International Journal of Pharmacy Research & Technology (IJPRT)

Successful Management of Cervical Ectopic Pregnancy in a Primigravida with Dilation and Evacuation: A Case Report

Dr. Avishek Bhadra, Dr. Rumela Biswas, Dr. Anubhuti Jha, Dr. Subhojit Bagchi — Tue, 07 Jan 2025 00:00:00 +0300

Cervical ectopic pregnancy (CEP) is a rare and potentially life-threatening condition, particularly in primigravid patients. This case presents a 20-year-old primigravida with painless vaginal bleeding at 8 weeks of amenorrhea, diagnosed with CEP via early pregnancy ultrasound. The patient underwent a successful emergency dilation and evacuation (D&E) procedure, preserving fertility and preventing excessive hemorrhage. Postoperative recovery was uneventful, and follow-up ultrasound confirmed complete evacuation. This case highlights the importance of early diagnosis and careful management of CEP, particularly in terms of preserving future fertility and minimizing complications like hemorrhage and cervical insufficiency.

Study of Surgical Methods of Umbilical Hernia Repair in the Rural District of Chickballapur

Dr. Sunita Prakash, Dr. Sunil Subhash Joshi, Dr. Arun Kumar S. L. — Wed, 05 Feb 2025 00:00:00 +0300

Background: Umbilical hernias are a frequent surgical issue, especially in rural areas. This study aims to assess the surgical techniques for umbilical hernia repair in the rural district of Chickballapur, Karnataka, India, and to compare the outcomes of open repair with primary sutures, open repair with mesh reinforcement, and laparoscopic repair.

Methods: This retrospective cohort study analyzed 100 adult patients who underwent surgery for symptomatic umbilical hernias at s 1 -District hospital and 4 taluk hospitals in Chickballapur from January 2019 -January 2024. Data on the type of surgery, postoperative complications, recovery times, recurrence rates, and functional recovery were collected. Statistical comparisons were made to evaluate the outcomes of different surgical approaches.

Results: A total of 100 patients were included in the study. Of these, 50% (n=50) underwent open repair with primary sutures, 30% (n=30) had open repair with mesh reinforcement, and 20% (n=20) received laparoscopic repair. Laparoscopic repair was associated with the lowest postoperative complication rate (3%), the shortest recovery time (mean 5 days), and the lowest hernia recurrence rate (2%). In comparison, open repair with mesh showed a recurrence rate of 6%, while primary suture repair had a higher recurrence rate of 10%. Socio-economic factors and resource availability influenced the choice of surgical method.Conclusion: Despite the prevalence of open repair techniques in this rural setting, laparoscopic repair yielded the best outcomes in terms of complications, recovery time, and hernia recurrence. This suggests that laparoscopic repair could be a beneficial option for rural areas with the necessary surgical expertise and equipment. Further research is recommended to explore the broader applicability and cost-effectiveness of laparoscopic repair in low-resource environments.

Incidence of Associated Injuries in Patients with ACL Tear on MRI – An Observational Study

Dr. Varun S., Dr. Bukke Ravindra Naik, Dr. V. Suresh Kumar, Dr. Sahana S. — Sat, 08 Feb 2025 00:00:00 +0300

Background

Anterior cruciate ligament (ACL) injuries are common, particularly in athletes, and often occur with additional knee injuries, including meniscal tears, ligamentous damage, and bone bruises. Identifying the incidence of these associated injuries is critical for optimizing treatment and improving recovery outcomes.

Objectives

This study aims to determine the incidence of associated injuries in patients with ACL tears and to explore the demographic profile and injury mechanisms that contribute to these additional knee injuries.

Methods

A multicentre, prospective observational study was conducted from December 2023 to December 2024, involving 200 patients diagnosed with ACL tears confirmed via MRI. Associated injuries such as meniscal tears, collateral ligament injuries, cartilage damage, and bone bruises were documented. Data on injury mechanisms, demographics, and sports participation were collected.

Results

Out of the 200 patients, 50% (n=100) had at least one associated injury. Meniscal tears were the most common (42%), followed by bone bruises (22%) and MCL injuries (18%). The majority of ACL injuries were due to non-contact mechanisms (60%), with football and basketball being the most frequent sports.

Conclusion

ACL tears frequently occur with associated knee injuries, particularly meniscal and ligamentous damage. These findings highlight the need for comprehensive diagnostic and treatment strategies to address multiple injuries and improve rehabilitation outcomes.

Morphometric Analysis of Glenoid, Coracoid Process and Scapular Spine in a tertiary care center- 3D CT Study

Dr Mozimul Haq Siddiqui, Dr Prashantha — Tue, 11 Feb 2025 00:00:00 +0300

Background: Recurrent anterior shoulder instability with glenoid bone loss poses a significant challenge in orthopedic practice. Achieving favourable functional outcomes depends on selecting an appropriate graft type and ensuring its safe fixation on the glenoid. Despite the importance of morphometric data, there is a paucity of studies analyzing the dimensions of the glenoid, coracoid process, and scapular spine in a tertiary care Center. Purpose: To evaluate the morphometric dimensions of the glenoid, coracoid process, and scapular spine in the Indian population, which can guide clinical decisions in managing recurrent anterior shoulder instability. Methods: A total of 3D CT scans of 300 shoulders from 150 patients with non-orthopedic conditions were analyzed. Measurements included: Glenoid: Mean height and width. Coracoid process: Mean height, width, and length of harvestable coracoid. Scapular spine: Mean width and length of harvestable segments. Results: This study highlights important morphometric data on the glenoid, coracoid process, and scapular spine among the Indian population. The results have direct clinical relevance, especially in addressing recurrent anterior shoulder instability with glenoid bone loss. The key findings include: Glenoid Dimensions: Mean height of 34.8 mm and mean width of 24.6 mm. Coracoid Process Dimensions: Mean height of 8.2 mm and 9.3 mm, and mean width of 11.7 mm and 13.1 mm at fixation points. Harvestable coracoid length averaged 21.9 mm. Scapular Spine Dimensions: Mean width of 8.2 mm and 7.7 mm at fixation points, and mean harvestable length of 30.4 mm. Gender Differences: Statistically significant differences in measurements were observed between genders. Conclusions: This morphometric evaluation can guide surgeons in selecting appropriate grafts and fixation techniques tailored to patient anatomy, potentially improving functional outcomes in cases of recurrent shoulder instability.

Clinical Study of Gynecological Problems in Adolescent Age Group at Tertiary Care Center

Dr. karalla chandana, Dr. Anita pawa, Dr.B.B.Yadav — Wed, 12 Feb 2025 00:00:00 +0300

Background: According to WHO adolescence is the age between 10-19 years Adolescents constitute 21.4% of the population in India [1]. It is the period where enormous physical and psychological changes occur. Hormonal events play a key role in this transition. Profound bodily changes, sexual development and altered emotional and behavioural changes are observed during this period, besides endocrine influences, genetic, nutritional and other environmental factors play an important role during this transitional period of life.

Aim and Objectives: 1. Clinical study of gynaecological problems in adolescent age group at tertiary care center. 2. To study proportion of different gynaecological problems in adolescent girls.3.To study the etiological factors in different gynaecological problems in adolescent girls.4.To study the treatment modalities in different gynaecological problems in adolescent girls.

Methods: Study Design: Cross sectional study. Study place: OBGY Department of VDGMC Latur, Maharashtra, India. Study Duration: September 2022 to May 2024. Study population: The study was conducted on all adolescent girls who were from urban and rural surroundings of tertiary care center visited the gynecology OPD. Study sample: 180

ResuResult: Majority of gynecological problems are present in late adolescent age group. In 180 cases admitted cases are 12 cases [6.66%] and 168 cases [93.3%] are from OPD.

26 cases who has normal menstrual patterns presented with dysmenorrhea (14 cases) and 8 cases with leucorrhea and 3 cases with dysuria and 1 case with mass per abdomen. most of the cases presented with hirsutism and acne 40 cases (22.22%) followed by Leucorrhoea and itching 29 cases (16.11%), Teenage pregnancy found in 12 cases (6.66%), overweight 6 cases(3.33%), Mass per abdomen 6 cases(3.33%), dysuria 3 cases (1.66%), Precocious puberty 1 case (0.55%) and Delayed puberty 1 case (0.55%).

most common etiopathology was AUB 96 cases (53.33%) followed by PCOS 39 cases (21.66%) and 4 cases diagnosed with Mullerian agnesis (2.22%),14 cases (7.77%)thyroid disorders, 06 cases(3.33%) hyperprolactinemia, 10 cases with vaginal infections and 02 cases with urinary tract infections. most common treatment modalities was Hormonal treatment 56 cases (31.11%) followed by Iron tablets in 59cases (32.77%), Blood transfusions in 2 cases(1.11%),Tranexamic acid in 38cases (21.11%), Mefenamic acid in 32 cases(17.77%),Thyroxin in 14cases[7.77%],Surgery in 10 cases (5.55%),Cabergoline in 4 cases[2.22%],antifungal in 4 cases (2.22%) , Antibiotics in 6 cases[5.55%], AKT in 1 case(0.55%). Many girls treated with multiple modalities.

Conclusions: Dysmenorrhea and heavy menstrual bleeding as predominant symptoms and excessive weight gain is most common examination finding. Majority of cases treated with hormonal treatment and iron supplementation.

Formulation, Optimization and Evaluation: Piroxicam Emulgel for Topical Drug Delivery Systems

Thu, 13 Feb 2025 00:00:00 +0300

Piroxicam is nonsteroidal anti-inflammatory drug that is classified as BCS class II drug (low solubility and high permeability). In the present study preparation of piroxicam loaded emulgel for the topical drug delivery is optimized by the central composite experimental design. The effect of different concentrations of surfactants i.e., span-80 & tween-80 was investigated on zeta potential (mv), polydispersity index (PDI), particle size (nm) & entrapment efficiency. The optimized batch of formulation suggested by the central composite design (CCD) was characterized by Fourier transform infrared spectroscopy (FT-IR) & Transmission electron microscopy analysis and also the mechanical and rheological properties were studied. The optimized batch of the formulation possess adequate spreadibility and viscosity. Results of in-vitro release studies revealed that the drug loaded emulgel showed (91.10 %) release in 12 hours dissolution study whereas in-vitro antiinflammatory study determined by egg albumin denaturation method exhibited 98.88% inhibition. However, ex-vivo bioadhesion study displayed the comparable results between piroxicam loaded emulgel (0.036 ± 0.4 N) and marketed Pirox® gel (0.037 ± 0.15). Hence, piroxicam when loaded in emulgel can be administered topically with improved properties.

Correlation of Gestational Age by Last Menstrual Period, Ultrasonography and New Ballard’s scoring

Dr Indra N, Dr Pradeep NM, Dr Hema KR, Dr Prerana M Ganaboor — Mon, 03 Mar 2025 00:00:00 +0300

Background: Gestational age or menstrual age is the time elapsed from the first day of last menstrual period (LMP), a time that precedes conception. The accurate calculation of gestational age holds key role in prevention of preterm birth; hence the study attempts to find which method gestational age calculation is more accurate.

Methods: prospective observational study with 179 participants whose gestational age was assessed using last menstrual period (LMP), ultrasonography (USG) and New Ballard scoring (NBS) which is considered gold standard.

Results: The mean age of the mother in our study is 24.68 years with a standard deviation of 3.99 and the mean birth weight of babies in our study is 2.80 kg with a standard deviation of 0.45. Pearson coefficient correlation is 0.677 (P <0.001) when comparing gestational age by LMP and gestational age by NBS which is statistically significant. A correlation of 0.779 (P <0.001) was found while comparing gestational age by T1 USG and NBS which was also found to be significant.

Conclusion: T1 USG is more consistent with NBS when compared to LMP gestational age, even though both have positive correlation with NBS.

Evaluation of Cardiac Autonomic Function Testing In a Tertiary Care Hospital

Wed, 05 Mar 2025 00:00:00 +0300

Introduction: The autonomic function testing (AFT) refers to the evaluation of the sympathetic, and parasympathetic division of autonomic nervous systems (ANS). The system affects function of almost every organ system in the body; hence, many tests that seem unique to a particular organ are really tests of autonomic function (e.g., urodynamic studies, gastric motility testing, pupillometry, tests of salivary and lacrimal gland secretion, etc.). Through scientific research and clinical experience published in peer-reviewed journals, autonomic function testing has proven its worth in the diagnosis and treatment of autonomic disorders over the past many years. Autonomic testing is now considered as a crucial part of the clinical assessment.

Materials and methods: The present work was designed and conducted in the Department of Physiology at Sri Siddhartha Institute of Medical Sciences & Research Centre (T Begur), Sri Siddharatha Academy of Higher Education., Tumkur over a period of 12 months. Fifty healthy male subjects doing MBBS in the same college between 19-24 years volunteered to participate in the present study. On the basis of detailed family history, participants were divided into two groups of twenty-five each as study group- with family history of hypertension (FH+) and control group- without any family history of hypertension (FH-). Either or both parents of the subjects of study group presented with history of hypertension of varying degree and duration and were under antihypertensive therapy which was further confirmed by their medical prescriptions as well. Both the groups were assessed and compared for their autonomic function tests to find out hyper-reactors for those having higher risk for hypertension in future. Sample size of 50 participants was decided including both the groups due to lack of consent from most of the senior MBBS students.

Results: There were no significant differences between age, BMI and other physical indices between two groups. All the physical characteristics of subjects of control as well as study group were statistically matched (p >0.05). However, the resting heart rate, systolic and diastolic blood pressures were found to be marginally higher (p>0.05) in the study group (Table 1). There was higher and significant (p <0.001) rise in diastolic blood pressure following isometric hand grip test at 1/3 of MVC and cold pressor tests in study group as compared with the control group indicating an attenuated sympatho-adrenergic system in subjects of study group (Table 2).

Conclusion: It may be concluded that sympathetic nervous system hyperactivity develops in children of hypertensive parents whereas the PNS remains unaltered. Though the subjects of study group may be normotensive initially, there is possibility of development of hypertension in future. Hyper-reactors who have positive family history were more vulnerable to future hypertension due to their sympathetic over activity. Regular monitoring of autonomic activity may prove to be a useful tool in predicting the future hypertensive cases. It also appears that genetic and environmental factors might be responsible for essential hypertension in families.

"Lupus And Anti-Dsdna: Does Anti-Dsdna Level Correlate With Disease Activity? – A Case Report."

Dharankumar P., Supriya Uppula, Sankha Gayan, R.P. Saini — Thu, 06 Mar 2025 00:00:00 +0300

Background: Systemic lupus erythematosus is a chronic autoimmune disease that mostly affects women. Approximately 50% of lupus patients experience lupus nephritis. In about 2% of cases, immune thrombocytopenia can develop into systemic lupus. High anti-dsDNA levels and low complement levels often mark disease activity. Anti-dsDNA levels are important in disease pathogenesis and correlate with disease activity. We are reporting a case of anti-dsDNA-negative lupus nephritis. Case report: A 26-year-old female presented with complaints of bilateral lower limb swelling and facial puffiness for a month. She was evaluated for thrombocytopenia around 6 months back and was labeled as a case of Immune thrombocytopenia she was not on any steroid therapy at the time of presentation with us. She was evaluated for the current complaints and a provisional diagnosis of nephrotic syndrome with suspicion of lupus nephritis as the primary pathology was made. Renal biopsy was done after building up her platelets and her biopsy revealed stage 5 lupus nephritis. However, her immunological profile showed a negative anti-dsDNA. She was started on mycophenolate mofetil (MMF) along with steroids, hydroxychloroquine, and Tacrolimus. Following drug therapy there was a significant reduction in proteinuria and remission was achieved. Conclusion: Anti-dsDNA titers are strongly associated with systemic lupus erythematosus disease activity, particularly in lupus nephritis. Managing lupus nephritis typically involves immunosuppressive medications, which can have adverse effects on reproductive health. Our case report examines the role of anti-dsDNA titers in lupus and guides in managing lupus nephritis in women of reproductive age.

Study of Dominance in the Foramen of Human Crania in Maharashtra Region

M. M. Peerzade, S. P. Fulari, G. S. Chakre, N.B. Masaram, W. F. Hiroli — Thu, 06 Mar 2025 00:00:00 +0300

Background: 104 non - pathological dried adult cranial bases studied for dominance of various foramina by using hand lens. Jugular foramina (70.19%), Superior Orbital Fissure (30.2%), Foramina ovale (32.3%), Carotid Canal (21.5%), optic canal (4%) were dominant on right side, statistically highly significant (P<0.01) with Chi. Square (x2) goodness of fit test. While Inferior orbital fissure (19.38%), foramen Rotundum (25%), foramina spinosum (24.7%), stylomastoid foramina (14.4%), internal acoustic meatus (20.3%) were dominant on left side & statistically highly significant (P<0.01) with Chi. Square (x2) goodness of fit test. This study will certainly help the radiologists because CT scan, MRI does not show exact footage of the foramina, moreover the dominance of these foramina will also help the Neurosurgeons during the surgery of basal crania. Moreover Medico- legal expert, Anthropologist, Anatomist to specify the Maharashtra state crania from other state crania.

A Multicenter Hospital Based Study on Prevalence of Lumbar Intervertebral Disc Herniation in Asymptomatic Individuals on MRI

Thu, 06 Mar 2025 00:00:00 +0300

Background:
Lumbar intervertebral disc herniation (LDH) is a common spinal disorder often associated with clinical symptoms such as low back pain and sciatica. However, recent studies have shown that a significant proportion of individuals with lumbar disc herniation remain asymptomatic. The role of magnetic resonance imaging (MRI) has become central in detecting these disc abnormalities, even in the absence of symptoms. Understanding the prevalence and characteristics of asymptomatic lumbar disc herniation can guide clinical decision-making and improve the management of patients presenting with back pain.

Objective:
This study aimed to assess the prevalence and types of lumbar intervertebral disc herniation and the degree of disc degeneration in asymptomatic individuals using MRI. The study also sought to evaluate the correlation between demographic factors and these abnormalities.

Methods:
A cross-sectional, hospital-based study was conducted over one year, including 200 asymptomatic individuals who underwent lumbar MRI for non-spinal conditions. Demographic data were collected, and MRI scans were analyzed for disc degeneration using the Pfirrmann grading system (Grades 1-5) and the presence of lumbar disc herniation, categorized as normal, bulge, protrusion, extrusion, or sequestration.

Results:
The prevalence of lumbar disc herniation in this asymptomatic population was 30%, with the majority of herniations occurring at the L4-L5 (40%) and L5-S1 (35%) levels. Disc bulge was the most common type of herniation (20%), followed by protrusion (7%). Extrusion and sequestration were rare (5% combined). Regarding disc degeneration, Grade 1 (normal) degeneration was observed in 55% of the cases, while Grade 4 (severe) degeneration was seen in 5%. The prevalence of herniation increased with age, particularly among individuals aged 40 and above (35% versus 25%).

Conclusion:
This study reinforces the concept that asymptomatic lumbar disc herniations are common and emphasizes the need for careful interpretation of MRI results in clinical practice. The findings underscore that disc abnormalities detected on imaging should be assessed in the context of symptoms, as many individuals with disc herniation may not require intervention.

Study Of The Efficacy, After Giving Equal Bolus Dose Of 8ml Of Ropivacaine 0.1% Vs Ropivacaine 0.2% With Fentanyl For Post-Operative Patient-Controlled Epidural Analgesia In Patients Undergoing Infra- Umbilical Abdominal Surgery And Lower Limb Orthopedic

Sat, 08 Mar 2025 00:00:00 +0300

Background: Epidural analgesia is widely accepted as the prime modality of providing optimal post-operative analgesia after major surgery, and patient-controlled epidural analgesia (PCEA) has recently gained popularity. It is often used in the post-operative phase and can be given as boluses, infusions, or a combination of the two. Local anesthetic has been used as the mainstay for epidural analgesia, alone or in combination with opioids. Ropivacaine is a relatively new amino amide local anesthetic, with Fentanyl is the opioid often used. Aims and Objectives: To study the efficacy, after giving 8ml bolus dose of ropivacaine 0.1% versus 0.2% with fentanyl for postoperative patient-controlled epidural analgesia in patients undergoing infra-umbilical abdominal and lower limb orthopedic surgery at Pravara Rural Hospital, Loni. Materials & methods: 74 patients were included in the study where the patients were divided into two groups with Group 1 given Ropivacaine 0.1% with Fentanyl 2 µg/ml and Group 2 given Ropivacaine 0.2% with Fentanyl 2 µg/ml. The PCEA pump will be programmed to deliver a continuous epidural infusion at the rate of 8 ml/hour after the initial 8 ml bolus dose, with a PCEA bolus dose of 4 ml and lockout interval of 20 minutes. Postoperatively the intensity of pain by vas score, degree of motor blockade, level of sedation, the total volume of drug infused, variation in hemodynamic parameters, and adverse effects were observed. Results: Group 1 reported a mean VAS, significantly higher than Group 2's mean VAS. Overall, the data suggest that Group 1 consistently experiences higher VAS scores compared to Group 2 across the measured time intervals, indicating potentially differing levels of perceived discomfort or pain between the two groups. Conclusion: Ropivacaine 0.2% with fentanyl is more efficacious than Ropivacaine 0.1% with fentanyl when used as PCEA in the postoperative period for analgesia.

Early Detection and Intervention for Hearing Impairment in Vietnamese Children Aged 0-6 Years

Nguyen Thi Trung Thuy — Tue, 11 Mar 2025 00:00:00 +0300

Hearing impairment during early childhood poses a significant challenge to speech and language development, with long-term consequences on cognitive and social integration. This study systematically investigates the prevalence, associated risk factors, and effectiveness of early intervention for hearing impairment in children aged 0-6 years who underwent audiological assessment at the Audiology Department of the National Otorhinolaryngology Hospital of Vietnam. A total of 72 children were comprehensively evaluated using a combination of objective and subjective audiological tests, including otoacoustic emissions (OAE), auditory brainstem response (ABR), and auditory steady-state response (ASSR). The findings reveal that 40.2% of children were diagnosed with hearing impairment before six months of age, reflecting the increasing impact of neonatal hearing screening programs. However, 29.1% of cases were only identified after three years of age, indicating a substantial delay in diagnosis for a significant proportion of children. Bilateral hearing loss was the predominant presentation, affecting 93.1% of the cases, with profound hearing loss accounting for 65.1% of the affected children. Notably, early intervention demonstrated a measurable impact on access to hearing rehabilitation. The proportion of children utilizing hearing aids increased from 4.5% before diagnosis to 20.9% following audiological evaluation, while cochlear implantation rates rose from 0% to 7.5% after diagnosis. This study underscores the critical importance of early hearing screening and prompt intervention to mitigate the developmental consequences of hearing impairment. Furthermore, it highlights the necessity of raising parental awareness and improving access to advanced audiological services to enhance early detection and effective management. The research provides new insights into the epidemiology of pediatric hearing impairment in Vietnam and emphasizes the urgent need for systematic neonatal hearing screening programs across healthcare facilities nationwide. Through these efforts, the study contributes to bridging the gap in early diagnosis and intervention, ultimately fostering better long-term outcomes for children with hearing impairment.

A Correlative Study on IL-6, TNF-Α, Deoxypyridinoline (DPD) In Patients with Hyperparathyroidism & Healthy Individuals

Dr. Akansha Srivastava, Miss Manisha Bhardwaj — Mon, 17 Mar 2025 00:00:00 +0300

Hyperparathyroidism is associated with metabolic disturbances, including alterations in cytokine levels and bone resorption markers. This case-control study aims to evaluate the correlation of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and deoxypyridinoline (DPD) levels in 150 patients with hyperparathyroidism and 150 healthy individuals. The study examines differences between these groups, using statistical analysis and graphical representations in the form of histograms and pie charts. The findings contribute to understanding the inflammatory and bone degradation processes in hyperparathyroidism.

ENGINEERING DREAMS, ENDURING STRESS: THE HEAVY TOLL OF STRESS ON ENGINEERING STUDENTS: A CROSS-SECTIONAL STUDIES

Janhavi Sarva, Kanika Gupta, Keshav Aggarwal, Ruchita Dixit, Amol R. Patil — Wed, 26 Mar 2025 00:00:00 +0300

Background: The pressure of professional courses like engineering and medicine often takes a toll on students, leading to stress, anxiety, and health issues. Heavy workloads and packed schedules disrupt sleep and eating habits, worsening stress over time. This study analyses stress factors among engineering students through a survey-based quantitative approach.

The study of brachial plexus anatomical variations in the Indore region variations in its formation, branching, and running

Umesh kumar mehta, Dr.Pawan kumar mahato, Dr Mukta Shreeram Pande — Wed, 26 Mar 2025 00:00:00 +0300

Background: The brachial plexus, a sophisticated network of nerves, plays a pivotal role in clinical anatomy, surgery, and anesthesia, as it is responsible for the motor and sensory innervation of the upper limb. This neural network, which arises from the anterior rami of the C5 to T1 spinal nerves, navigates intricate anatomical regions prior to diverging to innervate the integumentary system and musculature.

To determine morphometric analysis, vertical head diameter, foveal diameter, fovea transverse diameter, and foveal longitudinal diameter of the proximal femur in individuals from Central India

Dr.Asha Changil,Dr. Anjali patil,Dr. Rajendra singh — Wed, 26 Mar 2025 00:00:00 +0300

Background: The proximal femur, vital for human skeletal system, plays a vital role in hip joint biomechanical functions and is essential for medical and anthropological applications due to its anatomical dimensions. Aim: To determine the regional differences in this anatomical location by doing a thorough morphometric investigation of the vertical head diameter, foveal diameter, fovea transverse diameter, and foveal longitudinal diameter of the proximal femur.

To estimate the glucose and lipid profile levels in Diabetes without Nephropathy and in diabetic nephropathy patients

Maneesh Kumar Singh, Dr. Shreya Nigoskar — Wed, 26 Mar 2025 00:00:00 +0300

Background: Hyperglycemia, which results from impairments in insulin secretion, insulin action,or a combination of both, distinguishes diabetes mellitus (DM), a chronic metabolic condition. The way glucose metabolism and lipid homeostasis work together are a key part of how diabetic complications like nephropathy start and get worse. Aim: The study aimed to compare glucose and lipid profiles in diabetic patients without nephropathy with those affected by diabetic nephropathy

Synthesis and Characterization of Pullulan Encapsulated Ursolic Acid Nanoparticles for Enhanced Bioavailability and Acetylcholinesterase Inhibition in Alzheimer’s Disease Therapy

Aditi Kaushik, Sushila Kaura, Richa Mor — Wed, 26 Mar 2025 00:00:00 +0300

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that leads to cognitive decline and memory loss, primarily due to the dysfunction of acetylcholinesterase (AChE) in the brain. Natural compounds, such as Ursolic Acid (UA), have demonstrated significant neuroprotective and anti-inflammatory effects. However, the therapeutic potential of UA is often hindered by its low solubility and poor bioavailability. To address these limitations, we synthesized Pullulan-encapsulated Ursolic Acid nanoparticles (UA-Pull-NPs) with the aim of improving drug delivery efficiency and enhancing AChE inhibition in AD therapy.

Comparative evaluation of result after internal fixation of clavicle fracture with titanium elastic nail and plate

Wed, 26 Mar 2025 00:00:00 +0300

Objective: This study evaluated the outcomes of using titanium elastic nail (TEN) fixation in combination with plate fixation to treat midshaft clavicle fractures. Methods: 60 patients with displaced midshaft clavicle fractures were randomly assigned to either Group A (TEN fixation) or Group B (Plate fixation). At six weeks, three months, and six months following surgery, a number of factors were assessed. Surgical duration, intraoperative hemorrhage, radiological union time, functional results, and complications were among them.

Glue Sniffing Neuropathy in an 18-Year-Old Male Butcher with a History of Weed Smoking: Case Report

Allareddy Sathvika, Uma.M.Anand Kumar, Arun Pandiyan M — Thu, 27 Mar 2025 00:00:00 +0300

Glue sniffing neuropathy, a consequence of volatile substance abuse, presents with peripheral nerve damage. We present a case of an 18-year-old male butcher with a history of chronic glue sniffing and occasional marijuana use. He presented with a three-month history of progressive muscle weakness, small muscle wasting, hypotonia, hyporeflexia, and ascending quadriparesis. This case highlights the neurological repercussions of inhalant abuse, particularly in adolescents.

A Retrospective Comparative Study of Surgical Management of 4 Part Proximal Humerus Fractures between Internal Fixation with Philos Plate and Hemi Replacement with Neers Prosthesis

Dr P Amarnath Reddy, Dr K.Siva Krishna, Dr.N. Priyanka — Thu, 27 Mar 2025 00:00:00 +0300

Background: Neer recommended open reduction and internal fixation (ORIF) for three-part fracture dislocations and primary hemiarthroplasty (HA) for four-part fracture dislocations and for fractures with greater than 50% of cartilage-covered articular defect. The current study was conducted to compare surgical management of four part proximal humerus fractures between internal fixation vs hemi replacement.

Methods: The study is a hospital based retrospective case study, conducted in Government General Hospital, Kurnool during the period of June 2022 to June 2024. 30 patients (adults) presenting with proximal humerus fractures with a follow up period of minimum of 6 months and maximum of 18 months were included. After surgery, all patients were examined six weeks, three months, and six months later, as well as every two weeks until a fracture had healed. The constant Score were evaluated at each visit. A shoulder with affected arm X-ray was taken to check for fracture union and implant-bone interaction.

Results: In this study maximum age was 80 years and a minimum of 50 years with an the average age of 64.4 years. Significant differences were observed in all complications between range of movements between the two groups. Average time taken for internal fixation by hemiarthroplasty procedure was 120mins as compared to Philos which was100minutes.Blood loss was measured in terms of suction drain collection and mop count. The average amount of blood loss was 216 ml for PHILOS procedure and 356 ml for HEMIREPLACEMENT procedure.

Conclusions: the ROM pertaining to flexion, abduction, internal rotation, and external rotation for individuals with Philos plating was 17%, 20%, 4% and 4.6% higher than those who received Neer’s hemiarthroplasty. In conclusion, our study suggests that Philos plate osteosynthesis may have superior results than hemiarthroplasty when treating four-part proximal humerus fractures in individuals aged fifty and above.

Effect of Heartfulness Meditation Practices on Blood Pressure and Quality of Life in Patients with Hypertension – A Randomized Clinical Study

Thu, 27 Mar 2025 00:00:00 +0300

Background: Heartfulness meditation practices are modified form of Raja Yoga and gaining popularity worldwide. Studies have demonstrated the beneficial effects of heartfulness meditation on physical health, psychological health, emotional intelligence, heart rate variability, sleep and even on telomere length.

Methods: This is a randomized control study conducted in patients with hypertension to assess the effect of heartfulness meditation practices on blood pressure and quality of life. A total of 112 participants were randomized in 1:1 ratio to either intervention group or control group for a study period of four months. Intervention group were trained on heartfulness meditation practices by certified trainers on three consecutive days and were asked to practice them daily at their home. Quality of life was assessed by MINICHAL scale.

Results: After the intervention, there was a significant reduction in mean systolic and diastolic blood pressure in the intervention group compared to baseline (136.71 ± 8.64 vs 130.31 ± 8.78, p <0.001 for systolic BP and 82.78 ± 7.30 vs 77.44 ± 7.55, p <0.001 for diastolic BP). Comparison of BP changes between both the groups after the intervention showed significant reduction in both systolic (p=0.009) and diastolic BP (p=0.002) in the intervention group. There was also a significant improvement in mental domain, somatic domain, and overall quality of life in the intervention group.

Conclusion: The four months heartfulness meditation practices resulted in a significant reduction in the mean systolic and diastolic pressures. There was also improvement in the scores related to various aspects of quality of life.

Assessment of Nerve Conduction Abnormalities in Peripheral Vascular Disease: A Clinical and Electrophysiological Correlation Using Nerve Conduction Studies and Ankle-Brachial Index in Patients with Chronic Ischemia

Dr. M. Arafath Natchiar, Dr. V. Chougule, Dr. B. Sankararaman — Fri, 28 Mar 2025 00:00:00 +0300

Background: Peripheral Vascular Disease (PVD) is a progressive circulatory disorder characterized by arterial narrowing, leading to reduced blood flow to the extremities. Chronic ischemia associated with PVD can cause significant neurological complications, including peripheral neuropathy. However, distinguishing between neuropathy caused by ischemia and other factors, such as diabetes, remains a challenge. Nerve conduction studies (NCS) serve as an objective tool to evaluate peripheral nerve function in PVD patients. This study aimed to assess nerve conduction abnormalities in PVD patients and correlate findings with disease severity.

Methods: A prospective observational study was conducted on 40 patients diagnosed with PVD at Krishna Hospital, Karad, between May 2011 and May 2013. Patients were classified based on the Fountaine Staging System, and Ankle-Brachial Index (ABI) was used to determine the severity of arterial insufficiency. NCS was performed to evaluate motor and sensory nerve conduction velocities (NCV), compound motor action potential (CMAP), and sensory nerve action potential (SNAP). Patients with diabetes mellitus were excluded from the study to eliminate confounding factors. The relationship between PVD severity and nerve conduction abnormalities was analyzed statistically.

Results: The study population comprised 24 males and 16 females, with a mean age of 59 years (range: 42-78 years). The distribution of patients according to Fountaine Staging revealed that 32.5% had ischemic rest pain (Stage III), and 7.5% presented with ulceration or gangrene (Stage IV). ABI values indicated that 67.5% of patients experienced claudication pain (ABI: 0.4–0.85), while 7.5% had rest pain (ABI < 0.4). NCS findings demonstrated significantly reduced motor and sensory NCV in advanced PVD stages, with mean values of 40.92 m/s (motor) and 44.88 m/s (sensory). Furthermore, CMAP and SNAP amplitudes were markedly decreased in patients with severe PVD, suggesting ischemic nerve damage.

