Research Article
Open Access
Cross-Sectional Study of the Association between Maternal Vitamin D Levels and Pregnancy Outcomes in Hypertensive Disorders of Pregnancy
N S Prasanthi Singitham,
D Bhargava
Pages 843 - 851
View PDF
Abstract
Background: Hypertensive disorders of pregnancy (HDP) are major contributors to maternal and perinatal morbidity and mortality. Emerging evidence suggests that maternal vitamin D deficiency may play a role in their development and progression. This study aimed to evaluate the association between maternal serum 25-hydroxyvitamin D [25(OH)D] levels and pregnancy outcomes in women with HDP. Methods: A cross-sectional analytical study was conducted among 200 pregnant women diagnosed with hypertensive disorders of pregnancy at Dr. D. Y. Patil Medical College, Hospital and Research Institute, Kolhapur. Detailed clinical data, obstetric history, and laboratory parameters were recorded. Serum 25(OH)D levels were estimated using a quantitative ELISA method and categorized as deficient (<20 ng/mL), insufficient (20-29 ng/mL), or sufficient (≥30 ng/mL). Associations between vitamin D levels, disease severity, and maternal-fetal outcomes were analyzed using appropriate statistical tests and logistic regression models. Results: The mean serum vitamin D concentration was 19.8 ± 7.6 ng/mL, with 58.5% of participants being deficient. Women with adverse pregnancy outcomes had significantly lower vitamin D levels (17.8 ± 6.8 ng/mL) compared to those without complications (21.4 ± 7.8 ng/mL, p = 0.0009). Vitamin D levels showed a positive correlation with birth weight (r = 0.26, p = 0.0004) and gestational age (r = 0.22, p = 0.0021), and a negative correlation with systolic blood pressure (r = -0.19, p = 0.0068). The prevalence of severe preeclampsia/eclampsia was markedly higher in vitamin D-deficient women (37.6%) compared to those with sufficient levels (7.4%, p = 0.007). Logistic regression revealed that each 10 ng/mL increase in 25(OH)D reduced the odds of composite adverse outcomes by 34% (aOR 0.66; 95% CI 0.49-0.90; p = 0.0079). Conclusion: Vitamin D deficiency was highly prevalent and significantly associated with both the severity of HDP and adverse maternal and neonatal outcomes. Adequate maternal vitamin D levels appear to exert a protective effect against disease progression and poor perinatal results. Routine screening and timely supplementation of vitamin D during pregnancy may serve as an effective preventive measure in high-risk women.
Research Article
Open Access
AI in Endodontics: Automated Root Canal Detection and Measurement
Leelamma Kuruvilla ,
Suprit Pawar ,
Vidyut Theja Swargam,
. Mohamed Faizal M.R,
Amrutha Sathianath ,
Vinay Rao
Pages 838 - 842
View PDF
Abstract
Background: Root canal morphology is complex and varies across teeth and populations. Precise detection and measurement of canals is critical for successful endodontic therapy. Artificial intelligence (AI) has emerged as a promising tool for enhancing diagnostic accuracy in imaging modalities such as periapical radiographs and cone-beam computed tomography (CBCT). Materials and Methods: A scoping review and analysis were conducted on AI applications in endodontics. Inclusion criteria were studies (2015–2025) using AI or deep learning for root canal detection, measurement, or morphology assessment. Exclusion criteria were non-clinical datasets, reviews without primary data, and animal/in-vitro studies. Results: Across 31 studies, AI demonstrated high diagnostic performance, with mean accuracies ranging 88–96% for canal detection and 0.1–0.3 mm error for length measurements. Deep learning-based CNNs outperformed traditional machine learning in CBCT segmentation. Six summary tables illustrate diagnostic metrics, algorithm types, anatomical challenges, comparative studies, clinical workflow integration, and barriers. Conclusion: AI enhances root canal detection and measurement, supporting endodontists with consistent, accurate, and reproducible outcomes. Future work requires larger datasets, multi-center validation, and integration into clinical chairside systems.
Research Article
Open Access
Anaemia in Chronic Liver Disease: Insights into Prevalence and Prognostic Significance
Anjali J. Kelkar,
Akshara Jogi ,
Vaishali Patil ,
Harshal Patil
Pages 826 - 837
View PDF
Abstract
Background: Chronic Liver Disease (CLD) represents a major global health burden, with anaemia being one of its most frequent yet under-recognized complications. Anaemia in CLD adversely impacts clinical outcomes, contributing to higher morbidity, poorer quality of life, and increased mortality. This study aimed to evaluate the prevalence, aetiology, morphological patterns, and prognostic significance of anaemia in patients with CLD. Methods: A case-only observational study was conducted in the Department of Pathology, at a tertiary-care centre, over a three-year period (2019–2022). One hundred adult patients with histologically confirmed CLD were enrolled. Detailed clinical, biochemical, and histopathological data were recorded. Anaemia was classified according to WHO criteria, and its aetiology established using haematological and biochemical investigations. CLD severity was assessed by MELD-Na score. Statistical analysis was performed using IBM SPSS v20, applying non-parametric tests, correlation analyses, and regression models. Results: Anaemia was observed in 79% of CLD patients, with the majority (55%) presenting with moderate anaemia (Hb 8.0–10.9 g/dL). Macrocytic anaemia (39%) was most common, with vitamin B12 deficiency the predominant cause, followed by anaemia of chronic disease, iron deficiency anaemia, and haemolytic anaemia. Malignant causes of CLD (hepatic metastases 28%, hepatocellular carcinoma 16%) were more frequent than non-malignant causes (alcoholic liver disease 15%, cryptogenic cirrhosis, NASH, viral hepatitis). Cirrhosis was observed in 47% of cases, predominantly micronodular. A significant negative correlation was found between haemoglobin and MELD-Na score (r = –0.609, p < 0.01), indicating that anaemia severity paralleled CLD progression. At six-month follow-up, 60% of patients underwent surgical intervention (transplant or hepatectomy), 22% required repeated hospitalization, and 4% succumbed to the disease. Conclusions: Anaemia is highly prevalent in CLD, with distinct morphological and aetiological patterns. Its severity correlates with advanced liver dysfunction, underscoring the importance of routine detection and targeted management. Early recognition and treatment of anaemia may improve clinical outcomes, reduce morbidity, and enhance quality of life in patients with CLD.
Research Article
Open Access
Expired Tidal Volume During Conventional vs. Modified Thenar Eminence Mask Ventilation in General Anaesthesia: A Prospective Observational Study
Tejavath Vamshi ,
Sheeja Krishnan ,
Thusharendhu N ,
Sobha S
Pages 820 - 825
View PDF
Abstract
Background: Mask ventilation is a fundamental skill in airway management. It is a straightforward, non-invasive technique that can serve as a primary mode of ventilation for short procedures or as a bridge to definitive airway management. Bag-valve-mask ventilation remains the gold standard for rapid rescue ventilation in patients with apnea or severe ventilatory failure. Objectives: The primary objective was to compare expired tidal volume achieved with conventional mask ventilation versus the modified thenar eminence technique during induction of general anaesthesia. Secondary objectives included comparison of peak airway pressure (Pmax), end-tidal carbon dioxide (ETCO₂), oxygen saturation (SpO₂), and ease of ventilation between the two techniques. Methods: This prospective observational study was conducted in a tertiary care hospital and included 110 patients aged 18–55 years scheduled for elective surgery under general anaesthesia. Patients were allocated into two groups: Group C (conventional mask ventilation) and Group M (modified thenar eminence technique). Expired tidal volume, Pmax, ETCO₂, SpO₂, and ease of ventilation were recorded and analysed. Results: A higher expired tidal volume (>470 mL) was achieved in 49% of patients in Group M compared with 20% in Group C (p < 0.05). Peak airway pressure <20 cm H₂O was observed in 71.9% of Group M and 64% of Group C (p < 0.05). SpO₂ and ETCO₂ values were comparable between groups. Conclusion: The modified thenar eminence technique produced significantly higher expired tidal volumes compared with conventional mask ventilation during induction of general anaesthesia, suggesting improved efficacy in maintaining ventilation.
Research Article
Open Access
Correlation between Weight of the Thyroid Gland and Height of Cadavers - A Cadaveric Study
Megha Bapusaheb Saknure,
Chandrashekhar Santram Halnikar
Pages 813 - 819
View PDF
Abstract
Background: The thyroid gland is an essential endocrine organ whose size and weight vary with individual characteristics. Understanding the relationship between thyroid weight and anthropometric parameters such as height is important in anatomy, surgery, and forensic practice. Aim: To evaluate the correlation between thyroid gland weight and height of cadavers. Materials and Methods: This cross-sectional cadaveric study was conducted on 80 formalin-fixed cadavers (42 males, 38 females) available in the Department of Anatomy. Cadaver height was measured in the supine position, and the thyroid gland was dissected, cleaned of extraneous tissue, and weighed on a digital balance. Cases with gross thyroid pathology or distorted neck anatomy were excluded. Data were analyzed using descriptive statistics, Student’s t test, ANOVA, and Pearson’s correlation coefficient. A p-value <0.05 was considered statistically significant. Results: The mean age at death was 54.0 ± 12.1 years. Males were significantly taller than females (165.8 ± 7.9 cm vs. 154.7 ± 6.8 cm, p<0.001). The mean thyroid weight was 13.2 ± 2.9 g in males and 12.6 ± 2.5 g in females, with no significant sex difference (p=0.34). Thyroid weight showed a numerical increase across height categories (11.9 g in ≤150 cm to 13.6 g in ≥171 cm), but ANOVA revealed no significant difference. Correlation between thyroid weight and height was weak and statistically non-significant in males (r=0.213, p=0.169), females (r=0.146, p=0.379), and overall (r=0.192, p=0.086). Conclusion: Thyroid gland weight did not correlate significantly with cadaver height in this cohort. Height alone is not a reliable anthropometric predictor of thyroid gland weight. Larger multicentric studies incorporating additional anthropometric indices are warranted.
Research Article
Open Access
Religious Involvement and Psychological Resilience as Protective Factors against Suicide Risk in Urban Indian Psychiatric Patients: A Cross-Sectional Analysis
Sidhartha Bharathy ,
Karthikeyan Rajamanickam ,
Bharathy Sundar ,
Nivedha Venkatesh
Pages 803 - 812
View PDF
Abstract
Background: Religious involvement and psychological resilience represent important protective factors against adverse mental health outcomes, yet their relationships remain understudied in Indian psychiatric populations. Understanding these associations could inform culturally appropriate interventions for suicide prevention and mental health promotion. Objective: To evaluate associations between religious involvement, psychological resilience, and suicide risk among psychiatric outpatients in Chennai, India, and determine predictors of enhanced resilience in this population. Methods: This cross-sectional observational study recruited 180 consecutive psychiatric outpatients from Tagore Medical College Hospital during January-June 2024. Participants completed the Duke University Religion Index (DUREL) measuring organizational, non-organizational, and intrinsic religiosity dimensions; Connor-Davidson Resilience Scale (CD-RISC-25) assessing psychological resilience; and Columbia Suicide Severity Rating Scale (C-SSRS) evaluating suicide risk. Demographic and clinical data were collected through structured interviews. Statistical analyses included Pearson correlations, analysis of variance, and multiple linear regression modeling. Results: Participants averaged 34.2 ± 11.7 years with male predominance (58.3%). Major depressive disorder constituted the most frequent diagnosis (35.6%), followed by anxiety disorders (28.3%). Mean DUREL total score reached 11.8 ± 3.4, indicating moderate religious involvement. CD-RISC resilience scores averaged 64.3 ± 16.8, with 58.9% demonstrating moderate resilience levels. Religious involvement correlated strongly with resilience (r = 0.642, p < 0.001) and negatively with suicide risk (r = -0.518, p < 0.001). Resilience similarly predicted lower suicide risk (r = -0.589, p < 0.001). Multiple regression revealed religiosity as the strongest resilience predictor (β = 0.592, p < 0.001), with age (β = 0.183, p = 0.012) and education (β = 0.156, p = 0.028) contributing additionally. The model explained 48.3% of resilience variance. Conclusion: Religious involvement emerges as a significant protective factor strongly associated with enhanced psychological resilience and reduced suicide risk among urban Indian psychiatric patients. These findings support incorporating spiritual assessment into routine psychiatric evaluation and developing culturally informed interventions that leverage religious resources for mental health promotion
Research Article
Open Access
An Observational Study on Functional Outcome in Surgical Management Of Distal Tibial Fractures By Anterolateral Locking Plating In Adults In A Tertiary Care Center
J H Vidya Sagar,
Mohd Tanzeel Munawar,
Md Aslam Mohsin,
Nemali Saikalyan
Pages 796 - 802
View PDF
Abstract
Background: Distal tibial pilon fractures are complex injuries that are usually caused by high-energy trauma to the bones, and there are great challenges in the surgical management of such cases because of comminution, intra-articular extension, and rupture of soft tissue. Anterolateral locking compression plating is one of the techniques that has shown promise, as it provides stable fixation with the highest reduction in soft tissue complications. The purpose of this research was to examine the functional outcomes, fracture healing rates, and complications associated with surgical management using anterolateral plating. Materials and Methods: An observational study was conducted on 20 adult patients with distal tibial pilon fractures managed surgically using anterolateral locking plates at a tertiary care center. Radiological reduction was graded according to Teeny and Wiss criteria, functional outcome assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, and union and complications were documented. Follow-up was performed for a mean duration of 9 months. Results: The sample of the cohort was mostly young men (85%), and road traffic accidents were the most common cause (80%). In 80% of cases, radiological reduction was excellent or good. There were 85% excellent to good patient recoveries at 9 months, and the mean AOFAS score was 76. Fracture union in 95% of cases occurred within 12-24 weeks, and there was only one case of non-union. Thirty percent of patients experienced complications postoperatively, mainly superficial wound infection (20%). No cases of deep infections or tendon exposures were reported. Conclusion: In distal tibial pilon fractures, anterolateral locking compression plating offers a stable fixation, high union, and desirable functional results. Even though there are still complications, especially involving soft tissues, preoperative care can reduce the risk of complications with proper surgical technique. This method can still be used as an alternative method in the treatment of such problematic injuries.
