International Journal of Pharmacy Research & Technology (IJPRT)

Flipped Classroom Model Versus Conventional Teaching in Neurology Clerkship: A Comparative Randomized Study

2025-06-16

A randomized prospective study evaluated the educational impact of a flipped-classroom (FC)model versus conventional didactic teaching in a 4-week neurology clerkship among 104 medicalstudents. Participants were randomized to FC (n = 49)—comprising pre-class videos, readings

Assessing Long-Term Efficacy and Recurrence Rates of Endovenous Laser Therapy Compared to Surgical Stripping for Varicose Veins

2025-06-16

A prospective randomized controlled trial evaluated long-term efficacy and varicose veinrecurrence in adults treated with endovenous laser therapy (EVLT; n = 100) versus surgicalstripping (SS; n = 100) of the great saphenous

Evaluation of Fecal Calprotectin as a Non-Invasive Marker of Disease Activity in Ulcerative Colitis

2025-06-16

A cross-sectional analysis assessed the diagnostic accuracy of fecal calprotectin (FC) in 200ulcerative colitis (UC) patients undergoing surveillance colonoscopy. FC levels were comparedwith Mayo endoscopic subscore

Comparative Outcomes of Catheter Ablation and Antiarrhythmic Drugs in Elderly Patients with Atrial Fibrillation

2025-06-16

In a prospective cohort of 400 elderly patients (≥70 years) with symptomatic atrial fibrillation(AF), 200 underwent catheter ablation

Pyrazoline Derivatives: Potential Therapeutic Agents against Parkinson's disease

Bidhyut Kumar Dubey — 2025-06-20

Parkinson's disease (PD) is a neurodegenerative disorder that results in the gradual death of dopaminergic neurons in the human brain, leading to both motor impairment and a variety of non-motor symptoms. Pyrazoline is a heterocyclic compound known for its pharmacological spectrum and anti-inflammatory, antioxidant, and neuroprotective properties. Recent studies have highlighted its potential in modulating key pathways involved in PD, such as oxidative stress, mitochondrial dysfunction, and neuroinflammation, all of which are central to the progression of Parkinson's disease. These derivatives have shown promise in preclinical models by mitigating neuronal damage and preserving motor function, making them attractive candidates for further research. This review included the background on Parkinson’s disease, current treatment options, common synthetic route of Pyrazoline ring, current medicines used for the treatment of PD, and recent studies done on Pyrazoline ring as anti-Parkinson's.

Antibiotic Resistance Patterns in Pediatric and Adult Urinary Tract Infections

2025-06-24

Antimicrobial resistance in urinary tract infections (UTIs) poses a major challenge to effectivetreatment across age groups. This cross-sectional study examined resistance patterns in 240patients (120 pediatric, age 1–17; 120 adult, age 18–75) presenting with culture-confirmed UTIs.

Clinical Outcomes of Resorbable vs. Titanium Plates in Mandibular Fracture Fixation: A Prospective RCT

2025-06-24

A prospective randomized controlled trial compared clinical outcomes of resorbable versus
titanium plate fixation in mandibular fractures among 100 adult patients (aged 18–60 years) with
symphyseal or angle fractures

Forensic Investigation of Drowning, Biochemical Markers and Diatom Testing for Confirming Cause of Death. A cross-sectional study

2025-06-24

A cross-sectional forensic study evaluated the utility of biochemical markers (serum surfactant D,NT-proBNP, D-dimer) and diatom quantification for confirming drowning as the cause of death.Eighty postmortem cases were investigated

Assessment of Patient Satisfaction and Pain Control in Regional Anaesthesia with and Without Sedation During Orthopaedic Procedures

2025-06-24

A randomized controlled trial evaluated 180 adults undergoing elective distal-limb orthopaedicsurgery under regional anaesthesia (RA) with sedation (n=90) versus RA without sedation (n=90).Primary outcomes were patient satisfaction

Association of Serum Adiponectin and Leptin Levels with Glycemic Control in Type 2 Diabetes Mellitus

2025-06-24

Emerging evidence implicates adiponectin and leptin in glucose homeostasis and metabolicregulation among individuals with type 2 diabetes mellitus (T2DM). The present experimentalstudy investigated their association with glycemic control in a cross-sectional cohort of 120 adult

Salivary Alkaline Phosphatase as a Non-Invasive Biomarker in Early Detection of Oral Submucous Fibrosis

2025-06-25

Oral submucous fibrosis (OSF) is a chronic precancerous condition marked by progressive fibrosis
of the oral mucosa and restricted mouth opening. Early detection

Visual Recovery Following Primary Corneal Tear Repair in Penetrating Ocular Trauma: A Prospective Observational Study

2025-06-25

Penetrating ocular trauma frequently results in corneal tears requiring urgent globe repair topreserve anatomical integrity and visual function. This study investigates the visual outcomesfollowing corneal tear repair in patients presenting with penetrating eye trauma.

A Randomized Trial on the Efficacy of Topical Estrogen vs. Vaginal Laser Therapy for Postmenopausal Vaginal Atrophy and Urinary Incontinence

2025-06-25

A randomized controlled trial evaluated the efficacy of topical estrogen (TE) versus fractional CO₂
vaginal laser therapy (VLT) in treating postmenopausal vaginal atrophy (PVA) and urinary
incontinence (UI). One hundred twenty postmenopausal women

Visual Outcomes of Keratoprosthesis Versus Keratoplasty in Infective and Degenerative Corneal Opacifying Disorders

2025-06-25

Infective and degenerative corneal opacities compromise visual acuity and pose therapeuticchallenges. This experimental comparative study evaluated visual outcomes of keratoprosthesis

Comparative Study of Analgesic and Haemodynamic Spectrum Of 0.5% Ropivacaine Vs 0.5% Levobupivacaine in Ultrasonography Guided Supraclavicular Brachial Plexus Block

Yogini Ramdas Adhau — 2025-06-14

Background: Regional anesthesia via peripheral nerve blocks is widely used for providing effective intraoperative and postoperative analgesia in upper limb surgeries. The supraclavicular brachial plexus block offers reliable anesthesia for such procedures. Newer local anesthetics such as levobupivacaine and ropivacaine have been introduced to reduce cardiotoxicity concerns associated with bupivacaine while maintaining efficacy. This study aims to compare the analgesic efficacy and hemodynamic effects of 0.5% levobupivacaine versus 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus blocks. Methods: A prospective, randomized, double-blind comparative study was conducted on 60 ASA grade I and II patients aged 20–60 years undergoing elective upper limb surgery. Patients were randomized into two groups: Group L received 0.5% levobupivacaine, and Group R received 0.5% ropivacaine via ultrasound-guided supraclavicular brachial plexus block. The onset and duration of sensory and motor blockade, time to first rescue analgesia, and intraoperative hemodynamic parameters (heart rate, blood pressure, oxygen saturation) were recorded and analyzed. Results: Group L (levobupivacaine) demonstrated significantly earlier onset of sensory (11.13 ± 1.00 min) and motor blockade (13.20 ± 1.12 min) compared to Group R (ropivacaine) with sensory onset of 13.60 ± 0.81 min and motor onset of 15.60 ± 0.81 min (p=0.0001). Duration of both sensory and motor blockade was longer in Group L. Time to first rescue analgesia was also significantly prolonged in Group L (11.80 ± 0.40 hours) versus Group R (10.20 ± 0.55 hours) (p=0.0001). Hemodynamic parameters remained stable and comparable between groups throughout the study with no significant adverse events. Conclusions: 0.5% levobupivacaine provides faster onset, longer duration of sensory and motor blockade, and prolonged postoperative analgesia compared to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block, without significant hemodynamic compromise. Levobupivacaine is thus an effective and safe option for upper limb regional anesthesia.