Conclusion: This study highlights a strong correlation between PVD severity and nerve conduction abnormalities, indicating that ischemic neuropathy plays a critical role in disease progression. Sensory nerve dysfunction was more pronounced than motor involvement, aligning with findings from previous studies. Early detection of nerve conduction deficits in PVD patients may facilitate timely interventions to prevent further neurological complications. Incorporating routine NCS assessments alongside vascular evaluations could improve diagnostic accuracy and patient outcomes in PVD management. Further studies with larger cohorts are recommended to validate these findings and explore potential therapeutic strategies.

ASSESSMENT OF MICRO-SHEAR BOND STRENGTH OF BIODENTINE TO VARIOUS RESTORATIVE MATERIALS AFTER AGING: AN IN - VITRO STUDY

Dr. Sonia Meshram, Dr. Rahul Ramteke — Sun, 26 Jan 2025 00:00:00 +0300

Objective: This study aimed to determine the perfect timing for restoratives installations of the micro-shear bond strength (µSBS) of Biodentine with various restorative materials. Materials and Methods: Sixty Biodentine specimens were prepared and categorized into two groups based on aging periods: one week and two weeks. Each group was further divided into three subgroups according to the restorative material used—Short Fiber-Reinforced Composite, Zirconomer, and Cention N—with ten specimens in each subgroup.

Quantitative Culture of Bronchoalveolar Lavage Fluid for the Diagnosis of Bacterial Pneumonia at a Tertiary Care Centre

Chandrahas Kale, Pankaj Joshi — Mon, 31 Mar 2025 00:00:00 +0300

Background: Pneumonia remains the leading cause of infectious disease mortality globally, necessitating early diagnosis and appropriate antimicrobial management. Bronchoalveolar lavage (BAL) has been established as a crucial diagnostic tool in both immunocompetent and immunocompromised patients, offering advantages over conventional sputum samples by reducing contamination and providing accurate antimicrobial susceptibility data.

Objectives: This study aimed to evaluate the diagnostic yield of quantitative BAL fluid culture in identifying bacterial pathogens responsible for pneumonia and to assess the antimicrobial susceptibility of these pathogens to guide effective treatment.

Methods: Conducted at the Department of Microbiology, Government Medical College, Maharashtra, the study included patients over 18 years undergoing BAL via fiberoptic bronchoscopy for pneumonia diagnosis from June 2018 to May 2019. Quantitative cultures were grown on Blood Agar, MacConkey Agar, and Chocolate Agar, with a positive culture defined at ≥ 10^4 CFU/mL. Pathogen identification and antibiotic susceptibility testing were performed using standard microbiological techniques.

Results: Of the 63 patients studied, 57.14% showed a positive quantitative BAL culture. Staphylococcus aureus was the most frequently isolated pathogen, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli. Notably, Methicillin-resistant Staphylococcus aureus (MRSA) constituted a significant portion of S. aureus cases. Gram-negative bacteria showed high resistance to standard antibiotics but were sensitive to Imipenem and Piperacillin-Tazobactam.

Conclusion: Quantitative BAL fluid culture is a valuable diagnostic method for effectively identifying and managing bacterial pneumonia. The procedure not only confirms the pathogen but also informs targeted antibiotic therapy, thereby minimizing the use of broad-spectrum antibiotics and reducing the emergence of resistant bacterial strains.

Cross-Sectional Study of Prevalence and Patterns of Blood Transfusion-Related Complications in A Tertiary Care Hospital

Thu, 03 Apr 2025 00:00:00 +0300

Background: Blood transfusion is a lifesaving procedure but can lead to various complications, which differ widely in type and frequency. Understanding these complications within the context of a tertiary care setting is crucial for improving patient safety and transfusion practices. Methods: This retrospective cross-sectional study analyzed medical records from 2000 patients who received blood transfusions at a tertiary care hospital over one year. The study focused on identifying the prevalence and patterns of transfusion-related complications, categorized by type and associated with different blood products. Results: The most common complications were allergic reactions and febrile non-hemolytic reactions, reported in 13 and 11 cases respectively, indicating a prevalence with statistically significant p-values of 0.045 and 0.035. Severe complications such as hemolytic reactions, TRALI, and TACO were less frequent, with incidences and p-values of 1 (0.250), 1 (0.650), and 1 (0.800), respectively. The analysis of specific blood products revealed that whole blood transfusions were associated with the highest complication rate (83 cases, p-value 0.020), suggesting a significant risk compared to other blood components. Conclusion: The study highlights that while transfusion-related complications at a tertiary care hospital are mostly mild, severe reactions occur less frequently but remain a concern. The significant association of complications with whole blood underscores the need for careful consideration in its use and calls for continuous monitoring and improvement in transfusion protocols to enhance patient safety.

A Comparative Study of Open Reduction and Internal Fixation (Orif) Vs. External Fixation in Distal Radius Fractures

Rahul Bains, Kamlesh — Fri, 04 Apr 2025 00:00:00 +0300

Background: Distal radius fractures are among the most common injuries treated in orthopedic practice. The choice between Open Reduction and Internal Fixation (ORIF) and External Fixation often depends on the fracture type, patient factors, and surgeon preference. This study aims to compare the efficacy, functional outcomes, and complication rates of ORIF versus External Fixation in the treatment of distal radius fractures. Methods: A retrospective cohort study was conducted at a single tertiary care center, involving 100 patients with closed distal radius fractures. Patients were divided into two groups based on the treatment received: ORIF (n=50) and External Fixation (n=50). Outcomes measured included functional recovery (assessed by the DASH score), grip strength, wrist mobility, and complication rates. Statistical analysis was performed using t-tests and chi-square tests where appropriate. Results: The ORIF group demonstrated significantly better outcomes in terms of DASH scores (32.9 vs. 27.2, P=0.02) and wrist extension (61.5 degrees vs. 25.1 degrees, P=0.03). Although grip strength and wrist flexion were improved in the ORIF group, these differences were not statistically significant (P=0.12 and P=0.05, respectively). Complication rates were comparable between the two groups, with no significant differences in the rates of infection, nonunion, malunion, or nerve injury. Conclusion: ORIF provides superior functional outcomes compared to External Fixation in the treatment of distal radius fractures, without an increase in complication rates. These findings suggest that ORIF should be considered the preferred method for patients eligible for surgical intervention, taking into account individual patient conditions and surgical expertise.

Cross-Sectional Analysis of Complications in Patients Undergoing Primary vs. Revision Total Knee Arthroplasty

Rahul Bains, Kamlesh — Fri, 04 Apr 2025 00:00:00 +0300

Background: Total Knee Arthroplasty (TKA) is a common orthopedic procedure aimed at alleviating pain and restoring function in severely arthritic knee joints. With an increasing number of primary TKAs being performed, the number of revision surgeries has also risen. Understanding and comparing the complications associated with primary and revision TKA is crucial for improving surgical outcomes and patient care. Methods: This cross-sectional study analyzed 200 patients who underwent TKA, dividing them into two groups: those receiving primary TKA and those undergoing revision TKA. Data were collected retrospectively from medical records at a single tertiary care center, focusing on demographic information, surgical details, and postoperative complications. Statistical analysis was performed to compare the complication rates between the two groups. Results: The revision TKA group was older (average age 70 years) compared to the primary TKA group (average age 65 years), with a significant difference in age (P<0.05). Complication rates were higher in the revision TKA group, with infection rates at 11% compared to 7.5% in the primary group (P<0.01), mechanical failure rates at 9.5% versus 5.5% (P<0.01), and readmission rates at 15% against 9% (P<0.001). The severity of complications was also greater in the revision group, with a significant increase in moderate and severe complications. Conclusion: Revision TKA is associated with higher and more severe complications compared to primary TKA. These findings underscore the need for tailored perioperative strategies and enhanced patient selection to mitigate the risks associated with revision knee arthroplasty. Future research should focus on longitudinal studies to capture long-term outcomes and further refine surgical and management practices.

Comparison of Radiological Outcomes in Surgical Vs. Non-Surgical Treatment of Acute Achilles Tendon Rupture

Rahul Bains, Kamlesh — Fri, 04 Apr 2025 00:00:00 +0300

Background: Acute Achilles tendon rupture is a common and significant injury, especially among active individuals. The optimal management—whether surgical or non-surgical—remains a subject of debate. Objective: This study aims to compare the radiological outcomes between surgical and non-surgical treatments for acute Achilles tendon rupture. Methods: A retrospective cohort study was conducted involving 80 patients with acute Achilles tendon ruptures, divided equally between surgical (n=40) and non-surgical (n=40) treatment groups. Radiological outcomes, including tendon gap reduction and tendon integrity, were assessed through imaging techniques. Functional outcomes, healing time, and re-rupture rates were also evaluated. Results: Surgical treatment resulted in significantly better radiological outcomes compared to non-surgical treatment. The surgical group showed greater tendon gap reduction (mean 4.2 mm, SD=1.6) compared to the non-surgical group (mean 2.5 mm, SD=1.3) with a p-value <0.001. Tendon integrity scores were also higher in the surgical group (mean 8.4, SD=0.9) than in the non-surgical group (mean 7.1, SD=1.1), with a p-value of 0.002. Additionally, the surgical group exhibited faster healing times and lower re-rupture rates. Functional recovery scores and range of motion were superior in patients undergoing surgery. Conclusion: Surgical treatment of acute Achilles tendon ruptures is associated with superior radiological outcomes and reduced re-rupture rates compared to non-surgical management. These findings support the use of surgical intervention in suitable patients to optimize tendon healing and functional recovery.

A Comparative Study of Functional Outcomes in Patients with Proximal Femur Fractures Treated with Total Hip Arthroplasty vs. Hemiarthroplasty

Rahul Bains, Kamlesh — Fri, 04 Apr 2025 00:00:00 +0300

Background: Proximal femur fractures are a common and debilitating injury, particularly among the elderly. The choice between Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) significantly impacts the patient's functional recovery, mobility, pain management, and overall quality of life. Objectives: This study aims to compare the functional outcomes, postoperative mobility, pain levels, and long-term patient satisfaction between THA and HA in treating proximal femur fractures. Methods: A retrospective cohort study was conducted with a sample size of 120 patients, equally divided between THA and HA groups. The functional outcomes were assessed using the Harris Hip Score and Oxford Hip Score, while mobility was evaluated through Activities of Daily Living (ADL) scores and walking speed. Pain levels were measured using the Visual Analog Scale, and long-term satisfaction was assessed through SF-36 and EQ-5D scores. Statistical significance was determined using t-tests and chi-square tests where appropriate. Results: The THA group showed significantly higher functional scores, including mean Harris Hip Score (82.3 vs. 79.1, p=0.043) and Oxford Hip Score (84.0 vs. 80.2, p=0.043). Mobility assessments also favored THA with higher ADL scores (8.7 vs. 8.0, p=0.017) and faster walking speeds (1.2 m/s vs. 1.0 m/s, p=0.017). Pain levels were lower in the THA group (VAS score: 3.0 vs. 3.7, p=0.029), and reoperation rates were significantly reduced (5.8% vs. 10%, p=0.029). Long-term satisfaction measures were also superior in the THA group (SF-36: 75.0 vs. 70.3, EQ-5D: 0.82 vs. 0.77, both p=0.018). Conclusion: Total Hip Arthroplasty is superior to Hemiarthroplasty in improving functional outcomes, enhancing mobility, reducing pain, and increasing long-term patient satisfaction in the treatment of proximal femur fractures. These findings suggest that THA should be considered the preferred surgical intervention in suitable patients.

The Study of Tadalafil and Tamsulosin as Monotherapy for Lower Urinary Tract Symptoms Due to Benign Hyperplasia of Prostate

Fri, 04 Apr 2025 00:00:00 +0300

Introduction: Benign Prostate Hyperplasia (BPH) is the most prevalent benign disease in males with diverse LUTS. It is the fourth most prominent condition among men aged ≥50 years and accounts for 80% of men aged ≥70 years. According to available data, the prevalence of BPH surged from 25% in the 40-49 age group to 80% in the 70-79 age group. Clinically, BPH causes LUTS and its symptoms, such as storage (impaired bladder emptying, urinary frequency, nocturia, urinary urgency, and urge incontinence), voiding (urinary incontinence, a restricted urinary stream), and postmicturition, which can impair patients' quality of life. Materials and methods: We analysed 120 patients of BPH (Benign Prostatic Hyperplasia) with LUTS (Lower Urinary Tract Symptoms) with baseline parameters as international prostate symptom score (IPSS), QMAX (maximum urinary flow velocity), PVR (Post Voidal Residual urine volume), for a period of 12 months. They were divided in to two groups, one group receiving only alpha blockers, other group receiving only PDE -5 inhibitor (Phosphodiesterase type 5 inhibitor/PDE-5I) tadalafil in treatment of LUTS due to BPH. These patients were reviewed at 1, 3, 6 months interval with above mentioned parameters. Results: Of the 120 patients taken up for the study, 60 in each group, only 110 patients completed the study. (54 patients in alpha blockers group and 56 patients in PDE-5 inhibitors group). Both groups were reviewed with mentioned parameters. Conclusion: PDE-5 inhibitor (Tadalafil) should be preferred over alpha blockers in treating LUTS (Lower Urinary Tract Symptoms) due to BPH (Benign Prostatic Hyperplasia) as PDE-5 inhibitors are found to be more efficacious than alpha blocker with lesser incidences of side-effects.

Comparison of Efficacy and Hemodynamic Stability of 0.5 % Isobaric Levobupivacaine and 0.5% Hyperbaric Bupivacaine in Old Age Patients Posted For Lower Limb Surgery under Spinal Anaesthesia

Neepa Patel, Bhumika J Chaudhari, Pratik D Patel, Malti Pandya — Fri, 04 Apr 2025 00:00:00 +0300

Background: Spinal anaesthesia, first introduced by August Bier in 1898, has evolved significantly with the introduction of bupivacaine and levobupivacaine. Bupivacaine is the most commonly used local anesthetic, while levobupivacaine and bupivacaine are equivalent but levobupivacaine have fewer cardiac side effects. Isobaric levobupivacaine is less toxicity and is used in various Anesthetic procedures. Geriatric patients are more susceptible to haemodynamic fluctuations due to changes in vertebrae structure, decreased cerebrospinal fluid volume, and nerve degeneration. This study aims to compare the safety profiles of hyperbaric bupivacaine and isobaric levobupivacaine in elderly patients during spinal anaesthesia for lower limb surgery. Materials and methods- The study was conducted at a tertiary health care center over a period of one year and six months, with 110 patients above 60 years of age, either sex, ASA grade III & IV, posted for lower limb surgeries. The total sample size was figured as 110 based on a previous study by Herrera R et al.5 The study involved pre-anaesthetic evaluation, laboratory investigations, and informed consent from all study subjects.The patients were divided into two groups: Group B received a 0.5% 3 ml hyperbaric injection of bupivacaine intrathecally, and Group L received a 0.5% 3 ml isobaric injection of Levobupivacaine intrathecally. The patients were monitored using standard monitors such as pulse oximeter for saturation (SpO2), noninvasive blood pressure monitoring (NIBP), and electrocardiogram (ECG). Sensory and motor assessments were performed immediately after positioning supine and recorded as 0 minutes. The study also assessed the duration of motor blockade, Bradycardia, and hypotension. Postoperatively, hemodynamic parameters, duration of analgesia, and total duration of sensory and motor block were assessed every 2 hourly for 6 hours & 4 hourly till 24 hours. Result- The study compared the heart rate and blood pressure of two groups after spinal anesthesia. Both groups had similar baseline heart rates, but after spinal anesthesia, there was a significant difference in heart rate. Group B had greater pulse rate variability, indicating a statistically significant difference. Systolic blood pressure was comparable in both groups, but the decrease was greater in group B compared to group A. Mean arterial blood pressure was comparable in both groups, but Group B experienced a greater decrease. The onset time of sensory block at T10 level was comparable between groups, but the maximum sensory block level was different. The duration of sensory block was longer in Group B, while the total duration of analgesia was longer in Group B. Group B had greater pulse rate variability, but no significant difference in mean arterial pressure. Conclusion- The study concluded that 0.5% isobaric levobupivacaine is more effective than 0.5% hyperbaric bupivacaine in elderly patients undergoing lower limb surgery due to its superior hemodynamic stability.

Study of Socio Demographic Factors in Women with Stillbirth

Dr. Apurva Tribhuwan, Dr. Shrinivas Gadappa2, Dr. Ammu Ajith — Sat, 05 Apr 2025 00:00:00 +0300

Background: To develop preventive strategies, it is crucial to understand the etiology, risk factors, and associated factors leading to stillbirth. The aim of this study was to study the demographic profile of women experiencing stillbirth, to understand the risk factors for stillbirth in low resource settings, and to find the etiology of stillbirth so as to facilitate designing of a stillbirth prevention strategy. Material and Methods: Present study was hospital based, prospective, observational, descriptive study, conducted pregnant women with diagnosed stillbirth (birth weight weighing >500 gm and after 20 weeks of complete gestation) before delivery. Results: In present study, stillbirth rate of 3.99%. We studied 101 cases of stillbirth. Majority pregnant women were from 25-29 years age group (43.56 %) & from 19-24 years age group (32.26 %), were unbooked (60.40 %), were from rural background (58.42 %) & from Lower middle class (56.43 %). In present study, among 101 patients, majority were from para 2 to para 4 group (50.49 %), from 37-40 weeks gestational age (30.69 %) & delivered vaginally (88 %). Previous still birth was noted in 12 cases, among them 2 had history of ≥2 previous still births. Common fetal birth weight group in present study was 2501-3500 grams (26.01 %) & 501-1000 grams (23.76 %). Common maternal risk factors noted were hypertension (24.75 %), maternal obesity (14.85 %), diabetes (9.90 %), & smoking (1.98 %). While fetal growth restriction (11.88 %) & congenital abnormalities (8.91 %) were common fetal high risk factors noted. Conclusion: In still birth cases, majority pregnant women were from 25-29 years age group, were unbooked (60.40 %), were from rural background (58.42 %) & from Lower middle class (56.43 %). Maternal risk factors were identified in 50.4% of cases.

Isolation and Characterization of Hydrocarbon Degrading Bacteria Isolated from Oil Contaminated Soil

Saumya Mishra, Peeyush Sharma — Sat, 05 Apr 2025 00:00:00 +0300

This study investigates the physico-chemical properties of hydrocarbon-contaminated soil and the potential of isolated bacterial strains to degrade petroleum hydrocarbons. Soil samples were collected from Transport Nagar, Dehradun, and analyzed for pH, electrical conductivity, organic carbon content, moisture, and bulk density, etc. The results indicated significant differences between contaminated and uncontaminated soil properties. Out of 20 isolates, five isolates (DHCS2, DHCS6, DHCS9, DHCS11, and DHCS17) were screened as hydrocarbon degraders by spectrophotometric technique using DCPIP indicator. The percentage of degradation of five isolates were found to be 15.5%, 10.5%, 9.85%, 37.5%, and 15.5% respectively. DHCS11 was found to have highest degradation percentage (37.5%). The isolate DHCS11 was identified as Acromobacter sp., could be a potential candidate for the degradation of polycyclic aromatic hydrocarbons. These findings highlight the importance of microbial bioremediation in restoring contaminated soils.

A Prospective Comparative Study of Hemodynamic Response to Proseal Lma Insertion versus Endotracheal Intubation

Dr.Sudhanshu Sant, Dr.Archana Agarwal, Dr.Rohit Malhotra, Dr.Vikram Dalal — Sat, 05 Apr 2025 00:00:00 +0300

Introduction: Airway management is a critical skill for anaesthesiologists. The airway can be maintained in a variety of ways, with endotracheal intubation being the gold standard. The use of laryngoscopy and intubation induces an increase in blood pressure and pulse rate. The hemodynamic response to laryngoscopy and tracheal intubation has been extensively documented, and several approaches have been attempted to mitigate it. This response is harmful in patients with a compromised cardiovascular system, especially if it is unregulated. Materials and Methods: A total of 100 patients were randomly selected from the list of elective surgical procedures under general anaesthesia. They were divided randomly by computer generated number method into two groups of 50 patients each. Group ET (n=50):Laryngoscopy and endotracheal intubation with appropriate sized cuffed PVC endotracheal tube was done. Group PLMA (n=50): PLMA size 3 or 4 as appropriate for the patient was inserted and cuff inflated with recommended volume of air. Results: The demographic profile of the patients in Group ETT and Group PLMA were comparable (P>0.05).There was no statistical difference in insertion attempts between endotracheal tube and PLMA. The difference in time required for endotracheal intubation and PLMA insertion was not statistically significant. There was a rise in heart rate and mean arterial pressure (MAP) seen after insertion of both devices, but there was comparatively higher rise seen with endotracheal tube than PLMA and it was statistically significant. Conclusion: From the findings of present study it is concluded that PLMA insertion causes significantly less and transient hemodynamic response in comparison to endotracheal intubation. Hence it could be useful in situations where minimal changes in hemodynamics are desirable. PLMA is also found to be equally safe compared to endotracheal tube, as not a single incidence of aspiration was noted with its use. We recommend routine use of PLMA in place of endotracheal intubation for elective surgical procedures lasting 1 to 2 hours.

The Impact of Maternal Obesity on Labor and Delivery Outcomes: A Comparative Study

Neha U. Chandak, Ravikiran K Rathi — Mon, 07 Apr 2025 00:00:00 +0300

Background: Maternal obesity is a recognized risk factor for adverse labor and delivery outcomes. This study aims to compare the labor and delivery outcomes between obese and non-obese pregnant women to better understand the influence of obesity on these processes. Methods: A retrospective comparative study was conducted at a tertiary care hospital, involving a total sample size of 220 women categorized into obese (n=110) and non-obese (n=110) groups based on pre-pregnancy Body Mass Index (BMI). The primary outcomes measured included the duration of labor, rates of epidural anesthesia, spontaneous and assisted vaginal deliveries, labor induction, cesarean sections, and perinatal complications such as gestational diabetes and preeclampsia. Secondary outcomes assessed were postpartum hemorrhage, infection rates, and length of hospital stay. Results: The study found that obese women had a significantly longer average duration of labor (12.4 hours vs. 10.8 hours, p=0.007), higher rates of labor induction (65.5% vs. 48.2%, p=0.013), and cesarean sections (46.4% vs. 34.5%, p=0.038) compared to non-obese women. Additionally, obese women were less likely to have spontaneous vaginal deliveries (50% vs. 63.6%, p=0.028) and more likely to require assisted vaginal deliveries (15.5% vs. 9.1%, p=0.032). Rates of gestational diabetes (26.4% vs. 10.9%, p=0.002) and preeclampsia (20.9% vs. 8.2%, p=0.005) were also significantly higher in the obese group. Furthermore, obese women experienced more postpartum complications such as hemorrhage (12.7% vs. 5.5%, p=0.016) and infections (11.8% vs. 3.6%, p=0.023), and had a longer hospital stay (4.5 days vs. 3.8 days, p=0.011). Conclusion: This study underscores the significant impact of maternal obesity on labor and delivery outcomes, including increased durations of labor, higher intervention rates, and greater perinatal and postpartum complications. These findings highlight the need for targeted prenatal care and intervention strategies to manage obesity-related risks during pregnancy and delivery.

Comparative Efficacy of Atorvastatin and Guggul in LDL-C Reduction: A Randomized Clinical Trial

Lodangi Nagakrishna, Dr. Akash Vishwe — Mon, 07 Apr 2025 00:00:00 +0300

Hyperlipidemia is a major risk factor for cardiovascular diseases (CVD), necessitating effective lipid-lowering strategies. While atorvastatin remains the first-line treatment for LDL-C reduction, statin intolerance limits its long-term use in some patients. This study aimed to compare the efficacy of atorvastatin and Guggul (Commiphora mukul) in reducing LDL-C levels. A 12-week, randomized controlled trial (RCT) was conducted on 150 patients with hyperlipidemia, divided into atorvastatin (10 mg/day) and Guggul (2000 mg/day) groups. The atorvastatin group exhibited a 26.3% reduction in LDL-C, significantly higher than the 15.3% reduction in the Guggul group (p < 0.001). HDL-C increased by 11.0% and 12.9% in atorvastatin and Guggul groups, respectively, with no significant difference between the two (p = 0.08). While atorvastatin remains superior in LDL-C reduction, Guggul demonstrated moderate lipid-lowering efficacy with a better safety profile, suggesting its potential role as an alternative for statin-intolerant patients.

Detection of Extended Spectrum Beta Lactamases among Gram Negative Bacilli Isolated From Surgical Site Infection in a Tertiary Care Hospital

Chopade Apeksha, Ghatole Mangala, Kashetty Virendra — Thu, 06 Feb 2025 00:00:00 +0300

Background: Surgical site infection (SSI) is a common complication that contribute to significant morbidity and mortality. The common organisms encountered in SSI are Staphylococcus aureus, Enterococci, E.Coli, Klebsiella spp and Pseudomonas. Knowledge of antibiotic susceptibility and drug resistant pattern will be of great help to treating physician and patient. This study is carried out to determine the prevalence of ESBL producing gram negative bacteria associated with SSI. Material & Methods: This is a prospective study carried out in a tertiary care hospital for a period of 2.5 years. 248 cases were diagnosed as having surgical site infection. Pus samples were processed for culture and antibiotic sensitivity. ESBL detection among gram negative bacteria was done by Predictor disk method and AmpC detection was done by AmpC disk test Result: Out of the 248 pus samples 221 were culture positive. Gram negative isolates171 (69.35%) were predominantly isolated as compared to gram positive86 (34.68%). Among the gram negative isolates 133(77.78%) were ESBL producer of which 33.33% were pure ESBL producer, 27.48% isolates shown both ESBL & AmpC production while 16.95% isolates were pure AmpC producer. These isolates were sensitivity to Imipenem & Amikacin. Conclusion: Present study indicated high prevance of ESBL producing bacteria associated with SSI. To prevent such type of infections change of antibiotic prophylaxis, screening for ESBL colonization, better infection control practices should be considered.

Nanoemulsion Formulation for Enhanced Delivery of 5-Fluorauracil and Resveratrol with Advanced Techniques

Mr. Sivakumar Theegala, Dr. Rajasekaran. S M Pharm — Mon, 07 Apr 2025 00:00:00 +0300

This study focuses on the formulation and optimization of a nanoemulsion-based lipid nanosystem for the dual delivery of 5-fluorouracil (5-FU) and resveratrol (RSV) to enhance dermal drug permeation and therapeutic efficacy. A systematic approach was employed to evaluate excipient screening, lipid selection, emulsifier efficiency, and formulation techniques. Labrasol® (LBR) was identified as the optimal medium-chain oil (MCO) due to its high drug solubility and P-GP inhibitory activity, while Emulcire® 61 WL 2659 (EML) was chosen as the solid lipid for its excellent emulsification properties and stability. Among the various formulation methods tested (S, M, H, K), Method-K, involving double emulsification, demonstrated superior stability, smaller particle sizes, lower polydispersity index (PDI), and higher drug entrapment efficiency (%EE) compared to other methods. Drug-excipient interaction studies using DSC and Fourier-transform infrared spectroscopy (FTIR) confirmed the compatibility and stability of 5-FU and RSV within the optimized formulation. The developed nanoemulsion system exhibited promising potential for dermal drug delivery, with enhanced drug solubility, stability, and bioavailability. These findings provide a strong foundation for further clinical investigations into the use of lipid-based nanosystems for targeted skin cancer therapy. Binary mixture (BM) miscibility studies confirmed LBR and EML as the ideal lipid combination, further optimized using differential scanning calorimetry (DSC) analysis. Tween® 80 emerged as the most effective emulsifier due to its superior emulsification properties and enhancement of membrane fluidity, facilitating drug permeation.

Efficiency of Hospital Information Management Systems: A Comparative Study between Teaching and Non-Teaching Hospitals

Tue, 08 Apr 2025 00:00:00 +0300

Background: Hospital Information Management Systems (HIMS) are pivotal in enhancing healthcare delivery by improving the efficiency of hospital operations. The effectiveness of these systems may vary significantly between different types of hospitals, influencing various aspects of healthcare management. Objectives: This study aims to compare the efficiency, user satisfaction, and integration of advanced features in HIMS between teaching and non-teaching hospitals. Methods: A cross-sectional study was conducted involving 200 hospitals (100 teaching and 100 non-teaching). The study utilized standardized questionnaires to measure system efficiency, user satisfaction, and the extent of HIMS feature integration. Data analysis included calculating means, standard deviations, and conducting t-tests to compare the performance of HIMS between the two hospital groups. Results: Teaching hospitals demonstrated higher efficiency with a mean score of 80.3 (SD = 5.2) compared to 75.4 (SD = 5.0) in non-teaching hospitals (P < 0.001). Similarly, functionality and user satisfaction were higher in teaching hospitals (Mean = 84.3, SD = 9.6) than in non-teaching hospitals (Mean = 76.1, SD = 9.2), with significant statistical differences (P < 0.001). The integration of advanced features also showed a significant difference, with teaching hospitals scoring higher (Mean = 74.2, SD = 7.2) than non-teaching hospitals (Mean = 64.0, SD = 6.4). Conclusion: The study highlights that teaching hospitals tend to have more efficient, satisfactory, and advanced HIMS compared to non-teaching hospitals. These differences underscore the need for tailored strategies in the implementation and ongoing development of HIMS according to hospital type to maximize technological benefits.

Study of Pathways and Barriers in Accessing Mental Health Services during Coronavirus Pandemic at Pmch Psychiatry Opd

Vivek Pratap Singh, Amardeep Kumar, Narendra Pratap Singh — Tue, 08 Apr 2025 00:00:00 +0300

Aim: The aim of the present study was to understand the pathways to care among patients with psychiatric illnesses during the COVID 19 pandemic and the barriers to care among patients with psychiatric illnesses (both new and previously diagnosed) during the COVID 19 pandemic. Methods: A cross-sectional, hospital-based, exploratory study was done on patients visiting the OPD of the Department of Psychiatry, Patna Medical College and Hospital, Patna. The study enrolled total of 50 diagnosed cases of new onset psychiatric illness and 50 previously diagnosed cases of psychiatric illness in the Department of Psychiatry at PMCH, Patna, as out-patients was recruited as subjects. Results: In the study population, it was observed that maximum number of patients was in the newly diagnosed cases 18-28 years age group (50%) and previously diagnosed cases 18-28 years, age group (52%). On comparing both groups, significant difference was not found. (P. Value = 0.721). In newly diagnosed cases there were 34 (68%) male and 16 (32%) female and previously diagnosed cases had 32 (64%) male and 18 (36%) female subjects. In the study population, it was observed according to educational qualification maximum number of Illiterate patients were in the newly diagnosed cases18 (36%), Primary 3(6%), High school 5 (10%), Intermediate 14 (28%), Graduate 10 (20%) and previously diagnosed cases Illiterate 20 (40%), Primary 4 (8%), High school 6 (12%), Intermediate 12 (24%), Graduate 8 (16%). On comparing both groups, significant difference was found. (P. Value = 0.011). Conclusion: There was no statistical difference on items in BACE-3 scale. The pathways study found that most of the patients first visited native/ religious faith healers before seeking specialist psychiatric care. This study will help to assess the effect of a stressful event such as COVID 19 pandemic on the difficulties faced in treatment seeking pattern of mental health of the population more so in an already diagnosed case of psychiatric illness.

Impact of Resistance and Endurance Exercise Training on Heart Rate Variability

Dr Rakesh Yeole, Dr Devendra Ghodpage — Tue, 08 Apr 2025 00:00:00 +0300

Background: The “Heart rate variability (HRV) test is a non-invasive way to check the hearts and autonomic nervous system (ANS) overall health and performance. The test finds the average and standard deviation of the time between heartbeats. Aim: The goal of this 12-week trial is to find out how different types of exercise, including resistance and endurance training, affect people's HRV. Autonomic control and cardiovascular health will be the primary outcomes of the study.

Wernicke's encephalopathy In a Rural Tertiary Teaching Hospital: A Case Report

Dr.Shaik Fathimunni, Dr.Uma MA, Dr.Karthik, Dr. Oersala Thasneem ara — Fri, 11 Apr 2025 00:00:00 +0300

Background: Wernicke's encephalopathy is a neurologic disorder caused by thiamine (vitamin B1) deficiency, often associated with chronic alcoholism, malnutrition, or other conditions that impair thiamine absorption or utilization. It presents with a classic triad of confusion, ataxia, and ophthalmoplegia, but the full triad is rarely present in all cases.

Case Presentation: We report a case of Wernicke's encephalopathy in a 50-year-old male who presented with acute onset of confusion, unsteady gait, and blurred vision. His medical history was significant for chronic alcohol use and poor dietary intake. He was admitted to our rural tertiary hospital for evaluation and management.

Conclusion: Early recognition and prompt thiamine administration are critical for improving outcomes in patients with Wernicke's encephalopathy, especially in resource-limited settings.

Antibiotic Profile of K. Pneumoniae Isolated from Endotracheal Aspirate in a Tertiary Care Hospital

Dr. Sonia Pradhan, Dr. Ansuman Dash, Dr. Madhushree Mishra, Dr. Sonam Satpathy — Fri, 11 Apr 2025 00:00:00 +0300

Background & Aim: To identify local trends in antibiotic resistance, this study looks at the antibiotic resistance profile of K. pneumoniae isolates from endotracheal aspirates. Materials & methods: 7-month observational research at Hi-Tech Medical College & Hospital, Rourkela, involved 196 samples from ICU patients suspected of ventilator-associated pneumonia. Out of these, 132 were positive. The majority (46.96%) were K. pneumoniae, with a female and male gender distribution. Samples were processed using standard techniques. Identification was done using biochemical assays and automated techniques. Antibiotic susceptibility testing was performed using Kirby-Bauer disk diffusion and VITEK-2. The study examined various antibiotics, including beta-lactams, aminoglycosides, and fluoroquinolones. Results: Out of the 196 tested endotracheal aspirate samples, 132 (48%) were positive for K. pneumoniae, constituting about 62 (46.96%) of the total. Other organisms comprised 41 (31.06%), and others comprised 29 (21.96%). Most patients were male (58.06%), with an average age of 55 years. Patients with prolonged ICU stays (>10 days) accounted for most isolates. 10 (16.39%) were sensitive to gentamicin (n=61), and 12 (19.3%) were sensitive to amikacin (n=62). Conclusion: According to the study, K. pneumoniae in endotracheal aspirates from intensive care unit patients is growing more resistant to antibiotics. This suggests that urgent action is required, including prudent antibiotic usage, strong infection control, and ongoing resistance monitoring.

