International Journal of Research in Medical Sciences

Trends and outcomes of new-onset thrombocytopenia in hospitalized patients: a secondary care center experience

Sat, 31 Oct 2026 00:00:00 +0530

Background: Thrombocytopenia is common among hospitalized patients and is associated with increased morbidity, prolonged hospitalization, and mortality. It may result from infection, sepsis, medications, disseminated intravascular coagulation (DIC), or other acute conditions. However, data on new-onset thrombocytopenia in secondary care hospitals in Saudi Arabia are limited. This study assessed its incidence, severity, etiology, and clinical outcomes in hospitalized adults.

Methods: This retrospective study was conducted at Security Forces Hospital, Makkah, Saudi Arabia, from January 2020 to December 2024. A total of 392 adult inpatients who developed new-onset thrombocytopenia (platelet count <150×10⁹/l) after admission were included using consecutive sampling. Patients with pre-existing thrombocytopenia, hematological malignancies, or recent chemotherapy were excluded. Demographic, clinical, laboratory, and outcome data were extracted from medical records. Thrombocytopenia severity and underlying etiologies were classified according to clinical and laboratory findings.

Results: Sepsis was the leading cause of new-onset thrombocytopenia (34.7%), followed by viral infections (19.6%), drug-induced thrombocytopenia (12.5%), and DIC (11.2%). Severe thrombocytopenia occurred in 26.5% of patients. ICU admission was required in 38.8%, while in-hospital mortality was 21.4%. Mortality was particularly higher among patients with sepsis-related and severe thrombocytopenia, highlighting the prognostic significance of both the underlying cause and degree of platelet reduction.

Conclusions: New-onset thrombocytopenia during hospitalization is associated with substantial morbidity and mortality. Early recognition, close monitoring, and prompt identification of underlying causes may improve outcomes, particularly in resource-limited secondary care settings.

The evaluation of demographic factors, clinicopathological characteristics and plasma D-dimer levels among breast cancer patients

Sat, 31 Oct 2026 00:00:00 +0530

Background: Breast cancer is the most common malignancy among women worldwide. Activation of coagulation and fibrinolysis is linked to tumor progression and metastasis. Plasma D-dimer, a fibrin degradation product, may serve as a biomarker of disease severity in breast cancer. The objectives of the study is to assess the association of plasma D-dimer levels with demographic and clinicopathological characteristics of breast cancer patients.

Methods: This cross-sectional study was conducted in the Department of Pathology, Mymensingh Medical College, from September 2022 to October 2023. Eighty-six histopathologically confirmed breast cancer patients were enrolled. Data were collected using a structured questionnaire. Plasma D-dimer was measured and categorized as elevated or normal by laboratory reference values. Associations were analyzed using Chi-square and ANOVA tests; p<0.05 was considered significant.

Results: Mean age was 49.57±9.96 years; invasive ductal carcinoma predominated (95.3%). Elevated D-dimer was found in 55 (64.0%) patients. Mean D-dimer rose significantly from 0.57±1.08 µg/ml in T1 to 3.47±1.33 µg/ml in T4 tumors (p<0.001), and from 0.57±1.09 µg/ml in N0 to 3.54±1.35 µg/ml in N3 disease (p<0.001). Elevated D-dimer was significantly associated with advanced tumor stage (p=0.00002) and lymph node metastasis (p<0.001), but not with lymphovascular invasion (p=0.158) or histological subtype (p=0.407).

Conclusions: Plasma D-dimer was significantly associated with larger tumor size and greater nodal involvement, suggesting it may be a useful non-invasive biomarker of tumor progression. Larger prospective studies are needed to validate its prognostic value.

Determinants of exclusive breastfeeding among mothers attending postnatal clinic at the University of Benin teaching hospital, Benin City, Nigeria

Sat, 31 Oct 2026 00:00:00 +0530

Background: Exclusive breastfeeding (EBF) provides optimal nutrition and protection against common childhood illnesses. Despite its established benefits, EBF practice remains suboptimal in Nigeria. This study assessed the knowledge and practice of EBF and identified factors associated with its practice among mothers attending a postnatal clinic in Benin City, Nigeria.

Methods: A descriptive cross-sectional study was conducted among 137 mothers attending the postnatal clinic of the University of Benin Teaching Hospital. Data were collected using interviewer-administered questionnaires and analysed using SPSS version 26. Chi-square, Fisher's exact tests and logistic regression were applied, with significance set at p<0.05.

Results: Participants' mean age was 30.06±5.73 years and 94.2% were married. Good EBF knowledge and breastfeeding practice were recorded in 81% and 69%, respectively. Current EBF was reported by 61.3%, while 47.4% initiated breastfeeding within one hour of delivery. Antenatal breastfeeding counselling was received by 85.4%. Partner support and relatives' encouragement were reported by 83.2% and 81.8%, respectively. Breastfeeding challenges affected 56.9%, particularly breast/nipple pain (40.4%), perceived insufficient milk (23.4%) and return to work (12.8%). Good breastfeeding practice was significantly associated with antenatal counselling (p=0.016), EBF knowledge (p=0.006), partner support (p<0.001), relatives' encouragement (p<0.001) and peer practices (p=0.001). Partner support independently predicted good practice (OR=6.569; 95% CI: 4.328–37.951; p=0.008).

Conclusions: Knowledge of EBF was high, but gaps remained in recommended practices. Antenatal counselling and social support, particularly from partners and families, were strongly associated with good breastfeeding practice. Interventions should emphasise sustained counselling, management of breastfeeding difficulties and active family involvement.

Association between periodontal disease severity and glycemic control in patients with type 2 diabetes mellitus

Soumik Barua, Swarabithi Barua, Kawser Taslima Hoque, Mir Abeed Rahman — Sat, 31 Oct 2026 00:00:00 +0530

Background: Type 2 diabetes mellitus is a growing public health problem and is closely linked with several chronic complications, including periodontal disease. Poor glycemic control may increase periodontal tissue destruction, while periodontal inflammation may further worsen metabolic control. The study aimed to assess the association between periodontal disease severity and glycemic control among patients with type 2 diabetes mellitus.

Methods: This analytical cross-sectional study included 140 patients with type 2 diabetes mellitus selected by purposive sampling. The study was conducted at the Outpatient Department of Periodontology, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh, from July 2025 to June 2026. Glycemic control was assessed by HbA1c and periodontal disease severity was evaluated by clinical periodontal examination. Data were analyzed using SPSS version 26.0, applying the Chi-square test and the independent-samples t-test, with p<0.05 considered statistically significant.

Results: Among 140 patients, most were aged 51–60 years (52; 37.1%) and male (82; 58.6%). Poor glycemic control (HbA1c ≥7.0%) was observed in 97 patients (69.3% of patients). Moderate periodontitis was the most common finding, with 57 (40.7%), followed by severe periodontitis, with 52 (37.1%). Patients with poor glycemic control had significantly worse periodontal parameters, including higher probing pocket depth, clinical attachment loss, gingival index, plaque index and missing teeth (p<0.001). Poor glycemic control increased with periodontal disease severity, from 41.9% in mild periodontitis to 68.4% in moderate and 86.5% in severe periodontitis, with a significant association (p<0.001).

Conclusions: Periodontal disease severity was significantly associated with glycemic control among patients with type 2 diabetes mellitus. Poor glycemic control was more frequent in moderate and severe periodontitis, indicating the need for routine periodontal assessment and oral hygiene care in diabetes management.

Association of pro-brain natriuretic peptide with degree of severity and prognostic outcome in patients with acute exacerbation of chronic obstructive pulmonary disease

Sat, 31 Oct 2026 00:00:00 +0530

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major cause of morbidity and mortality. N-terminal pro-brain natriuretic peptide (NT-proBNP) is an established biomarker of heart failure, but its association with AECOPD severity in patients without overt cardiac disease remains unclear. The objective is to assess the association between NT-proBNP levels, disease severity, and prognostic outcomes in patients with AECOPD.

Methods: This cross-sectional study was conducted at the Department of Respiratory Medicine, NIDCH, Dhaka, Bangladesh, from July 2018 to June 2019. Seventy patients with established COPD admitted with acute exacerbation were enrolled through purposive sampling. Demographic and clinical data, SpO₂, arterial blood gas parameters, pulmonary artery systolic pressure (PASP), mMRC dyspnea grade, and NT-proBNP levels were recorded. Data were analyzed using chi-square tests, multivariate logistic regression, and Pearson correlation. Statistical significance was set at p<0.05.

Results: The mean age was 61.77±8.91 years, and 95.7% of participants were male. Elevated NT-proBNP levels were observed in 74.3% of patients. Multivariate logistic regression identified mMRC dyspnea grade as the only independent factor significantly associated with elevated NT-proBNP (OR=7.457, 95% CI: 1.772–31.370; p=0.006). Significant correlations were reported between NT-proBNP and SpO₂, pH, PCO₂, and PO₂. Smoking exposure of 21–30 pack-years was also significantly associated with elevated NT-proBNP (p=0.042).

Conclusions: Elevated NT-proBNP levels were associated with greater dyspnea severity and several respiratory parameters in patients with AECOPD, suggesting potential value in assessing disease severity. Further prospective studies are needed to establish its prognostic utility.

Outcomes of tympanoplasty as a day case surgery under local anesthesia: a prospective study

Sat, 31 Oct 2026 00:00:00 +0530

Background: Tympanoplasty is a commonly performed procedure for the management of chronic tympanic membrane perforations and associated hearing loss. Performing tympanoplasty as a day-case surgery under local anesthesia offers potential advantages, including reduced hospital stay and healthcare costs. This study aimed to evaluate the outcomes of tympanoplasty performed as a day-case procedure under local anesthesia.

Methods: This prospective study was carried out in the Department of Otolaryngology and Head-Neck Surgery at Bangladesh Medical College and Hospital, Dhaka, between January 2008 and September 2008. A total of 100 patients with chronic suppurative otitis media (CSOM), tubo-tympanic type, planned for day-case tympanoplasty under local anesthesia were included in the study. Data analysis was done using SPSS version 26.0.

Results: The study showed that most patients were aged 25–35 years (63.0%), male (58.0%) and from the middle socioeconomic class (78.0%). Postoperatively, hearing improved significantly, with the mean air conduction threshold reducing from 32.4 dB to 16.68 dB. Among successful cases, 91.3% achieved hearing gain, indicating good functional outcomes after tympanoplasty.

Conclusions: Tympanoplasty carried out as a day-case procedure under local anesthesia shows favorable clinical outcomes, with a high rate of graft success and significant improvement in hearing. The technique is generally well tolerated, allowing most patients to be managed on an outpatient basis without requiring hospital admission or general anesthesia. The results of this study suggest that day-case tympanoplasty under local anesthesia is a safe, effective and economical option for carefully selected patients with chronic suppurative otitis media, especially the tubo-tympanic type.

Use of tele-health and telemedicine interventions for the prevention and management of COVID-19: providers' and users' perspective from Nepal

Ramesh Bhatta, Kamal Aryal, Pramod Bhatta, Padam Raj Pant — Sat, 31 Oct 2026 00:00:00 +0530

Background: The COVID-19 pandemic disrupted routine healthcare services worldwide, including in Nepal. To ensure continuity of healthcare delivery during lockdowns and movement restrictions, telemedicine and telehealth services were widely adopted. This study explored the implementation, strengths, challenges, and perceived effectiveness of telemedicine and telehealth interventions for the prevention and management of COVID-19 in Nepal.

Methods: A cross-sectional mixed-methods study was conducted among 10 governmental and non-governmental organizations providing telemedicine services. Data were collected from 15 purposively selected healthcare providers and 20 randomly selected service users using semi-structured interviews, structured questionnaires, observation checklists, and record reviews. Quantitative data were analyzed descriptively, while qualitative data were analyzed using thematic analysis.

Results: Telemedicine ensured continuity of healthcare services through telephone calls, text messaging, video consultations, hotlines, and social media platforms. Participants reported improved access to healthcare, timely referrals, follow-up services, reliable health information, psychosocial support, and reduced travel-related costs. Service users expressed positive perceptions regarding the accessibility, affordability, and convenience of telemedicine services. Major challenges included inadequate patient recording and follow-up systems, shortages of trained personnel, poor internet connectivity, lack of standardized protocols, dependence on donor funding, and limited access in rural areas.

Conclusions: Telemedicine played a critical role in maintaining essential healthcare services during the COVID-19 pandemic in Nepal. Strengthening digital infrastructure, standardized guidelines, patient information systems, sustainable financing, and workforce capacity is essential for integrating telemedicine into routine healthcare and future public health emergency preparedness.

Efficacy of topical glycerin in the management of post-phacoemulsification corneal edema and striations

Palash Barua, Nazmun Nahar, Kaniz Ahmed Shahnaz — Sat, 31 Oct 2026 00:00:00 +0530

Background: Corneal edema and Descemet’s membrane striations are common early complications after phacoemulsification that may delay visual recovery. As hypertonic saline/NaCl may have limited or delayed effects in marked postoperative corneal edema, topical glycerin may serve as a useful hyperosmotic alternative. This study assessed the effectiveness of topical glycerin in post-phacoemulsification corneal edema and striations.

Methods: This prospective observational study was conducted at Medical College for Women and Hospital, Dhaka, Bangladesh and Maleka Eye Hospital, Faridpur, Bangladesh, from January 2024 to February 2026. Sixty patients with corneal edema and Descemet’s membrane striations on postoperative day 1 after phacoemulsification with posterior chamber intraocular lens implantation received topical glycerin and were followed on days 7 and 21. Visual acuity, corneal clarity and the severity of corneal edema and striations were assessed. Data were analyzed using SPSS version 26.

Results: Most patients were aged 60–69 years (41.7%). At baseline, moderate corneal edema and moderate Descemet’s membrane striations were present in 51.7% and 48.3% of patients, respectively. Progressive improvement occurred during follow-up. By day 21, complete resolution was achieved in 63.3% of patients, while 73.3% attained normal to mildly impaired visual acuity (6/6–6/12). Overall, 83.3% responded positively. Diabetes mellitus (p=0.041), grade IV cataract, prolonged surgical time, high phaco energy exposure and severe baseline edema or striations were significantly associated with delayed or incomplete response.

Conclusions: Topical glycerin effectively improved postoperative corneal edema and Descemet’s membrane striations after phacoemulsification, with most patients achieving good recovery within 2 weeks.

Molecular detection of Helicobacter pylori in rapid urease test-negative gastric biopsy samples

Sat, 31 Oct 2026 00:00:00 +0530

Background: Accurate detection of Helicobacter pylori remains challenging in dyspeptic patients because urease-based assays may be negative in low-density or patchy infection. The study aims to evaluate biopsy-based nested PCR targeting the ureA gene for detection of H. pylori, with emphasis on molecular detection among rapid urease test (RUT)-negative gastric biopsies.

Methods: This cross-sectional descriptive study enrolled 130 dyspeptic adults undergoing upper gastrointestinal endoscopy at the Department of Microbiology, Chittagong Medical College, Chattogram, in collaboration with the Department of Gastroenterology, Chittagong Medical College Hospital, over a one-year period from January 2023 to December 2023. Two antral biopsies were collected per patient, one for RUT and one for Nested PCR targeting ureA.

Results: The cohort included 76 males (58.46%) and 54 females (41.54%), with the largest age stratum 20-40 years. Endoscopy was normal in 52 (40.0%) and abnormal in 78 (60.0%), most commonly antral gastritis (31.5%). Nested PCR was positive in 97/130 (74.6%), RUT was positive in 87/130 (66.9%). Among RUT-negative cases (n=43), nested PCR detected H. pylori DNA in 12 (27.9%); among RUT-positive cases (n=87), PCR was positive in 85 (97.7%). RUT and PCR were strongly associated (χ²=74.18, p<0.0001). Using RUT as comparator, PCR Sensitivity was 97.70%, Specificity 72.09%, positive predictive value (PPV) 87.63%, negative predictive value (NPV) 93.94%, accuracy 89.23%.

Conclusions: Nested ureA PCR demonstrated high detection and identification even with infections among RUT-negative biopsies, supporting its adjunct value in tertiary-care workflows.

BDNF Val66Met polymorphism and BDNF levels in obese pregnant women

Aswin Boy Pratama, Yusrawati, Jamsari, Hardisman, Eny Yantri — Sat, 31 Oct 2026 00:00:00 +0530

Background: Maternal obesity is associated with chronic inflammation, oxidative stress, and metabolic alterations that may affect the intrauterine environment. Brain-derived neurotrophic factor (BDNF) plays an essential role in neuronal growth, neurogenesis, differentiation, and synaptic plasticity. The BDNF Val66Met (rs6265) polymorphism is a common genetic variant that may alter activity-dependent BDNF secretion. However, data regarding the distribution of this polymorphism and BDNF levels in obese pregnant women remain limited. The objective is to investigate the distribution of the BDNF Val66Met (rs6265) polymorphism and to determine maternal and umbilical cord blood BDNF levels among obese pregnant women.

Methods: This cross-sectional observational analytical study included 72 full-term obese pregnant women of Minangkabau ethnicity. The BDNF Val66Met polymorphism was analyzed using polymerase chain reaction (PCR), while BDNF concentrations in maternal and umbilical cord blood were measured using enzyme-linked immunosorbent assay (ELISA). Genotype distribution and BDNF concentrations were analyzed descriptively and statistically.

