgery. Emergency bowel anastomosis, performed in a physiologically stressed and often catabolic patient, carries a particularly high risk of anastomotic leak and other complications, and preoperative nutritional status may influence these outcomes.

Aim: To evaluate preoperative serum albumin as a predictor of postoperative outcome in patients undergoing emergency bowel anastomosis.

Materials and Methods: This hospital-based prospective observational study was conducted in the Department of General Surgery, Victoria Hospital, Bengaluru, over a 6-month period (January–June 2026). A total of 100 patients undergoing emergency bowel anastomosis were included. Preoperative serum albumin was measured and patients were categorised as having normal (≥3.5 g/dl) or low (<3.5 g/dl) albumin. Preoperative clinical presentation and postoperative outcomes — including surgical site infection, pulmonary complications, ventilatory support, sepsis, prolonged ileus, anastomotic leak, cardiac complications, prolonged hospitalisation, and mortality — were recorded and analysed against albumin category.

Results: Of 100 patients, 42 had normal and 58 had low preoperative serum albumin. Mean serum albumin was significantly lower in patients who developed fever, surgical site infection, pulmonary complications, need for ventilatory support, sepsis, cardiac complications, prolonged hospitalisation, and mortality (all p<0.001–0.001), and low albumin (categorically) was significantly associated with the same outcomes as well as vomiting (p=0.005) and anastomotic leak (p<0.001). Pain abdomen, per-abdominal tenderness, and prolonged ileus were not significantly associated with albumin level.

Conclusion: Preoperative serum albumin is a simple, inexpensive, and clinically useful marker for predicting postoperative morbidity — including anastomotic leak — and mortality in patients undergoing emergency bowel anastomosis. Routine preoperative assessment may help identify high-risk patients for closer perioperative monitoring and nutritional optimisation.

Study of Renal Functions in Chronic Liver Disease Patients Admitted to a Tertiary Care Hospital, Mysuru

2026-08-10T06:09:07+00:00

Background: Chronic liver disease is a major cause of morbidity and mortality worldwide, with renal dysfunction being one of its most serious complications. Hemodynamic alterations associated with portal hypertension and systemic vasodilation predispose patients to impaired renal perfusion, leading to acute kidney injury and hepatorenal syndrome. Early identification of renal dysfunction is essential to improve clinical outcomes. This study evaluated renal function abnormalities and their association with different etiologies of CLD (Chronic Liver Disease).

Methods: A hospital-based cross-sectional observational study was conducted at K.R. Hospital, MMC&RI, Mysuru, from April 2023 to April 2024. Adult patients (>18 years) diagnosed with chronic liver disease were enrolled. Patients with pre-existing kidney disease, diabetes mellitus, hypertension, or a history of nephrotoxic drug use were excluded. Clinical details and laboratory parameters were collected to assess renal function and determine the incidence of renal impairment across various etiologies of CLD.

Results: Among patients with chronic liver disease, renal impairment was observed in 26% of cases. The majority of affected patients were middle-aged males with alcohol-related cirrhosis. Renal dysfunction was predominantly functional in nature and attributed to portal hypertension and systemic circulatory disturbances. Serum creatinine demonstrated limitations as a reliable marker of renal function in cirrhotic patients, emphasizing the need for careful clinical evaluation and early recognition of renal impairment.

Conclusion: Renal dysfunction is a common and clinically significant complication of chronic liver disease, particularly in patients with alcohol-related cirrhosis. Early detection and timely management are crucial to reducing morbidity and improving patient outcomes. The study highlights the need for improved diagnostic strategies and further research to enhance the assessment and management of renal dysfunction in chronic liver disease.

Association between Serum Ferritin Levels and Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

2026-08-10T06:17:32+00:00

Background: Persistent hyperglycemia is a hallmark of T2DM (Type 2 Diabetes Mellitus), a chronic metabolic disease linked to oxidative stress, insulin resistance, and chronic inflammation. One possible biomarker for glycaemic management is serum ferritin, which is a measure of the body's iron reserves and an acute-phase inflammatory marker. The purpose of this study was to assess serum ferritin levels in T2DM patients and ascertain how they relate to glycaemic control.

Methods: Over the course of 18 months (April 2023–October 2024), a cross-sectional study was carried out at K.R. Hospital, Mysore Medical College and Research Institute. Convenience sampling was used to register 100 patients with T2DM. FBS (Fasting Blood Sugar), PPBS (Post-Prandial Blood Sugar), HbA1c, serum ferritin, complete hemograms, liver function tests, and renal function tests were among the laboratory tests and clinical information that were documented. Patients with diseases such as anaemia, liver illness, cancer, acute infections, pregnancy, and iron supplements that alter ferritin levels were not included. Descriptive statistics and Pearson's correlation coefficient were used in the statistical analysis; p <0.05 was deemed statistically significant.

Results: Among the 100 participants, 39% belonged to the 41–50-year age group and 56% were females. Polyuria and polydipsia were reported in 55% and 62% of patients, respectively. The mean age was 51.31±10.18 years, mean BMI was 26.75±4.37 kg/m², mean FBS was 208.87 mg/dL, mean PPBS was 284.97 mg/dL, mean HbA1c was 10.08%, and mean serum ferritin level was 508.20 ng/mL. Serum ferritin showed a weak positive correlation with FBS (r=0.095, p=0.049) and HbA1c, while a negative correlation was observed with PPBS. BMI demonstrated a significant negative correlation with serum ferritin (r=-0.279, p=0.005).

Conclusion: Serum ferritin levels were elevated in patients with poorly controlled T2DM and demonstrated an association with glycemic parameters. Although the correlations were modest, serum ferritin may serve as an additional biomarker for assessing glycemic control and monitoring disease severity. Larger prospective studies are recommended to further establish its clinical utility.

To Study the Serum Magnesium Levels in Subjects Admitted to the Intensive Care Unit and its Correlation with In-Hospital Outcomes

2026-08-10T06:25:52+00:00

Background: Magnesium is an essential intracellular cation involved in more than 300 enzymatic reactions and plays a vital role in neuromuscular function, cardiac rhythm, and electrolyte homeostasis. Hypomagnesemia is frequently encountered in critically ill patients but often remains underdiagnosed, despite its potential impact on patient outcomes. This study aimed to evaluate serum magnesium levels in ICU patients and determine their association with in-hospital outcomes.

Methods: A prospective observational study was conducted in the mixed medical-surgical Intensive Care Unit of Mysore Medical College and Research Institute from January to December 2024. A total of 116 adult patients admitted to the ICU were included. Serum magnesium levels were measured at admission, and patients were categorized into hypomagnesemia (<1.5 mEq/L), normomagnesemia (1.5–2.3 mEq/L), and hypermagnesemia (>2.3 mEq/L) groups. Clinical outcomes assessed included ICU mortality, duration of mechanical ventilation, and length of ICU stay. Statistical analysis was performed using appropriate tests, with adjustment for confounding variables such as APACHE II score and associated comorbidities.

Results: Hypomagnesemia was identified in 60% of the study population at ICU admission. Patients with low serum magnesium levels had significantly higher mortality rates, longer durations of mechanical ventilation, and prolonged ICU stays compared with those having normal magnesium levels. Multivariable analysis demonstrated that hypomagnesemia was an independent predictor of adverse in-hospital outcomes.

Conclusion: Hypomagnesemia is a common electrolyte abnormality among critically ill patients and is significantly associated with poor in-hospital outcomes, including increased mortality, prolonged mechanical ventilation, and extended ICU stay. Routine monitoring and timely correction of serum magnesium levels may improve prognosis and should be considered an integral component of ICU patient management.

Comparison of Sacubitril/Valsartan and Dapagliflozin on Functional Status, NT-proBNP Levels, and Hospital Readmissions in Patients with Heart Failure with Reduced Ejection Fraction

2026-08-10T07:40:18+00:00

Background: Heart failure with reduced ejection fraction (HFrEF) remains a leading cause ofmorbidity and mortality globally. Sacubitril/Valsartan and Dapagliflozin have individuallydemonstrated significant benefits in HFrEF management. However, direct comparative data evaluating their relative efficacy on functional outcomes, biomarker reduction, and hospitalreadmissions remain limited, particularly in the Indian population.

Prospective Cohort Study of Preoperative Pulmonary Function, Functional Capacity, and Risk of Postoperative ICU Admission

2026-08-10T09:43:08+00:00

Preoperativepulmonary function andfunctional capacity are critical determinantsof postoperative outcomes in patientsundergoing major surgical procedures. Thisprospective cohort study evaluated theassociation between preoperative spirometric

Antimicrobial Resistance in Intensive Care Units: Clinical Burden, Emerging Pathogens, Neutrophil-to-Lymphocyte Ratio, and Stewardship Strategies

2026-08-10T09:46:13+00:00

Antimicrobialresistance(AMR) hasemerged as one of the most significant threatsto patient safety in intensive care units(ICUs), where critically ill patients areparticularly vulnerabletohealthcareassociated infections caused by multidrugresistantorganisms.The increasingprevalence of resistant pathogens

Oral Steroids vs Watchful Waiting for Otitis Media with Effusion in Children: A Randomized Controlled Trial on Hearing Outcomes

2026-08-10T09:55:11+00:00

Otitis media with effusion remains a leadingcause of transient conductive hearing loss inchildren, frequently influencing speech
development, academic performance, andquality of life. Despite its high prevalence,optimal management remains controversial,
particularly regarding the role of systemiccorticosteroids compared with conservative observation.

Prospective Observational Study of Intraoperative Hypoxemia Burden and Postoperative Pulmonary Complications in Patients with Obstructive Sleep Apnea

2026-08-10T09:57:23+00:00

Obstructive sleep apnea (OSA) is stronglyassociated with perioperative respiratory instability, yet the role of intraoperative hypoxemia burden as a predictor of postoperative pulmonary
complications

MRI-Based Association of Spinal Tuberculosis with Diabetic Cystopathy and Lower Urinary Tract Dysfunction: A Cross-Sectional Study

2026-08-10T09:59:12+00:00

Spinal tuberculosis (STB) remains one of themost common forms of extrapulmonarytuberculosis and is frequently associated with
neurological complications due to spinal cordand nerve root compression. Diabetesmellitus is an established risk factor for both
tuberculosis and diabetic cystopathy, a form of autonomic neuropathy characterized

STUDY OF CLINICAL STAGING OF RETINOPATHY OF PREMATURITY IN A TERTIARY CARE HOSPITAL

2026-08-10T10:05:56+00:00

Background: In India, withadvancement in neonatal care units a large number of low birth weight prematurebabies are now surviving and also due tobetter screening protocols there is anapparent increase in the incidence of ROP.So this study was undertaken to clinically

Prevalence and Risk Factors of Pelvic Organ Prolapse in Rural Women

2026-08-11T05:50:18+00:00

Background: Pelvic organ prolapse (POP) is a common pelvic floor disorder that affects the quality of life of women through urinary, bowel, sexual, and psychosocial dysfunction.

Objective: This study aimed to determine the prevalence of pelvic organ prolapse and identify its associated risk factors among rural women.

Methodology: This hospital-based cross-sectional study was conducted at the Department of Gynaecology and Obstetrics, Saidu Group of Teaching Hospital, Swat, from 1^st January 2025 to 31^st December 2025 and included 190 rural women.

Results: The mean age of the participants was 46.7 ± 11.3 years, the mean BMI was 27.3 ± 4.2 kg/m², and the mean parity was 5.1 ± 2.3 deliveries. Pelvic organ prolapse was diagnosed in 68 (35.8%) women, with Stage II being the most common stage (41.2%). Anterior compartment prolapse was the predominant anatomical type (42.6%). The most frequent symptoms were vaginal bulge (86.8%), pelvic heaviness (77.9%), and lower back pain (64.7%). Women with prolapse were significantly older (53.2 ± 9.6 vs. 43.1 ± 10.8 years; p<0.001), had higher BMI (28.8 ± 4.5 vs. 26.5 ± 3.8 kg/m²; p=0.001), and greater parity (6.7 ± 2.1 vs. 4.2 ± 1.8; p<0.001) than those without prolapse. Multivariable analysis identified multiparity (AOR=3.47, 95% CI: 1.82–6.62), age ≥50 years (AOR=2.84, 95% CI: 1.46–5.53), heavy lifting (AOR=2.67, 95% CI: 1.39–5.12), postmenopausal status (AOR=2.31, 95% CI: 1.18–4.51), home vaginal delivery (AOR=2.12, 95% CI: 1.09–4.11), and chronic constipation (AOR=1.94, 95% CI: 1.01–3.75) as independent risk factors.

Conclusion: It is concluded that pelvic organ prolapse is highly prevalent among rural women and is strongly associated with multiparity, advancing age, postmenopausal status, heavy lifting, home vaginal delivery, and chronic constipation.

Evaluation of Pleural Fluid Adenosine Deaminase Activity and Its Biochemical and Physiological Significance in the Diagnosis of Tuberculous Pleural Effusion among Symptomatic Patients

2026-08-11T05:58:59+00:00

Background: One of the frequent extrapulmonary TB manifestation is tuberculosis Pleural effusion, which is often paucibacillary, making it a diagnostic challenge. Traditional techniques like pleur Tib and microbiological testing can be invasive, time consuming or only yield results in some cases. It has been suggested that the activity of adenosine deaminase in the pleural fluid can be used as a useful supportive test to support the early diagnosis of tuberculous pleural effusion.

Objective: To determine the diagnostic accuracy of adenosine deaminase activity in the diagnosis of tuberculous pleural effusion among symptomatic patients.

Methods: This is a cross sectional study of diagnostic accuracy conducted from 25th March 2025 to 25th June 2025 in Department of Medicine, Women Medical College, Abbottabad. The number of patients was 100, and the sampling method used was non-probability consecutive sampling, which were patients with symptoms of pleural effusion ranging in age from 16 to 75 years. Thoracentesis was performed to obtain the pleural fluid for ADA measurement. Tuberculous Pleural Effusion was considered to be positive when ADA level was >55.8 U/L. Biopsy of the pleura was done and was the gold standard. The data were analyzed by SPSS version 25. A 2×2 table was used to calculate sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy.

Results: The mean age of the patients was 42.6 ± 14.8 years, and 58.0% were male. Pleural biopsy confirmed tuberculous pleural effusion in 35.0% of patients, while ADA was positive in 39.0%. When ADA findings were compared with pleural biopsy, 31 cases were true positive, 57 were true negative, 8 were false positive, and 4 were false negative. The sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of ADA were 88.6%, 87.7%, 79.5%, 93.4%, and 88.0%, respectively. Patients with biopsy-confirmed tuberculous pleural effusion had significantly higher pleural fluid lymphocyte percentages and lymphocyte-to-neutrophil ratios than biopsy-negative patients. Lymphocyte-predominant pleural effusion was present in 91.4% of biopsy-positive patients compared with 60.0% of biopsy-negative patients (p = 0.001). A significant association was observed between ADA results and pleural biopsy findings (p < 0.001).

Conclusion: Pleural fluid adenosine deaminase activity showed good diagnostic accuracy for tuberculous pleural effusion in symptomatic patients. ADA testing is a rapid, simple, and less invasive supportive diagnostic tool, especially in settings where tuberculosis is common. However, ADA should be interpreted along with clinical findings, radiological assessment, and confirmatory investigations where required.

Toxicological Profiling Of Road Traffic Accident Victims: A Cross-Sectional Audit of Benzodiazepine and Opiate Influence

2026-08-11T06:56:39+00:00

Road traffic accidents (RTAs) are a major problem in Pakistan. This study aimed to assess the toxicological profile of RTA victims, specifically highlighting the prevalence and influence of benzodiazepines and opiates. A cross-sectional study was conducted at the Chandka Medical College Hospital Larkana between July 2025 and January 2026. A structured predefined proforma was used to collect comprehensive sociodemographic data for the toxicological audit, urine samples were collected as soon as the patient was stabilized. Data were entered and analyzed using SPSS Version 21. Our study revealed that at least 27 (28.1%) and 20 (20.8%) patients screened positive for benzodiazepines and opiates, respectively. The data demonstrates a clear and statistically significant link between opiate use and worse crash outcomes (p = 0.015). While a noticeable clinical trend emerged—with fatal crashes exhibiting the highest proportion of benzodiazepine-positive victims (41.7%) compared to mild crashes (12.5%)—this association did not reach statistical significance (p = 0.368). Our analysis revealed an alarming prevalence of central nervous system depressants, with 28.1% (n=27) and 20.8% (n=20) of RTA victims testing positive for benzodiazepines and opiates, respectively. We propose robust public health awareness campaigns and stricter enforcement of safety gear regulations, fines, and suspension of driving licenses to prevent such accidents.

Serum Magnesium, Insulin Resistance, and Cardiovascular Risk Markers in Metabolic Syndrome

2026-08-11T08:58:01+00:00

Metabolic syndrome is a multifactorialmetabolic disorder characterized by centralobesity, insulin resistance, dyslipidemia,hypertension, and increased cardiovascular risk. Emerging evidence suggests that serummagnesium plays a significant role in glucosemetabolism, insulin sensitivity,

Osteometric and Anthropometric Parameters in Forensic Identification: An Anatomical Study in the Pakistani Population

2026-08-11T09:01:13+00:00

Forensic identification of human remainsrelies heavily on population-specificosteometric and anthropometric databasesthat assist in establishing biological profiles such as sex, stature, and ancestry. In Pakistan,limited standardized skeletal reference datarestricts the accuracy of forensicreconstructions in medico-legalinvestigations.

Prospective Longitudinal Study of Inflammatory Biomarker Trajectories and Clinical Outcomes in Patients with Ventilator-Associated Pneumonia

2026-08-11T09:03:38+00:00

Ventilator-associated pneumonia (VAP)remains one of the most frequenthealthcare-associated infections amongcritically ill patients receiving mechanicalventilation and is associated with prolongedintensive care unit (ICU) stay, increasedhealthcare costs, and substantial mortality. Although inflammatory biomarkers

Relationship Between Pulmonary Artery Pressure and Left Atrial Enlargement: A Retrospective Study

2026-08-11T09:07:40+00:00

Left atrial enlargement (LAE) and elevatedpulmonary artery pressure (PAP) areinterrelated hemodynamic markersfrequently encountered in cardiovasculardisease. This retrospective study evaluates their association in 120 patients undergoingtransthoracic echocardiography

Comparative Effectiveness of Silver Diamine Fluoride Versus Atraumatic Restorative Treatment in Arresting Early Childhood Caries: A Randomized Controlled Trial

2026-08-11T09:10:50+00:00

Early childhood caries (ECC) remains asignificant global oral health burden,particularly in underserved populationswhere access to comprehensive dental care is limited. Silver diamine fluoride (SDF) andatraumatic restorative treatment (ART) areminimally invasive strategies widely

Biomarkers in Inflammatory Arthritis: Toward Precision Diagnosis and Personalized Treatment: A Prospective Cohort Study

2026-08-11T09:13:20+00:00

Inflammatory arthritis encompasses aheterogeneous group of immune-mediateddisorders characterized by chronic synovialinflammation, progressive joint destruction, disability, and substantial reductions inquality of life. Early diagnosis

Determinants of Axillary Lymph Node Metastasis in Breast Cancer: Association with Imaging Characteristics, Histopathological Features, Microbiological Findings, Therapeutic Management, and Clinical Outcomes

2026-08-11T09:16:10+00:00

Evaluating axillary lymph node status inprimary breast cancer remains crucial forclinical staging, surgical management, and long-term therapeutic planning. Thisprospective observational cohort studyevaluated radiological, pathological, microbiological, and therapeutic determinants of axillary lymph nodemetastasis in three hundred and fifty

Predictors of Margin Positivity and Re-excision Following Breast-Conserving Surgery: Association with Imaging Findings, Histopathological Characteristics, Microbiological Findings, Therapeutic Management, and Clinical Outcomes

2026-08-11T09:21:47+00:00

Achieving negative surgicalmargins during breast-conserving surgeryremains paramount to minimizing localrecurrence and optimizing oncological outcomes, yet variable rates of marginpositivity necessitate secondary re-excisionprocedures. This prospective observational

AI-Based Prediction of Dental Caries Using Clinical, Behavioral, and Population Risk Data: A Prospective Predictive Modeling Study

2026-08-11T09:24:16+00:00

Dental caries remains one of the mostprevalent chronic diseases worldwide despitesubstantial advances in preventive dentistry.Traditional caries risk assessment methods rely primarily on clinical judgment and oftenfail to integrate the complex interactions

Shifting Epidemiology of Infant Rotavirus Gastroenteritis in Pakistan Following Nationwide Vaccine Implementation: A Prospective Cohort Study

2026-08-11T09:27:21+00:00

Rotavirus gastroenteritis has historically been a leading cause of severe diarrhea,dehydration, hospitalization, and mortalityamong infants in Pakistan. Following the nationwide introduction of the monovalentrotavirus vaccine into the Expanded Program

Serum Hepatocyte Growth Factor (HGF) estimation and its correlation study with Hormonal Receptor Status (ER, PR, and HER2/neu) in Carcinoma Breast

2026-08-11T09:52:22+00:00

Background: Hepatocyte Growth Factor(HGF) and its receptor c-MET are involved in breast cancer progression, angiogenesis,invasion, and metastasis. Serum HGF hasemerged as a potential biomarker for tumoraggressiveness. Aim: To evaluate serumHGF levels in breast carcinoma patientsand correlate them with ER, PR, andHER2/neu receptor status.

Frequency of Comorbid Depression in Patients with Generalized Anxiety Disorder

2026-08-11T09:52:58+00:00

Background: Generalized anxiety disorder (GAD) is often comorbid with depression, and the association of this overlap with poorer quality of life, functional impairment, and treatment complexity.

Objective: To examine the prevalence of comorbid depression in GAD patients and its relationship to selected demographic and clinical features.

Materials and Methods: The study was descriptive cross sectional of six months’ duration from November, 2025 to April, 2026 in Department of Psychiatry, Dr Ruth KM Pfau Civil Hospital Karachi. The number of patients with GAD (N = 180) were recruited by consecutive sampling between the ages of 18 and 60 who met the criteria of the DSM-5 for GAD. The PHQ-9 was used to measure depression with a score ≥10 considered clinically significant. SPSS 26 was used to analyze the data.

Results: The mean age was 37.6±10.8 years; 57.8% were female. 78 (43.3%) patients had comorbid depression. Female gender, longer duration of GAD and previous psychiatric treatment were significantly associated with depression (p<0.05).

Conclusion: Depression is a very common comorbid condition in GAD, and should be screened for routinely in the treatment of anxiety.

Association between Gut Microbiome Dysbiosis and Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus: A Multidisciplinary Cross-Sectional Study

2026-08-11T10:03:13+00:00

Background: Diabetic peripheral neuropathy is one of the most frequent chronic complication of type 2 diabetes mellitus and can result in pain, decreased sensation and a diminished quality of life. Recent findings indicate that the gut microbiome changes can play a role in metabolic inflammation, in compromised intestinal barrier function and nerve injury. There is, however, little local evidence to support the association between dysbiosis of the gut microbiota and DPN.

Objective: To determine the association between gut microbiome dysbiosis and diabetic peripheral neuropathy among patients with type 2 diabetes mellitus.

Methods: This multidisciplinary cross-sectional study was conducted at Gomal Medical College, Dera Ismail Khan, from January 2025 to June 2025. Total 76 type 2 diabetes mellitus (T2DM) adult patients were consecutively recruited by non-probability sampling method. Diabetic peripheral neuropathy was evaluated with Michigan Neuropathy Screening Instrument, 10-g monofilament and vibration perception and ankle reflex examination. Bacterial 16S ribosomal RNA gene analysis was performed using fresh stool samples. Alpha diversity was assessed by Shannon, Simpson and Chao1 indices and the composition of bacteria and gut dysbiosis index were compared between patients with and without neuropathy. Multivariable binary logistic regression was employed to determine factors associated with diabetic peripheral neuropathy independently.

Results: Diabetic peripheral neuropathy was identified in 42 of 76 patients, giving a frequency of 55.3%. Patients with neuropathy had a longer duration of diabetes, higher fasting blood glucose, higher HbA1c and increased C-reactive protein levels compared with patients without neuropathy. The Shannon diversity index was significantly lower in the neuropathy group than in the non-neuropathy group (2.71 ± 0.46 versus 3.18 ± 0.51; p<0.001), whereas the gut dysbiosis index was significantly higher (3.8 ± 1.3 versus 2.4 ± 1.0; p<0.001). Patients with neuropathy had reduced abundance of Faecalibacterium, Roseburia, Akkermansia and Bifidobacterium and increased abundance of Escherichia–Shigella and Proteobacteria. The gut dysbiosis index was positively correlated with the neuropathy score (r=0.52; p<0.001). In multivariable analysis, a higher gut dysbiosis index, lower Shannon diversity, longer duration of diabetes and higher HbA1c were independently associated with diabetic peripheral neuropathy.

Conclusion: Gut microbiome dysbiosis was significantly associated with diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. Reduced microbial diversity, depletion of beneficial bacteria and increased abundance of potentially pro-inflammatory microorganisms may contribute to neuropathy through metabolic and inflammatory pathways. Longitudinal studies are needed to determine causality and evaluate microbiome-targeted interventions.

Proximal Femoral Nailing and It's Out Come for Intertrochanteric Fractures

2026-08-11T10:14:06+00:00

Background: Intertrochanteric fractures are common among elderly individuals and often require stable surgical fixation to permit early mobilization and restore function.

Aim/Objectives: To evaluate the clinical, radiological, and functional outcomes of proximal femoral nailing in patients with intertrochanteric fractures.

Materials and Methods: This prospective observational study included 25 patients treated with proximal femoral nailing at the Department of Orthopedics, Singareni Institute of Medical Sciences, Ramagundam, over two years. Patients were assessed for fracture union, complications, and functional outcome using the Harris Hip Score.

Results: Most patients were aged 61–70 years (36%), and falls were the predominant injury mechanism (72%). Radiological union occurred within 12–16 weeks in 60% of patients. No postoperative complications occurred in 80%, while 76% achieved good-to-excellent functional outcomes.

Conclusion: Proximal femoral nailing provides stable fixation, satisfactory fracture union, few complications, and favorable functional recovery in intertrochanteric fractures.

Comparison of Conventional and Accelerated Orthodontics Techniques in Reducing Treatment Time

2026-08-12T05:29:14+00:00

Objective: To compare the effectiveness of conventional and accelerated orthodontic technique in reducing overall treatment time and to assess the treatment outcome and patient satisfaction.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Orthodontics, Nishtar Institute of Dentistry, Multan from November 2025 to April 2026.

Methods: 120 patients were enrolled who needed fixed orthodontics treatment. Sample size was determined by the WHO formula for sample size determination at a 95% level of confidence, 80% study power and 5% level of significance. There were 60 patients in the conventional orthodontics group and 60 patients in the accelerated orthodontics group. Sixty patients were also assigned to one of the two groups, the conventional orthodontics group (n=60) and the accelerated orthodontics group (n=60). Treatment duration, alignment rate, pain perception and satisfaction were evaluated. Data was processed by SPSS version 26.0 with independent sample t-tests and Chi-square tests, p<0.05 was considered as statistically significant.

Results: There was a statistically significant difference in treatment time and tooth alignment between accelerated orthodontics and conventional orthodontics (p<0.05). The group that had accelerated treatment had better satisfaction and similar pain scores compared with the other group.

Conclusion: The accelerated orthodontic techniques do not compromise the treatment outcome and are safe and effective options when compared to conventional orthodontic therapy, and they are among those that can significantly shorten the time for treatment.

Patterns of Coronary Artery Disease in Patients under 40 with Acute Coronary Syndrome

2026-08-12T05:49:38+00:00

Background: In adult patients under 40 years of age, acute coronary syndrome can result in significant morbidity.

Objective: To identify the angiographic characteristics of coronary artery disease in young patients (< 40 years) with acute coronary syndrome.

Methods: This descriptive cross-sectional study involved 120 patients (18-39 years) with acute coronary syndrome (ACS) from March to August 2025 at Aga Khan University Hospital, Karachi. Demographic, risk factor, and coronary angiographic data were analyzed.

Results: The mean age was 34.2 ± 4.1 years, and 85.0% were male. The most common presentation (56.7%) was STEMI. The top risk factors were smoking (59.2%) and dyslipidemia (48.3%). Single-vessel disease was the most common (54.2%), and the left anterior descending artery was the most commonly affected (58.3%).

Conclusion: Single-vessel disease with LAD involvement predominated in young ACS patients and suggests the importance of early risk-factor control and prompt angiographic evaluation.

Predictive Histopathological and Molecular Biomarkers Guiding Surgical Management of Colorectal Cancer

2026-08-12T06:07:12+00:00

Introduction: Colorectal cancer is highly biologically heterogeneous and the conventional staging system does not fully define aggressiveness, treatment response or recurrence. Histopathological and molecular biomarkers may be used for individual management.

Objective: To evaluate the predictive value of histopathological and molecular biomarkers in colorectal cancer and their usefulness in guiding surgical management, treatment selection, and prognosis.

Materials and Methods: This was a prospective, observational study of 120 patients with histologically proven colorectal adenocarcinoma in Mercy Teaching Hospital, Peshawar Medical College, Peshawar, Pakistan from August 2025 to January 2026. Clinical, histopathological, molecular, surgical and biomarker-related data were gathered and analyzed.

Results: Advanced disease was correlated with high/intermediate tumour budding, lymphovascular invasion, perineural invasion and lymph-node involvement. MSI-high/MMR deficiency was found in 15.0%, RAS mutations in 35.8%, BRAF mutations in 9.2% and HER2 amplification in 5.8%. Pathological characteristics were found to be unfavorable if detectable postoperative ctDNA was detected.

Conclusion: Integrated biomarker assessment can enhance risk stratification and provide tailored surgical and post-surgical management.

A CLINICAL STUDY OF INGUINAL HERNIA AND COMPARISON BETWEEN OPEN MESH AND NON-MESH REPAIR

2026-08-12T08:20:20+00:00

Background: Hernias are among the oldestsurgical challenges and are currently the most commonly performed general surgicaloperations. Also, it can be argued that moreprogress has been made in hernia surgeryin the last 15 years than has been made inthe previous 1500 years. Many of thenewer techniques, have demonstrated

A STUDY OF CLINICAL AND ETIOLOGICAL PROFILE IN ELDERLY PATIENTS PRESENTING WITH ALTERED MENTAL STATUS

2026-08-12T08:22:34+00:00

Background :-Altered mental status (AMS) is a challengingdiagnosis in elderly patients and has a wide range of Etiologies.

Objectives: To know the clinical andetiological profile in elderly, so that physicianswill be better aware of AMS backgrounds and
thus improving morbidity and mortality rates ofthe patients.

Effect of Preoperative Anxiety on Postoperative Pain and Opioid Consumption After Elective Gynaecological Surgery

2026-08-12T08:36:09+00:00

Background: Preoperative anxiety is a prevalentpsychological issue for patients facing electivegynaecological surgery, linked to heightenedpostoperative pain, increased analgesic needs,prolonged recovery, and diminished patient satisfaction

Integrating Pharmacovigilance into Unani Medical Education: Evidence from a Knowledge–Attitude–Practice Survey

2026-08-12T09:04:27+00:00

Background: Pharmacovigilance is essential for detecting, assessing, and preventing adverse drug reactions (ADRs), including those associated with traditional medicines. Despite the growing use of Unani medicines, formal pharmacovigilance training within undergraduate Unani medical education remains limited. This study aimed to assess the knowledge, attitude, and practice (KAP) of pharmacovigilance among Unani medical students and to evaluate the need for structured pharmacovigilance training within the Bachelor of Unani Medicine and Surgery (BUMS) curriculum.

Materials and Methods: A descriptive cross-sectional questionnaire-based study was conducted over four months, from February to May 2025, among 130 BUMS students. A structured and validated questionnaire assessed demographic characteristics, pharmacovigilance knowledge, attitudes toward ADR reporting, and reporting-related practices. Domain scores were categorized according to predefined criteria. Associations between participant characteristics and desirable pharmacovigilance practice were evaluated using appropriate statistical tests and multivariable logistic regression. A P value <0.05 was considered statistically significant.

Results: Among the 130 participants, 21.5% demonstrated good knowledge, 43.8% moderate knowledge, and 34.6% poor knowledge regarding pharmacovigilance. Awareness that Unani medicines may cause ADRs was observed in 80.0%, whereas only 37.7% knew where suspected ADRs should be reported and 35.4% were familiar with an ADR reporting form. Attitudes were substantially more favorable, with 73.8% demonstrating a favorable attitude toward pharmacovigilance. Previous formal pharmacovigilance teaching was independently associated with desirable practice (adjusted OR 4.31; 95% CI 1.66–11.18; P = 0.003).

Conclusion: Unani medical students demonstrated favorable attitudes toward pharmacovigilance but important deficiencies in operational knowledge and ADR-reporting practice. The strong association between formal pharmacovigilance exposure and better practice supports the integration of structured, longitudinal, competency-based pharmacovigilance training into the BUMS curriculum.

Comparison of Labour Induction Outcomes with Sublingual versus Oral Misoprostol at Term: A Retrospective Cohort Study

2026-08-12T09:28:51+00:00

Background: Misoprostol can be administered through several routes for cervical ripening and labour induction. Route-related differences in absorption may influence the amount of drug required and the time from induction to birth, while maternal and neonatal safety must remain central.

Objectives: To compare induction efficiency, mode of delivery, maternal and intrapartum fetal safety outcomes, and early neonatal outcomes among term pregnancies managed with sublingual or oral misoprostol.

Methods: This retrospective cohort study included 50 term pregnancy records, with 25 women in the sublingual group and 25 in the oral group. Each administration contained 50 µg misoprostol. The principal outcome was the induction-to-delivery interval. Secondary outcomes included number and cumulative dose of misoprostol, oxytocin augmentation, delivery mode, uterine hyperstimulation, tachysystole, fetal distress or non-reassuring fetal status leading to caesarean delivery, postpartum haemorrhage, birth weight, Apgar scores, and neonatal intensive care unit admission. Continuous variables were compared using Welch’s t-test or the Mann-Whitney U test, while categorical variables were assessed using the chi-square test or Fisher’s exact test.

Results: Baseline age, parity, gestational age, Bishop Score, and indications for induction were comparable between groups. The sublingual group required fewer doses (median 2 versus 3; p=0.032) and a lower cumulative dose (median 100 versus 150 µg; p=0.032). Mean induction-to-delivery interval was 13.85±3.26 hours with sublingual administration and 20.14±3.32 hours with oral administration (mean difference 6.29 hours; 95% CI 4.42–8.16; p<0.001). Caesarean delivery occurred in 5 (20%) and 6 (24%) women, respectively. Fetal distress or non-reassuring fetal status leading to caesarean delivery occurred in 2 (8%) women in each group. Hyperstimulation, tachysystole, postpartum haemorrhage, birth weight, Apgar scores, and neonatal intensive care unit admission did not differ significantly.

Conclusion: In this cohort, sublingual misoprostol was associated with a shorter induction-to-delivery interval and lower drug exposure than the oral route. Fetal distress or non-reassuring fetal status was recorded equally in both groups, and the study did not demonstrate a fetal safety advantage for either route. Current guideline-supported practice favours low-dose oral misoprostol were incorporated into institutional protocols; the present findings should not be interpreted as support for routine 50 µg sublingual administration.

A Comparative Study of Stapled versus Hand-Sewn Bowel Anastomosis in Patients Undergoing Bowel Surgery: Safety, Operative Efficiency, Hospital Stay, and Cost Analysis

2026-08-12T09:33:55+00:00

Background: Bowel anastomosis is a fundamental component of gastrointestinal surgery, and the choice between stapled and hand-sewn techniques may significantly influence surgical outcomes. This study compared the two techniques with respect to anastomotic safety, operative efficiency, postoperative recovery, hospital stay, and overall treatment cost.

Methods: A single-centre, hospital-based observational comparative study was conducted over 18 months at JSS Medical College, Mysuru, involving 40 adult patients undergoing bowel resection and anastomosis. Patients were allocated into stapled (n=20) and hand-sewn (n=20) groups. Baseline demographic and clinical characteristics, operative details, anastomotic leak, anastomosis duration, postoperative bowel recovery, hospital stay, treatment cost, and 30-day postoperative outcomes were evaluated and compared.

Results: Both groups were comparable regarding baseline characteristics, including age (47.6 ± 13.4 vs 49.8 ± 12.9 years), sex distribution (65.0% vs 60.0% males), symptom duration, comorbidities, and laboratory parameters. Acute abdomen was the indication for surgery in 75.0% of patients in both groups, while revision ileostomy-related pathology accounted for 25.0%. Small bowel pathology predominated, with segmental small bowel resection performed in 50.0% and 55.0% of stapled and hand-sewn cases, respectively. Side-to-side anastomosis was significantly more common in the stapled group (65.0% vs. 25.0%, p=0.025). Stapled anastomosis demonstrated significantly shorter anastomosis duration (24.6 ± 5.8 vs. 35.9 ± 8.7 minutes, p<0.001), earlier return of bowel sounds by postoperative day 3 (85.0% vs. 50.0%, p=0.041), lower anastomotic leak rate (0.0% vs. 25.0%, p=0.042), and shorter hospital stay (7.1 ± 2.1 vs. 10.4 ± 4.2 days, p=0.004). However, overall treatment cost was significantly higher with stapled anastomosis (₹85,240 vs. ₹68,430, p=0.001). No 30-day mortality was observed.

Conclusion: Stapled bowel anastomosis was associated with superior short-term clinical outcomes, including reduced anastomotic leak, shorter operative time, faster postoperative recovery, and shorter hospital stay compared with hand-sewn anastomosis, although it incurred higher treatment costs.

Role of Percutaneous Endovascular Interventions in the Treatment of Failed Hemodialysis Fistula

2026-08-12T09:42:37+00:00

Background: Arteriovenous fistula is the preferred vascular access for patients requiring long-term hemodialysis because of its superior patency and lower complication rates. However, AVF (Arteriovenous Fistula) dysfunction caused by venous stenosis and thrombosis remains a major cause of access failure, compromising dialysis adequacy. PTA (Percutaneous Transluminal Angioplasty) has emerged as the first-line minimally invasive treatment for restoring fistula patency and prolonging vascular access survival. This study evaluated the procedural efficacy, safety, and short-term clinical outcomes of percutaneous endovascular intervention in failed hemodialysis fistulas.

Methods: A prospective longitudinal observational study was conducted in the Department of Radiodiagnosis, Government Medical College, Kozhikode, from June 2021 to June 2022. Forty patients with dysfunctional AVFs due to outflow vein stenosis who underwent percutaneous angioplasty were included. Clinical examination, Doppler ultrasonography, and angiographic findings were used for diagnosis and procedural planning. Balloon angioplasty was performed through arterial or venous access depending on lesion characteristics. Immediate technical success was defined by restoration of blood flow, successful recanalization, and reappearance of thrill, while clinical success was assessed by adequate dialysis flow and absence of restenosis during a 3-month follow-up. Statistical analysis was performed using SPSS version 22, with p<0.05 considered statistically significant.

Results: Among the 40 patients, radiocephalic fistulas constituted 62.5%, and combined fistula and outflow vein stenosis was observed in 97.5% of cases. Long-segment stenosis (90%) and total occlusion (85%) were the predominant lesions. Venous access was used in 75% of procedures, while fistuloplasty with venoplasty was performed in 97.5% of patients. Immediate technical success was achieved in 38 patients (95%), with only two technical failures due to inability to negotiate extensive thrombotic lesions. Minor access-site hematoma occurred in 5% of patients, with no major procedure-related complications. At 3-month follow-up, 36 of the 38 successfully treated patients (94.7%) maintained fistula patency, whereas two patients developed restenosis requiring repeat angioplasty. None of the demographic, clinical, or fistula-related variables demonstrated a statistically significant association with procedural or follow-up outcomes.

Conclusion: Percutaneous transluminal angioplasty is a safe, effective, and minimally invasive treatment for failed hemodialysis AVFs, providing a high immediate technical success rate (95%) and excellent short-term clinical patency with minimal complications. It should be considered the preferred first-line intervention for AVF dysfunction due to stenosis or thrombosis, helping preserve vascular access and improve dialysis outcomes.

MR Imaging of Brain in a Paediatric with Hypoxic Ischemic Encephalopathy, a Retrospective Study in Tertiary Care Center

2026-08-12T09:48:09+00:00

Background: Hypoxic–ischemic encephalopathy (HIE) remains a major cause of morbidity and long-term neurodevelopmental impairment in children. While basal ganglia and cortical injuries are well described, white matter involvement represents a critical but variable manifestation of hypoxic–ischemic injury, particularly beyond the neonatal period. Magnetic resonance imaging (MRI) plays a pivotal role in detecting and characterizing these white matter changes and in understanding injury patterns related to hypoxia–ischemia.

Methods: This retrospective study included children under 18 years of age diagnosed with hypoxic–ischemic encephalopathy who underwent brain MRI at a tertiary care center over a defined study period. Conventional MRI sequences including T1-weighted, T2-weighted, FLAIR, and diffusion-weighted imaging were reviewed. White matter involvement was assessed for distribution, symmetry, extent, and predominant regions affected, including periventricular, subcortical, and deep white matter. Imaging findings were analysed descriptively and correlated with age at insult and clinical history.

Results: White matter abnormalities were identified in the majority of cases, with periventricular and subcortical white matter being the most frequently involved regions. Diffuse bilateral involvement was more common than focal changes. Younger children demonstrated a higher prevalence of periventricular white matter injury, while older children showed more extensive subcortical and deep white matter involvement. Associated cortical and deep gray matter abnormalities were observed in a subset of patients.

Conclusion: MRI demonstrates a broad spectrum of white matter changes in Paediatric hypoxic–ischemic encephalopathy, with patterns varying according to age and severity of insult. Recognition of these imaging patterns is essential for accurate diagnosis, prognostication, and clinical management. White matter assessment should be an integral component of MRI evaluation in children with suspected hypoxic–ischemic brain injury.

A Histopathological Study of Placental Changes in Pregnancies Complicated by Preeclampsia

2026-08-12T09:53:45+00:00

Background: Placenta is a vital organ and the most accurate record of the infants prenatal experience. Preeclampsia is a serious complication encountered during pregnancy. Preeclampsia affects approximately 5–10% of all pregnancies regarding for almost 15% of pregnancy associated deaths, placing both mothers and babies at increased risk of adverse health outcomes. The conventional treatment to manage the preeclampsia is with anti-hypertensive drugs, bed rest and early delivery, which may lead to further complications. In this regard, safer alternative interventions like music therapy and yoga are emerging as promising strategies for the healthcare community. In the present study, the histopathological changes in the placentae of preeclamptic pregnancies were studied after giving interventions of music listening and yoga therapy for duration of 14 days in the third trimester of pregnancy.

Materials and Methods: A quasi-experimental study was carried out among hospitalized preeclamptic pregnant women (n=75), and normotensive controls (n=25) from the antenatal ward of Yenepoya Medical College Hospital, Mangalore, India. Preeclamptic patients were assigned into three experimental groups, group 1 music listening (n=25), group 2 yoga therapy (n=25) and group 3 preeclamptic control groups (n=25) using non-randomisation. Patient’s blood pressure (BP), both systolic (SBP) and diastolic blood pressure (DBP), were measured before and after giving the intervention in the study groups. Placentae were collected after delivery for evaluating the histopathological changes in the study groups.

Results: There was a reduction in basement membrane thickening in 37% in the placental samples of preeclamptic music listening group and a reduction in 25% of placentae of preeclamptic yoga therapy group as compared with preeclamptic controls. There was a reduction of stromal fibrosis in 50% of placentae of preeclamptic yoga therapy group as compared with preeclamptic controls.

Conclusion: The villous and stromal pathology of placentae between preeclamptic study groups and normotensive control pregnant women were statistically significant. In contrast, no statistically significant differences were found in villous and stromal pathology among the preeclamptic study groups.