Comparative Outcomes of Volar Locking Plate Fixation versus External Fixation in Unstable Distal Radius Fractures

Dr.Vinay B Patil, Dr Eshwar Masgal, Dr Vijayakumar — Mon, 14 Apr 2025 00:00:00 +0300

Background: Distal radius fractures that present instability frequently occur in orthopedic cases while requiring extensive clinical and economic resources for treatment. Doctors currently use two standard techniques for surgical stabilization because they involve volar locking plate fixation or external fixation. The field of implant development has made considerable progress while ongoing discussions continue on finding the most favorable method regarding fracture correction while minimizing complications. The goal of this research was to evaluate both radiological and functional results alongside adverse event occurrence when determining the effectiveness of volar locking plate fixation against external fixation for unstable distal radius fracture treatment. Methods: on this prospective comparative take a look at, 100 sufferers with unstable distal radius fractures have been randomized into two treatment groups: volar locking plate fixation (n = 50) and external fixation (n = 50). Radiographic parameters were measured preoperatively and at 6 weeks, 3 months, and six months postoperatively. useful consequences have been evaluated the use of the Disabilities of the Arm, Shoulder and Hand (dash) rating and grip strength assessments. headaches along with infection, lack of reduction, and hardware-associated troubles had been systematically recorded. Results: sufferers in the volar locking plate group established notably higher healing of radial height and volar tilt at 3 and six months (p < zero.05). Their practical results, measured via dash rankings and grip strength, had been notably advanced (p < zero.05) as compared to the external fixation organization. although each strategies yielded ideal scientific effects, outside fixation changed into related to a better occurrence of pin tract infections and not on time recuperation of wrist feature. Conclusion: Volar locking plate fixation supplied a more favorable radiological and practical healing profile in unstable distal radius fractures, with fewer headaches than outside fixation. nonetheless, outside fixation stays a possible alternative in unique situations, specifically in which inner fixation is contraindicated. in addition massive-scale, long-term research are warranted to refine treatment algorithms and optimize patient care.

A Comparative Interventional Study of Effects of Silicon Oil on Peripapillary Capillary Perfusion in Patients with Rhegmatogenous Retinal Detachmentat Sms Hospital

Dr Nagendra Shekhawat, Dr Raju Beniwal — Tue, 15 Apr 2025 00:00:00 +0300

Background: Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition often managed by pars plana vitrectomy (PPV) and silicone oil (SO) tamponade. While SO stabilizes the retina and facilitates reattachment, its impact on retinal microvasculature, particularly peripapillary capillary perfusion, remains under investigation. Optical Coherence Tomography Angiography (OCTA) enables detailed visualization of these vascular changes. This study evaluates the effects of SO tamponade and subsequent silicone oil removal (SOR) on peripapillary capillary perfusion in RRD patients.

Methods: This prospective, interventional, comparative study included 112 eyes with unilateral RRD undergoing PPV and SO tamponade. Patients were examined pre-SOR and at 1 week, 1 month, and 3 months post-SOR. OCT Angiography (4.5×4.5 mm² scans) assessed peripapillary capillary perfusion globally and by sectors (superior and inferior). Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were also recorded. Statistical significance was set at p<0.05.

Results: The global peripapillary perfusion improved from 42.266±0.913 pre-SOR to 42.870±0.884 at 3 months post-SOR (p<0.001). Superior and inferior perfusion segments showed similar progressive increases. BCVA improved significantly post-SOR (pre-SOR mean: 0.815±0.335 logMAR; post-SOR: 0.371±0.243; p<0.001). IOP normalized after SOR (pre: 18.670±2.002 mmHg; post: 12.348±3.382 mmHg; p<0.001). Each follow-up interval demonstrated statistically significant improvement compared to baseline and previous time points.

Conclusion: Silicon Oil tamponade transiently reduces peripapillary capillary perfusion. Following SOR, peripapillary perfusion progressively recovers, accompanied by improved BCVA and normalized IOP. OCTA offers valuable insights into the microvascular dynamics and recovery following SO removal, guiding postoperative management and timing of SOR. Further studies should explore long-term vascular and functional outcomes to refine clinical decision-making for RRD management.

The Role of Mca/Ua Pulsatility Index Ratio in Managing Preeclampsia and Gestational Hypertension: A Prospective Study

Dr. T. Shireesha — Tue, 15 Apr 2025 00:00:00 +0300

Background: Preeclampsia and gestational hypertension pose significant risks to both mother and fetus. The middle cerebral artery to umbilical artery (MCA/UA) pulsatility index ratio may serve as a valuable tool in predicting and managing adverse outcomes. Methods: In a prospective observational study, 200 pregnant women with preeclampsia or gestational hypertension were assessed using Doppler ultrasound to determine the MCA/UA PI ratio. Participants were grouped into cases (ratio ≤1) and controls (ratio >1). Maternal and neonatal outcomes were analyzed. Results: The study found that 52 women (26%) had an MCA/UA PI ratio ≤1. These cases had a higher progression to severe preeclampsia and eclampsia (p<0.00001), increased incidence of severe oligohydramnios (p<0.0001), and higher rates of emergency cesarean sections (p=0.00027). Neonatal complications, including low birth weight, low Apgar scores, and NICU admissions, were significantly higher in cases. Conclusion: The MCA/UA PI ratio is a significant predictor of both maternal and neonatal adverse outcomes in preeclampsia and gestational hypertension. Utilizing this ratio can enhance clinical decision-making and improve management strategies.

The Predictive Value of Mca/Ua Pulsatility Index Ratio in Adverse Perinatal Outcomes among Women with Preeclampsia and Gestational Hypertension

Dr. T. Shireesha — Tue, 15 Apr 2025 00:00:00 +0300

Background: Preeclampsia and gestational hypertension are significant causes of maternal and fetal morbidity and mortality worldwide. The middle cerebral artery to umbilical artery (MCA/UA) pulsatility index ratio has emerged as a potential predictor of adverse perinatal outcomes in these conditions. Methods: A prospective observational case-control study was conducted on 200 pregnant women diagnosed with preeclampsia or gestational hypertension after 30 weeks of gestation. Doppler ultrasound was used to measure the MCA/UA pulsatility index ratio. Women with a ratio ≤1 were categorized as cases, and those with a ratio >1 as controls. Adverse perinatal outcomes were recorded and analyzed. Results: Of the 200 women, 52 (26%) had an MCA/UA ratio ≤1. The cases showed a significantly higher incidence of severe oligohydramnios (26.9% vs. 6.7%, p<0.0001), emergency cesarean sections (71.15% vs. 37.16%, p=0.00027), low birth weight (<2.5 kg) infants (59.61% vs. 25.67%, p<0.00001), and NICU admissions (68.62% vs. 30.55%, p<0.00001). The MCA/UA ratio demonstrated a sensitivity of 39.04% and specificity of 88.40% in predicting adverse perinatal outcomes. Conclusion: An abnormal MCA/UA pulsatility index ratio (≤1) is significantly associated with adverse perinatal outcomes in women with preeclampsia and gestational hypertension. Routine use of this Doppler parameter can aid in early identification and management of at-risk pregnancies.

LARYNGEAL SIGNS AND SYMPTOMS AND GASTROESOPHAGEAL REFLUX DISEASE (GERD): A CRITICAL ASSESSMENT OF CAUSE AND EFFECT ASSOCIATION

Dr Jiyaul Haque Ansari, Dr. A.K. Singh — Tue, 08 Apr 2025 00:00:00 +0300

Background:
Laryngeal symptoms such as hoarseness, throat clearing, chronic cough, and globus sensation are frequently encountered in clinical practice and are often attributed to gastroesophageal reflux disease (GERD). However, the strength of the causal relationship between GERD and these laryngeal manifestations remains a subject of debate.

The Role of the Microbiome in Endodontic Treatment Failure

Wed, 16 Apr 2025 00:00:00 +0300

Background: Endodontic treatment failure remains a significant clinical challenge, often attributed to persistent or recurrent microbial infections within the root canal system. The complexity of the root canal microbiome, including its diversity and resistance mechanisms, is increasingly recognized as a critical factor influencing treatment outcomes. However, the specific microbial signatures and their correlation with clinical failure remain underexplored. Objective: This study aimed to investigate the microbial composition of endodontically treated teeth with persistent apical infections and to compare microbial diversity, abundance, and resistance profiles between treatment failure and successful outcome groups. The objective was to determine the role of the microbiome in contributing to post-treatment disease and resistance to conventional therapies. Methods: A prospective, cross-sectional study was conducted on 120 adult patients aged 18–65 years who had undergone non-surgical root canal therapy within the past six months. Sixty patients exhibited post-treatment apical periodontitis and persistent symptoms, while 60 age- and tooth-matched patients with successful treatment outcomes served as controls. Clinical evaluations, including symptom severity, radiographic lesions, and oral hygiene status, were recorded. Root canal samples were collected aseptically and analyzed using 16S rRNA gene sequencing and metagenomic shotgun sequencing. Bioinformatics tools (QIIME 2, MetaPhlAn) were used to assess alpha and beta diversity, species identification, and functional pathways. Statistical analyses included t-tests, chi-square, PCA, and multiple regression with significance set at p<0.05. Results: The treatment failure group demonstrated significantly higher alpha diversity (Shannon Index: 3.8 ± 0.5 vs. 2.5 ± 0.4; p=0.001), indicating a richer and more diverse microbial community. Dominant species in the failure group included Enterococcus faecalis (70%), Fusobacterium nucleatum (65%), Porphyromonas gingivalis (60%), and Candida albicans (30%). These microorganisms exhibited strong biofilm-forming abilities and resistance to common antibiotics such as vancomycin, tetracycline, and metronidazole. Positive correlations were found between microbial diversity and both symptom severity (r=0.65, p=0.01) and lesion size (r=0.70, p=0.01), while a negative correlation was observed with oral hygiene status (r=−0.50, p=0.01). Conclusion: The findings highlight the critical role of a diverse and resistant root canal microbiome in endodontic treatment failure. The prevalence of biofilm-forming and antibiotic-resistant species in failed cases underscores the limitations of conventional antimicrobial therapies. Future endodontic strategies should incorporate microbiome-informed diagnostic tools and tailored therapeutic approaches to improve treatment success and long-term outcomes.

Comparison of Vaginal Versus Cesarean Delivery in Women with Previous Cesarean: A Cross-Sectional Study on Maternal and Neonatal Outcomes

Vishwanath Dange, V. Malathi — Wed, 16 Apr 2025 00:00:00 +0300

Background: The decision between attempting a vaginal birth after cesarean (VBAC) and opting for a repeat cesarean delivery (RCD) can significantly impact maternal and neonatal outcomes. This study aims to compare the outcomes associated with these delivery options in women with one previous cesarean. Methods: This cross-sectional study involved 200 women with a history of one previous cesarean section who were delivering at a tertiary care center. Participants were grouped based on their delivery method: vaginal delivery (n=92) or cesarean delivery (n=108). Data were collected on maternal length of hospital stay, neonatal ICU admissions, postpartum hemorrhage, and Apgar scores at 5 minutes. Statistical analyses included t-tests, chi-square, and Fisher's exact tests, as appropriate. Results: The study found that women who underwent vaginal delivery had significantly shorter hospital stays (mean 3.2 ± 1.1 days) compared to those who had a cesarean delivery (mean 4.8 ± 1.4 days; p < 0.001). Neonatal ICU admission rates were lower in the vaginal delivery group (6.5%) compared to the cesarean delivery group (13%; p = 0.045). However, there was no significant difference in the rates of postpartum hemorrhage between the two groups (p = 0.21). Neonates born via vaginal delivery had significantly higher Apgar scores at 5 minutes (mean 9.4 ± 0.6) compared to those born via cesarean delivery (mean 9.1 ± 0.7; p = 0.032) Conclusions: Vaginal delivery in women with a previous cesarean section is associated with shorter hospital stays and potentially better neonatal outcomes in terms of Apgar scores and reduced ICU admissions. These findings support the consideration of VBAC in eligible women but underscore the importance of individualized clinical decision-making based on comprehensive risk assessments.

Clinico-Epidemiological Study of Management of Blunt Trauma Chest in a Tertiary Center

Dr.G.Kiran, Dr.P.Madan, Dr.Neerajakshi Reddi — Thu, 17 Apr 2025 00:00:00 +0300

Introduction: Blunt chest trauma denotes injuries to the chest resulting from forceful impact in the absence of penetration, such as those sustained from a blow, fall, or collision. Chest trauma is the leading cause of death from physical trauma after head and spinal cord injury. Thoracic injuries are primary or a contributing cause of about one- fourth of all trauma-related deaths. The mortality rate in these cases is about 10%. Thoracic injuries account approximately 20–25% of deaths due to trauma. 16,000 deaths occur per year in India alone as a result of chest trauma. Objective: To understand the epidemiological profile of patients reporting to the trauma center of our hospital with blunt thoracic trauma and to ascertain the impact of various etiologies of blunt chest trauma. Materials and methods: Between January 2023 and April 2024, consecutive patients with blunt thoracic trauma, who presented to the emergency department at Rangaraya Medical College (Kakinada, Andhra pradesh, India), were reviewed in this retrospective study. Data collected regarding common injury modes, age and gender distribution, pre-hospitalization practices, clinical presentations, associated injuries, severity of injuries, and management options from the hospital record section and these data were analyzed with descriptive statistics. Results: Majority of the patients were males who were involved in RTA. Presentation was mostly in the form of rib fractures, hemothorax, pneumothorax and flail chest. Most of the patients could be managed conservatively or by inserting an ICD tube and supportive treatment. None required an operative intervention. Mortality was mostly seen only when other systems were involved (CNS, abdominal organs, long bone fractures, spine injuries). Conclusion: Chest injury is seen commonly in RTA patients. Most of the patients of chest injuries can be managed by symptomatic care and simple life-saving intervention, i.e. intercostal drainage. CT chest is better than chest x-ray in early identification of pneumothorax and must be done if available. With increased RTAs, it is needed to have public awareness regarding road safety measures and educating them about the first aid measures for trauma patients.

Dual Plating Fixation for Schatzker Type V And VI Tibial Plateau Fractures: A Prospective Analysis of 30 Cases Assessed with the Modified Rasmussen Criteria

Dr Rishabh Goyal, Dr Nishant Panegaon, Dr Mohammed Ibrahim — Fri, 18 Apr 2025 00:00:00 +0300

Background: Bicondylar (Schatzker V–VI) tibial plateau fractures pose a demanding reconstructive challenge because axial–varus/valgus forces destroy both columns and jeopardise soft tissues. Although dual plating has become popular, high quality prospective data from the Indian sub continent remain sparse. Methods: Between July 2022 and December 2023 we prospectively enrolled 30 consecutive adults (mean age 37.9 ± 9.4 years; 83 % men) with closed Schatzker V (n = 19) or VI (n = 11) fractures treated at a level I trauma centre. A standardised protocol was followed: anterolateral rafting 3.5/4.5 mm locking plate plus posteromedial antiglide/buttress plate through dual approaches, elevation of depressed segments, autograft or synthetic bone substitute as required, and early mobilisation. Functional and radiological outcomes were evaluated at 6 months with the Modified Rasmussen score; complications were recorded. Results: Mean surgical delay was 5.8 days (2–12). All fractures united (mean 19.7 weeks). The mean functional score was 27.4 ± 2.8; 15 (50 %) results were excellent, 13 (43 %) good and 2 (7 %) fair. Radiological scores paralleled clinical findings (excellent = 15, good = 9, fair = 4, poor = 2). Knee range of motion averaged 0–118°. Complications comprised knee stiffness (5 patients), medial column collapse (2), superficial infection (2) and one wound dehiscence; no non unions, neurovascular injuries or deep infections occurred. Conclusion: Anatomical dual column plating delivered reliable union, restoration of alignment and predominantly excellent to good functional results in complex bicondylar fractures, with an acceptable, mostly avoidable complication profile. Early soft tissue–respecting fixation, meticulous posteromedial buttressing and regimented rehabilitation appear pivotal.

A Case Report On Carcinoma of the Left Maxillary Sinus in an Elderly Patient

Fri, 18 Apr 2025 00:00:00 +0300

Background: Maxillary sinus carcinoma is a relatively rare head and neck cancer malignancy but frequently appears in the advanced setting owing to initially non-specific symptoms. Tumors in this area can extend into the nasal cavity, oral cavity, orbit, and adjacent bony structures, often causing diagnostic and therapeutic difficulties. Case Presentation: We report the case of an 81-year-old woman who presented with progressive left-sided nasal blockage, episodic epistaxis, and ill-defined left midfacial swelling. MRI and PET-CT scan were found to reveal a heterogeneous soft-tissue mass originating from the left maxillary sinus with intranasal extension and erosions in the multiple bony walls. Histopathological assessment of biopsy tissues revealed a microcystic patterned malignant tumor; immunohistochemistry was recommended for further categorizing the neoplasm to conclusion. Conclusion: This case highlights the value of a high index of suspicion and thorough diagnostic imaging in the identification of malignant pathologies of the maxillary sinus. Surgical excision with adjunctive therapy is still the cornerstone of treatment, but care needs to be individualized according to tumor type, extent, and patient circumstances. This case contributes to the literature detailing the wide ranging presentations and therapeutic paradigms of maxillary sinus carcinoma, highlighting the importance of multidisciplinary management and early diagnosis.

Buccal Lymphoma: A Case Report

Dr Rajshekhar C Jaka, Dr N Chandramouli, RashmiV Gaikwad, Dr Sharmila V Resident — Sat, 19 Apr 2025 00:00:00 +0300

Background Non-Hodgkin’s Lymphoma (NHL) encompasses a diverse group of lymphoid malignancies with varied histopathological and clinical features. Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype of NHL, accounting for approximately 30–40% of adult cases. Although primarily arising in lymph nodes, extranodal presentations—especially in the oral cavity—are not uncommon. Oral lymphomas can mimic other neoplastic or inflammatory lesions, leading to potential delays in diagnosis. Case Presentation We report the case of a 41-year-old female patient with a painless swelling on the left side of her face and an associated oral ulceration over the buccal mucosa. She had poorly controlled diabetes mellitus but no significant history of weight loss, fever, or night sweats. Imaging showed a lobulated, heterogeneously enhancing soft-tissue lesion invading the left alveolar ridge and mandibular region. Biopsy of the buccal mucosa revealed large atypical lymphoid cells positive for CD20, PAX5, BCL-6, and CD10, with a Ki-67 proliferative index of ~98%, consistent with Diffuse Large B-Cell Lymphoma (DLBCL), germinal center subtype. The patient underwent six cycles of R-CHOP chemotherapy with significant metabolic remission observed on interim PET-CT scans. She also received prophylactic high-dose methotrexate to minimize CNS involvement. The patient responded well to therapy and was discharged on maintenance follow-up. Conclusion This case highlights an unusual primary presentation of DLBCL in the buccal mucosa. Extranodal lymphomas of the head and neck region can be diagnostically challenging given their broad differential diagnoses. A multidisciplinary approach—encompassing otolaryngology, maxillofacial surgery, oncology, pathology, and radiology—is essential for timely diagnosis. Aggressive regimens such as R-CHOP, with CNS prophylaxis when indicated, can yield favorable outcomes. Early recognition of oral lymphomas is particularly critical in immunocompromised or poorly controlled diabetic patients.

Clinicopathological Study of Skin Adnexal Tumours at Tertiary Care Centre

Dr. Chandrashekhar P. Bhale, Dr. Riya Shah — Sat, 19 Apr 2025 00:00:00 +0300

Background: Skin, which is composed of epidermis, dermis and skin adnexa has high incidence of Skin tumours. Subgroups of skin adnexal neoplasms are distinguished based on the differentiation of these tumours towards sebaceous, apocrine, eccrine, and hair follicles. Though clinical features provide clues to the diagnosis, histopathology remains the gold standard in the confirmation of the diagnosis. Categorization of the tumor as benign or malignant is vital for therapeutic and prognostic purposes. Present study was conducted to assess frequency, histological subtype, benign or malignant nature and age distribution of skin adnexal tumours which will further help diagnosis towards their line of differentiation. Materials and Methods: Present study is a cross sectional observation study conducted from October 2022 to September 2024. 43 cases of skin adnexal tumors of all ages & both gender who has been advised histopathology were enrolled. After Histo-morphological analysis of the tumors they were classified according to predominant pattern of differentiation into follicular, sebaceous, eccrine, and apocrine. Statistical analysis was performed using SPSS software, version 20. Observations and Results: majority cases i.e. 17 (39 %) were from age group between 41 to 60 years. Males were 24 (56 %) and females were 19 (44 %). In majority i.e. 28 (65 %) Head, neck & face was involved. Benign cases were 40 (94 %) whereas Malignant were 3 (6 %). In 26 (61 %) cases Hair follicle was involved. In 4 (10 %) Sebaceous gland, in 6 (13 %) Apocrine gland and in 7 (16 %) Eccrine gland was involved. amongst Benign cases Trichelemmal cyst was the commonest found in 12 (29 %) cases. Conclusion: To conclude Majority of the skin adnexal tumours were benign compared to malignant. Head, neck and face region were found as the commonest site of involvement and maximum cases involved hair follicle

A Comparative Study of Efficacy and Safety of Oral Contraceptive Pills versus Intrauterine Devices in Preventing Unintended Pregnancy

Vishwanath Dange, V. Malathi — Sat, 19 Apr 2025 00:00:00 +0300

Background: Unintended pregnancy remains a significant public health challenge worldwide, influencing the socio-economic and health outcomes for women. Oral Contraceptive Pills (OCPs) and Intrauterine Devices (IUDs) are widely used for contraception, but their comparative efficacy and safety have not been consistently evaluated across diverse populations. Objectives: This study aimed to compare the efficacy and safety of OCPs versus IUDs in preventing unintended pregnancies. Methods: A prospective observational cohort study was conducted involving 120 participants who were recruited from a family planning clinic and chose either OCPs or IUDs based on preference and medical suitability. The primary outcome measured was the rate of unintended pregnancies. Secondary outcomes included method continuation rates, user satisfaction, and the incidence of side effects. Data were analyzed using Chi-square tests, Fisher’s exact test, and Z-tests to compare proportions between the two groups. Results: The incidence of unintended pregnancies was significantly lower in the IUD group (1.7%) compared to the OCP group (6.7%), with a p-value of 0.037. Continuation rates were higher for IUD users (98.3%) than for OCP users (93.3%), with a significant difference (p-value = 0.045). The IUD group also reported fewer side effects and higher overall satisfaction. Safety profiles indicated fewer adverse effects among IUD users compared to those on OCPs. Conclusion: IUDs were found to be more effective and safer than OCPs in preventing unintended pregnancies. They also had higher user satisfaction and continuation rates. These findings support the use of IUDs as a preferable method of contraception for women seeking long-term prevention of unintended pregnancy. Limitations: The study’s limitations include its reliance on self-reported data, the non-randomized design, and the limited sample size and diversity which may affect the generalizability of the findings.

Evaluating the Clinical Outcomes of Total Hip Arthroplasty Utilizing Dual Mobility Implants: A Comprehensive Review

Sat, 19 Apr 2025 00:00:00 +0300

Objective This study set out to evaluate the clinical results of total hip arthroplasty (THA) with a dual mobility implant (DMI). Study design: A prospective cohort study Place and Duration: This study was done at, Pir Abdul Qadir Shah Jillani Institute of Medical Sciences GIMS Gambat Khairpur mir’s for period of one years from March 2024 to March 2025. Methodology Total 30 patients participated for this study. The patients were both male and female. The age bracket was from 32 years to 75 years. There were several reasons for which these patients were on the list of THA. Patients were assessed clinically and a radiograph of each patient was taken before the surgery. A DMI was used in the surgery. Patients were asked to attend their follow-up visit after three months of the surgery. This visit was arranged to check if there is any sign of dislocation. Results The ratio of male patients to female patients was 1.5:1. There were 18 (60%) male patients and 12 (40%) female patients. The average age of the patients was 60.21 ± 9.25 years. Harris Hip Score (HHS) of the patients was recorded before the surgery and an average of HHS was 47.70 ± 6.85. It improved after the surgery and was seen to be 85.25 ± 7.29 (p < 0.001). No patient was diagnosed with dislocation on the three months follow up visit. Conclusion The results of the study demonstrate that there was a significant improvement in the HHS of the patients treated by THA using a DMI and there was no dislocations observed after the surgery.

To Assess the Outcomes of Total Hip Arthroplasty Using Dual Mobility Implants

Sat, 19 Apr 2025 00:00:00 +0300

Background: A common and reasonably priced treatment, total hip arthroplasty (THA) is well-known for its positive results in treating advanced hip osteoarthritis and associated disorders. Although there has been a 9.2% revision rate in Pakistan due to cup shell fractures, dual mobility implants, which are being utilised more and more to lower the risk of dislocation, have shown promise. Objective: To assess the outcomes of total hip arthroplasty using dual mobility implants. Study design: Descriptive study Place and Duration: This study was conducted in, Muhammad Medical College, Ibn-e-Sina University Hospital Mirpurkhas Pakistan from January 2022 to January 2025 Methodology: 80 patients who had total hip arthroplasty (THA) with dual mobility implants participated in this descriptive study, which was carried out at the Department of Orthopaedic Surgery. Clinical evaluations and Harris Hip Scores were used to evaluate pre- and postoperative results, and SPSS version 28.0 was used to analyse the data. With a paired t-test and dependent stratified t-test by gender, we established statistical significance at p < 0.05. Results: The total number of patients was 80, aged 61.05 years on average, with 65% of them being male. The most common reason for performing THA was avascular necrosis of the femoral head. Surgical dislocations were not encountered and both sexes’ Harris Hip Scores improved (p < 0.001) statistically. Conclusion: The study found that there was a statistically significant difference in preoperative and postoperative evaluations of the Harris Hip Score. Moreover, no dislocations were observed after dual mobility total hip replacement.

Outcomes of Cyclogest Pessary versus Conservative Treatment in Managing Threatened Miscarriage: A Comparative Analysis

Sanna Khan, Kanta Bai Ahuja, Bushra, Saira Saeed, Urooj Niazi, Fozia Shaikh — Sat, 19 Apr 2025 00:00:00 +0300

Objective: This study aims to compare the effectiveness of Cyclogest pessary against conservative management in women experiencing Potential miscarriage or also referred to as threatened abortion, focusing on pregnancy continuation, maternal health outcomes, and neonatal results. Study design: A prospective cohort study Place and Duration: This study was conducted in, District Headquarter Hospital Mirpurkhas Pakistan from March 2024 to March 2025 Methodology: A prospective cohort design was employed. Participants were assigned to two groups based on the clinical management approach: The Cyclogest Group (n=100), which received a daily 400 mg dose of vaginal progesterone (Cyclogest pessary) until 20 weeks of pregnancy or symptom resolution; and the Conservative Management Group (n=70), where participants received alternate forms of progesterone (oral or intramuscular) for similar therapeutic purposes. The data was analyzed using the SPSS version 25, and the statistical significance was defined as p ≤ 0.05 and the software used descriptive statistics which set the baseline characteristics. Results: The average age for the Cyclogest group was 28.2 ± 5.1 years, and for the conservative group, it was 27.5 ± 5.4 years (p = 0.27). Both groups were similar in terms of gravidity, parity, and gestational age at the time of initial presentation (p > 0.05). Pregnancy continuation in the past 20 weeks was notably higher in the Cyclogest group (85%) compared to the conservative management group (75%), with a p-value of 0.005. The incidence of complete miscarriage was also lower in the Cyclogest group (12%) compared to the conservative group (28%). Maternal complications such as postpartum hemorrhage, infections, and hypertensive disorders showed no statistically significant differences between the two groups (p > 0.05). Conclusion: The use of Cyclogest pessary significantly enhances pregnancy continuation rates in women with Potential miscarriage or also referred to as threatened abortion compared to conservative management. Further randomized controlled trials are necessary to confirm these findings and refine clinical guidelines for treatment.

Impact of Digital Transformation on Healthcare Accessibility in Saudi Arabia: A Systematic Review

Mohammed Majed Alsahmah, Sulaiman A Alshammari — Mon, 21 Apr 2025 00:00:00 +0300

Introduction: Digital transformation is reshaping healthcare accessibility in Saudi Arabia, aligning with the Vision 2030 initiative to establish a sustainable and efficient healthcare system. Advances in telemedicine, electronic health records (EHRs), and AI-driven diagnostics offer new solutions to overcoming traditional barriers to care. Objectives: This systematic review examines how digital health technologies improve healthcare accessibility in Saudi Arabia. It explores their role in reducing geographical and time-related barriers while identifying key implementation challenges. Methods: A systematic review of peer-reviewed literature (2020–2024) was conducted using databases such as PubMed, Google Scholar, and the Saudi Digital Library. Studies assessing the impact of digital health technologies on healthcare accessibility in Saudi Arabia were included. The PICO framework guided the review, and quality was assessed using the Joanna Briggs Institute (JBI) checklist. Results: The review identified telemedicine and AI-assisted diagnostics as key drivers of improved healthcare access, particularly in rural areas. Studies reported up to a 40% reduction in consultation wait times and enhanced continuity of care due to digital records integration. However, barriers such as the digital divide, infrastructure limitations, and privacy concerns persist, hindering full-scale adoption. Conclusion: Digital health technologies significantly enhance healthcare accessibility in Saudi Arabia, supporting the goals of Vision 2030. However, targeted efforts are required to bridge digital literacy gaps, improve infrastructure, and strengthen data protection frameworks. Future research should focus on long-term digital health adoption and patient-centered outcomes to maximize the benefits of digital transformation in healthcare.

The Use of a Narrow Implant with Edentulous Patients: A Systematic Review

Sultan A. Alqahtani, Sulaiman A Alshammari — Mon, 21 Apr 2025 00:00:00 +0300

Background: Implant selection has been highly emphasized in fully edentulous patients, where using slender diameter implants has become a central area of interest in dental implantology, mainly where patients have limited bone width and height. New developments in implant technology have demonstrated that these implants are as effective as broader implants and may be used for tooth replacement. Objectives: This systematically planned and executed article aims to discuss the difficulties involving complications in completely edentulous patients along with the success and failure rates of narrow diameter implants. Methods: Electronic databases, including but not limited to MEDLINE and Google Scholar, were searched for articles with standard protocol as per the “PRISMA guidelines”. The criteria for paper selection involved articles between 2020 and 2024, limited to peer-reviewed sources that dealt with the use of implants with lesser diameter in edentulous individuals. Nine papers were chosen from the initial search's 2035 results based on specific inclusion criteria. Results: The analysis shows a high overall long-term success rate of small-diameter implants (SDIs), ranging from 94.6% to 100%, with minimal marginal bone loss. Studies report cumulative survival rates such as 99.4% at a two-year follow-up and 97.7% over 55 months. Marginal bone loss was low, with some studies showing mean values of 0.15 mm after 24 months and 0.14 ± 0.39 mm following functional loading over 1–4 years. Additionally, patient satisfaction was high, with some studies reporting that 99% of patients maintained good soft tissue health, and prosthetic survival rates reached 100%. The literature confirms that narrow implants are a viable solution for ridge resorption and for use in medically compromised patients. Conclusion: With much higher survival rates than conventional, large implants, small-diameter implants are a good and safe option for edentulous patients undergoing prosthetic rehabilitation. This review adds knowledge to the current debate about the appropriate approaches to dental implantology, discussing how thin implants can be used in treatment and possible drawbacks.

Safety and Efficacy of Travoprost (0.004%) Versus Timolol (0.5%) In Patients with Open Angle Glaucoma or Ocular Hypertension: A Randomized Prospective Double-Blind Study

Prasheeta V Praviraj, Gondi Surendra Kumar, Poovizhi Kannan, P Ushakiran — Tue, 22 Apr 2025 00:00:00 +0300

Background: The ultimate goal of pharmacotherapy in glaucoma is to reduce the IOP. The current study is designed to audit the efficacy and safety of 0.004% travoprost over 0.5% timolol eye drops for the treatment of primary open angle glaucoma or ocular hypertension and to suggest appropriate intervention for the treatment of the disease. Methods: A prospective, randomised, double blind, parallel group clinical study was conducted among adult patients aged 18 years and above of either gender, any ethnicity clinically diagnosed with primary open angle glaucoma or ocular hypertension without any recognizable secondary causes. 60 patients were randomly assigned in double blind fashion to the treatment groups (30 were in group A intervention other 30 were in Group B intervention). Efficacy and safety were assessed on periodic follow-up visits. Results: There was no significant difference observed between the two groups in the first two weeks of follow up i.e. 2nd and 6th week. But by 9th week onwards statistically significant difference was observed. On 12th week difference was extremely statistically significant. Timolol group showed more of eye irritation (23.33%) followed by red eye in only 2 patients (6.67%). The Group B (Travoprost) patients showed eye irritation (40.7%), red eye (29.6%), Iris pigmentation (3.7%), eyelash growth (14.8%), periorbital pigmentation (3.7%). Conclusion: Travoprost 0.004% eye drops once daily lowers the intra-ocular pressure significantly more than Timolol 0.5% eye drops twice daily. Though timolol has shown better tolerability, both travoprost and timolol were well tolerated and safe for use in patients with open angle glaucoma.

