International Journal of Pharmacy Research & Technology (IJPRT)

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

2025-06-16

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

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

2025-06-16

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

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

2025-06-16

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

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

2025-06-16

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

Pyrazoline Derivatives: Potential Therapeutic Agents against Parkinson's disease

Bidhyut Kumar Dubey — 2025-06-20

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

Antibiotic Resistance Patterns in Pediatric and Adult Urinary Tract Infections

2025-06-24

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

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

2025-06-24

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

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

2025-06-24

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

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

2025-06-24

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

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

2025-06-24

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

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

2025-06-25

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

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

2025-06-25

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

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

2025-06-25

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

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

2025-06-25

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

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

Yogini Ramdas Adhau — 2025-06-14

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

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

Dr Amudalapalli S Narayana — 2025-07-01

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

Foix–Chavany Marie syndrome-A rare entity

Dr.M.Deep Tejesh — 2025-07-02

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

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

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

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

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

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

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

Sustainable Development, Green Chemistry, and Its Applications

Aleza Rizvi — 2025-07-03

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

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

2025-06-30

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

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

2025-06-30

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

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

2025-06-30

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

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

2025-06-30

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

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

2025-06-30

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

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

2025-06-30

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

Evaluation of Idiopathic Late Onset Nephrotic Syndrome in Children

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2025-07-09

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

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

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

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

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

Dr Mandeep Bayan — 2025-07-12

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

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

2025-06-26

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

Camouflaged Myasthenia Gravis: Case Report

Dr K P Jeswanth Kiran — 2025-07-12

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

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

Dr. K P Jeswanth Kiran — 2025-07-12

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

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

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

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

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

Dr.Kuppani Dinesh — 2025-07-12

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

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

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

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

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

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

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

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

Dr. Akash Vilas Tarte — 2025-07-14

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

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

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

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

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

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

Muhammad Hashim Kalwar — 2025-07-14

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

Study design: An observational cohort study.

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

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

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

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

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

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

Ravi Kumar — 2025-07-14

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

Study design: Prospective comparative study

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

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

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

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

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

Dr. Suraj Bhutada — 2025-07-14

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

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

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

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

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

Dr. Kaustubh Gupta — 2025-07-14

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

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

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

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

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

Dr. Abhinav Banerjee — 2025-07-14

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

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

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

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

To Estimate the Risk of Cardiovascular Disease in Healthcare Workers

Sajid Ali — 2025-07-14

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

Study Design: A descriptive cross-sectional study.

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

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

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

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

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

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

Dr Anubhav Goel — 2025-07-14

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

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

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

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

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

Dr. Santosh M Hegde — 2025-07-14

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

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

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

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

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

Dr. ravi kumar singodia — 2025-07-14

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

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

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

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

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

Dr Basavaraj G Yatanoor — 2025-07-14

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

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

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

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

Analysis of Clinical Predictors for Mortality in Severe Organophosphate Poisoning

Dr. Aswin Madhusoodanan — 2025-07-14

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

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

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

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

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

Dr. Marinna Ponnachan — 2025-07-14

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

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

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

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

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

Dr. Megha Vijay — 2025-07-15

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

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

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

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

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

Dr. Ramkesh Meena — 2025-07-15

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

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

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

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

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

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

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

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

Hari Krishna Ramaprasad Saripalli — 2025-07-15

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

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

Endodontic Cryotherapy: A Review

Dr. Apeksha Ghatge — 2025-07-15

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

Clinicopathological Profile and Hormone Receptor Status of Malignant Surface Epithelial Tumours of the Ovary: A Prospective Retrospective Study from A Tertiary Military Centre

Dr Nalin Shankar Singh — 2025-07-16

Background. Surface epithelial tumours account for ~90 % of malignant ovarian neoplasms, yet data on the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2 neu) in Indian patients remain limited. This study characterises the clinicopathological spectrum of malignant surface epithelial ovarian tumours and evaluates ER, PR and HER2 neu expression in relation to established prognostic markers.

Methods. After institutional ethics approval, a combined prospective–retrospective observational study was performed in the Department of Pathology, Command Hospital (Northern Command). Fifty consecutive patients operated for ovarian tumours between May 2024 and May 2025 were screened; four were excluded because of scant tumour in deeper sections, yielding 46 analysable cases. Detailed clinical data were retrieved, tumours were classified per WHO 2020 and FIGO 2021 criteria, and immunohistochemistry for ER, PR (nuclear) and HER2 neu (membranous) was performed and scored independently by two pathologists. Associations were tested with χ²/ Fisher’s exact test, t test or one way ANOVA; p < 0.05 was considered significant.

Results. Median age was 52 years (range 26–74). High grade serous carcinoma predominated (71.7 %), followed by mucinous carcinoma (17.4 %). ER and PR positivity were seen in 65.2 % and 58.7 % respectively, while HER2 neu over expression (3+) occurred in 30.4 %. ER and PR correlated strongly with tumour grade (high > low; p < 0.001 each) but not with age or FIGO stage. HER2 neu positivity was significantly enriched in high grade tumours (p = 0.001) and in mucinous histology (50 %, p = 0.92). Triple positive phenotype (ER+ PR+ HER2+) comprised 10.9 % of cases—exclusively high grade—whereas triple negative tumours constituted 26.1 %. No significant correlation was found between receptor status and pre operative CA 125 levels.

Conclusion. ER and PR are expressed in nearly two thirds of malignant surface epithelial ovarian tumours, especially high grade lesions, underscoring the potential utility of endocrine therapy. HER2 neu over expression, although less common, clusters within high grade and mucinous carcinomas and may identify candidates for anti HER2 therapy. Routine assessment of these biomarkers could refine risk stratification and open avenues for targeted treatment in Indian ovarian cancer patients.

A Prospective Study of Circumcision by Plastibel Technique in Neonates and Infants

Dr. Suresh Patil — 2025-07-16

Background: Male circumcision (MC) is among the oldest surgical procedures, historically practiced across several continents for cultural, religious, and medical reasons. Plastibel circumcision has gained popularity due to its relative simplicity, reduced complication profile, and suitability for use under local anesthesia. Despite these advantages, complications such as bleeding, infection, and delayed plastibel separation are reported. Neonates are believed to experience fewer complications and faster recovery due to thinner prepuce and simpler anatomy compared with older infants.

Methods: We conducted a prospective study of 488 neonates and infants undergoing plastibel circumcision for cultural or religious indications at the Department of General Surgery, Basaveshwar Teaching and General Hospital, attached to M.R. Medical College, Kalaburagi, between January 2023 and March 2024. Children with congenital penile abnormalities, deranged coagulation profiles, or unstable medical conditions were excluded. Perioperative details including operation time, plastibel device separation day, and postoperative complications were recorded. Follow-up visits were scheduled on post-procedure day 3 and the day of plastibel separation.

Results: Of 488 participants, 66 (13.52%) were neonates and 422 (86.47%) were infants. Mean operative time was 6±2 minutes, and the plastibel fell off at a mean of 6.2 days (range 3–12 days). Neonates showed a shorter mean ring separation time compared with older infants. Successful plastibel circumcision without complications was observed in 408 (83.6%) cases, while 80 (16.4%) experienced minor complications. Delayed ring separation and mild bleeding were the most commonly observed adverse events.

Conclusion: Plastibel circumcision in neonates and infants is a safe, quick, and effective procedure with a favorable complication profile. Neonates generally demonstrate fewer complications and earlier ring separation than older infants, underscoring the potential benefits of early circumcision.

ASSESS THE COMPLICATIONS AND OPERATING TIME TAKEN BY HOLMIUM LASER AND PNEUMATIC LITHOTRIPSY USING SEMIRIGID SCOPE IN MANAGING URETERIC CALCULUS

Mohit Kumar Patel, Tushar Dani , Dipak Purohit, Sanscriti Tripathi — 2025-07-16

Background: Technology has made it possible to successfully access and treat virtually any stone within the ureter in a relatively atraumatic fashion. Different lithotriptors can be used for intracorporeal lithotripsy including electrohydraulic (EHL), ballistic (pneumatic), ultrasonic (US), laser (Ho: YAG). In the last few years lasers have been increasingly replacing others for intracorporeal lithotripsy.