Results: The mutant BDNF Val66Met genotype was identified in 80.6% of the participants. The mean BDNF concentration in umbilical cord blood was 2.36 ng/ml, which was higher than the mean maternal BDNF concentration of 2.04 ng/ml. The findings demonstrated a high prevalence of the BDNF Val66Met mutant genotype and differences in BDNF concentrations between maternal and umbilical cord blood among obese pregnant women.

Conclusions: The BDNF Val66Met polymorphism was frequently observed among obese pregnant women. Umbilical cord blood BDNF concentrations were higher than maternal BDNF concentrations, indicating differences in maternal-fetal BDNF regulation in obese pregnancies. These findings provide insights into the genetic variation and BDNF profile associated with maternal obesity.

The role of sperm chromatin structure assay in improving the diagnosis of male factor infertility in Benin city

James A. Osaikhuwuomwan, Oseihie I. Iribhogbe, Reuben O. Iweka — Sat, 31 Oct 2026 00:00:00 +0530

Background: Male factor infertility accounts for about 30% of infertility cases worldwide. In Nigeria, evaluation relies almost exclusively on seminal fluid analysis (SFA), which does not assess chromatin integrity; up to 15% of men with normal SFA remain sub-fertile from unrecognized chromatin abnormalities. This study aimed to determine the prevalence of abnormal sperm chromatin structure, its relationship with semen parameters, and associated risk factors among male partners of infertile couples in Benin City, using the Sperm Chromatin Structure Assay (SCSA).

Methods: In this cross-sectional study, 120 male partners of infertile couples attending the Infertility Clinic, University of Benin Teaching Hospital from April to July 2026, underwent SFA and SCSA (flow cytometry with acridine orange staining) to determine the DNA Fragmentation Index (DFI). Data were analysed using descriptive statistics, correlation, and logistic regression; p<0.05 was significant.

Results: Mean age was 45.3±8.0 years and mean DFI was 22.4±7.1%. Abnormal DFI (>25%) occurred in 39.2% (95% CI 30.9-48.1%) of participants. DFI correlated negatively with motility, progressive motility, morphology, and vitality (all p<0.05), but not with volume or sperm count. Notably, 21.3% of men with normal SFA had abnormal DFI. Cigarette smoking was the only independent predictor of abnormal DFI (adjusted OR 3.57, p=0.002); no seminal parameter achieved acceptable diagnostic accuracy (AUC≥0.70) as a DFI proxy.

Conclusions: Abnormal sperm chromatin structure is common among Nigerian men with infertility and is incompletely captured by semen analysis alone. SCSA should be incorporated into male infertility evaluation, particularly for semen with low vitality or progressive motility. Also, instructive to prioritize smoking cessation counselling as a modifiable risk factor.

Pre-existing heart failure subtype and in-hospital mortality in liver transplantation: a nationwide analysis

Sat, 31 Oct 2026 00:00:00 +0530

Background: Heart failure (HF) is increasingly encountered in liver transplant candidates, yet the influence of HF phenotype on perioperative outcomes remains unclear. We evaluated the association between pre-existing HF subtype and in-hospital mortality among liver transplant hospitalizations.

Methods: We conducted a retrospective cohort study of the National Inpatient Sample, 2016-2022. Adult liver transplant hospitalizations were stratified into no HF, chronic diastolic HF, and chronic systolic HF (surrogates for HF with preserved and reduced ejection fraction, respectively). The primary outcome was in-hospital mortality; secondary outcomes included acute kidney injury, acute HF, cardiogenic shock, cardiac arrest, discharge disposition, length of stay, and hospital charges. Survey-weighted multivariable logistic regression was adjusted for demographics, comorbidities, and hospital characteristics.

Results: Among 53,910 weighted hospitalizations, 98.1% had no HF, 1.5% had chronic diastolic HF, and 0.4% had chronic systolic HF. Patients with chronic diastolic HF were older with a greater comorbidity burden, including hypertension, diabetes, arrhythmias, and renal failure (all p<0.01). Unadjusted in-hospital mortality was higher in chronic diastolic HF (5.7%) and chronic systolic HF (7.0%) than in no HF (2.9%; p=0.03), as were acute kidney injury, cardiac arrest, length of stay, and charges. After adjustment, neither chronic diastolic HF (adjusted odds ratio 1.6, 95% confidence interval 0.7-3.4) nor chronic systolic HF (2.1, 0.7-6.7) was independently associated with mortality.

Conclusions: Pre-existing HF is associated with worse unadjusted outcomes in liver transplant hospitalizations, but HF subtype is not independently associated with in-hospital mortality after adjustment. Comorbidity burden, rather than HF phenotype, appears to drive mortality risk in this highly selected population.

Clinical outcomes of Ilizarov external fixation in the management of infected tibial non-union: an observational study from Bangladesh

Sat, 31 Oct 2026 00:00:00 +0530

Background: Infected tibial nonunion involves persistent infection, impaired bone biology, mechanical instability, and often bone loss or deformity. Ilizarov fixation enables debridement, stable fixation, compression, and bone transport but may require prolonged treatment and carries frequent complications.

Objective: To evaluate union, infection eradication, Association for the Study and Application of Methods of Ilizarov (ASAMI) outcomes, external fixation duration, and complications following Ilizarov treatment of infected tibial nonunion at a tertiary orthopaedic centre in Bangladesh.

Methods: This observational study reviewed 37 adults treated at the Department of Orthopaedic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, from 1 July 2022 to 31 July 2025. Radical debridement, individualized Ilizarov fixation, and culture-directed antibiotics were used; bone transport was performed when required. Patients were followed for 12 months, with descriptive analysis based on last follow-up data.

Results: Mean age was 33.7±11.4 years; 28 (75.7%) were men. Initial fractures were open in 25 (67.6%), and 15 (40.5%) had bone defects >2 cm. Union occurred in 34 (91.9%) after 5.8±1.4 months, and infection was eradicated in 33 (89.2%). Excellent/good ASAMI bone and functional outcomes occurred in 30 (81.1%) and 32 (86.5%), respectively. Mean external fixation duration was 7.4±1.5 months. Complications occurred in 28 (75.7%); pin-tract infection affected 16 (43.2%). One patient underwent amputation for persistent infection and sepsis.

Conclusion: Ilizarov treatment achieved high observed union, infection eradication, and favourable ASAMI outcomes, but complications and prolonged frame treatment remained substantial.

Completeness of national partogram documentation and intrapartum monitoring at Base Hospital Muthur, Sri Lanka: a retrospective clinical audit

Rajiya Mohamed Muyees, Thayal Nathasha Vitiyala Vidanage — Sat, 31 Oct 2026 00:00:00 +0530

Background: Accurate intrapartum documentation supports continuity of care, recognition of abnormal labour, and timely clinical decision-making. This clinical audit assessed the completeness of partogram documentation and selected maternal and fetal monitoring parameters in a base hospital in Sri Lanka.

Methods: A retrospective clinical audit was conducted using 48 bed-head tickets of women managed in the labour ward of Base Hospital Muthur. Twenty documentation and monitoring criteria were assessed using a structured data-extraction checklist. A tick was coded as documented and an X as not documented. We calculated descriptive statistics at the item and record levels and examined exploratory associations.

Results: The mean maternal age was 25.85 years (standard deviation 5.69; range 17-38). Across 960 item-record observations, 904 were documented, giving an overall completeness of 94.2%. Complete documentation was observed for 10 of the 20 assessed criteria. The main gaps were caput and moulding, each documented in 28/48 records (58.3%), commencement of pushing in 42/48 (87.5%), and vaginal examination at the specified interval in 44/48 (91.7%). Twenty-seven records (56.3%) were complete for all 20 criteria, and 41/48 (85.4%) achieved at least 90% completeness. Caput and moulding accounted for 40/56 (71.4%) of all missing entries.

Conclusions: Partogram-related documentation was generally high, but deficiencies were concentrated in a small number of labour-assessment components, particularly caput and moulding. Targeted reinforcement of these elements, clarification of clinically conditional criteria, and re-audit after corrective measures are recommended.

Evaluation of functional outcome following internal fixation of femoral neck fracture with cannulated cancellous screws: a prospective study from Bangladesh

Sat, 31 Oct 2026 00:00:00 +0530

Background: Femoral neck fracture is a significant cause of morbidity in adults admitted to tertiary care centers in Bangladesh, and internal fixation with cannulated cancellous screws is the preferred head-preserving procedure in physiologically fit patients. This study aimed to assess the functional results, radiological healing, and complication rate of cannulated cancellous screw fixation of femoral neck fractures.

Methods: This concurrent prospective observational study was carried out at the Department of Orthopaedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh, from January 2024 to December 2024, on 45 patients with femoral neck fracture who were treated with closed or open reduction and internal fixation with 3 or 4 cannulated cancellous screws. Demographic, fracture, and operative data were collected, and functional outcome was evaluated at 3, 6, and 12 months after surgery using the Harris Hip Score (HHS). The data were analyzed using SPSS version 26.

Results: The age group 31-40 years was the largest (24.4%), and there was a significant male predominance (71.1%). The most common mechanism of injury was road traffic accidents (53.3%). The most common fracture type was type III (37.8%), and the majority of fractures (86.7%) were closed reduction with anatomical alignment. Radiological union was obtained in 91.1% of patients, avascular necrosis in 11.1%, and shortening of the femur in 15.6%. The percentage of patients with excellent-to-good HHS increased from 22.2% at 3 months to 68.9% at 12 months.

Conclusion: Although early diagnosis, early surgery, and anatomical reduction are key to reducing complications, the union rate and functional recovery are progressive and favorable for femoral neck fractures treated with cannulated cancellous screw fixation.

Conventional risk factors and angiographic profile of young patients with ST-segment elevation myocardial infarction in comparison with older patients

Sat, 31 Oct 2026 00:00:00 +0530

Background: Globally, cardiovascular diseases (CVDs) remain the leading cause of death and have a substantial influence on public health. It has been shown that ischemic heart disease accounts for a larger proportion of deaths among South Asians. Risk factors and angiographic profile differ significantly in young people compared to older patients. The aim of this study was to compare conventional risk factors and angiographic profile between young and older patients with ST-segment elevation myocardial infarction.

Methods: This comparative study was conducted at the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet, from October 2022 to February 2025.

Results: Regarding risk factors for STEMI, Smoking was the most common and significant risk factor in group I patients compared to group II patients (80%vs 62.7%). Compared with group I, group II patients had a significantly higher prevalence of hypertension(28%vs14.7%) and diabetes mellitus (34.7%vs 20.0%). In this study, the mean gensini score of the group I patients were less (27.22±21.20) compared with group II (41.52±30.80). Majority of the patients in group I had significant single vessel disease compared to group II (30.7%vs10.7%) (p<0.05). Patient with group II had statistically significant triple vessel disease than group I (40%vs13.3%) (p<0.05).

Conclusions: Smoking is an important risk factor for development of ST elevation myocardial infarction in young patients, compared to older patients, where diabetes and hypertension were more significant. Young patients mostly present with SVD compared to older patients where multivessel disease were significantly higher.

Comparison of chest X-ray findings in smear-positive and smear-negative patients with pulmonary tuberculosis attending a tertiary care hospital in Bangladesh

Sat, 31 Oct 2026 00:00:00 +0530

Background: Tuberculosis (TB) continues to be a significant public health issue in Bangladesh and a significant number of people with active pulmonary TB (PTB) are sputum smear-negative, making chest radiography an important adjunctive diagnostic tool. The objective of this study was to compare the sociodemographic, clinical and chest radiographic profile of smear-positive and smear-negative PTB patients attending a tertiary care hospital in Bangladesh.

Methods: This descriptive cross-sectional study was conducted at the Department of Medicine in Enam Medical College & Hospital, Dhaka, from January to June 2018 on 100 patients with pulmonary tuberculosis who were equally divided into 50 sputum smear-positive and 50 sputum smear-negative groups according to Ziehl-Neelsen staining. The Chi-square test was used to compare the sociodemographic data, clinical symptoms, erythrocyte sedimentation rate (ESR) and chest radiographic findings between the groups and a p value of less than 0.05 was regarded as statistically significant.

Results: The two groups were mainly male, middle-aged and had no significant sociodemographic differences. Smear-positive patients were significantly more likely to have cough (100.0% vs 72.0%, p=0.001). Smear-positive patients had a higher rate of a raised ESR (>50 mm in the first hour) (50.0% vs 24.0%, p=0.007). Consolidation (56.0% vs 24.0%), inhomogeneous opacity (16.0% vs 4.0%), patchy opacity (32.0% vs 12.0%) and cavitary lesions (54.0% vs 22.0%) were all significantly more common in the smear-positive group (p<0.05), whereas nodular opacity, fibrosis, pleural effusion and collapse did not differ significantly between the groups.

Conclusions: Pulmonary tuberculosis with smear positivity was associated with more frequent cough, raised ESR and consolidation and cavitation on chest radiography, suggesting that chest radiography is complementary to sputum microscopy in the diagnostic evaluation of pulmonary tuberculosis.

Endometrial pathology in abnormal uterine bleeding

Apurva Goje, Shilpa Gupta, Shanu Srivastav — Mon, 05 Oct 2026 00:00:00 +0530

Background: Abnormal uterine bleeding (AUB) is a common gynaecological complaint requiring histopathological evaluation for accurate diagnosis. Histopathological examination remains essential for diagnosing AUB and detecting premalignant and malignant lesions.

Methods: This prospective observational study was conducted in the Department of Pathology, Terna Medical College and Hospital, Navi Mumbai, over a period of two years from August 2022 to August 2024. The study was undertaken to evaluate the histopathological spectrum of endometrial lesions in patients presenting with AUB and to assess their age-wise distribution

Results: A total of 293 endometrial biopsies and hysterectomy specimens from patients presenting with AUB were studied. The majority of patients belonged to the 40-49 years age group (151cases, 51.7%). Non-organic (functional) causes constituted the majority of cases, accounting for 209 cases (71.6%), organic lesions were 83 cases (28.8%). Endometrial polyp was the most common organic lesion, observed in 36 cases (12.3%). Among the non-organic lesions, proliferative phase endometrium was the most common finding, accounting for 64 cases (21.9%). Disordered proliferative endometrium demonstrated a statistically significant association with age distribution (p=0.034), with maximum prevalence in women aged 40-49 years. Endometrial carcinoma showed a significant association with advancing age

Conclusions: The present study demonstrated that non-organic endometrial lesions with the highest incidence observed in the perimenopausal age group (40-49 years). Early detection of premalignant lesions, malignant lesions and helps in guiding appropriate patient management.

Comparison of gestosis score vs uterine artery pulsatility index in predicting hypertensive disorders of pregnancy: a prospective observational study

Sunita Murmu, Milkhe Pavan Ashokrao, Saloni Raman — Thu, 08 Oct 2026 00:00:00 +0530

Background: Hypertensive disorders of pregnancy include conditions such as gestational hypertension, pre-eclampsia, and severe pre-eclampsia. Early prediction and management of these hypertensive disorders are therefore essential to improve health outcomes and reduce pregnancy-related complications. This study aims to compare the predictive performance of the gestosis score and uterine artery pulsatility index for hypertensive disorder of pregnancy, and to evaluate the individual effectiveness of each tool in predicting the severity of these disorders.

Methods: This prospective observational study included 140 pregnant women at 11 to 14 weeks. Participants were stratified into risk groups based on their gestosis score. The uterine artery PI was measured using doppler ultrasound and mean uterine artery PI>95th percentile was classified as high risk. Participants were followed up till delivery to record the occurrence of hypertensive disorders of pregnancy.

Results: Hypertensive disorders of pregnancy affected 34% of participants, with gestational hypertension in 16.4%, preeclampsia in 15.7%, and severe preeclampsia in 2.1%. The gestosis score classified 67.2% study participants as high risk, while uterine artery PI>95th percentile was noted in 37.1% pregnant women. The gestosis score demonstrated a sensitivity of 85.4% and specificity of 75.0% for hypertensive disorders of pregnancy (AUC 0.855), with 91.3% sensitivity for gestational hypertension and 77.2% sensitivity for preeclampsia, and 100% for severe preeclampsia. Uterine artery PI showed a sensitivity of 77.1% and specificity of 83.7% for hypertensive disorders of pregnancy (AUC 0.765), with 91.3% sensitivity for gestational hypertension, 63.6% for preeclampsia, and 66.7% for severe preeclampsia.

Conclusions: The gestosis score, owing to its high sensitivity is a valuable screening tool for HDOP in resource-limited settings. In contrast, UtA-PI offers superior diagnostic accuracy with balanced sensitivity and specificity, making it an effective non-invasive Doppler marker.

Early postoperative serum albumin decline as a predictor of complications following emergency exploratory laparotomy for duodenal perforation

Ranjeet Kumar Rajak, Anil Kumar Kamal, Kumar Gaurav, Madhu — Fri, 16 Oct 2026 00:00:00 +0530

Background: Emergency laparotomy for duodenal perforation carries substantial postoperative morbidity and mortality. Serum albumin falls after surgery because of inflammation-driven suppression of hepatic synthesis, capillary leak, and catabolism. We examined whether early postoperative changes in serum albumin are associated with complications and mortality after emergency surgery for duodenal perforation.

Methods: This single-centre prospective observational study was conducted over 18 months in the Department of General Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India. A total of 125 patients undergoing emergency exploratory laparotomy for duodenal perforation were enrolled. Serum albumin was measured preoperatively and on postoperative days (POD) 2 and 5. The outcomes were surgical site infection (SSI), wound dehiscence, burst abdomen, bile leak, intensive care unit (ICU) requirement, and in-hospital mortality. Albumin was compared across time points and between survivors and non-survivors, and survival was analysed by albumin category (<2.5 versus ≥2.5 g/dl). A p value <0.05 was considered statistically significant.

