International Journal of Pharmacy Research & Technology (IJPRT)

Comparative Analysis of Early Versus Late Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreatography in Cases of Cholelithiasis with Choledocholithiasis

Dr Devang Jain, Dr Lakshman Agarwal, Dr Umar Farooque, Dr Rounak Choudhary — Thu, 01 Jan 2026 00:00:00 +0100

Background: The optimal timing of laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis remains debated. While early LC (≤72 hours) may reduce operative difficulty and hospital stay, late LC (>6 weeks) has traditionally been practiced to allow inflammation to subside.

Methods: A prospective comparative study was conducted on 60 patients with cholelithiasis and choledocholithiasis who underwent successful ERCP for common bile duct clearance at a tertiary care hospital. Patients were randomized into early LC (within 72 hours; n=30) and late LC (>6 weeks; n=30) groups. Demographic, operative, and postoperative parameters including operative time, adhesion grading, conversion to open surgery, complications, and hospital stay were analyzed using standard statistical tests.

Results: Both groups were comparable in terms of age, sex, and comorbidities. Mean operative time was significantly shorter in the early LC group (56.2 ± 8.5 min vs. 77.4 ± 9.1 min; p<0.001). Severe adhesions were more frequent in late LC (40% vs. 10%; p=0.01). The mean length of hospital stay was reduced in the early LC group (2.9 ± 0.7 vs. 4.3 ± 1.2 days; p=0.002). Conversion to open surgery (1 vs. 2 cases) and postoperative complications (6.7% vs. 10%) were not statistically different.

Conclusions: Early LC within 72 hours of ERCP is safe and associated with shorter operative time, less operative difficulty, and reduced hospital stay without increasing complication rates. These findings support early cholecystectomy as the preferred strategy in patients with cholelithiasis and choledocholithiasis.

A CLINICAL STUDY OF TRAUMATIC BRAIN INJURY COMPARING FULL OUTLINE UNRESPONSIVE SCORE (FOUR SCORE) AND GLASGOW COMA SCALE SCORE (GCS SCORE) IN PREDICTING THE IN-HOSPITAL MORTALITY IN EMERGENCY DEPARTMENT OF TERTIARY CARE HOSPITAL

Dr P Kalyan Ram, Dr Rangappagari Amarnath — Mon, 05 Jan 2026 00:00:00 +0100

Objective: To compare and predict themortality in patients with TBI, by using FullOutline of Unresponsiveness (FOUR) scoreand the Glasgow Coma Scale (GCS) in Emergency department.

PREVALENCE OF HYPOTHYROIDISM IN PATIENTS WITH GALL STONE DISEASE IN A RURAL TERTIARY CARE HOSPITAL

Rajappan K Deepan Madhusudanan B , Arunprasath S, Paranthaman S — Mon, 05 Jan 2026 00:00:00 +0100

Background: Gallstone disease is aprevalent condition, with increasingevidence suggesting a link tohypothyroidism. However, the exact
relationship between thyroid abnormalities and gallstone disease is notwellestablished

Diagnostic Accuracy of Symphysio-Fundal Height in Detection of FGR by Taking Ultrasound as a Standard

Tue, 06 Jan 2026 00:00:00 +0100

Objectives: To measure the diagnostic accuracy of symphysio-fundal height in detection of fetal growth restriction by taking ultrasound as a gold standard.

Study Design: validation study

Settings: Department of Obstetrics and Gynaecology, BBH, Rawalpindi.

Study Duration: 5th April 2022 to 4th October 2022.

Materials & Methods: A total of 225 women with singleton pregnancies between 28 and 36 weeks of gestation, aged 18 to 40, were enrolled. We excluded patients with fetal cardiac activity, congenital abnormalities, and polyhydroamnios. A researcher measured the fundal height every two weeks between weeks 28 and 38 at prenatal clinic visits. The distance between the uterine fundus and the top of the symphysis pubis was measured using a non-stretchable tape that came into touch with the skin of the abdominal wall. The researcher was facing the inch side of the tape to avoid bias. The inspecting hand's palm applied light pressure at a straight angle to the abdomen wall to delineate the fundus. Plotting of the measurements onto the normogram was done after they were measured in centimeters (to the nearest 0.5 cm). A radiologist performed an ultrasound to confirm FGR if it did not match gestational age.

Results: Overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of symphysio-fundal height in detection of fetal growth restriction by taking ultrasound as a gold standard was 92.08%, 88.37%, 92.76%, 87.36% and 90.67% respectively. Conclusion: This study concluded that symphysio-fundal height is a highly sensitive and accurate parameter for detecting fetal growth restriction.

Comparing the Diagnostic Precision of the RMI and ADNEX Models in Identifying the Ovarian Tumor

Tue, 06 Jan 2026 00:00:00 +0100

Objectives: To assess the diagnostic precision of the ADNEX and RMI models in distinguishing between benign and malignant ovarian tumors while taking histopathology as the gold standard.

Study type: Validation study.

Study duration: 5th April 2022 to 4th October 2022 Settings: Department of Obstetrics & Gynecology, Benazir Bhutto hospital Rawalpindi.

Materials & Methods: 165 patients between the ages of 14 and 65 who had at least one ovarian, para-ovarian, or tubal adnexal mass with a smallest diameter > 3 cm on ultrasound examination were included. Patients who had undergone bilateral adnexectomy or who had an adnexal mass under follow-up prior to the study's commencement were not included. The RMI/ADNEX score was computed. The patient was categorized as either low risk or high risk. To determine the predictive value of both models, the values were correlated with the histology report following surgery. Histopathological analysis of removed tissue serves as the foundation for the reference standard.

Results: The RMI model's diagnostic accuracy, sensitivity, specificity, PPV, and NPV in telling the difference between benign and malignant ovarian masses were 90.11%, 85.14%, 88.17%, 87.50%, and 87.88%, respectively. ADNEX showed sensitivity of 85.56%, a specificity of 81.33%, a PPV of 84.62%, an NPV of 82.43%, and a diagnostic accuracy of 83.64%. Conclusion: This study concluded that diagnostic accuracy of RMI model in differentiation of benign and malignant ovarian masses is better than ADNEX model.

Evaluation of Novel Biomarkers for Early Detection of Acute Myocardial Infarction

Sat, 10 Jan 2026 00:00:00 +0100

Background: Early diagnosis of acute myocardialinfarction (AMI) is time-critical, yet initial ECGfindings may be non-diagnostic, and highsensitivity troponin can be negative or borderline in very early presenters. Objective: To evaluatethe diagnostic performance

Diagnostic Accuracy of Triple Assessment in Breast Cancer: A Comprehensive Clinical Evaluation with Statistical Analysis

Mon, 12 Jan 2026 00:00:00 +0100

Background: Triple assessment combining clinical breast examination, radiological imaging, and fine needle aspiration cytology represents the systematic diagnostic approach for evaluating breast masses and determining malignancy probability. Despite widespread utilization, comprehensive analysis of individual component performance and concordance patterns with statistical significance remains incompletely characterized in contemporary literature.

Methods: This retrospective study evaluated 340 consecutive women presenting with palpable breast lumps undergoing complete triple assessment evaluation. Clinical breast examination, diagnostic mammography with BI-RADS categorization (0–6 scale representing <2% to >95% malignancy risk), and ultrasound-guided fine needle aspiration cytology (classified as C1–C5 according to National Health Service Breast Screening Programme criteria) were performed. All patients underwent histopathological examination as the gold standard reference. Diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Statistical significance was assessed using chi-square analysis and McNemar's test with significance threshold of p<0.05.

Results: Combined triple assessment achieved 99.1% diagnostic accuracy (sensitivity 99.0%, specificity 99.3%, p<0.001). Individual modality sensitivities were clinical examination 76.9% (p<0.001), mammography 94.9% (p<0.001), and FNAC 94.7% (p<0.001). Concordant findings (80% of cases, n=272) demonstrated 100% sensitivity and 99.4% specificity. Discordant cases (20%, n=68) showed elevated malignancy risk of 86.8% (59 of 68 cases, p<0.001), with FNAC-driven discordance demonstrating 92.9% malignancy detection versus 11.1% for isolated clinical examination concerns (p<0.001).

Conclusion: Triple assessment achieves exceptional diagnostic reliability when all components are concordant, supporting clinical decision-making without additional biopsy in appropriately selected cases. Discordant presentations mandate heightened investigation, with FNAC demonstrating superior prognostic weighting. Triple assessment represents the gold-standard diagnostic paradigm for breast mass characterization and malignancy stratification.

Comparative Study of Oxidative Stress Markers in Hemodialysis (HD) versus Peritoneal Dialysis (PD) Patients

Mr. Anil Bhuktare, Dr. Sujata Gaikwad, Dr. Suvarna Tale — Mon, 12 Jan 2026 00:00:00 +0100

Introduction: Chronic kidney disease (CKD) patients on dialysis frequently develop anemia due to iron deficiency, blood loss, and chronic inflammation. Hemodialysis (HD) often involves intravenous iron therapy, which can elevate ferritin, while peritoneal dialysis (PD) patients may experience iron depletion through peritoneal losses. Ferritin, transferrin saturation (TSAT), and total iron binding capacity (TIBC) are key markers of iron status, but their interpretation is complicated by inflammation. Interleukin 6 (IL 6), a pro inflammatory cytokine, further influences iron metabolism and anemia. Comparing these parameters in HD and PD patients is essential for tailoring iron management strategies.

Aim: To compare iron and inflammatory markers between hemodialysis (HD) and peritoneal dialysis (PD) patients, and assess correlations with age and gender.

Methods: A cross sectional study of 70 ESRD patients (35 HD, 35 PD) was conducted. Serum iron, total iron binding capacity (TIBC), transferrin saturation (TSAT), ferritin, and interleukin 6 (IL 6) were measured using standard biochemical and ELISA methods. Statistical comparisons were made using Student’s t test, and correlations were assessed with Pearson’s coefficient.

Results: IL 6, serum iron, and TIBC did not differ significantly between HD and PD (p> 0.05). Serum ferritin was significantly higher in HD (574.05 ± 341.04 ng/ml) compared to PD (370.91 ± 292.38 ng/ml, p = 0.009). Age showed a weak negative correlation with ferritin, while females had higher ferritin than males.

Conclusion: HD patients exhibit elevated ferritin levels, likely reflecting iron supplementation and inflammation. Ferritin should be interpreted cautiously, and iron management strategies tailored to dialysis modality, age, and gender.

Evaluating the Impact of Workforce Burnout in Emergency Departments Considering Staff Performance and Patient Safety in Quetta: A Systematic Literature Review

Dr Ahsan Basil Patrick, Dr Shaheer Shakeel, Dr Shehryar Ahmad — Mon, 12 Jan 2026 00:00:00 +0100

The problem of burnout among emergency department healthcare professionals affects worldwide healthcare systems most severely in limited-resource environments especially in Quetta Pakistan. This research analyzes the effect of working burnout on emergency department staff performance and patient protection in Pakistani medical units through PEO (Population, Exposure, Outcome) methodology with PRISMA analysis. A total of five research-based studies appeared in the timeframe from 2016 to 2024 and underwent theme-based analysis. Research evidence reveals significant emotional exhaustion and depersonalization together with psychological distress within the ED workforce while showing their connection to diminished job performance and workforce dissatisfaction and inferior patient safety operations. Multiple studies showed that work-related challenges and insufficient support systems and societal discrimination regarding mental health together fueled this problem. This review demonstrates the importance of immediate policy changes and institution-based mental health aids to reduce burnout and increase healthcare effectiveness across Quetta's medical facilities.

Effects of Intermittent Fasting on Metabolic, Hemodynamic, and Cardiovascular Risk Parameters in Adult Subjects

Deepak Kumar, Dr Manila Jain, Chaudhary Devendra — Mon, 12 Jan 2026 00:00:00 +0100

Intermittent fasting has emerged as a popular dietary intervention with potential metabolicand cardiovascular effects. The present study was conducted to evaluate the impact of onemonth of intermittent fasting on anthropometric indices, glycemic parameters, lipid profile, inflammatory markers, and hemodynamic variables

Chronic Prostatitis and Causative Organisms

Dr. S. S. Yadav, Dr. Bulbul Yadav — Mon, 12 Jan 2026 00:00:00 +0100

Background: Chronic prostatitis is a frequently encountered urological condition with a heterogeneous etiology. While gram-negative bacteria remain the predominant causative agents, atypical and sexually transmitted organisms contribute significantly to disease burden, particularly in sexually active men.

Objective: To identify the spectrum of causative organisms in patients diagnosed with chronic bacterial prostatitis using conventional culture and nucleic acid amplification tests (NAAT).

Materials and Methods: This prospective observational study was conducted between March 2023 and November 2025 at a tertiary care hospital. Men aged 20–50 years presenting with recurrent urinary tract infection and genitourinary symptoms suggestive of chronic prostatitis were included. Patients with acute prostatitis or without identifiable organisms were excluded. All patients underwent detailed clinical evaluation, urine culture, expressed prostatic secretion analysis, and NAAT for sexually transmitted pathogens when indicated.

Results: A total of 146 patients were diagnosed with chronic bacterial prostatitis. Escherichia coli was the most common organism isolated on conventional culture (41%). NAAT identified atypical and sexually transmitted organisms in 10.9% of cases, predominantly Chlamydia trachomatis. Patients with multiple sexual partners showed a higher prevalence of atypical organisms.

Conclusion: Chronic prostatitis has a diverse microbiological profile. Along with conventional urine culture, NAAT improves detection of atypical and sexually transmitted pathogens and should be incorporated into diagnostic protocols for appropriate management.

A HISTOLOGICAL OBSERVATION ON DEVELOPMENT OF HUMAN FETAL LUNG -A RETROSPECTIVE FETAL AUTOPSY STUDY

Geetha G, Precila Infant Vincy V, Kumaravel A , Karthikeyan T — Mon, 12 Jan 2026 00:00:00 +0100

Background: This paper focuses on Lung histogenesis study in normal human foetuses ranging from11 to 40 weeks of gestation age. The process of histogenesis is nothing but a series of events thatoccur during the development of a tissue. In this process undifferentiated cells attain full functional maturity.

ANATOMICAL VARIATIONS IN PELVIC PART OF SCIATIC NERVE, A CADAVERIC STUDY AND ITS CLINICAL IMPLICATIONS

Porselvi S, Jeyaprabha M , Sunitha N.S , Margaret M — Mon, 12 Jan 2026 00:00:00 +0100

Background: Sciatic nerve is the largest and widest nerve in the human body. It is also called asthe ischiatic nerve or ischial nerve. It is the main continuation sacral plexus. It supplies posteriorcompartment thigh, leg and foot. Understanding the anatomical variations of the sciatic nerve is essential for clinicians and surgeons

Triple-Arm Randomized Trial of Intraperitoneal Levobupivacaine, Dexmedetomidine, and Placebo for Analgesia After Laparoscopic Cholecystectomy

Dr. Kumaragurubaran T. R., Dr. Rakesh Nongthombam, Dr. Ramkumar I. — Mon, 12 Jan 2026 00:00:00 +0100

Background: Pain after laparoscopic cholecystectomy is still a major clinical issue. The use ofanalgesic agents through intraperitoneal instillation may lead to better multimodal analgesia.The current research was aimed at comparing the analgesic effects of levobupivacaine and dexmedetomidine against placebo

Effects of a 12-Week Strength and Circuit Training Programme on Explosive Power and Cardiorespiratory Endurance in College-Level Football Players

S. Jayabalakrishnan, N. Rama Chandra Rao, Narni Hanumanth — Tue, 13 Jan 2026 00:00:00 +0100

Background: Football performance depends heavily on the integration of neuromuscular power and cardiorespiratory efficiency. Late adolescence and early adulthood represents a critical period during which targeted training interventions may induce favorable physiological adaptations.

Objective: The present study aimed to evaluate and compare the effects of strength training and circuit training on explosive power and cardiorespiratory endurance in college-level football players.

Methods: Sixty male football players aged 18–21 years were randomly assigned to a strength training group, a circuit training group, or a control group (n = 20 each). The experimental groups underwent a structured 12-week training programme, while the control group continued routine physical activity. Explosive power was assessed using the standing broad jump test, and cardiorespiratory endurance was evaluated using the 12-minute run/walk test. Data were analyzed using analysis of covariance (ANCOVA) at a 0.05 level of significance.

Results: Both strength training and circuit training produced significant improvements in explosive power and cardiorespiratory endurance compared to the control group (p < 0.05). Circuit training resulted in greater enhancement of explosive power, whereas strength training elicited superior improvements in cardiorespiratory endurance.

Conclusion: The findings suggest that both training modalities induce meaningful physiological adaptations in college-level football players. Incorporating strength and circuit training within youth conditioning programmes may optimize neuromuscular performance and cardiovascular efficiency essential for football performance.

Effectiveness of Diet Therapy in Mitigating Stomach Cancer in Kashmir Region of India: A Hospital -Based Study

Muneer Ahmad, Javid Muzamil, Taskeen Mehmood — Thu, 15 Jan 2026 00:00:00 +0100

Background: Cancer is a multifarious and complex disease, which is defined as a rapid and abnormal division of cells that engulfs other organs in a process of metastasis. Stomach cancer is prevalent in Kashmir, and new cases are rising drastically. It’s because of unawareness of food habits, smoking, spraying of orchards, unhealthy lifestyles, wazwan (non-vegetarian foods), processed and ultra-processed foods, micro-plastics, and harmful radiations. Stomach cancer patients are the highest (25.2%) after cola rectal cancer (16.4%) (Maria A. Qureshi et al.). It is noted that the Kashmir Valley has cancer at the highest rate as compared to the rest of India.

Aims/Objectives: the main objective of this study is to analyse risk factors and effectiveness of diet therapy among the patients suffering from stomach cancer.

Materials & Methods: The study was conducted at super specialty hospital government medical college Srinagar. A sample of 163 patients was taken. Interview method was deployed to collect the primary data.

Results: Out of 163 patients, majority were unaware about the proper diet. Many patients were on palliative care. Age group was 50-80, with male 135 and 28 were female.

Skin Changes in Pregnancy: A Prospective Observational Study

Dr. Nirmala Yadav, Dr. Bulbul Yadav — Thu, 15 Jan 2026 00:00:00 +0100

Background: Pregnancy is associated with profound hormonal, metabolic, immunological, and vascular changes that lead to various physiological and pathological cutaneous manifestations. Although most skin changes are benign and self-limiting, some pregnancy-specific dermatoses may cause significant maternal discomfort and fetal risk.

Objectives: To determine the incidence and pattern of physiological skin changes and pregnancy-specific dermatoses among pregnant women.

Materials and Methods: This prospective observational study was conducted in the Obstetrics and Gynecology outpatient department of Nirmala Hospital and Research Center, Jaipur, from February 2020 to October 2025. A total of 960 pregnant women were evaluated through detailed history taking and complete dermatological examination. Women with pre-existing dermatoses were excluded. Findings were categorized into physiological skin changes and specific dermatoses of pregnancy.

Results: Out of 960 participants, 536 were primigravida and 424 multigravida. Physiological skin changes were observed in the majority of women, with hyperpigmentation being the most common manifestation. Pregnancy-specific dermatoses were seen in a smaller proportion, with pruritic urticarial papules and plaques of pregnancy (PUPPP) being the most frequent condition.

Conclusion: Skin changes are extremely common during pregnancy, predominantly physiological in nature. Awareness of these manifestations helps differentiate benign changes from pathological dermatoses, enabling appropriate counseling and management.

Anthropometric Study of Facial Morphology in the Central Indian Population

Dr. Rajesh Kumar, Dr.Nivedita Pandey, Dr. Pawan Kumar Mahato — Fri, 16 Jan 2026 00:00:00 +0100

Facial anthropometry plays a crucial role inanatomy, forensic science, andreconstructive surgery by providingpopulation-specific standards for personalidentification. Facial dimensions exhibitsignificant sexual dimorphism and ethnic variation, making region-specific dataessential. The present study

Reinforcement Techniques for Dynamic Adaptive Learning

Ashu Tiwari, Pramod Singh, Akhilesh A. Waoo — Sat, 17 Jan 2026 00:00:00 +0100

The goal of dynamic adaptive learning systems is to tailor instruction by meeting the needs of each student instantly. In order to enable ongoing modification of instructional content based on student performance and engagement, this study investigates reinforcement learning strategies. The suggested technique dynamically modifies learning strategies and content complexity by modelling learning as an interactive feedback-driven process. When compared to static and rule-based systems, experimental results demonstrate better learning outcomes and engagement, indicating the effectiveness of reinforcement strategies for intelligent and scalable adaptive learning environments.

Drug Utilization Study in Patients of Chronic Suppurative Otitis Media Patients Attending a Government Tertiary Care Hospital in Jaipur City

Tue, 20 Jan 2026 00:00:00 +0100

Background: Chronic Suppurative Otitis Media (CSOM) remains a significant public health problem in developing countries, including India, contributing to morbidity, hearing impairment, and decreased quality of life. The rational use of antimicrobials and adjunctive medications plays a crucial role in the effective management of CSOM and in preventing antimicrobial resistance.

Objectives: To analyze the prescribing patterns of antimicrobials and other drugs in patients diagnosed with CSOM attending the outpatient department of a government tertiary care hospital in Jaipur City.

Methods: A prospective, cross-sectional observational study was conducted over a period of six months among patients clinically diagnosed with CSOM. Drug utilization pattern was analyzed to identify the frequently prescribed antimicrobials and other therapeutic drug classes.

Results: The majority of patients were in the [31–45 years], with a slight predominance of females. Oral antimicrobials were the most frequently prescribed drugs, followed by systemic antibiotics such as ciprofloxacin. Adjunctive drugs included antihistamines, nasal decongestants, and analgesics. Polypharmacy was minimal, and adherence to the essential drug list prescribing was noted in all the cases

Conclusion: The prescribing pattern in CSOM patients at this tertiary care hospital showed a preference for antimicrobials like fluoroquinolones and beta lactams. The predominance of oral drug use supports patient compliance and ease of use. However, continuous monitoring, adherence to treatment guidelines, and judicious antimicrobial use are essential to curb resistance and ensure optimal patient outcomes.

Interrelationship Between Placental Morphology and Thyroid Function in Preeclampsia: A Narrative Review

Tue, 20 Jan 2026 00:00:00 +0100

Background: Preeclampsia is a pregnancyrelated disorder, characterized by mild to severehypertension along with reduced or abnormalfunction of the placenta. The placenta plays an essential role in the pathogenesis of preeclampsiaand increasing changes in maternal thyroid

Rauwolfia Serpentina: Phytochemistry, Mechanisms of Action, and Clinical Implications – A Comprehensive Review

Wed, 21 Jan 2026 00:00:00 +0100

The Indian medical system has been using the medication Rauwolfia serpentina for many generations. The medication has been referred to as Sarpgandha due to its snake-like structure. Reserpine is the main alkaloid found in Rauwolfia serpentina, despite the fact that it contains over 50 alkaloids. Even at lower dosages, reserpine is an effective antihypertensive medication. In addition to its antihypertensive and hepatoprotective properties, the stems and leaves of Rauwolfia serpentine have numerous other therapeutic applications, such as sedative, antipsychotic, antidiahoerreal, and anticancer (in breast), among others. Although the herb Rauwolfia serpentina contains the principal four Indole alkaloids, the primary goal of this context is to provide information about the primary active alkaloid Reserpine, which is more concentrated in the plant's root and plays a significant part in the plant's antihypertensive activity. Reserpine must be used at a considerably lower level in order to have an antihypertensive effect; otherwise, it may have major side effects such as sedation, lethargy, psychological depressive disorders, hypotension, nausea, bradycardia, bronchospasm, and withdrawal psychosis.

A Cross-Sectional Study on Cervical Cancer Awareness and its Association with Demographic Factors in India

Sun, 11 Jan 2026 00:00:00 +0100

Introduction: Cervical cancer is a significant public health concern, ranking as the fourth most common cancer among women worldwide. India contributes nearly one-quarter of the global burden, with low screening and vaccination rates despite available preventive measures. Demographic factors may influence awareness levels, impacting early detection and prevention.

Aims and Objectives: This study aimed to assess cervical cancer awareness among reproductive-age women attending a tertiary care hospital in West Bengal and to analyze its association with demographic factors such as age, education, marital status, and place of residence.

Materials and Methods: A cross-sectional study was conducted among women aged 18–49 years visiting a tertiary care hospital. Data on demographics and cervical cancer awareness were collected using structured questionnaires. Associations between awareness and demographic variables were analyzed using Chi-square tests.

Results: Most participants were aged 20–25 years (31.4%) and had education above the 10th standard (45.3%). A majority were married (75.9%) and resided in urban areas (62.5%). Statistically significant associations were found between cervical cancer awareness and education (χ²=48.03, p=2.1×10⁻¹⁰), marital status (χ²=30.45, p=3.43×10⁻⁸), living area (χ²=9.59, p=0.0083), and age group (χ²=37.67, p=3.32×10⁻⁸).

Conclusion: Demographic factors significantly influence cervical cancer awareness. Tailored public health interventions focusing on less-educated, unmarried, rural, and older women are essential to improve preventive practices.

PRECISE SCORE, A PREDICTIVE TOOL VALIDATION FOR STONE-FREE RATE AFTER RETROGRADE INTRARENAL SURGERY (RIRS) FOR RENAL STONES GREATER THAN 2 CENTIMETRES-A RETROSPECTIVE STUDY

Tamilmuthu M, Senthil Kumar P, Mohan Periyasamy — Wed, 21 Jan 2026 00:00:00 +0100

Background: Retrograde intrarenal surgery (RIRS) is increasingly being used for renalstones > 2 cm in patients where indicated. The available nephrolithometric scoringsystems are limited when predicting outcomes in larger stones such as R.I.R.S., T.O.HO.,and STONE scores. The PRECISE score, a seven-parameter preoperative tool (each 0–2; total 0–14), was developed and validated retrospectively in a single-center cohort.

Paracetamol versus Diclofenac as Intravenous Postoperative Analgesia in Patients Undergoing Laparoscopic Surgeries

Dr Hemali Doshi, Dr Manish Nag, Dr Sadiya Shakeel — Sat, 24 Jan 2026 00:00:00 +0100

Laparoscopic surgery is increasinglypreferred because of its minimally invasivenature and faster postoperative recovery.Postoperative pain is a significant stressor and is inherently subjective. Inadequatepain management can adversely

Clinical Profile, Etiology and Outcome of Acute Encephalopathy among Children at Pediatric Intensive Care Unit in a Tertiary Care Hospital

Dr. A. Monisha, Dr Kovendan, Dr. J. Hemachitra — Sat, 24 Jan 2026 00:00:00 +0100

Encephalopathy is clinically defined as diffuse disorder of brain with at least two of the following ^[¹^] altered sensorium, altered cognition or personality, seizures. Acute encephalopathy is a pediatric emergency with high morbidity and mortality, however early identification and timely intervention can influence the outcome.

Bilayer Floating Tablet of Amoxicillin with Deglycyrrhizinated Licorice (DGL) Powder for the Treatment of Peptic Ulcer

Tue, 27 Jan 2026 00:00:00 +0100

Peptic ulcer disease is associated with mucosal erosion from an imbalance of gastric acid, pepsin, Helicobacter pylori infection, and weakened mucosal defenses. This study was done to treat Peptic ulcer disease by formulating Amoxicillin, which is a β-lactam antibiotic that kills bacteria by inhibiting cell wall synthesis. Moreover, Deglycyrrhizinated licorice, an herbal alternative, was added in the formulation to provide mucosal protection and anti-inflammatory activity, aiding ulcer healing without affecting acid secretion and reduceing side effects.

The current study aimed at formulating a bilayer-floating tablet containing amoxicillin and deglycyrrhizinated licorice, and the purpose of this study was to increase gastric retention, increase localised drug delivery, and generate a synergistic anti-ulcerative effect. The floating drug delivery system has been designed to extend the gastrointestinal residence time, and thus, enhance the systemic availability of the drug to act locally in the upper gastrointestinal tract. In addition, the polymers used to make the bilayer tablet a sustained-release tablet were complemented by effusive agents to provide buoyancy and prolonged gastric retention. Wise choices were made on the excipients in order to stabilise the tablet. Based on this, the main objective was to develop a gastro-retentive bilayer tablet enabling the gradual delivery of amoxicillin in combination with the immediate localised activity of deglycyrrhizinated licorice. The findings showed effective floating characteristics and a consistent drug release profile, suggesting its potential as a promising therapy for treating peptic ulcers.

Central Obesity as a Predictor of Renal Stress in Metabolic Syndrome: Biochemical and Urinary Evidence

Simmi Dubey, Dr.Ashutosh Jain — Thu, 29 Jan 2026 00:00:00 +0100

Background:Central obesity is a defining feature of metabolic syndrome (MetS) and is increasingly implicated in early renal dysfunction [1,2]. However, biochemical and urinary markers linking central obesity to renal stress in MetSare underexplored in Indian populations.

BIODENTINE PULPOTOMY ALTERNATE TO ROOT CANAL TREATMENT IN YOUNG ADULTS

Thu, 29 Jan 2026 00:00:00 +0100

Background: Vital pulp therapy using Biodentinehas emerged as a biologically conservativealternative to root canal treatment, especially inyoungadultswithirreversiblepulpinflammation. Objective: This study aimed to evaluate the clinical and radiographic success

Assessment of Knowledge, Attitude and Awareness towards Adverse Drug Reaction Reporting System among Undergraduate Medical Students in Shyam Shah Medical College, Rewa

Sat, 31 Jan 2026 00:00:00 +0100

Background: Adverse Drug Reactions (ADRs) are an important cause of morbidity and mortality worldwide. Although pharmacovigilance is included in the undergraduate medical curriculum, underreporting of ADRs remains a major limitation of spontaneous reporting systems. Raising awareness among healthcare professionals, especially medical students who are future prescribers, is essential to strengthen the pharmacovigilance system.

Aim and Objectives: To assess the knowledge, attitude, and awareness regarding the ADR reporting system among undergraduate medical students of Shyam Shah Medical College, Rewa.

Materials and Methods: An observational cross-sectional study was conducted in June 2024 using a pre-designed, structured questionnaire circulated through Google Forms. The questionnaire assessed knowledge, attitude, and awareness regarding ADRs and pharmacovigilance. A total of 277 undergraduate medical students from second year to final year MBBS participated in the study. Data were analyzed using descriptive statistics and expressed in percentages.

Results: Out of 277 students, 93 (33.6%) were from second year, 79 (28.5%) from third year, and 105 (37.9%) from final year. Overall, about 65% of students had adequate knowledge about ADRs and pharmacovigilance. A positive attitude towards ADR reporting was observed in nearly 92% of participants. Awareness was higher among final year students (approximately 69%), particularly regarding banned drugs, patient confidentiality, and legal responsibilities. However, nearly 30% of students still demonstrated insufficient awareness and practical understanding.

Conclusion: The study reveals satisfactory knowledge and attitude among undergraduate medical students; however, awareness and practical exposure to ADR reporting need further improvement. Regular training sessions, workshops, and integration of pharmacovigilance activities into clinical postings are recommended to strengthen ADR reporting culture among future healthcare professionals.

Prevalence of Anxiety and Depressive Disorders among Patients with Leprosy: A Cross-Sectional Study

Thu, 22 Jan 2026 00:00:00 +0100

Background: Leprosy, caused byMycobacterium leprae, is a chronicinfectious disease that imposes significantphysical, social, and psychological burden.Stigma, disability, and chronicity mayincrease the risk of anxiety and depressive disorders. This study aimed to estimate theprevalence of anxiety and depressive

A Study of Thrombocytopenia in a Pregnancy at a Tertiary Care Centre

Dr. Nilesh Narayanrao Bhalerao, Dr. Bhaurao Yadav — Tue, 03 Feb 2026 00:00:00 +0100

Background: Thrombocytopenia is the second most common haematological abnormality after anaemia encountered in pregnancy. Thrombocytopenia is defined as the platelet count of less than 150,000/ml. Pregnancy causes varied alterations in hematopoietic systems. Thrombocytopenia is second only to anemia as the most common hematologic abnormality in pregnancy. It occurs commonly during pregnancy and accounts for around 7–8% of the all the pregnancies. The causes are accelerated platelet consumption or decreased production

Aim and Objectives: “A Study of thrombocytopenia in pregnancy at a tertiary care center.2. To study proportion of thrombocytopenia in pregnancy at a tertiary care center. 3. To study the association of thrombocytopenia with risk factors. 4. To study clinical profile of thrombocytopenia cases

Methodology: Study Design: Cross sectional study.

Study Setting: OBGY department of VDGMC Latur, Maharashtra.

Study Population: All pregnant women with Gestational age from 28weeks to 40weeks with thrombocytopenia in ANC Clinic of OBGY department of VDGMC Latur such cases were included in the study.

Study Period: 18months from 1 Dec 2023 to 1 July 2025.

Sample Size = 140

Results: Proportion of Thrombocytopenia among ANC Women was 1.64%, most of cases presented with mild thrombocytopenia 120 (85.71%).The majority of cases occurred in the 20–30 years age group (75 cases, 53.6%), the majority were multigravida (97 cases, 69.2%), thrombocytopenia was most frequently observed beyond >37 weeks (61 cases, 43.6%), majority of cases reported vegetarian diet pattern 94 (67.14%),majority of cases reported no H/O platelets transfusion 134 cases (95%) and 6 cases (5%) had a history of platelets transfusion. majority of cases diagnosed with platelet count between 120001-150000, 88 cases , 31 cases (22.1%) had identifiable risk factors associated with thrombocytopenia. The most frequent association was anaemia (12 cases, 8.6%), followed by non-severe preeclampsia/gestational hypertension (4 cases, 2.9%) and infections including dengue (4 cases, 2.9%). The association between risk factors and thrombocytopenia was statistically significant (p < 0.001).

Conclusions: The present study provides a comprehensive overview of thrombocytopenia in pregnancy, its prevalence, severity, and associated determinants in a tertiary care setting. The proportion of thrombocytopenia was 1.64%, which, though relatively low, represents a clinically important condition due to the maternal and fetal risks involved.

Advancements in Virology and Microbiology: Emerging Trends, Challenges, and Future Perspectives

Dr. Fizza, Amina Farrukh Alavi, Dr. Rumaisha Faija — Sun, 01 Feb 2026 00:00:00 +0100

Background: Virology and microbiology are changing rapidly, thanks to innovations in vaccine technology, molecular diagnostics and artificial intelligence. Pioneering mRNA vaccines and CRISPR-based antiviral therapies are transforming disease prevention and treatment. Yet a range of challenges persists, including limited funding, antimicrobial resistance, and misinformation that impede advancement in those areas.

Objective: This study addresses the emerging trends, challenges, and future perspectives in virology and microbiology. Through a cross-sectional survey of subject matter experts in the field, the study aims to evaluate current progress, determine challenges and discuss possible directions to overcome these challenges.

Methodology Method: A predesigned questionnaire was developed and circulated among people from research institutes, healthcare organizations and pharmaceutical industries. The survey collected quantitative and qualitative data on recent breakthroughs, ongoing challenges and expected future developments. Moreover, a systematic bilateral literature review of peer-reviewed papers via Scopus, web of science, and pubmed was undertaken to gain a broader contextual understanding.

Key Findings: Recent trends: Discoveries in mRNA vaccine technology, CRISPR-based antiviral therapies and pathogen detection driven by AI have also impacted virology and microbiology. However, funding constraints, the rise of new infectious diseases, and antimicrobial resistance remain significant obstacles despite these advances. "Most researchers believe that artificial intelligence can help detect pathogens and discover drugs," explains the study[3], which was released around 14 months ago. Misinformation still constitutes a challenge that is detrimental to public health policies and vaccination uptake.

Future Directions: Experts emphasize that now more than ever, researchers, policymakers, and industries must come together to work toward solutions to these challenges. Innovative research and technology efforts need to be supported through robust funding mechanisms to ensure continued progress. Moreover, targeted public awareness campaigns are critical to countering misinformation and enhancing vaccine acceptance. Newer AI-based application in diagnostics and therapeutic modalities also appears as a useful utility in monitoring and controlling diseases.

Conclusion: Virology and microbiology are progressing at a pace, but we continue to face hurdles. As infectious disease research and public health preparedness evolve, addressing funding shortages, leveraging artificial intelligence, and fostering international cooperation will be critical. The global scientific community can strive like there is no tomorrow over the challenges and healthcare outcome through prudent interventions like early stages of care and providing sustained innovations like long term therapeutics.

Association Between Serum Prolactin Levels and Severity of Liver Cirrhosis Assessed by Child–Pugh Scoring: A Hospital-Based Cross Sectional Study

Dr. Prasanna Lakshmi Challa, Dr. Kumaragurubaran T. R., Dr. Ramkumar I — Fri, 30 Jan 2026 00:00:00 +0100

Introduction: Liver cirrhosis represents theterminal stage of chronic liver diseases andis characterized by progressive fibrosis andregenerative nodules, resulting insubstantial morbidity and mortality worldwide. Disease prognosis worsens

To Assess the Lip Print Pattern in the Patients of Psoriasis in Both Sexes & to Provide Baseline Data for the Same

Sanskriti, Dr. Nishant Gautam — Thu, 05 Feb 2026 00:00:00 +0100

Aim: The aim of the present study was to assess lip print pattern in the patients of psoriasis in both sexes & to provide baseline data for the same.

Methods: The present study was conducted on 200 subjects divided into two groups viz group A & group B. Group A was control group, comprising 100 subjects (M:F::50:50), taken from amongst Medical students of Govt. Medical College Patiala . Group B served as study group, comprising 100 subjects of psoriasis with or without involvement of lips reporting to Department of Dermatology of Rajindra hospital, Patiala.

Results: The prominent lip print pattern observed was Type 2(34.5%) followed by Type 3(26.75%) followed by Type 1(24.5%). Type 1(34.5%) Lip Print Pattern was found to be predominant, followed by Type 2(25.25%) and then by Type 3(18.75%). The dominant Pattern of Lip Print observed was Type 1(25.69%) followed by Type 2(21.53%) and then by Type 4(11.46). The main Pattern of Lip Print Pattern observed was Type 3(29.92%) followed by Type 2(27.23%) and then by Type 1(22.32%). The most prominent Lip Print Pattern observed was Type 2(29.87%). The most predominant Lip Print Pattern observed was Type 1(24.76%).

Conclusion: The data obtained from the present study showed promising results and indicated the uniqueness of lip prints. The major differences in the lip print patterns are seen in RUM and LUM region of Upper Lip (medial region) and RLM region of Lower Lip, which could be baseline data for further research work on lip print pattern in Psoriasis.

Intravenous Granisetron Versus Ondansetron for Attenuation of Hypotension and Bradycardia During Spinal Anaesthesia in Caesarean Section: A Prospective Randomized Double-Blind Study

Anuradha Nagpal, Dr Aditya Garg, Col (Dr) Nitin Goel , Dr Himani Saroha — Fri, 30 Jan 2026 00:00:00 +0100

Background: Spinal anaesthesia forcaesarean section is frequentlyassociated with hypotension, whichmay adversely affect both maternal andfetal outcomes. Serotonin (5-HT₃)receptor antagonists such as ondansetron and granisetron

Comparative Outcomes of Surgical Versus Medical Management of Ileocaecal Tuberculosis in a Single Tertiary-Care Centre

Dr Saikranti Medasani, DR. Riddhi E Shah, DR Pratik H Vyas, DR Mahek Tolia — Tue, 10 Feb 2026 00:00:00 +0100

Background: Ileocaecal tuberculosis (ICTB) represents the commonest form of gastrointestinal tuberculosis and poses a therapeutic dilemma when complications arise. While anti-tubercular therapy (ATT) achieves high cure-rates, obstruction, perforation or haemorrhage may necessitate surgery. Robust comparative data from South-Asian high-burden settings remain scarce.

Methods: We undertook a retrospective cohort analysis of all adults managed for ICTB between January 2018 and December 2023 at a 1 200-bed quaternary institute in northern India. Patients were stratified into a primary-medical group (≥ 6-month category I ATT) and a primary-surgical group (emergency or elective limited right hemicolectomy/stricturoplasty followed by ATT). Kaplan–Meier estimates, log-rank tests and multivariable Cox regression assessed 12-month composite success (symptom-resolution + endoscopic-healing).

Results: One-hundred patients met inclusion criteria (medical = 60; surgical = 40). Baseline age, sex-ratio and comorbidity burden were comparable. Complicated disease (multiple strictures, fistulae or perforation) was significantly higher in the surgical cohort (60 % vs 12 %, p < 0.001). At 12 months, composite success was 90 % in the surgical arm versus 80 % in the medical arm (HR 1.65, 95 % CI 1.02–2.66). Overall complication-rate was higher after surgery (20 % vs 10 %), but major (Clavien–Dindo ≥ III) events were rare (5 %). No mortality occurred.

Conclusion: In a real-world high-burden setting, surgery combined with standard ATT yielded superior clinical resolution in anatomically complicated ICTB at the cost of higher—but acceptable—morbidity. Elective surgery should be considered early for patients with advanced stricturing disease to optimise outcomes.

“Role of Sentinel Lymph Node Biopsy in Clinically Node-Negative Breast Cancer: A Prospective Study”

Dr. Anand Kumar Kushwaha — Thu, 12 Feb 2026 00:00:00 +0100

Sentinel lymph node biopsy (SLNB) has transformed axillary staging in early breast cancer by providing accurate nodal assessment while substantially reducing morbidity compared with complete axillary lymph node dissection (ALND)). The purpose of the study is to determine the accuracy of diagnostics used, false-negative rate, morbidity, and oncologic outcome of SLNB in patients with clinically node-negative (cN0) breast cancer and whose treatment is three years in a tertiary cancer centre. The second outcomes (sentinel node identification rate, false-negative rate, arm morbidity (lymphedema, shoulder dysfunction), local/regional recurrence, disease free and overall survival at minimum median follow-up, (36 months) were the important ones. We have established that our identification rates (>95%), in well established dual-tracer tests, of adequate node recovery are high, and that there are overall large changes in morbidity rates in both the short term and long-term as compared with the historic ALND cohorts. In combination with modern adjuvant systemic therapy and individualized radiotherapy, omissions of an incremental ALND in which complete replaces the excision of small limited-size sentinel node metastases does not appear to have a negative impact on oncologic outcome. The article endorses a guideline-based practice that underpins SLNB on how to handle the treatment of staging cN0 early breast cancer yet cites technical and pathological considerations, which can be used to interfere with the accuracy and the need to exercise caution and long-term follow-ups on patients. Contemporary technical arguments of the trial and guideline modifications useful to the contemporary practice are discussed.

Knowledge, Attitudes and Practices of Caregivers Regarding Diarrhoeal Diseases in Under-Five Children with Special Reference to Medication Use: A Hospital-Based Cross-Sectional Study

Dr. Poonam Baral — Thu, 12 Feb 2026 00:00:00 +0100

Background: Diarrhoeal diseases are the major causes of morbidity and mortality amongst children under the age of five years even though they can be avoided and cured. Lack of proper home management and irrational use of drugs and specifically antibiotics is among the factors that lead to poor outcomes and antimicrobial resistance. This would evaluate the knowledge, attitudes and practices (KAP) of caregivers of patients with diarrhoea under-five years old, and particularly medication use.

Methods: The current study was a cross-sectional study in which data was collected in the Departments of Pharmacology and Paediatrics, M.K.C.G. Medical College, between February 2020 and February 2021. One hundred forty four consenting caregivers of children aged 059 months with diarrhoeal illness presenting to OPD/IPD were recruited. A semi-structured, interviewer-administered questionnaire, which is based on WHO recommendations on childhood diarrhoea, was translated and back-translated to Odia, used to collect data. Socio-demographic variables and KAP domains were measured. GraphPad Prism was used to analyse data with the help of descriptive statistics (frequencies, percentages).

Results: Overall, [xx.x%] of caregivers demonstrated adequate knowledge of diarrhoea definition, danger signs and role of oral rehydration salts (ORS), while [xx.x%] had poor knowledge. Only [xx.x%] correctly identified zinc supplementation as a recommended adjunct therapy. A favourable attitude towards early health-facility consultation and continued feeding during diarrhoea was observed in [xx.x%] of participants. In practice, home initiation of ORS was reported by [xx.x%], whereas [xx.x%] used non-recommended remedies (antidiarrhoeals, antibiotics, or herbal preparations). Antibiotics were prescribed in [xx.x%] of cases, frequently in acute watery diarrhoea without dysentery or systemic sepsis. Caregiver education, urban residence and higher socio-economic status were positively associated with better KAP scores. Patterns of antibiotic use were often discordant with WHO recommendations.

Conclusion: Substantial gaps persist in caregiver knowledge and practices regarding evidence-based management of under-five diarrhoea, alongside high rates of potentially inappropriate antibiotic use. Strengthening caregiver education, reinforcing ORS–zinc as the standard of care, and promoting antimicrobial stewardship in paediatric diarrhoeal illness are urgently needed.

A Cross-Sectional Study on the Prevalence of Endometrial Tuberculosis Among Women with Unexplained Infertility Using CBNAAT

Dr Swati Sharma, Dr Ankur Pathak, Dr Chetna Yadav, Dr Fayaz Khan H — Fri, 30 Jan 2026 00:00:00 +0100

Background:Female genital tuberculosis (FGTB) is thesecond most common form ofextrapulmonary tuberculosis and is a well
recognized cause of infertility in women. Diagnosis of FGTB remains challengingdue to its varied clinical presentation

Spectrum of Clinicopathological Findings in Female Genital Tuberculosis at a Tertiary Care Hospital

Dr Swati Sharma, Dr Ankur Pathak, Dr Fayaz Khan H — Fri, 30 Jan 2026 00:00:00 +0100

Background: Female genital tuberculosis(FGTB) is an important yet oftenunderdiagnosed cause of infertility indeveloping countries. The present study aimed to describe the various

Patterns, Perceived Triggers, and Physiological Correlates of Yawning Behavior in First-Year Medical Undergraduates: A Cross-Sectional Questionnaire Study

Dr. Arjun Shekar, Dr. Arifuddin. M. K, Dr. Basavaraju. K — Fri, 13 Feb 2026 00:00:00 +0100

Background:-Yawning is a stereotyped reflex observed in humans and several animal species and is commonly associated with fatigue, boredom, and reduced alertness. It is also regarded as a socially contagious phenomenon. Despite its frequent occurrence, scientific evidence regarding the underlying causes, functional significance, and behavioral patterns of yawning remains limited, particularly among adolescent and young adult populations.

Objectives:-The present study aimed to assess the patterns of yawning behaviour and its associated factors among adolescents.

Materials and Methods:- This cross-sectional, questionnaire-based study was conducted among 200 first-year MBBS students . After obtaining informed consent, participants were administered a self-structured questionnaire incorporating a six-point Likert scale to assess yawning behaviour under various situations. Students were instructed to respond honestly, and anonymity was ensured. The collected data were compiled and analyzed, and the results were represented graphically.

Results:- Under routine conditions, the majority of students reported yawning either “somewhat” or “not at all.” A significantly higher frequency of yawning was reported during sleep deprivation, with 68.42% of students indicating yawning “very much” when they lacked adequate sleep. In contrast, 73.68% of participants reported not yawning during interviews, and 71.05% reported no yawning while completing the questionnaire. Although yawning is widely considered contagious, only 23.68% of students reported yawning frequently upon observing others yawn.

Conclusion:- The findings suggest that yawning among first-year MBBS students predominantly occurs in association with sleep deprivation rather than social or situational stimuli. Overall, the study population appears to maintain a satisfactory level of alertness and engagement, as reflected by low baseline yawning frequency.

CORRELATION BETWEEN CYCLE THRESHOLD VALUE AND CT SEVERITY SCORE DURING COVID 19 PANDEMIC

Dr Chandana Udayakumar, Dr Veena M, Dr Kiran Kumar B.M, Dr Arpitha Jayaram — Fri, 13 Feb 2026 00:00:00 +0100

Introduction: The novel SARS CoV-2 wasdeclared as a public health emergency inJanuary 2020. Patients infected with thisvirus show different severity of disease symptoms ranging from mild disease

FUNCTIONAL AND RADIOLOGICAL OUTCOME OF INTRA ARTICULAR DISTAL RADIUS FRACTURES TREATED WITH VOLAR PLATE OSTEOSYNTHESIS: A PROSPECTIVE STUDY

Fri, 06 Feb 2026 00:00:00 +0100

Background: Distal radius fractures areamong the most common fractures of theupper extremity, frequently involving thearticular surface and leading to functional impairment if inadequately

PROGNOSTIC SIGNIFICANCE OF DISSEMINATED TUMOR CELLS IN THE BONE MARROW OF PATIENTS WITH OVARIAN CANCER

Gowri Mahalakshmi R, Jeya Thilaga C , Surya A, Dr. K. Swaminathan MD4 — Wed, 11 Feb 2026 00:00:00 +0100

Background: Ovarian carcinoma isassociated with high mortality due to latepresentation and early systemicdissemination. Disseminated tumour cells (DTCs) in bone marrow representoccult haematogenous

Surgical Tenolysis for Post-Traumatic Finger Stiffness: Outcome Evaluation of Our Technique

Sat, 14 Feb 2026 00:00:00 +0100

Background Hand injuries are often associated with stiffness and loss of movement of the fingers because of adhesions and fibrotic tissue formation of tendons. Tenolysis surgery is performed to loosen these adhesions to allow the tendons to slide and move normally. Multiple methods have been outlined, each possessing its own pros and cons.

Objective: This paper analyzes the clinical results of our surgical process in the treatment of stiff fingers, which includes the release of flexor and extensor tendons under local anesthesia while allowing movement of the fingers during surgery to guarantee full adhesion release.

Duration and place of study: This study was conducted at Burns Center Civil Hospital and Dow University of Health Sciences Karachi from October 2024 to October 2025

Methodology: A retrospective study was provided on 50 patients who had tenolysis performed on them with the use of this technique. The demographic information, injury nature, and clinical observations were noted. Total active motion (TAM) and flexion lag were measured preoperatively and postoperatively and compared. The perioperative or postoperative complications were also analyzed.

Results: A total of 50 patients who had stiff fingers were analyzed. The average preoperative TAM had a significant limitation, and the postoperative measurements had a significant improvement in the active range of movement. The TAM was found to have increased statistically (p < 0.05). No significant surgical morbidity was noted, and the majority of the patients had significant functional recovery.

Conclusion: The comprehensive release of adhesions surrounding flexor and extensor tendons results in a significant increase in the mobility in the fingers. Tendon release when done under local anesthesia with active involvement of the patient during the surgical procedure increases the adequacy of the tendon release procedure and helps to improve the functional results.

Study of Nerve Conduction Velocity in Normal Subject Having Parental History of Diabetus Mellitus

Dr. Pallavi H. Pandhare, Dr. Mahendra K. Varthi, Dr. Jaya Surendra sawarkar — Mon, 16 Feb 2026 00:00:00 +0100

ABSTRACT: Background: Diabetes Mellitus (DM) is defined as a metabolic abnormality characterized by hyperglycaemia and disturbances of carbohydrate, fat and protein metabolism that are associated with absolute or relative deficiency in insulin secretion and/or insulin action. When fully evolved, it is characterized by fasting hyperglycaemia but it can also be characterized in the less overt stages and before fasting hyperglycaemia appears, most usually by the appearance of glucose intolerance.

Aim and Objectives:1. To evaluate nerve conduction in off-springs of diabetic and non-diabetic parents.2.To study BMI in off-springs of diabetic parents.

Methodology: Present study was a cross sectional study done at Department of Physiology, Grant Government Medical College Mumbai during a period of December 2014 to October 2016. The study involved randomly selected 100 students of first year MBBS students, these can be divided in two groups (50 study groups and 50 Control groups) depending on family history of diabetes mellitus and children with parents having diabetes mellitus were taken as study group.

Result: The study groups were comparable in terms of age and other physical parameters. There was no significant difference in mean ± S.D. of height, weight, Body mass index (BMI) between study group and controls but there was significant decreased in nerve conduction velocity in study group.

Conclusion: We find that neuropathy can be started at early age in study groups.

Effect of Orthodontic Braces on Gingival Health Status and the Role of Professional Scaling Frequency as a Preventive Factor

Sat, 14 Feb 2026 00:00:00 +0100

Fixed appliance orthodontic treatment is often linked with greater amounts of plaque retention, and thiscould adversely affect the health of the gums, provided that preventive measures are not taken. The presentcross-sectional observational study sought to measure the impact of the use of orthodontic braces on the level of gingival health and to determine the place of professional scaling frequency

Serum Uric Acid as a Marker of Disease Severity, Duration, and Target Organ Damage in Patients with Hypertension: A Cross-Sectional Study

Brahma B, Saha A , Bhowmick R — Mon, 16 Feb 2026 00:00:00 +0100

Background:Hypertension is a major contributor tocardiovascular and renal morbidity. Serum uricacid (SUA) has been implicated in the
pathogenesis and progression of hypertension;however, its association with disease severity, duration, and target organ damage in the Indianpopulation remains inadequately defined.

Unveiling the Therapeutic Potential of Carica Papaya Leaf Extracts a Study on Antifungal and Anti-Inflammatory Activities

Mon, 16 Feb 2026 00:00:00 +0100

Background: Traditional medical plants have been known to society for a long time. Other than easily available and inexpensive, they are able to cure diseases with few side effects compared to modern medicine. The use of papaya leaves in this study was not only because they contained various chemical compounds that could exert their pharmacological effects, but also the presence of various compounds, which are indicated as Antifungal and Anti-Inflammatory.

Objective: The present research tried to study the antifungal and anti-inflammatory effects of Carica papaya (Red Lady Variety) leaf extracts.

Methods: Freshly harvested Carica papaya leaves of the Red Lady Variety were collected and identified by the herbarium of the Department of Botany at Karachi University. After air-drying, they were chopped, ground into fine powder and extracted with n-Hexane and acetone in a Soxhlet apparatus using 10 grams and 82 grams respectively for drying sample. Extracts after concentration on a rotary vacuum evaporator were stored in a desiccator for further studies and applications. In vitro, agar tube dilution protocol for antifungal activity and oxidative burst assay using chemiluminescence technique for anti-inflammatory.

Results: The in- vitro antifungal Percentage of linear growth inhibition exhibited by n-hexane was between 24% and 40% on different fungal species tested, including Trichophyton rubrum (25%), Candida albicans (40%), Aspergillus niger (25%), Microsporum canis (26%), Fusarium Ini (24%), Candida glabarata (30%) and Aspergillus fumigatus (35%). On the other hand, the acetone extract was able to exhibit growth inhibition rates which were slightly lower, ranging from 20% to 26%. The inhibition rates were as follows: Trichophyton rubrum (23%), Candida albicans (26%), Aspergillus niger (23%), Microsporum canis (25%), Fusarium Ini (20%), Candida glabarata (23%), and Aspergillus fumigatus (23%). In-vitro anti-inflammatory, when tested at 100 µg/mL concentration, it was found that n-hexane leaf extract was able to exhibit 43.6% inhibition of inflammation but was still considered to be less active. Likewise, acetone leaf extract did not show any measurable inhibition when subjected to similar conditions and therefore this also ranked as inactive.

Conclusion: The antifungal inhibition rates were between 23% and 40%, meaning some potential but lower efficiency compared to standard antifungal agents. In the same line, anti-inflammatory activity was moderate where the n-hexane extract only achieved a 43.6% inhibition and the acetone extract had no significant effects at 100 µg/ml.

Comparative Study of Turp versus Medical Management in Benign Prostatic Hyperplasia

Mon, 16 Feb 2026 00:00:00 +0100

Objective: To identify the differences in the efficacy, safety and quality of life after transurethral resection of the prostate (TURP) and medical management in Pakistani men with moderate to severe benign prostatic hyperplasia (BPH).

Materials and Methods: A prospective randomized controlled trial was used as the study design in three tertiary care centres in Pakistan during the period between January 2023 and December 2024. Two hundred and forty men of [?]50 years with moderate to severe LUTS (IPSS 8-19) and a 30-80 mL prostate volume were randomly matched into TURP (n=120) versus medical treatment using tamsulosin 0.4 mg daily +- finasteride 5 mg daily (n=120). The primary outcomes were change in IPSS score, maximum urinary flow rate (Qmax), and quality of life (QoL) index in 6 months. Secondary outcomes were complication rates, the incidence of acute renal failure and re-intervention.

Results: Findings at 6 months TURP showed much higher increase in IPSS (14.2+-3.1 vs 6.8+-2.9), Qmax (+9.8+-3.2 vs +3.1+-1.8 mL/s) and QoL index ([?]3.4+-1.1 vs +1.9+-0.9) over medical treatment. The AUR rate was much less in the TURP-group (2.5% vs 15.8% p=0.001). Fewer immediate complications were noted in medical management (4.2% vs 18.3% p=0.002) although the majority of TURP complications were minor and self-limiting. Re-intervention of TURP was needed in 3.3 percent of the patients compared with 22.5 percent in the medical patients (p<0.001).

Conclusion: TURP is more effective rather than medical management in symptomatic relief, urodynamic and disease progression in Pakistani patients who have moderate to severe BPH. Although initial complication rates are greater, TURP is more effective in the long term and has reduced re-intervention rates, and hence is economical in a resource-restrained environment where late presentation with complications is prevalent.

Urodynamic Evaluation in Women with Chronic Lower Urinary Tract Symptoms

Mon, 16 Feb 2026 00:00:00 +0100

Objective: The purpose of this is to describe urodynamic results of women with chronic lower urinary tract symptoms (LUTS), and relate patterns of clinical symptoms to objective urodynamic diagnoses in order to streamline diagnostic clinical trajectories.

Materials and Methods: A prospective observational study was undertaken on 248 women with chronic LUTS (>6 month’s duration) who were referred to the comprehensive urodynamic assessment. The study involved the participants going through standardized history, validated symptom questionnaires (ICIQ-FLUTS, UDI-6), completing bladder diary, and multichannel urodynamic studies based on International Continence Society (ICS) guidelines. Urodynamic indicators were filling cystometry, pressure-flow, leak point pressure, and detrusor overactivity, stress urinary incontinence and bladder outlet obstruction evaluation.

Results: The median age was 52.3 -12.7 years with a median of 4.2 -3.1 years of symptoms. Detrusor overactivity, urodynamic stress incontinence, and mixed urinary incontinence were detected in 41.9% (n=104), 38.3% (n=95) and 29.8% (n=74). Video-urodynamic diagnosis was carried out with the bladder outlet obstruction in 12.5% (n=31) cases. A significant correlation was identified between clinical urgency symptoms and detrusor overactivity (p<0.001), post-void residual volume greater than 100mL and voiding dysfunction (p=0.003), and stress leakage on physical examination and urodynamic stress incontinence (p<0.001). It is worth noting that on urodynamics, 34.7 percent of females with predominant symptoms of stress were found to be detrusor overactive.

Conclusion: Urodynamic assessment demonstrates massive discordance in clinical symptom patterns and objective findings in women with chronic LUTS. Urodynamic testing is a broader diagnostic test used in conjunction with clinical assessment especially in complicated or refractory cases, mixed incontinence presentation and potential voiding dysfunction. These results encourage the selective usage of urodynamics in the complicated female LUTS to inform the specific treatment measures.

Comparative Study of Surgical Wound Healing and Dermatological Complications in Diabetic Versus Non-Diabetic Orthopedic Patients

Sat, 14 Feb 2026 00:00:00 +0100

Background: Diabetes mellitus is a majorsystemic condition known to impair woundhealing and increase susceptibility to
postoperative complications. Orthopedicsurgeries require optimal tissue repair, anddiabetic patients are at increased risk ofsurgical site infections and dermatological complications

Venous Thromboembolic Disease and Its Cutaneous Manifestations in Orthopedic Surgical Patients: A Cross-Sectional Study

Thu, 22 Jan 2026 00:00:00 +0100

Background: Venous thromboembolicdisease (VTE), comprising deep veinthrombosis (DVT) and pulmonary embolism(PE), is a common and potentially fatalcomplication following orthopedic surgery.Early clinical recognition, including identification of cutaneous manifestations

A Review on progress in ADHD Disorder: From Characterization to Cause

Minakshi Verma, Sandeep Kumar Mishra — Fri, 30 Jan 2026 00:00:00 +0100

The science of attentiondeficit/hyperactivity disorder (ADHD) ismotivated by a translational goal – thediscovery and exploitation of knowledge about the nature of ADHD to the benefit ofthose individuals whose lives it affects

Comparative Evaluation of Single-Dose Intravenous vs. Dual-Route (Intravenous and Peri-articular) Tranexamic Acid in Total Knee Arthroplasty: A Randomized controlled trial study in a Tertiary Orthopaedic Centre

Dr Praveen Kumar Chavan, Dr Avinash Parthasarthy, Dr R C Karthik — Mon, 16 Feb 2026 00:00:00 +0100

Background: Minimizing perioperativehaemorrhage is critical for enhancingrecovery after total knee arthroplasty (TKA). While the efficacy of Tranexamic Acid(TXA) is well-documented, the clinicaladvantage of augmenting systemicadministration with local joint infiltration

Nomophobia –Mobile Phone Dependence, A Cross-Sectional Study Among Engineering Students of Raichur

Dr Pratibharani Reddy, Dr Radha, Dr Roopakala N — Sun, 01 Feb 2026 00:00:00 +0100

Background: Nomophobia (no-mobilephone phobia) is an emerging behavioraldependence associated with excessive smartphone use and adverse psychosocialoutcomes. Limited data exist fromengineering student populations

Outcomes and Postoperative Complications Following Debridement and Split-Thickness Skin Grafting for Lower Limb Wounds: A Case Series of 30 Patients from a Tertiary Care Institution

Fri, 20 Feb 2026 00:00:00 +0100

Background: Lower limb wounds are an enormously high surgical burden, especially when complicated by infection and trauma or systemic comorbidities. Surgical debridement and split-thickness skin grafting (STSG) has been one of the keys to wound reconstruction. However, graft uptake and functional results are still affected by complications after surgery.

Case Presentation: This case series presents 30 patients treated in a tertiary care institution and who underwent surgical debridement of the wounds on the lower limbs and subsequently STSG. Patients ranged in age from 22 to 68 years of age and included wounds secondary to trauma, diabetic foot disease, post-infective necrosis and chronic non-healing ulcers. Comprehensive clinical evaluation, microbiologic assessment and optimization of comorbid conditions predicted operative intervention. All patients were subject to serial debridement until a healthy granulating wound bed was established, then STSG harvested from the thigh and applied over the wound and outcomes were documented.

Interventions and Outcomes: Postoperative results were analysed in reference to: graft uptake; wound healing time; infection; graft loss; haemorrhage; and donor site morbidity. Complete uptake of the graft was seen in 21 patients (70%). Partial graft loss occurred in six patients (20%) and complete graft failure occurred in three patients (10%). The most common complications observed after the operation were surgical site infection (16.7%), formation of seroma or hematoma (13.3%), and delayed healing of incision (20%). Patients with diabetes mellitus and peripheral vascular disease showed higher rate of complications.

Conclusion: Debridement followed by STSG remains an effective reconstructive option for lower limb wounds. However, postoperative complications are influenced by systemic comorbidities, wound etiology, and local wound conditions. Careful patient selection, meticulous surgical technique, and vigilant postoperative monitoring are critical to optimizing outcomes.

A COMPARATIVE STUDY BETWEEN PRIMARY RESECTION ANASTOMOSIS VERSUS HARTMANN`S PROCEDURE WITH COLOSTOMY IN PATIENTS OF LEFT SIDED COLONIC MASS PRESENTING WITH ACUTE INTESTINAL OBSTRUCTION– A PROSPECTIVE COMPARATIVE STUDY

Dr. S. R. Kuralarasi, Dr. G. Vinayagam, Dr. T. M. Selvam, Dr. S. Raasiga — Thu, 19 Feb 2026 00:00:00 +0100

Background: Left-sided colonic masses commonly present as acute intestinal obstructionrequiring emergency surgical intervention. Hartmann’s procedure has traditionally beenconsidered the safer approach in emergency settings due to concerns regarding anastomotic leakage. However, it is associated with stoma-related morbidity

A COMPARATIVE STUDY ON PORT SITE INFECTIONS WITH AND WITHOUT USE OF AUTOCLAVED PLASTIC ENDOBAG DURING LAPAROSCOPIC CHOLECYSTECTOMY

Dr Singh Rashmi, Dr G Vinayagam, Dr S Raasiga — Thu, 19 Feb 2026 00:00:00 +0100

Background: Port site infection (PSI)remains an important postoperativecomplication of laparoscopiccholecystectomy (LC). Gallbladder
perforation and stone spillage

COMPARATIVE STUDY OF CONVENTIONAL POLYPROPYLENE MESH WITH ANATOMICAL 3D POLYPROPYLENE MESH IN TAPP IN ADULTS

Dr.Vijayadevi V, Dr. G. Vinayagam, Dr. S. Raasiga — Thu, 19 Feb 2026 00:00:00 +0100

Background: Laparoscopic transabdominalpreperitoneal (TAPP) repair is widely performed for inguinal hernia. Conventionalflat polypropylene mesh requires mechanicalfixation using tackers

MAXIMAL VOLUNTARY VENTILATION VERSUS VITAL CAPACITY AS PREDICTORS OF EXERCISE CAPACITY IN HEALTHY YOUNG ADULT MALES: A CROSS-SECTIONAL STUDY

Dr Arup Mondal, Dr. Tamal Chakraborty, Dr. Prithwish Tantri — Sat, 21 Feb 2026 00:00:00 +0100

Background: Exercise capacity reflectsintegrated cardiopulmonary function and isinfluenced by multiple physiologicaldeterminants, including pulmonary ventilatory reserve. While forced vitalcapacity (FVC) is routinely assessed

Clinical Serum Lipidomic Profiling Reveals Potential Lipid Biomarkers for Early Diabetic Retinopathy

Dr. Mohammad Aarif, Dr. Mary Jenifa Tigga, Dr. Madhuri Akhilesh Agnihotri — Sat, 21 Feb 2026 00:00:00 +0100

Diabetic Retinopathy (DR) is a major micro vascular complication of Diabetes Mellitus and a leading cause of preventable vision loss. Recent evidence suggests that disturbances in lipid metabolism occur before visible retinal damage develops. Lipidomic analysis enables comprehensive profiling of circulating lipid molecules and may assist in identifying novel indicators for early DR detection.

Objective: To analyze serum lipid variations associated with early diabetic retinopathy and explore their potential role as biomarkers for its early diagnosis.

Methods: A cross-sectional study was carried out on 60 type 2 diabetes mellitus (T2DM) patients—30 with early non-proliferative diabetic retinopathy (NPDR) and 30 without any retinal abnormalities. Serum lipidomics was performed using ultra-high-performance liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS). Statistical and multivariate analyses were applied to identify significantly altered lipid species between the two groups.

Results: Distinct lipidomic alterations were identified in patients with early DR. Levels of lysophospha- tidyl cholines (LPCs), sphingomyelins (SMs), and ceramides (Cers) were significantly higher, while phosphatidylcholines (PCs) and certain triglycerides were reduced. Lipid species such as LPC (17:0), Cer(d17:1/24:0), and SM(d17:1/15:0) showed strong correlations with HbA1c and DR severity (p < 0.01). Combined ROC analysis of Cer(d17:1/24:0) and LPC(17:0) produced an AUC of 0.88, indicating excellent diagnostic accuracy.

Conclusion: Serum lipidomic analysis highlights early metabolic disruptions in DR. Elevated ceramide and lysophosphatidylcholine species may serve as promising biomarkers for the early identification of retinal microvascular injury. Incorporating lipidomic markers into diabetic screening could enhance early detection and risk assessment strategies.

MAXIMAL VOLUNTARY VENTILATION VERSUS VITAL CAPACITY AS PREDICTORS OF EXERCISE CAPACITY IN HEALTHY YOUNG ADULT MALES: A CROSS-SECTIONAL STUDY

Dr Arup Mondal, Dr. Tamal Chakraborty, Dr. Prithwish Tantri — Sat, 21 Feb 2026 00:00:00 +0100

Background: Exercise capacity reflectsintegrated cardiopulmonary function and is influenced by multiple physiologicaldeterminants, including pulmonarventilatory reserve. While forced vitalcapacity (FVC) is routinely assessed

Hematological, clinical, cytogenetic and molecular profiles of confirmed chronic myeloid leukemia patients at presentation at a regional cancer centre of North Eastern India: a cross-sectional study.

Manasi Bhowmik, Subrata Bhowmik, Prasun Bhattacharjee — Sun, 22 Feb 2026 00:00:00 +0100

Background: The evidence on hematological, clinical, cytogenetic and molecular profiles among new CML patients arevery insufficient in the developing countries like India and more so in the North-eastern states.. Therefore, this study isperformed among newly confirmed CML patients at Atal Bihari Vajpayee Regional Cancer Center (ABV RCC), Agaratala, Tripura.

Evaluation of Oxidative Stress Markers (Tac, Tos, Gsh) In Patients with Copd and Their Correlation with Cardiovascular Risk

Mon, 23 Feb 2026 00:00:00 +0100

Objectives: To evaluate oxidative stress markers—Total Antioxidant Capacity (TAC), Total Oxidant Status (TOS), and reduced glutathione (GSH)—in the patients with the chronic obstructive pulmonary disease (COPD) and to mainly determine their actual correlation with the cardiovascular risk.

Study Design and Setting: This descriptive cross-sectional study was conducted in the Department of Pulmonology and Internal Medicine, Jinnah Hospital, Lahore from 1 November 2024 to 30 April 2025.

Methodology: A total of 140 diagnosed COPD patients were mainly being enrolled using the consecutive sampling. Oxidative stress markers including the TAC, TOS, as well as serum GSH levels were measured using the standardized spectrophotometric form of methods. To aid in the estimation of the cardiovascular risk, the Framingham Risk Score (FRS) and assessment of the lipid profile and the blood pressure were counted. Cardiovascular risk parameters and the oxidative stress markers were analysed using correlation. All the participants were provided with informed consent and the ethical approval was obtained (ERC No: 2023-45).

Results: COPD patients demonstrated significantly elevated TOS levels and reduced TAC and GSH levels compared to reference values. It was discovered that patients with high risk cardiovascular patients were significantly higher in TOS (p<0.001) and significantly lower in TAC and GSH (p<0.001). TOS was exerting a strong negative connection with Framingham Risk Score (r= -0.58), TAC and GSH made mild negative correlations (r= -0.46 and r= -0.49 respectively).

Conclusions: COPD patients exhibit significant oxidative imbalance that correlates positively with cardiovascular risk.A possible indicator of assisting COPD patients (exposed to cardiovascular complications) could be the indicators of oxidative stress.

Metastatic Breast Cancer: A Correlation between Ki67, a Tumor Marker and Various Stages in Terms of age Groups

Mon, 23 Feb 2026 00:00:00 +0100

Breast cancer is common most malignancy in multipara, premenopausal women The antigen Ki-67 plays important role in evaluating this condition biochemically. Being expressed in all phases of cell cycle (S, G1, G2, M) except GO.

METHODS: This cross-sectional design of the observational research on 283 patients was arranged and executed at JPMC (Jinah Postgraduate Medical Center). The hormone receptor status staging is done with immune-histochemical (IHC) staining. Ki-67, the nuclear antigen was assessed quantitatively as well as visually way using light microscopes.

Result: Most Cases belonged to stage -4 of the breast cancer followed by Stage -2 and stage-3. The biomarker KI 67 was more positive in 3rd and 4th stages.

Conclusions: Biological markers are good parameters to assess the progression of the breast cancer.

Integration of Artificial Intelligence and Automated Systems in Contemporary Radiochemistry and Drug Discovery: A Systematic Review

Kaleem Ullah Ihsan, Jannat Khatoon, Misbah Zulfiquar, Saba Ishtiaq — Mon, 23 Feb 2026 00:00:00 +0100

Background: The recent breakthroughs in artificial intelligence (AI) and robotized technology have presented radical changes in radiochemistry and drug discovery with the results of the enhancement of choices accepted according to the data, the efficiency of an experiment and reduction of patterns of development. However, there is scanty comprehensive research done on their combined synergistic impact on these regions.

Objective: In line with the research question, the purpose of the paper and its abstract was to assess the efficacy, performance metrics, and translational capability of AI-driven and automated systems in the contemporary radiochemistry and drug discovery processes.

Methods: A total of 103 records focusing on systematic literature were searched in PubMed/MEDLINE, Scopus, Web of science, and IEEE Xplore and Google Scholar, in accordance with PRISMA 2020. Articles in the field of radiochemistry or drug discovery published between 2014 and 2024 that were exploring AI-based or other automated technologies were considered. Standardized tools were used to extract data and it was quality assessed. They were synthesized with the help of the thematic analysis and narrative synthesis methods to obtain results that pertain to synthesis efficiency, predictive accuracy, speed of development, reproducibility and cost reduction.

Results: A total of one hundred and six peer review articles were found and chosen. Radiochemical synthesis, optimized using AI, showed pooled radiochemical improvements in yield characterized by 32% (23-41) and significant improvements in the time spent in synthesis and increase in reproducibility. Pipelines in drug discovery using AI shortened the mean lead times on hitting and on pre-clinical development by 38 percent and increased efficiency of screening by 100 times. Robotic and automated systems showed better consistency in batch to batch and allowed close loop optimization. The analysis of correlation showed that there are strong positive correlations between the complexity of AI models, the extent of automation, and the general performance results.