COMPARISON OF COLD PRESSOR TEST IN CHILDREN OF HYPERTENSIVE AND NON HYPERTENSIVE PARENTS

Dr.B.V.Surendra,Dr.Thyelnai Dawn Khaling,Dr.T.Hari Prasad — 2025-06-02

INTRODUCTION: Early diagnosis of hypertension risk may enable a person to live a healthier lifestyle. Subjects with predisposing characteristics for hypertension had greater and longer-lasting blood pressure responses to stress. The Present study was conducted to examine the blood pressure response to cold pressor test in the medical students of hypertensive parents and compare it with the controls of normotensive parents

Ultrasound-Guided Versus Peripheral Nerve-Stimulator-Guided Supraclavicular Brachial Plexus Block for Elective Upper-Limb Surgery: An Observational Comparative Study

Dr. Deep Das — 2025-07-17

Background: Ultrasound (USG) visualisation of the brachial plexus has revitalised the supraclavicular approach, yet many centres still use peripheral-nerve stimulators (PNS). High-quality comparative data remain limited.

Methods: In a single-centre observational study, 84 ASA I–II adults undergoing elective upper-limb surgery were randomised to USG (n = 42) or PNS (n = 42) guidance. Primary outcomes were block-execution time and success rate. Secondary outcomes were onset of sensory and motor block and complications. Thirty millilitres of 0.5 % bupivacaine + 2 % lignocaine (1:1) were injected in both groups. Data were analysed with Wilcoxon-Mann-Whitney, t-test or χ² as appropriate; p < 0.05 was significant.

Results: Groups were comparable for age, sex and baseline vitals. Median block-execution time was shorter with USG (6 min [IQR 5–6.8]) than PNS (7 min [6–9]; p < 0.001). Motor-block onset was faster with USG (median 8 min [7.3–9] vs 9 min [8–9]; p = 0.019). Sensory-block onset did not differ (≈5.5 min, p = 0.51). Success reached 97.6 % with USG and 92.9 % with PNS (ns). One vascular puncture occurred in PNS; no pneumothorax or neurological injury was noted.

Conclusion: For supraclavicular blocks, ultrasound shortens execution time and hastens motor blockade while maintaining a high success rate and safety profile. These findings support adopting US guidance where resources allow.

Case Report of a Mega Appendix

Dr. Proff Surendra Pathak (MS) — 2025-07-17

Surgeons maintain continuous interest about the appendix due to its multiple presentation types and potential pathologies and functional aspects. The acute appendicitis condition represents one of the main reasons for sudden abdominal pain. Open appendectomy remains the preferred treatment and is a commonly performed emergency surgery, especially among trainees. The appearance of the appendix during surgery can be misleading, even for experienced surgeons. The standard surgical practice takes each appendicitis situation as an individual expulsion that requires specific treatment. Each person possesses an appendix of different sizes which generally measure between 6–9 cm in length with 7–8 mm in diameter. Previously, the longest appendix recorded in India was 17.5 cm, and the global record was a perforated appendix measuring 55 cm. This report highlights a rare case of non perforated inflamed appendix measuring 9.8 cm in length and 5.5 cm in diameter at its widest point,which appeared as a sealed off perforated appendicular mass on USG AND CECT ,was removed .Highlighting the fact that diagnosing acute appendicitis remains clinically challenging despite medical advances.

Impact of Mouthwash Type, Exposure Time and Application Frequency on Esthetic Degradation of Composite Restorations

2025-06-25

Although mouthwashes are frequently used for dental hygiene, little is known about their affect on theaesthetic qualities of composite restorations. Objective: To investigate the impact of exposure duration,application frequency, and mouthwash type on the aesthetic deterioration of composite restorations in patients who use different mouthwashes

Effects of Ph and Temperature on Dental Materials in Saliva and Oral Fluids

Dr Kainaat Basharat — 2025-07-17

The oral environment exposes dental materials to a range of pH and temperature, therefore influencing their durability and functionality. This research investigates how pH and temperature influence the dental materials in oral fluids and saliva.

Objective: To determine the impact of temperature and pH fluctuation on physical and chemical characteristics of dental materials.

Methodology: 60 dental materials specimens including composites, ceramics, and metals was employed in this in-vitro experimental study that was performed in a dental materials lab. SEM, EDX, and nanoindentation were used to examine the surface morphology, chemical composition and mechanical characteristics of the materials. The specimens were placed and pH levels (acidic, neutral, and alkaline) and temperatures included room temperature, body temperature and elevated temperature were applied.

Result: Exposure to high temperatures (p 0. 001) and acidic pH (p 0. 05) significantly modified the material's properties. Under acidic conditions, the surface roughness increased by 35. 2% 5. 1% while the mechanical strength dropped by 22. 5% 3. 2% at high temperatures.

Conclusion: The findings highlight the need of taking pH and temperature fluctuations in the oral environment into account while choosing and producing dental materials. Knowing this helps one to improve the durability and efficacy of dental restorations.

An Observational Study of Drug Prescription Pattern in Outdoor Patients of Hypertension in Department of Medicine at Sms Hospital, Jaipur

Dr. Purooshottam — 2025-07-18

Background: Hypertension represents a leading contributor to global morbidity and mortality, with an estimated 1.28 billion adults affected worldwide. In India, prevalence exceeds 30% among adults aged ≥18 years, imposing substantial economic and clinical burdens. Rational pharmacotherapy guided by prescribing indicators can optimize therapeutic outcomes and resource utilization. This study aimed to characterize antihypertensive prescription patterns among outpatients in the Department of Medicine at SMS Hospital, Jaipur, using WHO prescribing indicators and national treatment guidelines.

Methods: A study design (descriptive study) was to recruit 400 consecutive outpatients with a diagnosis of hypertension (systolic blood pressure values in excess of 160mmHg, or diastolic values greater or equal to 100mmHg). Demographic, comorbidities and prescribed medications information were obtained after ethical approval. The indicators that were measured based on prescriptions are the average number of drugs per encounter, the percentage of drugs prescribed by generic name, encounters with antibiotics or injections, and the percentage of the drugs in the Rajasthan Essential Drugs List of 2022. The comparisons of the patterns were done against the Standard Treatment Guidelines (6th Ed). The mean (SD) of continuous variables and percentages of categorical variables were reported and compared using a Student t-test or 2-way anova and 2-sample and 2-way 2-sample chi2 tests, respectively; p < 0.05 the level of significance.

Results: The average age was 54.3 years +- 10.2, male to female ratio was 1.2:1. The mean encounter drugs were 2.4 0.7. Generics comprised 78.5% of prescriptions, antibiotics in 12.0%, injections in 4.5%, and 85.2% from the Essential Drugs List. Monotherapy prevailed in 38%, dual therapy in 46%, and ≥3 drugs in 16% of encounters. ACE inhibitors (35%), calcium channel blockers (28%), and diuretics (22%) were most frequently prescribed. Overall adherence to national guidelines was 72.5%.

Conclusion: Prescription patterns at our center demonstrate moderate adherence to WHO indicators and national guidelines; however, scope exists for improved generic use and guideline conformity. Continuous prescriber education and periodic audit are recommended to promote rational antihypertensive therapy.

Prescription Patterns and Antimicrobial Susceptibility in Complicated Urinary Tract Infection at a North Indian Tertiary Care Hospital: A Descriptive Study

Dr. Anuj Pareek — 2025-07-18

Background Complicated urinary tract infection (cUTI) increases morbidity, length of stay and antimicrobial resistance. Indian data on real world prescribing and susceptibility trends remain limited .