Research Article
Open Access
Incidence and Management of Periprosthetic Joint Infection in Arthroplasty
Pages 790 - 795
View PDF
Abstract
Background: Periprosthetic joint infection (PJI) is among the most serious complications following hip and knee arthroplasty, leading to increased morbidity, prolonged hospitalization, and significant healthcare costs. Despite global data on incidence and outcomes, prospective evidence from Indian centers is limited. Objective: To determine the incidence, microbiological profile, and management outcomes of PJI in patients undergoing hip and knee arthroplasty at a tertiary care teaching hospital over a one-year period. Methods: This was a prospective observational study conducted at the Department of Orthopaedics, Saraswathi Institute of Medical Sciences, Hapur, from May 2024 to April 2025. All patients undergoing primary or revision total hip or knee arthroplasty were followed for a minimum of six months. PJI was diagnosed using the 2018 Musculoskeletal Infection Society (MSIS) criteria. Patients diagnosed with PJI were evaluated for demographics, comorbidities, microbial profile, surgical management, and outcomes. Results: A total of 102 arthroplasties were performed during the study period (hip = 42; knee = 60). Two cases of PJI were identified, giving an overall incidence of 1.96%. Both infections occurred in the early postoperative period (<3 months). Staphylococcus aureus was isolated in one case, while the other was culture-negative. Surgical management included debridement, antibiotics, and implant retention (DAIR) in one patient (50%) and two-stage revision in the other (50%). At six-month follow-up, both patients were infection-free, yielding a 100% eradication rate. Conclusion: The incidence of PJI in our institution was 1.96%, comparable to international data. Early recognition and individualized surgical–antibiotic strategies ensured favorable short-term outcomes. Larger multicenter prospective studies are warranted to strengthen the epidemiological database and guide prevention and management strategies in the Indian setting.
Research Article
Open Access
Comparative Efficacy of Ondansetron and Granisetron in Preventing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy: A Randomized Controlled Study
Pradeep Shivsambh Swami,
Nikhil Uttamrao Kamble,
Hari Wanole
Pages 778 - 783
View PDF
Abstract
Background: Postoperative nausea and vomiting (PONV) is a common and distressing complication following laparoscopic cholecystectomy, with significant implications for recovery and patient satisfaction. 5-HT3 receptor antagonists such as ondansetron and granisetron are widely used for prophylaxis, though comparative evidence is limited. Aim: To compare the efficacy of ondansetron and granisetron in preventing PONV after laparoscopic cholecystectomy. Methods: A prospective, randomized, double-blind controlled trial was conducted on 160 patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients were allocated into two groups: Group A (n=80) received granisetron 40 μg/kg intravenously, and Group B (n=80) received ondansetron 80 μg/kg intravenously, administered 5 minutes before induction. Patients were assessed for incidence and severity of nausea, vomiting, and requirement for rescue antiemetic at 1, 4, 9, 12, 18, and 24 hours postoperatively. Adverse drug effects and recovery profiles were also recorded. Statistical analysis was performed using Student’s t-test and chi-square test, with p<0.05 considered significant. Results: The baseline demographic characteristics (age, sex, weight, ASA status) were comparable between groups. Granisetron was associated with a lower overall incidence of nausea and vomiting compared to ondansetron, particularly in the 9-24 hour postoperative period. The need for rescue antiemetics was significantly reduced in the granisetron group. Both agents were well tolerated, with no major adverse effects observed. Conclusion: Both ondansetron and granisetron are effective in reducing PONV after laparoscopic cholecystectomy, but granisetron offers superior and more sustained prophylaxis. Its longer half-life makes it a better choice for patients undergoing laparoscopic cholecystectomy, particularly in preventing late PONV.
Research Article
Open Access
Knowledge, Attitudes, and Practices Regarding Kangaroo Mother Care among Mothers of Low Birth Weight Infants: A Single-Center Study
Rajesh Mhatre ,
Ravindra Ingale ,
Ramya Menon ,
Sarika Kangralkar ,
Madhavi Ingale
Pages 771 - 777
View PDF
Abstract
Background: Kangaroo Mother Care (KMC) is a cost-effective intervention involving skin- to-skin contact and exclusive breastfeeding that improves outcomes among low birth weight and preterm infants. This study assessed the knowledge, attitudes, and practices regarding KMC among mothers following a structured educational intervention. Methods: A pre-post interventional study was conducted among 96 mothers at Vashi General Hospital, Navi Mumbai. Data on maternal knowledge, attitudes, and practices regarding KMC was collected using a structured questionnaire before and after an educational session. Descriptive statistics were calculated. Results: Pre-intervention, 89.9% of mothers were unsure whether KMC could replace conventional care. Post-intervention, 57.4% correctly recognized KMC as complementary, and only 1.1% remained unsure. This reflects a significant improvement in maternal understanding and attitudes toward KMC. Conclusion: Targeted maternal education significantly improves awareness and attitudes toward KMC. Integration of structured KMC counseling into routine postnatal care may enhance adherence and improve neonatal outcomes.
Research Article
Open Access
Serum Lactate As a Prognostic Marker in Sepsis a Prospective Study
Irfan Hussain Dar,
Mehnaz Syed
Pages 764 - 770
View PDF
Abstract
Background: Sepsis remains a leading cause of morbidity and mortality worldwide, particularly in critically ill patients. Early risk stratification and prognostication are crucial for guiding management. Serum lactate has emerged as a reliable biomarker reflecting tissue hypoperfusion and impaired cellular oxygen utilization. Elevated lactate levels at admission and their persistence during resuscitation have been strongly correlated with worse outcomes in septic patients. However, limited data exist from resource-limited settings, including the Kashmiri population, where sepsis burden is significant. Aim: To evaluate the role of serum lactate levels as a prognostic marker in patients with sepsis admitted to the Intensive Care Unit (ICU) of Sher-e-Kashmir Institute of Medical Sciences (SKIMS), Soura. Methods: This was a prospective observational study conducted in the Department of Medicine and Critical Care at Sher-e-Kashmir Institute of Medical Sciences (SKIMS), Soura, over a period of 18 months. All patients aged ≥18 years admitted with sepsis, as defined by the Sepsis-3 criteria, were included. Serum lactate levels were measured at admission (0 hours), 6 hours, and 24 hours. Patients were followed for in-hospital outcomes, including mortality, duration of ICU stay, and need for vasopressors and mechanical ventilation. Statistical analysis was performed using SPSS v25.0, with p <0.05 considered significant. Results: A total of 120 patients were enrolled (mean age: 54.7 ± 15.3 years; 58% males). Initial serum lactate ≥4 mmol/L was observed in 42% of patients and was significantly associated with higher mortality (58% vs 22%, p <0.01). Lactate clearance at 6 and 24 hours was strongly predictive of survival. Patients with sustained lactate elevation had longer ICU stays (mean 11.4 vs 6.8 days) and greater need for vasopressors and ventilatory support. Multivariate analysis identified admission lactate ≥4 mmol/L and poor lactate clearance as independent predictors of mortality. Conclusion: Serum lactate is a valuable prognostic marker in sepsis, with elevated baseline levels and failure of clearance correlating strongly with adverse outcomes. Incorporating serial lactate monitoring in ICU protocols can aid in early risk stratification and guide resuscitation strategies, particularly in resource-limited settings like Sher-e-Kashmir Institute of Medical Sciences (SKIMS), Soura.
Research Article
Open Access
A Study on Microbiotia of Blood Stream Infections and Its Antibiotic Susceptibility Pattern
Shanthi Kumari S,
Sumanth Kumar GLS,
Nissi Priya M,
Kiran Mai R,
Srinivas rao K,
Chandra Sekhar BR
Pages 756 - 763
View PDF
Abstract
Background: Sepsis is most commonly caused by aerobic bacteria. On response to infection in the blood, body triggers the immune system and cause damage to tissues and organs, which leads to shock, multiorgan failure. Regular monitoring of antimicrobial susceptibility pattern of blood stream infections is primarily important to fight against the infections. The aim of the study is to know the pathogens associated with blood stream infections and the antibiotic sensitivity testing. Materials And Methods: A Retrospective cohort study was conducted on patients diagnosed to have septicemia, a total of 466 patients attended various clinical departments with clinical manifestations of septicemia were included in this study during the period of one year. Under aseptic precautions blood samples and inoculated in bacTalert blood culture bottles to increase the pathogen detection rate. These were loaded into BD BACTEC automatic blood monitoring system. Positively flagged Blood Cultures were further processed by conventional method. Antimicrobial susceptibility of isolates was determined using the Modified Kirby-Bauer disk diffusion method. Results: Out of 466 blood culture tests, 178 (38.1%) yielded growth in culture media. Out of these blood samples, S.aureus (17.7%) were predominantly noted followed by Pseudomonas species (38.1%), Candida (14.5%, E.coli (13.02%), Coagulase Negative Staphylococci (CoNS) (11.4%), Klebsiella (10.4%). Beta lactam and beta lactamase inhibitors, fluoroquinolones, cotrimoxazole yielded good result in good percentage of studied population, whereas third line antibiotics showed high sensitivity. Conclusion: Judicial usage of antibiotics by clinicians, provision of hospital anitbiogram at least annually by microbiologist and adherence to antimicrobial stewardship policy will help to manage blood poisoning patients effectively.
Research Article
Open Access
Enhancing Medical Education in Community Medicine through the Interactive Case-Based Learning Modules
Vilas Malkar ,
Vinayak Doijad ,
Geetanjali Sudke ,
Akshay Salgar
Pages 751 - 755
View PDF
Abstract
Background: Traditional didactic teaching methods dominate undergraduate medical education in India, often emphasizing theoretical knowledge. Interactive Case-Based Learning (ICBL) offers an innovative, student-centered approach designed to enhance engagement, clinical reasoning, and knowledge retention. Therefore, the study was done with an objective to develop ICBL modules aligned with the Community Medicine curriculum, evaluate their impact on students’ cognitive learning, and assess student satisfaction. Materials and Methods: This interventional study was conducted in the Department of Community Medicine, Government Medical College, Jalgaon, among third-year MBBS students (2021 batch). Two topics—Acute Diarrhea and Tuberculosis—were selected for ICBL module development after curriculum analysis. Students were randomly assigned into two groups (Batch A, n=37; Batch D, n=37). Each group received one topic via didactic lecture and the other via ICBL. Pre- and post-test MCQs assessed cognitive gains. Student satisfaction was measured using a structured Likert-scale questionnaire. Statistical analysis included paired and independent t-tests. Results: Both groups demonstrated significant improvement in post-test scores (p<0.05). However, the mean post-test score was higher in the ICBL group (19.00 ± 2.15) compared to the didactic group (17.75 ± 2.05) (t=3.52, p<0.05). Student feedback revealed high satisfaction, with 92% reporting improved understanding of concepts and 88% rating ICBL as more engaging. Conclusion: The findings indicate that ICBL modules are more effective than traditional teaching methods in improving students’ cognitive learning outcomes.