A Retrospective Study of Clinical Spectrum and Treatment Outcomes of Hiv Associated Cancers In A Tertiary Care Centre

Dr. T. Rethinesh Kumar, Dr. B. Jabapriya, Dr. A. Kodies — Wed, 23 Apr 2025 00:00:00 +0300

Introduction: With the introduction and widespread availability of highly active anti-retroviral therapy (HAART), the landscape of HIV/AIDS has changed considerably. This is true for HIV-associated malignancies as well. Post-HAART, the incidence of Kaposi's sarcoma and central nervous system (CNS) lymphoma (among AIDS-defining cancers) decreased in parallel with AIDS-defining infections. On the other hand, the incidence of systemic non-Hodgkin's lymphoma (NHL) and cervical cancer decreased less than others and remains higher in HIV-infected patients than in the general population. Materials and methods: The study was a retrospective observational study which included all the patients with HIV and cancer attending the Oncology Department OPD Department of Radiation Oncology, Government Madurai Medical College, Madurai between January 2024 and December 2024. Data obtained from the case records was used to fill up the proforma which included the patient factors (Age, sex, performance status, BMI, substance abuse), HIV related parameters (Time since diagnosis of HIV, baseline CD4 counts, comorbid conditions, treatment with HAART), tumour related factors (Site, type of cancer, subtype, stage, prognostic factors depending on the histology) and treatment aspects (Type of treatment, any requirement of dose modifications, toxicity, response, compliance). Results: The study included 200 patients with HIV and cancer (86 female patients and 114 male patients) with an average age of 42 years. A majority of the patients (39%) were in the 31-40 years age group. The mean BMI of the study group was 19.45 (Range: 10 -26.5). 59 of the 200 patients (29.5 %) had poor general condition with a performance status of 3 or 4 by the ECOG (Eastern Cooperative Oncology Group) scale. All patients were already enrolled for anti-retroviral therapy. The mean time to presentation of cancer after the diagnosis of HIV infection was 5.4 years (Range: 2 months to 15 years). 122 patients had Non-AIDS Defining Cancers (NADC) and 78 had AIDS defining cancers (ADC). Conclusion: In the HAART era, NADCs are more common than ADCs. The most common malignancy in HIV patients is NHL, with DLBCL (Diffuse Large B-Cell Lymphoma) subtype being the commonest in this study. Extranodal presentations are more common than nodal presentation. Standard chemotherapyachieves a response rate of 50% in HIV-NHL cases and 46% in HIV patients with solid cancers. The study illustrates the need for prolonged surveillance for the development of cancer in HIV patients. Early initiation of HAART, optimal chemotherapeutic regimens, radiotherapy protocols, appropriate palliative care and nutritional support should form an integral part of the care of HIV patients with cancer.

Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis: Impact of Anatomical Variations on Operative Safety and Correlation of CT Imaging with Nasal Endoscopy

Dr. Vivekkumar Makadiya, Dr. Krishna Makadia — Thu, 24 Apr 2025 00:00:00 +0300

Background: Anatomical variations of the paranasal sinuses influence the pathophysiology of chronic rhinosinusitis (CRS) and may increase operative risk during functional endoscopic sinus surgery (FESS). High resolution computed tomography (CT) is the imaging cornerstone, but its diagnostic yield vis à vis nasal endoscopy in the presence of variants remains debated. Methods: A prospective observational study of 52 adults with medically refractory CRS was undertaken at a tertiary otorhinolaryngology unit. All participants underwent pre operative non contrast CT (Lund–Mackay scoring) and diagnostic nasal endoscopy (Lund–Kennedy scoring), followed by standardised FESS. Anatomical variants, disease extent and peri operative complications were recorded. Diagnostic accuracy indices of CT were calculated against endoscopic findings. Results: Concha bullosa (50 %), deviated nasal septum (46 %) and agger nasi cells (31 %) were the commonest variants. CT correctly identified 88 % of osteomeatal complex obstruction and 83 % of maxillary sinus disease, but sensitivity fell to 69 % for the frontal sinus. Overall CT/endoscopy concordance was substantial (κ = 0.71). Variants significantly associated with persistent sinusitis included concha bullosa (p = 0.02) and agger nasi cells (p = 0.01). Concha bullosa also conferred greater odds of nasolacrimal duct (p = 0.02) and carotid artery (p = 0.05) injury, while septal spurs and polyps correlated with epistaxis (p < 0.03). Post operative complication rates were low (CSF leak 1.9 %; orbital injury 0 %). Conclusion: CT reliably delineates key variants and disease burden, but complementary nasal endoscopy remains essential—particularly for frontal recess and subtle mucosal pathology. Recognition of high risk variants (concha bullosa, agger nasi, accessory ostia) enables tailored surgical strategies that maximise safety without compromising disease clearance.

Correlation of Serum 25 Hydroxy Vitamin D and Iron Deficiency Anaemia in Children Attending a South Indian Tertiary Care Hospital: A Cross Sectional Study

Sat, 26 Apr 2025 00:00:00 +0300

Background: The molecule 25 hydroxy vitamin D influences the transcription of hepcidin as well as the transportation of iron through the intestines. New research shows that vitamin D deficiency causes iron deficiency anaemia to worsen although studies about this issue remain limited in the Paediatric population of the Indian sub continent. Methods: In a cross sectional study (July 2022–December 2023) we enrolled 350 term children aged 1 month–12 years with haematological criteria for IDA who were attending Niloufer Hospital, Hyderabad. Children with prematurity, haemolysis, chronic inflammatory disease or current vitamin D/iron therapy were excluded. Clinical details, anthropometry, dietary/sun exposure history, and venous samples for complete blood count, iron profile, C reactive protein, calcium and 25(OH)D were obtained. Pearson’s r evaluated correlations; p < 0.05 was significant. Results: Mean age was 3.29 ± 3.0 years; 63.7 % were boys and 71.1 % rural residents. Moderate IDA predominated (78.3 %); 98.6 % had microcytic hypochromic blood pictures. VDD (< 20 ng mL⁻¹) was ubiquitous (94 %; mean 12.3 ± 5.7 ng mL⁻¹). 25(OH)D correlated positively with haemoglobin (r = 0.33, p = 0.036), ferritin (r = 0.56, p = 0.002) and calcium (r = 0.54, p < 0.001). Children with severe VDD (< 10 ng mL⁻¹) had lower mean Hb (7.7 g dL⁻¹) than those with levels > 20 ng mL⁻¹ (9.3 g dL⁻¹; p = 0.001). Conclusion: Nearly all iron deficient children were concomitantly vitamin D deficient, and serum 25(OH)D showed a moderate, significant positive correlation with haemoglobin and ferritin. Our findings support bidirectional links between vitamin D, iron metabolism and calcium homeostasis and justify routine vitamin D screening in paediatric IDA.

Impact of an Algorithm Based Combination Therapy on Glycemic Control in Newly Diagnosed Type 2 Diabetes Mellitus: A Retrospective Observational Study

Dr.Namrata Vilas Patkar, Dr. Vijay K. Panikar — Sat, 26 Apr 2025 00:00:00 +0300

Background:Early, individualized pharmacotherapy is increasingly advocated to achieve prompt glycemic control and preserve β cell function in type 2 diabetes mellitus (T2DM) . Real world evidence on structured, algorithm driven combination regimens at diagnosis remains limited. Methods: We reviewed computerized outpatient records (January–October 2021) of adults with newly diagnosed T2DM attending a specialty clinic. Patients were stratified by baseline glycated hemoglobin (HbA1c) into Group 1 (7–9%), Group 2 (9–11%), and Group 3 (> 11%). A proprietary software generated treatment lines (triple, quadruple, or quintuple oral combinations) according to fasting/post prandial glucose–derived estimated HbA1c. Weight and glycemic indices were recorded at baseline, 3 and 6 months. The primary outcome was change in HbA1c. Results: Of 890 screened patients, 343 met inclusion criteria. Baseline mean ± SD HbA1c was 7.22 ± 0.54%, 9.09 ± 0.61%, and 12.92 ± 2.54% in Groups 1–3, respectively. HbA1c fell significantly at 3 months (–16.9%, –30.1%, –52.2%; p < 0.01) and was sustained at 6 months (Figure 1). Mean fasting and post prandial glucose declined by 14–57% and 27–61%, respectively (Tables 2–3). Body weight remained neutral in Groups 1–2 but increased modestly in Group 3 (+5.4%, p = 0.016). Medication burden decreased over time: in Group 3 the proportion receiving quintuple therapy fell from 100% to 0.5%, while triple or dual therapy rose to 80.6% by month 6 (Figure 2). No severe hypoglycemia or ketoacidosis was reported. Conclusion: An algorithm based strategy delivering intensive, baseline HbA1c matched oral combinations achieved rapid, durable glycemic control with progressive treatment de escalation in newly diagnosed T2DM. Pragmatic digital algorithms may complement current guidelines by operationalizing early combination therapy.

Investigate the Effect of Diabetes Mellitus on Oral Microbial Flora.A Microbiome Metagenomic Study

Mon, 28 Apr 2025 00:00:00 +0300

Introduction: Diabetes mellitus (DM) affects multiple biological systems, including the oral micro biome system because of its significant role in oral and general body health. In the following study, it is aimed to understand how T2DM affects the complexity of human saliva microbiota in search of possible disruption and its consequences: Objective: To examine whether T2DM alters the oral microbial profile and explore the relationship between microbial profile and glycemic control and clinical markers. Methods: This study was a cross-sectional, case-control study with 100 participants where the T2DM case group consists of patients (HbA1c > 6.5%) and 50 healthy control groups. Saliva and oral swab samples were collected in a standardized manner and placed in −80°C until further use. Bacterial nucleic acids were isolated; metagenomics was performed through high-throughput sequencing of 16S rRNA genes. To measure the microbial richness and community differences, alpha and beta diversity statistics were used. In differential abundance analysis, the taxa that are significantly correlated with diabetes were determined. Results: The alpha diversity had lower microbial diversity and relatively higher inequality in T2DM patients compared to the control samples. Beta diversity demonstrated that microbial community structure changed significantly; diabetics were found to be more susceptible to pathogenic genera of Porphyromonas and Fusobacterium. These microbial patterns significantly related to higher HbA1c values and changes in routines of oral care. Conclusion: According to the study, highly relevant dysbiosis has been observed in the setting of T2DM and reduced complexity of oral microbiota with the higher abundance of pathogenic species. The results presented here highlight the importance of diabetes in regulating the structure and composition of oral microbiota and could inform the development of interventions aimed at enhancing oral and overall health in diabetic patients.

Oral Health Behaviour and Knowledge of Adult Diabetic Patients

Mon, 28 Apr 2025 00:00:00 +0300

OBJECTIVE The purpose of this meta-analysis and systematic review is to identify and quantify the degree of cariogenic oral health practices and knowledge in the adult diabetic population. Because people with diabetes are at a higher risk for oral diseases and other complications, the perception and behavior of diabetes patients toward their oral hygiene really deserve attention in order to better improve the health outcome of diabetic patients with oral diseases. METHODS An exhaustive meta-analysis and systematic review was led to across different databases, including PubMed, Cochrane Library, and Google Scholar, from initiation to September 2024. Keywords utilized in the pursuit included "oral health behaviour ," "oral Health knowledge," "diabetic patients," and "diabetes and oral Health." Studies included were those that evaluated the oral health behaviour and knowledge of adult diabetic patients. Data extraction and quality appraisal were performed freely by two analysts. RESULTS The systematic review and meta-analysis included 25 studies incorporating a total of 8,400 participants. The discoveries show that while a huge piece of diabetic patients know about the significance of oral health, there is a hole in reasonable application. Normal oral health ways of behaving, like customary brushing and dental visits, were sub-standard. Numerous members needed complete information on the bidirectional connection among diabetes and oral health, including how oral infections can influence glycemic control as well as the other way around. CONCLUSION The systematic review and meta-analysis for developing training and mediation programs focusing on oral Health in diabetic patients. Upgraded patient education can overcome any barrier among knowledge and practice, eventually further developing both oral and generally speaking well-being results for people with diabetes. Healthcare services suppliers ought to integrate oral health education into routine diabetes the executives to address this basic part of patient care.

"Diagnostic Role of Bone Marrow Examination in Pediatric Hematologic Disorders"

Ashutosh Kumar Verma, Neha Shrivastava — Wed, 30 Apr 2025 00:00:00 +0300

Bone marrow examination (BME) remains one of the most critical diagnostic tools in pediatric hematology, providing valuable insights into a wide range of hematological disorders. This paper reviews the role of bone marrow aspiration and biopsy in diagnosing and prognosticating pediatric hematologic conditions, including leukemia, anemia, idiopathic thrombocytopenic purpura (ITP), and various infections. The review synthesizes findings from multiple studies, with a focus on the diagnostic utility of BMB in pediatric populations, its complementarity with bone marrow aspiration (BMA), and its role in assessing disease progression and treatment response. The paper also explores the challenges of bone marrow examination in resource-limited settings and the necessity of prospective studies to refine clinical guidelines.

Effectiveness of Patients Education in Improving Compliance with Oral Hygiene Practices

Wed, 30 Apr 2025 00:00:00 +0300

Objective: This Systematic Review and meta-analysis assesses the effectiveness of patient education in improving compliance with oral hygiene practices. Material and Methods: A systematic hunt and meta-analysis was directed across numerous data sets, including PubMed, Cochrane Library, and Google Researcher, for review distributed somewhere in the range of 2010 and 2023. The pursuit terms included "patient education," "oral hygiene," "compliance," "dental health education," and "social mediation." Consideration measures were concentrates on that surveyed the effect of educational mediations on oral hygiene compliance, distributed in peer-explored diaries, and remembered quantitative information for consistence results. Concentrates on not zeroing in on oral hygiene practices, not in English, or lacking unique information were excluded. Results: Out of 2,500 recognized articles, 45 examinations met the consideration models. These investigations incorporated different educational intercessions, remembering one-for one guiding, bunch education meetings, computerized and mixed media assets, and pieces of literature. Quality evaluation of the included examinations was performed utilizing the Cochrane Cooperation's device for surveying the gamble of predisposition. Most examinations displayed a low to direct gamble of inclination, demonstrating solid discoveries. In any case, the heterogeneity in concentrate on plan, test size, and mediation type presented difficulties in normalizing results and playing out a meta-analysis. In end, the proof proposes that patient education is effective in improving compliance with oral hygiene practices, prompting better oral health results. Conclusion: Future exploration ought to zero in on creating normalized educational conventions and evaluating their drawn-out viability across different populaces.

Comparative Study of Recovery Time between Endoscopic and Microscopic Tympanoplasty a Randomized Controlled Trial

Dr. Sudip Kumar Nath, Dr. Nandita Nath, Dr Smrity Rupa Borah Dutta — Thu, 01 May 2025 00:00:00 +0300

Background: Endoscopic tympanoplasty has emerged as a minimally invasive alternative to the traditional microscopic technique in the surgical management of chronic otitis media. While both approaches aim to restore hearing and achieve successful graft uptake, their comparative impact on recovery time remains under-investigated. Methods: This prospective randomized controlled trial was conducted at Silchar Medical College & Hospital between January 2022 and December 2024. A total of 120 patients diagnosed with chronic otitis media with tympanic membrane perforation were randomly assigned to undergo either endoscopic (n=60) or microscopic (n=60) tympanoplasty. Outcome parameters included hospital stay duration, time to return to normal activities, hearing improvement (measured by pure-tone audiometry), patient satisfaction, and complication rates. Follow-up was conducted for six months postoperatively. Results: Patients in the endoscopic group had significantly shorter mean hospital stays (1.2 ± 0.4 vs. 2.5 ± 0.6 days; p<0.001) and returned to normal activities more quickly (7.8 ± 2.1 vs. 11.3 ± 3.2 days; p<0.001). Both groups demonstrated comparable postoperative hearing improvement (mean gain: 18.8 ± 7.2 dB vs. 17.8 ± 6.9 dB; p=0.401). Patient satisfaction scores were significantly higher in the endoscopic group (p<0.001), with no notable difference in complication rates between the two techniques. Conclusion: Endoscopic tympanoplasty offers a significantly shorter recovery time and superior patient satisfaction compared to the microscopic approach, without compromising hearing outcomes or safety. These findings support its broader adoption in appropriate clinical settings.

The Outcome of Voice in Endoscope Assisted Intra-Operative Identification of External Branch of Superior Laryngeal Nerve during Thyroid Surgery

Dr.Easter Suchen, Dr.Kripamoy Nath — Thu, 01 May 2025 00:00:00 +0300

Introduction: The external branch of the superior laryngeal nerve (EBSLN) innervates the cricothyroid muscle (CTM),to promote lengthening and thinning of the vocal fold. The EBSLN is at an increased risk during superior thyroid pole ligation during thyroidectomy which can result in significant post operative complications in voice production. This injury can be avoided by intraoperative identification of the nerve which can be aided by endoscope assisted magnification during thyroid surgery. Aims: (I) To identify the External Branch of Superior Laryngeal Nerve (EBSLN), along with Recurrent Laryngeal Nerve (RLN), during thyroid surgery by adopting endoscopic magnification along with routine dissection methods. (II) To determine the significance of intra-operative identification of EBSLN for preservation of quality of voice following Thyroid surgery. Methodology: A prospective institutional comparative study was carried out for 2 years from November, 2022 to November, 2024 with a sample size of 80 patients. The sample size was divided into two equal groups of 40 patients each. In Group A, Thyroid surgery was conducted by employing conventional dissection techniques. In Group B, special care was taken to preserve the EBSLN with the aid of endoscopic magnification. The patients were clinically evaluated for any changes in voice, particularly related to injury to the EBSLN; by assessing for hoarseness of voice, easy fatigability, inability/difficulty to produce high pitched voice; at day 3 and one month following surgery. Furthermore, patients underwent indirect and flexible videolaryngoscopy and voice recording and the results were statistically evaluated. Results: Use of endoscopic magnification along with routine dissection techniques, helped in the preservation of EBSLN in Group B patients. Cernea Type 1 variation of EBSLN was the most common (74%). The voice outcome assessment in Group B patients was found to be superior to that in Group A. Conclusion: The preservation of EBSLN along with RLN during thyroid surgery plays a major role, for conserving a superior quality of voice and it has been found that endoscopic magnification aids in identification of EBSLN and its variants.

A Rare Case of Endobronchial Tuberculosis in a Young Male: A Case Report

Dr.Modapalli Lohith Chowdary, Dr.Uma.M. Anand Kumar, Dr. K.L. Jagadish — Sat, 03 May 2025 00:00:00 +0300

Tuberculosis (TB) is a global challenge, with high incidence and mortality rate. It has become a major cause of mortality alongside HIV.¹Endobronchial tuberculosis (EBTB) occurs when tuberculosis affects the trachea and bronchi. EBTB is more frequent in middle-aged women, with the left main bronchus being more commonly involved. In adults, it may present as a primary or reactivated tuberculosis.

Blind Adenoidectomy versus Blend Adenoidectomy: A Comparative Analysis

Dr. Shuklima Sengupta, Dr. Kripamoy Nath — Sat, 03 May 2025 00:00:00 +0300

Adenoids are masses of lymphoid tissues, situated at nasopharynx. Children with enlarged adenoids exhibit chronic nasal blockage, rhinorrhea, mouth breathing, snoring, etc., followed by hearing problems and delayed speech, thus requiring adenoidectomy. Due to the enormous quantity of adenoidectomies performed, surgeons must effectively consider safety, accuracy, and results while selecting from the several surgical adenoidectomy techniques available, such as curettage, microdebrider, bipolar coagulation, stripping under endoscopic control, and coblation. The Aim of this study is to compare safety and efficacy between conventional curettage adenoidectomy verses comprehensive Microdebrider with Coblation adenoidectomy. This is a Retrospective Observational Study of 1year, including 80 patients aged 3-15 years, with symptoms of upper airway obstruction undergoing adenoidectomy. Children with syndromes, bleeding disorders, cranio-facial abnormalities were excluded. The sample was divided into two groups, Group A: 40 patients who underwent Conventional Curettage adenoidectomy and Group B: 40 patients who underwent Microdebrider with Coblation adenoidectomy. The operating time, amount of bleeding, post-operative pain, days to resume regular diet and activity, residual tissues were compared and analysed. The operating time was approximately 10mins higher, Intraoperative bleeding 15ml lesser with lesser post operative pain found in Group B. Patients resumed regular meal and activity 0.5-2 days earlier in Group B. The recurrence of symptoms with residual adenoid tissues was 32.5% more in Group A.

Through this study it is found that, Blend adenoidectomy is superior to Blind adenoidectomy with respect to lesser intraoperative haemorrhage, post-operative pain and recurrence, early return to normal diet and activities but with increased operating time.

Comparative study of ultrasound guided fascia iliaca compartment block with femoral nerve block with iPACK in total knee arthroplasty for postoperative analgesia

Dr Deepti Sharma, Dr Arun puri, Dr Jyoti Sharma — Sat, 03 May 2025 00:00:00 +0300

Background: Significant pain after surgery following total knee arthroplasty (TKA) is usuallycontrolled with regional anaesthetic. Although femoral nerve block (FNB) provides effective painrelief, it may hinder movement because of quadriceps weakness. On the other hand fascia iliacacompartment block (FICB) might offer more or comparable pain alleviation with same or enhancedmotor preservation. In terms of pain management, the usage of rescue analgesics, quadricepsstrength, safety, and patient satisfaction, this study contrasts the effectiveness of continuous FICB+ iPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) with FNB + iPACK

Comparative analysis of logarithm of the minimum angle of resolution best corrected visual acuity in Central serous chorioretinopathy patients treated with 1% brinzolamide and control group

Dr Jyoti Sharma, Dr Jitender, Dr Deepti — Sat, 03 May 2025 00:00:00 +0300

Background: The retinal condition known as central serous chorioretinopathy (CSR) impairsvision acuity. In this study, the impact of placebo (carboxymethyl cellulose) (Group B) and 1%brinzolamide (Group A) in enhancing logMAR Best-Corrected Visual Acuity (BCVA) throughouta 3-month follow-up was evaluated

Utility of Serum Procalcitonin and Serum Albumin Ratio as Predictors in Discriminating Urosepsis from Patients with Febrile Urinary Tract Infection

Mon, 05 May 2025 00:00:00 +0300

Background: Serum procalcitonin (PCT) is a dependable and effective non-invasive diagnostic test that can assist a physician in determining the appropriate treatment for a urinary tract infection (UTI). this study aimed toassess the utility of serum procalcitonin and serum albumin ratio as predictors in discriminating urosepsis from patients with febrile urinary tract infection Methods: A Prospective observational study was conducted for 18 months. Study subjects include all cases of urinary tract infection. A total of 80 patients were included in the study. A proforma containing necessary details with baseline demographic data, clinical, and Laboratory data was recorded upon inclusion into the study. Other tests such as C-reactive protein, total leucocyte count, Complete blood count, liver function test, renal function test and USG abdomen and pelvis was done and documented. Results: Age group of 51-60 years constituted the majority. The levels of serum albumin were <3.5 mg/dl in 72% of the study subjects and >3.5 mg/dl in 28%. The bacterium Escherichia coli (E. coli) was identified in 26 cases, constituting 32.5% of the sample. Among the 80 study subjects with urinary tract infections, 7.5% had mortality. 34.78% of the fUTI cases had procalcitonin levels more than 2ng/mL and 97.1% of the urosepsis cases had procalcitonin levels more than 2ng/mL. PCT levels of > 2.0 ng/mL or ≥ 2.0 ng/mL. Conclusion: Procalcitonin/albumin ratios greater than 0.44 are useful in differentiating between fUTI and urosepsis, and they may be better than more conventional biomarkers like leucocyte counts and CRP levels. The procalcitonin/albumin ratio is a low-cost and quick biomarker for use in clinical settings.

Secondary Spontaneous Pneumothorax in a High-TB-Burden Region: Incidence, Aetiology and Short-term Outcomes

Dr Shagun, Dr Sunil Sharma, Dr Malay Sarkar, Dr RS Negi — Mon, 05 May 2025 00:00:00 +0300

Background: Secondary spontaneous pneumothorax (SSP) produces greater morbidity and recurrence than primary disease. Contemporary data from tuberculosis (TB)–endemic regions are sparse. Objectives: (i) Quantify SSP incidence among consecutive pneumothorax presentations in a North-Indian tertiary centre; (ii) delineate the current aetiological spectrum; (iii) describe two-hour radiographic response and early complications after guideline-adapted management; and (iv) identify 12-month recurrence predictors. Methods: Adults with radiologically confirmed pneumothorax were enrolled prospectively. SSP was defined as pneumothorax with underlying lung disease. Management followed British Thoracic Society (BTS-2023) algorithms. Primary outcome was full lung re-expansion two hours post-intervention; secondary outcomes were early complications and recurrence at 12 months. Predictors of recurrence were examined with multivariate Cox analysis. Results: Of 111 pneumothoraces, 75 (67.6 %) were SSP (median age 62 y; M:F = 6.3:1). TB—active 21.3 % plus post-TB sequelae 22.7 %—superseded COPD (40 %) as the leading cause. Heavy smoking index ≥ 300 pack-year-equivalents occurred in 50.7 % of SSP versus 11 % of non-SSP (p < 0.001). Intercostal drainage (ICD) was required in 94.7 % of SSP; two-hour full re-expansion reached 61.3 %. Sub-cutaneous emphysema (57 %) predominated among early complications. Twelve-month recurrence was 14.7 %; underlying TB (HR 2.1, 95 %CI 1.1–4.3) and persistent air-leak > 5 days (HR 3.4, 1.4–7.9) were independent predictors. Conclusions: In high-TB settings, TB now rivals COPD as the principal driver of SSP. Prompt small-bore ICD ensures rapid re-expansion, yet appreciable early recurrence supports first-episode pleurodesis and intensified smoking-cessation strategies.

Iatrogenic Pneumothorax: Procedure-Specific Risk Profile and Management Success in 23 Consecutive Cases

Dr Shagun, Dr Sunil Sharma, Dr Malay Sarkar, Dr RS Negi — Mon, 05 May 2025 00:00:00 +0300

Background: Iatrogenic pneumothorax (IPX) is a well-recognised complication of pleural and lung interventions, yet contemporary data from resource-limited hospitals are sparse. Objectives: To characterise the procedural spectrum precipitating IPX, describe immediate radiographic outcomes after guideline-adapted management, and identify predictors of chest-tube requirement in a North-Indian tertiary centre. Methods: This prospective sub-analysis examined 23 consecutive IPX events identified within a 12-month pleural cohort (November 2020–October 2021). Triggers, underlying lung disease, management modality and two-hour radiographic response were recorded. Descriptive statistics with exact 95 % confidence intervals (CI) were calculated; associations with intercostal-drainage (ICD) insertion were explored using Fisher’s exact test. Results: Percutaneous procedures accounted for 78.3 % of IPX: CT-guided transthoracic needle biopsy (TTNB) for suspected lung mass 10/23 (43.5 %) and diagnostic thoracentesis 8/23 (34.8 %). Bronchoscopic tissue acquisition, including cryo-biopsy for interstitial lung disease, caused 4/23 (17.4 %). One IPX followed invasive positive-pressure ventilation. ICD was inserted in 15/23 (65.2 %); needle aspiration + oxygen succeeded in 6/23 (26.1 %); oxygen alone sufficed in 2/23 (8.7 %). Two-hour full re-expansion was achieved in 17/23 (73.9 %). Procedure-related subcutaneous emphysema occurred in 7/23 (30.4 %); no deaths were recorded. Structural lung disease (COPD/ILD) independently predicted ICD requirement (p = 0.04). Conclusions: TTNB and thoracentesis dominate IPX aetiology in this setting. Small-bore ICD secures rapid lung re-expansion with low morbidity; pre-procedural risk stratification—particularly in COPD/ILD—could further curtail chest-tube utilisation.

Smoking Index and Risk Gradient for Spontaneous Pneumothorax: Evidence from 111 Indian Patients

Dr. Shagun, Dr. Sunil Sharma, Dr. Malay Sarkar, Dr. RS Negi — Mon, 05 May 2025 00:00:00 +0300

Background: Cigarette smoking is the single most modifiable risk factor for spontaneous pneumothorax (SP), yet South-Asian dose-response data remain sparse. Objectives: (i) Quantify the association between smoking index (SI) and pneumothorax type—primary (PSP) versus secondary (SSP); (ii) model SI cut-points that best predict SSP. Methods: Secondary analysis of a prospective cohort of 111 consecutive SP patients (November 2020–October 2021) at a North-Indian tertiary centre. SI was calculated as number of cigarettes smoked per day ×Total number of years of smoking and stratified: mild < 100, moderate 100–299, heavy ≥ 300. Logistic regression adjusted for age and sex estimated odds ratios (OR) for SSP versus PSP across SI strata. Receiver-operating-characteristic (ROC) analysis determined the optimal SI threshold for predicting SSP. Results: Overall, 80/111 (72.1 %) were ever-smokers; median SI 145 (IQR 45-295). Heavy SI occurred in 38/75 SSP (50.7 %) but in 0/36 PSP (p < 0.001). Adjusted OR for SSP rose stepwise: moderate SI = 5.6 (95 % CI 2.1-14.7); heavy SI = 14.8 (5.7-38.9). ROC analysis yielded area-under-curve 0.86; SI ≥ 220 pack-year-equivalents provided 78 % sensitivity and 81 % specificity for SSP. Conclusions: A clear SI dose-response is demonstrable: values ≥ 220 confer 15-fold higher odds of secondary pneumothorax. Incorporating SI into outpatient triage could trigger proactive imaging surveillance and smoking-cessation counselling in high-risk Indian smokers.

Pneumothorax Treatment in Low-Resource Hospitals: Intercostal Drainage Remains the Primary Approach

Dr. Shagun, Dr. Sunil Sharma, Dr. Malay Sarkar, Dr. RS Negi — Mon, 05 May 2025 00:00:00 +0300

Background: Ambulatory needle aspiration and outpatient one-way valves are increasingly recommended for uncomplicated pneumothorax, but the feasibility and effectiveness of such pathways in resource-constrained hospitals are uncertain. Objectives: To describe first-line treatment patterns, early radiographic success and procedure-related complications for all pneumothorax episodes presenting to an Indian district-level teaching hospital over 12 months. Methods: Prospective audit of 111 consecutive pneumothorax episodes (November 2020–October 2021). Interventions were categorised as (i) observation, (ii) oxygen, (iii) needle aspiration + oxygen, or (iv) intercostal drainage (ICD; 14 F pigtail). Primary outcome was full lung re-expansion on erect chest radiograph two hours after initial management. Secondary outcomes included early complications and hospital length of stay. Categorical variables were compared with χ²/Fisher’s exact test; p < 0.05 was significant. Results: ICD was performed in 98/111 episodes (88.3 %) independent of pneumothorax size. Two-hour full re-expansion occurred in 70/98 ICD (71.4 %) versus 5/13 non-ICD (38.5 %) (p = 0.02). Sub-cutaneous emphysema developed in 63/111 (56.8 %)—clinically minor in all; traumatic ICD insertion in 9/98 (9.2 %). No re-expansion pulmonary oedema or deaths occurred. Median hospital stay was five days (IQR 3–7), accounting for 680 inpatient bed-days annually. Conclusions: Despite guideline preference for ambulatory care, small-bore ICD remains the pragmatic and effective first-line therapy in low-resource hospitals, achieving rapid lung re-expansion with acceptable morbidity. Adapted outpatient aspiration protocols—requiring minimal equipment and tailored to tuberculosis-COPD overlap—deserve formal evaluation to ease bed pressures.

A Study to Assess Sociodemographic Profile and Prevalence of Metabolic Syndrome in Patients with Psychiatric Disorders

Dr. Vivek Pratap Singh, Dr. Archana Javadekar, Dr. Ekram Goyal — Thu, 27 Feb 2025 00:00:00 +0300

Aim: The aim of the present study to assess sociodemographic profile and prevalence of metabolic syndrome in patients with psychiatric disorders. Methods: The cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune from July 2015 to September 2017 and 126 patients were included in the study. Results: The majority of patients 78 (61.9%) were in the age group of less than 40 years and there were 48(38.1%) cases who were aged more than 40 years. Majority of cases were females 67 (53.2%) and 59 (46.8%) cases were males. 47 (37.3%) patients were having metabolic syndrome as compared to 79 (62.7%) who were not having metabolic syndrome. 56 (44.4%) cases were having Schizophrenia, 3 (2.38%) were having Delusional disorder, 25 (19.8%) cases were from others group, 22 (17.5%) cases were from Bipolar Affective Disorder and Manic episode group. There was significant difference of age according to metabolic syndrome was found in the study group as p value was <0.0001. A significant association was found between sex and metabolic syndrome and the data showed that females were more prone to metabolic syndrome as compared to males. There was no statistical significant relation was found between disease type and metabolic syndrome. A significant relation was found between family history of psychiatric illness and metabolic syndrome as p value was found to be <0.05. Conclusion: The factors which were found to be responsible for high risk of metabolic syndrome in psychiatric disorders were older age, female gender, schizophrenia and family history of psychiatric illness.

To Assess If Any 10 Years Cardiovascular Mortality Risk In Patients with Psychiatric Disorders By Using Framingham Risk Score

Dr. Vivek Pratap Singh, Dr. Archana Javadekar, Dr. Ekram Goyal — Thu, 06 Mar 2025 00:00:00 +0300

Aim: The aim of the present study was to assess if any 10 years cardiovascular mortality risk in patients with psychiatric disorders by using Framingham risk score. Methods: The cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research centre, Pimpri, Pune from July 2015 to September 2017 and 126 patients were included in the study. Results: The majority of patients 78(61.9%) were in the age group of less than 40 years and there were 48(38.1%) cases who were aged more than 40 years. Majority of cases were females 67(53.2%) and 59(46.8%) cases were males. The association between Framingham risk score with metabolic syndrome showed that patients with metabolic syndrome had a mean value of 10.32 with standard deviation of 5.97 on both sides and in patient who were not having metabolic syndrome mean Framingham risk score was 2.61 with standard deviation of 5.89. A significant difference of Framingham risk score according to metabolic syndrome was found as p value was found to be<.0001. The association between coronary artery heart disease risk with metabolic syndrome showed that in patients who were diagnosed with metabolic syndrome in them 0-5 % risk was seen in 34(72.34%) cases and >5% risk was seen in 13(27,66%) patients. In patients not having metabolic syndrome in 0-5% risk was seen in 73(92.41%) cases and >5 % risk was seen in 6(7.59%) patients. Conclusion: The study suggests that patients suffering from psychiatric disorders are at higher risk of developing metabolic syndrome. The Framingham risk score and 10 years coronary heart disease risk was also found to be higher in these patients. Asian population is already at higher risk to develop metabolic syndrome, routine screening of patients suffering from psychiatric disorder and those who are receiving psychotropics for metabolic disturbances becomes essential.