Methods A hospital based descriptive study (March 2023 – Feb 2024) enrolled 100 consecutive adults admitted with cUTI to the Urology ward of a 2200 bed tertiary hospital. Demographics, comorbidities, prescriptions (admission, culture directed, discharge) and adverse drug reactions (ADRs) were captured prospectively on a structured pro forma. World Health Organization (WHO) prescribing indicators were applied. Isolates underwent standard CLSI urine culture and antimicrobial susceptibility testing. Data were analysed with SPSS v16 using descriptive statistics and χ² as appropriate.

Results Mean age was 45.7 ± 17.0 years; 90 % were male. Stones (45 %) and hydronephrosis (38 %) were common risk factors. Median drugs/prescription = 4 (IQR 3–5); all were generic and Essential Drug List compliant. Antimicrobial use was universal at admission; ceftriaxone (61 %) and amikacin (100 %) predominated. After culture, de escalation occurred in 43 % and carbapenems were initiated in 50 % of culture guided regimens. Escherichia coli (56.7 %) and Klebsiella spp. (10.2 %) were leading pathogens. Overall susceptibility (%) was highest for colistin (94), nitrofurantoin (84) and piperacillin tazobactam (77); fluoroquinolone resistance exceeded 60 %. Thirty three patients (33 %) experienced ≥ 1 ADR, most commonly dyspepsia and headache with diclofenac/paracetamol or pantoprazole; no serious ADRs occurred.

Conclusion High third generation cephalosporin and aminoglycoside use with limited culture directed de escalation was observed. Rising fluoroquinolone resistance underscores the need for protocol driven, carbapenem sparing stewardship. Continuous surveillance and clinician feedback can optimise empirical choices and curb resistance.

Selective Nerve Root Block versus Caudal Epidural Block in Single-Level Lumbar Intervertebral Disc Prolapse

Dr. Narendra Kumar — 2025-07-18

Background: Chronic lumbar radiculopathy due to intervertebral disc prolapse is prevalent and causes significant morbidity. Interventional pain management techniques like Selective Nerve Root Block (SNRB) and Caudal Epidural Block (CEB) are commonly used when conservative treatments fail. This study compares the efficacy of SNRB and CEB in managing pain and improving function in patients with single-level lumbar disc prolapse.

Methods: Sixty-six patients with single-level lumbar disc prolapse-induced radiculopathy were assigned according to surgeons choice to receive either SNRB or CEB. Pain intensity was measured using the Visual Analog Scale (VAS), and functional disability was assessed using the Oswestry Disability Index (ODI) and the Roland-Morris Disability Questionnaire (RMDQ) at baseline, 3 weeks, 6 weeks, 3 months, and 6 months post-intervention. Statistical analyses compared outcomes between the two groups.

Results: Both SNRB and CEB groups showed significant reductions in VAS, ODI, and RMDQ scores over time (p < 0.001). However, no statistically significant differences were observed between the groups at any follow-up point (p > 0.05). The mean age and sex distribution were comparable between groups (p > 0.05).

Conclusion: Both SNRB and CEB are effective in reducing pain and improving function in patients with single-level lumbar disc prolapse. No significant difference was observed between the two interventions over six months, suggesting that either technique can be utilized based on clinical judgment and patient preference.

Comparative Gross and Histopathological Evaluation of Ante Mortem versus Post Mortem Electrocution Burn Marks: A Two Year Observational Study at Aiims, New Delhi

DR. Naresh Jeengar M.D — 2025-07-19

Background: Differentiating ante mortem (AM) from post mortem (PM) electrocution burn marks is a recurring forensic challenge, especially when only a single suspicious lesion is present at autopsy. The present study prospectively analysed gross and light microscopic characteristics of AM and experimentally produced PM electrocution marks to identify discriminative features.

Methods: In a comparative observational design (July 2018 – June 2020) we examined 25 AM electrocution fatalities and 30 fresh cadavers on which a standardised PM electroburn (220 V, 400–1000 mA, 3–4 s) was created following ethical approval. Systematic documentation of demographic context, lesion size/shape/location and quantitative histomorphology (16 predefined variables) was performed. Pearson’s χ² test with Yates’ correction determined significance (SPSS v24.0; p<0.05).

Results: AM victims were predominantly male (92%) and aged 21–50 years. AM lesions most frequently involved the palmar hand (72%), were elongated (60%) and >1 cm in 52% of cases. Histology revealed significantly higher frequencies of epidermal necrosis (72% vs 43%, p=0.03), streaming of nuclei (72% vs 53%, p=0.04), and dermo epidermal separation (28% vs 13%, p=0.01) in AM compared with PM samples. Vascular nuclear elongation was common in AM (72%) but only occasional in PM (33%). No inflammatory infiltrate, metallisation or sebaceous gland involvement was observed in either group.

Conclusion: While several microscopic criteria overlap, a constellation of pronounced epidermal necrosis, nuclear streaming, and dermo epidermal separation strongly favours an AM origin. The proposed algorithm incorporating five key variables yielded 84% sensitivity and 80% specificity for AM diagnosis in our cohort. Multicentric validation is recommended.

A Study on Leprosy Reactions in a Tertiary Hospital in Northeast India

Joydeep Roy — 2025-07-18

“Leprosy reactions are acute inflammatory episodes occurring in leprosy patients, significantly affecting morbidity and long-term disability.”The objective of this study is to assess the clinical and epidemiological profile of leprosy reactions in a tertiary care hospital in Northeast India. A retrospective analysis of medical records of leprosy patients presenting with reactions was conducted. The study categorizes cases based on age, sex, classification of leprosy, type of reaction, duration of treatment, and clinical symptoms. Prompt diagnosis and management are crucial for preventing permanent disabilities.

Comparative Efficacy of Intranasal Corticosteroids vs. Antihistamines in Allergic Rhinitis: A Randomized Biochemical-Based Study

2025-07-19

Allergic rhinitis (AR) significantly impairs quality of life and presents with chronic nasalinflammation. This randomized open-label study compared intranasal corticosteroids (INCS) andoral second-generation antihistamines (AH) in 120 adult patients over 8 weeks

Serum Vitamin D and Anti-Müllerian Hormone Levels in Patients with Ovarian Dysfunction: A Cross-Sectional Analysis or metaanalysis

2025-07-19

Objective: To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] and
Anti-Müllerian Hormone (AMH) in women with ovarian dysfunction.

Topical Corticosteroid vs. Leukotriene Antagonist Therapy in Recurrent Nasal Polyps: A case control: study with Biochemical Inflammatory Markers

2025-07-19

Recurrent nasal polyps (RNP) impose substantial morbidity and recurrence despite surgicalintervention. While topical corticosteroids (TCS) are frontline therapy, leukotriene antagonists

Diagnostic Accuracy of Serum Amylase, Lipase, CRP, and Correlative Histopathological and Microbiological Findings in Assessing the Severity of Acute Pancreatitis

2025-07-19

Diagnostic Accuracy of Serum Amylase, Lipase, CRP, and CorrelativeHistopathological and Microbiological Findings in Assessing the Severity ofAcute Pancreatitis

Association of Serum IL-6 and CRP Levels with Disease Severity in Acute Exacerbation of COPD

2025-07-19

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) carry significantmorbidity and mortality. This study evaluated the diagnostic and prognostic utility of seruminterleukin-6 (IL-6) and C-reactive protein (CRP) levels in 150 patients admitted with AECOPD

Association between Early Body Weight Loss and Development of Hyperbilirubinemia in Term Neonates at 72 Hours

Dr Deepak Sankhwar — 2025-07-19

Background: Neonatal hyperbilirubinemia affects approximately 60% of term and 80% of preterm newborns according to AIIMS NICU protocols, representing one of the most common neonatal conditions requiring clinical intervention. Early body weight loss patterns may serve as predictive indicators for subsequent jaundice development, particularly in resource-limited settings where simple monitoring tools are essential for timely intervention.