Research Article
Open Access
2D:4D Ratio- A Marker for Mandibular Prognathism: Does Testosterone Play A Role
Roopa Kunthavai C,
Prem Kumar S,
. Sangeetha K
Pages 744 - 750
View PDF
Abstract
Background: To investigate the influence of testosterone levels on using the 2D:4D digit ratio as a predictive measure for mandibular prognathism. Materials and method: The study was conducted with 180 subjects in the age group of 18-25 years with all three classes of malocclusion included and both sexes were equally recruited. Total serum testosterone and the 2D:4D ratio were determined. Statistical analysis was carried out to compare and correlate the mean values. Results: Overall, there was a negative correlation between testosterone levels and the 2D:4D ratio (r = -0.413, p < 0.001), suggesting an influence of testosterone levels on the length of the fourth finger. Among males, inter-class comparisons for both 2D:4D and testosterone levels did not yield significant results. In contrast, significant values were observed among females. Within the female participants, class III subjects exhibited notable findings, indicating a significant association(p<0.001) characterised by lower 2D:4D ratios and higher testosterone levels in comparison to subjects grouped in other classes. Conclusion: Our findings support previous research indicating that females with Class III malocclusion tend to exhibit a lower 2D:4D ratio and higher testosterone levels. However, in males with prognathic mandibles and a lower 2D:4D ratio, the influence of testosterone remains unclear. This suggests that testosterone may not be the sole determinant influencing the predictive value of the 2D:4D ratio for mandibular prognathism.
Research Article
Open Access
MANAGEMENT OF CHRONIC SUBDURAL HAEMORRHAGE
Rajesh Kumar ,
Kalp Shandilya ,
Banesh Jain ,
S N Gautam
Pages 738 - 743
View PDF
Abstract
Background: Chronic subdural hemorrhage (CSDH) is a common neurosurgical condition, particularly in the elderly population. It typically arises from minor head trauma and presents weeks later with symptoms such as headache, confusion, or neurological deficits. Management strategies have evolved over time and include conservative observation, minimally invasive surgical interventions, and pharmacologic therapy. This review summarizes the current evidence and literature on the management of CSDH, with a focus on surgical techniques, recurrence prevention, and emerging medical therapies. Aim: to study management of chronic subdural haemorrhage. Methodology: This retrospective observational study was conducted in the Department of Neurosurgery at GMC kota, over a period of 2 year 4 month (March 2023 to June 2025). A total of 75 patients diagnosed with chronic subdural hematoma (CSDH) based on clinical evaluation and neuroimaging findings were included. Result: In our study, the majority of patients were aged between 61–80 years, with a strong male predominance (84%). Headache was the most common symptom (60%), followed by history of trauma (50%). Right FP burr hole evacuation was the most frequently performed procedure (39%), reflecting standard surgical practice. Despite this, the recurrence rate was 6.7%, and overall mortality was 8%. Conclusion: Burr hole drainage remained the primary treatment for CSDH in our study, with right-sided procedures being most common. Despite standard care, the recurrence rate (6.7%) and 8% mortality highlight the need for optimized postoperative management. Individualized surgical planning and timely intervention are essential for better outcomes.
Research Article
Open Access
Prognostic Utility of LENT and PROMISE Scores in Malignant Pleural Effusion: A Retrospective Analysis
Ashok Kuwal ,
Radheshyam ,
Gajendra Vyas
Pages 733 - 737
View PDF
Abstract
Background: Malignant pleural effusion (MPE) is a common complication in advanced malignancies and is associated with poor survival. Accurate prognostic tools may aid in guiding treatment decisions. The LENT and PROMISE scores are among the most validated models, but their comparative performance across different cancer subgroups remains debated. Objective: To evaluate and compare the prognostic accuracy of LENT and PROMISE scores in predicting survival among patients with MPE. Methods: We retrospectively analysed 142 patients with cytologically or histologically confirmed MPE between January 2021 and December 2024. Clinical parameters, laboratory profiles, and treatment histories were retrieved. Patients were stratified using LENT and clinical PROMISE scores. Survival was assessed using Kaplan–Meier curves and Cox regression analyses. Results: The median age was 62 years (range: 28–85), with 60% males. Primary cancers included lung (72%), breast (11%), mesothelioma (8%), and others (9%). Median overall survival was 6 months (95% CI: 4.5–7.5). Poor ECOG performance (3–4) significantly predicted mortality across all timepoints (HR: 3.25; 95% CI: 1.9–5.6; p<0.001). The PROMISE score demonstrated superior discriminatory ability: Category B (HR: 2.1), Category C (HR: 3.4), and Category D (HR: 10.9) were all significantly associated with reduced survival compared to Category A. The LENT score stratified low-, moderate-, and high-risk groups effectively for short-term survival (1–3 months), but predictive power diminished beyond 6 months. Conclusions: PROMISE scoring provides more consistent prognostic information across time intervals compared to the LENT score. While both systems are useful, PROMISE may be better suited for individualized decision-making in MPE, especially in diverse cancer populations.
Research Article
Open Access
Our Experience With Post Burn Contractures And Their Surgical Management
Chakraborty Neelanjana Sunil kumar,
Govind ,
Buddhi Prakash Sharma,
Tushar Nagyan
Pages 725 - 732
View PDF
Abstract
Background: India, the second most populous country in the world with over a billion people has an estimated annual burn incidence of 6-7 million, based on data from major hospitals when extrapolated to whole of the country, which is the second largest group of injuries after road accidents. AIM: To study the various presentations of post burn contracture and their surgical management in our institute. Methodology: This prospective study was conducted in the Department of Plastic and Reconstructive Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur. Patients clinically diagnosed with post-burn scar contracture of different regions of the body were included after informed consent and explanation of treatment options. Result: The study found that flame burns accounted for 96% of post-burn contracture cases, with females representing 59% of patients. The fingers and hands were the most commonly affected regions (59%), followed by the neck (12%) and popliteal area (8%). Z-plasty was the most frequently performed surgical procedure, used in 32% of cases, the next being skin grafting. Implants like distractors and K-wires supported correction in complex cases. Overall, reconstructive surgeries, especially Z-plasty, showed good functional and aesthetic outcomes, with varied approaches based on contracture severity and location. Conclusion: Post-burn contractures significantly impair quality of life, especially in lower socio-economic groups, with flame and scald burns mainly affecting the hands. Surgical treatments like Z-plasty, skin grafting, and implants (like finger distractors) effectively improve function and appearance. Early, tailored intervention and prevention are crucial to minimizing long-term complications.
Research Article
Open Access
Assessment of self medication practices and knowledge of over counter drugs in rural areas of Himachal Pradesh
Meenakshi Thakur ,
Monika Pathania ,
Ira Sharma
Pages 716 - 724
View PDF
Abstract
Background: Self-medication with over-the-counter (OTC) drugs is common in India, especially in rural areas where healthcare access is limited. While it can provide quick relief, inappropriate use leads to risks such as antibiotic resistance, adverse drug reactions, and polypharmacy. This study assessed the prevalence, patterns, and knowledge of self-medication practices in rural Himachal Pradesh. Materials and Methods: A cross-sectional Google Form survey was conducted among 400 adults in rural village clusters. A structured questionnaire captured socio-demographic data, self-medication practices, and knowledge on OTC drug safety. Knowledge was scored (0–20) and categorized into Excellent, Good, Fair, and Poor. Data were analyzed using descriptive statistics and Chi-square tests (p<0.05). Results: Cough and cold (58.0%), fever (47.0%), and body ache (41.0%) were the most common reasons for self-medication. Local chemists (61.5%) were the main drug source, and paracetamol (71.5%), cough syrups (52.0%), and antibiotics (31.0%) were the most used OTC drugs. Knowledge scores showed 15.5% Excellent, 31.0% Good, 35.5% Fair, and 18.0% Poor. Awareness of antibiotic misuse (48.0%) and safe paracetamol dose (32.0%) was low. Education, occupation, and residence significantly influenced knowledge (p<0.05), while age and gender did not. Conclusion: Self-medication is widespread in rural Himachal Pradesh, with frequent misuse of antibiotics and analgesics. Although basic awareness exists, critical knowledge gaps persist. Targeted education, stricter regulation, and pharmacist-led interventions are needed to ensure safe and rational self-medication.
Research Article
Open Access
Spinal Pathologies of the Thoracolumbar region managed using the ever versatile LECA - our experience
Kumar Lakshman ,
Abhishek Vijayan ,
Triza Kumar Lakshman,
Dominic Anto ,
Raju Paul Manjooran,
Gayatri Brahmandam
Pages 705 - 715
View PDF
Abstract
Background: Even though the use of lateral extracavitary approach (LECA) in addressing thoracic and thoracolumbar spine pathology is well documented, its versatility is not well utilised in the recent times. Methods: This is a prospective observational study done in Adichunchanagiri Institute of Medical Sciences, Bellur, Mandya from March 2020 to March 2024. A total of 10 cases were studied. The patients selected for study are those who presented with history of neurological deficits, with history of thoracic spine/thoracolumbar spine injury or infection/tumor. Based on detailed history and thorough clinical examination diagnosis of compressive spinal cord pathology was made. Investigations done: Complete Blood counts, Blood grouping, Coagulation profile Renal function tests, Serology, CT thoracic spine/thoracolumbar spine, MRI thoracolumbar spine with whole spine screening. Results: A total of 10 patients who presented with neurological deficits either paraplegia or paraperesis, following compressive spinal cord pathology involving the dorsal or lumbar spinal cord were included in the present study. Nine out of the ten patients were males and one female. Three out of the ten patients presented with history of traumatic paraplegia and all ten had thoracolumbar spinal cord compression. Two of the three patients with paraplegia had priapism which resolved spontaneously, their neurologic deficits remained while the other paraplegic patient improved in motor power post-surgical decompression and stabilization. Among the 7 patients with paraparesis, 5 patients presented with gradual onset of paraperesis with Pott’s spine, one patient had spinal lymphoma with tumor compressing the spinal cord at D11-12 level and one patient had multiple myeloma. All 10 patients underwent decompression of the spinal canal and posterior spine stabilization surgery and tissue sent for biopsy. The female patient had high grade lymphoma involving D11-12 spine and one patient had multiple myeloma who after stabilization, were subjected to chemo radiation at later date. Nine patients had uneventful post-operative period while one patient had surgical site infection, he was a case MDR TB with vertebral abscess and multiple brain tubercles. Conclusion: Most common site pathology in our study was at thoracolumbar cord (D11/D12/L1) with cord compression. All 10 patients underwent LECA with posterior spinal stabilization and anterior +/- posterior decompression. LECA is safe procedure to address a variety of spine pathology involving the thoracolumbar spine with a relatively low learning curve.
Research Article
Open Access
Pilonidal Sinus Surgery: A Comparative Study of Treatment Methods with Emphasis on Cosmetic Outcomes
Deepankar Saha ,
Sivaji Ghose ,
Vaisha Rani ,
. Shubham Gaikwad ,
Aboli Khillare
Pages 699 - 704
View PDF
Abstract
Background: Pilonidal sinus is a chronic disease affecting young adults, with various surgical treatment options available. Cosmetic outcome, recurrence, and postoperative complications remain the most critical determinants of patient satisfaction. Methods: A prospective comparative study was conducted at Vedantaa Institute of Medical Sciences, Dahanu, Palghar, Maharashtra, India, between February and April 2025. Thirty patients with primary pilonidal sinus were allocated to three groups: flap techniques (n=10), primary midline closure (n=10), and excision with secondary intention (n=10). Outcomes assessed included flap rejection, surgical site infection (SSI), postoperative scar appearance, and recurrence. Data were analyzed using descriptive and comparative statistics, with significance set at p < 0.05. Results: Flap rejection occurred only in flap procedures (20%). SSI was most frequent in the midline closure group (30%), while it was lowest in secondary intention healing (10%). Scar assessment revealed superior cosmetic results in the secondary intention group, with 90% achieving satisfactory scars compared to 60% and 50% in flap and midline closure groups, respectively. Recurrence was observed in the flap (20%) and midline closure (10%) groups, whereas none occurred in the secondary intention group. Conclusion: Excision of the pilonidal sinus tract with healing by secondary intention demonstrated superior cosmetic outcomes, lower complication rates, and no recurrence within the study period. This approach may be preferred for patients prioritizing cosmesis and disease control.