To Study Cardiovascular Risk Factors In Patients with Psychiatric Disorders

Dr. Vivek Pratap Singh, Dr. Archana Javadekar, Dr. Ekram Goyal — Tue, 25 Mar 2025 00:00:00 +0300

Aim: The aim of the present study was to assess the cardiovascular risk factors in patients with psychiatric disorders. Methods: The cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research centre, Pimpri, Pune from July 2015 to September 2017 and 126 patients were included in the study. Results: The majority of patients 78 (61.9%) were in the age group of less than 40 years and there were 48(38.1%) cases who were aged more than 40 years. Majority of cases were females 67(53.2%) and 59(46.8%) cases were males. There were 54(42.9%) cases who were having no history of substance use, 41(32.5%) cases who were both drinking alcohol and also used to smoke,20(15.9%) cases were only drinking alcohol and 11(8.7%) cases only used to smoke. 71(56.35%) cases were having elevated triglycerides and 55(43.65%) cases were having triglyceride level under normal range. 83(65.9%) patients showed reduced HDL and 43(34.1%) cases were having HDL under normal range. 86(68.25%) were having their LDL under normal range and 40(31.75%) were having elevated LDL. 91(72.22%) cases were having their cholesterol under normal range and 35(27.78%) had increased cholesterol levels. 100(79.37%) cases were normotensive and 26(20.63%) were hypertensive. Conclusion: The present study suggests that about one-third of patients diagnosed with schizophrenia have metabolic syndrome. Among the various subcomponents of metabolic syndrome, increased waist circumference is the most common abnormality. These findings suggest that patients of schizophrenia should be closely monitored for the CVR factors, especially the waist circumference and BP, which can be done easily without any extra cost.

Compare Pre- and Post-Operative Refractive Errors in Patients Undergoing Cataract Surgery via Phacoemulsification (PHACO) Versus Manual Small Incision Cataract Surgery (SICS)

Dr Vandana Parasar, Dr Sudhanshu Shekhar, Dr Gyan Bhaskar — Wed, 16 Apr 2025 00:00:00 +0300

Purpose: To compare pre- and post-operative refractive errors in patients undergoing cataract surgery via phacoemulsification (PHACO) versus manual small incision cataract surgery (SICS).
Methods: A prospective comparative study was conducted on 48 patients (24 in each group) with senile cataracts. Pre-operative and post-operative (at 6 weeks) refractive errors were assessed. Statistical analysis was performed using paired and unpaired t-tests.
Results: The mean pre-operative spherical equivalent (SE) was comparable between groups (PHACO: -0.75 ± 1.25 D vs. SICS: -0.82 ± 1.30 D, p=0.85). Post-operatively, PHACO showed better refractive outcomes (SE: -0.25 ± 0.50 D) compared to SICS (SE: -0.65 ± 0.75 D) (p=0.02). Astigmatism was significantly lower in the PHACO group (0.50 ± 0.25 D vs. 1.25 ± 0.50 D, p<0.01).
Conclusion: PHACO provides superior refractive outcomes with less post-operative astigmatism compared to manual SICS.

To Compare the Safety and Effectiveness of Subtenon’s Anesthesia (STA) Versus Peribulbar Anesthesia (PBA) in Cataract Surgery: Randomized Controlled Trial

Dr Vandana Parasar, Dr Soumyadeep Hazra, Dr Gyan Bhaskar — Mon, 28 Apr 2025 00:00:00 +0300

Purpose: To compare the safety and effectiveness of Subtenon’s anesthesia (STA) versus Peribulbar anesthesia (PBA) in cataract surgery.

Methods: A prospective randomized controlled trial was conducted on 88 patients (44 in each group) undergoing cataract surgery. Parameters assessed included pain scores (VAS), akinesia scores, intraoperative complications, and postoperative outcomes.

Results: STA showed significantly lower pain scores during injection (2.1 ± 1.0 vs. 4.5 ± 1.2, p < 0.01) and comparable surgical comfort (p = 0.12). Akinesia was marginally better with PBA (p = 0.03), but STA had fewer complications (chemosis: 4.5% vs. 18.2%, p = 0.02). Both techniques provided adequate anesthesia for surgery.

Conclusion: STA is a safer and equally effective alternative to PBA, with better patient comfort and fewer complications.

A Study to Evaluate the Visual Outcomes and Complications of Surgical Management in Traumatic Cataract Cases

Dr Sudhanshu Shekhar, Dr Vandana Parasar, Dr Gyan Bhaskar — Sat, 03 May 2025 00:00:00 +0300

Purpose: To evaluate the visual outcomes and complications of surgical management in traumatic cataract cases at a tertiary care hospital.

Methods: A cross-sectional study was conducted on 66 patients with traumatic cataracts who underwent surgery. Preoperative assessment, surgical technique, postoperative visual acuity (VA), and complications were analyzed.

Results: Mean age was 32.5 ± 14.2 years, with 78.8% males. Postoperatively, 62.1% achieved VA ≥6/18, while 12.1% had VA <6/60. Posterior capsule rupture (28.8%) and zonular weakness (18.2%) were common intraoperative challenges. Posterior capsular opacification (15.2%) and glaucoma (9.1%) were notable postoperative complications.

Conclusion: Timely surgical intervention in traumatic cataracts yields good visual outcomes, though associated ocular injuries and complications impact prognosis. Individualized management is crucial for optimal results.

A Comparative Study on Effect of Small Group Discussion versus Didactic Lectures among Medical Students

Chithuru Vishnu Priya, Obbu Kiran Kumar, Phanindra Dulipala, Ravi Kiran — Tue, 06 May 2025 00:00:00 +0300

Background: Small group discussion stimulates collaboration and in-depth discussion for application and transfer of knowledge, known as collaborative learning. This study aimed to compare the effect of small group discussion and conventional didactic lecture teaching learning methods. Methods: A comparative study was conducted among final MBBS part 1 students for a period of one month. A total of 128 students were included in the study. All the students were divided into 2 groups. Didactic lecture was given to one group and small group discussion was conducted to another group. Post test was conducted to assess and scores were compared pre and post in both groups. Results: Of 128 students, 35% (45) were males and 65% (83) were females. In the post test, for a maximum score of 20 marks, the mean score of students subjected to didactic lecture was 13.1 ± 2.02 (66%) and that of small group discussion was 12.34 ± 2.08 (62%) and association between the two variables was found to be statistically significant. There is also significant difference in the performance of students of didactic lectures and that of small group discussion in the recall test with a mean score of 11.23 ± 2.65 (56%) and 12.28 ± 2.56 (61%) respectively Conclusion: The knowledge from small group discussion is more long lasting and has better recall. So small group discussion can be adopted as another alternative teaching modality which can bring better output among the medical students.

Traditional Ayurvedic Remedies and Modern Pharmacology: A Review of Indian Ethnomedicinal Plants

Vinodkumar Sarup Didwana, Dr. Navneet Sharma — Tue, 06 May 2025 00:00:00 +0300

Deeply ingrained in ancient medical systems including Ayurveda, Siddha, and Unani, where botanicals have been used for ages to treat a range of diseases, India has a significant ethnomedicinal tradition. These treatments are widely used and have known therapeutic value, yet they sometimes lack thorough scientific basis. With an especially focus on their bioactive components, therapeutic uses, and incorporation into modern pharmacology, this review explores the pharmacological relevance of Indian ethnomedicinal plants. Furthermore underlined in order to guarantee sustainable uses are the need of correcting the shortcomings in clinical validation, the present technological developments in research, and the conservation issues. The findings imply that, although conventional Ayurvedic medicines have great therapeutic value, their standardizing and worldwide acceptance depend on a multidisciplinary approach including ethnobotany, pharmacology, and biotechnology.

Cross-Sectional Study on the Anatomy of the Thyroid Gland and It’s Variations In Different Genders

Sindhu K S, Meer Chisthi M — Wed, 07 May 2025 00:00:00 +0300

Background: Anatomical variations of the thyroid gland significantly impact clinical diagnosis and surgical outcomes. This cross-sectional study aimed to evaluate thyroid anatomical variations across different genders. Aim: To assess and compare anatomical variations of the thyroid gland between males and females. Methods: A total of 80 participants (38 males, 42 females) were studied through ultrasonographic evaluations and surgical/autopsy records. Anatomical variations, gland dimensions, and demographic correlations were documented and statistically analyzed. Results: Significant gender differences were noted in the presence of the pyramidal lobe (68.4% males vs. 50.0% females, P=0.024). Males had significantly larger thyroid volumes, lengths, and widths compared to females (P<0.05). Higher BMI correlated significantly with anatomical variations (P=0.001). Conclusion: Significant gender-specific anatomical variations highlight the need for individualized assessment in clinical and surgical thyroid management.

Tolosa-Hunt Syndrome: A Rare Entity

Wed, 07 May 2025 00:00:00 +0300

Tolosa-Hunt Syndrome (THS) is a rare disorder characterized by painful ophthalmoplegia due to idiopathic granulomatous inflammation in the cavernous sinus, superior orbital fissure, or orbital apex. The condition is often self-limiting but responds well to corticosteroid therapy. We present a case of a 54-year-old male with classic THS features, emphasizing the diagnostic challenges and management strategies. Early recognition and treatment are crucial to prevent morbidity associated with this condition.

A Morphometric study of the mandibular foramen in dry adult human mandibles.

Dr Anjana Baitalik, Dr Amitabha Das — Wed, 07 May 2025 00:00:00 +0300

Background: Located on the medial side of the mandibular ramus, the mandibular foramen (MF)is a noticeable and vital anatomical structure. This incision is where the inferior alveolar nerve and veins emerge. Blood reaches the jaw, lower teeth, and surrounding tissues via these veins and nerves. Aim: The current study aimed to offer crucial baseline data for the anatomical literature and clinical practice by conducting a thorough morphometric analysis of the mandibular foramen in dry adult human mandibles. This was done to offer necessary information

A Composite Vascular Risk Index Integrating Flow-Mediated Dilatation, Carotid Intima–Media Thickness and Ankle–Brachial Index for Cardiovascular Stratification in Stable COPD

Dr Shagun, Dr Sunil Sharma, Dr Malay Sarkar, Dr RS Negi — Thu, 08 May 2025 00:00:00 +0300

Background: Single vascular biomarkers incompletely capture the excess cardiovascular risk observed in chronic obstructive pulmonary disease (COPD). Objective: To derive and validate an Integrated Vascular Score (IVS; range 0–3) assigning one point each for (i) brachial %ΔFMD < 4 %, (ii) CIMT > 0.8 mm or plaque ≥ 1.2 mm, and (iii) ABI < 0.90 or > 1.40, and to compare its predictive utility with that of the individual components. Methods: The IVS was calculated for 84 Himalayan adults (43 stable COPD, 41 controls) in whom all three vascular tests were available. Clinical end-points were GOLD group C/D, CAT ≥ 21, and ≥ 2 exacerbations in the preceding year. Discrimination was assessed with receiver-operating-characteristic (ROC) curves and compared by DeLong tests. Results: Score distribution differed strikingly between groups (controls: IVS 0 83 %, 1 15 %, ≥ 2 2 %; COPD: IVS 0 5 %, 1 16 %, 2 47 %, 3 32 %). IVS correlated strongly with GOLD stage (Spearman ρ 0.62, p < 0.001). A threshold ≥ 2 predicted GOLD C/D with 88 % sensitivity and 92 % specificity (AUC 0.93, 95 % CI 0.86–0.99), exceeding the best single biomarker (CIMT AUC 0.81, p = 0.04). AUCs for CAT ≥ 21 and frequent-exacerbator phenotype were 0.89 and 0.78 respectively. Calibration was satisfactory (Hosmer–Lemeshow p = 0.64) and a bedside nomogram showed good agreement with observed risk. Conclusions: A simple additive IVS out-performs isolated FMD, CIMT or ABI for identifying high-risk COPD phenotypes. An IVS ≥ 2 may trigger intensified statin or antiplatelet therapy pending multicentre validation.

Prevalence and Risk Factor Profile of Diabetic Peripheral Neuropathy among Adults with Type 2 Diabetes Mellitus: A Hospital Based Case–Control Study

Dr Vaibhav Bharatbhai Desai, Dr Niyati Gosai, Dr Ravi Rameshbhai Soriya — Thu, 08 May 2025 00:00:00 +0300

Background: Diabetic peripheral neuropathy (DPN) stands as the main microvascular complication among individuals with type 2 diabetes mellitus (T2DM) yet its diagnosis typically happens after nerve damage becomes irreversible. Research data from India shows varied information about the burden and risk factors which can be modified to manage diabetic peripheral neuropathy. Methods: The purpose of this single-centre case-control investigation at a hospital (January 2023 - June 2024) was to enroll 200 T2DM participants comprising 100 DPN-confirmed cases and 100 DPN-free controls who shared identical age groups. The study excluded pregnant patients along with those whose neuropathy resulted from alternative conditions (hypothyroidism, vitamin B12 deficiency, HIV, alcohol misuse), drug-related neuropathy and voluntary consent refusal. A structured proforma was used to log demographic and clinical and biochemical information. The Toronto consensus criteria served to determine the diagnosis of DPN. The researchers used Epi Info v7 for statistical analysis through t and χ² tests and set the significant threshold at p < 0.05. Results: Participants consisted of 50% males among the 55.5 ± 11.2 year old sample members. The research revealed DPN affects 44.9 % of all consecutive outpatients selected for screening. The duration of diabetes was longer for patients with DPN at 11.1 ± 7.2 versus 7.4 ± 3.2 years together with elevated rates of hypertension at 71 % vs 16 % and smoking at 38 % vs 18 %. The recorded mean systolic/diastolic pressure measurements were 145.5/90.6 mmHg for cases but 125.9/80.7 mmHg for controls (the comparison yielded p < 0.001). The post-meal glucose levels (250 ± 81.5 mg/dL) along with HbA1c (7.6 ± 0.7 %) showed significant differences between the affected and unaffected patients. Dyslipidemia existed at more severe levels in patients with DPN as they presented with cholesterol levels of 211 ± 47 mg/dL alongside triglycerides at 161 ± 26 mg/dL when compared to levels of 147 ± 24 mg/dL cholesterol and 118 ± 17 mg/dL triglycerides (p < 0.001 for both comparisons). The presence of micro vascular complications with diabetic peripheral neuropathy included retinopathy (55 % vs 9 %) and nephropathy (52 % vs 6 %) with both p values under 0.001. Conclusion: DPN affected approximately half of the adults within this tertiary care population which had T2DM. The main risk factors for developing DPN included both the length of time someone had the disease and uncontrolled blood sugars and blood pressure along with smoking habits and abnormal lipid levels. Strategic screening methods implemented with rapid management of cardiometabolic risk elements offer potential to reduce neuropathy cases while blocking the development of serious foot complications.

To Study Mean Platelet Volume in Acute Myocardial Infarction in a Tertiary Care Hospital of Gujarat

Dr Ravi Rameshbhai Soriya, Dr Dinkar Goswami, Dr Vaibhav Bharatbhai Desai — Thu, 08 May 2025 00:00:00 +0300

Background: Platelet activation drives intracoronary thrombus formation in acute myocardial infarction (AMI). Mean platelet volume (MPV)—a routinely reported hematological index—has emerged as a surrogate of platelet reactivity, but its role in Indian AMI populations remains under explored. Methods: We conducted a cross sectional study in the Medicine Emergency of GMERS Medical College & Hospital, Gandhinagar (March 2023–February 2024). Ninety consecutive adults presenting within 24 h of ST elevation (STEMI) or non ST elevation MI (NSTEMI) were compared with 90 age and sex matched controls free of clinical coronary artery disease. MPV and complete blood counts were obtained within 24 h using a SYSMEX XN 350 analyser. Associations between MPV and demographic factors, cardiovascular risk factors, infarct phenotype, in hospital complications and mortality were examined with parametric/non parametric statistics (α = 0.05). Results: Cases and controls were comparable in age (55.7 ± 9.5 vs 53.4 ± 8.0 y; p = 0.07) and sex distribution (M 74% vs 72%). Mean MPV was markedly higher in AMI (9.81 ± 0.61 fL) than in controls (8.16 ± 1.03 fL; p < 0.001). After stratification, MPV showed no significant variation with sex, smoking, hypertension or diabetes, but rose with age (≥ 60 y: 10.06 ± 0.66 fL) and prior MI (10.1 ± 0.56 fL; p = 0.03). MPV did not differ between STEMI and NSTEMI or among infarct locations. In hospital mortality was 13.3%; non survivors exhibited higher MPV than survivors (9.9 ± 0.84 vs 9.80 ± 0.56 fL; p = 0.039). Conclusion: Elevated MPV is independently associated with first day AMI and with prior infarction and mortality, underscoring its potential as a rapid, inexpensive prognostic biomarker in resource limited Indian settings.

A Rare Case of Amoebic Meningoencephalitis

Dr. Shaik Md Shoaib, Dr. Uma M Anand Kumar, Dr Manzoor Sharieff — Thu, 08 May 2025 00:00:00 +0300

Free-living amebas are protozoan environmental parasites, mainly in freshwater, lakes, and rivers, without needing a definitive host.1 In humans, there are four main genera of amebas that can cause disease, namely Naegleria (only Naegleria fowleri), Acanthamoeba (several species). A 32 years old male came with complaints of fever, altered sensorium, vomitings for 1 day and presented with involuntary movements of all four limbs.On presentation Blood pressure was 160/100 mm of Hg , pulse rate- 107 bpm, RR-36 cpm and was intubated in view of low GCS. The patient was initiated on intravenous Amphitericin B and dose was determined using body weight, and was changed to tab fluconazole and tab azithromycin in view of acute kidney injury after 9 days of administration. Patient survived with residual neurological deficits.

High Ankle–Brachial Index in COPD — Marker of Arterial Stiffness or Sampling Artifact? A Clinicoradiological Correlation Study

Dr Aseem Sirkeck, Dr Shagun, Dr Malay Sarkar — Thu, 08 May 2025 00:00:00 +0300

Background: An ankle–brachial index (ABI) > 1.40 denotes non-compressible, calcified arteries and predicts excess cardiovascular mortality, yet its prevalence and determinants in chronic obstructive pulmonary disease (COPD) remain unclear. Objectives: (i) Compare the frequency of high (> 1.40) and low (< 0.90) ABI between stable COPD patients and healthy never-smokers; (ii) identify clinical and radiographic correlates of high ABI within COPD. Methods: Forty-three spirometry-confirmed, exacerbation-free COPD patients and forty-one age-/sex-matched never-smoking volunteers were studied (March 2019 – April 2020). After 10 min supine rest, bilateral ankle and brachial systolic pressures were measured by continuous-wave Doppler; ABI was the higher ankle pressure divided by the higher brachial pressure. Categories: low < 0.90, normal 1.00–1.40, high > 1.40. Chest radiographs were scored for hyperinflation; symptom burden captured with the COPD Assessment Test (CAT). Multivariable logistic regression examined predictors of high ABI. Results: High ABI was more common in COPD (14/43, 32.6 %) than controls (3/41, 7.3 %; p = 0.005). Only one COPD subject exhibited low ABI. COPD patients with high ABI showed more radiographic hyperinflation (71 % vs 23 %, p = 0.01) and higher CAT scores (34 ± 6 vs 28 ± 8, p = 0.03). In adjusted analysis, dyslipidaemia (OR 3.4, 95 % CI 1.2–9.5) and hyperinflation (OR 4.1, 95 % CI 1.3–12.9) independently predicted high ABI, supporting a true arterial-stiffness phenotype rather than cuff artifact. Conclusions: One-third of Himalayan COPD patients harbour abnormally stiff, non-compressible peripheral arteries linked to hyperinflation and metabolic risk. Given its speed, low cost and prognostic power, routine ABI measurement should accompany spirometry for comprehensive cardiovascular stratification in COPD clinics.

Endothelial Dysfunction in Stable COPD: A Case-Control Evaluation of Flow-Mediated Dilatation and Its Clinical Correlates in Northern India

Dr Aseem Sirkeck, Dr Shagun, Dr Malay Sarkar — Thu, 08 May 2025 00:00:00 +0300

Background: Endothelial dysfunction is considered a mechanistic bridge between chronic obstructive pulmonary disease (COPD) and its excess cardiovascular mortality. Objectives: (i) Quantify brachial-artery flow-mediated dilatation (FMD) in clinically stable COPD versus never-smoking controls; (ii) identify clinical correlates of impaired FMD within COPD. Methods: In this hospital-based case-control study (March 2019 – April 2020) 43 spirometry-confirmed COPD patients (≥ 6 weeks exacerbation-free) and 41 age-/sex-matched never-smokers underwent ultrasound FMD (10 MHz probe, forearm occlusion 200 mmHg × 5 min). Endothelial dysfunction was predefined as %ΔFMD < 4 %. Multivariable logistic regression adjusted for age, body-mass index and smoking index. Results: Mean %ΔFMD was halved in COPD (21.7 ± 8.2 %) compared with controls (41.7 ± 5.8 %, p < 0.001). Endothelial dysfunction affected 79.1 % of COPD patients versus 12.2 % of controls (OR = 30.4, 95 % CI 11.1–82.7). Within COPD, lower FMD correlated with FEV₁ %-predicted (r = 0.41, p = 0.006), resting SpO₂ (r = 0.35, p = 0.02) and CAT score (r = –0.38, p = 0.01). Each 10 % decrement in FMD independently predicted GOLD 3/4 severity (adjusted OR = 1.9, 95 % CI 1.2–3.5). Conclusions: Northern-Indian COPD patients exhibit marked endothelial dysfunction proportional to airflow limitation and symptom burden. A simple FMD threshold (< 25 %) discriminates GOLD ≥ 3 disease with good accuracy and could enrich cardiovascular risk stratification in routine pulmonary clinics. Longitudinal trials should test whether interventions targeting systemic inflammation, hypoxaemia or oxidative stress restore endothelial function and reduce downstream vascular events.

Carotid Intima–Media Thickness as a Surrogate of Sub-clinical Atherosclerosis in COPD: Cross-Sectional Findings from a Himalayan Tertiary Centre

Dr Aseem Sirkeck, Dr Shagun, Dr Malay Sarkar — Thu, 08 May 2025 00:00:00 +0300

Background: Carotid intima–media thickness (CIMT) predicts myocardial infarction and stroke, yet COPD-specific data from low- and middle-income settings are sparse. Objectives: (i) Compare CIMT and carotid plaque prevalence between stable COPD patients and never-smoking controls; (ii) explore clinical determinants of CIMT within COPD. Methods: Forty-three spirometry-confirmed, exacerbation-free COPD patients and forty-one age-/sex-matched never-smokers underwent bilateral B-mode carotid ultrasound (7–11 MHz) between March 2019 and April 2020. Sub-clinical atherosclerosis was defined as CIMT > 0.8 mm and/or plaque ≥ 1.2 mm. Multivariable linear and logistic models assessed associations with COPD duration, smoking index and LDL-cholesterol. Results: Mean CIMT was markedly thicker in COPD (0.92 ± 0.18 mm left, 0.92 ± 0.20 mm right) compared with controls (0.54 ± 0.05 mm and 0.54 ± 0.03 mm; p < 0.001). Sub-clinical atherosclerosis occurred in 31/43 (72.1 %) COPD cases versus 3/41 (7.3 %) controls (adjusted OR = 39.6, 95 % CI 10.3–152). Every five-year increment in COPD duration was associated with a 0.06 mm rise in CIMT (p = 0.02). Smoking index and LDL-cholesterol remained independent predictors. Conclusions: Stable COPD confers a five-fold CIMT excess independent of classical risk factors, supporting routine carotid scanning to refine cardiovascular prevention in pulmonary clinics. Longitudinal studies should clarify whether aggressive lipid-lowering or anti-inflammatory therapy attenuates CIMT progression in this high-risk population.

A Rare case of Left Ventricular Hydatid Cyst

Dr. Kuppani Dinesh, Dr. Uma M Anand Kumar, Dr Ajay Ram R — Thu, 08 May 2025 00:00:00 +0300

Cardiac involvement by the hydatid disease is extremely rare and reported in 2% of cases.Cardiac hydatid cysts constitute a medical emergency, requiring prompt diagnosis through multiple imaging techniques. Early surgical intervention combined with pharmacological therapy is crucial, particularly for suspicious cystic lesions in regions where the disease is endemic. Here we report a 24-year-old female with no comorbidities and no significant past history,with history of pet dog exposure presented with acute pain in the peri umbilical region, grade 2 shortness of breath diagnosed as incisional hernia planned on surgery, in routine pre op evaluation diagnosed with left ventricular hydatid cyst.

Discriminating Antemortem From Post-Mortem Low-Voltage Electrocution Burns: A Prospective Two-Year Study Applying a Three-Point Histopathologic Checklist and Sem/Eds Correlation

Sat, 10 May 2025 00:00:00 +0300

Background: Correctly determining whether an electric-current skin lesion was produced during life (antemortem, AM) or after death (post-mortem, PM) remains pivotal in forensic reconstruction yet notoriously difficult when only gross inspection is available. Gross morphology overlaps, while several “vital” histological changes can be reproduced experimentally in cadavers. Methods: In a two-year prospective series (July 2018 – June 2020) we examined 25 consecutive AM electrocution fatalities and 30 fresh cadavers in which standardised PM electrical burns were experimentally created (220 V AC, 400–1000 mA, 3–4 s). For every lesion we recorded macro morphology, fourteen predefined light-microscopic variables on haematoxylin–eosin (H&E) sections and surface/elemental characteristics on scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM/EDS). Pearson’s χ² with Yates’ correction tested inter-group differences; diagnostic performance indices were calculated for individual and composite markers. Results: AM lesions were significantly larger (≥ 1 cm in 52 % vs 17 %, p = 0.01) and more often oval/elongated. Epidermal nuclear streaming (72 % vs 53 %, p = 0.04), coagulative epidermal necrosis (72 % vs 43 %, p = 0.02), dermal collagen homogenisation > ⅓ thickness (36 % vs 10 %, p = 0.01) and sweat-gland nuclear elongation (56 % vs 16 %, p < 0.001) discriminated AM from PM injuries. Combining any two of the three strongest criteria—deep dermal homogenisation, sweat-gland nuclear streaming, marked epidermal necrosis—achieved 84 % sensitivity and 90 % specificity for vitality. Metallisation was absent in both cohorts except sparse environmental particles, limiting the value of SEM/EDS in low-voltage deaths. Conclusion: The grade and depth of dermal and adnexal damage, rather than their mere presence, provide reliable positive criteria of vitality in electrocution burns. A simple three-point H&E checklist offers high diagnostic accuracy and can be readily adopted in routine forensic practice.

Comparative study of fracture shaft humerus treated by dynamic compression plate and interlocking nailing

Dr. Anand Kumar Goyal, Dr. Girish Dang, Dr. Vikrant Sharma — Fri, 09 May 2025 00:00:00 +0300

Background: Commonly deployed surgical procedures for humerus shaft fracturesinclude dynamic compression plating and interlocking nailing. This study compareddynamic compression plating (Group A) and interlocking nailing (Group B) in a cohort of 100 patients.

Dental Ceramics after Grinding and Polishing Treatments

Tue, 13 May 2025 00:00:00 +0300

Background: The longevity and aesthetic quality of dental ceramics heavily depend on their surface characteristics, particularly surface roughness, which is influenced by grinding and polishing treatments. Understanding how different polishing systems affect the surface integrity of various ceramic materials is crucial for optimizing restorative dental procedures. Objective: This study aimed to evaluate the effect of different grinding and polishing systems on the surface roughness and morphology of commonly used dental ceramics: feldspathic porcelain, lithium disilicate, and zirconia. Method: A total of 120 ceramic specimens (15 mm × 20 mm × 2 mm) were fabricated from feldspathic porcelain, lithium disilicate, and zirconia. Each material group was randomly divided into subgroups, with each subgroup receiving a specific polishing system (System A, B, or C), including a control group with no polishing. The specimens underwent grinding using fine diamond burs followed by polishing. Surface roughness (Ra) was measured using a contact profilometer, and surface morphology was analyzed through Scanning Electron Microscopy (SEM). Additionally, Energy Dispersive X-ray Spectroscopy (EDS) and X-ray Diffraction (XRD) were used to assess the elemental and crystalline composition of the polishing systems. Results: Polishing System B significantly reduced the surface roughness (Ra) across all ceramic types, producing the smoothest surfaces. System A showed moderate results, while System C was the least effective in reducing roughness. SEM analysis revealed that System B produced minimal surface defects, particularly in zirconia and lithium disilicate. Statistical analysis using ANOVA confirmed significant differences in surface roughness between the polishing systems (p < 0.05). Post hoc tests further supported these findings, with System B outperforming others in terms of surface smoothness. Conclusion: Polishing System B demonstrated superior performance in reducing surface roughness and improving surface morphology in dental ceramics, especially for zirconia and lithium disilicate. These findings highlight the importance of selecting the appropriate polishing system based on the ceramic material used in restorative dentistry. Further studies should explore the long-term clinical durability of these polished surfaces.

A Study on the Potential of Vitamin D in the Prophylactic, Therapeutic and Recovery of Cardiovascular Diseases

Gana Sahas S — Tue, 13 May 2025 00:00:00 +0300

in the blood lead to increased cardiovascular disease (CVD) occurrences but experimental treatment results remain uncertain. We examined whether vitamin D sufficiency is associated with reduced new-onset CVD, attenuated disease progression and enhanced post-event recovery. Methods: The study analyzed 4 218 adults with 63 ± 11-year mean age and 43 percent female participation who were CVD-free at baseline through three serum 25(OH)D groups. The research period extended up to 8 years with a median duration of 6.1 years. The study followed participants to assess MACE incidents including MI, stroke, and CV death along with other secondary targets. Other secondary goals covered changes in cIMT, SBP, and hs-CRP besides functional recovery assessment through 6MWD post-acute MI. The study utilized both Multivariable Cox and mixed-effects models for analysis while adjusting for the demographic as well as the clinical and behavioural confounders.. Results: The research showed that MACE risk decreased by 23 % for patients with vitamin D sufficiency compared to those with deficiency (adjusted HR 0.77, 95 %CI 0.63-0.93; p = 0.006). Subjects with sufficient vitamin D levels demonstrated slower annualised cIMT progression rates at -0.014 mm/y and their SBP decreased by -4.3 mmHg (p = 0.02 and p = 0.01). Additionally hs-CRP levels dropped 18% (p < 0.001). The pre-event 25(OH)D level of a sufficient range for 412 incident MI survivors led to 29 meters increase in 3-month 6MWD distance and 17 percent fewer hospital readmissions at year one (p = 0.03). Conclusion: Vitamin D sufficiency was independently associated with lower CVD incidence, slower subclinical atherosclerosis, favourable haemodynamic and inflammatory profiles, and better early functional recovery after MI. Although residual confounding cannot be excluded, these findings support prospective trials targeting personalised vitamin D optimisation in cardiovascular prevention and rehabilitation.

A Prospective Study of Urinary Tract Infection in Children with Nephrotic Syndrome in a Tertiary Care Hospital

Dr.M.Bhuvaneswari, Dr.G.B.Meghana — Tue, 13 May 2025 00:00:00 +0300

Introduction: Nephrotic Syndrome (NS) is among the most common chronic kidney diseases occurring in childhood. The incidence of idiopathic NS in Asian population is reported at 2-3 cases per 1,00,000 children. Defense mechanisms are impaired in patients with NS due to its consequences of tissue edema, urinary loss of immunoglobulin, complement and secondary effects to its treatment including steroids and other immunosuppressants. Immuno-compromised status of NS can result in increased susceptibility to various infections, which could be potentially serious and life-threatening without prompt diagnosis and treatment. Material and Methods: A prospective and descriptive study of all the patients with a diagnosis of nephrotic syndrome who attended to the Pediatric Outpatient Department (OPD) or were admitted at Department of Paediatrics, Surabhi Institute of Medical Sciences, Siddipeta, Telangana over a study period of one year from January 2024 to December 2024. 60 patients who have full filled the criteria of nephrotic syndrome (According to ISKDC) were included in the present study. The objective of the study were explained and written consent was obtained from the parents, prior to inclusion in the study. A detailed clinical examination was performed and findings were noted in the data sheet. Clean catch midstream urine samples were obtained from all the patients. Urine examination including routine analysis, microscopy, culture and sensitivity was done as per hospital standard policies. Results: The study was conducted over a period of 12 months and consisted of 60 children (40 males and 20 females). During this period, out of 60 children in the study nine had culture positive UTI (12 males and 6 females). The most common organism isolated from the urine culture was Escherichia coli followed by proteus, enterococcus, pseudomonas and Klebsiella, which was statistically significant (Binomial test p=0.043). Of the 18 cases who had culture positive UTI, 6 were newly diagnosed NS and 12 were relapse NS. There was no significant difference between the two groups with regard to sex and age distribution. Conclusion: We conclude that urinary tract infections are an important, but often under diagnosed infection in children with nephrotic syndrome. All children with nephrotic syndrome newly diagnosed or relapse should be screened for the presence of UTI.