Methods: A prospective observational cohort study was conducted at the Autonomous State Medical College, Fatehpur, Uttar Pradesh, from January to December 2024. Term neonates (≥37 weeks gestation, birth weight >2500g) were enrolled and monitored for body weight loss patterns during the first 72 hours. Total serum bilirubin levels were measured at 72 hours, with hyperbilirubinemia defined as ≥12 mg/dL for term infants, following AIIMS NICU protocol guidelines. Receiver operating characteristic curve analysis determined optimal weight loss thresholds, and multivariate logistic regression identified independent risk factors.

Results: Among 380 enrolled neonates, 228 (60.0%) developed hyperbilirubinemia at 72 hours, consistent with AIIMS protocol observations. Hyperbilirubinemic neonates experienced significantly higher weight loss at all-time points (day 3: 9.2±2.8% vs 5.8±2.1%, p < 0.001). The optimal predictive threshold was 7.8% weight loss at 72 hours (sensitivity 78.5%, specificity 81.2%, AUC=0.863). Independent risk factors included maximum weight loss >7.5% (OR = 4.12, 95% CI: 2.48-6.85), decreased gestational age (OR = 1.75 per week), primiparity (OR = 1.89), and reduced breastfeeding frequency (OR = 2.28).

Conclusion: Early neonatal body weight loss patterns, particularly exceeding 7.8% at 72 hours, strongly predict hyperbilirubinemia development in 60% of term neonates. This simple anthropometric assessment provides a practical screening tool for identifying high-risk neonates, enabling timely interventions and optimized clinical management consistent with AIIMS NICU protocols.

HISTOMORPHOMETRICAL STUDY OF THE PANCREAS

Dr Shashwati Geeta Deka — 2025-07-20

The pancreas is a digestive gland with both endocrine and exocrine functions. The endocrine units called the Islets of Langerhans, contain cells like alpha, beta, etc. and produce hormones like glucagon, insulin-having direct effect on glucose homeostasis. The beta cell failure or insulin resistance can lead to a common serious disease called Diabetes Mellitus.

HISTOMORPHOLOGY OF THE PANCREAS IN FIVE MAMMALS

DR SHASHWATI GEETA DEKA — 2025-07-20

Pancreatic transplantation is the only reliable therapy that can help a diabetic patient establish euglycemia without exogenous insulin. The potential of animal tissues as a source for organ transplantation has been advocated for the perennial shortage of human donors, posing problem in establishing viable transplantation programmes.

Lesion Sterilization and Tissue Repair: A Comprehensive Review

Dr. Hussain Topiwala — 2025-07-21

Lesion Sterilization and Tissue Repair (LSTR) is an innovative therapeutic approach designed to manage deep dental caries and necrotic pulp, particularly in pediatric patients. This review explores the fundamental principles, clinical applications, and effectiveness of LSTR in preserving natural tooth structure while promoting tissue regeneration. The technique involves the application of a combination of antimicrobial agents, such as metronidazole, ciprofloxacin, and minocycline, to eliminate pathogenic bacteria and create an optimal environment for healing. The review highlights the indications and contraindications of LSTR, as well as factors affecting its success. Collectively, the findings suggest that LSTR can significantly improve treatment outcomes in pediatric dentistry, providing a less invasive alternative to traditional methods. Ongoing research and clinical trials are essential for refining LSTR protocols and establishing its long-term efficacy and safety.

STUDY OF DRUG UTILIZATION PATTERN OF ANTIEPILEPTIC DRUGS AT TERTIARY CARE HOSPITAL

Rahul Wagh, Sudhir Padwal, Shrikant Dharmadhikari,Vinod Deshmukh — 2025-07-20

The World Health Organization (WHO) defined Drug Utilization Research(DUR) in 1977 as “The advertising, dissemination, prescription, and utilization of drugs in asociety, with an exceptional accentuation on the subsequent medical, social and monetaryresults.

PATTERN AND EXTENT OF ADVERSE DRUG REACTIONS (ADRS) WITH ANTIEPILEPTIC DRUGS AEDS

Rahul wagh, Sudhir Padwal, Shrikant Dharmadhikari, Vinod Deshmukh — 2025-07-20

There are additional challenges associated with anti-epileptic medications,such ADRs and compound interactions. The findings of systematic reviews and metaanalyses examining prospective research

Role of Transvaginal Sonographic Measurement of Uterocervical Angle in The Prediction of Preterm Labour

Dr Tomesh Shrimali — 2025-07-21

Background: Spontaneous pre-term labour (sPTL) remains the leading cause of neonatal morbidity and mortality despite advances in perinatal care. Trans-vaginal sonographic (TVS) cervical length (CL) has modest predictive value. Recent work suggests that the uterocervical angle (UCA)—the angle between the lower uterine segment and the cervical canal—may better capture the vector of intra-uterine force.

Methods: In this prospective observational study we enrolled 100 consecutive women with singleton pregnancies at 16–24 weeks who had ≥ 1 historical risk factor for sPTL (prior sPTB, prior PPROM or mid-trimester loss). After exclusions, 96 women underwent standardized TVS assessment of CL, cervical width (CW) and UCA. Participants were followed until delivery. Primary outcome was birth < 37 weeks. Diagnostic accuracy was assessed with ROC analysis; optimal cut-offs were determined by Youden index.

Results: Twenty women (20.8 %) delivered pre-term. Mean (±SD) UCA was significantly wider in the pre-term versus term group (113.5 ± 17.9° vs 91.6 ± 14.0°, p < 0.001), whereas mean CL did not differ (3.20 ± 0.61 cm vs 3.35 ± 0.55 cm, p = 0.14). An obtuse UCA > 98.5° predicted sPTB with sensitivity 85 %, specificity 79 %, AUC 0.86 and odds ratio 21.3 (95 % CI 6.9-65.0). CW > 3.05 cm was a moderate predictor (AUC 0.74). Combining UCA > 98.5° and CW > 3.05 cm improved sensitivity to 90 % but reduced specificity to 54 %.

Conclusion: In high-risk singleton gestations the mid-trimester UCA outperforms traditional CL screening and, in combination with CW, yields the highest overall sensitivity for sPTB. Routine measurement of UCA at the anatomy scan may enable targeted prophylaxis.

Ottawa Ankle Rule as a Tool for Reducing Radiation Exposure in Pregnant Trauma Patients

Dr. Anand Srivastav — 2025-07-21

Background Ionising-radiation‐based imaging is avoided whenever possible in pregnancy, yet ankle injuries remain common after falls or vehicular collisions. The Ottawa Ankle Rule (OAR) reliably rules out fracture in the general population, reducing unnecessary radiographs. Its impact on maternal–fetal radiation exposure in pregnant trauma patients has not been formally quantified.

Methods We performed a prospective cohort study (January 2019 – December 2024) at a level-1 trauma centre. Consecutive pregnant women (gestational age ≥ 6 weeks) presenting with ankle trauma were assessed by emergency physicians trained in the OAR. Primary outcomes were (i) diagnostic performance of OAR versus reference-standard radiography or CT and (ii) cumulative effective fetal radiation dose avoided. Secondary outcomes included emergency department (ED) length-of-stay and 30-day missed-fracture rate.

Results Two-hundred-and-twenty participants (mean age 28.7 ± 4.8 years; median gestation 22 weeks) were enrolled. OAR was positive in 94 (42.7 %) and negative in 126 (57.3 %). Forty-four fractures were confirmed, all in the OAR-positive group (sensitivity 100 %, 95 % CI 92–100 %; specificity 43 %, 95 % CI 36–51 %). Application of OAR reduced radiographs from 220 theoretical to 98 actual exams, yielding a 55.4 % reduction and an estimated fetal dose saving of 5.9 mSv (median 0.03 mSv per patient). No fractures were missed at 30 days. ED stay was shorter in the OAR-negative group (mean difference −41 min, p < 0.001).