Results: The mean age was 39.30±12.05 years, and 75 patients (60%) were male. Mean serum albumin was 2.80±1.09 g/dl preoperatively, 2.44±1.09 g/dl on POD 2, and 2.60±1.09 g/dl on POD 5 (repeated-measures ANOVA, p=0.034); the preoperative-to-POD 2 decline of 0.36 g/dl was significant on pairwise comparison (p=0.026). SSI and wound dehiscence each occurred in 66 patients (52.8%), burst abdomen in 38 (30.4%), and bile leak in 12 (9.6%). In-hospital mortality was 9.6% (12/125). Survivors had significantly higher albumin than non-survivors at all three time points (p<0.001). Survival was 100% in patients with albumin ≥2.5 g/dl and 79.3% in those with albumin <2.5 g/dl. In multiple linear regression, only length of hospital stay was an independent predictor of mortality.

Conclusions: Serum albumin fell significantly within 48 hours of emergency laparotomy for duodenal perforation, and low albumin levels, both before and after surgery, were associated with in-hospital mortality. Serial albumin measurement is a simple and inexpensive adjunct for postoperative risk stratification. However, albumin was not an independent predictor of mortality in multivariable analysis, and larger studies are needed to establish the prognostic value of the albumin decline itself.

Assessment of awareness and practice gaps related to antimicrobial resistance among medical practitioners

Ishan Sane, Jessica Gupte, Yogita Karandikar — Mon, 05 Oct 2026 00:00:00 +0530

Background: Antimicrobial resistance (AMR) is a major global health threat driven largely by irrational antibiotic use and inadequate antimicrobial stewardship (AMS). Clinicians play a pivotal role in combating AMR. This study assessed the knowledge, attitudes, and practices (KAP) regarding AMR among doctors in a tertiary care setting in India.

Methods: A cross-sectional study was conducted among 305 medical practitioners from government and private healthcare facilities. Data were collected using a validated, self-administered questionnaire evaluating knowledge, attitudes, and practices related to antibiotic use and AMR. Descriptive statistical analysis was performed.

Results: Overall knowledge and attitudes were satisfactory. Most participants recognized hand hygiene as essential in preventing AMR (95.1%), and 79.3% were aware of hospital AMS programs. However, knowledge gaps existed regarding antibiotic escalation-de-escalation (36.1%) and the WHO AWaRe classification (30.8%). A majority opposed prescribing antibiotics based on patient demand (91.5%) and supported mandatory AMS training (91.8%). While 84.3% reported never prescribing antibiotics due to patient pressure, 66.5% discontinued empiric therapy after negative culture reports.

Conclusions: Despite good knowledge and positive attitudes, gaps persist in stewardship implementation. Strengthening training, diagnostics, and guideline adherence is essential to bridge the knowledge practice gap and address AMR effectively.

Efficacy of prophylactic use of sotalol versus amiodarone in the prevention of new onset post operative atrial fibrillation post off pump coronary artery bypass surgery

Jaistri Jaishankar, Karthik Raman, Siva Muthukumar, Sanjay Theodore — Mon, 19 Oct 2026 00:00:00 +0530

Background: Atrial fibrillation (AF) is one of the most common arrhythmias following cardiac surgery, occurring in 20-40% of cases, and contributes significantly to increased ICU and hospital stay. While studies exist on sotalol and amiodarone individually for preventing new-onset AF post off-pump CABG, no study has directly compared their effectiveness.

Methods: Seventy-two patients undergoing off-pump CABG were randomised equally into two groups of 36. Group A received IV Amiodarone 6 mg/kg 30 minutes pre-incision, continued as oral Amiodarone 200 mg BD for 3 days then 100 mg BD for 2 days postoperatively. Group S received oral Sotalol 80 mg on the morning of surgery, continued at 80 mg BD postoperatively. Included patients had diabetes mellitus, hypertension, and preserved LV systolic function. Exclusion criteria comprised of COPD, CKD, PVD, moderate-to-severe LV dysfunction, emergency surgery, and pre-existing AF.

Results: Post-operative AF (POAF) occurred in 25% of Group A and 27.77% of Group S, with all cases presenting on post-operative day 2. No statistically significant differences were found between groups across heart rate, blood pressure, graft count, inotropic score, ICU stay, hospital stay, or ventilation duration. The only notable difference was cost Rs.170 for amiodarone versus Rs.10 for sotalol favouring sotalol.

Conclusions: Amiodarone and sotalol demonstrated comparable efficacy in preventing POAF following off-pump CABG. A larger study with broader inclusion criteria is recommended to better define the relative effectiveness of both agents.

Beyond radiographic severity: interrelationship of age, foot progression angle and psychological distress with WOMAC outcome in knee osteoarthritis

Aavrati Rastogi, Roop B. Kalia, Anindya Das — Sat, 31 Oct 2026 00:00:00 +0530

Background: Knee osteoarthritis (KOA) is a progressive degenerative joint disorder characterized by chronic pain, functional limitation, and impaired quality of life. Emerging evidence indicates that radiographic severity alone inadequately explains symptom burden, thereby highlighting the contribution of biomechanical and psychosocial determinants to functional disability. The objective is to investigate the interrelationship of age, foot progression angle (FPA), and psychological distress with functional disability measured using the WOMAC Index in patients with knee osteoarthritis.

Methods: A cross-sectional observational study was conducted among 108 patients aged 45–70 years with unilateral or bilateral knee osteoarthritis graded using the Kellgren–Lawrence grading system. Functional disability was evaluated using the WOMAC Index, psychological distress using the PHQ-9 and GAD-7, and resilience using the Brief Resilience Scale. Foot progression angle was assessed during gait analysis. Pearson correlation and multivariate linear regression analyses were performed.

Results: Advancing age and greater deviations in foot progression angle were significantly associated with worsening WOMAC-derived functional disability. Psychological distress exhibited weak-to-moderate positive correlations with WOMAC outcome, whereas resilience demonstrated an inverse relationship. Multivariate regression analysis identified foot progression angle and psychological distress as independent contributors to functional limitation beyond the effects of radiographic severity.

Conclusions: Functional impairment in knee osteoarthritis extends beyond radiographic disease severity and appears to be influenced by gait biomechanics and psychosocial factors. A comprehensive multidimensional assessment may improve individualized rehabilitation and long-term functional outcomes.

Rural–urban differences in disease activity and vitamin D status in ankylosing spondylitis

Sat, 31 Oct 2026 00:00:00 +0530

Background: Vitamin D has important immunomodulatory effects and may influence disease activity in ankylosing spondylitis (AS). Rural–urban differences in sunlight exposure, diet, and healthcare access may affect vitamin D status. This study evaluated the impact of residential background on serum vitamin D levels and disease activity among patients with AS in Northeast India.

Methods: This cross-sectional observational study included 40 consecutive patients fulfilling the ASAS 2009 classification criteria for AS at Assam Medical College and Hospital, Dibrugarh (2024–2025). Serum 25-hydroxyvitamin D [25(OH)D] was measured by enzyme-linked fluorescent assay (ELFA). Disease activity was assessed using BASDAI, ASDAS-ESR, and ASDAS-CRP. Rural and urban groups were compared using the Mann–Whitney U test, and correlations were assessed using Spearman's rank correlation.

Results: The mean age was 41.1±14.1 years, with 55% males; 62.5% were from rural areas. Vitamin D deficiency, insufficiency, and normal levels were observed in 45%, 32.5%, and 22.5% of patients, respectively. Mean serum 25(OH)D levels were similar in rural and urban groups (15.3±5.8 vs. 14.7±6.1 ng/mL; p=0.715). High disease activity (BASDAI ≥4) was present in 76.0% and 80.0% of rural and urban patients, respectively, with no significant differences in BASDAI or ASDAS-ESR scores. Serum vitamin D levels showed significant negative correlations with BASDAI, ASDAS-ESR, ASDAS-CRP, ESR, and CRP (all p<0.001).

Conclusions: Vitamin D deficiency was common and strongly associated with higher disease activity, although no significant rural–urban differences were observed. Routine assessment of vitamin D may be beneficial in patients with AS irrespective of residential background.

Thunderstorm asthma: mechanisms and prevention strategies: a prospective observational study from a tertiary allergy clinic in Eastern India

Gautam Modi — Sat, 31 Oct 2026 00:00:00 +0530

Background: Thunderstorm asthma (TA) is an environmental phenomenon in which specific meteorological conditions convert pollen into respirable allergenic particles, triggering acute asthma exacerbations in sensitised individuals. Although well documented internationally, data from the Indo-Gangetic plain remain limited. The objective of the study is to evaluate the clinico-epidemiological profile, aeroallergen sensitisation patterns, and risk factors associated with thunderstorm-triggered asthma exacerbations in patients attending a tertiary allergy clinic in Patna, and to assess effectiveness of a structured prevention and patient-education strategy.

Methods: This prospective observational study was conducted at Modi Allergy Clinic, Rajendra Nagar, Patna, from March 2025 to March 2026. A total of 135 patients with physician-diagnosed asthma, allergic rhinitis, or symptoms associated with thunderstorms were enrolled. Clinical history, ARIA-based rhinitis grading, skin prick testing, spirometry, peak expiratory flow rate monitoring, and serum total IgE estimation were performed. Thunderstorm-associated exacerbations occurring within 24–48 hours during the pollen season were documented and correlated with sensitisation status. A structured prevention protocol comprising weather/pollen alerts, inhaled corticosteroid optimisation, written asthma action plans, indoor sheltering, air filtration, and mask use was implemented.

Results: Most participants were sensitised to grass and weed pollens. Thunderstorm-associated exacerbations were more frequent among patients with moderate-to-severe allergic rhinitis and grass-pollen sensitisation. The prevention strategy was associated with fewer thunderstorm-related emergency visits and unscheduled exacerbations.

Conclusions: Identification of high-risk patients and pre-season optimisation of controller therapy, combined with early-warning and patient-education strategies, may reduce clinical impact of thunderstorm-triggered asthma in the Indo-Gangetic plain.

AI in patient education: a cross-sectional comparative analysis of patient information guides produced by ChatGPT versus Google Gemini for common haematology conditions

Sat, 31 Oct 2026 00:00:00 +0530

Background: Haematological disorders encompass a diverse range of conditions affecting blood and blood-forming organs. Educating Patients is crucial in managing these disorders, enabling individuals to understand their conditions, associated complications, and preventive measures. As artificial intelligence (AI) continues to progress, chatbots such as ChatGPT (CG) and Google Gemini (GG) offer readily available patient information.

Methods: This cross-sectional comparative study was performed from January 15, 2025, to January 22, 2025. Six haematological conditions were selected. Patient education materials were created using CG (version 4.0) and GG, following standardized prompts. The generated texts were analysed for readability, similarity, and reliability with the use of Flesch-Kincaid Calculator (FKC), Quill Bot Plagiarism Tool (QPT) and Modified DISCERN score, respectively.

Results: The study demonstrated no significant difference between the CG and GG in word count (WC), sentence count (SC), readability score, or reliability score in the statistical evaluation. The CG demonstrated a slightly higher ease-of-understanding score, but this difference was not statistically significant (p=0.175).

Conclusions: AI tools including CG and GG have an important role in educating patients by delivering quick and structured information on haematological conditions. Future studies should explore the role of AI in other medical domains and investigate ways to enhance AI-generated patient education materials.

Monitoring, reporting and causality assessment of adverse drug reactions among admitted adult patients at a tertiary care teaching hospital: a prospective observational study

Sat, 31 Oct 2026 00:00:00 +0530

Background: Adverse drug reactions (ADRs) add avoidably to illness, lengthen hospital stays and cost lives, yet they go under-reported in many wards. We set out to capture and report ADRs in admitted adult patients and to characterise their pattern, causality, severity, preventability and management at a tertiary care teaching hospital.

Methods: Over six months (21 March 2023 to 21 September 2023) we ran a prospective, cross-sectional, observational study based on spontaneous reporting among patients older than 18 years admitted to General Medicine, Surgery, Dermatology and Psychiatry. Suspected reactions were weighed for causality with the World Health Organization-Uppsala Monitoring Centre and Naranjo scales, for severity with the Hartwig and Siegel scale, and for preventability with the Schumock and Thornton criteria. Data were summarised with descriptive statistics and the chi-square test.

Results: Fifty-four ADRs arose in 38 patients across 5192 admissions, an incidence of 1.04 per 100 admissions. Reactions clustered in the 46–60-year age group and were more common in males (35.08%). Predictable type A reactions dominated (88.89%). The endocrine system was affected most often (22.22%), and hypoglycaemia was the single commonest event. Antidiabetics (19.29%) and antibiotics (12.28%) were the drug classes implicated most frequently. On Naranjo assessment the majority were probable (83.33%), and 94.44% were of moderate severity. Stopping the suspected drug (70.37%) was the mainstay of management, and 83.33% of patients improved.

Conclusions: The reactions seen here were largely predictable, moderate and preventable, driven chiefly by polypharmacy and coexisting illness. Disciplined spontaneous reporting and prescriber education are key to safer medicine use.

Diagnostic validity of transvaginal sonography and Doppler in women with abnormal uterine bleeding: predicting diagnosis of adenomyosis and leiomyoma – an observational design

Kalpana Mahadik, Razia Sultana, Shivani Raghuwanshi, Manju Rathi — Sat, 31 Oct 2026 00:00:00 +0530

Background: Adenomyosis and leiomyoma are common structural causes of abnormal uterine bleeding. Conservative or definitive management depends on accurate evaluation. Purpose of the study is to define validity of Morphological Uterus Sonographic Assessment features along with doppler to prognosticate the etiology in a cohort presenting with Abnormal Uterine Bleeding.

Methods: In an observational study carried out in Teaching Hospital 140 women having AUB were enrolled consecutively. All participants underwent Trans-vaginal sonography and Doppler. Histopathology of operated specimens was the reference standard for diagnosis. TVS signs; asymmetrical thickening of myometrium, myometrial cyst, venetian blind shadowing, well-defined hypoechoic mass and edge shadowing were noted. In Doppler, scattered intramural vascularity and peripheral outer feeding vessels were our target features. Diagnostic indices noted and compared using chi-square or Fisher exact test.

Results: 94 women underwent surgery; histopathology confirmed leiomyoma in54.3%, adenomyosis in 26.6%, combined pathology14.9% and normal findings in 4.2%. Age and parity were significantly associated, adenomyosis more in older and multiparous women and leiomyoma in younger and nullipara, (p=0.001 and p=0.014, respectively). TVS demonstrated accuracy of 97.8%, 97.8%, 78.5% in asymmetrical thickening, myometrial cyst and venetian blind shadowing respectively in adenomyosis and 99.2% and 93.5% accuracy in well-defined hypoechoic mass and edge-shadowing for leiomyoma. Doppler vascularity showed sensitivity of 85% in scattered intramural vascularity for adenomyosis and 92.2% peripheral feeding vascularity for leiomyoma.

Conclusions: Near to accurate clinical diagnosis of uterine pathology by MUSA features in TVS and a complemented color Doppler for AUB is the main outcome of this study.

Efficacy of simvastatin with collagen plug and collagen plug alone following bilateral tooth extraction: a comparative study

Sat, 31 Oct 2026 00:00:00 +0530

Background: The healing process of extraction sockets involves a tightly regulated sequence of events, including blood clot formation, angiogenesis, inflammation resolution, granulation tissue maturation, osteoid deposition, and finally mineralized bone formation. The aim of the study is to evaluate the efficacy of simvastatin with collagen plug and collagen plug alone in healing of an extraction socket.

Methods: A total of 30 patients were scheduled for bilateral extractions in two sessions, with 1 week interval in between. The extraction on either side will be divided into two groups: GROUP A sockets were filled with simvastatin with collagen plug and closure was done using 3-0 silk sutures. GROUP B sockets were filled with collagen plug alone and closure was done using 3- 0 silk sutures. The patients were assessed for bone density, post-operative pain, swelling, soft tissue healing in extraction sockets of the two groups.

Results: Radiographic bone density at three months favored the simvastatin-augmented sites markedly. Group A exhibited a greater numerical reduction in pain by one week, though differences did not reach statistical significance. Objective measures of facial swelling were minimal and equivalent between groups at baseline, 24 hours, and one week. Soft tissue healing scores at 24 hours and one week were similar, with no significant between-group differences. Conclusions: Simvastatin offers a bioactive alternative or adjunct to conventional socket preservation techniques such as collagen plugs, mineralized bone allografts, and PRF.

Skin staples versus skin sutures for skin closure in elective and emergency abdominal surgeries: a prospective comparative study

Pavan Kumar Adivishnu, Rajashekara Babu Gangappa, Sunil Kumar Kola — Sat, 31 Oct 2026 00:00:00 +0530

Background: Skin closure influences operative time, postoperative pain, wound healing, surgical site infection (SSI) and cosmetic outcome. This study compared skin staples with conventional skin sutures in elective and emergency abdominal surgeries.

Methods: In this prospective comparative study, 97 adults undergoing abdominal surgery were enrolled: 49 received metallic skin staples and 48 received conventional non-absorbable interrupted skin sutures. The primary outcome was skin closure time. Secondary outcomes were Visual Analog Scale (VAS) pain scores, SSI, wound dehiscence, Vancouver Scar Scale score at three months and time to removal of closure material.