Anatomical Variations of Renal Vessels- A Cadaveric Study with Clinical Relevance

Dr Amudalapalli S Narayana — 2025-07-01

Introduction: Blood supply to the kidneys is characterized by more frequent presence of variations in arteries and veins supplying them. Normally each kidney is supplied by single renal artery and drained by single renal vein. Variation in the number, origin, pathway and branching pattern of renal arteries is common. Frequently seen anatomical variation is additional renal artery. Aim: To identify the presence of variations of renal vessels in the human cadavers. Material and methods: An observational cadaveric study was conducted on 80 kidneys from 40 formalin-fixed human cadavers from 2019 to 2025 in the Department of Anatomy, Chalmeda Anandarao institute of medical sciences, Karimnagar, Telangana, India. The number of cadavers showing variations of renal vessels was determined. Results: The study included 80 kidneys from 40 formalin-fixed human cadavers. Eight (20%) cadavers were found to have variations in renal vessels while 32 (80%) cadavers show presence of single renal vessel going to each kidney. The double renal artery variations were present bilaterally in 01 (2.5%) cadaver and aberrant renal artery in 02 (5%) cadavers but both are in left side. The superior polar artery was present in 01 (2.5%) cadaver right side and inferior polar artery was present in 01 (2.5%) cadaver left side. Early divisions of renal artery were present in 2 (5%) cadavers. Accessory renal vein were present in right side 1 (2.5%) cadaver. Conclusion: Variations of renal vessels supplying to the kidneys it is necessary to have prior knowledge of them as now a day’s more number of patients is undergoing renal transplants, angiography procedures. The knowledge of these variations is also useful for treatment of renal trauma and tumors.

Foix–Chavany Marie syndrome-A rare entity

Dr.M.Deep Tejesh — 2025-07-02

Foix–Chavany Marie syndrome (FCMS), is a rare cortical type of pseudobulbar palsy that results in paralysis of orofaciopharyngeal muscles, wwhilethe autonomic, involuntary, and reflexive functions of the above muscles are preserved. Here we present a case of 65-year-old right-handed male patient presented with sudden inability to speak and swallow, or move the tongue, along with difficulty in chewing. While his verbal and reading comprehension were intact, and he communicated through writing and gestures. Neurological examination showed preserved pupillary and corneal reflexes, normal extraocular movements, and loss of voluntary facial and tongue motor control. Early recognition and comprehensive management, including supportive therapy and addressing underlying conditions, are paramount for optimising patient outcomes.

Exploring Skin Manifestations in Women with Polycystic Ovary Syndrome: A Cross-sectional Analysis.

Savita Pannu Rathi, Punit Pratap, Pravesh Yadav — 2025-06-30

Polycystic ovary syndrome (PCOS) is a complex multisystem metabolic disorder thatsignificantly affects fertility and overall quality of life. Cutaneous manifestations suchas acne, hirsutism, androgenetic alopecia,

A STUDY OF GROWTH PARAMETERS IN THE BABIES BORN TO HYPOTHYROID MOTHERS

Dr Rajesh Rathi, Dr Monica Deswal, Dr Savita Pannu Rathi — 2025-06-30

Background: Normal maternal thyroid function is crucial for fetal growth andneurocognitive development. Intrauterine growth restriction (IUGR) is a multifactorialcondition resulting from maternal, placental, or fetal factors. Any imbalance in maternalthyroid function may adversely affect both mother and fetus.

Sustainable Development, Green Chemistry, and Its Applications

Aleza Rizvi — 2025-07-03

Green chemistry (GC)–the design of chemical processes that reduce or eliminate hazardous substances – provides a framework for achieving sustainable development in industry and technology. This review summarizes recent advances (2020–2024) and emerging trends in green chemistry, highlighting how new catalysts, solvents, and biotechnologies are enabling cleaner processes. Key topics include alternative solvents (water, supercritical CO₂, ionic liquids, deep eutectic solvents), novel catalysts (metal, photocatalytic, and biocatalytic systems), and renewable feedstocks (biomass, CO₂). We discuss case studies such as plant-based PET (“Plant Bottle”) and biodegradable polymers, and note how industry adoption of GC principles has already reduced waste and emissions. We also examine current challenges – economic, regulatory, and technical barriers that slow implementation – and outline future directions (AI-driven process design, electrification of synthesis, circular economy). The content is presented for an audience of chemistry and environmental science students, with references to recent literature.

A Case Controlled Trial Comparing Biologic Therapy vs. Immunomodulators in Moderate-to-Severe Crohn’s Disease

2025-06-30

Moderate-to-severe Crohn’s disease (CD) remains therapeutically challenging, with escalatingcosts and variable outcomes between biologic and immunomodulator (IMM) strategies. Thepresent case-controlled trial enrolled 120 adult patients with active

Visual outcomes of medical and surgical modalities in secondary glaucomas (inflammatory vs pigmentary) compared to primary open-angle glaucoma. A multi-factorial comparative study

2025-06-30

Secondary glaucomas, particularly inflammatory glaucoma (IG) and pigmentary glaucoma (PG),demonstrate greater clinical variability and treatment complexity compared to primary open-angleglaucoma (POAG). This prospective, multifactorial cohort study

A Histological Study of Myocardial Fiber Disruption and Serum CK-MB in Ischemic Heart Disease

2025-06-30

Ischemic heart disease (IHD) precipitates disruption of myocardial fiber integrity and elevatesserum creatine kinase–MB (CK-MB), yet precise correlation remains underexplored. In thisexperimental study, myocardial biopsy specimens from 60 adult patients undergoing coronaryartery bypass grafting were compared

Efficacy of Bile Acid Sequestrants in Treating Bile Acid Diarrhea: A Double Blind, Placebo-Controlled RCT

2025-06-30

A double-blind, placebo-controlled randomized clinical trial evaluated the efficacy of colesevelam1.875 g twice daily in adults with bile-acid diarrhea (BAD) confirmed by SeHCAT retention≤10 %. Eighty participants were randomized

Assessment of Pulp Vitality Using Pulse Oxymetry Versus Electric Pulp Testing in Traumatized Teeth

2025-06-30

A randomized clinical trial evaluated diagnostic accuracy of pulse oximetry (PO) versus electricpulp testing (EPT) in 80 traumatized permanent incisors. Participants were randomized to testingat 1 week, 1 month, and 3 months post-trauma. Primary outcomes included pulp vitality status

Assessing the Benefits of Mobile Application-Based Psychoeducation for Patients with Schizophrenia: A Randomized Controlled Trial

2025-06-30

A randomized controlled trial evaluated the efficacy of a mobile application–basedpsychoeducation program for improving treatment adherence and symptom management among120 adult patients with schizophrenia. Participants were allocated to either the interventiongroup—receiving eight weeks of daily

Evaluation of Idiopathic Late Onset Nephrotic Syndrome in Children

Dr. P. Ravindranath Reddy — 2025-07-07

Introduction: Idiopathic nephrotic syndrome is defined by the combination of a nephrotic syndrome (proteinuria, hypoalbuminemia, hyperlipidemia, and edema) and non-specific histological abnormalities of the kidney. The prevalence of NS is estimated at 2 to 7 per 100,000 children around the world. Children between 2 to 7 years of age get affected by this condition more often, particularly boys.