Conclusion OAR maintains 100 % sensitivity in pregnant trauma patients and more than halves ionising-radiation exposure. Incorporating OAR into obstetric trauma protocols is a simple, evidence-based measure aligned with ALARA principles. Keywords: Ottawa Ankle Rule; pregnancy; radiation dose; trauma; diagnostic decision rule; ankle fracture.

High-Risk Pregnancies and Their Outcomes in a Tertiary-Care Centre in South India

Dr. Shruthi S. S — 2025-07-21

Background: High-risk pregnancies (HRP) account for a disproportionate share of maternal and perinatal morbidity and mortality in low- and middle-income countries. India’s Maternal Mortality Ratio (MMR) has fallen to 97 / 100 000 live births in 2018–20, yet preventable deaths persist, particularly among women with multiple risk factors.

Methods: A prospective observational study was conducted in the Department of Obstetrics & Gynaecology, ESIC Medical College & PGIMSR, Bengaluru (January 2023 – January 2025). All singleton or multifetal HRP admissions (n = 1 250) were enrolled after informed consent. Risk factors were classified as demographic, medical, obstetric or fetal. Primary outcomes were maternal morbidity/mortality and neonatal morbidity/mortality up to day 7 postpartum. Data were analysed with descriptive statistics; categorical variables were expressed as frequencies and percentages.

Results: HRP constituted 33 % (1 250 / 3 780) of obstetric admissions. The commonest risk factors were thyroid disorders (36.1 %), previous caesarean (28.1 %), anaemia (22.9 %), liquor abnormalities (14.9 %) and hypertensive disorders (11.8 %). Overall caesarean rate was 53.7 % (671 / 1 250), predominantly for scarred uterus (51 %) and iatrogenic indications such as severe pre-eclampsia and fetal growth restriction. Maternal morbidity was 5.8 %; postpartum haemorrhage (1.7 %) and eclampsia (1.8 %) were leading complications. There were no maternal deaths. Neonatal admission rate was 19.1 %; jaundice (11.6 % of all neonates) and respiratory distress (2.2 %) predominated. Perinatal mortality was 0.8 % (intra-uterine death 0.24 %, neonatal death 0.56 %).

Conclusion: Although HRP burden remains high, multidisciplinary management in tertiary centres can achieve zero maternal deaths and low perinatal loss. Targeted interventions—early anaemia correction, thyroid screening, VBAC counselling and strict hypertensive surveillance—could further improve outcomes. Strengthening peripheral referral and continuity of antenatal care under initiatives such as PMSMA and e-PMSMA is imperative.

Anterior Bridge Plating for Humeral Shaft Fractures: A Single-Arm Interventional Study

Dr. SAGAR — 2025-07-21

Background: Humeral shaft fractures represent a significant portion of upper extremity injuries. Treatment options range from conservative methods to surgical interventions. Anterior bridge plating, a minimally invasive surgical technique, has gained attention for its potential to provide stable fixation while minimizing soft tissue disruption.

Methods: A single-arm interventional study was conducted at Gulbarga Institute of Medical Sciences, Kalaburagi, from June 2021 to July 2024. Twenty patients with isolated diaphyseal humerus fractures were treated using anterior bridge plating. Functional outcomes were assessed using the Constant score for shoulder function and the Mayo Elbow Performance Score (MEPS) for elbow function. Radiological union time and associated complications were also evaluated.

Results: The study included 14 males and 6 females with a mean age of 51.6 years. The majority of fractures resulted from road traffic accidents (55%) and were left-sided (65%). The mean radiological time to union was 25.6 weeks. Functional assessment revealed a mean Constant score of 84.8, indicating good shoulder function, and excellent elbow function in 76.5% of patients based on MEPS. Three cases (15%) developed atrophic non-union, and four patients exhibited moderate shoulder stiffness, which improved with physiotherapy.

Conclusion: Anterior bridge plating for humeral shaft fractures demonstrates satisfactory functional outcomes. The technique offers stable fixation while preserving soft tissue integrity, making it a viable option for managing diaphyseal humerus fractures.

Risk Factor Profile and Clinical Characteristics of Acute Coronary Syndrome in Adults ≤45 Years: A Cross Sectional Study from Western India

Dr Prashant Vithalrao Salve — 2025-07-22

Background Young adults form a growing fraction of acute coronary syndrome (ACS) admissions in South Asia, yet granular data on their risk factor constellation remain sparse.

Methods We analysed prospectively collected data from 46 consecutive patients ≤45 years (mean 40.2 ± 4.0 y; 84.8 % men) admitted with STEMI, NSTEMI or unstable angina to a tertiary cardiac centre in Mumbai (2019 2021). Demographic, behavioural, anthropometric, biochemical and echocardiographic variables were recorded using a prespecified pro forma; associations with ACS phenotype were examined by χ²/Fisher tests (α = 0.05).

Results Half the cohort were active smokers and 54 % were obese (BMI ≥30 kg m⁻²). Hypertension and previously known diabetes were present in 24 % each, but HbA1c screening unmasked diabetes in an additional 30 %. High sensitivity CRP (hsCRP) >1 mg dl⁻¹ was seen in 83 % and was the only variable significantly associated with presentation type (STEMI/NSTEMI/UA, p < 0.001). Low HDL C (<40 mg dl⁻¹) affected 80 %, whereas LDL C was high in 57 %. Mean left ventricular ejection fraction was 45 ± 9 %.

Conclusion Young Indian ACS patients exhibit an adverse mix of modifiable risks—smoking, obesity, subclinical diabetes and systemic inflammation—underscoring the need for aggressive primordial prevention beginning in early adulthood.

Baseline Clinical and Angiographic Profile of Patients Undergoing Left Main Coronary Artery Percutaneous Intervention in an Indian Tertiary Centre

Dr. Mangesh Gajakosh — 2025-07-22

Background Left main coronary artery disease (LM CAD) accounts for 4–9 % of diagnostic angiograms and carries the highest risk among coronary lesions.[1] High quality baseline data from low and middle income settings remain sparse.

Methods We prospectively enrolled 35 consecutive adults (August 2022 – July 2023) undergoing unprotected LM percutaneous coronary intervention (PCI) at Jagjivan Ram Railway Hospital, Mumbai. Detailed demographic, laboratory, echocardiographic and quantitative angiographic variables were captured.

Results Mean age was 66.2 ± 6.3 years; 63 % were male. Hypertension (71 %), diabetes (63 %) and dyslipidaemia (43 %) predominated, with 43 % reporting current smoking. Distal bifurcation involvement occurred in 68 % of cases; 43 % had double vessel and 20 % triple vessel disease in addition to LM stenosis. Median SYNTAX score was 29 (IQR 24–33); IVUS/OCT guidance was used in 100 % of procedures. Left ventricular ejection fraction (LVEF) was preserved (>45 %) in 40 %, moderate (35–45 %) in 31 %, and severely reduced (<35 %) in 20 %.

Conclusion Patients undergoing LM PCI in this single centre Indian cohort were older, burdened with multiple cardiometabolic risk factors and presented predominantly with complex distal bifurcation disease. These data provide a contemporary regional baseline against which procedural strategies and outcomes can be benchmarked.

Role of Nebulised Dexmedetomidine, Midazolam or Ketamine as Premedication in Preschool Children Undergoing General Anaesthesia: A Prospective, Double-Blind, Randomised Study

Dr. Syeda Maryam Quadri — 2025-07-22

Background: Preschool-aged children are highly susceptible to peri-operative anxiety, which can impair induction of anaesthesia and provoke maladaptive behaviours post-operatively. Nebulisation offers a needle-free route that achieves high mucosal bio-availability while being well-tolerated. We compared nebulised dexmedetomidine, midazolam and ketamine as sedative premedicants in this population.