Results: Skin closure time was shorter with staples than sutures (3.2±0.8 vs. 9.6±1.9 minutes; p<0.001). Pain scores were lower with staples at 24 hours, postoperative day 3 and postoperative day 7. SSI occurred in 12.2% versus 20.8% and wound dehiscence in 4.1% versus 10.4%, in the staple and suture groups, respectively. Cosmetic scores were higher with staples (8.6±1.1 vs. 7.8±1.3; p=0.01) and removal occurred earlier (8.1±1.2 vs. 9.4±1.5 days; p=0.004).

Conclusions: Metallic skin staples reduced closure time and postoperative pain and produced better cosmetic outcomes without increasing wound-related complications. They are a safe and efficient alternative to conventional skin sutures for abdominal wound closure.

Clinical use of formoterol–budesonide through nebulization in asthma management: a nationwide survey of Indian pulmonologists

Nitinkumar S. Doshi, Sri Krishna Natarajan, Kunal Khobragade — Sat, 31 Oct 2026 00:00:00 +0530

Background: Asthma is a chronic inflammatory airway disease associated with substantial morbidity and impaired quality of life. Although inhaled corticosteroid (ICS) and long-acting beta-2 agonist (LABA) combinations remain the cornerstone of therapy, use of nebulized Formoterol–Budesonide (FB) respules may provide an effective alternative for patients with poor inhaler coordination, acute exacerbations, or difficulty using handheld devices.

Methods: A nationwide, cross-sectional, questionnaire-based survey was conducted among pulmonologists across India from September 2025 to October 2025. A structured 20-item multiple-choice questionnaire was distributed to pulmonologists through a secure online platform. Data were analyzed using descriptive statistics and expressed as frequencies and percentages.

Results: A total of 358 pulmonologists participated. FB respules were prescribed frequently by 58.66% and occasionally by 33.80% of respondents. Moderate-to-severe asthma was the most common indication (42.74%). Therapy was utilized in both acute exacerbation and maintenance settings by 39.66% of respondents. Clinical efficacy was rated as excellent or good by 94.69%, while 87.15% observed improved symptom control compared with conventional inhalers. Rapid symptom relief within 30 minutes was reported by 87.15% of pulmonologists. Better or improved patient adherence was noted by 92.18%, and 85.47% reported reduced oral corticosteroid requirements. Overall tolerability was favorable in 96.09% of responses.

Conclusions: Nebulized Formoterol–Budesonide are widely used by Indian pulmonologists and are perceived as an effective, well-tolerated, and adherence-friendly therapeutic option for asthma management across acute and maintenance settings.

Comparative evaluation of waist-to-height ratio and body mass index as predictors of cardiovascular risk among urban adults in Hyderabad, Telangana: a cross-sectional study

Sat, 31 Oct 2026 00:00:00 +0530

Background: Obesity is an important modifiable determinant of cardiovascular disease. Body mass index (BMI), although widely used, does not adequately reflect abdominal adiposity. Waist-to-height ratio (WHtR) may provide a simple alternative for identifying individuals with increased cardiometabolic risk. The aim of the study is to compare WHtR and BMI as predictors of cardiovascular risk among urban adults in Hyderabad, Telangana.

Methods: This cross-sectional study included 70 adults aged 18-60 years. Anthropometric parameters, blood pressure, fasting plasma glucose, and lipid profile were assessed. BMI and WHtR were calculated using standard formulae. Cardiovascular risk was assessed based on the presence of cardiometabolic abnormalities. Receiver operating characteristic (ROC) analysis was performed to compare the discriminatory ability of BMI and WHtR.

Results: The mean age was 41.6±10.8 years. Elevated WHtR (≥0.50) was observed in 45 (64.3%) participants, while 39 (55.7%) had BMI ≥25 kg/m². Participants with elevated WHtR demonstrated a greater burden of hypertension, dysglycemia, and dyslipidaemia. WHtR showed a higher area under the ROC curve than BMI (0.82 vs 0.71) for identifying increased cardiovascular risk.

Conclusions: WHtR demonstrated better discriminatory ability than BMI for identifying cardiovascular risk and may serve as a simple screening measure in urban Indian adults.

Assessment of quality of life in patients with trigeminal neuralgia receiving pregabalin as add-on therapy to carbamazepine

Arvind Narwat, Anjali Sindhu — Sat, 31 Oct 2026 00:00:00 +0530

Background: Trigeminal neuralgia significantly affects patients’ quality of life due to recurrent, severe pain. This study aimed to compare the quality of life in patients with trigeminal neuralgia receiving pregabalin as add-on therapy to carbamazepine.

Methods: A prospective, open-label, randomized comparative study was conducted on 50 patients from November 2015 to September 2016. The patients were divided into two groups (n=25 each) and treated for 12 weeks. Group I received carbamazepine 200 mg/day, titrated up to 1000 mg/day, while Group II received pregabalin 75 mg OD plus carbamazepine 200 mg/day, with pregabalin titrated up to 300 mg/day. Quality of life was assessed using PDI at weeks 4, 8 and 12.

Results: Intragroup analysis showed a statistically significant reduction in mean PDI scores (p<0.05) from baseline at 4, 8, and 12 weeks in both groups, indicating improved quality of life. Intergroup analysis showed no significant difference at 4 weeks (p=0.15), whereas pregabalin added to carbamazepine produced significantly better quality of life at 8 and 12 weeks (p<0.05).

Conclusions: Present study suggested that pregabalin as an add on therapy was found to cause significant improvement in quality of life & reduction in pain scoring at 8^th and 12^th weeks.

A comparative study of cognitive behavioural therapy versus relaxation therapy for fatigue and quality of life among teaching professionals with chronic fatigue syndrome

Urshila Gurung, Rina Kumari, Somesh Raju — Sat, 31 Oct 2026 00:00:00 +0530

Background: Chronic fatigue syndrome (CFS) is a complex and disabling condition characterized by persistent fatigue, cognitive difficulties, impaired functioning, and reduced quality of life. Cognitive Behavioural Therapy (CBT) and Relaxation Therapy (RT) are non-pharmacological approaches that may support symptom management. This study compared the effectiveness of CBT and RT among teaching professionals with CFS.

Methods: A prospective, randomized, comparative interventional study was conducted among 100 teaching professionals diagnosed with CFS. Participants were equally allocated to CBT (n=50) and RT (n=50) groups. Fatigue, psychological distress, functioning, work and social adjustment, and quality of life were assessed using the Fatigue Severity Scale (FSS), Multidimensional Fatigue Inventory (MFI), Short Form-36 (SF-36), Depression Anxiety Stress Scale (DASS), Work and Social Adjustment Scale (WSAS), and WHOQOL. Structured group sessions were conducted for 8 weeks. Pre- and post-intervention outcomes were compared using appropriate statistical tests, with p<0.05 considered significant.

Results: Both groups showed significant improvements in fatigue, psychological distress, physical functioning, work and social adjustment, and quality of life (p<0.001). Post-intervention FSS scores were lower in the CBT group than the RT group (3.67±0.52 vs. 4.70±0.51). SF-36 physical functioning (68.84±7.01 vs. 60.78±7.16) and WHOQOL scores (69.76±5.46 vs. 60.56±5.96) were also higher with CBT (p<0.001).

Conclusion: Both CBT and RT improved psychological well-being, functioning, and quality of life. CBT may be a useful structured supportive intervention for symptom management in appropriately selected teaching professionals with CFS.

Optical coherence tomography-angiography vascular changes in macula following cataract surgery

Sat, 31 Oct 2026 00:00:00 +0530

Background: The study was done to estimate vessel density (VD), perfusion density (PD) and Foveal avascular zone (FAZ) changes in macula after uncomplicated cataract surgery and to compare the same between diabetics and nondiabetics.

Methods: 63 patients who had undergone cataract surgery were included in study, 32 nondiabetics, 31 diabetics. After standard ophthalmic examination, Optical Coherence Tomography-Angiography scans were taken preoperatively & at 3 weeks, 6 weeks and 3 months of postoperative period.

Results: Vessel density and perfusion density values were higher and FAZ values were lower in non-diabetics when compared with diabetics in preoperative and postoperative period. Vessel density and perfusion density increased significantly in both groups at 3 weeks visit but there was no significant increase in following visits. FAZ perimeter and circularity index decreased significantly and FAZ area decreased insignificantly in both groups. The difference in rate of these changes between 2 groups was insignificant.

Conclusions: Similar changes were observed in other studies as well. These changes in our study could be a result of an increase in light exposure after cataract surgery. Although other studies suggest various reasons for this change in their study. Whether these changes are beneficial to macula or worsens DR cannot be concluded with the present study as it requires more studies with larger samples and longer follow-up.

Seropositivity and trends of transfusion transmitted infections among blood donors at blood center of tertiary care hospital of Marathwada region, Maharashtra, India

Ashwini R. Tangde, Vijaya Wane, B. R. Sonwane — Sat, 31 Oct 2026 00:00:00 +0530

Background: Blood transfusion is a life-saving intervention that has an essential role in patient management within health care system. The establishment of systems to ensure that all donated blood screened for transfusion -transmissible infections is a core component of every national blood programme. Testing for TTI’s before blood transfusion is crucial for safety of recipients. with each unit of blood, there is 1% chance of transfusion associated problems including TTI.

The aim of this 5-year retrospective study was to analyze the trend of transfusion transmitted infections among blood donors to evaluate the seroprevalence of HIV, HBV, HCV, syphilis and malaria.

Methods: A retrospective study was done at the blood center over a period of 5 years from January 2020 to December 2024 in healthy donors aged between 18-65 years. TTIs were performed using ELISA for HIV, HBV, HCV and HBsAg, peripheral blood smear for malaria and RPR (Rapid Plasma Reagin) for syphilis.

Results: Out of total 64603 healthy voluntary donors, prevalence of HIV, HBV, HCV, syphilis and malaria was (14) 0.021%, (257) 0.397%, (38) 0.058%, (12) 0.018% and 0 % respectively in our study.

Conclusions: Implementation of strict donor selection criteria along with proper counselling of donors can help to decrease seroprevalence rate of transfusion transmitted diseases. Also, the prevalence rate can be useful for government and health administrative services to implement better policy for safe blood collection and transfusion.

Association of maternal body mass index with maternal comorbidities and perinatal outcomes: a prospective observational study

Anshu Ghosh, Riya Ahirwar, Deepika Jain — Sat, 31 Oct 2026 00:00:00 +0530

Background: Evidence across the maternal body mass index (BMI) spectrum is limited in Central India. We assessed associations between third-trimester maternal BMI and maternal and perinatal outcomes.

Methods: This prospective observational study enrolled 369 women in the third trimester at a tertiary centre in Ujjain and followed them through delivery. Enrolment BMI was classified as underweight, normal, overweight, or obese using prespecified categories. Maternal and perinatal outcomes were compared using chi-square or exact tests.

Results: Among 369 women, 13.3% were underweight, 48.2% had normal BMI, 25.7% were overweight, and 12.7% were obese. Gestational diabetes mellitus increased from 0.0% in underweight and normal groups to 22.1% in overweight and 51.1% in obese women (p<0.001); hypertensive disorders reached 34.0% in obese women (p=0.003). Moderate and severe anaemia were most frequent in underweight women (40.8% and 10.2%; p<0.001). Caesarean delivery increased from 18.4% in underweight to 68.1% in obese women (p<0.001). Low birth weight occurred in 34.7% of neonates born to underweight women; Apgar score <8 and neonatal intensive care admission were most frequent in obese women (17.0% each; p=0.001).

Conclusions: Third-trimester BMI was associated with distinct maternal and perinatal outcome patterns. Higher BMI groups had greater metabolic, hypertensive, operative, and postpartum morbidity, whereas underweight women had more anaemia and low-birth-weight neonates. Antenatal nutritional assessment may help guide targeted maternal and neonatal surveillance.

Evaluation of high-fluorescence lymphocyte count as an early diagnostic marker of dengue infection using the Sysmex XN-350 hematology analyzer

Shivangi Chaudhari, Gautam Chauhan — Sat, 31 Oct 2026 00:00:00 +0530

Background: Dengue is a major mosquito-borne viral infection prevalent in tropical and subtropical regions. Early diagnosis is essential for appropriate patient management. High-Fluorescence Lymphocyte Count (HFLC), generated by Sysmex XN-Series hematology analyzers, may provide additional information about lymphocyte activation during viral infections. The aim is to evaluate HFLC as an early diagnostic marker of dengue infection using the Sysmex XN-350 hematology analyzer.

Methods: This prospective observational case-control study was conducted in the Department of Pathology, GMERS Medical College and Hospital, Gandhinagar, from 1st August 2026 to 31st August 2026. The study included 100 participants, comprising 50 laboratory-confirmed dengue-positive patients and 50 dengue-negative controls. Complete blood count parameters, including hemoglobin, total leukocyte count, platelet count, lymphocyte percentage, and HFLC percentage, were analyzed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: Dengue-positive patients showed significantly lower mean WBC counts (5140±2033.70 vs. 6522±1843.28 cells/µl; p<0.001) and platelet counts (208,340±143,548 vs. 287,680±93,384 cells/µl; p=0.002) than controls. Lymphocyte percentage was significantly higher in dengue-positive patients (40.16±16.93% vs. 29.66±6.06%; p<0.001). Mean HFLC percentage was significantly lower in dengue-positive patients (9.16±7.73% vs. 24.50±14.58%; p<0.001). ROC analysis yielded an AUC of 0.807. At a cutoff of ≤20%, HFLC demonstrated 96.0% sensitivity, 58.0% specificity, 69.6% positive predictive value, and 93.5% negative predictive value.

Conclusions: HFLC may serve as a useful adjunctive screening parameter for suspected dengue infection. However, its moderate specificity necessitates interpretation alongside clinical findings, routine hematological parameters, and established dengue-specific diagnostic tests.

Digital dinacharya and workplace burnout: a cross-sectional analytical study of occupational health

Neha S. Maske, Kirti B. Gaikwad, Meera K. Bhojani — Sat, 31 Oct 2026 00:00:00 +0530

Background: Prolonged screen exposure, after-hours connectivity, and sedentary work are linked to poor sleep and occupational burnout among Indian working professionals. Ayurvedic Dinacharya regulates waking, Vyayama, Bhojana Vidhi, and Nidra Vidhi; however, digital-era disruption of these domains among working adults remains unstudied. This study aimed to assess digital lifestyle behaviours mapped to Dinacharya principles as behavioural markers of Pragyaparadha, in relation to sleep quality and occupational burnout among working adults, and to identify behaviours independently associated with poor sleep and higher burnout.

Methods: A cross-sectional analytical survey (STROBE-reported) was conducted at the All-India Institute of Ayurveda (AIIA), New Delhi, during (January 2026 to July 2026), among 400 working adults aged 25-40 years with ≥1 year of occupational experience. A structured proforma captured sociodemographic details and Dinacharya-mapped digital behaviours across five domains (morning routine, bedtime device use, after-hours connectivity, screen breaks/sedentary time, mealtime practices). Sleep quality and burnout were assessed using the PSQI and Copenhagen burnout inventory.

Results: Of 400 participants, 56.8% had poor sleep quality, 61% personal burnout, and 55.8% work-related burnout. Bedtime device use and inadequate screen breaks/sedentary behaviour independently predicted poor sleep (aOR 1.76 and 1.98). After-hours connectivity, sedentary behaviour, and mealtime digital engagement predicted personal burnout; bedtime device use, sedentary behaviour, mealtime digital engagement, and digital overload predicted work-related burnout (all p<0.05).

Conclusions: Digital lifestyle behaviours reflect patterns of Pragyaparadha in daily digital conduct. Interpreted through Dinacharya and Nidra, the findings support a culturally grounded, preventive Digital Dinacharya framework for digital-era occupational health.

Psychological stress among faculty members of colleges and universities: a survey study

Prabhjot Kaur, Supreet Bindra, Pankajpreet Singh, Sukhpreet Kaur — Sat, 31 Oct 2026 00:00:00 +0530

Background: Psychological stress is a common issue among faculty members due to increasing academic, administrative, and professional responsibilities. Prolonged stress negatively affect mental well-being, job satisfaction, and work performance. Therefore, assessing the level of psychological stress among faculty members is essential for identifying the need for stress-management strategies. This study aimed to evaluate the level of psychological stress among faculty members of colleges and universities.

Methods: A cross-sectional survey was conducted among 101 faculty members from colleges and universities. Participants were recruited using a convenience sampling technique. Data were collected through structured online questionnaire consisting of demographic information and the Perceived Stress Scale (PSS). Descriptive statistics, including frequencies and percentages, were used for data analysis.

Results: A total of 101 faculty members participated in the study. The majority of participants were above 30 years of age (46%), female (64%), worked 40-50 hours per week (41%), and possessed a master's degree (68%). Assessment of stress levels using the perceived stress scale revealed 91% of participants experienced moderate stress, 6% experienced low stress, and 3% experienced high stress. Most respondents reported experiencing stress-related feelings such as being upset unexpectedly, inability to control important things in life, nervousness, and difficulty coping "sometimes," indicating a moderate level of perceived psychological stress.

Conclusions: The findings indicate that psychological stress is prevalent among faculty members of colleges and universities, with moderate stress being the most commonly reported level. These results highlight need for effective stress-management interventions and workplace wellness programs to promote psychological well-being among faculty members.