High-Sensitivity C - reactive protein As an Independent Predictor of Cardiovascular Complications in Chronic Obstructive Pulmonary Disease

Dr.Gaurav Dhandoria, Dr R P Meena, Dr Chitrak Jharwal — Tue, 13 May 2025 00:00:00 +0300

Background: Systemic low-grade inflammation is believed to link chronic obstructive pulmonary disease (COPD) with excess cardiovascular (CV) morbidity. High-sensitivity C-reactive protein (hsCRP) is an inexpensive, stable biomarker of this inflammatory state, yet its prospective prognostic value in COPD is uncertain. Objective: To determine whether baseline hsCRP independently predicts incident composite CV events over 12 months in clinically stable COPD and to consider implications for emerging anti- inflammatory pharmacology and drug-safety monitoring. Methods: In a prespecified sub-study of our echocardiographic cohort, 126 consecutive out- patients (June 2016 – May 2019) with post-bronchodilator FEV₁/FVC < 0.70 and ≥ 6 weeks clinical stability were followed for 12 months. Baseline hsCRP was measured by immunonephelometry (Siemens BN II) and dichotomised at 3 mg L⁻¹. The primary end-point was first occurrence of composite CV events (non-fatal myocardial infarction, stroke/TIA, hospitalised heart failure or CV death) adjudicated by blinded cardiologists. Multivariable Cox regression adjusted for age, sex, pack-years, GOLD grade, hypertension, diabetes and ischaemic heart disease. Results: Median hsCRP was 3.8 mg L⁻¹ (IQR 2.1–6.2); 54 % of patients exceeded 3 mg L⁻¹. Twenty-six events occurred (event rate 21 %): heart-failure hospitalisation 12, non-fatal MI 7, stroke/TIA 4, CV death 3. Event incidence was 31 % in the high-hsCRP group versus 9 % when ≤ 3 mg L⁻¹ (p = 0.002). hsCRP > 3 mg L⁻¹ doubled risk (adjusted HR 2.12, 95 % CI 1.01–4.46; p = 0.047). Adding hsCRP to a clinical model improved the C-statistic from 0.70 to 0.77 (p = 0.03) and net re-classification index by 0.21. Conclusions: Baseline hsCRP > 3 mg L⁻¹ independently predicts short-term CV events in COPD. Routine inflammatory profiling could refine risk stratification and guide inclusion in anti- inflammatory drug trials.

Developmental Defects of Enamel and in Primary Teeth

Wed, 14 May 2025 00:00:00 +0300

Background: Developmental defects of enamel (DDE) in primary teeth are prevalent worldwide and can predispose children to early childhood caries (ECC). Objective: To assess the prevalence of DDE in primary dentition and examine associated risk factors, including birth weight and early life events. Methods: A descriptive cross-sectional study was conducted on 192 children aged 3 to 5 years using non-probability convenience sampling technique. Clinical examinations were performed by trained dental professionals using standardized criteria for diagnosing developmental defects of enamel (DDE) in primary teeth, based on the presence of hypoplasia, demarcated opacities, and diffuse opacities. Data on potential risk factors such as parental education, infection history, medication during lactation, formula feeding, and birth complications were collected. Statistical analysis involved Fisher exact tests with a significance level set at p<0.05. Results: Among the 192 participants, the frequency of enamel defects was 14.6% (n=27). Mild defects were observed in 5.21% (n=10), moderate defects in 3.13% (n=6), severe defects in 3.65% (n=7), and atypical restorations in 1.56% (n=3). Significant associations were found between enamel defect severity and paternal education (p=0.04) and medication use during lactation (p=0.039). No significant associations were found for maternal education, infection history, or birth complications (all p>0.05). Conclusion: The study found a 14.6% frequency of enamel defects among the study population. Paternal education and medication use during lactation were significant risk factors. These findings highlight the need for targeted preventive strategies and further research into the etiology of enamel defects.

Self-Medication Practices and Drug Use Patterns Among First-Year Medical Students: A Cross-Sectional Gender based Analysis

Dr. Aruna Gurung, Dr. Pradnyesh Namdev Panshewdikar — Tue, 13 May 2025 00:00:00 +0300

Background: Self-medication, defined as using drugs for self-diagnosed conditions without professional consultation, is prevalent among medical students, especially during early training stages. It offers convenience but poses health risks, including misuse and adverse effects. This study evaluates the prevalence, patterns, and gender-based differences in self-medication practices among first-year medical students.

Retrospective Study to Evaluate the Anatomical variation in Proximal Branches of Great Saphenous Vein at SF Junction Encountered During Surgery for Varicose Vein

Ruchi Singh, Archana Sinha, Vanita Gupta — Tue, 13 May 2025 00:00:00 +0300

Background The Venous drainage of lower limb consists of Superficial and Deep venous system and the Perforators. Incompetence of valves in these veins lead to varicosities which needs surgery in form of Stripping of great saphenous vein and ligation of perforator in thigh and leg. Anatomy of lower limb veins need to be well known before proceeding for any kind of reflux surgery as there is high incidence of re-occurrence reflex if any of branches are left.

The Pattern of Psychosexual Problems and the Prevalence of Alcohol and Nicotine Dependence among Male Patients with Psychosexual Dysfunction

Hemant Chhabra, Neelu Yadav, Pankaj Kumar — Thu, 15 May 2025 00:00:00 +0300

Introduction. Substance use disorders (SUDs) are often associated with a number of psychiatric conditions. Community-based research has found a substantial correlation between SUDs and male sexual dysfunction, and in the case of alcohol and nicotine, a possible cause-and-effect relationship. Aim. To find out the pattern of psychosexual problems in patients reporting at tertiary care hospital. To determine the prevalence of alcohol & nicotine dependence among male patients with psychosexual dysfunction Methods. This is a cross-sectional descriptive study that was carried out in a tertiary care centre with 100 male patients who came to a clinic seeking treatment for psychosexual issues. We then find out the pattern of psychosexual disorders in patients, with and without concomitant substance use disorder (SUDs) and prevalence of substance use disorder (alcohol and nicotine) in these patients. ICD-10 was used in the evaluation. Results. 28% patients were diagnosed with erectile dysfunction. 30% patients were diagnosed with premature ejaculation and 42% patients were diagnosed with both premature ejaculation and erectile dysfunction. 60 of the 100 males had a current diagnosis of SUD. Out of the 60 with an identified substance use disorder 50% had nicotine dependence, 23.33% had alcohol dependence & 26.66% had dependence for both alcohol and nicotine. Nicotine was the most often used substances. Conclusion. Patients with psychosexual disorders were found to be frequently co-occurring with SUDs, especially nicotine use disorders. An essential part of management in this population is recognizing and treating these illnesses.

Effectiveness of Early Versus Delayed Antibiotic Therapy in the Management of Sepsis in Adults: A Systematic Review

Fri, 16 May 2025 00:00:00 +0300

Background: Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, leading to organ dysfunction. Timely administration of antibiotics is considered crucial in its management. However, the optimal timing of antibiotic therapy remains a subject of ongoing debate. Objective: This systematic review aims to evaluate the current evidence on the effectiveness of early versus delayed antibiotic administration in reducing mortality and improving clinical outcomes in adult patients with sepsis. Methods: A systematic search of PubMed, Embase, Cochrane Library, and Scopus was conducted for studies published between January 2010 to December 2024. Randomized controlled trials (RCTs), cohort studies, and observational studies comparing early (within 1 hour of recognition) versus delayed antibiotic therapy (beyond 1 hour) in adult septic patients were included. Outcomes assessed included all-cause mortality, ICU length of stay, organ dysfunction, and time to hemodynamic stabilization. Results: Twenty-one studies (8 RCTs and 13 observational studies) were included. Early administration of antibiotics (within 1 hour) was associated with a significant reduction in 28-day mortality (RR: 0.74; 95% CI: 0.62–0.88). Delays beyond 3 hours showed a marked increase in mortality (RR: 1.35; 95% CI: 1.12–1.61). Early therapy was also linked with shorter ICU stays and faster reversal of septic shock. Conclusion: Early administration of antibiotics, particularly within the first hour of sepsis recognition, significantly improves survival outcomes and reduces complications. This review reinforces current guidelines advocating for prompt antibiotic delivery in suspected sepsis.

Effects of Vitamin D Supplementation on Inflammatory Markers and Hematological Parameters in Type 2 Diabetes Mellitus

Sat, 17 May 2025 00:00:00 +0300

The growing prevalence of Type 2 Diabetes Mellitus (T2DM) has raised concerns about its relationship with inflammatory markers and hematological parameters, both of which are implicated in disease progression and complications. Recent studies suggest that vitamin D, a key regulator of immune function, may play a critical role in modulating these biomarkers. This study investigates the effects of vitamin D supplementation on inflammatory markers and hematological parameters in individuals diagnosed with T2DM.

Investigating the Prevalence and Impact of Dental Phobia on Quality of Life

Sat, 17 May 2025 00:00:00 +0300

Background: Dental phobia, a severe form of dental anxiety, is a prevalent psychological condition that leads to avoidance of dental care and contributes to deteriorating oral health, particularly among middle-aged adults. Its impact extends beyond oral health, significantly affecting overall quality of life. Understanding the prevalence and consequences of dental phobia is critical to developing effective patient-centered care strategies. Objective: This study aimed to investigate the prevalence of dental phobia among middle-aged adults and assess its impact on oral health-related quality of life (OHRQoL), with a focus on how fear and avoidance behaviors predict quality of life outcomes. Methods: A cross-sectional study was conducted between January and March 2024 in public and private dental clinics. A total of 150 adults aged 30–55 years were recruited using consecutive sampling. Data collection involved a structured self-administered questionnaire incorporating the Modified Dental Anxiety Scale (MDAS), selected items from the Dental Fear Survey (DFS), and the Oral Health Impact Profile-14 (OHIP-14). Statistical analyses were performed using IBM SPSS Statistics version 29. Pearson correlation was used to assess relationships between variables, while multiple linear regression evaluated the predictive role of dental fear and avoidance on OHIP-14 scores, controlling for age, gender, and frequency of dental visits. Results: The prevalence of moderate to high dental fear was notable, with a mean MDAS score of 14.2 ± 4.5 and DFS score of 18.6 ± 5.2. Participants reported compromised OHRQoL (mean OHIP-14 = 24.5 ± 8.3). Significant positive correlations were observed between dental fear, avoidance behaviors, and OHIP-14 scores (r = 0.65 to 0.72, p < 0.001). Regression analysis showed that both dental fear (β = 0.52, p < 0.001) and avoidance behavior (β = 0.38, p < 0.001) were strong predictors of reduced quality of life, while frequent dental visits were associated with better outcomes (β = -0.18, p = 0.013). Psychological discomfort and physical pain were the most affected domains. Conclusion: This study highlights the high prevalence of dental phobia in middle-aged adults and its significant negative impact on quality of life. Addressing dental fear and avoidance through early intervention and promoting regular dental attendance are essential to improve oral and overall well-being.

PROSPECTIVE STUDY OF ANALYSIS OF OCULAR MANIFESTATIONS OF BLUNT TRAUMA TO THE EYE

Dr.M.Jeevitha , Dr.T.Udaya kumar, Dr.V.S.Saravanan, Dr Arun Kumar Mohan — Sat, 17 May 2025 00:00:00 +0300

Introduction: Ocular blunt trauma is one of the major yet avoidable causes of monocular blindness throughout the world. As seen from study data, the people of the most active and productive age groups were involved in occupational hazards and RTA, which leads to visual
impairment, cosmetic disfigurement and serious economic loss to the community. Males are commonly injured in RTA which is probably related to both exposure and risk-taking behavior.

Presentation and Management of soft tissue Foreign Bodies The most challenging surgeries

Dr Pradeep BALMIKI — Sun, 18 May 2025 00:00:00 +0300

Introduction: Accidental penetrating injuries with foreign bodies are a common presentation in hospital's emergency rooms. If missed, these bodies can remain dormant or result in a wide range of complications. This study evaluated the characteristics of patients, presentation and management who suffered foreign body embedded in soft tissue at a ABV Government Medical College Vidisha MP India. Methods: The study was conducted at Department of surgery, Atal Bihari Vajpeyi Government Medical College Teaching Hospital from January 2021 to November2024. All cases confirmed to have a foreign body in soft tissue were enrolled.

Determination of Liver Cirrhosis by Liver Function Tests, Lipid Peroxidation (MDA) and Antioxidant Enzyme (SOD)

Dr. Asha Gupta, Dr. Dipika Shyoran, Dr. Pankaj Kumar Meena — Tue, 20 May 2025 00:00:00 +0300

Liver cirrhosis is a severe condition characterized by the replacement of healthy liver tissue with scar tissue, impairing its function. Caused by various liver diseases, it is a global health issue causing 1.47 million deaths in 2019. Common causes include chronic alcohol abuse, viral infections, obesity, diabetes, high cholesterol, hemochromatosis, Wilson's disease, autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. Prevention and management include lifestyle changes, medications, and liver transplants. Aims & Objectives: The study aims to determine Liver Cirrhosis by analyzing markers of LFT, MDA, and SOD, estimating SGOT/SGPT ratio, albumin/globulin ratio, MDA, and SOD, and examining their relationship. Materials and Methods: This study involved 100 patients, 50 with Liver Cirrhosis and 50 normal. Samples were collected from the Department of Medicine and tested at the Department of Biochemistry. The tests included serum SGPT by Kinetic UV Method, SGOT by Kinetic UV Method, Total protein by Roche Cobas 6000 method, Albumin by BCG Method, Globulin by Calculated manually, MDA by Jeans CD method, and SOD by Marlund and Marlund Method. Results: Liver cirrhosis patients have higher SGOT/SGPT ratio (2.56±0.38 U/L) and Albumin/Globulin ratio (0.81±0.06 g/dl) decreased compared to normal individuals. Serum Malondialdehyde (MDA) and Superoxide Dismutase (SOD) levels also differ between Liver Cirrhosis patients and normal individuals. Serum MDA (0.37±0.02 nmol/ml) increases in Liver Cirrhosis patients, while SOD (4.41±1.43 units/ml) decreases in Normal individuals. These findings highlight the importance of monitoring liver cirrhosis patients. Discussion: The study found that Liver Cirrhosis patients have a higher SGOT:SGPT ratio, Albumin: Globumin ratio, Malondialdehyde (MDA), and Serum Superoxide Dismutase (SOD) values compared to normal individuals. These results are consistent with previous studies, and further research is needed to estimate the relationship between SOD and Liver Cirrhosis. The results align with previous research and suggest further research is needed to better understand the relationship between these factors. Summary & Conclusion: The study, involving 50 individuals with Liver Cirrhosis and normal group, found that SGOT and SGPT ratios increased in Liver Cirrhosis patients, while Albumin and Globulin ratios increased. Malondialdehyde (MDA) also increased in Liver Cirrhosis patients, and Superoxide Dismutase (SOD) decreased in Liver Cirrhosis patients, but further research is needed.The conclusion was SGOT:SGPT ratio, Albumin: Globulin ratio, and Serum MDA are key markers for liver disorders detection, but further research is needed to understand Serum SOD levels.

Reconstruction of Maxillofacial Defects: Current Strategies and Future Innovations

Tue, 20 May 2025 00:00:00 +0300

Maxillofacial defects resulting from trauma, tumor resection, or congenital anomalies require complex reconstruction strategies that restore both function and aesthetics. Conventional techniques often involve autologous bone grafting or free flap transfers, which are associated with donor site morbidity and extended surgical time. Regenerative approaches incorporating autologous biologics such as Platelet-Rich Fibrin (PRF)* have demonstrated promising results in enhancing tissue healing and regeneration.

Thrombotic Thrombocytopenic Purpura and Systemic Lupus Erythematosus – A Rare Association

Dr. Vennapusa Girish Kumar Reddy, Dr. Uma M.A, Dr. Kotthinti Anil Kumar — Tue, 20 May 2025 00:00:00 +0300

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder characterized by a pentad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, renal dysfunction, neurological symptoms, and fever. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily affecting young females, involving multiple organ systems due to immune complex deposition and autoantibody-mediated tissue damage. The coexistence of SLE and TTP is rare but presents a significant diagnostic and therapeutic challenge. We report a case of an 18-year-old female presenting with fever, menorrhagia, and neurological deficits. Despite platelet transfusions, her cytopenia persisted. Laboratory investigations revealed hemolysis, ANA positivity, and MRI brain abnormalities. Due to financial constraints, plasmapheresis could not be performed, and the patient was successfully treated with corticosteroids and cyclophosphamide. This case highlights the importance of early recognition and alternative treatment strategies in resource-limited settings.

Clinical, biochemical and echocardiographic profile of young hypertensive patients

Tue, 20 May 2025 00:00:00 +0300

Introduction: Essential hypertension (idiopathic) and secondary hypertension (secondary to a recognized cause) are the two main categories of hypertension. Even in younger patients, about two-thirds of those with hypertension have essential hypertension. The term "young hypertension" refers to the start of the condition before the age of 45. 6 It is a major contributor to cardiovascular morbidity and death in the productive age group and is frequently asymptomatic at this age. Obesity, a positive family history, and a sedentary lifestyle are typical risk factors for hypertension. Aim: to study clinical, biochemical and echocardiographic profile of the young hypertensive patients attending PES medical college Results: The median age of the study participants was 30 years. Majority of the patients were male. Chronic Kidney disease was seen in 4 patients(6.25%). Mean Systolic blood pressure was 159 mm Hg (155, 163). Mean Diastolic blood pressure was 101 mm Hg (98.8 – 103). Abnormal ECG findings was seen in 35.9% i.e., 23 patients. Conclusion: Majority had proteinuria. Among ECG findings Left ventricular hypertrophy was commonest followed by LBBB, Prolonged PR interval. Among Echocardiography findings, Diastolic dysfunction was common followed by Left Ventricular Hypertrophy, Left atrial enlargement. Hypertensive retinopathy was seen in more than half of study population

Marin-Amat Syndrome: A Rare Entity

Tue, 20 May 2025 00:00:00 +0300

Marin Amat syndrome is a rare type of synkinesis that occurs when the jaw is fully opened or the involuntary closure of the eyelids during lateral movement of the jaw. It has been suggested that aberrant regeneration of 7 th cranial nerve and incorrect innervation between cranial nerves 5 and 7 may be responsible for this syndrome. In Case report A 60 year old male with no chronic diseases presented with a droopy right eyelid that he developed 1 year after sustaining right-sided Bell's palsy. Since then, the patient has made a reasonable recovery.

The Changing Spectrum of Cutaneous Manifestations in HIV Infection: Pre-ART Vs Post-ART Comparative Study

Wed, 21 May 2025 00:00:00 +0300

Background: Cutaneous manifestations are common in HIV-infected individuals and often reflect the degree of immunosuppression. The introduction of antiretroviral therapy (ART) has significantly altered the natural course of HIV, including its dermatological manifestations. Objective: To analyze the changing profile of cutaneous manifestations in HIV patients before and after the advent of ART. Methods: A comparative observational analysis of 80 HIV-positive patients (40 pre-ART era and 40 post-ART era) was conducted. Data on demographics, CD4 counts, and dermatological conditions were collected and compared. Results: Infectious dermatoses (bacterial, fungal, viral) were more prevalent in the pre-ART group (72.5% vs. 42.5%, p < 0.05), while inflammatory and ART-related dermatoses were more common in the post-ART group (35% vs. 12.5%, p < 0.05). Mean CD4 count was significantly higher in the post-ART group (312 cells/µL vs. 158 cells/µL, p < 0.001). Conclusion: The spectrum of HIV-associated cutaneous manifestations has shifted from predominantly infectious to more non-infectious and ART-related dermatoses following the widespread use of ART.

Ocular Manifestations in Systemic Lupus Erythematosus: A Case Series

Dr. Arpitha K S, Dr. Preethi G, Dr. S Kalpana, Dr. Ramya M — Wed, 21 May 2025 00:00:00 +0300

The primary purpose of this study is to elucidate the spectrum of ocular manifestations in patients with SLE, emphasizing the importance of early recognition and appropriate management to prevent irreversible vision loss. This case series includes eight patients diagnosed with SLE who presented with various ocular manifestations at a tertiary care center. Patient demographics, clinical presentations, diagnostic evaluations, treatment regimens, and outcomes were documented and analyzed. Diagnostic workups included fundus examinations, slit-lamp assessments, serological testing, and imaging studies when indicated.

Comparison of Fibreoptic Bronchoscope and C-Mac Video Laryngoscope for Awake Tracheal Intubation with Cervical Spine Immobilization

Wed, 21 May 2025 00:00:00 +0300

Background: Awake fiberoptic intubation (AFOI) is a widely accepted technique for managing difficult airways in patients with facial trauma, oropharyngeal masses, and obesity. It preserves the patient's spontaneous respiratory effort. This study was designed to compare the efficacy of the C-MAC video laryngoscope with a fibreoptic bronchoscope (FOB) in simulated cervical spine immobilization. Methods: This prospective, randomized study included 100 patients aged 18–80 years, with ASA physical status I or II, undergoing elective surgeries requiring cervical spine immobilization. Patients were randomized into two groups: Group I (FOB) and Group II (C-MAC VL). The primary outcome was time to successful intubation and overall success rate. Secondary outcomes included hemodynamic changes and intubation-related complications. Results: The C-MAC group had significantly shorter intubation times compared to the FOB group (p<0.05). No significant difference was observed in the number of attempts between groups (p>0.05). Conclusion: The C-MAC video laryngoscope offers a time advantage over the fibreoptic bronchoscope for awake tracheal intubation in patients with cervical spine immobilization, assuming adequate airway preparation.

A Comparative Study of Safety and Efficacy of Platelet Rich Plasma and Fractional Co2 Laser in Treatment of Post Acne Scar

Wed, 21 May 2025 00:00:00 +0300

Acne is a very common occurrence among adolescents, which may sometimes persist into adulthood.

Efficacy and Safety of Subcision and Microneedling in Treatment of Atrophic Acne Scar

Wed, 21 May 2025 00:00:00 +0300

Background: Acne vulgaris is a common skin disorder, with atrophic scars being a frequent sequela. Various treatments exist, but combination therapies like subcision and microneedling have shown promise in addressing different scar types effectively. Objective: To evaluate the efficacy and safety of combining subcision and microneedling in treating atrophic acne scars. Methods: A prospective study was conducted on 160 patients (aged 18–40 years) with atrophic acne scars. Participants underwent four sessions of combined subcision and microneedling at monthly intervals. Scar improvement was assessed using the Goodman and Baron qualitative grading scale, and patient-reported outcomes were recorded. Results: Grade 4 scars (60% of patients at baseline): 32% improved by 2 grades, 68% by 1 grade; none remained at Grade 4 post-treatment. Grade 3 scars (26%): 31% improved by 2 grades, 64% by 1 grade; 5% showed no improvement. Grade 2 scars (14%): 86% improved by 1 grade; 14% had no improvement. Patient satisfaction: 31% reported 75–100% improvement, 31% reported 50–74% improvement, and 35% reported 25–49% improvement. Transient erythema, edema, and pain (resolved within 2–3 days); occasional bruising and hyperpigmentation. Conclusion: The combination of subcision and microneedling is a safe, cost-effective, and efficacious treatment for atrophic acne scars, particularly for rolling and boxcar types. It demonstrated significant improvement in severe scars (Grades 3 and 4) with minimal downtime and high patient satisfaction. Further comparative studies are needed to optimize treatment protocols.

Nutritional Deficiencies in School-aged Children

Wed, 21 May 2025 00:00:00 +0300

Background: Nutritional deficiencies during childhood can have profound impacts on growth, cognitive development, and overall health. This study examines the prevalence and impact of key nutritional deficiencies among school-aged children and evaluates the effectiveness of school-based nutritional interventions. Methods: A cross-sectional study was conducted involving a sample of 350 school-aged children from both urban and rural settings. We assessed the prevalence of iron, vitamin D, and iodine deficiencies using biochemical markers and evaluated the impact of these deficiencies on physical growth and cognitive performance. The study also explored the influence of socioeconomic factors and the effectiveness of existing school-based nutritional programs. Results: The study found that 33.71% of the children were deficient in iron, 27.43% in vitamin D, and 25.43% in iodine. Nutritional deficiencies significantly impacted both growth (Mean = 153, SD = 49.14, p = 0.005) and cognitive performance (Mean = 165, SD = 50.43, p = 0.003). Socioeconomic factors such as income level, parental education, and access to healthcare were significantly associated with the nutritional status of the children. School-based interventions, including meal programs and nutrition education, showed a high effectiveness in improving the nutritional outcomes, with effectiveness scores ranging from 62.29% to 75.71%. Conclusion: The high prevalence of nutritional deficiencies and their significant impact on growth and cognitive development highlight the urgent need for effective public health interventions. School-based nutritional programs proved to be effective and should be expanded and supported as part of comprehensive strategies to mitigate these deficiencies.

Prevalence of HPV in Oral Squamous Cell Carcinoma Patients

Wed, 21 May 2025 00:00:00 +0300

Background: Human Papillomavirus (HPV) has been established as a contributing factor in various cancers, with increasing evidence linking it to Oral Squamous Cell Carcinoma (OSCC). This study aims to determine the prevalence of HPV in OSCC patients and identify the most frequent HPV types associated with the disease. Methods: A cross-sectional study was conducted on 200 patients diagnosed with OSCC at a tertiary care center. Samples were collected and tested for HPV DNA using Polymerase Chain Reaction (PCR) targeting high-risk HPV types. Demographic and clinical data were also analyzed to assess correlations between HPV status and clinical characteristics such as age, sex, and tumor stage. Results: Out of the 200 patients, 32% tested positive for HPV. HPV-16 was the most prevalent type, found in 24% of the patients, followed by HPV-18, HPV-31, and other types at lower frequencies. Statistical analysis revealed significant associations between HPV positivity and younger age (<40 years), male sex, and advanced tumor stages (III-IV). Conclusion: The study confirms a significant presence of HPV in patients with OSCC, predominantly HPV-16. The high prevalence in younger patients and those with advanced disease stages suggests that HPV is an important factor in the etiology and progression of OSCC. These findings highlight the need for further research into HPV as a marker for early detection and a potential target for vaccination and therapeutic strategies in OSCC.

Comparative Accuracy of Ultrasound and MRI in Diagnosing Rotator Cuff Tears

Wed, 21 May 2025 00:00:00 +0300

Background: Rotator cuff tears are a common cause of shoulder pain and disability, affecting millions of people worldwide. Accurate diagnosis is crucial for effective management and treatment. Ultrasound and MRI are both used for diagnostic imaging of rotator cuff tears, yet their comparative accuracy remains under continuous scrutiny. Objective: To compare the diagnostic accuracy of ultrasound and MRI in the detection of rotator cuff tears. Methods: This retrospective study involved 120 patients who underwent both ultrasound and MRI for suspected rotator cuff tears at a single tertiary care center. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated and compared between the two modalities. Statistical significance was determined using Chi-square and Z-tests where appropriate. Results: MRI demonstrated higher sensitivity (85%) compared to ultrasound (63.33%), with a statistically significant difference (p=0.001). Although both modalities showed high specificity—MRI at 95% and ultrasound at 87.5%—the difference was not statistically significant (p=0.064). MRI also exhibited a higher PPV (92.73%) compared to ultrasound (84.44%) with statistical significance (p=0.023). The NPV and overall accuracy were similarly high for both modalities but did not show significant differences. Conclusion: MRI is superior to ultrasound in terms of sensitivity and positive predictive value in diagnosing rotator cuff tears. Although both imaging modalities provide high specificity and accuracy, MRI should be considered the more reliable method for confirming rotator cuff pathology, especially in complex cases. Nevertheless, ultrasound remains a valuable tool for initial assessments given its cost-effectiveness and real-time imaging capabilities.

Comparative Study of Carbamazepine and Gabapentin in the Treatment of Trigeminal Neuralgia

Wed, 21 May 2025 00:00:00 +0300

facial pain. Carbamazepine is traditionally the drug of choice; however, gabapentin has been proposed as an alternative due to its favorable safety profile. This study aims to compare the efficacy and safety of carbamazepine and gabapentin in the management of trigeminal neuralgia. Methods: In this randomized, controlled trial, 80 patients diagnosed with trigeminal neuralgia were allocated into two groups to receive either carbamazepine or gabapentin. The primary outcome measured was the reduction in pain intensity, assessed using the Visual Analog Scale (VAS). Secondary outcomes included side effect profiles and patient preference. Data were collected at baseline and monthly intervals over a six-month period. Results: Both carbamazepine and gabapentin groups showed significant pain relief (p>0.05). There was no statistically significant difference in the effectiveness of pain reduction between the two drugs (p=0.42). However, gabapentin was associated with fewer and milder side effects and was preferred by patients over carbamazepine (p=0.04). Conclusion: Carbamazepine and gabapentin are both effective in the treatment of trigeminal neuralgia. Gabapentin, however, may offer an advantage in terms of tolerability and patient satisfaction, making it a compelling alternative to carbamazepine for some patients.

Comparative Analysis of Vaginal Birth After Cesarean (VBAC) Success Rates between Different Induction Methods

Wed, 21 May 2025 00:00:00 +0300

Background: Vaginal Birth after Cesarean (VBAC) offers significant benefits over repeat cesarean sections, including reduced recovery times and lower complication rates. However, the success of VBAC largely depends on the method of labor induction used. This study evaluates the effectiveness and safety of different VBAC induction methods to ascertain optimal practices. Methods: This retrospective study analyzed 180 women who attempted VBAC at a tertiary care center from January 2015 to December 2019. The induction methods compared were mechanical (Foley catheter), pharmacological (Misoprostol), and Oxytocin. Outcomes measured included the success rate of VBAC, time to labor onset, maternal complications, and neonatal ICU admissions. Statistical analysis involved chi-square tests for categorical data, t-tests for continuous variables, and logistic regression to adjust for confounding factors. Results: The success rate of VBAC was highest with the mechanical method (62.96%), followed by Oxytocin (57.41%) and pharmacological methods (53.70%). The mechanical method also showed a statistically lower rate of maternal complications (14.81%) compared to the pharmacological (24.07%) and Oxytocin (18.52%) methods. Despite quicker labor onset with pharmacological induction, it did not translate to higher VBAC success. Conclusion: Mechanical induction methods such as the Foley catheter are associated with higher VBAC success rates and fewer maternal complications compared to pharmacological and Oxytocin inductions. These findings suggest that mechanical methods might offer a safer and more effective option for inducing labor in women attempting VBAC. However, individual patient factors must be considered when selecting the appropriate induction method.

A Comparative Study of Laparoscopic Vs. Open Hernia Repair: Outcomes and Patient Satisfaction

Wed, 21 May 2025 00:00:00 +0300

Background: Hernia repair is one of the most common surgical procedures worldwide, with various techniques employed to optimize patient outcomes and satisfaction. This study aims to compare the outcomes and patient satisfaction between laparoscopic and open hernia repair techniques. Methods: This retrospective cohort study involved 120 patients who underwent hernia repair at a single tertiary care center, with 60 patients undergoing laparoscopic repair and 60 undergoing open repair. Outcomes measured included postoperative recovery time, recurrence rates, complications, and patient satisfaction regarding cosmetic results and overall treatment experience. Statistical analysis was conducted using Chi-square tests and t-tests where appropriate. Results: The laparoscopic group demonstrated a significantly lower recurrence rate (3.3% vs. 13.3%, p=0.045) and shorter postoperative recovery times in terms of resuming daily activities (3.2 vs. 6.4 days, p<0.001) and returning to work (5.6 vs. 9.2 days, p<0.001). Patients in the laparoscopic group also experienced fewer complications (5% vs. 20%, p=0.008) and reported higher satisfaction with cosmetic outcomes (8.7 vs. 7.2, p<0.001) and overall treatment (8.5 vs. 6.9, p<0.001). The likelihood of recommending the surgery was also higher among the laparoscopic patients (95% vs. 75%, p=0.013). Conclusion: Laparoscopic hernia repair is associated with better clinical outcomes, fewer complications, and higher patient satisfaction compared to open hernia repair. These findings support the adoption of laparoscopic techniques as a preferred option for hernia repair, subject to individual patient conditions and surgical expertise.

Impact of Mindfulness-Based Stress Reduction on Anxiety Levels in Healthcare Professionals: A Comparative Study

Tue, 20 May 2025 00:00:00 +0300

Background: Healthcare professionals frequently encounter high levels of stress and anxiety, which can adversely affect their health and job performance. Mindfulness-Based Stress Reduction (MBSR) has been identified as a potential intervention to mitigate these effects. Objective: This study aimed to evaluate the efficacy of an 8-week MBSR program in reducing anxiety levels among healthcare professionals compared to a control group receiving no intervention. Methods: A total of 140 healthcare workers from a single tertiary care center were randomly assigned to either the MBSR group or a control group. The MBSR group participated in an 8-week program consisting of guided mindfulness exercises, yoga, and meditation. Anxiety levels were measured using the Generalized Anxiety Disorder 7-item scale (GAD-7) at baseline and post-intervention. Results: Baseline anxiety levels were comparable between the two groups (MBSR: 14.3 ± 2.7; Control: 14.1 ± 2.8). Post-intervention results showed a significant reduction in anxiety scores in the MBSR group (10.4 ± 2.2) compared to the control group (13.9 ± 2.6), with a p-value < 0.001. The effect size of the intervention was significant, indicating a robust treatment effect. Conclusion: The findings suggest that MBSR is an effective intervention for reducing anxiety among healthcare professionals. The significant decrease in anxiety scores post-intervention highlights the potential of MBSR to enhance mental health and stress management in high-pressure medical environments.