A PROSPECTIVE STUDY OF EPIDEMIOLOGY, CAUSES AND PROGNOSIS OF ACUTE RENAL FAILURE IN A TERTIARY CARE HOSPITAL

2026-08-12T09:53:47+00:00

Introduction: AKI, previously known asAcute Renal Failure, is a clinical syndromecharacterized by an abrupt decline in glomerular filtration rate sufficient todecrease the elimination of nitrogenouswaste products (urea and creatinine) andother uremic toxins. Acute kidney injury(AKI) is a common clinical syndrome

A PROSPECTIVE STUDY OF AETIOLOGY AND OUTCOME OF ACUTE KIDNEY INJURY IN TYPE 2 DIABETES PATIENTS

2026-08-12T10:14:51+00:00

Introduction: Acute kidney injury (AKI)describes the clinical syndrome earliercalled acute renal failure. AKI is defined asstructural or functional abnormality of thekidney that manifests with in 48 h, asdetermined by blood, urine, tissue tests or byimaging studies. AKI is depicted by rapid (over hours to days) decline in glomerular

A PROSPECTIVE STUDY OF PREVALENCE OF AUTOIMMUNE THYROID DISEASE AND THYROID DYSFUNCTION IN TYPE 1 DIABETES MELLITUS PATIENTS- A TERTIARY CARE CENTRE

2026-08-12T10:18:30+00:00

Introduction: Children and adolescentswith T1DM are at increased risk for comorbid autoimmune diseases compared tochildren in the general population. A high proportion of children and adolescents withT1DM have other organ-specific

Early Laboratory Predictors of Sepsis-Associated Acute Kidney Injury: Development and Validation of a Clinical Prediction Model

2026-08-07T05:36:54+00:00

Objective: To identify early laboratory predictors of sepsis-associated acute kidney injury (SA-AKI) and develop a practical clinical prediction model using routinely available laboratory investigations among adult patients with sepsis admitted to tertiary care hospitals in Pakistan.

Methods: This prospective multicenter observational cohort study was conducted over 12 months in the Departments of Nephrology and General Medicine of tertiary care teaching hospitals in Pakistan. A total of 250 adult patients diagnosed with sepsis according to the Sepsis-3 criteria were enrolled consecutively. Demographic and clinical characteristics, along with routine laboratory investigations including complete blood count, serum creatinine, blood urea nitrogen (BUN), C-reactive protein (CRP), serum albumin, serum bicarbonate, and urine output, were recorded within 24 hours of admission. The primary outcome was the development of SA-AKI within seven days according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Independent predictors were identified using multivariable logistic regression. The predictive performance of the model was assessed using receiver operating characteristic (ROC) curve analysis, the Hosmer–Lemeshow goodness-of-fit test, and internal split-sample validation.

Results: Of the 250 enrolled patients, 92 (36.8%) developed SA-AKI. Higher serum creatinine, BUN, CRP, neutrophil-to-lymphocyte ratio, and lower serum albumin, serum bicarbonate, and urine output were independently associated with the development of SA-AKI (p<0.05). The final prediction model demonstrated good discrimination (AUC=0.85) and satisfactory calibration (Hosmer–Lemeshow p=0.58).

Conclusion: A prediction model based solely on inexpensive and routinely available laboratory investigations effectively identified septic patients at high risk of developing acute kidney injury. The model may facilitate early risk stratification and timely intervention in resource-limited tertiary care hospitals in Pakistan.

Objective: To determine the frequency of MDR bloodstream infections and identify factors associated with their development among adults with newly diagnosed AML.

Methods: This multicenter analytical cross-sectional study was conducted over one year at three tertiary care hospitals in Pakistan. Adults with newly diagnosed AML and culture-confirmed BSI before or during induction chemotherapy were included. Clinical, laboratory, and microbiological data were collected, and antimicrobial susceptibility testing was performed according to CLSI guidelines. Multivariable logistic regression identified independent predictors of MDR BSI.

Results: Among 186 patients, 72 (38.7%) developed MDR bloodstream infections. Gram-negative bacteria, mainly Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, predominated. Previous broad-spectrum antibiotic exposure, prolonged neutropenia, central venous catheterization, ICU admission, and prolonged hospitalization were independent risk factors. MDR infections were associated with longer hospital stay and increased in-hospital mortality.

Conclusion: MDR bloodstream infections are common among newly diagnosed AML patients in Pakistan. Early identification of high-risk patients, effective antimicrobial stewardship, and strengthened infection prevention strategies are essential to reduce infection-related morbidity and mortality.

Clinical Spectrum of Pediatric Hypopigmentary Disorders with Special Emphasis on Childhood Vitiligo: A Cross-Sectional Study

2026-08-12T11:30:18+00:00

Background: Hypopigmentary disorders constitute the majority of pigmentary dermatoses encountered in pediatric dermatology. Although most are benign, these disorders frequently cause cosmetic concerns, psychological distress, and anxiety among parents. Childhood vitiligo represents one of the most important acquired hypopigmentary disorders because of its chronic course and significant psychosocial impact.

Objective: To evaluate the clinical spectrum of pediatric hypopigmentary disorders with special emphasis on the demographic profile, clinical characteristics, and disease pattern of childhood vitiligo.

Materials and Methods: A hospital-based cross-sectional study was conducted among children aged 0–15 years presenting with hypopigmentary disorders to the Department of Dermatology, Venereology and Leprosy, Vijayanagara Institute of Medical Sciences, Ballari, Karnataka, between January and December 2021. Clinical history, demographic characteristics, lesion morphology, anatomical distribution, associated findings, and relevant investigations were recorded. Data were analyzed using SPSS version 25.0.

Results: Among 200 children with pigmentary disorders, 163 (81.5%) had hypopigmentary disorders. Vitiligo was the most common hypopigmentary disorder (38.7%), followed by pityriasis alba (30.7%), nevus depigmentosus (11.0%), pityriasis versicolor (8.0%), and post-inflammatory hypopigmentation (6.1%). Most hypopigmentary disorders occurred in the 11–15-year age group with a slight female predominance. Among children with vitiligo, the 6–10-year age group was most commonly affected, while mucosal involvement and Koebner phenomenon were observed in a minority of cases.

Conclusion: Hypopigmentary disorders constitute the predominant pigmentary disorders in children, with vitiligo representing the leading diagnosis. Recognition of characteristic clinical patterns facilitates early diagnosis, appropriate treatment, and effective counseling of patients and their caregivers.

Clinical and Epidemiological Profile of Hyperpigmentary Disorders in Children Attending a Tertiary Care Hospital: A Cross-Sectional Stud

2026-08-12T11:35:51+00:00

Background: Hyperpigmentary disorders constitute a relatively less common but clinically important group of pediatric pigmentary dermatoses. These disorders arise from diverse congenital, inflammatory, infectious, and developmental causes and frequently present diagnostic challenges because of their varied clinical manifestations. Although most are benign, visible pigmentation often results in cosmetic concerns and parental anxiety. Epidemiological data describing the clinical spectrum of childhood hyperpigmentary disorders remain limited.

Objective: To evaluate the clinical and epidemiological profile of hyperpigmentary disorders among children attending a tertiary care dermatology center.

Materials and Methods: A hospital-based cross-sectional study was conducted among children aged 0–15 years presenting with hyperpigmentary disorders to the Department of Dermatology, Venereology and Leprosy, Vijayanagara Institute of Medical Sciences, Ballari, Karnataka, between January and December 2021. Demographic characteristics, clinical history, lesion morphology, anatomical distribution, associated dermatological conditions, systemic associations, and relevant investigations were recorded. Data were analyzed using IBM SPSS Statistics version 25.0.

Results: Among 200 children with pigmentary disorders, 37 (18.5%) had hyperpigmentary disorders. The majority belonged to the 11–15-year age group (70.3%), with an almost equal gender distribution. Post-inflammatory hyperpigmentation and pityriasis versicolor were the most common hyperpigmentary disorders (21.6% each), followed by freckles (13.5%) and Becker nevus (10.8%). The head and neck region was the most frequently affected anatomical site, while scaling was observed in only a minority of patients.

Conclusion: Hyperpigmentary disorders represent an important subset of pediatric pigmentary diseases, with post-inflammatory hyperpigmentation and pityriasis versicolor being the predominant diagnoses. Early clinical recognition facilitates accurate diagnosis, appropriate management, and reassurance of affected children and their caregivers.

Clinical Profile and Outcome of Blunt Abdominal Trauma at a Rural Tertiary Care Centre in Andhra Pradesh: A Prospective Observational Study

2026-08-12T11:41:22+00:00

Background: Blunt abdominal trauma (BAT) is a major contributor to morbidity and mortality in patients presenting to emergency department and inexpensive, reliable tools for rapid triage are particularly valuable in resource-limited rural settings.

Objectives: To describe the clinical profile and outcome of patients with BAT at a rural tertiary care centre, to determine the frequency of a positive Extended Focused Assessment with Sonography in Trauma (E-FAST), and to assess the utility of the Clinical Abdominal Scoring System (CASS) in predicting the need for laparotomy.

Methods: A prospective observational study was conducted over 22 months in the Department of General Surgery at a tertiary care hospital in Kuppam, Andhra Pradesh. Thirty-nine patients aged 18-70 years with BAT were enrolled by purposive sampling. Clinical, laboratory and E-FAST findings were recorded on a structured proforma incorporating CASS, and data were analysed using SPSS version 26.0.

Results: The cohort was predominantly male (71.8%) with a mean age of 37.8 years; road traffic accidents accounted for 71.8% of injuries. E-FAST was positive in 94.9% of patients. Liver and splenic injuries were each present in 25.6% of cases. Conservative management succeeded in all 23 patients selected for it, with zero mortality, whereas 16 patients required surgery, among whom mortality was 25.0%. Overall mortality was 10.3%, and alcohol intoxication was associated with a 7.6-fold higher mortality (27.3% vs 3.6%). All patients with a CASS score ≥12 required laparotomy, whereas none with a score of 9 did.

Conclusion: Selective non-operative management guided by CASS and E-FAST achieved excellent outcomes in this rural cohort, and alcohol intoxication emerged as a key modifiable risk factor for mortality.

Role of Blood Eosinophils, Neutrophils and Serum IGE levels as Biomarkers in Chronic Obstructive Pulmonary Disease

2026-08-12T11:47:03+00:00

Aim: To predict the relationship of blood eosinophils, neutrophils & serum IgE levels in patients with chronic obstructive pulmonary disease, to modify disease progression, hospital admissions & prediction of COPD exacerbations. To correlate elevated blood eosinophils, neutrophils and serum IgE levels with exacerbation of COPD.

Materials and Methods: Cross sectional observational study of 140 patients at Department of Pulmonary Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, suspected to have COPD

Results: This study showed a male predominance of 85% (119/140) and female 15% (21/140), mostly in the 50–70 years age group (83.5%). COPD was most common in Stage II (28.5%) and Stage III (41.4%). Exacerbations increased with staging: Stage I (38%), Stage II (60%), Stage III (67%), Stage IV (76%). Mean FEV1 declined from 54.3% in stable COPD to 48.9% in exacerbations. Absolute eosinophil counts rose from 305 (Stage I) to 1065 (Stage IV), neutrophils from 4650 to 5782/µL, and serum IgE from 790 to 3247 IU/mL. Smokers with >10 pack years had more exacerbations and elevated biomarkers. Elevated eosinophils (>300 cells/µL), neutrophils (>6000 cells/µL), and IgE (>150 IU/mL) were significantly higher in exacerbations (p=0.001), supporting biomarker-guided COPD management.

Conclusion: Elevated eosinophils, neutrophils, and IgE levels are observed in both stable and exacerbated COPD, with higher levels during exacerbations. These markers correlate with disease severity, smoking, and environmental exposures. Eosinophils also predict better ICS response. Recurrent exacerbations worsen lung function.

Evaluation of Prescribing Acumen of Healthcare Professionals in a Tertiary Care Teaching Hospital in North India

2026-08-13T05:18:58+00:00

Background: Prescription writing is a critical component of clinical practice that directly influences therapeutic outcomes, patient safety and healthcare expenditure. Inappropriate prescribing practices contribute significantly to medication errors, irrational drug use, antimicrobial resistance and increased healthcare costs. Prescription audit serves as an effective quality assurance tool for evaluating prescribing behaviour and promoting rational use of medicines.

Objective: To evaluate prescribing skills of healthcare professionals in a tertiary care teaching hospital in North India.

Methods: A hospital-based, cross-sectional, observational study was conducted in the Department of Pharmacology at L.L.R.M. Medical College, Meerut and associated tertiary care teaching hospital, Meerut. A total of 207 outpatient prescriptions were audited using National Health Systems Resource Centre (NHSRC) guidelines.

Results: Complete documentation of OPD registration number, age and date of consultation was observed in 100% prescriptions, whereas gender was mentioned in 96.1%. However, major deficiencies were observed in recording patient name (11.1%), allergy status (2.4%), clinical history (8.2%), diagnosis (35.7%) and dose schedule (1.4%). Generic prescribing was noted in only 28.5% prescriptions. Antimicrobials were prescribed in 40.5% encounters, while adherence to antimicrobial prescribing policy was only 29.4%.

Conclusion: Substantial deficiencies exist in prescription completeness and rational prescribing practices. Regular prescription audits, structured educational interventions and strict implementation of standard prescribing guidelines are required.

Diagnostic Accuracy of Fetal Thymus Transverse Diameter on Ultrasound for Prediction of Chorioamnionitis in Preterm Prelabor Rupture Of Membranes (PPROM): Histopathology as the Gold Standard

2026-08-13T09:16:52+00:00

Objectives: To determine the diagnostic accuracy of fetal thymus transverse diameter measured by ultrasound for predicting chorioamnionitis in women with preterm prelabor rupture of membranes (PPROM), using histopathology as the gold standard.

Study design: Cross-sectional validation study.

Place and duration of study: Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital, Lahore. From June-2024 to December-2024.

Methodology: A total of 105 women aged 18 to 40 years, gestational age ≥22 and <37 weeks, with singleton pregnancy, and diagnosed with PPROM were enrolled. Ultrasound was performed at the time of admission, and the fetal thymus was visualized in the transverse section of the fetal thorax at the three-vessel view. A small fetal thymus was considered when it was below the 5th percentile for gestational age. Placental and membrane tissues were examined histopathologically for chorioamnionitis after delivery. Diagnostic accuracy parameters, including sensitivity, specificity, and predictive values, were calculated.

Results: Histopathology diagnosed chorioamnionitis in 45 (42.86%), while a small fetal thymus was detected by ultrasound in 46 (43.81%) of women. There were 39 true positive, 7 false positive, 6 false negative, and 53 true negative cases. This assessment tool showed a sensitivity of 86.67%, specificity of 88.33%, positive predictive value of 84.78%, negative predictive value of 89.83%, and overall diagnostic accuracy of 87.62%.

Conclusion: Ultrasound assessment of fetal thymus transverse diameter demonstrated a good diagnostic accuracy for predicting chorioamnionitis in women with PPROM and therefore may serve as a useful non-invasive antenatal marker.

Ethical Concerns Surrounding the Use of Artificial Intelligence in Medical Education: Insights from Dental Faculty at Rawal Dental College, Islamabad

2026-08-13T09:25:19+00:00

This study explores the perceptions of dental faculty members at Rawal Dental College, Islamabad, regarding the judicious and ethical use of Artificial Intelligence (AI) in medical education. With the increasing integration of AI into academic and clinical settings, its potential to enhance learning, improve diagnostic accuracy, and streamline administrative processes is widely acknowledged. However, its adoption also raises important ethical concerns that warrant careful consideration.

A qualitative phenomenological design was employed to explore the lived experiences and views of faculty members with exposure to AI in educational contexts. Ten participants were selected through purposive sampling and engaged in semi-structured interviews until data saturation was achieved. Data were analyzed using Braun and Clarke’s thematic analysis approach to identify key patterns within the narratives.

The findings revealed a balanced perception of AI among faculty, recognizing its educational benefits while simultaneously expressing significant ethical concerns. Key issues included data privacy and confidentiality, algorithmic bias, unequal access to AI tools, lack of institutional policies, and limited awareness of ethical guidelines. Participants also emphasized the need for transparency in AI systems and clear accountability mechanisms to ensure trust in academic and clinical decision-making.

The study highlights the necessity for institutional frameworks, structured ethical training, and faculty development programs to support the responsible integration of AI in dental education. Such measures are essential to ensure that AI serves as an educational aid while upholding professional integrity and ethical standards.

Metabolic Syndrome Prevalence in Chronic Plaque Psoriasis Patients

2026-08-13T09:37:02+00:00

Background: Chronic plaque psoriasis is now recognized as a systemic inflammatory disorder associated with an increased burden of cardiometabolic comorbidities.

Objective: To estimate the prevalence of metabolic syndrome in chronic plaque psoriasis patients and to compare this with age and sex matched controls.

Materials and Methods: The study was a case-control study conducted in the multi-centre including Department of Dermatology, MTI HMC, Peshawar, Nishtar Hospital Multan and Mukhtar A Sheikh Hospital Multan for 7 months from July 2025 to January 2026. Total 200 subjects were enrolled, 100 patients with chronic plaque psoriasis and 100 age- and sex-matched controls without psoriasis.

Results: The prevalence of metabolic syndrome was significantly higher in psoriasis patients than in controls (46.0% vs 22.0%, p<0.001). The individual components were more common in psoriasis patients, with abdominal obesity, elevated triglycerides, and low HDL cholesterol being significantly more prevalent.

Conclusion: Patients with chronic plaque psoriasis have a significantly higher prevalence of metabolic syndrome than the general population, and this worsens with disease severity.

Comparison of the Efficacy of Three Different Opioids as Adjuvants to Hyperbaric Bupivacaine for Subarachnoid Block in Lower Limb Orthopedic Surgeries - A Prospective Randomized and Double Blind Study

2026-08-13T09:45:49+00:00

Background: Regional anaesthesia provides effective intraoperative anaesthesia and postoperative analgesia for orthopaedic procedures. This prospective, randomized, double-blind study compared intrathecal buprenorphine, fentanyl, and nalbuphine as adjuvants to hyperbaric bupivacaine in lower-limb orthopaedic surgeries.

Materials and Methods: After IEC approval and written informed consent, 90 ASA I–II patients undergoing elective lower-limb orthopaedic surgery under combined spinal-epidural anaesthesia were randomized into three groups (n=30 each). All patients received 3 mL of 0.5% hyperbaric bupivacaine with either buprenorphine 150 µg, fentanyl 25 µg, or nalbuphine 1 mg intrathecally. Haemodynamic parameters were monitored throughout surgery and postoperatively. Sensory and motor block characteristics, duration of analgesia, VAS pain scores, sedation, patient satisfaction, and adverse effects were assessed. Appropriate statistical tests were applied.

Results: The three groups were comparable regarding demographic characteristics, sensory block characteristics, onset of motor block, duration of analgesia, haemodynamic parameters, and adverse effects. However, the duration of motor block was significantly longer in the fentanyl group compared with the buprenorphine and nalbuphine groups. Side effects were minimal and comparable among all groups.

Conclusion: Intrathecal fentanyl, nalbuphine, and buprenorphine, when added to hyperbaric bupivacaine, were safe and comparable regarding sensory block, analgesic duration, haemodynamic stability, and adverse effects. Fentanyl significantly prolonged motor block compared with buprenorphine and nalbuphine.

Effect of Esomeprazole and Pantoprazole on Gastric Ph and Volume in Patients Posted for Elective Abdominal Surgeries – a Comparative Clinical Study

2026-08-14T06:08:26+00:00

Background: Pulmonary aspiration during general anaesthesia is influenced by both gastric acidity and residual gastric volume. Proton pump inhibitors may improve these gastric characteristics before surgery.

Objective: To compare the effects of intravenous esomeprazole and pantoprazole on gastric pH and aspirate volume in patients undergoing elective abdominal surgery.

Methods: This prospective randomized comparative study included 60 ASA I–II adults, allocated equally to intravenous pantoprazole 40 mg or esomeprazole 40 mg administered 30 minutes before induction. Gastric aspirate pH and volume were measured after intubation and before extubation.

Results: Gastric volume decreased in both groups, with no significant between-group difference post-intubation (12.00 ± 3.23 vs 10.88 ± 3.75 mL; p=0.220) or pre-extubation (8.93 ± 3.03 vs 8.35 ± 3.92 mL; p=0.524). Gastric pH increased in both groups. Pre-extubation pH was significantly higher with esomeprazole than pantoprazole (6.05 ± 0.86 vs 5.27 ± 1.17; p=0.005). No drug-related adverse reactions were observed.

Conclusion: Esomeprazole provided greater perioperative acid suppression than pantoprazole, while both produced comparable effects on gastric aspirate volume.

Comparative Evaluation of Tea, Coffee, and Cold Drink Staining on Nanofilled Composite Restorations and Their Color Recovery after Tooth Whitening

2026-08-14T06:27:25+00:00

Background: Resin-based composites used in restorative dental procedures are susceptible to discoloration when in contact with common beverages. The esthetic effect of this discoloration is still of concern. Recent studies have shown that the nanofilled composites discolor when in contact with tea, coffee and cold carbonated beverages. The degree of discoloration is difficult to reverse with tooth whitening. Thus, this study aims to evaluate the staining potential of tea, coffee and cold carbonated beverages on nanofilled composites as well as the degree to which tooth whitening is able to restore the color of these stains.

Objective: To investigate the potential of tea, coffee, and cold carbonated drinks to stain nanofilled composites and the ability of a standard tooth-whitening procedure to restore color to the stained composites.

Methods: This in-vitro study consisted of 60 standardized nanofilled composite resin specimens, divided into three groups: beverage exposure groups for tea (n=20), coffee (n=20), and carbonated cold drink (n=20). Standardized molds were used to prepare all specimens which were polymerized as per the manufacturer’s instructions. Simple random sampling/allocation used to place specimens into the different groups. As the study if based in a laboratory and involves the use of composite specimens instead of human subjects, the age of participants was not relevant. Baseline and values obtained post exposure to the three beverages, measured using a digital spectrophotometer and the CIELAB color system. The calculation of overall color difference (ΔE) were done post exposure. All specimens were subjected to a standardized tooth whitening procedure using a commercially available whitening agent. Post whitening, color measurements were done to assess percentage color recovery.The values were recorded in a data collection proforma as group type, specimen ID, baseline and post exposure (staining and whitening) L*, a*, b* values, and calculation of ΔE and percentage color recovery. Statistical analysis was performed to analyze ΔE and percentage color recovery for all three groups in relation to color changes and recovery.

Results: Nanofilled composite restorations were discolored after being exposed to tea, coffee, and carbonated cold drinks. Coffee, and to an even greater extent, tea to discolor more as they both contain a greater amount of chromogenic compounds. Whitening procedure recovered color but partial and varied. ΔE values determined the effectiveness of the whitening procedure in removing discoloration caused by beverages.

Conclusion: The study added modern comparative data on the susceptibility of nanofilled composite restorations to staining by tea, coffee, and carbonated cold drinks, as well as the ability of tooth whitening to revert these restorations to their original color. The results should help dentists in explaining to their patients the interaction between beverage consumption and the post-whitening appearance of nanofilled composite restorations.

Association of Middle Ear Risk Index with Anatomical and Audiological Outcomes Following Tympanoplasty: A Prospective Observational Study

2026-08-14T09:59:09+00:00

Background: Chronic middle-ear disease may cause tympanic membrane perforation, chronic inflammation, ossicular damage, and conductive hearing loss, thereby affecting the outcome of tympanoplasty. The Middle Ear Risk Index (MERI) combines adverse middle-ear factors into a composite score and may assist in assessing disease severity and postoperative risk.

Objective: To evaluate the association between MERI severity and anatomical and audiological outcomes following tympanoplasty and tympanomastoid surgery and to assess its relationship with the extent of surgical intervention.

Methods: This prospective observational cohort study was conducted in the Department of Otorhinolaryngology, Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, from July 2023 to August 2024. A total of 111 patients were enrolled, of whom 88 had postoperative outcome data and were included in the final analysis. MERI was categorized as mild (1–3), moderate (4–6), or severe (7–12). The principal anatomical outcome was graft uptake at 6 months. Functional outcome was assessed using postoperative air–bone gap (ABG) and ABG gain. Categorical variables were analyzed using chi-square tests, within-group audiological changes using paired t-tests, and differences in ABG gain across MERI categories using one-way analysis of variance.

Results: Among 88 analyzed patients, 19 (21.6%) had mild, 37 (42.0%) moderate, and 32 (36.4%) severe MERI. Six-month graft uptake was 94.7%, 81.0%, and 68.7% in the mild, moderate, and severe groups, respectively; the categorical association was not statistically significant (χ²=5.04, p=0.080). Mean 6-month ABG gain was 17.7, 16.1, and 13.9 dB in the mild, moderate, and severe groups, respectively, with a significant between-group difference (F=32.24, p≈3.8×10⁻¹¹). MERI category was also significantly associated with the extent of surgical intervention (χ²=21.44, p=0.002).

Conclusion: Increasing MERI severity was associated with greater surgical complexity and a progressive reduction in postoperative hearing improvement. Graft uptake also showed a clinically relevant decline with increasing MERI, although the categorical association did not reach statistical significance. MERI may therefore be useful as a structured component of preoperative assessment and patient counselling, while larger multicentre studies with longer follow-up and multivariable analysis are needed to establish its independent prognostic value.

Clinical Characteristics and Psychosocial Correlates of Suicide Attempts: A Retrospective Cross-sectional Study from a Tertiary Care Centre

2026-08-14T10:19:27+00:00

Background: Suicide is a major public health problem and a leading cause of preventable mortality worldwide. Suicide attempts are substantially more common than completed suicides and represent the strongest predictor of future suicide. Understanding the socio-demographic, clinical, and psychosocial characteristics of individuals who attempt suicide is essential for identifying high-risk populations and developing effective prevention strategies, particularly in low- and middle-income countries such as India.

Aim: To evaluate the socio-demographic profile, clinical characteristics, psychiatric diagnoses, methods of suicide attempt, and psychosocial correlates among adults presenting with suicide attempts to a tertiary care teaching hospital.

Methods: A hospital-based retrospective cross-sectional study was conducted at a tertiary care teaching hospital in Chennai, South India. Medical records of adults (≥18 years) presenting with suicide attempts between January and December 2023 were reviewed. Of 84 eligible records screened, 56 fulfilled the inclusion criteria. Data regarding socio-demographic characteristics, methods of suicide attempt, psychiatric diagnoses, psychosocial precipitants, substance use, family history, previous suicide attempts, and hospitalization details were collected using a semi-structured data extraction proforma. Statistical analysis was performed using SPSS version 25.0. Categorical variables were expressed as frequencies and percentages, and associations were analysed using the Chi-square test, with p < 0.05 considered statistically significant.

Results: Among the 56 participants, 66.1% were females, and 58.9% belonged to the 18–30-year age group. Self-poisoning was the predominant method of suicide attempt (62.5%), with rodenticide poisoning (23.2%) being the most common subtype, followed by drug overdose (33.9%). Marital conflict (25.0%) and interpersonal conflict (23.2%) were the leading psychosocial precipitants. Depression was the most frequent psychiatric diagnosis (41.1%), followed by adjustment disorder (21.4%). Previous suicide attempts were documented in 32.1% of participants and were significantly associated with the interval between successive attempts (p < 0.001). Most participants attempted suicide while alone (67.9%), and alcohol was the most commonly reported substance among those with substance use (26.8%).

Conclusion: Suicide attempts in this cohort predominantly involved young adults and women and were strongly associated with depression, interpersonal stressors, and self-poisoning. Previous suicide attempts significantly increased the likelihood of recurrence, highlighting the importance of long-term follow-up. Strengthening early identification of psychiatric disorders, comprehensive psychosocial assessment, family-based interventions, responsible prescribing practices, and restriction of access to highly lethal means may substantially reduce the burden of suicidal behaviour and improve suicide prevention in similar healthcare settings.

Integration of Cardiovascular and Psychological Education in Undergraduate Medical Training: A Cross-Sectional Assessment of Knowledge, Clinical Reasoning and Educational Outcomes

2026-08-14T10:34:48+00:00

Introduction: Cardiovascular diseases remain a major cause of morbidity and mortality, while psychological factors such as stress, anxiety and depression substantially influence cardiovascular health and patient outcomes. Integrating cardiovascular and psychological education may improve students’ knowledge, clinical reasoning, communication and patient-centered care.

Objective: To assess undergraduate medical students’ knowledge of cardiovascular and psychological concepts, evaluate clinical reasoning skills and determine educational outcomes associated with integrated cardiovascular and psychological education.

Methodology: A descriptive cross-sectional study was conducted among 200 undergraduate MBBS students from preclinical and clinical years. Data were collected using a structured self-administered questionnaire assessing demographic characteristics, cardiovascular knowledge, psychological aspects of cardiovascular care, clinical reasoning and educational outcomes. Data were analyzed using IBM SPSS with descriptive statistics, Chi-square, correlation analysis and multiple linear regression. A p-value <0.05 was considered statistically significant.

Results: Among 200 students, 54% were female and 46% were male, with a mean age of 21.4 ± 1.8 years. Overall cardiovascular knowledge was 23.8 ± 4.6, with 52.5% demonstrating good knowledge. Psychological knowledge was also satisfactory, with an overall score of 21.5 ± 3.8. Clinical reasoning scores increased progressively from 15.6 ± 3.1 in first-year students to 24.5 ± 2.8 in final-year students (p<0.001). Good knowledge was significantly associated with higher clinical reasoning performance (p<0.001). Clinical reasoning showed a strong positive correlation with educational outcomes (r=0.73, p<0.001). Most students reported positive educational outcomes, including improved understanding (90.5%), clinical reasoning (87.0%), communication skills (88.0%) and patient-centered care (91.5%).

Conclusion: Integration of cardiovascular and psychological education was associated with satisfactory knowledge, improved clinical reasoning across academic years and favorable perceived educational outcomes. Integrated teaching may strengthen communication, confidence, clinical decision-making and patient-centered care in undergraduate medical education.

COMPARISON OF CLINICAL PROFILES OF PATIENTS WITH ACUTE CORONARY SYNDROME OF THE AGE ABOVE AND BELOW 40 YEARS

2026-08-14T12:39:53+00:00

Background: Acute coronary syndrome ismajor cause of mortality and morbidity inthe elderly population. Now it is increasing in younger age group also. There isdifferent clinical presentation in the youngand old age group

CORRELATION OF PLATELET COUNT–SPLEEN DIAMETER RATIO WITH ESOPHAGEAL VARICES IN PATIENTS WITH LIVER CIRRHOSIS

2026-08-14T12:41:51+00:00

Background: Esophageal varices are a majorcomplication of liver cirrhosis, and their earlydetection is important for preventing varicealbleeding. Endoscopy remains the reference standard for diagnosis but is invasive, costly,and resource-intensive, which has promptedinterest in simple non-invasive predictors

TRICHOSCOPIC FEATURES OF CLINICALLY SUSPECTED TINEA CAPITIS IN CHILDREN: A PROSPECTIVE STUDY

2026-08-14T12:48:35+00:00

Background: Tinea capitis (TC) is a common dermatophyte infection of the scalppredominantly affecting children. Clinical manifestations range from non-inflammatory scalingand alopecia to inflammatory presentations such as kerion. Although direct microscopy with potassium hydroxide (KOH) preparation is useful for diagnosis, trichoscopy has emerged as arapid, non-invasive technique for demonstrating characteristic hair and scalp abnormalities.

Comparison of Controlled and Rapid Decompression in Patients with Severe Traumatic Brain Injury

2026-08-16T09:56:15+00:00

Background: Traumatic brain injury (TBI)is a leading cause of mortality and long-termdisability worldwide. Elevated intracranialpressure (ICP) is a major contributor to poor neurological outcomes in patients withsevere traumatic brain injury

Correlation of Tumor Biology (ER/PR/HER2) With SLN Metastasis

2026-08-17T06:31:43+00:00

Background: Breast cancer is a complex disease, meaning it can have different biological characteristics and spread to other parts of the body. SLNB is a crucial procedure used in the axillary staging of early breast cancer, which is clinically node-negative. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) are tumor biology markers that could affect the risk of lymphatic spread.

Objective: To determine the correlation of ER, PR and HER2 status with sentinel lymph node metastasis among patients with Stage I–II invasive breast carcinoma.

Methods: In this descriptive analytical study, 85 women with histologically confirmed Stage I–II invasive breast carcinoma who had sentinel lymph node biopsy were included. The study was conducted at a Tertiary Care Hospital of Rawalpindi, over a period of six months, from January 2026 to June 2026. Patients who received neoadjuvant therapy, had locally advanced breast cancer, had distant metastasis or had recurrent disease were excluded. Data regarding demographic features, tumor stage, tumor grade, lymphovascular invasion, ER status, PR status, HER2 status and sentinel lymph node findings were recorded. Chi-square test or Fisher's exact test was used to determine the association of tumor biology markers with sentinel lymph node metastasis, and logistic regression was used to determine the value of tumor biology markers as predictors of SLN positivity. The p value < 0.05 was regarded as statistically significant.

Results: The mean age of patients was 48.7 ± 10.6 years. Stage II disease was present in 54 patients (63.5%), while Stage I disease was present in 31 patients (36.5%). Sentinel lymph node metastasis was identified in 28 patients (32.9%), whereas 57 patients (67.1%) were SLN-negative. ER-negative tumors showed a higher rate of SLN metastasis than ER-positive tumors (48.3% vs 25.0%, p=0.041). PR-negative tumors were also more frequently associated with SLN positivity than PR-positive tumors (44.4% vs 24.5%, p=0.049). HER2-positive tumors demonstrated the highest SLN positivity rate compared with HER2-negative tumors (52.0% vs 25.0%, p=0.015). SLN metastasis was also significantly associated with Stage II disease, T2 tumor size, Grade III tumors and lymphovascular invasion. On logistic regression, HER2-positive status, ER-negative status, Stage II disease, Grade III tumor and lymphovascular invasion were significant predictors of SLN metastasis.

Conclusion: Sentinel lymph node metastasis was observed in nearly one-third of patients with Stage I–II invasive breast carcinoma. ER-negative, PR-negative and HER2-positive tumors were more frequently associated with SLN involvement. HER2 positivity, ER negativity and lymphovascular invasion were important predictors of sentinel lymph node metastasis. Assessment of tumor biology markers along with clinicopathological features may improve nodal risk stratification in early-stage breast cancer.

Assessing Knowledge and Attitude towards Family Planning Among Postnatal Mothers at Community Level in Nuapada District, Odisha

2026-08-17T06:42:42+00:00

Background: removal of whole and addition of this - Postnatal care and family planning are essential for promoting maternal and child health after childbirth. Adequate knowledge of maternal and newborn care, breastfeeding, danger signs, contraception, and birth spacing supports informed decision-making. However, inadequate knowledge and misconceptions may limit the effective use of postnatal and family planning services. Structured health education can strengthen knowledge and promote appropriate postnatal care and family planning practices.

Methods: A quantitative pre-experimental, one-group pre-test–post-test design was conducted among 30 adolescents selected through purposive sampling from selected residential colleges in Chhattisgarh. Menstrual hygiene knowledge was assessed using a self-structured questionnaire. Participants received a structured adolescent-centred menstrual health education intervention, followed by a post-test assessment. Data were analysed using descriptive statistics and a paired t-test.

Results: Before the intervention, 18 participants (60.0%) had inadequate knowledge and 12 (40.0%) had average knowledge, with none demonstrating adequate knowledge. Following the intervention, 23 participants (76.7%) achieved an adequate level of knowledge and 7 (23.3%) had average knowledge; none remained in the inadequate category. The reported paired t-value was 5.83, which exceeded the critical value of 2.045 at the 5% level of significance, demonstrating a statistically significant improvement in menstrual hygiene knowledge following the intervention.

Conclusion: The adolescent-centred menstrual health education intervention demonstrated a significant improvement in menstrual hygiene knowledge among adolescents. Incorporating structured, adolescent-responsive menstrual health education into residential college and adolescent health programmes may help address knowledge gaps and promote informed menstrual health and hygiene practices.

Functional Balance and Electrophysiological Responses to Synchronized Lifestyle Modification and Physiotherapy in Type 2 Diabetic Peripheral Neuropathy

2026-08-17T07:03:20+00:00

Background: Diabetic peripheral neuropathy impairs proprioception, postural control, and mobility. Functional recovery may occur before measurable normalization of large-fiber electrophysiology, but few trials have evaluated balance and nerve-conduction outcomes together.

Objective: To compare the effects of synchronized lifestyle modification, supervised physiotherapy, and their combination on functional balance and lower-limb sensory and motor nerve-conduction parameters in adults with type 2 diabetic peripheral neuropathy.

Methods: In this four-arm randomized controlled trial, 120 adults aged 40–75 years were allocated to control (n=60), synchronized lifestyle modification (n=20), synchronized lifestyle modification plus physiotherapy (n=20), or physiotherapy (n=20). Interventions continued for 12 weeks. Balance was assessed using the Berg Balance Scale (BBS). Bilateral sural and peroneal sensory and peroneal and tibial motor nerve peak latency, amplitude, and conduction velocity were evaluated. BBS change scores were compared by one-way analysis of variance followed by Tukey testing. Nerve-conduction outcomes were assessed using the original repeated-measures analysis.

Results: Mean BBS change was −0.13±0.79 in control, +1.70±0.47 with lifestyle modification, +1.95±0.51 with the combined intervention, and +2.40±0.82 with physiotherapy. The between-group difference in change was significant (F(3,116)=94.37, p<0.001, η²=0.709); every active intervention outperformed control. Physiotherapy produced a greater improvement than lifestyle modification alone (mean difference 0.70 points, 95% CI 0.11–1.29; p=0.013), whereas the combined intervention did not differ significantly from either active intervention. Nerve-conduction measures showed small favorable directional changes in active groups, but no statistically significant between-group electrophysiological effects were detected.

Conclusion: Twelve weeks of synchronized lifestyle modification and/or physiotherapy improved balance, while nerve-conduction parameters remained statistically unchanged. Functional gains may precede detectable electrophysiological recovery, although the absolute BBS changes were modest.

Portal Hypertension Complicating Pregnancy: Safety, Tolerability, and Maternal-Fetal Outcomes of Non-Selective Beta-Blocker Therapy

2026-08-17T08:46:56+00:00

Background: Portal hypertension during pregnancy is associated with increased maternal and fetal risks, particularly variceal bleeding and hepatic decompensation. Non-selective beta-blockers (NSBBs) are widely used for variceal bleeding prophylaxis; however, pregnancy-specific safety data remain limited.

Objectives: To describe the maternal, fetal, and neonatal outcomes, clinical characteristics, treatment tolerability, and complications among pregnant women with portal hypertension receiving NSBB therapy.

Methods: This retrospective observational study included 30 pregnant women with portal hypertension who received NSBB at Raichur Institute of Medical Sciences and OPEC/RGSSH, Raichur, between January 2021 and June 2026. Demographic and clinical characteristics, NSBB exposure, maternal complications, and fetal and neonatal outcomes were retrieved from medical records and analyzed using descriptive statistics.

Results: Of 30 women, 53.3% had vascular causes of portal hypertension and 46.7% had cirrhosis-related portal hypertension. Propranolol was administered in 80.0% and carvedilol in 20.0%. NSBB therapy was continued throughout pregnancy in 90.0%, while 6.7% required dose reduction and 3.3% discontinued treatment because of intolerance. Variceal/gastrointestinal bleeding occurred in 6.7%, hepatic decompensation in 13.3%, and NSBB-related adverse effects in 10.0%. Maternal survival was 100%. Live births constituted 86.7% of pregnancies, with abortion and stillbirth occurring in 6.7% each. Among 26 live births, preterm birth occurred in 19.2%, low birth weight in 26.9%, intrauterine growth restriction in 23.1%, and neonatal intensive care admission in 15.4%. No congenital anomalies or neonatal deaths were recorded.

Conclusion: NSBB therapy was generally well tolerated in pregnant women with portal hypertension, with high treatment continuation and no maternal or neonatal mortality. Nevertheless, clinically important maternal and fetal complications remained, supporting individualized therapy with close multidisciplinary maternal and fetal monitoring.

Clinical Spectrum and Surgical Management of Parathyroid Adenoma: A Retrospective Observational Study

2026-08-17T09:57:00+00:00

Background: Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by inappropriate parathyroid hormone secretion, most commonly due to parathyroid adenoma. In developing countries, patients often present with advanced symptomatic disease.

Objective: To document the clinical spectrum, diagnostic evaluation, and management strategies of parathyroid adenoma in a tertiary care hospital.

Methods: This institution-based retrospective observational study included 21 patients who underwent surgery for parathyroid adenoma over a five-year period. Diagnosis was confirmed by postoperative histopathological examination. Clinical presentation, biochemical parameters, imaging findings, and anatomical location of adenomas were analyzed.

Results: The majority of patients were symptomatic, with fatigue, renal colic, renal calculi, and skeletal manifestations being the most common presentations. All patients demonstrated markedly elevated serum parathyroid hormone levels and hypercalcemia, along with reduced bone mineral density. Multimodality imaging aided accurate localization, with the left inferior parathyroid gland being the most frequent site.

Conclusion: Parathyroid adenoma in the Indian population frequently presents late with significant skeletal and renal morbidity. Early recognition, appropriate imaging, and surgical excision result in favorable biochemical and clinical outcomes.

Competency Based Medical Education in Undergraduate Medical Students: Trends, Innovations, and Future Directions at Private Medical College

2026-08-17T10:06:28+00:00

Background: Competency-Based Medical Education (CBME) is transforming undergraduate medical education from traditional time and content based approaches toward outcome oriented learning, emphasizing the demonstration of knowledge, clinical skills, professional behaviors, communication and patient centered competencies. Contemporary CBME increasingly incorporates workplace-based assessment, simulation, structured feedback, digital learning, entrustable professional activities (EPAs), learning analytics, and artificial intelligence (AI). Understanding students’ perceptions of these evolving approaches is essential for strengthening CBME implementation in Pakistani medical colleges.

Objective: To assess the perceptions of undergraduate MBBS students regarding CBME, including contemporary educational trends, innovative teaching and assessment approaches, perceived challenges, and future directions at Sahara Medical College, Narowal, Pakistan.

Methodology: A descriptive cross-sectional study will be conducted among undergraduate MBBS students from first to final year at Sahara Medical College, Narowal. Data will be collected using a structured, self-administered questionnaire assessing students’ perceptions of competency-based teaching and learning, formative and workplace-based assessment, feedback, simulation, digital learning, EPAs, and AI-supported education. Responses will be recorded using a Likert-type scale. Data will be analyzed using appropriate descriptive and inferential statistics, including frequencies, percentages, means, and standard deviations. Associations between academic year and students’ perceptions of CBME will be explored using appropriate statistical tests, with statistical significance set at p<0.05.

Results: Among 240 undergraduate MBBS students, representation across academic years was relatively balanced, with females comprising 56.3% and 72.5% reporting previous exposure to CBME. Overall perceptions of CBME were favorable (mean score 4.01 ± 0.44), with significantly higher perceptions among senior students (F = 7.84, p < .001). The highest-rated domains were future CBME innovations (4.31 ± 0.59), AI-supported learning (4.29 ± 0.61), and digital learning (4.21 ± 0.63). Students most frequently identified large class sizes (72.5%) and inadequate faculty training (69.6%) as implementation barriers, while AI-assisted learning (90.0%) and simulation/VR (87.9%) were the most supported future innovations.

Conclusion: Assessing undergraduate students’ perceptions can provide important institutional evidence for strengthening CBME at Sahara Medical College. Integrating authentic clinical experiences, innovative teaching strategies, continuous assessment, structured feedback, simulation, and responsible AI-supported learning may enhance competency development and graduate preparedness. Sustainable implementation should be supported by faculty development, appropriate assessment systems, technological infrastructure, and continuous curriculum evaluation.

Relationship Between Vitamin D Status, Neurocognitive Function, and Depressive Symptom Severity in Patients with Major Depressive Disorder

2026-08-17T11:31:19+00:00

Background: Major depressive disorder is frequently accompanied by cognitive difficulties that may impair daily functioning and treatment outcomes. The role of vitamin D in brain function, mood regulation and the performance of the neurocognitive function has been more and more investigated. The purpose of this study was to determine whether there was a correlation between depression severity, vitamin D status and neurocognitive function in patients with major depression.