Clinical and functional outcomes of the double-row suture anchor technique in the surgical treatment of Haglund syndrome: a prospective observational study

Mrinal Kanti Hazra, Aviroop Chakraborty, Amitava Narayan Mukherjee — Sat, 31 Oct 2026 00:00:00 +0530

Background: Haglund syndrome comprises a prominent posterosuperior calcaneal tuberosity, retrocalcaneal bursitis and insertional Achilles tendinopathy. Single-row suture anchor repair, with partial tendon detachment, risks incomplete decompression, recurrence and prolonged protected weight-bearing. Double-row fixation permits complete detachment, thorough debridement and stronger footprint repair; evidence in Haglund syndrome is limited.

Methods: Thirty consecutive patients with Haglund syndrome unresponsive to ≥6 months of conservative treatment underwent exostectomy, bursectomy, Achilles debridement and double-row suture anchor reattachment via a central tendon-splitting approach (March 2022–September 2023). AOFAS, hindfoot functional score (HFS), VAS and VISA-A scores were recorded preoperatively and up to 12 months; Arner–Lindholm criteria were applied at final review. Paired t-tests were used (p<0.05).

Results: Mean age was 36.33±6.19 years (60% male); mean follow-up was 29.97±4.99 months. AOFAS improved from 57.47±3.18 to 86.63±5.66 at 12 months, HFS from 51.70±1.66 to 87.53±2.37 and VISA-A from 51.00±3.12 to 87.40±3.50, while VAS fell from 8.13±0.77 to 2.27±0.45 at 6 months (all p<0.001). Arner–Lindholm outcomes were excellent in 14 (46.7%), good in 11 (36.7%) and poor in 5 (16.7%). Recurrence occurred in 5 (16.7%) and residual heel pain in 6 (20%); there were no wound complications, infections or tendon ruptures.

Conclusions: Double-row suture anchor repair via a central tendon-splitting approach produced significant, sustained improvement in pain and function without wound complications or tendon avulsion, allowing earlier mobilisation. Randomised trials against single-row fixation are needed.

Diagnostic concordance between FNAC and histopathology in salivary gland lesions: a retrospective analysis

Sat, 31 Oct 2026 00:00:00 +0530

Background: Cytological diagnosis of salivary gland lesions is often difficult due to the wide morphological diversity of these tumors, the continual addition of new entities in WHO classifications, and the striking heterogeneity within individual tumors. Moreover, the significant overlap in cytological features between benign and malignant lesions makes accurate distinction and definitive diagnosis particularly challenging.

Methods: This was a retrospective observational study conducted in the Department of Pathology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India. A total 136 Cytology cases and 66 Histopathology cases were retrieved from the Lab Information System and hospital record which were received between July 2022 to June 2026. FNAC and Histopathology slides were reviewed by two pathologists at different time and their diagnoses were correlated and final decision was made by their common consensus.

Result: The findings highlight that salivary gland lesions were most common among young and middle-aged adults, particularly between 20 and 40 years. Submandibular gland was the most frequently involved site and Pleomorphic Adenoma was the most common benign tumour. There were nine discrepant cases between FNAC and histopathology diagnoses highlights the diagnostic challenges in salivary gland lesions.

Conclusion: FNAC continues to serve as a reliable, minimally invasive diagnostic method for salivary gland lesions, showing strong concordance with histopathology in common benign and inflammatory conditions. Nonetheless, discrepancies highlight its limitations in identifying specific tumour subtypes and malignant lesions.

Cognitive abilities and toothbrushing amongst orphans: a kinship in disguise

Sat, 31 Oct 2026 00:00:00 +0530

Background: Oral hygiene practices in children are influenced by their cognitive abilities, particularly sustained attention and working memory. To understand whether these cognitive functions affect oral hygiene outcomes over time may help design better preventive programs in orphanage. To evaluate the correlation between sustained attention, working memory, and oral hygiene status using the oral hygiene index–simplified in children in orphanage.

Method: A cross-sectional observational study was conducted among typically developing children in orphanage aged 9–12 years. Baseline oral hygiene status was recorded by OHI-S index after using disclosing agent at baseline. Sustained attention and working memory were assessed using standardized neurocognitive tools like Stroop test and Corsi block test respectively. All participants received uniform toothbrushing instructions and a standardized brushing kit including toothbrush and toothpaste. Again OHI-S index is assessed after brushing. Data were analyzed using appropriate statistical tests with a significance level of p<0.05.

Results: The sustained attention, working memory, and toothbrushing efficacy increased significantly with age, and an association of sustained attention and working memory was seen with toothbrushing efficacy, irrespective of the child’s age, which was reported using Spearman’s coefficient (p=0.000).

Conclusion: Both sustained attention and working memory significantly increased with age, and were significantly associated with higher toothbrushing efficacy in orphans.

Prevalence and lifestyle correlates of adolescent hypertension in North India: a community and hospital-based cross-sectional study

Sat, 31 Oct 2026 00:00:00 +0530

Background: Adolescent hypertension is an emerging public health concern associated with adult cardiovascular morbidity. Data on adolescent blood pressure and its determinants in rural and semi-urban North India remain limited. This study aimed to determine the prevalence of hypertension and assess its socio-demographic, lifestyle, psychosocial, and anthropometric correlates among adolescents in Sitapur, Uttar Pradesh.

Methods: A cross-sectional observational study was conducted among 387 adolescents aged 10-19 years. Socio-demographic, dietary, physical activity, and psychosocial data were collected using structured questionnaires. Anthropometric indices using WHO BMI-for-age Z-scores were assessed. Blood pressure (BP) was measured using calibrated oscillometric devices and classified per AAP pediatric guidelines. Statistical analysis was performed using IBM SPSS v26.0, employing Chi-square tests for bivariate analysis. A p-value <0.05 was considered significant.

Results: The mean age was 14.48±2.99 years. Overall prevalence of hypertension was 4.9% (19/387), while 9.3% (36/387) exhibited elevated BP. Hypertension occurred exclusively among overweight (9.3%) and obese (24.4%) adolescents (χ²=79.199, p<0.001). Frequent fast-food consumption (p<0.001), daily carbonated drink intake (p<0.001), inadequate physical activity (p<0.001), screen-based sedentary behaviour (p<0.001), tobacco chewing (p<0.001), smoking (p<0.001), positive family history of hypertension (p=0.008), and sleep disturbances (p<0.001) were significantly associated with blood pressure categories.

Conclusions: Hypertension and elevated BP pose a notable burden among adolescents in Sitapur. Adiposity, physical inactivity, screen time, unhealthy diet, family history, and sleep disruption were key determinants. School health screenings and lifestyle modification programs are urgently needed.

Clinicopathological and histopathological spectrum of hysterectomy specimens in autopsy

Krupa Akbari, Ami Jagirdar — Sat, 31 Oct 2026 00:00:00 +0530

Background: This study evaluated the clinicopathological and histopathological spectrum of hysterectomy specimens at autopsy remains the gold standard for identifying the precise cause of death.

Methods: A retrospective observational study of 28 autopsy hysterectomy cases was conducted between 2024- 2026 (2.5 years) at SMIMER Medical College, Surat, Gujarat. Demographic profiles, obstetric characteristics, and histopathological findings were analyzed using descriptive statistics.

Results: The median age was 31.5 years, with 60.7% (n=17) aged >30 years. Maternal deaths accounted for 67.9% (n=19), while 32.1% (n=9) were non-gestational fatalities. Of the maternal deaths, 42.1% (n=8) collapsed antepartum while undelivered. Direct obstetric causes caused 63.2% (n=12) of maternal deaths, primarily driven by obstetric hemorrhage and morbid placental adherence (17.9%, n=5) and hypertensive disorders (14.3%, n=4). Other causes included spinal anesthesia toxicity (7.1%, n=2), sepsis (3.6%, n=1), indirect medical conditions (connective tissue disease, sickle cell crisis), and non-gestational etiologies (poisoning, cervical malignancy).

Conclusions: Preventable complications, predominantly direct obstetric causes (hemorrhage, preeclampsia) remain leading causes of mortality, particularly in women over 30 years. Microscopic evaluation of hysterectomy specimens is crucial for identifying occult pathology and strengthening maternal death audits.

Healthcare-seeking pathways and out-of-pocket expenditure amongst patients attending a tertiary care government medical college in Eastern India

Sat, 31 Oct 2026 00:00:00 +0530

Background: Cancer care imposes substantial financial burden on patients and their families, even when treatment is received at government-funded institutions. This study assessed healthcare-seeking pathways and Out-of-pocket expenditure (OOPE) among cancer patients attending a tertiary care government medical college in Eastern India.

Methods: A hospital-based cross-sectional study was conducted among 200 patients with pathologically confirmed malignancies attending the Department of Radiation Oncology of a tertiary care government medical college in West Bengal between 1^st August, 2024 and 31^st July, 2026. Data were collected using a semi-structured, pre-validated questionnaire, supplemented by clinical and treatment records.

Results: Of the 200 patients, 54% were female and the median age was 56 years. Most patients had a median monthly household income of ₹12,000. Breast cancer was the most common malignancy (30%). Overall, 76% patients reported a direct healthcare pathway. 64% percent of patients were referred outside the study centre, including 54% outside the city and 10% outside the state. The median total OOPE was ₹95,000. OOPE differed significantly according to referral status, with median expenditure increasing from ₹70,000 among non-referred patients to ₹1,00,000 among those referred outside the city and ₹3,00,000 among those referred outside the state (P<0.001). OOPE also different significantly across primary disease groups (P<0.001).

Conclusion: Despite treatment at a tertiary government medical college, cancer patients experience substantial OOPE and financial distress. Strengthening comprehensive surgical, radiotherapy, diagnostic, and supportive cancer services at tertiary government institutions, together with effective financial-risk protection, may help reduce the economic burden on patients and their families.

A study of clinical profile of frailty in elderly patients attending KIMS teaching hospital, Koppal

Srinivasa J., Tamberi Tejaswini, Gavishiddesh V. Ronad, Shivaprasada T. — Sat, 31 Oct 2026 00:00:00 +0530

Background: Frailty is a common geriatric syndrome associated with increased vulnerability to adverse health outcomes. Early identification is important for improving care among elderly populations. Objectives were to assess the clinical profile of frailty and identify factors associated with frailty among elderly patients attending a tertiary care teaching hospital in Koppal, Karnataka.

Methods: This prospective observational study was conducted over 18 months at KIMS Teaching Hospital, Koppal, among 100 patients aged ≥65 years. Frailty was assessed using the Fried frailty phenotype criteria. Demographic, socioeconomic, comorbidity, and functional data were collected and analyzed using descriptive statistics, bivariate analysis, and multinomial logistic regression.

Results: Among participants, 11% were robust, 52% pre-frail, and 37% frail. Frail participants were significantly older (p=0.013), with a higher proportion aged ≥70 years (p=0.008). Weak grip strength (73%) and reduced physical activity (48%) were the most common frailty components. Educational status (p=0.002), living arrangement (p=0.038), and income level (p<0.001) were significantly associated with frailty. Increasing age independently predicted frailty (OR=1.32, p=0.038), while hypertension showed a protective association (OR=0.07, p=0.039).

Conclusions: Frailty and pre-frailty were highly prevalent. Routine frailty screening may support early identification and targeted interventions.

Risk factors associated with urinary tract infection among adult patients attending a tertiary care hospital: a hospital-based cross-sectional study

Sat, 31 Oct 2026 00:00:00 +0530

Background: Urinary tract infection (UTI) is a common bacterial infection associated with significant morbidity. This study aimed to determine the proportion of symptomatic adult patients diagnosed with UTI and identify associated demographic and clinical factors.

Methods: A hospital-based cross-sectional study was conducted among 300 adults. Demographic characteristics, comorbidities, previous UTI, urinary catheterization, recent hospitalization, and urological instrumentation were recorded using a structured proforma. UTI status was assessed using clinical features and urine routine examination, and urine culture was performed for all participants. Associations were assessed using the chi-square test and multivariable logistic regression.

Results: Among 300 participants, 84 (28.0%) had UTI. The mean age was 48.6±16.2 years, and 174 (58.0%) were female. UTI was significantly more frequent among females than males (35.1% vs. 18.3%, p=0.002) and among participants with diabetes mellitus than those without diabetes (41.7% vs. 21.6%, p<0.001). Previous UTI (46.2% vs. 23.0%, p<0.001), urinary catheterization (50.0% vs. 23.2%, p=0.001), and recent urological instrumentation (48.0% vs. 24.0%, p=0.018) were also associated with UTI. Multivariable analysis identified female sex (adjusted odds ratio [aOR] 1.94, 95% CI 1.08-3.48), diabetes mellitus (aOR 2.31, 95% CI 1.32-4.05), previous UTI (aOR 2.76, 95% CI 1.53-4.97), and urinary catheterization (aOR 2.48, 95% CI 1.24-4.96) as independent correlates.

Conclusions: UTI affected 28.0% of participants. Female sex, diabetes mellitus, previous UTI, and urinary catheterization were independently associated with UTI. Identifying high-risk patients may support early diagnosis and preventive strategies.

Knowledge and awareness of chronopharmacology among medical undergraduates in a tertiary care teaching hospital

Sindhuja Pulijala, Sailaxmi Venepally, A. Naga Teja Pavani, Bharath Arakala — Sat, 31 Oct 2026 00:00:00 +0530

Background: Chronopharmacology examines the effect of circadian rhythms on drug response. Optimizing medication timing can improve efficacy and reduce adverse effects, but awareness among medical students remains unclear. This study assessed the knowledge and awareness of chronopharmacology among undergraduate medical students and interns.

Methods: A cross-sectional questionnaire-based study was conducted among MBBS students and interns at KAMSRC. A pre-validated Google Forms questionnaire assessed knowledge of chronopharmacological concepts, circadian rhythms, and appropriate medication timing. Data were analysed using descriptive statistics in SPSS.

Results: Among 217 participants (59 males, 158 females), most were third-year MBBS students. While 89.4% were familiar with chronopharmacology, only 76.5% correctly identified the circadian rhythm as a 24-hour cycle. Knowledge regarding optimal drug administration timing varied considerably, with notable gaps observed for H₂ receptor antagonists and anti-asthmatic medications.

Conclusion: Although general awareness of chronopharmacology was high, important deficiencies were identified in its practical application. Integrating chronotherapy concepts into the undergraduate medical curriculum may enhance future prescribing practices and improve patient care.

Impact of AETCOM module 1.4 (foundations of communication) on the knowledge and perception of MBBS phase I students regarding effective doctor–patient communication: a pre-test post-test study

Sat, 31 Oct 2026 00:00:00 +0530

diagnosis, treatment adherence, patient safety, patient satisfaction, and shared decision-making. The Attitude, Ethics and Communication (AETCOM) program was introduced as part of India’s competency-based undergraduate medical education curriculum. This study evaluated changes in Phase I MBBS students’ knowledge following AETCOM module 1.4 (foundation of communication) and explored their perceptions of the module.

Methods: A single-group pre-test post-test educational evaluation with a student-feedback survey was conducted among 150 Phase I MBBS students at a university-affiliated medical college and tertiary-care hospital in Pune, India, between May and July 2023. Students completed an eight-item questionnaire before and after the AETCOM sessions. Their perceptions were assessed using a structured feedback questionnaire. Pre and post-test scores were compared using a paired t-test.

Results: The mean score increased from 2.86±0.84 in the pre-test to 5.52±1.38 in the post-test (p<0.001). Student feedback was favorable: all respondents considered AETCOM useful for highlighting the importance of the doctor–patient relationship, and most endorsed its potential contribution to communication skills and patient-centered care. Students also recommended greater use of activity-based, student-centered learning.

Conclusions: AETCOM Module 1.4 was associated with improved scores on a knowledge-based assessment and was positively received by students. These findings support its role in introducing communication principles early in undergraduate medical education. Further studies using observed communication assessments and longitudinal follow-up are needed to determine whether knowledge gains translate into sustained communication skills in clinical practice.

Effectiveness of dynamic balance training on balance and physical function in alcoholic neuropathy: a case report

Chaithanya Prem, Chaithra B. Shetty, Surya Mol S. — Sat, 31 Oct 2026 00:00:00 +0530

Alcoholic neuropathy is a common complication of chronic alcohol consumption characterized by peripheral nerve damage, resulting in impaired sensation, muscle weakness, poor balance, and reduced functional ability. These impairments increase the risk of falls and negatively affect daily activities. Dynamic balance training has been shown to improve postural stability and neuromuscular control in individuals with balance deficits. This study was conducted to evaluate the effectiveness of dynamic balance training in improving balance and functional ability in individual with alcoholic neuropathy. The aim of the study is to evaluate the effectiveness of dynamic balance training on balance and physical function in patient with alcoholic neuropathy. This study involved a man of 64 year diagnosed with alcoholic neuropathy, selected based on predefined inclusion and exclusion criteria. A pre-test assessment was conducted on balance and functional ability and were assessed using Berg Balance Scale and Physical Performance Test. The intervention focused on progressively challenging balance activities aimed at enhancing postural control and functional mobility. Dynamic balance training program was given for 6 weeks, consisting of 5 sessions per week, with each session including 3 sets of 10 repetitions of balance exercises. Following the intervention, post-test assessment was also carried out using the same outcome measures. Following the six weeks of intervention, the participant demonstrated improvements in balance performance and functional ability following the dynamic balance training program. Enhanced postural stability and mobility were observed, indicating a reduction in balance-related impairments.