Materials and Methods: A Retrospective study of hospital records. Case sheets of children admitted in department of pediatrics, Government General Hospital, Kurnool with nephrotic children above the age of 10 years From January 2020 to December 2024. Children aged more than 10 years at onset fulfilled in the diagnostic criteria for nephrotic syndrome were included in the study. Secondary causes of nephrotic syndrome. (eg:SLE, Hepatitis B/C, Diabetic mellitus) were excluded from the study. Clinical data including age at onset, gender, presenting sympotoms and laboratory findings will be recorded histopathlogical finding will be categorized. Treatment response to steroids will be evaluated.

Results: The study included 108 children who were followed for a minimum duration of one year. The mean (±sd) age of the population was 13.3 (±1.4) years. The gender distribution of the population was males accounting for 66.7% and females at 33.3%. Hypertension was observed in 8(14.8%). Haematuria in microscopy was found in 28 (51.9%) study participants. Anti-Nuclear Antibodies investigation was done for 50 children and only 3(5.6%) were found to be positive. After the six weeks of steroidal therapy complete remission was found in 58 (53.7%) participants. No remission and partial remission were observed in 26 (24.1%) and 24 (22.2%) members of the study population respectively. Based on the response to steroidal therapy the participants were diagnostically classified as SRNS in 52 (48.1%) children followed SSNS in 50 (46.29%) children.

Conclusion: In our study most of the patients were diagnosed with SRNS and SSNS, and most common histological findings were MCNS, MES HC, FSGS and MESPGN. Late onset NS has higher frequency of atypical features, steroid resistance, and histopathology showing lesions other than MCD. Early biopsy may be useful guide to management.

ESOPHAGEAL LEIOMYOSARCOMA PRESENTING WITH RECURRENT LARYNGEAL NERVE PALSY AND GREAT VESSEL ENCASEMENT: A CASE REPORT

Dr Indujaa Rajkumar, Dr Baskar A, Dr G Murugan — 2025-07-08

Background: Esophageal leiomyosarcoma is an extremely rare malignancy of the esophagus of esophageal tumors) and typically presents with dysphagia and weight loss in middleaged or older patients. Hoarseness of voice due to recurrent laryngeal

Histomorphological Evaluation of Vitamin E’s Protective Role Against Bisphenol A-Induced Testicular Toxicity in Wistar Rats

Sadia Saqib, Nadia Haq, Raafea Tafweez, Ahmed Fawad Syami, Irfan Ali — 2025-07-08

Bisphenol A (BPA) exposure has been broadly implicated in male reproductive dysfunction,primarily via oxidative damage to testicular tissues. This experimental study aimed to evaluatetesticular histomorphological alterations induced

COMPARATIVE STUDY OF TARLEKAR’S ABHYANGA NASO LACRIMAL SNAN (BATH) VERSUS LACRIMAL SAC SYRINGING AFTER ENDONASAL DACRYOCYSTORHINOSTOMY (DCR)

Major Dr Ganesh Mohan Tarlekar (R), Sandesh Baburao Bagadi — 2025-07-08

Background: Endonasal dacryocystorhinostomy (DCR) is a widely performed surgery fornasolacrimal duct obstruction. Postoperative care typically involves lacrimal sac syringing tomaintain ostium patency, but this can be uncomfortable and requires

EVALUATION OF THE EFFICACY OF BUPIVACAINE WITH CLONIDINE IN BILATERAL SUPERFICIAL CERVICAL PLEXUS BLOCK FOR THYROID SURGERY- A PROSPECTIVE OBSERVATIONAL STUDY

Dr. P. Rajkumar, Dr. M. Bhaskar, Dr. S. Manojkumar, Dr. K. Murugesan — 2025-07-08

Background: Effective postoperative pain management is crucial for patients undergoingthyroid surgery to improve recovery and satisfaction. Systemic opioids, a traditional methodfor pain relief, are often associated with adverse effects like nausea, respiratory depression, andvomiting. A superficial cervical plexus block offers an alternative by providing targeted pain

COMPARATIVE STUDY OF INTRAVENOUS PARACETAMOL AND TRAMADOL IN MANAGEMENT OF POST-OPERATIVE ANALGESIA IN PERCUTANEOUS NEPHROLITHOTOMY- RANDOMIZED CLINICAL STUDY

2025-07-09

Postoperative pain is a critical aspect of surgical recovery, especially inprocedures like percutaneous nephrolithotomy (PCNL), where inadequate pain managementcan delay healing and increase complications. Common analgesics such as intravenous

EFFICACY OF STANDALONE ORAL METHYLCOBALAMIN IN THE MANAGEMENT OF DIABETIC DISTAL SYMMETRIC POLYNEUROPATHY IN INDIA: A SYSTEMATIC REVIEW

Dr Himadri Pathak, Dr Mukuta Medhi — 2025-07-10

Background: Diabetic distal sensory Polyneuropathy (DSPN) is an annoying and disablingcomplication of long standing type 2 diabetes mellitus (T2DM). These patients are also deficient invitamin B12. Methylcobalamin (MeCbl), an active form of vitamin B12, is widely used in Indiaespecially by prim

Comparison of Mifepristone-Misoprostol versus Dinoprostone-Misoprostol for Second-Trimester Pregnancy Termination: A Randomized Controlled Trial

Dr Mandeep Bayan — 2025-07-12

Background: Second-trimester abortions account for 10–15% of induced abortions globally.Misoprostol is widely used due to its efficacy and accessibility, with sublingualadministration often preferred for convenience. Cervical priming with oral mifepristone(inducing collagen breakdown) or endocervical Dinoprostone/PGE2 gel (promoting cervicalremodelling) may improve outcomes, but comparative data are limited.

Ophthalmic Artery Pulsatility Index Between 24–34 Weeks as a Diagnostic Predictor for Late-Onset Preeclampsia: High ROC Accuracy Despite Non-Significant Mean Differences

2025-06-26

Background: Late-onset preeclampsia remains a diagnostic challenge. Maternal ophthalmic arteryDoppler Pulsatility Index (PI) has emerged as a non-invasive surrogate marker for systemic vascularresistance

Camouflaged Myasthenia Gravis: Case Report

Dr K P Jeswanth Kiran — 2025-07-12

Myasthenia Gravis is an anti-acetylcholine receptor antibody-mediated neuromuscular junction disorder. Fluctuating fatiguability, diplopia, ptosis, dysphagia, and dysphonia are characteristic symptoms seen in patients with this disorder. Although uncommon, this illness can affect any skeletal muscle, from those in the neck to the proximal muscles of the limbs. Very few cases of myasthenia manifesting as neck weakness only have been documented.

Comparison of ccq, cat score & bode index in assessing severity and exacerbations of copd - a comprehensive study

Dr. K P Jeswanth Kiran — 2025-07-12

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. While spirometry remains the cornerstone for diagnosis, it does not adequately capture symptom burden or predict quality of life. Hence, tools like the Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), and BODE Index have been developed to offer a more comprehensive assessment of disease severity and progression. This study aimed to compare these tools in evaluating severity and exacerbations among COPD patients.