Conclusion: The combination of AI-based and automated solutions will be a paradigm shift in radiochemistry and drug discovery, and will provide significant increases in efficiency and accuracy and scalability. The technologies make available closed-loop experimental workflows that are data-driven and have extensive potential implications on radiopharmaceutical production and pharmaceutical innovation. Large-scale clinical and industrialization requires prospective validation and alignment of efforts to establish regulatory harmonization.

Machine Learning–Driven Integration of Multi-Omics Data for Biomarker Identification in Rheumatoid Arthritis

Muhammad Haroon Ashfaq, Amna Mahmood — Mon, 23 Feb 2026 00:00:00 +0100

Purpose: In this study, the author explores the possibility of using multi-omics data combined with ML to identify biomarkers in RA, a chronic autoimmune disease characterized by chronic joint inflammation, destruction, and disability. The work specifically investigates novel biomarkers for putting into practice multi-omics (genomics, proteomics, and metabolomics) interfaced with machine learning algorithms to improve diagnostic accuracy, prognosis, and therapy management for RA patients. It becomes the direction of future RA omics and AI studies to enhance clinical efficacy and develop more effective therapeutic management.

Design/Methodology/Approach: The study elicits data from a cross-sectional survey of a sample of RA patients and HCPs using a closed set of standardized quantitative research questions. This research framework involves using existing RA datasets to combine multi-omics data, subsequently using Machine Learning algorithms to predict biomarkers and other molecular characteristics related to the disease. The questionnaire was also employed to obtain participants' perceptions on the possibility of applying multi-omics-based biomarker discovery in RA, its efficiency, and barriers to implementation. The survey was done among patients with RA, clinicians, and researchers to determine the clinician, patient, and researcher’s perception of using those technologies in clinical practice.

Implications: The current study demonstrated that using multi-omics data with machine learning can potentially improve RA research and management efforts. Concerning discovering new biomarkers that may help diagnose a condition earlier … technologies gave very high scores of interest. Machine learning models provided hypothesis generation and testing for many associations throughout the omics data and offered prognosis of disease course and treatment efficacy. However, data heterogeneity, technical issues, and the lack of large high-quality datasets were recognized as key barriers to the broader use.

Implications: The study has shown how multi-omics and machine learning integration need further advancement in RA biomarker identification. The study raises awareness of the need to enhance data availability, resolve the practical issues of integration between minus data, and implement explainable algorithms to aid decision-making. Experts in healthcare and research insist that strong guidelines should be established for omics data assessment to help integrate these tools into clinical practice in RA cases. In addition, assembling broader and more numerous datasets will be equally essential for increasing the efficiency of machine learning predictions.

Contribution/Novelty: The present paper fills the gap in applying precision medicine for rheumatoid arthritis by employing multi-omics integrated with machine learning. It sheds new light on how some of these third-generation technologies may be applied to biomarker discovery, prognosis, and RA’s individualized management. This study also stresses the need to effectively integrate, often, disciplinary, knowledge, and patient-oriented concerns in computational competence, clinical experience, and application of omics and AI in rheumatology.

Evaluating the Hypolipidemic and Hepatoprotective effects of Varying Doses of Gymnema sylvestre in dyslipidemia induced hepatic injury: Impact on Physiological Restoration"

Mon, 23 Feb 2026 00:00:00 +0100

Background: Dyslipidemia and liver dysfunction are major contributors to metabolic disorders and cardiovascular risk. Herbal medicines such as Gymnema sylvestre have gained attention due to their traditional use and reported pharmacological activities, including lipid regulation and hepatoprotection. However, evidence regarding dose-dependent physiological restoration remains limited.

Objective: To evaluate the hypolipidemic and hepatoprotective effects of varying doses of Gymnema sylvestre and to assess their impact on physiological restoration.

Methodology: An experimental study was carried out using controlled groups receiving different doses of Gymnema sylvestre. Serum lipid profile parameters (total cholesterol, triglycerides, LDL, HDL) and liver function biomarkers (ALT, AST, ALP, bilirubin) were analyzed to determine dose-dependent effects and hepatic protection.

Results: Administration of Gymnema sylvestre resulted in significant, dose-dependent reductions in total cholesterol, triglycerides, and LDL levels, with a concomitant increase in HDL. Liver enzyme levels showed marked improvement, indicating reduced hepatic injury and restoration of normal liver function, particularly at higher doses.

Conclusion: The findings demonstrate that Gymnema sylvestre exerts significant hypolipidemic and hepatoprotective effects in a dose-dependent manner, supporting its therapeutic potential in the management of dyslipidemia and liver dysfunction.

Evaluation of Cardiac Biomarkers in Patients with Type 2 Diabetes and Subclinical Atherosclerosis: A Cross-Sectional Study

Dr. Gowthami sandhya Dwarampudi, Dr. tanzeem, Dr. khuda bakash N — Mon, 23 Feb 2026 00:00:00 +0100

Background: Cardiovascular risk in type 2 diabetes mellitus (T2DM) is heterogeneous, and atherosclerosis may evolve silently for years before clinical events. Circulating cardiac biomarkers—particularly high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro–B-type natriuretic peptide (NT-proBNP)—may capture subclinical myocardial injury and wall stress that accompany early atherosclerotic disease. We evaluated associations between cardiac biomarkers and ultrasound-defined subclinical atherosclerosis in adults with T2DM without known atherosclerotic cardiovascular disease.

Methods: We performed a hospital-based cross-sectional study (January 2024–December 2024) enrolling adults with T2DM (age 40–75 years) without known coronary, cerebrovascular, or peripheral arterial disease. Subclinical atherosclerosis was defined as mean carotid intima–media thickness (CIMT) ≥0.90 mm and/or carotid plaque on B-mode ultrasonography. Biomarkers included hs-cTnI, NT-proBNP, and high-sensitivity C-reactive protein (hs-CRP). Associations with CIMT were tested using Spearman correlation and multivariable linear regression; predictors of subclinical atherosclerosis were evaluated using multivariable logistic regression and ROC analysis.

Results: Among 260 participants (mean age 58.9±8.7 years; 44% women), 118 (45.4%) met criteria for subclinical atherosclerosis. Median hs-cTnI and NT-proBNP were higher in the subclinical atherosclerosis group versus controls (hs-cTnI: 6.2 vs 3.8 ng/L; NT-proBNP: 112 vs 78 pg/mL; both p<0.001), while hs-CRP showed a smaller gradient (p=0.04). In adjusted models, log-hs-cTnI (adjusted OR 1.78, 95% CI 1.27–2.48) and log-NT-proBNP (adjusted OR 1.52, 95% CI 1.12–2.07) independently predicted subclinical atherosclerosis. A combined biomarker model improved discrimination (AUC 0.82) over clinical risk factors alone (AUC 0.73).

Conclusion: In T2DM without known ASCVD, hs-cTnI and NT-proBNP were independently associated with ultrasound-defined subclinical atherosclerosis and improved risk discrimination. Biomarker-informed vascular phenotyping may support earlier identification of high-risk diabetic patients for intensified prevention strategies.

Effectiveness Of Oral Micronized Progesterone in The Prevention of Preterm Labour in Women with Previous History of Preterm Birth

Tue, 10 Feb 2026 00:00:00 +0100

Background: Births that happen before term still account for a large proportion of neonatalmorbidity and mortality around the world. Women who have experienced a history of preterm birth are recurrence candidates

Incidence and Arthroscopic Patterns of Meniscal Injuries Associated with Anterior Cruciate Ligament Tears: A Prospective Observational Study of 30 Patients

Dr. Pranjal Jain, Dr. Divyansh Sharma, Dr. Ankur Agarwal, Dr. Gurmeet — Tue, 24 Feb 2026 00:00:00 +0100

Background: Meniscal injury is a frequent comorbidity in anterior cruciate ligament (ACL) tears and strongly influences stability, repairability, and long-term osteoarthritis risk. Reported prevalence and tear patterns vary by chronicity, mechanism, and diagnostic intensity. This study quantified the incidence and arthroscopic patterns of meniscal injuries in ACL-deficient knees and explored associations with time-from-injury and patient factors.

Methods: A prospective observational study was conducted on 30 consecutive patients with MRI-confirmed ACL tear undergoing arthroscopic ACL reconstruction at a tertiary centre (January–December 2025). Meniscal status was defined intraoperatively (gold standard) using standardized mapping of side (medial/lateral/both), location (anterior horn/body/posterior horn/root), and morphology (longitudinal, radial/oblique radial, bucket-handle, complex, root tear, ramp lesion). Patients were categorized as acute (<6 weeks) or delayed (≥6 weeks) from injury to surgery. Descriptive statistics were reported; associations were tested using Fisher’s exact test and independent-samples t-test, with α=0.05.

Results: Mean age was 26.7±6.1 years; 73.3% were male. Overall, 18/30 (60.0%) had meniscal injury: medial only 10 (33.3%), lateral only 5 (16.7%), both 3 (10.0%). The posterior horn was the commonest site (medial 72% of medial tears; lateral 67% of lateral tears). Delayed presentation showed higher medial meniscal injury than acute (50.0% vs 14.3%, p=0.040). Acute cases showed a trend toward higher lateral tears (28.6% vs 6.3%, p=0.082). Ramp-type lesions constituted 4/13 (30.8%) of medial injuries, consistent with under-recognized posteromedial pathology described in the literature.

Conclusion: In this 30-patient cohort, meniscal injury accompanied ACL tears in 60%, with a posterior-horn predominance. Delay to reconstruction was associated with a significantly higher rate of medial meniscal injury, supporting early stabilization strategies to reduce secondary medial damage.

Comparison of Day-Care Versus In-Patient Acl Reconstruction in Terms of Postoperative Pain and Patient Satisfaction: A Prospective Randomized Study (N=30)

Dr Divyansh sharma, Dr pranjal Jain, Dr. Gurmeet, Dr Ankur Agarwal — Tue, 24 Feb 2026 00:00:00 +0100

Background: Health systems increasingly favor same-day discharge after anterior cruciate ligament reconstruction (ACLR) to reduce costs and improve patient flow; however, concerns persist regarding early postoperative pain control and patient experience. Prior randomized evidence suggests outpatient ACLR can yield equal safety and higher satisfaction, but results vary across pathways and settings.

Methods: A prospective randomized study was conducted in a tertiary orthopedic center over 12 months. Thirty adults undergoing primary arthroscopic ACLR with hamstring autograft were randomized 1:1 to day-care discharge (DC) or in-patient admission (IP). Pain was measured using a 0–10 visual analogue scale (VAS) at 6, 24, and 48 hours. Satisfaction was measured at postoperative day 7 using a 0–100 satisfaction VAS (higher scores indicating greater satisfaction). Secondary outcomes included rescue opioid use, postoperative nausea/vomiting (PONV), unplanned contacts, and readmissions within 7 days. Between-group comparisons used independent-samples tests; pain trajectories were assessed with mixed-effects modeling.

Results: Baseline characteristics were comparable between groups (mean age 26.9±5.4 years; 70% male). Mean VAS pain scores (DC vs IP) were 5.2±1.3 vs 4.6±1.4 at 6 h (p=0.18), 3.4±1.1 vs 3.6±1.2 at 24 h (p=0.62), and 2.1±0.9 vs 2.3±1.0 at 48 h (p=0.55). Satisfaction at day 7 was higher in DC (88.1±7.6) versus IP (79.4±9.8), mean difference 8.7 points (95% CI 1.8–15.6; p=0.016). Rescue opioid consumption and PONV rates were not significantly different. No participant required hospital readmission within 7 days.

Conclusion: In this randomized cohort (n=30), day-care ACLR achieved pain outcomes comparable to in-patient care while producing meaningfully higher patient satisfaction, without increased early adverse events. These findings support structured day-care pathways for appropriately selected ACLR patients.

Hypernatremic, Hyperkalemic Dehydration in an 8-Month-Old with Acute Gastroenteritis Managed With Controlled Hypotonic Rehydration

Dr Nitesh prasad — Tue, 24 Feb 2026 00:00:00 +0100

Background: Hypernatremic dehydration is a dangerous manifestation during infancy since hyperosmolality can trigger neurologic impairment and since excessive rapidity of correction may trigger cerebral edema. Even though acute gastroenteritis is typically associated with the emergence of iso- or hyponatremic dehydration, hypernatremia can also occur when the volume of free-water loss and reduced intake surpasses that of sodium loss, especially in young infants. Prerenal physiology (1) and gastrointestinal bicarbonate depletion (2), respectively, may be represented by concomitant hyperkalemia and hyperchloremia.

Case presentation: A male patient aged 8 months complained about several periods of vomiting and loose stools and a report of being drowsy with clinical signs including moderate dehydration. No previous administration of oral rehydration solution or intravenous fluids history. The first complete blood count revealed hemoconcentration (hematocrit 38.3%) and reactive thrombocytosis (platelets 470 ×10 3 /mm 3 ). Serum electrolytes demonstrated hypernatremia (Na 153.15 mmol/L), hyperchloremia (Cl 134.11 mmol/L), slight hyperkalemia (K 5.07mmol/L), and an increase in the ionized calcium (iCa 1.51 mmol/L). With close clinical and biochemical observation, controlled intravenous rehydration with 0.45% saline was initiated. After repeating the test about 6.7 hours later, the electrolytes focused on enhancement (Na 151.24 mmol/L; Cl 123.63 mmol/L; K 4.41 mmol/L; iCa 1.45 mmol/L), which matches approximately 0.29 mmol/L/h sodium correction rate, which is well within the safety extremes.

Conclusion: Physiologically consistent patterns of hypernatremia (net water loss and insufficient intake), hyperchloremia (diarrheal loss of bicarbonate and chloride retention under hypovolemia), hyperkalemia (temporarydownward changesin renal potassium excretion due to prerenal hypoperfusion +acidosis and mild hypercalcemia (hemoconcentration and impaired renal calcium clearance) are demonstrated in this case. Slow correction using hypotonic saline was linked to biochemical improvement without any known complications.

Heart Rate Variability and Autonomic Modulation During the First Year of MBBS Training

Dr Anam Shameem, Dr Iram Jaan, Dr Jaswinder Kaur, Dr Sheikh Junaid Aziz — Tue, 24 Feb 2026 00:00:00 +0100

Background: Heart rate variability (HRV) isa non-invasive marker of autonomicmodulation. Medical training may influence autonomic balance during the first academicyear.

Perception of Artificial Inelegance in Healthcare, Among Doctors In A tertiary Care Hospital of North Kashmir

Abdul Hamd, Arsalan Javid, Kashifa Yusuf, Phunchok Angmo, Mehak Fatima Bhat — Tue, 24 Feb 2026 00:00:00 +0100

Background: Artificial intelligence (AI) is increasingly integrated into healthcare, influencing diagnostics, clinical decision-making, and health system management. Understanding healthcare workers’ perceptions is essential for responsible implementation and curriculum development. This study aimed to assess awareness, attitudes, perceived benefits, risks, and institutional readiness regarding AI among doctors at Government Medical College (GMC) Baramulla, North India.

Methods: A cross-sectional observational study was conducted in May 2024 among faculty, consultants, and residents. Data were collected using a structured, literature-based questionnaire administered electronically through Epicollect software. Sociodemographic variables and Likert-scale perception items were included. Descriptive statistics summarized responses, reliability was assessed using Cronbach’s alpha, and inferential analyses including correlation and multivariable regression were performed using Jamovi version 2.7.18.

Results: A total of 108 doctors participated with equal gender distribution. Awareness of AI was high (96.3%), and 88.9% were aware of its healthcare applications. Overall perception toward AI was favourable (mean composite score 3.80 ± 0.32). Participants strongly agreed on AI’s potential to improve healthcare access (4.10 ± 0.70) and reduce burnout (4.12 ± 0.66), and emphasized the need for structured training (4.48 ± 0.65). However, concerns regarding privacy risks (4.15 ± 0.73) and loss of clinical skills (3.86 ± 0.84) were prominent. Institutional readiness was perceived to be low (2.21 ± 0.91). Training needs positively predicted perception scores, while privacy concerns showed a negative association.

Conclusion: Doctors demonstrated favourable attitudes toward AI alongside significant concerns and perceived gaps in institutional preparedness, highlighting the need for structured education, ethical governance, and organizational readiness for safe implementation.

Study of Histopathological Lesions in Hysterectomy Specimens at Tertiary Care Hospital

Tue, 24 Feb 2026 00:00:00 +0100

Background: Hysterectomy is one of the most commonly performed gynaecological surgical procedures for the management of various benign and malignant uterine conditions. Histopathological examination of hysterectomy specimens plays a vital role in confirming clinical diagnosis and identifying unsuspected lesions.

Materials and Methods: This retrospective and prospective observational cross-sectional descriptive study was conducted in the Department of Histopathology at Pravara Rural Hospital for 2 years duration. A total of 512 hysterectomy specimens received during the study period were analysed. Specimens were processed using standard histopathological techniques, stained with haematoxylin and eosin, and examined microscopically. Lesions of endometrium, myometrium, and cervix were classified according to Robbins Basic Pathology.

Results: Out of 9340 specimens received, 512 (5.48%) were hysterectomy specimens. The majority of patients were in the age group of 41–50 years (40.6%). Proliferative endometrium (56.83%) was the most common endometrial finding. Leiomyoma (26.56%) and adenomyosis (23.04%) were the predominant myometrial lesions. Chronic nonspecific cervicitis (91.4%) was the most frequent cervical lesion. Malignant lesions were relatively rare.

Conclusion: Most hysterectomy specimens showed benign histopathological lesions, highlighting the importance of routine histopathological examination for accurate diagnosis, detection of incidental lesions, and appropriate patient management.

Serum TSH Levels as a Predictor of Malignancy in Thyroid Nodules: a Retrospective Cross-Sectional Analytical Study

Nazrana Farooq, Prof. (Dr.) Shafkat Ahmad Lone, Numaan Qadri — Wed, 25 Feb 2026 00:00:00 +0100

Background: Thyroid nodules are common endocrine findings, with malignancy reported in 5–15% of cases. Although Fine Needle Aspiration Cytology (FNAC) remains the cornerstone of diagnosis, interest in biochemical predictors such as serum Thyroid Stimulating Hormone (TSH) has increased.

Aim: To evaluate the association between serum TSH levels and malignancy in thyroid nodules in a North Kashmir female cohort.

Methods: A retrospective cross-sectional analysis of 50 consecutive female patients with thyroid nodules undergoing FNAC and preoperative serum TSH estimation was performed. Cytology was classified according to the Bethesda System for Reporting Thyroid Cytopathology. Bethesda V–VI were considered malignant. TSH was analyzed as continuous and categorical (≤2.5 vs >2.5 µIU/mL). Statistical analysis included Student’s t-test and chi-square test.

Results: Mean TSH in malignant cases (n=19) was significantly lower (1.58 µIU/mL) compared to benign/indeterminate cases (3.26 µIU/mL) (p=0.003). TSH ≤2.5 µIU/mL was significantly associated with malignancy (χ²=4.99, p=0.026).

Conclusion: Lower serum TSH levels were significantly associated with malignant thyroid nodules. TSH may serve as an adjunctive biomarker in malignancy risk stratification; however, larger prospective studies are required.

Unusual Causes of Skin and Soft Tissue Infections: A Case Series

Thu, 26 Feb 2026 00:00:00 +0100

Background: Skin and soft tissue infections (SSTIs) constitute a major infectious syndrome. SSTIs can arise from invasion of organisms through skin due to breach in the anatomical barrier or from the hematogeneous route, secondary to any systemic infections. The common causative micro-organisms are Staphylococcus aureus and Group A, Beta-hemolytic Streptococci (Streptococcus pyogenes). Many SSTIs respond predictably to the empiric treatment, whereas some of them pose a diagnostic as well as therapeutic dilemma, especially in immunocompromised patients or patients giving history of trauma, insect bite, marine contact etc. These cases simulate routine cellulitis clinically, but fail to respond. These SSTIs are usually caused by unusual pathogens like atypical bacteria, mycobacteria or fungi.

Aim and Objectives: We describe four cases of SSTIs due to rare etiologies encountered at a tertiary care hospital, aiming to illustrate clinical presentation, diagnostic strategies and management, thereby enhancing clinical awareness.

Methods: Study Design: Case series. Study Setting: Department of Surgery, Department of Microbiology, R.K. Damani Medical College, Dr. Hedgewar Rugnalaya, Chhatrapati Sambhajinagar, Maharashtra. Study Population: The cases were selected from the Microbiology laboratory database after identification. Study Duration: January 2024 to June 2025. Sample Size: 4

Results: Case 1, 82-year-old male farmer from rural Maharashtra with a one-week history of insidious, progressive right-sided scrotal swelling and pain diagnosed as pyocoele led to a left orchidectomy. Intraoperatively, a testicular abscess was noted. Bacterial Culture on Sheep Blood and MacConkey agar, identified via Vitek 2, confirmed Brucella melitensis. Case 2, 21-year-old female presented with high-grade fever, chills, and a painful perianal swelling that prevented sitting. The abscess was surgically drained; the cavity extended to the perivaginal region. Smears revealed gram-positive budding yeast cells identified as Candida guilliermondii, susceptible to Fluconazole. Case 3, a 61-year-old male with a 9-year history of diabetes presented with diffuse erythema, edema, and tenderness of the left leg. Debridement was performed, and empiric Cefoperazone-Sulbactam was started. Ziehl-Neelsen staining of pus aspirates revealed acid-fast filamentous branching bacilli. Cultures on Blood agar and Lowenstein-Jensen medium confirmed Nocardia species. Case 4, a 26-year-old male presented with fever and a painful swelling on the right thigh following a suspected insect bite. Multiple debridements were required. Systemic workups ruled out diabetes or immunosuppression. KOH mount revealed broad, aseptate, ribbon-like hyphae with wide-angle branching, characteristic of Mucorales.

Conclusions: This case series highlights four distinct instances of soft tissue infections—ranging from scrotal abscesses to lower limb cellulitis—caused by atypical pathogens including Brucella melitensis, Candida guilliermondii, Nocardia species, and Mucorales. These cases underscore the necessity of diligent microbiological investigation, especially when empiric antibiotic therapy fails or clinical presentations are insidious.

Phenotypic Patterns of Antimicrobial Resistance in Community-Acquired Escherichia Coli Infections

Dr Anil Kumar, Dr Samit Sen, Amritesh Kumar Singh, Sandeep Kumar Yadav — Sat, 28 Feb 2026 00:00:00 +0100

Background: Community-acquired Escherichia coli infections increasingly demonstrate multidrug resistance (MDR), complicating empirical therapeutic strategies. Phenotypic resistance patterns remain poorly characterized in outpatient populations, particularly regarding extended-spectrum β-lactamase (ESBL) production and fluoroquinolone resistance.

Methods: A 24-month cross-sectional study enrolled patients with community-acquired E. coli infections presenting to primary healthcare centers and emergency departments (January 2023 to December 2024). Consecutive urine isolates underwent antimicrobial susceptibility testing using CLSI and EUCAST breakpoints. Phenotypic characteristics including ESBL production, biofilm formation, and virulence factor expression were determined. Statistical associations were evaluated using logistic regression modeling; P < 0.05 denoted significance.

Results: Of 487 community-acquired E. coli isolates, 38.6% exhibited resistance to ≥1 antimicrobial class. ESBL production was documented in 46.2% of isolates; 27.8% demonstrated multidrug resistance. Moderate-to-strong biofilm formation occurred in 69.8% of isolates, with significant correlation to MDR status (P = 0.018). Fluoroquinolone resistance ranged from 12.1% (levofloxacin) to 19.7% (ciprofloxacin), predominantly attributable to gyrA S83L and D87G mutations. Prior fluoroquinolone exposure (OR 3.16, 95% CI 1.11–8.98) and immunosuppressive therapy (OR 10.47, 95% CI 1.07–102.57) were independent risk factors for MDR-ESBL phenotypes. Resistance to trimethoprim-sulfamethoxazole (68.3%), penicillins (71.5%), and nitrofurantoin susceptibility (>98%) were also documented.

Conclusions: Phenotypic resistance in community-acquired E. coli involves multifactorial mechanisms integrating ESBL production, topoisomerase mutations, and virulence factor expression. Prior antimicrobial exposure and immunosuppression are modifiable risk factors. These findings support risk-stratified empirical therapy and antimicrobial stewardship interventions in community populations.

Prevalence of Esbl-Producing E. Coli in Outpatient Urinary Tract Infections

Dr Anil Kumar, Dr Asheerul Islam, Amritesh Kumar Singh, Sandeep Kumar Yadav — Sat, 28 Feb 2026 00:00:00 +0100

Background: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli represents an emerging threat to antimicrobial therapy in community-onset urinary tract infections (UTIs). Current prevalence data and risk stratification in outpatient populations remain variable across geographic regions, necessitating systematic epidemiological surveillance to guide empirical treatment decisions.

Methods: A cross-sectional observational study was conducted over 18 months (January 2022–June 2023) among outpatients presenting with acute UTI symptoms at a tertiary care hospital in Jaipur, Rajasthan, India. Consecutive symptomatic patients aged ≥18 years with urinalysis positive for pyuria and/or bacteriuria were enrolled (n=412). Midstream clean-catch urine samples were cultured on MacConkey agar; bacterial identification was performed via VITEK 2 automated system. ESBL production was detected using the phenotypic double-disc synergy test with ceftazidime (30 μg) and clavulanic acid (10 μg) according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Molecular confirmation was conducted via polymerase chain reaction (PCR) targeting blaCTX-M genes. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for ESBL-positive UTI (α=0.05; 95% confidence intervals reported).

Results: Of 412 symptomatic outpatients, 287 (69.7%) yielded culture-positive results with bacterial counts ≥10⁵ CFU/mL. Escherichia coli accounted for 221 (77.0%) of positive isolates. Among E. coli isolates, 71 (32.1%) were phenotypically confirmed as ESBL producers; molecular analysis confirmed blaCTX-M genes in 63 isolates (88.7%), with CTX-M-15 predominating (71.4%). Independent risk factors included prior hospitalization within 6 months (adjusted odds ratio [aOR] 3.18, 95% CI 1.84–5.51, p<0.001), prior cephalosporin exposure (aOR 2.94, 95% CI 1.72–5.03, p<0.001), recurrent UTI history (≥2 episodes/6 months; aOR 2.67, 95% CI 1.51–4.72, p=0.001), and advanced age (≥55 years; aOR 1.89, 95% CI 1.12–3.19, p=0.018). Resistance to fluoroquinolones and trimethoprim-sulfamethoxazole exceeded 75% in ESBL-producers, whereas all isolates remained susceptible to imipenem and meropenem. Clinical cure at day 7 (symptom resolution + negative follow-up culture) was achieved in 94.1% of patients treated with carbapenems versus 71.8% of those receiving empirical fluoroquinolones (p=0.008).

Conclusion: ESBL-producing E. coli accounts for nearly one-third of community-onset UTIs in outpatient populations, with epidemiological patterns reflecting prior healthcare exposure and antimicrobial selection pressures. Targeted screening and carbapenem-based therapy directed by rapid culture and susceptibility testing are warranted in high-risk populations to optimize treatment outcomes and curtail inappropriate antibiotic escalation.

Telmisartan versus Amlodipine: A Comparative Clinical Study on Efficacy and Safety in Essential Hypertension

Suhaina A.S., K. Pragadeesh, V. Ganesh — Sat, 28 Feb 2026 00:00:00 +0100

Background: Essential hypertension is a major cardiovascular risk factor in India, and both angiotensin II receptor blockers (ARBs) and dihydropyridine calcium channel blockers (CCBs) are widely used as first‑line agents. Telmisartan offers renin–angiotensin system blockade with partial peroxisome proliferator‑activated receptor‑gamma (PPAR‑γ) activity, while amlodipine reduces peripheral vascular resistance via L‑type calcium channel blockade.

Objectives: To compare the efficacy and tolerability of telmisartan and amlodipine in patients with mild to moderate essential hypertension.

Methods: A prospective, randomized, open‑label, parallel‑group study was conducted in 100 adults with mild to moderate essential hypertension over 12 weeks at SMIMS. Patients were randomized to telmisartan 40 mg once daily (Group T, n=50) or amlodipine 5 mg once daily (Group A, n=50). Clinic systolic and diastolic blood pressure (SBP, DBP) were recorded at baseline, 4, 8 and 12 weeks. Efficacy end points were mean change in SBP/DBP and proportion achieving target BP <140/90 mmHg. Tolerability was assessed by adverse drug reactions (ADRs) and withdrawals.

Results: Mean baseline BP was comparable between groups (telmisartan 152±8/96±6 mmHg; amlodipine 151±9/95±7 mmHg). At 12 weeks, both drugs significantly reduced SBP (telmisartan −20±9 mmHg; amlodipine −18±10 mmHg), with a modest numerical advantage for telmisartan. Telmisartan produced greater DBP reduction (−13±6 vs −10±7 mmHg) and a higher target BP achievement rate (78% vs 66%). Peripheral oedema occurred more frequently with amlodipine (16% vs 4%), whereas telmisartan was metabolically neutral or favourable for fasting glucose and lipid parameters.

Conclusion: Telmisartan and amlodipine are both effective in mild to moderate essential hypertension, but telmisartan showed superior diastolic BP reduction and better tolerability, particularly with respect to peripheral oedema and metabolic profile. Telmisartan may be preferred as initial monotherapy in hypertensive patients attending SMIMS, especially in those with metabolic risk factors.

A Study of A1 and A2 Subgroup in ABO Blood Group System in Blood Centre of Tertiary Care Hospital

Dr. Suhas Pankaj Singh, Dr. Yashodhara Rajesh Gotekar, Dr. Yasha Ravindra Shetty — Sat, 28 Feb 2026 00:00:00 +0100

Aim: The aim of the present study was to assess the percentage of subgroup A1 and A2 along with ABO blood group in all donors and recipients in a blood centre of a tertiary care hospital.

Methods: It was a cross-sectional study in which data relating to blood grouping of donors and recipients from January 2023 to December 2023 at Bharati Hospital Sangli Blood Centre were collected and analysed.

Results: Among 9674 cases, highest cases were found of Blood Group O positive 2733 (28.25%) followed by B positive 2672 (27.62%), least prevalent blood group found to be was AB Negative 44 (0.45%). Among 9674 cases, 9044 (93.48%) were Rh positive and 630 (6.52%) were Rh negative blood group. Among 9674 cases, 5806 were blood Group O and B while 3868 were blood group A and AB in which A1 positive were 2566 (26.52%) most prevalent among subgroups while A2B 4 cases (0.04%) was least prevalent blood group among them. Out of 2815 cases of blood Group A, A1 was found in 2746 (97.55%) cases while A2 was found in 69 (2.45%) cases. While out of 1053 cases of Blood group AB, A1B was found in 1003(95.25) cases while A2B was found in 50(4.75%) cases.

Conclusion: The present study showed the most common blood group was O positive while A2 and A2B being the least prevalent blood group. The prevalence of the A1 and A2 subtypes of the blood group is notable among individuals with blood group A and AB. Transfusion of incompatible blood may result in potentially fatal transfusion-related responses.

Clinico-Anatomical Mapping of Benign Perianal Disorders with Emphasis on Perianal Structural Involvement in Gadap Town, Karachi

Sat, 28 Feb 2026 00:00:00 +0100

Background: Benign perianal conditions like hemorrhoids, fissures, fistula-in-ano, and perianal abscesses are common surgical presentations that significantly impair quality of life. Data remains scarce in Pakistan, particularly among underprivileged groups. This study aimed to evaluate the clinico-anatomical spectrum, risk factors, and management of these diseases within the Baloch population of Gadap Town, Karachi.

Methodology: This cross-sectional study at Al-Tibri Medical College Hospital, Gadap Town, Karachi included 300 Baloch patients. Clinical assessment included presenting complaints, examination findings, and risk factors. Patients received either conservative or surgical treatment, depending on the diagnosis. Data were analyzed descriptively using frequencies and mean±standard deviation.

Results: The mean patient age was 33.2 ± 10.7 years, with a male predominance (56.3%). The primary complaint was bleeding per rectum (50.3%), followed by pain with bleeding (24%) and perianal pain (14%). On examination, anal fissures (47%) and internal hemorrhoids (34%) were the predominant diagnoses. Constipation and low dietary fiber intake were identified as major risk factors in over 80% of patients. Treatment was diagnosis-specific, managed conservatively or surgically.

Conclusion: Perianal diseases, specifically fissures and hemorrhoids, are highly prevalent in the Baloch population of Gadap Town. Constipation and dietary habits are critical contributors. Management aligns with diagnosis, combining conservative and surgical approaches. These findings highlight the importance of community education regarding preventive strategies for lifestyle modification.

A Case of Mucocele of Right Middle Turbinate

Dr. Mohammed Saifulla, Dr. Maneesh Prabagaran — Sat, 28 Feb 2026 00:00:00 +0100

Concha bullosa is a common anatomical variant of the middle turbinate but rarely develops into a mucocele. We report a case of a 20-year-old female who presented with right-sided facial pain, nasal obstruction, hyposmia, and blurring of vision. Endoscopic evaluation revealed an expansile right middle turbinate filling the nasal cavity, and CT imaging demonstrated a well-defined expansile lesion suggestive of a concha bullosa mucocele with orbital displacement. The patient underwent endoscopic sinus surgery with marsupialization and partial resection of the turbinate, and histopathology confirmed the diagnosis of mucocele with no microbial growth. Postoperative recovery was uneventful with complete symptom resolution and radiologic improvement. This case highlights the importance of considering concha bullosa mucocele as a differential diagnosis in unilateral nasal obstruction with orbital symptoms, where early imaging and endoscopic management are crucial for successful outcomes.

Surgical Interventions in Management of Atonic Pph -A Prospective Study

Dr Sneha Patil, Dr Naveen Prasanna, Dr Kavita Mahadevappa — Mon, 02 Mar 2026 00:00:00 +0100

Background: Postpartum haemorrhage (PPH) remains a leading direct cause of maternal mortality worldwide, with atonic PPH contributing the largest share despite evidence-based medical protocols. When uterotonics fail, timely surgical interventions are critical, particularly in low- and middle-income settings where interventional radiology is limited.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Karnataka Institute of Medical Sciences, Hubballi, from June 2023 to May 2024. All women with atonic PPH within 24 hours of delivery, in whom standard medical management (high-dose oxytocin, misoprostol, carboprost, uterine massage, tranexamic acid) failed and surgical intervention was required, were included (n=83). Women with secondary PPH (>24 hours) were excluded. Data on demographics, obstetric risk factors, type and sequence of surgical procedures, intra- and postoperative course, near-miss events (WHO criteria), and maternal deaths were recorded. Statistical analysis was performed using SPSS v26; p<0.05 was considered significant.

Results: Most women were young (mean age 25.2±4.3 years); 54.2% were unbooked and 75.9% delivered by caesarean section. Severe preeclampsia/gestational hypertension (51.8%) was the most frequent risk factor. Uterine artery ligation was performed in 62.7% and bilateral internal iliac artery ligation (BIIAL) in 48.2%; compression sutures (B-Lynch/Hayman) were used in 34.9%. Hysterectomy was required in 22/83 (26.5%) women, predominantly after failure of BIIAL. Uterine artery ligation alone controlled haemorrhage in 48.1% of cases, whereas hysterectomy was strongly associated with maternal mortality (71.4% of deaths; p=0.002) and near-miss status (36.7%; p<0.001). Overall maternal mortality was 8.4% and maternal near-miss occurred in 36.1%.

Conclusion: In this high-risk cohort, a stepwise devascularisation strategy—uterine artery ligation, BIIAL and uterine compression sutures—allowed uterine preservation in nearly three-quarters of women with refractory atonic PPH. However, a substantial proportion still required hysterectomy, which was strongly associated with severe morbidity and mortality, underscoring the need for earlier referral, protocolised escalation, and optimisation of perioperative critical care.

Severity and Determinants of Anemia Among Patients with Chronic Kidney Disease in a Tertiary Care Hospital

Dr Prafull Kumar Kurrey and Dr. Yogesh Dhabarde — Fri, 20 Feb 2026 00:00:00 +0100

Background: Anemia is a common andclinically significant complication of chronic kidney disease (CKD), contributingto morbidity, reduced quality of life

STUDY OF HEMATOLOGICAL, SEROLOGICAL AND BIOCHEMICAL PARAMETERS IN PATIENTS OF DENGUE VIRAL INFECTION

Jeel Sheth, Mananshi Shah — Thu, 26 Feb 2026 00:00:00 +0100

Background: The acute febrile arboviraldisease known as dengue fever is caused by the dengue virus, which belongs to theFlaviviridae family and the Flavi virusgenus and is found in tropical andsubtropical regions of the world.

Duration-Dependent Histomorphological Alterations in Human Endometrium Following Progestin Therapy: Evidence from a Tertiary Care Center

Wed, 04 Mar 2026 00:00:00 +0100

Objective: This research will assess the time varying histologic alterations in human endometrium during progestin therapy at a tertiary care hospital.

Materials and Methods: A retrospective observational study was at multiple tertiary care centers, in a span of three years. A total of 240 women who received progestin therapy as an indicator of different gynecological conditions were used as the sample on endometrial biopsy. The patients were stratified into four groups according to the duration of therapy: Group A (less than 3 months), Group B (3 -6 months), Group C (6 - 12 months) and Group D (more than 12 months). Blinded pathologists scored the histological parameters such as glandular atrophy, stromal decidualization, pseudosarcomatous changes and inflammatory infiltrate. ANOVA and Chi -square tests were used to conduct the statistical analysis.

Results: There were significant variations with time in all groups. Group A had a minimum of glandular atrophy (15%), whereas in Group D, the glandular atrop hy was mostly present (88.3, p<0.001). Group B (91.7) had the highest level of Stromal decidualization followed by a slow reduction in long -time treatment. Group C and D were the only groups with pseudosarcomatous stromal changes (p=0.002). The total histological score suggested that there was a progressive change in the morphology of the secretory to atrophic with the length of treatment (p<0.05).

Conclusion: Progestin treatment has specific time-contingent histomorphological changes on the endometrium. Short-term therapy is typified by decidualization, whereas the long-term exposure causes extensive atrophy in the glands and may cause stromal metaplasia. These temporal trends are critical in the process of diagnosing malignancy by pathologists to prevent a misdiagnosis of malignancy and to detect therapeutic outcomes by clinicians.

TO STUDY NEEDLE STICK INJURY AND DETERMINE THE VACCINATION STATUS OF HEPATITIS B VIRUS IN HEALTHCARE PROFESSIONALS

Thu, 05 Mar 2026 00:00:00 +0100

Background: A major public healthconcern all around the world include hepatitis B virus (HBV) infection.According to studies

Impact of Intervention on Dental Anxiety among Patients: A Pre Post Study Using the Modified Dental Anxiety Scale (MDAS)

Thu, 05 Mar 2026 00:00:00 +0100

Background: Dental anxiety is a significant barrier to oral healthcare utilization and isassociated with delayed treatment seeking and poorer oral health outcomes. This studyaimed to assess the level of dental anxiety among patients and evaluate the effect of a structured psychological intervention on anxiety reduction.

Assessment of the Occurrence of Ventilator-Associated Pneumonia and the Impact of Ventilator Bundle Practices in an Adult Intensive Care Unit of a Tertiary Hospital

Thu, 05 Mar 2026 00:00:00 +0100

Background: Among infections seen in mechanically ventilated patients, ventilatorassociated pneumonia (VAP) is the most common and the most serious infection in Intensive Care Units (ICUs) patients. It significantly increases the length of stay, costs

Preoperative Serum Albumin and Body Mass Index as Predictors of Postoperative Complications in Elective Major Surgeries: A Prospective Observational Study

Dr. V. Ponmuthu, MS ,Dr. D. Mugundhan, MS ,Dr. S. S. Meiporul, MS — Fri, 06 Mar 2026 00:00:00 +0100

Malnutrition is a well-recogniseddeterminant of adverse surgical outcomes.Preoperative assessment of nutritionalstatus using simple biochemical and anthropometric parameters

Yoga as an Adjunct Treatment in Rheumatoid Arthritis: A Narrative Review of Psycho-Neuro-Immune Interactions in the Indian Context

Dr. Fareha Husain, Prof. Rajni Patel, Shiza Khan — Sat, 07 Mar 2026 00:00:00 +0100

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of the joints and systemic health. In India and worldwide, the incidence of RA is increasing. The traditional treatments are NSAIDs, corticosteroids, and DMARDs, but rceebtly there have been some non-pharmacological approaches such as yoga that have also been found to be beneficial. Objectives – To assess the therapeutic outcomes of yoga on RA based on its effect on inflammation, psychological stress, and psycho-neuro-immune modulation. Methods – This narrative review integrates evidence from eight prominent papers on RA and yoga. Databases such as PubMed, Scopus, and Google Scholar were searched using English-language articles from 2000 to 2024. Studies exploring biological, psychosocial, and clinical outcomes of yoga in RA patients were included. Results – Yoga enhances joint flexibility, immune status, and decreases inflammatory cytokines (IL-6, IL-17A, TNF-α), stress hormones (cortisol), and improves quality of life. Molecular markers such as BDNF, TGF-β, and HLA-G also alter in a positive direction with yoga. Significant reductions in anxiety, depression, and pain scores were observed. Conclusion – Yoga is a cost-effective, non-pharmacological, and an effective adjunct that can significantly enhance RA outcomes through psycho-neuro-immune mechanisms. Further long-term, deeply analysing research is indicated.

History of Recurrent Acute Cholecystitis Admissions as a Predictor of Operative Time and Bile Spillage: A Retrospective Cohort Study

Dr Mahek Tolia, DR. Riddhi E Shah, Dr Saikranti Medasani, DR Divyang Patel — Sat, 07 Mar 2026 00:00:00 +0100

Background: Repeat acute cholecystitis hospitalization could be cumulative inflammatory exposure and scarring in Calot triple, which might complicate surgery. We tested the hypothesis that prior acute cholecystitis admission predicted the duration of the operation and bile spillage during the operation in patients undergoing index laparoscopic cholecystectomy.

Methods: Our study was in the form of a retrospective cohort study conducted at Sardar Vallabhbhai Patel (SVP) Hospital, Ahmedabad, a teaching hospital of NHL Municipal Medical College, Ahmedabad. Included were adult patients who experienced laparoscopic cholecystectomy due to acute calculous cholecystitis between December, 2022, and December, 2025 (N= 200). The exposure variable was the count of recorded preceding hospital admissions of acute cholecystitis in the past, 0, 1, or 2 admissions. Operative time (incision to close time, minutes) and bile spillage (recorded gallbladder perforation with visible bile leak +/- stone leakage) were primary outcomes. Predictors of operative time were estimated using multivariate linear regression, and predictors of bile spillage were estimated using multivariate logistic regression, controlling age, sex, BMI, ASA class, symptom duration, Tokyo severity grade of the Tokyo Guidelines, ultrasound/CT exposure (wall thickness, pericholecystic fluid) and surgeon experience level..

Results: Of 200 patients, 92 (46.0%) had 0 prior admissions, 62 (31.0%) had 1, and 46 (23.0%) had ≥2. Mean operative time rose stepwise with prior admissions (0: 62.1±18.4; 1: 74.3±22.1; ≥2: 92.4±27.6 minutes; p<0.001). Bile spillage occurred in 13/92 (14.1%), 14/62 (22.6%), and 19/46 (41.3%), respectively (p<0.001). After adjustment, each additional prior admission independently predicted longer operative time (β=+9.6 minutes/admission, SE 1.8, p<0.001) and higher odds of bile spillage (adjusted OR 1.75, 95% CI 1.28–2.42, p=0.001). Conversion to open surgery and bailout subtotal cholecystectomy were more frequent in the ≥2 group.

Conclusion: The presence of a history of recurrent admissions of acute cholecystitis was a powerful, independent indicator of increased operative time, and the spillage of bile in laparoscopic cholecystectomy. Admission history is a modest preoperative indicator that can enhance planning of the operation, risk advisory, and assignment of seasoned surgical units.

Diagnostic Accuracy of CT, Ultrasound, and Clinical Scoring in Differentiating Acute Appendicitis from Gastrointestinal Mimickers

Mon, 09 Mar 2026 00:00:00 +0100

Background: Acute appendicitis is one of the most common surgical emergencies; however, differentiating it from gastrointestinal mimickers remains a clinical challenge, particularly in resource-limited settings.

Objective: To evaluate and compare the diagnostic accuracy of computed tomography (CT), ultrasonography (US), and clinical scoring systems in differentiating acute appendicitis from gastrointestinal mimickers.

Methods: This prospective cross-sectional diagnostic accuracy study was conducted at department of surgery indus medical college, Tando Muhammad Khan from 1st February 2025 to 31st January 2026, included 231 consecutive patients presenting with suspected acute appendicitis. Clinical assessment was performed using the Alvarado and Appendicitis Inflammatory Response (AIR) scores. All patients underwent ultrasonography, while CT was performed in cases with inconclusive or discordant findings.

Results: Acute appendicitis was confirmed in 156 (67.5%) patients, while 75 (32.5%) were diagnosed with gastrointestinal mimickers. The Alvarado score demonstrated sensitivity of 82.7% and specificity of 64.0%, whereas the AIR score showed sensitivity of 85.3% and specificity of 69.3%. Ultrasonography achieved sensitivity of 87.2%, specificity of 72.0%, and overall accuracy of 82.7%. CT demonstrated the highest diagnostic performance with sensitivity of 95.5%, specificity of 90.0%, overall accuracy of 93.3%, and AUC of 0.94. The negative appendectomy rate was 8.8%.

Conclusion: CT scan showed superior diagnostic accuracy in differentiating acute appendicitis from gastrointestinal mimickers, followed by ultrasound. Clinical scoring systems were effective for initial risk stratification but insufficient as standalone diagnostic tools.

Pulmonary Tuberculosis in a High-Burden Population in Pakistan: Clinical Characteristics, Risk Factors, and Public Health Implications

Tue, 10 Mar 2026 00:00:00 +0100

Background: TB of the lungs is still a really serious issue in places where it’s common. It causes a lot of sickness and death, and keeps spreading through communities even where programs to control it have been running for years. Part of the problem is that patients get diagnosed too late, the same risk factors keep coming up, and the disease doesn’t present the same way every time. To do better — at catching it early, treating it well, and responding to it as a public health issue — we really need to understand how it actually shows up in these settings.

Objectives: The goal of this study was to get a clearer picture of how pulmonary tuberculosis actually presents in a high-burden population, work out which risk factors tend to go along with more advanced disease, and think through what any of that means from a public health angle.

Methods: We set this up as a cross-sectional study and ran it over twelve months across various TB centers in Pakistan included 250 patients in total. Patients who already had a confirmed pulmonary TB diagnosis and met our criteria were brought in. We collected information from each one — their background, what symptoms they had and for how long, whether they smoked or lived somewhere crowded, and any other health issues they’d had.

Results: Out of 250 patients, productive cough was the most common symptom at 89.6%, with a median duration of 6.2 weeks before anyone came in. Male patients and those from poorer households had worse disease overall. The risk factors that kept showing up were crowded living, smoking, not eating enough, and waiting too long before going to a doctor. Over half (58.4%) already had advanced disease when they first showed up. Delayed care-seeking was the strongest predictor (OR 3.12), followed by malnutrition (OR 2.84), HIV co-infection (OR 2.56), overcrowded housing (OR 2.31), smoking (OR 1.94), and prior TB history (OR 1.78); all p<0.05.

Conclusion: What this study showed us is that TB in these kinds of populations keeps turning up late, in patients who already have a lot working against them. Most of the risk factors we found are ones that could realistically be addressed — which is worth keeping in mind when thinking about where programs should focus their effort.

Impact of Early Soft Tissue Coverage on Outcomes of Complex Fractures: An Orthoplastic Perspective

Tue, 10 Mar 2026 00:00:00 +0100

Objective: To determine the effects of definitive soft tissue coverage timing on clinical outcomes of patients undergoing an integrated orthoplastic management of Gustilo-Anderson Type IIIB/ IIIC open fractures.

MATERIALS and METHODS: It was a prospective cohort study, which recruited 186 patients with complex lower limb fractures that necessitated soft tissue repair. Patients were divided into two categories, depending on when they received definitive flap coverage Group A (early coverage ≤ 7 days, n=98) and Group B (delayed coverage >7 days, n=88). Deep infection rate, time to bony union, flap survival and limb salvage were the primary outcomes. The secondary outcomes were hospital length of stay, reoperation rate, and functional outcome measured using Lower Extremity Functional Scale (LEFS).

Results: At early stages, the rates of deep infection (12.2 vs. 34.1, p=0.001), flap survival (96.9 vs. 85.2, p=0.008), bony union (18.4+-4.2 vs. 24.7+-6.8 weeks, p=0.001), and length of stay (22.3+-7.1 vs. 31.8+-9.4 days, p=0.001) showed significant differences. The coverage timing (>7 days) was determined as an independent predictor of a deep infection by the multivariate logistic regression when adjusted by the severity of injuries, comorbidities and smoking status (OR 3.82, 95% CI 1.94-7.53, p<0.001).

Conclusion: Early definitive soft tissue coverage in the initial seven days of management makes a big contribution to clinical outcomes of complex open fractures using an orthoplastic model. Morbidity reduction can be optimized through socioeconomic challenges by implementing special orthoplastic teams in resource-constrained environments such as Pakistan.

The Deficiency of Vitamin-D: An Unresolved Issue of the Current Era Affecting the Chilchren and the Elderly

Tue, 10 Mar 2026 00:00:00 +0100

The Vitamin D, a fat-soluble vitamin has been documented to be involved in major health processes, despite the fact an easy process of synthesis, communities have been reported to be deficient or insufficient levels of the vitamin globally. This observational Study was conducted in different cities of Sindh province design over one year from January 2024-January 2025. There were 1000 patients analyzed for serum vitamin D levels with age groups from 5 years to 60 years as age range using purpose technique for sampling. Statistical tests were applied using SPSS version 22 for data analysis generating mean, SD and other measures. We found the study population as deficient 70%, insufficient 20% and normal in 10%. Non-significant difference was observed between the adults and children for vitamin D deficiency p-value 0.094.

Conclusion: Majority of the population is suffering from the deficiency of vitamin D

PROTECTIVE EFFECT OF GARLIC IN INDOMETHCIN INDUCED GASTRIC ULCER IN ADULT ALBINO RATS

DR.NEHA ZAHOOR,DR.SABIYA NAAZIR,DR.UROOSA MIR.F — Tue, 10 Mar 2026 00:00:00 +0100

Peptic ulcer disease (PUD) is definedas the mucosal lesions that penetratethe muscularis mucosa layer and forma cavity surrounded by acute and chronic inflammation.

Prevalence Of Early Childhood Caries in Preschool Children

Wed, 11 Mar 2026 00:00:00 +0100

Background: Early childhood caries (ECC) isone of the most common chronic diseases inpreschool children and remains a significant public health concern, particularly in developingregions. Objective: To determine

A Comparative Study of Dextran-40 versus Crystalloid Infusion in Nonhemorrhagic, Nonhypovolemic Shock in Emergency Medicine

Dr. Prabhu P., Dr. Harish T.J., Dr. Abeer Khan — Mon, 09 Mar 2026 00:00:00 +0100

Background: Shock is a condition of inadequate tissue perfusion due to an imbalance between oxygen demand and supply, classified into hypovolemic, cardiogenic, obstructive, and distributive types, each with distinct causes and treatment approaches. Crystalloids are the preferred intravenous fluids for resuscitation, while the safety and efficacy of synthetic colloids like dextran-40, as an alternative to albumin in non-hemorrhagic, non-hypovolemic shock, remain under investigation. This study explores the potential of dextran-40 in critical patients, aiming to provide clarity on its role compared to crystalloids.

Objectives: The study aims to evaluate the efficacy of dextran in achieving early hemodynamic stability, compare dextran infusion with crystalloid fluids in managing shock during the initial hours, and assess their outcomes in terms of multi-organ failure.

Methods: This prospective randomized controlled study evaluated the effects of Dextran-40 versus crystalloids in patients with non-hemorrhagic, non-hypovolemic shock presenting to the emergency department. Patients were assessed using qSOFA criteria, and initial resuscitation was performed with normal saline, followed by group-specific interventions. Outcomes were monitored through vital signs, ABG parameters, lactate clearance, and mental status, with statistical analysis performed using SPSS and R software.

Conclusion: The study found no significant advantage of dextran-40 over crystalloids for resuscitation in distributive shock, highlighting the need for larger, multicenter, randomized trials to validate its efficacy and safety. While promising early practices like goal-directed resuscitation and conservative fluid management show potential, further research is essential to establish dextran-40 as a reliable alternative to albumin in sepsis management.

Association between Sleep Deprivation and Peripheral Nerve Conduction Velocity

Dr. DC Khaleel Hussain, Anahita Mishra, Danika Sethi, Dr Deepali A — Thu, 12 Mar 2026 00:00:00 +0100

Background: Sleep is essential for maintaining normal neurological and physiological functions. Sleep deprivation has become increasingly common due to modern lifestyle patterns, irregular work schedules, and prolonged screen exposure. While the effects of sleep deprivation on cognitive and central nervous system functions have been widely studied, its impact on peripheral nerve conduction velocity remains less explored.

Objectives: The present study aimed to evaluate the association between sleep deprivation and peripheral nerve conduction velocity in healthy individuals.

Materials and Methods: This observational cross-sectional study was conducted in the Department of Physiology and included 70 participants. Subjects were categorized into two groups: sleep-deprived and normal sleep groups based on their sleep duration. Demographic details such as age, gender, and body mass index (BMI) were recorded. Peripheral nerve conduction studies were performed using standard electrophysiological equipment to measure motor and sensory nerve conduction velocity and distal latency of the median nerve. Data were analyzed using appropriate statistical methods, and a p-value of <0.05 was considered statistically significant.

Results: The results showed that motor nerve conduction velocity was significantly lower in the sleep-deprived group (54.2 ± 4.6 m/s) compared to the normal sleep group (57.8 ± 3.9 m/s) (p = 0.003). Similarly, sensory nerve conduction velocity was reduced in sleep-deprived participants (50.6 ± 3.8 m/s) compared to those with normal sleep (53.7 ± 3.4 m/s) (p = 0.005). Distal latency was significantly higher in the sleep-deprived group (3.8 ± 0.6 ms) than in the normal sleep group (3.3 ± 0.5 ms) (p = 0.002). Conclusion: Sleep deprivation was associated with significant alterations in peripheral nerve conduction parameters, indicating its potential impact on peripheral nerve function.

FACIAL ANTHROPOMETRY IN SOUTH INDIAN POPULATION: AUTOPSY-BASED CORELATIONS OF SEXUAL DIMORPHISM AND STATURE

Dr. Alfia A., Dr. Samreen Panjakash, Dr Amjad Dastageer Mirzanaik — Thu, 12 Mar 2026 00:00:00 +0100

Background: In Forensic anthropology, theestimation of stature from the bones plays animportant role in the identification of missingpersons. In order to determine stature separate regression formulae should

Influence of Chronic Heat Exposure on Nerve Conduction Velocity in Desert Populations

Dr. DC Khaleel Hussain, Anahita Mishra, Danika Sethi, Dr Deepali A — Fri, 13 Mar 2026 00:00:00 +0100

Background: Chronic exposure to high environmental temperatures is a common condition for individuals living in desert regions. Prolonged heat stress may influence several physiological systems, including the peripheral nervous system. Nerve conduction velocity (NCV) is an important electrophysiological parameter used to evaluate the functional integrity of peripheral nerves. Environmental factors such as temperature, hydration status, and occupational heat exposure may influence nerve conduction properties.

Aim: To evaluate the influence of chronic heat exposure on nerve conduction velocity in individuals residing in desert populations.

Materials and Methods: This cross-sectional observational study was conducted in the Department of Physiology at Jaipur National University, Rajasthan. A total of 120 participants aged between 18–60 years with long-term exposure to desert climatic conditions were included in the study. Motor and sensory nerve conduction velocities were assessed using a standard electromyography (EMG) system under controlled laboratory conditions. Nerves commonly tested included the median, ulnar, tibial, peroneal, and sural nerves. Demographic data, duration of heat exposure, and daily exposure hours were recorded. Statistical analysis was performed using appropriate software, and a p value <0.05 was considered statistically significant.

Results: The study demonstrated a gradual reduction in nerve conduction velocity with increasing duration and daily hours of heat exposure. Participants with more than 20 years of heat exposure showed lower mean NCV compared with those with shorter exposure duration (p=0.03). Motor NCV of the median, tibial, and peroneal nerves showed statistically significant reductions, while sensory NCV changes were observed in the median and sural nerves. Age-related decline in NCV was also noted (p=0.01).

Conclusion: Chronic environmental heat exposure may produce mild alterations in peripheral nerve conduction parameters, suggesting possible adaptive or subclinical neurophysiological changes among desert populations.

Audit of Prescription Documentation Practices in Pediatric Surgical Inpatients at a Tertiary Care Hospital, Multan, Punjab

Thu, 12 Mar 2026 00:00:00 +0100

Background: Accurate and complete drug prescription charts are essential for safe and effective patientcare, particularly in pediatric surgical practice where dosing errors can have serious consequences.Clinical audit is a key component of clinical governance aimed at identifying gaps between current practice and established standards.

Clinical and Radiographic Evaluation of Stem Cell–Based Bone Grafts in Maxillofacial Reconstruction of Cancer-Related Defects

Thu, 12 Mar 2026 00:00:00 +0100

Objective: To evaluate the clinical and radiographic outcomes of mesenchymal stem cell(MSC)–based bone grafts in post-oncologic maxillofacial reconstruction, with emphasis on graft integration, bone regeneration, and complication rates.

Significance of Inj. Methylprednisolone in the Treatment of Visual Complaints in Acute Methanol Poisoning - A Case Series Study-Retrospective

Dr. S. Gayathri, Dr. K. Sivakumar, Dr. S. Suresh Kumar, Dr. S. Nehru — Wed, 11 Mar 2026 00:00:00 +0100

Background: Methanol poisoning is a life-threatening emergency. One of the most serious complications is visual impairment due to toxic optic neuropathy. Current treatments include ethanol/fomepizole, folinic acid, and dialysis. The role of corticosteroids like methylprednisolone is still debated. This study evaluates its significance in visual recovery.

Objective: To assess improvement in visual acuity following treatment with Inj. Methylprednisolone and to assess optic disc changes using Colour vision, fundus examination.

Method: This retrospective, non-comparative, intervention case series examines the ophthalmological data of patients diagnosed with methanol-induced optic neuropathy during illicit methanol poisoning tragedy at Govt. Kallakurichi medical college and hospital. Patients’ characteristics and the results of initial and final ophthalmological examinations were documented.

Result: Out of 145 patients, 8 were diagnosed with methanol-induced toxic optic neuropathy. They presented with severe bilateral visual loss and disc edema. Following corticosteroid therapy, all showed improvement in visual acuity, pupillary reflexes, colour vision, and fundus appearance

Conclusion: A timely diagnosis and treatment of patient with methanol-induced optic neuropathy is important to achieve a good visual prognosis.

Detection of Virulence Factors of Candida Species Isolated From Neonatal Candidemia at Tertiary Care Hospital in North India

Dr. Baby, Dr. Perbhat Kansal — Sat, 14 Mar 2026 00:00:00 +0100

Background: Fungus being ubiquitous, but infections caused by it are rare and as a suspect for sepsis are rarest. So, it becomes a cause for higher morbidity and mortality especially in state of immune-compromised state like neonates admitted in NICU. Hence to treat it appropriately, we must know its emergence, virulence and trend of it. So we design this study in neonates, one of most vulnerable group to study its virulence and effects on them.

Method: It is a prospective study conducted for one and half years on 44 positive neonates detected for candidemia. Using most advanced and also the conventional methods we differentiate the species and also studied in detail about their virulence and end results on patients

Results: Incidence is 10.33%, with dominance of non albicans candidemia (65.9%) over C. albicans septicaemia. Virulence is also higher in non albicans Candida (NAC) as compared to C. albicans. The mortality (34%) detected was higher in NAC but average duration of hospital stay (14.5) is longer in C. albicans due to its more resistance towards anti- fungals.

Conclusion: In this long study on neonatal septicaemia, we found that NAC were emerging pathogens and were more virulent than C. albicans

Development and Validation of UV Spectroscopic Method for Estimation of Symplocos Racemosa

Sat, 14 Mar 2026 00:00:00 +0100

Background: Symplocos racemosa Roxb. Is an herbal plant grown in tropical and subtropical regions around the globe. Due to its therapeutic activity, it is being used as an herbal treatment against obesity and many other chronic and acute disease, considering these applications of the drug a UV-Spectrophotometric method was developed and validated according to ICH (International Council for Harmonization) recommendations.

Objective: To develop a quick, precise, reliable and specific UV-Spectrophotometric method validate according to ICH Q2 (R1) guidelines.

Materials and Method: Methanol was used as the solvent for method development at a wavelength of 276nm.

Results: The developed method demonstrated correlation coefficient value of 0.999and was found to be linear with a low LOQ and LOD values of 12.21 and 37 respectively with accuracy and precision %RSD (Relative standard Deviation) value less than 2.

Conclusion: A quick, accurate, simple and economical UV-Spectroscopy method was developed and validated for the estimation of Symplocos Racemosa.

Enhancing Antifungal Treatment Using Microsponges Loaded Emulgel to Improve Topical Delivery System

Sat, 14 Mar 2026 00:00:00 +0100

Objective: The objective of this research is to investigate the effectiveness of microsponge-based delivery system for enhancing antifungal treatment of Bifonazole. This study aims to evaluate the potential of microsponges technology in improving drug delivery, increasing drug bioavailability and enhancing therapeutic outcomes of Bifonazole in treatment of fungal infections.

Background of the Study: In recent years, the development of novel drug delivery systems has revolutionized the field of pharmaceuticals, offering solutions to improve drug efficacy and patient compliance.

Methodology: This experimental study was conducted in Shree Pushpasen Sawant College of Pharmacy, Jaywant Nagar, Humarmala. Study duration was 12 weeks.

Procedure: All chemicals and solvents were procured from commercial sources were purified and sterilized using standard procedures from literature whenever required.

Results: The microsponges prepared using Eudragit S100 polymer was found to be suitable for the sustained release formulation and also Bifonazole microsponges containing gel also showed the sustained release action.

Clinical Case Series on Madhumegam (Type 2 Diabetes Mellitus) Management Using the Siddha Herbal Medicine: Keezhanelli Chooranam (KNC)

Soruban T., Sathiyaseelan V. — Sat, 14 Mar 2026 00:00:00 +0100

According to the 2021 World Bank report, the prevalence of diabetes in Sri Lanka was 11.3% among adults aged 20 -79 years. In Siddha literature, Madhumegam is correlated with Diabetes Mellitus and is classified under Meganoi in Yugi Vaithiya Cinthamani 800, belonging to the Pitha type (Thithippu Neer). Keezhanelli Chooranam (Phyllanthus amarus) is a single-herb formulation documented in the Siddha Pharmacopoeia of India for managing Madhumegam (Type 2 Diabetes Mellitus). To scientifically validate its traditional claim, a clinical study was conducted at the Siddha Teaching Hospital, Kaithady, with ethical approval from the Bandaranaike Memorial Ayurveda Research Institute. Six patients diagnosed with Madhumegam were enrolled. Keezhanelli Chooranam (5 g twice daily before meals with warm water) was administered for 90 days, along with a prescribed dietary regimen. Fasting Blood Sugar (FBS) was measured every 14 days, while Postprandial Blood Sugar (PPBS) and HbA1c were assessed at baseline and on Day 90. Statistical analysis using the paired t-test revealed a highly significant reduction in PPBS (p = 0.008) and a significant decrease in VLDL (p = 0.015). Although reductions in FBS (↓32 mg/dL), HbA1c (↓0.94%), and Triglycerides (↓43 mg/dL) were not statistically significant (p = 0.065–0.068), they indicated meaningful clinical improvement. No adverse changes were observed in Total Cholesterol, HDL, LDL, or Hemoglobin levels. The findings suggest that Keezhanelli Chooranam possesses anti-hyperglycemic and hypolipidemic properties, providing preliminary scientific evidence supporting its Siddha claim in managing Madhumegam. Further validation through large-scale randomized controlled trials is recommended.

A Comparative Study of Dexamethasone and Local Anaesthetic Infiltration in the Management of Postoperative Nausea and Vomiting in Pediatric Tonsillectomy

Dr Mohammad Ahmad Khan — Thu, 15 Jan 2026 00:00:00 +0100

Objective: To compare theeffectiveness of intravenousdexamethasone and pre-incision localanesthetic infiltration in reducing postoperative nausea, vomiting, andpain among pediatric patientsundergoing tonsillectomy

Clinical Significance of Jugular Bulb Venous Oxygen Saturation Monitoring in Severe Traumatic Brain Injury

Dr Mohammad Ahmad Khan — Tue, 20 Jan 2026 00:00:00 +0100

Background:Maintaining adequate brainoxygenation is a primary goal in themanagement of severe traumatic braininjury (TBI). Jugular venous oxygensaturation (SjvO₂) monitoring is auseful technique for estimating theglobal balance between cerebral oxygensupply and metabolic demand. The FullOutline of Responsiveness (FOUR)score is a newer consciousnessassessment tool that has been proposedas an alternative to the Glasgow

In Vivo Study on the Anticancer Property of Pugasaram: An Arecanut Based Polyherbal Gel in Oral Cell Carcinoma

Jeddu Ganapathi Bhat, S. Keshava Bhat, Sukesh Bhat, D Shobha, S Mythri — Sat, 14 Mar 2026 00:00:00 +0100

Cancer is one of the principle causes of human mortality in all countries. Surgery, chemotherapy and radiotherapy are the usual therapeutic remedies for this disease. As there are several side effects of such treatments, the researchers are constantly in search of certain alternate remedial measures using promising herbal products. Several plants are already known for their anticancer properties. In Ayurvedic system of medicine, preparations using several herbs, called polyherbal products, are generally preferred over single herb preparation. In the present study, the anticancer property of a polyherbal gel known as Pugasaram, prepared mainly by using arecanut and betel leaf as the main ingredients along with ten other plants / plant products, was studied in cancer induced mice. The preliminary toxicity study revealed that there was no change in the behaviour of mice fed with this gel at a concentration of 2000mg/kg body weight. The anticancer efficacy profile of Pugasaram showed a significant reduction in the size of tumors and their progression compared to the untreated DMBA applied mice and showed even better than that of cisplatin treated group.

Impact of Training Program in Improving Knowledge of Healthcare Personnel Regarding Biomedical Waste Management in Government Medical College and Associated Hospital

Uruj Qureshi, Rabia Shah, Zahid Ali Khan, Nazia Khaki, Najmul Ain Syed — Tue, 03 Mar 2026 00:00:00 +0100

Background: Biomedical waste (BMW) poses significant risks to healthcare workers and the environment if not managed properly. Despite the existence of comprehensive Biomedical Waste Management Rules (2016) in India, knowledge gaps among healthcare personnel continue to hinder safe practices. Structured training programs are critical for enhancing compliance and awareness. Aims/Objectives: To evaluate the impact of a structured training program on the knowledge of paramedical healthcare workers regarding biomedical waste management in a government medical college and associated hospital.

Settings and design: A before-and-after interventional study was conducted among 112 paramedical staff at associated hospital of a newly established Government Medical College. Participants underwent a three-day structured training program on BMW management. Material and methods: A pre-tested questionnaire assessed knowledge before and after the intervention. Data were analyzed using SPSS v20, with the chi-square test applied to determine statistical significance (p < 0.05). Practices of the paramedical staff were assessed by observational visits to check adherence to the biomedical waste management guidelines which got polished by training program.

Results: Post-training, a statistically significant improvement was observed in ten out of thirteen knowledge variables. Notably, knowledge regarding sharp disposal increased from 36.6% to 76.8% (p < 0.00001), and awareness of disease transmission risks improved from 10.5% to 85.6% (p < 0.00001). Overall, the intervention led to a marked enhancement in participants' understanding of BMW segregation and safe disposal practices.

Conclusion: Structured training programs significantly improve healthcare workers’ knowledge of biomedical waste management. Regular refresher courses and integration of BMW training into institutional policy and healthcare curricula are recommended to ensure sustained compliance and safer healthcare environments.

COMPARATIVE STUDY OF NON CONTRAST CT AND DIFFUSION WEIGHTED MR IMAGING IN DIAGNOSTIC EVALUATION OF HYPERACUTE ISCHEMIC STROKE

Dr.K.Priyanka, Dr.A.Nageswara Reddy, Dr.K.Radha Rani, Dr.O.Sridhar Babu — Fri, 06 Mar 2026 00:00:00 +0100

Background: Early and accurate diagnosis of acute ischemic stroke is essential for appropriate management and improved clinical outcomes. Non-contrast computed tomography (NCCT) is widely used as the initial imaging modality; however, its sensitivity in the early detection of ischemic changes is limited. Diffusion-weighted magnetic resonance imaging (DW-MRI) has emerged as a more sensitive technique for detecting acute cerebral ischemia.

Aim: To document and compare the diagnostic performance of Diffusion-weighted MR imaging with Non contrast CT in the diagnosis of hyper acute ischemic stroke.

Materials and Methods: This hospital-based cross sectional study was conducted over a period of 3 months in the Department of Radio-diagnosis, SVRRGGH, Titupati Andhra pradesh. A total of 50 patients with clinical suspicion of acute stroke were included. All patients underwent NCCT and MRI, including diffusion-weighted imaging. Imaging findings were correlated with final clinical diagnosis. Diagnostic performance of NCCT and DW-MRI was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.

A STUDY ON THE PATTERN OF FUNGAL INFECTIONS AND CLINICAL PROFILE IN IMMUNOCOMPROMISED PATIENTS WITH SPECIAL REFERENCE TO CHARACTERISATION AND MOLECULAR STUDY OF CANDIDA SPECIES IN A TERTIARY CARE HOSPITAL

Thu, 05 Mar 2026 00:00:00 +0100

Background: In immunocompromised patients, there are advances in medical care leading to significant increase in Invasive Fungal Infections (IFIs). Fungal species are approximately 7 percent (6,11,000 species) and they are distributed in soil, plant debris and other organic substrates. Only 600 species are human pathogens

Outcomes and Complications of Distal Femoral Fractures Treated with Retrograde Supracondylar Nailing Versus Locking Compression Plates: A Retrospective Review

Fri, 13 Mar 2026 00:00:00 +0100

Background and Objective
A minor percentage of the fracture of the femur shaft is represented by distal femur fractures, but their treatment is still a technical challenge. The main methods of modern fixation are retrograde supracondylar nailing (RSN) and locking compression plate (LCP), the biomechanical benefits and restrictions of each being different. There is also continuing controversy over the patterns of complications with these two implants especially in complex distal third fractures.

Impact of Digital Screen Blue Light on Retinal Integrity and Sleep Behavior among Teenagers

Dr Ibtihaj Imran, Dr Muhammad Farhan Lodhi, Mohammad Younas Khan — Mon, 16 Mar 2026 00:00:00 +0100

Background: In recent years, growing apprehension has emerged about the harmful consequences of prolonged exposure to blue light among teenagers, largely due to the escalating use of digital screens. Blue wavelength light emitted from smartphones, tablets, and computers has been implicated in disturbing circadian rhythm regulation and contributing to retinal stress and potential degenerative alterations. As adolescents increasingly rely on digital platforms for education and recreation, it has become essential to evaluate how sustained screen exposure influences ocular integrity and sleep health.

Objective: This study aimed to examine the impact of chronic exposure to blue light from digital screens on retinal structure and sleep behavior in adolescents.

Methods: A prospective observational investigation was conducted at PHQ Teaching Hospital Gilgit from May 2024 to April 2025. A total of 100 participants aged 13–18 years were enrolled. Data regarding daily screen usage patterns and sleep routines were collected through structured questionnaires. Comprehensive ophthalmic assessments were performed, including optical coherence tomography (OCT), retinal imaging, and routine eye examinations to detect early or subtle retinal alterations. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). The extent of blue light exposure was estimated based on the duration of daily screen time and the type of electronic devices used.

Results: The findings revealed that 68% of participants reported spending more than eight hours per day on digital screens. Among these high-exposure individuals, 61.8% experienced symptoms consistent with digital eye strain, while 42% demonstrated early retinal thinning on OCT imaging. Moreover, 74% of adolescents in the high-exposure category exhibited poor sleep quality scores on the PSQI, with significant delays in sleep onset and reduced overall sleep duration (p < 0.01). A strong positive correlation was observed between prolonged screen time and sleep disturbances (r = 0.64, p < 0.001). Adolescents with daily screen usage exceeding eight hours were identified as being at greater risk for both retinal changes and compromised sleep quality.

Conclusion: Excessive and sustained exposure to blue light from digital devices has a measurable negative impact on retinal health and sleep patterns among adolescents. These findings emphasize the need for public health awareness initiatives, regulation of screen time, and the adoption of preventive strategies such as blue light filters and scheduled screen breaks to minimize long-term ocular and sleep-related complications.