Dynamic Balance Training improved balance and physical function in patient with alcoholic neuropathy following a 6-week intervention.

Renal vein thrombosis with hydronephrosis in seropositive rheumatoid arthritis with hepatitis B reactivity: a diagnostic challenge suggestive of renal tuberculosis

Rathod Sai Harshini, Yatri Patel, Pankhuri Saxena, Abhinash Jha, Minakshi Dhar — Mon, 05 Oct 2026 00:00:00 +0530

Rheumatoid arthritis (RA) is associated with an increased susceptibility to infection, while immunosuppressive treatment may further complicate the recognition and management of tuberculosis (TB). Renal TB is an indolent form of genitourinary TB that may present with non-specific constitutional and urinary manifestations and can cause obstructive uropathy. Renal vein thrombosis (RVT) is an uncommon vascular complication that may occur in the setting of systemic inflammation or infection. We report a 65-year-old man with recently diagnosed seropositive RA and hepatitis B surface antigen positivity who presented with six months of intermittent low-grade fever, constitutional symptoms and symmetrical inflammatory polyarthritis, followed by left flank pain, intermittent haematuria and bilateral lower-limb swelling. Laboratory evaluation showed anaemia, markedly elevated inflammatory markers and strongly positive rheumatoid factor and anti-CCP antibodies. HBsAg was positive, while HBV DNA was undetectable. Contrast-enhanced CT demonstrated a bulky left kidney with moderate hydronephrosis, pelvicalyceal dilatation, PUJ obstruction and left RVT with extensive collateral formation. Urine culture was sterile and renal function was preserved. Subsequent urine CBNAAT detected Mycobacterium tuberculosis and showed rifampicin susceptibility, establishing renal TB in the appropriate clinical and radiological context. The patient was treated with anticoagulation, RA-directed therapy, supportive measures and subsequently drug-susceptible antitubercular therapy. This case emphasizes the diagnostic challenge posed by overlapping inflammatory, infective and thrombotic manifestations and highlights the importance of considering renal TB in patients with hydronephrosis, urinary symptoms and unexplained RVT, particularly when routine bacterial cultures are sterile.

Large incarcerated inguinoscrotal type I Amyand's hernia managed with appendix preserving Lichtenstein mesh repair: a case report

Sat, 31 Oct 2026 00:00:00 +0530

Amyand's hernia is the presence of the vermiform appendix within an inguinal hernia sac and represents an uncommon intraoperative finding whose management depends on appendiceal viability and operative-field contamination. We report a 70-year-old man with a six-week history of a right inguinal hernia who developed one week of progressive inguinoscrotal enlargement, pain rated 8/10, and absence of bowel movements despite preserved flatus. Examination showed a large, firm, nonreducible right inguinoscrotal hernia without skin inflammatory changes or clinical peritonitis. Plain pelvic radiographs demonstrated marked right hemiscrotal enlargement with bowel-containing herniation. Because urgent surgery was indicated, no ultrasonography or computed tomography was obtained. Open exploration revealed a large indirect inguinoscrotal sac measuring approximately 15 × 10 cm. Controlled opening demonstrated the cecum and a macroscopically normal appendix without inflammation, ischemia, perforation, or contamination, establishing a Losanoff-Basson Type I Amyand's hernia. The appendix was preserved and reduced, the redundant sac was resected, and a tension-free Lichtenstein repair with polypropylene mesh was completed. Recovery was uncomplicated. At two-week follow-up, there was no edema, clinical recurrence, testicular abnormality, or other identified complication. This case illustrates that urgent symptoms and large scrotal extension do not necessarily imply appendiceal inflammation and supports a contamination-directed strategy in which a normal appendix may be preserved while definitive prosthetic hernia repair is performed.

Rare giant renal angiomyolipoma in a 2-year-old female: a case report

Rukhsar Javaid, Amna Tariq — Sat, 31 Oct 2026 00:00:00 +0530

Renal angiomyolipoma (AML) is a benign renal tumor that is uncommon in early childhood, particularly in giant form. We report a 2-year-old girl who presented with progressive abdominal distension, constipation, and vomiting for two months. Examination revealed pallor and a large left-sided abdominal mass, with hemoglobin of 8 g/dl (11-14g/dl). Contrast-enhanced CT showed a 15×12×11 cm [CC×AP×TR] mass arising from the left kidney with areas of fat attenuation and additional fat-density foci in the left renal sinus. Due to the patient's young age and the large size of the renal mass, a preoperative Tru-cut biopsy was performed to establish the tissue diagnosis and guide definitive management. Histopathology demonstrated thick-walled blood vessels, smooth muscle bundles, and nests of clear cells without mitotic figures or necrosis. Immunohistochemistry was positive for HMB-45 and Cathepsin K and negative for cytokeratin and Ki-67, supporting the diagnosis of AML. After correction of anemia and preoperative optimization, the patient underwent left nephrectomy with complete tumor excision and had an uncomplicated postoperative recovery. This case highlights the exceptional rarity of giant renal AML in a very young child and emphasizes considering AML in large pediatric renal masses, particularly when fat-containing components are identified on imaging.

Caroli disease in a 23-month-old boy: a rare paediatric presentation with an inconclusive cystic renal phenotype

Sat, 31 Oct 2026 00:00:00 +0530

Caroli disease is a ductal plate malformation defined by non-obstructive, communicating dilatation of the intrahepatic bile ducts without congenital hepatic fibrosis; when fibrosis is present, the condition is termed Caroli syndrome. We report the case of a 23-month-old boy who presented with hepatomegaly and jaundice. Abdominal ultrasound showed an enlarged liver with saccular cystic dilatation of the intrahepatic bile ducts and bilaterally enlarged kidneys with poor corticomedullary differentiation, prompting further cross-sectional evaluation. Magnetic resonance cholangiopancreatography confirmed non-obstructive, communicating intrahepatic bile duct dilatation consistent with Caroli disease, while renal imaging revealed a diffuse bilateral microcystic pattern with cortical thinning, most consistent with medullary sponge kidney. Imaging was thus central both to establishing the hepatic diagnosis and to characterizing the associated renal phenotype, sparing the child invasive investigation. This case illustrates that a hepatic ductal plate malformation may present in early childhood and unmask an otherwise silent renal cystic phenotype, and adds to the limited pediatric reports of this association.

Catamenial rectal bleeding as a manifestation of rectosigmoid endometriosis in a young woman: a case report and literature review

Sat, 31 Oct 2026 00:00:00 +0530

Bowel endometriosis is a manifestation of deep endometriosis that most commonly involves the rectum and sigmoid colon. Diagnosis can be challenging because disease involvement usually predominates in the outer layers of the bowel wall, while endoscopic findings may be normal or nonspecific. We report the case of a 21-year-old woman with a three-year history of recurrent catamenial rectal bleeding, an unrevealing initial gynecologic evaluation, and a previous colonoscopy without relevant abnormalities. Because bleeding persisted, repeat colonoscopy was performed and showed edema and loss of the vascular pattern in the rectum and sigmoid colon. Rectosigmoid biopsies demonstrated glandular structures extending toward the submucosa that were morphologically compatible with endometriosis. Clinicopathologic correlation established the diagnosis of bowel endometriosis. This case highlights the importance of considering rectosigmoid endometriosis in reproductive-aged women with cyclic rectal bleeding, even after a previous negative endoscopic evaluation, and illustrates that colonoscopic biopsy may establish the diagnosis when mucosal or submucosal involvement is present.

Ayurvedic management of cervical spondylosis: a case report

Anjanasree K., Nikhil Neelakandhan E. U., Dileep K. S. — Sat, 31 Oct 2026 00:00:00 +0530

Cervical spondylosis is an important health issue considering its associated disability and impact on quality of life. Previously, it was considered a disease of old age due to degenerative changes occurring in the cervical spine. However, it is now increasingly observed among the younger population, possibly due to the current lifestyle. This is a case of a 41-year-old male patient who presented with neck pain and was admitted to the Kayachikitsa IPD of Vaidyaratnam Ayurveda College Hospital on 24/02/2025. He was diagnosed with cervical spondylosis based on the radiological findings, clinical presentation, and physical examination. The patient underwent treatment based on the principles of Vatavyadhi Chikitsa. The treatment included both internal and external Ayurvedic treatment modalities. Internally, Rasnasaptaka Kashaya, Dhanwantara Arishta and Vatayog tablets were administered, while externally, Churna Pinda Sweda, Yogavasti, Jambira Pinda Sweda, Marsha Nasya and steam bath were administered. A considerable improvement was observed in both the Oswestry Disability Index for neck pain and the Visual Analogue Scale following the Ayurvedic treatment modalities, indicating their potential effectiveness in the management of cervical spondylosis.

The present case suggests that Ayurvedic Vatavyadhi Chikitsa may be a useful approach in the management of cervical spondylosis and provides a basis for further clinical evaluation.

Long-standing unconjugated hyperbilirubinaemia disproportionate to β-thalassaemia trait: unmasking coexisting homozygous UGT1A1*28 Gilbert syndrome through stepwise diagnostic reasoning

Gagan Harnathka, Swati Saini, Rahul Prasad Sah, Prakash Tendulkar, Ravi Kant — Sat, 31 Oct 2026 00:00:00 +0530

A man in his late twenties presented with a 13-year history of icterus and dark urine, together with a short history of abdominal pain for 2.5 months. Biochemical evaluation demonstrated a total serum bilirubin of 9.46 mg/dL with an unconjugated fraction of 9.04 mg/dl, normal hepatocellular enzymes, and splenomegaly on abdominal ultrasonography. The peripheral blood film showed a microcytic, hypochromic picture with anisopoikilocytosis and mild red-cell fragmentation. Whole-exome sequencing identified a heterozygous pathogenic HBB c.92+5G>C splice-donor variant (IVS-I-5 G>C), confirming β-thalassaemia carrier status. The magnitude of unconjugated hyperbilirubinaemia was, however, disproportionate to trait alone, prompting a targeted search for a coexisting inherited disorder of bilirubin conjugation. UGT1A1 promoter fragment analysis revealed a homozygous (TA)7/(TA)7 (*28/*28) genotype, confirming Gilbert syndrome. Recognising the coexistence of the two disorders, rather than accepting a single incomplete diagnosis, altered counselling, drug-safety advice and reproductive planning. This case underscores that when unconjugated hyperbilirubinaemia is disproportionate to the demonstrable degree of haemolysis, a second inherited disorder of bilirubin metabolism should be actively sought.

Minimally invasive management of a comminuted bicondylar middle phalanx head fracture using Joshi’s external stabilization system: a case report

Sachin Sahuji, Vijay Raghav Kanakam, J. V. Srinivas — Sat, 31 Oct 2026 00:00:00 +0530

Fractures of the middle phalanx head are uncommon injuries that pose a challenge in restoring articular congruity while preserving proximal interphalangeal (PIP) joint mobility and extensor tendon function. We report the case of a right-hand-dominant 29-year-old male software engineer who sustained a closed, comminuted bicondylar intra-articular fracture of the right little finger middle phalanx following a road traffic accident. Three days after injury, closed reduction under fluoroscopic guidance and percutaneous fixation using a modified Joshi’s External Stabilization System (JESS) was performed under regional anaesthesia. The construct comprised two 2.0-mm and two 1.6-mm Kirschner wires, four mini-clamps, and two connecting rods. The procedure lasted 30 minutes. The fixator was maintained for four weeks, followed by supervised rehabilitation. Radiographs at four weeks confirmed fracture union, maintained articular congruity, and no loss of reduction. At final follow-up, the patient achieved a total active motion of 220°, with MCP, PIP, and DIP joint arcs of 90°, 100°, and 30°, respectively. Grip strength recovered to 95% of the contralateral hand, and pain was minimal (VAS 1/10). The patient returned to full occupational computer work at four weeks, without pin-tract infection, joint stiffness, malunion, or hardware-related complications. This case highlights modified JESS fixation as a minimally invasive option for selected comminuted intra-articular fractures of the middle phalanx head. It may facilitate maintenance of reduction while preserving tendon gliding and supporting functional recovery through timely rehabilitation.

Effect of takradhara and ayurvedic internal medications on stress associated worsening of glycemic control in a patient with type 2 diabetes mellitus: a case report

Ajithkumar S. V., Navaneeth Krishnan N. — Sat, 31 Oct 2026 00:00:00 +0530

Diabetes is a chronic health condition characterized by impaired glucose regulation, which may result from inadequate insulin production or ineffective utilization of insulin. Uncontrolled diabetes can lead to complications affecting multiple organs, while psychological stress may further worsen glycemic control and quality of life. This case report describes a 61-year-old female patient with elevated blood glucose levels, emotional stress, and persistent fatigue who was admitted to the Kayachikitsa IPD of Vaidyaratnam Ayurveda College on 12/08/2024. The patient was assessed using the Quality-of-Life Instrument for Indian Diabetes Patients (QOLID). Management was primarily based on Prameha Chikitsa, with consideration of the Manovaha Srotas, using Nisakathakadi Kashaya, Chitrakatriphaladi Kashaya Choorna, Pramehoushadhi tablets, Chandraprabha tablets, Takradhara, and Abhyanga with Murivenna and Mahanarayana Taila. Following treatment, the patient showed marked relief from emotional stress and general weakness, along with improved glycemic control. The QOLID score increased from 65 to 83.46, indicating improvement in quality of life, and FBS reduced from 213 mg/dl to 136 mg/dl, while the insulin dosage was reduced from 30 U–30 U–15 U to 15 U–0–15 U. Although Prameha is considered a Yapya condition, the observed improvement suggests that Ayurvedic management may have a beneficial role in controlling stress-associated hyperglycemia and improving quality of life.

Ayurvedic management of unilateral thenar atrophy mimicking Hirayama disease: a case report

Shereena K. M., Abdul Ravoof P. K., Dileep K. S., Aneesh M. S. — Sat, 31 Oct 2026 00:00:00 +0530

Thenar atrophy is the atrophy of the muscles on the radial aspect of palm, flexor pollicis brevis, abductor pollicis brevis and opponens pollicis which have the function of precision pinching and grip strength. Thenar atrophy can be correlated to Viswachi in Ayurveda in which there is deficit in function of hand. Viswachi is a disease said in vatavyadhi nidana in which vata affected Kandara which supplies the bahu cause diminished functioning of the hand. The article assesses the effect of Ayurveda treatment as a supportive measure in motor neuron disease. Here is an Ayurvedic management and supportive rehabilitation of 24 years old male who was presented with weakness and atrophy of thumb of right hand since 2 years. The clinical presentations are very much similar to Hirayama disease and on detailed clinical examination there is motor deficit of recurrent branch of median nerve. Upon investigations the MRI findings are suggestive of cervical myelopathy rather than Hirayama disease. The patient was admitted and manged with the protocol of vatavyadhi chikitsa. The treatment protocol included shodhana, samana and brimhana chikitsa adopted in this case and mode of action is described in this article. Considering the thenar atrophy treatment local brimhana therapy was also administered. Follow up medicines were prescribed along with upanaha and continued for one month. The case was assessed using the MRC scale of muscle strength, and Quick DASH questionnaire for quality of life. Muscle strength improved and QOL with DASH questionnaire improved from 61.36 before treatment to 40.90 after treatment. The present case of viswachi was rehabilitated and got improvement in quality of life related to the function of the hand by conservative ayurvedic treatment protocol.

Trichoblastoma arising in nevus sebaceous of Jadassohn: a case report and review of the literature

Shabana Andleeb Ansari, Beant Kaur, Sanjay Kannaujia, Manzeela Swale — Sat, 31 Oct 2026 00:00:00 +0530

Nevus sebaceous of Jadassohn (NSJ) is a congenital hamartoma that may develop secondary neoplasms, most of which are benign. Trichoblastoma (TB) is the most common benign tumor arising in NSJ but is frequently misdiagnosed as basal cell carcinoma (BCC). We report a 34-year-old female with a slow-growing nodule on a pre-existing yellowish, hairless plaque on the right chin, present since childhood. Excision and histopathology showed epidermal hyperkeratosis, acanthosis, and abnormally positioned sebaceous glands opening directly onto the epidermis, consistent with NSJ. Within the dermis, a well-circumscribed tumor composed of basaloid cells with peripheral palisading and papillary mesenchymal bodies was identified, confirming TB. This case highlights the importance of distinguishing TB from BCC to avoid unnecessary aggressive treatment. Pathologists and clinicians should be aware of this entity.

Interstitial lung disease unmasked as myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis following acute kidney injury

Nisha B. Jana, Bahlah A. Surka, Yatri S. Patel — Sat, 31 Oct 2026 00:00:00 +0530

Small-vessel vasculitis driven by antineutrophil cytoplasmic antibodies (ANCA) is a severe, systemic autoimmune condition whose clinical behavior can be notoriously unpredictable. When the offending antibody targets myeloperoxidase (MPO), the disease most commonly manifests as microscopic polyangiitis (MPA), a necrotizing vasculitis that, unlike its granulomatous counterparts, destroys vessel walls without forming granulomas. We report a 49-year-old woman who had been living with what appeared to be idiopathic interstitial lung disease (ILD) for a full year before presenting to our emergency department in florid acute respiratory failure. She required emergent intubation for severe metabolic acidosis and, within 48 hours of admission, her kidneys, previously unaffected, collapsed into acute kidney injury (AKI) necessitating hemodialysis (HD). Serological testing came back strongly positive for MPO-ANCA, and renal biopsy showed crescentic glomerulonephritis (GN) in a pauci-immune pattern, confirming the diagnosis. We initiated plasmapheresis, high-dose pulse methylprednisolone, and cyclophosphamide, with rituximab planned as sequential therapy. Despite a brief biochemical response at three weeks, her clinical trajectory proved irreversible and she died. A high index of suspicion for underlying vasculitis is essential in any patient with established pulmonary fibrosis who develops sudden, unexplained renal deterioration.