Methods: A cross-sectional study was conducted on 60 COPD patients attending PES Institute of Medical Sciences & Research, Kuppam. Participants were assessed using CAT, CCQ, and BODE Index. Spirometry was used to determine FEV₁ levels. Statistical analysis was done using SPSS software. Pearson correlation and Chi-square tests were applied to analyze associations between scoring tools and FEV₁ values.

Results: Most participants were male (75%) and aged above 60 years. Smoking (70%) and biomass fuel exposure (36.7%) were common risk factors. The most frequent FEV₁ category was mild obstruction (43.3%). Strong positive correlations were found between CCQ and CAT (r = 0.788), CCQ and BODE Index (r = 0.759), and CAT and BODE Index (r = 0.766), all statistically significant (p < 0.01). Significant associations were observed between all three scoring tools and spirometric severity.

Conclusion: CCQ, CAT, and BODE Index are strongly correlated and effective in assessing COPD severity. These tools offer practical alternatives to spirometry in evaluating symptom burden and predicting functional status. Their integration into clinical practice can enhance comprehensive management of COPD patients.

Serum N-Terminal Pro-Brain Natriuretic Peptide, D-Dimer Levels In Community-Acquired Pneumonia and Its Correlation with CURB-65 as a Prognostic Marker

Dr.Kuppani Dinesh — 2025-07-12

Background: Community-acquired pneumonia (CAP) is a common medical condition, especially in older adults, and is usually associated to systemic inflammatory response syndrome (SIRS). The study aimed to study serum N-terminal pro-brain natriuretic peptide (NT -probnp) and D-dimer levels in community acquired pneumonia and its correlation with CURB-65 as a prognostic marker.

Methods: A prospective study was conducted for 18 Months among 96 patients admitted with community-acquired pneumonia. All eligible patients underwent relevant investigations like renal function tests, liver functions tests, complete blood count, blood –culture and sensitivity, sputum or tracheal aspirate – gram stain, culture and sensitivity, ECG, Chest X ray, USG abdomen. The scoring will be done in these patients to assess the severity and the need for admission in these patients including CURB 65 and PSI.

Results: Among 96 patients, Comorbidities are present in 67% of the study population. The mean and SD NT pro-BNP levels are 336.58±109.78pg/ml. Survivors' mean NT-proBNP levels were 321.37 pg/ml. 425.71 pg/ml with an SD of 108.74 pg/ml are found in non-survivors. Survivors have mean D-dimer levels of 1410.39 ng/ml, while non-survivors have mean D-dimer levels of 2334.29 ng/ml with SD of 1173.00 ng/ml.

Conclusions: The values of NT proBNP and D-dimer in the survivors of patients with higher CURB-65 are lower in this study and in non survivors even with a lower CURB-65 the values of D-dimer and NT pro BNP are higher indicating that NT pro BNP and D-dimer levels are slightly better in predicting the mortality and prognosis which is statistically significant.

A role of MR Elastography in Assessment of Liver Fibrosis in North in India in tertiary care centre

Dr Karan Singh, Dr Phool Singh Sagar, Dr Aneeta Agrahari — 2025-06-26

Background: Liver fibrosis is a common outcome of various chronic liver diseases,including viral hepatitis, alcohol-related liver disease, and non-alcoholic fatty liverdisease (NAFLD). If left untreated, progressive fibrosis can lead to cirrhosis

Comparative Efficacy of Oral Clonidine versus Intravenous Esmolol for Attenuating the Pressor Response to Laryngoscopy and Tracheal Intubation: A Randomised Controlled Trial

Dr. Akash Vilas Tarte — 2025-07-14

Background: Direct laryngoscopy and endotracheal intubation elicit a brisk sympathetic surge that may precipitate myocardial ischaemia or cerebrovascular events in high-risk patients. Although several pharmacologic strategies exist, the relative effectiveness of an α<sub>2</sub>-agonist versus an ultra-short-acting β-blocker in routine elective surgery remains uncertain.

Objective: To compare the haemodynamic-stabilising efficacy and safety of oral clonidine (2 µg kg⁻¹) and intravenous esmolol (0.5 mg kg⁻¹) administered before anaesthetic induction.

Methods: In this single-centre, parallel-group trial, 116 ASA I–II adults (18–60 y) scheduled for elective surgery under general anaesthesia were randomised to receive clonidine 90 min pre-induction (Group C, n = 58) or esmolol 90 s pre-intubation (Group E, n = 58). Standardised anaesthesia (fentanyl–propofol–atracurium, sevoflurane MAC 1•0) was used. Heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) were recorded at baseline, post-induction, immediately after intubation, and 1, 3, 5, 7 and 10 min thereafter. Primary end-points were peak HR and SBP within 3 min of intubation.

Results: Baseline variables were comparable. Peak HR (mean ± SD) rose to 92 ± 6 bpm in Group E but fell to 66 ± 5 bpm in Group C (p < 0.001). Corresponding SBP values were 143 ± 8 vs 116 ± 8 mmHg (p < 0.001). MAP, DBP and rate-pressure product followed similar patterns. Haemodynamics in Group C returned to baseline by 10 min; Group E remained significantly elevated. No clinically important bradycardia, bronchospasm or hypotension occurred.

Conclusions: A single pre-operative oral dose of clonidine 2 µg kg⁻¹ provides superior attenuation of intubation-induced tachycardia and hypertension compared with esmolol 0.5 mg kg⁻¹. Clonidine is a simple, inexpensive, and well-tolerated option for routine adult elective surgery.

Examining the Link between Serum Uric Acid Levels and Coronary Artery Disease (CAD) Severity in Patients Undergoing Elective Coronary Angiography

Muhammad Hashim Kalwar — 2025-07-14

Background: High serum uric acid (SUA) is prevalent in subjects with obesity, renal disease, glucose intolerance, hyperlipidemia, hypertension, and atherosclerosis, all of which are established risk factors for coronary artery disease (CAD). Uric acid is a significant antioxidant in the initial atherosclerosis but can potentially switch to a pro-oxidant in advanced cases, depending on the factors like tissue acidity and oxidative stress. This paradoxical behavior, in addition to its association with inflammation and insulin resistance—a characteristic of metabolic syndrome—requires further investigation. Therefore, the aim of this study was to examine the relationship between SUA levels and the presence and severity of CAD.

Study design: An observational cohort study.

Duration and place of study: This study was conducted in People’s University of Medical and Health Sciences Nawabshah (PUMHS) from January 2023 to January 2024.

Objective: To explore the relationship between serum uric acid level and the presence and seriousness of coronary artery disease (CAD) in individuals undergoing elective coronary angiography

Methodology: This cohort study of 200 consecutive hospitalized patients with CAD symptoms, all undergoing elective coronary angiography, was observational. Patients were divided into CAD-positive (with stenosis) or CAD-negative (without stenosis) groups according to their angiographic findings. CAD severity was graded using the Gensini grading system, and two blinded cardiologists assessed the angiograms. Risk factors like age, gender, smoking, diabetes, hypertension, hyperlipidaemia, family history, and hyperuricemia were documented and biochemical tests such as lipid profiles, fasting glucose, and uric acid were performed employing routine methods after 10 hours.

Results: Observational cohort study included 200 patients who underwent coronary artery disease (CAD) assessment via coronary angiography. Out of these, 175 had CAD, whereas 25 did not. CAD patients had significantly higher levels of blood uric acid compared to non-CAD patients (358.23 µmol/L vs. 251.32 µmol/L, p < 0.001). In accordance with logistic regression analysis, elevated levels of uric acid, smoking, decreased levels of HDL-C, and hypertension were all significantly related with the presence of CAD. These findings reflect a significant correlation between elevated serum uric acid and the presence and seriousness of CAD.