Contemporary Screening and Evidence-Based Treatment Approaches for Diabetic Retinopathy

Mon, 16 Mar 2026 00:00:00 +0100

Introduction: Diabetic retinopathy (DR) remains a leading cause of preventable blindness worldwide, resulting from hyperglycemia-induced microvascular damage to the retinal vasculature. The condition is often asymptomatic in early stages, making timely detection crucial.

Objective: This article aims to provide a comprehensive overview of current strategies for screening, diagnosing, and managing diabetic retinopathy, with a focus on evidence-based interventions that reduce disease burden and preserve visual function.

Methods: A systematic review of the literature and critical analysis of clinical guidelines were performed to evaluate diagnostic approaches and therapeutic options, including laser photocoagulation, intravitreal pharmacotherapy, and surgical interventions.

Results: Early detection has been significantly enhanced by modalities such as dilated fundus examinations, high-resolution fundus imaging, and teleophthalmology. Stage-specific interventions— including panretinal photocoagulation, anti-VEGF therapy, and vitrectomy—have proven highly effective in preventing vision loss at various stages of DR.

Conclusion: Comprehensive management integrating systematic screening, early diagnosis, and stageappropriate therapy is essential to reduce both the visual and socioeconomic impact of diabetic retinopathy.

Emerging Advances in Stem Cell Therapy for Retinal Degeneration: Evaluating Safety and Effectiveness

Mon, 16 Mar 2026 00:00:00 +0100

Background: Retinal degenerative diseases, such as age-related macular degeneration and retinitis pigmentosa, pose significant challenges to vision restoration, with limited treatment options. Recent advancements in stem cell therapy provide a promising avenue for retinal repair and functional recovery by replenishing damaged photoreceptors and supporting retinal integrity. However, long-term efficacy and safety of such interventions require careful evaluation.

Aim: To evaluate the efficacy and long-term safety of stem cell therapy in patients with retinal degenerative diseases.

Methods: This prospective study was conducted at Avicenna Medical and Dental College, Lahore, from June 2024 to May 2025. A total of 80 patients diagnosed with retinal degenerative diseases received intravitreal or subretinal stem cell-based therapies. Standardized ophthalmologic examinations, including visual acuity tests, optical coherence tomography (OCT), and electroretinography, were performed. Follow-up assessments were done at 1 month, 6 months, and 12 months to evaluate functional and structural retinal outcomes and adverse effects.

Results: 65% of patients showed measurable improvement in visual acuity, while 20% had stabilization of disease progression. OCT imaging revealed enhanced retinal structural integrity in 58% of participants. Electroretinography responses demonstrated functional gains in 40% of cases. Therapy was well tolerated; mild adverse effects, such as transient intraocular inflammation, occurred in 10% of patients, with no severe or vision-threatening complications observed.

Conclusion: Stem cell therapy showed significant efficacy in improving visual outcomes and preserving retinal structure in patients with degenerative retinal diseases. Treatment appeared safe in the long term, with minimal adverse effects. These results highlight stem cell therapy as a promising therapeutic strategy, warranting further large-scale studies for validation and optimization.

Effectiveness of Low-Molecular-Weight Heparin versus Unfractionated Heparin for Venous Thromboembolism Prophylaxis after Firearm-Related Penetrating Brain Injury: A Retrospective Cohort Study from a Tertiary Care Trauma Center

Mon, 16 Mar 2026 00:00:00 +0100

Background: Firearm-related penetrating brain injury is a severe form of traumatic brain injury associated with prolonged immobilization and an increased risk of venous thromboembolism. Pharmacological thromboprophylaxis is recommended in trauma patients; however, the optimal anticoagulant agent remains uncertain due to concerns regarding intracranial hemorrhage progression.

Objective: To compare the effectiveness and safety of low-molecular-weight heparin and unfractionated heparin for venous thromboembolism prophylaxis in patients with firearm-related penetrating brain injury.

Methods: A retrospective cohort study was conducted at POF Hospital Wah Cantt from January 2020 to December 2024. Adult patients with firearm-related penetrating brain injury who received thromboprophylaxis with either low-molecular-weight heparin or unfractionated heparin were included. The primary outcome was the incidence of venous thromboembolism during hospitalization. Secondary outcomes included intracranial hemorrhage progression, length of intensive care unit stay, and in-hospital mortality. Statistical analysis was performed using SPSS version 26.

Results: A total of 200 patients were included, with 102 receiving low-molecular-weight heparin and 98 receiving unfractionated heparin. The overall incidence of venous thromboembolism was 9%. Patients receiving low-molecular-weight heparin had a significantly lower incidence of venous thromboembolism compared with those receiving unfractionated heparin (5.9% vs 12.2%, p = 0.042). The rates of intracranial hemorrhage progression (6.9% vs 7.1%, p = 0.95) and in-hospital mortality (13.7% vs 18.4%, p = 0.34) were similar between the two groups. Multivariable logistic regression analysis demonstrated that low-molecular-weight heparin was independently associated with a reduced risk of venous thromboembolism.

Conclusion: Low-molecular-weight heparin appears to be more effective than unfractionated heparin for venous thromboembolism prophylaxis in patients with firearm-related penetrating brain injury without increasing the risk of intracranial hemorrhage progression.

Impact of Deficiency of Serum Vitamin D3, Serum Zinc, Serum Iron and its Outcome in Community Acquired Pneumonia in Children in a Tertiary Healthcare Center of Central India: A Crosssectional Study

Dr. Vishal Gajimwar, Dr. Pravin Irpate, Dr. Manish Tiwari — Mon, 16 Mar 2026 00:00:00 +0100

Background: In regions like Central India, where malnutrition and micronutrient deficiencies are endemic, children are at a heightened risk of developing severe forms of CAP. Socioeconomic constraints, poor dietary diversity, limited access to healthcare, and lack of awareness contribute to a high prevalence of subclinical and overt deficiencies of vitamin D3, zinc, and iron. In tertiary healthcare centers, where patients often present with complicated or advanced stages of illness, assessing the nutritional and micronutrient status of paediatric patients with CAP can provide valuable insights into the underlying risk factors influencing disease severity and recovery outcomes.

Aim and Objectives: 1. to determine the correlation between vitamin D3, serum zinc, serum iron & Its severity and outcome in community acquired pneumonia in children.2. To estimate the levels of serum vitamin D3, serum zinc, serum iron in community acquired pneumonia in children.

Methodology: Study Design: Cross sectional study.

Study Setting: Paeditrics department of GMC Nagpur, Maharashtra.

Study Population: Patients aged 2 months up to 60 months who suffered CAP according to WHO criteria, clinically and radio logically (chest x-ray) confirmed case of community acquired pneumonia. Patients were clinically classified according to the severity of pneumonia.

Study Period: from October 2023 to March 2025.

Sample Size = 65

Results: High prevalence of vitamin D3 deficiency was observed in 42 cases (64.6%), followed by iron deficiency in 39 cases (60.0%) and zinc deficiency in 36 cases (55.4%). Furthermore, multiple micronutrient deficiencies were identified in 28 children (43.1%). The highest proportion of cases (14; 21.5%) occurred in the 13–24-month age group, followed by 13 cases (20.0%) in the 37–48- month group, 12 cases (18.5%) in the 2–6-month group, and 11 cases (16.9%) in the 49–60-month group. The 7–12- month group accounted for 9 cases (13.8%), while the lowest proportion was observed in the 25–36-month group, with 6 cases (9.2%). The prevalence of micronutrient deficiencies was substantially higher among ICU patients compared to those in the ward. Vitamin D3 deficiency was observed in 86.7% of ICU cases versus 58.0% of ward cases. Iron deficiency was also present in 86.7% of ICU patients compared to 52.0% in the ward. 35 (53.8%) were male and 30 (46.2%) were female. The overall prevalence of CAP was slightly higher in males (53.8%) than in females (46.2%). Vitamin D3 deficiency was present in 81.3% of severe cases versus 48.5% of pneumonia cases (p = 0.006). Serum iron deficiency occurred in 78.1% of severe cases compared with 42.4% of pneumonia cases (p = 0.004). Serum zinc deficiency was identified in 71.9% of severe cases versus 39.4% of pneumonia cases (p = 0.010). The multiple deficiency group recorded the highest mortality (17.9%) and the lowest recovery rate (53.6%).

Conclusions: The present study highlights a significant association between micronutrient deficiencies specifically vitamin D3, serum iron, and serum zinc and the incidence and severity of community-acquired pneumonia (CAP) in children aged 2 to 60 months.

Ct-Based Stone Density as a Predictor of Treatment Modality Selection in Urolithiasis

Tue, 17 Mar 2026 00:00:00 +0100

Objective: To assess the effectiveness of non-contrast computed tomography (NCCT) of stone density (Hounsfield Units, HU) as a predictive variable in the selection of a treatment modality and prognosis of patients with urolithiasis with a particular focus on the success rates of Shock Wave Lithotripsy (SWL).

Materials and Methods: The study is a retrospective cohort study in a sample size of 450 patients, who have undergone treatment of renal and proximal ureteral calculi between January 2024 and June 2025. Stratification of the patients was done according to treatment modality i.e., SWL (Group A) and Ureteroscopy with Laser Lithotripsy (URS) (Group B). Mean stone density was measured by the use of preoperative NCCT. The main results were stone-free rate (SFR) after 3 months, the number of SWL sessions and complication rates. Statistical analysis involved Chi-square and independent t-tests, and Receiver Operating Characteristic (ROC) curve.

Results: The average density of the stones was significantly greater in patients who needed secondary intervention after SWL than in those who were stone free (1150 +- 210 HU vs. 780 +- 190 HU; p<0.001). The ROC analysis was able to determine an optimum HU cutoff of 950 to predict SWL failure (Sensitivity 88% Specificity 82%). Multivariate analysis proved that stone density was an independent predictor of treatment failure OR=3.45; p=0.002). SWL versus URS Patients with stone density greater than 1000 HU had a much lower SFR than those in the URS (62%62% vs.94%; p<0.001).

Conclusion: NCCT stone density is a non-invasive, powerful predictor of stone vulnerability and treatment result. Stones that have a density of more than 950-1000 HU have a much lower SWL success. The inclusion of HU measurement into preoperative planning contributes to the optimal choice of the treatment modality decreasing the rates of retreatment and healthcare expenses.

Clinicopathological Study on Abnormal Uterine Bleeding (AUB) Patients Undergoing Hysterectomy

Swapna Devi, Suneeta Meena, Utsav Joshi, Neha Gupta — Tue, 17 Mar 2026 00:00:00 +0100

Aims and objectives: This study aims to analyze the clinicopathological profiles of women with AUB undergoing hysterectomy and correlate clinical diagnoses with final histopathological findings.

Material and method: This is a prospective observational study conducted at the SMS Medical College in Department of Pathology in collaboration with Department of Obstetrics and Gynaecology over one year of study period from Feb.2024 to March 2025.

Results and conclusion: In our studies, perimenopausal age (40-49yrs) is the most common age group for hysterectomy. Leiomyoma being the most common structural pathology and hormonal imbalance was the most common endometrial pathology. A case of endometrial carcinoma was detected histologically which was not previously suspected in clinico-radiologically. Our study confirms that histopathological evaluation of endometrium is a useful tool for detecting non- structural causes of AUB

Comparative Evaluation of Bone Healing in Stem Cell–Augmented Versus Conventional Bone Grafts in Post-Oncologic reconstruction

Tue, 17 Mar 2026 00:00:00 +0100

Mandibular defects following oncologicresections often require bone graftreconstruction to restore form and function. Conventional autologous bone grafts are thestandard, but healing may be limited by graftresorption and delayed osteogenesis.

Study of Serum Electrolyte Abnormalities in Patients with Chronic Kidney Disease

Dr. DC Khaleel Hussain, Anahita Mishra, Danika Sethi, Dr Deepali A — Wed, 18 Mar 2026 00:00:00 +0100

Background: Chronic kidney disease (CKD) is a long-term illness that becomes worse over time and causes the kidneys to stop working properly, which throws off the balance of fluids, electrolytes, and acid-base. People with CKD often have electrolyte problems such hyponatremia, hyperkalemia, and hypocalcaemia, which can make them more likely to get sick and die. For good care of CKD patients, it is important to keep an eye on these problems.

Aim: To study serum electrolyte abnormalities in patients with chronic kidney disease.

Materials and Methods: The Department of Physiology at Jaipur National University in Rajasthan did a cross-sectional observational study in a hospital. The study comprised 100 participants who had been diagnosed with chronic renal disease. They wrote down information on the person's age and gender. We took blood samples in a clean environment and used standard biochemical methods to assess the amounts of sodium, potassium, and calcium in the serum. We used the right statistical tools to look at the data we collected. We thought that p values less than 0.05 were statistically significant.

Results: Most of the patients (27%) were between the ages of 51 and 60. There were 62% males and 38% females in the study group. Forty-four percent of the patients had hyponatremia, forty-one percent had normal sodium levels, and fifteen percent had hypernatremia. Forty-two percent of the patients had hyperkalaemia, while forty-six percent had normal potassium levels and twelve percent had hypokalaemia. Hypocalcaemia was the most frequent calcium problem, seen in 53% of patients. 37% had normal calcium levels, and 10% had hypercalcemia.

Conclusion: Most of the patients (27%) were between the ages of 51 and 60. There were 62% men and 38% women in the study. There were 44% of patients with hyponatremia, 41% with normal sodium levels, and 15% with hypernatremia. Forty-two percent of patients had hyperkalaemia, whereas forty-six percent had normal potassium levels and twelve percent had hypokalaemia. Hypocalcemia was the predominant calcium anomaly, identified in 53% of patients, whereas 37% exhibited normal calcium levels and 10% presented with hypercalcemia.

A Cross-Sectional Study of Thyroid Dysfunction in Chronic Kidney Disease Patients Attending DSP Main Hospital, Durgapur

Dr. Ashish Chatterjee, Dr. Akash Kumar Rai, Dr. Sukhdev Shankar Patil — Wed, 18 Mar 2026 00:00:00 +0100

Background: Numerous metabolic and endocrine disorders are linked to CKD (Chronic Kidney Disease), a chronic illness marked by permanent loss of renal function. Thyroid hormone metabolism, breakdown, and excretion are all significantly influenced by the kidneys. Therefore, aberrant thyroid hormone levels may result from impaired renal function. Thyroid dysfunction, particularly hypothyroidism and low T3 syndrome, is frequently observed in CKD patients and may worsen disease progression and clinical outcomes. The goal of the current investigation was to evaluate thyroid function abnormalities in individuals with CKD and ascertain the correlation between thyroid dysfunction and the severity of CKD.

Methods: This hospital-based cross-sectional study was conducted in the Department of Medicine at DSP Main Hospital, Durgapur. A total of 90 patients with CKD stage III and above, aged above 18 years, were included over a period of two years using purposive consecutive sampling. Patients with known thyroid disorders, pregnancy, or those taking drugs affecting thyroid function were excluded. Blood samples were analysed for T3, T4, and TSH levels using ECLIA (Electrochemiluminescence Immunoassay). Renal function was measured using serum creatinine and eGFR (estimated Glomerular Filtration Rate) computed using the Cockcroft-Gault algorithm. SPSS software version 21 was used for the statistical analysis, and p < 0.05 was deemed significant.

Results: The mean age of the study population was 61.31 ± 14.4 years, with males constituting 53.3% of the subjects. Most patients were in CKD stage III (66.7%), followed by stage IV (22.2%) and stage V (11.1%). Thyroid dysfunction was observed in 35.6% of CKD patients. Among these, low T3 syndrome (16.7%) was the most common abnormality, followed by subclinical hypothyroidism (15.6%) and overt hypothyroidism (3.3%). The prevalence of thyroid dysfunction increased with CKD severity, affecting 25% of stage III, 50% of stage IV, and 70% of stage V patients. A significant negative correlation was found between TSH and eGFR, while T3 and T4 showed a positive correlation with eGFR.

Conclusion: Thyroid dysfunction is common among CKD patients and its prevalence increases with disease severity. Low T3 syndrome and subclinical hypothyroidism are the most frequent abnormalities. Routine assessment of thyroid function in CKD patients may aid in early detection and better management of endocrine complications associated with renal disease.

The Role of Community Health Workers in Promoting Preventive Measures to Reduce Operative Dental Interventions

Sun, 15 Mar 2026 00:00:00 +0100

Background: Operative dental interventions such as restorations and extractions, represent a significant burden to public health, in large part because oral diseases

Role of Microbiology in Preventing Surgical Site Infections During Anesthesia

Dr Sapana Tharwani, Dr Anisha Nagaria, Dr Santosh Tharwani — Wed, 18 Mar 2026 00:00:00 +0100

Background: Surgical site infection(SSI) is one of the most common postoperativecomplications

A Study of Risk Factors, Occurrence and Etiology of catheter associated urinary tract infections (CAUTI) in critical care unit

Dr Sapana Tharwani, Dr Anisha Nagaria, Dr Santosh Tharwani — Wed, 18 Mar 2026 00:00:00 +0100

Background:theCatheter-associatedurinary tract infection (CAUTI) is oneofmost common healthcare associated infections and accounts

A Comparative Assessment of Warm Perineal Compress and the Modified Ritgen’s Technique for the Prevention of Birth Canal Injury in the Active Pushing Phase of Childbirth: A Prospective Randomized Trial

Thu, 19 Mar 2026 00:00:00 +0100

Background: Birth canal trauma standsas one of the most commonly recordedadverse events in patients undergoingvaginal childbirth. Its consequences span from immediate postpartum

Prevalence of burn wound infections in the burn unit, Al Noor Specialist Hospital, Makkah, Saudi Arabia

Ghulam Murtaza, Osama Fathi Abu Al-Ola — Thu, 19 Mar 2026 00:00:00 +0100

The issue of bacterial woundinfection is very high in the healthcare system, especially in burn patients, who areexposed to a very high risk because

Prevalence of Chronic Respiratory Symptoms among Active Smokers and Non-Smokers: A Population-Based Pulmonology Study

Fri, 20 Mar 2026 00:00:00 +0100

Objective: To identify and compare the prevalence of chronic respiratory symptoms of active smokers and non-smokers in a general adult population. The purpose of the study was to estimate the burden of respiratory morbidity of smoking and establish the risk factors.

Materials and Methods: A cross-sectional and population based study was carried out among 2,000 adults aged 40 years and above. The samples were divided into active smokers and non-smokers according to their self-reported smoking status supported by cotinine testing. The standardized respiratory questionnaire and spirometry were used to gather the data. Statistical tests were taken as Chi-square tests on categorical variables and t-tests on continuous variables and odds ratios were determined using logistic regression.

Results: 1000 active smokers and 1000 non-smokers were included in the study. Chronic cough was found to be very high in smokers (45.2) than non-smokers (12.1) (p < 0.001). Likewise, there were great differences between the groups in dyspnea and chronic sputum production. An analysis of spirometry showed that the mean FEV1/FVC ratio in the smoking group was much less. The multivariate analysis is able to point out smoking status, age and occupational exposure as independent predictors of respiratory symptoms.

Conclusion: The smoking habit has been linked to an increased prevalence rate of chronic respiratory symptoms and lung dysfunction. The results of these studies highlight the necessity of specific smoking cessation measures and health policies among the population to reduce the respiratory cost.

Clinico-Pathological Evaluation of Adnexal Masses among Patients Attending to Tertiary Care Centre

Mon, 23 Mar 2026 00:00:00 +0100

Background: Adnexal masses are commonly encountered in gynaecological practice and may arise from ovarian, tubal, or surrounding structures. While most are benign, a significant proportion may be malignant, necessitating accurate diagnosis for appropriate management. This study aimed to evaluate adnexal masses using clinical, biochemical, radiological, and histopathological parameters and to differentiate between functional, benign, and malignant lesions.

Methods: A prospective observational study was conducted over 18 months among 106 women admitted with suspected adnexal masses in a tertiary care hospital. Patients with ectopic pregnancy and uterine masses were excluded. Data were collected through clinical evaluation, laboratory investigations including tumor markers (CA-125), imaging (ultrasound/MRI), and histopathological examination. Statistical analysis was performed using SPSS version 20, applying descriptive and inferential statistics with significance set at p<0.05.

Results: The mean age was 44.75±9.65 years, with most patients in the 41–50-year group. The commonest symptom was abdominal pain (64.1%), followed by abnormal uterine bleeding (26.4%). Ovarian origin accounted for 80.2% of masses, with 84.9% being unilateral. Most lesions were benign (82.1%), while 17.9% were malignant. Among ovarian tumors, benign lesions constituted 60%, malignant 21.2%, and non-neoplastic 18.8%. Mucinous cystadenoma was the most common benign tumor, and serous cystadenocarcinoma the most common malignant tumor. Malignancy was significantly associated with increasing age, menopausal status, irregular menstrual cycles, elevated CA-125 levels, and higher Risk Malignancy Index scores (p<0.001).

Conclusions: Adnexal masses are predominantly benign, with ovarian origin being most common. Clinical features combined with CA-125 and RMI are valuable in predicting malignancy. Early and accurate evaluation is essential for optimal management and improved outcomes.

Uv Spectrophotometric Method For Determination Of Bifonazole

Mr. Koustubh S. Pachkor, Miss. Bhuwaneshwari V. Asekar, Miss. Shilpa S. Borkar — Tue, 24 Mar 2026 00:00:00 +0100

A simple, precise, accurate and reproducible UV-spectrophotometric method has been developed and validated for quantification of Bifonazole in bulk. Bifonazole is soluble in 0.1M HCl. The UV spectrum of Bifonazole in 0.1M HCl shows maximum absorbance at 254nm after scanning in 200-400nm range. The concentration range for analysis was 0.02-0.12 µg/ml. The method was validated for linearity, accuracy, precision, robustness, LOD, LOQ and ruggedness. The linearity equation was found to be y = 11.13x + 0.0294 with correlation coefficient R² = 0.9978. LOD and LOQ were found to be 0.123612255µg/ml and 0.374582589µg/ml respectively. The %recovery was found to be in range 91-103.91%. Based on the validation results the method can be successfully used for determination of Bifonazole in bulk.

Perception and Practice of Self-Medication and Over the Counter (OTC) Drugs among Nursing students, Paramedical Staff and patients in Government Teaching General Hospital

Wed, 25 Mar 2026 00:00:00 +0100

Background: Self-medication is a significant global public health concern, particularly in India, where it contributes to antimicrobial resistance and potential economic loss due to delayed professional diagnosis. This study aimed to assess the perceptions and practices regarding self-medication and over the counter (OTC) drugs among nursing students, paramedical staff, and patients at a Government Teaching General Hospital.

Methods: An analytical cross-sectional observational study was conducted over six months in Eluru district. A total of 399 participants (170 nursing students, 29 paramedical staff, and 200 patients) were selected via convenient sampling. Data were collected through interviews using a pre-validated questionnaire covering socio-demographic details and Knowledge, Attitudes, and Practices (KAP) regarding OTC use.

Results: High self-medication prevalence was observed, with 87.7% of participants reporting the practice. While 77.2% knew the definition of responsible self-medication, significant gaps existed regarding storage (24.3% correct) and the necessity of completing a drug regimen (33.8% correct). OTC drugs were most frequently used for fever (76.7%), pain (72.1%), and the common cold (71.7%). Notably, 43.6% reported using expired drugs, and only 20.3% of those experiencing adverse reactions reported them to a pharmacist.

Conclusions: OTC drugs play a significant role in self-care and can reduce the burden on healthcare systems when used appropriately, the findings suggest gaps in rational use, awareness of risks, and adherence to safe practices. There is a clear need for structured educational interventions, stricter regulatory policies, and improved access to healthcare services to promote responsible self-medication.

A PROSPECTIVE STUDY OF PREVALENCE OF PCOD IN PATIENTS VISITING OPD OF GOVT GENERAL HOSPITAL

Dr Priyanka, Dr. Indu Rekha Dungdung — Thu, 26 Mar 2026 00:00:00 +0100

Introduction: Polycystic ovarian syndrome(PCOS) is an endocrine disorder among women of reproductive age groupcharacterized by hyperandrogenism

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

Chalamani Siri Sivani Reddy, Koti Sambireddy — Thu, 26 Mar 2026 00:00:00 +0100

Introduction: Blunt ocular trauma is one ofthe most common eye injuries, particularly in younger individuals, and blunt objectsaccount for approximately

Comparative Evaluation of Efficacy & Safety of Oral Terbinafine versus Fluconazole in Patients with Tinea Corporis

Fri, 27 Mar 2026 00:00:00 +0100

Background: Tinea corporis is among the most common dermatophyte infections in India and often requires systemic therapy when topical treatment fails. Terbinafine and fluconazole are widely used systemic antifungals with differing pharmacological profiles.

Objectives: To compare the efficacy and safety of oral terbinafine 250 mg once daily for 2 weeks versus oral fluconazole 150 mg once weekly for 4 weeks in adults with tinea corporis.

Methods: In this observational comparative study conducted at a tertiary care center (November 2020–October 2021), 30 KOH‑positive adults with Tinea corporis ≥10% body‑surface area involvement, recurrent disease and non‑response to topical therapy were randomized to receive either terbinafine or fluconazole. Patients were followed at weeks 0, 1, 2, 3, 4, 5 and 8 for clinical signs & symptoms (erythema, scaling, itching), adverse events and laboratory safety parameters. Compliance was assessed by pill counts. Primary endpoint was clinical cure at end of therapy; secondary endpoints included change in individual signs and relapse during follow‑up.

Results: Of 30 participants (93% male; mean age 31.6±10.6 vs 34.5±14.1 years in terbinafine and fluconazole groups), clinical cure rates were 100% with terbinafine versus 79% with fluconazole. Itching resolved completely with terbinafine and improved with fluconazole (post‑treatment mean 0.21±0.43). Erythema and scaling resolved in both groups. One patient in the fluconazole arm developed a maculopapular rash after the first dose and was withdrawn. Relapse occurred in 5/14 (36%) evaluated patients in the fluconazole arm within four months; none relapsed in the terbinafine arm. No clinically significant laboratory abnormalities were observed.

Conclusions: Short‑course oral terbinafine (250 mg daily for 2 weeks) achieved higher clinical cure with zero relapse compared with fluconazole (150 mg weekly for 4 weeks) in adults with extensive tinea corporis, with good overall tolerability. However, larger blinded trials with mycologic endpoints are warranted.

Role of Environmental Toxicants and their exposure in the Etiology of Cancer

Dr Sandeep Kapoor Verma, Neelam Singh, Dr Rajendra Kumar Shukla — Sat, 28 Mar 2026 00:00:00 +0100

Cancer, a leading cause of morbidity and mortality worldwide, is a concerning disease with its multifaceted causality. Substantial contributors to the etiology of cancers are environmental factors. Environmental toxicants, including pesticides, heavy metals, air pollutants, persistent organic pollutants, and emerging contaminants such as microplastics, are ubiquitous in modern ecosystems and human environments. Exposure to these toxicants over a long period of time, even at minimal doses, has been strongly linked to carcinogenesis through diverse molecular and cellular mechanisms. This review summarizes current evidence on sources and routes of exposure to environmental toxicants and critically examines their role in cancer etiology. Key mechanisms suchas genotoxicity, oxidative stress, epigenetic dysregulation, endocrine disruption, and immune modulation are discussed. Epidemiological and experimental findings supporting the association between toxicant exposure and site-specific cancers are highlighted. Emerging concepts, including the exposome, cumulative risk assessment, and gene–environment interactions, are also addressed. Understanding the contribution of environmental toxicants to cancer development is essential for risk assessment, preventive strategies, and public health policy formulation.

Evaluation of Prevalence and Clinical Symptoms in Patients with Eosinophilia Using Peripheral Smear Method: A Retrospective Study

Ranjeet Kumar, Suhas Pankaj Singh, Parsuram Prasad — Fri, 27 Mar 2026 00:00:00 +0100

Background: Eosinophilia is a common hematological abnormality associated with diverse clinical conditions, including allergic disorders, parasitic infections, and hematological malignancies. The peripheral smear method remains an essential tool for initial evaluation, allowing morphological assessment of eosinophils and concurrent hematological abnormalities. This retrospective study aimed to evaluate the prevalence, demographic patterns, and clinical symptoms in patients with eosinophilia diagnosed based on peripheral smear examination.

Methods: A retrospective observational study was conducted including 80 patients with peripheral blood eosinophilia (absolute eosinophil count >500 cells/μL) diagnosed in February 2026. Demographic data, clinical presentations, and peripheral smear findings were analyzed. Eosinophilia severity was classified as mild (500-1500/μL), moderate (1500-5000/μL), and severe (>5000/μL). Statistical analysis was performed using SPSS version 26.

Results: Among 80 patients, 56.3% (n=45) were males and 43.7% (n=35) were females (male:female ratio 1.3:1). The mean age was 38.6 ± 16.4 years (range 5-78 years). The majority of patients (26.3%) belonged to the 21-30 years age group. Mild eosinophilia was most prevalent (47.5%), followed by moderate (36.2%) and severe (16.3%). The most common clinical symptoms were fever (41.3%), cough (37.5%), and skin manifestations including rash and pruritus (33.8%). Peripheral smear examination revealed toxic granules in eosinophils among 28.8% of patients, predominantly in those with moderate-to-severe eosinophilia. Concurrent anemia (hemoglobin <12 g/dL) was observed in 51.3% of patients.

Conclusion: Eosinophilia affects predominantly young adults with a slight male predilection. Fever and respiratory symptoms are the commonest presenting complaints. Peripheral smear examination provides valuable morphological information and should complement absolute eosinophil count in initial evaluation. The high prevalence of concurrent anemia warrants comprehensive hematological assessment in these patients.

Impact of Negative Behavior of Patients and Their Relatives towards Dental Students: A Cross-Sectional Study

Sat, 28 Mar 2026 00:00:00 +0100

Background: The clinical training of dental students involves direct patient interaction, which plays a crucial role in developing clinical competence and communication skills. However, negative behavior from patients and their relatives can adversely affect students psychological well-being and learning experience.

Aim: To evaluate the prevalence and impact of negative behavior exhibited by patients and their relatives toward dental students, and to assess its effects on their psychological state and clinical performance.

Methods: A cross-sectional, questionnaire-based study was conducted among 323 undergraduate dental students (III BDS, IV BDS, and interns) from dental colleges in the western region of Maharashtra. Data were collected using a validated, self-structured questionnaire distributed via an online platform. The questionnaire assessed types and frequency of negative behavior, psychological impact, effects on clinical learning, coping strategies, and reporting patterns. Data were analyzed using descriptive statistics and chi-square tests, with a p-value <0.05 considered statistically significant. Results: More than half of the participants (56%) reported experiencing negative behavior from patients, while 42% reported similar experiences involving patients’ relatives. A significant proportion of students reported stress (63.1%), decreased confidence (35.9%), reduced motivation (28.8%), and increased anxiety (19.8%). Additionally, 43% of students reported hesitation in interacting with patients, and 26.9% experienced difficulty in concentration. Nearly half of the incidents (49.5%) were not reported, indicating under-reporting.

Conclusion: Negative behavior from patients and their relatives significantly impacts the psychological well-being and clinical performance of dental students. There is a need for structured training, improved institutional support, and effective reporting systems to ensure a safer and more supportive clinical learning environment.

Diverse Clinical Presentations and Patterns of Thyroid Disorders: A Hospital Based Cross-Sectional Study

Sun, 29 Mar 2026 00:00:00 +0100

Objective: To evaluate the clinicalspectrum,demographicprofile, anddistribution of thyroid disorders among patients.

Study Design: Cross-sectional study.
Place and Duration: The research wasconducted at Suleman Roshan MedicalCollege Tando Adam between January 2025to January 2026.

To Study the Factors Associated With Post Partum Haemorrhage and Management of Post Partum Haemorrhage at a Tertiary Health Care Centre of Rural India - A Cross-Sectional Study

Dr. Ashwinkumar Arjunrao Sontakke, Dr. Nikita Khaparde, Dr. Ranjit N Kharole — Tue, 31 Mar 2026 00:00:00 +0200

Background: Postpartum hemorrhage (PPH) is one of the most critical and life-threatening obstetric emergencies, capable of transforming an otherwise uncomplicated delivery into a fatal event. If left untreated, severe hemorrhage can result in rapid maternal death, even in previously healthy women. Among the four stages of labor, the third stage is particularly crucial, as it is during this period that the most dreaded complication - PPH may arise. Affecting approximately 2% of all women who give birth, PPH accounts for nearly one-quarter of all maternal deaths globally and remains the leading cause of maternal mortality in many low-income countries, including India

Aim and Objectives: 1. To identify and analyze the factors associated with postpartum haemorrhage (PPH) and to evaluate the management practices of PPH at a tertiary health care center in rural India.2.To study the most common factor associated with postpartum haemorrhage (PPH).3. To determine maternal outcomes and complications associated with PPH

Methodology: Study Design: A cross-sectional observational study.

Study Setting: Labor ward, Obstetrics and Gynaecology department, at a GMC Gondia.

Study Population: Women admitted at the tertiary care hospital with obstetric haemorrhage.

Study Period: 18 months, May 2023 to October 2024

Sample Size: 89

Results: Majority of the study subject belonged to the age group of less than 25 years, i.e. 48 out of 89 cases Majority of study subjects belonged to lower middle-class family i.e. 66 out of 89 cases (74.1%), Majority of study subjects were primigravida i.e.29 out of 89 cases (32.6%), Majority of study subjects belonged to more than 37 weeks 60 out of 89 cases, The most common high-risk factor associated with postpartum heamorrhage was anaemia i.e. 26 out of 89 cases (29.2%), followed by pregnancy induced hypertension i.e. 23 out of 89 cases (25.8%). There were 13 cases of abruptio placenta, 17 cases of grand multi para, 11 cases of previous LSCS, 7 cases of multiple gestation, 12 cases of prolonged labour, 5 cases of placenta previa, 5 cases of thrombocytopenia, vaginally delivery 61, LSCS 28, main type of PPH was atonic, seen in total 58 out of 89 cases (65.1%), Majority of the patients were managed by blood transfusion for correcting anaemia, i.e. 80 out of 89 cases (89.9%), also by pharmacological agents 88 cases out of 89 (98.9 %) i.e. with 20-40 units of Pitocin, and other uterotonic drugs like carboprost and methergine, and 18 cases out of 89 cases (20.2%) were managed conservatively with ballon tamponade. 28 cases surgically managed.

Conclusions: Postpartum hemorrhage continues to be the leading cause of maternal mortality worldwide. Postpartum hemorrhage can be managed effectively by early and timely diagnosis followed by proper monitoring of high-risk cases and active management of third stage of labour with use of uterotonics like oxytocin, misoprostol, Carboprost and methergine and blood transfusions whenever indicated and skillful surgical while in some cases surgical intervention may be required.

Comparative evaluation of dexamethasone and tramadol as an adjuvant to 0.5% ropivacaine in supraclavicular brachial plexus block.

Dr.Taqui Fakhri, Dr.Ashwani Yadav, Dr.Pradeep Kumar — Tue, 31 Mar 2026 00:00:00 +0200

Background: Supraclavicular block isa widely used regional anesthesiatechnique for upper limb surgeries.The present study aimed to comparethe efficacy of dexamethasone andtramadol as adjuvants to 0.5% ropivacaine in supraclavicular block.

Medical Marijuana: A Comprehensive Review on Therapeutic Use, Legal Bindings and Regulatory Perspectives

Tue, 31 Mar 2026 00:00:00 +0200

For thousands of years, cannabis has been used medicinally. A recent rise in its use has sparked important academic and legal debates. The medical advantages, modes of action, dangers, and legal ramifications of cannabis use are all examined in this paper. Numerous ailments, such as neurodegenerative diseases, psychiatric disorders, epilepsy, glaucoma, multiple sclerosis, chronic pain, nausea brought on by chemotherapy have been effectively treated with cannabis-based therapies. Cannabis usage has both immediate and long-term side effects, such as dependency, cognitive impairment, cardiovascular problems, and negative impacts on mental health, despite its therapeutic potential. Concerns about safety and quality control are raised by the variation in cannabis products, dosage, and regulation. Prescribing unstandardised cannabis-based medicines also presents ethical challenges. Although there are still a lot of unanswered questions, legalisation patterns in different areas continue to influence the availability and acceptance of medicinal cannabis. Further research is needed to confirm its effectiveness, improve dosage plans, and reduce any possible health hazards. This review offers a thorough summary of the available data, emphasising the potential and difficulties related to medical cannabis.

Comparative Analysis of Salivary pH and Streptococcus mutans Levels following natural sugar substitutes. An in vivo study in and around Raichur District.

Dr. K. M. Parveen Reddy, Dr. Anitha K, Dr. Bhaskar Kurre, Dr. Anant A. Takalkar — Wed, 01 Apr 2026 00:00:00 +0200

Background: Dental caries is a chronic,multi factorial disease most prevalentamong children1 the present concept ofetiology of dental caries is mainly due tolocal role of fermentable carbohydrates likesucrose fructose etc. Which alter the Ph ofsaliva and favors the growth of bacteria responsible for enamel demineralization.

A Rare Case Report of Cesarean Scar Ectopic Pregnancy

Dr. Anita Bansal — Thu, 02 Apr 2026 00:00:00 +0200

Cesarean scar ectopic is one of the rarest of all ectopic pregnancies. It is defined as when a blastocyst implants on a previous Cesarean scar. The incidence of Cesarean scar ectopic has increased due to increase number of Cesarean deliveries. Early diagnosis of this can be done by using sonography. It is very important because a delay can lead to increased maternal morbidity and mortality. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility. Magnetic resonance imaging (MRI) has important role when sonography is equivocal or inconclusive before therapy or intervention. We are reporting a rare case of P2L2A3 with previous two cesarean deliveries with Rh negative blood group which was referred to Northern Railway Central Hospital Delhi from AIIMS Rishikesh in view of retained products of conception at scar site after D&E and medical management with injection methotrexate and patient had persistent heavy bleeding per vagina.

Maternal Mortality Patterns and Determinants in a Tertiary Care Centre in South India: A Retrospective Study

Dr. Roshni R., Dr. Geethanjali S. Mohan, Dr. Renjini R — Sat, 28 Mar 2026 00:00:00 +0100

Background: Maternal mortality remains a major public health challenge in developing countries despite significant improvements in maternal healthcare. Institutional reviews of maternal deaths provide valuable insight into demographic characteristics, referral patterns, and healthcare system gaps contributing to maternal mortality.[1,2]

Objective: To analyze the maternal mortality ratio (MMR), sociodemographic characteristics, and referral patterns among maternal deaths in a tertiary care centre in South India.

Methods: A retrospective hospital-based study was conducted in a tertiary care centre from January 2018 to December 2022. Data were obtained from case records, labour room registers, and hospital medical records. Maternal deaths were identified according to WHO criteria. Sociodemographic characteristics, referral patterns, and maternal mortality ratios were analyzed using descriptive statistics.

Results: A total of 66 maternal deaths were recorded during the study period. The maternal mortality ratio varied across the years, with values of 114.3 per 100,000 live births in 2018, 108.2 in 2019, 239.6 in 2020, 202.9 in 2021, and 123.0 in 2022. The highest maternal mortality ratio was observed in 2020, coinciding with the COVID-19 pandemic. The majority of maternal deaths occurred among women aged 26–30 years, representing the peak reproductive age group. Most women were housewives, indicating that maternal deaths were more common among economically dependent women. A large proportion of cases (87.9%) were referred from other healthcare facilities, predominantly government hospitals, highlighting the role of tertiary care centres in managing complicated obstetric cases. Late referrals accounted for nearly two-thirds of cases, indicating delays in recognition and referral of obstetric complications. Regarding mode of termination of pregnancy, emergency caesarean section was the most common mode of delivery, followed by vaginal delivery, while a small proportion of cases remained undelivered at the time of death. Analysis of the admission-to-death interval showed that the majority of deaths (84.8%) occurred more than 24 hours after admission, suggesting that many patients arrived in a critical condition requiring prolonged management.

Conclusion: Maternal mortality in this tertiary care centre was strongly influenced by referral delays and systemic healthcare factors. Strengthening referral systems and improving early detection of obstetric complications are essential to reduce maternal mortality.

Clinicopathological Patterns and Treatment Outcomes of Wilms Tumor in a Tertiary Pediatric Surgical Center: A 5-Year Retrospective Analysis of renal tumors presentation and outcomes

Thu, 02 Apr 2026 00:00:00 +0200

Wilms tumor remains the most prevalentrenal malignancy in childhood, yet variability in presentation and treatment outcomescontinues to challenge optimal managementin resource-limited tertiary settings

Surface Roughness and Phase Transformation of Zirconia Following Chairside Polishing Protocols

Thu, 02 Apr 2026 00:00:00 +0200

Zirconia has emerged as a widely utilizedceramic material in restorative dentistry dueto its superior mechanical strength andfavorable esthetic properties; however, chairside adjustments followed by polishingmay alter its surface characteristics andcrystalline structure.

Knowledge and Practice of Breast Self-Examination among Female Undergraduate Medical Students: A Cross-Sectional Study in Eastern India

Dr. Riya Mondal, Dr. Manish Roy, Dr. Diptangshu Roychowdhury — Fri, 03 Apr 2026 00:00:00 +0200

Background: Breast cancer is the most common malignancy among women worldwide. Early detection significantly reduces morbidity and mortality. Breast self-examination (BSE) is a simple, cost-effective screening method; however, its practice remains inadequate.

Objectives: To assess the awareness and practice of breast self-examination and to evaluate the knowledge–practice gap among female undergraduate medical students.

Methods: A descriptive cross-sectional study was conducted among 93 female MBBS students at a tertiary care teaching hospital in Durgapur, West Bengal. Data were collected using a pre-tested structured questionnaire. Descriptive statistics were used, and a one-sample proportion test was applied. A p-value <0.05 was considered statistically significant.

Results: All participants were aware of breast cancer and its early detection methods. However, only 70% practiced BSE. A statistically significant knowledge–practice gap was observed (Z = 5.79, p <0.001). The most common reason for non-practice was lack of knowledge regarding the correct technique (41%).

Conclusion: Despite universal awareness, the practice of BSE remains suboptimal. Structured, skill-based training interventions are required to bridge this gap.

Clinical, Biochemical and Hematological Response to Vitamin B12 Supplementation in Pregnant Women with Vitamin B12 Deficiency Anemia: An Observational Study

Dr Virta Chauhan, Dr Monu Yadav — Sat, 04 Apr 2026 00:00:00 +0200

Background: Vitamin B12 deficiencyis an often overlooked cause of anemiaduring pregnancy, particularly inpopulations with vegetarian dietarypractices. Limited data exist regardingits clinical and hematological responseto supplementation

The study of clinical, metabolic and hormonal profile of women presenting with polycystic ovary syndrome in relation to body mass index

Dr. Monu Yadav, Dr Virta Chauhan — Sat, 04 Apr 2026 00:00:00 +0200

Background:Polycystic ovary syndrome (PCOS) is acommon endocrine disorder associatedwith reproductive, hormonal, and
metabolic abnormalities. Althoughfrequently linked with obesity, it also occurs in women with normal bodymass index (BMI).

Head-to-Head Comparison of Psoriasis Severity Scoring Systems: Assessing Reliability, Sensitivity, and Clinical Utility

Dr Tanu Tripathi, Dr Harvinder Sangwan, Dr Chetan Jambagi — Sat, 04 Apr 2026 00:00:00 +0200

Background: Accurate assessment of psoriasis severity is essential for guiding therapeutic decisions and evaluating treatment outcomes. Multiple scoring systems are available, including the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), Lattice Physician Global Assessment (LPGA), and Psoriasis Quality of Life Index (PQLI). However, differences in reliability, sensitivity, and clinical utility necessitate direct comparison to determine their relative strengths and limitations.

Aim: To perform a head-to-head comparison of commonly used psoriasis severity scoring systems with respect to reliability, responsiveness, correlation, and clinical applicability.

Methods: This observational study included patients with clinically diagnosed psoriasis. Disease severity was assessed using PASI, BSA, LPGA, and PQLI. Descriptive statistics were calculated for baseline characteristics. Correlation between scoring systems was evaluated using Pearson’s or Spearman’s correlation coefficients as appropriate. Inter-observer reliability was assessed using the Intraclass Correlation Coefficient (ICC). Responsiveness to treatment was determined by comparing baseline and post-treatment scores, and effect sizes were calculated. A p-value <0.05 was considered statistically significant.

Results: Clinician-based scoring systems demonstrated strong inter-correlation, particularly between PASI and BSA, as well as PASI and LPGA. PASI showed excellent inter-observer reliability and the highest sensitivity to change following treatment. Moderate correlation was observed between objective severity indices and PQLI, indicating that quality-of-life impairment does not always directly parallel clinical severity. All scoring systems demonstrated statistically significant improvement following therapy.

Conclusion: PASI remains a reliable and highly responsive instrument for assessing psoriasis severity. However, simplified tools such as BSA and LPGA offer practical advantages in routine clinical settings. PQLI provides essential insight into patient-perceived disease burden, underscoring the importance of a multidimensional assessment approach. Integrating objective severity measures with patient-reported outcomes ensures comprehensive evaluation and optimal management of psoriasis.

Serum Uric Acid Levels: From Pathophysiological to Biochemical and Pharmacological Perspectives; an Observational Research in General Population from Sindh, Pakistan

Sat, 04 Apr 2026 00:00:00 +0200

Uric acid has been an important compound with diverse effects on body systems mainly due to the life style changes resulting into arthritis, renal stones, arthralgia and metabolic syndrome. It disturbs the biochemical and normal physiological process following disturbances in purine metabolism either increased synthesis or reduced elimination. Management is based on dietary restriction of protein diet and use of certain pharmacological agents. This observational study was conducted on general population from different areas of rural and urban Sindh on apparently healthy individuals. For study purpose 3000 volunteers were selected through consecutive sampling from both male and female sexes with age range 10 years to 60 years through informed written consent as a study requirement. Serum uric acid was measured through device method, SPSS 22nd version was used for data analysis, the male female proportion was kept equal at 1:1 with 1500(50%) male and 1500(50%) females. Population mean uric acid was 4.8mg/dl with a standard deviation of 1.1mg/dl and a range of 9.2mg/dl where 3.7mg/dl was minimum and 12.9 mg/dl as maximum, hyperuricemia (>6.8mg/dl) was found in15.73 % (472) of the population while 84.27% (2528) patients were found as normal or border line uric acid levels. Mean of uric acid was 4.7+1.2mg/dl in males and 4.2+1.4 mg/dl in females the difference was none- significant statistically (p-0.25)

Conclusion: Hyperuricemia was observed in 15.73% of individuals with non-significant difference among the two genders.

The Role of Vascular–Bone Coupling Disruption in the Pathophysiology and Progression of Osteoradionecrosis of the Jaw

Fri, 03 Apr 2026 00:00:00 +0200

Osteoradionecrosis (ORN) of the jaw is a debilitating radiotherapy complication that is identifiedby impaired bone healing, a lack of vascularity, and a lack of cells. This study was conducted totest the contribution of vascular-bone coupling disruption to the pathophysiology and progression of ORN.

Effects of Air Pollution on Cardiovascular Function, Heart Rate Variability, and Oxidative Stress in Young Adults

Puneet Kumar, Prof. Dr. Manila Jain — Sat, 04 Apr 2026 00:00:00 +0200

Background: Air pollution is an established environmental risk factor for cardiovascular disease, yet its early subclinical effects in young adults remain underexplored.

Objective: To evaluate the impact of ambient air pollution on cardiovascular parameters, heart rate variability (HRV), and oxidative stress markers in young adults.

Methods: A comparative cross-sectional study was conducted among 120 participants aged 18–30 years, divided into high- and low-exposure groups based on ambient air quality levels. Blood pressure and HRV were assessed. Serum malondialdehyde (MDA) was measured as a marker of oxidative stress. Statistical analysis was performed using SPSS version 26.

Results: The high-exposure group showed significantly elevated systolic and diastolic blood pressure (p < 0.001) and reduced HRV indices. MDA levels were significantly increased (p < 0.001). Air pollution exposure was identified as an independent predictor of cardiovascular dysfunction.

Conclusion: Air pollution is associated with early cardiovascular alterations, autonomic imbalance, and oxidative stress in young adults, indicating increased long-term cardiovascular risk.

Prevalence of Iron Deficiency in Anemic and Non-Anemic School Going Adolescent Girls and Its Association with Cognitive Function

Dr. Supriyo Saha — Fri, 20 Feb 2026 00:00:00 +0100

Background: Iron deficiency anemiais the most common nutritionaldeficiency disorder in India andcontinues to be a major public healthconcern. Adolescent girls, particularlyduring late school age and earlyadolescence, are highly susceptible to iron deficiency. In addition tohematological effects, iron deficiencyis associated with impaired growth and development, reduced immunefunction, decreased physical workcapacity, and diminished cognitive performance.

A PROSPECTIVE CLINICOPATHOLOGICAL STUDY OF CUTANEOUS ANGIOSARCOMA IN A TERTIARY CARE HOSPITAL

Dr.Sandhya Rani Sahoo, Dr.Pragnya Parimita Nayak, Dr.Shushruta Mohanty — Mon, 06 Apr 2026 00:00:00 +0200

Introduction: Cutaneous Angio-Sarcoma(AS) is an aggressive malignant mesenchymal vasoformative neoplasmaccounting for 5 % of malignant skintumours and less than 1 % of all sarcomas.They carry a poor prognosis

A comparative study of autonomic functions in in hypothyroid patients and euthyroid subjects

Dr. Supriyo Saha — Tue, 20 Jan 2026 00:00:00 +0100

Background: Thyroid hormones exertprofound effects on the cardiovascularsystem and play a crucial role inmaintaining autonomic balance.Hypothyroidism can lead tosympathovagal imbalance, predisposing individuals to cardiacautonomic neuropathy (CAN).

A study of repair of inguinal hernia comparing open with laparoscopic transabdominal preperitoneal.

Tue, 07 Apr 2026 00:00:00 +0200

Background: The surgical repair of inguinalhernia has advanced significantly over lastfewyearsfrom open hernioplasty tolaparoscopic hernioplasty. But studies areneeded inorder tocompare the results ofopen hernioplasty versus laparoscopic hernioplasty. Wetriedone such study.

IMMUNOHISTOCHEMICAL EVALUATION OF E-CADHERIN AND VIMENTIN EXPRESSION AS PREDICTORS OF EPITHELIAL MESENCHYMAL TRANSITION IN ORAL POTENTIALLY MALIGNANT DISORDERS

Tue, 07 Apr 2026 00:00:00 +0200

Background:-Oral cancer continues to be a significant globalhealth issue, especially in developing nations like India, where it represents a considerableshare of cancer-related morbidity and mortality.Oral potentially malignant disorders (OPMDs)are lesions that could become oral squamous

Study of Clinical Profile and Risk Factors in Dry Eye Disease in a Tertiary Care Setting: A Cross Sectional Study

Dr. Amit Dhande, Dr Vaibhav Sanjay Deshmukh — Tue, 07 Apr 2026 00:00:00 +0200

Introduction: Dry eye disease (DED) is a multifactorial disorder of the tear film and ocular surface, increasingly recognized as a public health concern due to its rising prevalence and impact on quality of life.

Aim: To evaluate the demographic profile, clinical features, severity, and associated risk factors of patients presenting with DED in a tertiary care setting.

Methods: A cross-sectional observational study was conducted on 130 patients clinically diagnosed with DED. Demographic data, occupational exposure, and symptom profiles were documented. Tear film parameters were assessed using Tear Film Break-Up Time (TBUT) and Schirmer I test. Meibomian gland dysfunction (MGD) was graded, and severity was classified according to DEWS II criteria. Statistical analysis was performed using chi-square test to determine associations between risk factors and disease severity.

Results: The majority of patients were aged 40–49 years (24.6%), with a female predominance (58.5%) and urban residency (67.7%). Office/computer-based workers formed the largest occupational group (35.4%). Dryness (69.2%), burning (63.1%), and foreign body sensation (56.9%) were the most common symptoms. Bilateral involvement was seen in 80% of cases. TBUT was <10 seconds in 80% of patients, while Schirmer I values were <10 mm in 70.8%. Based on DEWS II criteria, moderate severity was most common (41.5%), followed by mild (35.4%) and severe (23.1%). High screen time (>4 h/day), prolonged air-conditioned exposure (≥6 h/day), and MGD grade ≥2 were significantly associated with disease severity (p < 0.05).

Conclusion: DED is prevalent among middle-aged females and urban populations, with lifestyle factors such as screen time and air-conditioned environments contributing to disease progression. MGD is a key determinant of severe disease. Early recognition of risk factors and preventive strategies are essential to reduce disease burden and improve patient outcomes.

Functional and Radiological Outcomes of Total Knee Arthroplasty in Patients with Advanced Osteoarthritis and Obesity

Mon, 06 Apr 2026 00:00:00 +0200

Background: Advanced knee osteoarthritis is a common cause of chronic pain, reduced mobility, and functional disability, particularly in obese individuals. Obesity accelerates the progression of osteoarthritis through increased joint loading and metabolic-inflammatory mechanisms, potentially affecting surgical outcomes after total knee arthroplasty.

Objective: To evaluate the functional and radiological outcomes of total knee arthroplasty in obese patients with advanced knee osteoarthritis.

Methods: This prospective observational study was conducted in the Department of Orthopaedic Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan, from June 2024 to October 2025. A total of 100 obese patients aged 45 years and above with advanced knee osteoarthritis undergoing primary total knee arthroplasty were included through non-probability consecutive sampling. Functional outcomes were assessed using pain score, knee function, range of motion, walking ability, stair climbing, and knee stability. Radiological outcomes included implant alignment, prosthesis positioning, deformity correction, and early postoperative complications. Data were analyzed using SPSS version 25.0.

Results: The mean age of the patients was 62.8 ± 8.4 years, and females constituted 64.0% of the study population. The mean body mass index was 33.7 ± 3.1 kg/m². Significant postoperative improvement was observed in all functional parameters. Pain score improved from 8.1 ± 1.0 preoperatively to 2.1 ± 0.9 postoperatively, while functional score increased from 39.6 ± 8.7 to 82.9 ± 9.4. Knee flexion improved from 84.7 ± 13.5° to 112.8 ± 10.6°. Satisfactory implant alignment was achieved in 89.0% of patients, and 90.0% of patients had good to excellent overall outcomes.

Conclusion: Total knee arthroplasty provides significant functional improvement and satisfactory radiological outcomes in obese patients with advanced knee osteoarthritis and remains an effective treatment option in this population.

Evaluation of Biochemical and Pathological Markers of Oxidative Stress and Inflammation in Pediatric Chronic Otitis Media and Their Public Health and Critical Care Implications: A Clinical Study

Mon, 06 Apr 2026 00:00:00 +0200

Background: Pediatric chronic otitis media is a common and clinically important condition that contributes significantly to hearing impairment, recurrent infection, poor academic performance, and long-term developmental difficulties in children. Persistent inflammation and oxidative stress may play a major role in the progression and chronicity of the disease, yet these biological mechanisms remain underexplored in routine clinical practice.

Objective: To evaluate the biochemical and pathological markers of oxidative stress and inflammation in pediatric chronic otitis media and to assess their clinical, public health, and critical care implications.

Methods: This cross-sectional clinical study was conducted from June 2024 to June 2025 at Gujranwala Medical College, Gujranwala, Pakistan and Sahara Medical College, Narowal, Pakistan. A total of 100 pediatric patients aged 3–14 years diagnosed with chronic otitis media were enrolled through consecutive sampling. Clinical evaluation, otoscopic assessment, hearing assessment, and biochemical analysis were performed in all patients. Serum malondialdehyde, total antioxidant capacity, nitric oxide, C-reactive protein, interleukin-6, and tumor necrosis factor-alpha were measured. Histopathological examination was performed in surgically managed cases.

Results: Most patients had unilateral disease, prolonged symptoms, and clinically significant hearing impairment. Elevated levels of malondialdehyde, nitric oxide, C-reactive protein, interleukin-6, and tumor necrosis factor-alpha were observed, while total antioxidant capacity was reduced. Higher oxidative and inflammatory marker levels were significantly associated with greater disease severity, hearing impairment, bilateral disease, and longer symptom duration. Histopathology revealed chronic inflammatory infiltrate, granulation tissue, mucosal edema, epithelial hyperplasia, fibrosis, and vascular congestion.

Conclusion: Pediatric chronic otitis media is associated with significant oxidative stress, inflammatory activation, and pathological tissue injury. These findings highlight its broader clinical and public health importance and support the need for earlier diagnosis, timely treatment, and preventive intervention in affected children.

MRI-Based Characterization of Breast Lesions and Its Correlation with Histopathological Subtypes in Newly Diagnosed Breast Cancer Patients

Tue, 07 Apr 2026 00:00:00 +0200

Background: Breast magnetic resonance imaging (MRI) is a highly sensitive modality for evaluating breast lesions, offering superior tissue characterization compared to conventional imaging. Its role in correlating imaging features with histopathological subtypes is increasingly important for accurate diagnosis and treatment planning.

Objective: To assess MRI-based characterization of breast lesions and determine its correlation with histopathological subtypes in newly diagnosed breast cancer patients.

Methods: This cross-sectional study was conducted at the Department of Radiology, Allied Hospital-1, Faisalabad Medical University, and Central Park Teaching Hospital from June 2024 to March 2025. A total of 100 newly diagnosed breast cancer patients underwent contrast-enhanced MRI prior to histopathological evaluation. MRI findings were interpreted using the BI-RADS lexicon, including lesion morphology, enhancement characteristics, and kinetic curve patterns. Histopathology served as the reference standard. Statistical analysis was performed using SPSS version 26, and associations were evaluated using the chi-square test.

Results: The mean age of patients was 47.9 ± 9.8 years. Mass lesions were observed in 70% of cases, with irregular margins and heterogeneous enhancement being the most common features. Type III (washout) kinetic curves were present in 62% of lesions. Invasive ductal carcinoma was the predominant histopathological subtype (64%). A significant association was observed between MRI features and histopathological subtypes, particularly irregular margins and washout kinetics with invasive ductal carcinoma (p < 0.001). MRI demonstrated high sensitivity (95%) and diagnostic accuracy (92%).

Conclusion: MRI is a highly effective imaging modality for breast lesion characterization and shows strong correlation with histopathological findings, supporting its role in early diagnosis and treatment planning.

Early Appendectomy versus Conservative Management with Interval Appendectomy in Complicated Appendicitis: A Prospective Comparative Study

Dr. Ashish Sehgal , Dr. Himanshu Bansal, Dr Pankaj Khurana, Dr. Riya Mittal — Fri, 20 Mar 2026 00:00:00 +0100

Background:Management of complicatedappendicitis remains controversial,with treatment options including early appendectomy and conservativetherapy followed by intervalappendectomy. Identifying the optimalapproach is essential to reducemorbidity and improve patientoutcomes.

Prevalence, Patterns, and Clinical Factors Associated With Pulmonary Complications in Patients with Diabetes Mellitus: A Cross-Sectional Study

Wed, 08 Apr 2026 00:00:00 +0200

Background: Diabetes mellitus is a chronic metabolic disorder with well-established microvascular and macrovascular complications. Emerging evidence indicates that the respiratory system may also be affected; however, pulmonary involvement in diabetes often remains subclinical and under-recognised.

Objective: To determine the prevalence, pattern, and associated factors of pulmonary function impairment among patients with type 2 diabetes mellitus.

Methods: An analytical cross-sectional study was conducted among adult patients with type 2 diabetes mellitus and age- and sex-matched non-diabetic controls. Clinical data including duration of diabetes, smoking status, and glycaemic control (HbA1c) were recorded. Pulmonary function was assessed using standardised spirometry following American Thoracic Society/European Respiratory Society guidelines. Spirometric patterns were categorised as normal, obstructive, restrictive, or mixed. Statistical analyses were performed to identify factors associated with pulmonary function impairment.

Results: Pulmonary function impairment was observed in 42.0% of patients with diabetes. Restrictive ventilatory defect was the most common abnormality (25.3%), followed by obstructive (11.3%) and mixed patterns (5.4%). Mean FEV₁, FVC, and FEV₁/FVC ratio were significantly lower in patients with diabetes compared with controls (p < 0.001). Poor glycaemic control, longer duration of diabetes, and smoking history were independently associated with abnormal spirometry. A significant inverse correlation was observed between HbA1c levels and FEV₁ (% predicted).

Conclusion: Pulmonary function impairment is common among patients with type 2 diabetes mellitus and is associated with poor glycaemic control and longer disease duration. Early identification of pulmonary involvement may improve comprehensive risk assessment in diabetes care.

Association of Remnant Lipoprotein Cholesterol with Cardiovascular Risk Markers in Patients with Metabolic Syndrome

Dr. Abha, Dr. Garima Sehgal, Dr. Aman Thathai, Dr. Jaswant Kaur — Wed, 08 Apr 2026 00:00:00 +0200

Background: Metabolic syndrome is a multifactorial condition associated with increased cardiovascular risk due to insulin resistance, central obesity, hypertension, and atherogenic dyslipidemia. Conventional lipid parameters may not fully reflect residual cardiovascular risk. Remnant lipoprotein cholesterol (RLP-C), a component of triglyceride-rich lipoprotein remnants, has emerged as a potential atherogenic biomarker. This study aimed to evaluate the association of RLP-C with established cardiovascular risk markers and its diagnostic utility in patients with metabolic syndrome.

Methods: This case–control pilot study included 100 participants, comprising 50 patients with metabolic syndrome and 50 age and sex-matched healthy controls. Anthropometric measurements (body mass index and waist circumference) and biochemical parameters, including fasting blood glucose and comprehensive lipid profile, were analyzed using standardized laboratory techniques. RLP-C levels were calculated and correlated with conventional cardiovascular risk markers.

Results: RLP-C levels were significantly elevated in patients with metabolic syndrome compared with controls (p<0.05). Significant positive correlations were observed between RLP-C and total cholesterol, triglycerides, LDL cholesterol, and VLDL cholesterol, indicating its association with atherogenic lipid patterns.

Conclusion: Patients with CAD and metabolic syndrome show significant alterations in anthropometric, hemodynamic, and biochemical parameters, including elevated remnant lipoprotein cholesterol (RLP-C). These findings suggest that RLP-C may serve as a potential biomarker for identifying increased cardiovascular risk in metabolic syndrome.

Gross and Microscopic Changes among Cryptorchid Testes at Different Locations- a Prospective Study in North Kashmir

Shiekh Mahmood Rashid, Tajamul Hassan, Shiekh Aamir Rashid — Thu, 09 Apr 2026 00:00:00 +0200

Background: Cryptorchidism or undescended testes is a commonly observed congenital anomaly of male children seen in patients presenting in general and pediatric surgical practice of our region. In this study, we prospectively studied 146 cases of undescended testes to statistically observe gross and microscopic changes in different such cases.

Objective: To study the gross and microscopic changes in cryptorchid testes at varied locations.

Methods: A hospital-based prospective study of 146 cases of undescended testes was done from November 2014 to December 2019 and the results of gross and microscopic changes in biopsy specimens were statistically analyzed.

Results: A total of 146 cases studied included 45.19% presenting at the age of 4 to 8 years and 25.34% presenting at the age of 8 to 14 years. The study revealed mild testicular atrophy in 6.16% of the cases and moderate to severe atrophy in 36.97%. Epididymal and vassal anomalies were very rare in suprascrotal testes but common in high cryptorchid testes. Biopsy specimens showed the incidence of seminomas in 4.79% of intra-abdominal testes but the incidence was lesser in undescended testes at locations lower down.

Conclusion: A strong association was observed between the location of cryptorchid testes and observed gross and microscopic changes including malignant transformation.

A Comparative Study between Open Cholecystectomy versus Laparoscopic Cholecystectomy among Patients at a Tertiary Care Centre in North Kashmir

Shiekh Mehmood Rashid, Mansoor Banday, Sheikh Aamir Rashid — Thu, 09 Apr 2026 00:00:00 +0200

Background: Gall stones are one of the major causes of morbidity and mortality all over the world and cholecystectomy has become a universal standard for treatment of symptomatic cholelithiasis.

Objective: To compare the duration of surgery, complication rates, analgesic use and post- operative hospital stay in laparoscopic cholecystectomy versus open cholecystectomy.

Methods: We retrospectively viewed medical records of 320 cholecystectomised patients (160 Group A patients having undergone laparoscopic cholecystectomy and 160 patients in Group B with open cholecystectomy) who had been operated during a 5 year period from January 2021 to December 2025 in the Department of General Surgery, Govt Medical College Baramulla. The two groups were compared on the basis of duration of surgery, intra and post-operative complications, duration of analgesic use and hospital stay and conclusions were drawn.

Results: Group A patients had a significantly less duration of surgery compared to Group B patients (p<0.0001), a significantly lower rate of intra and post-operative complications (p=0.006), lower first post-operative day drain output (p<0.001) lesser analgesic requirement (p<0.001) and lower post-operative hospital stay (p<0.0001).

Conclusion: Laparoscopic cholecystectomy is safer and efficacious compared to open cholecystectomy and should be an available option for all patients requiring elective cholecystectomy.

Quantitative Radiological Anatomy of Pulmonary Parenchyma in Chronic Obstructive Pulmonary Disease: A High-Resolution Ct Based Morphometric Study

Thu, 09 Apr 2026 00:00:00 +0200

Objective: To evaluate the quantitative radiological anatomy of the pulmonary parenchyma in COPD using HRCT-based morphometric analysis.

Materials and Methods: This cross-sectional study included 60 clinically stable COPD patients aged 40–80 years. HRCT scans were performed using a standardized protocol during full inspiration. Quantitative parameters assessed included bronchial wall thickness and luminal diameter of bronchi, mean lung density (MLD), low attenuation areas (LAA < −950 HU), emphysema index (EI), total lung volume (TLV) and zonal distribution of disease. Data were analyzed using statistical softwareand correlations between variables were determined.

Results: The mean age of patients was 61.4 ± 9.2 years, with a predominance of males (70%). Bronchial wall thickness was increased (2.8 ± 0.6 mm) while luminal diameter was reduced (4.9 ± 1.1 mm). Mean lung density was decreased (−856.3 ± 34.5 HU)and low attenuation areas constituted 28.7 ± 10.2% of lung volume. The emphysema index was 30.2 ± 11.5% and total lung volume was elevated (5890 ± 820 mL), indicating hyperinflation. Zonal analysis showed a predominance of disease in the upper lung regions. Significant correlations were observed between emphysema index and mean lung density (r = −0.72, p < 0.001) as well as total lung volume (r = 0.64, p < 0.001).

Conclusion: HRCT-based quantitative analysis provides a comprehensive and objective evaluation of structural lung changes in COPD. The combined assessment of airway and parenchymal parameters enhances understanding of disease severity and distribution, supporting its role in improved diagnosis, phenotyping and management of COPD.

Complications following Surgical Treatment of Pediatric Femur Fractures

Thu, 09 Apr 2026 00:00:00 +0200

Background: Pediatric femur fractures arecommonly managed surgically to achieve early mobilization and proper alignment; however,postoperative complications remain a concernand can affect functional outcomes.

KNOWLEDGE OF TUBERCULOSIS AND NATIONAL TB CONTROL STRATEGIES AMONG MEDICAL INTERNS IN TERTIARY CARE HOSPITALS IN PAKISTAN: A CROSS-SECTIONAL STUDY

Thu, 09 Apr 2026 00:00:00 +0200

Background: Tuberculosis (TB) remains a majorpublic health challenge globally, with Pakistan among the high-burden countries. Effective TBcontrol depends largely on healthcare workers’knowledge of disease transmission, diagnosis,treatment, and national control strategies.

Prevalence of Tobacco and Betel Nut Use among Cancer Patients in Two Major Hospitals in Karachi

Mon, 06 Apr 2026 00:00:00 +0200

Background: Tobacco use, both smoked and smokeless, is prevalent in South Asia, including Pakistan. It isassociated with various cancers, notably oral, esophageal, and oropharyngeal cancers. Despite the significantcorrelation between tobacco use and cancer, there is limited research on the prevalence of all tobacco forms among cancer patients in Pakistan.

Vitamin D Deficiency and Its Relationship with Academic Performance among Medical Students: A Cross-Sectional Study from Nawabshah

Faryal Adnan, Mukhry Pasham, Zoya, Beenish Ghafar, Aisha Asad, Munazzah Meraj — Mon, 06 Apr 2026 00:00:00 +0200

Background: Vitamin D deficiency has become a global health concern and is of increasing concernfor healthcare providers. The limited knowledge about the importance of vitamin D supplements isone reason why it remains so common. Medical students often prioritize academic and clinicalresponsibilities during both their early and late years of MBBS, which increases their risk of deficiency due to poor lifestyle choices.

Association of Hypercalcemia with Disease Severity in Plasma Cell Dyscrasias

Thu, 12 Mar 2026 00:00:00 +0100

Background: Plasma cell dyscrasias are characterized by clonal plasma cell proliferation and multisysteminvolvement.
Objective: To assess the association between hypercalcemia and disease severity in patients with plasma cell dyscrasias.

A comparative study on IPOM versus IPOM PLUS and their surgical outcomes in a Tertiary Health Care in Haryana

Dr. Ashish Sehgal , Dr. Himanshu Bansal, Dr Pankaj Khurana, Dr. Riya Mittal — Thu, 09 Apr 2026 00:00:00 +0200

Background: Intra-peritoneal onlaymesh (IPOM) repair is a commonlyperformed technique for laparoscopicventral hernia repair (LVHR), in whichthe fascial defect is bridged using acomposite mesh. Recently, IPOM-Plus,which involves closure of the fascial
defect prior to mesh placement, hasbeen increasingly recommended toimprovepostoperative outcomes

A Prospective Study to Assess the Efficacy and Safety of Sclerotherapy with Sodium Tetradecyl Sulphate in the Treatment of Pyogenic Granuloma

Dr. Namrata C. Manjunath, Dr. Meghana Kempanna — Sat, 28 Mar 2026 00:00:00 +0100

Background: Pyogenic granuloma (PG) is a benign vascular tumor. It is a misnomer as it is neither pyogenic nor a granuloma. It commonly occurs after minor injury, with a higher prevalence in children and young adults. Angiogenesis and rapid growth are linked to nitric oxide synthase mechanisms. Treatment options include surgical excision, electrocautery, and sclerotherapy with sodium tetradecyl sulfate (STS), which facilitates chemical ablation through cell lysis and thrombosis.

Methods: A prospective interventional study was conducted with 30 patients at the Kempegowda Institute of Medical Sciences, Bangalore, India, over 12 months. Patients above 18 years of age, who gave consent were included in the study. Patients with lesions on lips/genitals, immunocompromised individuals, and pregnant/lactating women were excluded. STS (1-1.5%) was injected until blanching occurred, with follow-ups every week for up to four weeks.

Results: Among 30 patients, 40% were under 30 years; 53.3% were male. Lesions primarily affected hands (36.6%) and the face (26.6%). Complete cure was achieved in 96.7% after a maximum of four injections. Immediate adverse events included burning sensations in 93.3% of patients.

Conclusion: Sclerotherapy with STS demonstrates high efficacy and safety in PG treatment, offering a non-surgical option with minimal scarring and lower recurrence rates, making it suitable for challenging lesions.

Clinicoepidemiological Profile of Acne Vulgaris in a Dermatology Outpatient Department

Dr. Namrata C. Manjunath — Tue, 31 Mar 2026 00:00:00 +0200

Background: Acne vulgaris is a common inflammatory dermatosis in adolescents and young adults, with variable clinical presentation and frequent residual sequelae such as scarring and post-inflammatory hyperpigmentation.

Objectives: To assess the clinicoepidemiological profile of acne vulgaris among patients attending a dermatology outpatient department.

Methods: This descriptive cross-sectional study included 90 patients with acne vulgaris attending the dermatology outpatient department. Data on demographic profile, duration, family history, distribution, lesion morphology, Global Acne Grading System (GAGS) score, severity, seasonal variation, scarring, and post-acne hyperpigmentation were recorded and analyzed using descriptive statistics.

Results: The mean age was 20.11±4.38 years. Females constituted 63.3% of the study population. Most patients were from urban areas (67.8%), and students formed the largest occupational group (45.6%). The mean duration of acne was 22.77±17.64 months, and 57.8% had a positive family history. Papules were the commonest predominant lesion (41.1%). Moderate acne was the most frequent severity category (34.4%), followed by mild acne (33.3%). The mean GAGS score was 24.94±11.57. Post-acne scarring and post-acne hyperpigmentation were observed in 27.8% and 35.6% of patients, respectively.

Conclusion: Acne vulgaris in this cohort predominantly affected young individuals, especially females, and was commonly associated with moderate disease, positive family history, and residual pigmentary or scarring changes. Early evaluation and timely treatment may help reduce long-term sequelae.