A genetic storm an adult: unmasking familial HLH — a rare presentation

Rishikesh Dessai, Kunal Chawla, Shipra Gulati, Nikhil Gupta — Sat, 31 Oct 2026 00:00:00 +0530

Hemophagocytic lymphohistiocytosis (HLH) is a life‑threatening hyperinflammatory syndrome, with familial (primary) HLH typically manifesting in infancy. Adult‑onset familial HLH—particularly due to mutations in PRF1 (type 2)—is exceedingly rare. We report a 26‑year‑old veterinary student who presented with fever, jaundice, pancytopenia, hepatosplenomegaly, and shock. Investigations confirmed hyperferritinemia, hypofibrinogenemia, hypertri-glyceridemia, hemophagocytosis on bone marrow, and EBV detection on PCR. Genetic testing revealed a pathogenic autosomal recessive PRF1 mutation, confirming familial HLH type 2. Despite initiation of high‑dose steroids, IVIG, and supportive care, disease activity persisted, and the patient subsequently left against medical advice, before the proposed treatment could be initiated. This case underscores the importance of considering primary HLH even in adults, and the role of genetic testing to guide diagnosis and management.

Artificial intelligence in plastic and reconstructive surgery: clinical applications, translational readiness and barriers to real-world implementation

Sat, 31 Oct 2026 00:00:00 +0530

Artificial intelligence (AI) is expanding rapidly in plastic and reconstructive surgery, but the central question has shifted from whether an algorithm can perform a task to whether it can generalize, improve clinical decisions, and remain safe after deployment. This critical review examines contemporary AI applications in burn assessment, facial and craniofacial surgery, microsurgical free-flap monitoring, breast reconstruction, and patient communication, with emphasis on translational readiness rather than cataloguing technologies. A structured PubMed/MEDLINE search through September 6, 2026 was supplemented by reference chaining from recent systematic reviews and reporting guidance. Image-based systems have reached high performance for selected bounded tasks, including automated free-flap monitoring (area under the curve 0.960), burn-depth assessment (95% accuracy in a prospective clinical cohort), and some externally validated breast-reconstruction outcome models (area under the curve up to 0.97). In contrast, prediction of multifactorial complications remains less discriminative, and general-purpose large language models have shown clinically important limitations in factual accuracy and postoperative triage. The principal barrier is therefore not algorithm development but clinical translation: external validation, prospective impact studies, subgroup performance, human-AI workflow design, data governance, and post-deployment monitoring remain inconsistently addressed. Plastic surgery is well positioned to benefit from AI because it is image-rich and outcome-sensitive, but implementation should prioritize narrowly defined tasks with measurable clinical value and preserve surgeon oversight, patient-reported outcomes, and transparent lifecycle governance.

The integration and sequencing of scapular-focused and eccentric exercises in shoulder rehabilitation: a scoping review of combined protocols for RCRSP

Najila M. K., Subhashchandra Rai, Royline Fathima Pinto, Alen Mathew, Ramya K. — Sat, 31 Oct 2026 00:00:00 +0530

Rotator cuff related shoulder pain shoulder pain is a common musculoskeletal condition associated with pain, decreased shoulder function, and impaired quality of life. Eccentric exercise and scapula focused rehabilitation are frequently prescribed. However, their optimal integration and sequencing remain unexplored. Systematic searches of PubMed, Scopus, Web of Science, CINAHL and PEDro (2015-2025) identified randomized controlled trials investigating eccentric exercise, scapular stabilization or combined rehabilitation approaches in individuals with RCRSP. Data were extracted on study characteristics, intervention protocols, outcome measures and key findings. Eight studies met the inclusion criteria, including randomized controlled trials and pilot randomized studies. Eccentric exercise interventions demonstrated improvements in pain, strength, tendon-related outcomes, and functional recovery. Scapular-focused programs showed significant benefits in pain reduction, shoulder function, neuromuscular control, scapular alignment, and movement mechanics. Multimodal approaches combining exercise with adjunct therapies also reported positive clinical outcomes. However, no included study explicitly investigated the combined sequencing of scapular stabilization and eccentric exercise within a single rehabilitation framework. Most studies evaluated these interventions in isolation or as comparative protocols. Both eccentric exercise and scapular-focused rehabilitation are effective in managing RCRSP. However, evidence regarding their optimal integration and sequencing is lacking. A biomechanically informed progression in which scapular stabilization precedes eccentric strengthening may be clinically reasonable, but this hypothesis requires confirmation through high-quality randomized controlled trials.

Beetroot (Beta vulgaris L.): evidence-based review of phytochemistry, functional properties, anti-cancer mechanisms and clinical translation

Chirag B. Dhanani — Sat, 31 Oct 2026 00:00:00 +0530

Due to its high nutritional composition and complex phytochemical profile, beetroot (Beta vulgaris L.) has been increasingly studied scientifically as a functional food. This comprehensive review summarises the existing knowledge about beetroot botanical traits, nutritional composition, phytochemical contents, biological activities, anti-cancer activity, molecular pathways, processing methods, and clinical uses. Beetroot is a rich source of carbohydrates, dietary fibre, important vitamins and minerals, dietary nitrates and bioactive compounds such betalains, polyphenols, flavonoids and pectic chemicals. These ingredients combine to provide to it powerful antioxidant, anti-inflammatory and antibacterial capabilities. Beetroot has demonstrated significant anticancer activity in models of breast, prostate, colorectal and liver cancer, with considerable in vitro and in vivo evidence to support its activity via mechanisms involving reactive oxygen species modulation, apoptosis induction, cell cycle arrest, angiogenesis inhibition, autophagy regulation and immune modulation. Further improvements in the bioavailability, stability and therapeutic efficiency of beetroot bioactives have resulted from advances in fermentation, probiotic enhancement and nanoliposomal formulations. Clinically, beetroot has been used in functional foods, sports nutrition, cardiovascular health interventions and cancer supportive therapy and has a favourable safety profile. Results are promising, however there are still issues with standardising the dose and lack of confirmation in large-scale clinical trials. In conclusion, this review identifies beetroot as an evidence-based functional food with great nutraceutical and therapeutic potential, while outlining future research pathways required for its effective translation into clinical and personalised nutrition applications.

Distraction osteogenesis: a review on management of acquired and congenital deformities

Ramanpreet Kour, Vikas Grack, Avleen Kour — Sat, 31 Oct 2026 00:00:00 +0530

Distraction osteogenesis which is also called as callus distraction orcallotasis is used to restore the skeletal deformities and in reconstructive surgery. Most commonly, it is carried out in the department of oral maxillofacial surgery, orthopaedics and paediatric surgery. It is a very favourable and effective method for stable long-term effects. The use of distraction osteogenesis is found to have increased multiple folds in the last decade. And this is attributed to its advantages like little relapse, bigger movements range, generation of soft tissue, less likelihood of nerve injury, less likelihood of idiopathic condylar resorption. Some important applications of distraction osteogenesis are as an alternative to conventional surgery for maxillary and mandibular lengthening and reconstruction of alveolar segmental defects after tumour resection before implant installation.1 The distracter devices are found to transfer forces and they act as a rigid support for bone consolidation to occur. In this article, an attempt has been made to review the evolution of distraction osteogenesis over eons.

Efficacy of injectable platelet-rich fibrin (i-PRF) in gingival recession coverage: a narrative review

Priyanka Yadav, Nancy Nagpal, Vanshika Thakur, Aishwarya Pandey — Sat, 31 Oct 2026 00:00:00 +0530

Gingival recession presents significant esthetic, functional, and structural challenges in periodontology. While subepithelial connective tissue grafts (SCTGs) remain the gold standard for root coverage, their application is limited by donor site morbidity and tissue availability. This systematic review comprehensively evaluates the biological profile and clinical efficacy of injectable platelet-rich fibrin (i-PRF) as a primary or adjunctive therapy for gingival recession coverage. By analyzing the synergistic effects of i-PRF with connective tissue grafts, collagen membranes, free gingival grafts, and standalone semisurgical methodologies, this review demonstrates that i-PRF significantly enhances keratinized tissue width and thickness, accelerates neo-angiogenesis, and provides predictable root coverage while minimizing postoperative morbidity.

Poverty and corruption affecting antimicrobial resistance: a silent pandemic

Santosh Kumar Swain, Pragnya Paramita Jena — Sat, 31 Oct 2026 00:00:00 +0530

Antimicrobial resistance (AMR) occurs when microorganisms like bacteria, viruses, fungi, and parasites become able to adapt and grow even with medications that once killed them. AMR is a growing global problem. The causes for AMR in countries with poverty and corruption are complex and may be rooted in the practices of health care professionals and behaviour of patients towards the use of antimicrobials as well as supply chains of antimicrobials in the public. The factors like inappropriate prescription practices, insufficient patient education, limited diagnostic facilities, unauthorized sale of antimicrobials, absence of appropriate functioning drug regulatory mechanisms, and non-human use of antimicrobials such as animal production. This can lead to serious infections and cause difficulty in treatment of the infections. Poverty and corruption are two important parameters which strongly accelerate AMR by weakening drug regulation and forcing reliance on cheap or fake medicine. Poor infection control, poor water sanitation and poor hygiene all increase the spread of resistant bacteria from person to person. The appropriate use of antibiotic is related to economic development of countries. According to the World Health Organization (WHO), poverty is very crucial for development of AMR. This review discusses the importance of governmental, social, and economic factors related to antibiotic resistance including poverty and corruption.

Use of antioxidant-rich nutrients to slow the advancement of cataracts

Amna Naqui, Asra Warees, Anam Rais, Saima Ahsan, Anuradha Singh, Wasil Hasan — Sat, 31 Oct 2026 00:00:00 +0530

Cataracts occur due to opacification of the crystalline lens and are a leading cause of vision loss globally. The primary mechanism of cataract development is oxidative stress. Worldwide, nearly 17 million individuals are blind due to cataract, with 33% of cases of reduced vision. Current treatments mainly involve surgery, which may be associated with the risks of infection, astigmatism, glaucoma, pseudophakic bullous keratopathy, and retinal detachment. This study emphasizes prevention over treatment, using antioxidant-rich nutrients to delay or prevent cataract progression. This can shift the focus from conventional surgical treatment to a non-invasive, accessible approach. Eating antioxidant-rich fruits and vegetables is the effective method to obtain essential nutrients. Antioxidants, such as vitamins C and E and β-carotene, and enzymes, including superoxide dismutase, catalase, and glutathione peroxidase, can alleviate oxidative stress, help neutralize reactive oxygen species, and protect the integrity of the crystalline lens. This review aims to highlight the potential of antioxidant-rich nutrients in preventing or slowing the progression of cataract.

Extra-pulmonary tuberculosis: towards an integrated diagnostic and management pathway: a narrative review

Sat, 31 Oct 2026 00:00:00 +0530

Extrapulmonary tuberculosis (EPTB) accounts for a substantial and increasing share of global tuberculosis (TB) notifications, yet remains disproportionately difficult to diagnose because of its paucibacillary nature, heterogeneous organ involvement, and the fragmented way in which clinical, radiological, histopathological, and microbiological data are typically interpreted. To synthesize current evidence on EPTB diagnosis and management within a single pathway-based framework, with attention to organ specific diagnostic yield, special populations, and unresolved controversies. This narrative review synthesizes evidence from World Health Organization (WHO) consolidated guidelines, Cochrane systematic reviews, landmark randomized trials and recent diagnostic accuracy studies to provide an updated overview of the diagnosis and management of EPTB. Evidence suggests that no single test reliably excludes EPTB, diagnostic yield varies markedly by disease site and specimen type, with Xpert MTB/RIF Ultra outperforming Xpert MTB/RIF and smear microscopy across most extrapulmonary specimens but still leaving important gaps, particularly in cerebrospinal and pleural fluid. Children and people living with HIV are disproportionately affected and pose distinct diagnostic challenges. Management increasingly requires site-specific tailoring, especially for drug-resistant disease, where current WHO shorter regimens explicitly exclude central nervous system, osteoarticular, and disseminated forms. An integrated, multidisciplinary diagnostic pathway rather than test by test or organ by organ, evaluation offers the most practical framework for reducing diagnostic delay in EPTB.

From the classroom to the clinic: a pedagogical perspective on attention-deficit/hyperactivity disorder in Mexican children and adolescents

Marcelina Chávez Arreola, Karla Itzel Vazquez Chávez — Sat, 31 Oct 2026 00:00:00 +0530

Attention deficit/hyperactivity disorder (ADHD) is the most frequently diagnosed neurobehavioral condition of childhood, and the classroom, not the consulting room, is usually where its consequences are first noticed. In Mexico, school-based screening studies using the Conners 3 scale have identified probable ADHD in roughly one in six primary school children, yet fewer than three in four screened-positive families ever complete a full evaluation, and among children who do reach specialized services, seven in ten receive a diagnosis later than clinically desirable. This narrative review synthesizes epidemiological, neurobiological, and educational evidence generated chiefly in Mexican and Latin American populations to examine ADHD from a pedagogical standpoint, and how the disorder disrupts executive, academic, and socio-emotional functioning, how teachers function, in practice, as the earliest and most consistent filter for detection, despite receiving little formal training in neurodevelopmental disorders and despite a demonstrated tendency to under-recognize the quieter, inattentive presentations more common in girls, how family explanatory beliefs and a fragmented referral pathway between schools and specialized mental health services compound these delays, and how Mexican specific tools and programs, including the FX-II functional-impairment scale and the CLS-R-FUERTE school-based training program, are beginning to close this gap. We argue that improving outcomes for Mexican children with ADHD depends as much on strengthening the bridge between the education and health sectors as on any further refinement of pharmacological treatment, which is already comparatively well established, and propose specific, evidence-consistent elements of an integrated pedagogical-clinical model adapted to Mexican public education.

Tendon neuroplastic training and motor cortex excitability in patellar tendinopathy: a literature review

Harsh Kaur, Aashima, Supreet Bindra, Pankajpreet Singh — Sat, 31 Oct 2026 00:00:00 +0530

Patellar tendinopathy (PT) is a common overuse condition, particularly among athletes involved in jumping and running activities. Although traditionally considered a local tendon disorder, increasing evidence suggests that changes in motor control and corticospinal excitability may contribute to persistent symptoms and impaired function. Tendon neuroplastic training (TNT) combines progressive tendon loading with externally paced exercise or timing cues intended to influence motor-system adaptation. Objectives were to review evidence regarding TNT, exercise-based rehabilitation, and neurophysiological changes associated with PT, with emphasis on the potential relationship between TNT and motor cortex excitability. A literature review was conducted using PubMed, Google Scholar, and ResearchGate. Studies related to PT, TNT, corticospinal excitability, motor cortex excitability, and exercise-based rehabilitation were considered. English-language studies published between 2004 and 2026 were included. Studies unrelated to PT, TNT, motor cortex excitability, or tendon rehabilitation were excluded. The literature was organized into three groups: studies directly investigating TNT, exercise-based rehabilitation studies in PT, and studies investigating motor cortex or corticospinal excitability in PT. Direct TNT studies were predominantly conducted in lateral elbow tendinopathy and reported improvements in pain and function. Studies in PT demonstrated beneficial effects of progressive tendon loading, including eccentric, heavy slow resistance, and isometric exercise. Neurophysiological studies demonstrated alterations in corticospinal and cortical excitability in individuals with PT. TNT represents a promising neurophysiologically informed approach that may complement progressive tendon-loading rehabilitation. However, direct evidence demonstrating that TNT modifies motor cortex excitability or is superior to conventional rehabilitation in PT remains insufficient.

Liver disorders in Unani and modern medicine: current concepts, etiopathogenesis, diagnosis and future perspectives: a narrative review

Tayyaba Khatoon, Ataullah Fahad, Naved Ahmad — Sat, 31 Oct 2026 00:00:00 +0530

Liver diseases are a major cause of morbidity and mortality worldwide, encompassing a wide spectrum of conditions ranging from acute infections to chronic liver disorders and malignancies. Owing to the liver's central role in metabolism, detoxification and immune regulation, hepatic diseases are complex and require a comprehensive understanding. While modern medicine explains these disorders through pathological and biochemical mechanisms, Unani medicine interprets them on the basis of humoral imbalance and the principles of Ilmul Amraz. A narrative review was conducted by systematically searching electronic databases, including PubMed, Scopus, DOAJ, Wiley Online Library, Springer Link, Science Direct, MDPI, NCBI, Google Scholar and Index Copernicus. Relevant peer-reviewed articles, review papers and classical Unani texts were identified using predefined keywords related to liver diseases, hepatic disorders, Unani medicine and integrative medicine. The retrieved literature was critically analyzed and compared. The review demonstrates that both Unani and modern medicine provide valuable perspectives on liver diseases. Modern medicine offers detailed insights into disease mechanisms, diagnosis and evidence-based therapeutic strategies, whereas Unani medicine emphasizes on humoral equilibrium, temperament (Mizāj). Several complementary concepts were correlated, suggesting potential areas for integrative approaches in the prevention and later on management of liver disorders. An integrated understanding of liver diseases through both Unani and modern medical perspectives may enhance clinical decision-making and patient care. Future interdisciplinary research is warranted to validate traditional concepts and explore evidence-based integrative strategies for improving liver disease management.