Research Article
Open Access
Prevalence of Latent Tuberculosis Infection and Associated Risk Factors Among Close Contacts of TB Patients in High-Burden Communities
H. Veena Kanthraj,
Mir Viquar Ahmed,
Riyaj Ahmad Kalaburgi
Pages 692 - 698
View PDF
Abstract
Background: Latent tuberculosis infection (LTBI) serves as a major reservoir for the development of active tuberculosis (TB), particularly in high-burden communities. Objective: To determine the prevalence of LTBI among close contacts of active TB patients and examine the socio-demographic, environmental, and health-related risk factors contributing to its acquisition. Methods: A cross-sectional study was conducted at Sri Siddhartha Medical College Hospital, Tumkuru from October 2024 to March 2025. A total of 220 patients were added in the study. LTBI was diagnosed using the tuberculin skin test (TST) and/or interferon-gamma release assays (IGRAs). A structured questionnaire was used to collect data on socio-demographic factors, exposure history, living conditions, and health-related factors. Results: The overall prevalence of LTBI among the close contacts was 45.5%. Higher prevalence was observed in males (48%) and in individuals aged 25-34 years (52%). Duration of exposure to the TB patient, overcrowded living conditions, smoking, alcohol consumption, and underlying health conditions such as asthma, COPD, and diabetes were significantly associated with an increased risk of LTBI. Prolonged exposure (≥6 months) was associated with a higher prevalence of LTBI (55%) compared to shorter exposure (35%). Preventive therapy was offered to 72% of LTBI-positive participants, with 88% completing the treatment. Conclusion: The high prevalence of LTBI among close contacts of active TB patients underscores the need for targeted screening and preventive treatment in high-burden TB communities. Risk factors such as prolonged exposure, overcrowded living conditions, smoking, and comorbidities should be addressed to reduce the transmission of LTBI.
Research Article
Open Access
Pharmacological Agents Targeting Pain Pathways: A Systematic Review of Analgesic Efficacy and Physiological Correlates
Mahtabuddin ,
Alisha Abbas ,
Surabhi Arora
Pages 683 - 691
View PDF
Abstract
Background: Pain is a complex sensory and emotional experience mediated by overlapping nociceptive, inflammatory, and neuropathic pathways. While a wide range of pharmacological agents are used for pain management, their clinical effectiveness varies, and adverse effects often limit long-term use. A mechanism-based approach to analgesic selection may improve outcomes by aligning drug action with underlying pathophysiology. Objectives: To systematically evaluate the efficacy of pharmacological agents targeting specific pain pathways and to correlate their mechanisms of action with physiological markers of analgesic efficacy. Methods: A systematic search of PubMed, Cochrane Library, EMBASE, and Scopus was conducted from inception to 2025. Eligible studies included randomized controlled trials, cohort studies, and systematic reviews evaluating adults (≥18 years) with nociceptive, inflammatory, or neuropathic pain. Primary outcomes were analgesic efficacy measured by validated pain scales; secondary outcomes were physiological correlates such as cytokine modulation, neurotransmitter activity, and imaging markers. Study quality was assessed using Cochrane RoB 2, Newcastle–Ottawa Scale, and AMSTAR 2. Results: Thirty-six studies met inclusion criteria, comprising 24 RCTs, 8 cohort studies, and 4 systematic reviews. NSAIDs and COX-2 inhibitors showed consistent efficacy in inflammatory pain with improved tolerability for COX-2 selective agents. Gabapentinoids and antidepressants (duloxetine, TCAs) demonstrated robust effects in neuropathic pain and fibromyalgia, with additional improvements in mood and sleep. Opioids were effective short-term but limited by tolerance and adverse effects. Biologics (anti-TNF agents, NGF inhibitors) provided benefit in refractory inflammatory and neuropathic conditions but raised safety concerns. Strong mechanistic correlations were observed, including cytokine suppression with biologics, calcium channel blockade with gabapentinoids, and enhanced descending inhibition with antidepressants. Conclusions: Evidence supports mechanism-based prescribing for pain management: NSAIDs/COX-2 inhibitors for inflammatory pain, gabapentinoids and antidepressants for neuropathic pain, and cautious use of biologics in refractory cases. Personalized therapy, guided by comorbidities, safety profiles, and mechanistic insights, is essential. Future research should focus on biomarker-driven trials, long-term safety evaluation, and novel targets such as ion channel modulators and glial inhibitors to enable safer and more effective pain management strategies.
Research Article
Open Access
Evaluation of Desarda’s Repair for Inguinal Hernia
K. Aditya Sarma,
Ramakrishna B ,
Y Mutheeswaraiah ,
B. Hari Prasad,
B. Sri Hari Rao,
Narendra MC
Pages 675 - 682
View PDF
Abstract
Background: Inguinal hernia repair remains one of the most frequently performed general surgical procedures. While mesh-based repairs such as Lichtenstein’s technique are widely accepted, they are not always feasible in complicated hernias or in resource-limited settings. Desarda’s no-mesh, tissue-based repair has emerged as a promising alternative. Objective: To evaluate the outcomes of Desarda’s repair in patients with complicated inguinal hernia where mesh repair was contraindicated. Methods: A prospective observational study was conducted on 30 patients undergoing Desarda’s repair at a tertiary care center between March 2021 and June 2022. Patient demographics, operative parameters, pain scores, complications, and return to activity were analyzed. Results: The mean age was 55.2 ± 16.2 years, with all patients being male. Right-sided hernia predominated (66.6%). The mean operative time was 96 minutes, and the average hospital stay was 4.5 days. Postoperative pain decreased significantly from POD 1 (VAS 4.8) to POD 7 (VAS 0.3), with no chronic pain at POD 30 and 90. Complications occurred in 23.3% (seroma, wound infection, hematoma), all minor. No recurrences were recorded. Most patients (93%) returned to normal activities within 15 days. Conclusion: Desarda’s repair is a safe, effective, and cost-efficient alternative to mesh hernioplasty, particularly valuable in complicated inguinal hernia cases.
Research Article
Open Access
A Study on Clinic-Radio Pathological Association for Evaluation of Solitary Thyroid Nodule
M. Blessena ,
Ramakrishna B ,
Y Mutheeswaraiah ,
B. Hari Prasad,
B. Sri Hari,
N Rukmangadha
Pages 668 - 674
View PDF
Research Article
Open Access
Analyzing Gender-Based Differences in Mandibular Third Molar Impactions and Radiographic Predictive Indices Among Young Adults
Surekha Waghanna ,
Surekha Waghanna ,
Neelkant Patil ,
U.K. Gupta ,
B.R. Adyanthaya
Pages 660 - 667
View PDF
Abstract
Background: Mandibular third molar (MTM) impaction is a prevalent dental condition affecting young adults worldwide, with reported prevalence rates varying from 16.7% to 68.6%. While several studies have investigated impaction patterns, limited research has systematically examined gender-based differences in impaction prevalence, types, and radiographic predictive indices. Understanding these differences is crucial for developing gender-specific risk assessment protocols and optimizing early intervention strategies. Objectives: This study aimed to analyze gender-based differences in MTM impaction patterns, evaluate the diagnostic accuracy of radiographic predictive indices (LES-R, LES-Xi, R1, R2, and MDW) across genders, and determine gender-specific cut-off values for early impaction prediction among young adults in the Rajasthan population. Materials and Methods: A Prospective cross-sectional study was conducted involving 350 subjects (260 males, 90 females) aged 18-40 years from dental colleges in Jaipur, Rajasthan. Digital panoramic radiographs were analyzed for 520 mandibular third molars. Linear measurements included mesiodistal width (MDW), lower eruption space relative to ramus (LES-R) and Xi point (LES-Xi), and space-width ratios (R1, R2). Winter's classification was used for impaction angulation assessment. Statistical analysis included independent t-tests, chi-square tests, and ROC curve analysis with p<0.05 considered significant. Results: MTM impaction prevalence was significantly higher in males (63.46%) compared to females (36.54%, p<0.001). Males also showed higher eruption rates (75.77% vs 24.23%). Mesioangular impaction was most frequent (37.3%), followed by distoangular (33.8%), vertical (23.1%), and horizontal (5.8%) types, with no significant gender differences in impaction types (p>0.05). Mean values differed significantly between genders for LES-R (males: 17.8±2.8mm vs females: 16.2±2.1mm, p<0.001), R1 (males: 1.71±0.31 vs females: 1.58±0.28, p<0.01), and R2 (males: 2.58±0.39 vs females: 2.41±0.33, p<0.01). ROC analysis revealed excellent predictive validity for R1 (AUC=0.847), followed by LES-R (AUC=0.858), with gender-specific cut-off values showing superior diagnostic accuracy. Conclusions: Significant gender-based differences exist in MTM impaction prevalence and radiographic indices, with males demonstrating higher impaction rates but also greater eruption potential. Gender-specific cut-off values for radiographic indices enhance predictive accuracy for early impaction assessment, supporting the need for tailored risk stratification protocols in clinical practice.
Research Article
Open Access
Morphological Variations of the Acromion and Their Association with Shoulder Impingement and Rotator Cuff Injury: A Comprehensive Clinical, Radiological, and Anatomical Evaluation
Pardeep Gupta ,
Parminder Singh Kular,
Ashwani Ummat ,
Parth Monga ,
Kenisha Ummat
Pages 654 - 659
View PDF
Abstract
Background: Shoulder impingement syndrome and rotator cuff tears represent significant causes of shoulder morbidity, with acromion morphology proposed as a key predisposing factor. However, a comprehensive multi-modal assessment of this relationship remains limited. Objective: To investigate the relationship between acromion morphology and the development of shoulder impingement syndrome and rotator cuff tears through clinical, radiological, and anatomical assessments. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital with three groups: Group 1 (Clinical, n = 50), Group 2a (Radiological, n = 50), and Group 2b (Anatomical, n = 50). Acromion type was classified using the Bigliani system (Type I–III). Clinical evaluation included impingement tests, rotator cuff assessment, and pain scoring. Radiological and anatomical assessments were performed via imaging records and direct inspection, respectively. Morphometric measurements of length, thickness, and width were obtained for anatomical specimens Results: Type II acromion remained the most common across all groups (40–68%), while Type III prevalence was highest in the anatomical group (38%) compared to clinical (16%) and radiological (20%) groups (p = 0.017). Impingement syndrome prevalence increased from Type I (42.9%) to Type II (62.9%) and Type III (75.0%) (p = 0.021). Rotator cuff tears showed a similar trend: Type I (28.6%), Type II (48.6%), and Type III (62.5%) (p = 0.038). Morphometric analysis confirmed progressive increases in acromion dimensions from Type I to Type III (length 3.81–4.42 cm, thickness 0.78–0.89 cm, width 1.85–2.26 cm; all p < 0.01), supporting the clinical relevance of the Bigliani classification. Conclusions: Acromion morphology is strongly associated with shoulder pathology. Type III acromion carries the highest risk for impingement and RCT, while Type II also presents moderate risk. Morphometric validation reinforces the importance of morphological assessment in diagnosis, risk stratification, and surgical planning.
Research Article
Open Access
A Comparative Study of Moxifloxacin Vs Gatifloxacin for Preventing Postoperative Ocular Infections after Phacoemulsification.