Methods: This cross-sectional analytical study was conducted at Khalifa Gul Nawaz Teaching Hospital, Bannu from January 2025 to June 2025. The subjects were selected by non-probability consecutive sampling technique, total of 78 patients with major depressive disorder were selected. Serum 25-hydroxyvitamin D (25(OH)D) was quantified, and vitamin D deficiency, insufficiency, or sufficiency was defined. The Montreal Cognitive Assessment (MoCA) was used to measure neurocognitive function and the Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depressive symptoms. IBM SPSS Statistics version 25.0 was used for data analysis. The group comparisons were performed by using group correlation, chi-square testing and a p value <0.05 was accepted as statistically significant.

Results: The mean serum vitamin D level was 21.7 ± 9.4 ng/mL. Vitamin D deficiency was present in 35 (44.9%) participants, insufficiency in 25 (32.1%), and sufficient levels in 18 (23.1%). The mean MoCA score increased significantly across deficient, insufficient, and sufficient vitamin D groups (20.8 ± 3.9, 23.5 ± 3.4, and 26.2 ± 3.1, respectively; p < 0.001). Mean PHQ-9 scores showed the opposite pattern (18.4 ± 4.7, 15.0 ± 4.2, and 11.8 ± 4.0, respectively; p < 0.001). Cognitive impairment was significantly more frequent among vitamin D-deficient patients (71.4%) than among those with insufficient (48.0%) or sufficient (27.8%) vitamin D levels (p = 0.005). Serum vitamin D was positively correlated with MoCA score (r = 0.52, p < 0.001) and inversely correlated with PHQ-9 score (r = −0.47, p < 0.001).

Conclusion: Lower vitamin D levels were significantly associated with poorer neurocognitive performance and greater depressive symptom severity among patients with major depressive disorder. Assessment of vitamin D status may provide useful supplementary information in the evaluation of patients with MDD, although larger longitudinal and interventional studies are required to determine causality.

MRI and CT Correlation of Pelvic Fractures with Urinary Bladder Injury, Associated Lumbar Spine Trauma, and Microbiological Profile of Urinary Tract Infections

2026-08-17T12:18:05+00:00

Background: High-energy pelvic traumafrequently co-occurs with complex soft tissueand osteoligamentous injuries, includinglower urinary tract disruption and lumbar spine fractures.

Clinical Predictors of Mortality in Patients with Cardiogenic Shock Requiring Mechanical Ventilation

2026-08-17T12:23:04+00:00

Cardiogenic shock accompanied byrespiratory failure requiring mechanical ventilation carries an exceptionally highmortality rate in intensive care settings.Identifying early clinical indicators ofsurvival or demise is critical for guiding

CORRELATION OF ABDOMINAL GIRTH WITH SPREAD OF SPINAL ANAESTHESIA IN PATIENTS UNDERGOING LOWER LIMB SURGERY: A PROSPECTIVE OBSERVATIONAL STUDY

2026-08-18T03:40:41+00:00

Background: The spread of spinalanaesthesia is influenced by several patient, procedure-, and drug-related factors.Although height,weight and body massindex are routinely considered,anthropometric parameters such asabdominal girth may also influence intrathecal drug distribution. Increasedintra-abdominal pressure may reducelumbosacral cerebrospinal fluid volumeand thereby alter the cephalad spread oflocal anaesthetic. Evidence regarding

CORRELATION OF VERTEBRAL COLUMN LENGTH WITH SPREAD OF SPINAL ANAESTHESIA IN PATIENTS UNDERGOING LOWER LIMB SURGERY: A PROSPECTIVE OBSERVATIONAL STUDY

2026-08-18T03:43:21+00:00

Background: The spread of intrathecallocal anaesthetic varies considerablybetween individuals despite administrationof astandardized dose. Conventionalpatient characteristics such as age, height,weight and body mass index do not completely explain this variability.Vertebral column length may represent amore direct anatomical determinant of the distance available for longitudinaldistribution of intrathecal local anaesthetic

ASSESSMENT OF AIRWAVE OSCILLOMETRY AND ITS CORRELATION WITH SPIROMETRY AND HRCT THORAX FINDINGS AMONG COPD PATIENTS

2026-08-18T03:45:32+00:00

Background:Chronicobstructivepulmonary disease (COPD) is characterizedby progressive airflow limitation andstructural lung abnormalities. The presentstudyaimedtocorrelateairwaveoscillometry (AOS) parameters with spirometry and High-Resolution ComputedTomography (HRCT) Thorax findingsamong COPD patients.

Perioperative Morbidity and Short-Term Surgical Outcomes Following Sacrospinous Ligament Fixation in Women with Advanced Uterovaginal Prolapse: A Prospective Observational Study

2026-08-18T03:49:37+00:00

Background:-Advanced uterovaginal prolapse is a common pelvicfloor disorder requiring surgical correction in women with severe pelvic support defects. Vaginalhysterectomy combined with sacrospinous ligamentfixation (SSLF) has gained acceptance as aneffective vaginal reconstructive procedure thatrestores apical support while minimizing the risk of postoperative vaginal vault prolapse

Retinal Manifestations of Hematological Disorders: Clinical and Hematological Correlates in a Tertiary Eye Care Centre

2026-08-18T05:55:52+00:00

Purpose: To evaluate the demographic profile, clinical characteristics, hematological abnormalities, and retinal manifestations of patients with hematological disorders, with particular emphasis on the association between individual hematological parameters and anemic retinopathy/Roth spots.

Materials and Methods: A hospital-based observational cross-sectional study was conducted among 14 patients with hematological abnormalities. Demographic and clinical details, ophthalmic findings, and hematological parameters including hemoglobin, PCV, RBC count, MCV, MCH, MCHC, TLC, and platelet count were recorded. The association between individual hematological parameters and anemic retinopathy was assessed using appropriate statistical tests.

Results: A total of 14 patients were included, with a mean age of 44.3 ± 17.5 years; 8 (57.1%) were females and 6 (42.9%) were males. Anemia was the most common hematological abnormality, present in 12 (85.7%) patients, followed by pancytopenia in 3 (21.4%), thrombocytopenia in 2 (14.3%), and polycythemia in 2 (14.3%). Retinal abnormalities were documented in 4 (28.6%) patients, including anemic retinopathy with Roth spots in 2 (14.3%). One patient with Roth spots also had a pre-macular hemorrhage. Patients with anemic retinopathy had significantly lower median hemoglobin (3.80 vs. 8.35 g/dL; P=0.030) and PCV (12.75% vs. 26.80%; P=0.036) compared with those without retinal involvement. Hemoglobin and PCV demonstrated significant inverse correlations with anemic retinopathy (r=−0.648, P=0.023 and r=−0.671, P=0.024, respectively). Other hematological indices, including RBC count, MCV, MCH, MCHC, TLC, and platelet count, showed no significant association.

Conclusion: Severe anemia, particularly markedly reduced hemoglobin and PCV, was significantly associated with anemic retinopathy and Roth spots. Thrombocytopenia may contribute to the severity of associated retinal hemorrhage, particularly in profound anemia. Larger studies are required to validate these findings.

Clinical Profile and Management of Chemical Ocular Burns at a Tertiary Eye Care Centre in South India: A Retrospective Observational Study

2026-08-18T06:02:38+00:00

Purpose: To describe the demographic profile, clinical characteristics, severity, and management of patients presenting with chemical ocular injuries at a tertiary eye care centre in South India between January 1, 2025, and December 31, 2025.

Materials and Methods: A retrospective observational study was conducted on patients presenting with chemical ocular injuries during the study period. Demographic details, mode and place of injury, laterality, presenting visual acuity, Roper–Hall grading, and treatment modalities were retrieved from medical records and analysed using descriptive statistics.

Results: A total of 47 patients (56 affected eyes) were included. The mean age was 33.6 ± 14.9 years, and 74.5% were males. Alkali injuries were the most common mode of injury, followed by acid injuries, with the workplace (53.2%) being the commonest site of exposure. Unilateral involvement was observed in 80.9% of patients. Among the affected eyes, 55.4%had presenting visual acuity ≥6/12. Grade 1 chemical injury was the most frequent severity grade (53.6%), followed by Grade 2 (23.2%), Grade 4 (14.3%), and Grade 3 (8.9%). Medical management was sufficient in 85.1% of patients, while 14.9% required surgical intervention.

Conclusion: Chemical ocular injuries predominantly affected young working-age males and were most commonly workplace-related. Although most eyes had mild injuries and were managed conservatively, severe injuries requiring surgery were also encountered. Early ophthalmic evaluation and prompt management are essential to optimize visual outcomes.

Hidden Malignancy behind the Hernial Sac: Incidental Low-Grade Appendiceal Mucinous Neoplasm Discovered during Incisional Hernia Repair

2026-08-18T07:05:15+00:00

Background: Low-grade appendiceal mucinous neoplasms (LAMNs) are uncommon epithelial tumors of the appendix, often discovered incidentally during imaging, surgery, or histopathological examination. Their clinical presentation is frequently nonspecific, making preoperative diagnosis challenging.

Case Presentation: A 55-year-old male presented with multiple swellings over a previous laparotomy scar for four months. He had undergone emergency laparotomy with colorectal anastomosis for sigmoid colon carcinoma three years earlier. Clinical examination and radiological evaluation were consistent with a large incisional hernia. Contrast-enhanced computed tomography demonstrated supraumbilical herniation of omentum and divarication of recti without evidence of recurrent malignancy. Colonoscopic evaluation was normal. The patient underwent open onlay mesh repair with anterior component separation. During surgery, the appendix appeared inflamed, with a mucinous lesion involving the tip. Appendicectomy was performed. Histopathological examination revealed low-grade appendiceal mucinous neoplasm (LAMN), pathological stage pTisNx, with negative proximal margins and no lymphovascular or perineural invasion.

Conclusion: This case highlights the importance of careful intraoperative inspection during abdominal wall reconstruction procedures. Incidental appendiceal neoplasms, although rare, may be encountered unexpectedly, and timely surgical management can prevent disease progression and complications such as pseudomyxoma peritonei.

Pneumatosis Cystoides Intestinalis Coli Presenting As Acute Large Bowel Obstruction: A Rare Case Report

2026-08-18T07:20:14+00:00

Background: Pneumatosis intestinalis is a rare condition characterized by the presence of gas-filled cysts within the bowel wall. Colonic involvement, termed pneumatosis cystoides intestinalis coli, is uncommon and is usually asymptomatic or associated with nonspecific gastrointestinal complaints. Presentation as sigmoid volvulus causing acute large bowel obstruction is extremely rare and may mimic malignant obstruction on imaging.

Case Presentation: A 65-year-old female presented with abdominal pain and distension for two days, obstipation for four days, and vomiting with fever for one day. Examination revealed a distended abdomen with diffuse tenderness and absent bowel sounds. Laboratory parameters were within normal limits. Contrast-enhanced CT abdomen showed multiple dilated large bowel loops with irregular wall thickening in the sigmoid colon causing luminal narrowing, raising suspicion of malignant large bowel obstruction. The patient underwent emergency exploratory laparotomy. Intraoperatively, a redundant sigmoid colon with 180-degree twist was noted. After derotation and decompression, multiple grape-like cysts were seen throughout the sigmoid colon. Sigmoidectomy with end colostomy (Hartmann’s procedure) was performed. The postoperative period was uneventful. Histopathological examination confirmed pneumatosis cystoides intestinalis. Stoma reversal with colorectal anastomosis was performed two months later.

Conclusion: Pneumatosis cystoides intestinalis coli presenting as sigmoid volvulus is exceedingly rare and can mimic malignant obstruction on imaging. Definitive diagnosis is often intraoperative or histopathological. Surgical resection is indicated in complicated cases presenting with volvulus and obstruction. Awareness of this rare presentation is important for appropriate management.

Formulation, Optimization and Evaluation of a Ribavirin-Loaded Liposomal Emulgel for Targeted Topical Antiviral Delivery

2026-08-18T07:31:05+00:00

The skin’s stratum corneum act as major barrier and to overcome it while reducing the systemic toxicities associated with conventional dosage forms, this study is aimed to develop, optimize and evaluate a novel ribavirin-loaded liposomal emulgel for localized antiviral therapy minimizing systemic exposure. Ribavirin-loaded liposomes were prepared using a thin-film hydration technique and optimized using a Central Composite Design (CCD) to assess the effects of phospholipid and cholesterol concentrations on drug encapsulation and release. After optimization an ideal formulation contained 741.5 mg of phospholipid and 201.6 mg of cholesterol, which yielded a high entrapment efficiency of 82.3±0.38% and a cumulative in vitro release of 83.4±0.33% over 12h was selected. Scanning electron microscopy (SEM) revealed a smooth, spherical vesicular morphology with a zeta potential value of −35 mV, indicating good colloidal stability.an emugel was prepared by combining these optimized liposomes into a Carbopol 934. The resulting emulgel exhibited good dermatological properties, with a skin-compatible pH of 5.9±0.10, a viscosity of 12,580±0.79 cP, and a spreadability of 7.86±0.12 g⋅cm/s. The emulgel exhibited linear, zero-order release kinetics (83.52±0.62% over 420 min) and ex vivo skin permeation studies using excised goat skin showed good dermal retention with minimal flux into systemic circulation. These results show that the developed carrier system successfully crossed the epidermal barrier to establish a controlled therapeutic reservoir within target tissues, giving a stable and efficient formulation for the localized antiviral thrapy.

Association of Twist expression with multilocular and unilocular variant of odontogenic keratocyst

2026-08-18T07:38:45+00:00

Objective: To evaluate the association of twist expression with multilocular and unilocular variant of odontogenic keratocyst. Material &

Methods: This study was performed at the department of Pathology, Khyber Medical University Peshawar from January 2022 to June 2022. A total of 83 subjects meeting the inclusion criteria were included. According to WHO criteria, diagnosis of OKC was done. Twist immunoexpression of unilocular and multilocular OKC blocks were performed according to IHC protocol. The data were analysed using statistical software.

Results: Amongst the 43 cases of multilocular variant of odontogenic keratocyst, 41 (95.3%) were associated with the twist immuno-reactivity and 2 (4.75%) cases were negative, while amongst the 40 cases of unilocular variant of odontogenic keratocyst, 10 (25%) cases were associated with the twist immuno-reactivity and 30 (75%) cases were negative.

Conclusion: It is concluded that twist immunohistochemical expression was more common in the multilocular variant than unilocular variant. In multilocular variant of OKC, whether solitary or syndromic, its increased rate of recurrence and pathogenesis is greatly influenced by Twist expression and suggest its place in the neoplastic category.

Formulation and Evaluation of Pulsatile Drug Delivery System of Metoprolol Tatrate

2026-08-18T07:53:52+00:00

Background: Hypertension exhibits marked circadian variations, with an increased risk of cardiovascular events during the early morning hours. Conventional dosage forms fail to synchronize drug release with these biological rhythms, highlighting the need for chronotherapeutic drug delivery systems. Pulsatile drug delivery offers a promising strategy by providing a programmed lag phase followed by rapid drug release at the desired therapeutic time.

Objective: The present study aimed to develop and evaluate a compression-coated pulsatile drug delivery system of Metoprolol Tartrate for chronotherapeutic management of hypertension.

Materials and Methods: Metoprolol Tartrate core tablets were prepared by direct compression and enteric coated using Eudragit L100. The coated core tablets were subsequently compression coated with optimized immediate-release and sustained-release layers. The formulations were evaluated for pre- and post-compression parameters, FTIR drug–excipient compatibility, acid uptake, drug content, and in vitro dissolution studies.

Results: FTIR analysis confirmed the compatibility of Metoprolol Tartrate with the selected excipients. The optimized formulation exhibited satisfactory physicochemical properties and complied with pharmacopeial specifications. The enteric coating provided effective gastric protection, while the compression-coated system produced a distinct lag phase followed by controlled drug release, achieving 81.85% cumulative drug release within 8 hrs.

Conclusion: The developed compression-coated pulsatile tablet successfully achieved time-dependent release of Metoprolol Tartrate and demonstrated its potential as a chronotherapeutic drug delivery system for hypertension. The formulation may improve therapeutic efficacy by synchronizing drug release with the circadian pattern of cardiovascular events.

Role of the Appendicitis Inflammatory Response (Air) Score in the Early Diagnosis of Acute Appendicitis

2026-08-18T08:01:00+00:00

Background: Acute appendicitis is one of the most common surgical emergencies worldwide and remains a significant diagnostic challenge because of its variable clinical presentation. Delayed diagnosis may result in complications such as perforation and peritonitis, whereas overdiagnosis can lead to unnecessary appendectomies. The Appendicitis Inflammatory Response (AIR) score is a clinical scoring system that combines symptoms, signs, and inflammatory markers to improve diagnostic accuracy and assist in clinical decision-making.

Aim: To evaluate the role of the Appendicitis Inflammatory Response (AIR) score in the early diagnosis of acute appendicitis and assess its impact on imaging utilization and emergency department management.

Materials and Methods: This prospective observational study was conducted in the Institute of General Surgery, Rajiv Gandhi Government General Hospital, Chennai, over a period of one year. A total of 120 patients aged 16 years and above presenting with suspected acute appendicitis were included. AIR scores were calculated using clinical parameters and laboratory investigations, including white blood cell count, neutrophil percentage, and C-reactive protein levels. Patients were categorized into low-risk (0–4), intermediate-risk (5–8), and high-risk (≥9) groups. Final diagnosis was established by histopathological examination in operated patients and clinical follow-up in non-operated patients. Diagnostic performance parameters including sensitivity, specificity, positive predictive value, and negative predictive value were analyzed.

Results: The study included 64 females (53.3%) and 56 males (46.7%), with a mean age of 42.3 ± 18.7 years. The mean AIR score was 6.2 ± 2.1. Based on risk stratification, 27 patients (22.5%) were classified as low risk, 80 (66.7%) as intermediate risk, and 13 (10.8%) as high risk. Acute appendicitis was confirmed in 95 patients (79.2%), including 55 cases (45.8%) of uncomplicated appendicitis and 40 cases (33.3%) of complicated appendicitis. At a cutoff score of ≥5, the AIR score demonstrated a sensitivity of 96% and specificity of 76% for diagnosing acute appendicitis. Computed tomography was required in only 35 patients (29.2%), and the negative appendectomy rate was 4.2%. The mean emergency department length of stay was 5.8 ± 2.4 hours, with a significant association between AIR score category and duration of stay (p < 0.001).

Conclusion: The Appendicitis Inflammatory Response score is an effective and reliable tool for the early diagnosis of acute appendicitis. It provides excellent diagnostic accuracy, facilitates risk stratification, reduces unnecessary CT imaging, improves emergency department efficiency, and minimizes negative appendectomy rates. Routine incorporation of the AIR score into clinical practice may enhance patient outcomes and optimize healthcare resource utilization.

Mobile Dental Units: Role in Periodontal Care and Global and Indian Perspectives

2026-08-18T08:47:15+00:00

Mobile Dental Units (MDUs) are an important alternative model for delivering oral healthcare to populations facing geographic, socioeconomic and mobility-related barriers. They function as mobile or portable dental facilities providing screening, preventive care and selected basic treatment at community locations. Their relevance to periodontics is substantial because periodontal diseases represent a major oral health burden, particularly among underserved populations. The Indian National Oral Health Survey reported periodontal disease prevalence of 67.7% among 15-year-olds and 89.6% among adults aged 35–44 years. MDUs can contribute to periodontal disease control through community screening, oral hygiene education, plaque and calculus control, scaling, prophylaxis, selected non-surgical periodontal therapy and referral of advanced cases. Globally, MDUs have been successfully implemented among rural communities, schoolchildren, migrants, elderly and homebound individuals and socially disadvantaged populations. In India, they provide an opportunity to address urban–rural disparities and limitations in availability, affordability and accessibility of dental services. Integration with dental institutions, primary healthcare facilities, tele-dentistry and structured referral systems can strengthen their role in community periodontal care.

A Study to Assess the Knowledge, Attitude and Practice of Ashas towards the Community Based Assessment Checklist (CBAC) Form in the Rural Field Practice Area, RHTC Banda, District Sagar (Madhya Pradesh)

2026-08-18T10:03:25+00:00

Background: Non-communicable diseases (NCDs) account for nearly 63% of deaths in India, and one in four Indians faces a risk of premature death between 30 and 70 years of age due to NCDs. The Community Based Assessment Checklist (CBAC) is a universal screening tool used by Accredited Social Health Activists (ASHAs) to screen for common NCDs diabetes, hypertension, and oral, breast and cervical cancers among adults aged over 30 years, as part of Population-Based Screening under Comprehensive Primary Health Care (CPHC), initiated in 2016.

Objectives: To assess the knowledge, attitude, and practice of ASHAs regarding the purpose, components, and use of the CBAC form in early screening of NCDs in the rural field practice area of RHTC Banda, District Sagar, Madhya Pradesh.

Methods: A cross-sectional study was conducted among 180 ASHAs with at least six months of field experience, working under RHTC Banda, District Sagar (MP), over a three-month period. After obtaining informed consent, data were collected using a structured, pre-validated questionnaire covering demographic details and knowledge, attitude, and practice domains related to the CBAC form. Knowledge and practice were scored one point for each correct response and zero for an incorrect response; attitude was assessed on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). Mean scores were used to categorise participants as having adequate/inadequate knowledge and good/poor practice. Statistical analysis, including descriptive measures and appropriate tests of association, was performed using MS Excel 2023 and IBM SPSS software.

Results: Most participating ASHAs were aged 30–49 years with more than nine years of field experience. The mean knowledge score was 21.13 out of 24, with 88% of respondents demonstrating adequate knowledge and 12% inadequate knowledge. The mean practice score was 5.32 out of 6, with 89% showing good practice and 11% poor practice in screening and follow-up. The mean attitude score was 4.18 out of 5, reflecting a predominantly positive and favourable outlook, with most ASHAs perceiving the CBAC form as a useful screening tool.

Conclusion: ASHAs in the study area demonstrated satisfactory knowledge, practice, and attitude toward the CBAC form, indicating a good level of readiness for effective community-based NCD screening. These findings underscore the value of ongoing training and field-level support under CPHC and highlight the need for periodic refresher training to address residual gaps.

Study of Serum Vitamin B12 and Vitamin D Level amongst Medical Professionals in Tertiary Health Care Center, Rewa

2026-08-18T11:02:20+00:00

Background: Vitamin D and Vitamin B12 are essential micronutrients required for maintenance of musculoskeletal health, neurological function, hematopoiesis, immunity, and overall well-being. Medical professionals are particularly vulnerable to deficiencies because of prolonged indoor working hours, shift duties, irregular dietary habits, stress, and limited sunlight exposure. Despite their health awareness, micronutrient deficiencies often remain undetected. The present study was conducted to assess serum Vitamin B12 and Vitamin D levels among medical professionals in a tertiary health care center at Rewa and to evaluate their association with demographic, occupational, and lifestyle factors.

Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Physiology, Shyam Shah Medical College, Rewa, over a period of 18 months (May 2024–October 2025). A total of 150 medical professionals aged 15–60 years were enrolled and equally distributed into three age groups (15–30, 31–45, and 46–60 years). Data regarding age, gender, profession, dietary habits, physical activity, work shifts, stress levels, and sunlight exposure were collected using a structured questionnaire. Serum Vitamin B12 levels were measured by chemiluminescent immunoassay and serum 25-hydroxy Vitamin D [25(OH)D] levels were estimated using standard laboratory methods. Statistical analysis was performed using SPSS version 20.

Results: Among the 150 participants, females constituted 55.33% and males 44.67%. The mean serum Vitamin B12 level was 280.78 pg/mL, while the mean serum Vitamin D level was 22.54 ng/mL, indicating borderline/insufficient status. Vitamin B12 deficiency (<200 pg/mL) was observed in 16.67% participants, insufficiency (200–300 pg/mL) in 38.67%, and normal levels in 44.67%. Vitamin D deficiency (<20 ng/mL) was present in 37.33%, insufficiency (20–29 ng/mL) in 42.0%, and normal levels in only 20.67% participants. No statistically significant association was found between age or gender and Vitamin B12 or Vitamin D status. Higher Vitamin B12 deficiency was observed among technicians, individuals with low physical activity, and those experiencing high stress, whereas Vitamin D deficiency was more common among consultants, rotational shift workers, and vegetarians.

Conclusion: Vitamin B12 and Vitamin D deficiencies are highly prevalent among medical professionals in a tertiary health care center. Occupational factors, dietary habits, physical inactivity, shift work, and stress appear to contribute to poor micronutrient status. Regular screening, nutritional counseling, lifestyle modification, and appropriate supplementation should be incorporated into institutional health programs to improve the health and productivity of healthcare workers.

Radiographic evaluation of the association between dental anomalies and cleft lip and plate

2026-08-18T16:31:55+00:00

Background: Cleft lip and palate is acommon craniofacial anomalyfrequently associated withdevelopmental dental abnormalities.
Radiographic evaluation helps identify these anomalies and assists incomprehensive treatment planning

ASSESSMENT OF PANORAMIC RADIOGRAPHS IN PREDICTING THE DIFFICULTY OF IMPACTED THIRD MOLAR EXTRACTION

2026-08-18T16:35:03+00:00

Background: Accurate preoperative assessment of impacted mandibular third molarsis essential for planning surgical extraction and minimizing complications. Panoramic radiography is routinely used to evaluate the position of impacted teeth and estimatethe difficulty of extraction

Mastering Minimally Invasive Spine Surgery: Analyzing the Learning Curve, Safety Insights, and Complication Rates in Modern Spinal Procedures

2026-08-19T05:37:14+00:00

Background: Minimally invasive spine surgery (MISS) is a technique that minimizes tissue trauma and has a quicker recovery period, but it can be quite technically demanding. Operative efficiency and patient safety could be affected by the learning curve.

Objective: To assess the learning curve, perioperative outcomes, and complication rates of MISS.

Methods: A retrospective analytical cohort study with 154 consecutive adult patients who underwent MISS in a tertiary-care hospital was performed. Demographic, clinical, operative, and postoperative data were obtained. Patients were divided into groups based on the number of years they had performed the surgery. Assessed were duration of operation, blood loss, hospitalization, conversion to open surgery, and complications. The proficiency threshold was determined by using a CUSUM analysis, and logistic regression was performed to determine factors associated with complications.

Results: Mean age was 48.6 ± 11.7 years, and 59.1% were male. Operative duration decreased from 123.4 ± 39.6 to 86.7 ± 27.8 minutes, while blood loss decreased from 112.6 ± 64.1 to 69.5 ± 41.7 mL between early and proficiency phases (both p<0.001). Complications decreased from 18.2% to 6.5% (p=0.028). The proficiency was detected using CUSUM analysis at about 66-70 cases. Complications were independently associated with early case surgery (p=0.014).

Conclusion: MISS showed a significant learning curve, showing progressive improvements in working efficiently and safely as the experience increased.

Anesthetic Insights: Navigating the Complexities of Hypertension in Elderly Surgical Patients

2026-08-19T05:48:43+00:00

Background: Hypertension is a frequent finding in older surgical patients and can be a challenge during anesthetic management due to reduced cardiovascular reserve and heightened sensitivity to perioperative blood pressure changes in these patients. This study aimed to assess anesthetic factors and predictors of perioperative haemodynamic instability in elderly hypertensive patients.

Methods: A prospective observational analytical study was conducted among 200 hypertensive patients aged ≥65 years undergoing elective surgery. Patients were recruited through consecutive sampling. Demographic, hypertension-related, anesthetic, intra- and postoperative data were noted. Independent-samples t test, Mann–Whitney U test, chi-square/Fisher exact test, and multivariable logistic regression were used for data analyses.

Results: Hemodynamic instability occurred in 74 (37.0%) patients, of which 48 (24.0%) patients experienced intraoperative hypotension, and 38 (19.0%) patients experienced hypertension. Older patients and those with higher preoperative SBP and DBP, longer surgery, more blood loss, and longer hospital stays (p<0.05) were found in patients with instability. Independent predictors included age ≥75 years (AOR 1.98), ASA III (AOR 2.31), hypertension ≥10 years (AOR 2.08), SBP ≥160 mmHg (AOR 2.76), poor medication adherence (AOR 2.17), general anesthesia (AOR 2.54), and surgery >90 minutes (AOR 2.63).

Conclusion: Elderly hypertensive patients were highly vulnerable to perioperative haemodynamic changes. Carefully planned anesthesia and close blood-pressure supervision may enhance anesthetic safety.

Women Grievance Redressal Committee in Medical Education

2026-08-19T06:02:33+00:00

Background: Medical education demands an environment that promotes equality, dignity, mutual respect, and professional well-being. Women students, interns, residents, faculty members, nurses, and other healthcare professionals constitute a substantial proportion of the medical workforce and contribute significantly to healthcare delivery, education, and research. However, gender discrimination, sexual harassment, workplace bullying, verbal abuse, cyber harassment, and unequal opportunities continue to affect women in academic and healthcare institutions worldwide. Such incidents adversely influence mental health, academic performance, professional development, job satisfaction, and patient care. Recognizing these concerns, India enacted the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 (POSH Act), which mandates the establishment of Internal Complaints Committees (ICCs) in all workplaces, including medical institutions. The National Medical Commission (NMC), University Grants Commission (UGC), and other regulatory bodies have further emphasized the importance of institutional mechanisms for preventing gender-based discrimination and ensuring safe educational environments.

Objective: To review the role of Women Grievance Redressal Committees (Internal Complaints Committees) in medical education, discuss the legal and regulatory framework governing women's safety, and highlight strategies for promoting gender equality, dignity, and professional well-being in medical institutions.

Methods: A narrative review was conducted using peer-reviewed literature published between 2021 and 2026 together with statutory provisions under the POSH Act, 2013, recent University Grants Commission (UGC) regulations, National Medical Commission (NMC) directives, World Health Organization (WHO) recommendations, and United Nations (UN Women) policy documents. Publications related to workplace harassment, gender equity, medical professionalism, institutional governance, and higher education were critically reviewed.

Results: Women Grievance Redressal Committees play a pivotal role in preventing sexual harassment, addressing complaints confidentially, promoting gender-sensitive institutional policies, and fostering safe learning and working environments. Effective implementation of preventive education, awareness programmes, institutional accountability, transparent grievance mechanisms, and timely redressal significantly improves women's safety, psychological well-being, professional confidence, and academic productivity. Leadership commitment, faculty sensitization, and continuous monitoring further strengthen institutional compliance with legal and ethical standards.

Conclusion: Women Grievance Redressal Committees represent an essential component of good institutional governance in medical education. Strengthening grievance redressal mechanisms, promoting gender equality, and fostering respectful institutional culture are fundamental to ensuring safe, inclusive, and professionally supportive medical institutions. Such initiatives not only protect women's rights but also enhance educational quality, workplace harmony, and patient care.

Clinical and Radiological Correlation of Chronic Rhinosinusitis Using Lund-Mackay CT Scoring

2026-08-19T06:24:29+00:00

Objective: To evaluate the correlation between clinical symptoms and radiological findings using the Lund-Mackay CT scoring system in patients with chronic rhinosinusitis and to assess its usefulness in disease severity assessment and management.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Conducted in the Department of Otorhinolaryngology in collaboration with Radiology department, Khyber Teaching Hospital, Peshawar, from January 2025 to September 2025.

Methods: 300 patients clinically diagnosed as having chronic rhinosinusitis were enrolled in the study. Using the formula recommended by the World Health Organisation, the number of samples was determined. The patients aged 18-60 years and older than 12 weeks of CRS, both males and females were included in the study by non-probability consecutive sampling. Detailed clinical examination was performed including nasal obstruction, nasal discharge, facial pain, headache, hyposmia and postnasal drip. All patients had a computed tomography (CT) scan of paranasal sinuses performed, and the severity of the disease was graded on this scan according to the Lund-Mackay CT scoring system. The outcome of clinical findings was compared to the radiological scores. SPSS version 26 was used for data analysis. A value of p of ≤ 0.05 was statistically significant.

Results: Nasal obstruction (300 patients), headache and nasal discharge were the common symptoms. CT showed the most frequent patterns of involvement to be in the maxillary or ethmoidal sinuses. The clinical symptom and the Lund-Mackay CT in the present study had a significant positive correlation. There was a significant difference between the radiological score in patients with higher symptom scores.

Conclusion: In patients with chronic rhinosinusitis (CRS), the Lund-Mackay CT score had good correlation with clinical severity. Nevertheless, CT evaluation is still a useful diagnostic and disease assessment tool which can help the clinicians in treatment planning and surgical decision making.

A Comparative Study of Modern Technologies in Urban and Rural Medical Education

2026-08-19T07:12:03+00:00

Background: Technology-enhanced learning has become an important component of contemporary medical education. Digital platforms, immersive visualization, simulation, artificial intelligence, and mobile-based learning have expanded the ways in which medical students acquire, apply, and retain knowledge. Nevertheless, the availability and effective use of these technologies are not uniform across medical institutions. Differences in infrastructure, financial resources, faculty preparedness, internet connectivity, and institutional support may create a substantial technological divide between urban and rural settings.

Aim: This comparative review examines the adoption and educational application of contemporary technologies in urban and rural medical education, with particular emphasis on their relevance to undergraduate anatomy teaching.

Content: The review considers major technology-enabled educational approaches, including digital anatomy laboratories, three-dimensional anatomical visualization, virtual dissection platforms, augmented reality (AR), virtual reality (VR), artificial intelligence (AI), learning management systems, computer-assisted instruction, simulation-based education, tele-education, and mobile learning. Urban medical institutions generally have greater access to high-end digital infrastructure, dedicated simulation facilities, advanced visualization systems, and specialized technical support. Rural institutions, in comparison, may encounter limitations related to internet connectivity, hardware availability, maintenance costs, technical support, and faculty training. However, the increasing availability of smartphones, cloud-based platforms, open educational resources, low-cost digital applications, and blended learning models has created new opportunities for rural medical colleges to incorporate technology into teaching without depending exclusively on expensive infrastructure.

Conclusion: The educational value of technology should not be determined solely by the sophistication or cost of the equipment available. Appropriate technology, when aligned with curricular objectives, faculty capability, and local institutional needs, can substantially improve learning opportunities in both urban and rural settings. Reducing the urban–rural technology gap requires sustained investment in digital infrastructure, faculty development, technical support, affordable educational resources, and curriculum integration. A context-sensitive and equitable approach to technology-enabled medical education can strengthen anatomy learning, support competency-based medical education, and contribute to the development of clinically competent healthcare professionals.

Traditional Versus Technology-Enhanced Demonstrations in Competency-Based Medical Education

2026-08-19T07:20:21+00:00

Background: Anatomical demonstration is a fundamental component of undergraduate medical education and provides the bridge between theoretical knowledge and clinical application. Cadaveric dissection, prosection, anatomical specimens, models, charts, and microscopy have traditionally formed the core of anatomy teaching. However, increasing student numbers, limited cadaver resources, reduced teaching time, and the need for clinically integrated learning have encouraged the adoption of technology-enhanced approaches.

Objective: This narrative review compares traditional and technology-enhanced methods of anatomical demonstration within the framework of Competency-Based Medical Education (CBME) and examines their educational strengths, limitations, and potential for integration.

Materials and Methods: Recent literature concerning cadaveric teaching, three-dimensional models, virtual reality (VR), augmented reality (AR), three-dimensional printing, virtual dissection, simulation, and artificial intelligence (AI) in anatomy education was reviewed. Evidence from recent comparative studies, systematic reviews, and meta-analyses was synthesized according to visualization, knowledge acquisition, spatial understanding, learner engagement, retention, clinical integration, and competency development.

Results: Traditional demonstrations provide authentic three-dimensional and tactile experiences, appreciation of anatomical variation, professional development, teamwork, and ethical engagement with body donors. Technology-enhanced approaches provide interactive visualization, repeatable demonstrations, individualized learning, radiological correlation, and simulation-based practice. Recent evidence indicates that VR and other immersive technologies can improve anatomy learning, particularly when used as complementary rather than replacement strategies.

Conclusion: Traditional and technology-enhanced demonstrations have complementary educational strengths. A blended model integrating cadaveric experience with validated digital technologies, simulation, and appropriately supervised AI is likely to provide the most effective framework for competency-oriented anatomy education.

The Medical Profession: A Lifelong Commitment to Humanity

2026-08-19T07:29:44+00:00

Background: The medical profession has long been regarded as one of the noblest and most respected professions because of its unwavering commitment to preserving life, alleviating suffering, and promoting the health and well-being of individuals and communities. Despite rapid technological advancements, evolving healthcare systems, and changing patient expectations, the fundamental principles of medicine—compassion, professionalism, ethical conduct, and lifelong learning—remain unchanged. Modern physicians are expected not only to possess scientific knowledge and clinical competence but also to demonstrate empathy, communication skills, integrity, and social responsibility. This review explores the evolution of the medical profession, its enduring core values, and its relevance in contemporary medical education and healthcare delivery.

Objective: To review the historical evolution of the medical profession, discuss its ethical and humanitarian foundations, and highlight the importance of professionalism, lifelong learning, and patient-centered care in modern medicine.

Methods: A narrative review was conducted using recent literature published between 2021 and 2026, together with authoritative guidelines from the World Health Organization (WHO), National Medical Commission (NMC), World Medical Association (WMA), and other international organizations. Peer-reviewed articles related to medical professionalism, ethics, anatomy education, physician well-being, competency-based medical education, and healthcare delivery were reviewed.

Results: The medical profession has evolved from traditional healing practices to evidence-based, technology-assisted healthcare while maintaining its central commitment to humanity. Advances in artificial intelligence, digital health, precision medicine, simulation-based education, and competency-based medical education have transformed clinical practice and medical training. Nevertheless, compassion, ethical responsibility, respect for human dignity, lifelong learning, teamwork, and patient-centered care remain indispensable characteristics of a competent physician. Anatomy education, particularly cadaveric dissection, continues to play a pivotal role in nurturing professional identity, empathy, and respect for human life.

Conclusion: Medicine is far more than an occupation; it is a lifelong commitment to humanity characterized by service, compassion, scientific excellence, and ethical responsibility. Continuous professional development, technological adaptation, and humanistic values will remain essential for preparing future physicians capable of addressing evolving global healthcare challenges while preserving the trust placed in the medical profession.

Bioethics in Competency Based Medical Education

2026-08-19T07:37:56+00:00

Background: Bioethics has become an indispensable component of modern medical education because it guides healthcare professionals in making morally sound, patient-centered, and socially responsible decisions. The rapid advancement of medical science, biotechnology, artificial intelligence (AI), genomics, organ transplantation, reproductive medicine, and digital healthcare has generated complex ethical challenges that extend beyond traditional clinical practice. Competency-Based Medical Education (CBME), introduced by the National Medical Commission (NMC), recognizes ethical competence as a core outcome of undergraduate medical training through the Attitude, Ethics, and Communication (AETCOM) module. Bioethics is therefore no longer confined to theoretical instruction but has become an integral part of clinical reasoning, professional identity formation, patient safety, and compassionate healthcare.

Objective: To review the principles of bioethics, examine their integration into Competency-Based Medical Education, and discuss the evolving role of ethical education in developing competent, compassionate, and socially accountable physicians.

Methods: A narrative review was conducted using peer-reviewed literature published between 2021 and 2026, together with recommendations from the National Medical Commission (NMC), World Health Organization (WHO), UNESCO, World Medical Association (WMA), and other international organizations. Recent publications addressing bioethics, professionalism, anatomy education, competency-based medical education, artificial intelligence, digital health, and healthcare ethics were critically reviewed.

Results: Bioethics provides the moral and professional framework necessary for ethical clinical decision-making, patient-centered care, informed consent, confidentiality, professionalism, and social accountability. Competency-Based Medical Education integrates ethical competencies throughout undergraduate training by emphasizing experiential learning, reflective practice, communication skills, professionalism, and interdisciplinary collaboration. Anatomy education, particularly cadaveric dissection and voluntary body donation, provides an early opportunity to cultivate respect for human dignity and professional responsibility. Emerging technologies such as artificial intelligence, telemedicine, genomic medicine, and digital health further highlight the need for comprehensive bioethical education.

Conclusion: Bioethics is a foundational pillar of Competency-Based Medical Education and is essential for developing physicians who combine scientific competence with ethical integrity, compassion, professionalism, and lifelong commitment to patient welfare. Strengthening bioethical education through integrated curricula, clinical application, faculty development, and reflective learning will prepare future physicians to address increasingly complex ethical challenges in modern healthcare.

Traditional Gravity Embalming Technique for Effective Cadaver Preservation

2026-08-19T08:30:32+00:00

Background: Cadaveric dissection remains the cornerstone of anatomy education and continues to provide an irreplaceable learning experience for undergraduate and postgraduate medical students. Although digital anatomy, virtual dissection tables, and three-dimensional simulation technologies have advanced considerably, preserved human cadavers remain indispensable for understanding anatomical relationships, anatomical variations, tissue characteristics, and surgical anatomy. Effective cadaver preservation is therefore fundamental to anatomy teaching and research. Traditional gravity embalming is one of the oldest arterial embalming techniques and continues to be widely practiced because of its simplicity, affordability, and reliability, particularly in resource-limited medical institutions.

Objective: To review the principles, historical evolution, and educational importance of the traditional gravity embalming method for human cadaver preservation.

Methods: This narrative review was developed from the author's original manuscript together with recent literature on cadaver preservation, anatomy education, and embalming practices. Current evidence published between 2021 and 2026 was incorporated to provide an updated perspective while maintaining the classical principles of gravity embalming.

Results: Traditional gravity embalming utilizes hydrostatic pressure to distribute embalming fluid through the arterial system without mechanical pumps. The method requires minimal equipment, low maintenance costs, and no electricity, making it particularly suitable for medical colleges with limited infrastructure. Despite the availability of modern soft-fix and pump-assisted embalming techniques, gravity embalming continues to provide satisfactory long-term preservation for routine anatomical dissection and teaching (1–4).

Conclusion: Traditional gravity embalming remains a practical, economical, and effective technique for preserving human cadavers. Continuous refinement of embalming solutions, safety practices, and standardized protocols will further improve its role in anatomy education and research.

Comparison of Laparoscopic and Open Splenectomy in Patients with Benign Hematological Disorders

2026-08-19T08:43:59+00:00

Objective: The aim of this study is to compare the two procedures (laparoscopic and open splenectomy) in patients with benign hematological disorders in terms of operative time, blood loss, postoperative pain, hospital admission, complications, and recovery.

Study Design: Comparative observational study

Place and Duration of Study: Conducted in Department of Surgery, Aziz Fatimah Medical and Dental College, Faisalabad from January 2025 to July 2025.

Objective: To evaluate the effectiveness of laparoscopic and open splenectomy in patients with benign hematological diseases in terms of surgical time, blood loss, pain level, hospital stay, complications and outcome of surgery.

Methodology: A comparative study was performed of 150 patients who were undergoing elective splenectomy for benign hematological disorders. The WHO sample size calculation formula was used to determine the sample size. The patients were split into two groups: laparoscopic and open splenectomy. Demographic parameters, operative and postoperative results were documented and analyzed.

Results: Laparoscopic splenectomy was associated with less blood loss, less pain, less wound complications and a quicker recovery time and hospital stay. There were no differences in major complications and operative time was slightly longer than open surgery.

Conclusion: Laparoscopic splenectomy is a safe and effective method with the advantages of better short-term results than open splenectomy.

Amenities for Medical Students with Physical Disabilities in the Medical Institution

2026-08-19T09:01:52+00:00

Background: Inclusive medical education is fundamental to achieving equitable healthcare systems and developing a diverse healthcare workforce. Medical students with physical disabilities possess the potential to become competent healthcare professionals when provided with appropriate institutional support, reasonable accommodation, and accessible learning environments. Despite significant advancements in medical education, physical, educational, technological, and attitudinal barriers continue to limit equal participation for students with disabilities. The Rights of Persons with Disabilities (RPwD) Act, 2016, the National Medical Commission (NMC), the World Health Organization (WHO), and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) advocate inclusive education through barrier-free infrastructure, assistive technologies, reasonable accommodation, and equal educational opportunities. Medical institutions therefore have both ethical and legal responsibilities to ensure accessibility throughout academic, laboratory, clinical, residential, and recreational environments.