Methods: Ninety-six ASA I–II children (3–7 y) scheduled for elective surgery were randomised (1:1:1) to receive dexmedetomidine 2 µg kg⁻¹ (Group D), midazolam 0.2 mg kg⁻¹ (Group M) or ketamine 2 mg kg⁻¹ (Group K) in 3 mL saline via jet nebuliser 30 min before induction. Investigators, caregivers and data collectors were blinded. Primary outcome was quality of sedation at 30 min (five-point sedation scale, FPSS). Secondary outcomes included parental-separation anxiety (PSAS), mask-acceptance (MAS), haemodynamics, and emergence agitation (EAS). Data were analysed with two-way repeated-measures ANOVA or Kruskal-Wallis test as appropriate (α = 0.05).

Results: Group D showed deeper sedation than Groups M and K (median FPSS 4 vs 3 and 3; χ² = 8.56, p = 0.014). Parental separation was easiest with dexmedetomidine (mean rank 38.5 vs 43.8 and 56.9; p = 0.009) and mask acceptance was superior (mean rank 34.5 vs 51.7 and 53.5; p = 0.003). Emergence agitation was lowest with dexmedetomidine (median EAS 1 vs 2 and 2; p < 0.001). Haemodynamic variables remained within 15 % of baseline in all groups, although heart rate and mean arterial pressure were lower with dexmedetomidine intra-operatively (p < 0.05).

Conclusion: Nebulised dexmedetomidine 2 µg kg⁻¹ provides more satisfactory pre-operative sedation, smoother parental separation and mask induction, and less emergence agitation than equi-sedative doses of nebulised midazolam or ketamine in preschool children.

Non-Opioid versus Opioid Peri-Operative Analgesia in Neurosurgery (Nopain): A Multi-Centre Randomised Controlled Trial

Dr. Sumangala Mulagund — 2025-07-21

Background Up to 70 % of patients report moderate-to-severe pain after craniotomy despite intra-operative opioid titration. Opioids delay neurological evaluation and are frequently complicated by respiratory depression, sedation, nausea, and ileus—effects that are particularly hazardous in neurosurgical patients. Small, single-centre trials suggest that the α2-agonist dexmedetomidine provides comparable analgesia with fewer opioid-related adverse events, but imprecision and heterogeneity have precluded practice change.

Methods The NOPAIN trial is a prospective, parallel-group, assessor-blinded, multi-centre RCT conducted at five high-volume Indian neurosurgical centres. Five-hundred adults (18–65 y) undergoing elective supratentorial tumour resection are randomised (1:1) to an intra-operative infusion of fentanyl 1 µg kg-1 h-1 (opioid arm) or dexmedetomidine 0.5 µg kg-1 h-1 (non-opioid arm). Primary end-points are (a) rescue fentanyl consumption during surgery and (b) numerical rating scale (NRS) pain score in the post-anaesthesia care unit (PACU). Key secondary end-points include haemodynamic stability, opioid-related adverse events, emergence quality, patient-reported sleep and satisfaction, and persistent pain/health-related quality of life (HRQoL) at 3 and 6 months. Intention-to-treat analysis with mixed-effects models is pre-specified.

Results Between 19 October 2022 and 15 March 2024, 500 participants were enrolled; 493 (98.6 %) completed primary outcome assessment. Baseline demographic and surgical variables were comparable. Median (IQR) intra-operative rescue fentanyl was 50 µg (30–75) in the opioid arm versus 0 µg (0–25) in the dexmedetomidine arm (p < 0.001). Median PACU NRS was 4 (3–5) versus 3 (2–4), respectively (p = 0.002). Dexmedetomidine reduced early PACU nausea (12 % vs 28 %) and coughing at extubation (8 % vs 23 %) without prolonging extubation time.

Conclusions Intra-operative dexmedetomidine markedly decreases rescue opioid requirements and modestly improves early postoperative pain and recovery quality after elective supratentorial craniotomy. Long-term pain and HRQoL follow-up is ongoing.

Comparative Hemodynamic Stability in Low-Dose versus Conventional-Dose Bupivacaine for Spinal Anaesthesia in Elderly Patients

Dr. Arvind Patel — 2025-07-22

Background: Spinal anaesthesia is favoured for lower-limb and lower-abdominal surgery in the elderly, yet conventional doses of hyperbaric bupivacaine frequently precipitate hypotension and bradycardia. Reducing the intrathecal dose may mitigate these effects while preserving surgical anaesthesia.

Methods: In this prospective, randomised, double-blind trial we enrolled 120 patients aged ≥ 65 years (ASA II–III) scheduled for elective hip or knee arthroplasty. Participants received either low-dose (LD, 6 mg) or conventional-dose (CD, 12 mg) 0.5 % hyperbaric bupivacaine with 25 µg fentanyl. Primary outcome was incidence of clinically significant hypotension (≥ 20 % fall in mean arterial pressure or MAP < 65 mmHg) during the first 30 min after block. Secondary outcomes included bradycardia (HR < 50 beats•min⁻¹), vasopressor usage, sensory-motor block characteristics, surgeon satisfaction, and major adverse events.

Results: Baseline characteristics were comparable. Clinically significant hypotension occurred in 17 % of LD versus 48 % of CD patients (relative risk 0.35; p < 0.001). Mean MAP at 5, 10, 20 and 30 min was consistently higher in LD (84 ± 9, 82 ± 8, 80 ± 7, 79 ± 6 mmHg) than CD (72 ± 11, 70 ± 10, 68 ± 9, 67 ± 8 mmHg; p < 0.01 at all points). Bradycardia was less frequent in LD (10 % vs 28 %; p = 0.02). Ephedrine requirements (median 0 mg [IQR 0–6] vs 12 mg [6–18]; p < 0.001) and atropine administration (2 % vs 12 %; p = 0.04) were reduced in LD. Surgical anaesthesia was adequate in both groups; time to two-segment regression was shorter in LD (78 ± 14 min vs 103 ± 18 min; p < 0.001) but did not prolong recovery room discharge. No patient required conversion to general anaesthesia.

Conclusion: In elderly patients, intrathecal low-dose 0.5 % bupivacaine (6 mg) supplemented with fentanyl provides satisfactory surgical conditions while significantly improving haemodynamic stability compared with the conventional 12 mg dose. Routine dose reduction should be considered to diminish peri-operative cardiovascular morbidity in this population.

Intrathecal Dexmedetomidine 5 µg Prolongs Post-Spinal Analgesia in Elective Lower-Limb Orthopaedic Surgery: A Prospective, Randomised, Double-Blind Trial

Dr. Arvind Patel — 2025-07-22

Background: Prolonging spinal-anaesthetic analgesia without raising complication rates remains a central goal in orthopaedic anaesthesia. Α-2-agonist dexmedetomidine (DEX) is increasingly injected intrathecally as an adjuvant, yet evidence in lower-limb orthopaedic surgery is heterogeneous.

Methods: In this prospective, double-blind, parallel-arm trial, 60 adults (ASA I–II) scheduled for elective lower-limb fixation under spinal anaesthesia were randomised to hyperbaric bupivacaine 0.5 % 3.5 mL plus 0.5 mL saline (Control) or plus DEX 5 µg (DEX group). Primary end-point was duration of effective analgesia (time from intrathecal injection to first rescue analgesic). Secondary outcomes included onset times, block characteristics, haemodynamics, adverse events and 24 h opioid-sparing.

Results: All patients completed follow-up. Mean analgesia duration increased from 258 ± 44 min to 327 ± 41 min (∆ ≈ 69 min, P < 0.001). Sensory onset was faster (3.1 ± 0.5 vs 3.8 ± 0.6 min, P = 0.002) and two-segment regression slower (212 ± 35 vs 153 ± 38 min, P < 0.001) with DEX. Post-operative morphine equivalents fell by 38 %. Haemodynamic profiles were comparable, although bradycardia occurred more often with DEX (5 vs 1 patients, NS). No neuro-toxic events were observed.