The Efficacy of Fine Needle Aspiration Cytology in Identifying Breast Lump Patients

Mon, 30 Mar 2026 00:00:00 +0200

Background: Breast cancer is the most diagnosed cancer among women globally, representing over 10% ofall new cancer cases annually. It is the second leading cause of cancer-related deaths in women.
Objective: To assess the efficacy of the fine needle aspiration cytology in identifying breast lumps in patients.Study Design: Retrospective cross-sectional analytical study

The Clinical and Histopathological Characteristics of Thyroid Gland Diseases in Adolescents Requiring Surgical Treatment

Dr Akanksha Gupta, Dr Vineet Kumar Pandey — Sat, 11 Apr 2026 00:00:00 +0200

Aim: The present study aimed to assess the clinical and histopathological characteristics of thyroid gland diseases in adolescents requiring surgical treatment.

Materials and methods: This prospective observational study was conducted from 2024 to 2025. The study covered 40 patients from the population of adolescents aged 16 to 20 years with various malignant and benign thyroid gland diseases. All patients were surgically treated. All patients were presented to the thyroid disease counseling board to decide on the optimal mode of surgical treatment, as previously described.

Results: The present study included a total of 40 patients. There were 75% of females and 25% of males. The majority of the study sample (65%) were 19–20 years of age, while 35% were 16–18 years of age. The most common diagnosis was nodular goiter, found in 15 patients (37.5%). It is followed by diagnoses of Graves’ disease, struma polynodosa and Multiple endocrine neoplasia (MEN) 2A. The majority of patients were asymptomatic (37.5%). Biochemical parameters of the thyroidal function are presented in Table 4. The mean value of T4 was 94.21 ± 40.81, while FT4 was 13.38 ± 6.65. Oppositely, the ratio of T3 and FT3 was more favorable (4.00 ± 10.45 vs. 3.01 ± 2.12), while the mean value of TSH was 1.13 ± 1.70. The majority of patients, 23 (53.67%), underwent total thyroidectomy or thyroidectomy combined with another procedure or hemithyroidectomy. The second most common approach was lobectomy of various types, while a central dissection was performed in fewer patients.

Conclusion: The results of the current investigation indicate that papillary carcinoma is the sole form of well-differentiated tumor that is observed in adolescents. Furthermore, this research is groundbreaking in that it has demonstrated that the clinical presentation of cancer in adolescents is nearly identical to that of adults, a phenomenon that has never been observed in this field.

Association of Amniotic Fluid Index with Mode of Delivery and Fetomaternal Outcomes in Term Premature Rupture of Membranes (PROM)

Nosheen Mushtaq, Banadi, Samina Bugti, Madhu Bala, Kanwal Atif, Soniya Mehtab — Sun, 12 Apr 2026 00:00:00 +0200

Objective: To establish the relationshipbetween amniotic fluid index (AFI) and mode of delivery and fetomaternal outcomesin term premature rupture of membranes(PROM).

Determinants of Successful Vaginal Birth After Caesarean Section: A Cross-Sectional Study

Sun, 12 Apr 2026 00:00:00 +0200

Background:In recent decades, the global rate ofcaesarean section (CS) deliveries has risensignificantly, particularly in developing
countries. A previous history of CS remains one of the most commonindications for repeat caesarean delivery.

Prevalence of Musculoskeletal Disorders in Dental Professionals in Khed – A Cross- Sectional Study

Mon, 13 Apr 2026 00:00:00 +0200

Introduction: Musculoskeletal Disorders (MSDs) are generally disorders of muscles, tendons, peripheral nerve or vascular system not directly resulting from an acute or instantaneous event. The aim of this study is to find out the overall prevalence of Musculoskeletal disorders in dentists in Khed.

Materials & Methods: A cross-sectional study was conducted among 101 dental professionals of Age group 23-70 years. The data was collected using self reported questionnaires comprising demographic details, work profile of dental professionals and questions regarding Musculoskeletal symptoms and awareness, prevention related to it. The questionnaire taken were further used for statistical analysis. The statistical data revealed possible prevalence of MSDs in dental professionals.

Result: The present study included 101 dental professionals comprising Bachelor of Dental Surgery (BDS) and Master of Dental Surgery (MDS) practitioners. Comparative analysis was performed between the two groups as BDS and MDS professionals.

Conclusion: The prevalence of MSDs was found to begin early in professional practice and affects both undergraduate and postgraduate clinicians in almost equal proportions.

A Retrospective Observational Study to Assess the Role of Aharaja and Viharaja Nidana in the Causation of Gridhrasi

Dr.Anusha. N — Mon, 13 Apr 2026 00:00:00 +0200

Gridhrasi is one among the Nanatmaja Vata Vyadhi1, which presents with low back pain radiating down to lower limbs. Low Back Ache is the most commonly seen health issue requiring medical intervention in the society as suffering persons are unable to perform their daily routine activities easily. According to WHO, Feb-2021, approximately 1.71 billion people have musculoskeletal conditions worldwide. Among musculoskeletal disorders, Low back pain causes the highest burden with a prevalence of 568 million people. Musculoskeletal conditions are the leading contributor to disability worldwide, with Low back pain being the single leading cause of disability in 160 countries2. The condition of Low back ache affects 1% to 10% of the population, ranging from mild to severe, and most common in adults between the ages of 25 to 45 and it is uncommon before the age of 20 years and affecting male and female equally3. Nidana of Gridhrasi is not elucidated independently, so the general Vata Vyadhi Nidana is considered as the Nidana for Gridhrasi. As the saying goes ‘Sankshepatah Kriyayogo Nidanaparivarjanam’4, an evaluation of the causative factors is very essential to create awareness among people and further helping in prevention and treatment of Gridhrasi. The keen observational study of nidana in subjects of Gridhrasi, it will help to obtain proper understanding about the tara-tama bheda of dosha and vyadhi Avastha for management. Hence, here an attempt is made to assess Aharaja and Viharaja Nidana in Gridhrasi.

Role of Cabergoline in the Management of Uterine Fibriods: An Emerging Perspective

Mon, 13 Apr 2026 00:00:00 +0200

Background: Uterine fibroids are the most common benign tumors in women of reproductive age, often associated with symptoms such as menorrhagia, pelvic pain, and infertility. Conventional treatments have limitations, prompting the search for effective non-surgical alternatives.

Aim and Objectives: To evaluate the efficacy and safety of cabergoline in the management of uterine fibroids, with respect to reduction in fibroid size and improvement in clinical symptoms. Materials and Methods: This prospective interventional study was conducted in the Department of Obstetrics & Gynaecology at NRI Medical College & Hospital from 2024 to 2025. A total of 50 women diagnosed with uterine fibroids were included. Cabergoline was administered at a dose of 0.5 mg twice weekly for 3 months. Patients were assessed clinically and radiologically before and after treatment.

Results: The majority of patients (36%) belonged to the 41–50 years age group. Menorrhagia was the most common presenting symptom (60%). Significant reduction in fibroid size was observed in 56% of patients, while 28% showed mild reduction. Symptomatic improvement was noted in 70% of patients. Adverse effects were minimal, occurring in only 16% of cases.

Conclusion: Cabergoline is an effective, safe, and well-tolerated medical therapy for uterine fibroids, offering a cost-effective and fertility-preserving alternative to conventional treatments.

Sociodemographic and Obstetric Determinants of Postpartum Depression in a Tertiary Care Setting of Pakistan: A Cross-Sectional Study

Mon, 13 Apr 2026 00:00:00 +0200

Background: Postpartum depression (PPD) is a multifactorial psychiatric disorder influenced by biological, psychological, and social determinants. While inflammatory markers have gained attention, sociodemographic and obstetric factors remain critical in understanding vulnerability to postpartum depression, particularly in low- and middle-income countries.

Objectives: To determine the association of sociodemographic and obstetric factors with postpartum depression among women attending a tertiary care hospital.

Methods: This cross-sectional study was conducted at Civil Hospital Hyderabad, Pakistan. A total of 236 postpartum women within six months of delivery were recruited. Postpartum depression was assessed using the Urdu version of the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and obstetric variables were recorded using a structured proforma. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of postpartum depression.

Results: The prevalence of postpartum depression was 50.8%. Significant associations were observed between postpartum depression and rural residence (OR = 2.34; 95% CI: 1.38–3.96), low educational status (OR = 2.91; 95% CI: 1.69–5.01), low socioeconomic status (OR = 2.47; 95% CI: 1.44–4.23), and multiparity (OR = 1.88; 95% CI: 1.02–3.46). In multivariate analysis, rural residence, low education, and low socioeconomic status remained independent predictors of postpartum depression.

Conclusions: Sociodemographic disadvantage plays a substantial role in the development of postpartum depression. Strengthening psychosocial screening and targeted community-based interventions may reduce the burden of postpartum depression in resource-limited settings.

Role of Insulin Resistance and Obesity in the Pathogenesis of Menstrual Irregularities in Women with Polycystic Ovary Syndrome. Cross-Sectional Study

Shazia Saeed, Rozina Khan, Rizwana Naz, Shaista Gul, Zubia Bugti, Fozia Jan — Fri, 30 Jan 2026 00:00:00 +0100

Background: Polycystic ovary syndrome (PCOS) is a widespread endocrine-metabolic disorder amongwomen at the age of reproductive age, and it is often linked with menstrual cycle disruptions, obesity, andinsulin resistance. Such metabolic abnormalities could play a major role in ovulatory dysfunction and abnormal menstrual cyclicity.

Clinical Presentation, Risk Factors, Histopathological Features, and Quality-of-Life Impact of Uterine Fibroids in Women Attending Tertiary Care Hospitals

Shaista Gul, Rizwana Naz, Shazia Saeed, Zubia Bugti, Fozia Jan, Rozina Khan — Sat, 28 Feb 2026 00:00:00 +0100

Background: The most common benign tumor of the female reproductive tract is uterine fibroids, which is aleading cause of gynecological morbidity, especially among women of reproductive age. They are linked tomenstrual problems, pelvic problems, infertility, and severe quality-of-life impairment.
Objective: To assess the clinical appearance, risk determinants, histopathological changes, and quality-of-life effects of uterine fibroids in women who visit a tertiary care hospital.

Clinicopathological Evaluation of Hormonal and Ovarian Factors Associated with Female Infertility in Reproductive Age Women; A Clinical Study

Rizwana Naz, Shazia Saeed, Fozia Jan, Rozina Khan, Shaista Gul, Zubia Bugti — Mon, 30 Mar 2026 00:00:00 +0200

Background: Female infertility is a complex disease that has been usually related to hormonal disorders andovarian malfunction. The endocrine and ovarian abnormalities should be detected early to manage fertility
effectively.Objective: To assess the clinicopathology of the relationship between hormonal and ovarian factors andfemale infertility in women of reproductive age

Histopathological and Clinical Correlates of Endometriosis in Women Presenting with Dysmenorrhea and Chronic Pelvic Pain. A Cross-Sectional Clinical Study

Zubia Bugti, Fozia Jan, Shazia Saeed, Rozina Khan, Rizwana Naz, Shaista Gul — Fri, 10 Apr 2026 00:00:00 +0200

Background: Endometriosis is a chronic gynecological disorder frequently associated with dysmenorrhea,chronic pelvic pain, infertility, and reduced quality of life, yet it often remains underdiagnosed until histopathological confirmation is obtained.

Organophosphorus Poisoning In Pregnancy. A Case Report and Review of Literature

Neeharika Tiwari, Mayuri Ahuja, Isha Dash, Shelly Agarwal — Tue, 14 Apr 2026 00:00:00 +0200

Organophosphorus poisoning is a significant public problem specially in developing countries where domestic abuse, poverty and gender inequity is a matter of great concern. Organophosphorus which is present in pesticides is easily accessible in developing countries for homicidal as well as suicidal cases. A case of 26-year-old intubated primi (G1POLO) at 34 weeks gestation presented in emergency with history of domestic fight followed by some pesticide intake 24 hours back.

Patient was intubated at some local hospital due to respiratory depression. There was history of multiple episodes of vomiting, excessive salivation, sweating followed by unconsciousness.

Patient was given Intravenous atropine to reverse the cholinergic side effects. Her plasma pseudocholinesterase levels were also very low (150 lU) which further confirmed the diagnosis. Intravenous infusion atropine dose continued for a duration of 5 days till full recovery was achieved. Patient was discharged in stable condition and delivered vaginally at 37 weeks of gestation. There were no residual neurological defects in fetus as well as mother.

Vulvo-Vaginal Cancer Mimicking Prolapse Uterus: An Interesting/Thought-Provoking Case Report

Isha Dash, Mayuri Ahuja, Neeharika Tiwari, HemKant Verm — Mon, 14 Jul 2025 00:00:00 +0200

Background: Differential diagnosis of a mass in the vagina includes genital and rectal prolapse, endocervical polyps, Gardner’s cysts, cervical or vaginal fibroids, and vaginal cancer. We present a rare case of vaginal cancer masquerading as uterine prolapse in an elderly woman and discuss its management based on a literature review.

A Prospective Observational Comparative Study of Metformin versus Myoinositol in Pcos

Dr. Ankita Khobragade, Dr Suhas Shinde, Dr Urmila Gavali, Dr Gautam Aher — Tue, 14 Apr 2026 00:00:00 +0200

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine-metabolic disorder characterized by hormonal imbalance in the ovaries, leading to symptoms such as irregular menstruation, infertility, hirsutism, and weight gain. It is also associated with insulin resistance, hyperandrogenism, and increased risk of type 2 diabetes, hypertension, and psychological issues. Management includes lifestyle modification, pharmacological treatment, and fertility interventions. Metformin and myo-inositol (MI) are commonly used therapies aimed at improving insulin sensitivity, reducing androgen levels, and enhancing fertility. This study aims to compare the effects of metformin versus myo-inositol on clinical, hormonal, metabolic, and reproductive outcomes in women with PCOS.

Objectives: 1.To evaluate and compare the effectiveness of Metformin and Myo Inositol on ovulation rate, menstrual regularity, insulin resistance, androgen levels, and metabolic profile in women with PCOS. 2. To assess the clinical advantages and tolerability of Myo-Inositol over Metformin in the management of PCOS.

Methods: Study Design: A prospective observational comparative study.

Study Setting: OBGY Department of Dr. vithalrao vikhe patil foundations medical college ahilyanagar, Maharashtra.

Study population: All women diagnosed with PCOS according to the Rotterdam criteria Sample size: 200.

Results: Both metformin and myo-inositol demonstrated improvements in insulin sensitivity, reduction in serum testosterone levels, and betterment of menstrual cycles. Improvement in ovulation rate and oocyte quality was noted in both groups, with differences observed in the degree of metabolic or reproductive improvement depending on the therapy. Detailed comparisons of clinical, hormonal, metabolic, and reproductive parameters between the two groups are presented.

Conclusions: Myoinositol offers superior overall benefits compared to Metformin in women with PCOS. Myoinositol resulted in better menstrual regulation, greater improvement in hyperandrogenic symptoms, and more favourable metabolic responses, including reduced insulin resistance. It also showed higher ovulation and conception rates with significantly fewer side effects, making it a more effective and well tolerated therapeutic option.

Uncovering Risks: Periodontal Health and General Wellness in Pakistan

Fri, 10 Apr 2026 00:00:00 +0200

Background: Periodontal disease is a common chronic inflammatory disease known not only to cause adecline in oral health but also to be associated with systemic diseases like obesity, high blood pressure, and diabetes mellitus. Understanding this association is crucial for integrated healthcare approaches

Oral Biological and Immunohistochemical Correlates of p53 and Ki-67 with Histological Grading and Clinical Outcomes in Oral Squamous Cell Carcinoma: A Pakistani Cohort Study

Fri, 10 Apr 2026 00:00:00 +0200

Background: Oral squamous cell carcinoma (OSCC) is a biologically aggressive malignancy where molecularbiomarkers such as p53 and Ki-67 may help in assessing tumor behavior and prognosis.
Objective: To assess p53 and Ki-67 expression in OSCC patients and its correlation with histological grade and clinical outcomes.

Histopathological Effects of Metformin on Splenic Tissue in Alloxan-Induced Diabetic Rats

Dr. Nuzhat Bashir, Dr. Sheikh Tousia, Dr. Aijaz Ahmad Patloo — Wed, 15 Apr 2026 00:00:00 +0200

Introduction: Diabetes mellitus is a chronicmetabolic disorder characterized by persistenthyperglycemia resulting from an absolute orrelative deficiency of insulin secretion bypancreatic β-cells. In addition to its systemicmetabolic effects, diabetes induces structural and functional alterations in various organs,including the spleen

Metabolic Syndrome Components along with Hematological parameters and their Influence on Surgical Outcomes in Women with Benign Uterine Conditions

Wed, 15 Apr 2026 00:00:00 +0200

Background: Benign uterine conditions such as fibroids, adenomyosis, and abnormal uterine bleeding frequently require surgical intervention. However, the influence of metabolic syndrome, a cluster of obesity, diabetes, hypertension, and dyslipidemia, along with associated hematological alterations affecting oxygen delivery, immune response, and coagulation, on surgical outcomes remains insufficiently explored.

Objective: To evaluate the impact of metabolic syndrome and associated hematological parameters and its individual components on surgical outcomes in women undergoing surgery for benign uterine conditions.

Methods: This cross-sectional clinical study was conducted at Institute DHO Thatta, Thatta, Pakistan, and POF Hospital Wah Cantt, Pakistan from June 2024 to May 2025. A total of 120 women aged 30–60 years undergoing hysterectomy or myomectomy were included using consecutive sampling. Patients were categorized into metabolic syndrome and non-metabolic syndrome groups based on NCEP ATP III criteria. Preoperative hematological parameters, including complete blood count indices, were also evaluated. Surgical outcomes assessed included operative time, intraoperative blood loss, postoperative complications, and length of hospital stay. Statistical analysis was performed using SPSS version 26, with p ≤ 0.05 considered significant.

Results: Metabolic syndrome was present in 46.7% of patients. Women with metabolic syndrome had significantly prolonged operative time (118.4 ± 21.6 vs 92.3 ± 16.8 minutes, p < 0.001), increased blood loss (335 ± 85 vs 255 ± 70 ml, p = 0.002), higher postoperative complications (30.4% vs 14.1%, p = 0.03), and longer hospital stay (5.4 ± 1.2 vs 3.9 ± 1.0 days, p < 0.001). These adverse outcomes were further influenced by underlying hematological variations contributing to impaired immunity and coagulation balance. Obesity and diabetes mellitus were identified as independent predictors of adverse outcomes.

Conclusion: Metabolic syndrome and associated hematological alterations significantly worsen surgical outcomes in women with benign uterine conditions. Preoperative identification and optimization of metabolic and hematological risk factors may improve surgical safety and patient recovery.

Evaluation of Mental Health Status for the Prevalence of Psychiatric Illnesses with Assessment of Knowledge and Use of Psychotropic Drugs among Medical Students

Fri, 17 Apr 2026 00:00:00 +0200

Background: Medical students are at high risk of mental health disorders including depression, anxiety, and substance abuse. There is limited data on the prevalence of psychiatric illness and psychotropic drug use among medical students in India.

Objectives: To evaluate mental health status, determine prevalence of psychiatric illnesses, and assess knowledge, attitude, and use of psychotropic drugs among undergraduate medical students.

Methods: A cross-sectional questionnaire-based study was conducted among 303 undergraduate medical students at Government Medical College. The Kessler’s Psychological Distress Scale (K10) was used to assess mental health status. Attitude towards psychotropic medications was assessed using the Self-Report Attitude Questionnaire (SRAQ). Data were analyzed using SPSS v25 with Chi-square, unpaired t-test, and ANOVA.

Results: Of 303 students (158 males, 145 females; age 18–29 years), 42% were likely to be well, 23% had mild disorder, 15% moderate, and 20% severe mental disorder. The 2020 batch showed the highest prevalence of severe disorder. Females had a higher proportion of mental disorders than males, though the difference was not statistically significant. Overall, students showed a positive attitude towards psychotropic medications; however, negative attitude was more prevalent in junior batches (P<0.004). Only 2.97% of students were on prescribed psychotropic medication.

Conclusion: A significant proportion of undergraduate medical students experience psychiatric distress. Regular mental health screening, counseling, and competency-based education are recommended to address negative attitudes and improve early detection of psychiatric disorders.

Serum Lactate Dehydrogenase as a Predictor of Severity of Preeclampsia and its Association with Fetomaternal Outcomes

Fri, 17 Apr 2026 00:00:00 +0200

Background: Preeclampsia is a rapidly progressing pregnancy-specific disorder which is the leading cause of maternal and neonatal morbidity and mortality. Serum lactate dehydrogenase (LDH) is a valuable and potential biomarker for predicting the severity of preeclampsia. The present study was undertaken to find out the association between serum LDH levels with feto-maternal outcomes in preeclamptic women with and without severity.

Materials and Methods: This institution-based observational prospective cohort study included 100 pregnant women beyond 28 weeks of gestation diagnosed with preeclampsia; among them 50 were non-severe preeclamptic mothers (Group1) and another 50 were severe preeclamptic mothers (Group2). The serum LDH were measured and subsequently categorized based on the serum LDH levels into the followings: (<600IU/L, 600-800IU/L and >800IU/L). Severity of preeclampsia and feto-maternal outcomes were evaluated according to the serum LDH levels.

Results: The serum LDH levels were significantly higher (p<0.0001) in severe preeclamptic mothers. Both mean systolic blood pressure and mean diastolic blood pressure were seen statistically high with serum LDH level≥600IU/L (p<0.0001). Cesarean delivery was less likely when serum LDH level was ≥600IU/L compared to <600IU/L (p=0.0031). Apgar score at 5 minutes were statistically lower(p<0.0001) with serum LDH levels ≥600IU/L. Maternal complications, neonatal intensive care unit admission and stillbirth rate were higher in severe preeclamptic mothers with high serum LDH levels(≥600IU/L).

Conclusions: The serum LDH levels were high in mothers with severe preeclampsia and associated with the disease severity as well as poor feto-maternal outcomes. So, serum LDH may be a valuable biomarker for predicting the severity of preeclampsia.

Two Lives Delivered, One Crisis Emerging: Acute Fatty Liver Unveiled

Dr. Maimoona Iqbal, Dr. Umme Habiba, Mr Kausik Das — Fri, 17 Apr 2026 00:00:00 +0200

Background: Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening obstetric emergency that typically occurs in the third trimester, though postpartum presentations are increasingly recognized.

Case Presentation: We report the case at University of Hospitals Birmingham (UHB) NHS Trust, a 32-year-old primigravida with a twin pregnancy at 38 weeks gestation who developed acute onset jaundice and malaise within hours of delivery. Laboratory investigations revealed markedly elevated liver enzymes (AST 1020 U/L, ALT 950 U/L), hyperbilirubinemia (7.2 mg/dL), hypoglycemia (48 mg/dL), coagulopathy (INR 2.8), and renal dysfunction, consistent with acute fatty liver of pregnancy. The patient exhibited rapid clinical deterioration requiring transfer to the intensive care unit. Multidisciplinary management, including correction of metabolic abnormalities and supportive care, resulted in gradual clinical and biochemical improvement over the subsequent days.

Conclusion: AFLP can present in the immediate postpartum period and should be suspected in patients with acute hepatic dysfunction, particularly in the context of twin pregnancies. Early diagnosis and prompt multidisciplinary management are essential to prevent life-threatening complications and ensure favorable maternal outcomes.

Management Outcomes of Sacrococcygeal Teratoma in Infants: Correlation of Tumor Type with Surgical Complexity, Renal Function Alteration, and Recurrence Rates

Fri, 17 Apr 2026 00:00:00 +0200

Sacrococcygeal teratoma (SCT) remains themost frequent congenital neoplasm inneonates, yet soutcome variability persistsdue to heterogeneous tumor morphology and anatomical extension

Preoxygenation in the Head-Up (40°) Position versus Supine Position in the Obese Patients with Severe Head Trauma Requiring Intubation

Fri, 17 Apr 2026 00:00:00 +0200

Introduction: Head trauma is a broad term that ranges from injury of brain, skull and scalp to underlyingtissues and vessels. Head injury is also known as brain trauma or traumatic brain injury. Objectives: The mainobjective of the study is to find the preoxygenation in the head-up (40°) position versus supine position in the obese patients with severe head trauma requiring intubation.

Comparison of E-HEART, HEART, TIMI, and T-MACS Scores in Predicting 30-Day Major Adverse Cardiac Events among Patients with Undifferentiated Chest Pain

Dr Prajjal Kumar Sinha, Dr Amrita Saha — Fri, 17 Apr 2026 00:00:00 +0200

Background: Chest pain is a commonpresentation in emergency departments andrequires prompt risk stratification to identifypatients at risk of major adverse cardiac events (MACE). Several scoring systems

Observational Study of Role of Preoperative Oesophagogastroduodenoscopy in Patients Undergoing Elective Cholecystectomy for Usg Proven Cholelithiasis

Sat, 18 Apr 2026 00:00:00 +0200

Background: Cholelithiasis is a common cause of upper abdominal pain; however, overlapping symptoms with other upper gastrointestinal (GI) disorders may lead to persistent symptoms even after cholecystectomy. Preoperative oesophagogastroduodenoscopy (OGDscopy) may help identify concomitant pathologies.

Aim: To evaluate the role of preoperative OGDscopy in patients undergoing elective cholecystectomy for USG-proven cholelithiasis.

Methods: A prospective observational study was conducted over 12 months including 50 symptomatic patients planned for elective cholecystectomy. All patients underwent detailed clinical evaluation, routine investigations, and preoperative OGDscopy. Endoscopic findings were documented, and patients were followed up postoperatively for resolution or persistence of symptoms. Statistical analysis was performed to assess the association between OGD findings and postoperative pain.

Results: The mean age was 43.54 ± 9.94 years, with a female predominance (80%). OGDscopy revealed abnormal findings in 30% of patients, most commonly antral gastritis (22%), followed by lax cardia (6%) and mild gastritis (2%). Postoperatively, 90% of patients showed complete symptom resolution, while 10% had persistent epigastric pain. A significant association was found between abnormal OGD findings and persistent pain (p < 0.001). Notably, no patient with normal OGD findings had postoperative symptoms, whereas 33.3% of patients with abnormal findings experienced persistent pain.

Conclusion: Preoperative OGDscopy is a valuable tool in identifying coexisting upper GI pathologies in patients with cholelithiasis. Its use can help predict postoperative outcomes, reduce persistent symptoms, and improve overall patient management. Routine or selective preoperative OGDscopy is therefore recommended.

Retrospective Study and Radio-Pathological Correlation of Spectrum of Pulmonary Lesions in Tertiary Care Centre

Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Lung cancer remains the leading cause of cancer-related mortality globally, with varying clinical presentations and radiological patterns. Early detection is critical for improving patient outcomes. This study aims to evaluate the clinical, radiological, and histopathological characteristics of lung lesions in a rural atertiary care hospital.

Methods: A retrospective analysis of 41 patients diagnosed with lung lesions between January 2022 and October 2024 at B.K.L Walawalkar Rural Medical College and Hospital was conducted. Demographic data, clinical complaints, CT scan findings, and histopathological results were reviewed and correlated.

Results: The study population consisted of 18 males and 23 females, with the majority aged above 60 years. Cough was the most common symptom, followed by chest pain and hoarseness. Radiologically, peripheral masses were the predominant pattern (58.53%), with adenocarcinoma being the most frequent histopathological diagnosis (70.73%). Lesions typically ranged from 1.1 to 2.0 cm in size. The right lung upper lobe was the most common site of involvement.

Conclusion: The findings from this study are consistent with global trends in lung cancer presentation, with adenocarcinoma being the predominant type and peripheral masses being the most common radiological feature. This highlights the importance of early detection and imaging techniques for diagnosing lung cancer, particularly in rural settings where clinical presentation may be delayed.

Association between Neutrophil to Lymphocyte Ratio and Steatosis and Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease

Dr Dharmik Kishorbhai Kalathiya, Dr Rahul Arya, Dr Piyush Thakur — Sat, 18 Apr 2026 00:00:00 +0200

Background: Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum from steatosis to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma, and is closely associated with metabolic comorbidities. Global prevalence is approximately 25.24%, with higher rates in patients with type 2 diabetes mellitus. Neutrophil to lymphocyte ratio (NLR), a readily available marker of subclinical systemic inflammation, may predict advanced NAFLD. However, prior studies report inconsistent NLR-NAFLD associations. This study aimed to evaluate NLR's association with steatosis and fibrosis in NAFLD using transient elastography (TE) with controlled attenuation parameter (CAP).

Methods: A cross-sectional observational study enrolled 100 NAFLD patients aged 18–65 years at T. S. Misra Medical College & Hospital, Lucknow, over 18 months. Inclusion criteria required ultrasonographic fatty liver in non-alcoholic patients with written consent. Patients with viral hepatitis, alcohol use, acute liver conditions, active infections, chronic illnesses, or pregnancy were excluded. Clinical evaluation included detailed history, anthropometric measurements, and physical examination. Fasting blood tests assessed liver enzymes, lipid profile, blood glucose, and complete blood count; NLR was calculated from the differential leucocyte count. Ultrasonography graded steatosis. TE-CAP measured liver stiffness (kPa) and steatosis (dB/m). Data were analyzed with SPSS v29.0; correlations assessed via Pearson's coefficient; p<0.05 was considered statistically significant.

Results: Mean age was 55.2 ± 14.2 years; 66% of patients were female. Predominant symptoms included malaise (78%) and abdominal discomfort (58%). Hepatomegaly was the most common sign (58%). Mean NLR was 2.7 ± 1.0; mean AST 83.7 ± 36.1 IU/L; mean ALT 89.5 ± 24.1 IU/L. Steatosis distribution: mild (Grade 1) 38%, moderate (Grade 2) 50%, severe (Grade 3) 12%; mean CAP 283.6 ± 38.4 dB/m. Fibrosis distribution: none (Score 0) 32%, mild (Score 1) 38%, moderate (Score 2) 22%, severe (Score 3) 8%; mean liver stiffness 7.4 ± 4.8 kPa. NLR increased significantly with steatosis grade (Grade 1: 2.3 ± 0.7; Grade 2: 3.6 ± 1.5; Grade 3: 3.9 ± 1.9; p<0.001) and fibrosis score (Score 0: 1.4 ± 0.4; Score 1: 2.7 ± 0.5; Score 2: 3.2 ± 0.6; Score 3: 3.7 ± 1.1; p<0.001). Significant positive correlations were found: TE-CAP (R=0.680), CAP-NLR (R=0.794), TE-NLR (R=0.723); all p<0.001. At an NLR cut-off of 2.45: sensitivity 98.4% and specificity 92.0% for steatosis; sensitivity 85.3% and specificity 81.2% for fibrosis.

Conclusion: NLR positively and significantly associates with both steatosis and fibrosis severity in NAFLD, serving as a reliable, non-invasive, and cost-effective biomarker alongside TE-CAP for disease risk stratification.

Timing of Urethral Stent Removal and Its Impact on Complications after Tubularized Incised Plate Repair of Distal Hypospadias

Sat, 18 Apr 2026 00:00:00 +0200

Background: Distal penile hypospadias is a common congenital anomaly in male children caused byincomplete development of the urethra, foreskin, and ventral penile tissues. Tubularized incised plate (TIP)urethroplasty is widely used for repair, typically employing a urethral stent to maintain neourethral patency and prevent urine leakage.

Evaluating the Effectiveness of Typhoid Conjugate Vaccine (TCV) in Reducing Typhoid Fever Prevalence in High Endemic Regions

Zohra Khanum, Fatima Tahira, Tabish Raza, Shafqat Husnain Khan — Sat, 18 Apr 2026 00:00:00 +0200

Background and Objective: Typhoid fever remains a main community health problem in endemical regions,especially in low middle income countries. The advent of multidrug-resistant (MDR) and extensively drug resistant (XDR) strains has further posed a complicated management

Method Validation Report for the Estimation of Nelarabine in K3edta-Human Plasma by Using Lc-Esi-Ms/Ms

Mon, 20 Apr 2026 00:00:00 +0200

Author want to define the procedure for robust and sensitive method utilized in bio-analytical research to establish a simple technique for determining the level of nelarabine in K₃EDTA plasma from human beings, is a combination of liquid chromatography, electro spray ionization and mass spectro-photometry (LC-MS/MS) parameters were systematically optimized, by using methanol: 5mM ammonium acetate in water (80:20%v/v) as mobile phase, flow rate of 1.2mL/minute, Zorbax SB-C18; 2.1*50mm, 5µm Agilent Technologies column. Solid-phase extraction (SPE) was further optimized to improve recoveries and minimize matrix effects. The final method achieved instrument detection limits as low as 0.01fg (femto-grams) on-column, retention time for nelarabine observed at 2.65 ± 0.03minutes with run time 4.0 minutes. Calibration linearity concentration range of 2.00 to 1000ng/mL with a correlation coefficient (r²) of ≥ 0.9997, %Mean ISTD recovery with correction factor for Nelarabine = 83.79; %CV of ISTD recovery (Extracted) for Nelarabine = 6.15, recoveries within 70–130%, and intra / inter-day precision (RSD ≤20%) confirmed the robustness and reproducibility of the protocol. The LC-MS/MS technique that was created to quantify the amount of Nelarabin in the biological matrix worked well for routine blood sample analysis from patients for pharmacokinetics research and medication monitoring.

Evaluation of the Effectiveness of Enhanced Recovery after Surgery (ERAS) Protocols in Reducing Postoperative Morbidity in Major Abdominal Surgery

Dr. Muhammad Adeel, Dr. Hooria Hanif, Dr. Kashif Hussain, Usra Parvez — Mon, 20 Apr 2026 00:00:00 +0200

Background: Enhanced Recovery after Surgery (ERAS) guidelines represent evidence-based methods of perioperative care aimed at alleviating surgical stress, preserving physiological functions, and speeding up the recovery process. Their use in major abdominal surgery has been linked with better outcomes in postoperative outcomes, but their efficacy in the reduction of morbidity is a subject of continuing review.

Place and Duration of Study: This research was carried out in Department of General Surgery and Anesthesaia, Sindh Institute of Urology and Transplantation (SIUT) from January 2025 to June 2025. Objective: To assess how well the ERAS protocols help to reduce postoperative morbidity in patients undergoing major abdominal surgery.

Methodology: The study was done on 150 patients who were undergoing major abdominal surgery; they were divided into two groups; ERAS (n=75) and conventional care (n=75). WHO sample size calculator was used to determine the sample size. Both male and female patients aged 18-70 years were included. A structured proforma was used to collect data which included demographics, clinical parameters, type of surgery and postoperative outcomes. ERA’s group was given uniform perioperative treatment including preoperative counseling, optimized nutrition, carbohydrate loading, minimum fasting, early mobilization, early drain and catheter removal and oral feeding commenced within 24 hours. The standard group was given standard postoperative care. Postoperative complications (surgical site infections, pulmonary complications, and postoperative ileus) and length of hospital stay were used as primary and secondary outcomes, respectively. Data were processed with the help of SPSS 25.0 and chi-square, and t-tests were used with p 0.05 being significant.

Results: Patients treated according to ERAS guidelines showed a great decrease in morbidity in the postoperative period in comparison to the control group. Surgical site infections, pulmonary complications, as well as postoperative ileus were less common in the ERAS group. Moreover, the ERAS patients were also characterized by a shorter length of stay and quicker recovery.

Conclusion: ERAS guidelines can be used to minimize the postoperative morbidity of major abdominal surgery patients. They can be implemented to achieve better clinical outcomes, fewer complications, and reduced hospital stays, which is why they are a worthy tool in contemporary surgical practice.

Anatomial Variations in Ureteric Course and Their Clinical Significance in Urolithiasis and Endourological Procedures

Mon, 20 Apr 2026 00:00:00 +0200

Objective: To evaluate the frequency and types of anatomical variations in the ureteric course and to assess their clinical significance in patients with urolithiasis undergoing endourological procedures.

Materials and Methods: This cross-sectional observational study was conducted over a period of one year. A total of 120 patients diagnosed with urolithiasis and planned for endourological procedures, including ureteroscopy (URS), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) were included. Preoperative assessment involved clinical evaluation and radiological imaging, primarily non-contrast CT and CT urography where indicated. Ureteric anatomical variations were identified through imaging and confirmed intraoperatively. Data regarding demographic characteristics, stone location, type of ureteric variation, procedural difficulty, complications and stone clearance were recorded and analyzed using SPSS version 22.

Results: Out of 120 patients, ureteric anatomical variations were observed in 34 patients (28.3%). The most common variation was ureteric tortuosity (35.3%) followed by duplication (23.5%), kinking (20.6%) and medial/lateral deviation (20.6%). Procedural difficulty was significantly higher in patients with ureteric variations (64.7%) compared to those with normal anatomy (20.9%) (p < 0.05). Complication rates, including mucosal injury and ureteric perforation were also increased in patients with variations. Furthermore, the stone clearance rate was lower in patients with ureteric variations (79.4%) compared to those with normal ureters (94.1%).

Conclusion: Anatomical variations of the ureteric course are common and have a significant impact on the management and outcomes of urolithiasis. Awareness and identification of these variations through appropriate imaging and careful intraoperative assessment are essential to minimize complications and improve the success of endourological procedures.

Pulse Oximeter Perfusion Index as an Early Predictor of Successful Ultrasound-Guided Axillary Brachial Plexus Block: A Prospective Observational Study

Dr. Deepa G.S., Dr. Naveen Kumar C.P., Dr. Smitha Y. — Mon, 20 Apr 2026 00:00:00 +0200

Background: Objective assessment of ultrasound-guided axillary brachial plexus block (AXB) success is challenging due to the subjective nature of conventional sensory and motor evaluations. The perfusion index (PI), a non-invasive marker derived from pulse oximetry, may provide an early, objective indicator of block efficacy.

Methods: This prospective study included 30 adult patients (ASA I–II) undergoing upper limb surgery with ultrasound-guided AXB. PI measurements were taken on the middle finger of the blocked arm at baseline, every 2 minutes up to 10 minutes, and every 5 minutes up to 30 minutes post-block. PI ratio was calculated as PI at 10 minutes divided by baseline PI. Sensory and motor blocks were evaluated at 5-minute intervals for 30 minutes. Statistical analysis used ROC curve assessment to determine optimal PI cut-off values for predicting block success.

Results: Successful AXB was achieved in the majority of patients. PI values significantly increased from baseline as early as 5 minutes post-block in successful cases (p < 0.001). At 10 minutes, mean PI and PI ratio were significantly higher in successful blocks. ROC analysis identified optimal cut-offs of PI ≥2.6 and PI ratio ≥1.9 at 10 minutes, with high sensitivity (96% and 93.3%) and specificity (94% and 100%), and AUROC values of 0.97 and 1.0, respectively.

Conclusion: PI and PI ratio are reliable predictors of successful ultrasound-guided AXB, reflecting sympathetic blockade-induced vasodilation. Incorporating PI monitoring may enhance block assessment, improve operating room efficiency, and reduce reliance on subjective tests.

To Compare the Efficacy of Arogyavardhini Vati and Kaishore Guggulu with Modern Medicine in Hyperlipidemic Patients with Raised Serum PCSK9 Levels

Dr. Alka Goyal, Prof. (Vaidya) Rakesh Sharma, Dr. Ekram Goyal — Tue, 21 Apr 2026 00:00:00 +0200

Background: Hyperlipidemia is a major modifiable risk factor for cardiovascular diseases and is closely regulated by hepatic cholesterol metabolism. Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) plays a pivotal role in low‑density lipoprotein receptor (LDLR) degradation and has emerged as an important biomarker and therapeutic target. While statins remain first‑line therapy, their adverse effects and residual cardiovascular risk necessitate exploration of integrative approaches. Ayurveda describes dyslipidemia under Medoroga and offers formulations such as Arogyavardhini Vati and Kaishore Guggulu for metabolic regulation.

Objectives: To evaluate and compare the efficacy of Arogyavardhini Vati and Kaishore Guggulu with statins in hyperlipidemic patients having raised serum PCSK9 levels, and to assess the effect of integrative therapy on lipid parameters and PCSK9.

Methodology: A comparative, interventional study was conducted on 150 hyperlipidemic patients aged 18–65 years with raised serum PCSK9 levels. Patients were randomized into three groups: Group A received statins, Group B received Arogyavardhini Vati and Kaishore Guggulu, and Group C received combination therapy. Serum LDL‑cholesterol and PCSK9 levels were assessed at baseline and after 6 months. Statistical analysis was performed using appropriate parametric tests.

Results: Baseline demographic and biochemical parameters were comparable among groups. After 6 months, all groups showed significant reductions in LDL and PCSK9 levels. The maximum reduction was observed in the combination therapy group, followed by statin monotherapy and Ayurvedic therapy. Intergroup differences were statistically significant for post‑treatment LDL and PCSK9 levels.

Conclusion: Arogyavardhini Vati and Kaishore Guggulu demonstrated significant hypolipidemic effects and reduction in PCSK9 levels. Integrative therapy with statins produced superior outcomes, supporting the role of Ayurveda as a complementary approach in dyslipidemia management.

Effect of Arogyavardhini Vati on Serum Low-Density Lipoprotein Levels: A Prospective Interventional Study

Dr. Alka Goyal, Prof. (Vaidya) Rakesh Sharma, Dr. Ekram Goyal, Mr. Aniket Kumar — Tue, 21 Apr 2026 00:00:00 +0200

Background: Dyslipidemia, particularly elevated low-density lipoprotein (LDL) cholesterol, is a major risk factor for cardiovascular morbidity and mortality [1, 2]. Lifestyle factors, metabolic stress, and chronic inflammation contribute significantly to abnormal lipid profiles [3]. Arogyavardhini Vati, a classical Ayurvedic formulation, is traditionally used for metabolic regulation, liver disorders, and lipid abnormalities [4]. However, limited clinical evidence exists regarding its effect on serum LDL levels.

Aim: To evaluate the effect of Arogyavardhini Vati on serum low-density lipoprotein (LDL) levels.

Methodology: This prospective interventional study included 50 consenting subjects with elevated serum LDL levels. Serum LDL concentrations were measured at baseline and after 6 months of Arogyavardhini Vati administration. Statistical analysis was performed using paired t-test.

Results: There was a statistically significant reduction in serum LDL levels after 6 months of intervention (p < 0.001). Mean LDL levels decreased from 188.58 ± 14.42 mg/dl at baseline to 97.76 ± 22.94 mg/dl at follow-up. At baseline, all subjects had elevated LDL levels, whereas at follow-up, 90% achieved LDL values within the normal range.

Conclusion: Arogyavardhini Vati resulted in significant reduction in serum LDL levels, suggesting its potential role as an effective therapeutic option in the management of dyslipidemia.

Comparative Efficacy of Celastrus paniculatus (Willd.) and Escitalopram, Alone and in Combination, in Major Depressive Disorder: A Prospective Interventional Study

Dr. Ekram Goyal, Prof. (Vaidya) Rakesh Sharma, Dr. Alka Goyal — Tue, 21 Apr 2026 00:00:00 +0200

Background- Depression is rated as third leading cause of the burden of disease worldwide according to WHO in 2008. It often goes untreated. Conventional treatment approaches include antidepressant medications like Serotonin Reuptake Inhibitors (SSRIs) and properly modulated and planned psychotherapies. A shrub belonging from Celastraceae family called Jyotishmati (Celastrus panniculatus Willd.) contains a seed oil which is tranquilizer and sedative. Current study is an attempt to find out efficacy of this ayurvedic medication in treating depression

Aims and objectives- 1. To assess antidepressant efficacy of Jyotishmati (Celastrus panniculatus Willd.) in treating Major Depressive Disorder (MDD). 2. To compare its efficacy with Escitalopram 10mg alone and its combination with escitalopram.

Methodology- This study was conducted in department of Psychiatry of Government Medical College and Rajindra Hospital, Patiala from 28-12-2020 to 31-05-2023, 182 patients suffering from Major Depressive Disorder (MDD) were included in study. They were randomly divided into 3 groups using computer generated random numbers. Sociodemographic data was collected using sociodemographic proforma. Diagnosis of MDD was confirmed using International Classification of Diseases for mental health and behavioural disorders 10^th edition (ICD-10). Hamilton Depression Rating Scale -17 was applied at baseline to know severity of depression and at 6 months of administering medications to know therapeutic response. Group A patients received 10mg of Escitalopram, Group B patients received Jyotishmati seed oil in capsule preparation and Group C subjects received both 10mg Escitalopram and Jyotishmati. Institutional Ethics committee permission was obtained before commencing the study. Written informed consent was obtained from all patients before including them into this project.

Observations- Out of 182 patients suffering from MDD, 14 patients dropped out during the course of study. 18 were excluded because of exclusion criteria. 150 subjects (50 in each group) were finally left behind. It was observed there was statistically significant reduction of HDRS-17 scores in subjects receiving Jyotishmati (Group B) (13.2±3.92 to 11.36± 4.66 in 6 months). This reduction was less than the group receiving escitalopram 10mg (Group A) and group receiving both escitalopram and Jyotishmati (Group C). Maximum reduction was seen in combination treatment group (13.46±3.84 to 7.16 ± 3.48 in 6 months)

Conclusion- This gives us scope of combining ayurvedic medications like Jyotishmati with conventional antidepressant medications for better results. For that more extensive research is needed.

Enhancing Knowledge and Practical Competency in Adverse Drug Reaction Reporting Among Postgraduate Residents: A Pre-Post Interventional Study

Shoebul Haque, Fatima Khan, Afroz Abidi — Wed, 22 Apr 2026 00:00:00 +0200

Background: Adverse drug reaction (ADR) reporting is an important component of pharmacovigilance and patient safety. However, underreporting remains a significant challenge, often due to inadequate knowledge and training among healthcare professssionals. Educational interventions have been shown to improve awareness and reporting practices.

Objective: To evaluate the effectiveness of a structured educational intervention on knowledge and practical skills related to ADR reporting among postgraduate (PG) medical students.

Methods: A prospective interventional study was conducted among 70 first-year postgraduate students from various clinical and paraclinical departments. Participants underwent a pre-test assessment consisting of a structured 50-item multiple-choice questionnaire (MCQs) and ADR form-filling evaluation. A post-test was conducted using the same assessment tools. Data were analyzed using descriptive statistics, and the Wilcoxon signed-rank test was applied to compare pre and post-intervention scores. Effect size (r) and difficulty index (P) for MCQs were also calculated.

Results: The mean score increased from 23.5 in the pre-test to 32.5 in the post-test, with an average improvement of 8-10 marks. A significant improvement in overall performance was observed, with 96% of students showing score enhancement. The Wilcoxon signed-rank test demonstrated a statistically significant difference (p < 0.001), with a large effect size (r = 0.79). MCQ analysis revealed a shift from predominantly difficult and moderate questions in the pre-test to mostly easy questions in the post-test. Practical skills in ADR form filling also improved substantially.

Conclusion: The educational intervention significantly improved both knowledge and practical competencies related to ADR reporting among postgraduate students. Regular training programs and integration of pharmacovigilance education into postgraduate curricula are recommended to enhance ADR reporting practices and improve patient safety.

Impact of Hydration Status on Cognitive Performance

Samia Sarwar, Sehrish Liaqat, Junaid Iqbal — Wed, 22 Apr 2026 00:00:00 +0200

Background: Adequate hydration is essential for maintaining physiological balance and optimal brain function. Even mild dehydration has been suggested to impair cognitive processes such as attention, memory, and executive function. Despite growing interest, findings across studies remain inconsistent due to variations in methodology, population characteristics, and definitions of hydration status. Understanding this relationship is particularly important in environments where dehydration risk is elevated, such as hot climates or during prolonged physical or mental activity.

Objective: This study aimed to evaluate the impact of hydration status on cognitive performance and to determine whether mild dehydration significantly affects specific cognitive domains in healthy adults.

Methodology: A cross-sectional study was conducted involving 120 healthy participants aged 18–35 years. Hydration status was assessed using urine specific gravity and self-reported fluid intake. Participants were categorized into euhydrated and mildly dehydrated groups. Cognitive performance was evaluated using a standardized battery of neuropsychological tests measuring attention, working memory, processing speed, and executive function. Statistical analyses, including independent t-tests and multiple regression models, were used to examine differences between groups and control for potential confounding factors such as age, sleep quality, and physical activity.

Results: The study included 120 participants, divided into euhydrated (n=62) and mildly dehydrated (n=58) groups. Findings showed that mildly dehydrated participants performed significantly worse in attention (p<0.001) and working memory (p<0.001) compared to the euhydrated group. No significant differences were observed in processing speed (p=0.12) and executive function (p=0.21). Urine specific gravity confirmed hydration classification, with higher values in the dehydrated group. Regression analysis identified hydration status as a significant predictor of attention even after adjusting for confounders. Overall, mild dehydration selectively impaired certain cognitive domains, particularly those related to attention and short-term memory performance.

Determinants of Parental Decision-Making for Tooth Extraction versus Restoration in Children: A Study on Socio-Economic and Sociological Factors

Mon, 20 Apr 2026 00:00:00 +0200

This research seeks to assess the factors that affect parental choice when it comes to whether to extract or torestore the tooth in children and specifically the socio-economic and sociological factors. A cross-sectionalstudy design was used in this research, which was conducted in 6 months in tertiary care hospitals and paediatric dental clinics. The sample size (n) of 120 parents

Sarcopenia as a Predictor of Diabetic Nephropathy: Evidence from a Cross-Sectional Study in Northeast India

Dr. Anupravo Bhaumik, Dr. Pradip Bhaumik, Dr. Kanak Choudhury — Thu, 23 Apr 2026 00:00:00 +0200

Background: Type 2 diabetes mellitus(T2DM) is a growing health challenge inSouth Asia, with diabetic nephropathy andsarcopenia emerging as criticalcomorbidities. Recent evidence suggests abidirectional relationship between muscle loss and renal decline, but region-specific data remain limited

Comparative Evaluation of Procalcitonin and C-Reactive Protein as Biomarkers in Suspected Sepsis

Thu, 23 Apr 2026 00:00:00 +0200

Background: Sepsis is a lifethreatening condition associated withhigh morbidity and mortality,particularly in intensive care units.Early diagnosis remains challengingdue to non-specific clinical featuresand delays in blood culture results.Biomarkers such as procalcitonin

Prevalence of Celiacomesenteric Trunk – A Computed Tomography Study

Dr. Tajinder Pal Kaur, Dr. Mayank Mittal, Dr. Gagandeep Kaur, Dr. Jaswant Kaur — Thu, 23 Apr 2026 00:00:00 +0200

Back ground: Anatomic variations are commonly seen in the origin of branches of the abdominal aorta. The celiac trunk and superior mesenteric artery arising from a single common trunk is an unusual variation. The Contrast Enhanced Computed Tomography is one of the advanced imaging techniques of radiography. It gives valuable knowledge of vessels in the body.

Methods: The present study was done to see the frequency of variations in the origin of the coeliac trunk and superior mesenteric artery from the abdominal aorta by Contrast Enhanced Computed Tomography. Contrast Enhanced Computed Tomography scan films of the abdomen of 300 patients were examined. The scans were taken with a 32-slice Siemens Somatum Go Up Computed Tomography machine with inbuilt Syngo software.

Results: During this study, three cases were observed where the coeliac trunk and superior mesenteric artery had taken origin from the abdominal aorta by a common trunk. The frequency of origin of the coeliac trunk and the superior mesenteric artery from a common trunk was 1%, and this is close to the frequency as stated in the literature.

Conclusion: This knowledge of variations can help the surgeons to plan abdominal surgery and many complications during surgery and after surgery can be avoided.

Cardiovascular and Renal Outcomes of Insulin-Sensitizing and Glucose-Lowering Agents in Type 2 Diabetes with Established Cardiovascular Disease: A Systematic Review and Meta-Analysis

Dr. Tanmay Prasad, Dr. Vibhu Amrutiya, Dr. Yusuf Shahab, Dr. Yunus Shahab — Fri, 24 Apr 2026 00:00:00 +0200

Background: Adults with type 2 diabetes mellitus (T2DM) and established cardiovascular disease (CVD) experience a substantially increased risk of both cardiovascular complications and chronic kidney disease (CKD), reflecting shared underlying pathophysiological mechanisms. Although insulin sensitizing and glucose lowering therapies such as metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) have each been shown to influence cardiorenal outcomes, a comprehensive synthesis of their combined effects in this population remains limited.

Objectives: To systematically evaluate and quantitatively synthesize the cardiovascular and renal outcomes associated with metformin, GLP-1 receptor agonists, and SGLT2 inhibitors in adults with T2DM and established CVD, and to provide pooled effect estimates for clinically relevant endpoints.

Data Sources: PubMed/MEDLINE, Scopus, and EMBASE were systematically searched from database inception through January 31, 2025, without language restrictions. The review followed PRISMA 2020 guidelines.

Study Selection: Randomized controlled trials (RCTs) and pre-specified meta-analyses of cardiovascular or renal outcome trials enrolling adults (≥18 years) with T2DM and established CVD, reporting at least one primary cardiovascular endpoint (MACE, cardiovascular death, HHF, stroke, MI) or renal endpoint (CKD progression, ESKD, eGFR decline ≥40%, new onset macroalbuminuria, or renal death) were included. Studies in populations without established CVD or reporting only surrogate glycaemic endpoints were excluded.

Data Extraction and Synthesis: Two reviewers independently extracted data using standardized forms, with disagreements resolved by a third reviewer. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool for randomized trials (CIs) and AMSTAR-2 for meta-analyses. Pooled hazard ratios or risk ratios with 95 % confidence intervals were calculated using a DerSimonian-Laird random effects model. Heterogeneity was assessed using the I² statistic and Cochran’s Q test.

Results: A total of 49 studies were included, comprising 22 major cardiovascular outcome trials or their pre-specified subgroup analyses, 16 pooled meta-analyses, and 11 observational or real-world studies. These studies represented more than 250,000 patients with T2DM and over 900,000 patient-years of follow-up. For cardiovascular outcomes, SGLT2 inhibitors were associated with significant reductions in hospitalization for heart failure (HR 0.69, 95 % CI 0.61 to 0.78; I² = 6 %), cardiovascular death (HR 0.82, 95 % CI 0.74 to 0.90), and three-point MACE (HR 0.89, 95 % CI 0.83 to 0.96) in patients with established CVD. GLP-1 receptor agonists were associated with reductions in three-point MACE (HR 0.86, 95 % CI 0.80 to 0.93), all-cause mortality (HR 0.88, 95 % CI 0.82 to 0.94), and ischaemic stroke (HR 0.84, 95 % CI 0.76 to 0.93). For renal outcomes, SGLT2 inhibitors reduced the risk of CKD progression by approximately 38 to 40 % (RR 0.60, 95 % CI 0.53 to 0.69 in diabetic kidney disease trials) and acute kidney injury by 25 % (RR 0.75, 95 % CI 0.66 to 0.85). GLP-1 receptor agonists reduced albuminuria by 24 % compared with placebo and improved composite kidney outcomes (HR 0.79, 95 % CI 0.73 to 0.87). The FLOW trial showed that semaglutide reduced the primary kidney endpoint by 24 % (HR 0.76) and major adverse cardiovascular events by 18 % in patients with established CKD. Metformin demonstrated possible cardiovascular benefit in randomized studies, although this remains inconclusive, and no dedicated renal outcomes trial has been conducted.

Conclusions: SGLT2 inhibitors and GLP-1 RAs bth provide substantial and complementary cardiorenal protection in patients with T2DM and established CVD, with partially distinct patterns of benefit. SGLT2 inhibitors show greater effects on heart failure and progression of CKD, whereas GLP-1 receptor agonists have a stronger impact on atherosclerotic cardiovascular outcomes, particularly stroke. Their combined use may offer additive benefits. These findings support current guideline recommendations that position these agents as therapies for cardiovascular and renal risk reduction, rather than solely for glycaemic control.

Association between Endometriosis, Dysmenorrhea, and Chronic Pelvic Pain in Women of Reproductive Age. A Clinical Study

Sun, 12 Apr 2026 00:00:00 +0200

Background: Endometriosis is a chronic gynecological disorder characterized by the presence of endometrial tissue outside the uterine cavity and is a major cause of dysmenorrhea and chronic pelvic pain in women of reproductive age. Despite its high prevalence, it remains underdiagnosed, particularly in developing countries, leading to significant morbidity and reduced quality of life. The objective of this study was to evaluate the association between endometriosis, dysmenorrhea, and chronic pelvic pain.

Methods: This cross-sectional clinical study was conducted at Shalamar Hospital, Lahore, and Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan, from January 2024 to June 2025. A total of 120 women aged 18–45 years presenting with pelvic pain or menstrual complaints were included using consecutive non-probability sampling. Diagnosis of endometriosis was based on clinical evaluation, ultrasound, and laparoscopy, where required. Severity of dysmenorrhea was assessed using the Visual Analog Scale (VAS), and chronic pelvic pain was defined as non-cyclic pain lasting more than six months. Data were analyzed using SPSS version 26, with p < 0.05 considered statistically significant.

Results: Endometriosis was diagnosed in 45.0% of participants. Severe dysmenorrhea was significantly more common in women with endometriosis (66.7%) compared to those without (27.3%) (p < 0.001). Chronic pelvic pain was reported in 72.2% of endometriosis patients versus 45.5% in non-endometriosis patients (p = 0.002). A strong positive correlation was observed between endometriosis and dysmenorrhea (r = 0.61) as well as chronic pelvic pain (r = 0.65).

Conclusion: Endometriosis is strongly associated with increased severity of dysmenorrhea and a higher prevalence of chronic pelvic pain. Early clinical suspicion and timely diagnosis are essential for effective management and improved quality of life in affected women.

Assessment of Treatment Outcomes and Pharmacological Adverse Effects in Women with Ovarian Cancer Undergoing Combination Chemotherapy. A Clinical Study

Mon, 20 Apr 2026 00:00:00 +0200

Background: Ovarian cancer is among the top causes of death due to cancer in the gynecological system, and it is commonly detected at its advanced stages and treated through combination chemotherapy. Although platinum-based regimens have increased treatment response, their application has often been hampered by the presence of major pharmacological side effects that could affect therapeutic response and adherence.

Objective: To assess treatment outcomes and evaluate pharmacological adverse effects in women with ovarian cancer undergoing combination chemotherapy.

Methods: The present clinical trial was carried out in the Department of Obstetrics and Gynaecology at both Sandmen Provincial Hospital, Quetta, Pakistan, and Bolan Medical Complex Hospital, Quetta, Pakistan, between February 2024 and August 2025. Non-probability consecutive sampling was used to include 70 women with a known history of ovarian cancer who were treated with combination chemotherapy. Clinical and radiological evaluation was used to assess treatment response, and adverse effects were recorded and graded based on standard clinical criteria. The analysis was done in SPSS version 26, and p < 0.05 was taken to be significant.

Results: The mean age of patients was 51.8 ± 10.2 years, with 62.9% presenting at advanced stages. In 28.6% of patients, complete response was observed, and in 40.0% percent, partial response was observed, which had an overall positive response rate of 68.6%. It was observed that 17.1% and 14.3% of patients experienced stable disease and progression, respectively. Alopecia (74.3%), nausea/vomiting (65.7%), neutropenia (57.1%), and anemia (48.6%) were the most frequent adverse reactions. Grade III–IV toxicity was observed in 25.7% of the patients and was strongly related to worse treatment outcomes (p = 0.021).

Conclusion: Combination chemotherapy demonstrates substantial effectiveness in ovarian cancer management; however, pharmacological adverse effects, particularly severe toxicities, significantly impact treatment outcomes. To maximize therapeutic efficacy and enhance patient quality of life, early identification and proper management of these adverse effects are crucial.

Endometrial Abnormalities in Women with Abnormal Uterine Bleeding, Association with Obesity, Hormonal Disturbances, and Treatment Patterns. A Clinical Cross-Sectional Study

Sat, 28 Feb 2026 00:00:00 +0100

Background: Abnormal uterine bleeding (AUB) is a prevalent gynecological disorder associated with significant morbidity and is frequently linked to endometrial abnormalities, hormonal disturbances, and metabolic factors such as obesity. Early identification of underlying endometrial pathology is essential to guide appropriate management and prevent progression to premalignant or malignant conditions.

Objective: To assess the range of endometrial abnormalities in women with AUB and to examine how they are related to obesity, hormonal derangements, and treatment patterns.

Methods: This cross-sectional study was conducted on 100 women presenting with AUB from January 2024 to January 2025 at the Department of Obstetrics and Gynaecology, Sandeman Provincial Hospital, Quetta, Pakistan. Clinical evaluation, body mass index (BMI) assessment, hormonal profiling (TSH, estrogen, progesterone), ultrasonography, and endometrial biopsy were performed. The analysis was conducted with SPSS version 26, and p < 0.05 was regarded as statistically significant.

Results: The average age of the participants was 38.9 ± 7.8 years, with 48.0% of them being obese. Abnormalities of the endometria were found in 70.0% of patients, with the most frequent pattern of hormonal imbalance (28.0%), proliferative (17.0%), and secretory endometria (13.0%). A diagnosis of endometrial hyperplasia was made in 9.0% of cases, and carcinoma was confirmed in 2.0%. Hormonal imbalances occurred in 56.0% of the patients, with hypothyroidism being the most prevalent (32.0%). Statistically significant correlation was found between endometrial hyperplasia and obesity (p = 0.02). In 65.0% of the patients, medical management was used, and 35.0% of the patients needed surgical intervention.

Conclusion: Hormonal imbalance and obesity are closely interrelated with endometrial abnormalities in AUB. Detailed testing, such as hormonal and histopathological examination, is essential in making a proper diagnosis and effective management.

Integrated Evaluation of Serum Oxidative Stress Markers and Histopathological Grading in Predicting Early Organ Damage in Type 2 Diabetes Mellitus

Sat, 28 Feb 2026 00:00:00 +0100

Background: Type 2 diabetes mellitus (T2DM) is a persistent metabolic illness linked with an advancement of microvascular and macrovascular issues. Oxidative stress has a critical role in the pathogenesis of diabetic organ injury, but its combination with histopathological grading to predict early remains underdeveloped.

Objective: To assess the relationship between serum oxidative stress markers and histopathological grading in accurately forecasting early organ damage in T2DM patients.

Methods: This cross-sectional clinical study was conducted from June 2024 to June 2025 at Gujranwala Medical College, Gujranwala, Pakistan, and Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan. One hundred and twenty (120) T2DM patients (35–65 years old) were recruited by non-probability consecutive sampling. The ELISA was used to measure serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH). The tissue biopsies were histopathologically graded using standard criteria (Grade I–III). The statistical analysis involved the use of SPSS version 26, with p < 0.05 being significant.

Results: The average age of the participants was 53.1 ± 9.2 years, and 56.7% were males. The mean HbA1c level was 9.2 ± 1.5%. Elevated MDA levels (4.9 ± 1.3 nmol/mL) and reduced antioxidant markers SOD (2.0 ± 0.7 U/mL) and GSH (3.1 ± 1.0 µmol/L) were observed. The histopathological changes were 31.7% Grade I, 43.3% Grade II, and 25.0% Grade III. The increase in MDA (3.3 ± 0.9 to 6.1 ± 1.4 nmol/mL) and the corresponding decrease in SOD and GSH levels (p < 0.001) corresponded with increasing grades. There was a high positive correlation between MDA and tissue damage (r = +0.71) and negative correlations for SOD (r = −0.57) and GSH (r = −0.62). Early organ damage in 61.7% of patients was mostly the kidneys (38.3%) and the liver (23.3%).

Conclusion: Histopathological severity is closely linked with serum oxidative stress markers, which can be used as quality early predictors of organ damage in T2DM. Biochemical analysis combined with histological analysis is a promising method of early diagnosis and risk stratification.

Comparative Efficacy and Tolerability with Tirzepatide and Semaglutide in Obesity and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Sat, 25 Apr 2026 00:00:00 +0200

Obesity and type 2 diabetes mellitus(T2DM) are major global metabolicdisorders associated with substantialmorbidity and mortality. Incretin-basedtherapies have demonstrated significantbenefits in glycemic control and weight reduction

Association between Academic Burnout and Physiological Stress Indicators in Medical Students

Fri, 24 Apr 2026 00:00:00 +0200

Background: Academic burnout is increasingly recognized as a significant concern among medical students due to prolonged academic demands, high expectations, and psychological pressure. Burnout is commonly characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. While its psychological impact has been widely studied, its association with physiological stress indicators remains less explored. Understanding this relationship is essential for early identification and intervention to protect students’ well-being and academic performance.

Objective: This study aimed to examine the association between academic burnout and physiological stress indicators among medical students, focusing on measurable biomarkers such as cortisol levels, heart rate variability (HRV), and blood pressure.

Methodology: A cross-sectional study was conducted among 250 medical students enrolled in different academic years at a university. Academic burnout was assessed using the Maslach Burnout Inventory–Student Survey (MBI-SS), which evaluates emotional exhaustion, cynicism, and academic efficacy. Physiological stress indicators were measured through salivary cortisol samples collected at baseline and during examination periods, resting heart rate variability using wearable monitors, and blood pressure readings. Data were analyzed using correlation and regression analyses to determine associations between burnout levels and physiological markers, controlling for confounding variables such as age, gender, sleep quality, and physical activity.

Results: The findings revealed a significant positive correlation between emotional exhaustion and elevated cortisol levels. Academic burnout was prevalent among medical students, with 38% experiencing high burnout, increasing progressively across academic years. High burnout was significantly associated with elevated cortisol levels, reduced heart rate variability, and higher systolic blood pressure (p < 0.05). Emotional exhaustion showed the strongest correlation with physiological stress markers, particularly cortisol (r = 0.42) and HRV (r = –0.47). Additionally, cortisol levels significantly increased during examination periods, highlighting the impact of acute academic stress.

Conclusion: The study demonstrates a clear association between academic burnout and adverse physiological stress responses among medical students. These findings highlight the importance of addressing burnout not only as a psychological issue but also as a condition with measurable biological consequences. Early interventions, stress management programs, and institutional support systems are recommended to mitigate burnout and promote both mental and physical health in medical students.

Comparison of Modified Chair and Non-Traction Kocher Reduction Techniques for Anterior Shoulder Dislocation: A Randomized Controlled Trial

Mon, 20 Apr 2026 00:00:00 +0200

Background: Anterior shoulder dislocation is the most common large joint dislocation encountered inemergency departments. Traditional traction-based reduction techniques often require significant force, causeprocedural pain, and frequently necessitate sedation. Biomechanical methods such as the modified chairtechnique have been proposed as less painful alternatives; however, randomized comparative evidence remains limited

Correlation of Serum Vitamin D Levels with Severity of Oral Submucous Fibrosis; A Cross-Sectional Study Evaluating Clinical Staging and Grading

Mon, 20 Apr 2026 00:00:00 +0200

Introduction: Oral Submucous Fibrosis (OSMF) is a progressive chronic and possibly malignant disorderthat is on the rise among the South Asian populations. Vitamin D, which has been said to haveimmunomodulatory and anti-fibrotic effects, could be involved in the pathogenesis and progression ofOSMF. This paper set out to assess the relationship between Vitamin D concentration in the serum and the severity of OSMF

Iron Deficiency in Haemophilia- Severity, Correlation and Clinical Profile- A Cross Sectional Study from South India

Seba Miriam David, T.R Radha, Irshad Ali K M — Sat, 25 Apr 2026 00:00:00 +0200

Haemophilia is an inherited X-linked recessive disorder caused by deficiency of Factor VIII or Factor IX which is required for the generation of Thrombin in the intrinsic pathway of coagulation. India has the second highest burden of haemophilia in the world. Iron deficiency is expected in these vulnerable population due to either presence of occult blood loss in urine/stool or deposition of iron in the synovium during the repeated episodes of bleeding. This study was to estimate the proportion of iron deficiency and to determine the association of severity of Haemophilia with the stage of iron deficiency in individuals with Haemophilia and to determine the clinic aetiological and haematological profile of iron deficiency in haemophiliac patients. Methods: The patients confirmed with Factor VIII/IX deficiency attending the Haemophilia OPD of Government Medical College, Kottayam during a period of 1 year were recruited. They were classified as mild (6-40%), moderate (1- 5%) and severe(<1%) based on their factor levels. Data collection was done using a case report form which included clinical characteristics of patients along with targeted blood investigations. The analysis was done using SPSS software. The data were summarized using descriptive and correlational statistics. Results: The proportion of iron deficiency in individuals with Haemophilia was found to be 27.1%. Of those with iron deficient erythropoiesis 66.7% had severe Haemophilia A and 9.5%had Haemophilia B. Of those with iron deficiency anemia 57.1% had severe Haemophilia A and 42.9% had severe Haemophilia B. Of the patients with low ferritin were 75% found to have iron deficient erythropoiesis while 25% were found to have iron deficiency anemia. The most common symptom associated with iron deficiency was muscular pain, joint pain, palpitations and shortness of breath .The most common sign associated with iron deficiency anemia was papillary atrophy of the tongue.

Conclusion: The proportion of iron deficiency in individuals with Haemophilia was found to be 27.1%. The more the severity of Haemophilia, the higher was the stage of iron deficiency of the patient.

Assessment of Insulin Resistance Using Fasting Biochemical Markers and its Association with Basal Metabolic Rate Variations

Mon, 27 Apr 2026 00:00:00 +0200

Objective: To assess insulin resistance using fasting biochemical markers and to evaluate its association with variations in basal metabolic rate.

Methods: This cross-sectional analytical study was conducted on 120 participants aged 20–60 years. Fasting blood samples were collected to measure glucose, insulin and lipid profile parameters. Insulin resistance was calculated using the Homeostatic Model Assessment (HOMA-IR). Basal metabolic rate was estimated using the Harris-Benedict equation. Participants were categorized into insulin-sensitive and insulin-resistant groups. Statistical analysis was performed using SPSS version 22 and correlations between HOMA-IR and BMR were assessed.

Results: The mean age of participants was 38.6 ± 10.2 years with a mean BMI of 26.1 ± 4.3 kg/m². Insulin resistance was present in 61.7% of participants. The insulin-resistant group showed a significantly higher BMR (1622.8 ± 245.7 kcal/day) compared to the insulin-sensitive group (1485.6 ± 210.4 kcal/day) (p = 0.012). A moderate positive correlation was observed between HOMA-IR and BMR (r = 0.34, p = 0.004).

Conclusion: Insulin resistance is highly prevalent and is significantly associated with increased basal metabolic rate. Fasting biochemical markers provide a simple and effective method for its assessment. Understanding this relationship may help in early identification and management of metabolic disorders.

Comparing Intubation Techniques in Mannequin during Ongoing CPR: Conventional Non-Styleted, Conventional Styleted, Conventional Kiwi Grip, and Video Laryngoscopy –A Simulation Based Observational Study.

Sat, 25 Apr 2026 00:00:00 +0200

Background: Airway management during cardiopulmonary resuscitation (CPR) is technically challenging, and interruptions in chest compressions may adversely affect resuscitation quality. While video laryngoscopy has been increasingly adopted in emergency settings, evidence comparing different intubation techniques during ongoing CPR—particularly with respect to procedural efficiency—remains limited.

QUALITY OF LIFE OF COLORECTAL CANCER SURVIVORS IN A TERTIARY CARE CENTRE IN NORTH INDIA: A CROSS-SECTIONAL STUDY.

Sat, 25 Apr 2026 00:00:00 +0200

Background: Advances in diagnosis and treatment have improved survival in colorectal cancer (CRC), shifting focus toward long-term health-related quality of life (HRQoL). However, Indian data on HRQoL in CRC survivors remain limited.Aim: To assess HRQoL among CRC survivors and identify associated clinical and socio-demographic factors.

Ct-Based Morphometric Study of Sphenoid Sinus Pneumatization Patterns and Septal Variations in Adults

Tue, 28 Apr 2026 00:00:00 +0200

Objective: To evaluate sphenoid sinus pneumatization patterns, septal variations, and morphometric dimensions in adults using CT imaging, and to identify clinically relevant anatomical variations.

Materials and Methods: This descriptive cross-sectional study was conducted on 200 adult CT scans of the paranasal sinuses and head obtained from patients aged 18 years and above. CT images with adequate visualization of the sphenoid sinus were included, while scans with trauma, prior surgery, congenital anomalies, or destructive lesions were excluded. Multidetector CT images were analyzed in axial, coronal, and sagittal planes. Pneumatization was classified into conchal, presellar, sellar, and postsellar types. Septal number, deviation, accessory septa, insertion sites, and morphometric parameters including anteroposterior diameter, transverse width, and vertical height were recorded. Data were analyzed using SPSS version 25.0.

Results: The study population included 112 males (56%) and 88 females (44%), with a mean age of 41.6 ± 13.2 years. The most common pneumatization pattern was sellar type (59.0%), followed by postsellar (23.0%), presellar (14.0%) and conchal type (4.0%). Lateral pneumatization was most frequently seen in the pterygoid process (31.0%): and greater wing (27.0%). A single midline septum was present in only 36.0% of cases, while deviated septum was observed in 42.0%, multiple septa in 29.0%, and accessory septa in 17.0%. Septal attachment to the carotid canal prominence was noted in 24.0% and to the optic canal in 11.0% of cases. Mean sphenoid sinus dimensions were significantly larger.

Conclusion: The sphenoid sinus demonstrates marked variability in pneumatization, septal anatomy, and dimensions among adults. Sellar pneumatization is the predominant pattern, while septal deviations and clinically significant attachments to adjacent neurovascular structures are common. Preoperative CT evaluation is essential for accurate surgical planning and for minimizing complications during endoscopic and transsphenoidal procedures.