Sustainable energy and water management in green hospitals: a narrative review

Ramandeep Kaur, Settepalli Jasmin Debora, Arba Khatun, Chitra Mehta — Sat, 31 Oct 2026 00:00:00 +0530

Hospitals consume substantial amounts of energy and water, while intensive care units (ICUs) have high resource demands because life-support equipment, monitoring systems and heating, ventilation and air conditioning operate continuously. This narrative review examines hospital and critical-care environmental impacts, sustainable energy and water management, healthcare workers’ knowledge and practices, and the use of Plan-Do-Study-Act (PDSA) cycles. Literature and guidance were identified through PubMed/MEDLINE, PubMed Central, Google Scholar, publisher databases and relevant health-agency and professional-society websites, and findings were synthesised thematically. The reviewed evidence identifies building energy, especially HVAC, and clinical consumables as major environmental hotspots. Water conservation must be planned alongside infection prevention and essential hygiene. Healthcare workers often express environmental concern but lack practical training, infrastructure and organisational support. Education combined with prompts, checklists, audit and feedback, local champions and leadership support is more likely to translate awareness into routine practice. The review also describes a 45-day quality-improvement project involving 80 staff members in ICUs at a hospital in Gurugram, India. Following two PDSA cycles, knowledge scores and observed practice adherence improved. In a descriptive comparison of one pre-intervention month with one post-intervention month, electricity use per occupied bed decreased by 17.7%, diesel use by 54.9% and water use per occupied bed-day by 11.25%. Because the project had no concurrent control group and compared only one month before and after the intervention, these changes cannot be attributed conclusively to the intervention. Longer time series, patient-safety balancing measures and transparent carbon accounting are needed to assess whether improvements are sustained.

Music interventions in exercise performance, recovery and sleep: a scoping review

Mahi Parikh, Adarsh Keshari — Sat, 31 Oct 2026 00:00:00 +0530

Music has been investigated as a potential influence on exercise performance, perceived exertion, recovery, and sleep. However, studies vary in their interventions, populations, exercise contexts, and measured outcomes. This scoping review aimed to map experimental evidence on music interventions in resistance, isometric and handgrip, aerobic exercise, acute recovery, and sleep, and to identify evidence gaps. PubMed/MEDLINE, SPORTDiscus, Scopus, and Web of Science were searched for studies published between 1980 and October 2026. Eligible studies involved human participants, compared a music intervention with a control or alternative condition, and reported exercise performance, perceived exertion, psychological responses, physiological recovery, or sleep outcomes. Screening was conducted using Rayyan. Findings were synthesised descriptively across four domains. Thirty studies involving 1,183 participants were included. Studies were published between 1981 and 2021 and examined resistance exercise (n=11), isometric and handgrip exercise (n=8), aerobic exercise and acute recovery (n=7) and sleep (n=4). The evidence maps a broad range of music interventions and outcomes, with variable findings across exercise and sleep contexts. Research gaps include limited participant diversity and insufficient investigation of sleep and recovery in athletic populations. Further studies are needed to clarify how music characteristics, individual preferences, and task demands relate to outcomes.

Chronic stress, allostatic load and multisystem disease: mapping mechanisms and evidence for lifestyle interventions – a narrative review

Maha Swetha Sayapogu, Yadhushree P. V., Shivaprasad Shetty, Sujatha K. J. — Sat, 31 Oct 2026 00:00:00 +0530

Chronic psychological stress is linked to cardiovascular, metabolic, immune-mediated, gastrointestinal, and depressive disorders. Allostatic load (AL), defined as the cumulative physiological cost of repeated or sustained adaptation, serves as the primary framework for explaining these associations. Lifestyle interventions, including yoga, meditation, physical activity, sleep improvement, dietary modification, and social support, are widely recommended for stress-related health issues. It remains uncertain whether these interventions influence multisystem AL or only affect individual biomarkers and symptoms. This narrative review is based on a structured, though non-systematic, PubMed/MEDLINE search that prioritised systematic reviews, meta-analyses, randomised trials, and large cohort studies. The review summarises neural, neuroendocrine, autonomic, inflammatory, metabolic, gut-brain, cellular, and epigenetic pathways through which stress becomes biologically embedded, distinguishing mechanisms established in humans from those inferred primarily from animal or cross-sectional studies. Intervention evidence is then mapped against the five biomarkers of a recently proposed consensus AL index (C-reactive protein [CRP], resting heart rate, high-density lipoprotein cholesterol, waist-to-height ratio, and glycated haemoglobin) as well as clinical endpoints. Physical activity and a Mediterranean-style diet have the strongest support across these domains and clinical outcomes. Meditation, yoga, and slow breathing yield small-to-moderate improvements in distress and in certain cardiometabolic and autonomic markers, while cognitive behavioural therapy demonstrates clinical-endpoint evidence in insomnia and coronary heart disease. Few randomised trials have assessed composite AL, and their findings are inconsistent. No intervention has yet demonstrated disease prevention through reduction of AL. Standardised AL measurement in adequately powered trials represents the most important next step.

Intra-operative and post-operative caudal analgesia with 0.125% bupivacaine and dexmedetomidine using single shot 20G IV cannula technique

Arulmurugan Balasubramanian, Muralidhar Anakapalli — Sat, 31 Oct 2026 00:00:00 +0530

Optimal perioperative analgesia is essential in paediatric anaesthesia, particularly for acute postoperative pain following lower thoracic, abdominal, and urological surgery. This prospective observational study evaluated the efficacy and adverse effects of single-shot caudal epidural analgesia using 0.125% bupivacaine combined with dexmedetomidine in children undergoing elective urological surgery. Sixteen paediatric patients aged 3–15 years (mean age 7.5±4.1 years) with ASA physical status I–IV were included. Following induction of general anaesthesia, a caudal block was performed using a 20G intravenous cannula, with 0.125% bupivacaine and dexmedetomidine at 1 µg/kg administered at a volume of 1 ml/kg. Descriptive statistics and Student’s t-test were used for data analysis, with p<0.05 considered statistically significant. The study included 13 male and 3 female patients, and the mean duration of analgesia was 513.7±162 minutes. No significant difference in analgesic duration was observed according to sex or type of surgical incision. Haemodynamic parameters remained stable throughout the perioperative period, and no clinically significant bradycardia or hypotension was observed. One patient experienced a transient event that resolved spontaneously. Single-shot caudal epidural analgesia using 0.125% bupivacaine combined with dexmedetomidine through a 20G intravenous cannula provided prolonged perioperative analgesia with a favourable safety profile in children undergoing elective urological surgery.

Surgical outcomes of Limberg flap reconstruction for pilonidal disease: a five-case series and literature review

Karla A. Becerra, Eduardo D. Cruz, Diana A. Gonzalez, Hugo E. Estrada — Sat, 31 Oct 2026 00:00:00 +0530

Pilonidal disease is a chronic inflammatory condition of the sacrococcygeal region associated with significant morbidity, wound complications and recurrence. Various surgical techniques have been described, with off-midline closure methods demonstrating improved outcomes. The Limberg flap is widely used because it enables wide excision, tension-free off-midline closure, and low reported recurrence rates. We present a case series of five patients with pilonidal disease treated with excision and Limberg flap reconstruction. Clinical presentation, operative management, postoperative complications, and follow-up outcomes were evaluated. All patients achieved complete wound healing. Three patients developed partial wound dehiscence, which healed by secondary intention with conservative management, and one patient developed a postoperative abscess requiring incision and drainage. No recurrence was documented during the available follow-up period, which ranged from 2 to 4 months. These findings support the Limberg flap as a feasible surgical option for pilonidal disease, including recurrent and complicated presentations, with satisfactory wound healing and manageable postoperative complications.

Joubert syndrome misclassified as cerebral palsy/global developmental delay: lessons from a case series

Nazish Malik, M. Arif — Sat, 31 Oct 2026 00:00:00 +0530

Global developmental delay (GDD) is a frequent diagnosis in pediatric practice, often labelled idiopathic or sometimes attributed to perinatal asphyxia. However, a subset of these cases is caused by underlying genetic or metabolic disorders, some of which are treatable or have disease-modifying options. Joubert syndrome (JS), a rare ciliopathy, exemplifies such conditions that may initially masquerade as nonspecific GDD. In this case series, we evaluated four children who were initially labeled as having GDD. Two of them had a history of perinatal asphyxia. All children presented with developmental delay, ataxia, ocular abnormalities, and craniofacial dysmorphism. Neuroimaging revealed cerebellar vermis hypoplasia and the characteristic molar tooth sign (MTS) in two cases, while genetic testing identified pathogenic variants in AHI1, TMEM67 and TCTN3 genes in three patients. Systemic involvement included retinitis pigmentosa, chorioretinal colobomas, hepatic fibrosis and ventricular septal defect. Each child benefited from multidisciplinary management. This series highlights that even when perinatal asphyxia is documented, children with GDD should still undergo thorough evaluation for alternative etiologies. Early identification of such conditions enables timely intervention, targeted surveillance, family counseling, and better long-term outcomes.

Therapeutic outcomes of virechana karma in dyslipidaemia: a case series

Kirti B. Gaikwad, Meera K. Bhojani — Sat, 31 Oct 2026 00:00:00 +0530

Dyslipidaemia is a major global health concern associated with cardiovascular disease, with prevalence ranging from 20% to over 80% depending on region, age, sex, and diagnostic criteria. It is strongly linked to sedentary lifestyle and unhealthy dietary habits. In Ayurveda, dyslipidaemia can be correlated with Medoroga characterized by abnormal accumulation of Medo Dhatu due to impaired Dhatvagni, predominantly involving Kapha and Pitta Dosha. The objective is to evaluate the therapeutic outcome of classical Virechana Karma on lipid profile parameters in patients with dyslipidaemia. Five clinically diagnosed cases aged 18–40 years with disease chronicity of approximately three years were selected after obtaining written informed consent. Classical Virechana Karma was administered followed by Samsarjana Krama. Serum lipid profile parameters were assessed before intervention and after completion of therapy. Post-therapy follow-up of six months included dietary regulation and lifestyle modification. Post-intervention assessment showed reduction in total cholesterol, triglycerides, LDL, and VLDL levels across all cases, with a modest increase in HDL. Intra-individual comparison demonstrated consistent improvement in lipid profile parameters following Virechana Karma. Associated clinical symptoms such as heaviness and lethargy showed reduction. Incidental borderline glycaemic parameters, including HbA1c, improved in select cases, and no adverse events were reported. This case series indicates an association between classical Virechana Karma and improvement in serum lipid profile parameters in dyslipidaemia; however, findings are limited by small sample size and lack of a control group, warranting further controlled studies.

Single-dose versus multiple-dose antibiotic prophylaxis in elective laparoscopic cholecystectomy

Sat, 31 Oct 2026 00:00:00 +0530

The benefit of continuing prophylactic antibiotics beyond the perioperative period in elective laparoscopic cholecystectomy remains uncertain. Prolonged antibiotic exposure may increase healthcare costs, adverse drug events, and antimicrobial resistance without providing additional clinical benefit. This systematic review was conducted between May and July 2026 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Adults aged 18 years or older undergoing elective laparoscopic cholecystectomy were eligible. Studies directly comparing single-dose perioperative antibiotic prophylaxis with multiple-dose or prolonged prophylaxis were included. The primary outcome was postoperative surgical-site infection or a clinically equivalent infectious complication. Randomized studies were assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, while non-randomized studies were assessed using ROBINS-I. A narrative synthesis was performed because of clinical and methodological heterogeneity. Eighteen eligible studies involving 3,448 participants were included. Of these, 1,723 participants received single-dose prophylaxis and 1,725 received multiple-dose or prolonged prophylaxis. Most studies reported no statistically significant difference in postoperative infectious outcomes between the two strategies. Haider et al. reported significantly fewer postoperative infections in the single-dose group, whereas the remaining evidence generally showed comparable outcomes. Secondary outcomes, including hospital length of stay and healthcare resource utilization, were inconsistently reported. In adults undergoing uncomplicated elective laparoscopic cholecystectomy, single-dose perioperative antibiotic prophylaxis appears to provide postoperative infectious outcomes comparable to multiple-dose or prolonged regimens. The available evidence does not demonstrate a consistent clinical benefit from extending prophylaxis beyond the perioperative period. These findings should be interpreted in light of the methodological heterogeneity, limitations in study quality, and inconsistent outcome reporting across the included studies.

Beyond weight loss: the long-term effects of glucagon-like peptide-1 receptor agonists in metabolic dysfunction-associated steatohepatitis and fibrosis regression

Sat, 31 Oct 2026 00:00:00 +0530

Metabolic dysfunction-associated steatohepatitis (MASH), a progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD), is characterized by hepatic steatosis, inflammation, and fibrosis. Although lifestyle modification is foundational, effective pharmacotherapy is needed, particularly for advanced fibrosis. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) show promise beyond weight loss, but their long-term effects on fibrosis and underlying mechanisms remain unclear. This systematic review evaluates their effects on MASH and fibrosis, mechanisms of action, clinical evidence, and knowledge gaps. A systematic search of PubMed, Embase, Medline, and Cochrane Library identified randomized controlled trials and observational studies evaluating GLP-1 RAs in MASLD, reporting histological or non-invasive markers of fibrosis and steatosis. Comparisons with pioglitazone and vitamin E, alongside cardiovascular and metabolic outcomes, were assessed. GLP-1 RAs improved hepatic steatosis and inflammation, although fibrosis regression varied across trials, some demonstrated MASH resolution without worsening fibrosis, while others reported modest effects. Additional benefits included improvements in weight, glycemic control, lipid profiles, and cardiovascular risk factors. The contribution of direct hepatic versus weight-mediated effects remains unclear, and long-term safety in cirrhosis, including sarcopenia and worsening portal hypertension, requires further investigation. GLP-1 RAs offer promising hepatic and extrahepatic benefits in MASLD, but their effects on fibrosis require confirmation through larger, longer-term trials with robust histological endpoints. Combination therapy, long-term safety, and individualized treatment remain priorities for defining their role as first-line therapy.

Strategies for effective community participation in public health emergency preparedness and response in Nigeria: a systematic review

Sat, 31 Oct 2026 00:00:00 +0530

Management of public health emergencies is a challenge in resource constrained environments, like Nigeria. In such contexts, community engagement is a key tool for effective emergency responses. This review aimed to examine the state of community engagement strategies in Nigeria's public health emergency preparedness and response framework, while highlighting their strengths and weaknesses. The PRISMA guidelines were used for this review. Medline, Scopus, Embase, CINAHL, and APA PsycINFO databases, were searched for studies focused on community engagement in public health emergencies in Nigeria, between the period from 2014 to 2024. Thirteen studies were selected and assessed using UNICEF's key indicators for community engagement. There were strengths and gaps identified in Nigeria's community engagement in public health emergencies. Some studies recorded some community involvement, but there was limited capacity building, community ownership of response, inclusion of marginalized groups and two-way communication. While most studies recognized the need for adaptability and context-specific engagement, only a few included community inputs in prioritizing project priorities or in the design process. The review shows that although there have been some improvements in the level of community engagement in the public health emergency responses in Nigeria, there are still gaps in some of the activities, such as empowerment, communication, and ensuring the involvement of marginalized groups. Improving Nigeria's health system sustainability and strengthening the public health system's capacity to respond to outbreaks and become more resilient depends on addressing these gaps.

Artificial intelligence in adaptive radiotherapy for head and neck cancer: a systematic review of synthetic CT, automated segmentation and prediction of anatomical change and adaptive RT requirement

Abhishek Basu, Rahul Mahawar, Ipsita Palui, Arya Ray — Sat, 31 Oct 2026 00:00:00 +0530

Artificial intelligence (AI) is increasingly being explored to overcome the technical and workflow challenges of adaptive radiotherapy (ART) in head and neck cancer (HNC). However, the available evidence remains heterogeneous, with varying degrees of technical and clinical validation. This review evaluated the current role and clinical maturity of AI-enabled ART in HNC. A systematic literature search of PubMed, Scopus and EMBASE was performed from inception to 1 August 2026. Original prospective or retrospective human studies published between 1 January 2020 and 1 August 2026 were eligible. Studies were restricted to photon-based radiotherapy using CBCT, kVCT or MVCT. Eligible studies were classified into four domains: synthetic CT/image enhancement; AI-based auto-segmentation and deformable image registration; anatomical change prediction and adaptive planning; and prediction of ART requirement. Reporting quality was assessed using CLAIM 2024, QUADAS-2 was applied where appropriate. Out of 62 records screened, 25 studies were included. Sixteen studies addressed synthetic CT/image enhancement, seven addressed auto-segmentation/deformable registration, two evaluated anatomical change prediction/adaptive planning, and three investigated predictions of ART requirement, with some overlap between domains. AI consistently demonstrated technical improvements in image quality, CT-number accuracy, segmentation performance and dosimetric agreement. However, evidence for prospective prediction of anatomical change and ART requirement was considerably limited. CLAIM adherence ranged from approximately 68% to 88%, with a mean of 79.9%±5.8%. AI demonstrates substantial technical potential across HNC ART workflows, particularly for image synthesis, segmentation and registration. However, multicentre evidence demonstrating improved clinical decision-making and patient outcomes remains insufficient.