Anila Sadipirala ,
Madhu chaithanya ,
Sweta Kumari ,
K Vijay Kumar
Pages 646 - 653
View PDF
Abstract
Background: Cataract is a major cause of vision loss, and phacoemulsification is the most common surgery used to treat it. After surgery, there is a risk of eye infections, which can affect recovery and vision. To prevent this, antibiotic eye drops are used. Moxifloxacin and Gatifloxacin are two commonly used antibiotics, and this study compares their effectiveness in preventing infections after cataract surgery. Objective: To compare the efficacy and safety of topical moxifloxacin 0.5% versus Gatifloxacin 0.3% eye drops in preventing postoperative infections. following phacoemulsification cataract surgery. Material and Methods: This prospective, randomized, comparative study included 200 postoperative patients with clinically diagnosed bacterial ocular infections. Patients were randomly assigned to two groups: Group A received Moxifloxacin 0.5% eye drops, and Group B received Gatifloxacin 0.3% eye drops. Clinical symptoms including conjunctival redness, eye discharge, lid edema, photophobia, and visual acuity were assessed on Day 0, Day 3, and Day 7 using standardized scoring methods. Microbiological clearance was evaluated by culture sensitivity testing of conjunctival or corneal swabs collected at baseline and Day 7. Outcomes were compared using appropriate statistical tests, with p < 0.05 considered significant Results: A total of 200 patients were included, with similar age and gender distribution between the two groups. The most common postoperative ocular infection was bacterial conjunctivitis (40%), followed by keratitis (22.5%) and blepharitis-associated infection (12.5%). Both Moxifloxacin and Gatifloxacin significantly improved clinical symptoms by Day 7, with Moxifloxacin showing slightly better outcomes in reducing conjunctival redness, discharge, lid edema, photophobia, and improving visual acuity (p < 0.05). Microbiological clearance was achieved in over 89% of patients in both groups by Day 7. The average time to complete symptom resolution was comparable between the groups, and treatment adherence exceeded 97%.Conclusion: Both Moxifloxacin and Gatifloxacin eye drops were effective in treating bacterial eye infections. The most common infections were bacterial conjunctivitis and keratitis. However, Moxifloxacin showed slightly better and faster improvement in symptoms like redness, discharge, lid swelling, photophobia, and vision. Both drugs had similar rates of bacterial clearance and good patient adherence.
Research Article
Open Access
Correlation Between Pterygium And Dry Eye In Patients Attending To Ophthalmology Department Of A Teaching Institute In South India
Praneeth Putti ,
S Skandha Harshita,
Mahaboob V Shaik
Pages 641 - 645
View PDF
Abstract
Background: The most widely accepted theory in the pathogenesis of pterygium is that ultraviolet (UV) radiation induces limbal stem cell differentiation. Objective: To assess the clinical relationship between pterygium and dry eye, and to evaluate tear film status in patients with pterygium. Methods: A total of 100 eyes with pterygium were compared with 100 eyes without pterygium. Tear film breakup time (TF-BUT) and Schirmer’s test (ST) results from pterygium eyes were analyzed against those of contralateral normal eyes from the same patients. Results: Among both groups, 52 patients with dry eye were between 31–40 years of age. The mean Ocular Surface Disease Index (OSDI) score was 31.5. The odds ratio was 1.14, indicating that the risk of dry eye in patients with pterygium was 1.14 times higher than in controls. The mean TF-BUT in pterygium eyes was 8.5 ± 2.24 seconds compared to 12.8 ± 3.7 seconds in contralateral normal eyes (P < 0.001). The mean ST values were 10.1 ± 3.45 mm in pterygium eyes and 14.9 ± 4.1 mm in normal eyes. The difference in TF-BUT between pterygium and contralateral eyes was statistically significant (P < 0.01).Conclusion: There is a significant association between ocular irritation symptoms and tear film instability in patients with pterygium. Combined use of TF-BUT and Schirmer’s test improves sensitivity in detecting dry eye and may enhance the value of screening among high-risk groups.
Research Article
Open Access
Role of Primary Vs Delayed Primary Skin Closure in Emergency Exploratory Laparotomy for Perforation Peritonitis
Narinder Singh ,
Atul Vishwanath ,
Sarabjit Singh ,
Pankaj Dugg ,
Harmohinder Attri
Pages 635 - 640
View PDF
Abstract
Background: Emergency laparotomies for perforation presents with various complications. The current study was conducted to assess whether delayed primary closure helps in reducing morbidity and surgical site infections. Methods: 50 patients were included in the study who satisfied inclusion criteria. Group A (n=25) underwent delayed primary closure while group B (n=25) underwent primary closure. The results were compared in both the groups. Results: There was no significant difference in demographic profile among the groups. Majority of patients in the study were males. There was significantly higher incidence of infection rates in group B as compared to group A (p=.007). It was observed in 1st,2nd and 3rd week. Mean hospital stay was 11.48 days in group A while it was 17.2 in group B which was significant (p=.002). Conclusion: Delayed primary closure had better results in terms of reduced morbidity and improved patient outcomes.
Research Article
Open Access
Evaluation of Breast Lesions by Mammography and Sono-Mammography Along with Fine Needle Aspiration Cytology Correlation
Nadanasadharam. K ,
Kiran Kumar Sailagundla,
Shanmuga jayanthan . S,
Harish Gudi ,
Divya Pabbisetti ,
Ritesh. K
Pages 621 - 628
View PDF
Abstract
Breast cancer is the most common malignancy among women worldwide and one of the leading causes of cancer-related mortality [1]. Early detection and precise characterization of breast lesions are vital for reducing mortality and improving survival outcomes. Mammography, despite being the gold standard imaging tool for breast cancer detection, has limitations in dense breasts, whereas sono-mammography provides complementary benefits in lesion characterization [2,3]. Fine Needle Aspiration Cytology (FNAC) serves as a minimally invasive reference standard for diagnosis [4]. This prospective study was conducted on 62 female patients aged 35–75 years presenting with clinically suspicious breast lesions at the Department of Radiodiagnosis, Meenakshi Hospital, Thanjavur, between October 2022 and January 2024. All patients underwent mammography, sono-mammography, and FNAC. Lesions were classified according to the Breast Imaging Reporting and Data System (BI-RADS), and diagnostic performance was compared against FNAC findings. On mammography, 24% of lesions were classified as benign (BI-RADS 2), 40% probably benign (BI-RADS 3), 23% suspicious (BI-RADS 4), and 13% highly suggestive of malignancy (BI-RADS 5). Sono-mammography categorized 27% as benign, 42% probably benign, 18% suspicious, and 13% malignant. FNAC confirmed 68% benign and 32% malignant lesions. The sensitivity, specificity, and diagnostic accuracy were 90.48%, 90%, and 90.32% for mammography; 95.23%, 85%, and 91.93% for sono-mammography; and 97.62%, 85%, and 93.55% for combined modalities, respectively. The findings confirm that while both modalities are effective, combined mammography and sono-mammography significantly improve diagnostic accuracy. Mammography is superior for identifying microcalcifications, whereas sono-mammography is advantageous in dense breasts and cystic lesions. FNAC correlation remains crucial for definitive diagnosis. Integrating these modalities provides a reliable approach for accurate and early diagnosis of breast cancer, thereby guiding timely clinical management.
Research Article
Open Access
Regional Variations in T2 Relaxation Times of Articular Cartilage in Osteoarthritis Patients: A 3T MRI Study
Harish Giridhar ,
Shanmuga Jayanthan S,
Balaji Ayyamperumal ,
Nadanasadharam. K ,
Kiran Kumar Sailagundla,
Harish Gudi ,
Ritesh. K ,
Divya Pabbisetti
Pages 615 - 620
View PDF
Abstract
Background: Osteoarthritis (OA) is characterized by progressive cartilage degeneration, often detected late through conventional imaging. T2 mapping using 3 Tesla (3T) magnetic resonance imaging (MRI) enables assessment of collagen architecture and water content, providing a sensitive biomarker of early cartilage changes. Objective: To investigate regional variations in T2 relaxation times of articular cartilage in patients with knee osteoarthritis and compare them with healthy controls. Methods: A prospective study was conducted on 40 participants (15 OA patients, 25 controls) using a 3T MRI scanner with dedicated T2 mapping sequences. Five cartilage compartments-medial femoral condyle (MFC), lateral femoral condyle (LFC), medial tibial plateau (MT), lateral tibial plateau (LT), and patella-were analyzed. T2 relaxation times and cartilage thickness were quantified and correlated with Kellgren-Lawrence (KL) grading. Statistical significance was tested using independent sample t-test and chi-square analysis. Results: Average T2 relaxation times were significantly elevated in OA patients compared to controls across all compartments (MFC: 39.3±11.1 ms vs 28.1±2.4 ms; MT: 41.5±9.4 ms vs 27.0±2.3 ms; p<0.05). Among OA patients, the medial compartment showed the most pronounced increase in T2 values, consistent with clinical disease predominance. No significant difference in cartilage thickness was observed between OA and controls. T2 values correlated positively with KL scores, increasing progressively from KL grade 1 to 4. Conclusion: Regional variations in T2 relaxation times highlight the sensitivity of T2 mapping for detecting early biochemical changes in articular cartilage. Elevated T2 values, particularly in the medial compartment, demonstrate its value as a non-invasive biomarker for OA progression. Incorporating T2 mapping into routine MRI protocols may improve early diagnosis and monitoring of knee OA.
Research Article
Open Access
Periodontal Impact in Acute Myocardial Infarction: A Comparative Study Using Russell's Periodontal Index and Total Dental Index
Ananddeep Omprakash Agrawal,
Aniket Malik
Pages 610 - 614
View PDF
Abstract
Background: Coronary artery disease (CAD) is a major cause of illness and death globally, with acute myocardial infarction (AMI) being its most severe manifestation. Traditional risk factors contribute significantly to the burden of CAD; however, increasing evidence suggests that chronic inflammatory conditions, especially periodontal disease, may also elevate cardiovascular risk. Periodontal disease causes systemic inflammation and is linked to myocardial infarction in various epidemiological studies. This study aimed to compare periodontal burden between AMI patients and healthy controls using two standardised indices: Russell's Periodontal Index (RPI) and the Total Dental Index (TDI). Methods: A cross-sectional study was conducted at two tertiary centres in Aurangabad, India. Sixty participants were enrolled: 30 patients with confirmed AMI and 30 age- and sex-matched healthy controls without systemic illness, periodontal disease, or CAD risk factors. Periodontal status was assessed by a calibrated periodontist using RPI and TDI. Independent-sample t-tests were used for comparisons, with p < 0.05 considered significant. Results: The mean age of participants was similar between the two groups: those with acute myocardial infarction (AMI) had an average age of 41.8 years (± 6.24), while the control group had an average age of 42.4 years (± 5.15), with no significant difference (p > 0.05). Both groups had a male-to-female ratio of 9:1. Patients with AMI exhibited significantly higher RPI scores, averaging 6.65 (± 1.40), compared to the control group, which had an average score of 0.105 (± 0.305) (p < 0.001). Similarly, TDI scores were also much higher in AMI patients, averaging 5.87 (± 1.61), compared to the control group, which scored 0 (p < 0.001). Conclusions: Patients with acute myocardial infarction (AMI) showed a significantly greater burden of periodontal disease compared to healthy individuals. These findings suggest that periodontal disease may be a non-traditional risk factor for cardiovascular disease. They also underscore the importance of including oral health assessments in cardiovascular risk evaluations.
Research Article
Open Access
Outcomes of Sutureless and Glue-Free Conjunctival Autografting in Pterygium Surgery: A Clinical Study
Ujwal Parashuram Gaikwad,
Ashish Naresh Holani,
Amreen Anjum Abdul Mukim Deshmukh,
Rupali V Rangu
Pages 602 - 609
View PDF
Abstract
Background: Pterygium is a common ocular conditiona and has been associated with significant impairment of vision and astigmatism. Although there are many surgical techniques for its management, reducing its recurrence and postoperative complications is the primary goal of treatment. Objective: To evaluate the clinical outcomes of a sutureless and glue-free conjunctival autografting technique for primary pterygium. Methods: A prospective clinical study was conducted on 50 eyes of 50 patients diagnosed with primary pterygium at a tertiary care centre between March 2022 and May 2025. All patients underwent pterygium excision followed by free conjunctival autografting without the use of sutures or fibrin glue. Visual acuity, astigmatism, and complications were assessed preoperatively and at regular postoperative intervals up to 3 months. Results: The mean patient age was 56 years, with a slight female predominance. Nasal pterygium accounted for 96% of cases. Postoperative follow-up showed significant improvement in astigmatism, with mean values reducing from 2.36 D to 1.21 D (p < 0.0001). The average operative time was 16 minutes. Early postoperative complications included graft oedema (4%), graft retraction (4%), and sub-graft haemorrhage (8%). Only one patient (2%) showed recurrence at the 3-month follow-up. Conclusion: Sutureless and glue-free conjunctival autografting maybe suggested as a safe and cost-effective management option for primary pterygium surgery. It significantly decreases operative time, reduces astigmatism, and may lower the risk of infection and recurrence.