Conclusion: In short, serum uric acid level was significantly correlated with the presence and seriousness of coronary artery disease (CAD).

Evaluating the Relative Risk of Pulmonary Microaspiration in Sedated Versus Intubated Patients During ERCP Procedures

Ravi Kumar — 2025-07-14

Objectives This study aims to compare the risk of pulmonary microaspiration in patients undergoing ERCP under general anesthesia versus deep sedation.

Study design: Prospective comparative study

Duration and place of study: This study was conducted in Liaquat National Hospital and Medical College Karachi from December 2022 to December 2023

Methodology: One hundred and fifty patients (ASA I-III) undergoing ERCP were selected and randomly distributed in two groups of 75 each: Group I (n= 75) received a general anesthesia (endotracheal intubation) and Group S (n = 75) received deep sedation. All patients were carefully observed in a high-dependency unit (HDU) within 48 hours after the procedure to detect the symptoms of hypoxia. The number of chest CT scans was also taken 48 hours after ERCP to determine if there are new pulmonary infiltrates that indicate microaspiration.

Results: Similarly, evidence of microaspiration on CT was much more severe in the sedation group (24%) than in the intubation group (5.3%), at a p-value of 0.002. Although postoperative hypoxic incidents were seen more frequently in sedation group (26.6%) compared to intubated group (6.6%), the difference was found statistically significant with p-value 0.001. Microaspiration was observed to a greater extent in patients in the sedation group who were between 65 years and more (50%) than in the younger category (6.7%) with a p-value of 0.0008. Other parameters that included incidences of postoperative fever, cough, tachypnea, or obligation to oxygen therapy were alike in the two groups.

Conclusion: The prevalence of postoperative CT alterations that seemed suggestive of microaspiration was increased in sedated patients compared to patients with tracheal intubation who underwent ERCP, especially those aged 65 or more. This notwithstanding, there were no clinical evidences of overt chest infection in any of the groups. These are the findings that advocate that one should be cautious in the selection of patients and close observation in the postoperative period in choosing deep sedation as an option in ERCP.

Impact of Type and Duration of Alcohol Consumption on the Severity and Outcomes of Alcoholic Liver Disease in Women

Dr. Suraj Bhutada — 2025-07-14

Background: The prevalence of alcoholic liver disease (ALD) in women has increased over the past decades, mirroring shifts in drinking patterns and social norms. Women are known to be more susceptible to alcohol-related liver injury at lower consumption thresholds than men. Yet, the specific impact of the type and duration of alcohol intake on ALD severity, progression, and clinical outcomes in women remains understudied.

Methods: In this prospective observational study, we enrolled 160 adult women with ALD from a tertiary care center. Detailed alcohol use histories, including type of alcoholic beverage (wine, Desi Darus, beer) and duration of heavy drinking, were obtained. Baseline assessments included clinical evaluation, liver function tests, and imaging studies. Patients were followed for two years to assess disease progression and outcomes, including decompensation events, hospitalization, and mortality. Multivariate analyses examined the relationships between beverage type, duration of heavy drinking, severity of ALD (fibrosis stage, MELD score), and clinical endpoints.

Results: At baseline, mean age was 48.5 ± 9.2 years. Women who primarily consumed Desi Darus had more advanced fibrosis and higher MELD scores compared to those favoring wine or beer (p<0.01). A prolonged duration (>10 years) of heavy alcohol intake correlated with higher rates of cirrhosis and hepatic decompensation (p<0.001). After adjusting for confounders such as BMI and viral co-infections, both beverage type and drinking duration independently predicted disease severity. During follow-up, patients with long-term Desi Darus intake experienced higher rates of variceal bleeding and hepatic encephalopathy, leading to increased hospitalizations and mortality.

Conclusion: In women with ALD, both the type and duration of alcohol consumption significantly influence disease severity and clinical outcomes. Desi Darus consumption and prolonged heavy drinking pose a greater risk for advanced liver damage and worse prognosis. Recognizing these patterns may guide more tailored interventions and preventive strategies.

A Forward-Looking Study on the correlates of Postoperative Pain after Retrograde Intrarenal Surgery with FANS for Kidney Stones

Dr. Kaustubh Gupta — 2025-07-14

Background: Retrograde Intrarenal Surgery with FANS (flexible and navigable suction ureteric access sheath) is increasingly favored for treating renal calculi due to its minimally invasive nature and high stone-free rates. Despite reduced morbidity compared to traditional methods, postoperative pain remains a challenge. This prospective study aimed to evaluate patient-related, stone-related, and operation-related factors that predict severe postoperative pain following RIRS with FANS.

Methods: A total of 97 patients (aged 18–65) with radiologically confirmed renal stones underwent RIRS at our center between March 2021 and September 2022. Preoperative data included demographics, stone characteristics (number, size, location, density), hydronephrosis, and stent status. All procedures utilized a 7.5 Fr flexible digital ureteroscope, Holmium:YAG laser lithotripsy and 10/12 fr flexible and navigable suction ureteric access sheath . Postoperative pain was assessed via the Visual Analogue Scale (VAS) at 6, 12, and 24 hours. Patients requiring additional analgesia with VAS ≥7 were categorized as having severe pain (Group II), whereas those with VAS <7 were grouped as mild pain (Group I). Associations between potential predictors and pain scores were analyzed using SPSS version 25 (p<0.05 was considered significant).

Results: Among the 97 participants, 84.5% had VAS <7 (Group I) and 15.5% reported VAS ≥7 (Group II). No significant differences were noted in age, gender, stone location, stone size, or preoperative hydronephrosis between the groups (p>0.05). Two operation-related factors emerged as significant: smaller-diameter ureteral access sheaths (p=0.027) and prolonged sheath indwelling time exceeding 60 minutes (p=0.043) correlated with higher postoperative pain.

Conclusion: Technical factors—namely ureteral access sheath size and sheath indwelling time—were key predictors of postoperative pain following RIRS with FANS. Identifying high-risk patients preoperatively may guide refined surgical approaches and more targeted analgesic protocols, ultimately improving patient comfort and overall satisfaction.

Comparison of Low-Dose Granisetron (0.1 Mg) and Dexamethasone (8 Mg) With Ondansetron (4 Mg) and Dexamethasone (8 Mg) for Prevention of Postoperative Nausea and Vomiting Following Laparoscopic Surgery

Dr. Abhinav Banerjee — 2025-07-14

Background: Postoperative nausea and vomiting (PONV) are common complications following laparoscopic surgery, adversely affecting patient recovery and satisfaction. Effective prophylaxis is essential to enhance postoperative outcomes.

Methods: This double-blind, prospective, randomized study was conducted at the Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur. Eighty adult patients (ASA I-II, aged 18-60 years) undergoing elective laparoscopic surgery under general anesthesia were randomized into two groups. Group I received dexamethasone 8 mg and ondansetron 4 mg intravenously, while Group II received dexamethasone 8 mg and granisetron 0.1 mg intravenously. PONV incidence, nausea scores (Verbal Rating Scale), vomiting episodes, rescue antiemetic and analgesic requirements, and side effects were monitored at multiple postoperative intervals up to 48 hours.