Objective: To review the essential amenities required for medical students with physical disabilities, examine the legislative and regulatory framework governing disability inclusion, and discuss strategies for creating accessible and inclusive medical institutions.

Methods: A narrative review was conducted using peer-reviewed publications published between 2021 and 2026 together with guidelines issued by the National Medical Commission (NMC), World Health Organization (WHO), United Nations (UN), Department of Empowerment of Persons with Disabilities (Government of India), and other international organizations. Literature related to disability inclusion, universal design, assistive technologies, competency-based medical education, anatomy education, and accessibility in higher education was critically reviewed.

Results: Inclusive medical education requires integration of accessible infrastructure, assistive technologies, barrier-free campus design, digital accessibility, adaptive laboratory facilities, accessible anatomy education, reasonable examination accommodations, faculty sensitization, and institutional disability support systems. Recent NMC recommendations emphasizing Enabling Units further strengthen institutional responsibility toward students with benchmark disabilities. Adoption of Universal Design for Learning (UDL), competency-based educational approaches, and accessible clinical training environments significantly improves educational participation and academic success among medical students with physical disabilities.

Conclusion: Medical institutions should move beyond regulatory compliance toward comprehensive disability inclusion by integrating universal accessibility, assistive technologies, faculty development, individualized accommodations, and inclusive educational policies. Such initiatives will strengthen competency-based medical education, promote diversity within the medical profession, and ultimately improve equitable healthcare delivery.

Knowledge and Skills Regarding Cardiopulmonary Resuscitation among Staff of the 108 Ambulance Service in Sagar District, Madhya Pradesh, India: A Cross-Sectional Study

2026-08-19T10:34:46+00:00

Background: Cardiopulmonary resuscitation (CPR) is a time-critical intervention that significantly improves survival after cardiac arrest. Ambulance personnel are often the first healthcare providers to initiate CPR in out-of-hospital cardiac arrest (OHCA); however, deficiencies in CPR knowledge and practical skills may compromise patient outcomes.

Objectives: To assess CPR knowledge and practical skills among personnel of the 108 ambulance service in Sagar district, Madhya Pradesh; to evaluate the availability and functionality of emergency equipment; and to identify training gaps.

Methods: A cross-sectional observational study was conducted among 161 ambulance personnel working in Basic Life Support (BLS) and Advanced Life Support (ALS) ambulances. Data were collected using a structured questionnaire based on American Heart Association recommendations, direct observation of CPR skills using standardized checklists, and assessment of ambulance equipment.

Results: The study revealed considerable deficiencies in both CPR knowledge and practical skills despite prior training among many participants: 57.1% had average knowledge and 54.7% had average skills, while only 19.9% and 18.0%, respectively, achieved a good level. Knowledge and skill levels were significantly associated (χ² = 26.71, df = 4, p = 0.00002). Equipment assessment showed high overall availability (ALS: 95.6%; BLS: 93.6%) and functionality (ALS: 95.0%; BLS: 95.9%), with selected deficiencies in AEDs, infant/child AMBU bags, and select airway devices.

Conclusion: Regular simulation-based refresher training, competency assessment, and improved ambulance preparedness are essential to strengthen prehospital emergency care under the 108 ambulance system.

Comparative Study of Lipid Profile in Reproductive-Age and Postmenopausal Women

2026-08-19T10:44:18+00:00

Background: Menopause is accompanied by physiological and metabolic changes that may adversely affect lipid metabolism and cardiovascular risk.

Objective: To compare fasting serum lipid parameters and selected cardiovascular risk indicators between reproductive-age and postmenopausal women.

Methods: A hospital-based cross-sectional comparative observational study was conducted at Shyam Shah Medical College and associated hospitals, Rewa, from May 2024 to September 2025. Four hundred women were studied: 200 reproductive-age women and 200 postmenopausal women. Clinical, anthropometric, and fasting biochemical parameters were assessed. Total cholesterol (TC), triglycerides (TG), and HDL-C were measured by standard enzymatic methods; LDL-C and VLDL-C were calculated using Friedewald's formula where applicable.

Results: Dyslipidemia was significantly more prevalent among postmenopausal women (66.0%) than reproductive-age women (39.0%, p<0.001). Mean TC, TG, LDL-C, and VLDL-C were higher, and HDL-C was lower, in postmenopausal women. Atherogenic ratios and moderate/high cardiovascular-risk categories were also more frequent after menopause.

Conclusion: In this study population, postmenopausal status was associated with a significantly more atherogenic lipid profile and greater cardiometabolic risk.

An Integrated Environmental and Ecotoxicological Assessment of Biomedical Waste Treatment Facilities in Mysuru, India

2026-08-20T05:11:30+00:00

Biomedical waste mismanagement has become a significant environmental and public health issue, especially in areas that are quickly urbanizing. This study evaluates the impact of biomedical waste treatment facilities on Mysuru's public health. In 2023 and 2024, seasonal soil, plant, and groundwater sampling was done near the Shree consulting site, Mysuru city, before and after the monsoon. Heavy metal concentrations were measured using Inductively Coupled Plasma–Atomic Emission Spectroscopy (ICP-AES), whereas physico-chemical properties were examined using standard analytical methods. The results demonstrated that seasonal variations in environmental conditions were substantial. with typically high levels of copper and cadmium. When compared to the control, plant samples showed comparatively reduced heavy metal accumulation, suggesting limited bioavailability and selective metal uptake. Groundwater samples during pre-monsoon seasons displayed higher hardness and ion concentrations (compared to normal range according to BIS IS 10500-2012) due to lower dilution and increased mineral dissolution. The study highlights the environmental issues associated with improper disposal of biological waste as well as the necessity of continuous monitoring and improved waste management strategies. To reduce contamination and safeguard the sustainability of ecosystems, it is recommended to use environmentally friendly treatment technologies and remediation strategies like phytoremediation.

Abbreviations: ICP-AES – Inductively Coupled Plasma Atomic Emission Spectroscopy; TDS – Total Dissolved Solids; EC – Electrical Conductivity; WHO – World Health Organisation.

Examination Stress and Its Correlation with Blood Pressure, Pulse Rate and Respiratory Rate in First-Year Mbbs Students

2026-08-20T05:26:45+00:00

Background: Examination stress is a common acute psychological stressor in medical education. It can activate autonomic and neuroendocrine pathways and produce measurable changes in cardiovascular and respiratory function. First-year MBBS students are exposed to a major transition in academic workload and repeated examinations.

Methods: A hospital-based cross-sectional observational study was conducted in the Department of Physiology, Shyam Shah Medical College, Rewa, during April 2024 to June 2025. Two hundred first-year MBBS students were included. Stress was assessed using the 40-item Medical Student Stressor Questionnaire (MSSQ). Blood pressure, heart rate and respiratory rate were recorded using standardized procedures. The results presented in the thesis compare measurements 15 days before examination with those obtained 30 minutes before examination.

Results: Of 200 participants, 91 (45.5%) had slight stress and 109 (54.5%) had moderate stress. No participant was classified as having no stress or high/extreme stress. SBP >120 mmHg increased from 73.5% to 100%, DBP >80 mmHg from 77.0% to 97.0%, heart rate >80 bpm from 76.5% to 100%, and respiratory rate >16/min from 77.0% to 91.5%. Mean SBP increased from 119.72 ± 14.06 to 144.88 ± 9.10 mmHg, DBP from 78.71 ± 9.13 to 89.61 ± 6.03 mmHg, heart rate from 79.31 ± 10.10 to 96.50 ± 7.39 bpm, and respiratory rate from 16.72 ± 2.78 to 18.94 ± 2.05/min; all reported comparisons were p<0.001.

Conclusion: Examination-related stress was associated with significant acute cardiovascular and respiratory changes. The findings support early recognition of examination stress and institution-based stress-management strategies.

An observational study of diagnostic hysterolaparoscopy for evaluation of infertility

2026-08-20T07:53:33+00:00

Background: Infertility is an illness recognised by the World Health Organisation (WHO) that refers to the inability to achievea clinical pregnancy after engaging in regular, unprotected sexual intercourse for a period of 12 months or more. The incidence
of primary infertility in India ranges from 3.9% to 16.8%. Hysteroscopy has emerged as a crucial technique for diagnosinginfertility, providing a direct view of the uterine chamber to detect any possible abnormalities. The objective of this research is to analyse the use of diagnostic hysterolaparoscopy (DHL) in the evaluation of infertility.

Single-Centre Retrospective Analysis of the Diagnostic Yield and Safety of Image-Guided Percutaneous Core-Needle Biopsy of Renal and Perirenal Masses

2026-08-21T05:45:34+00:00

Background. Image-guided percutaneous core-needle biopsy is increasingly used to characterise renal and perirenal masses before definitive management, but its performance in mixed paediatric-and-adult referral practice, particularly in resource-limited settings, is not well described.

Objective. To determine the diagnostic yield and safety of image-guided percutaneous core-needle biopsy of renal and perirenal masses in a single interventional radiology service.

Methods. We retrospectively reviewed 25 consecutive image-guided percutaneous core biopsies of renal and perirenal masses performed in one service, with histopathology reported at two reference laboratories, between December 2021 and September 2024. Procedural details, tissue adequacy, immunohistochemistry use, final histological diagnosis and complications were recorded. Diagnostic yield was defined a priori as a biopsy providing a specific histological diagnosis sufficient to direct management; a broader yield estimate additionally counted biopsies that confirmed a neoplasm without finalising the entity. Proportions are reported with 95% Wilson confidence intervals (CI).

Results. The cohort comprised 17 children and 8 adults (15 male, 10 female); median lesion size was 7.0 cm (range 3.3–14.4). All biopsies used an 18-gauge semi-automatic needle; 20 (80%) were ultrasound-guided and 5 (20%) CT-guided, with a median of 3 passes (range 2–6). Tissue was adequate in 20/25 (80%) and immunohistochemistry was required in 24/25 (96%). A specific histological diagnosis was achieved in 18/25 (72.0%; 95% CI 52.4–85.7%); when biopsies confirming a neoplasm without a final entity were included, the yield rose to 22/25 (88.0%; 95% CI 70.0–95.8%). Three biopsies (12.0%; 95% CI 4.2–30.0%) were non-diagnostic or preliminary. Wilms tumour (n=9) and neuroblastoma (n=4) predominated in children; clear cell renal cell carcinoma and other adult malignancies were seen in adults. Complications occurred in 8/25 (32.0%; 95% CI 17.2–51.6%) and were exclusively minor (SIR class A–B): self-limiting pain (n=4), focal haematoma (n=3) and a vasovagal episode (n=1); there were no major complications, transfusions, embolisations, tract seeding or procedure-related deaths.

Conclusions. In this single-centre series, image-guided percutaneous core biopsy of renal and perirenal masses achieved a diagnostic yield comparable to published adult experience and was safe, with only minor complications. Near-universal reliance on immunohistochemistry underscores that such a service requires ready access to a full ancillary pathology panel.

Oral Epithelial Barrier Integrity: a Humanized Immunohistochemical Study of Junctional Proteins in Oral Diseases

2026-08-21T05:57:19+00:00

Introduction: The oral epithelial barrier is crucial for the control of microbial invasion and immune response to maintain mucosal homeostasis. Impaired epithelial barrier integrity has been associated with the pathogenesis of inflammatory, potentially malignant, and malignant oral diseases.

Objective: To examine the immunohistochemical expression of oral epithelial barrier proteins, including E-cadherin, Claudin-1, Occludin, and ZO-1, across inflammatory, potentially malignant, and malignant oral lesions.

Methods: This descriptive cross-sectional study was conducted at the Khyber Medical University, Peshawar, Pakistan, from November, 2025 to April, 2026. Non-probability consecutive sampling was used to enroll a total of 120 participants. Histopathological and immunohistochemical analysis of oral tissue samples was performed for the expression of E-cadherin, Claudin-1, Occludin, and ZO-1. SPSS version 27.0 was used for statistical analysis.

Results: 120 participants were analyzed. The decrease in expression of E-cadherin was found in 61.7% of the tissue samples, followed by ZO-1 (59.2%), Claudin-1 (55.8%), and Occludin (51.7%). All four epithelial barrier proteins were found to be significantly different between the study groups, with statistically significant results for E-cadherin (p < 0.001), Claudin-1 (p = 0.002), Occludin (p = 0.011) and ZO-1 (p < 0.001). These results suggest that there is a progressive decrease of the expression of epithelial barrier proteins in inflammatory lesions, potentially malignant lesions, and malignant lesions of the oral cavity.

Conclusion: Oral epithelial barrier dysfunction is closely linked to disease progression and could serve as a useful biomarker and therapeutic target. Restoration of epithelial integrity may be beneficial for disease prevention and clinical outcomes with strategies.

Strategies to Enhance Doctor-Inpatient Communication in a Tertiary Care Hospital, Bahawalpur, Pakistan: a Qualitative Study

2026-08-21T06:12:57+00:00

Objective: This study primarily aimed to explore and compare strategies to effective communication between doctors and inpatients in a tertiary care hospital in Bahawalpur, Pakistan. This study also identified common and divergent strategies proposed by the stakeholders and generated contextually informed recommendations for bridging the communication gap between the doctor-inpatient relationships in a tertiary care setting.

Study Design and Setting: A qualitative, exploratory inquiry was conducted in the medical ward of Bahawal Victoria Hospital, Bahawalpur, from August to September 2024.

Methodology: Semi-structured interviews were conducted with 10 purposively selected doctors and 10 inpatients. Interviews were audio-recorded, transcribed verbatim, and analyzed manually using Braun and Clarke’s thematic analysis framework.

Results: Analysis yielded six themes from doctors and six themes from inpatients, reflecting solutions at individual, interpersonal, and systemic levels. Doctors emphasized language and cultural competence, communication training, patient education, structural support, safety, and multidisciplinary reforms. Inpatients highlighted enhanced availability, clear explanations, fairness, education, supportive environments, doctor’s behavior, and systemic navigation support.

Conclusion: Implementing strategies targeting communication skills, patient engagement, institutional support, and systemic reforms could foster patient-centered, empathetic interactions and improve care quality in tertiary care hospitals.

Study on Feto-maternal outcome in second stage caesarean section

2026-08-21T06:43:51+00:00

Background: Caesarean section is the most commonly performed abdominal operation in women all over the world. Caesarean
sections during the second stage labour accounts for approximately one fourth of all primary caesareans. Caesarean section at
full cervical dilatation is technically difficult and is associated with increased trauma to the lower uterine segment and adjacent
structures, as well as increased haemorrhage and infection. Aims and objectives were to determine the indications, maternal
and foetal morbidity associated with caesarean section in the second stage of labour

B-Lynch Compression Suture as a Uterus-Preserving Technique for Uncontrolled Atonic Postpartum Haemorrhage During Caesarean Section: A Retrospective Study

2026-08-21T06:57:18+00:00

Atonic postpartum hemorrhage (PPH) is a majorobstetric emergency and can progress rapidlydespite pharmacological treatment. If uterotonicsare not successful in achieving adequate hemostasis, then surgical intervention may berequired. B-Lynch uterine compression suturing

Mean Platelet Volume as a Marker of Glycemic Control in Type 2 Diabetes Mellitus: A Cross-Sectional Study

2026-08-21T08:19:52+00:00

Background: Platelet activation contributes significantly to the development of vascular complications in type 2 diabetes mellitus (T2DM). Mean platelet volume (MPV), a routinely available hematological parameter, reflects platelet size and activity and has been proposed as a simple marker of platelet activation. This study aimed to evaluate the association between MPV and glycemic control in patients with T2DM.

Methods: A hospital-based cross-sectional study was conducted in the Department of General Medicine at Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, India, from January 2022 to June 2023. One hundred patients with confirmed T2DM were enrolled. Clinical details, fasting blood glucose (FBS), postprandial blood glucose (PPBS), glycated hemoglobin (HbA1c), and complete blood counts including MPV were recorded. Correlations between MPV and glycemic parameters were analyzed using Pearson's correlation coefficient. Comparisons between glycemic control groups were performed using Student's t-test and one-way ANOVA. A p value <0.05 was considered statistically significant.

Results: The study population had a mean age of 51.7 ± 9.7 years, with females constituting 57% of participants. The mean HbA1c and MPV were 8.6 ± 1.8% and 8.27 ± 1.05 fL, respectively. MPV showed significant positive correlations with HbA1c (r=0.591, p<0.001), PPBS (r=0.349, p<0.001), FBS (r=0.239, p=0.017), and duration of diabetes (r=0.493, p<0.001). Mean MPV increased progressively with worsening glycemic control, from 7.29 ± 0.80 fL in patients with HbA1c <7% to 8.75 ± 0.99 fL in those with HbA1c >8% (p<0.001). No significant associations were observed between MPV and age, sex, or body mass index.

Conclusion: Mean platelet volume is significantly associated with poor glycemic control and longer duration of diabetes in patients with T2DM. As an inexpensive and routinely available laboratory parameter, MPV may serve as a useful adjunctive marker for identifying patients at increased risk of platelet activation and vascular complications. Larger prospective multicenter studies are warranted to validate its prognostic utility.

Relationship Analysis of Risk Factors in Carcinoma Breast with Particular Relevance to Lipid Profile and Obesity

2026-08-21T08:26:33+00:00

Background: Breast cancer is the second most common cancer in the world. One of the reasons for increasing prevalence of carcinoma breast and that too in younger women has been attributed to lifestyle changes like smoking, alcohol, obesity, sedentary work, lack of physical activity etc. All these factors also have a strong association with lipid metabolism.

Materials and Methods: This study was a descriptive study, here a total of 50 female patients with carcinoma breast and recurrent cases of carcinoma breast were studied. Which was conducted at Department of General Surgery at Rajarajeswari Medical College and Hospital, Bangalore from October 2017 to October 2019.

Results: The mean duration of lump was found to be 4.35 months.

The mean age of menarche in pre-menopause was found to be 13.96 years and postmenopause 13.61 yrs.

Most common stage in post menopause was found to be 3A and pre menopause 2B.

The mean TC in pre-menopause was found to be 179.04 and post-menopause 188.3.

The mean TG in pre-menopause was found to be 151 and post-menopause 146.61.

The mean LDL in pre-menopause was found to be 118.22 and post-menopause 120.57.

The mean HDL in pre-menopause was found to be 39.61 and post-menopause 41.74.

The mean HDL in pre-menopause was found to be statistically significant with p value 0.049^*

Conclusion: We conclude that decreased HDL-cholesterol among pre-menopausal women may act as a marker of increased breast carcinoma risk.

A COMPARATIVE STUDY OF CLONIDINE AND FENTANYL AS ADJUVANTS TO 0.5% LEVOBUPIVACAINE IN ULTRASOUND-GUIDED PECTORAL NERVE (PEC) BLOCK FOR MINOR BREAST SURGERIES

2026-08-21T08:52:04+00:00

Background: Ultrasound-guided PectoralNerve (PEC) block is a well-establishedregional anesthesia technique providing
targeted perioperative analgesia for minor breast procedures. Adding adjuvants to localanesthetics enhances blockade speed

Assessment of Household Waste Management Practices in South Indian Villages

2026-08-22T05:29:50+00:00

Background: Household waste management is an important public health and environmental concern in rural areas of South India. Rapid population growth, changing lifestyles, and increased consumption have led to a rise in the generation of household waste. In many villages, inadequate waste segregation, improper disposal practices, open dumping, and burning of waste contribute to environmental pollution and health hazards. Effective household waste management is essential for achieving sustainable rural development and improving the quality of life in South Indian villages. The aim of the present study is to assess the awareness regarding waste management and to determine waste generation, segregation, storage and disposal practices at the household level.

Methods: A community-based cross-sectional study was conducted in the field practice area of Adichunchanagiri Institute of Medical Sciences, comprising five villages to assess household waste management practices. Data were collected from households using a pre-tested structured questionnaire through face to face interviews. Information regarding waste generation, segregation, storage, collection, and disposal practices was gathered. The collected data were compiled and analyzed using descriptive statistics, and the findings were presented as frequencies and percentages.

Results: Among 153 participants, awareness of waste management was moderate; however, proper practices were inadequate. Open dumping (60.1%) and the use of uncovered bins (88%) were highly prevalent, while lack of waste collection services (51%) emerged as the major barrier to effective household waste management.

Conclusion: Despite reasonable awareness, scientific household waste management practices remain poor in rural communities. Strengthening waste collection infrastructure, promoting source segregation, and implementing sustained community-based awareness programs are essential to achieve sustainable environmental health.

AI-Assisted Detection of Secondary Caries and Assessment of Composite Restoration Failure: Association with Periodontal and Oral Biological Factors

2026-08-22T06:09:36+00:00

Background: Secondary caries and degradation of resin based composite restorations continue to be significant problems for restoration repair and replacement. Besides the material consideration, there are a variety of factors that can affect long-term performance of the composite restorations including periodontal inflammation, plaque accumulation, salivary characteristics, and cariogenic microorganisms. AI supported diagnostic systems could be available to assist in the detection of recurrent caries and the assessment of risk of failure of restorations.

Objective: To evaluate AI-assisted detection of secondary caries and assess composite restoration failure in relation to periodontal, oral biological, and restoration-related factors.

Methods: This analytical cross-sectional study included 85 participants, with one eligible composite restoration evaluated per participant, resulting in 85 restorations for analysis. Clinical, periodontal, radiographic, salivary, and microbiological parameters were recorded. Secondary caries was assessed using combined clinical and radiographic examination, while AI-assisted radiographic assessment was performed using Diagnocat™ for detection of secondary caries. Composite restoration failure was determined clinically using predefined criteria. Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, salivary pH, salivary flow rate, buffering capacity, Streptococcus mutans level, restoration age, number of restored surfaces, and marginal adaptation were evaluated. Diagnostic performance measures and multivariable logistic regression were used for statistical analysis.

Results: Secondary caries was confirmed in 29 of 85 restorations (34.1%), while 25 restorations (29.4%) were clinically classified as failed. AI-assisted secondary caries detection demonstrated a sensitivity of 89.7%, specificity of 91.1%, positive predictive value of 83.9%, negative predictive value of 94.4%, and overall accuracy of 90.6%. Restorations with secondary caries were associated with significantly higher Plaque Index, Gingival Index, and probing pocket depth, along with lower salivary pH and flow rate. High S. mutans levels were also significantly more frequent in restorations affected by secondary caries. Composite restoration failure was significantly associated with secondary caries, restoration age >5 years, involvement of three or more surfaces, poor marginal adaptation, poor oral hygiene, and high S. mutans levels. In multivariable analysis, secondary caries, poor marginal adaptation, restoration age >5 years, and high S. mutans levels remained independently associated with composite restoration failure.

Conclusion: AI-assisted radiographic assessment demonstrated high diagnostic performance for secondary caries detection. Composite restoration failure was independently associated with secondary caries, defective marginal adaptation, greater restoration age, and elevated S. mutans levels. These findings support the use of AI as an adjunct to conventional secondary caries detection while emphasizing the importance of periodontal, biological, and restoration-related factors in the clinical assessment of composite restoration outcomes.

Correlation of C-Reactive Protein with Alvarado Score and CT Findings in Acute Appendicitis: A Prospective Observational Study

2026-08-22T12:55:19+00:00

Background: Acute appendicitis remains acommon emergency surgical condition inwhich timely and accurate diagnosis is essential. Clinical scoring systems,inflammatory biomarkers and cross-sectionalimaging are frequently used together, but their individual limitations may lead to diagnosticuncertainty.

COMPARISON OF GABAPENTIN V/S PREGABALIN FOR PREEMPTIVE ANALGESIA FOR ACUTE POSTOPERATIVE PAIN AFTER SURGERY UNDER SPINAL ANAESTHESIA

2026-08-22T13:06:40+00:00

Introduction: Pain is defined as anunpleasant sensory and emotionalexperience associated with actual orpotential tissue damage. Postoperative pain is an inevitable consequence of surgicaltrauma and remains one of the majorconcerns in perioperative patient care.

LIPID RATIOS, CLINICAL MANIFESTATIONS AND SEVERITY STRATIFICATION IN ALCOHOL-RELATED LIVER CIRRHOSIS: INSIGHTS FROM A TERTIARY TEACHING HOSPITAL

2026-08-22T13:09:00+00:00

Background: Alcohol consumption is aleading cause of chronic liver disease worldwide. Chronic alcohol toxicity alterslipid homeostasis, hepatic vascularresistance, and systemic metabolism. Thisstudy investigated clinical characteristics

Organ Transplantation: Current Challenges and EmergingInnovationsacross Preservation,Immunology and Xenotransplantation

2026-08-22T13:12:51+00:00

Background: Organ transplantation has evolved from a life-saving surgical intervention into amultidisciplinary field integrating immunology, bioengineering, and data science. Despite majoradvances in donor management, perioperative care, and immunosuppression, long-term outcomesremain constrained by a persistent global shortage of transplantable organs, ischemia-reperfusioninjury, chronic rejection, and the toxicity of lifelong immunosuppression.

Clinical and Laboratory Predictors of Esophageal Varices in Patients with Liver Cirrhosis: A Prospective Observational Study

2026-08-23T05:31:35+00:00

Background :-Esophageal varices are a major manifestation ofportal hypertension in liver cirrhosis, which are associated with potentially life-threateninghemorrhage. Upper gastrointestinal endoscopyremains the reference investigation

A COMPARATIVE STUDY OF KELLER’S ARTHROPLASTY VERSUS CONVENTIONAL DRESSING IN THE MANAGEMENT OF DIABETIC FOOT ULCERS

2026-08-23T06:53:59+00:00

Background: Diabetic foot ulcers areassociated with delayed healing and highrecurrence rates, particularly when mechanical pressure contributes to ulcerpersistence. Keller’s arthroplasty mayimprove healing by reducing pressure over thehallux and forefoot.

Association of Allergic Rhinitis with Sinonasal Polyposis: A Clinical and Laboratory-Based Observational Study

2026-08-23T07:05:02+00:00

Background: Allergic rhinitis and sinonasalpolyposis share several inflammatorymechanisms, including eosinophilicinfiltration, type 2 inflammation and immunoglobulin E-mediated immuneactivity. However, the contribution of allergyto sinonasal-polyp formation remains

Psychological Burden and Quality of Life in Stable and Unstable Vitiligo: A Prospective Observational Study

2026-08-24T03:36:45+00:00

Background :-Vitiligo is a chronic depigmenting disease withvisible cutaneous changes that may result inserious psychosocial consequences. Althoughdisease activity is clinically relevant fortreatment decisions, the relationship betweenclinical stability and psychological burden isless consistently described. This study aimed toevaluate quality of life and psychological
symptoms of patients with stable and unstable vitiligo.

Association of Glycemic Status with Stroke Severity and In-Hospital Neurological Outcome in Patients with Acute Ischemic Stroke: A Hospital Based Observational Study

2026-08-24T03:39:10+00:00

Background: Hyperglycemia is frequentlyobserved in the setting of an acute ischemicstroke and may reflect both pre-existing
diabetes and an acute stress response. Increasedglucose levels have been associated with moresevere neurological damage and worseoutcomes, but the association between specific glycemic parameters and early neurologicalimprovement is still clinically relevant.

Admission Soluble ST2 and Its Correlation with NT-Probnp and Hscrp in Acute Heart Failure and Acute Myocardial Infarction: A Prospective Observational Study

2026-08-24T05:48:48+00:00

Background: Natriuretic peptides such as NT-proBNP are the standard biomarkers for diagnosis and prognosis in heart failure, but their concentrations are influenced by age, renal function, and body-mass index. Soluble suppression of tumorigenicity-2 (sST2), a marker of myocardial fibrosis and remodelling, has emerged as a complementary, load-independent prognostic biomarker in heart failure, but data relating admission sST2 to NT-proBNP and high-sensitivity C-reactive protein (hsCRP), and to clinical outcomes, in Indian patients with acute heart failure (AHF) and acute myocardial infarction (MI) are scarce.

Aim and Objectives: To assess the correlation of admission sST2 with NT-proBNP and hsCRP in patients with acute heart failure and acute myocardial infarction. To evaluate the prognostic value of admission sST2 for in-hospital mortality, length of hospital stay, and 3-month mortality and readmission in this population.

Methodology:

Study Design: Prospective observational study. Study Setting: Tertiary cardiac-care centre, Latur, Maharashtra. Study Population: Consecutive patients older than 18 years admitted with acute heart failure (AHF, n=75) or acute myocardial infarction (MI, n=75); patients with pregnancy, cirrhosis, chronic pulmonary disease, rheumatic valvular heart disease, collagen vascular disease or rheumatoid arthritis, or septic shock were excluded. Study period: 2 April 2025 to 2 April 2026. Sample Size = 150. sST2, NT-proBNP, hsCRP, and troponin I were measured within 6 hours of hospitalisation. Correlations were assessed using Spearman's method; group medians were compared using the Mann-Whitney U test or Kruskal-Wallis H test. Patients were followed for in-hospital and 3-month outcomes (mortality and readmission).

Results: Of 150 patients (89 [59.3%] men, 61 [40.7%] women; mean age 65.61 ± 12.85 years), admission sST2 correlated positively with NT-proBNP (r=0.871) and hsCRP (r=0.860; both p<0.001) and negatively with left ventricular ejection fraction (r=-0.878, p<0.001) across the whole cohort, with similar directionally consistent correlations in the AHF and MI groups separately. Median sST2 was higher in patients who died in hospital than in survivors (228.5 vs 107.5 ng/mL, p<0.001), in those with a longer hospital stay (215.0 vs 116.0 ng/mL, p<0.001), and in those who died (215.5 vs 105.0 ng/mL, p=0.004) or were readmitted (204.0 vs 102.0 ng/mL, p<0.001) within 3 months.

Conclusions: In this Indian cohort, admission sST2 tracked closely with established biomarkers of myocardial wall stress and systemic inflammation and identified patients at higher risk of in-hospital death, prolonged hospital stay, and adverse 3-month outcomes in both AHF and MI. These findings support consideration of sST2 as an adjunct, relatively load-independent prognostic marker alongside NT-proBNP and hsCRP, while highlighting the need for population-specific reference ranges and larger multicentre validation.

Comparative Study between Efficacies of Different Concentration of Ropivacaine (0.75% Vs 0.5%) In USG Guided Supraclavicular Brachial Plexus Block In Upper Limb Surgeries

2026-08-24T08:34:54+00:00

Background: Regional anaesthesia using brachial plexus block is widely preferred for upper limb surgeries, with ultrasound guidance improving accuracy and safety. Ropivacaine, a long-acting amide local anaesthetic with reduced cardiotoxicity compared to bupivacaine, provides differential sensory and motor blockade depending on concentration. Determining the optimal concentration for effective block with minimal motor impairment and toxicity is clinically important. The aim of this study was to evaluate the efficacy of different concentrations of ropivacaine, (0.5% and 0.75%) in supraclavicular brachial plexus block in upper limb surgeries.

Material and Methods A prospective, blinded randomized study was conducted, enrolling 64 patients of either sex, American Society of Anesthesiologists (ASA) I and II, who were allocated into two groups in which supraclavicular brachial plexus block was performed using ropivacaine in concentrations of 0.5% and 0.75%, respectively. The onset and duration of sensory and motor blocks were recorded.

Results: The sensory and motor blockade onset and duration was longer in patients who received ropivacaine 0.75%, in comparison to patients who received ropivacaine 0.5%. The time to first rescue analgesia was longer with Ropivacaine 0.75% (12.27 ± 2.34 hours vs. 9.32 ± 1.17 hours; p = 0.001). Both the concentration of Ropivacaine maintained stable haemodynamics, with no major adverse effects reported.

Conclusion: The results suggest that 0.5% ropivacaine is optimal for most routine upper limb surgeries, reserving 0.75% for longer procedures or when extended analgesia is desired. Both concentrations were well-tolerated without any significant complications.

Bacterial Isolates and their Antimicrobial Susceptibility Patterns of Wound Infections among Patients in Surgery Department of Tertiary Health Care Centre

2026-08-24T08:47:45+00:00

Introduction: Wound infections are an important cause of delayed healing and morbidity among surgical patients, and increasing antimicrobial resistance complicates their management. Identification of bacterial pathogens and determination of their antimicrobial susceptibility patterns are important for appropriate antimicrobial selection.

Aim: To determine the bacterial profile and antimicrobial susceptibility patterns of wound infections among patients attending the Surgery Department of a tertiary healthcare centre.

Methods: A retrospective study is done among clinical samples obtained from both inpatients and outpatients attending Surgery Department of National Institute of Medical Sciences and Research (NIMS&R) Hospital from February 2026 to July 2026. The isolates were identified and their antibiotic sensitivity was determined following the standard protocol and CLSI guidelines.

Results: A total of 348 bacterial isolates were included in the analysis. Gram-negative organisms predominated, accounting for 67.2%, while Gram-positive organisms accounted for 32.8%. Staphylococcus spp. was the most frequently isolated organism (28.4%), followed by Escherichia coli (23.3%), Klebsiella pneumoniae (12.9%), and Pseudomonas spp. (7.8%). Most isolates were recovered as single-organism infections (91.38%), while multiple microbial isolates accounted for 8.62%. Wound swabs constituted the majority of specimens (66.4%). High resistance was observed among Staphylococcus spp. to penicillin (72.7%), E. coli to ampicillin and ciprofloxacin (81.4% each), K. pneumoniae to ampicillin (86.6%), and Pseudomonas spp. to cefepime and cefoperazone–sulbactam (66.6% each). Relatively high susceptibility was observed to amikacin among E. coli (85.1%) and to gentamicin among K. pneumoniae (66.6%) and Pseudomonas spp. (77.7%).

Conclusion: The study demonstrated a diverse bacterial profile among wound infections, with Gram-negative organisms predominating and substantial resistance to several commonly used antimicrobials. The variation in susceptibility among bacterial species highlights the importance of bacterial identification and antimicrobial susceptibility testing for appropriate management of wound infections in the study setting.

EFFECT OF DIFFERENT DOSES OF INTRATHECAL DEXMEDETOMIDINE AS AN ADJUVANT COMBINED WITH 0.75% HYPERBARIC ROPIVACAINE IN PATIENTS UNDERGOING LOWER ABDOMINAL AND LOWER LIMB SURGERIES

2026-08-24T09:19:31+00:00

Background: Spinal anaesthesia is widelyused for lower abdominal and lower limbsurgeries due to its rapid onset, effectivesensory and motor blockade,haemodynamic stability, and costeffectiveness. Ropivacaine, a safer alternative to bupivacaine, provides

Correlation of High-Risk HPV Genotype Spectrum With Histopathological Severity of Cervical Lesions

2026-08-24T09:26:30+00:00

Persistent infection with high-risk humanpapillomavirus represents the primary driverof cervical carcinogenesis, yet thedistribution of genotype spectrums across progressive histopathological grades requirescomprehensive characterization.

Inflammatory Biomarkers as Predictors of Fertility Outcomes in Women With Adenomyosis

2026-08-24T09:29:55+00:00

Adenomyosis is a benign gynecologicalcondition characterized by the presence of ectopic endometrial glands and stroma withinthe myometrium, leading to chronic pelvicpain, heavy menstrual bleeding, andsubfertility

COMPARITIVE STUDY OF EFFICACY OF TRANEXAMIC ACID AND HEMOCOAGULASE IN REDUCING PERIOPERATIVE BLOOD LOSS IN MAJOR ORTHOPAEDIC LOWER LIMB SURGERIES: A DOUBLE BLIND RANDOMIZED CONTROL STUDY

2026-08-24T13:24:08+00:00

Background and Aims: Major orthopaedicsurgeries are associated with significantperioperative blood loss and necessitateblood transfusion. Aim was to evaluate and compare blood loss and need for bloodtransfusion in the perioperative periodbetween the two groups

GALL BLADDER FUNCTION IN DIABETES MELLITUS: A CLINICAL PROSPECTIVE STUDY

2026-08-24T13:26:36+00:00

Introduction: Diabetes mellitus (DM) is acomplex, systemic metabolic disordercharacterized by chronic hyperglycemia resulting from defects in insulin secretion,insulin action, or both.1 While microvascularand macrovascular complications are wellrecognized long-term sequelae of diabetes

MACULOPAPULAR RASH WITH FEVER AND ARTHRALGIA IN PRIMARY CARE

2026-08-24T13:30:12+00:00

A 29-year-old male presented to primarycare with intermittent fever for four weeks,initially preceded by mild coryzalsymptoms, followed by recurrent severepolyarthralgia, myalgia, fatigue, and generalized weakness.

A CASE OF UNUSUAL PRESENTATION OF CARDIAC TAMPONADE – CLINICAL CASE REPORT

2026-08-24T13:32:20+00:00

Cardiac tamponade is a medical emergencyin which fluid or blood accumulates in thespace between the heart and the sac thatsurrounds it, called the pericardium. This accumulation of fluid puts pressure on theheart and restricts its ability to pump bloodeffectively, leading to a potentially life

AN UNUSUAL PRESENTATION OF SEROTONIN WITHDRAWAL SYNDROME- CLINICAL APPROACH IN DIAGNOSIS

2026-08-24T13:34:44+00:00

Serotonin withdrawal syndrome, also knownas serotonin discontinuation syndrome orSSRI withdrawal syndrome, is a constellation of symptoms that can occurwhen a person stops taking selectiveserotonin reuptake inhibitors

PREVALENCE AND SEVERITY OF METABOLIC ACIDOSIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON MAINTENANCE HAEMODIALYSIS: A CROSS-SECTIONAL STUDY

2026-08-25T05:41:25+00:00

Background: Metabolic acidosis is acommon complication of advanced chronickidney disease (CKD) and may persistdespite maintenance haemodialysis.Persistent acidosis is associated withprotein catabolism, muscle wasting, bone disease, inflammation, and increasedcardiovascular risk

Caesarean Section Audit Using the Robson Ten-Group Classification System: A Retrospective Study

2026-08-25T05:43:58+00:00

Background :Caesarean section (CS) is an importantintervention when medically indicated, but rising CS rates have raised concerns about theappropriate use of operative delivery. The RobsonTen-Group Classification System (TGCS) is astandardised classification system for auditingCS based on routinely recorded obstetriccharacteristics.

Clinical Profile and Determinants of Stroke Severity in Patients with Acute Ischemic Stroke: A Hospital-Based Study

2026-08-25T05:46:03+00:00

Background: Stroke severity at presentation isan important predictor of early clinical course andutilization of resources. Neurologicalalimpairment in acute ischemic stroke may beassociated with demographic data, vascularcomorbidities, smoking, alcohol consumption,blood pressure and other available clinicalparameters.

Enhanced Recovery After Surgery (ERAS) Protocol in Colorectal Surgery: A Prospective Observational Study

2026-08-25T05:50:55+00:00

Background: Enhanced Recovery After Surgery(ERAS) is a multimodal perioperative pathwaydesigned to reduce surgical stress,acceleraterecovery and shorten hospital stay. The present study evaluated the feasibility and outcomes of an ERAS protocol in patients undergoing colorectalsurgery.

Prevention of Burst Abdomen by Interrupted Closure: A Comparative Study of Conventional Continuous Versus Modified Smead-Jones Far-And-Near Interrupted Abdominal Fascial Closure in Surgical Patients

2026-08-25T10:00:38+00:00

Introduction: Abdominal wound dehiscence or burst abdomen is disruption of any or all off the layers in a wound. Abdominal wound dehiscence is a common complication of emergency laparotomy in cases of perforation peritonitis in Indian setup.

Aims: To estimate and compare the incidence of Abdominal Wound Dehiscence or Burst Abdomen among Continuous closure and Modified Smead-Jones Far-and-Near interrupted type abdominal fascial closure.

Materials and method: The present study was a comparative study. This Study was conducted from 8 months at the Institute of General Surgery, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai. Total 114 patients were included in this study.

Result: In Conventional Continuous, 32 (56.1%) patients had incidence of burst abdomen. In Modified Smead Jones, 22 (38.6%) patients had incidence. Association of Incidence with Group was not statistically significant (p=0.0606). In Conventional Continuous, the mean Hypoproteinenmia of patients was 3.1579 ± 2.4333. In Modified Smead Jones, the mean Hypoproteinenmia (mean ±s.d.) of patients was 3.5965 ±2.2667. Distribution of mean Hypoproteinenmia with treatment was not statistically significant (p=0.3215). In Conventional Continuous, the mean Uremia of patients was 2.5965 ± 1.9259. In Modified Smead Jones, the mean Uremia of patients was 2.2456 ±2.0025. Distribution of mean Uremia with Treatment was not statistically significant (p=0.3424).

Conclusion: The far-and-near interrupted closure technique may offer superior strength and support to the abdominal fascia, thereby reducing the risk of postoperative complications such as wound dehiscence.

Clinico-Epidemiological Profile and Outcome of Acute Lower Respiratory Infections among Hospitalized Children Age 2 Months to 5 Years: A Prospective Observational Study from a Tertiary Care Centre in North-Western India

2026-08-25T10:06:44+00:00

Background: Acute lower respiratory infections (ALRIs) remain one of the leading causes of childhood morbidity and mortality, particularly in low- and middle-income countries. Identification of factors associated with severe disease is essential for improving clinical outcomes.

Objective: To evaluate the clinico-epidemiological profile, associated risk factors, and clinical outcome of children admitted with acute lower respiratory infections.

Methods: This prospective observational study included 210 children aged 2 months to 5 years admitted with ALRIs at the Department of Paediatric Medicine, SMS Medical College and Attached Group of Hospitals, Jaipur. Demographic characteristics, nutritional status, immunization status, environmental exposures, laboratory investigations, disease severity, treatment requirements, and outcomes were recorded. Statistical analysis was performed using SPSS, and multivariable logistic regression identified independent predictors of severe disease.

Results: Severe pneumonia was the most common presentation (59.5%), followed by very severe pneumonia (21.4%). Low birth weight, poor maternal literacy, incomplete immunization, malnutrition, anaemia, use of non-gas cooking fuel, and attached kitchen were significantly associated with greater disease severity (p<0.05). Multivariable logistic regression identified malnutrition, anaemia, incomplete immunization, low birth weight, maternal literacy, cooking fuel, attached kitchen, and increasing age as independent predictors of severe pneumonia. Oxygen therapy and mechanical ventilation requirements increased significantly with disease severity. Overall mortality was 1.4%, with all deaths occurring among children with very severe pneumonia.

Conclusion: Nutritional deficiencies, inadequate immunization, adverse household environmental conditions, and low birth weight independently increase the risk of severe ALRIs in children. Early identification of these modifiable factors, together with timely treatment and preventive interventions, may substantially reduce disease severity and improve clinical outcome.

Prevalence of Carbapenem Resistant Enterobacterales at a Tertiary Care Hospital

2026-08-25T10:31:35+00:00

Background: Carbapenem-resistant Enterobacterales (CRE) have emerged as a major public health concern owing to their increasing prevalence, limited therapeutic options, and association with high morbidity and mortality. The rapid dissemination of carbapenemase-producing organisms has significantly challenged the management of healthcare-associated infections worldwide.

Aim: To determine the prevalence of Carbapenem-resistant Enterobacterales among clinical isolates obtained from patients attending a tertiary care hospital.

Materials and Methods: A prospective observational study was conducted in the Department of Microbiology of a tertiary care hospital from July 2023 to December 2023. Clinical specimens including urine, pus, swabs, blood, sputum, cerebrospinal fluid, pleural fluid, and other body fluids received for culture and antimicrobial susceptibility testing were included. Enterobacterales were isolated and identified using conventional microbiological methods. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disc diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: A total of 306 Enterobacterales isolates were recovered during the study period, of which 133 (43.5%) were carbapenem-resistant. Escherichia coli was the predominant organism isolated (162/306) followed by Klebsiella pneumoniae (48/306). CRE were most commonly seen in Escherichia coli (74 isolates, 45.6%), most frequently isolated from urine specimens (59%) and hospitalized patients (48%). Among the carbapenem-resistant isolates, more resistance towards Imipenem was observed compared to Meropenem.

Conclusion: The high proportion of CRE observed in the present study highlights the growing burden of antimicrobial resistance in tertiary healthcare settings. Continuous microbiological surveillance, strict infection prevention measures, and implementation of antimicrobial stewardship programmes are essential to limit the emergence and spread of CRE.