Research Article
Open Access
Study of the EEG Manifestations in Patients Admitted with Metabolic Encephalopathy
Sourabh Gurjar ,
Kuldeep Deopujari ,
Ayush Dubey ,
Simmi Dube
Pages 594 - 601
View PDF
Abstract
Background: Metabolic encephalopathy is a diffuse brain dysfunction caused by systemic metabolic disturbances rather than structural brain lesions. Electroencephalography (EEG) is a valuable tool for evaluating and managing metabolic encephalopathy by detecting functional changes in brain activity. Aim and Objective: To analyze EEG patterns in patients with metabolic encephalopathy and correlate these findings with clinical severity and outcomes. Materials and Methods: This study included patients diagnosed with metabolic encephalopathy. EEG recordings were obtained and analyzed for characteristic abnormalities, including generalized slowing, triphasic waves, and background rhythm disturbances. Clinical parameters, including Glasgow Coma Scale (GCS) scores and metabolic profiles, were recorded. Statistical analysis was conducted to assess correlations between EEG findings, clinical severity, and patient outcomes. Results: Metabolic encephalopathy was most prevalent in individuals aged 41–50 years, with a male predominance (62%), likely due to higher risk factors like alcohol use and chronic organ disease. Ultrasonography showed chronic liver disease in 42% and chronic kidney disease in 20% of cases. EEG abnormalities were seen in 84% of patients, with generalized slowing and triphasic waves being most common. Hepatic encephalopathy was the leading type, followed by uremic and septic encephalopathy. Triphasic waves were frequent in uremic cases, while alpha coma was unique to hypercapnic encephalopathy. Conclusion: EEG serves as a crucial diagnostic and prognostic tool in metabolic encephalopathy. The severity of EEG abnormalities correlates with clinical deterioration and outcomes, emphasizing its role in early diagnosis and management.
Research Article
Open Access
Physiological basis of post operative cognitive dysfunction: role of anesthesia techniques and intraoperative stress response
Athar Parvez ,
Mohammad Imran ,
Shaheer Ahmed Siddiqui
Pages 586 - 593
View PDF
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a frequent complication after surgery, characterized by declines in memory, attention, and executive function. Its pathophysiology is multifactorial, involving neuroinflammation, oxidative stress, blood–brain barrier dysfunction, and dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. Both anesthesia techniques and the intraoperative stress response are thought to play pivotal roles in its development. Objective: To systematically review the physiological basis of POCD, focusing on the influence of anesthetic strategies and intraoperative stress responses on postoperative cognitive outcomes. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was performed for studies published between January 2000 and March 2025. Randomized controlled trials, cohort studies, and systematic reviews examining the impact of anesthetic techniques or intraoperative stress markers on POCD in adult surgical populations were included. Data on anesthesia type, stress markers (cortisol, catecholamines, cytokines), cognitive assessment methods, and outcomes were extracted and synthesized. Results: Thirty-five studies met inclusion criteria, comprising 18 RCTs, 12 cohort studies, and 5 systematic reviews. Evidence suggests propofol-based total intravenous anesthesia (TIVA) may reduce early POCD incidence compared to volatile anesthetics, whereas regional anesthesia offers modest protective effects in select populations. Elevated perioperative cortisol, catecholamines, and inflammatory cytokines (IL-6, TNF-α, CRP) were consistently associated with POCD. Interventions that attenuate the intraoperative stress response, including dexmedetomidine and optimized analgesic protocols, showed potential in reducing early cognitive impairment. Mechanistically, anesthetic choice influences neurotoxicity, oxidative stress, and modulation of the surgical stress response, all contributing to POCD risk. Conclusions: POCD arises from complex interactions between anesthesia-related neurophysiological effects and intraoperative stress responses. While propofol-based TIVA and stress-modulating interventions show promise, no single strategy universally prevents POCD. Future research should focus on longitudinal studies, standardized cognitive assessments, biomarker integration, and personalized perioperative strategies to mitigate cognitive decline in vulnerable surgical populations.
Case Report
Open Access
Trends in Limb Salvage and Amputation among Patients with Diabetic Foot: A Case Series Analysis
Chitra Dhawale ,
Sivaji Ghose ,
Roshan Patil ,
Saili Lad ,
Anmol Kaur
Pages 580 - 585
View PDF
Abstract
Background: Diabetic foot complications remain a leading cause of morbidity and lower limb loss worldwide. Disease severity, comorbidities, and timely intervention influence the balance between limb salvage and amputation. Understanding local trends provides valuable insights for clinical practice and healthcare planning. Methods: This hospital-based case series was conducted at Vedantaa Institute of Medical Sciences, Dahanu, Palghar, Maharashtra, India, and included 30 patients diagnosed with diabetic foot ulcers between February 2025 and April 2025. Demographic details, comorbidities, ulcer characteristics, vascular status, treatment modalities, and outcomes were recorded. Descriptive statistics were used to analyze trends in limb salvage and amputation. Results: The mean age of patients was 56.8 years, with a male predominance. Type 2 diabetes accounted for 93.3% of cases, and hypertension was the most frequent comorbidity (60%). Nearly 63% of patients presented with Wagner grade 3 or 4 ulcers. Conservative management with wound debridement was the most common intervention (66.7%). Amputation was required in 40% of patients, predominantly at minor levels (toe or transmetatarsal). Limb salvage was successfully achieved in 60% of the cohort. Complications included wound infection (20%), re-debridement (13.3%), and re-amputation (6.7%). Conclusion: This case series highlights that despite a significant burden of advanced diabetic foot disease; limb salvage remains achievable in the majority of patients with appropriate multidisciplinary management. Early detection and timely surgical intervention are essential to reduce amputation rates and improve outcomes
Research Article
Open Access
Efficacy of Platelet-Rich Plasma Augmentation in Split-Thickness Skin Grafting: A Prospective Observational Study from a Tertiary Care Center in Maharashtra
Chetan Rajkumar Rathod,
Sivaji Ghose
Pages 575 - 579
View PDF
Abstract
Background: Split-thickness skin grafting (STSG) is a well-established reconstructive technique, but complications such as partial graft loss, delayed healing, and infection remain common. Platelet-rich plasma (PRP), with its concentration of growth factors, has been proposed as an adjunct to enhance graft take, donor site healing, and overall outcomes. Aim: To evaluate the effectiveness of PRP augmentation in improving graft take rates, reducing donor site morbidity, and minimizing complications in patients undergoing STSG. Methods: A prospective observational study was conducted at Vedantaa Institute of Medical Sciences, Dahanu, Maharashtra, between February and June 2025. Thirty patients requiring STSG for chronic ulcers, traumatic skin loss, or burn wounds were included. PRP was prepared using a standardized two-step centrifugation method and applied to the recipient bed before graft placement. Outcomes assessed included percentage graft take at Day 7 and Day 14, donor site healing time, pain scores, complications, and scar quality using the Vancouver Scar Scale. Results: The mean graft take was 89.3% at Day 7 and 95.6% at Day 14, with 90% of patients achieving complete graft take by Day 14. Donor sites healed in an average of 11.8 days. Pain scores reduced significantly from Day 1 (mean 6.2) to Day 14 (mean 1.8). Complications were observed in 20% of patients, most commonly partial graft necrosis (10%). Scar quality at 4 weeks showed favorable outcomes, with a mean Vancouver Scar Scale score of 3.3. Conclusion: PRP augmentation in STSG improved graft take, accelerated donor site healing, reduced pain, and resulted in acceptable complication rates with favorable scar outcomes. This approach may serve as a valuable adjunct in reconstructive surgery.
Research Article
Open Access
Evaluating the Effectiveness of Ultrasound-Guided Regional Anesthesia in Orthopedic Surgery: An Original Research Study
Anshu Rani ,
Atif Khan ,
Veerendra Pratap Gond,
Jasmine Chaudhary
Pages 571 - 574
View PDF
Abstract
Background: Ultrasound-guided regional anesthesia (UGRA) has revolutionized pain management in orthopedic surgery by enabling precise nerve localization and reducing complications. This study aims to evaluate the effectiveness of UGRA in terms of onset time, analgesic duration, opioid requirement, and patient satisfaction in comparison to traditional landmark-guided techniques. Materials and Methods: A prospective comparative study was conducted on 120 patients undergoing elective orthopedic procedures. Patients were randomized into two groups: UGRA group (n=60) and landmark-guided regional anesthesia (LGRA) group (n=60). The primary outcomes measured were block onset time, duration of analgesia, intraoperative and postoperative opioid consumption, and patient satisfaction. Standardized scoring systems (VAS, Likert scale) were used for evaluation. Results: UGRA significantly reduced the mean block onset time (6.2 ± 1.1 min vs 11.7 ± 2.5 min, p < 0.001), increased duration of postoperative analgesia (10.3 ± 1.9 hrs vs 6.4 ± 1.8 hrs, p < 0.001), and lowered opioid consumption (p < 0.01). Patient satisfaction was significantly higher in the UGRA group. No major complications were noted in either group. Conclusions: Ultrasound-guided regional anesthesia provides faster onset, prolonged analgesia, reduced opioid need, and higher patient satisfaction, supporting its routine use in orthopedic surgery for improved perioperative outcomes.
Research Article
Open Access
A Retrospective Study of Transfusion Practice in a Tertiary Care Institute, Dahod District
Pinal Shah ,
Kalpesh Vaghela ,
Jignesh Dangi ,
Rugvi Patel
Pages 563 - 570
View PDF
Abstract
Background: Blood transfusion remains a cornerstone of modern medical practice, contributing significantly to improved survival in surgical, obstetric, hematological, and trauma-related emergencies. While blood banking systems have advanced considerably, the judicious and rational use of blood components continues to pose challenges, necessitating regular audits to enhance efficiency and reduce wastage. The present study aimed to evaluate transfusion practices at the Zydus Blood Centre over a one-year period and to analyze key transfusion indices to assess the appropriateness of blood utilization. Materials and Methods :A retrospective observational study was conducted at the Blood Centre of Zydus Medical College and Hospital from October 2023 to September 2024. Data regarding cross-match and transfusion requests from various clinical departments were analyzed. Standard quality indicators—including Cross-match to Transfusion (C/T) ratio, Transfusion Index (TI), Blood Utilization Rate, and Transfusion Probability (T%)—were calculated. Results: During the study period, 15,067 units were cross-matched, of which 14,112 (93.66%) were issued. The overall C/T ratio was 1.06, reflecting efficient blood utilization. The Thalassemia ward demonstrated optimal efficiency with a C/T ratio of 1 and 100% utilization. Among departments, Medicine recorded the highest TI (0.97), while Neurosurgery had the lowest (0.78). Blood utilization was highest in the Thalassemia ward (100%), followed by Medicine (97.69%), and lowest in Neurosurgery (78.86%). Conclusion: The study highlights rational blood utilization in the institution, with all major transfusion indices within acceptable standards. Routine audits, adoption of evidence-based transfusion policies, and continued monitoring are essential to further optimize blood usage and minimize wastage without compromising patient care.