Results: Group A (dexamethasone + ondansetron) demonstrated significantly lower nausea scores at 30 minutes, 1 hour, 2 hours, and 4 hours postoperatively (p<0.05). The incidence of moderate to severe nausea was higher in Group B (dexamethasone + granisetron) (p=0.01). Complete response rates were significantly greater in Group A (20%) compared to Group B (5%) (p=0.01). The requirement for rescue antiemetics was higher in Group B (30% vs. 10%, p=0.01). No significant differences were observed in vomiting incidence or side effects between the groups.

Conclusion: The combination of low-dose granisetron (0.1 mg) with dexamethasone (8 mg) is less effective than ondansetron (4 mg) with dexamethasone (8 mg) in preventing PONV following laparoscopic surgery. Ondansetron with dexamethasone provides superior prophylaxis, resulting in lower nausea scores and reduced need for rescue antiemetics.

To Estimate the Risk of Cardiovascular Disease in Healthcare Workers

Sajid Ali — 2025-07-14

Background: A major cause of mortality around the world, cardiovascular diseases (CVDs) are most prevalent in countries like South Asia, Central Asia, and Eastern Europe, including Pakistan, with a twin disease burden of communicable and non-communicable disease. HCWs, even though they are at the forefront of fighting CVDs, are most vulnerable because of work-related stress and uneven shifts. By employing the QRISK2 calculator, in the present research CVD risk among healthcare workers is attempted to be measured. By identifying those at risk, special measures can be implemented for their well-being over the long term and their capacity to provide high-standard treatment.

Study Design: A descriptive cross-sectional study.

Duration and Place of Study: This study was conducted in People’s University of Medical and Health Sciences for Women Nawabshah from February 2024 to February 2025.

Objective: To estimate the risk of cardiovascular disease in healthcare workers.

Methodology: In this cross-sectional descriptive study, 200 health profession workers aged 25-60 years had their cardiovascular disease (CVD) risk factors determined. Biochemical and modified QRISK2 questionnaires were used to gather data. Demographic, lifestyle, and physiological variables were processed with SPSS 22. Descriptive statistics, Chi-square, and Independent Sample T-tests were used, with p<0.05 as the level of significance. To establish study validity, ethical approval and informed consent were sought.

Results: Using the QRISK2 calculator, the cardiovascular disease (CVD) risk was estimated in 200 health care workers (HCWs). They were predominantly men aged 36 years on average. Paramedics, light smokers, males, and individuals with diabetes or a positive family history were at increased risk of CVD. Very few of them were categorized as high-risk subjects, and the majority were low-risk. The findings indicate the need for individually addressed preventative measures in the at-risk groups among the healthcare workers.

Conclusion: Healthcare workers involved in this research had a low overall risk of cardiovascular disease (CVD).

Determinants of Survival and Mortality Patterns in 99 Consecutive Burn Admissions at a North-Indian Tertiary Network: A Retrospective Cohort Study

Dr Anubhav Goel — 2025-07-14

Background. Burns remain a major cause of injury in low- and middle-income countries, yet granular outcome data from North-Indian districts are scarce.

Methods. We retrospectively analysed 99 consecutive acute thermal-injury admissions (January 2023 – March 2024) to four linked tertiary units in western Uttar Pradesh. Demographic, clinical-burn and outcome variables were extracted from prospectively maintained ward registers and validated against referral slips. Primary outcome was in-hospital survival; secondary outcomes were timing and proximate cause of death. Categorical data were compared with χ² or Fisher’s exact test and continuous variables with t- or Mann–Whitney-U tests; p<0.05 was significant.

Results. Mean age was 32 ± 15 years (range 10 months–75 years); 57 patients were male (57.6%). Median total body surface area (TBSA) burned was 38 % (IQR 22–60 %). Overall survival was 38 % (38/99). Survival exceeded 80 % for TBSA < 20 % but fell sharply to 14 % for 60–80 % TBSA and nil for > 80 % (Table 2, Figure 2). Of 61 deaths, 26 (42.6 %) occurred within 72 h (early deaths), predominantly from airway obstruction with inhalational injury, whereas 35 (57.4 %) were delayed, chiefly due to septic and/or hypovolaemic complications (Table 3). Increasing TBSA, third-degree depth, and inhalation injury were independent predictors of mortality on multivariable analysis (all p<0.01).

Conclusion. In this under-resourced regional network, survival remains unacceptably low once TBSA exceeds 40 %, and deaths shift from airway-related to septic aetiology after 72 h. Extending critical-care capacity and infection-control bundles beyond the first week is likely to yield the greatest mortality benefit.

Snake-Bite Envenomation and Early Kidney Risk: Duration to Hospital, Coagulation Indices and Species as Predictors of Acute Kidney Injury in Southern India – A Prospective Observational Study

Dr. Santosh M Hegde — 2025-07-14

Background Snake-bite is a neglected medical emergency in the tropics. Acute kidney injury (AKI) is its gravest systemic complication and is potentially preventable if patients at risk are recognised early. Simple, rapidly available indices—time-to-hospital, 20-min whole-blood-clotting-time (WBCT20), pro-thrombin time/international normalised ratio (PT-INR) and offending species—may offer reliable bedside predictors but have not been examined in a single analytic framework.

Methods We prospectively studied 100 consecutive adults (> 15 y) with proven or strongly suspected envenomation admitted to Gulbarga Institute of Medical Sciences (June 2023–Dec 2024). Demography, bite-to-hospital interval, species (clinical identification or dead specimen), WBCT20, PT-INR (at admission and 24 h) and serum creatinine were recorded. AKI was defined by KDIGO criteria. Indices independently associated with AKI were explored with multivariable logistic regression.

Results Median age was 55 y (IQR 38–68) and 53 % were male. Median bite-to-hospital interval was 11 h (IQR 7–16). Krait (29 %), Russell’s viper (26 %) and cobra (21 %) accounted for 76 % of bites. AKI developed in 24 patients (24 %) at a mean of 0.7 ± 1.4 days. Russell’s viper accounted for 54 % of AKI (adjusted OR 5.4, 95 % CI 2.0–14.7, p = 0.002). A bite-to-hospital interval > 12 h was present in 67 % of AKI versus 32 % of non-AKI patients (aOR 3.1, 1.2–7.8, p = 0.018). All AKI cases showed incoagulable WBCT20 and prolonged PT-INR at baseline; PT > 15 s or INR > 1.2 at 24 h remained independently associated with AKI (aOR 4.6, 1.3–16.0). Model-AUROC was 0.87. Dialysis was required in 6/24 (25 %) AKI cases and overall mortality was 8 %, confined to the AKI cohort.

Conclusion (1) Delay > 12 h, (2) Russell’s viper bite, (3) incoagulable WBCT20 and (4) persistent PT-INR derangement at 24 h reliably identify victims at very high risk of AKI. These bedside variables should prompt pre-emptive renal-protective strategies and early transfer to dialysis-capable centres in resource-limited settings.

Post-Vaccination Adverse-Effect Profile Among Adult Beneficiaries of a Tertiary-Care Hospital in Rajasthan: A Prospective

Dr. ravi kumar singodia — 2025-07-14

Background: Robust pharmacovigilance is essential to sustain public confidence in India’s COVID-19 immunisation drive. Published data from northern India remain limited, and heterogeneity persists in reporting practices.