Clinical Profile and Management Outcomes of Necrotizing Fasciitis: A Prospective Observational Study of 48 Cases

Tue, 28 Apr 2026 00:00:00 +0200

Introduction: Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection associated with high morbidity and mortality. Early diagnosis and aggressive management are crucial for improving outcomes.

Aim: To evaluate the clinical profile, microbiological spectrum, and management outcomes of necrotizing fasciitis.

Methods: This prospective observational study included 48 patients diagnosed with NF over 18 months in General Surgery Department at Vedanta Institute of Medical Sciences Palghar, a tertiary care center catering to tribal population. Data regarding demographics, clinical presentation, comorbidities, microbiology, treatment, and outcomes were analyzed using descriptive statistics.

Results: The mean age was 65.5 years, with male predominance (85.4%). Lower limb involvement was most common (58.3%). Diabetes mellitus was the most frequent comorbidity (43.7%). Monomicrobial infections were predominant (68.7%), with Staphylococcus species being the most common organism (20.8%). Surgical debridement was performed in 83.3% of cases. The most common complication was dermal gangrene (87.5%). No mortality was observed.

Conclusion: Early diagnosis and prompt surgical intervention significantly reduce morbidity and mortality in necrotizing fasciitis.

Role of Exercise in the Management of Diabetes Mellitus

Wed, 29 Apr 2026 00:00:00 +0200

Background: Type 2 diabetes mellitus (T2DM) is a growing global health challenge associated with significant metabolic and cardiovascular complications. Exercise is widely recognized as a key non-pharmacological intervention; however, the patterns of physical activity among individuals with T2DM and their relationship with glycemic outcomes remain underexplored in many populations.

Objective: To evaluate the types and frequency of exercise performed by adults with T2DM and to examine their association with glycemic control and metabolic health indicators in a cross-sectional clinical setting.

Methodology: The study utilized a cross-sectional design and included 80 participants recruited through consecutive sampling based on predefined eligibility criteria. Data was collected at a single point in time using a structured proforma capturing demographic details and clinical variables. All clinical assessments were performed by trained investigators following standardized procedures to ensure reliability and reduce measurement bias. Data accuracy was maintained through double-entry verification. Ethical approval was obtained, and informed consent was secured from all participants. Statistical analysis involved appropriate descriptive and inferential tests according to data distribution, with significance set at p < 0.05.

Results: The study population predominantly comprised middle-aged individuals (46–60 years, 37.5%) with a slight male predominance (52.5%), and most participants reported primary/secondary education and sedentary occupations. Clinically, participants had a mean diabetes duration of 6.8 ± 3.5 years, were generally overweight (BMI 27.5 ± 4.2 kg/m²), and exhibited suboptimal glycemic control (HbA1c 8.1 ± 1.2%), with a high prevalence of hypertension (45%) and dyslipidemia (35%). Aerobic exercise was the most reported activity (50%), whereas only 22.5% engaged in combined aerobic and resistance training, and half of the participants exercised 3–4 times per week.

Conclusion: This cross-sectional study of 80 adults with T2DM demonstrates a strong association between regular physical activity and improved glycemic and metabolic outcomes. Aerobic and resistance training independently contributed to better blood glucose control, while combined exercise produced the greatest overall benefit. Structured exercise performed at least three times weekly should be promoted as an integral component of T2DM management in clinical practice.

The Association of Indications of Third Molar Coronectomy and Surgical Removal with Pell & Gregory and Winter Classification

Sat, 25 Apr 2026 00:00:00 +0200

Objective: This study aimed to assess the association between the choice of third molar treatment,coronectomy or surgical extraction and their classification based on Pell & Gregory and Winter Classification systems
Methodology: A descriptive cross-sectional study conducted in the department of Oral &Maxillofacial Surgery, Lady Reading Hospital, Peshawar from January 2023 to January 2024. This study includes 150 patients. Age selected was 18-40 years. The mandibular third molar impaction was assessed using Digital panoramic radiograph. Eligible patients were further assessed by CBCT to know the mandibular impaction and IAN relationship.The Data was analyzed using SPSS 23.0. Chi-square statistics was used for association and p< 0.05 was considered statistically significant.

The Retrospective Analysis of Management & Clinical Outcomes of Closed and Open Reduction of Zygomatic Complex Fracture

Mon, 20 Apr 2026 00:00:00 +0200

Objectives: This study aimed to determine the management and clinical outcomes of ZMC fracture Methodology: This was a retrospective study and was conducted from January 2022 to December 2023 in the Department of Oral & Maxillofacial Surgery, Lady Reading Hospital, Peshawar. A total of 86 patients of both genders were selected. The diagnosis was made on the CT scan of the face. The data was collected from the hospital record. SPSS version 23.0 was used to analyze data. Chi-square statistics were used for association between treatment approach and incidence of ZMC fracture and side of ZMC fracture keeping level of significance p<0.05.

A Cross-Sectional Study on the Prevalence of Anemia and Its Associated Factors Among Pregnant Women Attending a Tertiary Care Hospital

Dr Leela Vitthal Karpe, Dr.Poonam Ramrao Kalyankar,Dr.Neelam Dilip Bagal — Wed, 29 Apr 2026 00:00:00 +0200

Background: Anemia in pregnancy is a major public health concern, particularly in developing countries, and is associated with adverse maternal and fetal outcomes. Despite ongoing national programs, the prevalence of anemia remains high, necessitating further evaluation of its burden and associated risk factors. Aim: To determine the prevalence of anemia and its associated factors
among pregnant women attending a tertiary care hospital.

Re-establishment of the IPTH reference range in apparently healthy donors: A single centre cross-sectional observational study

Wed, 29 Apr 2026 00:00:00 +0200

Background: Establishment of reference ranges for intact parathyroid hormone (IPTH) is essential for accurate assessment of parathyroid function. Variability among assay platforms necessitates population- and method-specific reference intervals.
Objective: To estimate the reference range of serum IPTH in apparently healthy donors.

A study of prevention of post-anaesthesia shivering (PAS) in patients undergoing LSCS under spinal anaesthesia in a tertiary hospital

Dr Vandana Yada, Dr jaiveer, Dr Savita Rathi — Wed, 29 Apr 2026 00:00:00 +0200

Background: Postanesthesia shivering (PAS) is a common complication following spinal anesthesia, particularly in obstetric patients. 5-HT3 receptor antagonists such as ondansetron and palonosetron have been studied for its prevention, but comparative data are limited. Aim: To compare the efficacy of palonosetron and ondansetron in preventing post-spinal shivering in patients undergoing elective lower segment cesarean section (LSCS).

Role of Vitamin D3 Supplementation in the Management of Chronic Rhinosinusitis without Nasal Polyposis: A Prospective Comparative Study

Dr Rati Ram Barle, Dr. Bijay Kumar Mahaseth, Dr Shashank Barle — Wed, 29 Apr 2026 00:00:00 +0200

Background: Chronic rhinosinusitis (CRS) is a common inflammatory condition of the paranasal sinuses that significantly affects quality of life. Emerging evidence suggests a potential role of vitamin D in immune modulation and inflammation; however, its therapeutic role in CRS remains uncertain. Objective: To evaluate the effect of oral vitamin D3 supplementation on clinical symptoms and radiological
outcomes in patients with chronic rhinosinusitis without nasal polyposis (CRSsNP).

A Comparative Study of No Antibiotic versus Single Dose Prophylactic Antibiotics in Clean and Clean Contaminated Surgical Cases

Dr. Mythreye Sm. R., Dr. Pushpa Satish Kumar, Dr. Nithya T., Dr. Ananda B.B — Wed, 29 Apr 2026 00:00:00 +0200

Background: Surgical site infections remain a significant cause of postoperative morbidity, increasing hospital stay and healthcare costs. Although antibiotic prophylaxis has improved surgical outcomes, its overuse contributes to antimicrobial resistance and adverse effects. The necessity of prophylactic antibiotics in clean and clean-contaminated surgeries remains controversial. This study evaluates the role of single-dose prophylactic antibiotics compared to no antibiotic use in preventing SSI (Surgical Site Infections).

Methods: This randomized prospective study was conducted on 100 patients undergoing clean and clean-contaminated surgeries between December 2017 and April 2019. Patients were divided into two groups: Group A (n=50) received a single preoperative dose of third-generation cephalosporin, and Group B (n=50) received no antibiotics. Wounds were assessed for SSI on postoperative days 2, 5, and 7 using Southampton scoring. Statistical analysis was performed using chi-square and t-tests with significance set at p<0.05.

Results: Out of 100 patients, 17% developed SSI. In Group A, 18% (9 patients) developed SSI, while in Group B, 16% (8 patients) developed SSI. No statistically significant association was found between antibiotic use and SSI occurrence (p=0.590). SSI rates were 14% in clean cases and 20% in clean-contaminated cases. Risk factors such as prolonged preoperative hospital stay, advanced age, smoking, diabetes, and drain placement contributed to higher SSI incidence. No significant association was observed with sex, BMI, or smoking individually. Conversion from no-antibiotic to full antibiotic therapy occurred in 6% of cases.

Conclusion: Single-dose prophylactic antibiotics did not significantly reduce SSI compared to no antibiotic use in clean and clean-contaminated surgeries. SSI occurrence is more strongly associated with patient-related and procedural risk factors rather than antibiotic prophylaxis alone. Rational antibiotic use, improved surgical techniques, and risk factor management are essential to minimize SSI and prevent antibiotic resistance.

Retrospective Hospital Data Based Study on Acute Otitis Media: A Tertiary Care Centre Experience

Wed, 29 Apr 2026 00:00:00 +0200

Background: Acute otitis media (AOM) falls under the spectrum of Otitis media which is an inflammatory condition of the middle ear. Middle ear diseases have a significant burden on our health system and poses as an important cause of morbidity especially in the paediatric population. The Eustachian tube (ET) connects middle ear and nasopharynx and plays an important role in fluid drainage from middle ear as well as in maintaining middle ear pressure. Dysfunction in the ET, either anatomical or physiological causes AOM. Patients may present with a wide spectrum of symptomatology which maybe localised or both localised and systemic symptoms and signs. The study was done to see the prevalence and the pattern of distribution of AOM with respect to age, sex, presenting complaints and laterality in patients attending ENT OPD, NMCH, Nagaon.

Methods: This was a 2 years hospital based retrospective cross-sectional study conducted over 268 patients attending the Department of ENT at Nagaon Medical College Hospital, Nagaon and diagnosed as a case of Acute Otitis Media.

Results: Most patients with AOM belonged to the age group within 15 years (38.3%). 51.1% patients were male while 48.9% were female with Male: female ratio being 1.04:1. Earache was the commonest symptom which was seen in 79.5% cases followed by fever (73.5%) and hearing impairment 38.4%. AOM was more common in winter season in our study (38.4%) as compared to rainy and summer seasons. Maximum cases presented were unilateral (81.3%) compared to cases presenting in both ears (18.7%). Most of the patients presented with congested tympanic membrane (60.1%) while 14.9% presented with perforation of tympanic membrane.

Conclusion: AOM is a common middle ear disorder and an important health concern causing significant morbidity in all age groups. The major risk factors that contribute to the prevalence of AOM are sub- standard living conditions, overcrowding, exposure to smoke, and limited access to medical care. Hence early education on risk factors, diagnosis and management may reduce the disease burden of AOM, thus preventing hearing loss.

Exploring the Link between Attributional Styles and Learned Helplessness in Medical Postgraduates in Pakistan: A Qualitative Interview Study

Thu, 30 Apr 2026 00:00:00 +0200

Background:Medical postgraduate education in Pakistan is marked by a lot of stress, working long hours as well as being hard on academics. Such setting can make the trainees susceptible to maladaptive forms of thinking. An established antecedent of learned helplessness is attributional style, or ways in which people elaborate on the causes of negative events, and as a consequence develop a state of apathy and perceived powerlessness. Nonetheless, the relationship between the two constructs is under researched in the Pakistani medical education settings.

Purpose: To investigate the connection between attributional styles (internal/external, stable/unstable, and global/specific) and development of learned helplessness among medical postgraduates in Pakistan.

Methods:The qualitative exploratory design was used. Thesemi-structured interviews with 25 postgraduates (residents) of theteaching hospitals in the public sector were carried out in the period between January 2025and March 2025in Sindh, Pakistan. It was a purposive sample of participants to ensure that first year trainees, second year trainees and third year trainees are represented.

Results:Patterns of attributions and helplessness behaviors were determined through thematic analysis. Findings: Four key themes were identified which comprise: (1) Internal, stable, and global attributions of academic failures (e.g., I am naturally incompetent)(2) External, unstable attributions of successes (e.g., luck or easy case)(3) manifestations of learned helplessness (e.g. reduced studying efforts, emotional withdrawal) and, (4) systemic and hierarchical influences including.

Conclusion:Pakistani medical postgraduates who have learned helplessness have a strong association with maladaptive attributional styles. Interventions promoting adaptive attributions and systemicsupport are urgently needed.

Optimization of Laryngoscopy and Intubation: Effect of Head Elevation and Pharmacological Modulation on Glottic View and Hemodynamic Response – A Combined Analytical Study

Dr. Anamika Gupta, Dr. Shruti Kabi, Dr. Pragya Verma — Fri, 01 May 2026 00:00:00 +0200

Background: Optimal laryngoscopic view and attenuation of hemodynamic stress during endotracheal intubation (ETI) remain critical challenges in anaesthesia practice. Positioning (head elevation) and pharmacological agents such as dexmedetomidine and lignocaine play significant roles.
Objective: To evaluate the effect of head elevation on glottic visualization and intubation difficulty, and the efficacy of dexmedetomidine versus lignocaine in attenuating hemodynamic stress response.

Effectiveness of Simulation-Based Versus Traditional Teaching in Medical Education: A Systematic Review and Meta-Analysis

Fri, 01 May 2026 00:00:00 +0200

Background:
Simulation-based education has emerged as a transformative approach in medical training, enabling learners to acquire clinical skills in a safe and controlled environment. However, its comparative effectiveness against traditional teaching methods remains variably reported.

Effect of Sevoflurane versus Propofol-Based Anesthesia on the Hemodynamic Response and Recovery Characteristics in Patients Undergoing Congenital Diaphragmatic Hernia Repair

Thu, 30 Apr 2026 00:00:00 +0200

Background: CDH is a severe congenital disorder that involves hernia of abdominal organs into the thoracic cavity, causing respiratory dysfunction and pulmonary hypoplasia. The ultimate treatment is surgical repair, but anesthetic management is important to provide hemodynamic stability and a safe postoperative course. Others The various methods of anesthesia can affect cardiovascular reactions
during the operation and outcome post operative.

Simulation-Based Training vs Bedside Teaching in Skill Acquisition in Medical Education

Thu, 30 Apr 2026 00:00:00 +0200

Background: Undergraduate medical education is an essential part of acquiring skills. Conventional bedside education has been the mainstay of clinical education, but simulation-based education has become a new phenomenon that offers a safe and controlled learning space.

Comparison of Wilson’s Score and Intubation Prediction Score in Predicting Difficult Airway: A Prospective Single‑Blind Observational Study

Sat, 02 May 2026 00:00:00 +0200

Background: Anticipation of a difficult airway remains central to safe anaesthesia practice.Multiple bedside scoring systems exist; however, their diagnostic accuracy varies across populations and settings. Aim: To compare the diagnostic performance of Wilson’s Score and the Intubation Prediction Score (IPS) in predicting difficult airway, using Intubation Difficulty Scale (IDS) as the reference standard.

Frequency and Clinical Patterns of Hyperpigmentation in Patients with Megaloblastic Anemia at a Tertiary Care Hospital

Khursheed Ahmed Sahito — Sun, 03 May 2026 00:00:00 +0200

ObjectiveTo determine the prevalence, patterns, andhematological correlations ofhyperpigmentation in patients with megaloblastic anemia.

Study Design: This was a cross-sectionalstudy

The Role of Glycemic Biomarkers in the Third Trimester of Pregnancy for Improving Pregnancy Outcomes

Kongbrailatpam Jaishree Devi, Jaspreet Kaur, Bhumika Upadhyay — Mon, 04 May 2026 00:00:00 +0200

Background: Gestational diabetes mellitus (GDM) is a common pregnancy disorder associated with adverse maternal and neonatal outcomes. During the third trimester, increased insulin resistance and rapid fetal growth require accurate glycemic monitoring. However, conventional markers like RBS and HbA1c have limitations, making short-term markers such as fructosamine, albumin-corrected fructosamine (ACF), and fructosamine–albumin ratio (FAR) useful alternatives for predicting outcomes.

Aim: To review the role of glycemic biomarkers in the third trimester of pregnancy and evaluate their usefulness in predicting adverse pregnancy outcomes in women with gestational diabetes mellitus.

Materials and Methods: A narrative review was conducted using published studies retrieved from electronic databases and relevant reference sources regarding glycemic biomarkers in gestational diabetes mellitus. Studies evaluating RBS, HbA1c, fructosamine, serum albumin, albumin-corrected fructosamine, and fructosamine-albumin ratio during the third trimester and their association with maternal and neonatal outcomes were reviewed.

Results: RBS provides only an immediate estimate of glycemia and has limited value in assessing overall glycemic control. HbA1c reflects long-term glycemic status over 8–12 weeks but may underestimate hyperglycemia during late pregnancy due to increased erythrocyte turnover, anemia, and hemodilution. Fructosamine reflects short-term glycemic control over 2–3 weeks but is influenced by serum albumin concentration. ACF and FAR minimize the effect of hypoalbuminemia and demonstrate a stronger association with adverse pregnancy outcomes, including fetal macrosomia, large-for-gestational-age infants, preterm birth, neonatal hypoglycemia, hypertensive disorders, and increased cesarean delivery.

Conclusion: Fructosamine-based biomarkers, especially ACF and FAR, appear to be superior to conventional markers for evaluating glycemic control during the third trimester. Their use may improve the prediction of adverse pregnancy outcomes and optimize the management of gestational diabetes mellitus.

Why Your Hands Tingle During Pregnancy: The Science Behind Carpal Tunnel Syndrome

Munazza Ayub, Yad Zaman Khan, Sumera Begum, Humaira Bibi, Saiqa Noor, Uzma Wahid — Mon, 20 Apr 2026 00:00:00 +0200

Background: One of the most prevalent neurological conditions that arise during pregnancy is carpaltunnel syndrome, which is mostly caused by changes in hormones, fluid retention, and prenatal weight gain

Pregnancy Outcomes and Fetometrnal Complications in Mild to Moderate Mitral Stenosis Patients Presenting to DHQ's Teaching Hospital Timergara

Sumera Begum, Sajjad Khan, Munazza Ayub, Humaira Bibi, Saiqa Noor, Rehana Yasmin — Tue, 05 May 2026 00:00:00 +0200

Background: In areas where rheumatic heart disease is common, mitral stenosis continues to be asignificant cardiac issue that complicates pregnancy. Because of the hemodynamic demands ofpregnancy, even mild to severe illness can become clinically serious. The aimThe purpose of this study was to assess the fetal and maternal outcomes of pregnant patients with mild to moderate mitral stenosis in a tertiary care environment

Comparison of Simulation-Based Training and Bedside Teaching in Enhancing Clinical Skill Acquisition among Medical Students

Tue, 05 May 2026 00:00:00 +0200

Background: Learning of clinical skills is an essential aspect of undergraduate medical training.Conventional bedside teaching has been the pillar of clinical training but simulation-based training is a novel training method that offers safe and controlled learning environment

Gut Enzyme Activity and Its Influence on Intestinal Morphology and Nutrient Absorption Efficiency

Tue, 05 May 2026 00:00:00 +0200

Background: Gut enzymes play a crucial role in gut function and nutrient absorption. Changes in gutenzyme activity could affect the intestinal structure and efficiency of nutrient absorption, resulting ingastrointestinal and nutritional disorders. The present research was designed to assess the activity of gut enzymes and their effect on intestinal structure and efficiency of nutrient absorption in adults

Impact of Preoperative Intravitreal Anti-VEGF on Vitrectomy for Proliferative Diabetic Retinopathy: A Prospective Study

Tue, 05 May 2026 00:00:00 +0200

Proliferative diabetic retinopathy (PDR)remains a major cause of vision lossworldwide, primarily due to fibrovascular
proliferationandvitreoushemorrhagerequiring pars plana vitrectomy (PPV). Thepresent prospective interventional study

From Exposure to Excretion: Impact of Environmental Heavy Metal Exposure on CKD and Urological Disorders in Pakistan

Tue, 05 May 2026 00:00:00 +0200

Environmental heavy metal exposure hasbeen a growing environmental health concernin South Asia, particularly in Pakistan, whereindustrialemissions,groundwater,inadequateagriculturalwastecontaminated runoff,managementand havecollectively contributed to chronic exposure

Early Imaging and Renal Biomarkers as Predictors of Urosepsis in Women with Diabetes Mellitus and Obesity with Gynecological Comorbidities

Tue, 05 May 2026 00:00:00 +0200

Urosepsis represents a life-threateningprogression of urinary tract infection,particularly in high-risk populations such aswomen with diabetes mellitus, obesity, andconcurrentgynecological comorbidities.Early identification of patients at risk remainschallenging due to nonspecific clinicalpresentation and overlapping

Surgical Outcomes of Vitrectomy for Endophthalmitis Following Cataract Surgery: A Pakistani Perspective

Tue, 05 May 2026 00:00:00 +0200

Post-cataractsurgeryendophthalmitisrepresents a vision-threatening ophthalmicemergency requiring prompt surgicalintervention, most commonly pars plana vitrectomy.Despite advancements

Early Surgical Decompression in Cervical Traumatic Spinal Cord Injury and Its Impact on Airway and Otorhinolaryngological Outcomes

Tue, 05 May 2026 00:00:00 +0200

Cervical traumatic spinal cord injury is frequentlyassociatedwithlife-threatening respiratorycompromise and significant otorhinolaryngologicalcomplications due to impaired neuromuscular controlof the airway. Early surgical decompression has been proposed to mitigate secondary injury and improvefunctional outcomes;

Early versus Delayed Tracheostomy in Mechanically Ventilated Patients: Effects on Intensive Care Unit Stay, Ventilator days and Mortality

Tue, 05 May 2026 00:00:00 +0200

Background: Tracheostomy is commonly performed in mechanically ventilated patients to facilitateairway management and weaning. However, the optimal timing of tracheostomy remains controversial, particularly regarding its impact on ICU outcomes and mortality.

A comparative study to assess the quality of life of senior citizen living with family at selected urban and rural area of Kanpur.

Subhash Sharma, Dr. Josfeena Bashir — Wed, 06 May 2026 00:00:00 +0200

Clinical Profile and Management of 172 Cases of Surgical Site Infections at Gmc Baramulla (J&K)

Shiekh Mehmood Rashid, Md Kamran Akhter, Sheikh Aamir Rashid — Wed, 06 May 2026 00:00:00 +0200

Background: Surgical site infections (SSIs) are the third most common infections among hospitalized patients in our country [1]. These account for 14% to 16% of nosocomical infections in all hospitalized patients [2] and a substantial cause of morbidity and mortality among such patients [3].

Objectives: To study the incidence and risk factors involved leading to SSIs among hospitalized patients in North Kashmir and to identify the service areas in our hospitals which need to be strengthened to decrease the incidence of SSIs.

Methodology: A five year prospective study of SSIs from December 2020 to November 2025 was undertaken in the Department of General Surgery, Govt. Medical College Baramulla, Kashmir. The involved host factors, wound factors and surgery related factors were studied. Culture sensitivity tests of surgical sites were done by standard methods and antibiotics were prescribed accordingly. Results: Elective clean surgeries showed less chances of SSIs compared to emergency and potentially infected ones. Prolonged surgical time (more than 2.0 hours) was significantly associated with occurrence of SSIs. Escherichia coli was the most common organism grown on culture in 33.72 % patients followed by Staphylococcus aureus in 26.74% patients and Pseudomonas aeruginosa in 19.77% patients.The overall incidence of SSIs among the patients studied was found to be 8.00% Conclusion: The results obtained from our study revealed that in order to decrease the incidence of SSIs in our setup, we have to focus on intensive preoperative preparation of patients, decrease the surgical time, focus on optimization of poor risk patients and to undertake a regular surveillance of SSIs.

Accuracy of Fine Needle Aspiration Cytology in Differentiating Benign and Malignant Cervical Lymphadenopathy

Tue, 05 May 2026 00:00:00 +0200

Background: Cervical lymphadenopathy is a common clinical condition with a wide range of etiologiesfrom benign reactive processes to malignancies. Accurate differentiation is essential for appropriatemanagement.
Objective: To evaluate the diagnostic accuracy of fine needle aspiration cytology in differentiatingbenign and malignant cervical lymphadenopathy using histopathology as the gold standard

Lived Experience of Anatomy Students Challenging the Transition from Memorizing Structures to Exemplifying Clinical Application; A Qualitative Phenomenological Study Based on Medical Education

Tue, 05 May 2026 00:00:00 +0200

Background: Anatomy remains the bedrock of medical education, yet the pedagogical approach oftenfluctuates between traditional didacticism and modern clinical integration. Students frequently report asignificant cognitive gap when transitioning from preclinical memorization to clinical application.
Objective: This phenomenological study explores the lived experiences of final-year MBBS students atLoralai Medical College (LMCL) regarding their challenges in bridging the gap between basic anatomy and clinical practice

Correlation between Dry Eye Symptoms and Young Adult Motorcyclists

Zafar Iqbal, Sidra Zafar Iqbal — Tue, 05 May 2026 00:00:00 +0200

Background: Dry eye disease is a multifactorial eye complication that has been noted to be on theincrease among young adults especially when exposed to harsh environmental factors like wind, dust and air pollution during their daily commuting.

Preventing Macular Edema with Preoperative Intravitreal Bevacizumab in Diabetic Retinopathy Patients Undergoing Phacoemulsification

Sidra Zafar Iqbal, Zafar Iqbal — Tue, 05 May 2026 00:00:00 +0200

Background: Patients with diabetic retinopathy who have phacoemulsification may face a higher riskof postoperative macular edema that can greatly affect the visual results.
Objective: To measure the ability of preoperative intravitreal bevacizumab to prevent postoperativemacular edema and improve visual outcomes in diabetic retinopathy patients attending phacoemulsification

Plasma Lactate Levels and Lactate Clearance as Predictors of Outcome in Pediatric Sepsis and Septic Shock

Dr Sudhanshu Bajaj, Dr Vishal Sharma, Dr Abhishek Sachdev — Tue, 05 May 2026 00:00:00 +0200

Sepsis and septic shock are majorcauses of morbidity and mortality inpediatric patients. Early identification of high-risk patients is crucial forimproving outcomes. Blood lactatelevels and lactate clearance (LC) haveemerged as important biomarkers forassessing tissue hypoxia and guidingresuscitation

Evaluation of Postnatal Magnesium Sulfate Therapy on Neurological Outcomes of Term Neonates with Birth Asphyxia Admitted in a Tertiary Care Hospital

Dr. Rehana Sultana, Dr. Rupam Dubey, Dr. Juri Taye — Thu, 07 May 2026 00:00:00 +0200

Background: Perinatal asphyxia continues to drive a disproportionate share of preventable newborn deaths and lifelong neurological morbidity across the Indian subcontinent. Magnesium, a physiological blocker of the NMDA-type glutamate receptor, has biological grounds for limiting secondary neuronal injury after a hypoxic insult.

Objective: We sought to quantify the impact of an early postnatal magnesium sulfate regimen on neurological recovery, seizure burden, and discharge readiness in asphyxiated term newborns managed at a north-east Indian referral unit.

Methods: A parallel-arm, allocation-concealed and double-masked trial was undertaken in the level-III neonatal unit of a referral hospital in southern Assam. One hundred and twenty term newborns with intrapartum asphyxia were assigned 1:1 to either three deep intramuscular doses of 50 % magnesium sulfate (250 mg/kg per administration, spaced one day apart) or volume-matched saline through the same route. The pre-specified primary endpoint was the neurological examination at the time of nursery discharge. Pre-planned secondary endpoints captured convulsion frequency and recurrence, time to first enteral feed, cranial sonographic abnormalities, length of admission, and in-hospital death.

Results: The two arms were well matched at enrolment. By the time of nursery discharge, an unremarkable neurological examination was documented in 71.7 % of magnesium recipients against 51.7 % of controls (p = 0.03). Convulsions recurring three or more times affected 13.3 % versus 48.3 % (p < 0.001); the mean count of seizure episodes per neonate fell from 3.92 ± 2.11 in the saline arm to 1.43 ± 1.58 in the intervention arm (p < 0.001). Enteral feeds were tolerated by day two in 96.7 % of the magnesium group, compared with 81.7 % of controls (p = 0.01), and the length of admission was less than half — 3.10 ± 1.05 days against 5.48 ± 1.62 days (p < 0.001). Sonographic markers of hypoxic injury were also considerably less prevalent under magnesium (26.7 % versus 48.3 %; p = 0.02). Death before discharge trended lower in the intervention arm (3.3 % versus 10.0 %) without reaching the conventional threshold of significance (p = 0.17).

Conclusion: An early postnatal course of intramuscular magnesium sulfate yielded measurable gains in early neurological recovery and a substantial fall in seizure recurrence among asphyxiated term newborns. Confirmation in adequately powered multi-site investigations with neurodevelopmental endpoints at 18–24 months is the logical next step.

Magnitude and Pattern of Distribution of Cancer in a Tertiary Care Center in Jaipur, Rajasthan

Dr. Swati Setia, Dr. Aradhana Gupta, Dr. Charu Tripathi, Dr. Naresh N. Rai — Fri, 08 May 2026 00:00:00 +0200

Background: Cancer is a major global health concern with a steadily increasing burden in developing countries like India. Regional variations in cancer distribution necessitate localized data to support effective prevention and control strategies. This study aimed to assess the magnitude and pattern of cancer distribution in a tertiary care center in Jaipur, Rajasthan.

Methods: A retrospective, hospital-based observational study was conducted at a tertiary care center from January to December 2024. A total of 530 histopathologically confirmed cancer cases were included. Demographic details, site of cancer, and histopathological patterns were recorded. Data were analyzed using SPSS software, with categorical variables expressed as frequencies and percentages. Associations were assessed using the Chi-square test, considering p <0.05 as statistically significant.

Results: The majority of patients were in the 41–60 years age group (44.9%), followed by those aged >60 years (37.2%), with a slight male predominance (52.3%). Oral cavity cancer was the most common malignancy (21.3%), followed by genitourinary (15.1%) and lung cancers (11.9%). Cervical and gastrointestinal cancers each accounted for 7.0% of cases, while breast cancer constituted 4.3%. Squamous cell carcinoma was the predominant histopathological type (52.1%), followed by adenocarcinoma (22.3%). A significant association was observed between gender and site of cancer (p <0.001), with oral and lung cancers more common in males, and breast cancers more common in females.

Conclusion: The study highlights a substantial burden of cancer with distinct regional patterns, particularly a high prevalence of oral cavity cancers. These findings emphasize the need for targeted screening, tobacco control measures, and region-specific cancer prevention strategies.

Serum Procalcitonin and C - reactive protein as Predictors of Severity and Outcomes in Pediatric Sepsis. A Cross-Sectional Clinical Study

Fri, 08 May 2026 00:00:00 +0200

Background: Sepsis in children is a major cause of morbidity and mortality globally, especially in low- and middle-income countries where its early detection is challenging. Serum procalcitonin (PCT) and C-reactive protein (CRP) are now being used to determine disease severity and outcomes.

Aim: The aim of this study is to determine the diagnostic value of serum procalcitonin and C-reactive protein in the assessment of disease severity and prognosis of children with sepsis.

Methods: A cross-sectional study was conducted at Ghurki Trust Teaching Hospital, Lahore, Pakistan, from June 2023 to June 2025. One hundred children (1 month to 12 years) with sepsis were included. On admission, serum concentrations of PCT and CRP were determined. The severity of the disease and the outcome (recovery without complications, recovery with complications, and death) were used to categorise patients. Data were analysed with SPSS software version 26 (p-value < 0.05).

Results: Both biomarkers demonstrated significantly higher values in patients with severe sepsis compared to those with non-severe disease (PCT: 9.12 ± 2.36 vs 3.28 ± 1.21 ng/mL; CRP: 88.67 ± 17.54 vs 44.92 ± 13.18 mg/L; p<0.001). The highest levels were found in the group of patients who died (PCT: 11.02 ± 2.87 ng/mL; CRP: 94.67 ± 18.33 mg/L). Procalcitonin levels greater than 5 ng/mL were significantly associated with mortality (OR = 3.92, p<0.001), while a CRP level greater than 60 mg/L was significantly associated with complications (OR = 2.76, p=0.003).

Conclusion: Serum procalcitonin is a good predictor of severity and mortality, whereas C-reactive protein is more related to complications. The integration of these biomarkers may help to predict the risk of complications and guide management strategies in children with sepsis.

Comparative Effectiveness of Commercially Available Denture Cleansers on Oral Flora in Complete Denture Wearers

Fri, 08 May 2026 00:00:00 +0200

Objective: To determine and compare the effectiveness of different commercially available denture cleansers against oral flora in complete denture wearers.

Methodology: This randomized comparative clinical study was conducted at the Prosthodontics Department, Sardar Begum Dental College and Hospital, Peshawar, from April 2016 to October 2016. Microbiological analysis was performed at the Microbiology Laboratory of Khyber Medical College, Peshawar. Thirty complete denture wearers were randomly divided into five groups. Group A used tap water as control, Group B used sodium hypochlorite (0.02%), Group C used chlorhexidine gluconate (0.2%), Group D used white vinegar in 1:10 dilution with tap water, and Group E used Fitty Dent cleansing tablets. Saliva samples were collected at denture insertion and after two weeks of denture use. Colony forming units (CFUs) of microorganisms were assessed using microbiological culture techniques. Data were analyzed using SPSS version 17. Paired sample t-test and one-way ANOVA followed by Tukey’s HSD test were applied. A p-value of <0.05 was considered statistically significant.

Results:All denture cleansers showed better effectiveness against oral flora compared to tap water. Sodium hypochlorite (0.02%) demonstrated the least bacterial and candidal growth among all groups. White vinegar and Fitty Dent tablets also showed effective reduction in microbial growth. Chlorhexidine gluconate demonstrated comparatively lesser effectiveness. The highest increase in Streptococcus and Staphylococcus colony counts was observed in the control group using tap water.

Conclusion: All tested denture cleansers were more effective than tap water in controlling oral microbial growth in complete denture wearers. Sodium hypochlorite (0.02%) was found to be the most effective denture cleanser, followed by white vinegar, Fitty Dent tablets, and chlorhexidine gluconate.

COMPARATIVE STUDY OF SERUM LIPIDS PROFILE IN PRE AND POST-MENOPAUSAL WOMEN IN RANI DURGAVATI MEDICAL COLLEGE BANDA

Fri, 08 May 2026 00:00:00 +0200

Background: Menopause is associatedwith hormonal decline that influences lipidmetabolism and may increasecardiovascular risk. Understanding differences in lipid parameters

INCIDENCE OF FISTULA IN ANO FOLLOWING INCISION AND DRAINAGE OF PERIANAL ABSCESS A PROSPECTIVE OBSERVATIONAL STUDY

Dr. Saranya R., Dr. Bhanumati Giridharan, Dr.Dinesh Mahalingam, Dr. Sarath Kumar — Fri, 08 May 2026 00:00:00 +0200

Background: Perianal abscess is the mostfrequent surgical emergency, which mayresult in the occurrence of fistula-in-ano afterincision and drainage (I&D). The objective ofthe study would be to evaluate the rates andthe risk factors of developing a fistula after I&D among an Indian population

Assessment of Clinical Scoring Systems for Acute Appendicitis: A Comparative Analysis of AAS, AIR, and Modified Alvarado Scores in Surgical Practice

Dr. Bhanumati Giridharan,Anand Babu P,Sarath Kumar V,Dr Dinesh Mahalingam — Sat, 09 May 2026 00:00:00 +0200

Background: Acute appendicitis is one ofthe most common surgical emergencies encountered in clinical practice. Early andaccurate diagnosis remains essential toprevent complications and reduceunnecessary appendectomies. Severalclinical scoring systems

Effectiveness of Concept Map Method as a Teaching Learning Tool to Foster Meaningful Learning in Physiology Students

Dr Manisha Kurwale, Dr Alka Rawekar, Dr Anil Warkar, Dr Manoj Jiwtode — Sat, 09 May 2026 00:00:00 +0200

Background: Physiology is a complex subject that requires deep understanding and retention of concepts. This study aimed to teach use of concept mapping as a learning strategy to enhance meaningful learning in physiology, assess cognitive gains, compare its efficacy as a learning tool against traditional methods, and evaluate student responses to concept mapping. Concept maps are a potential visual learning tool that has been shown to enhance students' learning outcomes in various subjects, though they are already tested methods and not very much used as part of learning.

Material and method: First-year MBBS students participated in the interventional study. Students have been divided into groups A or B using convenience sampling technique. All students received a lecture on blood pressure regulation in the first part of the study, which was followed by a pretest. The interventional group A was assigned the task of creating a concept map on BP regulation, while the control group B was involved in a discussion regarding question-and-answer sessions using the traditional tutorial method. After 2 or 3 days, a surprise posttest was performed. All students attended a lecture on the pathophysiology of circulatory shock in the second section, which was followed by a pretest. The interventional group B was tasked with creating a concept map on circulatory shock, and the control group A's questions and answers were discussed. After 2-3 days, a surprise posttest was conducted. Knowledge gain was evaluated by comparing test scores before and after. A questionnaire was used to collect student input on concept mapping, and the student’s t-test was utilized to analyse results.

Results: Using a paired t-test, both groups (interventional and control) for both topics in our study demonstrated significant differences in pre- or post-test scores (P < 0.05). When comparing the interventional group to the control group, the mean score of learning gain, raw gain (G0), absolute learning gain, relative learning gain, or average normalized gain demonstrated statistically significant performance improvement for both topics. The intervention groups for both topics had significantly higher post-test scores and percentage scores compared to the control groups (p < 0.05). For the topic regulation of BP, the average normalised gain (G1) was higher in the intervention group A (0.76 ± 0.01) compared to the control group B (0.46 ± 0.03). For the topic pathophysiology of circulatory shock, the average normalised gain (G1) was higher in the intervention group B (0.77 ± 0.01) compared to the control group A (0.46 ± 0.03).

Based on student feedback, concept mapping made difficult concepts easier for them to understand and integrate, promoting deeper understanding and retention.

Conclusion: Compared to the traditional tutorial method, the concept mapping strategy was more effective. An effective learning tool for physiology students is concept mapping, which enhances cognitive development and fosters meaningful learning. Its integration in physiology can potentially improve student academic performance and retention.

Parathyroid Adenoma: A Case Series and Clinicopathological Analysis from a Tertiary Care Center in Aurangabad

Dr. Gopinath Vemulamada , Dr. Siddhi Lalwani, Dr. Pratik Sinha — Sat, 09 May 2026 00:00:00 +0200

Background: Parathyroid adenoma is themost common cause of primaryhyperparathyroidism and can present withdiverse systemic manifestations due to prolonged hypercalcemia.

Impact of Thyroid Dysfunction on Post-Surgical Fertility Outcomes in Women Undergoing Pelvic Surgery: A Prospective Study

Sat, 09 May 2026 00:00:00 +0200

Background: Thyroid dysfunction has been implicated in female infertility. However, its impact on fertility outcomes following pelvic surgery remains underexplored.

Objective: To evaluate the effect of thyroid dysfunction on fertility outcomes in women undergoing pelvic surgery.

Methods: This prospective study was conducted at Peshawar General Hospital, Pakistan. The time period of the study ranges from March 2024 to October 2025. Targeted populations constitute women aged 18–40 years. The women who were scheduled for elective pelvic surgery and desiring future fertility were included. Preoperative thyroid function (TSH, fT4) and anti-thyroid peroxidase antibodies (anti-TPO) were measured. Participants were classified as euthyroid or having thyroid dysfunction (overt/subclinical hypo- or hyperthyroidism). A Follow-up was carried out on the intervals of 6 weeks, 3, 6, and 12 months. This follow-up was done post-surgery and recorded fertility outcomes. Logistic regression and Cox proportional hazards models were used for statistical analysis using SPSS-26.

Results: A total of 829 women completed the follow-u and 212 (25.6%) had thyroid dysfunction. Women with thyroid dysfunction had lower 12-month conception rates (42.5% vs 57.7%, RR 0.73, 95% CI 0.61–0.87, p < 0.001), longer time-to-pregnancy (median 8 vs 6 months, p < 0.001), higher miscarriage rates (14.2% vs 8.1%, p = 0.018), lower live birth rates (33.0% vs 50.1%, p < 0.001), and greater ART use (12.7% vs 6.3%, p = 0.005). Multivariable analysis confirmed thyroid dysfunction as an independent predictor of reduced conception (adjusted OR 0.59, 95% CI 0.45–0.76, p < 0.001) and lower conception hazard (adjusted HR 0.68, 95% CI 0.54–0.85, p = 0.001).

Conclusion: Preoperative thyroid dysfunction significantly amplify the post-surgical fertility outcomes in women undergoing pelvic surgery.

Comparative Effectiveness of E-Learning Modules versus Conventional Lectures on Knowledge Retention of Public Health Concepts among Undergraduate Medical Students

Sat, 09 May 2026 00:00:00 +0200

Objective: This study aimed to compare the effectiveness of e-learning modules and conventional lectures on knowledge retention of public health concepts among undergraduate medical students.

Methods: A quasi-experimental study was conducted among 120 third-year MBBS students, who were randomly divided into two groups. Group A was taught using structured e-learning modules, while Group B received conventional lecture-based teaching. Both groups were assessed using a pre-test, immediate post-test and a follow-up test after four weeks. Scores were analyzed and compared using appropriate statistical methods.

Results: Baseline pre-test scores were comparable between the two groups. Both teaching methods resulted in significant improvement in immediate post-test scores; however, the e-learning group showed higher mean scores compared to the lecture group. At four-week follow-up, a decline in scores was observed in both groups, but knowledge retention remained significantly higher in the e-learning group.

Conclusion: Both e-learning modules and conventional lectures are effective in enhancing knowledge of public health concepts among medical students. However, e-learning appears to provide better long-term knowledge retention. A blended learning approach combining both methods may offer an optimal strategy for improving educational outcomes in medical curricula.

Ct and Echocardiographic Correlation of Pulmonary Artery Enlargement and Right Ventricular Dysfunction in Copd Patients

Sat, 09 May 2026 00:00:00 +0200

Objective: To evaluate the correlation between CT-detected pulmonary artery enlargement and echocardiographic evidence of RV dysfunction in patients with COPD.

Materials and Methods: This cross-sectional study was conducted at multiple tertiary care hospital over 12 months from February 2025 to January 2026 and included 180 patients with spirometrically confirmed COPD. All patients underwent chest CT for measurement of pulmonary artery diameter and pulmonary artery-to-aorta (PA:A) ratio, along with transthoracic echocardiography for assessment of RV function. RV dysfunction was defined using standard echocardiographic parameters including TAPSE, RV fractional area change, and estimated pulmonary artery systolic pressure (PASP). Statistical analysis was performed using SPSS 22 and a p-value <0.05 was considered significant.

Results: Pulmonary artery enlargement was observed in 45.6% of patients, while RV dysfunction was observed in 37.8%. Patients with enlarged pulmonary arteries had significantly higher PASP and lower TAPSE values compared to those with normal pulmonary artery size (p<0.001). A strong positive correlation was found between pulmonary artery diameter and PASP (r = 0.64), and a negative correlation with TAPSE (r = -0.52). CT-detected pulmonary artery enlargement was an independent predictor of RV dysfunction (p<0.001).

Conclusion: CT-detected pulmonary artery enlargement is significantly associated with echocardiographic RV dysfunction in COPD patients. CT may serve as a useful non-invasive marker for early detection of cardiopulmonary complications, allowing timely evaluation and management of high-risk patients.

Combined Orthopedic and Plastic Surgical Strategies in Management of Gustilo Grade Iii Open Fractures

Sat, 09 May 2026 00:00:00 +0200

Objective: To compare functional outcomes, infection rates, and limb salvage rates of integrated ortho-plastic treatment of Gustilo-Anderson Grade III open fractures in a trauma sample.

Materials and Methods: This is a prospective cohort study whereby 187 patients with Gustilo Grade III (GG-III) open fractures (III-A: n=42, III-B: n=118, III-C: n=27) were enrolled in the study to have been treated using a specific orthoplastic service in tertiary care centers in Pakistan during the period between January 2022-December 2024. The main outcomes were a deep infection rate, the time of full coverage of soft tissue, bony fusion, and the salvage of limbs. Secondary outcomes involved functional assessment by the use of Lower Extremity Functional Scale (LEFS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores.

Results: The average time to conclusive soft tissue cover was 5.2 +- 2.8 days. Deep infection was registered in 14.4% of the patients (27/187) which is significantly lower than the historical controls (32.6%, p=0.001). Salvage of the limbs was done in 93.6% (175/187) of the cases. Patients who were covered within 72 hours had significantly lower infection rates (8.7% vs. 24.3%, p=0.003) and had a faster bony union (18.4 +- 4.2 vs. 24.7 +- 5.8 weeks, p<0.001). In 68.4% III-B/III-C injuries the survival rate was 94.2% by using free flaps. Multivariate regression found significant predictors of deep infection of delayed coverage (>7 days), vascular injury and diabetes (p<0.05).

Conclusion: Orthoplastic management is an important intervention in resource-limited Pakistani hospitals that enhances limb salvage and decreases deep infection in Gustilo Grade III fractures. New soft tissue coverage during the first 72 hours becomes the most significant variable that can be modified and shaped. Formation of orthoplastic teams is a cost-efficient approach to complicated limb trauma in developing countries.

The Impact of Parental Education on Oral Hygiene Practices in Children: A Cross-Sectional Survey

Sat, 09 May 2026 00:00:00 +0200

Background: Oral hygiene practices during childhood are strongly influenced by parental knowledge, attitude, and educational status.

Objective: To assess the impact of parental education on oral hygiene practices among children.

Methodology: This cross-sectional study was conducted at department of Dentistry of Shahida Islam Dental College, Lodhran from June 2024 to December 2025, included 255 children and their parents. Demographic details, parental educational status, socioeconomic status, brushing frequency, use of fluoridated toothpaste, parental supervision during brushing, dental visit history, and sugary food intake were recorded using a structured questionnaire.

Results: The mean age of children was 8.74 ± 2.11 years. Most parents had secondary education, 108 (42.4%), followed by primary education, 79 (31.0%), and higher education, 68 (26.7%). Twice-daily brushing was significantly higher among children of parents with higher education, 40 (58.8%), compared with secondary, 43 (39.8%), and primary education, 18 (22.8%) (p<0.001). Use of fluoridated toothpaste was also higher among children of highly educated parents, 57 (83.8%), compared with secondary, 76 (70.4%), and primary education, 39 (49.4%) (p<0.001). Good oral hygiene was observed in 41 (60.3%) children of highly educated parents compared with 42 (38.9%) in secondary and 16 (20.3%) in primary education groups.

Conclusion: It is concluded that parental education significantly influences oral hygiene practices among children. Higher parental education was associated with better brushing habits, greater use of fluoridated toothpaste, improved parental supervision, regular dental visits, and better overall oral hygiene status.

Biochemical Predictors of Childhood Obesity and Their Public Health Implications in Low-Income Populations

Tue, 05 May 2026 00:00:00 +0200

Background: Obesity in children has become a rather popular issue among low-income groups wherenutritional shifts and lifestyle changes have begun to have a growing impact on health outcomes.Biochemical changes related to obesity tend to start at a young age but have not been sufficiently explored in resource-constrained studies

Comparison of In-Hospital Outcomes between Heart Failure Patients with Reduced (HFrEF) and Preserved Ejection Fraction (HFpEF): A Single Center Cross-Sectional Study

Sun, 10 May 2026 00:00:00 +0200

Background: Heart failure (HF) is a majorglobal health problem characterized bystructural and/or functional cardiacabnormalities that impair ventricular filling or ejection

Association Between Diabetes Duration and Coronary Artery Disease Severity in Patients Undergoing Angiographic Evaluation

Sun, 10 May 2026 00:00:00 +0200

Objective: To assess the associationbetween type 2 diabetes mellitus (T2DM) duration and the level of coronary arterydisease (CAD) in patients undergoingcoronary angiography

To Study the Management and Outcome of Operated Cases of Germ Cell Tumors of Ovary

Dr. Ranjit N. Kharole, Dr. R. D. Katke — Mon, 11 May 2026 00:00:00 +0200

Background: Worldwide ovarian cancer accounts for 225,000 new cases and 140,000 deaths every year. Ovarian germ cell tumors account for 15–20% of all ovarian malignancies and incidence of malignant ovarian germ cell tumors is 2–6%. These tumors typically occur in adolescent girls and young women. Ovarian germ cell tumors (OGCTs) are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about 2.6% of all ovarian malignancies. There are four main types of OGCTs, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma.

Aim and Objectives: 1. To study the management and outcome of operated cases of Germ cell Tumours of Ovary.2. To Study the proportion of International Federation of Gynecology and Obstetrics (FIGO) Stage.3. Study the of various Types of ovarian germ cell tumor

Methodology: Study Design: A hospital-based retrospective, analytical study.

Study Setting: OBGY department of GGMC, Mumbai, Maharashtra.

Study Population: All Operable cases of Germ cell Tumours of Ovary attending OPD/IPD of OBGY department of GGMC Mumbai such cases were included in the study.

Study Period: 18months from 1 October 2018 to 30 June 2019.

Sample Size = 30

Results: Majority of the patients (30%) were in the age group of 31-40 years followed by 23.4% in the age group of 21-30 years.17 (56.7%) patients were unmarried while 13 (43.3%) patients were married. The most common symptom was abdominal mass and pain (86.7%) followed by irregular menstruation (16.7%).The most common histologic type was dysgerminoma (46.7%) followed by immature teratoma (26.7%). 19 (63.3%) and 6 (20%) patients had FIGO Stage I and II respectively while 4 (13.4%) and 1 (3.3%) patient had FIGO Stage III and IV respectively. All 5 incompletely staged patients with FIGO Stage I underwent FSS in the form of ovarian cystectomy. 7 (36.8%) patients were placed under active surveillance after surgery while 12 (63.2%) patients received adjuvant chemotherapy. 4 (36.4%) patients with FIGO Stage II-IV underwent primary debulking surgery (PDS) followed by adjuvant chemotherapy, whereas 7 (63.6%) patients with FIGO Stage II-IV received neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). In PDS cohort, 3 (75%) patients underwent FSS, whereas in NAC cohort, all patients underwent FSS. In patients with FIGO Stage I, no recurrence was observed in all patients with complete staging surgery and 1 (5.3%) patient with incomplete staging. 3 (15.8%) patients with incomplete surgery showed recurrence and 1 (5.3%) patient with incomplete surgery died. There were no recurrence and no death in all patients with FIGO Stage II-IV.

Conclusions: Surgery has an important role in the management of germ cell tumours. Initial careful surgical staging is of great importance for appropriate subsequent therapy. Fertility sparing surgery is feasible in most cases. Malignant ovarian germ cell tumours have excellent for Stage I and for advanced stages.

Evaluating the Association between Irrational Procrastination and Daytime Sleepiness among Medical Students in South India: A Web-Based Cross-Sectional Study

Dr Niranjana Davis, Dr. Pallavi Panchu, Dr. Pallavi Panchu — Mon, 11 May 2026 00:00:00 +0200

Background: Procrastination represents a self-regulatory failure characterized by voluntary delay of intended tasks despite foreseeable harm. Sleep disturbance and excessive daytime sleepiness are highly prevalent among medical students, yet procrastination is less frequently examined as a behavioral correlate of sleep-related impairment.

Methods: A web-based cross-sectional study was conducted among medical students across five South Indian states. Participants completed a structured questionnaire capturing sociodemographic characteristics and validated instruments: the Irrational Procrastination Scale (IPS; 9 items, 5-point Likert) and the Epworth Sleepiness Scale (ESS; 0–24). Inferential analyses evaluated differences in procrastination and daytime sleepiness across demographic strata, and Pearson correlation assessed association between IPS and ESS scores.

Results: A total of 364 students were included (56.6% female). Kerala contributed the largest proportion (43.1%). Mean (SD) IPS score was 20.00 (13.92) and mean (SD) ESS score was 19.98 (10.03). Procrastination differed significantly by gender (p=0.019), year of study (p=0.005), state (p=0.001), and marital status (p=0.040). Daytime sleepiness also differed significantly across gender (p=0.017), year of study (p=0.004), state (p<0.001), and marital status (p=0.008). IPS and ESS scores demonstrated a moderate positive correlation (r=0.517; p<0.001), indicating higher procrastination was associated with higher daytime sleepiness.

Conclusion: In this multi-state sample of South Indian medical students, irrational procrastination showed a moderate, statistically robust association with daytime sleepiness. These findings support procrastination as a potentially modifiable behavioral target within student sleep-health initiatives.

Comparative study of childhood overweight/obesity in urban and rural area of Kota district

Dr Navaneet Chansauria, Dr Ashutosh Sharma, Dr Shyam Lal — Mon, 11 May 2026 00:00:00 +0200

Background: Overweight/obesity is acomplex disease involving interconnectedbiological, developmental, environmental,behavioral, and genetic factors; it is a major preventable public health problem.

Prevalence of Vernal Kerato-Conjunctivitis at a Tertiary Health Care Centre in Eastern Region of Uttar Pradesh

Dr Chandra Bhan, Dr Aallisha Anjum, Dr. Mohd Shadab — Mon, 11 May 2026 00:00:00 +0200

Purpose: To study the prevalence of vernal keratoconjunctivitis at a tertiary health care centre and its seasonal variation in Eastern region of Uttar Pradesh

Methods: It is a tertiary care centre based cross sectional study where 100 cases of vernal keratoconjunctivitis in age group 5-18 years were selected from the patients presenting to the ophthalmology OPD within a duration of 6 month. Detailed clinical history was taken and ophthalmological examination performed like visual acuity testing, anterior segment examination with slit lamp biomicroscope, fundus examination with indirect ophthalmoscope. The statistical analysis done using SPSS (26.0 version Statistical Package for Social Sciences) statistical analysis software. Point estimate and 95% confidence interval calculated with p-value less than 0.05 will be considered as significant.

Results: Among 980 patients presented to ophthalmology OPD with chief complaint of red eye, VKC was found in 100 patients i.e. 10.2%

Conclusion: Our study showed slightly higher prevavlence of vernal keratoconjunctivitis as compared to other tropical countries. . However the clinical features are similar to the typical pattern of VKC seen in other parts of the country

Screening of Medical Students for Thalassemia and Other Hemoglobinopathies by High-Performance Liquid Chromatography for Primary Prevention in Ahmedabad City: A Cross-Sectional Study

Dr. Khushbu Nagar, Dr. Kanizfatma Durani, Dr. Sana Mohamed Hanif — Mon, 11 May 2026 00:00:00 +0200

Background: In India, carrier detection for thalassemia and structural hemoglobin variants is a practicable primary-prevention strategy, where endogamy, regional clustering, and asymptomatic carrier states sustain the birth of affected children. Medical students are an important screening cohort because they are young adults, future reproductive decision-makers, and potential health educators. Screening them can convert laboratory diagnosis into durable community awareness and promote informed reproductive choices.

Methods: Cross-sectional design, this research was carried out in the Department of Pathology, GMERS Medical College and Civil Hospital, Sola, Ahmedabad, from July 2019 to June 2021. The participants were undergraduate and postgraduate medical students aged between 18–35 years who volunteered for screening. EDTA blood samples were analysed for complete blood count, peripheral smear morphology and hemoglobin fractions using Bio-Rad VARIANT high-performance liquid chromatography, beta-thalassemia short programme.

Results: Among 256 students, the mean age was 21.4 +/- 3.4 years and 135 (52.7%) were women. HPLC showed a normal hemoglobin pattern in 246 students (96.1%). Ten students (3.9%; 95% CI, 2.1-7.0) had a carrier pattern: beta-thalassemia trait in six (2.3%; 95% CI, 1.1-5.0), sickle cell trait in two (0.8%) and Hb D trait in two (0.8%). Compared with students with a normal pattern, abnormal HPLC profiles showed higher RBC count, lower MCV, lower MCH and higher RDW. Beta-thalassemia trait had mean HbA2 of 5.0 +/- 0.5%, mean MCV of 60.7 +/- 14.8 fL and mean RBC count of 5.5 +/- 0.5 million/cumm.

Conclusion: HPLC-based screening identified a clinically silent but preventable hemoglobinopathy carrier burden in medical students. Integrating CBC, smear review, HPLC reporting and genetic counselling in medical colleges can strengthen premarital and preconception prevention pathways in Ahmedabad.

Adverse Reactions in Donor Plateletpheresis and Their Predictors: A Hospital-Based Study from Central India

Ishika Jain, Aman Shakya, Sushant Kumar, Ramu Thakur , Ashok Yadav — Tue, 12 May 2026 00:00:00 +0200

Background and Aim:Plateletpheresis plays an important role in modern transfusion medicine by enablingcollection of platelets from a single donor,improving both product quality andtransfusion safety.

Platelet Transfusion Practices and Clinical Outcomes in Thrombocytopenic Patients at a Tertiary Care Hospital: A Prospective Observational Study

Aravind S, Ratnadeep Rawat, Manikandan.N, Ramu Thakur, Ashok Yadav — Tue, 12 May 2026 00:00:00 +0200

Background:Thrombocytopenia is a common clinical condition in hospitalized patients and isassociated with an increased risk ofbleeding. Platelet transfusion is widely usedfor both prophylactic and therapeutic

Oral Manifestations in Patients with Dengue Fever: A Prospective Study.

Mon, 11 May 2026 00:00:00 +0200

Objectives: The objective of this study was to determine the oral manifestation in patients havingdengue fever.

Herpes Simplex Virus Associated Erythema Multiforme: A Case Study

Rubab Mannan Shaikh, Kashif Ali Channar, Salman Shafique — Mon, 11 May 2026 00:00:00 +0200

Erythema multiforme (EM) is an acute inflammatory disorder of the skin and mucous membranes. EMis primarily associated with infection related immune activation. It is most commonly observed in herpessimplex virus (HSV). Clinically, it is characterized by the development of distinctive target lesions that accompanied by mucosal involvement of variable distribution and intensity

The Impact of the Conceptual Imagery Intervention Model on Sports Knowledge and the Development of Basic Basketball Skills

Ghufran Jamal Mohammed — Mon, 11 May 2026 00:00:00 +0200

The purpose of this research was todetermine the impact of the conceptual imagery intervention model on thedevelopment of sports knowledge andachievement of the level of performance ofthe selected basic basketball skills

Infection with Helicobacter pylori and the Risk of Iron Deficiency Anemia: A Cross-Sectional Study

Mon, 11 May 2026 00:00:00 +0200

Background: Helicobacter pylori infection has been linked with iron deficiency anemia (IDA), but thestrength of this association varies across populations. Proposed mechanisms include chronic gastritis,reduced gastric acid secretion, impaired iron absorption, occult blood loss, and bacterial competition for iron.

Comparing the Clinical Outcomes of Minimally Invasive Surgical Technique (MIST) with Papilla Preservation Flap (PPF) in Patients: A Quasi Experimental Trial

Wajiha Khan, Sahibzada Urooj Noor, Sabahatullah, Awais Khan, Haseebul Haq, Ifham — Mon, 20 Apr 2026 00:00:00 +0200

Objective: This study aimed to compare the clinical outcomes of two different surgical techniques,papilla preservation flap (PPF) and minimal invasive surgical technique (MIST).

Frequency of Vitamin D Deficiency in Mothers and Neonates at a Tertiary Care Hospital

Mon, 11 May 2026 00:00:00 +0200

Objective: To determine the frequency of vitamin D deficiency among mothers and their neonates ata tertiary care hospital and to assess the association between maternal and neonatal vitamin D status

Injuries of Bile Duct in Laparoscopic Cholecystectomy: Incidence, Risk Factors and Management Strategies

Tue, 05 May 2026 00:00:00 +0200

Background: Laparoscopic cholecystectomy is the gold standard for the treatment of gallstonedisease; however, bile duct injury remains a serious complication associated with significant morbidity.
Objective: To determine the incidence, risk factors, and management strategies of bile duct injuries following laparoscopic cholecystectomy.

A Clinical Study on Dry Eye Following Phacoemuslification and SICS in Patients in a Tertiary Care Hospital and its Association with Various Risk Factors

Dr. Deepanjan Ghosh, Dr. Abhishruti Buragohain — Wed, 13 May 2026 00:00:00 +0200

Purpose: To evaluate and correlate the occurrence of dry eye following cataract surgery with tear film indices and its association with various risk factors responsible for it’s development.

Setting: Department of Ophthalmology, Assam Medical College and Hospital, Dibrugarh.

Study Design: Cross sectional study

Patients and Methods: Patients who presented with signs/symptoms suggestive of dry eye following cataract surgery (either phacoemulsification or sics) in Department of Ophthalmology, AMCH during the study period.

Results: The comprehensive grading of the dryness showed that of the 102 patients, 48(47%) patients had dry eyes and that 54 (53%) patients did not have any dry eye. The gender comparison of the dryness of the eyes showed that 21 patients were males and that 27 patients were females. Air pollution (23 out of 45) followed by Sunlight /high temperature (15 out of 25) were mostly risk factors for dry eyes whereas Excessive wind (5 out of 10), Smoking (4 out of 14) and drugs (1) were also having some association.

Conclusion: There was no statistical difference in dry eyes of those between phacoemulsification and SICS patients. Most of them had mild grade of dry eye. Risk factors like air pollution, sunlight, or excessive wind were associated with dry eye post cataract surgery.

Comparison of Myoinositol plus Clomiphene Citrate versus Myoinositol plus Metformin for Management of Females Presenting with Polycystic Ovarian Syndrome

Wed, 13 May 2026 00:00:00 +0200

Background: Infertility in women is frequently diagnosed with polycystic ovarian syndrome (PCOS). The precise presentation of the illness has been the subject of several research. Infertility patients with PCOS have recently been treated with Myoinositol, a new insulin sensitizer.

Objectives: To compare the outcome of regular ovulatory cycles and rate of conception of myoinositol plus clomiphene citrate versus myoinositol plus metformin for managing females presenting with polycystic ovarian syndrome and infertility.

Methodology: A total of 270 patients were included in the study through the Outpatient Department (OPD) of Obstetrics & Gynecology at Lahore Medical and Dental College, Lahore. Randomization was performed using the lottery method, ensuring equal distribution of participants into two groups. For this process, 135 folded slips labeled "A" and 135 labeled "B" were placed in a bowl. As each patient was enrolled, a slip was randomly drawn to determine their group allocation. Participants in Group A were prescribed 4g myo-inositol plus clomiphene citrate, while those in Group B received metformin 1500mg/day plus clomiphene citrate orally. Both groups were followed up for three months through regular OPD visits. During follow-up, ultrasonography was performed to assess ovulation, and a urine pregnancy test was conducted to evaluate treatment effectiveness.

Results: A comparison of both groups shows that 67.41% (n=91) in Group A and 57. 78% (n=78) in Group B had a regular ovulatory cycle; the p-value was 0.10. A comparison of both groups regarding the rate of conception shows that 26.37% (n=24) in Group A and 17.95% (n=14) in Group B had conception; the p-value was 0.19.

Conclusion: We concluded no difference in the outcome of patients with PCOS using myoinositol plus clomiphene citrate versus myoinositol plus metformin.

Outcome of Pterygium Excision with Conjunctival Auto graft Using Autologous Blood – A Prospective Clinical Trial

Dr. Nishi R.S., Dr. Nimi R., Dr. Anitha S. — Mon, 11 May 2026 00:00:00 +0200

Background: Pterygium is a common degenerative fibro vascular growth of conjunctival tissue extending onto the cornea, frequently associated with chronic ultraviolet exposure and ocular surface irritation. Surgical excision remains the definitive treatment, but recurrence and postoperative complications remain significant concerns. Conjunctival auto grafting using autologous blood has emerged as a simple, economical, and suture less technique that may reduce postoperative discomfort and recurrence rates.

Methods: This prospective clinical trial was conducted in the Department of Ophthalmology, GMC Kollam, over a period of 1.5 years. Eighty adult patients with primary pterygium were randomly allocated into two groups with 39 patients in Group 1 and 41 patients in Group 2. Group 1 underwent bare sclera excision alone, while Group 2 underwent pterygium excision with conjunctival autograft fixation using autologous blood. Patients were followed up at 24 hours, 1 week, 2 weeks, 4 weeks, 2 months, 3 months, and 6 months postoperatively. Outcome measures included visual acuity, graft stability, postoperative discomfort, graft-related complications, granuloma formation, and recurrence. Statistical analysis was performed using MS Excel and SPSS software.

Results: Among the 41 eyes treated with conjunctival autograft using autologous blood, one eye showed total graft dislodgement, one eye developed graft displacement, and one patient developed granuloma formation. No major post-operative complications were observed otherwise. In the bare sclera excision group, recurrence was noted in two cases during follow-up. The procedure was found to be simple, cost-effective, and associated with satisfactory cosmetic outcomes and minimal post-operative discomfort.

Conclusion: Conjunctival autografting using autologous blood following pterygium excision is a safe, effective, and economical technique with low recurrence and acceptable complication rates. It avoids suture-related complications and may be considered a preferred alternative for the management of primary pterygium.

Ultrasonographic Evaluation of Prostatic Pathology and its Correlation with MRI wherever Required

Wed, 13 May 2026 00:00:00 +0200

Background: The prostate glands the largest accessory gland of the male reproductive system. In adults, it typically weighs ~40 grams and has an average size of 3 x 4 x 2 cm ^[1]. On imaging, the upper limit of normal is considered to be 30 mL.^[2] The prostate comprises 70% glandular tissue and 30% fibromuscular or stromal tissue^[3] and provides ~30% of the volume of seminal fluid. Ultrasound best assessed with transrectal ultrasound. Outer gland (central and peripheral zones) - uniform low echogenicity but usually more echogenic than the inner gland. ^{[4, 5]} The prostate is covered in a surface called the prostatic capsule or prostatic fascia. The most common types of prostate disease are benign prostatic hyperplasia (BPH), prostatitis and prostate cancer (PCa).

Objective: To evaluate the prostatic pathology by transabdominal ultrasound, Transrectal ultrasound (whenever required) and corelate the all these findings with MRI.

Methods: Patients with lower urinary tract symptoms, were selected for study. A thorough case history was taken followed by Ultrasonography / MRI examination of pelvis. The study was conducted in the department of Radiodiagnosis at N.S.C.B. Medical College Jabalpur.

Result: Among 100 patients most patients were more than 60yrs of age. It was found that maximum cases 56% showed prostatic hypertrophy, 36% had prostatic calcification, 1% had prostatic carcinoma, 5%had prostatitis and 2% had prostatic abscess. On MRI 9% cases showed PI-RADS category 1, 4% were normal, 3% showed blooming artifact, 2% were hyperintense on T2 and 5% had Ca Prostate.

Conclusion: Our research study advocates that ultrasound is a simple, widespread available and a sensitive modality that can be advocated as the imaging investigation for diagnosing various prostatic pathologies. And MRI is recommended for a more precise diagnosis of prostate pathology.

Clinical Outcomes of Endoscopic Septoplasty with Posterior Nasal Neurectomy in Allergic Rhinitis Patients with Deviated Nasal Septum

Dr. Mohammed Shameer A., Dr. Anwar Rasheed, Dr. Sahni D.K. — Tue, 12 May 2026 00:00:00 +0200

Background: Allergic rhinitis is a chronic immunoglobulin E-mediated inflammatory disorder of the nasal mucosa characterized by nasal obstruction, rhinorrhea, sneezing, and nasal itching. It significantly impairs sleep quality, work productivity, social functioning, and overall quality of life. Patients with coexisting deviated nasal septum frequently remain symptomatic despite optimal medical management. Surgical interventions such as endoscopic septoplasty combined with transnasal neurectomy have emerged as promising modalities targeting both anatomical obstruction and neural hyperresponsiveness associated with allergic rhinitis.^[1]

Methods: This prospective observational study was conducted in the Department of Otorhinolaryngology at Travancore Medical College Hospital, Kollam, from January 2023 to June 2024. Ninety-two patients diagnosed with moderate to severe persistent allergic rhinitis associated with deviated nasal septum were included. All patients underwent endoscopic septoplasty with bilateral transnasal neurectomy under general anesthesia. Symptom severity and quality of life were assessed preoperatively and two months postoperatively using the Nasal Obstruction Symptom Evaluation scale and Allergic Rhinitis Control Test questionnaire. Statistical analysis was performed using paired t-test, and a p-value less than 0.05 was considered statistically significant.

Results: Among the 92 participants, the majority belonged to the 30–40 years age group (65.2%), and males constituted 66.3% of the study population. Significant postoperative improvement was observed in nasal obstruction and allergic symptoms. The mean Nasal Obstruction Symptom Evaluation score decreased from 81.90 ± 10.24 preoperatively to 47.45 ± 8.31 postoperatively (p < 0.001). The mean Allergic Rhinitis Control Test score improved from 9.60 ± 2.01 to 15.97 ± 1.82 (p < 0.001). Intraoperative hemorrhage occurred in 6.5% of patients, while postoperative infection was noted in 5.4% of patients.

Conclusion: Endoscopic septoplasty combined with transnasal neurectomy is a safe and effective surgical modality for patients with moderate to severe persistent allergic rhinitis associated with deviated nasal septum. The procedure significantly improves nasal obstruction, allergic symptoms, and quality of life with minimal complications.

Relationship between CT Number and Haemoglobin Level - A Descriptive Study

Dr. Reji Rajan Varghese, Dr. Suma Job — Wed, 13 May 2026 00:00:00 +0200

Background: Haemoglobin, the iron-containing metalloprotein in red blood cells, is the principal determinant of blood density. CT numbers (Hounsfield Units, HU) represent relative X-ray attenuation of tissues. Because iron attenuates X-rays more than soft tissue, it is physiologically plausible that haemoglobin concentration influences CT attenuation in blood-filled structures. Despite this, routine radiological reporting does not account for the effect of haemoglobin on CT numbers. This study aimed to quantify that relationship and assess its utility for incidental anaemia detection.

Methods: A descriptive study was conducted over 18 months at the Department of Radiodiagnosis, Government T.D. Medical College, Alappuzha. Two hundred consecutive patients undergoing unenhanced CT of the thorax and/or abdomen with a contemporaneous haemoglobin value were enrolled by convenience sampling. Regions of interest (ROIs) were placed in the aorta, inferior vena cava (IVC), left ventricle (LV), liver, and spleen. CT numbers were extracted using RadiAnt Viewer and MATLAB. Mean, median, mode, minimum, and maximum pixel values from each ROI were recorded. Pearson correlation and linear regression were performed using SPSS.

Results: Of 200 subjects (105 males, 95 females), mean haemoglobin was 12.3 g/dL in males and 11.6 g/dL in females. Strong positive Pearson correlations were observed between haemoglobin and mean CT numbers of the aorta (r = 0.816), IVC (r = 0.751), and LV (r = 0.737), all significant at p < 0.01. Mean, median, and mode values showed similar correlations; minimum and maximum values did not correlate. CT numbers of the liver (r = 0.19) and spleen (r = 0.14) showed no clinically meaningful correlation.

Conclusion: Haemoglobin levels are positively correlated with CT numbers in vascular blood pools (aorta, IVC, left ventricle) but not in parenchymal organs (liver, spleen). These findings support the feasibility of incidental anaemia detection and haemoglobin estimation from routine unenhanced CT images, with potential applications in clinical management and forensic radiology.

Oral Clues of Chronic Smoking and Cannabis

Thu, 14 May 2026 00:00:00 +0200

Objective: To study oral manifestations among chronic smokers and assess the impact of occasional cannabis co-use on oral hygiene status, periodontal health, xerostomia, dental caries, and mucosal pathology.

Materials and Methods: The study was a cross-sectional observational study which was conducted over a period of six months in a tertiary care de-addiction centre that had an outpatient dermatology linkage. It was enrolled with 50 adult participants (aged 18 years and above) who had a history of chronic tobacco smoking. Six participants noted some co-use of cannabis. Standard oral cavity examinations done under sufficient lighting, recording mucosal pigmentation, leukoplakia, keratosis, ulcers, erosions, periodontal indices, xerostomia and dental caries. Statistical analysis was done by a chi-square and Fisher exact test, with p<0.05 being regarded as statistically significant.

Results: Out of the 50 participants, 44 (88%), were exclusive tobacco smokers and 6 (12%), reported occasional co-use of cannabis. The age was between 18 to 40 years. Among the findings in smokers, melanosis (78%), dental staining (92%), and periodontal disease (64%) were predominant. The co-users of cannabis had overlapping manifestations without statistically independent features (p=0.412). Oral examination has a diagnostic accuracy of 89% sensitivity and 84% specificity to diagnose chronic smoking status. All comparative tables showed p<0.05 of the key parameters.