Conclusion: A single 5-µg dose of intrathecal dexmedetomidine significantly and safely prolongs analgesia after lower-limb orthopaedic surgery, reduces rescue-opioid need and accelerates block onset without increasing major adverse effects. The findings support routine use of low-dose DEX as an effective spinal adjuvant in lower-extremity trauma and reconstructive procedures.

Study on the Clinical Spectrum of Respiratory Conditions Presenting with Hypercapnic Respiratory Failure – A Cross-Sectional Observational Study

Dr kauser mohd Yaseen shaikh — 2025-07-22

Background: Hypercapnic respiratory failure (HRF) reflects failure of pulmonary ventilation and confers substantial short-term morbidity and mortality. Patterns of disease precipitating HRF vary geographically and influence outcome.

Methods: We performed a prospective cross-sectional study at a tertiary centre in Hyderabad (Sept 2022 – Feb 2023). Sixty-nine consecutive adults (≥18 y) with respiratory-cause HRF (PaCO₂ > 45 mmHg, pH < 7.35) were enrolled. Clinical variables, comorbidity, arterial blood-gases, radiology, echocardiography and hospital course were recorded. Non-invasive ventilation (NIV) was first-line; failure was defined as need for endotracheal intubation or in-hospital death. Descriptive statistics and logistic regression explored factors associated with NIV failure and mortality.

Results: Mean age was 55 ± 16 y; 50.7 % were male. Leading aetiologies were acute exacerbation of COPD (AECOPD, 26 %), bronchiectasis (9 %), and OSA/OHS (7 %); mixed phenotypes accounted for 42 % (Figure 2). Hypertension (39 %) and diabetes (25 %) were common comorbidities. Median hospital stay was 7 days (IQR 6–8). NIV succeeded in 85.5 % (59/69). NIV failure (14.5 %) was strongly associated with prior-year HRF admission (OR 4.3, p = 0.029) and in-hospital mortality (100 % vs 3 %, p < 0.001). Overall mortality was 11.6 %; AECOPD contributed 62.5 % of deaths.

Conclusion: In this South-Indian cohort, AECOPD—often co-existing with other airway diseases—was the commonest precipitant of HRF and the principal driver of mortality. NIV was effective in the majority; previous HRF admission heralded NIV failure and death, highlighting a target group for enhanced post-discharge care.

Severity of Cad and Duration of Diabetes in Patients Undergoing Coronary Angiography

Qurban Ali Rahu — 2025-07-22

Background: Diabetes mellitus, including prediabetes, links to a higher risk of coronary artery disease (CAD). The longer the illness lasts and the worse blood sugar control, the more complex and widespread coronary problems become. Research using tools like the Gensini score and coronary CT scans shows that high blood sugar over time, insulin resistance, age, and gender all play a big role in how CAD gets worse. New markers (hs-CRP, NT-proBNP) and imaging methods (CCTA, EAT checks) help predict risk better.

Objective: Investigating the relationship between diabetes duration and the severity of coronary artery disease (CAD) in patients undergoing coronary angiography Study design: Cross-sectional observational study Duration and place of study: This study was conducted in Peoples University of Medical and Health Sciences for Women Shaheed Benazirabad Nawabshah February 2024 to February 2025

Methodology: Researchers conducted this cross-sectional study in the Cardiology Department. They included 240 patients between 40 and 70 years old who had type 2 diabetes for 5 years or more. The main participants for this study were people who had a history of high blood pressure, were either smokers, or had a history of smoking as well as dyslipidemia. All patients taken for this study were preparing to undergo a coronary angiography, the results of which coupled with Gensini scores were used to establish and study the link between the severity of coronary artery disease and patients that suffer from chronic diabetes. Extensive statistical analyses were being done to understand this connection. The control group for this study was limited to various factors which included the age and gender of the participants, as well as their reported hypertension and dyslipidemia. Their smoking status was also taken into consideration.

Results: The control group for this study consisted of 240 participants that were diagnosed with diabetes at least 5 years ago. The study was age restrictive, hence participants in the control group were all between 40 and 70 years of age. This study observed that there exists an established connection between the length of chronic diabetes and a higher Gensini score, at r = 0.65. This study includes multiple regression analysis to understand the correlation between the duration of diabetes with high Gensini scores. This was coupled with patients diagnosed with hypertension and dyslipidemia.

Conclusion: This study has quantitatively established that there exists a significant link between the length of a diagnosis of diabetes mellitus, and the more severe the risk of a chronically diabetic patient suffering from coronary artery disease (CAD).

Adenosine Vs Verapamil: Treating No-Reflow Phenomenon in Individuals with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention (PCI)

Zuhaib Zahoor Soomro — 2025-07-22

Background: A condition that results from an imbalance between coronary blood supply and myocardial oxygen demand is called acute coronary syndrome (ACS). The no-reflow phenomenon is one of the most challenging complications for ACS which occurs during percutaneous coronary intervention (PCI). A few microvascular dysfunction mechanisms are included in the pathophysiology of the no-reflow phenomenon. These medicines include two names that are commonly used; adenosine and verapamil. Adenosine is a strong drug which is used to activate special A2 receptors that eventually help in opening up small blood vessels in the heart. On the other hand, verapamil is also used to relax the small blood vessels. Through this drug, the amount of calcium that enters into the muscle cells in the vessel walls is reduced.

Objective: To compare the efficiency of adenosine with verapamil to treat no-reflow phenomenon in individuals with acute coronary syndrome undergoing percutaneous coronary intervention (PCI).

Study design: An observational study

Duration and place of study: This study was conducted in Peoples University of Medical and Health Sciences for Women Shaheed Benazirabad Nawabshah from August 2023 to August 2024

Methodology: This is an observational study which was performed in the Cardiology Department of the hospital. There were a total of 120 individuals who were a part of this study. They all were having an age of 18 years or older. All the participants of this study were having acute coronary syndrome (ACS). Along with this, they required percutaneous coronary intervention (PCI). All the patients were divided into 2 groups equally. Each group had 60 individuals. One group received intracoronary verapamil while the other group received adenosine.Variables such as IMR, TIMI, and FMD were expressed in terms of mean with standard deviations. To analyse the data, SPSS version 25 was used.

Results: There were a total of 160 people included in this research. They all were having an age of 18 years or older. All the participants of this study were divided into 2 groups with each group having 60 individuals. One group received intracoronary verapamil while the other group received adenosine. The majority of the individuals were males in both the groups. The average age of the verapamil group was 60 years while it was 61 years for the adenosine group. Conclusion: In our study, both drugs, adenosine and verapamil, are effective but verapamil was found to be statistically significant in helping improve TIMI flow grades.

Management Strategies for Spondylolisthesis: A Contemporary Review of Emerging Techniques

Dr. Ankush Ratanpal — 2025-07-23

Background: Spondylolisthesis—the anterior or posterior translation of one vertebra on another—affects up to 11 % of older adults and 6 % of adolescent athletes. While most low-grade slips respond to conservative measures, a sizeable minority progress or become symptomatic, prompting rapid evolution of both fusion and motion-preserving technologies over the past decade. Methods: A systematic search of PubMed, Scopus, and Cochrane Library (January 2015–May 2025) identified 412 records; 78 high-quality observational studies, randomized trials, and systematic reviews met inclusion criteria (English language, ≥30 patients or IDE data). Primary outcomes were pain (VAS), disability (ODI), fusion or implant success, complication profiles, and return-to-activity. Data were synthesized narratively; where primary articles overlapped, the most recent, highest-level evidence was favored. Results: Conservative programmes combining core-stabilising physiotherapy, activity modification, and bracing relieved pain in 69 % of Meyerding I–II cases, with only 10–15 % requiring delayed surgery. Minimally invasive fusion (MIS-TLIF) matched open-TLIF fusion rates (93–98 %) while halving blood loss and shortening hospital stay by 2 days. Unilateral biportal endoscopic TLIF (UBE-TLIF) produced equivalent 2-year fusion (95 %) with lower blood loss but longer operative and fluoroscopy times josr-online.biomedcentral.com. Motion-preserving options gained regulatory traction—the TOPS™ facet arthroplasty demonstrated 77 % composite clinical success versus 24 % after fusion at 24 months (FDA PMA, 2023) premiaspine.com. Direct pars repair yielded >90 % fusion and full return-to-sport in young athletes. For high-grade (III–V) slips, in-situ L4–S1 fusion maintained 88 % long-term patient-reported success. Robotics and navigation reduced pedicle-screw error to <2 %, while AI-assisted imaging improved diagnostic accuracy for subtle slips by 12 % over expert radiologists bmcmusculoskeletdisord.biomedcentral.comsciencedirect.com. Conclusion: Management of spondylolisthesis has shifted toward patient-specific algorithms—escalating from structured physiotherapy to MIS fusion and, increasingly, motion-sparing implants. Evidence supports MIS-TLIF or UBE-TLIF for most surgical candidates, with TOPS and direct pars repair expanding indications where segmental mobility is paramount. Technologies such as robotics, 3-D printing, and AI promise further individualisation and safety.