Methods: We undertook a six-month, single-centre, prospective, comparative cohort study at Mahatma Gandhi Medical College & Hospital, Jaipur (IEC No. MGMC&H/IEC/JPR/2021/508; 21 June 2021). All consecutive adults (≥18 y) receiving either dose of Covishield™ or Covaxin™ between July-December 2021 were observed on-site for 30 min and contacted telephonically on day 1, 3 and 7. Adverse events following immunisation (AEFI) were graded (mild/moderate/severe) using Government of India guidelines. Primary outcome was cumulative incidence of any AEFI after dose 1 versus dose 2. Predictors were explored using multivariable logistic regression.

Results: Of 613 recipients (mean age 36.4 ± 12.1 y; 53.2 % male), 54.5 % reported ≥1 AEFI after dose 1 versus 35.5 % after dose 2 (p < 0.001). Local pain (41 %), fever (23 %), myalgia (13 %), fatigue (12 %) and headache (8 %) predominated. Almost 83 % of AEFI were mild and self-limiting; no anaphylaxis or thromboembolic events were recorded. Independent predictors of systemic AEFI were female sex (aOR 1.43, 95 % CI 1.02-2.00), age <30 y (aOR 1.57, 1.08-2.28) and previous SARS-CoV-2 infection (aOR 1.68, 1.05-2.70).

Conclusion: Both vaccines exhibited favourable short-term safety profiles; reactogenicity declined significantly after the second dose. Active surveillance should be continued to capture rarer, late-onset events and to strengthen public trust.

Admission High-Sensitivity Cardiac Troponin T as an Independent Predictor of 28-Day Mortality in Adult Sepsis: A Prospective Cohort Study

Dr Basavaraj G Yatanoor — 2025-07-14

Background: Sepsis remains a leading cause of critical-care mortality. Mounting evidence suggests that biomarkers of myocardial injury may refine risk-stratification.

Methods: This is a prospective observational study of 120 adults with Sepsis-3 who were recruited in a tertiary intensive-care unit. Patients were measured within 6 h of admission in the authors measured high-sensitivity cardiac troponin-T (hs-cTnT), creatine-kinase MB (CK-MB) and lactate-dehydrogenase (LDH) and re-evaluated the outcomes after 28 days. Organ failure was determined by way of SOFA (Sequential Organ Failure Assessment) score.

Results: There was a significantly higher median hs-cTnT in non-survivors (n = 39, 32.5 %) (0.202 ng mL 1) in comparison to those that survived (0. 048 ng mL 1; p < 0.001). The same tendency was seen with CK-MB and LDH. hs-cTnT was strongly correlated with SOFA ( 28 = 0.78, AUC of 28 days mortality was 1.00 with an optimal cut-off of 0.10 ng mL 1 delivering 97 % sensitivity/99 % specificity. Another excellent discrimination was apparent in CK-MB (AUC = 0.96) and LDH (AUC = 0.99). Multivariable modelling substantiates hs-cTnT as the overwhelming predictor after being adjusted to age, sex and SOFA.

Conclusion: Early elevation of cardiac enzymes—particularly hs-cTnT—portends poor short-term prognosis in sepsis and may complement clinical scores.

Analysis of Clinical Predictors for Mortality in Severe Organophosphate Poisoning

Dr. Aswin Madhusoodanan — 2025-07-14

Background: Severe organophosphate (OP) pesticide poisoning remains a major public-health problem in many low- and middle-income countries, with reported in-hospital mortality rates of 10–40 % despite antidotal therapy. Accurate early prediction of fatal outcome could optimise triage and critical-care resource allocation.

Methods: We conducted a prospective cohort study of 150 consecutive adults (≥ 18 y) with confirmed severe OP poisoning admitted to two tertiary toxicology centres between January 2024 and December 2024. Demographic, clinical and laboratory variables collected within 1 h of admission were analysed. Primary outcome was all-cause in-hospital death. Multivariate logistic regression, Kaplan–Meier survival analysis and receiver-operating-characteristic (ROC) curves were applied to identify independent predictors and evaluate existing scoring systems.

Results: Overall mortality was 20 % (30/150). Independent predictors of death were (i) time-to-presentation > 3 h (adjusted OR 3.4, 95 % CI 1.5–7.8), (ii) Glasgow Coma Scale ≤ 10 (OR 4.8, 2.0–11.4), (iii) serum butyryl-cholinesterase < 3 000 U/L (OR 6.1, 2.2–16.9), (iv) arterial pH < 7.25 (OR 5.2, 2.0–13.2) and (v) shock on admission (OR 10.2, 3.1–34.3). Kaplan–Meier curves showed significantly poorer 14-day survival for patients with low cholinesterase (log-rank p < 0.001; Fig. 1). The APACHE II score demonstrated the best discrimination (AUC 0.94; Fig. 2), followed by a modified SOFA-Lac (AUC 0.88) and Poisoning Severity Score (AUC 0.85).

Conclusion: Easily measurable bedside variables—particularly shock, profound acidaemia, low cholinesterase activity and delayed presentation—identify OP-poisoned patients at highest risk of death. Incorporating these factors into standard assessment, alongside APACHE II, could enhance early critical-care referral in resource-limited settings.

SERUM CHLORIDE-TO-SODIUM RATIO AND OUTCOMES IN HYPONATRAEMIC ACUTE DECOMPENSATED HEART FAILURE: A PROSPECTIVE COHORT STUDY

Dr. Marinna Ponnachan — 2025-07-14

Background: Hyponatraemia frequently accompanies acute decompensated heart failure (ADHF) and portends poor outcome. Emerging data suggest that chloride—long overshadowed by sodium—may carry independent prognostic weight. We assessed whether the admission serum chloride-to-sodium ratio (Cl⁻/Na⁺) improves risk‐stratification in hyponatraemic ADHF.

Methods: In this prospective cohort (January 2022–June 2024) we enrolled 302 consecutive adults (age 66 ± 12 years, 38 % women) hospitalised with ADHF and serum Na⁺ < 135 mmol L⁻¹. Baseline demographics, comorbidities, natriuretic peptides and full metabolic panels were recorded. The primary end-point was 180-day all-cause mortality; secondary end-points were in-hospital worsening HF and 30-day readmission. Patients were stratified by admission Cl⁻/Na⁺ tertiles (T1 ≤ 0.98, T2 0.99–1.03, T3 ≥ 1.04). Multivariable Cox and logistic models adjusted for age, sex, eGFR, LVEF, NT-proBNP and diuretic dose evaluated associations.

Results: Mean admission Na⁺ was 129 ± 4 mmol L⁻¹ and Cl⁻/Na⁺ 1.01 ± 0.04. During follow-up, 71 deaths (23.5 %) occurred. Crude 180-day mortality rose step-wise across tertiles (T1 14 %, T2 21 %, T3 35 %; p < 0.001). Each 0.01-unit decrement in Cl⁻/Na⁺ conferred a 6 % relative risk reduction (adjusted HR 0.94, 95 % CI 0.90–0.99, p = 0.02). Adding Cl⁻/Na⁺ to a validated ADHF score improved C-statistic from 0.77 to 0.81 (p = 0.01) and yielded a net reclassification improvement of 0.18. Low Cl⁻/Na⁺ also independently predicted in-hospital worsening HF (OR 1.42 per 0.01-unit drop, p = 0.008) and 30-day readmission (OR 1.27, p = 0.04).

Conclusion: Among hyponatraemic ADHF patients the admission Cl⁻/Na⁺ ratio is an easily obtainable, independent predictor of short- and medium-term outcomes and meaningfully enhances existing risk scores. Routine reporting and therapeutic trials targeting chloride homeostasis merit consideration.