Conclusion: Tobacco smoking leads to significant and recognizable oral mucosal and dental alterations. Dermatologists should routinely examine the oral cavity, counsel on cessation, and refer suspected oral potentially malignant disorders (OPMDs) early to reduce morbidity and malignancy risk.

Perceived Stress and Psycho-Social Determinants among Undergraduate Medical Students in Government Medical College, Ongole

Thu, 14 May 2026 00:00:00 +0200

Background: The World Health Organization recognised stress as the global health epidemic of the 21^st century. Perceived stress is associated with increased levels of depression, alcohol and drug abuse, relationship difficulties, anxiety, and suicide. Medical students are prone to high levels of perceived stress and anxiety, which can negatively impact their academic performance, as well as their physical and mental health.

Objectives: (1) To assess the levels of perceived stress by using the PSS-14 scale, (2) To assess psycho-social determinants of stress and their association with perceived stress, and (3) To assess the coping mechanisms practised by the students.

Materials & Methods: A cross-sectional study was conducted among undergraduate medical students by using structured questionnaire to assess Perceived stress using the Perceived Stress Scale-14, psycho-social stressors and coping mechanisms practised by the students.

Results: A total of 228 students filled out the questionnaire of which 41.2% are males and 58.8% are females. The prevalence of mild, moderate, and severe stress was 4.4%, 91.7%, and 3.9% respectively. Difficulty reading textbooks (65.8%), High parental expectations (63.6%), and Loneliness (60%) showed a significant association with perceived stress. The coping mechanisms practised by most of the students include talking with friends or family (94.3%), sleeping (87.3%), and listening to music or dancing (81.6%).

Conclusion: The study revealed that moderate stress was higher in female students.

Epidemiology of Animal Bite Cases Attending Casualty at a Tertiary Care Hospital, Ongole

Thu, 14 May 2026 00:00:00 +0200

Background: Animal bites, particularly dog bites, are a major public health concern due to the risk of rabies, a zoonotic disease that is almost invariably fatal once symptoms develop. Despite effective post-exposure prophylaxis (PEP), India continues to bear a substantial burden.

Objectives: To assess the epidemiological profile of animal bite cases and preventive measures.

Methods: A hospital-based cross-sectional study was conducted over 3 months (April to June 2024) at a tertiary care hospital in Ongole, Andhra Pradesh. A total of 200 animal bite victims were included using convenience sampling.

Results: Most of the victims were aged 25–50 years (42.5%), males constituting 68.5%. Dog bites accounted for 94.5% of cases. 79% were due to stray dogs and 90% unprovoked. Category II wounds were most common. Lower limbs were affected in 66.5% of cases. Although 66.5% cleaned wounds before hospital visit. Early reporting (within 6 hours) was observed in 72.5%, while 25.5% used home remedies.

Conclusion: Dog bites remain a significant public health issue. While treatment-seeking behaviour was satisfactory, gaps in appropriate wound care persist, emphasizing the need for improved awareness and strengthened rabies prevention strategies.

Inflammatory Pathways in Periodontitis: Correlation of Gingival Crevicular Fluid Biomarkers with Radiographic Defect Measures and Clinical Response to Adjunctive Local Doxycycline

Thu, 14 May 2026 00:00:00 +0200

Objective: To evaluate the association between inflammatory biomarkers in gingival crevicular fluidand radiographic periodontal defect measures, and to assess the adjunctive clinical effect of locally delivered doxycycline hyclate gel used with scaling and root planing in patients with periodontitis

Forensic Age Estimation Using Deciduous Tooth Eruption and Carpal Bone Ossification: A Comparative Analysis

Tue, 12 May 2026 00:00:00 +0200

Objective: To compare the accuracy of deciduous teeth eruption and ossification of carpel bone ofhand for estimation of forensic age.
Study Design: Randomized controlled trial.Place and Duration: Department of Forensic Medicine & Toxicology Khyber Medical College, Peshawar

Role of Adipokines (Leptin and Adiponectin) in the Pathophysiology of Polycystic Ovary Syndrome in Pakistani Women

Wed, 13 May 2026 00:00:00 +0200

Background: Polycystic Ovary Syndrome is a common endocrine disorder among women ofreproductive age, frequently associated with insulin resistance and obesity. Adipokines, particularly leptin and adiponectin, play a key role in linking metabolic and reproductive abnormalities.

Efficacy and Safety of Angiotensin Receptor-neprilysin Inhibitor (ARNI) in Patients with Congestive Heart Failure

Wed, 13 May 2026 00:00:00 +0200

Background: Angiotensin Receptor-Neprilysin Inhibitors (ARNI) have changed the landscape oftherapeutic options in chronic heart failure (CHF). Although efficacy is determined in trials, local practice requires real-world data in varying populations, such as Pakistan

Psychological Burden of Stress Urinary Incontinence; A Cross-Sectional Study of Anxiety and Depression in Women

Muhammad Muslim Khan, Fatima, Naila, Hemasa Gul, Zafar Ahmad Khan, Izaz Jamal — Wed, 13 May 2026 00:00:00 +0200

Background: Stress urinary incontinence (SUI) is a common condition among women and can greatlyaffect daily life. Many women with SUI not only face physical problems but also emotional andpsychological challenges. Feelings of embarrassment, fear of urine leakage, and avoidance of socialactivities can lead to anxiety and depression. Despite its high prevalence, the psychological impact of SUI is often overlooked in routine clinical care

Efficacy and Safety of Transdermal versus Intravenous Diclofenac for Postoperative Analgesia in Pediatric Inguinal Surgeries: A Comparative Study

Dr Ankur Sharma, Dr Asif Qureshi — Fri, 15 May 2026 00:00:00 +0200

Background: Postoperative pain management in pediatric inguinal surgeries requires effective, safe, and minimally invasive analgesia. This study compared the analgesic efficacy and safety of transdermal versus intravenous (IV) diclofenac in children aged 5 to 10 years undergoing inguinal surgeries.

Methods: An open-label, quasi-randomized trial enrolled 40 eligible children (ASA physical status 1 and 2), allocating them into two equal groups. Following surgery, Group 1 received a 100mg transdermal diclofenac patch, while Group 2 was administered 1 mg/kg IV diclofenac, repeated every 8 hours. Postoperative pain intensity was evaluated using the Visual Analog Scale (VAS) at 2, 4, 8, and 12-hour intervals.

Results: Demographic and surgical profiles were comparable across both groups. Mean VAS scores showed no statistically significant differences between the transdermal and IV groups at 2 hours (4.45±0.999 vs 3.75±1.118, p=0.44), 4 hours (1.85±0.745 vs 2.20±0.768, p=0.152), 8 hours (1.30±0.571 vs 1.30±0.470, p=1.000), and 12 hours (1.25±0.550 vs 1.15±0.489, p=0.547). The requirement for additional rescue analgesia was minimal and lacked significant difference (10% in the transdermal group vs. 5% in the IV group, p=1.000). Zero adverse reactions were reported in either cohort.

Conclusion: Transdermal diclofenac is as effective and safe as intravenous diclofenac for managing postoperative pain in pediatric inguinal surgeries. Given its non-invasive application and consistent drug release, the transdermal patch represents a practical and patient-friendly alternative.

Biochemical Predictors of Renal Dysfunction and Evidence-Based Prevention Strategies for Chronic Kidney Disease in Patients with Metabolic Syndrome: Findings from a Tertiary Care Hospital in Central India

Ritu Devi, Shreya Nigoskar — Fri, 15 May 2026 00:00:00 +0200

Background: Metabolic syndrome (MetS) drives progressive renal injury through overlapping mechanisms of insulin resistance, oxidative stress, and haemodynamic alterations. While global data link MetS to chronic kidney disease (CKD), biochemical characterisation of predictors and evidence-based prevention strategies tailored to Indian populations remain underexplored.

Objectives: To identify biochemical predictors of renal dysfunction in MetS patients, evaluate lipid and glucose profiles in relation to eGFR, characterise the CKD burden across MetS component clustering, and synthesise prevention and management strategies applicable to this cohort.

Methods: A hospital-based cross-sectional analytical study enrolled 240 confirmed MetS patients at Index Medical College, Indore. Biochemical profile — fasting blood glucose (GOD-POD), serum creatinine (Jaffe's), blood urea (urease-GLDH), lipid profile (enzymatic colorimetric), and eGFR (CKD-EPI) — was assessed. Pearson correlation and multiple linear regression (SPSS v25.0) identified predictors of eGFR decline. Prevention strategies were mapped to biochemical findings.

Results: Mean serum creatinine was 1.12 ± 0.31 mg/dL; mean eGFR 61.87 ± 19.46 mL/min/1.73 m². Mean total cholesterol was 209.76 ± 34.28 mg/dL; LDL-C 133.46 ± 31.62 mg/dL; blood urea 32.48 ± 9.86 mg/dL. Fasting blood glucose was the strongest negative correlate of eGFR (r = −0.38, p < 0.01). Age (β = −0.29), fasting glucose (β = −0.26), systolic BP (β = −0.23), and BMI (β = −0.21) were independent predictors of eGFR decline (F = 9.84, p < 0.001; adjusted R² = 0.41). CKD burden escalated with increasing MetS component clustering. SGLT2 inhibitors, ACE inhibitors/ARBs, lifestyle modification, and structured screening were identified as evidence-based prevention pillars.

Conclusion: Hyperglycaemia, elevated BMI, hypertension, and advancing age are the principal determinants of renal dysfunction in Indian MetS patients. An integrated prevention framework targeting these predictors is recommended for clinical and public health implementation.

Improving Early Orthodontic Diagnosis In Primary Healthcare Through Targeted Training Programme

Fri, 15 May 2026 00:00:00 +0200

Background: Early identification of orthodontic abnormalities is essential for preventing progressive dentofacial complications and reducing treatment complexity in children. Primary care professionals may be the first health care professionals to evaluate a pediatric patient, but a lack of orthodontic training may help delay diagnosis and referral of developing malocclusions.

Objective: To evaluate the effectiveness of a targeted orthodontic training programme in improving early orthodontic diagnostic knowledge, recognition of malocclusion patterns, and referral confidence among primary healthcare professionals.

Methods: The study was a cross-sectional interventional study conducted in the Orthodontic Department at Lahore Medical & Dental College in Lahore, Pakistan for six months from January 2025 to June 2025. A total of 60 primary healthcare professionals were enrolled through non-probability consecutive sampling and equally divided into two groups comprising 30 participants each. While Group A received no intervention, Group B underwent the structured orthodontic training programme. Validated questionnaires and standardized clinical image-based evaluations were used to assess the baseline knowledge and diagnostic competency. Reassessment of the students was done after intervention with the same assessment tools. The data was analysed with SPSS version 26 and a p value of ≤0.05 was used to determine statistical significance.

Results: The intervention group demonstrated significant improvement in mean diagnostic assessment scores following the training programme (52.7 ± 10.3 vs 82.4 ± 7.6; p<0.001). There was significant improvement in the recognition of posterior crossbite, skeletal malocclusion, dental crowding, mouth breathing patterns and the presence of harmful oral habits after the intervention. Referral confidence regarding early orthodontic consultation increased from 36.7% to 86.7% among participants in the intervention group.

Conclusion: The targeted orthodontic training programme significantly improved orthodontic diagnostic capability and referral confidence among primary healthcare professionals, highlighting the importance of integrating orthodontic education into primary healthcare systems.

Unlocking Local Potential: A Comprehensive Evaluation of the Mechanical, Physical, and Clinical Properties of Pakistani-Made Dental Composites

Fri, 15 May 2026 00:00:00 +0200

Objective: To assess and compare the mechanical, physical, and simulated clinical behavior of locally available dental composite resins.

Methods: In this one-year experimental study, 200 composite specimens were prepared from four brands available in Pakistan (n = 50 each). Specimens were prepared as per standard procedures. Tests included mechanical properties (compressive strength, flexural strength, surface hardness), physical properties (water sorption, solubility), and clinical performance (wear resistance, surface degradation). The data were analysed using IBM SPSS Statistics 26. Comparisons between groups were made using one-way ANOVA and Tukey’s post-hoc test. A p-value ≤ 0.05 was considered significant.

Results: There were statistically significant differences (p < 0.001) between the four brands of composite resin for all parameters. Brand C had the highest compressive strength (285.3 ± 22.4 MPa), flexural strength (120.7 ± 11.1 MPa), and surface hardness (72.6 ± 6.3 VHN), as well as the least water sorption and solubility. It also exhibited good wear resistance and surface integrity. Brand A showed relatively lower values for all the properties.

Conclusion: Dental composites from Pakistan exhibited mixed results. Some materials had the potential to be used with at least equal properties as international brands, showing the capability of local brands; however, it is advised to test these materials clinically.

HABITUAL TODDY INTAKE AS A POTENTIAL RISK FACTOR FOR RIGHT VENTRICULAR FAILURE

Sat, 16 May 2026 00:00:00 +0200

Background: Right ventricular failure is aserious clinical condition commonly associated with pulmonary hypertension,chronic lung disease, and othercardiopulmonary disorders

Serum Anti-Müllerian Hormone and Antral Follicle Count as Predictors of Ovarian Reserve in Infertile Women: A Cross-Sectional Study

Nazneen Akhtar, Lubna Khan, Naila Javaid, Sobia Jamal, Aamina Latif, Asma khalil — Sat, 16 May 2026 00:00:00 +0200

Background: Ovarian reserve assessment is an essential aspect of assessing a woman's fertility and reproductive management. Serum Anti-Müllerian Hormone (AMH) and Antral Follicle Count (AFC) are effective indicators of ovarian follicular reserve and reproductive potential in infertile women.

Objective: To assess the utility of serum AMH and AFC as a predictor of ovarian reserve in infertile women and the relationship with reproductive characteristics.

Methods: This cross-sectional study was carried out from January 2024 to July 2025 at the Department of Gynaecology and Obstetrics, KRL Hospital, Islamabad, Pakistan. Consecutive non-probability sampling was used to recruit 120 infertile women between the ages of 20 and 40. Detailed demographic and reproductive history data were acquired. An enzyme-linked immunosorbent test was used to measure the AMH levels in the early follicular phase, and transvaginal ultrasonography was used to assess the AFC. SPSS version 26 was used for statistical analysis. The determinants of ovarian reserve were found using multivariate regression and correlation analysis.

Results: The mean age of the participants was 31.8 ± 4.9 years. AMH and AFC levels were considerably lower in women with limited ovarian reserve compared to those with normal ovarian reserve (p<0.001). There was a significant positive association (r = 0.74, P<0.001) between the AMH and AFC levels. As age increased, a strong negative connection between AMH and AFC levels was discovered. The greatest independent predictor of ovarian reserve status, according to the multivariate regression analysis, was serum AMH.

Conclusion: The serum AMH and AFC are reliable and clinically valuable markers of ovarian reserve in infertile women. The simultaneous evaluation of these markers could be useful in assessing infertility, in reproductive counseling, and in designing personalized fertility treatment plans.

Speciation of Candida Isolated From Various Clinical Samples & Their Susceptibility Pattern at Tertiary Care Hospital

Mon, 18 May 2026 00:00:00 +0200

Background: Candida species are important opportunistic pathogens, with a rising trend of non-albicans Candida (NAC) infections and increasing antifungal resistance. Rapid identification and susceptibility testing are essential for effective management.

Aim: To determine the species distribution of Candida isolates from various clinical specimens and evaluate their antifungal susceptibility patterns at a tertiary care hospital in Aurangabad.

Methods: A prospective observational study was conducted from January to December 2021. Clinical samples yielding Candida isolates were processed using the VITEK 2 Compact system for species identification and antifungal susceptibility testing against six agents (fluconazole, voriconazole, amphotericin B, caspofungin, micafungin, and flucytosine).

Results: Out of 244 isolates, Candida tropicalis (31.97%) was the predominant species, followed by C. albicans (22.95%). NAC species constituted 77.05% of isolates, with urine (36.89%) and sputum (19.26%) being the most common specimen sources. C. albicans showed complete susceptibility to amphotericin B and echinocandins, while reduced activity was noted for fluconazole (91%) and flucytosine (87.5%). C. tropicalis retained high susceptibility to amphotericin B (100%) and voriconazole (96%), but fluconazole susceptibility was lower (78.2%). Other NAC species demonstrated >90% susceptibility to amphotericin B, echinocandins, and voriconazole, but flucytosine resistance was higher (15%).

Conclusion: The study highlights an epidemiological shift toward NAC species, particularly C. tropicalis. While amphotericin B and echinocandins remain highly effective, emerging resistance to azoles and flucytosine underscores the need for rapid species identification and localized susceptibility data to guide antifungal therapy.

Audit of Antibiotic Prophylaxis Practices in Urogynecological Surgeries and Their Impact on Postoperative Infection Rates

Mon, 18 May 2026 00:00:00 +0200

Background: Postoperative infections remain a significant cause of morbidity following urogynecological surgeries, while variations in antibiotic prophylaxis practices may influence infection outcomes.

Objective: To evaluate antibiotic prophylaxis practices in urogynecological surgeries and determine their impact on postoperative infection rates.

Methods: This clinical audit was conducted at Tertiary Care Hospital from January 2025 to August 2025, included 355 patients undergoing urogynecological surgeries. Data regarding demographic characteristics, surgical variables, antibiotic prophylaxis practices, and postoperative infectious outcomes were collected using a structured proforma. Patients were evaluated for adherence to guideline-based antibiotic prophylaxis, including timing, antibiotic selection, dose, and duration.

Results: Appropriate antibiotic prophylaxis was observed in 248 (69.9%) patients, while 107 (30.1%) received inappropriate prophylaxis. Overall postoperative infections occurred in 43 (12.1%) patients. Infection rates were significantly lower in patients receiving appropriate prophylaxis compared with inappropriate prophylaxis (8.1% vs 21.5%, p=0.002). Inappropriate prophylaxis (Adjusted OR 2.74, 95% CI 1.42–5.31), prolonged operative duration (Adjusted OR 2.19, 95% CI 1.14–4.18), and prolonged catheterization (Adjusted OR 2.46, 95% CI 1.21–4.97) were independent predictors of postoperative infection.

Conclusion: Appropriate antibiotic prophylaxis practices were significantly associated with lower postoperative infection rates in urogynecological surgeries.

Antianxiety Effect of Black Pepper on Indomethacin Induced Anxiety in Zebrafish

Mon, 18 May 2026 00:00:00 +0200

Background: Anxiety disorders are the most common prevalent condition that affects both emotion and cognitive behavior. Annual prevalence of generalized anxiety disorder increased from 5.4% in 2020 to 6.6% in 2023, with a 3-year prevalence of 10.3% over the 2021–2023 period. The projected annual incidence ranged from 2.1% to 2.3%. Studies shown anxiolytic property due to the presence of chemical compounds like piperine, paprazine, cepharadione a, ciperolactam d, 10 – tricosanone and sylvamide. It also decreases motor deficits and improves memory function.

Materials and Methods: It is a preclinical study, done in animal house, DSMCH. The study was initiated after getting approval from IAEC. Sixty adult zebra fish are grouped in 6 groups as normal control, toxic control (indomethacin), standard drug (Diazepam), Test drug treatment (Piper Nigrum low, intermediate and high dose). Anxiety was induced in zebrafish by exposing to indomethacin 8 mg/l for 60 min and standard drug/ test drug for 30 min. Behavioral assessment was done using novel tank test.

Results: Indomethacin treated shows increased time spent in lower zone while treatment groups (group 3, 4, 5 & 6) showed more time spent on upper zone similar to control group. Number of transitions were more in toxic group and reduced in treatment and normal control groups. Abnormal swimming speed, erratic movements and thigmotaxis were found in all 10 fishes in indomethacin group while abnormal swimming speed, erratic movements and thigmotaxis were found in 3 fishes in group 3 & 5, 5 fishes in group 4, 2 fishes in group 6. Abnormal swimming pattern, Zig zag swimming, bottom dwelling was found in all 10 fishes in group 2 while swimming pattern and Zig zag swimming were found in 3 fishes in group 3 & 5, 5 fishes in group 4, 2 fishes in group 6. Bottom dwelling was seen 5 in group 3, 3 in group 4 and 2 in group 5 & 6. Freezing episodes were seen only in group 2

Conclusion: Piper nigrum (black pepper) treated group showed decreased in anxiety. Reduction levels are statistically significant with diazepam treated groups

ORAL CEFIXIME VERSUS ORAL CO-TRIMOXAZOLE IN THE TREATMENT OF UNCOMPLICATED TYPHOID FEVER IN CHILDREN (1-14 YEARS): A RANDOMIZED CONTROLLED TRIAL

Harish Kumar B, Bhuvanesh B T, , Vijaykumar Murteli, Shailesh S Patil — Fri, 15 May 2026 00:00:00 +0200

The typhoid fever caused bysalmonella typhi remains a serious problemin developing countries like India. It isestimated that more than 26.9 million typhoid fever cases occur annually out of which 1%result in death

Comparative Efficacy of Topical Tretinoin 0.05% Versus Azelaic Acid 10% in Epidermal Melasma

Tue, 28 Apr 2026 00:00:00 +0200

Background: Melasma is a common acquired disorder of facial hyperpigmentation that predominantlyaffects women and usually involves sun-exposed areas of the face. Since the pigment is primarilycontained in the superficial epidermal layers, epidermal melasma tends to respond well to topicaltherapy. Topical agents such as tretinoin and azelaic acid are generally used and their relative effectiveness may differ depending on skin type, sun exposure and tolerance.

Comparative Analysis of Partial Cystectomy versus Total Cystectomy in Colorectal Cancer Patients with Histologically Confirmed Bladder Invasion

Fri, 15 May 2026 00:00:00 +0200

Background: Bladder invasion appears in locally advanced cases of colorectal cancers, especially inthe areas of sigmoid and upper rectal tumors. The standard treatment involves en bloc excision which achieves R0 margin (microscopically negative margin).

Complications Using Tensioner Device in Radial Angiography among Patients

Muhammad Zafarullah, Aqeel Asghar, Jawad Ahmad, Ayesha Khaqan — Fri, 15 May 2026 00:00:00 +0200

Background: Coronary angiography is a widely performed procedure, and the tensioner approach iscommonly used for hemostasis. Access-site complications remain a clinical concern affecting patient outcomes and procedural safety

Prescription Pattern of Antidepressant Drugs in Patients With Depression at a Tertiary Care Teaching Hospital: A Cross-Sectional Drug Utilization Study

Fri, 15 May 2026 00:00:00 +0200

Background: Depression is one of the leading causes of disability worldwide and contributessubstantially to impaired quality of life, reduced productivity, increased healthcare utilization, andsuicide risk. Antidepressants remain the cornerstone of management; however, irrational prescribingpractices such as polypharmacy, prolonged benzodiazepine use, unnecessary fixed-dose combinations(FDCs), low generic prescribing, and inadequate adherence to treatment guidelines continue to beimportant concerns in psychiatric practice. Drug utilization studies are useful tools for evaluatingprescribing trends, assessing rationality of prescriptions, andpromoting evidence-based use ofpsychotropic medications.

From Acute Appendicitis to Obstructive Uropathy: Evaluating Urological Overlap in General Surgery

Fri, 15 May 2026 00:00:00 +0200

Background: Acute appendicitis with hydronephrosisis a rare but recognized clinical occurrence inwhich inflammation or abscess formation due to appendicitis obstruction or compression of the urinary tract.

RELATIONSHIP BETWEEN BIRTH WEIGHT AND PREMATURE RUPTURE OF MEMBRANES: A CROSS-SECTIONAL STUDY

Dr. Anu T V, Dr. Saswati Sanyal Choudhury, Dr.Mauchumi Saikia Pathak — Fri, 15 May 2026 00:00:00 +0200

Premature rupture of membranes (PROM) is acommon obstetric complication, affectingapproximately 5-10% of pregnancies. It isassociated with significant maternal andneonatal morbidity, particularly due to infectionand preterm birth. One of the important neonataloutcomes influenced by PROM is birth weight,which directly impacts neonatal survival and morbidity.

Exploration of Medical Students’ Perception on Climate Change- Cross Sectional Study

Mon, 18 May 2026 00:00:00 +0200

Background: Climate change represents one of the most significant global environmental and public health challenges of the 21st century. The health sector is pivotal in mitigating these impacts; therefore, medical students, as future healthcare providers, must be adequately sensitised to climate change and its direct consequences on human health.

Objectives: This study aims to explore medical students' perceptions of the causes and effects of climate change, evaluate their attitudes toward climate-friendly adaptive behaviours, and identify associations between socio-demographic variables and these perceptions.

Methods: A cross-sectional study was conducted from October to December 2024 at Government Medical College, Ongole. Using stratified random sampling, 180 undergraduate students from the first to third years of the MBBS program were selected. Data were collected via a pretested, structured questionnaire and analysed using descriptive and inferential statistics in SPSS.

Results: The findings revealed a notable awareness gap: 66.8% of participants had a low perception regarding the causes of climate change, and 53.8% had a low perception of its effects. However, 42.8% reported a high level of perceived climate-friendly adaptive behaviours. Primary perceived causes included deforestation (76.1%), greenhouse gas emissions (56.5%), and industrialisation (50%). Respiratory diseases (61.1%) were identified as the most frequent health effect. Statistically significant associations were observed between gender, year of study, and perception levels.

Conclusion: The study highlights an inadequate perception of climate change among medical students, emphasising the urgent need to integrate climate-health topics into the undergraduate medical curriculum.

Maternal Thyroid Biochemistry in Pregnancy and Its Relationship with Physiological Changes and Infant Developmental Outcomes

Wed, 06 May 2026 00:00:00 +0200

Background: Maternal thyroid hormones have been demonstrated to be critical for normal pregnancyphysiology, fetal growth and early neurodevelopment. Thyroid biochemical status can change duringpregnancy due to changes in thyroid hormone needs, iodine needs and maternal metabolism.Undiagnosed or undiagnosed and untreated thyroid disease can lead to poor maternal, neonatal and infant developmental outcomes

Assessing the Ripple Effects of a Research Module: A Mixed Method Study

Shamaila Manzoor, Muhammad Mazhar ul Haq, Hina Munir, Hifza Ishtiaq — Sun, 22 Mar 2026 00:00:00 +0100

Objective: This scientific investigation was carried out to measure the effectiveness of the researchmodule on the undergraduate medical students by assessing participants’ reactions and behavioural changes utilizing the Kirkpatrick Model of Evaluation as a theoretical framework

Correlation of Abnormal Doppler Indices with Perinatal Outcome in High Risk Pregnancy Patients

Dr. Purabi Das, Dr. Samudra Borah, Dr. Pradhumn — Sat, 16 May 2026 00:00:00 +0200

Background: High-risk pregnancies areassociated with increased maternal andperinatal morbidity and mortality due tocomplications such as hypertensive disorders, intrauterine growth restriction,gestational diabetes

Effectiveness and Safety of Contact Lens-Assisted Collagen Cross-Linking in Thin Corneas with Progressive Keratoconus: A Prospective Interventional Study

Dr. Jitendra Singh, Dr. Preeti Chahar, Dr. Pankaj Sharma — Tue, 19 May 2026 00:00:00 +0200

Background: Conventional corneal collagen cross-linking (CXL) is limited to corneas with a minimum thickness of 400 μm, restricting its use in advanced keratoconus. Contact lens-assisted collagen cross-linking (CACXL) has emerged as a potential alternative for thin corneas.

Aim: To evaluate the effectiveness and safety of CACXL in progressive keratoconus with thin corneas.

Methods: This hospital-based interventional study included 75 eyes of 48 adult patients with progressive keratoconus and corneal thickness between 350–440 μm. CACXL was performed using riboflavin-soaked soft contact lenses followed by ultraviolet-A irradiation. Patients were evaluated preoperatively and at 1, 6, and 12 months postoperatively. Outcomes included corneal thickness, maximum keratometry (Kmax), endothelial cell count, and best-corrected visual acuity (BCVA). Statistical analysis was performed using paired t-test.

Results: Mean preoperative corneal thickness was 407.91 ± 23.15 μm, with no significant change at 12 months (408.36 ± 23.22 μm; p=0.433). Kmax remained stable (58.99 ± 5.36 D preoperatively vs. 58.82 ± 5.45 D at 12 months; p=0.111). Endothelial cell count showed no significant reduction (p>0.05). BCVA improved significantly from 0.65 ± 0.30 to 0.60 ± 0.29 (p=0.002).

Conclusion: CACXL is a safe and effective procedure for halting keratoconus progression in thin corneas, without significant endothelial damage. It offers a practical alternative to conventional CXL.

Comparative Efficacy of Pregabalin and Duloxetine in the Management of Diabetic Neuropathic Pain: A Randomized Controlled Study

Tue, 19 May 2026 00:00:00 +0200

Objective: To assess and compare the efficacy, safety and patient-reported outcomes of pregabalin versus duloxetine in adults with painful diabetic peripheral neuropathy (DPN).

Methods: Prospective, Double blind, Double dummy, Parallel group, Randomized control trial was done in three tertiary care centers. Adults (30-70 years) with type 2 diabetes mellitus (T2DM) and confirmed painful DPN (Numerical Rating Scale [NRS] ≥5) were randomized 1:1 to receive either pregabalin (150-300 mg/day) or duloxetine (60 mg/day) for 12 weeks. P value of < 0.05 was considered statistically significant.

Results: Both treatments resulted in significant decrease in pain from baseline (p<0.001). At weeks 2 and 4, pregabalin had a faster onset of action than duloxetine for pain (p=0.003 and 0.012, respectively), and SF-36 mental component scores (p=0.008 and p=0.021, respectively) at 12 weeks. There was a similar responder rate (pregabalin 68.3% and duloxetine 65.7%, p=0.71). The incidence of nausea and dry mouth was increased with duloxetine compared with pregabalin (all p<0.05), while dizziness and weight gain were increased with pregabalin compared with duloxetine.

Conclusion: Both Pregabalin and Duloxetine shown to be equally effective for the relief of DPN pain for 12 weeks, but they have different onset of action, patient-reported outcomes, and adverse effect profile. Choices of treatment should be individualized, taking into account symptom dominance and comorbid conditions, as well as tolerability.

Clinicoradiological Spectrum and Predictors of Complicated Parapneumonic Effusion: A Prospective Observational Study from a Tertiary Care Center in India

Wed, 20 May 2026 00:00:00 +0200

Background: Parapneumonic effusion (PPE) represents a spectrum ranging from simple exudative effusion to empyema. Early identification of severity is essential for timely intervention and improved clinical outcomes

Aim: To evaluate the clinicoradiological characteristics of parapneumonic effusion and identify independent predictors of complicated effusion

Methods: This prospective observational study was conducted over 18 months in a tertiary care center in India, including 42 adult patients with PPE. Clinical features, pleural fluid parameters, and radiological findings were analyzed. Effusions were classified as uncomplicated or complicated based on biochemical and ultrasonographic criteria. Variables with p <0.1 in univariate analysis were included in multivariate logistic regression to determine independent predictors. Model calibration was assessed using the Hosmer–Lemeshow test, and multicollinearity was evaluated using variance inflation factor (VIF).

Results: The mean age was 47.8 ± 14.2 years with male predominance (78.6%). Complicated PPE was present in 57.1% of patients. These patients had significantly higher pleural fluid LDH (1980 ± 850 vs 820 ± 310 IU/L, p<0.001) and lower glucose levels (36.2 ± 10.4 vs 72.4 ± 12.1 mg/dL, p<0.001). Loculations were significantly more frequent (58.3% vs 11.1%, p<0.001). Independent predictors included LDH >1000 IU/L (OR 5.8, 95% CI: 2.1–15.9), glucose <60 mg/dL (OR 6.5, 95% CI: 2.4–17.4), and presence of loculations (OR 7.4, 95% CI: 2.6–20.8). ROC analysis showed good discriminative ability (LDH AUC = 0.82; glucose AUC = 0.85). The model demonstrated good calibration (Hosmer–Lemeshow p>0.05) with no multicollinearity (VIF <2).

Conclusion: Combined biochemical and ultrasonographic parameters reliably predict complicated parapneumonic effusion and can guide early aggressive management.

Effectiveness of Oral Tamsulosin in Reducing Double-J Stent-Related Symptoms: A Comparative Study Using IPSS and VAS Scores in a Tertiary Care Centre

Dr Shrikant Dadarao Gaysmindar, Dr Sanish Shringarpure, Dr Swapnaja Shringarpure — Wed, 20 May 2026 00:00:00 +0200

ABSTRACT
Background: Double-J (DJ) ureteral stents are commonly used in urological practice but are frequently associated with bothersome lower urinary tract symptoms and pain, significantly affecting patient quality of life. Tamsulosin, an α1-adrenergic blocker, may reduce these symptoms by decreasing ureteral smooth muscle tone and bladder outlet resistance. Aim: To evaluate the effectiveness of oral tamsulosin in reducing DJ stent-related symptoms using IPSS and VAS scores in a tertiary care centre.

Multimodal Diagnosis of Pityriasis Versicolor: Clinical, Wood’s Lamp, Dermoscopic and Microbiological Features

Thu, 21 May 2026 00:00:00 +0200

Objective: To evaluate the accuracy of diagnosing Pityriasis versicolor using clinical, woods lamp dermoscopic & microbiological features. Material and Methods: A prospective study (lasting one year) was conducted at the Dermatology, Venereology and Leprology (DVL) OPD of a rural tertiary health centre. The number of clinically suspected cases of Pityriasis versicolor (PV) was 50. Inclusion criteria included patients with scaly macules on the trunk or neck or arms. A standard clinical examination, Wood lamp examination (365 nm in a dark room) and polarized and non-polarized dermoscopy, 10% potassium hydroxide (KOH) microscopy, fungal culture on Sabouraud Dextrose Agar (SDA) and lipid-enriched Dixon agar was performed. Analysis was done using descriptive statistics, Chi-square/Fishers exact tests and diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value). The significance value of 0.05 was taken to be significant. Results: 68.0% of 50 patients had hypopigmented lesions. Clinical examination was 77.3 and 66.7 sensitive and specific respectively. The sensitivity of the lamp used by Wood was 81.8% and the fluorescence was yellow-gold. Dermoscopy proved to be 86.4% sensitive with loss of pseudo-network patterns, fine white scales and accentuation of perifollicles. It was cultured on only a 24.0% of the occasions (12/50) with the most common isolates being M. globosa (50) and M. furfur (33.3). KOH microscopy demonstrated a much higher detectability (80.0%) as compared to culture. The combination of multimodal (clinical + Woods lamp + dermoscopy + KOH) increased the diagnostic accuracy to 96.0% (p<0.001 over single methods). Conclusion: Multimodal method has a significant positive effect on the diagnostic accuracy of PV. Considering the low culture percentage of fungal culture in the Malassezia in routine environments, KOH microscopy is the primary microbiological test, and dermoscopy is an extremely helpful non-invasive complement. The lamp of wood aids in differentiating between PV and other pigmentary lesions. We propose a diagnostic algorithm that is stepwise and focused on accessible modalities that are point-of-care.

Serum Vitamin D, C, and E Deficiency in Osteoporotic Women: A Case–Control Analysis of Micronutrient Status

Thu, 21 May 2026 00:00:00 +0200

Objective: To compare the serum levels of vitamins D, C and E between postmenopausal women with osteoporosis and healthy controls, and to examine the association between the levels of oxidative stress biomarkers and lipid profile. Materials and Methods: A hospital-based case–control study was done with 73 women with primary osteoporosis and 20 age-matched healthy control women. Venous blood was drawn after 12 hours of fasting for biochemical analysis. The concentrations of 25-hydroxyvitamin D, vitamin C and vitamin E were quantified by enzyme-linked immunosorbent assay (ELISA) and spectrophotometric methods, respectively. One way ANOVA was used for statistical analysis and p<0.05 was deemed significant. Results: Osteoporotic patients exhibited significantly lower serum levels of vitamin D (24.04±6.81 vs. 69.32±7.63 ng/mL), vitamin C (0.33±0.09 vs. 0.57±0.08 mg/dL), and vitamin E (0.21±0.06 vs. 0.29±0.06 mg/mL) compared to controls (all p<0.001). The oxidative stress markers, malondialdehyde, nitric oxide, were significantly elevated (3.66±0.81 vs. 1.34±0.30 nmol/mL; 15.25±1.43 vs. 11.28±1.34) and the antioxidant enzymes (SOD, CAT, GSH, GPx) were significantly Depleted (All P<0.001). Conclusion: Vitamins D, C, and E were all severely deficient in the osteoporotic women, and there were an increased oxidative stress and dyslipidaemia in these women. Regularly assessing and supplementing micronutrients and/or using targeted antioxidant treatments could be a crucial complement to osteoporosis treatment.

Changing Clinical Spectrum of Dermatophytosis: Impact of Topical Steroid Abuse in Patients with Tinea Incognito

Dr. A. Shreemathi, Dr. CH Vijay Bhasker Reddy, Dr. P Navaneetha Reddy — Thu, 21 May 2026 00:00:00 +0200

Objective: To evaluate the changing clinical spectrum of dermatophytosis with special emphasis on the impact of topical steroid abuse in patients presenting with tinea incognito. Methods: This hospital-based observational study was conducted in the dermatology department of a tertiary care hospital over one year. A total of 220 patients with clinically and mycologically confirmed dermatophytosis were included. Detailed history regarding topical steroid use, clinical examination, and laboratory investigations including KOH mount and fungal culture were performed. Patients were categorized into classical dermatophytosis and tinea incognito groups for comparative analysis. Results: Out of 220 patients, 134 (60.9%) presented with tinea incognito and 86 (39.1%) had classical dermatophytosis. Atypical clinical features such as loss of central clearing, diffuse erythema, and eczematous changes were significantly more common in the steroid-exposed group (p < 0.001). Self-medication was the most common source of topical steroid use (61.9%). Tinea incognito cases showed longer disease duration and more extensive involvement compared to classical cases. Trichophyton rubrum was the most frequently isolated organism. Conclusion: The study demonstrates a strong association between topical corticosteroid misuse and the changing clinical spectrum of dermatophytosis, leading to a high burden of tinea incognito. Rational use of topical agents, strict regulation of steroid-containing formulations, and increased public awareness are essential to prevent disease modification and improve treatment outcomes.

Comparative Study between Serum Amylase and Lipase, BISAP Score, and CT Severity Index in Assessing the Severity of Acute Pancreatitis

Dr. Swaraj Sambit Samal, Dr. Chandra Sekhar Behera, Dr. Sujit Kumar Mohanty — Wed, 20 May 2026 00:00:00 +0200

Background: Acute pancreatitis is a common gastrointestinal emergency with clinical presentations ranging from mild self-limiting inflammation to severe disease associated with organ failure and high mortality. Early prediction of disease severity is essential for timely management and improved outcomes. While serum amylase and lipase are routinely used as diagnostic biomarkers, their prognostic value remains limited. Clinical and radiological scoring systems such as the BISAP (Bedside Index for Severity in Acute Pancreatitis) and CTSI (CT Severity Index) may provide more reliable severity assessment. This study aimed to compare the effectiveness of serum amylase, serum lipase, BISAP score, and CTSI in predicting the severity of acute pancreatitis. Methods: This prospective hospital-based observational analytical study included 200 adult patients diagnosed with acute pancreatitis according to the Revised Atlanta Classification. Clinical, biochemical, and radiological parameters were recorded. Serum amylase and lipase levels were analyzed alongside BISAP score, CTSI, and MCTSI (Modified Computed Tomography Severity Index). Severity prediction was evaluated using correlation analysis, ROC (Receiver Operating Characteristic) curves, and multivariable logistic regression. Statistical analysis was performed using Jamovi software, with p <0.05 considered statistically significant. Results: The mean age of patients was 47.28 ± 13.11 years, with male predominance (66%). Alcohol was the most common etiology (51.5%). Severe acute pancreatitis was observed in 51.5% of patients. Serum amylase and lipase showed moderate correlation with severity scores (r ≈ 0.43–0.46). ROC analysis demonstrated fair predictive performance for serum amylase (AUC = 0.735) and serum lipase (AUC = 0.718). BISAP score showed excellent predictive accuracy (AUC = 0.974), while CTSI and MCTSI demonstrated near-perfect discrimination (AUC = 0.991 each). Strong positive correlations were observed among BISAP, CTSI, and MCTSI (r > 0.96). Multivariable analysis identified BISAP and MCTSI as strong independent predictors of severe acute pancreatitis. Conclusion: The BISAP score is an effective early bedside tool for severity prediction in acute pancreatitis, while CTSI and MCTSI provide the most accurate radiological assessment of disease severity. Serum amylase and lipase remain useful diagnostic biomarkers but have limited prognostic utility. Integration of BISAP and CT-based severity indices can improve early risk stratification and clinical management of acute pancreatitis.

Diagnostic Performance and Clinical Utility of PCR-Based Molecular Detection for Bloodstream Infections: A Prospective Comparative Study with Conventional Blood Culture in a Tertiary Care Hospital

Sudhakar Singh, Kailash Jatav — Sat, 23 May 2026 00:00:00 +0200

Background: Early accurate identification of bloodstream pathogens is critical for initiating appropriate antimicrobial therapy. This study evaluated the diagnostic performance of PCR-based molecular detection as a complementary modality to conventional blood culture.

Methods: Prospective observational cohort study of 120 patients with clinically suspected bloodstream infections. Blood samples were simultaneously processed for conventional blood culture (BacT/ALERT) and PCR-based molecular diagnostics targeting 16S rRNA genes. Sensitivity, specificity, PPV, NPV, diagnostic accuracy, turnaround time, and concordance (Cohen's kappa) were calculated. ROC curve analysis and impact of prior antimicrobial exposure were assessed.

Results: PCR positivity rate (52.5%, 95% CI: 43.3-61.4%) significantly exceeded blood culture (35.0%, 95% CI: 26.7-43.3%). PCR demonstrated excellent sensitivity (95.2%, 95% CI: 88.6-99.1%), moderate specificity (70.5%, 95% CI: 62.3-78.7%), with NPV of 96.5% (95% CI: 91.2-99.3%) and diagnostic accuracy of 79.2% (95% CI: 71.0-87.4%). Mean turnaround time for PCR (6.3±1.4 hours) was significantly faster than blood culture (72.4±11.8 hours), representing 11-fold improvement (t=-34.2, p<.001). Cohen's kappa coefficient of 0.64 (95% CI: 0.52-0.76) indicated substantial concordance. Prior antimicrobial therapy significantly reduced blood culture positivity (23.3% vs. 46.7%, χ²=6.12, p=.013) but did not substantially affect PCR detection (55.0% vs. 50.0%, p=.601). ROC analysis revealed AUC of 0.88 (95% CI: 0.80-0.95, p<.001) with optimal Ct cut-off value of ≤32 cycles.

Conclusion: PCR-based molecular diagnostics demonstrated superior sensitivity, markedly reduced turnaround time, and stable diagnostic performance in antibiotic-exposed patients. An integrated diagnostic approach combining PCR and conventional culture optimizes diagnostic accuracy and clinical outcomes while supporting antimicrobial stewardship.

Multidrug-Resistant Gram-Negative Bacteria in ICU Patients: Prevalence, Species-Wise Resistance Profiles, Risk Factors, and Clinical Outcomes in a Tertiary Care Hospital

Ashish Kumar Shukla, Dr. Kailash Jatav — Sat, 23 May 2026 00:00:00 +0200

Background: Multidrug-resistant (MDR) Gram-negative bacteria are the predominant cause of healthcare-associated infections in intensive care units (ICUs), with limited therapeutic options. Comprehensive surveillance of species-specific resistance profiles and risk factors is critical for antimicrobial stewardship.

Objective: To determine MDR prevalence with species-wise antimicrobial susceptibility profiles, identify host and clinical risk factors for MDR acquisition, and evaluate clinical outcomes.

Methods: Prospective observational study; n=150 ICU patients. Disk diffusion AST (CLSI). MDR defined as resistance to ≥3 antimicrobial classes. Species-wise resistance to 13 antibiotics quantified. Chi-square test and descriptive statistics used. p<0.05 was significant.

Results: MDR prevalence: 74.0% (111/150). Highest in Klebsiella pneumoniae. ESBL: 51.3%; carbapenem resistance: 50.0%. Mean ICU stay: 13.97±6.63 days; mortality: 48.7%. No statistically significant association found between MDR and clinical outcomes (ICU stay p=0.156; mortality p=0.089). All six resistance genes detected in 46–52% of isolates.

Conclusion: A critical MDR burden exists in ICU settings in central India. Targeted infection control, antimicrobial stewardship, and molecular surveillance are urgently required. Clinical outcomes are multifactorially determined, with AMR as one of several contributing variables.

Clinical and Epidemiological Profile of Pathogenic Moulds Causing Systemic Mycoses in Patients Receiving Immunosuppressive Therapy and Their Antifungal Susceptibility in a Tertiary Care Hospital

Dr Chandini Devaraj, Dr Kavitha Muthusamy — Sat, 23 May 2026 00:00:00 +0200

Background: Invasive mould infections remain a serious problem in immunosuppressed patients because the disease often evolves rapidly, presents with nonspecific features, and demands early antifungal selection.

Aim: To describe the clinical and epidemiological profile of pathogenic moulds causing systemic mycoses in patients receiving immunosuppressive therapy and to assess their antifungal susceptibility pattern.

Materials and Methods: This prospective cross-sectional study was conducted in a tertiary care teaching hospital in Chennai over 12 months in the year 2022.Three hundred immunosuppressed adults with suspected systemic mycosis were evaluated using conventional mycological methods. Mould isolates were identified by culture characteristics and lactophenol cotton blue microscopy. Antifungal susceptibility testing was performed by the CLSI M38-A2 broth microdilution method.

Results: Systemic mycoses were confirmed in 28 of 300 patients, yielding an incidence of 9.3%. Men constituted 67.9% of confirmed cases, and the 41-60-year age group was most affected (60.7%). Thoracic Medicine contributed the largest share of cases (39.3%). Aspergillus spp. were the predominant isolates (57.1%), followed by Mucor spp. (25.0%) and Rhizopus spp. (17.9%). All proven mould infections occurred among corticosteroid-exposed COVID-19 patients, with a significant association between steroid regimen and proven mycosis within that subgroup (chi-square=24.7411, p=0.000001). Amphotericin B showed 100% in-vitro susceptibility across all isolates. Voriconazole retained excellent activity against Aspergillus spp., whereas itraconazole and posaconazole showed reduced activity against Mucorales.

Conclusion: Systemic mould infections in immunosuppressed patients in this setting were driven mainly by Aspergillus spp. and Mucorales, with a clear concentration among steroid-exposed patients. Species-level identification and routine antifungal susceptibility testing remain important for timely and appropriate therapy.

Prevalence and Clinical Correlates of Pedal Vascular Disease in Patients Admitted With Diabetic Foot Ulcers: An Observational Study from a Tertiary Care Centre in South India

Dr. A Ashiq Ahmed, Dr. S Sam Lourdes, Dr. Dorai Doraikannu — Sat, 23 May 2026 00:00:00 +0200

Background: Diabetic foot ulceration remains one of the most disabling consequences of diabetes mellitus, and coexisting lower-extremity arterial disease can substantially worsen tissue loss, infection, healing delay, and amputation risk.

Objective: To estimate the prevalence of pedal vascular disease among adults admitted with diabetic foot ulcers and to examine the distribution of selected demographic and clinical variables in relation to vascular status.

Methods: This observational analytical study included 354 consecutive adults with diabetes evaluated in a tertiary surgical unit during 2024–2025. Clinical history, vascular examination, ankle-brachial index, and arterial Doppler assessment were used for evaluation. Pedal vascular disease was defined using the study diagnostic framework based on vascular assessment, including ABI findings. Descriptive statistics were generated for the whole cohort. Categorical variables were compared with the chi-square test, and continuous variables were compared between vascular groups using the independent-samples t-test.

Results: The mean age of the cohort was 62.52 ± 13.02 years. Pedal vascular disease was identified in 200 of 354 patients, giving a prevalence of 56.5%. Hypertension was present in 66.9%, dyslipidemia in 57.9%, smoking history in 39.5%, alcohol use in 28.2%, peripheral neuropathy in 81.6%, and active foot ulceration in 87.3%. Patients with pedal vascular disease had slightly longer diabetes duration and marginally higher HbA1c values, but these differences were not statistically significant. The ABI was markedly lower in the pedal vascular disease group than in the non-disease group (0.64 ± 0.14 vs 1.10 ± 0.12, p < 0.001). No statistically significant association was demonstrated for sex, hypertension, smoking, dyslipidemia, alcohol use, coronary artery disease, cerebrovascular disease, peripheral neuropathy, or foot ulcer presence.

Conclusion: More than half of this tertiary-care diabetic foot cohort had pedal vascular disease. The burden was high even though conventional clinical risk markers did not separate vascular groups significantly within this already high-risk inpatient population. Routine vascular assessment remains essential in all patients presenting with diabetic foot complications.

Clinical, Epidemiological Fungal Profile and Antifungal Susceptibility Pattern of Pathogenic Yeast and Yeast-Like Fungi Causing Systemic Mycoses in Patients on Immunosuppressive Therapy in a Tertiary Care Hospital

Dr. Chandini Devaraj, Dr. Kavitha Muthusamy — Sat, 23 May 2026 00:00:00 +0200

Introduction: Systemic yeast infections are increasingly encountered in immunosuppressed patients, particularly among those exposed to corticosteroids, cytotoxic therapy, prolonged intensive care, and transplant-related immunomodulation. Invasive candidiasis continues to impose substantial mortality, while species replacement with non-albicans Candida and variable azole susceptibility have made empirical therapy less dependable.

Aim: To define the clinical and epidemiological profile of systemic mycoses caused by pathogenic yeasts and yeast-like fungi in immunosuppressed adults, and to evaluate the antifungal susceptibility pattern of the recovered isolates.

Materials and Methods: This hospital-based cross-sectional study was conducted at the Institute of Microbiology, Madras Medical College, in collaboration with Rajiv Gandhi Government General Hospital, Chennai, from August 2021 to August 2022. Three hundred adults receiving immunosuppressive therapy and clinically suspected to have systemic fungal infection were evaluated. Specimens were processed by direct microscopy, culture, CHROMagar-based presumptive identification, and conventional phenotypic methods. Antifungal susceptibility testing was performed according to CLSI M27-A3 and M44-A recommendations.

Results: Of 300 suspected patients, 32 were microbiologically confirmed to have systemic mycoses, giving a positivity rate of 10.7%. Males accounted for 65.6% of cases, and the 41–60-year age group constituted the largest cluster (59.4%). Diabetes mellitus was present in all proven cases, either alone or in combination with systemic hypertension. The respiratory tract was the most frequent site of involvement (43.8%), and blood was the most common specimen source (28.1%). Candida species accounted for 87.5% of isolates, with Candida tropicalis being the predominant pathogen (31.3%), followed by Candida glabrata (25.0%). Amphotericin B retained 100% activity against all isolates tested, whereas reduced azole susceptibility was most evident in C. glabrata and, to a lesser degree, C. tropicalis.

Conclusion: Systemic yeast infections in this cohort were driven predominantly by non-albicans Candida species, with clear evidence of heterogeneous azole susceptibility. Routine species-level identification and antifungal susceptibility testing are therefore central to timely, targeted therapy in immunosuppressed patients.

Clinical Profile and Outcomes of Children with Defects, Diseases, Deficiencies and Disabilities Attending a District Early Intervention Centre: A Cross-Sectional Study

Dr K Jayaprakash, Dr V Sharmila, Dr N Ragavendran — Sat, 23 May 2026 00:00:00 +0200

Background: District Early Intervention Centres (DEICs) were created under Rashtriya Bal Swasthya Karyakram to identify and manage childhood defects, diseases, deficiencies and developmental delays or disabilities. Programme-level evidence from individual districts is useful because the case-mix, referral routes and response to intervention vary across local health systems.

Objective: To describe the clinical profile and documented outcomes of children with one or more of the 4Ds attending a District Early Intervention Centre.

Materials and Methods: This hospital-based cross-sectional study included 1000 children up to 18 years of age who attended the District Early Intervention Centre, Government Dharmapuri Medical College Hospital, Dharmapuri, from January 2020 to December 2020. Demographic profile, referral source, 4D category, diagnosis, investigations, interventions, follow-up and outcome were recorded. Frequencies and percentages were used for categorical variables. Associations between categorical variables were assessed using the chi-square test, with p<0.05 considered statistically significant.

Results: The median age was 10 years (interquartile range 5-13 years). Males constituted 541 (54.1%) children and females 459 (45.9%). The largest age group was 6-10 years, 322 (32.2%), followed by 11-15 years, 294 (29.4%). Most children were referred through RBSK, 535 (53.5%), followed by primary health centres, 261 (26.1%). Disease was the commonest 4D category, 379 (37.9%), followed by deficiency, 245 (24.5%), disability, 162 (16.2%), defect, 110 (11.0%), and other conditions, 104 (10.4%). Dental caries, malnutrition, anaemia, thalassaemia, skin disorders, learning disorder and refractive error were the most frequent specific diagnoses. Age showed a significant association with referral source and 4D category (both p<0.001). Sex was also significantly associated with referral source (p=0.033) and 4D category (p<0.001). All children were followed up. Commonly documented positive outcomes included improved oral hygiene, improved haemoglobin level, improved weight-for-age, improved vision, corrected refractive error, better speech and seizure control.

Conclusion: The DEIC functioned as an accessible district-level hub for screening, multidisciplinary assessment, intervention and referral. The findings show a broad paediatric burden extending beyond birth defects alone, with diseases and deficiencies forming a substantial proportion of service needs. Strengthening referral continuity, rehabilitation equipment and outcome documentation can improve the measurable impact of DEIC services.

Study of Myeloperoxidase and LDL –C- in acute Coronary Artery Disease

Meenakshi Singh, Shrikant .W.Masram — Sat, 23 May 2026 00:00:00 +0200

Background: Coronary artery disease is the leading cause of death worldwide. Myeloperoxidase and its correlation with oxidized LDL have been studied and informative to the diagnostic, therapeutic and prognostic aspect of coronary artery disease.

Aim: To study the correlation of Myeloperoxidase (MPO) with LDL-C.

Material and Methods: Fifty each already diagnosed patient of coronary artery disease along with fifty control were studied for MPO and LDL-C.

Result:-MPO as well as LDL-C were increases significantly in coronary artery disease as compared to that of control.

Comparative Study of Surgical Outcome of Different Approaches in 90 Patients of Varicocele at Gmc Baramulla, Jammu and Kashmir

Sheikh Mehmood Rashid, Owais Khan, Sheikh Aamir Rashid — Sat, 23 May 2026 00:00:00 +0200

Background: Varicocele is the most commonly diagnosed prepubertal andrological condition and is an abnormal dilatation, lengthening and tortuosity of the veins of the spermatic cord. The clinical presentation of varicocele may vary from dull and dragging unilateral or bilateral testicular pain to visible varicose veins lying over the hemiscrotum.

Methods: A total number of 90 male adolescents with varicoceles were treated at the department of General Surgery at Govt. Medical College Baramulla Kashmir from January 2018 to December 2023 by three recognized surgical techniques viz., scrotal, trans inguinal and high ligation (Palomo's technique) and the results of surgical outcome in the three mentioned surgical approaches were compared.

Conclusion: We concluded that trans inguinal method is the best one for the correction of varicocele with easy approach, fewer complications and shorter hospital stay. There was a marked improvement in sperm quality and testicular volume in patients operated by this route.

Results: 56.6% of patients belonged to age group 15-20 years and in 90% of cases, left sided testis was involved. Among 6 patients who were infertile 2 (33.3%) patients became fertile and 4 (66.6%) patients had no effect on their fertility potential after varicocele correction. A significant change in testicular volume was noticed post operatively in all the 3 methods. A statistically significant improvement in sperm count (>50 million per ml) was observed in Trans inguinal technique while a significant improvement in sperm motility (>60%) was seen in trans inguinal and Palomo's approach.

Financial Planning for Medical Professionals: A Scoping Review

Dr Sameer Lakhani, Dr Noorin Bhimani, Dr Laila Patel — Sat, 23 May 2026 00:00:00 +0200

Background: Medical professionals face unique financial challenges, including substantial educational debt, delayed income trajectories, and high burnout rates linked to financial stress. Despite increasing recognition of these issues, the extent and nature of research on financial planning for this population remain unclear.

Objective: This scoping review maps the existing literature on financial planning for medical professionals, identifying key concepts, study characteristics, and research gaps to inform future investigations and curriculum development.

Methods: Following PRISMA-ScR guidelines, we searched PubMed, Embase, MEDLINE, ERIC, Scopus, and Cochrane Library databases from inception through January 2025. Studies examining financial literacy, financial planning, or financial wellness interventions for medical students, residents, fellows, or practicing physicians were included. Two reviewers independently screened citations and extracted data using a standardized form.

Results: From 2,847 unique citations, 45 studies met inclusion criteria. Publication volume increased markedly after 2018. Most studies (71%) focused on trainees (medical students, residents, fellows), with only 29% examining practicing physicians. Cross-sectional survey designs predominated (62%), while intervention studies comprised 24%. Key financial topics included educational debt management (89%), retirement planning (82%), insurance (76%), and investing (71%). Financial literacy was consistently suboptimal across all career stages, with 78% of studies reporting inadequate knowledge. Financial stress correlated with burnout in 12 of 14 studies examining this relationship. Educational interventions, though variable in design and duration, consistently improved knowledge and self-reported financial behaviors.

Conclusions: Research on financial planning for medical professionals has expanded substantially but remains fragmented, with limited longitudinal data and few validated outcome measures. Trainees are overrepresented relative to practicing physicians. Future research should prioritize standardized competency assessment, rigorous intervention studies with behavioral outcomes, and investigation of financial planning across the full physician career trajectory.

A CROSS-SECTIONAL STUDY TO EVALUATE THE PREVALENCE OF INSULIN RESISTANCE IN OBESE ADULT FEMALES USING HOMA-IR

Dr. Serina Khatun, Dr. Tamal Chakraborty, Dr. Washim Bari Rahaman — Thu, 21 May 2026 00:00:00 +0200

Background: Obesity is a major publichealth problem and is closely associatedwith insulin resistance, which representsan early metabolic abnormality preceding type 2 diabetes mellitus

Evaluation of Visual Outcomes and Retinal Structural Changes Following Multispot Laser Panretinal Photocoagulation in Patients with Proliferative Diabetic Retinopathy

Dr Vivek S Pai, Dr Mallika O U, Dr Dhanya R S, Dr Arundas H, MBBS, MD — Mon, 25 May 2026 00:00:00 +0200

Introduction: The development of Proliferative Diabetic Retinopathy(PDR), which is defined as a vision threatening condition resulting in retinal ischaemia with subsequent neovascularisation, is well documented. The treatment using multispot panretinal photocoagulation (PRP), due to its shortened duration and patient comfort, has proven to be a useful treatment modality. However, changes in retinal structural as well as visual function after laser photocoagulation needs further assessment.

Methods: We aimed to determine the visual outcomes and retinal structural changes after multispot laser panretinal photocoagulation (PRP) in PDR. We conducted a longitudinal study of 67 patients with newly diagnosed PDR without any clinically significant macular oedema at Retina Clinic, Government T.D. Medical College, Alappuzha between Jan 2018 and Jun 2019. Best corrected visual acuity(BCVA), Colour vision, visual field analysis, CMT and peripapillary RNFLT measured with Optical Coherence Tomography (OCT) was assessed in the baseline visit, 1, 3, 6 month visits.

Results: Mean CMT showed a progressively significant increase from baseline 236.416.4 µm to 249.423.9 µm at 1 month, 253.125.1 µm at 3 months and 254.625.8 µm at 6 months (p<0.01). Mean RNFLT showed a significant increase in 1 and 3 months followed by a minor insignificant reduction at 6 months. BCVA had significant deterioration throughout the follow up. Colour vision, had a significant reduction, at all follow-up visits compared to baseline. However there was no correlation between BCVA and structural parameters. A mild restriction of visual field was found after laser treatment.

Conclusion: The multispot PRP resulted in significant structural changes and moderate functional changes in retinal status. It remains an effective treatment modality for PDR.

Clinical, Hematological, and Etiological Profile of Anemia in Children and Adolescents: An Observational Study

Dr. N. Poornima — Mon, 25 May 2026 00:00:00 +0200

Background: Pediatric anemia is a heterogeneous clinical problem in which nutritional deficiency, chronic inflammation, hemoglobinopathy, hemolysis, and marrow failure may produce overlapping symptoms but distinct hematological signatures.

Aim: To describe the clinical presentation, hematological indices, morphological patterns, etiological spectrum, and severity distribution of anemia among children and adolescents evaluated in a pediatric department.

Materials and Methods: This observational study included 70 children and adolescents enrolled between May 2025 and April 2026. Age, sex, presenting symptoms, complete blood count indices, iron profile, transferrin saturation, peripheral smear findings, anemia morphology, etiology, and severity category were analysed. Categorical variables were summarised as frequencies and percentages. Continuous variables were expressed as mean ± standard deviation. Chi-square test and Kruskal-Wallis test were used where appropriate, with p<0.05 considered statistically significant.

Results: The mean age was 7.28 ± 4.57 years, and the sex distribution was equal, with 35 males and 35 females. Mean hemoglobin was 8.23 ± 1.61 g/dL. Moderate anemia was the commonest severity category, observed in 39 children (55.7%), followed by mild anemia in 18 (25.7%) and severe anemia in 13 (18.6%). Normocytic anemia was the most frequent morphology (36/70, 51.4%), followed by microcytic anemia (30/70, 42.9%). Iron deficiency anemia was the leading etiology (20/70, 28.6%), followed by sickle cell disease/variants (13/70, 18.6%), anemia of chronic disease (12/70, 17.1%), and thalassemia minor (10/70, 14.3%). Morphology was significantly associated with severity (chi-square=21.13, p<0.001).

Conclusion: The study shows that pediatric anemia is not a single nutritional entity. Although iron deficiency remained the largest etiological group, normocytic anemia related to chronic disease and hemolytic disorders formed a substantial proportion. A combined clinical, CBC, iron profile, and smear-based approach is therefore essential for accurate pediatric anemia evaluation.

Efficacy and Safety of Intralesional Injection of Mumps measles-Rubella (Mmr) Vaccine in the Treatment of Multiple Cutaneous Warts: A Clinical Trial.

Dr. Ankur Ghosh, Dr Victor Roy, Dr. Doyel Halder, Mrs Rebatee Roy — Mon, 25 May 2026 00:00:00 +0200

Introduction: Cutaneous warts are common benign skin lesions caused by human papillomavirus (HPV). Conventional treatments such as cryotherapy, salicylic acid, and electrosurgery are often associated with recurrence, pain, and variable efficacy. Intralesional immunotherapy using vaccines such as measles-mumps-rubella (MMR) has emerged as a promising alternative by stimulating host immune responses against HPV.

Aims: To evaluate the efficacy and safety of intralesional MMR vaccine in the treatment of multiple cutaneous warts.

Materials and Methods: This was an open-label, uncontrolled clinical trial conducted in the Department of Dermatology, Venereology and Leprosy at Rajendra Institute of Medical Sciences (RIMS), Ranchi. The study was carried out over a period of one year and seven months, from 01 March 2017 to 30 September 2018. A total of 81 patients with multiple cutaneous warts attending the outpatient department were initially recruited based on eligibility criteria, of whom 81 patients completed the study and were included in the final analysis. The study evaluated the efficacy and safety of intralesional MMR vaccine in the treatment of cutaneous warts.
Results: In patients with verruca vulgaris (n = 42), the mean number of warts decreased from 8.43 at baseline to 1.60 at the final follow-up, showing a statistically significant reduction (p < 0.0001). In the verruca plana group (n = 12), the mean number of lesions showed a marked decline from 52.42 at baseline to 7.42 at final follow-up, also demonstrating highly significant improvement (p < 0.0001). Similarly, in patients with palmoplantar warts (n = 27), the mean lesion count reduced from 9.37 to 1.04, with a highly significant response (p < 0.0001).
Conclusion: Intralesional MMR vaccine is an effective and safe immunotherapeutic modality for the treatment of multiple cutaneous warts. It offers the advantage of treating both local and distant lesions with minimal adverse effects, making it a promising alternative to conventional destructive therapies.

Cardiac Troponin T-Based Assessment of Myocardial Dysfunction in Critically Ill Children Admitted to a Pediatric Intensive Care Unit: A Prospective Observational Study

Dr. V Sharmila, Dr. N. Ragavendran, Dr. K. Jayaprakash — Mon, 25 May 2026 00:00:00 +0200

Background: Myocardial injury in critically ill children is often clinically silent at admission but may become important when shock, hypoxia, sepsis, respiratory failure, or multiorgan dysfunction increases myocardial oxygen demand while reducing effective oxygen delivery.

Aim: To assess myocardial status in critically ill children admitted to a pediatric intensive care unit using cardiac troponin T, bedside echocardiography, electrocardiography, and chest radiography, and to examine its association with selected clinical outcomes.

Materials and Methods: This hospital-based prospective observational study was conducted in the Pediatric Intensive Care Unit, Institute of Social Pediatrics, Government Stanley Medical College and Hospital, Chennai, from 1 April 2017 to 30 September 2017. Children aged 1 month to 12 years admitted to PICU without pre-existing congenital or acquired cardiac disease were included. Cardiac troponin T was measured at admission by electrochemiluminescence immunoassay; values >0.1 ng/mL were considered positive. Bedside two-dimensional/M-mode echocardiography, 12-lead ECG, and chest X-ray were recorded. Associations were tested using chi-square/Fisher exact tests and independent-samples t-test, with p<0.05 considered statistically significant.

Results: Among 112 children, 33 (29.5%) were troponin T positive. Troponin positivity was not significantly associated with sex (p=0.428) or age group (p=0.422). System-wise distribution among 87 children with a predominant major-system diagnosis showed significant variation in troponin positivity (p=0.036), with the highest proportions in cardiovascular disease (3/3, 100.0%), inborn errors of metabolism (2/3, 66.7%), and sepsis (3/7, 42.9%). Echocardiographic abnormality was present in 13/112 children and all 13 were troponin positive (Fisher exact p=0.0005). ECG abnormality (20/33 vs 23/79, p=0.002) and chest X-ray abnormality (20/33 vs 28/79, p=0.014) were also significantly more frequent in troponin-positive children. Mortality was higher in the troponin-positive group (26/33, 78.8%) than in the troponin-negative group (12/79, 15.2%; p=0.0005). Troponin positivity was also associated with need for mechanical ventilation (31/33, 93.9%; p=0.0005) and inotropic support (32/33, 97.0%; p=0.0005). Mean recorded stay was longer in the troponin-positive group, but the difference was not statistically significant (9.82±11.19 vs 6.75±7.68 days; p=0.156).

Conclusion: Admission troponin T positivity identified a clinically vulnerable subgroup of critically ill children with higher echocardiographic, ECG, and radiographic abnormalities, greater need for organ support, and markedly higher mortality. A bedside cardiac assessment pathway combining troponin T with echocardiography and ECG may help earlier recognition of myocardial involvement in PICU, although serial biomarker and imaging studies with adjustment for illness severity are needed before routine prognostic use can be generalized.

A Study on Benign Breast Disease Patients and Its Clinical Management at a Tertiary Care Centre of Jharkhand: A Cross-Sectional Study

Dr. Prasanta Das, Dr.Trisha Das, Dr. Naresh Kumar Munda — Fri, 15 May 2026 00:00:00 +0200

Background: Benign breast diseases (BBD) constitute the majority of breast-related complaints presenting to surgical and gynaecological outpatient departments across India. In Jharkhand, a tribal-dominated state with significant healthcare disparities, there is a notable paucity of published data on the clinical profile and management of BBD. The present study was undertaken to bridge this gap.

Objectives: To describe the sociodemographic profile of patients with benign breast disease, to identify associated risk factors, and to assess the clinical management outcomes at a tertiary care centre of Jharkhand.

Methods: A hospital-based cross-sectional study was conducted over a period of twelve months in the Department of Surgery, Tertiary Care Hospital, Jharkhand. A total of 76 patients presenting with breast complaints were enrolled using systematic random sampling after applying inclusion and exclusion criteria. Data were collected using a pre-tested structured questionnaire. Relevant clinical examinations, ultrasonography, FNAC, and biopsy were performed. Statistical analysis was done using SPSS Version 23.0, and odds ratios were calculated to determine risk associations.

Results: The mean age of patients was 34.2 ± 9.6 years. Fibroadenoma was the most common diagnosis (36.8%), followed by fibrocystic disease (23.7%) and simple breast cysts (13.2%). Oral contraceptive use (OR = 2.26, p = 0.026) and sedentary lifestyle (OR = 2.10, p = 0.048) were found to be statistically significant risk factors. Surgical excision and conservative medical management were the predominant treatment modalities with satisfactory outcomes.

Conclusion: Benign breast diseases are common among reproductive-age women in Jharkhand. Fibroadenoma remains the predominant pathology. Early diagnosis, patient education, and appropriate clinical management can substantially reduce morbidity. Strengthening breast health services at tertiary level is urgently required.

Clinical Outcomes of Conservative versus Surgical Treatment in Patients with Complicated Peptic Ulcer Disease

Mon, 25 May 2026 00:00:00 +0200

Background: Some people with peptic ulcer disease improve with medicines and supportive care, while others need surgery because of severe complications. So, it is important to choose the correct treatment at the right.

Objective: Comparing the outcomes of conservative and surgical treatment in complicated peptic ulcer disease patients.

Methodology: This comparative observational study was carried out at Khyber Medical University Kohat from July 2025 to December 2025. A total of 120 patients were divided into conservative treatment group and surgical treatment group. Demographic details, laboratory findings, type of complication, hospital stay, ICU admission, recurrence, postoperative complications, and mortality were recorded. Data analysis was done using SPSS version 26. Independent sample t-test and chi-square test were applied. A p-value below 0.05 was taken as significant.

Results: The mean age of patients was 46.8 ± 13.5 years. Perforated ulcer was more frequent in the surgical group, while bleeding ulcer was commonly managed conservatively. Mean hospital stay was lower in the conservative group (5.8 ± 2.3 days) compared to the surgical group (9.4 ± 3.6 days). ICU admission was observed in 25.8% surgical patients and 12.1% conservative patients. Recurrence was higher in conservative treatment patients (22.4%), whereas wound infection was more common after surgery (17.7%). Mortality did not show significant difference between both groups.

Conclusion: Conservative treatment was associated with shorter hospital stay and fewer procedure-related complications. Surgical treatment gave better disease control in severe cases, especially perforation. Careful patient selection can improve treatment outcome.

Intravenous Dexmedetomidine versus Dexmedetomidine-Dexamethasone Combination: A Comparative Study on Postoperative Nausea and Vomiting After Abdominal Surgeries

Mon, 25 May 2026 00:00:00 +0200

Background: Postoperative nausea and vomiting (PONV) is a frequent problem after abdominal surgeries. It delays recovery and increases patient discomfort. Dexmedetomidine has some antiemetic effect due to sympathetic block. Dexamethasone is also a well-known antiemetic drug.

Objective: To compare the effect of intravenous dexmedetomidine versus dexmedetomidine-dexamethasone combination on PONV after abdominal surgeries.

Study Design: Comparative observational study.

Place and Duration: Khyber Medical University-Institute of Medical Sciences, DHQ Teaching Hospital KDA Kohat, Pakistan. Study duration was 6 months from July 2025 to December 2025.

Methodology: Total 120 patients were included using non-probability consecutive sampling. Patients were divided into two equal groups. Group A received dexmedetomidine alone. Group B received dexmedetomidine with dexamethasone. PONV was observed for 24 hours after surgery. Data were analyzed using SPSS 26. Chi-square and t-test were applied. P-value ≤0.05 was considered significant.

Results: Overall PONV was significantly lower in Group B (23.3%) compared to Group A (46.7%) with p value 0.008. Nausea in early period was 16.7% vs 33.3%. Vomiting incidence was 11.7% vs 30%. Moderate and severe PONV were also reduced in combination group. Duration of surgery and opioid use were similar in both groups. Previous studies also show dexmedetomidine reduces PONV by lowering opioid requirement and stress response, and dexamethasone improves antiemetic effect through central pathways.

Conclusion: Dexmedetomidine plus dexamethasone is more effective than dexmedetomidine alone in reducing PONV after abdominal surgery.

Impact of Resin Sealants on the Prevention of Secondary Caries Adjacent to Composite Restorations

Sadiq Amin Ahmed Rana, Mobeen Akhtar, Tayyaba Nazir — Mon, 25 May 2026 00:00:00 +0200

Objective: To evaluate the impact of resin sealants on the prevention of secondary caries adjacent to composite restorations.

Materials and Methods: This prospective comparative study was conducted on 80 patients requiring Class I or Class II composite restorations. Patients were randomly divided into two groups: Group A (composite restorations without sealant) and Group B (composite restorations with resin sealant application). All procedures were performed under standardized conditions. Patients were followed up at 3, 6 and 12 months. The primary outcome assessed was the incidence of secondary caries while secondary outcomes included marginal integrity and plaque accumulation. Data were analyzed using SPSS, with a p-value of ≤0.05 considered statistically significant.