Effectiveness of Neurodevelopmental Therapy on Trunk Control and Sitting Balance in Children with Spastic Quadriplegic Cerebral Palsy: A Quasi-Experimental Study

Dr. Rosaline Sujitha J — 2025-07-23

Background: Spastic quadriplegic cerebral palsy (CP) severely limits trunk control and sitting balance. Neurodevelopmental therapy (NDT) is widely used, yet its added value over conventional physiotherapy remains debated. Methods: Thirty children (6–10 years; GMFCS III–IV) with spastic quadriplegic CP were allocated to NDT + conventional therapy (n = 15) or conventional therapy alone (n = 15) for 6 weeks, three 45-min sessions per week. Gross Motor Function Measure-88 (GMFM-88) and Trunk Control Measurement Scale (TCMS) were recorded pre- and post-intervention. Paired and unpaired t-tests compared within- and between-group change. Results: Both groups improved significantly. In the NDT arm GMFM rose from 30.22 ± 5.79 to 35.19 ± 5.81 (p < 0.001) and TCMS from 11.07 ± 1.90 to 15.34 ± 2.60 (p < 0.001). Conventional therapy produced smaller gains (GMFM 30.05 ± 4.97 → 31.47 ± 5.21, p = 0.0003; TCMS 11.18 ± 3.05 → 12.71 ± 2.97, p < 0.001). Between-group comparison showed a clinically relevant but non-significant difference for GMFM (p = 0.075) and a significant advantage for NDT on TCMS (p = 0.015). Conclusion: Adding NDT to conventional exercises yields greater improvements in trunk control and sitting balance than conventional therapy alone in children with spastic quadriplegic CP.

An In-Vivo Study of the Accesory Bands of Hamstring Tendons

Dr. Pyntngen Kharbamon — 2025-07-23

Background. The objective of our study is to determine the characteristics of accessory bands of hamstring tendons and their implications for a successful graft harvest during Arthroscopic ACL reconstruction

Method. 30 middle-aged patients,17 males and 13 females with Anterior cruciate ligament injuries posted for arthroscopic ligament reconstruction were included in this study. Both semitendinosus and gracilis graft were harvested in all patients. The number of bands in each tendon and their location from the tendon insertion is measured and recorded

Results. The majority of patients in the study had two accessory bands of semitendinosus (66.67%). Other enrolled patients either had one accessory band (20%) or three accessory bands (13.33%). On the other hand, the majority patients (76.67%) had no accessory bands of gracilis, while the remaining had one accessory band. Of all the gracilis tendons, a single accessory band was observed in 7 tendons. They were found arising at a distance ranging from 4-6 cm from the tendon insertion at the tibial crest. For the semitendinosus, there was always a constant distal band arising at distance ranging from 3-7 cm. 13% of semitendinosus had a 3 accessory band with the most proximal band arising at 9-11 cm. 66.67% had only 2 accessory bands with the proximal band found at a distance of 8-10 cm measured from the insertion point

Conclusion Although accessory bands are highly variable in their location, we have observed that none of the bands were located more than 11 cm from the tendon insertion point. Tendon stripper can be safely advanced beyond this point

A Case Report of Right Pulmonary Artery Agenesis Presentation in an Adult Female

Dr Vinjamuri Anuhya — 2025-07-24

Unilateral pulmonary artery agenesis (UPAA) is a rare congenital anomaly resulting from maldevelopment of the sixth aortic arch. Its presentation in adulthood, particularly in the absence of associated congenital cardiac anomalies, is uncommon and often poses a diagnostic challenge.

A STUDY ON CLINICAL PATTERN OF DERMATOSES IN PAEDIATRIC AGE GROUP IN A TERTIARY CARE HOSPITAL IN ASSAM

Divya J N, Bhaskar Gupta, Johnson Cyriac , Joydeep Roy, Arup Paul, Shromona Kar — 2025-07-24

Paediatric dermatoses are a distinct group of disorders,comprising skin problems encountered during both childhood and adolescence.
Skin diseases are a major health problem in the paediatric age group and areassociated with significant morbidity and mortality.

An observational study evaluates neonatal outcomes in infants born to mothers with pre-eclampsia

Dr. Valluri. Sireesha — 2025-07-24

Background: Pre-eclampsia is a leading cause of maternal and neonatal morbidity and mortality. This study evaluates neonatal outcomes in infants born to mothers with pre-eclampsia.

Methods: A prospective observational study was conducted on 84 neonates born to pre-eclamptic mothers in tertiary care hospital. The study was conducted for the duration of 12 months. Maternal and neonatal parameters were recorded, including gestational age, birth weight, Apgar scores, NICU admissions, and complications.

Results: The mean gestational age was 35.2 ± 2.4 weeks, with 62% preterm deliveries. Low birth weight (<2500g) was observed in 58.3% of neonates. Respiratory distress syndrome (RDS) (26.2%), neonatal jaundice (19%), and intrauterine growth restriction (IUGR) (21.4%) were common complications. NICU admission was required in 45.2% of cases.

Conclusion: Neonates born to pre-eclamptic mothers have higher risks of prematurity, low birth weight, and neonatal complications. Early antenatal monitoring and timely delivery can improve outcomes.

Clinicopathological and Radiological Evaluation of Cervical Lymph Node Metastasis in Head & Neck Malignancies

Dr Yash Garg — 2025-07-24

Background: Head and neck cancers, highly prevalent in Asia and India, often present with cervical lymph node metastasis, impacting prognosis. This study evaluates the diagnostic accuracy of clinical examination, CT, ultrasonography, and pathological findings in detecting nodal metastasis, emphasizing imaging's role when clinical assessment is inconclusive.

Objectives: The objectives are to assess the role of radiological imaging, pathological results and clinical examination in evaluating cervical lymph node metastasis and to assess the diagnostic accuracy of radiological imaging when clinical examination produces negative results

Material methods: This cross-sectional study, conducted over 18 months in the Department of Otorhinolaryngology, included 157 patients with suspected head and neck malignancies. Patients aged 21–80 were included based on strict criteria. Radiological imaging was assessed using standardized criteria, and statistical analysis determined diagnostic accuracy.

Results: In this study involving 157 patients with suspected head and neck malignancies, oral cavity carcinoma was the most common diagnosis. Cervical lymph node metastasis was evaluated using clinical examination, CT, ultrasonography, and fine needle aspiration cytology, with histopathology serving as the reference standard. USG demonstrated the highest sensitivity (93.3%) for detecting metastasis, followed by FNAC (90%) and CT (83.3%).

Conclusion: This study emphasizes a multidisciplinary diagnostic approach for cervical lymph node metastasis in head and neck cancers. Ultrasound showed highest sensitivity, while CT provided anatomical precision. Combining clinical examination, USG, CT, FNAC, and histopathology enhances diagnostic accuracy, improves staging, guides treatment planning, and leads to better patient outcomes and prognosis.