Comparative Efficacy of Tamsulosin and Finasteride in the Management of Lower Urinary Tract Symptoms Due To Benign Prostatic Hyperplasia

Dr. Tushar Maruti Kharmate, Dr. Parag Surendra Bhirud, Dr. Hemant Sharad Kelkar — Tue, 20 May 2025 00:00:00 +0300

Background: Benign Prostatic Hyperplasia (BPH) is a prevalent condition affecting elderly males, characterized by lower urinary tract symptoms (LUTS) that significantly impair quality of life. Tamsulosin, an alpha-blocker, and Finasteride, a 5-alpha reductase inhibitor, are commonly prescribed for BPH management. However, comparative analyses of their efficacy and safety profiles are essential for optimal therapeutic strategies. Objective: To compare the efficacy of Tamsulosin and Finasteride in the management of LUTS associated with BPH. Methods: This prospective, randomized clinical trial involved 180 men diagnosed with BPH, evenly divided into two treatment groups: Tamsulosin and Finasteride. The primary outcomes measured were changes in the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax). Secondary outcomes included the assessment of drug-related side effects. Data were analyzed using t-tests for continuous variables and chi-square tests for categorical variables. Results: Both Tamsulosin and Finasteride significantly improved IPSS and Qmax compared to baseline. However, Tamsulosin demonstrated a significantly greater improvement in Qmax (p=0.003) and IPSS (p=0.014) than Finasteride. Regarding safety profiles, Tamsulosin was associated with a higher incidence of dizziness, whereas Finasteride showed a significant increase in sexual dysfunction, including decreased libido (p=0.001). Conclusion: Tamsulosin may offer superior efficacy in improving urinary flow and symptom scores in men with BPH compared to Finasteride. However, side effects such as dizziness and sexual dysfunction must be carefully considered when prescribing these medications. These findings support the need for individualized treatment planning based on patient-specific symptoms and side effect profiles.

Comparative Study of Outcomes in Stroke Patients Receiving TPA within 3 vs. 4.5 Hours of Symptom Onset

Dr. Suhas Sopan Borole, Dr. Shaunak Ramakant Patil, Dr. Nitesh Suresh Chhajed — Tue, 20 May 2025 00:00:00 +0300

Background: Timely administration of tissue plasminogen activator (tPA) is crucial for effective stroke management, but the optimal therapeutic window remains under debate. This study examines the outcomes of stroke patients treated with tPA within two distinct time frames: within 3 hours and between 3 to 4.5 hours of symptom onset. Methods: In this retrospective cohort study, 180 stroke patients (90 in each group) treated at a tertiary care center were analyzed. Patients receiving tPA within 3 hours of onset were compared with those treated within 4.5 hours regarding functional outcomes, complication rates, and long-term disability and mortality. Functional independence, neurological improvement, and incidence of complications such as intracerebral hemorrhage were assessed. Statistical significance was determined using chi-square and t-tests, with a p-value <0.05 considered significant. Results: Patients treated within 3 hours showed a higher rate of functional independence at 3 months (54% vs. 47%, p=0.29) and better improvement in NIHSS scores. The incidence of intracerebral hemorrhage was lower in the 3-hour group (6.7% vs. 13.3%, p=0.05). Moreover, earlier treatment was associated with lower rates of severe disability and mortality at 6 months, although these differences did not reach statistical significance. Conclusion: This study suggests that treating stroke patients with tPA within 3 hours of symptom onset may lead to better functional outcomes and fewer complications compared to treatment within 4.5 hours. Despite the non-significant differences in some outcomes, the findings support the current clinical emphasis on the earliest possible administration of tPA.

Comparative Study of Epidural vs. Intravenous Patient-Controlled Analgesia in Abdominal Surgery

Tue, 20 May 2025 00:00:00 +0300

Background: Effective postoperative pain management is crucial for recovery in patients undergoing abdominal surgery. Epidural Patient-Controlled Analgesia (EPCA) and Intravenous Patient-Controlled Analgesia (IVPCA) are prominent methods, but their comparative efficacy and patient satisfaction rates have not been thoroughly explored in this specific surgical context. Objective: This study aims to compare the efficacy, safety, and patient satisfaction of EPCA and IVPCA in managing postoperative pain in patients undergoing abdominal surgery. Methods: A retrospective cohort study was conducted with a sample of 140 patients who underwent various abdominal surgeries and received either EPCA (n=70) or IVPCA (n=70) for pain management. Data on pain scores, patient satisfaction, and complication rates were collected and analyzed. Statistical significance was determined using chi-square tests for categorical data and t-tests for continuous variables. Results: Patients in the EPCA group reported significantly lower pain scores at 6, 12, 24, and 48 hours post-surgery (p < 0.05 for all) compared to the IVPCA group. EPCA was also associated with higher patient satisfaction regarding pain management, ease of use, and overall comfort (p < 0.01). The incidence of nausea and vomiting was significantly lower in the EPCA group (14.3% vs. 35.7%, p < 0.001). There were no significant differences in the rates of respiratory depression and hypotension between the two groups. Conclusion: EPCA provides superior pain control and greater patient satisfaction compared to IVPCA in the context of abdominal surgery, with fewer gastrointestinal side effects. These findings suggest that EPCA should be considered as a preferred method for pain management post-abdominal surgery when clinically appropriate.

Epigenetic Regulation of Embryonic Development: Insights into Congenital Anomalies

Thu, 22 May 2025 00:00:00 +0300

Epigenetic mechanisms are pivotal in orchestrating embryonic development, and theirdysregulation has been implicated in the etiology of congenital anomalies. This experimental studyaimed to elucidate the role of DNA methylation and histone modification patterns in embryonic

Comparison of Zirconia and Lithium Disilicate Crowns: A Randomized Controlled Trial on Longevity and Patient Satisfaction

Thu, 22 May 2025 00:00:00 +0300

The comparison of zirconia and lithium disilicate crowns in terms of longevity and patientsatisfaction represents an important aspect of restorative dentistry. Both materials have gainedpopularity due to their excellent esthetics and strength; however,

A Randomized Controlled Trial to Investigate the Efficacy of Bioactive Materials in Orthodontic Brackets for Reducing Decalcification

Thu, 22 May 2025 00:00:00 +0300

Enamel decalcification, manifesting as white spot lesions, remains a prevalent complication duringfixed orthodontic treatment. This randomized controlled trial aimed to evaluate the efficacy oforthodontic adhesives incorporating bioactive materials

Comparing DNA Degradation Rates Under Different Environmental Conditions: A Controlled Study

Thu, 22 May 2025 00:00:00 +0300

DNA degradation is a critical factor in the preservation and analysis of biological samples.Environmental conditions such as temperature, humidity, and UV exposure significantly influencethe stability of DNA. This study aimed to investigate the degradation rates of DNA under different

Impact of Antioxidant Supplementation on Sperm Quality and Embryo Development

Thu, 22 May 2025 00:00:00 +0300

Oxidative stress is a significant contributor to male infertility, adversely affecting sperm qualityand embryo development. This double-blind, randomized controlled trial aimed to evaluate theimpact of a specific antioxidant supplementation

Mucinous Tubular and Spindle Cell Carcinoma of the Kidney: A Case Series of Three Patients Including Rare Presentations and Histological Variants

Tue, 13 May 2025 00:00:00 +0300

Background: Mucinous Tubular and Spindle Cell Carcinoma (MTSCC) is a rare subtype of renal cell carcinoma (RCC), typically characterized by a biphasic pattern of tubules and spindle cells embedded in a mucinous stroma. It presents diagnostic challenges due to overlapping features with other RCC subtypes. Most cases are detected incidentally. Objective: To describe the clinicopathological characteristics and diagnostic challenges of MTSCC through a series of three cases with varying presentations and histological features. Case Presentation: Case 1: A 59-year-old male presented with non-specific abdominal pain and chronic constipation. Imaging revealed an exophytic lesion in the left kidney. Partial nephrectomy and histopathology confirmed MTSCC with low-grade features and focal capsular invasion. Case 2: A 47-year-old female presented with intermittent hematuria and flank pain. Imaging detected a well-circumscribed lesion in the lower pole of the left kidney. Radical nephrectomy was performed. Histology showed MTSCC with epithelial predominance and oncocytic changes. Case 3: A 64-year-old asymptomatic postmenopausal female was evaluated for uterine bleeding. Incidental renal mass was found on MRI. Partial nephrectomy revealed classic MTSCC with focal high-grade transformation, characterized by increased mitoses and nuclear atypia. Results: All cases demonstrated classic biphasic histomorphology. Immunohistochemistry showed CK7 and PAX8 positivity and CD10 negativity in all three cases. The Ki-67 index ranged from <5% in low-grade tumors to ~20% in areas of high-grade transformation. No metastases were detected, and all patients were placed on surveillance. Conclusion: MTSCC is an indolent renal tumor with distinct histological and immunohistochemical features. Although typically low-grade, some tumors may exhibit aggressive behavior, underscoring the importance of accurate histopathological evaluation. Close follow-up is recommended due to the potential for high-grade transformation and recurrence.

Knowledge and Attitudes Regarding Cervical Cancer Risk Factors and Screening

Dr. Renu Verma, Dr. Mini — Fri, 23 May 2025 00:00:00 +0300

Background: - Cervical cancer remains a leading cause of morbidity and mortality among women worldwide, particularly in low- and middle-income countries. Despite advances in screening and prevention, late detection contributes significantly to poor outcomes. Identifying gaps in knowledge and understanding prevailing attitudes toward screening can guide targeted interventions to improve early detection and reduce disease burden. Methods: - A cross-sectional survey was conducted among 450 women aged 30 years and above in selected healthcare facilities. Participants were recruited through stratified or convenience sampling methods, depending on resource availability. Data were collected using a validated, self-administered questionnaire covering sociodemographic factors, knowledge of risk factors (e.g., early sexual debut, smoking, weak immune system), and attitudes toward screening. Descriptive analyses were performed to summarize participant characteristics. Inferential statistics, including Chi-square tests and multivariate regression, were used to assess associations between knowledge, attitudes, and screening uptake. Ethical approval was obtained before data collection. Results: - Most respondents (89.8%) identified early sexual debut as a risk factor, while 94.2% acknowledged smoking as a contributing factor. However, only 2.4% recognized immunocompromised status as a risk factor. Over 98% of participants were aware of cervical cancer screening, yet barriers to screening persisted, including perceived lack of necessity (34.9%), uncertainty about locations offering Pap smears (16.7%), and underestimation of personal risk (45.3%). Conclusion: - The study highlights substantial awareness of certain cervical cancer risk factors but identifies persistent misconceptions and barriers related to screening. Interventions should focus on clarifying risk factors, bridging knowledge gaps regarding screening facilities, and addressing attitudinal barriers to encourage regular screening.

Prognostic Significance of C-reactive protein Vs Neutrophil Lymphocyte Ratio in Patients with Acute Myocardial Infarction in a Tertiary Care Hospital

Dr Bhaskara V Krishna Harsha, Dr Uma M A, Dr Kandula Venkata Sai Raghavendra — Fri, 23 May 2025 00:00:00 +0300

Background: Prior studies have independently researched the prognostic significance of CRP and NLR in the context of AMI, the comparative effectiveness of these biomarkers and their alignment with in-hospital outcomes remain largely unexplored territories. This study aimed to study the prognostic significance of C - reactive protein versus Neutrophil to Lymphocyte Ratio and their correlation with in-hospital outcomes in patients with AMI. Methods: A prospective observational study was conducted in patients admitted to the Cardiac Care Unit from October 2022 to July 2024. Study participants include Patients diagnosed with AMI admitted to the Cardiac Care Unit. 105 patients were included n the study. Blood samples were drawn at admission, on day 3 of admission, and sent for C-reactive protein levels, complete blood count. Complete blood counts were used to calculate the neutrophil-lymphocyte ratio. Patients were followed up during their hospital stay for in-hospital outcomes. Results: Of total, 60% (n=63) belonged to age group of 51-70 years, 75.2% (n=79) were males. The mean (SD) CRP level among patients with hospital stay ≤7 days was 25.1 (39.5) mg/dL and in 8-14 days it was 42.4 (57.5). The mean (SD) CRP level among patients who succumbed to illness was 130.9 (119.2) mg/dL and who recovered was 22.4 (20.1). The mean (SD) NLR level among patients with hospital stay ≤7 days was 4.6 (3.3) and in 8-14 days it was 4.9 (2.5). The mean (SD) NLR level among patients with cardiogenic shock was 5.4 (3.1) and without cardiogenic shock was 4.6 (3.1). The mean (SD) NLR level among patients who succumbed to illness was 6.9 (3.3) and who recovered was 4.6 (3.0). Conclusion: The study demonstrates the significance of inflammatory markers, particularly CRP, as predictors of adverse outcomes in patients with AMI. Elevated CRP levels on the first- and third-days following AMI were associated with longer hospital stays, cardiogenic shock, and mortality. These findings suggest that CRP could serve as a valuable prognostic indicator for identifying patients at higher risk of complications post-AMI.

Comparison of Nalbuphine V/S Fentanyl as Intrathecal Adjuvant to Hyperbaric Bupivacaine in Orthopedic Lower Limb Surgeries

Dr. Babita Meena, Dr. Lekha Salvi, Dr. Prakyath Shetty — Mon, 26 May 2025 00:00:00 +0300

Aims: To compare intrathecal nalbuphine v/s fentanyl added to 0.5% hyperbaric bupivacaine for perioperative anaesthesia and postoperative analgesia in patients undergoing lower limb orthopaedic surgery. Settings and Design: Single centre, prospective, randomized double blind controlled interventional study in patients posted for lower limb orthopaedic surgery. Methods and Material: 90 patients posted for elective orthopaedic lower limb surgeries under spinal anaesthesia were randomly divided into three groups of 30 each. Group B with 0.5ml saline, group F with 50 microgram fentanyl and group N with 1 mg nalbuphine as adjuvants to 0.5% hyperbaric bupivacaine. Block characteristics, hemodynamic parameters, duration of analgesia and advesre effects were monitored. Statistical analysis used: The collected data were analysed by one- way ANOVA and results were obtained in form of mean and standard deviation. The probability value p < 0.05 is considered as statistically significant. Results: Onset of sensory blockade in group N, F and G was 305.67 ±19.42, 292 ± 14.48 and 290 ± 18.36 seconds respectively. Duration of motor block Group N is higher than the Group F & Group B & it is statistically significant (191±19.31, 164.37±7.05 and 161.6 ±6.07 minutes respectively). Regression of sensory level is prolonged in Group N in comparison to Group F and B (300.13 ± 14.69, 181.37±7.92 and 178.97±7 minutes respectively). Duration of analgesia was 408 ± 21.44 and 391.93 ± 25.37 and 383.27 ± 19.75 minutes in group N and group F and group B respectively. Conclusion: Nalbuphine providing longer duration of motor block and analgesia compared to fentanyl can act as an effective alternate adjuvant in spinal anaesthesia.

Treatment outcomes and recurrence rates in patients with granulomatous mastitis undergoing lumpectomy and anti-tubercular therapy

Dr. Abhinav Puri, Dr. Mahim Khan,Dr. Anil Kumar Mongia — Tue, 20 May 2025 00:00:00 +0300

Background: Granulomatous mastitis (GM) is an uncommon, persistent inflammatory breast condition that can be difficult to diagnose and treat. It often looks like breast cancer. The goal of this study was to evaluate treatment outcomes and recurrence rates in GM patients undergoing anti-tubercular therapy (ATT) after a lumpectomy. Methods: A prospective observational study was conducted on 23 female GM patients at a tertiary care center. Clinical presentations, histological findings, and treatment outcomes following lumpectomy and Category 1 ATT were investigated during a one-year follow-up. Results: The mean age of patients was 33 ± 5 years,
with lump sizes ranging from 3 to 5 cm and average symptom duration of 3 months.

The Critical Role of Clinical Examination in Diagnosing Atrial Septal Defect in an Elderly Male with Haemoptysis: A Case Report

Dr.Krishna Harsha Bhaskara, Dr.M A Uma — Mon, 26 May 2025 00:00:00 +0300

Atrial septal defects (ASDs) are among the most prevalent congenital heart defects and often remain undiagnosed until adulthood. They may present later in life with a diverse range of symptoms, including arrhythmias, thromboembolic events, heart failure, and haemoptysis. Although diagnosis can typically be established through echocardiography, limitations in technical expertise in resource-constrained settings may necessitate reliance on clinical examination. Here, we report a case of an elderly male presenting with haemoptysis, whose initial echocardiogram failed to identify any congenital heart defect. However, clinical findings raised suspicion of an ASD, later confirmed by transoesophageal echocardiography as a 22-mm ostium secundum defect.

To Determine the Resistance Patterns of Enterococcus Isolates Against Vancomycin, Linezolid, and Daptomycin: A Cross-Sectional Study

Dr. Shruti Sharma, Dr. Ashish Pareek, Dr. Kiran Meena — Mon, 26 May 2025 00:00:00 +0300

Background: The emergence of multidrug-resistant Enterococcus species, particularly vancomycin-resistant enterococci (VRE), poses a significant challenge in clinical settings. This study aimed to determine the resistance patterns of Enterococcus isolates against vancomycin, linezolid, and daptomycin. Methods: A total of 60 Enterococcus isolates were collected from clinical specimens (urine, blood, wound swabs) over six months. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method and minimum inhibitory concentration (MIC) determination for vancomycin (VAN), linezolid (LZD), and daptomycin (DAP). Results: Among the 60 isolates, Enterococcus faecalis (65%) was more prevalent than Enterococcus faecium (35%). Vancomycin resistance was observed in 18.3% (n=11) of isolates, with higher resistance in E. faecium (27.3%) than E. faecalis (12.8%). Linezolid resistance was detected in 6.7% (n=4), while daptomycin resistance was found in 5% (n=3). Multidrug resistance (MDR) was observed in 10% (n=6) of isolates. Conclusion: The study highlights increasing resistance to vancomycin and emerging resistance to linezolid and daptomycin among Enterococcus isolates. Continuous surveillance and strict antimicrobial stewardship are essential to curb resistance.

To Compare the Diagnostic Accuracy of CRP with Blood Culture In Neonatal Sepsis: A Prospective Study

Dr. Shruti Sharma, Dr. Kiran Meena, Dr. Ashish Pareek — Mon, 26 May 2025 00:00:00 +0300

Background: Neonatal sepsis is a leading cause of morbidity and mortality in newborns. Early diagnosis remains challenging due to nonspecific clinical signs. Blood culture is the gold standard but has limitations, including delayed results. C-reactive protein (CRP) is an acute-phase reactant that may aid in early diagnosis. Objective: To compare the diagnostic accuracy of CRP with blood culture in neonatal sepsis. Methods: A prospective study was conducted on 48 neonates with suspected sepsis. CRP levels were measured at admission, and blood cultures were performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP (cutoff ≥10 mg/L) were calculated against blood culture. Results: Blood culture was positive in 18/48 (37.5%) cases. CRP showed a sensitivity of 83.3%, specificity of 76.7%, PPV of 71.4%, and NPV of 86.2%. The agreement between CRP and blood culture was moderate (κ = 0.58). Conclusion: CRP is a valuable adjunct to blood culture in neonatal sepsis, offering rapid results with reasonable accuracy. Combining both tests may improve early diagnosis and treatment.

Assessment of Depression and Suicidal Risk in Patients with Psoriasis Vulgaris: A Hospital Based Observational Study

Tue, 27 May 2025 00:00:00 +0300

Background- Psoriasis which is a chronic inflammatory skin disease with multiple psychiatric comorbidities. However there has been limited evaluation on the aspect of psychiatric illness in chronic dermatological conditions. In this tertiary hospital based study we aim to evaluate the prevalence of depression and suicidality in 50 selected patients suffering from psoriasis vulgaris. Results- We have found through our study that the prevalence of depression was 30% and suicidality was 92% mild, 4% both moderate and severe suicidal risk with rate of depression and suicidality increasing with the increase in PASI score. Conclusion – Through this study we have gather the evidence the commonality of psychiatric comorbidities and the association that it shares with the PASI score among the psoriasis vulgaris patients.

A Comparative Analysis of Two Hypofractionated Palliative Radiotherapy Regimens for Inoperable Metastatic Non-Small Cell Lung Cancer

Tue, 27 May 2025 00:00:00 +0300

Introduction: Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related mortality globally, including in India. Most patients present with advanced-stage disease, often experiencing severe, quality-of-life-limiting symptoms. Palliative radiotherapy plays a vital role in symptom management for these patients. This study aims to evaluate the effectiveness of a high-dose, weekly palliative radiotherapy regimen compared to the standard palliative schedule. Methodology: This prospective randomized control trial was conducted from July 2023 to July 2024, involving 50 patients with biopsy-confirmed NSCLC. Patients were randomized into two treatment arms: Arm A received 21 Gy in 3 fractions (one fraction per week, 25 patients), while Arm B received the standard 30 Gy in 10 fractions over two weeks (25 patients). Symptom assessment was performed using the EORTC QLQ-LC13 questionnaire before treatment, immediately after completion, and at 1 and 3 months post-treatment. Results: Overall, there was no significant difference in symptomatic relief between the two arms. Patient-reported outcomes at the end of treatment were comparable, with no significant differences in palliation of cough, dyspnea, or other symptoms, except for pain, which was statistically improved in Arm A (p = 0.021). At the 1-month follow-up, no significant differences were observed across parameters, while at 3 months, cough relief remained better in Arm B (p = 0.021), with other symptoms showing no significant difference. Conclusion: The hypofractionated regimen of 21 Gy in 3 weekly fractions offers comparable symptomatic relief to the standard 30 Gy in 10 fractions regimen, making it a viable, shorter treatment option for patients with advanced NSCLC and thoracic symptoms.

Klebsiella pneumoniae Isolated from Splenic abscess of a patient with autoimmune haemolytic anaemia: A Case Report

Priya Dharsini S, Dr. Nishanthy.M, Dr. R. Vasanthi — Tue, 27 May 2025 00:00:00 +0300

Splenic abscesses may be solitary or multiple and are unusual infections. Signs and symptoms are variable and do not always include left upper quadrant pain or tenderness, as the Case Report illustrate. Abscesses of the spleen may occur because of endocarditis or from hematogenous seeding from a distant focus of infection. Computed tomographic scan of the spleen is the diagnostic method of choice. We report a case of Splenic abscess caused by Klebsiella pneumoniae from a Patient who was diagnosed with splenic abscess and underwent splenectomy for the same.

Association of Thyroid Profile in Chronic Liver Disease: A Cross-Sectional Study at a Tertiary Care Center in Bareilly

Tue, 27 May 2025 00:00:00 +0300

Background: Chronic liver disease (CLD) significantly impacts thyroid hormone metabolism. The interplay between hepatic dysfunction and thyroid abnormalities can affect prognosis. Aim: To assess the thyroid profile in patients with CLD and correlate thyroid function with liver disease severity. Methods: This cross-sectional study included 94 CLD patients. Thyroid function tests (T3, T4, TSH) and liver function tests were analyzed. Child-Pugh scores were calculated to grade disease severity. Results: A significant proportion of patients showed altered thyroid profiles, with low T3 syndrome being the most common abnormality. T3 levels inversely correlated with Child-Pugh scores, indicating that thyroid dysfunction worsened with liver disease progression. Conclusion: Thyroid dysfunction, particularly low T3 syndrome, is common in CLD and correlates with disease severity. Routine thyroid evaluation in CLD patients may improve clinical outcomes.

Serum Homocysteine as a Prognostic Marker in Liver Cirrhosis

Tue, 27 May 2025 00:00:00 +0300

Background: Liver cirrhosis is a global health burden with significant diagnostic and prognostic challenges. Serum homocysteine, a sulfur-containing amino acid, is increasingly recognized as a marker of endothelial dysfunction and liver impairment. Aims: This study aims to investigate serum homocysteine levels as a prognostic indicator in liver cirrhosis. Methods: A cross-sectional analysis of 50 patients was conducted, showing a strong correlation of homocysteine with MELD and CTP scores. Results: These findings suggest serum homocysteine as a valuable prognostic biomarker in liver cirrhosis. Conclusion: Serum homocysteine levels show a significant correlation with the severity of liver cirrhosis. As a non-invasive marker, it holds promise for prognostication in cirrhotic patients. Future longitudinal studies are warranted to further validate its utility.

A Study on the Pattern of Traumatic Faciomaxillary Fractures and Their Management

Dr. Monjita Borthakur, Dr. Smrity Rupa Borah Dutta — Tue, 27 May 2025 00:00:00 +0300

The most frequent life-threatening emergency in both industrialized and developing countries is a faciomaxillary injury, which accounts for 7.4–8.7% of emergency medical care. These injuries not only cause functional derangement but also cause face disfigurement, which can result in psychological stress. Aim: To study the pattern of faciomaxillary fractures and their management in trauma cases. Methodology: The study was conducted on 120 patients with traumatic Faciomaxillary fracture over a one-year period. Data regarding patient particulars, cause, site of fracture, and management were recorded, and statistical analysis was done. Results: Out of the 120 patients, the commonest fracture was found to be nasal bone (33%), with male preponderance (82%) in the age group of young adults (63%). Most common cause found was RTA (51%). Open reduction was done for fracture mandible and middle third of face. Discussion: Demographic distribution, cause, management and complications of faciomaxillary fractures were compared to previous studies. Nasal bone has been found to be most commonly affected. 35% of patients needed open reduction. Conclusion: The authorities should be made aware of the need to enforce strict traffic laws due to the rising number of traffic accidents.

Assessing Patient Satisfaction with enhanced Recovery Surgery Protocol in Elective Cesarean Sections (CS) Deliveries

Tue, 27 May 2025 00:00:00 +0300

This study aimed to explore patient satisfaction associated with the implementation ofEnhanced Recovery after Surgery (ERAS) protocols in women undergoing elective Cesarean Sections (CS).

TO EXAMINE THE DISTRIBUTION OF CAESAREAN DELIVERIES USING THE ROBSON TEN GROUP CLASSIFICATION SYSTEM (RTGCS)

Tue, 27 May 2025 00:00:00 +0300

Caesarean section is a major surgery that comes with risks for both mothers andbabies, both in the short and long term. Over the past few decades, the number of caesarean births has increased dramatically

Prevention of Early Onset Preeclampsia with Aspirin 150mg

Savita Namdev Kamble, Yuga Mohan Jamdade, Karthik K.M — Wed, 16 Apr 2025 00:00:00 +0300

Background: Objectives: To study efficacy of aspirin 150 mg for prevention of early onset preeclampsia and to study maternal and fetal outcome. Methods: Hospital based interventional, case-control and prospective study. Study was carried out in tertiary health care center. Pregnant women between 12 to 20 weeks gestation with high risk for preeclampsia were included in the study. Results: Low dose aspirin reduces the incidence of early onset preeclampsia and its severity. Total 34% reduction was seen in the study. The treatment did not hamper the onset of spontaneous labour. Aspirin therapy reduced the incidence of caesarean section by better utero placental blood-flow and reduced IUGR. Conclusion: Aspirin acts as a prophylactic by preventing preterm preeclampsia and severe forms of preeclampsia. The maternal outcome is improved because the risk of severe preeclampsia, APH, PPH and caesarean section is reduced. The fetal outcome is improved in terms of birth weight, reduction in preterm deliveries & IUGR.

Characterisation of Vaccinium Sect.Cyanococcus Mediated Synthesis of Hafnium Oxide Snanoparticles and its Cytotoxic Effect against Fibroblast Cell Line

Dr. Surabhi, Dr. Rajesh Kumar.S — Tue, 27 May 2025 00:00:00 +0300

Introduction Green synthesized Hafnium oxide nanoparticles (HfONPs) can be prepared for various other applications to address oral health concerns like bacterial infections and inflammation. Hafnium oxide nanoparticles exert their antimicrobial, anti-inflammatory and antioxidant effects through mechanisms like producing reactive oxygen species and direct interaction with microbial cells. Aim The present research article describes the anti-microbial, anti-inflammatory and antioxidant activity of green synthesised of Hafnium oxide nanoparticles (HfONPs) using Vaccinium sect.cyanococcus extract. Materials and Methods The Vaccinium sect. Cyanococcus mediated Hafnium oxide nanoparticles were developed and tested for various applications.These Hafnium oxide nanoparticles were characterized using UV-visible spectroscopy and Scanning electron microscopy.The antimicrobial activity of HfONPs was assessed using Mueller hinton agar plates. The anti-oxidant was evaluated using 2,2-diphenyl-1-picryl hydrazyl (DPPH), hydrogen peroxide (H2O2) assay methods. The anti-inflammatory activity was determined through the egg albumin denaturation method, the bovine serum albumin denaturation method, and the membrane stabilization assay. Results The present study gave insight about the anti-inflammatory, antioxidant and antimicrobial activity. There was a positive outcome when testing for Antimicrobial activity showing maximum zone of inhibition in C.albicans. Conclusion The green synthesised hafnium oxide nanoparticles using Vaccinium sect.cyanococcus showed an excellent antimicrobial, anti-inflammatory and antioxidant activity suggesting its potential for oral application and other inflammatory conditions.

Comparative Study between Continuous Epidural Analgesia and Continuous Femoral Nerve Blockade for Pain Relief Following Total Knee Replacement Surgery

Shilpi Vishnoi, Aditi Bharat Jain, Ashok Hirabhai Patel — Tue, 27 May 2025 00:00:00 +0300

Background: Total knee replacement surgery (TKR) is one of the most painful orthopaedic procedures, mandating effective postoperative pain management. Traditionally postoperative analgesia following TKR is provided by intravenous patient controlled analgesia, epidural analgesia and peripheral nerve blocks. Femoral nerve blockade is good analgesia method. Aim and Objectives: To compare VAS scores at different time intervals, requirement of rescue analgesics and incidence of postoperative side effects or complications related to these techniques in postoperative period. Methodology: A prospective observational study and done in Department of Anaesthesia at Sterling Hospital, Ahmadabad Gujarat over a period of six month (April 2017 to September 2017). Total 60 patients of age 50-75 yrs, ASA grade I and II undergoing for total knee replacement surgery were included in the study. Results: Analysis revealed that there was significant difference observed in VAS scores between both groups. When ANOVA test was applied in two time interval ( first 6 hrs and after 6 hrs ) mean of VAS scores in group F is greater than group E before 6 hrs and in 6 to 48 hrs mean VAS scores of group E is more than group F. In three time interval ( 1 to 6 hrs, 6 to 24 hrs, 24 to 48 hrs) ANOVA test mean VAS score of group F more than group E in 1 to 6 hrs and 6 to 24 hrs while in 24 to 48 hrs mean VAS score of group E more than group F. VAS scores of one time interval are compared with VAS scores of other two time interval in post hoc test. The difference is significant at the .05 level. So VAS scores in one time interval is significantly different from other two time intervals. Need of rescue analgesia were more in patient of group F in 1-6 hrs. Incidence of hypotension, nausea and vomiting were not statistically significant in group E and group F. Conclusion: Analysis revealed that there was significant difference observed in VAS scores between both groups. Epidural analgesia was found to be superior than continuous femoral blockade in pain relief in first 6 hrs. Need of rescue analgesia were more in patient of femoral nerve block in first six hours.

Antibiotic Resistance in WHO Priority Bacteria: South-East Asia’s Looming Crisis

Viqar Agha, Mohini Chaurasi, Zeeshan Fatima — Tue, 27 May 2025 00:00:00 +0300

One of the biggest concerns to world health is still antimicrobial resistance (AMR), which disproportionately affects South and Southeast Asian nations. According to latest WHO research, bacterial AMR is projected to be responsible for approximately 5 million fatalities per year by 2025. Self-medication, illogical antibiotic usage, inadequate sanitation, and unregulated antibiotic use in the poultry, aquaculture, and agricultural sectors all contribute to the acceleration of resistance in these areas. Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Gram-positive Staphylococcus aureus are among the resistant Gram-negative pathogens that represent a serious threat, according to the World Health Organization's 2024 edition of the Global Priority Pathogens List (GPP). GLASS, the World Health Organization's Global Antimicrobial Resistance and Use Surveillance System has expanded to over 130 countries by 2024, with enhanced modules to monitor antimicrobial use and resistance patterns in real time. Southeast Asia remains a high-risk zone for the appearance and dissemination of multidrug-resistant organisms, including carbapenem-resistant Enterobacteriaceae and colistin-resistant Acinetobacter species, with increasing detection of resistance genes such as blaNDM-5 and mcr variants. This review highlights the evolving resistance trends in South and Southeast Asia, focusing on high-priority pathogens and their mechanisms of resistance—such as efflux pumps, target modification, and enzymatic degradation. The abstract concludes by stressing the importance of coordinated surveillance, antimicrobial stewardship, cross-border collaboration, and One Health strategies to effectively curb the spread of resistance and safeguard future treatment efficacy.

Postoperative Complications in the Early Phase Following Laparotomy and Ileostomy for Ileal Perforation

Thu, 29 May 2025 00:00:00 +0300

Objective: To explore the early postoperative challenges faced by 100 patients undergoing laparotomy and ileostomy for ileal perforation. Study Design: A prospective study Duration and place of study: this study was conducted in Mekran Medical College Kech Turbat Pakistan from January 2024 to January 2025 Methodology: The present study is a descriptive study. We enrolled 100 consecutive adult patients diagnosed with peritonitis secondary to ileal perforation. Following general anesthesia, all underwent midline laparotomy with loop ileostomy formation. Patients were monitored for stoma-related and general postoperative complications. Outcomes were assessed at two weeks post-surgery. Results: Just over half of the cohort (52%) experienced at least one ileostomy-related complication. Wound infection topped the list (n=20; 20%), closely followed by peristomal skin excoriation (n=15; 15%). Wound dehiscence occurred in 12 patients (12%), and stoma retraction in 7 (7%). Notably, stoma-related fluid losses led to electrolyte imbalances in 18% (n=18), contributing to additional morbidity. No mortalities were recorded within the two-week follow-up. Conclusions: More than half of patients with ileal perforation managed by laparotomy and ileostomy face stoma-specific complications early in their recovery, with wound infection and fluid-loss–related electrolyte disturbances being most prevalent. Vigilant stoma care and proactive fluid-electrolyte management are critical to reducing these burdens and improving short-term outcomes.