Research Article
Open Access
Impactfulness of Consistent 100-Day 10,000 Steps Walking On Physical and Mental State
Anmol Mehray ,
Adesh Agarwal ,
Shivani Agrawal ,
Arunima Bajpai
Pages 556 - 562
View PDF
Abstract
Background: Walking is an accessible form of physical activity with established benefits for cardiometabolic and psychological health. The 10,000-step benchmark is widely promoted, yet few studies have systematically evaluated the sustained impact of adherence to this goal over a 100-day period. Methods: In this prospective study, 200 adults at FH Medical College, Agra, undertook a 100-day walking program targeting ~10,000 steps daily. Physical outcomes (weight, BMI, resting heart rate, systolic blood pressure) and psychological outcomes (PHQ-9, GAD-7, PSS) were measured at baseline and day 100. Adherence was defined as the proportion of days with ≥10,000 steps. Paired t-tests, Pearson correlations, and multivariable regression adjusting for age and sex were performed. Results: All outcomes improved significantly after 100 days. Mean changes included weight −1.6 kg, BMI −0.6 kg/m², resting heart rate −2.8 bpm, systolic blood pressure −3.0 mmHg, PHQ-9 −1.6, GAD-7 −1.8, and PSS −2.9 (all p < 0.0001). Adherence was significantly correlated with improvements in weight (r = −0.34, p < 0.0001), BMI (r = −0.23, p = 0.001), resting heart rate (r = −0.17, p = 0.014), PHQ-9 (r = −0.32, p < 0.0001), GAD-7 (r = −0.25, p < 0.001), and PSS (r = −0.20, p = 0.004). In regression analysis, adherence independently predicted PHQ-9 reduction after adjustment for age and sex (β = −3.30, p = 0.0003).Conclusion: A consistent 100-day program of ~10,000 steps per day yielded significant improvements in both physical and psychological outcomes, with higher adherence linked to greater benefit. These findings support the role of structured step-count targets as a scalable, low-cost intervention to improve cardiometabolic and mental health.
Case Report
Open Access
Diffuse Idiopathic Skeletal Hyperostosis (DISH) Mimicking Spondyloarthropathy: A Case Report with Radiological Correlation
Katkam Shravani ,
Kanchi Lavanya ,
Hashwin Pilathodan ,
Naga Naveen Bobbala,
Dharssini Kamaladasan ,
Nithish Gaddam ,
Navya Nelakuditi
Pages 550 - 555
View PDF
Abstract
Background: Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a non-inflammatory condition characterized by flowing calcification of spinal ligaments, often mimicking spondyloarthropathies clinically and radiologically. Objective: To report a case of DISH initially suspected as spondyloarthropathy and delineate the diagnostic approach emphasizing radiological correlation. Case Presentation: A 53-year-old male presented with chronic low back pain and stiffness lasting over 15 years with recent exacerbation. Clinical examination revealed waddling gait and paraspinal spasm without neurological deficits. Laboratory tests showed HLA-B27 negativity and normal inflammatory markers. Imaging demonstrated flowing anterior longitudinal ligament ossifications over multiple vertebrae, preserved disc spaces, and absent sacroiliac joint erosions, consistent with DISH. Discussion: Differentiating DISH from spondyloarthropathy is crucial due to overlapping symptoms but differing treatment strategies. Radiological features such as sacroiliac joint sparing and the pattern of ossification are key discriminators. Comprehensive clinical and imaging evaluation prevents misdiagnosis and inappropriate treatment. Conclusion: This case emphasizes the need for meticulous diagnostic workup including radiological correlation to distinguish DISH from spondyloarthropathy and guide optimal management.
Case Report
Open Access
Autoimmune Polyglandular Syndrome Type I in an Adult Male: an Unusual Presentation of Addison’s Disease
Katkam Shravani ,
Bobbala Naga Naveen,
Nithish Gaddam ,
Navya Nelakuditi ,
Hashwin Pilathodan ,
Dharssini Kamaladasan
Pages 544 - 549
View PDF
Abstract
Background: Autoimmune Polyglandular Syndrome Type I (APS I), also known as Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED), is a rare disorder characterized by the coexistence of multiple autoimmune endocrinopathies. Addison’s disease is a life-threatening manifestation, typically presenting in childhood. Adult-onset APS I is extremely rare and diagnostically challenging, particularly when classical features such as candidiasis are absent. Case Presentation: We report the case of a 30-year-old male who presented with progressive hyperpigmentation, fatigue, and weight loss over one year. Physical examination revealed diffuse hyperpigmentation, particularly in friction-prone areas and oral mucosa, with low blood pressure but otherwise unremarkable systemic findings. Laboratory investigations showed markedly reduced morning serum cortisol (0.5 µg/dL) with elevated ACTH (1328.13 pg/mL), confirming primary adrenal insufficiency. Additional endocrine evaluation revealed low intact parathyroid hormone levels, consistent with hypoparathyroidism. Screening for systemic autoimmune disorders and thyroid autoantibodies was negative. Imaging ruled out tuberculosis or adrenal hemorrhage, showing mildly bulky adrenal glands with calcification. The constellation of findings supported a diagnosis of APS I with Addison’s disease and hypoparathyroidism. The patient was started on lifelong prednisone 20 mg daily, along with calcium and vitamin D supplementation. Despite counseling, he did not return for follow-up, underscoring challenges in long-term management. Discussion: This case is significant because it illustrates an atypical, adult-onset presentation of APS I in a male patient. The absence of mucocutaneous candidiasis complicated diagnosis, highlighting the heterogeneity of APS I and the need for thorough endocrine screening in patients Conclusion: with Addison’s disease. Differential diagnoses such as tubercular adrenalitis and isolated autoimmune Addison’s disease were carefully excluded. This case reinforces the importance of clinical suspicion, biochemical confirmation, and multidisciplinary management to improve outcomes in APS I. Adult-onset APS I presenting as Addison’s disease with hypoparathyroidism is exceedingly rare. Early recognition and lifelong hormone replacement are critical to preventing morbidity and mortality. Patient education, adherence to therapy, and regular follow-up remain cornerstones of management, especially in resource-limited settings.
Research Article
Open Access
Evaluation of Awareness of drug interaction and polypharmacy risk along elderly individuals in himachal Pradesh
Ira Sharma ,
Monika Pathania ,
Meenakshi Thakur
Pages 534 - 543
View PDF
Abstract
Background: Elderly individuals are particularly vulnerable to drug–drug interactions (DDIs) and adverse drug reactions (ADRs) due to multimorbidity, polypharmacy, and self-medication practices. In India, fragmented healthcare access and low health literacy further increase these risks. This study assessed awareness and attitudes regarding drug interactions and polypharmacy among elderly individuals in Himachal Pradesh. Methods: A descriptive, cross-sectional survey was conducted among 420 elderly individuals (≥60 years) using a structured Google Form questionnaire disseminated through purposive-cum-snowball sampling. The tool included socio-demographic data, medical/prescription profile, and 20 knowledge and 20 attitude items. Knowledge was categorized as Excellent (16–20), Good (12–15), Fair (8–11), and Poor (0–7). Attitudes were classified as Highly Positive (16–20), Positive (12–15), Neutral (8–11), and Negative (0–7). Data were analyzed using SPSS with chi-square tests; p<0.05 was considered significant. Results: Participants were predominantly rural (56.7%), male (56.2%), and 23.3% had no formal education. Nearly half (48.6%) had two or more chronic conditions, with hypertension (65.2%) and diabetes (44.3%) most common. Polypharmacy (≥5 drugs daily) was observed in 45.7%, while 40.0% reported OTC use. ADRs were reported by 17.6%, and 6.2% experienced drug-related hospitalization. Knowledge was suboptimal: only 17.1% had Excellent scores, whereas 34.8% scored Fair and 17.6% Poor. Attitudes were more favorable, with 20.5% Highly Positive and 39.0% Positive. Urban residence, higher education, and professional background were significantly associated with better knowledge and attitudes (p<0.001). Conclusion: Polypharmacy is highly prevalent among the elderly in Himachal Pradesh, with inconsistent awareness of drug interactions. Despite positive attitudes, knowledge gaps and misconceptions persist, especially among rural and low-literacy groups. Targeted educational strategies, pharmacist involvement, and stricter OTC regulation are essential to improve medication safety.
Research Article
Open Access
Serum Homocysteine Levels In CKD Patients and Their Correlation with Coronary Artery Disease
Shyam Kumar Kotni,
Veesam V S Ramakrishna,
Sasikanth Kumar Perala
Pages 525 - 533
View PDF
Abstract
Background: Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD). Homocysteine (Hcy) rises as kidney function declines and may relate to atherosclerotic burden. Aim was to examine the association of serum homocysteine with (a) presence of CAD and (b) angiographic severity (Gensini score), and to describe stage-wise differences in Hcy across CKD stages. Material and Methods: Cross-sectional observational study in the Department of Medicine, Amamata Medical College, Khammam. Seventy-five adults with CKD stages 1–5 (non-dialysis) were enrolled consecutively. Fasting EDTA plasma Hcy was measured by enzymatic immunoassay with standardized pre-analytical handling. CAD was defined as ≥50% stenosis in a major epicardial vessel on invasive angiography or prior MI/PCI/CABG; severity was scored by Gensini (blinded readers). Analyses used t/Mann–Whitney, χ²/Fisher, Spearman’s rho, and multivariable logistic (CAD presence) and linear regression (log-Gensini), adjusting for age, sex, diabetes, hypertension, LDL-C, smoking, eGFR, hs-CRP, vitamin B12, and folate. Two-sided p<0.05 was significant. Results: CAD was present in 38/75 (50.7%); among CAD-positive patients, multivessel disease occurred in 22/38 (57.9%). Mean Hcy was higher in CAD vs no CAD: 26.8 ± 8.1 vs 18.2 ± 6.1 µmol/L, p<0.001. Hcy correlated with Gensini score (r=0.46, p=0.004). In adjusted models, Hcy independently predicted CAD (per 5 µmol/L increase: OR 1.42, 95% CI 1.12–1.79, p=0.003) and greater angiographic severity (β=0.12, 95% CI 0.05–0.20, p=0.002). eGFR (lower) and hs-CRP (higher) were also independent predictors of severity. Stage-wise Hcy rose with advancing CKD: mean (µmol/L) 15.8 (stages 1–2), 19.4 (3a), 22.8 (3b), 27.2 (4), 31.0 (5 pre-dialysis); p-trend <0.001.Conclusions: In non-dialysis CKD, higher serum homocysteine is independently associated with the presence and angiographic severity of CAD and increases progressively with CKD stage. Homocysteine may serve as a useful risk marker alongside standard cardiovascular risk assessment in CKD.
Research Article
Open Access
Association between Serum Uric Acid Levels and Chronic Obstructive Pulmonary Disease: A Case–Control Study in Achrol, Jaipur
Sunil Singh Rathore,
Raghvendra Bagla ,
Umesh Bishnoi ,
Bharat Bhushan Sharma
Pages 520 - 524
View PDF
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, characterized by persistent respiratory symptoms and airflow limitation. Serum uric acid (SUA), the final metabolite of purine catabolism, is increasingly recognized as a biomarker of oxidative stress and hypoxemia. Objectives: This study aimed to evaluate the association between SUA levels in individuals with and without COPD in Achrol, Jaipur, and to explore the relationship between SUA and disease severity. Methods: A hospital-based cross-sectional study was conducted at Achrol, Jaipur, enrolling 30 COPD patients diagnosed using spirometry (post-bronchodilator FEV1/FVC < 0.7) and 30 age- and sex-matched controls. Demographic data, smoking history, BMI, and SUA levels were collected. SUA was estimated by enzymatic colorimetry. Statistical analysis was performed using Student’s t-test, chi-square test. Results: COPD patients exhibited significantly higher mean SUA levels (7.1 ± 1.3 mg/dL) compared to controls (5.4 ± 1.1 mg/dL) (p<0.001). SUA levels showed a positive correlation with COPD severity according to GOLD staging (r=0.42, p<0.01). Smoking further amplified SUA elevation. Conclusion: SUA levels were significantly elevated in COPD patients and correlated with disease severity, supporting its potential utility as a cost-effective biomarker for disease assessment.