Morphometric Characteristics of the Vermiform Appendix and Their Histopathological Correlation in Adult Patients Undergoing Appendectomy for Acute Appendicitis: A Prospective Observational Study

2026-08-25T10:54:41+00:00

Background: The vermiform appendix demonstrates considerable variation in length, diameter, position, and wall morphology, while acute appendicitis produces characteristic inflammatory changes that may alter its gross dimensions. Data integrating appendiceal morphometry with histopathological severity are limited in South Asian populations.

Objective: This study was conducted to determine the morphometric characteristics of the vermiform appendix in adults undergoing appendectomy for clinically suspected acute appendicitis and to evaluate their relationship with histopathological findings.

Methods: This prospective observational study was conducted at multiple tertiary-care teaching hospital in Pakistan over 12 months. Adult patients undergoing appendectomy for clinically suspected acute appendicitis were consecutively enrolled. Following removal, appendix length, external diameter at the base, middle and tip, and anatomical position were recorded using a standardized proforma. Representative tissue sections were fixed in 10% buffered formalin, processed routinely, stained with hematoxylin and eosin, and examined microscopically. Histopathological severity was categorized according to the predominant inflammatory pattern.

Results: Among 180 patients, the mean age was 29.4±10.8 years and 109 (60.6%) were males. Mean appendiceal length was 7.2±2.0 cm and mean maximum external diameter was 10.1±2.4 mm. Retrocecal position was most frequent (43.9%). Acute suppurative appendicitis was the commonest histological diagnosis (51.1%). Increasing appendiceal diameter was significantly associated with increasing histopathological severity (p<0.001), whereas length showed no significant association (p=0.29).

Conclusion: Appendiceal diameter showed a stronger relationship with inflammatory severity than appendiceal length. Simple gross morphometry combined with routine histopathology provided useful anatomical and pathological information using inexpensive methods suitable for resource-limited settings.

Sugary Snack Intake Frequency, Socioeconomic Status, and Oral Hygiene Compliance among Adolescents with Fixed Orthodontic Appliances

2026-08-26T06:02:48+00:00

Background: This study evaluated the relationships among sugary snack intake frequency, socioeconomic status (SES), parental supervision, treatment duration, and clinical oral hygiene outcomes in adolescent patients undergoing fixed orthodontic treatment.

Methods: A cross-sectional analytical study was conducted on 132 adolescent patients (aged 12–18 years) with a minimum of 6 months of fixed orthodontic treatment selected via systematic random sampling. Structured questionnaires recorded snack intake frequency, SES, treatment duration, parental supervision, and self-care compliance. Plaque accumulation was measured using the Turesky modification of the Quigley-Hein Plaque Index. Data were analyzed using descriptive statistics, Chi-square tests, multivariable regression, and mediation/moderation analysis via the PROCESS macro (p < 0.05).

Results: High dietary snack frequency and extended treatment duration (>24 months) were significantly associated with elevated plaque accumulation and lower compliance. Snack frequency mediated the relationship between lower SES and higher plaque scores. Active parental supervision served as a significant moderating variable, correlating with lower plaque buildup, particularly in patients with high dietary snack intake.

Conclusion: Extended orthodontic treatment duration, frequent sugary snack consumption, and lower SES are significantly associated with poor oral hygiene compliance and plaque accumulation. Targeted dietary counseling and structured, direct parental involvement correlate with improved clinical outcomes during fixed appliance therapy.

A Prospective Study of 206 Cases of Cryptorchid Testes with Particular Reference to Their Location and Morphological Changes

2026-08-26T07:10:14+00:00

Background: The undescended testis is a common congenital anomaly, occurring in about 1 to 2 per cent of the male population at birth, and in 0.8 per cent of boys at one year of age. Cryptorchid testes are frequently associated with gross morphological changes with regard to size and shape of the tests, various degrees of detachment between the epididymis and testis as well as histological changes.

Objective: To study the incidence and types of cryptorchid testes in different age groups and correlation between location of undescended testes and associated gross and microscopic changes in different patients.

Methods: 206 male children were operated in the department of General Surgery at our institute from January 2019 to December 2024. Cases were analysed according to the age, type and location of cryptorchid testes, any testicular atrophy, epididymal and vassal anomalies and histological changes. The results were analysed and conclusions drawn.

Results: There was not a significant difference between the incidences of undescended testes on two sides. 74.75 % patients were older than 4 years and the mean age at presentation was 6.7 years. The frequency of abdominal undescended testes increased with increase in age while that of suprasrcotal testes decreased with increase in age. Most testes in suprascrotal position were normal or had mild atrophy (80%) while intracanlicular, internal ring and abdominal testes showed moderate to severe atrophy (79.56%). Testes at abdominal positions showed moderate or profound epididymal (49.46%) and vassal (32.25%) anomalies. Orchidectomy or testicular biopsy specimens showed an incidence of Seminomas has 3.76% in intra-abdominal testes while high scrotal, inguinal canal and internal ring testes showed an incidence of 0.00%, 1.61% and 2.15% respectively.

Conclusion: It was concluded that even though the necessity for early surgical correction is well established, these patients at least in our region, still tend to present very; late for undergoing surgery, with consequent increased risks of infertility and malignant transformation.

Clinical Profile and Management of 200 Patients of Prostatitis Syndrome at a Tertiary Care Hospital in North Kashmir

2026-08-26T07:16:53+00:00

Background: Prostatitis is a common diseases in middle aged men in north Kashmir, causing major morbidity with symptoms such as dysuria, perennial discomfort, low back ache, sexual dysfunction and very often infertility. In this study we prospectively studied 200 cases of prostatitis to analyse the symptomatology, clinical signs and results of expressed prostatic secretions (EPS) and urine to classify the disease.

Objective: To analyse the symptoms, signs and laboratory results of EPS and urine in 200 patients. Methods: A hospital based prospective study of 200 patients of prostatitis was conducted from December 2019 to December 2024 and the results of microscopic and microbiological examination of expressed prostatic secretions and urine were analysed.

Results: A total of 200 male patients studied showed dysuria (32%), perennial discomfort (52%) and increased urinary frequency (21%) as the most common presenting symptoms with duration of more than 6 months in 77% cases. Enlarged firm prostate was observed in 98% cases. Cultures of EPS and urine revealed E. Coli as most common infecting organism and WBC counts in EPS where more than 10 in significant number of patients. Among all types of prostatitis, chronic non-bacterial prostatitis was most prevalent in 43% cases studied.

Conclusion: It was concluded that although reliance on symptoms to differentiate or diagnose prostatitis is appropriate to some extent, analysis of prostatic fluid and fractions of urine and classification of prostatitis offers a valuable insight into the importance, incidence and aetiology of prostatitis.

Clinical Profile, Management Strategies, and Early Outcomes of Acute Limb Ischemia in Patients with COVID-19: A Prospective Observational Study

2026-08-26T07:22:08+00:00

Background: Coronavirus disease 2019 (COVID-19) is associated with endothelial dysfunction and a hypercoagulable state that may result in arterial thrombosis and acute limb ischemia (ALI). ALI may occur during active infection or in the post-COVID period and can result in substantial limb loss and mortality. This study evaluated the clinical profile, patterns of arterial involvement, management strategies, and early outcomes of COVID-19-associated ALI.

Methods: This prospective, non-randomized, single-centre observational study included 52 adult patients presenting with ALI during active COVID-19 infection or within 12 weeks following infection at Yashoda Super Speciality Hospitals, Hyderabad, between January 2021 and December 2022. Clinical presentation, comorbidities, COVID-19 status, laboratory parameters, Rutherford ALI classification, arterial distribution, treatment strategies, amputations, limb salvage, mortality, and follow-up outcomes up to four weeks were evaluated. A P value <0.05 was considered statistically significant.

Results: Of the 52 patients, 42 (80.9%) were male, and 65.4% were aged >50 years. Lower-limb involvement predominated (78%), and 42.3% developed ALI 2–3 weeks after COVID-19 infection. The most frequent comorbidities were type 2 diabetes mellitus (59.6%) and hypertension (48.1%), while 94.2% had elevated D-dimer levels. Clinically, coldness of the limb was present in 98.1%, pain in 84.6%, absent sensation in 21.1%, and gangrenous changes in 17.3%. Rutherford class IIb was the most frequent presentation (42.3%), followed by IIa (32.7%) and III (17.3%).

Popliteal and tibial arterial occlusions were the predominant anatomical pattern (55.8%), followed by brachial (15.4%) and femoral (11.5%) involvement. Open revascularization was performed in 40 patients (76.9%), most commonly popliteal trifurcation thromboembolectomy with vein patch angioplasty (34.6%). Trans femoral and trans brachial thromboembolectomy were each performed in 17.3%. Only one patient (1.9%) underwent endovascular thrombolysis with mechanical thrombectomy, while 11 patients (21.1%) received no revascularization because of irreversible ischemia or critical systemic illness. Fasciotomy was required in 17.3%.

Major amputation was required in 9 patients (17.3%), while 14 (26.9%) underwent minor amputations. The overall limb-salvage rate was 73%, and mortality was 19.2% (10/52). Diabetes (P=0.02), hypertension (P=0.003), coronary artery disease (P=0.006), and chronic kidney disease (P=0.018) were significantly associated with mortality.

Conclusion: COVID-19-associated ALI was characterized by predominant lower-limb involvement, frequent popliteal-tibial arterial thrombosis, elevated D-dimer levels, and a high prevalence of diabetes and hypertension. Most patients presented with threatened limbs requiring active revascularization, with open surgery being the predominant treatment strategy. Despite a 73% limb-salvage rate, major amputation and mortality occurred in 17.3% and 19.2%, respectively. Early recognition, appropriate anticoagulation, prompt assessment of limb viability, and timely revascularization remain central to optimizing early outcomes.

OBSERVATIONAL STUDY OF CONTINUOUS RENAL REPLACEMENT THERAPY USING OXIRIS FILTER AND SUSTAINED LOW EFFICIENCY DIALYSIS IN PATIENTS WITH SEPTIC ACUTE KIDNEY INJURY

2026-08-26T07:34:44+00:00

Background: Sepsis-associated acutekidney injury (AKI) is a severecomplication of critical illness andfrequently requires renal replacementtherapy (RRT). Sustained low-efficiencydialysis (SLED) andcontinuous renalreplacement therapy (CRRT) using theoXiris adsorptive hemofilter are established treatment options, althoughdirect prospective comparisons remainlimited

A STUDY OF EFFECT OF HAEMODIALYSIS ON LEFT VENTRICULAR MASS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

2026-08-26T07:46:49+00:00

Background: Cardiovascular disease isthe major cause of morbidity and mortalityamong patients with advanced chronickidney disease (CKD), and structuralcardiac abnormalities, particularly leftventricular hypertrophy (LVH), are highlyprevalent in patients receivinghaemodialysis. Chronic volume overload, hypertension, anaemia, mineral-boneabnormalities and uraemiccardiomyopathy contribute to increasedleft ventricular mass (LVM).

ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN DIABETIC FOOT ULCER: A PROSPECTIVE INTERVENTIONAL STUDY

2026-08-26T08:01:24+00:00

Background: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus and may resultin prolonged hospitalization, repeated surgical procedures and limb amputation. Management requiresassessment of the ulcer, debridement where indicated,infection control, adequate perfusion,glycaemic control, off-loading and appropriate wound care. Negative pressure wound therapy(NPWT) is an adjunctive woundmanagement modality that may facilitate wound-bed preparation, granulation tissue formation and reduction of wound dimensions. The present study evaluated theclinical efficacy and safety of NPWT in patients with diabetic foot ulcers.

Comparison of Bacterial Contamination in Bristles of Charcoal Toothbrushes versus Non-Charcoal Toothbrushes: A Randomized Clinical Trial

2026-08-26T09:56:10+00:00

Background: Toothbrush may serve as a reservoir for harbouring diverse colonies of microorganisms. For protection against toothbrush mediated oral contamination, toothbrushes with charcoal infused bristles are also available in the market. They are regarded as antibacterial in their role but limited evidence is available on their performance over an extended period of use. This study compares bacterial contamination in the bristles of charcoal versus non-charcoal toothbrushes after two weeks of routine use.

Methods: A randomized clinical trial was carried out for comparing bacterial colonization of charcoal and non-charcoal toothbrushes in n=230 dental students and house officers after two weeks of routine brushing. Both groups received identical toothpaste and standardized brushing instructions and used their assigned brush for two weeks. Bristles from their respective toothbrushes were then aseptically excised, suspended in nutrient broth, and cultured on blood agar for 24–48 hours under standard laboratory conditions. Colony-forming units (CFUs) were counted, and the two groups were compared using an independent-samples t-test, with p≤0.05 taken as significant.

Results: Charcoal bristles carried a mean of 5.1 CFUs compared with 15.0 CFUs for non-charcoal bristles, a highly significant difference (p=0.001).

Conclusions: After two weeks of daily use, charcoal-infused bristles carried substantially low bacterial load as compared to conventional non charcoal toothbrushes. Therefore charcoal infused toothbrushes resist bacterial ccolonization supporting their potential role in reducing toothbrush-related contamination.

Latch Score at Discharge as a Predictor of Exclusive Breastfeeding at Six Weeks in Healthy Term Newborns: A Prospective Observational Study

2026-08-26T11:27:57+00:00

Background: Early breastfeeding difficulties may contribute to inadequate feeding, and early discontinuation of exclusive breastfeeding (EBF). The LATCH score provides a structured assessment of breastfeeding effectiveness.

Methods: This prospective observational study included 667 mother–infant dyads at Mahaveer Institute of Medical Sciences, Vikarabad, Telangana. LATCH scores were assessed within 24 hours of birth and at discharge. Mothers were followed up at six weeks to determine feeding pattern.

Results: The mean LATCH score increased significantly from 7.11±0.825 within 24 hours to 8.78±1.082 at discharge (p=0.001). At six weeks, 501 (75.1%) infants were exclusively breastfed. A discharge LATCH score >8 predicted EBF at six weeks with 95.4% sensitivity, 91.6% specificity, and an AUC of 0.949.

Conclusion: A higher LATCH score at discharge was associated with EBF at six weeks. LATCH scoring may help identify mother–infant dyads requiring additional breastfeeding support.

Preeclampsia Prediction in Pcos Women: Identifying Biomarkers for Early Intervention and Improved Pregnancy Outcomes

2026-08-27T05:11:06+00:00

Objective: To identify clinical, metabolic, inflammatory, and angiogenic biomarkers associated with subsequent development of preeclampsia among pregnant women with polycystic ovary syndrome (PCOS).

Methods: A prospective observational cohort study of 202 women with PCOS during pregnancy. Demographic, anthropometric, obstetric, metabolic, inflammatory, and angiogenic parameters were evaluated at enrollment and followed until delivery. Appropriate comparative tests and logistic regression were used to determine association with preeclampsia. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance.

Results: In 17 (8.4%) participants, preeclampsia occurred. Women with preeclampsia also had significantly higher BMI, blood pressure, fasting glucose, HOMA-IR, triglycerides, and hs-CRP; lower PlGF; and higher sFlt-1 and sFlt-1/PlGF. HOMA-IR ≥2.5, hs-CRP >5 mg/L, lower PlGF, and higher sFlt-1/PlGF ratio were independent predictors determined by multivariable analysis. The sFlt-1/PlGF ratio had an AUC of 0.889. A combined model of HOMA-IR, hs-CRP, PlGF, and sFlt-1/PlGF had an AUC of 0.931, and a sensitivity and specificity of 88.2% and 88.1%, respectively.

Conclusion: Women with PCOS who presented with metabolic, inflammatory, and angiogenic disorders had a subsequent risk of preeclampsia. A combination of biomarkers showed good predictive performance and could help initiate earlier risk stratification and more frequent antenatal monitoring.

Association between Multidrug-Resistant Bacterial Infections, Inflammatory Hematological Indices, and Physiological Outcomes: A Predictive Analysis of Neutrophil-to-Lymphocyte Ratio, Platelet Indices, and Physiological Parameters in Bacterial Sepsis

2026-08-27T05:19:10+00:00

Background: Bacterial sepsis is still one of the most common causes of morbidity and mortality in intensive care units (ICUs) and the increasing emergence of multidrug-resistant (MDR) microorganisms only adds to the problem of prognosis and management. Identification of high risk patients early in the process is important for timely intervention. This study aimed to evaluate the predictive value of the Neutrophil to Lymphocyte Ratio (NLR), the Mean Platelet Volume (MPV), the Platelet Distribution Width (PDW) and the physiological parameters (heart rate, mean arterial pressure, respiratory rate) in the assessment of disease severity and outcome among patients with bacterial sepsis to further investigate the relationship between these variables and the presence of MDR infection.

Methods: The methods employed included a prospective cohort study at Abbottabad District Headquarters (DHQ) Hospital from January 2024 to December 2025. There were 150 adult patients diagnosed with bacterial sepsis who were enrolled. Demographic data and physiological parameters and hematological indices (NLR, MPV and PDW) were noted. To culture the blood for the presence of bacterial pathogens and their susceptibility to antimicrobial agents, blood cultures were ordered. In-hospital mortality and the development of septic shock were the main outcomes.

Resuls: The median age of the cohort was 58 years (IQR: 45-71), and there was a male predominance (58%). Acinetobacter baumannii and Klebsiella pneumoniae were the most prevalent MDR organisms, which were found in 41.3% (n=62) of patients. The NLR, MPV and PDW of patients with MDR infections were significantly higher than those with non-MDR infections (p=0.001, p=0.003 and p=0.01 respectively). A significant correlation was found between physiological parameters like increased heart rate, decreased mean arterial pressure and increased NLR and MPV. On multivariate analysis, an NLR > 12.5 (OR: 3.8, 95% CI: 2.1-6.9) and an MPV > 11.2 fL (OR: 2.9, 95% CI: 1.6-5.2) were identified as independent predictors of 28-day mortality. When added to physiological parameters (qSOFA score), NLR and MPV together showed the best predictive performance for mortality (AUC: 0.86) vs either of them alone.

Conclusion: The inflammatory hematological indices were significantly correlated with MDR infections and poor physiological status in sepsis, especially NLR and MPV. When used with clinical physiological markers, these simple, affordable markers can be used as a powerful tool for risk stratification and early identification of those patients at the highest risk for mortality, particularly in resource limited areas such as DHQ Abbottabad.

Comparative Evaluation of Laparoscopic Versus Open Surgical Management of Complicated Acute Appendicitis: Postoperative Morbidity, Recovery and Long-Term Outcome

2026-08-27T05:29:02+00:00

Background: Complicated acute appendicitis is associated with increased postoperative morbidity, prolonged hospitalization, and delayed recovery.

Objective: To compare the laparoscopic and open appendectomy in patients with complicated acute appendicitis.

Methodology: This comparative observational study was conducted at Department of General Surgery, Khairpur Medical College, Khairpur Mir’s from 1^st April 2025 to 30^th September 2025 included 282 patients with complicated acute appendicitis. Out of these, 146 underwent laparoscopic appendectomy and 136 underwent open appendectomy. Baseline characteristics, operative findings, postoperative complications, recovery parameters, readmission and long-term outcomes were compared.

Results: Baseline demographic and disease characteristics were comparable between the groups. Operative time was longer with laparoscopic appendectomy than with open appendectomy (76.5±18.7 vs. 69.4±17.1 minutes, p=0.001), whereas estimated blood loss (42.3±18.6 vs. 71.8±29.5 mL, p<0.001) and hospital stay (4.8±1.9 vs. 7.2±2.8 days, p<0.001) were lower. Laparoscopic appendectomy was associated with lower rates of surgical-site infection (8.2% vs. 19.1%, p=0.009), postoperative ileus (6.2% vs. 14.0%, p=0.031), and overall postoperative morbidity (18.5% vs. 33.8%, p=0.004). Patients in the laparoscopic group resumed oral intake and bowel function earlier, required analgesics for a shorter duration, and returned to normal activities sooner (all p<0.001).

Conclusion: Laparoscopic appendectomy was associated with lower postoperative morbidity, shorter hospitalization, and faster recovery than open appendectomy in patients with complicated acute appendicitis, without increasing intra-abdominal abscess, readmission, or reoperation rates.

Oral Biological and Periodontal Inflammatory Responses Following Endodontic Treatment of Endo-Perio Lesions

2026-08-27T06:01:08+00:00

Background: Endodontic-periodontal lesions are complex lesions that involve a combination of pulpal infection and periodontal inflammation. Pathological and anatomical connections between the pulp and periodontal tissues make it possible that a pulp infection could help to maintain periodontal tissue destruction and continuing inflammation. A comprehensive assessment of healing after endodontic therapy may be achieved by the evaluation of both clinical parameters and inflammatory markers.

Objective: To evaluate oral biological and periodontal inflammatory responses following endodontic treatment of endo-perio lesions.

Methods: This prospective clinical study included 75 patients with confirmed endodontic-periodontal lesions and was conducted from January 2025 to June 2025 at Women Dental College, Abbottabad. The parameters evaluated at baseline, 3 months and 6 months included probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival index (GI) and plaque index (PI). Interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels were measured in gingival crevicular fluid samples. Radiographic healing was also assessed as was clinical symptoms. Appropriate statistical tests, repeated measures and comparative were used to analyze data and a p value of < 0.05 was deemed to be statistically significant.

Results: Mean PPD decreased from 6.18 ± 1.27 mm at baseline to 3.29 ± 0.89 mm at six months, while mean CAL improved from 6.74 ± 1.42 mm to 3.91 ± 1.02 mm (p < 0.001). BOP declined from 72.4 ± 18.6% to 25.8 ± 13.9%, accompanied by significant improvement in GI and PI. Mean IL-1β decreased from 86.3 ± 22.7 to 43.5 ± 14.9 pg/mL, IL-6 from 41.7 ± 12.6 to 19.6 ± 7.7 pg/mL, and TNF-α from 32.8 ± 9.7 to 16.4 ± 6.2 pg/mL at six months (all p < 0.001). Overall treatment success was observed in 64 (85.3%) patients. Greater reductions in inflammatory biomarkers were associated with more pronounced periodontal improvement.

Conclusion: Endodontic treatment of endo-perio lesions was associated with significant improvement in periodontal health, reduction in local inflammatory cytokines, symptom resolution, and favorable radiographic healing. Monitoring IL-1β, IL-6, and TNF-α alongside conventional periodontal parameters may provide additional insight into biological healing following treatment.

From Burettes to Biosensors: A Review on the Advancements in Pharmaceutical Quantitative Analysis

2026-08-27T06:19:52+00:00

Quantitative analysis is the cornerstone of pharmaceutical quality assurance, ensuring the safety, efficacy, and consistency of therapeutic agents. Over the past several decades, the methodologies driving pharmaceutical quantification have undergone a profound paradigm shift, spurred by the need for greater sensitivity, selectivity, and high-throughput capabilities.

This review traces the evolutionary trajectory of pharmaceutical quantitative analysis, chronicling its transition from classical wet chemical methods to state-of-the-art analytical technologies.

The review commences with an examination of foundational classical techniques, including titrimetry and gravimetry, noting that despite their simplicity and cost-effectiveness, they present distinct limitations regarding automation and trace detection. The narrative then transitions to the advent of instrumental analysis exploring the revolutionary impact of spectrophotometric methods and chromatographic separations. Special emphasis is placed on the modern era of hyphenated techniques—such as LC-MS and GC-MS—which have redefined complex mixture analysis and impurity profiling.

By bridging the gap between historical practices and contemporary innovations, this review provides a comprehensive roadmap of pharmaceutical analysis, offering insights into future trends that will continue to shape regulatory compliance and drug development.

A Comparative Study between Efficacy of Hyperbaric Bupivacaine and Hyperbaric Levobupivacaine in the Subarachnoid Block for Cesarean Section

2026-08-27T06:25:47+00:00

Background: Spinal anaesthesia is one of the most commonly employed regional anaesthetic techniques for cesarean section. The prolonged period and reliability of the sensory blockade have made it possible to recognize bupivacaine as the gold standard of the local anaesthetic to be employed in spinal anaesthesia. However, the cardiotoxicity and neurotoxicity issues associated with bupivacaine triggered the desire to have less toxic analogy such as levobupivacaine that is the pure S-enantiomer of bupivacaine. This study aims to compare the efficacy, safety, and haemodynamic effects of bupivacaine and levobupivacaine when used for spinal anaesthesia in cesarean section.

Materials and Methods: This prospective, randomized, double-blinded study included 112 ASA II parturients scheduled for elective cesarean section. Group B received 2 ml of (10 mg) 0.5% hyperbaric Bupivacaine and Group L received 2 ml of (10 mg) 0.5% hyperbaric Levobupivacaine intrathecally. Sensory and motor block characteristics, duration of effective analgesia, neonatal outcome, and incidence of side effects were compared.

Results: Both drugs achieved effective spinal anaesthesia. The onset of sensory block was comparable between Groups B and L (2.39±0.30, 2.60±0.71 mins, p=0.29). The onset of motor block was fastest in Group B (p<0.001). The duration of sensory block (153.96±12.37, 142.06±11.64 mins), motor block (146.48±12.24, 138.23±11.26 mins, p=0.012), and analgesia (137.21±5.16, 130.16±8.06 mins, p=0.037) were longer in Groups B compared to Group L. Levobupivacaine was associated with significantly greater hemodynamic stability and a lower incidence of side effects such as hypotension, and nausea/vomiting.

Conclusion: Levobupivacaine is a safer and clinically effective alternative to Bupivacaine for spinal anaesthesia in cesarean sections, offering enhanced hemodynamic stability and quicker recovery without compromising anaesthetic efficacy.

Association between Student Participation in PBL Sessions and Performance in Integrated Modular Examinations

2026-08-27T06:59:43+00:00

Background: Problem-based learning (PBL) is widely used in integrated medical curricula to promote active learning, collaborative problem-solving, communication, and application of knowledge to clinical scenarios. There are, however, considerable variations between students in their active involvement in PBL sessions and it is important to further study the correlation between student involvement during PBL sessions and examination scores.

Objective: To determine the association between student participation in PBL sessions and performance in integrated modular examinations among undergraduate medical students.

Methods: This analytical cross sectional study was carried out in Rawal Institute of Health Sciences between March 2025 and September 2025. 85 undergraduate medical students were involved. The extent of participation in PBL was evaluated by attendance data and tutor assessment of knowledge gained through preparation, knowledge shared during group discussion, problem solving, collaborative efforts, and overall involvement. The students were divided into three groups – low, moderate and high participation groups. Academic achievement was measured by the scores earned in the integrated modular examination for the same academic standards. Descriptive statistics, one-way analysis of variance, Chi-square test, correlation analysis and multiple linear regression were used to analyze data. The significance of p value was <0.05.

Results: The mean PBL attendance was 82.6 ± 11.7%, while the mean overall active participation score was 73.9 ± 12.8%. Of the 85 students, 21 (24.7%) had low participation, 34 (40.0%) had moderate participation, and 30 (35.3%) had high participation. Mean integrated modular examination scores increased significantly across participation groups, from 63.2 ± 8.1% in the low-participation group to 72.2 ± 7.4% in the moderate group and 79.1 ± 7.0% in the high-participation group (p < 0.001). Examination pass rates were 61.9%, 82.4%, and 93.3%, respectively (p = 0.018). Overall active participation showed a strong positive correlation with examination score (r = 0.62, p < 0.001), while attendance demonstrated a moderate positive correlation (r = 0.48, p < 0.001). In multivariable analysis, active PBL participation and attendance remained significant independent predictors of examination performance.

Conclusion: Higher participation in PBL sessions was significantly associated with better performance in integrated modular examinations. Active engagement demonstrated a stronger relationship with academic achievement than attendance alone. These findings support the use of structured PBL activities that encourage meaningful student participation, discussion, preparation, and problem-solving within integrated medical curricula.

Developing Aptasensors for Periodontitis Associated Biomarkers Detection in Saliva: A +

2026-08-27T07:17:50+00:00

Objective: To evaluate the effectiveness of Aptasensors in detecting salivary biomarkers linked to periodontitis.

Method: The literature search for this systematic review was conducted using the keywords "Aptasensors/Biosensors," "oral biomarkers," "oral diseases," "saliva," and "Aptamers" in the 'PubMed' and 'Google Scholar' databases for articles published between 2015 and 2025. The initial search yielded 249 publications relevant to the selected 10-year period of the study. After a thorough systematic review and application of the inclusion criteria, 13 studies were included.

Results: This review has demonstrated that Aptasensors had achieved exceptional sensitivity for periodontitis associated biomarkers, analyzing ODAM at 1.63 nM, HBD-2 at 6.8 nM, and cortisol in the low nanomolar range. Aptamer specific for Tannerella forsythia had also shown great specificity with minimal cross-reactivity. These innovative approaches had been successfully applied for periodontitis diagnosis, with a versatile multi-platform technique for ODAM (Lateral Flow, SPR, GO-FRET), a wearable smartwatch for cortisol analysis, and flow cytometry for periodontitis associated microbes’ identification. The integration of Aptamers into Biosensors had enabled detection of periodontal disease and its associated stress conditions, in saliva and gingival crevicular fluid respectively, facilitating real-time analysis and early, chair-side diagnosis

Conclusions: Aptasensors are highly sensitive and specific, offering real-time analysis of underlying conditions by examining targeted biomarkers in saliva.

Assessment of Baseline Oral Health Knowledge and Practices among Adult Oral Cancer Patients Undergoing Chemotherapy

2026-08-27T08:16:42+00:00

Background: Oral issues of patients with oral cancer (OC) receiving chemotherapy include mucositis, xerostomia, dental caries, periodontal disease, oral infection and oral hygiene problems. An appropriate baseline knowledge and oral health practices could help to minimize such complications and enhance oral health-related quality of life related to treatment.

Objective: The aim was to assess the knowledge on oral health and oral hygiene practices among oral cancer patients before their commencement of chemotherapy.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Conducted in the department of Community and Preventive Dentistry, Shahida Islam Dental College, Lodhran from December 2025 to June 2026.

Methodology: A total of 130 oral cancer patients who were undergoing chemotherapy were included using a non-probability consecutive sampling technique. The sample size was calculated using the WHO sample size formula. Data was collected through an interviewer-administered structured questionnaire covering sociodemographic characteristics, oral health knowledge, oral hygiene practices, dental visits, and chemotherapy-related oral care. The data collected were analyzed using SPSS.

Results: The study showed that many patients had inadequate knowledge about oral health and were not following sufficient preventive oral health practices.

Conclusion: Baseline oral health knowledge and practices can be used to determine patients who may need specific oral health education and preventive dental treatment prior to and during chemotherapy.

Comparative Study of Fascia Iliaca Block vs. Femoral Nerve Block for Postoperative Pain Management in Hip Fractures

2026-08-27T08:56:52+00:00

Introduction: An effective postoperative analgesia as part of hip fracture management is key in optimising the recovery of a patient. Of the available regional specific techniques of administration of Anesthesia, the Fascia Iliaca Compartment Block (FICB), and the Femoral Nerve Block (FNB) have become routine in regards to perioperative Anesthesia of Hip surgery. However, there is still a scholarly debate concerning the relative efficacy of the two procedures. For this reason the study that will be conducted aims to critically evaluate and compare the analgesic strength of the FICB and FNB when it comes to ensuring a postoperative pain relief of elective hip arthroplasty patients.

Methodology: It was a prospective, randomized, and comparative study done at Central Park Teaching Hospital, Lahore between June 10, 2024, and December 9, 2024. Eighty individuals coming to elective hip arthroplasty were recruited into two groups randomly: FICB and FNB. All subjects were given spinal anesthesia. The assessment of pain applying the Numeric Rating Scale (NRS) was conducted both prior to the nerve block operation and within the action of spinal anesthesia. The data are interpreted using SPSS version 25.0 with p-value of p 0.05.

Results: The score pain at the time of pre-block did not differ between the two groups (p=0.196). Nonetheless, the participants in the fascia iliaca compartment block (FICB) group reported significantly reduced pain scores during spinal anesthesia positioning (1.90±0.74) when compared to those registered in the fascia neutraflex block (FNB) group (2.78±0.83) post-the commencement of the procedure (p=0.001).

Conclusion: Comparison of fentanyl with caudal bupivacaine (FICB) with fascia iliaca nerve block (FNB) used in reducing preoperative pain during spinal anesthesia positioning in individuals undergoing hip arthroplasty inception showed a significant difference in the pain reduction (p<0.05) with FICB being more effective. It can, therefore, be concluded that FICB is the most optimal local anesthetic method that should be used in the preoperative pain management of hip fracture surgical procedures.

Assessment of the Efficacy of Bisphosphonates and Teriparatide Treatment on Lumbar Spine Fusion Surgery Outcomes

2026-08-27T09:20:15+00:00

Objective: To compare the efficacy of bisphosphonate and teriparatide therapy in improving radiological fusion and clinical outcomes among patients undergoing lumbar spine fusion surgery.

Methods: A comparative cohort study was conducted at Bahria International Hospital Rawalpindi Pakistan from January 2026 to June 2026. Ninety patients undergoing instrumented lumbar spinal fusion surgery were included. Forty-five patients received teriparatide and 45 patients received bisphosphonate therapy. Radiological fusion, postoperative pain, functional disability and postoperative mechanical complications were evaluated. Multivariable logistic regression was used to identify independent predictors of successful fusion.

Results: Fusion at three months was observed in 53.3% of the teriparatide group and 28.9% of the bisphosphonate group. At six months, fusion was achieved in 86.7% and 64.4% respectively. Mean time to fusion was shorter with teriparatide. Greater reductions in visual analogue scale and Oswestry Disability Index scores were also observed with teriparatide. Mechanical complications occurred in 13.3% of patients receiving teriparatide compared with 35.6% receiving bisphosphonates. Teriparatide remained independently associated with successful lumbar spinal fusion.

Conclusion: Teriparatide was associated with faster fusion, better functional recovery and fewer mechanical complications than bisphosphonate therapy following lumbar spinal fusion surgery.

Prognostic Accuracy of Albumin Bilirubin Score for Outcomes of In-Hospital Patients with Heart Failure

2026-08-28T05:23:44+00:00

Background: Hepatic congestion and hypoperfusion are integral to heart-failure (HF) pathophysiology and lead to hyper-bilirubinaemia and hypo-albuminaemia. The logarithmic Albumin–Bilirubin (ALBI) score, already validated in hepatology, may provide an inexpensive prognostic marker in HF, but data for acute, in-hospital outcomes remain sparse.

Objective: To compare the prognostic accuracy of ALBI with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and with a composite (ALBI + NT-proBNP) for predicting all-cause in-hospital mortality among adults admitted with acute HF.

Methods: In this 18-month prospective cohort at a tertiary centre in New Delhi (n = 100, Framingham criteria), serum albumin, total bilirubin and NT-proBNP were assayed within 24 h of admission; ALBI was calculated as −0.0852 × albumin (g L⁻¹) + 0.66 × log₁₀(bilirubin µmol L⁻¹). Primary end-point was in-hospital death. Discrimination was examined with ROC curves.

Results: Mean age 52.6 ± 16.4 y; 63 % male. Mortality occurred in 39 %. Median ALBI −2.20 (IQR −2.68 to −1.59). An ALBI threshold ≥ −2.08 yielded 90 % sensitivity and 79 % specificity; AUROC = 0.889 versus 0.776 for NT-proBNP (cut-off ≥ 10 242 pg mL⁻¹). The composite marker achieved AUROC = 0.929 (p = 0.001 vs NT-proBNP). Across HF phenotypes, ALBI ≥ −2.27 identified 93.5 % of deaths in HFrEF and 100 % in HFmrEF.

Conclusions: A single ALBI measurement on admission is non-inferior to NT-proBNP and markedly enhances prognostic accuracy when combined with NT-proBNP. Given its negligible cost and bedside availability, ALBI offers a practical risk-stratification tool, particularly where natriuretic-peptide assays are inaccessible.

Comparative Evaluation of Linear Rail System and Ilizarov Ring Fixator in the Management of Infected Tibial Nonunion: A Prospective Comparative Study

2026-08-28T05:41:17+00:00

Background: One of the most challenging conditions seen in orthopedics is infected nonunion of the tibia due to its complexities associated with persistent infection, poor vascularity, bone loss, deformity, limb-length discrepancy and compromised soft-tissue coverage. In such cases, a successful treatment requires eradication of infection, radical removal of nonviable bone, restoration of mechanical stability and, when required, reconstruction of the resultant bone defect. Ilizarov circular external fixation has been widely used for the management of infected tibial nonunion. It permits compression, distraction, deformity correction and bone lengthening. An alternative method for managing such cases is Linear Rail systems, that provides external fixation and may offer advantages in terms of application, postoperative management and patient comfort.

Aim: To compare the clinical and radiological outcomes of linear rail system (LRS) fixation and Ilizarov ring fixation in the treatment of infected tibial nonunion.

Materials and Methods: This prospective comparative study included 34 patients with infected nonunion of the tibia involving the proximal, middle or distal third. Fourteen patients were treated with a linear rail system, 15 patients were treated with an Ilizarov ring fixator and 5 patients dropped out of study. Patients with infected nonunion with an implant in situ, infected nonunion of less than 9 months duration and patients with atrophic nonunion of another long bone, such as the femur, in the same limb were excluded. In the LRS group, radical debridement of the infected nonunion was performed, including excision of the infected bone segment and fibular osteotomy where required. The medullary canal was opened and acute docking of the healthy bone ends was achieved using the LRS. A proximal or distal corticotomy was subsequently performed depending upon the location of the docking site. Distraction at the corticotomy site was initiated after a latency period of 7 days, while compression was continued at the docking site. Patients treated with Ilizarov fixation underwent radical debridement followed by application of a standard Ilizarov frame, with compression, acute docking and/or distraction osteogenesis according to the bone defect and operative findings. Outcomes were assessed using union rate, time to union, ASAMI bone and functional scores, pin-tract infection and limb-length discrepancy.

Results: Fourteen of 14 patients in the LRS group achieved union, giving an observed union rate of 100%, whereas 12 of 15 patients in the Ilizarov group achieved union, giving an observed union rate of 80%. The mean time to union was approximately 6 months in the LRS group compared with 8 months in the Ilizarov group; giving an inference of overall ASAMI bone outcome be excellent in the LRS group and good in the Ilizarov group. The overall ASAMI functional outcome was predominantly good in the LRS group and fair in the Ilizarov group. Pin-tract infection occurred in one patient in the LRS group and three patients in the Ilizarov group. Limb-length discrepancy occurred in one patient in the LRS group and three patients in the Ilizarov group.

Conclusion: Both linear rail and Ilizarov external fixation are an effective management approach for infected tibial nonunion. In the present study, LRS fixation was associated with a higher observed union rate, shorter mean time to union, better overall ASAMI bone and functional outcomes and fewer reported complications. Therefore, LRS may represent a useful alternative to circular fixation in appropriately selected patients with infected tibial nonunion.

Gasserian Ganglion Radiofrequency Ablation for Trigeminal Neuralgia: A Resident’s Experience of 23 Consecutive Cases and the Procedural Learning Curve

2026-08-28T05:46:54+00:00

Background: Trigeminal neuralgia is a severe neuropathic pain disorder characterized by recurrent paroxysmal facial pain in the distribution of one or more divisions of the trigeminal nerve. Although pharmacological therapy remains the initial treatment, patients with refractory symptoms or medication intolerance may require interventional treatment. Percutaneous procedures targeting the Gasserian ganglion, particularly radiofrequency (RF) thermocoagulation, provide an effective minimally invasive option.^[1,2]

Percutaneous access to the Gasserian ganglion through the foramen ovale is technically demanding and requires familiarity with skull-base fluoroscopic anatomy and three-dimensional needle trajectory. This is particularly relevant during residency training in interventional pain medicine.^[2,11]

Objective: To describe our experience with 23 consecutive percutaneous procedures for trigeminal neuralgia, predominantly Gasserian ganglion Radiofrequency ablation, with particular emphasis on clinical outcome, duration of pain relief, technical successand the progressive acquisition of fluoroscopic and needleplacement skills by residents.
Methods: A retrospective descriptive review was performed of 23 consecutive patients undergoing percutaneous treatment for trigeminal neuralgia at our institution. Twenty-two patients underwent Gasserian ganglion RF ablation, and one patient underwent balloon compression. The affected trigeminal division, duration of pain relief, technical success, clinical success, and resident participation in identification of the foramen ovale and needle placement were documented.^[1,2]

Of the 23 patients, 4 had V1 involvement, 2 had V2 involvement, and 17 had V3 involvement. Technical success was defined as successful completion of the intended percutaneous procedure, while clinical success was defined according to meaningful post-procedural pain relief as documented during follow-up.^[1]

Results: All 23 procedures were technically successful and all 23 patients achieved clinical success. The mean duration of pain relief was approximately 18 months, with a median duration of 18 months, ranging from 2 weeks to 3 years.^[3,5]

Residents were able to independently identify the foramen ovale in 14 of 23 cases (60.9%). Independent needle placement into the foramen ovale was achieved in 10 of 23 cases (43.5%). The data demonstrated a progressive improvement in resident procedural capability over the case series, with independent needle placement occurring in the later cases.^[12,13]

Conclusion: Our experience demonstrates that Gasserian ganglion RF ablation can provide substantial and prolonged pain relief in appropriately selected patients with trigeminal neuralgia. Importantly, the series also demonstrates a progressive resident learning curve in fluoroscopic identification of the foramen ovale and percutaneous needle placement. Structured supervision, repeated exposure to skull-base fluoroscopic anatomyand correlation of radiological landmarks with three-dimensional needle trajectory appear to be important components of training in this technically demanding procedure.^[3,4,5]

Immediate Breast Reconstruction Following Modified Radical Mastectomy: A Comparative Study of Mastectomy Alone Versus Mastectomy with Immediate Reconstruction

2026-08-28T06:43:29+00:00

Background: Mastectomy remains necessary for asubstantial proportion of women with breastcarcinoma. Although oncologically appropriate,removal of the breast may adversely affect bodyimage, psychological well-being and quality oflife. Immediate breast reconstruction aims torestore breast contour at the same operative sittingand may reduce the psychosocial burdenassociated with mastectomy

Correlation of Ultrasonographic Fatty Liver Grading with Liver Function Tests in Patients with Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study

2026-08-28T06:46:37+00:00

Background: Non-alcoholic fatty liver disease (NAFLD) is a common metabolicliver disorder ranging from simple steatosisto steatohepatitis, fibrosis and cirrhosis.Ultrasonography is widely used for detectingand grading hepatic steatosis, while liverfunction tests provide biochemical evidenceof hepatocellular injury, cholestasis andsynthetic dysfunction. The relationship
between ultrasonographic severity and biochemical abnormalities requires furtherevaluation.

COMPARATIVE PROSPECTIVE STUDY OF OUTCOME BETWEEN EARLY VERSUS DELAYED SURGERY IN SPONTANEOUS CEREBRAL BLEED AT GGH, KAKINADA, (TERTIARY CARE CENTRE)

2026-08-29T04:58:49+00:00

Introduction: Spontaneous intracerebral bleed represents a severe neurological pathology that often results in lifelong disability.[1] Owing to the variability in bleed location and size, patients have a variety of clinical syndromes and deficits, making standardization of treatment protocols difficult and impossible. There is evidence to support both medical and surgical management; however, the literature is largely lacking in data that can define the optimal management strategy and timing of intervention.

COMPARISON OF SERUM URIC ACID LEVELS AMONG PATIENTS ON SGLT2 INHIBITORS AND THOSE NOT ON SGLT2 INHIBITORS.

2026-08-29T05:03:36+00:00

Background: SGLT2 are exclusively expressed in kidneys, especially in early proximal tubule and promotes reabsorption of 80-90% of glucose filtered by glomerulus. Uric acid is a weak acid generated from the metabolism of purine and that high circulating uric acid levels may increase risk of type 2 diabetes, metabolic syndromes. SGLT2 inhibitors has demonstrated an effect in reducing serum urate levels among patients with type 2 diabetes mellitus.

Menopausal Symptoms In Urban Versus Rural Women Aged Above 40 Years in Central India: A Cross-Sectional Study

2026-08-29T05:19:09+00:00

Background: Menopause is a critical period in a woman’s life that not only marks the end of reproductive ability but is also associated with multiple physical, vasomotor, psychological, and sexual complaints.