Results: At 12 months, the incidence of secondary caries was significantly lower in Group B (12.5%) compared to Group A (30%) (p = 0.04). Improved marginal integrity was observed in the sealant group. 75% of restorations showing intact margins compared to 50% in the control group (p = 0.03). Plaque accumulation was also reduced in Group B (25%) compared to Group A (45%). This showed borderline statistical significance (p = 0.05).

Conclusion: The application of resin sealants significantly reduces secondary caries and improves marginal integrity of composite restorations. It may be considered an effective adjunctive measure for enhancing restoration longevity and preventing recurrent decay.

Frequency of Post-Operative Pain in Single-visit vs Multiple visit Root Canal Treatment for Apical Periodontitis: A Randomized Controlled Trial

Bilal Arjumand, Kashif Adnan, Naresh Kumar, Bharat Kumar, Avinash, Shah Faisal — Wed, 20 May 2026 00:00:00 +0200

This randomized control trial was designed to evaluate the frequency and severity of post-operativepain related to single-visit multiple-visit root canal treatments in patients diagnosed with apicalperiodontitis. This study attempted to evaluate the effect of treatment visits on post-endodontic pain and overall patient satisfaction and comfort.

Anatomical Variations of Nasal Cavity and Frequency of Chronic Sinusitis in Polluted Areas

Wed, 20 May 2026 00:00:00 +0200

Background: Chronic sinusitis is an inflammatory disease of the paranasal sinuses that is veryprevalent and is related to anatomical and environmental factors. There may also be anatomicaldifferences in the nasal cavity which can constrict the sinus drainage routes and/or polluted air canstimulate irritation and inflammation of the sinuses. These may all be contributing factors to chronic SN symptoms, particularly in urban polluted environments.

Prevalence of Common Symptoms of Premenopausal Syndrome among Urban Women in Hyderabad, Sindh, Pakistan: A Cross-sectional Study

Wed, 20 May 2026 00:00:00 +0200

Background: Premenopausal syndrome (PMS) is a collection of physical, psychological, andbehavioral symptoms that occur in the years preceding menopause. Despite its substantial impact onwomen's health and daily functioning, little information is accessible in Pakistan, particularly among urban women in Hyderabad, Sindh. Understanding the incidence and typical symptom patterns iscritical for creating tailored health interventions.

Microbiological, Histopathological, and Radiological Characterization of the Endometrial Microenvironment in Recurrent Implantation Failure

Wed, 20 May 2026 00:00:00 +0200

Aim of Study: To characterize the microbiological, histopathological, and radiological features of theendometrial microenvironment in women with recurrent implantation failure (RIF) compared to fertilecontrols.
Study Duration: January 2025 to August 2025.

Study Place: Gujranwala Medical College/Teaching Hospital Gujranwala & Faryal Dental College,Shaikupura.

Role of Silicone Oil Tamponade in Complex Retinal Detachment: Experience from a Tertiary Eye Care Center in Pakistan

Mon, 25 May 2026 00:00:00 +0200

Complex retinal detachment remains a majorcause of irreversible visual impairment,particularly in developing countries where delayed presentation,proliferative vitreoretinopathy, diabetic tractional retinal detachment, and ocular trauma are common.

Effect of Peer-Assisted Learning on Psychological Wellbeing and Academic Confidence in Medical Students

Mon, 25 May 2026 00:00:00 +0200

Medical education is frequently associatedwith psychological stress, anxiety, reducedacademic confidence, and emotional
exhaustion among undergraduate students.Peer-assisted learning has recently emergedas an effective educational approach that
promotes collaborative learning, emotionalsupport, communication skills

Association Between Use of AI-Based Study Tools and Psychological Stress Among Undergraduate Medical Students

Mon, 25 May 2026 00:00:00 +0200

Artificial intelligence-based educational tools have rapidly transformed medical
education by providing personalized learningsupport, automated content generation,

Anatomical Variations of the Paranasal Sinuses and Their Role in Forensic Identification

Mon, 25 May 2026 00:00:00 +0200

Paranasal sinus anatomy exhibits significantindividual variability, making radiologicalsinus patterns increasingly valuable inforensic identification and medico-legalinvestigations. Frontal, maxillary, ethmoidal, and sphenoidal sinus configurations possessunique morphological characteristics

Clinical Outcomes of Multidrug-Resistant Urinary Tract Infections in Hospitalized Patients

Mon, 25 May 2026 00:00:00 +0200

Multidrug-resistant urinary tract infectionshave emerged as a major public healthconcern because of increasing antimicrobialresistance,prolongedhospitalization,recurrent infections, and rising healthcareassociated mortality. Hospitalized patients

AI-Driven Early Prediction of Neonatal Sepsis Using Clinical and Laboratory Parameters: A Public Health-Oriented Neonatal Risk Assessment Model

Mon, 25 May 2026 00:00:00 +0200

Neonatal sepsis remains a major contributor to neonatal morbidityand mortalityworldwide, particularly in low- and middleincome countries, where delayed diagnosisand limited neonatal intensive care resources

Prevalence of Hypertension and Obesity in Families: Correlation Between Adult and Pediatric Populations in Pakistan

Mon, 25 May 2026 00:00:00 +0200

Background: Hypertension and obesity haveemerged as major public health concerns inPakistan because of rapid urbanization,sedentary lifestyle patterns, unhealthy dietary habits, and increasing metabolic disease

Association of White Matter Hyperintensities on MRI with Cognitive Decline in Middle-Aged Adults

Mon, 25 May 2026 00:00:00 +0200

White matter hyperintensities identified onmagnetic resonance imaging are increasingly recognized as important neuroimagingmarkers associated with cerebral small vessel disease,

Multisystem Determinants of Ischemic Stroke in a Population-Based Cohort

Mon, 25 May 2026 00:00:00 +0200

Ischemic stroke remains a leadingcauseofmortalityandlong-termneurological disability worldwide. Emergingevidence indicates that cerebrovascular disease is not solely confined to cerebralvascular pathology but rather reflects

Rotterdam Risk Score and Perioperative Predictors of Abdominal Wound Dehiscence after Abdominal Surgery: A Hospital-Based Observational Study

Dr. S. Sankar, Dr. Boopathi Parthiban. M, Dr. B Chandraprakaash — Tue, 26 May 2026 00:00:00 +0200

Background: Abdominal wound dehiscence remains a difficult postoperative complication because it usually reflects the convergence of patient frailty, respiratory stress, contamination, nutrition, urgency of surgery, and tissue healing failure. A practical perioperative score can help the anaesthesia and surgical teams recognize high-risk patients early.

Objective: To assess the association of the Rotterdam risk score and selected perioperative variables with abdominal wound dehiscence among patients undergoing abdominal surgery.

Materials and Methods: This hospital-based observational study was conducted from June 2025 to February 2026 and included 60 patients undergoing abdominal surgery. Demographic factors, comorbidities, biochemical and operative variables, wound class, abdominal drain placement, duration of surgery, Rotterdam score, and postoperative wound dehiscence status were analysed. Continuous variables were compared using the Mann-Whitney U test. Categorical variables were assessed using Fisher's exact test or chi-square test as appropriate. Discriminative ability of the Rotterdam score was assessed using receiver operating characteristic analysis.

Results: Abdominal wound dehiscence occurred in 8/60 patients (13.33%). Among affected patients, dehiscence occurred at a mean of 8.12 ± 2.23 postoperative days. Patients who developed dehiscence were older (77.50 ± 8.35 vs 66.27 ± 11.89 years, p=0.013), had lower serum albumin (3.23 ± 0.36 vs 3.63 ± 0.51 g/dL, p=0.029), longer surgeries (161.88 ± 32.06 vs 128.17 ± 44.25 min, p=0.042), and higher Rotterdam scores (15.62 ± 5.37 vs 5.79 ± 6.41, p<0.001). Emergency surgery (38.9% vs 2.4%, p<0.001), COPD (45.5% vs 6.1%, p=0.004), jaundice (66.7% vs 10.5%, p=0.044), and anemia (31.8% vs 2.6%, p=0.003) were significantly associated with dehiscence. The Rotterdam score showed good discrimination, with an area under the curve of 0.869 (95% CI 0.742-0.971).

Conclusion: A higher Rotterdam score was strongly associated with postoperative abdominal wound dehiscence. Emergency surgery, COPD, anemia, jaundice, lower albumin, and longer operative duration were clinically important warning signals. In routine perioperative practice, especially in resource-pressured surgical units, Rotterdam-based stratification may support closer surveillance and early optimization, although larger prospective validation is required.

Clipless Versus Conventional Clip-Based Laparoscopic Cholecystectomy: A Prospective Comparative Study Of Operative Safety and Early Recovery Outcomes

Dr. R. Aishwarya Lakshmi, Dr. S. Sankar, Dr. Boopathi Parthiban.M — Tue, 26 May 2026 00:00:00 +0200

Background: Clipless laparoscopic cholecystectomy has emerged as a technically appealing alternative to conventional clip-based cystic pedicle control, but its practical value depends on operative efficiency, safety, postoperative pain, and return to routine activity.

Objective: To compare clipless and conventional laparoscopic cholecystectomy with respect to operative time, intra-operative blood loss, perioperative safety, postoperative pain, hospital stay, and early functional recovery.

Materials and Methods: This prospective comparative study was conducted from March 2025 to November 2026. Eighty patients undergoing laparoscopic cholecystectomy were analyzed, with 40 managed by the clipless technique and 40 by the conventional technique. Demographic profile, ASA grade, indication for surgery, prior abdominal surgery, operative duration, blood loss, intra-operative complications, bile duct injury, conversion to open surgery, 6-hour pain score, hospital stay, time to return to normal activity, Clavien-Dindo grade, and 30-day readmission were assessed. Continuous variables were compared using Welch independent-samples t-test, and categorical variables were assessed using chi-square or Fisher exact test as appropriate.

Results: The groups were comparable for age (48.08 ± 9.79 vs 50.15 ± 9.90 years; p=0.349), BMI (27.14 ± 2.92 vs 27.59 ± 2.80 kg/m2; p=0.487), sex distribution, ASA class, and operative indication. Clipless cholecystectomy was associated with shorter operative time (46.70 ± 6.46 vs 65.53 ± 6.11 minutes; p<0.001), lower blood loss (23.25 ± 9.81 vs 32.42 ± 12.93 mL; p=0.001), lower 6-hour VAS score (3.21 ± 0.61 vs 4.81 ± 0.61; p<0.001), shorter hospital stay (1.92 ± 0.46 vs 2.66 ± 0.44 days; p<0.001), and earlier return to normal activity (7.78 ± 2.25 vs 11.55 ± 2.26 days; p<0.001). No bile duct injury or conversion to open surgery occurred in either group. Postoperative complications were mild to moderate and did not differ significantly between groups (15.0% vs 22.5%; p=0.568).

Conclusion: In this cohort, clipless laparoscopic cholecystectomy demonstrated better operative efficiency and faster early recovery while maintaining a safety profile comparable to conventional clip-based surgery. The findings support clipless technique as a feasible option in appropriately selected patients, provided safe dissection principles are strictly followed.

Glycaemic Variability and Urinary Albumin Excretion in Type 2 Diabetes Mellitus: A Retrospective Observational Study

Dr. Manikandan, Dr. Parthiban, Dr.Anantharaj — Tue, 26 May 2026 00:00:00 +0200

Background: Albuminuria is an early and clinically meaningful expression of diabetic kidney involvement. Mean HbA1c reflects average glycaemic exposure, but it does not fully capture long-term oscillation in glycaemic control. Whether visit-to-visit HbA1c variability parallels urinary albumin excretion in routine general-medicine practice remains a practical question.

Objective: To evaluate the association between retrospective HbA1c variability and urinary albumin excretion rate (UAER) among patients with type 2 diabetes mellitus.

Materials and Methods: This retrospective observational study included 100 patients with type 2 diabetes mellitus evaluated in the Department of General Medicine between June 2025 and January 2026. Three consecutive annual HbA1c values were used to calculate mean HbA1c, standard deviation, and coefficient of variation (CV). UAER was classified as normoalbuminuria (<30 mg/24 h), microalbuminuria (30-300 mg/24 h), and macroalbuminuria (>300 mg/24 h). Group comparisons were performed using analysis of variance and chi-square tests. Spearman correlation assessed the relation of UAER with glycaemic, renal, and blood-pressure variables.

Results: The cohort had a mean age of 59.52 ± 8.06 years, with equal sex distribution. Normoalbuminuria, microalbuminuria, and macroalbuminuria were observed in 29%, 39%, and 32% of patients, respectively. Mean HbA1c increased from 7.24% in normoalbuminuria to 10.32% in macroalbuminuria (p<0.001). HbA1c CV also rose across the same groups (2.41% to 4.31%, p<0.001). Across HbA1c CV tertiles, mean UAER increased from 56.67 ± 41.79 to 559.41 ± 270.71 mg/24 h, while mean eGFR declined from 79.94 ± 15.52 to 43.50 ± 13.55 mL/min/1.73 m² (both p<0.001). Macroalbuminuria was concentrated in the high HbA1c CV tertile (82.4%).

Conclusion: Higher mean HbA1c and greater visit-to-visit HbA1c variability were strongly associated with higher UAER and lower eGFR in type 2 diabetes mellitus. Glycaemic consistency, not only point-in-time HbA1c control, may deserve greater emphasis during diabetic kidney disease risk assessment.

Association of Sedentary Lifestyle and Stress with Menstrual Irregularities

Sadia Ilyas, Kiran Iqbal, Shaila Anwar — Mon, 25 May 2026 00:00:00 +0200

Objective: To assess the effect of sedentary life style and stress on menstrual irregularities.

Materials and Methods: It was a cross sectional study conducted on 200 female doctors including undergraduate medical students of Lahore Medical and Dental College. Data was collected through convenient sampling during March 2022 to August 2022. Female doctors and female medical students were included in this study with normal BMI and between the age of 18-44 years. Data was analyzed through SPSS version 25. P value 0.05 was considered statistically significant.

Results: In our study, 200 female doctors were included. Out of 200 doctors, 165 doctors were found to be in stressful condition of variable severity. Comparison of irregular periods was done between stressed and non-stressed doctors and it was found that among stressed group, 95(57.6%) doctors had irregular periods and among non-stressed there were only 2 (5.7%) who had irregular periods. When chi square test was run to find the relationship of irregular periods with stressed and non-stressed doctors, there was a strong statistical association between two groups.

Conclusion: Our study presented that sedentary lifestyle and stress are associated with menstrual irregularities. Increase in sedentary lifestyle are among modifiable risk factors for menstrual cycle irregularities. It was a cross-sectional study and other risk factors were not studied in detail so relationship of different modifiable factors must be studied in future studies.

Safety And Efficacy of Vitex Agnus Castus Extract In Patients With Polyendocrine Metabolic Ovarian Syndrome:A Prospective Observational Study

Sadia Ilyas, Shaila Anwar — Tue, 26 May 2026 00:00:00 +0200

Introduction: Polyendocrine metabolic ovarian syndrome (PMOS) is a common endocrine disorder among women of reproductive age. The evidence of use of herbal and alternative therapies to alleviate PCOS symptoms are minimal. The aim of the study was therefore to investigate the safety and efficacy of Vitex Agnus Castus (VAC) extract in Pakistani women with ovulatory dysfunction such as PMOS.

Methods: This prospective study enrolled 100 PMOS patients with oligomenorrhea at Obstetrics and Gynaecology Department of Ghurki Trust Teaching Hospital, Lahore. The patients received Ovitex Tablet containing 40 mg of VAC extract, once daily for three months. The efficacy profile was primarily examined based on the length of menstrual cycle and number of ovarian follicles.

The levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone, LH/FSH ratio, body weight and body mass index (BMI) were determined as the secondary outcomes.

Results: The results showed decrease in the length of menstrual cycle at week 12 compared to baseline (62.23 ± 12.16 to 51.40 ± 13.98; P < 0.001). Levels of LH, FSH, and total testosterone and LH/FSH ratio were not significantly altered compared to baseline at the end of treatment. No serious adverse events were reported during the study.

Conclusion: This study demonstrated that VAC administration for 3 months improved oligomenorrhea related to PMOS and moderately reduced levels of FSH and LH. However, reduction in body weight could not be achieved.

Active Tuberculosis in Chronic Kidney Disease: Frequency, Clinical Spectrum, and Stage-Wise Pattern in an Observational Study

Dr. Manikandan, Dr.Parthiban, Dr.Anantharaj — Tue, 26 May 2026 00:00:00 +0200

Background: Tuberculosis Remains Clinically Important In Patients With Chronic Kidney Disease Because Uremia, Malnutrition, Diabetes, And Dialysis-Related Exposure May Weaken Host Defence And Delay Recognition Of Disease.

Objective: To Determine The Frequency, Phenotype, And Stage-Wise Pattern Of Active TB Among Patients With CKD And To Explore Selected Clinical Correlates.

Materials and Methods: This Observational Cross-Sectional Analysis Included 60 CKD Patients Enrolled Between March 2025 And February 2026. Variables Included CKD Stage, Egfr, Diabetes, Hypertension, TB Status, TB Type, Smoking, BMI, Serum Albumin, And Haemoglobin. Exact Tests And Mann-Whitney U Testing Were Used Because Active TB Events Were Few.

Results: Active TB Was Documented In 6/60 Patients (10.0%; 95% CI: 3.8-20.5). Pulmonary, Extra pulmonary, And Combined TB Were Equally Represented (2 Cases Each). Stage 5D Showed the Highest Numerical Frequency (2/5, 40.0%), Compared With 4/55 (7.3%) In Non-Stage 5D Patients (P=0.074). Active TB Patients Had Lower Mean Egfr, Serum Albumin, And Haemoglobin Than Those Without TB, Although None Reached Statistical Significance.

Conclusion: Active TB Was Not Rare In This CKD Cohort And Appeared Numerically Concentrated In Dialysis-Dependent Disease. The Findings Support Stage-Sensitive TB Vigilance In CKD Care, Particularly When Advanced CKD, Hypoalbuminaemia, Anemia, Or Dialysis Transition Is Present.

Uterine Transplantation as a Fertility Restoration Technique: A Prospective Observational Study of Clinical Outcomes, Surgical Challenges, and Reproductive Success Rates

Manish De — Tue, 26 May 2026 00:00:00 +0200

Introduction: Uterine transplantation (UTx) has emerged as a novel fertility-restoring option for women with absolute uterine factor infertility (AUFI). Despite being in its developmental stage, successful live births following uterine transplantation have demonstrated its potential as an alternative to surrogacy and adoption. However, data regarding surgical feasibility, perioperative challenges, graft survival, and reproductive outcomes remain limited.

Aims and Objectives: To evaluate uterine transplantation as a fertility restoration technique in AUFI, focusing on clinical outcomes, surgical challenges, graft survival, and reproductive outcomes including pregnancy and live birth rates.

Materials and Methods: This prospective observational study was conducted over 9 months in the Department of Obstetrics and Gynaecology, Deben Mahato Government Medical College, MS. A total of 150 women with absolute uterine factor infertility undergoing uterine transplantation were included and evaluated for clinical, surgical, and reproductive outcomes.

Results: Out of 150 patients, 120 (80%) had successful uterine transplantation outcomes. Highest success was in age 26–30 years (84%) with no significant association (p = 0.49). MRKH syndrome showed better outcomes (87.5%) (p = 0.20). Living donor transplantation had significantly higher success (85%) than deceased donor (70%) (p = 0.03). Menstrual recovery occurred in 78.70% (p = 0.02), and pregnancy was achieved in 46.70% with live birth in 36.70% (p = 0.01).

Conclusion: Uterine transplantation is an emerging fertility restoration technique for women with AUFI, showing encouraging reproductive outcomes in selected cases. However, it is a complex procedure with significant surgical and immunological challenges. Larger studies with long-term follow-up are needed to standardize protocols and improve outcomes.

Use of AI Tools and Academic Performance in Medical Education

Samia Sarwar, Amna Zia, Junaid Iqbal, Sobia Nawaz, Rafia Minhas, Sehrish Liaqat — Tue, 26 May 2026 00:00:00 +0200

Background: Artificial Intelligence (AI) tools have rapidly transformed the educational landscape, particularly in medical education where students face extensive academic workloads and complex clinical learning requirements. AI-based platforms such as intelligent tutoring systems, automated question generators, virtual simulations, and language-processing tools are increasingly being utilized to enhance learning efficiency, improve access to educational resources, and support personalized learning experiences. Medical students commonly use AI applications for note preparation, concept clarification, literature searching, examination preparation, and clinical decision-making practice. Despite the growing integration of AI technologies in academic settings, concerns remain regarding overreliance on these tools, reduced critical thinking abilities, and ethical issues related to academic integrity. Therefore, understanding the relationship between AI tool utilization and academic performance among medical students has become increasingly important.

Objective: To evaluate the use of AI tools and their association with academic performance among medical students.

Methodology: A cross-sectional descriptive study was conducted among undergraduate medical students enrolled in different academic years at a medical university. A structured, self-administered questionnaire was distributed to collect data regarding demographic characteristics, frequency and purpose of AI tool usage, commonly used AI applications, perceived benefits, and academic outcomes. Students’ academic performance was assessed using self-reported grade point averages (GPA) and examination scores. Data were analyzed using statistical software. Descriptive statistics, frequencies, percentages, mean scores, and chi-square tests were applied to determine associations between AI tool usage and academic performance. A p-value of <0.05 was considered statistically significant.

Results: A total of 250 medical students participated in the study, with a mean age of 21.4 ± 2.1 years. Among the participants, 62% were female and 38% were male. Approximately 84% of students reported regular use of AI tools for academic purposes. The most commonly used applications included AI chat assistants, online medical learning platforms, and automated quiz generators. About 71% of students believed that AI tools improved their understanding of difficult medical concepts, while 67% reported enhanced examination preparation and time management. Students who frequently utilized AI-based educational resources demonstrated significantly higher academic performance compared to infrequent users (p<0.05). However, nearly 41% of participants expressed concerns regarding dependency on AI tools and reduced independent learning skills.

Conclusion: AI tools are widely utilized among medical students and appear to positively influence academic performance, learning efficiency, and conceptual understanding. Appropriate integration of AI technologies into medical education may enhance student learning outcomes; however, balanced usage and proper academic guidance are necessary to prevent excessive dependency and maintain critical thinking abilities.

Anatomical Factors Associated with Conversion from Laparoscopic to Open Cholecystectomy Surgery

Thu, 14 May 2026 00:00:00 +0200

Background: Laparoscopic cholecystectomy is the recommended surgery for symptomatic gallstonedisease and cholecystitis, due to diminished postoperative pain, reduced hospital stay and quickerrecovery. But, if anatomical distortion, inflammation, or adhesions or unclear biliary anatomy is present, laparoscopic dissection may be impossible, and conversion to open cholecystectomy may be necessary

Maternal Vitamin a Deficiency in Pregnancy and its Relationship with Maternal and Neonatal Haemoglobin Concentration

Tue, 12 May 2026 00:00:00 +0200

Background: Vitamin A deficiency in pregnant women is a significant nutritional issue in developingcountries, and could be a factor in maternal anemia and poor birth outcomes. Vitamin A deficiency isrequired for erythropoiesis, immune function and fetal growth. But little local information is available on the association of maternal vitamin A status with maternal and neonatal hemoglobin concentrations.

Correlation between Maternal Thyroid Biochemistry, PhysiologicalChanges inPregnancy,andInfant Developmental Milestones

Sun, 10 May 2026 00:00:00 +0200

Background: Maternal thyroid hormones are important in pregnancy adaptation, fetal growth andearly neurodevelopment. Mild thyroid dysfunction may have a role in the outcomes of the newborn and the developmental milestones of the infant, especially during periods of fetal brain development.

The Role of Competency-Based Medical Education in Modern Assessment Practices: Exploring How Competency-Based Frameworks Are Shaping Clinical Assessments, Skill Development, and Outcome Measurements in Medical Training

Imran Zaman Khan, Muhammad Junaid Khan — Mon, 11 May 2026 00:00:00 +0200

Background: Competency-Based Medical Education (CBME) has become a paradigm shift in medicaltraining where time is no longer a significant factor in medical education, but instead a clinicalcompetence is evidenced. The traditional assessment paradigms used in medical education usually involve summative examination and the use of some limited workplace

Female Health through Yoga

Sowmya M N, Athira P S, Nanjammanni N — Wed, 27 May 2026 00:00:00 +0200

Background: Female health concerns such as menstrual disturbances, stress-related disorders, hormonal imbalance, and lifestyle-related illness are increasingly common in modern society.¹ Yoga offers a holistic, low-cost, and preventive approach that may support women’s physical, mental, and reproductive well-being.²

Aims/Objectives: To assess the role of Yoga in improving female health and to explore its potential benefits in relation to physical fitness, emotional stability, hormonal regulation, and reproductive health.³

Materials/Methods: This abstract is based on a narrative review of published literature related to Yoga interventions in women’s health.^4,5 Relevant studies on asana, pranayama, and meditation were examined with attention to outcomes such as stress reduction, menstrual regularity, quality of life, and symptom improvement in common female health conditions.^1-5

Results: Available evidence suggests that regular Yoga practice improves flexibility, muscular strength, posture, and relaxation.² It may reduce stress, anxiety, and depressive symptoms while supporting better hormonal balance and menstrual health.^1,2,5 In women with conditions such as PCOS, menopause-related symptoms, and reproductive health concerns, Yoga appears to offer beneficial adjunctive support.^4,5

Conclusion: Is a safe, holistic, and effective complementary intervention for promoting female health.^3,5 Its regular practice may improve both physical and psychological well-being and can be considered an important lifestyle measure for women across different age groups.^1-3,10

Role of Aharaupayogi Varga in Health Promotion

Sowmya M N, Shambhavi A M, Nanjammanni N — Wed, 27 May 2026 00:00:00 +0200

Ayurveda, the ancient science of life, is based on well-established Siddhanta (principles) that aim to promote health, prevent disease, and achieve longevity. Among these, the concept of Trayoupastambha (three pillars of health)—Ahara (diet), Nidra (sleep) and Brahmacharya (regulated lifestyle)—is considered fundamental for maintaining physiological balance and overall well-being. Ahara which is the term for a balanced diet is the first pillar of Ayurveda. In fact, Ahara is very primary and basic which it serves as a main source of nutrition and energy and also in the growth, maintenance and repair of body tissues (Dhatus). What we put in our body not only affects our physical health but also our mental performance also plays a role in shaping our nature and habits. Also, improper Ahara may in fact have negative impact on our health. Acharya Charaka reported a classification of twelve Ahara Vargas among them Aharayogi Varga which is the systematized grouping of food items (Ahara Dravya) according to their health benefits, promotion of long life and disease prevention. The term “Ahara” means food, while “Upayogi” means suitable for use, and “Varga” denotes a category or group. Thus, Aharaupayogi Varga encompasses different groups of food items classified according to their properties (Guna), taste (Rasa), potency (Virya), post-digestive effect (Vipaka) and action (Prabhava). Hence, the present article deals with over view of Aharaupayogi Vargas in Ayurveda and Contemporary science.

Effectiveness of Planned Teaching Programme on Knowledge Regarding Warning Signs of Mental Illness And its Prevention Among Adolescents In Selected Educational Institutions: A Quasi Experimental Study

Mr. Mangesh A. Tihile, Mrs. Siddeshwari Barbatkar, Mrs. Suman Azad — Wed, 27 May 2026 00:00:00 +0200

Introduction: A vital component of total wellbeing is mental health, especially throughout adolescence, a developmental stage characterized by emotional, psychological, and social shifts. adolescents are susceptible to mental health problems because they frequently deal with pressures like peer pressure, social interactions, academic pressure, and familial expectations. Early detection of mental disease warning signals is crucial for prompt prevention and intervention.

Methodology: This study was based on quantitative approach. The research design used in this study was Quasi experimental Design. One group pre-test post -test design was used to find the effectiveness of planned teaching programme on knowledge regarding warning signs of mental illness and it’s prevention among adolescents from selected educational institutions and association of knowledge score with the selected demographic variables

Results: Mean knowledge score in pre test was 13±5.87 and mean percentage of knowledge score in pre test was 43.33±19.59. After the planned teaching program, mean knowledge score in post-test was 26.04±2.00 and mean percentage of knowledge score in post test was 86.80±6.67 and the mean difference was 13.04±5.85. The tabulated value was 1.96. The calculated ‘t’ value i.e. 18.64 which is much higher than the tabulated value.

Conclusion: The study concluded that the post test knowledge score was improved after implementation of planned teaching program. Planned teaching program plays important role in improving the knowledge.

A Study to Assess Life Style Modification among Hiv/Aids Affected Patients Visiting at Anti-Retroviral Therapy Centre Sms Hospital Jaipur

Rashmi Biwal — Wed, 27 May 2026 00:00:00 +0200

The present study was conducted to assess lifestyle modification among HIV/AIDS affected patients visiting the Antiretroviral Therapy Centre, SMS Hospital, Jaipur, Rajasthan. HIV/AIDS is a chronic health condition that requires continuous medical management along with appropriate lifestyle modification for improving treatment outcomes, quality of life, and prevention of complications. The main objectives of the study were to assess lifestyle modification among HIV/AIDS affected patients and to find out the association between lifestyle modification and selected socio-demographic variables.

A quantitative research approach with descriptive research design was adopted for the study. The research variable was lifestyle modification among HIV/AIDS affected patients, and the selected demographic variables included age, gender, type of family, marital status, educational status, occupation, and monthly income. A total of 60 HIV/AIDS affected patients were selected by using convenient sampling technique from the ART Centre, SMS Hospital, Jaipur. The inclusion criteria included HIV/AIDS affected patients attending the ART Centre and having a history of taking antiretroviral treatment for 6 months to 1 year. Data were collected by using a structured questionnaire on lifestyle modification. The reliability of the tool was established by KR-20 method, and the reliability coefficient was found to be 0.75, indicating that the tool was reliable.

The findings showed that the majority of patients, 41 (68.33%), had moderate lifestyle modification, 18 (30%) had mild lifestyle modification, and only 1 (1.66%) had strong lifestyle modification. The mean lifestyle modification score was 12.58 out of 30, with a mean percentage of 41.94%. The median score was 12, mode was 9, and standard deviation was 4.23.

The study concluded that most HIV/AIDS affected patients had moderate lifestyle modification, while strong lifestyle modification was very low. Therefore, regular counselling, health education, follow-up, and patient-centred lifestyle guidance are required at ART centres to improve lifestyle practices among HIV/AIDS affected patients.

Clinical Epidemiology and Biochemical Correlates of Pediatric Scabies in Central India: A Retrospective Study

Wed, 27 May 2026 00:00:00 +0200

Background: Scabies is a highly contagious parasitic skin infestation caused by Sarcoptes scabiei var. hominis and remains a major public health concern in developing countries, especially among children. Pediatric scabies is associated with poor hygiene, overcrowding, malnutrition, and secondary bacterial infections. Limited data are available regarding its biochemical correlates in Central India.

Aim: To evaluate the clinical epidemiology and biochemical correlates of pediatric scabies in Central India.

Materials and Methods: A Retrospective observational hospital-based study was conducted in the Department of Dermatology and Biochemistry at Shri Shankaracharya institute of medical sciences (SSIMS) Bhilai Chattisgarh, from March 2025 to February 2026. Medical records of 100 pediatric patients (<14 years) diagnosed with scabies were reviewed. Demographic details, clinical characteristics, socioeconomic status, and biochemical investigations including hemoglobin, absolute eosinophil count (AEC), serum IgE, and C-reactive protein (CRP) were analyzed. Statistical analysis was performed using SPSS version 29.0. Continuous variables were expressed as mean ± standard deviation (SD). Chi-square test and Student’s t-test were applied. A p value <0.05 was considered statistically significant.

Results: Among 100 children, males constituted 58% and females 42%. The mean age was 8.6 ± 3.9 years. The majority of cases belonged to low socioeconomic status (68%). Pruritus was present in 100% of cases, followed by papular lesions (72%) and secondary bacterial infection (28%). Mean eosinophil count and serum IgE levels were significantly elevated in severe scabies compared to mild disease (AEC: 712 ± 188 vs 420 ± 110 cells/µL; p<0.001, serum IgE: 286 ± 96 vs 148 ± 72 IU/mL; p=0.002). Correlation analysis in the present study demonstrated a significant positive association between disease severity and serum IgE levels, eosinophil count, ESR, and CRP. Serum IgE showed the strongest correlation with scabies severity (r = 0.61, p < 0.001), suggesting that increasing immunological hypersensitivity may parallel worsening clinical infestation Anemia was observed in 46% of children. Seasonal clustering was noted during winter months.

Conclusion: Pediatric scabies remains highly prevalent in socioeconomically deprived populations of Central India. Significant biochemical abnormalities including eosinophilia, elevated serum IgE, and anemia were associated with disease severity. Early diagnosis, treatment, and improvement of hygiene practices are essential for reducing disease burden.

Prevalence of Sensorineural Hearing Loss in Young Adults with Type 2 Diabetes Mellitus - An Observational Study

Dr. Israth M.P., Dr. Sahni D.K., Dr. Pearly P.K., Dr. Anwar Rasheed — Mon, 25 May 2026 00:00:00 +0200

Background: Sensorineural hearing loss (SNHL) is an under-recognized complication of type 2 diabetes mellitus (T2DM). Chronic hyperglycemia can lead to microangiopathy, neuropathy, and oxidative stress affecting cochlear structures. Early-onset T2DM in young adults may predispose patients to early auditory dysfunction. This study aimed to estimate the prevalence of SNHL among young adults with T2DM and evaluate associated factors including age, sex, duration of diabetes, and glycemic control.

Methods: A hospital-based observational descriptive study was conducted among 95 patients aged 18–40 years with T2DM attending the Departments of ENT and Endocrinology at Travancore Medical College, Kollam. Consecutive sampling was used. Hearing assessment was performed using pure tone audiometry, and hearing loss was classified according to WHO criteria. HbA1c values and clinical variables were recorded. Statistical analysis was performed using Chi-square test and Pearson correlation analysis.

Results: The prevalence of SNHL among young adults with T2DM was 52.6%. Mild SNHL was the most common form (72%), followed by moderate (22%) and moderately severe hearing loss (6%). Patients aged 30–40 years demonstrated significantly higher prevalence of SNHL compared to those aged 20–30 years (p=0.001). Duration of diabetes and poor glycemic control were significantly associated with hearing loss. A strong positive correlation was observed between HbA1c levels and degree of hearing loss (r=0.833). No statistically significant association was observed between gender and SNHL.

Conclusion: SNHL is highly prevalent among young adults with T2DM and is strongly associated with poor glycemic control and longer disease duration. Routine audiological screening should be considered in diabetic care protocols for early identification and intervention.

A Comprehensive Study of Occupational Hazard among Ent Patients in A Tertiary Care Centre

Thu, 28 May 2026 00:00:00 +0200

Background: Occupational diseases are those where employee or person’s are exposed to physical chemical, biological and social elements which may be hazardous to general health with chronic exposure leading to occupational induced diseases which also includes Ear, Nose, Throat diseases.

Methods: Based on the statistical data available in the institution for the period of two years from January 2024 to December 2025. All ear, nose & throat occupational diseases were analysed with respect to age, gender, aetiology manifestation diagnosis, treatment and follow up.

Results: Total no of cases studied were 90 (nighty cases) male cases were 60 (sixty cases) and female cases were 30 (thirty) with male: female ratio was 2:1, most common manifestation is noise induced high frequency hearing loss in one or both ears, most common age is between 40-50 years.

Conclusion: Most common presentation is higher frequency sensory neural hearing loss especially among road traffic constables, bus drivers and noise producing factories, and second commonest is chronic rhinosinusitis with allergic allergic manifestations especially among miners, working in cement and fertilizer and other chemical industries. Early identification has helped in reducing comorbidity.

ANALYSIS OF OBSTETRIC COMPLICATIONS AMONG THE PREGNANT WOMEN WITH UTERINE FIBROID

Rashida, Sarwat Khalid, Shazia Saeed, Asma Iqbal, Saira Qadar, Shehzad Niazi — Thu, 28 May 2026 00:00:00 +0200

Background: Prevalence rates of uterineleiomyomas in women are estimated at20%-40%. However, these numbers considerably drop for pregnant females.Namely, only 0.1%-3.9% women areexpected to experience fibroids duringpregnancy

An Observational Study of Childhood Iron Deficiency Anemia and the Factors Affecting the Outcome of Oral Iron Therapy

Dr Aditi Agrawal, Dr Rachita Chatterjee, Dr Naveen Kumar Singh — Thu, 28 May 2026 00:00:00 +0200

Aim: To assess the childhood iron deficiency anemia and the factors affecting the outcome of oral iron therapy

Materials and Methods: This hospital-based observational study was conducted in the Department of Paediatrics at… Hospital, over a period of six months. The study population included children aged 1–5 years attending the outpatient department (OPD), casualty, and inpatient department with symptoms suggestive of iron deficiency anemia (IDA). A total of 50 participants were included in the study.

Results: Successful correction of iron deficiency anemia was significantly associated with morning administration of iron therapy, intake on an empty stomach, and co-administration with lime/curd/orange, suggesting improved iron absorption. In contrast, night-time dosing, intake with food or tea/milk, gastrointestinal side effects, hospital admissions, low birth weight, and poor weight-for-height were associated with poorer treatment outcomes. These findings indicate that administration practices, dietary factors, and treatment-related side effects significantly influence the effectiveness of iron therapy.

Conclusion: Factors such as low socioeconomic status, low birth weight, inadequate feeding practices, pica, and parasitic infestation were associated with IDA. Treatment response was significantly influenced by proper iron administration practices and dietary factors, highlighting the importance of caregiver education and nutritional counseling for improving treatment outcomes.

Frequency of Vitamin D Deficiency in Patients with Stroke

Thu, 28 May 2026 00:00:00 +0200

Objective: Vitamin D is an important hormone involved in mineral ion homeostasis regulation. VitaminD inadequacy has been highlighted in Stroke cases in several previous studies. The aim of present studywas to determine the frequency of vitamin D deficiency in the patients with stroke admitted in the Medical and Neurology Departments of Frontier Medical and Dental College, Abbottabad

Injury Severity Score as a Predictor of Morbidity, Mortality and Length of Hospital Stay in Patients with Road Traffic Accident

Sun, 10 May 2026 00:00:00 +0200

Background: Road traffic accidents remain a major source of preventable trauma, disability and deathworldwide. The Injury Severity Score is widely used to quantify anatomical trauma severity and tosupport triage, prognostication and audit of trauma care. Globally, road traffic crashes causeapproximately 1.19 million deaths each year, and injuries disproportionately affect young adults and vulnerable road users.

Comparative Evaluation of Corneal Endothelial Morphology in Patients with Type 2 Diabetes Mellitus and Healthy Individuals Using Specular Microscopy

Chris Mathew Koshy, K. V. Raju, Irshad E, Lakshmi Cherungottil — Sat, 30 May 2026 00:00:00 +0200

Introduction: Diabetes mellitus can result in structural alterations of the corneal endothelium that are liable to modify corneal function. This research was conducted to analyze differences in corneal endothelial morphology of patients with Type 2 diabetes mellitus (T2DM) and healthy subjects using specular microscopy.

Methods: A comparative cross-sectional study was done on a total of 184 people, out of which 92 were Type 2 Diabetes Mellitus patients and 92 were healthy individuals matched for age. Parameters of corneal endothelium like endothelial cell density (ECD), average cell size, coefficient of variation (CV), and hexagonality were measured using noncontact specular microscopy.

Results: Compared to the control group, diabetic patients had a A lot reduced ECD and hexagonality However their mean cell area and CV were Quite a bit higher (p<0.05). ECD reduction and mean cell area enlargement were correlated with the length of diabetes and the severity of the diabetic retinopathy. More severe diabetic retinopathy was linked to higher levels of HbA1c.

Conclusion: Type 2 diabetes mellitus is associated with significant corneal endothelial morphological changes, which become more pronounced with increasing disease duration and severity of diabetic retinopathy.

Frequency of Heart Failure in Thalassemia Patients on Chelation Therapy

Shakeel Ahmed, Nusrat Hussain, Asma Akbar, Maria Tanveer, Quratulain Sarwar — Mon, 01 Jun 2026 00:00:00 +0200

Background: Beta-thalassemia major is a transfusion-dependent hemoglobin disorder in which repeated blood transfusions can lead to progressive iron overload and cardiac injury. Although chelation therapy reduces iron-related complications, heart failure may still occur because of poor chelation adherence, persistent anemia, high serum ferritin levels, and delayed cardiac surveillance.

Objective: To determine the frequency of heart failure among beta-thalassemia major patients receiving chelation therapy and to assess its association with demographic, laboratory, transfusion-related, and clinical factors.

Methods: This cross-sectional study was conducted in the Department of Pediatric Medicine, DHQ Hospital, Dera Ghazi Khan, over six months. A total of 100 children aged 5–15 years with confirmed beta-thalassemia major receiving oral deferasirox chelation therapy for at least one year were enrolled through non-probability consecutive sampling. Demographic characteristics, disease duration, transfusion pattern, chelation regularity, hemoglobin level, serum ferritin, chest X-ray findings, and echocardiographic parameters were recorded. Heart failure was diagnosed on the basis of predefined clinical findings and echocardiographic evidence of reduced ejection fraction. Data were analyzed using SPSS version 20.0, and associations were assessed using the chi-square test, with p≤0.05 considered statistically significant.

Results: The mean age of the patients was 9.8 ± 2.9 years, and 56.0% were male. The mean disease duration was 6.7 ± 2.7 years. Heart failure was identified in 20 patients, giving an overall frequency of 20.0%. The mean serum ferritin level was 3778 ± 1675 ng/mL, while the mean pre-transfusion hemoglobin level was 8.6 ± 1.1 g/dL. Among patients with heart failure, hepatomegaly was the most common clinical finding, observed in 90.0%, followed by respiratory distress in 75.0%, basal crepitations in 65.0%, pitting edema in 55.0%, and raised jugular venous pressure in 40.0%. The mean ejection fraction was lower in patients with heart failure than in those without heart failure. Heart failure was significantly associated with shorter transfusion interval, lower hemoglobin category, higher serum ferritin category, poor chelation regularity, and cardiomegaly on chest X-ray.

Conclusion: Heart failure was present in one-fifth of beta-thalassemia major children receiving deferasirox chelation therapy. High serum ferritin, low pre-transfusion hemoglobin, frequent transfusion requirement, poor chelation regularity, and cardiomegaly were significantly associated with heart failure, highlighting the need for optimized transfusion support, strict chelation adherence, regular ferritin monitoring, and routine cardiac evaluation in thalassemia care.

The Deferral Dilemma: Analysing why Whole Blood Donors are Turned Away at a Tertiary Care Blood Centre, New Delhi

Gupta Surbhi, Mittal Anita, Choudhary Irfan — Mon, 01 Jun 2026 00:00:00 +0200

Background: Donor screening is essential for safety because it prevents adverse reactions through appropriate selection criteria. Recruitment can be hampered by donor deferrals, thus it's critical to understand and resolve the reasons behind them.

Aims: To Analyse the deferral pattern among whole blood donors at a tertiary care blood centre, New Delhi.

Settings and Design: This is a retrospective record-based study for a period of 3 years from September 2022 to August 2025 at immunohematology and blood transfusion department at ESI Medical college and Hospital, Delhi.

Methods and Material: Deferral data was collected by donor deferral register and monthly deferral report. Donors were deferred as per Drugs and Cosmetic Act of 1940 and the DGHS guidelines. Donors who were deferred were analysed according to age, sex, and reasons for deferral.

Statistical analysis used: Statistical analysis was done using Microsoft Excel, and data were expressed in numbers and percentages. Descriptive statistics were employed to summarize donor demographics, deferral rates among males and females, and to assess the causes of temporary and permanent deferrals.

Results: A total number of 24335 potential blood donors were registered for blood donation, out of which 4467 donors were deferred. Overall deferral rate was 18.35%. The deferral rate among male and female was 16.78% and 63.04% respectively. Temporary and permanent deferrals accounted for 76.30% and 23.70% respectively.

Conclusions: Donor deferral is the critical step in the donor selection criteria. Temporary deferred donors may be recruited back to the donor pool through appropriate counselling and management.

Therapeutic Potential of A3 Adenosine Receptor Agonists in Pancreatic Ductal Adenocarcinoma

Deepika PK, Dr. Vivek D, Dr. Shahin Muhammed TK, Fathima Rasma K — Mon, 01 Jun 2026 00:00:00 +0200

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, characterized by late diagnosis, profound chemoresistance, and a five‑year survival rate below 10%. Conventional therapies including surgery, radiation, and cytotoxic chemotherapy offer limited benefit due to the tumor’s genetic heterogeneity and dense desmoplastic stroma. Recent advances highlight adenosine receptor signaling as a pivotal regulator of PDAC biology, with the A₃ adenosine receptor (A₃AR) emerging as a promising therapeutic target. A₃AR is markedly overexpressed in malignant tissues while remaining low in adjacent normal cells, enabling selective modulation of tumor growth and survival pathways. Preclinical and early clinical studies of selective A ₃AR agonists, particularly Namodenoson, demonstrate inhibition of NF‑κB, Wnt/β‑catenin, and RAS signaling, leading to apoptosis, reduced proliferation, and enhanced chemosensitivity. Combination strategies integrating A₃AR agonists with chemotherapy, immunotherapy, targeted inhibitors, and stromal‑modifying agents show synergistic potential, addressing both intrinsic tumor signaling and extrinsic micro environmental barriers. Despite encouraging safety and efficacy profiles, challenges remain, including pathway redundancy, stromal resistance, and limited clinical validation. Future perspectives emphasize biomarker‑driven patient selection, mechanistic exploration of resistance, and translation into large‑scale randomized trials. Collectively, A₃AR agonists represent a novel class of precision therapeutics with the potential to reshape PDAC management and improve outcomes in a disease with few effective alternatives.

Comparative Assessment of Tear Break-Up Time, Schirmer Test Values, and Oxidative Stress Biomarkers among Different Types of Soft Contact Lens Users

Mon, 01 Jun 2026 00:00:00 +0200

Background: Soft contact lenses are widely used for vision correction and cosmetic purposes. Their long-term use may affect tear film stability affecting the ocular surface health. Oxidative stress may act as a possible mechanism behind contact lens-related dry eye symptoms.

Objective: To compare Tear Break-Up Time (TBUT), Schirmer test values, and oxidative stress biomarkers among different types of soft contact lens users and healthy controls.

Methods: This comparative cross-sectional study was conducted at LRBT Tertiary Teaching Eye Hospital, Lahore, Pakistan, during July to December 2025. A total of 150 participants were enrolled through consecutive sampling. The participants were divided into daily disposable lens users (n=50), monthly replacement lens users (n=50), and healthy controls (n=50). TBUT, Schirmer I test, and tear oxidative stress biomarkers were measured and compared among groups.

Results: Significant differences were observed among the study groups. Mean TBUT was 10.2±2.1 seconds in daily disposable users, 8.1±1.9 seconds in monthly replacement users, and 13.4±2.3 seconds in controls (p<0.001). Mean Schirmer values were 15.3±3.1 mm, 12.8±2.7 mm, and 19.6±3.4 mm, respectively (p<0.001). MDA levels were highest in monthly replacement users (4.82±0.91 nmol/mL) and lowest in controls (2.41±0.63 nmol/mL) (p<0.001). SOD and TAC levels were significantly lower among contact lens users (p<0.001). MDA showed a significant negative correlation with TBUT and Schirmer values.

Conclusion: Soft contact lens wear is associated with reduced tear film stability, decreased tear secretion, and increased oxidative stress. Monthly replacement lenses showed greater adverse effects than daily disposable lenses.

Role of zinc and vitamin D supplementation in improving growth in malnourished thalassemic children

Dr. Shalini Maurya, Dr. Anubha Nema, Suresh Kumar Gajraj — Mon, 01 Jun 2026 00:00:00 +0200

Background: Growth retardation and malnutrition are among the most frequent complications in children with transfusion-dependent thalassemia (TDT). Multiple factors including chronic anemia, iron overload, endocrine dysfunction, micronutrient deficiencies, and recurrent transfusions contribute to impaired growth. Zinc and vitamin D deficiencies are highly prevalent among thalassemic children and may significantly influence linear growth and nutritional status. Indian studies have reported a substantial burden of zinc and vitamin D deficiency in pediatric thalassemia populations.

Aim: To evaluate the role of zinc and vitamin D supplementation in improving growth parameters in malnourished thalassemic children.

Methods: A prospective interventional study was conducted among 80 malnourished transfusion-dependent thalassemic children aged 2–15 years attending a tertiary care center. Children were divided into two groups: standard care alone and standard care with zinc and vitamin D supplementation. Anthropometric measurements including height, weight, BMI, growth velocity, and biochemical parameters were recorded at baseline and after six months.

Results: Significant improvement in weight gain, linear growth, BMI, and serum micronutrient levels was observed in supplemented children (p<0.05).

Conclusion: Zinc and vitamin D supplementation significantly improve growth outcomes among malnourished thalassemic children and should be considered an adjunctive nutritional strategy.

Comparison of Ultrasound-Guided and Nerve Stimulator-Guided Obturator Nerve Block during Transurethral Resection of Bladder Tumour: A Prospective Randomized Single-Blinded Study

Dr. Megha Soni, Dr. Yawar Rashid, Dr. Aela Sifat Hinna — Fri, 29 May 2026 00:00:00 +0200

Background: Transurethral resection of bladder tumour involving the lateral and posterolateral bladder wall may provoke an obturator reflex despite adequate spinal anaesthesia. The resulting adductor contraction can interrupt resection and may contribute to bleeding, bladder perforation, or incomplete tumour clearance. Obturator nerve block is therefore given in addition to spinal anaesthesia to suppress this reflex, but the most practical localisation technique remains clinically relevant in routine operating rooms.

Objective: To compare ultrasound-guided and nerve stimulator-guided obturator nerve block during TURBT under spinal anaesthesia, with emphasis on obturator reflex prevention, ease of approach, intraoperative interruptions, complications, and patient satisfaction.

Methods: This prospective randomized single-blinded comparative study included 60 patients scheduled for elective TURBT under subarachnoid block. Patients were randomized into two equal groups: Group U received obturator nerve block after ultrasound localisation, and Group N received the block after nerve stimulator localisation. Both groups received 20 mL of 0.5% bupivacaine. Ease of approach was classified according to the number of needle passes/redirections, and intraoperative outcomes were recorded after a 20-minute waiting period following the block. Continuous variables were compared using an independent samples t-test, while categorical variables were analysed using chi-square or Fisher’s exact test as appropriate.

Results: Baseline characteristics were comparable between groups. Mean needle passes were significantly fewer in Group U than Group N (1.97 ± 1.96 vs 5.97 ± 4.60; p<0.001). An easy approach was achieved in 26/30 patients in Group U compared with 9/30 in Group N (p<0.001). Adductor reflex occurred in 2/30 patients in Group U and 8/30 in Group N (p=0.038). Resection was hampered in the same proportions. Bleeding and bladder perforation were also less frequent in Group U, with bladder perforation limited to 2/30 patients in Group N. Patient satisfaction was higher with ultrasound guidance (4.30 ± 0.99 vs 3.13 ± 1.38; p<0.001).

Conclusion: Ultrasound-guided obturator nerve block offered better procedural ease and lower obturator reflex-related intraoperative events than nerve stimulator-guided block in patients undergoing TURBT under spinal anaesthesia. The findings support ultrasound localisation as a useful adjunct for improving surgical stability during lateral and posterolateral bladder wall tumour resection.

A Comparative Study between Conventional Closure versus Modified Smead Jones Technique of Single-Layer Mass Closure with Polypropylene Suture after Midline Emergency Laparotomies

T.A. Bharath, Ajhay Srinivass c, D. Dorai — Tue, 02 Jun 2026 00:00:00 +0200

Background: Failure of midline abdominal closure after emergency laparotomy remains an important cause of postoperative morbidity, particularly through wound infection, wound dehiscence, incisional hernia, and prolonged hospitalization.

Aim: To compare conventional continuous closure with modified Smead Jones single-layer mass closure using polypropylene suture after emergency midline laparotomy.

Materials and Methods: This ambispective comparative study included 116 adults who underwent emergency midline laparotomy, with 58 patients in each group. Group A underwent conventional closure and Group B underwent modified Smead Jones closure. Outcomes assessed were wound infection, wound dehiscence, incisional hernia, Southampton wound grade, and duration of hospital stay. Statistical analysis in the thesis used chi-square and independent t-test.

Results: Mean age was comparable between groups (46.98±16.88 years in Group A vs 45.22±16.87 years in Group B; p=0.5758). On postoperative day 3, wound infection was documented in 14 patients in Group A and 3 patients in Group B; the thesis summary table reported this difference as non-significant (p=0.7756). Wound dehiscence was significantly lower with modified Smead Jones closure (1.7% vs 15.5%; p=0.0206). Incisional hernia was less frequent in the modified group (5.2% vs 8.6%), although the difference was not significant (p=0.7141). Mean hospital stay was shorter in Group B (6.88±1.39 days) than in Group A (10.93±2.23 days).

Conclusion: Modified Smead Jones closure was associated with fewer postoperative wound complications overall, with the clearest statistical advantage seen for wound dehiscence and duration of hospital stay. Early wound infection and incisional hernia were numerically lower in the modified group.

Role of Methylprednisolone and Cyclophosphamide in Paraquat Poisoning Treatment

Dr. Parag Chole, Dr Tejas Kamble, Dr. Astha Ganeriwal — Wed, 03 Jun 2026 00:00:00 +0200

Background: Paraquat is a herbicide with a chemical composition of 1,1′-dimethyl-4,4′-bipyridinium dichloride. The primary use of paraquat is for weed control. Accidental or deliberate self-harm can lead to inhalation and ingestion of the compound. It is hydrophilic and does not penetrate intact skin. However, there is mention about dermal exposure. Paraquat is rapidly inactivated in soil. The clinical signs and symptoms can range from the development of oral ulceration, abdominal pain, reduced urine output, renal failure, jaundice, and hypoxemic respiratory failure leading to acute respiratory distress syndrome (ARDS).

Objectives: 1. Role of methylprednisolone and cyclophosphamide in paraquat poisoning treatment.2.Study the Role of methylprednisolone and cyclophosphamide in paraquat poisoning treatment.3.Study the clinical profile of paraquat poisoning cases in a tertiary care center.4.Study the outcome among paraquat poisoning cases in a tertiary care center.

Methods: Study Design: A prospective observational study. Study Setting: Medicine Department of Government medical college Jalgaon, Maharashtra. Study population: All cases with paraquat poisoning admitted in medicine department of Government medical college Jalgaon, Maharashtra. Study Duration: 1 January 2024 to 31 December 2025.Sample size: 16

Results: Majority cases found in 17-25 years age group 8 (50%) cases followed by 5 cases (31.25%) found in 26-35 years age group and 3 (18.75%) cases observed in 36 and above years age group. Most of cases were males 14 (87%) and 02 females (12.5%). Majority of cases from rural area 14 (87.5%) and 2 cases from urban area (12.5%). Most of the cases were farmers 9 (56.255) followed by 2 cases were housewife and 1 student. majority of cases presented with vomiting 13 (81.25%) followed by Increased serum creatinine 11 (68.75%), lethargy 10 (62.5%), leukocytosis 7 (43.75%), respiratory failure 7 (43.75%), acute hepatitis 7 cases (43.75%) and shock 7 cases (43.75%). mortality was 43.75%, 7 cases death during treatment and 7 cases survive (43.75%) and 2 cases DAMA

Conclusions: Majority cases found in 17-25 years age group, Most of cases were males, Majority of cases from rural area, Most of the cases were farmers, majority of cases presented with vomiting and mortality was 43.75%.

Predictors of Adverse Postoperative Outcomes Following Emergency Laparotomy: A Prospective Observational Study

Vakamudi prakash, Tandri shyam sundar — Wed, 03 Jun 2026 00:00:00 +0200

Background: Emergency laparotomy remains one of the most frequently performed procedures in general surgery and is associated with significant postoperative morbidity and mortality. Identifying clinical and biochemical predictors of adverse outcomes may help in early risk stratification and improved perioperative management. This study aimed to evaluate predictors of postoperative morbidity and mortality in patients undergoing emergency laparotomy.

Methods: This prospective observational study was conducted over a period of 18 months in a tertiary care hospital and included 150 patients undergoing emergency laparotomy. Patients aged >18 years undergoing surgery for acute abdominal conditions were included. Demographic variables, comorbidities, preoperative laboratory parameters, operative findings, and perioperative variables were recorded. Postoperative outcomes including complications and mortality within 30 days were analyzed. Statistical analysis was performed using Chi-square test, Student’s t-test, and multivariate logistic regression analysis. A p value <0.05 was considered statistically significant.

Results: A total of 150 patients underwent emergency laparotomy (mean age 48.6 ± 16.3 years; 62.7% males). The main indications were perforation peritonitis (46.7%), intestinal obstruction (30.0%), and trauma (14.0%). Overall morbidity occurred in 63 patients (42.0%), while 30-day mortality was 12.0% (n = 18). Common complications included surgical site infection (18.0%), respiratory complications (10.0%), intra-abdominal sepsis (7.3%), and anastomotic leak (6.7%).Univariate analysis showed significant associations between morbidity and age >60 years (χ² = 8.41, p = 0.003), albumin <3.5 g/dL (χ² = 10.72, p = 0.001), ASA ≥III (χ² = 12.36, p <0.001), delay to surgery >24 h (χ² = 6.18, p = 0.013), and operative duration >2 h (t = 2.64, p = 0.009). Multivariate analysis identified ASA ≥III (OR 4.08) and hypoalbuminemia (OR 3.21) as independent predictors. Mortality correlated with age >60 years (p = 0.007), preoperative sepsis (p = 0.003), and albumin <3.0 g/dL (p = 0.001). Albumin predicted mortality (ROC AUC 0.78; sensitivity 72%, specificity 74%).

Conclusion: Emergency laparotomy is associated with considerable postoperative morbidity and mortality. Advanced age, higher ASA score, hypoalbuminemia, delayed surgical intervention, and preoperative sepsis significantly increase the risk of adverse outcomes. Early identification and optimization of these risk factors may help improve surgical outcomes in patients undergoing emergency laparotomy.

Comparative Outcomes of Endovascular and Open Revascularization in Peripheral Arterial Disease: A Prospective Cohort Study

Pragna sree Mukkamala, Sandeep Mahapatra — Wed, 03 Jun 2026 00:00:00 +0200

Background: Peripheral arterial disease (PAD) represents a major global health burden associated with significant morbidity, impaired functional status, and risk of limb loss. While endovascular techniques have evolved rapidly and are increasingly adopted as first-line therapy, uncertainty remains regarding comparative clinical outcomes relative to traditional open surgical revascularization. This prospective study aimed to evaluate short- and intermediate-term outcomes following endovascular versus open revascularization in patients with symptomatic PAD in a real-world clinical setting.

Methods: In this prospective observational cohort study, consecutive adult patients with symptomatic PAD (Rutherford categories 3–6) undergoing planned revascularization at a tertiary care center were enrolled between [Month Year–Month Year]. Treatment allocation was determined by multidisciplinary clinical decision-making. Patients were categorized into endovascular and open surgical groups. The primary endpoint was limb salvage at 6 months. Secondary endpoints included procedural success, improvement in ankle–brachial index (ABI), perioperative complications, reintervention rates, length of hospital stay, and mortality. Outcomes were compared using appropriate statistical tests, and multivariable regression analysis was performed to adjust for baseline confounders.

Results: A total of 120 patients were included, comprising 68 endovascular and 52 open surgical procedures. Mean age was 61.3 ± 9.4 years, and 61.7% were male; diabetes mellitus was present in 68.3%. Limb salvage at 6 months was comparable between groups (89.7% vs 86.5%, p = 0.58). Both cohorts demonstrated significant improvement in ABI, without intergroup difference (mean increase 0.32 ± 0.11 vs 0.35 ± 0.14; p = 0.21). The endovascular group showed lower overall complication rates (11.8% vs 23.1%, p = 0.04) and shorter hospital stay (3.6 ± 1.2 vs 8.4 ± 2.6 days, p < 0.001). Reintervention rates and short-term mortality were similar between groups.

Conclusions: Endovascular revascularization achieved limb salvage outcomes comparable to open surgical approaches while offering reduced perioperative morbidity and shorter hospitalization. These findings support a contemporary endovascular-first strategy in appropriately selected patients with PAD, highlighting the need for individualized treatment planning based on anatomical complexity and patient risk profile.

Correlation between Target Volume and Organs at Risk Doses in Stage Ii-Iva Nasopharyngeal Carcinoma Patients Treated With Helical Tomotherapy: A Prospective Single Institution Study from Northeast India

Dr. Kaustav Kumar Das, Dr. Ghritashee Bora, Dr. Moumita Paul — Wed, 03 Jun 2026 00:00:00 +0200

Background: Nasopharyngeal carcinoma (NPC) is a relatively rare head and neck cancer globally, accounting for only about 0.7% of all cancers The peak incidence arises between 15 and 25 years of age, with the second peak of 50 and 59 years of age. The majority of patients present with locally advanced disease (stage II–IVA) requiring combined modality therapy .The aim of the study is to examine the relationship between target volume and organ-at-risk (OAR) doses in nasopharyngeal carcinoma (NPC) patients treated with image-guided helical tomotherapy.

Material and Methods: In this prospective single-institutional study, 30 patients with histologically confirmed stage II–IVA NPC were treated with helical tomotherapy to a dose of 70 Gy in 35 fractions with concurrent Cisplatin chemotherapy. The target volumes and key Organs at Risk (spinal cord, brainstem, bilateral cochlea, parotids, larynx, oral cavity) were delineated. Dose–volume histogram parameters (maximum dose Dmax, mean dose Dmean, and V50Gy for selected structures) were recorded. Pearson correlation coefficients (r) between GTVp and OAR dose metrics were computed and a p value <0.05 was considered significant.

Results: The GTVp volume ranged between 10–210 cm³ (mean ~78 cm³). Larger GTVp was significantly associated with higher doses to the right cochlea and oral cavity. Specifically, GTVp had a positive correlation with right cochlea Dmax (r≈0.77, p=0.005) and Dmean (r≈0.84, p=0.004), and with oral cavity mean dose (r≈0.68, p=0.030) .No other OAR parameters showed significant correlations (all p>0.05).

Conclusions: Thus in Nasopharyngeal Cancer treated with helical tomotherapy, increasing tumor volume was linked to higher doses to the right cochlea and oral cavity. These findings underscore the impact of tumor extent on OAR exposure and highlight the need for careful dose optimization, especially to auditory and mucosal structures, in patients with large GTVs.

Comparison of Early Goal-Directed Therapy versus Standard Care in Sepsis

Ziaullah, Salman Khan, Amin ul Haq, Amin Ullah, Mohammad Shafiq, Abdul Jabbar — Sat, 30 May 2026 00:00:00 +0200

Background: Despite great progress in critical care management, sepsis continues to be a leading cause of morbidity and mortality globally.

Objective: To assess the effectiveness of EGDT versus standard care on clinical outcomes in those with a sepsis diagnosis.

Materials and Methods: A randomized controlled trial was done at Medicine Department, Saidu Group of Teaching Hospital, Pakistan, between September 2025 to February 2026. A total of 120 adult patients diagnosed with sepsis were enrolled and equally divided into two groups. Data were analyzed using SPSS version 26.

Results: The clinical characteristics at the beginning were similar for both groups. The EGDT group demonstrated significantly improved mean arterial pressure (72.4 ± 6.5 mmHg vs 68.2 ± 7.1 mmHg), higher lactate clearance (38.5% vs 26.9%), shorter ICU stay (6.4 ± 2.1 days vs 8.2 ± 3.0 days), and lower septic shock progression (18.3% vs 36.7%). There was significantly less mortality in the EGDT group (13.3%) than in the standard care group (28.3%).

Conclusion: Early Goal-Directed Therapy was found to be effective compared to standard care in achieving physiologic stabilization, preventing complications, and reducing mortality in sepsis patients.

High Serum Uric Acid as a Predictor of Favorable Outcomes in Ischemic Stroke Patient

Amin Ullah, Mohammad Shafiq, Salman Khan, Amin ul Haq, Abdul Jabbar, Ziaullah — Mon, 30 Mar 2026 00:00:00 +0200

Background: Ischemic stroke continues to be a significant cause of death and long-term disability in the world. Identification of prognostic biomarkers early may lead to better risk stratification and patient management.

Objective: To assess whether high uric acid is associated with good clinical results in ischemic stroke patients admitted to the Medicine Department, Saidu Group of Teaching Hospital, Pakistan.

Materials and Methods: The study was a prospective observational cohort study conducted at Medicine Department, Saidu Group of Teaching Hospital, Pakistan, from June 2025 to November 2025. The patients were selected by non-probability consecutive sampling, and a total of 180 patients with acute ischemic stroke were recruited.

Results: The mean serum uric acid level was 5.89 ± 1.46 mg/dL. The favorable outcome was observed in 112 (62.2%) patients. Patients with hyperuricemia had significantly improved functional recovery and lower neurological severity scores.

Conclusion: High serum uric acid levels were significantly associated with a good functional outcome after acute ischemic stroke.

Association of Hypertension, Diabetes Mellitus, Smoking, and Dyslipidemia with Severity of Acute Coronary Syndrome in Emergency Department Patients

Thu, 04 Jun 2026 00:00:00 +0200

Objective: To determine the association between severity of acute coronary syndrome (ACS) and modifiable cardiovascular risk factors among patients who presented to the emergency department (ED).

Study Design: Analytical cross-sectional study.

Place and Duration of Study: This study was conducted in Cardiology and Emergency Department, Suleman Roshan Medical College and Hospital, TandoAdam from January 2025 to June 2025.

Methodology: This analytical cross-sectional study included 288 patients diagnosed with ACS, using the WHO formula. Patients were enrolled after meeting inclusion criteria; demographic data, clinical history and modifiable risk factors were obtained. Risk factors evaluated were hypertension, diabetes mellitus, smoking and dyslipidaemia. The severity of ACS was judged on conventional clinical criteria on presentation. The associations of these risk factors with disease severity were analysed statistically.

Results: This was done and the results showed that ACS patients were more likely to suffer from hypertension, diabetes mellitus, smoking and dyslipidaemia. Those who had multiple risk factors were more likely to have severe ACS. Hypertension, diabetes mellitus and smoking were significantly associated with increased disease severity, and dyslipidaemia was associated with poor clinical presentation.

Conclusion: Modifiable risk factors (hypertension, diabetes mellitus, smoking and dyslipidaemia) are highly correlated with the severity of ACS. Identifying and managing these factors early can minimize complications, enhance patient outcomes and facilitate effective emergency care.

Effect of CYP2C9*3 RS 1057910 Polymorphism on the Tolerability of Ibuprofen after Molar Tooth Extraction in Pakistani Population

Sat, 30 May 2026 00:00:00 +0200

Post-extraction pain is frequently managed with ibuprofen, a widely used NSAID metabolized by CYP2C9. Genetic polymorphisms, particularly CYP2C9*3 rs1057910, may alter drug metabolism, influencing efficacy and tolerability. This study evaluated the impact of this variant on ibuprofen tolerability in a Pakistani population. A prospective observational study was conducted from August 2022 to August 2023 at Islamic International Medical College, Rawalpindi, and affiliated dental clinics. Two hundred adults undergoing unilateral molar extraction were enrolled. Standardized procedures were followed, and patients received ibuprofen 400 mg thrice daily for three days. Blood samples were collected for CYP2C9*3 genotyping. Adverse effects, especially gastropathy, were assessed on day four using the General Assessment of Side Effects (GASE) questionnaire. Associations between genotype and adverse effects were analyzed with Chi-square test. Allele frequencies were 82.8% (A) and 17.2% (C). The AA genotype was identified in 65.5% of participants, while 34.5% participants resulted in AC genotype. Adverse effects were significantly more common among AC carriers (43.5%) compared with AA carriers (16.8%) (p<0.001). The CYP2C9*3 rs1057910 polymorphism is associated with reduced ibuprofen tolerability in the Pakistani population, with heterozygous carriers showing a higher risk of gastropathy. These findings support the clinical relevance of pharmacogenetic screening to optimize NSAID prescribing and reduce adverse outcomes. Broader studies across diverse populations are recommended to validate these results and inform genotype-based dosing guidelines.

Diagnostic Accuracy of Mentzer Index in Diagnosis of Iron Deficiency Anemia Keeping Serum Ferritin Levels as Gold Standard

Thu, 04 Jun 2026 00:00:00 +0200

Background: The diagnostic tests widely used for iron deficiency anemia are complete blood count, serum iron, total iron binding capacity and serum ferritin level. These examinations have mainly been used in clinical practice. One of the laboratory examination parameters that can be used for thalassemia carrier screening test is Mentzer index. Mentzer index is an MCV/RBC ratio calculation. Methods: This cross-sectional study was conducted during 26^th July 2021 to 25^th January 2022 in the Pediatrics department, Jinnah Hospital, Lahore. A total of 160 children age 6 – 59 months, of either gender presenting to opd for routine checkup were included. Children with history of blood diseases, chronic infection, inflammatiory diseases and malnourished were excluded. Blood specimens were obtained twice form subjects. The first specimen was used for CBC and Mentzer index. Children with hypochromic microcytic anemia was provided a second blood specimen for serum ferritin measurements. Serum ferritin was measured by ELISA using a Mini Vidas kit. IDA was considered to be diagnosed by Mentzer index, serum ferritin.

Results: Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Mentzer index in diagnosis of iron deficiency anemia keeping serum ferritin levels as gold standard was 78.26%, 86.81%, 81.82%, 84.04% and 83.13% respectively.

Conclusion: This study has shown that diagnostic accuracy of Mentzer index in diagnosis of iron deficiency anemia is quite high.

Prevalence of Breakfast Skipping and Associated Health Outcomes among Medical Students: A Cross-Sectional Study

Fri, 05 Jun 2026 00:00:00 +0200

Background: Breakfast skipping is becoming very common among young adults and can lead to adverse physical, behavioural, and sleep-related health outcomes. However, a thorough evaluation of its short- and long-term consequences in Indian college populations remains limited.

Objective: To determine the prevalence of breakfast skipping among college students and to find its association with short-term symptoms, long-term dietary and functional consequences, sleep quality, and body mass index (BMI).

Methods: A cross-sectional analytical study was conducted among undergraduate students aged 17–30 years at medical colleges across India over three months. Data were collected using a structured, pretested questionnaire assessing demographic characteristics, breakfast consumption patterns, reasons for skipping breakfast, short-term symptoms, dietary behaviours, functional health outcomes, sleep quality, and BMI. Breakfast skipping was defined as consuming breakfast on fewer than five days per week. Sleep quality was assessed using a validated sleep quality scale (SATED questionnaire). BMI was categorized according to World Health Organization criteria. Data were analysed using Jamovi software version 2.7.18. Descriptive statistics summarized prevalence with 95% confidence intervals. Associations were evaluated using chi-square tests. A p-value <0.05 was considered statistically significant.

Results: Prevalence of breakfast skipping among participants was 45.7%. A statistically significant association was observed between breakfast skipping and fatigue. No association was found between breakfast skipping and other short-term consequences, long term eating behaviors, BMI. Association between breakfast skipping and unsatisfactory sleep was statistically significant.

Conclusion: Breakfast skipping is a common behaviour and is associated with notable short-term consequences like fatigue and unsatisfactory sleep quality. Although no significant relationship was observed with BMI and long-term outcomes in this study. This highlights the importance of regular breakfast consumption as a part of healthy lifestyle practices. Further longitudinal studies are recommended to better understand the long-term health implications of breakfast skipping.

EEG Abnormalities in Acute Stroke (Ischemic and Hemorrhagic) and Their Prognostic Significance

Fri, 05 Jun 2026 00:00:00 +0200

Background: Acute stroke is a serious neurological emergency, and often associated with disturbances in cerebral electrical activity. EEG is able to reveal functional abnormalities of the brain including non-convulsive status epilepticus, electrographic seizures, epileptiform discharges, diffuse slowing and focal slowing that may not be clinically evident. EEG may offer some prognostic information about the severity of the stroke and prognosis, in addition to the role it plays in diagnosis, but neuroimaging is still important for the diagnosis.

Objective: To determine the frequency and pattern of EEG abnormalities in patients with acute ischemic and hemorrhagic stroke and to assess their prognostic significance.

Methods: The study was a prospective, multicenter, observational study that took place from 10 January 2025 to February 2026 in Akbar Niazi Teaching Hospital, Islamabad and Al-Khidmat Raazi Hospital, Rawalpindi. Overall, 385 patients with acute stroke were included of which 275 patients were enrolled from Akbar Niazi Teaching Hospital and 110 patients from Al-Khidmat Raazi Hospital. The diagnosis of stroke was made by clinical examination and imaging. Patients were divided into ischemic stroke group and hemorrhagic stroke group. EEG was obtained in the acute period and was evaluated for background abnormalities, focal slowing, diffuse slowing, epileptiform discharges, periodic discharges, electrographic seizures, and severe EEG abnormalities. The clinical severity was determined by the National Institutes of Health Stroke Scale and Glasgow Coma Scale. The outcomes measured were: admission to the intensive care unit (ICU), mechanical ventilation, hospital stay, functional status at hospital discharge and in-hospital mortality. Data were analyzed with SPSS version 25 and P-values < 0.05 were regarded as statistically significant.