Comparative Evaluation of Hemodynamic Responses and Ease of Intubation with Tuoren Video Laryngoscope Vs Macintosh Laryngoscope in Patients Undergoing Coronary Artery Bypass Graft Surgery

Dr. Megha Vijay — 2025-07-15

Background: Cardiac patients are highly vulnerable to the hemodynamic alterations that follow the laryngoscopy and endotracheal intubation making it beneficial to use methods which can mitigate these effects. This randomized study aimed to compare the eﬃcacy and associated hemodynamic variations between the Macintosh and Tuoren Videolaryngoscope for airway management in patients undergoing coronary artery bypass graftingsurgery.

Method: 60 patients undergoing elective CABG were evenly distributed into Group A (Tuoren Video laryngoscope) and Group B (Macintosh laryngoscope). Hemodynamic parameters, including systolic blood pressure (SBP), diastolicblood pressure (DBP), mean arterial pressure (MAP), pulse rate (PR), rate-pressure product (RPP) and peripheral oxygen saturation (SpO2) were recorded. Laryngoscopy and intubation time, ease of intubation assessed by Krieg’s scale, and intubation diﬃculty score (IDS) were documented.

Results: There was a greater increase in hemodynamic parameters in group B from 1 minute followingintubation until 5 minutes (p<0.05). Group A provided better glottic visualisation as assessed by CL grade (p<0.05) in significantly shorter laryngoscopy time (p=0.001). Group A had a significantly lower Krieg’s score (p=0.02) and IDS (p=0.04) than group B. The total intubation time, number of attempts, and complications were comparable between both groups, but the need for stylet was higher in group A (p=0.04).

Conclusion: The use of Tuoren video laryngoscope has been associated with faster laryngoscopyand improved glottic visualization, contributing to reduced hemodynamic alterations duringintubation but using a stylet is recommended to enhance the first-attempt successrate during intubation.

Levetiracetam Vs Sodium Valproate as First-Line Monotherapy in Childhood Epilepsy: An Open-Label Randomised Controlled Trial from Western India

Dr. Ramkesh Meena — 2025-07-15

Background: Epilepsy affects nearly 10 million Indian children and is often treated empirically. Evidence comparing broad-spectrum agents in paediatric‐onset epilepsy is limited. We compared the efficacy and tolerability of levetiracetam (LEV) versus sodium valproate (VPA) as initial monotherapy.

Methods: In this open-label parallel RCT (October 2022–March 2024, Udaipur, India) 52 drug-naïve children (1–18 y) with newly diagnosed epilepsy were randomised 1:1 to LEV (20 mg kg⁻¹ day⁻¹) or VPA (20 mg kg⁻¹ day⁻¹). Primary outcome was seizure-free interval over 6 months. Secondary outcomes were seizure recurrence latency, episode duration, need for rescue/adjunctive AEDs, and adverse events (AEs).

Results: Baseline characteristics were comparable (mean age 9.0 ± 4.9 y vs 9.3 ± 5.0 y; males 50 % vs 54 %; generalised-onset 62 % each). Six-month seizure freedom occurred in 77 % (LEV) vs 85 % (VPA) (p = 0.47). Mean time to first recurrence was shorter with LEV (39.7 ± 5.4 days) than VPA (59.4 ± 5.7 days; p < 0.001), yet mean repeat-episode duration favoured LEV (1.7 ± 0.6 min vs 4.0 ± 1.2 min; p < 0.001). No child on LEV required add-on therapy; one VPA recipient did (4 %). AEs were mild: behavioural symptoms predominated with LEV (15 % personality change, 12 % aggression) whereas metabolic/GI effects predominated with VPA (8 % weight-gain, 12 % abdominal pain). No serious or irreversible toxicity occurred.

Conclusion: Both agents provided high seizure-freedom rates. LEV shortened individual seizure duration and eliminated rescue AED need but showed earlier recurrences and more behavioural AEs. VPA achieved longer recurrence-free spans at the cost of metabolic/GI issues. Tailoring first-line therapy to individual comorbidity risk is essential.

IRREGULAR & LOSS OF FOLLOWUP AMONG IDU’S ATTENDING AT OST CENTER KOTA, RAJASTHAN: A CROSS SECTIONAL STUDY

Dr. Saurabh Sharma,Dr. Ashutosh Sharma,Dr. Anita Sharma,Dr. Manaswini Rathore — 2025-07-15

Background: Opioid Substitution Therapy (OST) is a proven intervention for opioiddependence and HIV prevention among Injecting Drug Users (IDUs). However, irregularfollow-up and treatment dropout are significant challenges, especially in OST centers likeKota, Rajasthan.

Novel Validated Uhplc-Dad Method for Quantification of Leptosperin in New Zealand Mānuka Honey: A Definitive Chemical Marker for Authentication and Quality Control Incorporating Sustainable Practices with Minimal Sample and Plastic Usage for Cost-Effectiv

Hari Krishna Ramaprasad Saripalli — 2025-07-15

Leptosperin is a unique floral marker compound found exclusively in the Leptospermum genus, with particularly high concentrations in Leptospermum scoparium (mānuka) honey from New Zealand. Due to mānuka honey’s global demand and valued therapeutic properties, reliable authentication methods are essential to ensure product quality, traceability, and prevent adulteration. This study reports the development and full validation of a sensitive and robust Ultra-Performance Liquid Chromatography with Diode Array Detection (UPLC-DAD) method for the quantification of Leptosperin in honey samples. The method employs a straightforward aqueous extraction followed by reverse-phase chromatography, enabling accurate and selective detection of Leptosperin at 282 nm.

Validation was conducted in accordance with international guidelines, encompassing specificity, linearity, precision, accuracy (expressed as recovery), trueness, limit of detection (LOD), and sample stability. The method exhibited excellent linearity (R² > 0.99) over a concentration range of 5 to 436 mg/kg. Precision studies showed relative standard deviations (%RSD) below 3% for both intra-day and inter-day measurements. Recovery rates ranged between 90% and 94%, demonstrating the method’s accuracy in complex honey matrices. The LOD was established at 10 mg/kg, sufficient to detect typical Leptosperin levels in mānuka honey. Stability testing confirmed that extracted samples remain stable for up to 36 hours’ post-preparation under refrigerated conditions, facilitating flexible laboratory workflows. Method performance was further corroborated through comparative analysis with accredited external laboratories, yielding strong concordance with relative standard deviations below 10.1%. This validated UPLC-DAD method offers a rapid, reliable, and cost-effective analytical tool for mānuka honey authentication and quality control. Its applicability extends to both monofloral and multifloral mānuka honey types, supporting research, regulatory compliance, and commercial quality assurance efforts. In summary, the method provides a scientifically rigorous approach to quantify Leptosperin—a definitive chemical marker of Leptospermum species—thus enabling robust authentication of mānuka honey to maintain consumer confidence and uphold export quality standards.

Endodontic Cryotherapy: A Review

Dr. Apeksha Ghatge — 2025-07-15

Endodontic cryotherapy involves using cold therapy during root canal treatments to reduce inflammation, pain, and improve patient comfort. This review examines the efficacy, mechanisms, and clinical outcomes of cryotherapy in endodontics. Preliminary findings suggest it enhances analgesic effects post-treatment, warranting further research for standardized protocols and long-term benefits.