Aim & objective: To compare menopausal symptoms among urban and rural women aged above 40 years using Menopausal Rating scale.

Materials & methods: A community based cross sectional study was carried out in urban and rural Field practice area of Government Medical College, Nagpur. This study included 180 women from both urban and rural area of age above 40 years and menopausal symptoms were assessed using Menopausal Rating Scale.

Result: The most prevalent symptom reported among urban & rural women was joint & muscular discomfort i.e. 140(77.8%) & 121(67.2%). Significantly higher proportions of urban women have moderate to severe scores for somatic and psychological domains like joint & muscular discomfort, sleep problem, irritability, physical & mental exhaustion whereas higher proportion of rural women have urogenital symptoms.

Conclusions: Higher proportions of women are suffering from menopausal symptoms with variation in prevalent symptoms among urban & rural women.

Hypertensive Retinopathy as a Window to Kidney Damage: A Severity Assessment Study in CKD Patients of Bastar, Chhattisgarh, India

2026-08-29T05:34:17+00:00

Background: Hypertension is a major contributor to chronic kidney disease (CKD) and systemic target-organ damage. Because the retinal and renal microvasculature share anatomical and physiological characteristics, hypertensive retinopathy may provide a non-invasive clinical marker of renal disease severity. This study assessed the severity of hypertensive retinopathy and its association with CKD stage in hypertensive patients.

Methods: A cross-sectional observational study was conducted over 15 months among 100 hypertensive patients aged ≥18 years with diagnosed CKD. Patients with diabetes mellitus, renal vascular abnormalities, glomerulonephritis, congenital renal anomalies, and renal tumours were excluded. All participants underwent detailed ophthalmic examination, including visual acuity, intraocular pressure measurement, and dilated fundus examination. Hypertensive retinopathy was graded using the Keith-Wagener-Barker classification. Blood pressure, CKD stage, serum creatinine, blood urea, and estimated glomerular filtration rate were recorded. Statistical analysis was performed using SPSS version 26, with p <0.05 considered statistically significant.

Results: The mean age of participants was 45.98 ± 14.45 years, with 54% females and 46% males. Hypertensive retinopathy was present in 84% of patients. Grade 1, 2, 3, and 4 retinopathy were observed in 20%, 32%, 24%, and 8% of patients, respectively. A statistically significant association was observed between CKD stage and severity of hypertensive retinopathy (p <0.05). Severe retinopathy (Grades 3–4) was more frequently observed in advanced CKD, particularly stages 4 and 5, whereas milder grades predominated in earlier CKD stages. Grade 4 retinopathy was associated with poorer visual acuity. Anaemia was present in 84% of patients and showed a significant association with CKD severity (p = 0.0085). No significant association was observed between intraocular pressure and retinopathy severity.

Conclusion: The study demonstrates a significant relationship between hypertensive retinopathy severity and CKD stage. Fundoscopic examination may therefore serve as a simple, non-invasive and cost-effective method for identifying hypertensive CKD patients at increased risk of advanced renal disease and visual impairment, particularly in resource-limited settings.

Comparative Study of Lateral Internal Sphinterotomy versus Anal Advancement Flap in the Treatment of Chronic Anal Fissure: A Randomized Controlled Trial

2026-08-29T05:47:12+00:00

Background: Chronic anal fissure (CAF) is a common benign anorectal disorder characterized by severe pain during defecation, rectal bleeding, and impaired quality of life. Although lateral internal sphincterotomy (LIS) remains the standard surgical treatment because of its high healing rates, concerns regarding postoperative fecal incontinence have encouraged the development of sphincter-preserving procedures such as anal advancement flap (AAF). This study aimed to compare the short-term clinical outcomes of LIS and AAF in the management of chronic anal fissure.

Methods: A randomized controlled trial was conducted in the Department of Surgery, Nishtar Medical University and Hospital, Multan, Pakistan. A total of 142 patients with chronic anal fissure were randomly allocated into two equal groups: Group A underwent lateral internal sphincterotomy (n = 71), while Group B underwent anal advancement flap surgery (n = 71). Patients were followed for eight weeks after surgery. Primary outcome measures included symptom resolution, complete fissure healing, and fecal incontinence assessed using the Wexner Fecal Incontinence Score. Secondary outcomes included postoperative wound infection and recurrence. Statistical analysis was performed using SPSS version 26, and a p-value ≤0.05 was considered statistically significant.

Results: The estimated mean age was 36.0 ± 12.2 years in the LIS group and 35.5 ± 11.8 years in the AAF group, with comparable baseline demographic characteristics between the groups. Symptom resolution was achieved in 51 (71.8%) patients undergoing LIS compared with 63 (88.7%) patients treated with AAF (p = 0.01). Complete fissure healing at eight weeks occurred in 56 (78.9%) patients in the LIS group and 67 (94.4%) patients in the AAF group (p = 0.006). Postoperative fecal incontinence was significantly lower following AAF than LIS (1.4% vs. 14.1%; p = 0.005). Although postoperative wound infection (5.6% vs. 12.7%) and recurrence (2.8% vs. 9.9%) were less frequent after AAF, these differences were not statistically significant.

Conclusion: Anal advancement flap demonstrated superior short-term clinical outcomes compared with lateral internal sphincterotomy, with significantly higher rates of symptom resolution and fissure healing and a markedly lower incidence of postoperative fecal incontinence. As a sphincter-preserving procedure, AAF represents a safe and effective surgical alternative for the treatment of chronic anal fissure, particularly in patients at increased risk of continence impairment.

Effectiveness of Non-Invasive Ventilation in Preventing Intubation in Acute Respiratory Failure

2026-08-29T05:59:56+00:00

Objective: The purpose of this study was to assess the Outcomes Associated with Non-Invasive Ventilation (NIV) in the prevention of invasive mechanical ventilation in patients with severe respiratory distress.

Methods: This was an analytical cross-sectional study conducted at the Pulmonology Departments of Doctors Hospital and Farooq Hospital, Lahore. Overall, 160 Patients meeting the diagnostic criteria for acute respiratory failure were included in the study. With acute respiratory failure were included in the study using consecutive sampling. Patients were managed with NIV and monitored for outcomes including the need for intubation. Clinical parameters, comorbidities, and response to NIV were recorded. Statistical analysis was performed using SPSS software version 27, A p-value of <0.05 was considered statistically significant.

Results: Out of 160 patients, 104 (65%) showed successful response to NIV, while 56 (35%) required intubation. Patients with successful NIV had significantly higher PaO₂ and SpO₂ levels and lower respiratory rates compared to those who failed NIV (p<0.001). Severe hypoxemia, delayed initiation of NIV, and presence of comorbidities were significantly associated with NIV failure.

Conclusion: NIV is a valuable supportive modality that reduces the need for intubation in acute respiratory failure in reducing the need for intubation in acute respiratory failure, particularly when initiated early and applied to appropriately selected patients.

HAEMODYNAMIC STABILITY AND ADVERSE EFFECTS OF INTRATHECAL NALBUPHINE VERSUS FENTANYL AS ADJUVANTS TO HYPERBARIC BUPIVACAINE IN LOWER LIMB SURGERY

2026-08-29T08:46:20+00:00

Background: Intrathecal opioids improve the quality and duration of spinal anaesthesia but may produce haemodynamic and opioid-related adverse effects. Nalbuphine has been proposed as an alternative to fentanyl because of its potentially favourable adverse-effect
profile. This study compared perioperative haemodynamic changes and adverse effects following intrathecal nalbuphine or fentanyl combined with hyperbaric bupivacaine.

Relationship between Salivary Flow Rate, Salivary Protein Concentration and Dental Caries Experience among Young Adults in Peshawar, Pakistan

2026-08-29T10:10:30+00:00

Background: Dental caries is a multifactorial, biofilm-mediated disease influenced by microbial, dietary, behavioral and host-related factors. Saliva is an important host-protective factor because it contributes to oral clearance, acid buffering, antimicrobial defense and remineralization of dental hard tissues. Both the quantity and composition of saliva may influence susceptibility to dental caries. Salivary flow rate and protein concentration are relatively simple, non-invasive parameters that may provide useful information about an individual's caries experience.

Objective: To determine the relationship between unstimulated salivary flow rate, total salivary protein concentration and dental caries experience among young adults in Peshawar, Pakistan.

Methods: An analytical cross-sectional study was conducted among 150 young adults aged 18–30 years in Peshawar, Pakistan. Dental caries experience was assessed using the Decayed, Missing and Filled Teeth (DMFT) index. Unstimulated whole saliva was collected over five minutes under standardized conditions. Salivary flow rate was calculated in mL/min, while total salivary protein concentration was determined using a colorimetric biochemical assay and expressed in mg/mL. Descriptive statistics, independent-samples t-test, Pearson correlation and multiple linear regression were performed. Statistical significance was set at p<0.05.

Results: The mean age of participants was 23.8±3.1 years. The mean DMFT score was 3.2±2.8. The mean unstimulated salivary flow rate was 0.31±0.14 mL/min, while the mean total salivary protein concentration was 1.02±0.36 mg/mL. Participants with high caries experience had significantly lower salivary flow rates than those with low/no caries experience (0.27±0.13 vs. 0.36±0.12 mL/min; p<0.001). Conversely, total salivary protein concentration was significantly higher among participants with high caries experience (1.12±0.38 vs. 0.92±0.30 mg/mL; p=0.002). Salivary flow rate demonstrated a significant negative correlation with DMFT (r=-0.36, p<0.001), whereas total protein concentration demonstrated a significant positive correlation with DMFT (r=0.29, p<0.001). In multivariable regression analysis, salivary flow rate and total protein concentration remained significantly associated with DMFT after adjustment for age, sex, sugar consumption and tooth-brushing frequency.

Conclusion: Reduced unstimulated salivary flow rate and increased total salivary protein concentration were associated with greater dental caries experience among young adults in Peshawar. The findings support the potential value of salivary parameters as supplementary indicators of caries susceptibility. However, longitudinal studies and investigation of individual salivary proteins are required before these parameters can be considered reliable predictive biomarkers.

COMPARATIVE OUTCOMES OF SURGICAL INCISIONS MADE WITH DIATHERMY VERSUS SCALPEL WITH LOCAL LIGNOCAINE-ADRENALINE INFILTRATION IN CLEAN AND CLEAN-CONTAMINATED SURGERY

2026-08-29T11:12:00+00:00

Background: Scalpel and diathermy are widely used for surgical skin incisions. Diathermy provides simultaneous tissue division and coagulation, whereas scalpel incision combined with local lignocaine and adrenaline infiltration may provide haemostasis while avoiding thermal tissue injury. This study compared perioperative and scar-related outcomes of the two techniques in clean and clean-contaminated surgery.

ACUTE MESENTERIC ISCHEMIA: A RETROSPECTIVE CASE SERIES FROM A TERTIARY CARE CENTRE

2026-08-29T11:20:40+00:00

Background: Acute mesenteric ischemia (AMI) is a life-threatening surgical condition caused by interruption of intestinal blood supply and may progress rapidly to bowel necrosis, sepsis and death.Delayed diagnosis remains a major challenge.
Aim: To review the clinical presentation, radiological spectrum, operative management and outcomes of surgically treated patients with AMI at a tertiary care centre, with particular attention to revascularization and non-revascularization strategies.

Correlation Between Cervical Cytology, Human Papillomavirus Detection, and Hematological Parameters in Women with Cervical Lesions

2026-08-29T11:41:47+00:00

Cervical cancer remains a significant global health challenge, driven predominantly by persistent high-risk Human Papillomavirus (hrHPV) infection and progressive intraepithelial neoplasia.Beyond cytological dysplastic changes, systemic host factors—including systemic inflammatory responses, peripheral immune profiles, and hematological indices—play a crucial role in lesion persistence and malignant transformation.

Machine Learning Prediction of Depression and Anxiety through Social Media and Psychosocial Factors: A Population Mental Health Approach

2026-08-29T11:49:19+00:00

Mental health disorders, particularly depression and anxiety, represent a growing global burden with significant social, economic, and healthcare implications. Early identification of high-risk individuals remains a critical challenge in population mental health management. The present population-based experimental study aimed to develop and evaluate machine learning models for predicting depression and anxiety using integrated clinical, behavioral, and psychosocial variables.

Heart Rate Variability and Ewing's Battery-Derived Cardiac Autonomic Neuropathy in Prediabetic versus Healthy Adults: A Case-Control Study from Central India

2026-08-31T05:49:55+00:00

Aims: Prediabetes affects an estimated 136 million Indian adults, with central India identified as a region of disproportionate burden. We assessed and compared heart rate variability (HRV) and Ewing's-battery-derived cardiac autonomic neuropathy (CAN) between prediabetic and healthy adults, and correlated autonomic indices with clinical and biochemical parameters.

Methods: In this age- and sex-matched case-control study, 100 prediabetic adults (ADA 2024 criteria) and 100 healthy controls underwent anthropometric and biochemical assessment, 5-minute resting HRV recording, and the five-test Ewing battery. Between-group comparisons used the independent t-test/Mann-Whitney U test, Chi-square/Fisher's exact test, Pearson/Spearman correlation, and multiple linear regression (α=0.05).

Results: All time- and frequency-domain HRV parameters and all five Ewing-battery components were significantly impaired in prediabetic participants (p<0.001). CAN, graded by composite Ewing score, was present in 100% of prediabetic participants (63% Early, 21% Definite, 16% Severe) versus 3% of controls (p<0.001). Within the prediabetic group, waist circumference, not BMI or glycaemic indices, was the only significant independent predictor of SDNN (β=−0.68 ms/cm, p=0.019; model R²=0.114).

Conclusions: Cardiac autonomic dysfunction is already measurable, and in this cohort near-universal, in prediabetic adults, and correlates more consistently with central adiposity than with glycaemia. These findings support incorporating brief, non-invasive autonomic screening into the routine evaluation of prediabetic individuals in high-burden Indian populations.

Post-Obturation Pain Following Single-Visit Versus Two-Visit Endodontic Treatment Using A Hybrid Root Canal Preparation Technique

2026-08-31T06:04:45+00:00

Background and Objective: The number of appointments required to complete root canal treatment remains a clinically relevant consideration, particularly because postoperative pain can influence patient comfort and treatment acceptance. This study compared the frequency of post-obturation pain 24 hours after single-visit and two-visit endodontic treatment performed using a hybrid root canal preparation technique.

Materials and Methods: This randomized clinical trial was conducted in the Operative Dentistry Department of Nishtar Institute of Dentistry, Multan, Pakistan, from 1^st January 2023 to 30^th June 2023. One hundred forty patients aged 12–40 years with acute pulpitis or asymptomatic non-vital maxillary anterior teeth through first molars were allocated equally to a single-visit group (n=70) or a two-visit group (n=70). Both groups underwent the same hybrid canal preparation protocol. Postoperative pain was assessed 24 hours after treatment using the Heft-Parker visual analogue scale. Categorical variables were compared using the chi-square test, with p≤0.05 considered statistically significant.

Results: At 24 hours, 18/70 (25.7%) patients in the single-visit group reported pain compared with 38/70 (54.3%) in the two-visit group. No pain was reported by 52/70 (74.3%) and 32/70 (45.7%) patients, respectively. The between-group difference was statistically significant (χ² test, p=0.001). Age and sex were not significantly associated with pain within either treatment group.

Conclusion: In this study population and under the treatment protocol used, single-visit endodontic treatment was associated with a lower frequency of pain at 24 hours than two-visit treatment. However, the findings should be interpreted in the context of the study's limited follow-up, single-center design, and the evolving evidence base regarding the influence of treatment visits on postoperative pain.

Association of Smoking, Nutritional Status, and Socioeconomic Factors with Radiographic Evidence of Delayed Fracture Healing

2026-08-31T06:16:18+00:00

Background: Fracture healing is influenced by a complex interaction of biological, behavioral, nutritional, and socioeconomic factors. Other factors such as smoking, which may negatively affect vascularity and osteogenesis, and malnutrition or socioeconomic disadvantage, which may negatively impact on the physiologic processes involved in bone repair, can also adversely affect the healing of fractures.

Objective: To determine the association of smoking, nutritional status, and socioeconomic factors with radiographic evidence of delayed fracture healing.

Methods: This analytical cross-sectional study was conducted at the Rawal Institute of Health Sciences from January 2025 to June 2025. Using non-probability consecutive sampling, a total of 86 cases of adult fractures were included in the study based on the patients' radiographs. Demographic data, smoking habits, nutritional indicators, serum albumin, hemoglobin level, socio-economic status, fracture characteristics, and radiographic healing were obtained. The healing of fractures was evaluated by serial roentgenograms by the methods of callus formation, formation of the bone line, persistence of the fracture line and overall progress toward healing. Chi-square or Fisher's exact test was used for analysis and multivariable binary logistic regression for associations. A p value <0.05 was deemed to be statistically significant.

Results: Delayed radiographic fracture healing was identified in 29 of 86 patients (33.7%). Delayed healing was more frequent among smokers than non-smokers (51.4% vs. 21.6%, p=0.004), among patients who were nutritionally at risk or malnourished compared with well-nourished patients (54.8% vs. 21.8%, p=0.006), and among those with low serum albumin compared with normal albumin levels (61.9% vs. 24.6%, p=0.003). Low socioeconomic status was also significantly associated with delayed healing (p=0.018). On multivariable analysis, current smoking (AOR=3.21, 95% CI: 1.22–8.43), poor nutritional status (AOR=2.84, 95% CI: 1.07–7.56), low serum albumin (AOR=3.47, 95% CI: 1.18–10.20), and low socioeconomic status (AOR=2.73, 95% CI: 1.01–7.39) remained independent predictors of delayed fracture healing.

Conclusion: Smoking, inadequate nutritional status, hypoalbuminemia, and socioeconomic disadvantage were significantly associated with delayed radiographic fracture healing. Early identification and modification of these risk factors may contribute to improved fracture-healing outcomes.

Morphometric Analysis of the Glenoid Cavity in Adult Human Dry Scapulae from Central India: A Population-Specific Reference Study with Surgical and Forensic Correlation

2026-08-31T06:26:40+00:00

Background: Glenoid cavity morphometry underlies the sizing of prosthetic glenoid components in shoulder arthroplasty and carries independent forensic value, yet reference values are well documented to vary between populations and between neighbouring regions within India. No dry-bone morphometric dataset previously existed for the Malwa region of Madhya Pradesh.

Objective: To determine the linear dimensions, glenoid cavity index, shape distribution, and surface area of the glenoid cavity in adult dry scapulae from Central India, and to compare findings with published national and international series.

Methods: An observational, cross-sectional osteometric study examined 150 fully ossified adult dry scapulae (75 right, 75 left) using a dual-examiner, triplicate-measurement protocol. Supero-inferior (SI) and antero-posterior (AP-D1, AP-D2) diameters, glenoid cavity (GC) index, shape (pear/oval/inverted-comma), and surface area were recorded. Side-wise comparison used the independent t-test or Mann-Whitney U test; shape distribution used the chi-square test; one-way ANOVA compared GC index across shape categories.

Results: Mean SI diameter was 36.22 ± 1.71 mm and mean GC index was 67.08 ± 5.21% (range 55.08-81.18%). The pear shape predominated (51.3%), followed by oval (25.3%) and inverted-comma (23.3%) configurations. No parameter differed significantly between sides (all p > .05), and GC index did not differ significantly across shape categories (F(2,147) = 0.733, p = .482).

Conclusion: Glenoid dimensions in this Central Indian population are bilaterally symmetrical and broadly consistent with, yet numerically distinct from, other published Indian series, supporting the need for regionally specific reference data in prosthesis design and forensic identification.

Significance of Meconium-Stained Liquor on Neonatal Outcome

2026-08-31T06:34:00+00:00

Background: Meconium-stained amniotic fluid is encountered in 12-20% of term deliveries and remains controversial regarding its true significance. The differentiation between thin and thick meconium is especially controversial, and there is a lack of prospective data comparing outcomes based on consistency. The aim of this study was to assess the significance of MSAF on neonatal outcome, comparing clear amniotic fluid, thin meconium and thick meconium groups.

Methods: A prospective cohort study was conducted in the department of Gynaecology and Obstetrics and the Neonatal Intensive Care Unit, Moulvi Ameer Shah Memorial Hospital, Peshawar, Pakistan for the duration from from January 2025 to December 2025 and included 110 term singleton pregnancies. Amniotic fluid at rupture of membranes was classified as clear (n=37), thin meconium (n=36), and thick meconium (n=37). Primary outcomes were the rate of meconium aspiration syndrome (MAS), need for positive pressure ventilation (PPV), and neonatal encephalopathy. Data were analyzed using chi-square, ANOVA and logistic regression.

Results: MSAF incidence was 66.4%. MAS occurred exclusively in the thick meconium group (51.4%, n=19). PPV was required in 83.8% of thick meconium cases versus 16.7% in thin meconium and 0% in clear cases (p<0.001). Neonatal encephalopathy occurred in 27.0% of thick meconium cases. Thick meconium was the strongest independent predictor of MAS (OR 48.2, p<0.001) and neonatal encephalopathy (OR 22.5, p<0.001). Thin meconium did not show a significant increased risk of MAS or encephalopathy as compared to clear fluid.

Conclusion: Thick meconium is an important predictor of poor neonatal outcome, MAS, acidemia and encephalopathy. The risk of adverse neonatal outcome with thin meconium is minimal in the absence of fetal heart rate abnormalities. These findings support a stratified approach to the management of MSAF based on the consistency of meconium.

Incidence, Prevalence of Dermatophytes in Clinically Suspected Fungal Skin Infections in Tertiary Care Hospital

2026-08-31T06:43:43+00:00

Background: Dermatophytes are the most common fungal species that affect hair, skin, and nails. In order to prevent infections from spreading quickly, it is important to evaluate the prevalence of dermatophytes. This study was conducted to analyze the dermatophyte prevalence in patients with superficial cutaneous skin infection in the hospital.

Methods: This cross-sectional study was carried out over the course of a year (July 2024 to July 2025) by the departments of Dermatology in Ibn-e-Siena Hospital Multan. Samples were prepared for a wet mount potassium hydroxide solution preliminary screening test. Data was analysed using SPSS version 22.

Results: Seven hundred and thirty-seven (74%) of the 1000 skin samples were positive for dermatophytes. There were 86 (9%) non-dermatophytes. A total of 95 (8%) were identified as yeast, and 13 (1%) as mixed growth. The most common clinical type was shown to be tinea corporis, followed by tinea cruris. Patients between the ages of 21 and 40 made up the majority of the isolates.

Conclusion: In the hospital used for this study, dermatophytes were the most ubiquitous fungi causing superficial cutaneous skin infections. The most frequent skin infection in the population under study is tinea corporis. When assessing the causes of skin illnesses, it is crucial to take into account the reported incidence of dermatophytes (8%) in superficial skin infections. This will allow for anextra tailored approach in managing superficial skin infections.

Role of Preoperative Radiological Assessment in Predicting Difficult Airway Management during General Anesthesia

2026-08-31T07:01:48+00:00

Background: Difficult airway management continues to be a significant cause of perianesthetic complications under general anesthesia. While conventional bedside airway exams are helpful, they may not be sufficient to detect internal anatomical abnormalities which can lead to difficult laryngoscopy and tracheal intubation. Radiological evaluation before surgery might be useful to provide objective parameters of airway structures, and help predict airway difficulty.

Objective: To evaluate the role of preoperative radiological airway assessment in predicting difficult airway management during general anesthesia.

Methods: This prospective observational study was conducted at Islamabad Diagnostic Centre, Islamabad, from January 2025 to June 2025 and included 85 adult patients undergoing elective procedures under general anesthesia with endotracheal intubation. The Mallampati classification, thyromental distance, sternomental distance, inter-incisor distance, neck circumference and cervical extension were performed as a part of the pre-operative clinical assessment of the airway. Radiological parameters measured were skin to epiglottis distance, tongue thickness, pre-epiglottis space, hyomental distance, hyomental distance ratio and mandibular length. Intraoperative airway difficulty was evaluated by Cormack–Lehane grade, number of intubations, intubation time, first-pass success and need for adjunct airway devices. The predictive performance was calculated using ROC curve analysis and multivariable logistic regression.

Results: Difficult airway management was observed in 19 (22.4%) patients, while 66 (77.6%) had an easy airway. Patients with difficult airways had significantly greater skin-to-epiglottis distance (25.8 ± 3.6 vs 20.4 ± 3.2 mm; p < 0.001) and tongue thickness (59.3 ± 6.1 vs 52.1 ± 5.7 mm; p < 0.001), together with lower hyomental distance and hyomental distance ratio. Skin-to-epiglottis distance showed the highest predictive accuracy, with an AUC of 0.86, sensitivity of 84.2%, and specificity of 80.3% at a cut-off of >23.5 mm. Tongue thickness and hyomental distance ratio showed AUCs of 0.82 and 0.80, respectively. Increased skin-to-epiglottis distance, increased tongue thickness, and Mallampati class III–IV remained independent predictors of difficult airway management.

Conclusion: Preoperative radiological assessment can provide valuable objective information for prediction of difficult airway management. Skin-to-epiglottis distance showed the strongest predictive ability and may be particularly useful when combined with conventional bedside airway examination.

SIGNIFICANCE OF ORTHODONTICS IN FORENSIC SCIENCE: A SYSTEMATIC REVIEW

2026-08-31T09:14:44+00:00

Frequency of Diabetes Mellitus in Patients with Chronic Hepatitis C Infection

2026-08-31T09:15:49+00:00

Introduction: ChronicPatients with chronic hepatitis C virus (HCV) infection have hepatic and extrahepatic complications such as metabolic abnormalities and insulin resistance.

Methods: This was a descriptive cross-sectional study carried out in the multi-center, from October, 2025 to March, 2026. Fifteen patients were enrolled in each of the three clinics, and 150 patients with confirmed chronic HCV infection were enrolled by consecutive sampling. Demographic and clinical data were obtained, and fasting blood glucose and glycated hemoglobin (HbA1c) were measured.

Results: Among 150 patients, 86 (57.3%) were male and 64 (42.7%) were female. Of the 36 patients, 24.0% were diagnosed with diabetes mellitus and 114 (76.0%) were non-diabetic. The mean fasting glucose and HbA1C were higher in the diabetic patients than in the non-diabetic patients.

Conclusion: Diabetes Almost one-fourth of HCV-infected patients had diabetes mellitus. Comprehensive management of HCV should include routine metabolic screening.

Gnrhagonist versus GNRH Antagonist in IVF: A Comparison of Ovarian Hyperstimulation Syndrome in Infertile Females

2026-08-31T09:26:44+00:00

Objective: To compare the frequency of ovarian hyperstimulation syndrome in infertile females with GnRH agonists versus GnRH antagonists seeking invitro fertilization

Study design: A prospective cohort study

Settings and duration: At Obstetrics and Gynecology Department of Arif Memorial Teaching Hospital Lahore, from 14^th March 2024 to 14^th March 2025.

Methods: A total of 60 infertile women aged 20-40 years referred for the first IVF/ ICSI were selected for the study, using non-probability, consecutive sampling.Women were divided into two groups: Group A and Group B. Patients in Group A were 30 women administered 500 µg GnRH agonist (Buserelin) subcutaneously every day since the 21st day of the menstrual cycle. The dose was reduced by 300 µg on the 2nd day of the cycle after pituitary suppression, and 150 µg gonadotropin was added to the regimen. Patients in Group B were 30 women administered 0.25 mg GnRH antagonist (Cetrotide) subcutaneously. 150 IU Pregonal was administered intramuscularly from the third day.After ovum retrieval,if more than three follicles had estradiol greater than 3000 pg/ml at 3 months and 6 months, it was described as OHSS, which was managed by standard procedure

Results: The frequency of primary infertility patients in Group A was 16 (53.3%), and secondary infertility was 14(46.7%). The frequency of primary infertility patients in GroupB was 19(63.3%), and secondary infertility was 11(36.7%). The mean number of mature follicles of patients in GroupA was 14.4±1.27 (1-35). The mean number of mature follicles of patients in GroupB was 13.6±1.24 (2-27). The mean E2 level in patients of GroupA was 3261.8±134.7 (Range: 1008-4215) and the mean E2 level in patients of GroupB was 3500±167.4 (Range: 1000-4890). The frequency of patients with ovarian hyperstimulation syndrome in GroupA was 2 (6.7%) and in GroupB was 8 (26.7%).

Conclusion: GnRH agonist is more effective than GnRH antagonist in terms of frequency of ovarian hyperstimulation syndrome in infertile women seeking invitro fertilization.

Prevalence and Antibiotic susceptibility pattern of Pseudomonas in Urinary TractInfections: A Retrospective Observational study:Insights from a tertiary care hospital, North Karnataka

2026-08-31T09:38:22+00:00

Background: Urinary tract infections (UTI) are the most common infections encountered by clinicians and one of the leading causes of morbidity in human population. Pseudomonas is an important uropathogen, that has shown varied antibiotic susceptibility patterns.

Aims and Objective: This study focuses on reviewing and analysing the prevalence of Pseudomonas spp in Urinary tract infection & to assess the Antibiotic susceptible pattern of the Pseudomonas at Ballari Medical college and research centre BMCRC, Ballari, Karnataka.

Materials and Methods: A Retrospective study was conducted by collecting urinary infection samples from 1/7/2022 to 30/6/2023. Urine samplesunderwent initial procedures like Urine Microscopy analysis i.e Wet Mount and were inoculated on various culture plates. Antimicrobial Susceptibility testing was performed using the Kirby – Bauer disk diffusion methodand results interpreted as per CLSI guidelines.All the culture and sensitivity reports of urine with positive Pseudomonas spp showing ≥ 10⁵CFU /ml were considered as significant bacteriuria

Results: A total of 6,084 urine samples were analyzed during the one-year study period. Among these, 1,903 showed significant bacteriuria, and Pseudomonas spp. were isolated from 354 culture-positive samples. Pseudomonas spp. was the third most common urinary pathogen after Escherichia coli and Klebsiella spp. Multidrug resistance was identified in 122 isolates. Among the antibiotics tested, meropenem, piperacillin-tazobactam, and imipenem showed the highest in vitro susceptibility against the Pseudomonas isolates.Meropenem (93.22%), piperacillin-tazobactam (92.94%), and imipenem (90.40%) showed the highest antimicrobial susceptibility among the Pseudomonas isolates.

Conclusion: The study highlights the increasing occurrence of multidrug-resistant Pseudomonas spp. in urinary tract infections and is a major clinical concern. Regular monitoring of antimicrobial susceptibility patterns and the implementation of effective antibiotic stewardship programs are essential to guide appropriate therapy and prevent the further development of antimicrobial resistance. In this study the antimicrobial susceptibility pattern observed suggests effective options for treatment, emphasizing the need for ongoing surveillance to adapt to resistance patterns.

CYTOMORPHOLOGICAL SPECTRUM OF BREAST TUBERCULOSIS DIAGNOSED BY FINE-NEEDLE ASPIRATION CYTOLOGY: A CASE SERIES OF 12 CASES

2026-09-01T05:10:48+00:00

Background: Tuberculosis of the breast isan uncommon manifestation ofextrapulmonary tuberculosis and may clinically mimic breast carcinoma, pyogenicabscess, granulomatous mastitis and otherinflammatory breast lesions. Fine-needle aspiration cytology (FNAC) is a minimallyinvasive and cost-effective technique

A PROSPECTIVE COMPARATIVE EVALUATION OF THE SAFETY AND EFFECTIVENESS OF EXTRA-CORPOREAL KNOT TYING SUTURE, METALLIC ENDOCLIPS, AND LOOP LIGATURE FOR CLOSURE OF THE APPENDICULAR STUMP IN LAPAROSCOPIC APPENDECTOMY

2026-09-01T05:13:51+00:00

Background: Acute appendicitis is the most common cause of intra-abdominalsurgical emergency, and laparoscopic
appendectomy has become the preferredapproach. Several techniques are used to secure the appendiceal stump, but noconsensus exists on the optimal method.

A Multidisciplinary Evaluation of Sharp-Force Injuries: Clinical, Physiological, and Forensic Perspectives from a Tertiary Care Surgical Unit

2026-09-01T05:25:14+00:00

Background: Sharp-force injuries are clinically heterogeneous and may combine major anatomical damage, physiological instability, and medicolegal complexity.

Objective: To evaluate the clinical, physiological, and forensic characteristics of sharp-force injuries and identify factors associated with adverse outcomes.

Methods: This prospective multicenter observational study included 120 adults presenting with acute sharp-force injuries to Amna Inayat Medical College, Sheikhupura, and Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan, from January to September 2025. Clinical variables, anatomical injury patterns, shock index, serum lactate, hemoglobin, Injury Severity Score, wound morphology, defense-type injuries, management, and in-hospital outcomes were recorded.
Results: Mean age was 32.4 ± 11.2 years; 81.7% were male. Interpersonal assault accounted for 68.3% of cases, and stab wounds for 72.5%. Major visceral or vascular injury occurred in 40.8%, while 52.5% required operative intervention, 18.3% required intensive care, and mortality was 5.0%. Adverse outcomes occurred in 37.5% of patients. Shock index >0.9, serum lactate >2 mmol/L, Injury Severity Score ≥16, and major visceral or vascular injury were independently associated with adverse outcomes. Defense-type injuries were more frequent in assault-related cases but did not independently predict clinical deterioration. Thoracoabdominal injuries carried the greatest burden of internal damage and operative management, underscoring the importance of assessment.

Conclusion: Sharp-force trauma requires integrated clinical, physiological, and forensic assessment. Early physiological compromise and anatomical severity were the strongest determinants of adverse outcome, while forensic wound patterns provided complementary medicolegal context.

Forensic and Clinical Evaluation of Orbital Morphometry, Ocular Physiological Dysfunction, and Injury Severity as Predictors of Visual Outcomes Following Orbital Fracture Reconstruction

2026-09-01T05:40:28+00:00

Background: Orbital fractures may cause persistent visual dysfunction despite successful anatomical reconstruction. Combining radiological morphometry with ocular physiological assessment and injury severity may improve prediction of postoperative visual recovery.

Objective: To evaluate orbital morphometric parameters, ocular physiological dysfunction, and injury severity as predictors of visual outcomes following orbital fracture reconstruction.

Methods: This prospective observational study included 100 adults with unilateral traumatic orbital fractures treated at Amna Inayat Medical College, Sheikhupura, Pakistan, from January 2024 to December 2025. Preoperative computed tomography was used to assess fracture defect area, orbital volume difference, herniated tissue volume, and fracture displacement. Ophthalmic evaluation included best-corrected visual acuity, pupillary responses, color vision, diplopia, intraocular pressure, and extraocular movements. Patients were followed for three months—multivariable logistic regression identified independent predictors of unfavorable visual outcome.

Results: Seventy-six patients achieved favorable visual recovery, whereas 24 had unfavorable outcomes. Poor outcomes were associated with larger fracture defects, greater orbital volume difference, increased tissue herniation, impaired preoperative visual acuity, relative afferent pupillary defect, and marked extraocular movement restriction. Independent predictors included relative afferent pupillary defect, orbital volume difference ≥15%, moderate-to-marked motility restriction, high injury severity, preoperative BCVA >0.50 logMAR, and reconstruction after 14 days. The combined model showed good discrimination and supported the complementary prognostic value of structural and functional parameters in postoperative visual assessment.

Conclusion: Integrated assessment of orbital structure, ocular physiology, and injury severity may improve prognostic stratification, surgical decision-making, patient counseling, and surveillance after orbital fracture reconstruction.

Forensic, Anatomical, and Physiological Predictors of Visual Outcomes Following Surgical Management of Orbital Trauma. A Clinical Study

2026-09-01T05:48:48+00:00

Background: Orbital trauma can produce persistent visual impairment through bony disruption, optic nerve injury, soft-tissue entrapment, and ocular physiological dysfunction. Identifying early predictors of visual recovery may improve surgical planning and medico-legal assessment.

Objective: To determine forensic, anatomical, and physiological predictors of visual outcome following surgical management of orbital trauma.

Methods: This prospective observational study included 80 patients treated at Amna Inayat Medical College, Sheikhupura, Pakistan, from April 2024 to April 2025. Mechanism and severity of injury, computed tomography findings, best-corrected visual acuity, pupillary responses, color vision, intraocular pressure, ocular motility, and diplopia were recorded. Visual outcome was assessed three months after surgery. Multivariable logistic regression identified independent predictors of unfavorable recovery.

Results: Favorable visual outcome was achieved in 54 patients (67.5%), while 26 (32.5%) had unfavorable recovery. Severe injury, associated facial fractures, multiple-wall fractures, globe displacement, orbital volume alteration, optic canal involvement, retrobulbar hematoma, impaired color vision, marked ocular motility restriction, and persistent diplopia were significantly associated with poorer outcomes. Relative afferent pupillary defect was the strongest independent predictor of unfavorable recovery (adjusted OR 7.21), followed by optic canal involvement (adjusted OR 5.63), preoperative visual acuity worse than 0.70 logMAR (adjusted OR 4.48), severe injury, and surgery performed more than 14 days after trauma.

Conclusion: Visual prognosis after orbital trauma depends on injury severity, orbital anatomy, and ocular physiological function. Early recognition of optic nerve dysfunction and posterior orbital involvement may support timely surgery, prognostic counseling, and forensic documentation.

Association between Serum Cortisol Levels and Autonomic Nervous System Function during Anesthesia in Adults with Chronic Migraine

2026-09-01T06:02:35+00:00

Background: Chronic migraine is associated with autonomic dysregulation and altered hypothalamic–pituitary–adrenal activity. The perioperative interaction between cortisol responses and autonomic function remains poorly defined.

Objective: To evaluate the association between serum cortisol concentrations and heart rate variability during general anesthesia in adults with chronic migraine.

Methods: This prospective observational study included 120 adults with chronic migraine undergoing elective surgery at Khawaja Muhammad Safdar Medical College, Sialkot, and Jinnah Hospital, Lahore, from January 2025 to January 2026. Serum cortisol and five-minute electrocardiographic recordings were obtained before induction, after induction, 30 minutes after incision, and near the end of surgery. Autonomic function was assessed using RMSSD, HF-HRV, and SDNN. Associations were examined using correlation analysis and multivariable linear mixed-effects modeling.

Results: Mean age was 39.2 ± 10.4 years, and 72.5% were women. Cortisol decreased after induction from 14.1 ± 4.3 to 11.9 ± 3.8 μg/dL, then increased to 17.4 ± 5.1 μg/dL after incision and 19.2 ± 5.6 μg/dL near surgery completion. RMSSD declined significantly across the same period. Cortisol correlated inversely with RMSSD after incision (r=−0.46, p<0.001) and near surgery completion (r=−0.43, p<0.001). Each 1-μg/dL increase in cortisol was independently associated with a 2.1% reduction in RMSSD. Greater headache frequency was also associated with lower RMSSD, suggesting reduced autonomic adaptability with increasing migraine burden.

Conclusion: Higher perioperative cortisol concentrations were independently associated with reduced vagally mediated heart rate variability, indicating coordinated neuroendocrine and autonomic stress responses in adults with chronic migraine.

Toxicological Patterns of Psychoactive Substance Use as Predictors of Violent Behavioral Outcomes in Medico-Legal Cases: A Retrospective Cohort Study

2026-09-01T06:10:39+00:00

Background: Psychoactive substance use is frequently encountered in medico-legal practice and may influence aggression through effects on judgment, behavioral inhibition, arousal, and impulse control. However, substance-specific toxicological predictors of violent behavior remain insufficiently characterized in local forensic populations.

Objective: To determine toxicological patterns of psychoactive substance exposure and identify independent predictors of violent behavioral outcomes among medico-legal cases.

Methods: This retrospective cohort study included 120 adult medico-legal cases evaluated at the Department of Forensic Medicine, King Edward Medical University, and Lahore Medical and Dental College, Lahore, Pakistan, between January 2025 and February 2026. Demographic, clinical, behavioral, and toxicological data were extracted from institutional records. The primary outcome was documented interpersonal violent behavior associated with the index medico-legal event. Associations were evaluated using univariable and multivariable binary logistic regression.

Results: Overall, 67 cases (55.8%) had violent outcomes and 92 (76.7%) had at least one psychoactive substance detected. Alcohol was identified in 45 (37.5%), cannabis in 34 (28.3%), stimulants in 24 (20.0%), opioids in 22 (18.3%), and benzodiazepines in 16 (13.3%) cases; 35 (29.2%) demonstrated polysubstance exposure. Violence occurred in 80.0% of polysubstance-positive, 79.2% of stimulant-positive, and 75.6% of alcohol-positive cases. Independent predictors were previous violent behavior (aOR 4.31, 95% CI 1.68–11.05), stimulant positivity (aOR 3.71, 95% CI 1.26–10.93), polysubstance exposure (aOR 3.39, 95% CI 1.30–8.87), alcohol positivity (aOR 2.88, 95% CI 1.23–6.74), and male sex (aOR 2.41, 95% CI 1.02–5.71).

Conclusion: Violent medico-legal outcomes were independently associated with stimulant exposure, alcohol positivity, polysubstance use, and previous violence. Integrating toxicological findings with behavioral history may improve early forensic risk stratification.

A Comparative Study of Maternal and Perinatal Outcomes in Gestational Diabetes Mellitus Treated with Metformin versus Insulin

2026-09-01T06:20:15+00:00

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy and is associated with adverse maternal and neonatal outcomes. Insulin has traditionally been the standard treatment for GDM; however, oral metformin has emerged as an effective alternative because of its ease of administration, lower cost, and better patient compliance.

Aim: To compare the maternal and neonatal outcomes among women with gestational diabetes mellitus treated with metformin versus insulin therapy.

Materials and Methods: This prospective comparative observational study was conducted in the Department of Obstetrics and Gynecology of a tertiary care teaching hospital. A total of 50 pregnant women diagnosed with GDM were included and divided into two groups: metformin group (n=25) and insulin group (n=25). Maternal demographic characteristics, glycemic control, maternal complications, mode of delivery, and neonatal outcomes were assessed and compared between the groups. Statistical analysis was performed using SPSS software, and a p-value <0.05 was considered statistically significant.

Results: The baseline characteristics were comparable between the two groups. Adequate glycemic control was achieved in 84% of women in the metformin group and 92% in the insulin group. Cesarean section rates were higher in the insulin group (48%) compared to the metformin group (36%). Neonatal hypoglycemia, macrosomia, respiratory distress, and NICU admissions were more frequently observed in the insulin group. However, the differences were not statistically significant.

Conclusion: Metformin demonstrated comparable efficacy to insulin in achieving glycemic control in gestational diabetes mellitus with relatively favorable maternal and neonatal outcomes. Metformin may be considered a safe, effective, and convenient alternative to insulin therapy in selected women with GDM.

Role of Uterine Artery Doppler in the Prediction of Preeclampsia: A Prospective Observational Study

2026-09-01T06:28:51+00:00

Background: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. Early prediction of preeclampsia allows timely intervention and close antenatal surveillance. Uterine artery Doppler ultrasonography has emerged as a useful noninvasive tool for assessing uteroplacental circulation and identifying women at risk for hypertensive disorders of pregnancy.

Aim: To evaluate the predictive value of uterine artery Doppler in identifying pregnant women at risk of developing preeclampsia.

Materials and Methods: This prospective observational study was conducted among 70 antenatal women between 11 and 14 weeks of gestation attending a tertiary care hospital. Participants underwent uterine artery Doppler assessment for pulsatility index, resistance index, and presence of early diastolic notch. Women were followed until delivery for the development of preeclampsia. Data were analyzed using SPSS software. Chi-square test was used to determine associations, and diagnostic accuracy indices were calculated. A p-value <0.05 was considered statistically significant.

Results: Among the 70 participants, 16 (22.9%) developed preeclampsia. Abnormal uterine artery Doppler findings were observed in 21 (30%) women. Preeclampsia developed in 57.1% of women with abnormal Doppler findings compared to 8.2% with normal Doppler findings, which was statistically significant (p<0.001). Increased pulsatility index and bilateral early diastolic notch showed strong association with subsequent development of preeclampsia. Uterine artery Doppler demonstrated a sensitivity of 75%, specificity of 83.3%, positive predictive value of 57.1%, and negative predictive value of 91.8%.