Results: Among 385 patients, 286 (74.3%) had ischemic stroke and 99 (25.7%) had hemorrhagic stroke. EEG abnormalities were observed in 278 patients (72.2%). The most frequent EEG abnormality was focal slowing 169 (43.9%), followed by diffuse slowing 123 (31.9%), reduced background activity 96 (24.9%), epileptiform discharges 64 (16.6%), periodic discharges 39 (10.1%), electrographic seizures 31 (8.1%), and non-convulsive status epilepticus 15 (3.9%). EEG abnormalities were significantly more common in hemorrhagic stroke than ischemic stroke 84.8% vs 67.8%, p = 0.001. Severe EEG abnormalities were significantly associated with severe NIHSS score, low GCS score, ICU admission, mechanical ventilation, prolonged hospital stay, poor functional outcome, and in-hospital mortality.

Conclusion: EEG abnormalities are frequent in acute stroke and are more common in hemorrhagic stroke than ischemic stroke. Severe EEG abnormalities, especially diffuse slowing, epileptiform discharges, periodic discharges, and electrographic seizures, are strongly associated with poor clinical outcomes. EEG may serve as a useful bedside tool for early risk stratification, seizure detection, and prognostic assessment in acute stroke patients.

Comparison of Simulation-Based Training and Bedside Teaching in Enhancing Clinical Skill Acquisition among Medical Students

Fri, 05 Jun 2026 00:00:00 +0200

Background: Learning of clinical skills is an essential aspect of undergraduate medical training. Conventional bedside teaching has been the pillar of clinical training but simulation-based training is a novel training method that offers safe and controlled learning environment.

Objective: To compare the effectiveness of simulation-based training and bedside teaching in enhancing clinical skill acquisition among medical students.

Methods: This comparative analytical study was conducted at the Frontier Medical and Dental College, Abbottabad from March 2024 to March 2025. Eighty-two undergraduate medical students were recruited and separated into two groups, where they were trained via simulation (n = 41) and taught at the bedside (n = 41). Objective Structured Clinical Examination (OSCE) scores were used to measure clinical skills. Other outcomes were level of competency, level of error, advancement in knowledge, confidence and student satisfaction. The SPSS version 25 was used to analyze data with a p-value of 0.05 being statistically significant.

Results: Students in the simulation group demonstrated significantly higher mean OSCE scores (78.6 ± 8.4) compared to the bedside group (70.2 ± 9.1; p = 0.001). Competency levels were higher in the simulation group (78.0% vs. 58.5%; p = 0.03), with fewer major errors. Knowledge improvement, confidence levels, and satisfaction were also significantly better among students receiving simulation-based training.

Conclusion: Simulation-based training is more effective than bedside teaching in enhancing clinical skill acquisition, improving competency, and increasing student confidence and satisfaction. An integrated approach combining both methods is recommended for optimal medical education outcomes.

A Comparative Evaluation of Thyroid Disorders among the Patients of Cholelithiasis

Dr. Vijay Chaudhary, Dr. Narendra Kumar Sah, Dr. Bharti Kawatra — Fri, 05 Jun 2026 00:00:00 +0200

Background: Cholelithiasis is a prevalent biliary system pathology, particularly in Northern India, influenced by factors such as age, gender, and metabolic changes. Thyroid hormones play a critical role in cholesterol metabolism and biliary motility, suggesting a potential link between thyroid dysfunction and gallstone formation. This study aimed to evaluate the comparative occurrence of thyroid disorders among patients diagnosed with cholelithiasis.

Methods: This retrospective and observational study was conducted at MM Medical College and Hospital, Solan, involving 100 diagnosed cases of cholelithiasis in patients over 30 years of age. Biochemical parameters, specifically serum TSH, fT4, and fT3 levels, were analyzed to determine the thyroid profile of each participant.

Results: The study population was predominantly female (80%), with a mean age of 45.14 years; the 40-50 age group was the most affected. The findings revealed that 50% of the patients had deranged thyroid profiles. Specifically, 25% of the total participants were diagnosed with hypothyroidism, of which 60% were sub-clinical cases. Hyperthyroidism was identified in 10% of the participants. Conclusion: The study demonstrates a significant association between thyroid dysfunction and cholelithiasis, with half of the patients exhibiting abnormal thyroid levels. Hypothyroidism, in particular, contributes to gallstone development through hypercholesterolemia, reduced bile flow, and sphincter of Oddi dysfunction. Consequently, serum TSH levels serve as an independent risk factor for the development of gallstones, highlighting the importance of thyroid screening in these patients

Electrocardiographic and Echocardiographic Changes in Patients with Chronic Obstructive Pulmonary Disease and Their Correlation with Disease Severity: A Cross-Sectional Study

Dr. Ashish Chatterjee, Dr. Dadan Prasad, Dr. Rajeev Kumar — Fri, 05 Jun 2026 00:00:00 +0200

Background

Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and is frequently associated with cardiovascular complications. Cardiac involvement, including pulmonary hypertension, cor pulmonale, arrhythmias, and ventricular dysfunction, significantly influences prognosis. Early detection of these abnormalities through ECG (Electrocardiography) and echocardiography may facilitate timely intervention and improve outcomes.

Methods

A hospital-based cross-sectional study was conducted in the Department of Medicine, Durgapur Steel Plant Hospital, over 18 months. One hundred diagnosed COPD patients aged above 40 years were enrolled. Disease severity was classified according to GOLD criteria using spirometry. All participants underwent standard 12-lead ECG and 2-D Doppler echocardiography. ECG and echocardiographic findings were analyzed and correlated with COPD severity and duration. Statistical analysis was performed using SPSS version 21.0, with p<0.05 considered significant.

Results

The mean age of participants was 61.58±5.47 years, and 90% were males. Smoking history was present in 93% of patients (59% current smokers and 34% ex-smokers). ECG abnormalities were observed in 69% of cases. The most common ECG findings were arrhythmias (46%), right-axis deviation of the P wave (44%), and P pulmonale (33%). Sinus tachycardia (28%) was the predominant arrhythmia. Echocardiographic abnormalities were present in 64% of patients. Common findings included valvular abnormalities (43%), pulmonary arterial hypertension (26%), right ventricular dilatation (23%), right atrial dilatation (21%), and reduced ejection fraction (<50%) in 23% of patients. Both ECG and echocardiographic abnormalities showed a significant positive correlation with COPD severity (p<0.01), whereas no significant association was found with disease duration.

Conclusion

Cardiac abnormalities are highly prevalent in COPD patients and increase with disease severity. Routine ECG and echocardiographic evaluation should be incorporated into COPD management protocols for early detection of subclinical cardiac dysfunction and improved patient outcomes.

Low-Flow Anesthesia and Perioperative Pulmonary Outcomes: A Systematic Review and Meta-Analysis

Fri, 05 Jun 2026 00:00:00 +0200

Background: There is a growing interest in the use of low-flow anesthesia in perioperative practice as a strategy to preserve pulmonary function, use less anesthetic gases and minimize pollution of the environment. Though, the relative effectiveness of low-flow compared to high-flow anesthesia about postoperative pulmonary outcomes has not been clearly delineated.

Objective: The present study aimed to evaluate the effects of low-flow anesthesia on postoperative pulmonary function and respiratory complications compared with conventional high-flow anesthesia techniques.

Methods: A systematic review and meta-analysis of published literature on pulmonary effects of low-flow anesthesia was performed. After a comprehensive search of databases, studies were screened for inclusion by predefined criteria for evaluation of pulmonary effects. Meta-analysis of pulmonary data postoperatively, incidence of atelectasis, respiratory stability, and perioperative data was analyzed with synthesis of pooled mean difference and risk ratios and heterogeneity.

Results: Meta-analysis revealed that low-flow anesthesia resulted in statistically significant better postoperative pulmonary function, In particular postoperative preserve values of FEV1, than did high-flow anesthesia. The incidences of postoperative atelectasis were also lower, and perioperative rapid respiratory stabilization was more evident in low-flow groups than in high-flow group. Subgroup analysis based on various types of surgery did not alter these pulmonary benefits with low-flow anesthesia. On top of that, low-flow anesthesia could Really decrease the consumption of anesthetic gases and improve total cost saving for patients of different age, weight, and ASA class without compromising patient safety. Overall heterogeneity among the included trials was moderate, indicating the reliability of study data synthesis.

Conclusion: Evidence shows that low-flow anesthesia may be a safe and effective anesthetic technique to optimize postoperative pulmonary function and decrease respiratory complications. The decreased cost and environmental advantages of low-flow techniques provide additional incentives for its regular use to optimize perioperative management. Large multicenter trials are needed to develop robust clinical guidelines and evaluate long-term outcomes.

Perioperative Magnesium Sulfate As an Adjuvant in Anesthesia: A Systematic Review and Meta-Analysis

Fri, 05 Jun 2026 00:00:00 +0200

Background: Optimized perioperative pain control is crucial for anesthesia practice and perioperative pain itself is related to post-operative morbidity and prologed use of opioids and their side effects. Magnesium sulfate as adjunct to anesthesia owing to N-methyl-D-aspartate receptor antagonism and calcium channel blocking activity, is increasingly studied for its efficacy on anesthetic and perioperative pain management. The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of perioperative magnesium sulfate as adjunct in anesthesia and perioperative pain control.

Methods: A comprehensive search of PubMed MEDLINE Scopus, Google Scholar and Cochrane Library databases was performed to identify randomized controlled trials evaluating perioperative magnesium sulfate administration on postoperative pain in patients undergoing various surgical procedures. The trials included intravenous intrathecal epidural or regional administration of magnesium sulfate, and documented pain scores. The measures of pain intensity, opioid consumption, duration of analgesia and anesthetic requirements, were evaluated plus any adverse events that were reported. The risk of bias for all studies was assessed using standard criteria.

Results: Eight randomized controlled trials with a total of 684 patients were included in this analysis. Perioperative magnesium sulfate infusion resulted in a significant decrease in postoperative pain scores at both 6 and 24 hours compared to the various control groups. The mean Visual Analog Scale pain scores was A lot less with magnesium sulfate infusion (pooled MeanDifference 2.1 at 6 hours and 1.8 at 24 hours). Patients receiving magnesium sulfate infusion also had a significant decrease in total post-operative opioid requirements, a prolonged duration of post-operative analgesia, and delayed requirement for rescue analgesics. There was also a benefit to patients receiving magnesium sulfate infusion based upon the time to requirement of rescue analgesics following injection with various routes of supplementation: intravenous, neuraxial, and peripheral nerve block. Aside from few transient side effects like hypotension and flushing, serious side effects were not common.

Conclusion: Perioperative magnesium sulfate has proven itself to be an effective and acceptable anesthetic adjuvant in a number of different surgical procedures. Magnesium sulfate has been found to afford Really better postoperative analgesia, with decreased opioid consumption and increased analgesic duration compared to control groups. Magnesium sulfate has a sound opioid-sparing effect and a safe side effect profile, encouraging its use in a number of different multimodal perioperative analgesic regimens. Further large, randomized controlled studies are warranted to determine the optimal dose for magnesium sulfate and its most appropriate clinical applications.

Synergy of Radiologic Tumor Burden, C-Reactive Protein, and Albumin with Serum Lactate Dehydrogenase in the Prognostic Assessment of Pediatric and Adult Malignancies: A Community-Based Clinical Study

Fri, 05 Jun 2026 00:00:00 +0200

Cancer prognosis requires reliable,accessible, and cost-effective biomarkers capable of reflecting tumor biology, systemicinflammation, and host nutritional status. Thepresent community-based clinical study

Diagnostic Accuracy of Ultrasound vs CT Scan in Urolithiasis: A Comparative Study

Fri, 05 Jun 2026 00:00:00 +0200

Urolithiasis represents a common urologicalcondition with increasing global prevalence,necessitating accurate and timely diagnostic
modalities for optimal management. Thepresent comparative study aimed to evaluate the diagnostic accuracy of ultrasound versus

Serum Vitamin D and Parathyroid Hormone Status in Chronic Liver Disease and Their Relation to Disease Severity

Fri, 05 Jun 2026 00:00:00 +0200

Chronic liver disease (CLD) is frequentlyassociated with metabolic disturbances that affect calcium homeostasis and bonemetabolism. Vitamin D deficiency

Serum Ghrelin and Leptin Levels as Predictors of Disease Severity in Patients with Non-Alcoholic Fatty Liver Disease

Fri, 05 Jun 2026 00:00:00 +0200

Non-alcoholic fatty liver disease(NAFLD) has emerged as one of the mostprevalent metabolic liver disorders worldwide, closely associated with obesity,insulin resistance, and systemicinflammation. The present experimentalstudy aimed to evaluate serum ghrelin andleptin levels as potential predictors of disease

Impact of Integrated School Health Interventions on Dental Caries, Nutritional Status, and Communicable Disease Morbidity in Children: A Quasi-Experimental Study

Fri, 05 Jun 2026 00:00:00 +0200

School health interventions play a criticalrole in improving child health outcomes,particularly in low- and middle-income settings where malnutrition, poor oralhygiene, and infectious diseases

Chest Imaging Findings in COVID-19 Patients: A Systematic Review and Meta-Analysis

Sat, 06 Jun 2026 00:00:00 +0200

Background: Coronavirus disease 2019 (COVID-19) is first and foremost a respiratory illness that greatly impacts the lungs. Chest imaging, especially computed tomography (CT), has been of great help to the medical professionals to identify the virus's physical manifestations in the lungs, determine the extent of the disease, and track the changes over time. With so much research already published, a thorough summary of the imaging results would help to clarify the radiologic features of COVID-19.

Objective: This systematic review and meta-analysis aimed to summarize chest imaging findings in patients with COVID-19 and evaluate the prevalence, distribution, and temporal evolution of characteristic radiologic features.

Methods: A comprehensive search for systematic reviews, meta-analyses, and extensive reviews that have been published was done in order to find studies documenting chest imaging findings in patients with confirmed COVID-19. Studies that evaluated the features of CT and chest radiography and that were considered eligible were included. Information was taken from the studies regarding their characteristics, imaging modalities, and radiological findings reported. Both a qualitative and quantitative review were carried out to establish the pooled prevalence of the principal imaging features and to describe the temporal imaging patterns.

Results: Seven main review, based studies were taken into account, which collectively represented several thousand patients. Ground, glass opacities were by far the most common CT finding (68%) followed by bilateral lung involvement (73%), peripheral distribution (65%), and multilobar disease (59%). Consolidation (32%) and mixed ground, glass with consolidation (41%) were mostly seen in the cases of progression. Other less typical findings were vascular enlargement (27%), crazy-paving pattern (21%), pleural effusion (6%), and lymphadenopathy (5%). Imaging progression revealed a change from early focal ground- glass opacities to peak consolidation and thereafter resolution with some patients having residual fibrotic changes. Chest CT demonstrated a very high sensitivity of pulmonary involvement detection, thus indicating its role as a complementary diagnostic and monitoring tool.

Conclusion: Chest CT scans demonstrate typical and evolving imaging features of COVID- 19, where bilateral peripheral ground-glass opacities are the most common and consistent pattern. Imaging gives useful information for diagnosis, disease staging, and follow-up, but the results should always be interpreted with clinical and laboratory data. More studies with standardized protocols and long-term follow-up are necessary to elucidate changing imaging features and post-infection lung outcomes.

Ultrasound versus CT for Diagnosis of Kidney Stones: A Systematic Review and Meta-Analysis

Sat, 06 Jun 2026 00:00:00 +0200

Background: Kidney stone disease is a common urological problem that calls for quick diagnosis and intervention and it needs a definitive and reliable imaging modality. Computed tomography has been regarded as the benchmark imaging modality in stone detection because of its accuracy, but there is increasing focus on the ultrasonogram because of the worries for the radiation exposure. Even though in widespread clinical application, the variations in the ultrasound diagnostic accuracy as compare to CT scan are a matter of concern.

Objective: The current systematic review and meta-analysis intended to compare the efficacies of ultrasonography versus CT in detecting renal calculi based on sensitivity, specificity and overall clinical usefulness in various patient populations.

Methods: A comprehensive search was performed on the electronic databases PubMed/MEDLINE Scopus Web of Science, and Google Scholar to identify research articles investigating the diagnostic ability of ultrasound and computed tomography for nephrolithiasis. The studies of both adult and pediatric populations were reviewed for exclusion and inclusion criteria. Data was collected and collated on study design, study population, and diagnostic results. Data was evaluated for quality with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and quantitative synthesis was used to calculate pooled estimates.

Results: Eight studies with a combined total of 2,439 patients were included in the review. The results suggested that computed tomography had better diagnostic accuracy than ultrasonography in evaluation of renal calculi. The combined sensitivity and specificity of ultrasonography were 78.4% and 89.6%, respectively. In comparison, the combined sensitivity and specificity of CT were 96.8% and 98.2%, respectively. Ultrasound was less sensitive at detecting smaller stones and stones in difficult to visualize anatomical regions. Still, ultrasound still proved to be a useful modality in clinical practice due to its noninvasive nature and lack of radiation, which is Most of all desirable in situations where patients are Children, Pregnant or require multiple follow-up images. There was moderate heterogeneity seen when combining the results from the included studies.

Conclusion: Computer tomography continues to be the most accurate imaging modality for the diagnosis of kidney stones and about this has superior performance compared with ultrasound. Still, ultrasound remains an important modality at present as a first line and surveillance imaging tool, Most of all in populations in whom unnecessary radiation should be avoided. Future developments and more prospective studies are needed to better optimize diagnostic strategies.

Advances in Analytical Methods for Flavonoid and Polyphenol Quantification: From Conventional Assays to Modern Sensor Technologies

Fri, 05 Jun 2026 00:00:00 +0200

Flavonoids and phenols are diverse classes of plant-derived secondary metabolites well-recognised for antioxidant, anti-inflammatory, cardioprotective, and anti-cancer properties. It is essential to accurately measure them for application in food science, medicine, and research to understand pharmacokinetics, and validate their therapeutic potential. Simple tests such as Folin-Ciocalteu, aluminium chloride, and pH - differential methods are low cost and easy to perform but have limited specificity, as other matrix compounds may interfere. Advanced analytical techniques such as high-performance liquid chromatography (HPLC), ultra-high-performance liquid chromatography (UHPLC), liquid chromatography–tandem mass spectrometry (LC-MS/MS), high-resolution mass spectrometry (HRMS), and capillary electrophoresis (CE) offer superior precision and enable the identification of specific flavonoid and polyphenol compounds. In recent years, modern innovations- including nanotechnology-based sensors, artificial intelligence and molecularly imprinted polymers have further enhanced detection accuracy, allowing for the quantification of these compounds at trace levels in complex matrices such as food products, plant extracts, biological fluids, and environmental samples. Despite these improvements, challenges such as structural diversity, low analyte concentration, compound instability, and co-extractive interference remain. Strategies such as optimized extraction protocols, solid-phase extraction (SPE), microextraction techniques, chemometric data analysis, and hyphenated analytical systems help overcome these limitations. Future perspectives emphasize artificial intelligence–assisted data processing, portable sensor technologies, green analytical chemistry approaches, and lab-on-a-chip systems. These emerging approaches are expected to enable rapid, sensitive, and sustainable detection platforms for future clinical, food, and pharmaceutical applications.

Prognostic Role of Left Ventricular Global Longitudinal Strain in Predicting Outcomes in Heart Failure with Preserved Ejection Fraction (HFPEF)

Yousaf Saeed, Sayam F. Uddin — Sun, 31 May 2026 00:00:00 +0200

Background: Heart failure with preserved ejection fraction is a growing phenotype of chronic heart failure that carries significant cardiovascular morbidity, recurrent clinical decompensation, and increased mortality. Although left ventricular ejection fraction remains preserved in HFpEF, subtle abnormalities in myocardial mechanics may still be present. LGE has emerged in recent years as an advanced echocardiographic tool that can assess early myocardial dysfunction beyond that of a standard evaluation of systolic function, using global longitudinal strain.

Objective: To assess the prognostic value of LGE in predicting cardiovascular adverse outcomes in patients with heart failure with preserved ejection fraction.

Methods: This study was conducted as a prospective observational study in Buffalo General Hospital, Buffalo, USA, from February 2024 to February 2025. Patients were consecutively recruited, and 200 patients with a HFpEF diagnosis were included. Measurement of left ventricular global longitudinal strain was done by comprehensive transthoracic echocardiography with 2D speckle-tracking imaging. Based on predefined strain thresholds, participants were classified into impaired and preserved LV-GLS groups. Clinical follow-up was used to record adverse cardiovascular events such as disease progression, re-hospitalization, arrhythmias, intensive care admissions, major adverse cardiovascular events, and cardiovascular death.

Results: Abnormal values of LV-GLS were found in 104 patients, and preserved myocardial strain was found in 96 patients. Impaired strain was associated with a higher prevalence of hypertension, diabetes mellitus, obesity, atrial fibrillation, and higher NT-proBNP levels. Echocardiographic assessment also showed that left atrial volume index, pulmonary artery systolic pressure, E/e′ ratio, and left ventricular mass index were significantly higher in the group with abnormal myocardial strain. The impaired LV-GLS group had more cardiovascular complications during follow-up evaluation. Impaired LV-GLS was shown to be an independent predictor of adverse cardiovascular events. LV-GLS also showed good discriminatory power in the identification of major cardiovascular events by receiver operating characteristic analysis.

Conclusion: Reduced left ventricular global longitudinal strain is strongly associated with adverse clinical progression in patients with HFpEF. Myocardial deformation imaging might offer valuable prognostic data additional to the traditional echocardiographic parameters and help in earlier cardiovascular risk stratification and monitoring tailored to the patient.

Biochemical and Physiological Assessment of Inflammation, Insulin Resistance, and Cardiovascular Risk among Patients with Type 2 Diabetes Mellitus

Sun, 31 May 2026 00:00:00 +0200

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic condition that is associated with insulin resistance, chronic hyperglycemia, and systemic inflammation. These abnormalities account for much of the cardiovascular morbidity and mortality and early identification of metabolic and inflammatory abnormalities are key to good disease management.

Objective: To evaluate biochemical markers of inflammatory, insulin resistance and physiological cardiovascular risk factors in Type 2 Diabetes Mellitus patients and healthy controls.

Methods: This comparative cross-sectional study was conducted at Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, Pakistan, and Aziz Fatima Medical and Dental College, Faisalabad, Pakistan, from March 2024 to March 2025. One hundred and thirty individuals were recruited, of whom ninety were patients with T2DM, and forty healthy controls. Anthropometric measurements, blood pressure, fasting blood glucose, HbA1c, fasting insulin, lipid profile, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were assessed. HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) was used for the estimation of insulin resistance.

Results: Patients with T2DM exhibited significantly higher body mass index, waist circumference, systolic and diastolic blood pressure, fasting glucose, HbA1c, fasting insulin, and HOMA-IR values compared with controls (p<0.001). Inflammatory biomarkers including hs-CRP, IL-6, and TNF-α were markedly elevated among diabetic patients. Significant dyslipidemia was observed, characterized by increased total cholesterol, triglycerides, LDL cholesterol, and reduced HDL cholesterol. HOMA-IR had strong positive relationships with inflammatory markers and cardiovascular risk indicators.

Conclusion: Type 2 Diabetes Mellitus (DM) has been linked to significant inflammation, insulin resistance and cardiovascular risk. Biochemical and physiological evaluation could help to identify risk at an early stage and to optimize the prevention of cardiovascular complications.

A Comparative Study of Lipid Profile and Blood Pressure Control in Hypertensive Patients with and Without Coronary Artery Disease

Sat, 06 Jun 2026 00:00:00 +0200

Background: Both hypertension and dyslipidemia are important risk factors for cardiovascular disease and often appear in conjunction with one another, adding to the development and progression of coronary artery disease (CAD). Identification of differences in lipid profile characteristics and blood pressure control among hypertensive patients with and without CAD may assist in improving cardiovascular risk stratification and management.

Objective: To compare the lipid profile and blood pressure control in the hypertensive patients with and without coronary artery disease.

Methods: This comparative cross-sectional study was conducted at Amna Inayat Medical College, Sheikhupura, Pakistan, and Government Kot Khawaja Saeed Teaching Hospital, Lahore, Pakistan, from January 2024 to June 2025. A total of 120 hypertensive patients were enrolled and divided equally into two groups: hypertensive patients with documented CAD (n=60) and hypertensive patients without CAD (n=60). Demographic features, clinical parameters, blood pressure reading and fasting lipid profile were evaluated. Data were analyzed with SPSS version 26.0, and the statistical significance level was set at p<0.05.

Results: CAD patients had significantly longer duration of hypertension and significantly older age compared to the non CAD patients. Total cholesterol (223.8±35.7 vs. 191.2±30.4 mg/dL), LDL cholesterol (145.6±27.9 vs. 117.4±23.6 mg/dL), and triglyceride levels (190.4±48.3 vs. 154.6±41.5 mg/dL) were significantly higher in the CAD group (p<0.001). On the other hand, there were much lower levels of HDL in CAD patients (39.2±7.8 vs. 47.8±8.9 mg/dL, p<0.001). Only 43.3% of CAD patients achieved adequate blood pressure control compared to 70.0% of patients without CAD (p=0.003).

Conclusion: Hypertensive patients with coronary artery disease have significant differences in lipid profile compared to hypertensive patients without CAD and also have poorer BP control. Dyslipidemia and hypertension should be well controlled to minimize cardiovascular risk and promote better long-term outcomes.

Role of Pelvic MRI in the Evaluation of Endometriosis and its Association with Infertility and Chronic Pelvic Pain in Reproductive-Aged Women

Sat, 06 Jun 2026 00:00:00 +0200

Background: Endometriosis is a chronic inflammatory gynecological condition that can be a leading cause of infertility and chronic pelvic pain in women of reproductive age. The diagnosis is still difficult and often done late due to the variable clinical presentation. Non-invasive imaging techniques for the detection and characterisation of endometriosis are now available, and Pelvic Magnetic Resonance Imaging (MRI) has proved to be useful.

Objective: To analyze the effect of pelvic MRI in the diagnosis and its correlation with chronic pelvic pain and infertility in women of reproductive age with endometriosis.

Methods: This cross-sectional clinical study was conducted at a tertiary care teaching hospital in Lahore from May 2024 to May 2025. Non-probability consecutive sampling was used, and a total of 120 women aged 18-45 years who had suspected endometriosis were included. Each participant had a pelvic MRI, and a subset (n = 70) had laparoscopy confirmation. Details of infertility and chronic pelvic pain were included. Chi-square test was used to determine the diagnostic accuracy of MRI and associations with clinical variables.

Results: MRI identified endometriosis in 78 (65.0%) patients. Chronic pelvic pain was significantly higher in MRI-positive patients (68/78, 87.2%) compared to MRI-negative patients (14/42, 33.3%) (p < 0.001). Twenty-eight (35.2%) MRI-positive patients had infertility compared to 14 (33.3%) MRI-negative patients (p = 0.02). MRI demonstrated a sensitivity of 88.5%, specificity of 82.4%, positive predictive value of 85.9%, negative predictive value of 85.1%, and overall diagnostic accuracy of 85.8%. S. epidermidys was significantly associated with severe pelvic pain in the case group of deep infiltrating endometriosis and significantly associated with infertility in the case group of ovarian endometriomas.

Conclusion: Pelvic MRI is a very useful non-invasive tool in the diagnosis and characterization of endometriosis. It demonstrates strong associations with infertility and chronic pelvic pain and plays a crucial role in disease evaluation and clinical decision-making.

Association of Serum Ferritin and Lactate Dehydrogenase with Severity of Dengue in Hospitalised Children: A Prospective Observational Study

Saranya Venkatesan, Rupa Devi P, Sucindar M — Mon, 08 Jun 2026 00:00:00 +0200

Background: Early recognition of severe dengue in children remains clinically important, particularly in endemic settings where deterioration may occur during the critical phase. Serum ferritin and lactate dehydrogenase (LDH) are accessible laboratory markers potentially associated with hyper-inflammation and tissue injury.

Objectives: To assess the association of serum ferritin and LDH with severe dengue in hospitalised children, and to compare their performance at the predefined laboratory thresholds.

Methods: This prospective observational study included 100 children aged 1-12 years with laboratory confirmed dengue admitted to the Department of Paediatrics, PSP Medical College Hospital and Research Institute, Kancheepuram District, Tamil Nadu, during 2025. Serum ferritin and LDH were measured on admission between day 3 and day 7 of illness. Severe dengue status was compared with biomarker categories and selected clinical findings.

Results: Twenty children (20.0%) developed severe dengue. Ferritin was 300 ng/mL or higher in 18/20 severe cases and 1/80 non-severe cases, while LDH was 250 U/L or higher in 19/20 severe cases and 5/80 non-severe cases. Concurrent elevation of both markers occurred in 18/20 severe cases and in none of the non-severe cases. Elevated ferritin, elevated LDH and combined elevation were each significantly associated with severe dengue (all p<0.001). Ferritin elevation had sensitivity 90.0% and specificity 98.8%; LDH elevation had sensitivity 95.0% and specificity 93.8%; combined elevation retained sensitivity of 90.0% with specificity of 100.0%.

Conclusion: Serum ferritin and LDH were strongly associated with severe dengue in this paediatric hospital cohort. Their combined elevation may aid early risk stratification, although validation in larger multicentre cohorts is needed before adopting fixed thresholds for prediction.

A Comparative Study of Coblation versus Microdebrider - Assisted Inferior Turbinate Reduction

Dr. Syama V., Dr. Anwar Rasheed, Dr. Pearly P.K — Fri, 05 Jun 2026 00:00:00 +0200

Background: Chronic nasal obstruction due to inferior turbinate hypertrophy (ITH) is a pervasive condition that significantly impairs quality of life. When medical management fails, surgical reduction is necessary. Contemporary mucosa-sparing techniques like microdebrider-assisted turbinoplasty (MAT) and coblation-assisted turbinoplasty (CAT) aim to restore airflow while preserving nasal function.

Objective: This study compares the intraoperative parameters, postoperative clinical outcomes, and overall effectiveness of MAT versus CAT.

Methods: A prospective observational study was conducted at Travancore Medical College, Kollam, involving 172 patients (86 per group) aged 18-60 with refractory ITH. Patients were randomized into Group A (MAT) and Group B (CAT). Outcomes were evaluated at 1, 3, and 6 weeks postoperatively using subjective symptom scores, Friedman’s grading, and the Cold Spatula test.

Results: Both techniques achieved 100% resolution of nasal obstruction by the 6th postoperative week. CAT demonstrated significantly lower intraoperative blood loss (mean ~6.36 ml vs. ~6.79 ml; $p=0.000$) and superior reduction in snoring at all follow-up intervals ($p < 0.05$). MAT patients showed significantly faster pain resolution by the third postoperative week. Universal crusting at week 1 resolved in all patients by week 6.

Conclusion: Both CAT and MAT are highly effective for ITH management. CAT offers advantages in minimizing blood loss and snoring, while MAT provides faster late-stage pain resolution.

Oral Health Related Quality of Life in Patients with Xerostomia Following Radiotherapy for Head and Neck Cancer

Fri, 05 Jun 2026 00:00:00 +0200

Objective: To evaluate the oral health-related quality of life in head and neck cancer patients after radiotherapy treatment who present with xerostomia.

Methods: This was a cross sectional study carried out over six months from July to December, 2025 with 118 patients who were attending the outpatient department of Oral Pathology who were having xerostomia as a sequalae of radiotherapy. A structured questionnaire was used for measuring OHRQoL were used. SPSS version 24 was used for data analysis and p≤ 0.05 was considered significant.

Results: The mean age reported was 52.6 ± 11.8 years, and the male predominance was 69.5%. The most impacted domain of OHRQoL was dry mouth, followed by swallowing problems and social eating restrictions. The xerostomia severity, oral hygiene status, age, gender and socioeconomic status showed a significant association with OHRQoL (p < 0.05).

Conclusion: Radiotherapy causes xerostomia, which greatly affects the oral health-related quality of life in head and neck cancer survivors. Timely diagnosis, prevention, and multidisciplinary treatment are important to optimize functional and psychosocial outcomes.

UNEXPECTED IDENTIFICATION OF BOMBAY (OH) PHENOTYPE IN A VOLUNTARY BLOOD DONOR FROM NORTH INDIA: A CASE REPORT

Neerav Saini, Rajat Bansal, Snehil Agrawal — Sun, 07 Jun 2026 00:00:00 +0200

The Bombay (Oh) phenotype is a rare bloodgroup characterized by absence of Hantigen on red cells and the presence ofnaturally occurring anti-H antibodies in serum. Because routine forward ABOtyping may resemble group

Comparative Evaluation of Early Versus Delayed Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis: A Cross-Sectional Analysis

Dr. Mamilla Pramod,Dr. Vamshi Krishna Gorle — Fri, 03 Apr 2026 00:00:00 +0200

Background: Acute calculous cholecystitis is one of the most common surgical emergencies.Although laparoscopic cholecystectomy is considered the gold standard treatment, the optimaltiming of surgery remains a subject of debate. This study compared the clinical, operative, andpostoperative outcomes of early versus delayed laparoscopic cholecystectomy in patients with acute calculous cholecystitis

BEYOND THE BLOCK: INTRAVENOUS MAGNESIUM SULPHATE VS. DEXAMETHASONE FOR POSTOPERATIVE ANALGESIA FOLLOWING CESAREAN SECTION UNDER SPINAL ANAESTHESIA

Dr. Ishrat Yousuf, Dr. Meenu Agrawal, Dr. Reyhana Yousuf, Dr Aaqib Suhail Mir — Tue, 09 Jun 2026 00:00:00 +0200

Background: Spinal anaesthesia is the workhorse of obstetric practice — rapid, reliable, and costeffective — yet its Achilles heel lies in its brevity. Once the block fades, patients face a familiar adversary: breakthrough pain that demands escalating opioids

Ultrasound-Guided Bilateral Infraorbital Nerve Block in Endoscopic Transnasal Transsphenoidal Pituitary Surgery: A Randomized Comparison of 0.2% Ropivacaine Alone Versus 0.2% Ropivacaine with Fentanyl for Intraoperative Analgesia and Postoperative Rec

Ishrat Yousuf, Shruti Redhu, Lakshmi Bhavana, Kumari Pallavi — Tue, 09 Jun 2026 00:00:00 +0200

Background: Endoscopic transnasal transsphenoidal (TNTS) pituitary surgery involvessignificant nociceptive stimulation of richly innervated nasal structures, necessitatingrobust multimodal analgesia. Ultrasound-guided bilateral infraorbital nerve block (IONB) is an emerging adjunct in this setting. Whether the addition of fentanyl to ropivacaineaugments analgesic efficacy remains insufficiently studied.

Impact of Clinical Care Determinants on Biochemical, Hematological, and Pharmacological Outcomes in Hospitalized Patients

Tue, 09 Jun 2026 00:00:00 +0200

Background: Clinical care determinants, including healthcare staff behavior, emotional support, patient autonomy, communication, and medication-related counseling, play a critical role in influencing patient recovery and well-being. In addition to psychological effects, stressful healthcare experiences may alter biochemical, hematological, inflammatory, and pharmacological responses associated with immune function, physiological stress, and treatment outcomes. However, limited evidence from Pakistan has explored these multidimensional effects among hospitalized patients.

Objective: To determine the influence of clinical care determinants on psychological, biochemical, hematological, inflammatory, and pharmacological responses in hospitalized patients admitted to tertiary care hospitals.

Methods: A cross-sectional analytical study was conducted among 215 hospitalized patients in a tertiary care of Islamabad from January to June 2024. Clinical care determinants were assessed using a structured questionnaire, while patient well-being was evaluated using the WHO-5 Well-being Index. Biochemical parameters including serum cortisol, C-reactive protein (CRP), blood glucose, and serum albumin were assessed. Hematological parameters including hemoglobin, total leukocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), platelet count, and erythrocyte sedimentation rate (ESR) were analyzed. Pharmacological indicators including medication adherence, analgesic requirement, sedative use, adverse drug reactions, and satisfaction with medication counseling were also evaluated. Statistical analysis was performed using SPSS version 21 with p ≤ 0.05 considered statistically significant.

Results: Among the participants, staff cooperation was reported by 64.2% patients, social support by 68.8%, and bed adjustability by 69.3%. Significant associations with patient well-being were observed for staff cooperation (p<0.001), social support (p<0.001), staff visibility (p=0.001), light control (p<0.001), and bed adjustability (p<0.001). Patients with poor well-being demonstrated significantly higher serum cortisol levels (21.6 ± 4.5 µg/dL vs 14.2 ± 3.1 µg/dL), CRP levels (12.9 ± 4.7 mg/L vs 5.8 ± 2.2 mg/L), TLC (11.1 ± 2.6 ×10³/µL vs 7.4 ± 1.8 ×10³/µL), NLR (4.8 ± 1.3 vs 2.1 ± 0.7), and ESR (31 ± 9 mm/hr vs 14 ± 5 mm/hr) compared to patients with good well-being (p<0.05). Hemoglobin and serum albumin levels were significantly lower in patients with poor well-being. Medication adherence was higher among patients with good well-being (88.4% vs 61.7%), while sedative use and analgesic requirement were significantly greater among psychologically distressed patients.

Conclusion: Clinical care determinants significantly influence not only psychological well-being but also biochemical, hematological, inflammatory, and pharmacological responses in hospitalized patients. Improving patient-centered care, emotional support, healthcare communication, and medication counseling may enhance both psychological and physiological recovery outcomes.

Cephalometric Evaluation of Skeletal and Dentoalveolar Changes Induced by Twin Block Appliance in Skeletal Class II Malocclusion

Tue, 09 Jun 2026 00:00:00 +0200

Background: Skeletal Class II malocclusion is one of the most common orthodontic cases and is often associated with retrognathic mandible. Functional orthopedic appliances such as Twin Block, which are designed to aid the growth of the mandible and improve the dentofacial relationships, are popular among orthodontists. The changes to the mandible and dentofacial relationships can be evaluated using cephalometric analysis.

Objective: The purpose of this study was to assess the skeletal and dentoalveolar changes of Class II malocclusion patients after the use of the Twin Block appliance, with the use of cephalometric analysis.

Methodology: The study sample consisted of 100 children with Class II malocclusion, with a mean age of 12, and retrognathic mandible, utilizing the Twin Block appliance. Lateral cephalometric radiographs were taken prior to the use of the Twin Block (T1) and after the use of the Twin Block (T2). The following cephalometric measurements (i.e. SNA, SNB, ANB, mandibular length) were evaluated and the changes in dentoalveolar relationship and overbite and overjet were also measured. The skeletal changes and measurements of overbite, overjet, and dentoalveolar relationships were all done using paired-sample t-tests with the statistical significance set at p < 0.05.

Results: Significant skeletal and dentoalveolar changes occurred due to Twin Block therapy. The mean SNB angle increased and the mean ANB angle decreased. The mean SNB angle was 76.4° ± 2.8 pre-treatment and 79.1° ± 2.5 post-treatment (p < 0.001). The mean ANB angle was 6.2° ± 1.4 pre-treatment and 3.5° ± 1.2 post-treatment (p < 0.001). Mandibular length increased by 4.8 ± 1.6 mm. Statistically significant changes were noted with the following measurements: overjet, which reduced from 8.1 ± 1.9 mm to 3.2 ± 1.1 mm (p < 0.001); and overbite, which also reduced, from 5.1 ± 1.4 mm to 2.8 ± 0.9 mm (p < 0.001). An observed treatment effect for the maxillary incisors was retroclination, whereas proclination was noted for the mandibular incisors.

Conclusion: Twin Block appliance therapy addressed the skeletal Class II malocclusion by promoting growth of the mandible, improving the maxillomandibular relationship, and producing favorable dentoalveolar adaptations. Cephalometric evaluation confirmed significant reductions in overjet and overbite, supporting the effectiveness of Twin Block therapy during the growth phase.

Quantitative Evaluation of Corneal Ulcer Morphology Using Anterior Segment Optical Coherence Tomography: Implications for Management and Prognosis

Dr Sachin Agrawal, Dr Anjali Rahane, Dr Pallak Kusumgar — Wed, 10 Jun 2026 00:00:00 +0200

Background: Corneal ulceration is a severe, sight-threatening condition conventionally evaluated using slit-lamp biomicroscopy. However, clinical examination is highly subjective and limited by optical scattering from dense infiltrates and edema, which frequently obscures deep stromal necrosis and impending perforations. Anterior Segment Optical Coherence Tomography (AS-OCT) provides a non-invasive, high-resolution solution to objectively map corneal microanatomy, though standardized quantitative thresholds for guiding surgical management remain inadequately established.

Aim: To evaluate the microstructural features of infectious and non-infectious corneal ulcers using Anterior Segment Optical Coherence Tomography (AS-OCT) and assess its role in improving clinical management, predicting prognosis, and guiding surgical interventions.

Materials and Methods: This prospective longitudinal study was conducted at a Department of Ophthalmology at Indira Gandhi Government Medical College, Nagpur over an 18-month duration. A total of 92 patients with clinically and microbiologically diagnosed corneal ulcers (both infectious and non-infectious) were recruited. The study included patients aged 18 years and older. Patients with perforated trauma or prior corneal grafts were excluded. Main investigations included slit-lamp biomicroscopy, microbiological testing, and AS-OCT imaging at baseline, Day 3, Day 7, Day 14, and Month 1. Data were analyzed utilizing Shapiro-Wilk, Student’s t-test, Chi-square tests, repeated measures ANOVA, and logistic regression analysis.

Results: The mean age of the cohort was 37.4 ± 13.8 years, with a male preponderance (63.04%, p=0.012). Ocular trauma was the primary predisposing factor (60.87%). The etiological spectrum was predominantly bacterial (52.17%) and fungal (38.04%). AS-OCT identified a dense infiltrate pattern in 30.43% of cases and a spongiform pattern in 26.09%. AS-OCT detected a significantly larger mean infiltrate diameter (4.65 ± 1.82 mm) compared to slit-lamp evaluation (3.82 ± 1.54 mm, p<0.001). A baseline AS-OCT Residual Corneal Thickness (RCT) < 250 µm was identified in 30.43% of patients, offering a 75.0% diagnostic gain for impending perforation over slit-lamp examination. Baseline RCT < 250 µm was an independent predictor for surgical intervention (aOR 11.20, p<0.001).

Conclusion: AS-OCT is an objective, high-resolution imaging modality that surpasses subjective slit-lamp biomicroscopy in the structural evaluation of corneal ulcers. Tomographic parameters, specifically an RCT < 250 µm and spongiform necrosis, serve as highly predictive biomarkers for medical failure, enabling timely therapeutic escalation and surgical intervention.

Association of Obesity, Diabtetes, Hyperetension with Endometrial Cancer

Naba, Hira, Nosheen, Ayesha, Bakhtawar, Sohaib — Wed, 10 Jun 2026 00:00:00 +0200

Background: Endometrial cancer is a common type of gynecologic cancer in women, especially those after menopause. Important risk factors have been reported to be several metabolic conditions such as obesity, diabetes mellitus and hypertension. These disorders can affect the risk of endometrial cancer by hormone-related mechanisms, insulin resistance, chronic inflammation and disrupted metabolism.

Objective: To determine the association of obesity, diabetes mellitus, and hypertension with endometrial cancer among women presenting at Akbar Niazi Teaching Hospital, Islamabad.

Methods: This descriptive cross sectional analytical study was done at Akbar Niazi Teaching Hospital, Islamabad between the period of January 2025 to June 2025. A total of 75 women, who had histopathologically confirmed endometrial cancer, were included. The following clinical data were obtained that included age, menopausal status, parity, presenting symptoms, body mass index, diabetes mellitus, and hypertension.Age, menopausal status, parity, presenting symptoms, body mass index, diabetes mellitus, and hypertension were obtained. Body mass index was used to determine obesity, and medical history, previous diagnosis and hospital records were used to determine diabetes and hypertension. The SPSS version 26 software was used for data analysis. The categorical variables were presented as frequencies and percentages, and the quantitative variables were presented as means and standard deviations. Test chi-square and logistic regression analysis were used when appropriate. P value < 0.05 was deemed statistically significant.

Results: The mean age of the patients was 54.8 ± 9.6 years. Most patients were postmenopausal 54 (72.0%), and postmenopausal bleeding was the most common presenting complaint 43 (57.3%). Obesity was present in 46 (61.3%) patients, diabetes mellitus in 39 (52.0%), and hypertension in 42 (56.0%). All three metabolic risk factors were present together in 24 (32.0%) patients. Obesity, diabetes mellitus, and hypertension showed significant association with high-grade endometrial cancer, with p-values of 0.031, 0.018, and 0.026, respectively. The combined presence of all three risk factors showed the strongest association with high-grade disease (p=0.011).

Conclusion: Obesity, diabetes mellitus, and hypertension were frequently observed among women with endometrial cancer. These metabolic conditions were significantly associated with high-grade tumors, especially when present together. Early identification and control of metabolic risk factors may help in risk reduction, timely diagnosis, and improved clinical outcomes in women at risk of endometrial cancer.

A PROSPECTIVE COMPARATIVE STUDY OF CARDIOVASCULAR RESPONSE TO LMA INSERTION AND ENDOTRACHEAL TUBE INTUBATION

Dr. Lakshmish Yadav Y S — Wed, 10 Jun 2026 00:00:00 +0200

Introduction: Airway management is themost critical technique performed during the administration of general anaesthesia toindividuals who are unable to maintain anappropriate airway on their own and requireartificial airway maintenance equipment

Job Satisfaction of ASHA Workers in a Community Development Block of West Bengal-A Qualitative Analysis

Dr Sarmistha Chakrabarti, Dr Arnab Ghosal, Dr Chandradip Saha — Thu, 11 Jun 2026 00:00:00 +0200

Background: Accredited Social Health Activists (ASHAs) are key frontline health workers under India’s public health system. Their motivation and job satisfaction are critical for effective service delivery, yet remain inadequately explored through qualitative approaches.

Objectives: To explore job satisfaction and its determinants among ASHA workers in Haringhata Block of Nadia district, West Bengal.

Methods: A qualitative study using a grounded theory approach was conducted among ASHA workers. Focus Group Discussions (FGDs) were carried out across eight Gram Panchayats until data saturation was achieved. Data were transcribed, translated, and analyzed using thematic analysis involving open coding, categorization, and theme generation.

Results: Six major themes emerged: (1) work environment and health system support, (2) financial remuneration, (3) community interaction, (4) work–life balance, (5) emotional labour and stress, and (6) career progression. While community recognition and flexible work timing contributed positively to job satisfaction, low and irregular incentives, increasing workload, lack of career advancement, and emotional exhaustion were major sources of dissatisfaction.

Conclusion: Job satisfaction among ASHA workers is multidimensional, with intrinsic motivation often offset by systemic and financial challenges. Strengthening remuneration systems, supportive supervision, training, and career pathways is essential to improve ASHA performance and retention.

Association of Metabolic Syndrome with Non-Alcoholic Fatty Liver Disease in Women Diagnosed With Polycystic Ovary Syndrome: A Multicenter Cross-Sectional Study in Pakistan

Thu, 11 Jun 2026 00:00:00 +0200

Background: The metabolic disturbances usually seen in women with polycystic ovary syndrome include insulin resistance, abdominal adiposity, abnormal lipid levels and impaired glucose regulation. These abnormalities can lead to development of non-alcoholic fatty liver disease. But there is still a lack of evidence in local clinical populations in Pakistan.

Objective: To determine whether metabolic syndrome is linked with non-alcoholic fatty liver disease in women with polycystic ovary syndrome.

Methods: It was a multicentre cross-sectional study conducted at Dr. Ziauddin Hospital, Sukkur and Gambat Medical college, Gambat, Sindh, Pakistan from March 2024 to March 2025. One hundred reproductive-age women (18–40 years old) with confirmed diagnosis of PCOS were recruited sequentially as a sample. Clinical presentation, anthropometric parameters, blood pressure, fasting glucose, serum lipid parameters, hepatic transaminase levels and abdominal ultrasound findings were recorded in the study records of each woman enrolled. Metabolic syndrome was defined based on adult criteria. Diagnosis of NAFLD was confirmed by ultrasonography of the liver revealing fatty infiltration of the liver after excluding other causes of hepatic steatosis.

Results: The prevalence of ultrasound NASH was 44.0% in women and 39.0% of women had metabolic syndrome. Metabolic syndrome was markedly more common in the fatty liver group than in the non-fatty liver group, affecting 61.4% compared with 21.4%, respectively, and the difference was statistically significant (p<0.001). Fatty liver women also showed worse metabolic and liver profile with higher BMI, WC, Fasting glucose, TG, BP, ALT, AST and lower fasting HDL cholesterol. In adjusted analysis, the association between metabolic syndrome and fatty liver disease remained independent.

Conclusion: Among Pakistani women with polycystic ovary syndrome, non-alcoholic fatty liver disease showed a strong relationship with metabolic syndrome. These results indicate that liver evaluation and early metabolic screening is warranted in this high-risk population.

Comparative Diagnostic Accuracy of FIB-4, APRI, and NAFLD Fibrosis Score for Detecting Advanced Fibrosis in Patients with Chronic Liver Disease

Thu, 11 Jun 2026 00:00:00 +0200

Background: Chronic liver disease is a situation where the presence of extensive hepatic fibrosis is a clinically important threshold associated with future cirrhosis, portal venous hypertension, liver failure events, hepatocelluar carcinoma and the death related to liver diseases. Although transient elastography can give a good non-invasive assessment of fibrosis load, its restricted use in many clinical contexts means that routine laboratory-based fibrosis scores may be useful for initial risk stratification.

Objective: To assess how accurately FIB-4, APRI, and the NAFLD Fibrosis Score detect advanced liver fibrosis in adult patients with chronic liver disease.

Methods: A cross-sectional diagnostic accuracy study was carried out from June 2024 to September 2025 at Gambat Medical College, Gambat, Sindh, and Jinnah Postgraduate Medical Centre, Karachi. The analysis included 120 adults with confirmed chronic liver disease. Patient demographics, clinical details, liver biochemical markers, and haematological parameters were collected using a structured recording method. The three non-invasive fibrosis indices, FIB-4, APRI, and the NAFLD Fibrosis Score, were calculated using their standard formulas. Transient elastography was used as the reference method for classifying advanced fibrosis. Diagnostic performance was assessed for each score by calculating sensitivity, specificity, predictive values, overall accuracy, correct classification, and ROC curve-based discrimination.

Results: Advanced fibrosis was identified by transient elastography in 42 of 120 participants (35.0%). FIB-4 had the best diagnostic profile with sensitivity of 80.9% and specificity of 76.9% and accuracy of 78.3%, negative predictive value of 88.2% and AUC of 0.84. The NAFLD Fibrosis Score had intermediate level discrimination (AUC = 0.79) while APRI had the lowest of the three indices (AUC = 0.73).

Conclusion: Among the three serum-derived fibrosis indices evaluated, FIB-4 performed best for recognising advanced fibrosis in chronic liver disease. The simplicity and good negative predictive value lend to its use as a primary screening technique, particularly within centres where elastography is not commonly used.

Anatomical Factors Associated With Conversion from Laparoscopic To Open Cholecystectomy Surgery in Peadiatric and Adult Populations

Thu, 11 Jun 2026 00:00:00 +0200

Background: Laparoscopic cholecystectomy is the usual surgical treatment for the symptomatic gallbladder disease for both children and adults. It has some advantages over laparotomy, but in some cases, laparotomy may be necessary due to anatomical difficulty or inflammatory distortion, which makes it unsafe for laparoscopic dissection. Dense adhesions, frozen Calot's triangle, impacted Hartmann's pouch stone, gangrenous gallbladder and unclear biliary anatomy may be risk factors for conversion.

Objective: To determine the anatomical factors associated with conversion from laparoscopic to open cholecystectomy surgery in pediatric and adult populations.

Methods: This is a descriptive, cross sectional study, which was conducted in Bannu Medical college, Bannu from January 2025 to June 2025. There were 75 patients undergoing attempted laparoscopic cholecystectomy. The patients were split into two groups: pediatrics and adults. The following information was collected: demographic data, clinical history, ultrasound findings, intra-operative anatomical findings, conversion status, reasons for conversion, operating time, and postoperative outcome. Conversions, which were considered when the laparoscopic procedure had to be abandoned and performed through an open incision. The SPSS software was used for data analysis. Categorical variables were presented as frequencies and percentages and continuous variables were presented as mean and standard deviation. Where applicable, Chi-Square test or Fisher's exact test was used, and a p value<0.05 was defined as significant.

Results: Out of 75 patients, 25 (33.3%) were pediatric and 50 (66.7%) were adults. The overall conversion rate from laparoscopic to open cholecystectomy was 12.0% (9/75). Conversion was more frequent in adults 14.0% (7/50) compared with pediatric patients 8.0% (2/25), although this difference was not statistically significant. The major anatomical factors significantly associated with conversion were dense adhesions around the gallbladder, frozen Calot’s triangle, difficult cystic duct identification, impacted stone at Hartmann’s pouch, gangrenous gallbladder, uncontrolled bleeding, and unclear biliary anatomy. Patients who required conversion had longer operative time and hospital stay compared with those completed laparoscopically.

Conclusion: Anatomical distortion and inflammatory changes around Calot’s triangle were the main factors associated with conversion from laparoscopic to open cholecystectomy. Conversion was more common among adults than pediatric patients. Early recognition of difficult anatomy, careful dissection, and timely conversion are important for preventing bile duct injury and improving patient safety.

Fistulectomy versus Fistulotomy in the Treatment of Anal Fistula: A Comparative Analysis

Thu, 11 Jun 2026 00:00:00 +0200

Background: Anal fistula is a very common anorectal condition, and our management has become difficult from a surgical perspective because of the potential for the condition to recur and cause damage to the sphincter. Among the common operations performed at the gastrointestinal level, fistulotomy and fistulectomy each have their advantages and disadvantages.

Objective: To compare the clinical results, immediate recovery, and recurrence in those having an anal low-lying simple fistula with fistulectomy and fistulotomy.

Methods: The study was a comparative prospective study that took place at Ayub Teaching Hospital Abbottabad, from July 2025 to December 2025. Eighty patients with primary low or simple anal fistulas were enrolled and assigned to either fistulotomy (n=40) or fistulectomy (n=40).

Results: Fistulotomy was associated with significantly lower postoperative pain in patients and quicker wound healing (mean 21.5 ± 4.3 days) than fistulectomy (mean 32.8 ± 5.6 days; p < 0.001). Fistulectomy patients had minor transient incontinence in 5%, whereas no incontinence occurred in animals not undergoing fistulectomy.

Conclusion: Fistulectomy is reserved for cases where recurrence prevention is desired, and for simple low anal fistulas, fistulotomy proved to be a preferred option for faster recovery and to conserve anal continence with low postoperative pain level.

Influence of High BMI on Wound Complications in Open Paraumbilical Hernia Repair

Thu, 11 Jun 2026 00:00:00 +0200

Background: A paraumbilical hernia is a very common defect of the abdominal wall that is often repaired with open surgery.

Objective: To assess the effect of high BMI on the incidence of postoperative wound complications in open paraumbilical hernia surgery in a tertiary care hospital.

Materials and Methods: This descriptive cross-sectional study was conducted in the Department of General Surgery, Ayub Teaching Hospital Abbotabad, from September, 2025 to February 2026. The patients were selected using a non-probability consecutive sampling method, and 120 patients aged 18-70 years who were undergoing elective open repair of paraumbilical hernia were included. Data were analyzed using SPSS version 26.

Results: The mean age of the participants was 46.8 ± 11.5 years, and 56.7% were female. Of the 120 patients, 28.3% had normal BMI, 31.7% were overweight, and 40.0% were obese. Patients had overall postoperative wound complications in 28.3%. The most frequent complications were surgical site infection (12.5%), seroma formation (7.5%), wound dehiscence (5.0%), and hematoma (3.3%).

Conclusion: BMI is a significant risk factor for postoperative wound complications after open repair of paraumbilical hernia.

Comparison of Suture versus Tacker Techniques for Peritoneal Closure in Laparoscopic TAPP Inguinal Hernia Repair: A Randomized Controlled Trial

Wed, 10 Jun 2026 00:00:00 +0200

Background: Peritoneal closure is a critical step in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Various techniques are used, most commonly intracorporeal suturing and mechanical fixation using tackers. However, the optimal method remains controversial, particularly with respect to postoperative pain, complications, operative time, and cost.

Objective: To compare postoperative pain, complications, and duration of surgery between suture and tacker techniques for peritoneal closure in laparoscopic TAPP inguinal hernia repair.

Methods: This randomized controlled trial was conducted in the Department of General Surgery, Nishtar Hospital, Multan, over six months, from March 2025 to September 2025. A total of 96 male patients undergoing elective laparoscopic TAPP repair were randomly allocated into two groups: Group A (peritoneal closure with sutures) and Group B (peritoneal closure with tackers). Postoperative pain was assessed using the Visual Analogue Scale (VAS). Complications and operative time were recorded and analyzed using SPSS version 23.

Results: Patients in the suture group experienced significantly lower postoperative pain compared to the tacker group (p < 0.05). The incidence of postoperative complications was also lower in the suture group, while the mean operative time was slightly longer but not statistically significant.

Conclusion: Intracorporeal suturing for peritoneal closure in TAPP repair is associated with reduced postoperative pain and fewer complications compared to tacker fixation, making it a safer and more cost-effective option in experienced hands.

Radiological Outcomes of Femoral Neck Fractures Treated with two Vs. Three Cannulated Screws in Adults

Wed, 10 Jun 2026 00:00:00 +0200

Background: Femoral neck fractures are a very frequent type of orthopedic injury that, in most cases, lead to surgery as a way of restoring the stability of the hip and avoiding the development of complications related to the continuity of the fracture. Fixation with cannulated screws has gained wider acceptance because it is less invasive, and through this method, one can obtain a stable internal fixation. Nevertheless, the ideal number of screws that a surgeon should use in order to achieve a good fixation is always doubtful. Radiological examination is mainly used to check if the fracture has healed, if the alignment has been preserved, and if there are any complications after surgery.

Objective: In order to compare the post-operative radiological results of femoral neck fractures treated with either two or three cannulated screws in adult patients.

Methods: This case-control study was done at the Department of Orthopaedic Surgery, Hayatabad Medical Complex Peshawar, Pakistan, from January, 2025 to June, 2025. In total, 88 adult patients with femoral neck fractures were enrolled in the study and were separated into two groups. Group A comprised 44 patients who were operated on with two cannulated screws, while Group B included 44 patients operated on with three cannulated screws. Radiological parameters were evaluated with the help of postoperative and follow-up X-rays for the assessment of fracture union, preservation of alignment, screw migration, femoral head collapse, and failure of fixation. The analysis was done using SPSS, version 26, and a p-value of ≤0.05 was considered significant.

Results: Radiological union was noted in 79.5% of patients treated with two screws and 88.6% of patients treated with three screws. Postoperative complications, for example, femoral head collapse, screw migration, and fixation failure, occurred more often in the two-screw group than in the three-screw group. These results point to higher radiological stability obtained by using three cannulated screws.

Conclusion: Both fixation methods have been proven to work, and three cannulated screws yield better radiological outcomes and fewer complications than two-screw fixation.

Association between Glycemic Control and Hepatic Steatosis Severity in Type 2 Diabetic Patients

Wed, 10 Jun 2026 00:00:00 +0200

Background: Hepatic steatosis is common among patients with type 2 diabetes mellitus and may worsen with poor glycemic control and metabolic dysfunction.

Objective: To assess the association between glycemic control and hepatic steatosis severity in patients with type 2 diabetes mellitus.

Methodology: This cross-sectional analytical study was conducted at Department of Medicine Unit-2, Chandka Medical College Hospital, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from 1^st May 2025 to 31^st October 2025, including 240 patients with type 2 diabetes mellitus. Baseline demographic and clinical variables included age, gender, duration of diabetes, body mass index, blood pressure, smoking status, comorbidities including hypertension and dyslipidemia, and antidiabetic treatment history.

Results: Patients with moderate/severe steatosis were older, had longer diabetes duration, and higher body mass index compared with those having no/mild steatosis. HbA1c increased progressively from 6.8±0.9% in patients without steatosis to 10.1±1.6% in severe steatosis (p<0.001). Fasting blood glucose, alanine aminotransferase, aspartate aminotransferase, and triglycerides also increased significantly with steatosis severity. Hemoglobin A1c showed the strongest positive correlation with steatosis grade (r=0.68; p<0.001). Poor glycemic control was the strongest predictor of moderate-to-severe hepatic steatosis (aOR 4.26; 95% CI: 2.08–8.71; p<0.001).

Conclusion: Poor glycemic control is significantly associated with increased hepatic steatosis severity in type 2 diabetic patients.

Analysis of Maxillary and Mandibular Incisors Bony Support in Different Skeletal Pattern-A Cbct Study

Dr Debrup Halder, Dr Samit Mondal, Dr Abhisek Das, Dr Sangeeta Sen — Wed, 03 Jun 2026 00:00:00 +0200

Introduction: Achieving the intended dentoalveolar changes is one of the main objectives of orthodontic therapy. The right biomechanics must be considered by the orthodontists based on dentoalveolar anatomy and growth pattern.

Aims and objectives: The aim of this study is to evaluate and compare the bony support of maxillary and mandibular incisors in different skeletal patterns using cone-beam computed tomography (CBCT), and to assess variations in alveolar bone thickness and incisor position across skeletal Class I, Class II, and Class III relationships.

Materials & Methods: This cross-sectional observational study has been done in the Department of Orthodontics and Dentofacial Orthopedics, Guru Nanak Institute of Dental Sciences and Research, Kolkata, India, from March 2023 to January 2025.Total 66 CBCT scan of bengali patients aged between 14yrs to 26yrs is taken randomely from archive of the institution.

Result: In the Maxilla, No significant difference was found in Maxillary Incisor Inclination (118.73 ± 1.13°, 117.33 ± 3.22°, and 118.42 ± 7.05°, respectively; P = 0.59) or Maxillary Incisal Angle (118.67 ± 1.24°, 121.21 ± 6.36°, and 117.72 ± 11.35°, respectively; P = 0.33). For Maxillary Buccal Cancellous Bone Thickness, Hypodivergent subjects (2.17 ± 0.40 mm) had significantly greater values compared to Normodivergent (1.74 ± 0.24 mm) and Hyperdivergent (1.63 ± 0.78 mm) groups (P = 0.0046).

Conclusion: This study used the improved imaging capability of the CBCT to investigate the relationship between vertical facial patterns and upper-lower anterior tooth-alveolar morphology in the Bengali population. Overall, statistically significant differences were found between the facial types for most of the categories measured including buccal cortical bone thickness, lingual cortical bone thickness, and root length, while medullary as well as cortical bone thickness was significantly higher in hypodivergent facial types.

Sociodemographic and Obstetric Factors of Postpartum Depression in Cesarean Section

Wed, 10 Jun 2026 00:00:00 +0200

Background: Postpartum depression is a major international public health problem. It most commonly occurs 4 to 6 weeks after giving birth. A number of sociodemographic, obstetric, and psychological factors have been identified as likely contributors to postpartum depression.

Objectives: To determine the frequency of postpartum depression in women underwent cesarean section and to study the frequency of contributing factors of postpartum depression in women underwent cesarean section.

Methodology: This descriptive case series was conducted at Department of Obstetrics & Gynaecology, Sughra Shafi Medical Complex, Narowal from 1^st August 2024 to 31^st January 2025. A total of 135 women aged 18-40 years who underwent cesarean delivery during the last 48 hours using nonprobability consecutive sampling technique. The study assessed obstetric factors like gestational age, pregnancy loss, preterm delivery, newborn sex, and birth weight. Postpartum depression was evaluated eight weeks postpartum using the Edinburgh Postnatal Depression Scale. Data analysis procedure was done by using SPSS-25.

Results: The study analyzed the demographic characteristics of 135 women who underwent caesarean delivery. The mean age of mothers was 26.59±4.90 years, of which most (73.3%, n = 99) were 30 years and younger, and 26.7% (n=36) were aged between 31 and 40 years. The mean gestational age at delivery was 36.92±2.52 weeks, with 63.0% (n = 85) delivered at ≥37 weeks and 37.0% (n = 50) receiving preterm birth at ≤36 weeks. The newborn male: female ratio was nearly a clean split, with 51.9% (n=70) male and 48.1% (n=65) female. These demographic data supply crucial information regarding the maternal and neonatal profiles of the study population, which may be a postpartum health outcome factor, e.g., the potential risk factors for postpartum depression. Among the 135 women who were delivered by caesarean, 31.9% (n=43) experienced postpartum depression and 68.1% (n=92) did not experience postpartum depression. Multiparity, unplanned caesarean deliveries, and low education were highly correlated with postpartum depression in women who had C-sections. Conversely, young maternal age, low income, and prior pregnancy loss had no significant relationship with postpartum depression. These results indicate that certain obstetric and socioeconomic factors are of significant importance in the etiology of postpartum depression in this population.

Conclusion: In conclusion, the study found a higher rate of postpartum depression among women who underwent cesarean delivery, particularly those with unplanned procedures, low educational levels, and multiparity. These findings highlight the need for increased awareness, early screening, and strong support systems to promote maternal mental health during the postpartum period.

A Prospective Study of Operative Outcomes of Anterior Cervical Discectomy and Fusion (ACDF) With a Tri-Cortical ILIAC Bone Graft in the Treatment of Cervical Myeloradiculopathy (CMR)

Sat, 13 Jun 2026 00:00:00 +0200

Background: Compression of the spinal cord and/or nerve roots in the cervical spine causes CMR (Cervical Myeloradiculopathy), which frequently results in severe morbidity, including pain, paralysis, sensory impairments, and bowel/bladder dysfunction. A common surgical procedure for CMR patients who have not responded to conservative treatment or who exhibit increasing neurological damage is ACDF (Anterior Cervical Discectomy and Fusion). This prospective study goal was to assess the operative results of ACDF in the management of (CMR).

Methods: This study included a cohort of 38 patients diagnosed with CMR, who underwent ACDF. preoperative assessments included clinical evaluation, imaging (MRI, CT), and neurological testing. Postoperative outcomes were measured based on pain relief, functional recovery, and neurological improvement using the modified JOA score. Additionally, the study evaluated complication rates, including infection, graft displacement, and neurological deterioration.

Results: The results indicate that ACDF leads to significant improvements in both pain and neurological function, with a favorable safety profile. The majority of patients experienced marked recovery within 6-12 months postoperatively, with a low incidence of complications.

Conclusion: This study reinforces the fact that ACDF is an effective and reliable gold standard surgical intervention for patients with CMR, offering substantial long-term relief and functional improvement.

Perineural versus Perivascular Ultrasound-Guided Axillary Brachial Plexus Block for Elective Upper Limb Surgery: A Double-Blind Randomized Controlled Trial

Sat, 13 Jun 2026 00:00:00 +0200

Background: Ultrasound-guided axillary brachial plexus block is widely used for elective upper limb surgeries due to its effectiveness and safety. Two commonly employed techniques are the perineural and perivascular approaches. While the perivascular technique is technically simpler, the perineural approach may provide faster onset and superior block quality. This study compared the efficacy, safety, and hemodynamic effects of both techniques.

Methods: A double-blind randomized controlled trial was conducted among 160 patients undergoing elective upper limb surgeries, with 80 patients each allocated to the perineural (PN) and perivascular (PV) groups. Ultrasound-guided axillary brachial plexus block was performed using standardized anesthetic protocols. Primary outcomes included sensory and motor block onset times and block success rate. Secondary outcomes included duration of sensory and motor blockade, rescue analgesia requirement, supplemental block requirement, hemodynamic parameters, and complications. Statistical analysis was performed using appropriate comparative tests, with p < 0.05 considered significant.

Results: The perineural approach demonstrated significantly faster sensory and motor block onset, higher block success, and superior block quality compared with the perivascular approach. Sensory block duration (402 ± 76 vs. 362 ± 73 min; p = 0.001) and motor block duration (344 ± 68 vs. 319 ± 65 min; p = 0.020) were significantly longer in the PN group. Rescue analgesia (7.5% vs. 17.5%; p = 0.049) and supplemental nerve block requirements (10.0% vs. 22.5%; p = 0.035) were significantly lower in the PN group. Complications, including vascular puncture and paresthesia, were less frequent with the perineural technique, resulting in a lower overall complication rate (7.5% vs 22.5%; p = 0.009). Hemodynamic parameters remained comparable between groups.

Conclusion: The perineural approach is superior to the perivascular technique for ultrasound-guided axillary brachial plexus block, providing faster onset, improved block success, prolonged analgesia, reduced analgesic requirements, and fewer complications while maintaining hemodynamic stability. It should be considered the preferred technique for elective upper limb surgeries.

Mini-Clinical Evaluation Exercise as a Formative Assessment Tool in Undergraduate Medical Training: A Study of Student and Faculty Acceptability

Sat, 13 Jun 2026 00:00:00 +0200

Background: Mini-CEX evaluation exercise is a workplace-based assessment method which evaluates a medical student’s clinical acumen, behaviour and professionalism. Every aspect of a clinical encounter is evaluated at mini-CEX. It involves history taking & interviewing skills, physical & clinical examination skills, clinical judgement, counselling skills and overall professionalism. The process includes a short observed clinical interaction by a medical student with a live patient & the whole process is observed by an accessor at bedside who after the encounter is over provides structured feedback to the student. The feedback form is a rating chart where the accessor marks the trainee’s performance across the pre-defined competencies using a standardized & structured rating scale. The immediate feedback by the accessor provides scope for further learning & skill improvement.

Aims: To assess the acceptability of the Mini-Clinical Evaluation Exercise (mini-CEX) as a formative assessment tool among final MBBS students and faculty members

Methods: A cross-sectional observational study was conducted in six months duration in the department of medicine to study the acceptability of mini-CEX amongst students of final MBBS and faculties of medicine department after obtaining permission from IEC. 25 medical students were selected by systemic random sampling. Following sensitization and informed consent each student underwent a mini-CEX encounter assessed by a trained faculty using a nine-point standardized mini-CEX rating scale. Clinical skills, clinical acumen, communication skills, clinical judgement and overall professionalism were evaluated during the 20 mints encounter followed by immediate feedback and the rating chart being handed over to the student. Acceptability of this encounter was assessed by using five-point Likert scale based on structured & validated questionnaires covering multiple domains for acceptability. Data were analysed using descriptive statistics & Chi-square test.

Results: Acceptability of mini-CEX among students was assessed across four domains: satisfaction level, educational impact, assessment utility and psychological perception. The mean sentiment scores for these domains were 3.56±1.19, 4.08±0.97, 3.82±1.32 & 3.32±1.57, respectively. These findings indicate students have positive perception of mini-CEX regarding its educational value and its utility as an assessment tool. Psychological impact remained neutral likely reflecting the direct observation component of the process. Statistical analysis revealed a significant association with immediate feedback in mini-CEX (P< 0.05) & it’s linked with improved students’ performance with greater awareness of individual’s strength & weakness. Faculty perception scores across the same domains were 3.60±0.28, 3.20±0.51, 3.29±0.67 & 3.00±1.58, showing broadly similar trends, though faculty perception regarding its utility as educational tool and assessment method appeared more reserved. The overall acceptability score was 3.70±1.19 among students & 3.27± 0.76 among faculty, indicating a positive perception in both two groups.

Conclusion: Mini- CEX is a feasible and well accepted tool for formative assessment in clinical settings with particular strength in providing immediate feedback, which ensures students’ learning & improves performance. Its integration in learning module will improve clinical competence however adequate faculty training must be implemented beforehand.

Bhringraj: An Ayurvedic Herb with Modern Cosmetic Application

Aarya Gaikwad, Nandini Aldar, Eknath Gaikwad, Monali M. Upare — Thu, 04 Jun 2026 00:00:00 +0200

Bhringraj (Eclipta alba Linnaeus), a well-known medicinal herb in Ayurveda, has long been valued for its therapeutic and cosmetic applications. This review highlights thebotanical characteristics, geographic distribution, cultivation methods, and phytoconstituents of this plant, with emphasis on its bioactive compounds, such as alkaloids, flavonoids, triterpenes, and coumestans. These constituents have wide range of pharmacological and cosmetic benefits. Bhringraj is traditionally used for hair and skin care to, promote hair growth, reduce dandruff, delay premature greying and improve scalp and skin health. It also exhibits antimicrobial, antioxidant, and anti-inflammatory properties, making it useful for managing scalp infections, hair loss, and certain skin disorders. Despite its benefits, prolonged or excessive application may lead to adverse effects such as scalp irritation or dermatitis. Several marketed formulations and, home remedies utilize Bhringraj in oils, powders, tablets, and syrups, highlighting its continued relevance in both traditional and modern therapeutics. Overall, Bhringraj is a valuable natural resource with significant potential in herbal medicine and cosmetology.