A Comparative Study of Early Versus Delayed Cholecystectomy among Patients with Mild to Moderate Acute Gallstone Pancreatitis

Thu, 29 May 2025 00:00:00 +0300

Objective: The current study aims to compare the early cholecystectomy outcomes with delayed cholecystectomy outcomes in cases involving mild to moderate acute gallstone pancreatitis (AGP). Study Design: Observational Studies Place and Duration: This study was conducted at, Makran Medical college, Turbat Pakistan for a period of 1 year from January 2024 date to January 2025. Methods: The research comprised a total of 54 participants with mild to moderate AGP. The study allocated patients into two categories in a random manner: one group of patients had early cholecystectomy (n=27), and the other experienced delayed cholecystectomy (n=27). Laparoscopic cholecystectomy was performed on the Early Cholecystectomy (EC) group during the initial hospitalization, while surgery was performed on the Delayed Cholecystectomy (DC) group four weeks after they were discharged. Data on surgery duration, conversion rates, complications, hospital stay, and recurrent biliary events were collected. Results: For the EC group, the median time to surgery was 6 days, but for the DC group, it was 30 days. The conversion rate of DC group and EC group to open surgery was 7.4% and 11.1%, respectively (p=0.6841). There were 25.9% perioperative complications in the EC group compared to 14.8% in the DC group (p=0.3155). The DC group had significantly higher recurrent biliary events (29.6%, p=0.0003). There was no mortality observed in either group. Conclusion: For individuals with mild to moderate AGP, early cholecystectomy decreases the incidence of recurrent biliary events more than delayed cholecystectomy. This finding is supported by the benefits of early intervention along with a need for further studies to verify long term outcomes.

Assessing the Diagnostic Effectiveness of Appendicitis Scoring Systems: A Comparative Analysis with Histopathology as the Reference Standard

Thu, 29 May 2025 00:00:00 +0300

Background: The most common reason for acute severe abdominal pain that requires surgery is acute appendicitis, which may be challenging to diagnose because of unusual symptoms, especially in young patients, the elderly, and fertile women. Although imaging techniques such as CT and ultrasound enhance diagnostic accuracy, they are not universally available, particularly in settings where resources are less, and may lead to delays or unnecessary operations. In aiding early diagnosis from clinical and laboratory findings, some clinical scoring systems have been devised in response, such as the Alvarado, Ohmann, RIPASA, Tzanakis, and Eskelinen scores. In a bid to enhance diagnostic efficacy and reduce morbidity, the current study compares various scoring systems to identify which is best adapted for use during emergency cases. Objective: To compare various scoring systems such as RIPASA, Alvarado, Tzanakis, Ohmann, and Eskelinen for identifying which is best adapted to use during emergency cases. Duration and place of study: This study was conducted in Suleman Roshan Medical College Hospital Tando Adam Pakistan from January 2023 to December 2023 Methodology: 120 ASA I–II status patients with presumed acute appendicitis aged between 20 and 60 years are selected for this comparative study. Patients were recruited after taking informed consent and ethical clearance. Patients were subjected to imaging, laboratory assessment, clinical assessment, and the use of five scoring diagnostic grading systems. All underwent surgery that was histopathologically confirmed. Standard statistical tests were employed while analyzing the data in SPSS Version 23 for assessing the diagnostic accuracy of each scoring system. Results: There were a total of 120 patients involved in this study. All the people who were a part of this study were aged from 20 years to 60 years. The mean age calculated was 32.5 years. The females included in this study were representing 55.8% of the total population. The remaining 44.2% were males. The highest sensitivity as well as specificity was shown in the RIPASA score. Moreover, the highest positive predictive value and highest accuracy was also shown in the RIPASA score. The positive appendectomy group had 78 cases while the negative appendectomy group had 42 cases. There was no significant difference seen in gender distribution (p=0.422). Conclusion: This research highlights the RIPASA and Ohmann scores as the most accurate diagnostic tools for acute appendicitis, with the highest sensitivity and specificity of the score systems evaluated.

Comparative Analysis of Direct Pressure and Electrocauterization Techniques for Hemorrhage Control in the Liver Bed during Laparoscopic Cholecystectomy

Thu, 29 May 2025 00:00:00 +0300

Background: Gallstones affect a significant percentage of the population, and the gold standard treatment is laparoscopic cholecystectomy. Hemorrhage, however, is a frequent complication, and bleeding from the liver bed is difficult to control. This study compares two hemostatic methods—direct pressure with a hot sponge and electrocauterization—to control hemorrhage from laparoscopic cholecystectomy. Direct pressure is 83% effective and electrocauterization is 65% effective according to previous studies. Objective: To compare and evaluate the effectiveness of electrocauterization and direct pressure in managing intraoperative bleeding and postoperative pain. Study Design: A descriptive study Duration and place of study: This study was conducted in Gulam Muhammad Mahar Medical College Hospital Sukkur from December 2023 to December 2024 Methodology: 100 patients with ultrasound-proven cholelithiasis, ranging from 12 to 70 years, underwent laparoscopic cholecystectomy. Patients were randomly allocated in two groups: Group B received monopolar electrocauterization, while Group A received direct gauze compression to manage liver bed hemorrhage. Gallbladder fossa intraoperative bleeding was the primary outcome, and postoperative bleeding and pain were measured using the visual analogue scale at 6, 12, and 24 hours. Results: There were a total of 100 participants of this study. All the people in this study were equally divided into 2 groups (50 in each group). The average age calculated was 40.39 for Group A and 42.22 for Group B. There were a total of 22 males and 78 females overall in this study. Bleeding during surgery was secured in 86% cases (n=43). Conclusion: In laparoscopic cholecystectomy, electrocauterization is more effective than direct pressure in achieving haemostasis in the presence of liver bed.

Preoperative and Operative Risk Factors Associated with the Conversion of Laparoscopic Cholecystectomy to Open Surgery

Thu, 29 May 2025 00:00:00 +0300

Background: Although laparoscopic cholecystectomy (LC) is the standard treatment for gallbladder disease, some cases still require conversion to open cholecystectomy (OC). Identifying risk factors for conversion can improve surgical outcomes and decision-making. Study Design: A prospective study Duration and place of study: This study was conducted in Liaquat University of Medical and Health Sciences Jamshoro Pakistan from December 2023 to December 2024 Methods:A prospective study was conducted, involving 200 patients who underwent LC. Patients were grouped based on whether conversion to OC occurred. Clinical and operative factors were analyzed using SPSS v26.0, with p<0.05 considered statistically significant. Results : The conversion rate was 7.78%. Significant risk factors included age ≥65, obesity, diabetes, and prior abdominal surgery. Elevated ALP, bilirubin, dilated CBD, and multiple gallstones on ultrasound were also associated with higher conversion risk. Intraoperative findings such as dense adhesions, empyema, perforated, and scleroatrophic gallbladder were linked to conversion. Preoperative ERCP showed no significant association. Conclusion:While LC remains the preferred approach, OC is a necessary and safe option in complex cases. Recognizing risk factors early can help anticipate the need for conversion and guide operative planning.

A Comparative Evaluation of Direct Pressure and Electrocautery Techniques for Hemorrhage Management in the Liver Bed during Laparoscopic Cholecystectomy

Thu, 29 May 2025 00:00:00 +0300

Background Gallstone disease is highly prevalent, with laparoscopic cholecystectomy (LC) being the standard treatment. Bleeding from the liver bed is a common intraoperative challenge, typically managed by direct pressure or electrocauterization. Objective To compare direct pressure and electrocauterization for liver bed hemostasis during LC, assessing intraoperative bleeding, postoperative bleeding, and pain. Study Design: randomized controlled trial Duration and place of study: This study was conducted in Peoples University of Medical and Health Sciences Nawabshah from July 2023 to July 2024 Methodology This randomized controlled trial conducted at our hospital. A total of 100 patients included in the study were divided into two groups: Group A (n=50) received gauze pressure, and Group B (n=50) received electrocauterization. Bleeding control and pain scores at 12 and 24 hours postoperatively were recorded. Results Mean ages were 40.5 ± 12.4 years (Group A) and 42.3 ± 10.5 years (Group B). Bleeding control was successful in 86% of Group A and 95% of Group B (p = 0.008). Group A had lower pain scores at both 12 and 24 hours (p = 0.0001). Conclusion Electrocauterization offers superior bleeding control, while direct pressure is associated with reduced postoperative pain.

Effects of Metformin on the Bioactivity and Osseointegration of Dental Implants

Thu, 29 May 2025 00:00:00 +0300

Background: Metformin is known to benefit bone remodeling and increase osteoblast activity, thus it may have some medicinal value in dentistry. This study aimed to analyze its influence on the osseointegration of dental implants. Objective: To assess the impact of metformin in boosting the bioactivity, osseointegration, and efficacy of dental implants. Methods: This study was a randomized, double blinded, placebo controlled trial conducted on 100 patients aged 25-60 years scheduled for dental implants. Patients received either metabolic adjunct (500mg, twice daily) or placebo for 12 weeks. Assessment of the implants stability, bone density, and activity if osteoprogenitor cells was done at the baseline, 6 weeks, and 12 weeks after implant placement. Results: Patients in the Metformin group showed improved stability of the implants, osteoblast activity, and bone density as compared to the control group. Bone formation and maturation around the implants was also better in patients on Metformin. Conclusion: Metformin increases the bioactivity and osseointegration of the dental implants therefore may be considered an adjunctive therapy for improving the success rate of implants and bone healing in dental patients.

Epidemiology and Antibiotic Resistance Pattern of Prosthetic Joint Infections: A Cross-Sectional Study

T. Ashita Singh, K. Jaya Krishna Singh — Thu, 29 May 2025 00:00:00 +0300

Background: One of the most dangerous side effects after joint arthroplasty is prosthetic joint infections (PJIs), which raise morbidity, hospital stays, and medical expenses. Optimising empirical therapy requires an understanding of epidemiology and trends in antimicrobial resistance (AMR). Objectives: To evaluate the demographic profile, microbiological etiology, and antimicrobial resistance patterns among patients with PJIs. Methods: This cross-sectional study included 98 patients diagnosed with PJIs at MediCiti Institute of Medical Sciences, Medchal, from January 2024 to December 2024. Microbiological cultures were performed, and isolates were tested for antimicrobial susceptibility. Results: The mean age was 64.5 ± 10.3 years, with a male-to-female ratio of 1.4:1. The most commonly infected joint was the knee (58.2%), followed by the hip (35.7%). The leading causative organisms were Staphylococcus aureus (43.9%, of which 58.1% were MRSA), Coagulase-negative staphylococci (CoNS, 26.5%), and Gram-negative bacilli (21.4%). High resistance was observed to penicillin (87.2%) and ciprofloxacin (69.2%), while linezolid and vancomycin retained good activity. Among Gram-negatives, Pseudomonas aeruginosa and Klebsiella pneumoniae showed high resistance to cephalosporins and fluoroquinolones. Conclusion: PJIs at our institution are predominantly caused by Gram-positive cocci, particularly MRSA and CoNS, with worrying antimicrobial resistance trends. Routine local surveillance and antibiotic stewardship are essential to guide empirical therapy.

Comparative Study of Electrocardiographic and Echocardiographic Evidence of Left Ventricular Hypertrophy in Post COVID Hypertensive patients

Dr. Aditya Patidar, Dr. Aditya Patidar, Dr. Asrar Ahmed, Dr. Rajendra Dhar — Tue, 27 May 2025 00:00:00 +0300

Background: COVID-19 has harmed cardiovascular health, especially hypertensives. Left ventricular hypertrophy (LVH) by chronic hypertension raises cardiovascular risk. Aim: To compare ECG LVH criteria for diagnosing LVH in post-COVID hypertensive patients using ECHO as the gold standard. Materials and Methods: This 12-month observational comparison was done in NIMS Jaipur's General Medicine Department. Written informed consent was obtained from all 80 purposive sampled participants. Left ventricular hypertrophy (LVH) was diagnosed using the Sokolow-Lyon Index and Cornell Voltage Criteria on ECG and ECHO. Age, sex, residence, family history of hypertension, and duration of hypertension for known patients were obtained using a pre-designed questionnaire. Echocardiography verified LVH after ECG. Materials: Our study comprised 80 hypertensives, 52.5% of whom were men. The average age was 56.36 ± 12.35 years, and the average duration of hypertension was 4.57 ± 4.75 years. The average pulse rate was 78 ± 9.46 beats/minute, with systolic and diastolic blood pressures of 135 ± 17.46 and 86 ± 11.43 mmHg, respectively 7.5% had newly diagnosed hypertension, 42.4% family history. Using Sokolow-Lyon criteria, ECG sensitivity and specificity for LVH diagnosis were 46.6% and 98.6%, with a PPV of 96.4% and an NPV of 70.5%. Cornell Voltage criterion yielded 40.1% sensitivity, 94.9% specificity, 86.0% PPV, and 67.3% NPV. Using both ECG criteria increased sensitivity to 53.0%, specificity to 94.9%, PPV to 87.9%, and NPV to 76.0%. Conclusion: Cornell Voltage criteria had 40.1% ECG sensitivity for left ventricular hypertrophy (LVH) and Sokolow-Lyon criteria 46.6%. Using both criterion increases sensitivity to 53.0%. High specificity (>95%) for both criteria. Due to its low sensitivity, ECG cannot screen post-COVID hypertensives for LVH.

Evaluating Pulmonary Artery Measurements in Pulmonary Hypertension Patients Secondary to Interstitial Lung Disease Using Computed Tomography

Dr Govind Grewal, Dr R.P. Bansal, Dr Prasad Hegde, Dr Hiteshi Goyal — Tue, 27 May 2025 00:00:00 +0300

Background: Pulmonary hypertension (PH) is a common complication of interstitial lung disease (ILD), associated with increased morbidity and mortality. Computed tomography (CT) provides a non-invasive method to assess pulmonary artery (PA) enlargement, which may correlate with PH. Objectives: To evaluate the utility of CT-derived PA diameter measurements in predicting PH in ILD patients.Methods: An observations assessment of 48 ILD patients who underwent CT and right heart catheterization (RHC) was conducted. The main PA diameter (MPAD), PA-to-aorta ratio (PA/A) and right ventricular (RV) dimensions were measured. PH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg on RHC.Results: PH was present in 62.5% (n=30) of patients. MPAD ≥29 mm had 83.3% sensitivity and 72.2% specificity for PH detection (AUC=0.82, p<0.001). The PA/A ratio ≥1.0 showed 76.7% sensitivity and 77.8% specificity (AUC=0.79, p=0.002). RV hypertrophy was more prevalent in PH-positive patients (p=0.01).Conclusion: CT-measured PA enlargement correlates with PH in ILD patients, supporting its role as a non-invasive screening tool.

Tension-Band Wiring For Transverse Fractures of the Patella, Olecranon and Medial Malleolus: A Prospective Single-Centre Study

Dr.Vinay B Patil, Dr Eshwar Masgal, Dr Vijayakumar — Fri, 30 May 2025 00:00:00 +0300

Background Transverse fractures of the patella, olecranon and medial malleolus threaten joint mechanics and daily function. Tension-band wiring (TBW) converts distracting tensile forces into compression and permits early motion, but contemporary prospective data across the three sites are sparse. Methods Fifty skeletally mature patients with acute, closed transverse fractures (patella 25, olecranon 20, and medial malleolus 5) were enrolled at a tertiary trauma unit (May 2023 – Oct 2024). All fractures were stabilised with AO-standard TBW and followed for 18 months. Functional outcomes were assessed serially with Gaur’s Knee Score, Mayo Elbow Performance Score (MEPS) or the AOFAS Ankle-Hind-foot Scale. Union was graded radiographically. Complications and re-operations were recorded. Results Mean age was 38 ± 14 years; 56 % were male. Union was achieved in 48/50 fractures (96 %) with a median time to radiological union of 11 weeks (IQR 10–13) (Figure 2). At 18 months, 88 % of knees demonstrated excellent–good knee-ROM scores, 91 % of elbows scored ≥ 75 on MEPS, and 80 % of ankles scored ≥ 90 on the AOFAS scale (Table 2-4; Figure 1). Quadriceps wasting, power loss and extension lag all improved steadily over each review point. Complications included two painless wire breakages and two non-unions (one patella, one olecranon) managed by revision plating; there were no deep infections or implant migrations. Conclusion TBW provided reliable union, high functional scores and a low complication burden across three anatomically distinct peri-articular fracture sites. Its simplicity, cost-effectiveness and allowance for early mobilisation make it a valuable primary fixation method, particularly in resource-constrained settings.

An Observational Study to Evaluate the Antibiotic Prescribing Pattern Using Who Access, Watch, Reserve (Aware) Criteria Among Pediatric Patients Admitted In Intensive Care Unit At Sir Padampat Institute Of Neonatology & Paediatric Health, Jaipur

Fri, 30 May 2025 00:00:00 +0300

Background: Escalating antimicrobial resistance (AMR) threatens the effectiveness of life saving antibiotics, particularly in low and middle income countries. The World Health Organization (WHO) introduced the Access, Watch, Reserve (AWaRe) framework to monitor and optimise antibiotic use. Robust paediatric data remain scarce, especially for Indian intensive care settings. Methods: We performed a descriptive, hospital based observational study of consecutive new admissions to the Paediatric Intensive Care Unit (PICU) and Neonatal Intensive Care Unit (NICU) at Sir Padampat Institute of Neonatology & Paediatric Health (SPINPH), Jaipur. All children receiving at least one antibiotic were enrolled until the target sample of 400 was achieved (95 % CI, 10 % relative error). Prescriptions were analysed for drug, dose and adherence to Standard Treatment Guidelines (STG, 6th edition). Each molecule was mapped to the WHO AWaRe list (2021). Primary outcomes were the proportions of antibiotics in the Access, Watch and Reserve groups. Secondary outcomes included adverse drug reaction (ADR) incidence and culture-confirmed resistance patterns. Data were summarised as means ± SD or proportions; χ² and paired t tests were applied as appropriate. Results: A total of 400 children (male: female = 2.1: 1; mean age 2.6 ± 3.6 years) received 838 antibiotic (mean 2.09 ± 0.63 per encounter). Watch agents predominated (65.2 %), surpassing Access (32.5 %) and Reserve (2.4 %) drugs (Figure 1). Amikacin (Access) was most frequent (22.7 % of all prescriptions), whereas cefotaxime and vancomycin led the Watch category (19.3 % and 16.0 %, respectively) (Figure 2). Ninety-seven per cent of agents were on the Indian Essential Medicines List and were prescribed generically. Adherence to STG exceeded 85 % for nine major drugs but fell below 60 % for azithromycin, aztreonam, linezolid and teicoplanin. Culture results were available for only 4.8 % of cases, isolating Pseudomonas spp. (32 %), Acinetobacter spp. and E. coli (each 21 %). ADRs occurred in 5 % of children, mostly mild, with no fatalities. Conclusion: Two-thirds of antibiotic use in this ICU/NICU cohort derived from the Watch group, underscoring an urgent stewardship need to shift prescribing towards Access agents. Limited microbiological testing hampers rational escalation/de escalation. Implementing real-time culture surveillance and AWaRe-based feedback could curb unnecessary exposure to broad-spectrum antibiotics and mitigate AMR.

An Observational Study for the Assessment of Adverse Drug Reactions of Platinum Based Chemotherapy in Cancer Patients at Sms Hospital, Jaipur

Dr. Ashish Sharma, Dr. Sushil Sharma, Dr. Charu Jain — Fri, 30 May 2025 00:00:00 +0300

Background: Platinum analogues—cisplatin, carboplatin and oxaliplatin—are the cornerstone of many solid tumour regimens but are limited by a broad spectrum of adverse drug reactions (ADRs). Robust Indian pharmacovigilance data in real world oncology settings remain scarce. Methods: We conducted a hospital based, prospective, descriptive observational study (April 2023 – March 2024) among 100 consecutive adult and paediatric cancer patients who developed at least one ADR while receiving a platinum agent in the Department of Medical Oncology, SMS Hospital, Jaipur. ADRs were characterised and uploaded to VigiFlow. Causality (WHO UMC), severity (modified Hartwig–Siegel) and preventability (modified Schumock–Thornton) were assessed; outcomes and seriousness were recorded. Results: A total of 467 ADRs were documented (median 4, IQR 3–6 per patient). Central nervous system manifestations predominated (35.8 %), followed by haematological (26.6 %) and gastrointestinal (19.5 %) systems. Nausea (14.8 %), vomiting (10.1 %), anaemia (13.1 %) and alopecia (6.9 %) were most frequent. Carboplatin was the most commonly used agent (57 % of patients) yet showed no statistically significant difference in ADR profile versus cisplatin or oxaliplatin (p > 0.3 for all comparisons). WHO UMC categorised 96.2 % of ADRs as possible and 3.8 % as probable. Severity was predominantly moderate (60.8 %); no life threatening reactions were observed. Almost half of all ADRs (49.0 %) were definitely preventable. All events were either recovering (68 %) or recovered (32 %) at last contact; none were fatal. Conclusion: Platinum chemotherapy produces a predictable but largely preventable burden of predominantly moderate ADRs in Indian oncology practice. Systematic monitoring, timely supportive care and proactive patient counselling can mitigate toxicity and optimise treatment continuity.

To Study the Functional Outcome in Patients of Lateral Epicondylitis Treated with Platelet Rich Plasma

Mohd.Rizwan Khan, Nazim Mughal, Ajay Srivastav, Vinay Agarwal, Rav, Vidit — Sat, 31 May 2025 00:00:00 +0300

Background: Lateral epicondylitis, commonly known as tennis elbow, is characterized by inflammation of the common extensor tendon near the lateral epicondyle of the forearm, leading to persistent elbow pain. It affects approximately 1-3% of the population, particularly in individuals with occupations involving repetitive forearm movements such as construction, gardening, and computing. Traditionally treated with corticosteroid injections, new treatment options like platelet-rich plasma (PRP) have gained attention due to their regenerative properties, promoting tissue repair and healing. Objectives: This study aimed to evaluate the effectiveness of PRP injections in treating lateral epicondylitis by assessing pain reduction, wrist extensor strength, and functionality. Methodology: This randomized controlled trial was conducted at a tertiary care hospital over 12 months. A total of 50 participants with lateral epicondylitis were randomly assigned to receive either a PRP injection or a placebo saline injection. Participants were assessed at baseline, 4, 8, and 12 weeks post-treatment using DASH and VAS scores to measure pain and functionality. Data were analyzed using SPSS software with inferential statistics such as paired t-tests and ANOVA. Results: The study revealed a predominant age group of 31-40 years (44%) and a male majority (56%). Participants had a mean symptom duration of 5.2 ± 1.8 months. Baseline VAS and DASH scores indicated moderate to severe pain and disability. Post-treatment, significant reductions in pain (VAS) and disability (DASH) scores were observed, with VAS scores decreasing from 78.6 at baseline to 42.3, 24.7, and 18.2 at 4, 8, and 12 weeks, respectively (p < 0.001). Similarly, DASH scores improved from 64.3 to 45.2, 32.8, and 22.5 over the same period (p < 0.001). Pain relief was more pronounced in higher socioeconomic groups, with the upper and upper-middle classes showing significant improvement. Conclusion: PRP injections led to significant improvements in both pain and disability scores in patients with lateral epicondylitis, indicating their efficacy as a treatment option. The study also highlighted the role of socioeconomic status in treatment outcomes, with higher socioeconomic groups experiencing greater pain relief. Overall, PRP therapy demonstrates substantial benefits in managing lateral epicondylitis, providing a viable alternative to traditional treatments like corticosteroid injections.

Evaluation of Blood Parameters in Vitamin B12-Deficient Pediatric and Adolescent Patients

Ronuque Hussain, Saier Hussain, Arif Khan, Arbaj khan — Sat, 31 May 2025 00:00:00 +0300

Background: In India, megaloblastic anemia caused by vitamin B12 deficiency is aleading cause of nutritional anemia among children. Objectives: To evaluate thehematological profile of vitamin B12-deficient children and adolescents aged 1 to 18years.

Evaluation of Metabolic Parameters in Diabetic Patients With and Without Nephropathy

Ronuque Hussain, Saier Hussain, Arif Khan, Arbaj khan — Sat, 31 May 2025 00:00:00 +0300

Background: Diabetes mellitus (DM) is a chronic metabolic disorder characterized byhyperglycemia resulting from impaired insulin secretion, insulin action, or both. The interplaybetween glucose metabolism and lipid homeostasis plays a critical role in the onset and progressionof diabetic complications, particularly diabetic nephropathy

Examine the Relationship between Proinflammatory Cytokines and Breast Cancer

Samia Rashid, Dr Mehak Fatima — Mon, 02 Jun 2025 00:00:00 +0300

Breast cancer is a complicated illness marked by long-lasting inflammation. Tumor development and progression depend critically on proinflammatory cytokines. Knowing how proinflammatory cytokines interact with breast cancer will shed light on the etiologic factors of the disorder and possible therapeutic targets. Objective: This research sought to investigate how breast cancer related to proinflammatory cytokines. Methods: This quantitative study employed a case-control design. Sample size consisted of 100 healthy controls patients and 100 breast cancer patients aged 25 to 60 years. Using ELISA, serum samples from participants were examined for proinflammatory cytokines (IL-6, TNF-α, IL-1β). Statistical Analysis was performed using SPSS Independent t-test and Pearson correlation. Results: Breast cancer patients had proinflammatory cytokines (IL-6, TNF-“, IL-1²), which was significantly higher than healthy (P <0.001). Cytokine levels and tumor stage were positively correlated (r = 0.456, p <0.001). Conclusion: This research shows a clear link between breast cancer and proinflammatory cytokines. High levels of proinflammatory cytokines could aid in tumor growth and progression. A possible therapeutic approach for breast cancer therapy targeting these cytokines may be found in targeting them.

Assessment of Hearing in Patients with Allergic Rhinitis

Dr Simran Kaur, Dr Amit Modwal, Dr Neeti Sahay, Dr Porshia Rishi — Mon, 02 Jun 2025 00:00:00 +0300

Aim: The aim of the present study was to evaluate the type and extent of hearing loss among AR patients and assess the association between allergic markers and audiological findings. Methods: A cross-sectional observational study was conducted on 100 patients diagnosed clinically with allergic rhinitis. Detailed ENT examinations including otoscopy and Pure Tone Audiometry (PTA) were performed. Laboratory investigations included serum IgE, absolute eosinophil count (AEC), total leukocyte count (TLC), and relative eosinophil percentage. Data were statistically analyzed using chi-square and t-tests, with p < 0.05 considered significant. Results: Among 100 patients, 60% were male and 40% female, with a mean age of 28.3 ± 9.2 years. Conductive hearing loss was observed in 54 patients (54%), sensorineural hearing loss in 12 patients (12%), and mixed hearing loss in 6 patients (6%), while 28% had normal hearing. PTA revealed significantly elevated thresholds at low frequencies (250–500 Hz) in patients with middle ear effusion (p = 0.001). Otoscopic findings showed retracted tympanic membranes and dullness in 42% of patients. Serum IgE levels were elevated (>100 IU/mL) in 78% of patients, with a statistically significant correlation between high IgE levels and presence of hearing loss (p = 0.002). Similarly, patients with AEC > 500 cells/mm³ were more likely to have abnormal audiometric findings (p = 0.01). Conclusion: This study establishes a clear link between allergic rhinitis and hearing impairment, predominantly conductive in nature due to Eustachian tube dysfunction. A significant correlation was noted between elevated IgE and eosinophil counts and auditory deficits. Routine audiological assessment should be an integral part of AR management to enable early intervention and prevent long-term hearing complications.

Comparison of Endoscopic Sliced Cartilage versus Temporalis Fascia Grafting For Tympanic Membrane Perforations

Dr Alok Yadav, Dr Ritesh Surana, Dr Neeti Sahay, Dr Samanvaya Soni — Mon, 02 Jun 2025 00:00:00 +0300

Aim: The aim of the present study was to compare endoscopic sliced cartilage versus temporalis fascia grafting for tympanic membrane perforations. Methods: A prospective comparative study was conducted involving 100 patients with central tympanic membrane perforations. Patients were divided into two groups: one receiving endoscopically placed sliced tragal cartilage grafts, and the other receiving temporalis fascia grafts. Surgeries were performed under endoscopic guidance. Postoperative follow-up was carried out for three to six months. Results: The cartilage graft group demonstrated a higher graft uptake success rate of 92%, compared to 85% in the temporalis fascia group. This difference was statistically significant (p < 0.05). Audiological outcomes were similar between both groups, with an average ABG closure of 12–15 dB. While both grafts provided effective hearing restoration, cartilage exhibited superior durability and resistance to retraction, especially in patients with Eustachian tube dysfunction, anterior perforations, or recurrent ear infections. Conclusion: Endoscopic sliced cartilage tympanoplasty offers superior anatomical success compared to temporalis fascia, with comparable functional (audiological) outcomes. It is especially beneficial in high-risk cases, such as large, anterior, or recurrent perforations, and in patients with poor middle ear ventilation. While temporalis fascia remains a reliable option in straightforward cases, cartilage should be the preferred graft in complex tympanoplasties. Tailoring the graft material to the patient’s middle ear condition and perforation characteristics is crucial for optimizing surgical success.

Identification of Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates by Conventional Methods and Determination of Their Minimum Inhibitory Concentrations Using VITEK 2: A Prospective Observational Study

Dr. T likhita, Dr. V. Sarojamma, Dr. R. Hymavathi — Tue, 03 Jun 2025 00:00:00 +0300

Background: MRSA represents a central global contributor to hospital- and community-acquired infections because it produces severe healthcare complications that result in numerous deaths. The main component creating resistance in MRSA is the mecA gene that generates penicillin-binding protein PBP2a/PBP2 through its coding function. Effectual infection control requires immediate identification of MRSA with accurate results to determine proper therapeutic approaches plus prevent spread of multidrug-resistance. Methods: A six-month prospective observational research determined its findings. Biochemical tests identified 314 S. aureus isolates that researchers obtained from different clinical specimens. The testing laboratory performed cefoxitin (30 µg) disc diffusion assays using Mueller–Hinton agar with 2% NaCl enhancement to evaluate all obtained isolates. Additionally they used mannitol salt agar-Ceinasefoxitin (MSA-CFOX) containing 8 mg/L of the antibiotic. VITEK 2 automated system tested the minimum inhibitory concentrations (MIC) values for the identified MRSA isolates after the confirmation step. The lab designation of MRSA required either cefoxitin inhibition zones equal to or less than 21 mm and MIC values at or above 4 µg/mL. Results: Among 314 S. aureus isolates, cefoxitin disc diffusion found 90 cases of MRSA corresponding to 29% of these strains. MSA-CFOX detected 96 potential MRSA isolates based on its results (31%) yet six of these cases turned out to be incorrect due to MIC values which failed to meet the MRSA threshold. The laboratory confirmed 29% of MRSA cases through VITEK 2 testing. The results from cefoxitin disc diffusion tests match closely with VITEK 2 readings which show the validity of disc diffusion testing for MRSA identification but users need to recognize that MSA-CFOX may produce false-positive results in select cases. Conclusion:Definitive MRSA isolate identification uses Cefoxitin disc diffusion together with the VITEK 2 system for accurate MIC value determination in a cost-efficient manner. Therapeutic decision support along with suitable infection control protocols depend on proper identification timing and accurate MIC measurement.

Clinical outcomes of combined laparoscopic abscess drainage and appendicectomy in the management of appendicular abscess

Dr. Abhinav Puri, Dr. Rishab Sharma, Dr. Anil Kumar Mongia — Sat, 31 May 2025 00:00:00 +0300

Background: Appendicular abscess frequently arises as a complication of acute appendicitis,typically requiring surgical treatment. This research assesses the clinical results of a combinedlaparoscopic technique that includes both abscess drainage and appendicectomy for treatingappendicular abscess.

Prevalence of Vitamin-D- Associated-Gestational Diabetes-Mellitus among Mothers in Third Trimester

Wed, 04 Jun 2025 00:00:00 +0300

OBJECTIVE: This study was aimed to evaluate the association-between-Vit D-deficiency-and risk-of developing GDM-during pregnancy at a tertiary care Hospital. BACKGROUND: In the United States, Gestational diabetes mellitus (GDM) results in complication of 7–14% of gravidities. Another common side effect of pregnancy is vitamin D deficiency. It is unknown, nevertheless, if taking vitamin D supplements can stop GDM. According to recent studies, vitamin D supplementation can improve glucose and insulin tolerance. There is conflicting evidence from observational studies about association between GDM and low serum 25(OH) D levels. METHODOLOGY: A-case-control-study-was carried out at the department-of-Obstetrics & Gynecology, -Jinnah-Hospital, -Lahore from 01-07-2022 to 31-12-2022. Using consecutive sampling method. 122 pregnant females were inducted in the study. All the females aged between 20 to 40 years and parity less than five who presented with gestational age of more than 24 weeks by dating scan were made part of the study. The SPSS version 21 program was used to enter and analyze the data. To test for significance, post-stratification adjusted OR was calculated, with OR>1 being considered significant. RESULTS: In this study, out of 122 cases (61 in each group), 78.68% (n=48) in cases and 77.05 %( n=47) in controls were aged between 20-30 years, whereas 21.32 %( n=13) in cases and 22.95 %( n=14) in controls were aged between 31-40. Vitamin D deficiency in cases was 29.51 %( n=18) in cases and in controls 9.84 %( n=6) whereas. The odds ratio was 3.90 and p value was 0.007. CONCLUSION: This study reached to the conclusion that the risk of gestational diabetes mellitus is greatly increased by vitamin-D- during the third trimester of pregnancy.

MORPHOMETRIC STUDY OF PTERION IN HUMAN SKULLS

Fri, 30 May 2025 00:00:00 +0300

Pterion is a small, H-shaped region located in the temporal fossa on the Normalateralis of the skull, where four bones—frontal, parietal, greater wing ofsphenoid, and squamous part of temporal