Conclusion: Uterine artery Doppler is an effective noninvasive screening tool for early prediction of preeclampsia and can aid in identifying high-risk pregnancies for closer monitoring and timely management.

Maternal and Perinatal Outcomes in Pregnant Women with Hypothyroidism: A Comparative Study at a Tertiary Care Center

2026-09-01T06:33:56+00:00

Background: Hypothyroidism is one of the most common endocrine disorders encountered during pregnancy and is associated with several maternal and fetal complications. Early identification and management are essential to improve pregnancy outcomes.

Aim: To evaluate the impact of maternal hypothyroidism on maternal and fetal outcomes in comparison with euthyroid pregnant women attending a tertiary care center.

Materials and Methods: This hospital-based comparative observational study was conducted among 60 pregnant women admitted to a tertiary care hospital. The study population included 30 hypothyroid pregnant women and 30 euthyroid pregnant women selected based on predefined inclusion and exclusion criteria. Detailed clinical history, obstetric profile, thyroid function status, maternal complications, and fetal outcomes were recorded using a structured proforma. Maternal outcomes such as anemia, gestational hypertension, preeclampsia, gestational diabetes mellitus, preterm labor, and mode of delivery were assessed. Fetal outcomes including low birth weight, preterm birth, fetal distress, APGAR score, NICU admission, and intrauterine fetal death were evaluated. Data were analyzed using SPSS version 25.0, and a p-value <0.05 was considered statistically significant.

Results: Maternal complications such as anemia (46.7%) and preterm labor (30.0%) were significantly higher among hypothyroid mothers compared to euthyroid women. Cesarean section was more common in the hypothyroid group (50.0%). Fetal complications including low birth weight (36.7%) and NICU admission (30.0%) were also significantly increased among hypothyroid pregnancies. Overall adverse pregnancy outcomes were significantly associated with maternal hypothyroidism (p=0.01).

Conclusion: Maternal hypothyroidism is associated with increased maternal and fetal morbidity. Routine antenatal thyroid screening and timely management may help reduce adverse pregnancy outcomes.

Clinical Profile and Treatment Outcomes of Pelvic Inflammatory Disease among Reproductive-Age Women: A Comparative Observational Study

2026-09-01T06:38:02+00:00

Background: Pelvic inflammatory disease (PID) is a major gynecological disorder affecting women of reproductive age and is associated with significant short-term and long-term reproductive morbidity. Early diagnosis and prompt treatment are essential to prevent complications such as infertility, chronic pelvic pain, and ectopic pregnancy.

Aim: To evaluate and compare the clinical profile and treatment outcomes of pelvic inflammatory disease among reproductive-age women.

Materials and Methods: This hospital-based comparative observational study was conducted in the Department of Obstetrics and Gynecology of a tertiary care hospital over a period of one year. A total of 100 women aged 18–45 years diagnosed with PID were included in the study. Participants were divided into two groups: Group A comprising women with mild to moderate PID and Group B comprising women with severe PID requiring hospitalization. Detailed history, clinical examination, laboratory investigations, and ultrasonographic findings were recorded. Treatment outcomes including symptom resolution, duration of hospital stay, complications, and recurrence were assessed. Statistical analysis was performed using SPSS version 25.0, and a p-value <0.05 was considered statistically significant.

Results: The majority of participants belonged to the 26–35 years age group. Lower abdominal pain was the most common presenting complaint. Fever, cervical motion tenderness, elevated inflammatory markers, adnexal masses, and tubo-ovarian abscesses were significantly more common among women with severe PID. Intravenous antibiotics and surgical interventions were more frequently required in severe cases. Complete symptom resolution was observed in 92% of Group A and 76% of Group B participants. Complications occurred predominantly among severe PID cases.

Conclusion: Severe PID is associated with increased morbidity, prolonged hospitalization, and poorer treatment outcomes. Early recognition and timely management can significantly improve clinical outcomes and reduce complications.

Frequency of Somatic Symptom Disorder and its Association with Irritable Bowel Syndrome in Patients with Newly Diagnosed Generalized Anxiety Disorder: A Cross-Sectional Study

2026-09-01T10:38:43+00:00

Background: There are several overlapping physical symptoms that are common amongst GAD (Generalized Anxiety Disorder) and functional gastrointestinal disorders (FGIDs). These symptoms often become more pronounced, worsening the quality of life. Some studies have described the coexistence of anxiety, Irritable Bowel Syndrome (IBS), and Somatic Symptom Disorder (SSD) with FGIDs. However, the prevalence and relationship of SSD to IBS in first-year adult GAD patients remains largely unexplored.

Objective: To assess the prevalence of Somatic Symptom Disorder and to examine the relationship of IBS among 18 to 40 years old GAD patients.

Methods: A cross-sectional study including 180 GAD patients (aged 18-40 years) was done. Participants were selected through non-probability consecutive sampling. The study participants were assessed in accordance with the DSM-5 criteria for the diagnosis of GAD. The 8-item Somatic Symptom Scale (SSS-8) was used to assess the burden of somatic symptoms, and the Rome IV criteria for IBS were used for its assessment. A structured questionnaire was used to collect the demographic and clinical data. Data were analyzed with SPSS version 26.0. Frequencies and percentages were used for the analysis of categorical variables. The association of SSD and IBS was assessed using the chi-square test. A p-value of less than 0.05 was interpreted as statistically significant.

Results: Of the 180 participants, 78 (43.3 %) participants had significant somatic symptom burden as classified as SSD. 56 (31.1%) participants also fulfilled the criteria for IBS as defined by the Rome IV criteria. Among those with IBS, the burden of somatic symptoms was higher at 64.3 %, whereas among those without IBS, the burden was 33.9 % Participants with IBS had a significant burden of somatic symptoms compared with those without IBS (χ² = 15.13, p < 0.001). Somatic symptom burden was more observed among women than men, though this was not significant (p = 0.074).

Conclusion: Among adults aged 18 to 40 with newly diagnosed GAD, a high prevalence of somatic symptom burden and IBS were observed. There was a significant burden of somatic symptoms for GAD patients and the need to address psychological and gastrointestinal symptoms.

Comparison of Prognostic Accuracy of Albumin–Bilirubin Score and Child–Pugh Score in Cirrhosis

2026-09-01T11:27:27+00:00

Background: Accurate prognostication in cirrhosis guides triage, transplant referral and end-of-life discussions. The Child–Pugh (CTP) score, although widely used, incorporates subjective variables. The albumin–bilirubin (ALBI) score is an entirely laboratory-based alternative, but Indian data comparing the two scores are scarce.

Aim: To compare short-term (7- and 30-day) prognostic performance of the ALBI score with CTP and MELD scores in cirrhosis.

Methods: In this single-centre observational study, 150 consecutive adults (>18 years) with ultrasound-confirmed cirrhosis admitted between January 2023 and June 2024 were prospectively enrolled. Serum albumin, bilirubin, creatinine and INR were measured within 24 h; ALBI, CTP and MELD scores were calculated. Primary outcome was all-cause 7-day mortality; secondary outcome was 30-day mortality. Discrimination was assessed with receiver-operating-characteristic (ROC) analysis and compared with DeLong’s test.

Results: Mean age was 40.0 ± 8.8 years; 69 % were male. Aetiologies were alcohol (42 %), hepatitis B (31 %) and hepatitis C (19 %). Twenty-one patients (14 %) died within 7 days and 31 (21 %) within 30 days. For 7-day mortality, ALBI showed an AUC 0.888 (95 % CI 0.80–0.97) versus CTP 0.718 and MELD 0.724 (p < 0.001 for ALBI vs both). A cut-off > –0.72 gave 81 % sensitivity and 88 % specificity. For 30-day mortality, ALBI again out-performed CTP and MELD (AUC 0.940 vs 0.741 and 0.751; p < 0.001).

Conclusions: In this Indian cohort the ALBI score provided superior, objective prediction of short-term mortality compared with CTP and MELD scores. Its simplicity and bedside applicability support routine use.

Association between Insulin Resistance and Abnormal Menstrual Cycle in Females with Polycystic Ovary Syndrome

2026-09-01T11:36:41+00:00

Aim: To determine the association between insulin resistance and abnormal menstrual cycle in females with polycystic ovary syndrome.

Materials and methods: The prospective observational study was conducted in the Department of Gynaecology and Obstetrics. Total 100 females had complaints of abnormal menstruation, acne, hirsutism, and problems with fertility, and 100 controls having long-standing history of normal menstrual cycles, were enrolled for the study. Demographic, menstrual, clinical, and family history data were collected using a structured questionnaire. Anthropometric measurements and transvaginal ultrasonography were performed. Fasting blood samples were analyzed for glucose, lipid profile, insulin, FSH, LH, and testosterone using standard methods. HOMA-IR >2.5 was considered indicative of insulin resistance.

Results: The mean age was comparable between groups (p = 0.455), while BMI and WHR were significantly higher in women with PCOS. PCOS women also had significantly higher fasting glucose, insulin, HOMA-IR, total cholesterol, LDL, triglycerides, LH/FSH ratio, and testosterone levels than controls. Among PCOS subgroups, fasting insulin, HOMA-IR, LH/FSH ratio, and testosterone increased significantly with longer menstrual cycle intervals (p < 0.05), indicating greater insulin resistance and hyperandrogenism with increasing menstrual irregularity.

Conclusion: Oligomenorrhea (>45-day cycles) was common in women with PCOS, with increasing menstrual irregularity associated with greater hyperandrogenism and insulin resistance. Menstrual cycle length may serve as a simple clinical predictor of insulin resistance in PCOS.

NOCTURNAL OXYGEN SATURATION IN CHILDREN WITH ADENOTONSILLAR HYPERTROPHY AND ITS IMPROVEMENT AFTER ADENOTONSILLECTOMY

2026-09-01T11:40:59+00:00

Background: Adenotonsillar hypertrophy isan important cause of upper-airwayobstruction and sleep-disordered breathingin children. Nocturnal oxygen desaturationmay accompany obstructive events duringsleep. This study evaluated nocturnal oxygen saturation before and afteradenotonsillectomy in children withadenotonsillar hypertrophy

Development and Validation of an Explainable Machine Learning Model for Early Prediction of Intradialytic Hypotension by Integrating Antihypertensive Medication Profiles and Clinical Parameters in Maintenance Hemodialysis Patients: A Prospective Cohort

2026-09-01T11:43:23+00:00

Intradialytic hypotension (IDH) is a majorcomplication of maintenance hemodialysis(MHD), strongly associated with vascularaccess thrombosis, cardiovascular events,and mortality. Existing predictive toolsfrequentlyoverloodetailedantihypertensive drug timing and lack explainability.

Artificial Intelligence and Machine Learning in Drug Discovery and Pharmacology: Applications, Explainability, and Future Directions

2026-09-02T07:13:54+00:00

Drug discovery and pharmacology are undergoing a significant transformation driven by advances in artificial intelligence (AI) and machine learning (ML). What historically required a decade or longer and substantial capital investment per approved therapeutic is increasingly being reshaped by data-driven computational pipelines capable of accelerating target identification, virtual screening, lead optimization, toxicity prediction, and drug repurposing. This review synthesizes recent developments in AI/ML applications across the drug discovery and development pipeline, with particular attention to deep learning architectures such as graph neural networks and transformer-based models, generative molecular design methods, and reinforcement-learning strategies for lead optimization. It further examines the growing importance of explainable AI (XAI) in pharmacology, where regulators and clinicians increasingly demand transparent, auditable model reasoning rather than opaque predictions. Persistent challenges — including data quality and bias, limited generalizability across chemical space, the interpretability-performance trade-off, and evolving regulatory expectations — are discussed alongside emerging directions such as federated learning, multimodal foundation models, and physics-informed explainability. The review argues that the next phase of AI-enabled pharmacology will be defined less by predictive accuracy alone and more by the trustworthiness, reproducibility, and clinical integration of these systems.

A Critical Subjective Review of Homoeopathic Mother Tinctures and Their Therapeutic Applications

2026-09-02T07:44:07+00:00

Mother tinctures are the primary pharmaceutical preparations in homoeopathy and constitute the foundation for the manufacture of potentized medicines. Their therapeutic efficacy, safety, and reproducibility depend on the quality of the source material and the standardization of the manufacturing process. Indigenous medicinal plants, owing to their rich phytochemical diversity and long-standing use in traditional medicine, represent an important source for the preparation of homeopathic mother tinctures. However, factors such as geographical variation, seasonal changes, cultivational practices, harvesting time, post-harvest handling, and extraction procedures may significantly influence the phytochemical composition and quality of the final product.

Therefore, standardization is essential to ensure batch-to-batch consistency, authenticity, purity, safety, and therapeutic reliability.

This review critically examines the current principles and practices involved in the preparation and standardization of mother tinctures from indigenous medicinal plants. It discusses the selection and authentication of plant materials, collection methods, extraction techniques, physicochemical analysis, phytochemical screening, chromatographic fingerprinting, microbial quality testing, heavy metal analysis, and stability studies. Recent advances such as DNA barcoding, high-resolution chromatographic techniques, artificial intelligence-assisted quality control, and green extraction technologies are also highlighted.

Mother Tincture, Homeopathy, Indigenous Medicinal Plants, Pharmacognosy, Standardization, Quality Control, Herbal Medicines, HPTLC, HPLC, Medicinal Plant Authentication.

Adjunctive Role of Elemental Zinc in Infants and Children with Severe Pneumonia

2026-09-02T10:10:52+00:00

Objective: To assess the adjunctive role of elemental zinc in infants and children hospitalized with severe pneumonia in terms of duration of remission of signs of severe pneumonia and hospital stay.

Study Design: Randomized controlled study.

Duration and place of study: The study was conducting in the department of Pediatric Medicine, Fauji foundation hospital, Rawalpindi from February 2026 till

May 2026.

Methodology: All infants and children with clinical diagnosis of pneumonia were enrolled. Group A (intervention group) received 10mg and 20mg daily of elemental zinc for children younger than 6 months and older than 6 months respectively, from the first day of treatment for 14 days along with standard treatment and Group B (control group) received standard treatment alone. Patients were monitored daily for the remission of signs till their discharge from the hospital. All the information was entered on the predesigned Performa and analyzed by using the SPSS 23 version.

Results: Duration of symptoms remission in the Zinc+ Standard care group & standard care alone group was (4.33±0.64 days vs 5.58±0.81 days, p=0.0001 respectively). The duration of hospital stay in the Zinc+ Standard care group & standard care alone group was (4.87±0.67 days vs 6.33±1.00 days, p=0.0001).

Conclusion: Zinc supplementation with standard care resulted in earlier remission of signs of severe pneumonia and shorten hospital stay in infants and children hospitalized with severe pneumonia.

Diagnostic Validity of Ultrasound-Guided Fine Needle Aspiration Cytology in the Evaluation of Thyroid Swellings

2026-09-02T11:13:51+00:00

Background: Thyroid nodules are frequently encountered in clinical practice, and differentiating benign from malignant lesions is essential for appropriate management. FNAC (Fine Needle Aspiration Cytology) is the standard diagnostic technique; however, conventional palpation-guided FNAC may produce inadequate samples and false-negative results. Ultrasound-guided FNAC allows precise localization of thyroid nodules and targeted sampling, potentially improving diagnostic accuracy while reducing unnecessary surgeries and treatment costs. This study evaluated the diagnostic validity of ultrasound-guided FNAC compared with conventional palpation-guided FNAC in patients with thyroid swellings.

Methods: A diagnostic test evaluation (cross-sectional) study was conducted over one year in the Department of General Surgery, Government Medical College, Thrissur, Kerala. Ninety-six patients with clinically diagnosed thyroid swellings were randomly allocated into two groups: 48 underwent ultrasound-guided FNAC and 48 underwent conventional palpation-guided FNAC before thyroid surgery. Histopathological examination of surgical specimens served as the reference standard. Data were analyzed using SPSS, and sensitivity, specificity, PPV (Positive Predictive Value), NPV (Negative Predictive Value), and diagnostic accuracy were calculated.

Results: Among the 96 participants, 81 (84.4%) were females and 15 (15.6%) were males, with a mean age of 42.69 ± 11.3 years. Histopathology confirmed thyroid malignancy in 24 patients. Ultrasound-guided FNAC demonstrated a sensitivity of 90.9%, specificity of 97.3%, PPV of 90.9%, NPV of 97.3%, and diagnostic accuracy of 95.83%. In comparison, conventional palpation-guided FNAC showed a sensitivity of 53.84%, specificity of 94.28%, PPV of 77.77%, NPV of 84.61%, and diagnostic accuracy of 83.33%.

Conclusion: Ultrasound-guided FNAC is a superior diagnostic modality for evaluating thyroid swellings. It significantly improves sensitivity, diagnostic accuracy, and positive predictive value while reducing false-negative results compared with conventional palpation-guided FNAC. Routine use of ultrasound guidance is recommended wherever available to optimize the diagnosis and management of thyroid nodules.

Comparison of C-MAC Videolaryngoscope and Macintosh Laryngoscope for Ease of Double-Lumen Tube Insertion in Patients Undergoing Elective Thoracic Surgeries: A Prospective Randomized Controlled Study

2026-09-02T11:19:57+00:00

Background: Double-lumen tube placement is the gold standard for lung isolation during elective thoracic surgery but is technically more challenging than single-lumen intubation due to its larger size and rotational requirements. The C-MAC videolaryngoscope may improve glottic visualization and facilitate easier DLT (Double-Lumen Tube) insertion compared with the conventional Macintosh laryngoscope.

Methods: A prospective randomized controlled study was conducted among patients undergoing elective thoracic surgeries requiring DLT insertion. Participants were randomly allocated to either the C-MAC videolaryngoscope group or the Macintosh laryngoscope group. The primary outcomes included IDS (Intubation Difficulty Score), intubation time, first-pass success rate, and overall success rate. Secondary outcomes were hemodynamic responses (heart rate, systolic and diastolic blood pressure, and mean arterial pressure) and airway-related complications, including mucosal trauma, sore throat, and hoarseness.

Results: The C-MAC videolaryngoscope demonstrated superior intubation performance compared with the Macintosh laryngoscope. First-pass success was significantly higher with C-MAC (93.8%) than with Macintosh (75.0%; p=0.039). Overall success was 100% with C-MAC compared with 93.8% with Macintosh. C-MAC was associated with lower intubation difficulty, shorter intubation time, improved glottic visualization, fewer intubation attempts, reduced need for optimization maneuvers, and fewer airway-related complications. Hemodynamic responses were also more favourable with C-MAC during DLT insertion.

Conclusion: The C-MAC videolaryngoscope offers significant advantages over the conventional Macintosh laryngoscope for DLT insertion during elective thoracic surgery. Its higher first-pass success, reduced intubation difficulty, shorter intubation time, improved glottic visualization, and lower complication rates make it a reliable and effective device for thoracic airway management.

Diagnostic Efficacy of Cerebrospinal Fluid Procalcitonin as a Novel Biomarker in Neonatal Bacterial Meningitis: An Original Observational Study

2026-09-03T05:48:28+00:00

mortality and severe neurological sequelae.Because conventional cerebrospinal fluid (CSF)parameters and blood cultures often presentdiagnostic dilemmas—especially in preterm infants or following traumatic lumbarpunctures—reliable early biomarkers areurgently required.

Knowledge, Attitudes, and Practices Regarding Infant and Young Child Feeding: A Comparative Study Between Nursing Professionals and Mothers

2026-09-03T05:51:05+00:00

Background: Optimal Infant and Young ChildFeeding (IYCF) techniques are crucial forensuring healthy physiological growth andcognitive progression during early developmental stages. Healthcare staff,particularly clinical nurses, serve as front-lineadvisors to mothers

Effectiveness of Cascade Screening in the Detection of β-Thalassemia Carriers and Prevention of Thalassemia Major

2026-09-03T05:53:09+00:00

Background & Objectives: Beta-thalassemia isone of the most common autosomal recessivehemoglobinopathies worldwide, imposing asubstantial financial, psychological, and clinicalburden on affected families and healthcaresystems. Because universal population screeningis often resource-prohibitive in developing nations, targeted screening mechanisms areurgently required.

Comparative Evaluation of Two Doses of Dexmedetomidine for Attenuation of Hemodynamic Responses to Laryngoscopy and Endotracheal Intubation: A Randomized Controlled Study

2026-09-03T05:51:31+00:00

Background: Laryngoscopy and endotracheal intubation produce a transient sympathetic response characterized by increases in heart rate and blood pressure. Dexmedetomidine, a selective α2-adrenergic agonist, can attenuate this response, although the optimal dose remains uncertain. This study compared the efficacy of two doses of dexmedetomidine in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation.

Methods: This comparative study included 60 patients who were allocated into two equal groups of 30 patients each. Group L received dexmedetomidine 0.5 µg/kg, while Group H received dexmedetomidine 1 µg/kg. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were assessed at baseline and at 1, 3, 5, and 10 minutes following the intervention. Between-group comparisons were performed using independent-samples t test, while within-group changes were assessed using paired analysis with Bonferroni correction.

Results: The demographic characteristics were comparable between the groups. HR was significantly lower in the high-dose group at baseline and at 1, 3, 5, and 10 minutes (p<0.001). SBP, DBP, and MAP were also significantly lower in the high-dose group at 5 and 10 minutes (p<0.05), whereas differences at 1 and 3 minutes were not statistically significant. Within-group analysis showed no significant changes in SBP, DBP, or MAP from baseline in the low-dose group. In contrast, the high-dose group demonstrated significant reductions in SBP, DBP, and MAP at 1, 3, 5, and 10 minutes after administration.

Conclusion: Dexmedetomidine 1 µg/kg provided greater attenuation of peri-intubation hemodynamic responses than 0.5µg/kg. The higher dose produced a more sustained reduction in HR, SBP, DBP, and MAP, particularly from 5 minutes onward. Thus, 1 µg/kg may be more effective when stronger suppression of the cardiovascular response to laryngoscopy and intubation is desired.

Functional Outcomes Following Arthroscopic 270-Degree Circumferential Labral Repair in Multidirectional Shoulder Instability: A Prospective Clinical Evaluation

2026-09-03T05:55:37+00:00

Background: Complex multidirectional shoulderlaxity frequently incorporates extensive labraltearing spanning 270 degrees acrossquadrants[cite: 11]. Clinical tracking regarding circumferential labral stabilization remainsscarce [cite: 11]. This prospective evaluationcharts functional performance following

Functional Outcome Post Arthroscopic Shoulder Rotator Cuff Repair Using Double Row Technique: A Prospective Clinical Study

2026-09-03T06:00:18+00:00

Background: Rotator cuff tears represent aprimary etiology for shoulder pain andfunctional limitation in middle-aged and elderly
cohorts [cite: 9]. Although arthroscopic doublerow configurations biomechanicallyapproximate the native footprint more closely than single-row setups, intermediate-termclinical validation remains imperative

Role of Doxycycline in Seropositive Paediatric Dengue and Its Effect on Inflammatory Markers: A Prospective Randomized Case-Control Study

2026-09-03T06:03:51+00:00

Background: Dengue virus (DENV) infectionpresents a broad clinical spectrum ranging from self limiting febrile illness to severe dengue driven bysystemic immune activation and capillary leakage.Doxycycline possesses immunomodulatory andantiviral properties that may attenuate cytokinemediated inflammatory cascades.

Coexistence of Tetracycline Resistance and Virulence Determinants in Klebsiella pneumoniae Isolated from Hospitalized Patients in Pakistan

2026-09-03T06:03:59+00:00

Background: Klebsiella pneumoniae is an important opportunistic pathogen and an increasingly difficult cause of healthcare-associated and community-acquired infections because of its capacity to accumulate antimicrobial-resistance determinants and virulence-associated traits. Data linking phenotypic resistance with specific resistance and virulence genes remain limited in many settings in Pakistan. This study investigated the antimicrobial susceptibility profile of clinical K. pneumoniae isolates and characterized selected tetracycline-resistance and virulence-associated genes among tetracycline-resistant isolates.

Methods: A total of 250 clinical specimens, comprising urine, sputum, and blood, were collected from patients with suspected urinary tract, respiratory, or bloodstream infections at Hayatabad Medical Complex. K. pneumoniae was identified by colony morphology, Gram staining, and biochemical testing. Antimicrobial susceptibility was determined by the Kirby–Bauer disc diffusion method according to CLSI M100, 35th edition (2025). Genomic DNA was extracted by phenol–chloroform extraction. PCR was used to detect tetA, tetB, and the selected virulence-associated target endr among tetracycline-resistant isolates.

Results: K. pneumoniae was recovered from 110/250 specimens (44.0%). The isolates showed marked resistance to ampicillin (96.36%), trimethoprim–sulfamethoxazole (86.36%), ceftriaxone (80.00%), and ciprofloxacin (63.64%). Resistance to tetracycline and doxycycline was 32.73% and 29.09%, respectively, whereas meropenem showed the lowest resistance rate (10.00%). Among the 36 tetracycline-resistant isolates screened by PCR, tetA was detected in 27 (75.00%), tetB in 22 (61.11%), and endr in 30 (83.33%).

Conclusions: The high level of resistance to several commonly used antimicrobials highlights a substantial therapeutic challenge associated with clinical K. pneumoniae in this setting. The frequent detection of tetA and tetB among tetracycline-resistant isolates, together with the high occurrence of the selected endr target, indicates a population in which antimicrobial resistance and virulence-associated determinants may coexist. These findings support continued local AMR surveillance, culture-directed therapy, antimicrobial stewardship, and further genomic investigation of resistant K. pneumoniae in Pakistan.

A PROSPECTIVE RANDOMIZED CONTROLLED CLINICAL STUDY COMPARING THE EFFICACY OF AUTOLOGOUS PLATELET-RICH PLASMA VERSUS CONVENTIONAL DRESSING IN CHRONIC NON HEALING ULCERS

2026-09-03T07:39:42+00:00

Background: Chronic non-healing ulcers aredifficult to treat and may persist despiteappropriate wound care. Platelet-rich plasma
(PRP) provides platelet-derived growth factorsthat may support tissue repair and wound healing.

Clinical Profile, Surgical Indications, Perioperative Characteristics, and Postoperative Outcomes among Women Undergoing Hysterectomy in a Tertiary Care Centre: A Prospective Observational Study

2026-09-03T08:45:22+00:00

Background: Hysterectomy is one of the most frequently performed major gynecological surgeries for the management of benign uterine disorders. Evaluating the demographic profile, clinical indications, operative characteristics, histopathological findings, and postoperative outcomes helps optimize patient selection and improve surgical care.

Methods: This hospital-based observational study included 92 women who underwent hysterectomy for benign gynecological conditions at a tertiary care center. Data regarding demographic characteristics, presenting symptoms, obstetric history, menstrual status, preoperative evaluation, indications for surgery, type of hysterectomy, intraoperative findings, operative duration, blood loss, postoperative complications, duration of hospital stay, and histopathological examination were collected and analyzed using descriptive statistics.

Results: The mean age of the participants was 53.45±2.95 years, with the majority (70.65%) belonging to the 41–50-year age group. Heavy menstrual bleeding was the most common presenting complaint (51.09%). Most patients had a previous normal vaginal delivery (59.78%). The mean uterine size was 13.63±10.45 weeks. Most procedures were completed within 60–90 minutes (75.0%), and estimated intraoperative blood loss was less than 100 mL in 50.0% of cases. More than half of the patients (56.52%) had a postoperative hospital stay of 6–10 days. Leiomyoma constituted the most frequent indication for hysterectomy and was the predominant histopathological diagnosis. Postoperative morbidity was low, with surgical site infection and dysuria representing the most commonly encountered complications.

Conclusion: Hysterectomy remains a safe and effective surgical treatment for benign gynecological disorders. Leiomyoma was the leading indication for surgery, while operative outcomes and postoperative recovery were favorable with minimal complications. Histopathological evaluation continues to play an essential role in confirming clinical diagnoses and guiding postoperative management.

Marginal Bone Loss and Peri-Implant Bleeding Around CAD/CAM Zirconia vs. Titanium Abutments with Concave Emergence Profiles: A Systematic Review and Meta-Analysis

2026-09-03T10:16:27+00:00

Background: Implant abutment material may influence peri-implant hard- and soft-tissue responses. Titanium remains widely used because of its mechanical reliability and established long-term clinical performance, whereas zirconia offers favorable esthetic characteristics and may influence plaque accumulation and peri-implant soft-tissue behavior. Variation in abutment customization, CAD/CAM fabrication, transmucosal contour, implant location, and follow-up duration contributes to heterogeneity in reported clinical outcomes. Objective: This systematic review compared marginal bone-level outcomes and peri-implant soft-tissue health around zirconia and titanium implant abutments and examined abutment design and transmucosal geometry as potential sources of clinical heterogeneity.

Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. We searched MEDLINE via PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials for prospective clinical studies directly comparing zirconia and titanium implant abutments; we also examined ClinicalTrials.gov and the reference lists of eligible publications. No language restriction was applied. Two reviewers independently screened records, assessed full-text eligibility, and extracted study and outcome data, resolving disagreements by discussion and consensus. We assessed randomized controlled trials with the Cochrane Risk of Bias 2 tool and non-randomized comparative studies with ROBINS-I. Publications originating from the same clinical population were identified by comparing study centers, investigators, sample characteristics, and follow-up periods, and were linked rather than treated as independent cohorts.

Results: Nineteen publications met the eligibility criteria, corresponding to twelve independent clinical investigations. Four publications followed a single randomized cohort over 1, 3, 5, and approximately 13 years (Sailer 2009 [5]; Zembic 2009 [6]; Zembic 2013 [7]; Humm 2023 [8]). Three publications followed a second cohort over 1, 3, and 5 years (Hosseini 2011 [9]; Hosseini 2013 [10]; Hosseini 2022 [11]). Two publications followed a third cohort over 1 and 5 years (Carrillo de Albornoz 2014 [14]; Ferrantino 2023 [15]). Two further publications reported a linked or related cohort at 3 years (de Oliveira Silva 2020 [20]; de Freitas 2021 [21]). The remaining eight publications (Lops 2013 [12]; Lops 2015 [13]; Bressan 2011 [16]; Cosgarea 2015 [17]; Payer 2015 [18]; Baldini 2016 [19]; Bittencourt 2023 [22]; Bharate 2020 [23]) were treated as independent investigations. Follow-up across the evidence base ranged from approximately 1 year to more than 13 years. Quantitative descriptive data for probing pocket depth, peri-implant bleeding, and marginal bone level or bone-level change were available for ten of the nineteen publications. Probing pocket depth was broadly similar between zirconia and titanium groups across these studies. Bleeding parameters were reported using non-interchangeable measures (mean bleeding-on-probing scores, percentages of bleeding sites, and modified bleeding indices) and did not show a consistent direction of difference favoring either material. Marginal bone level or bone-level change was comparable between zirconia and titanium in most studies reporting this outcome, with a numerically greater bone-level change reported for zirconia relative to the titanium/metal group in one cohort at 5 years (Hosseini 2022 [11]). Bharate et al. 2020 [23] similarly reported significantly less 1-year crestal bone-height reduction around zirconia than titanium abutments (0.487 ± 0.159 mm vs 0.621 ± 0.207 mm; P=0.02) — the only study in the evidence base to report a statistically significant between-material difference for a hard-tissue outcome. Because of differences in outcome definitions, measurement time points, and the repeated-cohort structure of the evidence, these findings are reported as a narrative synthesis of study-level results; pooled quantitative effect estimates were not generated. Conclusion: Zirconia and titanium abutments show broadly comparable clinical performance for probing depth, peri-implant bleeding, and marginal bone stability across the available prospective evidence, with an isolated exception in one cohort. Zirconia's principal reported advantage relates to esthetics in mucosally thin sites, whereas titanium is supported by the longest available follow-up data. Interpretation is limited by heterogeneity in abutment design, outcome definitions, incomplete reporting of transmucosal geometry, and the repeated-cohort structure of the literature.

Comparative Study of Lipid Profile in Treated and Untreated Multibacillary Leprosy Patients and Healthy Controls

2026-09-04T05:21:42+00:00

Leprosy, a chronic infectious disease caused by Mycobacterium leprae, can impact various metabolic processes, including lipid metabolism. Changes in the serum lipid profile have been documented in individuals with Multibacillary (MB) leprosy, and these changes may differ based on treatment status. To assess and contrast the lipid profiles of treated and untreated Multibacillary leprosy patients with those of healthy controls. This comparative study involved untreated MB leprosy patients (n=76), treated MB leprosy patients (n=73), and healthy controls (n=76). The parameters of the serum lipid profile, including total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol, were analyzed and compared across the groups. Statistical tests were applied to assess significance, with a p-value of less than 0.01 deemed significant. Untreated patients with MB leprosy exhibited significantly lower mean levels of total cholesterol (117.0 ± 16.39 mg%), triglycerides (105.8 ± 37.62 mg%), and LDL cholesterol (98.4 ± 12.01 mg%) compared to controls (140.0 ± 15.72 mg%, 124.3 ± 19.51 mg%, and 113.4 ± 27.5 mg%, respectively; p=0.001). Nonetheless, the levels of HDL cholesterol in untreated patients (48.2 ± 5.08 mg%) were significantly greater than those in the control group (40.2 ± 4.94 mg%). Treated MB leprosy patients also showed significantly lower levels of total cholesterol (129 ± 10.0 mg%), triglycerides (97.3 ± 12.26 mg%), and LDL cholesterol (90.7 ± 7.79 mg%) compared to controls, while HDL cholesterol levels were significantly higher (45.9 ± 3.70 mg%) (p=0.001). The comparison of treated and untreated MB leprosy patients showed that total cholesterol levels were significantly higher in treated patients, while triglycerides, HDL cholesterol, and LDL cholesterol levels were lower in treated cases compared to untreated cases (p=0.001). Multibacillary leprosy is linked to considerable changes in lipid metabolism. Both treated and untreated MB leprosy patients showed lower levels of total cholesterol, triglycerides, and LDL cholesterol, along with higher HDL cholesterol, when compared to healthy controls. The therapy seemed to enhance total cholesterol levels, suggesting a partial restoration of lipid metabolism after treatment.

Integrated Radiologic and Intraoperative Assessment of Gallbladder Carcinoma: Evaluating the Role of Multidetector CT in T and N Staging

2026-09-04T05:34:33+00:00

Background: Gallbladder carcinoma (GBC) is an aggressive malignancy often diagnosed at an advanced stage, particularly in South Asian populations. Accurate preoperative staging is essential for surgical planning and prognosis. While multidetector computed tomography (MDCT) is commonly employed for this purpose, its diagnostic performance relative to intraoperative findings remains underexplored in resource-limited settings.

Objective: To evaluate the accuracy of MDCT in predicting T (tumor) and N (nodal) staging in gallbladder carcinoma, using intraoperative findings as the reference standard.

Methods: This prospective cross-sectional study included 50 patients with suspected or radiologically confirmed GBC at Kuwait Teaching Hospital, Peshawar, between December 2024 and June 2025. All patients underwent triphasic contrast-enhanced MDCT using a Toshiba Activion 16-slice scanner, followed by exploratory surgery. T and N staging based on MDCT was compared with intraoperative findings. Sensitivity, specificity, predictive values, accuracy, and Cohen’s kappa coefficient were calculated.

Results: The study population had a mean age of 58.4 years; 68% were female. MDCT demonstrated an overall accuracy of 84% for T staging and 82% for N staging. Sensitivity and specificity for T staging were 87.5% and 80.0%, respectively; for N staging, they were 83.7% and 78.6%. Kappa coefficients indicated substantial agreement between radiologic and intraoperative staging (κ = 0.72 for T; κ = 0.68 for N). Discrepancies were most common in early-stage tumors and in cases of reactive lymphadenopathy.

Conclusion: MDCT shows high diagnostic accuracy in the preoperative staging of gallbladder carcinoma, particularly in identifying advanced-stage disease. While early-stage tumors and nodal involvement may be underestimated, MDCT remains a reliable tool for surgical decision-making in settings lacking immediate histopathology. Integration with intraoperative assessment enhances the effectiveness of staging and improves patient management.

Treatment Outcomes of Congenital Pseudarthrosis of Tibia Treated with Ilizarov

2026-09-04T05:44:41+00:00

Congenital pseudarthrosis of the tibia (CPT) is a rare but very difficult issue to deal. There is dysplasia of the tibia which leads to progressive anterolateral bowing, pathological fracture, nonunion and limb length discrepancy. The Ilizarov method works on the basic principle of distraction osteogenesis. It has advantage of deformity correction, compression at the nonunion site, correction of limb shortening, and early mobilization and weight-bearing. This retrospective study was done at the Department of Orthopaedic Surgery Chandka Medical College Hospital Larkana @ SMBB Medical University from January 2018 to March 2025. Data was collected in terms of age, gender, side involved, limb length discrepancy (LLD), previous treatment history, time to union, and complications were collected and analyzed using SPSS version 27. Continuous variables were presented as mean ± standard deviation, while categorical variables were expressed as frequencies and percentages. The study included 15 patients with a mean age of 7.9 ± 3.1 years. There were 9 males (60%) and 6 females (40%). Right-sided involvement was observed in 8 patients (53.3%) and left-sided involvement in 7 patients (46.7%). Mean preoperative LLD was 4.6 ± 1.4 cm. Ten patients (66.7%) had undergone previous interventions. Union was achieved in 13 patients (86.7%). Pin tract infection occurred in 5 patients (33.3%), wire loosening in 3 patients (20%), wire breakage in 2 patients (13.3%), and refracture in 2 patients (13. 3%).The Ilizarov technique is an effective treatment modality for congenital pseudarthrosis of the tibia with a high union rate and satisfactory correction of limb length discrepancy. Refracture remains the most significant long-term complication and necessitates prolonged follow-up.

Vitamin D Deficiency and Its Association with Fatigue and Cognitive Performance in Adults

2026-09-04T05:53:20+00:00

Objective: To assess the prevalence of vitamin D deficiency and its correlation with fatigue and cognitive function in adults attending for tertiary care in a tertiary care hospital.

Methods: A prospective cross sectional study was carried out at Lady Reading hospital from 23 January 2025 to 23 December 2026. 154 adults were consecutively sampled to obtain an enrollment into the study. Vitamin D was analysed in serum samples by chemiluminescence immunoassay. Fatigue Severity Scale was used to measure the severity of fatigue and Montreal Cognitive Assessment questionnaire was used to evaluate cognitive performance. The data were analyzed statistically using Statistical Package for Social Sciences (SPSS) version 26. P values < 0.05 were deemed statistically significant.

Results: Vitamin D deficiency was found in 53.2% and insufficiency was seen in 29.9% of the participants Participants with vitamin D deficiency had significantly higher Fatigue Severity Scale scores and lower Montreal Cognitive Assessment scores than participants with sufficient vitamin D levels. There was significant association of vitamin D deficiency with generalized weakness, daytime tiredness, decreased concentration and cognitive impairment. Pearson correlation analysis showed an inverse correlation between the vitamin D levels and fatigue severity, and a positive relationship was seen between the vitamin D concentration and cognitive performance.

Conclusion: Vitamin D deficiency was common among adults attending a tertiary healthcare facility and was significantly associated with greater fatigue severity and lower cognitive performance. These findings support consideration of vitamin D assessment in adults presenting with fatigue and cognitive complaints. Longitudinal and interventional studies are required to determine causality and the effects of treatment.

EFFICACY OF METHYLENE BLUE DYE FOR INTRAOPERATIVE IDENTIFICATION OF PARATHYROID GLANDS AND RECURRENT LARYNGEAL NERVE DURING THYROIDECTOMY: A PROSPECTIVE STUDY

2026-09-04T06:18:14+00:00

Background: Thyroidectomy carries risks ofinjury to parathyroid glands and the recurrentlaryngeal nerve (RLN). Methylene blue dye
has emerged as a potential aid for theintraoperativeidentification structures.ofthese

Carbapenem Resistance in Uropathogenic Escherichia coli Isolates from Children with Urinary Tract Infections

2026-09-04T08:50:04+00:00

Carbapenem-resistant Enterobacterales,particularly uropathogenic Escherichia coli(UPEC), pose an escalating threat in pediatricnephrology due to severely limitedtherapeutic options. The objective of thiscross-sectional study was to determine the
prevalence, molecular mechanisms

Determinants of Human Papillomavirus (HPV) Vaccine and Factors of Hesitancy to Vaccinate Adolescent Girls against HPV Faced by their Parents in Pakistan: A Community-Based Study

2026-09-04T09:13:20+00:00

Background: Human papillomavirus (HPV) vaccination is a highly effective strategy for preventing cervical cancer, yet parental vaccine hesitancy remains an important barrier to achieving adequate vaccination coverage. Evidence regarding the factors of parental HPV vaccine hesitancy in Pakistan remains limited.

Objective: To assess determinants of HPV vaccine hesitancy among parents of adolescent girls in Pakistan and evaluate the factors associated with reluctance or refusal to vaccinate.

Methods: A community-based cross-sectional study was conducted among 500 parents of adolescent girls in Islamabad, Pakistan. Data were collected using a structured questionnaire assessing sociodemographic characteristics, HPV-related knowledge, vaccine perceptions, information sources, reasons for hesitancy, and factors of delayed or refused vaccination. Factors associated with HPV vaccine hesitancy were evaluated using multivariable logistic regression, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) reported.

Results: HPV vaccine hesitancy was identified among 293 (58.6%) parents. The most frequently reported concerns were vaccine safety (61.1%), inadequate knowledge (56.0%), adverse effects (48.8%), and infertility (43.7%). Adequate HPV knowledge was independently associated with lower odds of hesitancy (aOR 0.39, 95% CI 0.25–0.61), whereas safety concerns (aOR 2.71, 95% CI 1.78–4.12), infertility concerns (aOR 2.34, 95% CI 1.53–3.59), and misinformation (aOR 2.08, 95% CI 1.38–3.14) were associated with greater hesitancy.

Conclusion: Parental HPV vaccine hesitancy was common and was driven predominantly by modifiable knowledge, safety, misinformation, and counselling-related factors. Targeted healthcare-provider counselling and culturally appropriate community education may improve vaccine acceptance.

A Comparative Study to Evaluate the Safety and Efficacy of Cilnidipine versus Amlodipine in Newly Diagnosed Essential Hypertensive Patients at a Tertiary Health Care Centre of Uttar Pradesh

2026-09-04T09:20:14+00:00

Introduction: Hypertension remains a major modifiable determinant of cardiovascular, cerebrovascular and renal morbidity, and sustained pharmacological therapy is frequently required to achieve adequate blood-pressure control. Amlodipine is an established long-acting L-type calcium-channel blocker, whereas cilnidipine inhibits both L- and N-type calcium channels and may provide additional attenuation of sympathetic activity. Comparative assessment of their antihypertensive efficacy and tolerability is clinically relevant, particularly because peripheral edema and other treatment-related adverse effects may influence long-term adherence.

Aim: To compare the safety and efficacy of cilnidipine versus amlodipine in newly diagnosed essential hypertensive patients.

Methodology: This prospective, randomized, open-label comparative clinical study was conducted in the Department of Pharmacology and Therapeutics in collaboration with the Department of Medicine, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, from September 2024 to September 2025. A total of 180 newly diagnosed Stage 1 or Stage 2 essential hypertensive patients were allocated in a 1:1 ratio by simple randomization. Ninety received cilnidipine 10 mg once daily and 90 received amlodipine 5 mg once daily. Clinical assessment was performed at baseline and at 1, 3, 6, 9 and 12 months. Blood pressure, heart rate, treatment compliance and adverse events were evaluated during follow-up.

Results: The treatment groups were comparable at baseline. Among participants completing 12-month follow-up, mean SBP reduction was −22.3 ± 10.1 mmHg with cilnidipine and −23.1 ± 9.8 mmHg with amlodipine (p=0.611), while DBP reduction was −14.3 ± 6.2 and −13.5 ± 6.0 mmHg, respectively (p=0.407). At 12 months, SBP was 130.4 ± 4.8 versus 130.1 ± 4.6 mmHg (p=0.686), while DBP was 81.5 ± 2.7 versus 82.8 ± 2.8 mmHg (p=0.003). Pedal edema occurred in 5.6% versus 16.7% (p=0.018). Overall adverse events occurred in 15.6% versus 26.7% (p=0.068), and drug-related events in 12.2% versus 23.3% (p=0.051). Heart-rate reduction was greater with cilnidipine (−5.9 ± 4.1 vs −0.8 ± 3.8 bpm; p<0.001).

Conclusion: Both agents provided substantial antihypertensive efficacy. Cilnidipine demonstrated a favourable tolerability and heart-rate profile, with a significantly lower frequency of pedal edema, while systolic blood-pressure reduction was similar between treatments.

Diffusion Weighted MRI Patterns in Viral Encephalitis and Their Correlation with Clinical Outcomes

2026-09-04T11:10:51+00:00

Objectives: To study the DW-MRI pattern in patients with viral encephalitis and to assess its association with clinical outcome.

Methods: It is a descriptive cross sectional study, where the study setting was in the department of radiology at Liaqat National hospital and medical college Karachi from 23 February 2025 till 23 November 2025. The patients with viral encephalitis were selected by consecutive non probability sampling and a total of 89 patients were included with clinically suspected and radiologically confirmed viral encephalitis. The pattern of lesions and their anatomical distribution were used to classify DW-MRI findings. The clinical outcomes were evaluated as complete or incomplete or no recovery. Data was analyzed using a statistical package for social sciences (SPSS) version 26, and a p value of < 0.05 was set as the threshold for significance.

Results: The mean age of the patients was 34.6 ± 11.3 years and 58.4% were males. The pattern of bilateral cerebral involvement occurred in 38.2% of patients and was the most common pattern of DWI involvement. In 57.3% of cases, there was involvement of the temporal lobes. 68.5% of patients made a full neurological recovery. Diffuse cerebral involvement had the worst clinical outcome and there was a significant relationship between diffusion weighted imaging patterns and clinical outcome (p < 0.001).

Conclusion: There was a significant relationship between DW-MRI patterns and neurological outcomes in viral encephalitis. The presence of extensive and diffuse diffusion restriction was correlated with poor prognosis and with the presence of neurological deficits.

Clinical Profile and Outcomes of Patients with Concurrent Acute Myocardial Infarction and Gastrointestinal Bleeding: Challenges in Antithrombotic Management

2026-09-05T05:10:31+00:00

Background: Concurrent acute myocardial infarction (AMI) and gastrointestinal bleeding (GIB) presents a major therapeutic challenge because antithrombotic therapy reduces ischemic risk but may worsen active bleeding. Careful balancing of these competing risks is essential for improving outcomes.

Objective: To evaluate the clinical profile, antithrombotic management, and in-hospital outcomes of patients presenting with concurrent AMI and GIB.

Methods: This retrospective observational study was conducted at the Department of Internal Medicine Saidu Teaching Hospital Swat from August 2025 to December 2025. Demographic characteristics, comorbidities, type of AMI, hemoglobin level, left ventricular ejection fraction (LVEF), bleeding presentation, endoscopic management, transfusion requirement, antithrombotic therapy, and in-hospital outcomes were recorded.

Results: The mean age was 63.92±11.60 years, and 78 (65.0%) patients were male. STEMI was present in 67 (55.8%) patients. Patients with adverse outcomes had lower hemoglobin (8.50±2.00 vs. 10.30±1.80 g/dL, p<0.001) and lower LVEF (39.80±10.20% vs. 48.70±9.50%, p<0.001). Antithrombotic therapy was interrupted in 61 (50.8%) patients. Interruption was associated with more recurrent myocardial ischemia (26.2% vs. 6.8%, p=0.004) and reinfarction (18.0% vs. 5.1%, p=0.027), whereas rebleeding was more frequent when therapy was continued (25.4% vs. 11.5%, p=0.048). Independent predictors of adverse outcomes included cardiogenic shock (adjusted OR 4.76), chronic kidney disease (OR 3.02), hemoglobin <9 g/dL (OR 2.88), antithrombotic interruption >24 hours (OR 2.79), LVEF <40% (OR 2.67), transfusion requirement (OR 2.42), STEMI (OR 2.31), and age ≥65 years (OR 2.24).

Conclusion: Patients with concurrent AMI and GIB have substantial risks of both ischemic and bleeding complications. Prolonged interruption of antithrombotic therapy was associated with increased recurrent ischemia, while continuation increased rebleeding. Individualized management, early bleeding control, and timely resumption of antithrombotic therapy are essential.

Inflammatory and Oxidative Stress Biomarkers in Women with Endometriosis: Association with Disease Severity

2026-09-05T05:29:11+00:00

Background: Endometriosis is a chronic inflammatory disorder in which oxidative imbalance may support lesion survival and disease progression. Affordable circulating biomarkers may help assess severity in resource-limited settings.

Objective: To compare inflammatory and oxidative stress biomarkers in women with and without endometriosis and determine their association with disease severity.

Methods: This multicenter analytical cross-sectional study included 240 women undergoing pelvic laparoscopy at three tertiary-care hospitals in Pakistan. Histologically confirmed cases were categorized as revised American Society for Reproductive Medicine stage I–II or stage III–IV. Women without endometriosis served as controls. Serum high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, malondialdehyde, superoxide dismutase and total antioxidant capacity were measured.

Results: The study included 160 women with endometriosis and 80 controls. Women with endometriosis had significantly higher inflammatory markers and malondialdehyde, whereas superoxide dismutase and total antioxidant capacity were significantly lower than controls (all p<0.001). Biomarker disturbance increased progressively from controls to stage I–II and stage III–IV disease. Interleukin-6, malondialdehyde and total antioxidant capacity remained independently associated with advanced disease. The combined biomarker model effectively distinguished stage III–IV disease, achieving an area under the receiver operating characteristic curve of 0.86.

Conclusion: Endometriosis was associated with increased systemic inflammation, lipid peroxidation and impaired antioxidant defense. A combined biomarker panel may support severity assessment but cannot replace clinical evaluation, imaging or histopathology.

Cornea Donation Calls In a Tertiary Eye Care Centre: an Audit of Donor Characteristics, Retrieval Timelines, and Corneal Grade

2026-09-05T06:39:12+00:00

Purpose: To characterize cornea donation calls received at a tertiary eye care center and evaluate donor demographics, cause of death, retrieval workflow, and their association with recorded donor corneal grade.

Methods: This retrospective observational audit included 84 consecutive cornea donation calls documented between February and August 2026. Donor age, sex, cause of death, retrieval pathway, timing variables, and recorded corneal grade were extracted. Each donor contributed two recorded corneal grades. Spearman correlation was used for ordinal grade scores; categorical associations were assessed using chi-square or Fisher exact tests, and nonparametric comparisons used the Mann–Whitney U test. Partial rank correlations controlling for age were performed for timing variables.
Results: Mean donor age was 47.8 ± 19.2 years; 68 (81.0%) donors were male. Traumatic brain injury was the commonest cause of death (43/84, 51.2%). Sixty-six (78.6%) calls involved all-organ donation and 18 (21.4%) were eye-only calls. Among 168 recorded corneas, 101 (60.1%) were grade A, 38 (22.6%) grade B, and 29 (17.3%) grade C. Forty-two donors (50.0%) had bilateral grade A corneas. Donor age showed a strong inverse correlation with corneal grade score (Spearman ρ = −0.748, P < 0.001). The association persisted across age groups (χ² = 62.42, P < 0.001). Apparent associations between grade and retrieval timing were attenuated after adjustment for age.
Conclusion: Younger donors contributed substantially more grade A tissue. Systematic recording of donation calls, rapid retrieval, and age-stratified monitoring may improve eye-bank procurement and quality assessment.

Clinical Profile and Etiological Spectrum of Secondary Glaucoma at a Tertiary Eye Care Centre in Karnataka, South India: A Retrospective Observational Study

2026-09-05T06:50:29+00:00

Objective: To describe the demographic characteristics, etiological spectrum, and clinical presentation profile of secondary glaucoma among patients presenting to a tertiary eye care centre in Karnataka, South India, including comparisons between pediatric and adult subgroups, while distinguishing patient-level from eye-level parameters.

Material and Methods: This retrospective, single-centre, observational study included 300 patients (365 eyes) with a clinical diagnosis of secondary glaucoma presenting to a tertiary eye care hospital in Bangalore, Karnataka, between March 2025 and April 2026. Data were abstracted from medical records and analyzed separately at the patient level (demographic and systemic comorbidity variables) and the eye level (etiology, visual acuity, intraocular pressure [IOP], anterior segment, gonioscopic, and fundus variables) to avoid unit-of-analysis errors arising from inter-eye correlation in bilaterally affected patients.

Results: The mean age of the cohort was 48.6 ± 21.4 years; 170 patients (56.7%) were male, and 34 (11.3%) were younger than 18 years. Bilateral involvement was present in 65 patients (21.7%). Lens-induced glaucoma was the most frequent aetiology (63 eyes, 17.3%), followed by inflammatory/uveitic glaucoma (58, 15.9%), neovascular glaucoma (53, 14.5%), and steroid-induced glaucoma (44, 12.1%). Presenting best-corrected visual acuity was worse than 6/60 in 149 eyes (40.8%), and mean presenting IOP was 27.4 ± 11.8 mmHg. Severe visual impairment, elevated IOP, and advanced optic nerve cupping were concentrated predominantly in the neovascular and lens-induced subgroups. The pediatric subgroup (n = 34) differed significantly from adults in aetiology (predominantly developmental anterior-segment anomalies), bilaterality (35.3% vs. 19.9%; p = 0.044), and systemic comorbidity burden (82.4% vs. 43.2% with no comorbidity; p < 0.001).

Conclusions: Lens-induced and neovascular glaucoma were the leading and most visually damaging categories of secondary glaucoma at this South Indian tertiary centre, while pediatric secondary glaucoma showed a distinct, largely developmental aetiological pattern. These findings identify lens-induced and neovascular glaucoma as priority targets for earlier detection and referral in this population.

Comparative Analgesic Efficacy of Intravenous Ibuprofen versus Intravenous Paracetamol Following Laparoscopic Cholecystectomy

2026-09-05T09:45:57+00:00

Aim: To compare the Analgesic Efficacy of Intravenous Ibuprofen versus Intravenous Paracetamol Following Laparoscopic Cholecystectomy.

Materials and Methods: The prospective comparative study was conducted in the Department of Anesthesia. Total 100 patients were enrolled for the study, divided into two groups. Group A received IV ibuprofen 400 mg and Group B received IV paracetamol 1 g, both administered over 30 minutes. The study comprised patients scheduled for elective laparoscopic cholecystectomy. All patients received instruction on how to use the Visual Analogue Scale (VAS) for pain assessment during the preoperative evaluation. Convenience sampling was used for participant recruitment, after which participants were assigned into two groups using a computer-generated allocation sequence.

Results: The two groups were comparable at baseline, with no significant differences in age, gender, weight, height, or BMI (p > 0.05). Postoperative pain scores were significantly lower in the ibuprofen group at 0, 2, 4, and 6 hours, with the greatest difference at 6 hours (p < 0.05). Rescue analgesic requirement was also lower with ibuprofen, particularly at 4 and 6 hours. Heart rate and systolic blood pressure were generally lower in the ibuprofen group, while no consistent significant difference was observed in diastolic blood pressure.

Conclusion: Intravenous ibuprofen provided better postoperative analgesia than intravenous paracetamol, with lower pain scores, delayed rescue analgesia, and reduced overall rescue analgesic use.

Predictive Role of Liver Functional Reserve, Serum Alpha-Fetoprotein, and Histopathological Grade in Patients Receiving Combination Immunotherapy for Advanced Hepatocellular Carcinoma

2026-09-07T05:37:50+00:00

Background: Hepatocellular carcinoma (HCC) is frequently diagnosed at an advanced stage, when impaired hepatic reserve and aggressive tumor biology may adversely affect the efficacy of systemic immunotherapy. Liver functional reserve, serum alpha-fetoprotein (AFP), and histopathological grade may therefore provide important predictive information.

Objective: To determine the predictive role of liver functional reserve, serum AFP, and histopathological grade in patients with advanced HCC receiving combination immunotherapy.

Methods: A prospective observational study was conducted in a tertiary hospital among 100 patients with advanced HCC receiving combination immunotherapy. Baseline liver function was assessed using Child–Pugh classification and albumin-bilirubin (ALBI) grade. Serum AFP, bilirubin, albumin, ALT, AST, and other biochemical parameters were recorded. Histopathological tumor grade was determined according to tumor differentiation. Treatment response was assessed radiologically, while progression-free survival (PFS) and overall survival (OS) were evaluated during follow-up. Associations between baseline variables and treatment outcomes were analyzed using logistic regression and Cox proportional-hazards models.

Results: Among 100 patients, 38 (38.0%) achieved an objective response, including 12 (12.0%) complete and 26 (26.0%) partial responses, while 34 (34.0%) had stable disease and 28 (28.0%) showed progressive disease. Objective response was significantly higher in patients with Child–Pugh class A than class B (45.5% vs. 18.2%, p=0.008) and in patients with ALBI grade 1 compared with grades 2–3 (52.9% vs. 26.0%, p=0.006). Patients with AFP <400 ng/mL demonstrated a significantly higher response rate than those with AFP ≥400 ng/mL (46.8% vs. 22.2%, p=0.011). Poorly differentiated tumors were associated with a lower objective response compared with well/moderately differentiated tumors (20.0% vs. 43.8%, p=0.018). Median PFS was 8.7 months in Child–Pugh A patients compared with 4.6 months in Child–Pugh B patients (p=0.003), while median OS was 18.9 and 10.2 months, respectively (p<0.001). On multivariate analysis, impaired liver functional reserve (HR=2.18, 95% CI: 1.31–3.63, p=0.003), AFP ≥400 ng/mL (HR=1.91, 95% CI: 1.16–3.15, p=0.011), and poor histopathological differentiation (HR=1.84, 95% CI: 1.08–3.14, p=0.025) were independently associated with shorter OS.

Conclusion: Preserved liver functional reserve, lower serum AFP, and favorable histopathological grade were significantly associated with improved response and survival among patients with advanced HCC receiving combination immunotherapy. The combined assessment of hepatic reserve, AFP, and tumor differentiation may provide a useful approach for pretreatment risk stratification and prediction of immunotherapy outcomes.

Unmasking Anemia: Insights into Prevalence, Severity, and Comorbidities in Hospitalized Elderly Patients

2026-09-07T05:43:46+00:00

Background: The elderly population is expanding globally, presenting unique healthcare challenges, particularly in resource-limited settings like Pakistan, where geriatric medicine is not yet a recognized specialty. Anemia is a common health concern among older adults, associated with increased morbidity, functional decline, and mortality. This study explores the severity of anemia in hospitalized elderly anemic patients and its association with comorbid conditions.

Methods: This was a descriptive study conducted at Medical Department of Bacha Khan Medical Complex (BKMC) Swabi from November 2022 to January 2023, involving 71 newly diagnosed anemic patients of age 60 years and above. Patients who had critical illness, had a recent surgery and were on treatment for anemia were excluded from the study. Data collection involved a review of the medical history, laboratory analysis and categorization of hemoglobin into different categories by WHO standards. Statistical analysis was done using SPSS version 20 and R version 4.1.

Results: The mean age of patients was 68 ± 8 years and 50.7% of them were male. The average Hb level was recorded 7.1 ± 2.2 g/dL and Severe anemia (Hb <8 g/dL) was observed in 69.0% of patients. Most patients (74.6%) had at least one comorbidity, while 25.4% had isolated anemia. Chronic diseases were the most prevalent (47.9%), followed by infectious diseases (12.7%), cardiovascular diseases (8.5%), and neurological diseases (7.2%). The "Others" category was made up of 28.2% of the patients, meaning that the nature of comorbid conditions was very diverse. The lowest level of hemoglobin occurred in patients suffering from hematological and gastrointestinal diseases.

Conclusion: Chronic and infectious diseases predominate the causes of anemia in elderly patients. There was a significant variation in severity across comorbidity groups. The findings underscore the importance of addressing underlying comorbid conditions for effective anemia management in this vulnerable population, hospital setting. The severity varied significantly between the comorbidity groups. Underlying comorbid conditions must be addressed in order to adequately manage anemia in this susceptible population.

Relationship between Maternal Vitamin D and Calcium Status and Neonatal Calcium Homeostasis in Pregnancies Complicated by Hypertensive Disorders

2026-09-07T05:58:43+00:00

Background: Hypertensive disorders of pregnancy can lead to maternal and fetal complications and can affect the transfer of nutrients from the placenta. Vitamin D and calcium play a crucial role in maternal mineral balance, fetal skeletal development and neonatal calcium regulation. Changes in maternal vitamin D and calcium levels might consequently influence the development of neonatal hypocalcemia, especially during preeclampsia and other hypertensive disorders.

Objective: To determine the relationship between maternal vitamin D and calcium status and neonatal calcium homeostasis in pregnancies complicated by hypertensive disorders.

Methodology: This analytical cross-sectional study was carried out in January-June 2025 in Khalifa Gul Nawaz Teaching Hospital, Bannu. The pregnant women with hypertensive disorders and neonates were selected by consecutive sampling, with a total number of 75. Serum 25-hydroxyvitamin D, calcium, phosphate, magnesium and albumin levels were measured. Data recorded included: Neonatal birth weight, Apgar scores, cord blood calcium, neonatal serum calcium, phosphate, magnesium, and neonatal hypocalcemia status. Correlation analysis, Chi-square/Fisher’s exact test and multivariable logistic regression were used to evaluate the associations between maternal biochemical status and neonatal calcium homeostasis. One-sided p-value of < 0.05 was regarded as statistically significant.

Results: The mean maternal serum 25(OH)D level was 20.46 ± 8.17 ng/mL, while mean maternal serum calcium was 8.42 ± 0.71 mg/dL. Vitamin D deficiency was observed in 45.3% of mothers and low maternal calcium in 34.7%. The mean neonatal serum calcium concentration was 8.21 ± 0.76 mg/dL, and neonatal hypocalcemia occurred in 25.3% of newborns. Maternal vitamin D and serum calcium were positively correlated with neonatal calcium levels (r = 0.46 and r = 0.52, respectively; both p < 0.001). Neonatal hypocalcemia was significantly more frequent among vitamin D-deficient mothers, mothers with low serum calcium, and women with severe preeclampsia.

Conclusion: Lower maternal vitamin D and calcium levels were significantly associated with impaired neonatal calcium homeostasis in hypertensive pregnancies. Maternal vitamin D deficiency, low calcium status, and severe preeclampsia may identify neonates at increased risk of hypocalcemia and may warrant closer biochemical monitoring after birth.

Decoding Glioblastoma: An Integrated Prognostic Gene Signature and Molecular Landscape Analysis

2026-09-07T07:26:52+00:00

Background: Glioblastoma (GBM) exhibits extensive molecular heterogeneity and poor clinical outcomes, necessitating reliable molecular prognostic markers. This study aimed to develop and validate a transcriptome-based prognostic signature for GBM.

Methods: RNA-sequencing and clinical data from The Cancer Genome Atlas (TCGA) were analyzed using differential expression, Kaplan–Meier survival, univariate and multivariable Cox regression, and LASSO Cox regression. Functional enrichment, gene set enrichment analysis (GSEA), protein–protein interaction (PPI), and immune-infiltration analyses were performed. The Chinese Glioma Genome Atlas (CGGA) cohort was used for external validation.

Results: Differential expression analysis identified 15,098 DEGs, including 8,922 upregulated and 6,176 downregulated genes. After filtering, 41,864 genes from 283 patients were analyzed for survival. Univariate Cox analysis identified 76 significant genes, while Kaplan–Meier analysis identified 35 prognostically significant genes. Multivariable Cox regression demonstrated a C-index of 0.7101 (SE 0.0205). LASSO Cox regression selected an 18-gene signature at λmin = 0.055606. Using a risk-score cutoff of 1.135096, patients were classified into 142 high-risk and 141 low-risk groups. The model achieved AUCs of 0.7711, 0.8560, and 0.8864 for 1-, 3-, and 5-year overall survival, respectively. A nomogram incorporating age and risk score was developed, with coefficients of 0.027826 and 1.401713, respectively. Functional and immune analyses demonstrated distinct biological and immune characteristics between risk groups.

Conclusion: The 18-gene signature demonstrated promising prognostic discrimination and provides a potential framework for GBM risk stratification and biomarker discovery. Further experimental and prospective clinical validation is required.

Preservation of the Intercostobrachial Nerve during Axillary Surgery: Anatomical Considerations and Clinical Outcomes

2026-09-08T05:35:21+00:00

Background: Injury to the intercostobrachial nerve during axillary lymph-node dissection may result in numbness, paresthesia and persistent neuropathic pain. Evidence regarding nerve preservation in resource-constrained healthcare systems remains limited.

Objective: This study evaluated the anatomical patterns, feasibility and clinical outcomes of intercostobrachial nerve preservation during axillary surgery.

Methods: This prospective multicenter comparative cohort study included 132 women undergoing level I–II axillary lymph-node dissection at three tertiary-care hospitals in Pakistan. The nerve was preserved whenever technically and oncologically feasible. The primary outcomes were medial upper-arm sensory deficit and neuropathic pain at six months. Secondary outcomes included operative time, lymph-node yield, surgical complications and shoulder function. Multivariable logistic regression was performed to identify factors independently associated with sensory deficit and neuropathic pain.

Results: The nerve was preserved in 91 (68.9%) patients and divided in 41 (31.1%). A single trunk was observed in 52.3%, two branches in 34.1%, and three or more branches in 13.6%. Preservation increased the median operative time by seven minutes without reducing lymph-node yield. At six months, sensory deficit occurred in 15.4% of the preservation group and 46.3% of the division group (p<0.001). Neuropathic pain occurred in 9.9% and 29.3%, respectively (p=0.004). Preservation independently reduced sensory deficit and neuropathic pain. Complication rates were comparable.

Conclusion: Intercostobrachial nerve preservation was feasible and improved postoperative sensory outcomes without compromising axillary clearance.

Comparative Study of Serum Vitamin D in the Urban and Rural Adult Population of Larkana District

2026-09-08T06:05:32+00:00

Vitamin D deficiency is a global phenomenon and a significant risk factor for various metabolic disorders. The current investigation emphasizes the notable disparities in serum vitamin D concentrations and lipid profiles between adult populations in urban and rural settings. A total of 264 individuals were chosen. Blood samples were collected and serum vitamin D levels and parameters assessed using automated enzymatic colorimetric techniques, all according to standardized procedures. Information on demographic traits, family history, physical activity, and sun exposure was gathered using structured questionnaires. The present findings showed that the BMI value in the rural area ranged from 11.07 to 47.34, with an average of 29.43 and a standard deviation of 9.05. The rural region presents a more dependable range of BMI values. The average BMI value was 29.43, which is somewhat lower than that of the urban area. The mean vitamin D score for the urban group was 18.39, significantly lower than that of the rural group. People living in urban areas tended to indicate that they engaged in less physical activity. Physical activity levels of urban and rural participants differed significantly with respect to Vitamin D, indicated by a P-value of less than 0.001. Vitamin deficiency or insufficiency affects most individuals across both rural and urban settings, irrespective of age, with those aged 31 to 50 being the most impacted. None show signs of vitamin intoxication, and only a small number of individuals have adequate vitamin levels. Pointing out the necessity of enhanced understanding of nutrition and possible supplements, particularly among younger and middle-aged individuals. The means of the age groups do not differ statistically significantly, as all p-values exceed 0.05. Even though the Age 31–50 group exhibits greater variance, the central tendencies of the distributions. The findings indicate that young individuals in rural areas exhibit a significantly higher level of physical activity compared to those in urban areas. This could be a reflection of how the two environments differ in terms of infrastructure, environmental elements, lifestyle, and work needs.

Level-Wise and Bilateral Morphometry of the Adult Lumbar Vertebral Column in a Central Indian Population: A Cross-Sectional Osteometric Study

2026-09-08T06:12:39+00:00

Purpose: Population-specific morphometric data for the adult lumbar vertebral column remain absent for the Madhya Pradesh and Central Indian population. Existing regional data are restricted either to vertebral body and angular parameters alone or to pedicle dimensions alone, from small, non-power-calculated samples. This study aimed to generate a comprehensive, level-wise morphometric database of the adult lumbar vertebral column in this population.

Methods: A cross-sectional osteometric study was conducted on 110 dry adult human lumbar vertebrae (22 at each of L1-L5) drawn from a departmental osteology collection. Nine linear parameters, vertebral body height, transverse width, and antero-posterior length; right and left pedicle width; interpedicular distance; vertebral canal antero-posterior and transverse diameter; and spinous process length, were measured in triplicate using a digital Vernier caliper. Level-wise differences were tested by one-way ANOVA with Tukey's post-hoc test; bilateral (right-left) pedicle width symmetry was tested by paired t-test and Pearson correlation.

Results: All nine parameters increased significantly from L1 to L5 (p < .001 for each), pedicle width showing the largest proportional increase (8.05 mm to 12.92 mm on the right, a 60.5% increase). Vertebral body transverse width showed a fully stepwise gradient (all ten pairwise level comparisons significant), whereas vertebral body height and spinous process length showed a more gradual, level-clustered pattern. Right and left pedicle width did not differ significantly (mean difference 0.02 ± 0.42 mm; t(109) = 0.48, p = .634) and were strongly correlated (r = .971, p < .001).

Conclusion: The adult lumbar vertebral column in this Central Indian population shows a consistent cranio-caudal morphometric gradient and marked bilateral pedicle symmetry, with absolute dimensions generally smaller than Western reference data. These level-specific normative values provide a population-appropriate reference for transpedicular screw sizing and radiological assessment of the lumbar spine in Central India.

Comparative Evaluation of Two Different Doses of Dexmedetomidine as an Adjunct to Levobupivacaine in Subarachnoid Block for Lower Abdominal Surgeries

2026-09-08T06:24:53+00:00

Background: Spinal anaesthesia is the preferred mode of anaesthesia for lower abdominal and lower limb surgeries. Levobupivacaine is being increasing used for spinal anaesthesia nowadays. Dexmedetomidine which is a potent α₂agonist is being used as an adjunct to various local anaesthetics.

Aim: In this study, we aimed to compare two different doses of dexmedetomidine when added to Levobupivacaine in terms of onset, duration of sensory and motor block and post operative analgesia.

Method: A prospective, randomized study was carried out which included 100 patients between 18-65 years, of ASA I and II who underwent lower abdominal surgeries. Group D1 received 3ml levobupivacaine 0.5% +2.5mcg dexmedetomidine (in 0.5ml normal saline) total volume 3.5 ml and Group II D₂ received 3ml levobupivacaine 0.5% + 5mcg dexmedetomidine (in 0.5 ml of normal saline) total volume 3.5 ml. Sensory and motor block onset time, block reaching time to T6 dermatome, highest dermatome level of sensory block, two dermatome regression time, time to achieve complete motor block, VAS score at 2, 4 and 6 hours post spinal.

Results: Sensory block onset time, block reaching time to T6 dermatome and time to achieve complete motor blockade was same in both groups. Whereas motor block onset time was earlier in group D2 (p=0.003), two dermatome regression time was longer in group D2(p<0.001), and VAS score at 4 and 6 hrs was better in group D2(p-values 0.013 and <0.001 respectively).

Conclusion: We conclude that 5 mcg dose of dexmedetomidine has early onset of motor block, longer two dermatome regression and better VAS scores at 4 and 6 hours.

Comparative Evaluation of Post-Operative Facial Nerve Injury in Conventional 45º Incision V/S Modified 90º Incision in Al-Kayat Bramley and Hemi-Coronal Approach

2026-09-08T07:21:53+00:00

Introduction: The facial nerve is considered the “Queen of The Face” as it innervates the muscles of facial expression. Al-Kayat and Bramley a modified preauricular approach to TMJ and malar arch in an effort to protect temporal and zygomatic branches. They insisted upon placing a 45⁰ incision in superficial temporalis fascia. However temporal and zygomatic branches involvement were still noted following Al-Kayat Bramley approach. Hence, we believed a necessity to revisit this conventional 45⁰incision.

Methods: The present study was meticulously planned and executed, involving patient who sought consultation at outpatient department. The sample consisted of 34 patients operated by the same surgical team using Al-Kayat Bramley and Hemi-coronal approach. Patients were divided randomly into two groups. Group 1 included patients operated using the conventional 45⁰ incision and group 2 included patients operated using the modified 90⁰ incision. All patients were examined using the House Brackmann Facial Nerve Grading System scale at regular intervals to assess the degree of improvement or deterioration.

Results: The incidence of temporal and zygomatic nerve injuries was less in modified 90⁰ incisions than conventional 45⁰ incision

Conclusion: Facial nerve impairment was shown to be of a temporary nature. This study shows that the modified 90º incision is associated with reduced incidence of facial nerve injury post operatively when compared to conventional 45⁰ incision.

Comparison of Triglyceride-Glucose (TyG) Index in Patients with Ischemic Heart Disease with and Without Multivessel Coronary Artery Disease

2026-09-08T08:15:48+00:00

Background: The triglyceride-glucose (TyG) index is a readily available indicator of insulin resistance and may be related to the severity of coronary artery disease. This study compared the TyG index in patients with ischemic heart disease with and without multivessel coronary artery disease (MV-CAD).

Methods: A comparative analytical cross-sectional study was carried out on 208 patients with ischemic heart disease (IHD) who were undergoing coronary angiography. Participants were divided equally into MV-CAD group and non-MV-CAD group. Demographic, clinical and biochemical parameters were recorded and the TyG index was obtained from the fasting levels of triglycerides and glucose. Comparisons between groups, logistic regression, and ROC analysis were conducted.

Results: The mean TyG index was significantly higher in patients with MV-CAD compared with those without MV-CAD (p<0.001). There were also differences in fasting glucose and triglyceride levels, and in HDL-C levels, between the MV-CAD group and the non-MV-CAD group. TyG was independently related to MV-CAD after multivariable adjustment (p<0.001). The ROC analysis resulted in an AUC of 0.733 and a cut-off value of 8.91 with a sensitivity of 72.1% and specificity of 65.4%.

Conclusions: Higher TyG was independently associated with MV-CAD and had moderate discriminatory capability, suggesting that it could be a low-cost, supplementary marker of coronary disease burden.

Comparative Assessment of Serum Protein Profiles in Broiler and Indigenous Chickens in Response to Different Feeding Patterns

2026-09-08T10:38:07+00:00

Although the binding of antibiotics to serum proteins has been extensively investigated, limited information is available on how antibiotics influence serum protein levels under different feeding patterns. This study evaluated the effects of enrofloxacin and colistin on serum proteins (albumin and globulin) in broiler and indigenous chickens fed either commercial or organic diets. A total of 80 one-day-old chicks were assigned to enrofloxacin (n = 40) and colistin (n = 40) treatment groups. Each treatment included 20 broiler and 20 indigenous chicks, which were further allocated into experimental and control groups. Antibiotics were administered through drinking water over a 4-week experimental period. Blood samples were collected weekly, serum was separated by centrifugation, and albumin and globulin concentrations were determined using standard laboratory methods. In all control groups, serum protein levels increased progressively throughout the study. In contrast, antibiotic-treated groups exhibited a reduction in albumin and globulin concentrations, although protein levels remained unchanged during the fourth week in some groups. Overall, both enrofloxacin and colistin reduced serum protein levels in broiler and indigenous chickens regardless of whether they were fed commercial or organic diets, indicating that antibiotic treatment adversely affects serum protein metabolism during the growth period.

Influence of Anatomical Alignment on Pharmacological Response and Functional Outcomes Following Conservative Management of Knee Osteoarthritis

2026-09-08T11:05:10+00:00

Background: Knee osteoarthritis (KOA) is a progressive musculoskeletal disorder characterized by pain, functional impairment, and reduced quality of life. Anatomical alignment of the lower limb is an important biomechanical factor that may influence disease progression and the effectiveness of conservative pharmacological management.

Objective: To evaluate the influence of anatomical alignment on pharmacological response and functional outcomes among patients undergoing conservative treatment for knee osteoarthritis.

Methods: A cross-sectional analytical study was conducted involving 180 patients with radiographically confirmed knee osteoarthritis managed conservatively. Participants were categorized according to lower limb alignment into varus (n = 82), neutral (n = 46), and valgus (n = 52) groups using standing anteroposterior radiographs. All patients received standard pharmacological therapy consisting of nonsteroidal anti-inflammatory drugs (NSAIDs) with or without acetaminophen, along with physiotherapy and lifestyle modification. Pain intensity was assessed using the Visual Analog Scale (VAS), functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and physical performance using the Timed Up and Go (TUG) test after 12 weeks of treatment. Statistical analysis was performed using one-way ANOVA, chi-square test, and multivariate linear regression. A p-value <0.05 was considered statistically significant.

Results: Patients with neutral alignment demonstrated significantly greater improvement in pain and function compared with those having varus or valgus deformities. Mean reduction in VAS score was 3.8 ± 1.1 in the neutral group compared with 2.4 ± 1.0 in the varus group and 2.7 ± 1.2 in the valgus group (p < 0.001). WOMAC total scores improved by 39.6%, 24.8%, and 27.3%, respectively (p = 0.002). The mean TUG time improved from 12.3 ± 2.5 s to 9.8 ± 2.1 s in the neutral group, whereas improvements were significantly smaller in varus and valgus groups (p = 0.004). Multivariate regression identified varus malalignment as an independent predictor of poorer pharmacological response (β = 0.34, p = 0.001) after adjusting for age, sex, body mass index, and disease severity.

Conclusion: Anatomical alignment significantly influences the clinical response to conservative pharmacological management in knee osteoarthritis. Patients with neutral lower limb alignment achieved superior pain relief and functional recovery, whereas varus and valgus malalignment were associated with reduced treatment effectiveness. Incorporating anatomical alignment assessment into routine clinical evaluation may facilitate individualized treatment strategies and improve patient outcomes.

Comparative Assessment of Liver Function Parameters among Untreated Leprosy and Controls in Pakistan

2026-09-08T11:24:14+00:00

Leprosy is a long-lasting infectious disease that mainly impacts the skin and peripheral nerves, although it can also involve other systems. Given the liver's key roles in metabolism, detoxification, and maintaining biochemical homeostasis, evaluating liver function could yield valuable insights into potential hepatic involvement in leprosy. As a disease progresses or as treatment is administered, liver profile abnormalities may take on clinical significance. To compare selected liver profile parameters, including total bilirubin, direct bilirubin, SGPT (ALT), SGOT (AST), alkaline phosphatase (ALP), and Gamma-GT, in untreated leprosy patients versus healthy controls. A comparative study involving 186 participants was carried out, consisting of 110 untreated leprosy cases and 76 healthy controls. Standard biochemical methods were used to measure the serum liver profile parameters. For each parameter, mean values and standard deviations were computed, and statistical assessments were conducted to determine the differences between the two groups. A p-value of less than 0.05 was deemed statistically significant. In untreated leprosy cases, the average total bilirubin was 0.54 ± 0.12 mg/dL, while in the control group it was 0.53 ± 0.10 mg/dL (p = 0.566). Die Werte für direktes Bilirubin lagen bei 0,13 ± 0,02 und 0,12 ± 0,19 mg/dL (p = 0,102). In cases, the mean SGPT was 27.2 ± 5.17 U/L, whereas in controls it was 28.6 ± 6.19 U/L (p = 0.142). For SGOT, the values were 27.2 ± 4.58 U/L in cases and 28.7 ± 5.67 U/L in controls (p = 0.078). Likewise, ALP levels were 202.2 ± 30.52 U/L in cases and 208.0 ± 33.30 U/L in controls (p = 0.229), while Gamma-GT levels were 22.9 ± 4.69 U/L and 24.5 ± 7.75 U/L, respectively (p = 0.124). All of the assessed parameters exhibited no statistically significant difference between the groups. The results show that the liver biochemical profiles of untreated leprosy patients and healthy individuals are broadly comparable. Even though the mean values of SGPT, SGOT, ALP, and Gamma-GT were somewhat lower in leprosy cases, these differences did not reach statistical significance. The lack of major changes indicates that untreated leprosy was not linked to obvious biochemical hepatic dysfunction in this study population. There was no connection between untreated leprosy and significant changes in serum liver profile parameters. The levels of bilirubin, transaminases, ALP, and Gamma-GT were similar to those of healthy controls, indicating that there was no significant biochemical evidence of hepatic dysfunction in the untreated cases examined.

Eccrine Syringofibroadenoma (Of Mascaro): A Rare Case Report

2026-08-05T07:22:41+00:00

Eccrine syringofibroadenoma is a very rare, benign, adnexal neoplasm derived from cells of the acrosyringium of eccrine sweat ducts and glands, with a propensity for extremities in elderly persons, especially palms and soles. It was first described by Mascaro in 1963. It has a variety of clinical manifestations and distribution of lesions, yet a characteristic histological appearance. In order to illustrate a typical presentation of the tumor, we report a case of eccrine syringofibroadenoma that occurred in a 69-year-old man. He presented to us with unilateral(right) distal lower limb lesions with marked trophic skin changes and extensive non-healing ulcerations associated with necrosis and erythematous nodular plaques, over a period of 1 year. Histopathological evaluation of skin biopsy from representative site revealed slender anastomosing network of monomorphous cuboidal cell cords extending from basal layer of epidermis infiltrating into dermis, with focal luminal differentiation resembling duct structures, embedded in a marked fibrovascular myxoid stroma, consistent with the diagnosis of eccrine syringofibroadenoma. Complete surgical excision is advised for these tumours in view of the risk of carcinomatous transformation.

An Incidental Sertoli-Leydig Cell Tumor in a Perimenopausal Woman with Abnormal Uterine Bleeding: A Case Report

2026-08-13T08:41:34+00:00

Introduction: Sertoli-Leydig cell tumors (SLCTs) are rare ovarian tumors, accounting for less than 0.5% of all ovarian tumors, typically seen in younger women with virilization, their presentation in perimenopausal women without androgenic features is uncommon. We report a rare case of a 50-year-old female with complaints of heavy menstrual bleeding who underwent total abdominal hysterectomy for uterine fibroids, where an incidental omental SLCT was discovered intraoperatively. The diagnosis of SLCT was confirmed by histology and immunohistochemistry reports.

Conclusion: This case highlights the importance of intraoperative vigilance and complete excision of unexpected peritoneal masses to avoid missed diagnoses of rare extra-ovarian malignancies and the crucial role of immunohistochemistry in identifying rare tumors with atypical presentation.

The Disappearing Viral Signature: A Clinical Report of Three Cases of Hepatitis B with Subsequent Hbsag Seroclearance Following Individualised Homoeopathic Treatment

2026-08-24T10:30:04+00:00

Hepatitis B is an infectious disease cause by infection of Hepatitis B virus (HBV). It is one of the major public health problems globally and it also has potential to progress in cirrhosis of liver or hepatic carcinoma. Objective of this article is to evaluates the effects of individualized homoeopathic medicine in patients with hepatitis B infection. In this article a total of three cases has been discussed. These cases primarily diagnosed based on clinical presentation and serological positive finding and treated with individualized homoeopathic medicine (IHM). In all the cases HbsAg became non-reactive and patients also got symptomatic relief. Causal attribution also assessed with Modified Naranjo Criteria for Homoeopathy (MONARCH). Individualized homoeopathic medicinal intervention in cases of Hepatitis B infection may prove effective. Further methodologically rigorous trials are needed to assess proper effectiveness of IHM in cases of HBV infection.

Terlipressin Induced Headache- An Uncommon Phenomenon

2026-08-28T05:29:00+00:00

Introduction: Terlipressin is used in treatment of variceal bleed and hepatorenal syndrome in cirrhotic patients. It may cause neurological or cardiac problems like cardiac ischemia, cerebrovascular ischemia, peripheral ischemia, or mesenteric ischemia. It may also cause confusion, constipation, diarrhea, headache, itching skin, numbness and tingling of the face, fingers, or toes, pain in the arms, legs, or lower back, especially pain in the calves and/or heels upon exertion, pain or discomfort in the arms, jaw, back or neck, pale, bluish-coloured, or cold hands or feet.

Case Report: We report a fifty-two-year-old male, a known case of alcoholic liver disease for last two years who presented with haematemesis and malena for last two days. On clinical examination, he was thin with average stature. He was looking pale with hypotension and reflex tachycardia. He had mild anemia, ascites and bilateral pedal edema. Rest of general physical and systemic examination was normal. On biochemical evaluation complete hemogram revealed pancytopenia, liver function test was deranged i.e. there was mild hyper bilirubinaemia, transaminitis, hypoproteinaemia and hypoalbunemia. The complete lipid profile was in below normal range but renal function test, serum electrolytes and blood sugar level were in normal range. The ultrasonogram abdomen showed altered echotexture with moderate ascites. The upper gastro-intestinal endoscopy revealed grade two oesophageal varices with stigmata of recent bleed, hence endoscopic variceal ligation was done. The AFP level was normal. His viral screen, autoimmune, wilson’s profile was negative. He was started on injection Terlipressin, vitamin K, broad spectrum antibiotic, proton -pump inhibitor and other supportive therapy. After first dose of injection Terlipressin, he developed severe headache which warranted even need of injectable analgesics. There was no documented hypertension at this point of time, to which headache could have been attributed. Immediately, injection Terlipressin was stopped and patient headache subsided after few hours. After, a gap of one day, again injection Terlipressin was re-started on trial basis but again patient developed severe headache which again needed injectable analgesics. Again, injection Terlipressin was stopped and patient became headache free after few hours. Patient was switched to tablet carvedilol which he tolerated well and he was discharged under haemodynamically stable condition.

Conclusion: Terlipressin is commonly used for treatment of variceal bleed and hepatorenal syndrome. The most common side-effects noted are pain abdomen, diarrhoea, cardiac ischemia but headache is not frequently seen. The awareness regarding the same can lead to timely intervention and substitution with other oral alternative drugs.

From Prescription to Patient: Measuring Success in Reducing Medication Errors

2026-08-08T08:42:44+00:00

Throughout the whole medication-use cycle, including prescription, transcription, dispensing, administration, and monitoring, medication errors continue to pose a persistent and avoidable risk to patient safety. The evidence on medication-error patterns, contributing factors, and interventions meant to lessen medication-related harm is summarized in this review. With a stated publication window of 2010–2024, the source review took into account secondary evidence from peer-reviewed literature, hospital and clinical safety reports, WHO and national health authority publications, pharmacovigilance and medication safety bulletins, and systematic reviews and meta-analyses found through PubMed, Scopus, Google Scholar, Web of Science, ResearchGate, and official WHO and PvPI repositories. Errors in dose selection, incorrect drug selection, omissions, timing errors, documentation issues, and confusion between look-alike and sound-alike medications were common in prescribing and administration.

Risk is influenced by human factors, communication gaps, workload, non-standardized procedures, disruptions, personnel constraints, insufficient automation, and low pharmacist participation. Technology-based treatments, clinical pharmacist involvement, organized training, better labelling and storage, and non-punitive reporting systems can all lower medication-related risk, according to evidence in the source review. When technology, pharmacist involvement, staff training, monitoring, and a supportive safety culture are used in tandem, the greatest and longest-lasting benefits take place.

SIGNIFICANCE OF ORTHODONTICS IN FORENSIC SCIENCE: A SYSTEMATIC REVIEW

2026-08-29T05:01:24+00:00

Forensic science relies on various medical disciplines to address legal questions in criminal and civil cases. Forensic odontology (forensic dentistry) focuses on the careful management, analysis, and interpretation of dental evidence for judicial purposes. Orthodontics, a specialized branch of dentistry, offers unique contributions to forensic identification due to its extensive documentation practices, including study models, radiographs, photographs, and detailed treatment records.

PLATELET-RICH PLASMA IN IMPLANT DENTISTRY: BRIDGING THE GAP BETWEEN COMPROMISED BONE AND PREDICTABLE IMPLANT SUCCESS – A SYSTEMATIC REVIEW

2026-08-29T11:03:31+00:00

Platelet-rich plasma (PRP) has emerged as a promising biologic adjunct in implant dentistry to enhance osseointegration, accelerate bone healing, and improve implant stability. This systematic review evaluates the clinical efficacy, classification systems, and applications of PRP in implant placement and bone regeneration procedures. A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2024