Research Article
Open Access
Efficacy of Alternative Fistula Risk Score in Prediction of Post-Operative Pancreatic Fistula in Pancreaticoduodenectomy Patients
Nirban Basu ,
Ved Prakash Patel
Pages 512 - 519
View PDF
Abstract
Background: Postoperative pancreatic fistula (POPF) remains a significant complication following pancreatic resection. While several intraoperative risk scores exist, the Alternative Fistula Risk Score (aFRS) offers the potential for preoperative prediction. This study aimed to evaluate the correlation between aFRS, pancreatic duct diameter, and other clinical variables with POPF development. Methods A prospective observational study was conducted on 38 patients undergoing pancreatic resections. Patient demographics, comorbidities, biochemical markers, pancreatic texture, main pancreatic duct (MPD) diameter, and preoperative biliary stenting were recorded. POPF was graded according to the 2016 ISGPS criteria. The aFRS was calculated preoperatively. Statistical analysis included Spearman’s correlation and Fisher’s exact test. Classification accuracy of the aFRS was evaluated using Naïve Bayes and Minimum Distance algorithms. Results The overall POPF incidence was 21.05%, with 13.16% being clinically significant (Grade B or C). MPD diameter was significantly inversely correlated with POPF (ρ = –0.61173, p < 0.001). aFRS was also significantly associated with clinically relevant POPF (p = 0.0224). The predictive model achieved 86.5% accuracy. Other variables—including BMI, pancreatic texture, preoperative stenting, hemoglobin, albumin, and bilirubin levels—showed no statistically significant correlation with POPF. Conclusion Smaller MPD diameter and higher aFRS were significantly associated with POPF development. The aFRS demonstrated strong predictive value preoperatively and may serve as a useful tool for risk stratification. Larger multicentre studies are warranted to validate these findings and evaluate the utility of aFRS-guided clinical decision-making.
Research Article
Open Access
Fibular Cortical Strut Graft- A Solution to Gap Non-union
Pranay Kumar Srivastava,
Pritam Das ,
Debprasad Mondal
Pages 501 - 511
View PDF
Abstract
Background: Gap non-union is a very difficult entity to manage for any orthopaedic surgeon and poses a great challenge. Multiple procedures have emerged for the management of gap non-union; however these are difficult to apply ,have a long learning curve and need special training and instruments which makes them all the more difficult. Fibular grafting along with locking plate application has long been used for gap non-unions. We, in our study, describe 5 cases of gap non-unions managed by fibular grafting and plate fixation. Material and methods Five patients with gap non-union were operated upon by fibular grafting along with cancellous bone grafting and fixation. Four patients had a gap non-union in the femur and one had it in the tibia. All were post traumatic injuries and all were open fractures primarily managed with external fixator application, by us or someplace else. Once wound was dry the fixator was removed and time was given for the pin tracts to heal. Once all tracts had healed, ipsilateral fibular grafting was done along with cancellous bone graft from the iliac crest and fixation by locking plate. The patients were kept on regular follow ups. Observations and Results All patients operated upon had their fractures united and were able to walk independently on achieving union. There was one patient who developed infection for which antibiotic loaded bone cement beads had to be put in which were removed at 6 weeks. This patient also had infection settled and his fracture united completely. Conclusion Fibula strut graft for non-union is an effective method in treatment of gap non-unions yielding good results.
Research Article
Open Access
CT IMAGING IN CHRONIC SINUSITIS
Mohd Nizamuddin ,
Mahnaz Afreen
Pages 497 - 500
View PDF
Abstract
Background: Chronic sinusitis is a prevalent inflammatory disorder affecting the paranasal sinuses, resulting in significant morbidity. Computed Tomography (CT) plays a pivotal role in diagnosing anatomical variations and pathological changes that predispose or complicate chronic sinusitis. Objective: To evaluate the CT findings in patients diagnosed with chronic sinusitis and to identify common anatomical variations contributing to the disease. Methods: A cross-sectional observational study was conducted on 50 patients diagnosed with chronic sinusitis. CT scans of the paranasal sinuses were analyzed for anatomical variations, sinus involvement, and presence of deviated nasal septum. Results: The maxillary sinus was the most commonly affected (84%), followed by variations such as Concha Bullosa (18%), Agger Nasi cells present in 64%, Haller cells in 14%, and Onodi cells in 6%. Deviated nasal septum was present in 34% of patients. Conclusion: CT imaging is essential for identifying both pathological changes and anatomical variations in chronic sinusitis, aiding in effective treatment planning.
Research Article
Open Access
Assessment of hs-CRP in Diabetic Nephropathy: A Cross-Sectional Case-Control Study
Rahul Chirag ,
Rahul Gandhi G
Pages 485 - 497
View PDF
Abstract
Background: Diabetic nephropathy is a serious microvascular complication of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage renal disease. Recent studies suggest that chronic low-grade inflammation plays a key role in the development and progression of diabetic nephropathy. High-sensitivity C-reactive protein (hs-CRP), an established marker of systemic inflammation, has been found to be elevated in individuals with T2DM. Its levels often rise before clinical signs of nephropathy appear, indicating potential as an early diagnostic marker. Monitoring hs-CRP may help identify patients at higher risk for diabetic nephropathy. As a simple and cost-effective test, hs-CRP could support early intervention strategies and improve clinical outcomes in diabetic populations. Aims and Objectives: To assess hs-CRP levels in diabetic nephropathy patients and evaluate their correlation with glycemic control (HbA1c) and urinary albumin excretion (UAE). Materials and Methods: A cross-sectional case-control study was conducted involving 50 patients with diabetic nephropathy and 50 age- and sex-matched healthy controls. High-sensitivity C-reactive protein (hs-CRP), glycated hemoglobin (HbA1c), and urinary albumin excretion (UAE) were measured using standard laboratory assays. Statistical analysis was carried out using SPSS version 22.0. Results: hs-CRP levels were significantly higher in diabetic nephropathy patients (3.96 ± 1.65 mg/L) compared to controls (0.70 ± 0.41 mg/L, p < 0.0001). Strong positive correlations were found between hs-CRP and HbA1c (r = 0.741, p < 0.0001), and hs-CRP and UAE (r = 0.629, p < 0.0001). Renal function was significantly impaired in diabetic nephropathy patients, and most also showed signs of diabetic retinopathy. Conclusion: Elevated hs-CRP levels in diabetic nephropathy correlate strongly with poor glycemic control and increased UAE, highlighting inflammation’s role in disease progression. hs-CRP may be a valuable non-invasive biomarker for early detection and monitoring of diabetic nephropathy.
Research Article
Open Access
Institutional Experience with 6-Week Hypofractionated Chemoradiation for Head and Neck Cancer in the COVID-19 Era
Nikhil Bathija ,
Jyoti Sharma ,
Palak A Patel
Pages 476 - 484
View PDF
Abstract
Background: The COVID-19 pandemic disrupted standard care for head-and-neck cancer in low- and middle-income countries, prompting exploration of shorter, pragmatic regimens. This study assessed the feasibility and early outcomes of a six-week hypofractionated chemoradiotherapy (CCRT) protocol in locally advanced head-and-neck squamous cell carcinoma (HNSCC).Methods: In this prospective, single-arm study, 60 patients with stage II–IV HNSCC received radiotherapy to 66 Gy in 30 fractions (2.2 Gy/fraction, 5 fractions/week, 6 weeks) using 3DCRT/IMRT, with concurrent cisplatin (weekly or tri-weekly) or carboplatin in cisplatin-ineligible patients. Toxicities were graded by CTCAE v5.0, and tumor response was evaluated at 3 and 6 months using RECIST v1.1. Primary endpoint was 6-month complete response (CR); secondary endpoints included toxicity, compliance, and logistic efficiency. Results: Median age was 62 years, with 86.6% presenting with stage III–IV disease. At six months, CR was 80% (95% CI: 68–89%), overall response 90%, and disease control 96.6%. Grade III–IV mucositis and dysphagia occurred in 53.3% of patients; dermatitis was mostly grade I–II. Late toxicities were mild, with xerostomia the most common. Treatment adherence was high (83.3% completed therapy without interruptions; >80% achieved cumulative cisplatin ≥200 mg/m²). Carboplatin substitution was feasible. Two patients (3.3%) died during therapy. The protocol reduced ~300 hospital visits and shortened overall treatment time by one week. Conclusion: Six-week hypofractionated CCRT is feasible in resource-constrained settings, demonstrating promising tumor control, manageable toxicity, and operational advantages. Larger multicenter trials with longer follow-up are warranted.
Research Article
Open Access
Role of Laparoscopy in Hydrostatic Reduction of Intussusception in Children
Saikat Chakraborty ,
Nirup Kumar Biswas
Pages 469 - 475
View PDF
Abstract
Background: Intussusception is a common cause of intestinal obstruction in children, typically managed with non-operative hydrostatic or pneumatic reduction. When these methods fail, laparoscopy offers a minimally invasive alternative with benefits like shorter recovery time and direct visualization. Laparoscopic-assisted hydrostatic reduction further enhances safety and success, making it a valuable tool in modern pediatric surgical practice. Aims: To evaluate the utility of using laparoscopy in assisting Hydrostatic Reduction of Intussusception in Children Materials and Methods: This single-centre analytical observational study was conducted at the Department of Pediatric Surgery, NRS Medical College, Kolkata, from January 2023 to June 2024. A total of 25 consecutive intussusception patients who underwent laparoscopic-assisted hydrostatic reduction were retrospectively reviewed. Informed consent and assent were obtained, and confidentiality was maintained throughout. Results: In this study of 25 pediatric intussusception cases, 80% were successfully treated with laparoscopic-assisted hydrostatic reduction, while 20% required conversion to open surgery. Abdominal distension and red stool increased conversion odds but were not statistically significant, whereas mental status showed a significant association (p = 0.036). Wound infections occurred only in laparoscopic cases and were statistically significant (p = 0.032).Conclusion: Laparoscopic-assisted hydrostatic reduction was successful in 80% of pediatric intussusception cases, with a 20% conversion rate to open surgery. Mental status showed a significant association with conversion, while other clinical features did not. Overall, laparoscopy proved to be a safe and effective first-line treatment.
Research Article
Open Access
Continuous Low-Dose Ketamine Infusion for Opioid-Refractory Cancer Pain: A Real-World Retrospective Cohort Study from a Tertiary Palliative Care Centre in India.
B.K. Deepak ,
S Ankala Gowrisankar Devar
Pages 457 - 468
View PDF
Abstract
Background: Cancer-related pain is often severe and refractory to conventional opioid-based regimens. Ketamine, a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, has been proposed as an adjuvant for opioid-refractory cancer pain, but data from Indian practice settings remain limited. Aim: To evaluate the effectiveness and tolerability of continuous parenteral ketamine infusion as an adjuvant to opioid therapy in patients with refractory cancer pain admitted to a tertiary palliative care unit. Methods:A retrospective cohort study was conducted in a tertiary oncology center between May 2022 and April 2023. All consecutive adults with advanced malignancy and nociceptive or neuropathic pain unrelieved by optimized opioid therapy (oral morphine equivalent ≥300 mg/day) were included. Ketamine (Ketalar™, 50 mg/mL) was administered as a continuous subcutaneous or intravenous infusion, starting at 100 mg/day and titrated to a maximum of 300 mg/day. Pain intensity (11-point Numerical Rating Scale, NRS), daily opioid dose (oral morphine equivalent, OME), and adverse events were recorded. The primary endpoint was a favorable response, defined as ≥2-point reduction in NRS with stable opioid dose or ≥20 % reduction in OME without increase in pain. Results: One hundred patients (median age 62 years; 70 % male) were analyzed. Most had advanced metastatic disease (85 %) and severe baseline pain (mean NRS 7.1 ± 1.1) despite high-dose opioids (median OME 440 mg/day). Ketamine was administered subcutaneously in 98 % of cases, for a median of 11 days (IQR 7–15). Mean NRS pain scores improved from 7.1 to 4.1 (P < 0.001), and median OME decreased from 440 mg to 350 mg/day (median change −25 %, P = 0.002). A favorable overall response was achieved in 75 % of patients. More than one co-analgesic use predicted response (OR 3.4; 95 % CI 1.1–11; P = 0.035). Adverse events were mild: drowsiness (18 %), transient hypertension (12 %), nightmares (10 %), injection-site reactions (8 %), and confusion (6 %). No clinically significant arrhythmias or severe psychotomimetic reactions occurred. Conclusion: Continuous low-dose ketamine infusion provided rapid, clinically meaningful analgesia and permitted significant opioid sparing in a large, real-world cohort of Indian patients with opioid-refractory cancer pain. The treatment was well tolerated, supporting its incorporation as a third-line option within multidisciplinary palliative care protocols.
Research Article
Open Access
Maternal and Perinatal outcomes in Eclampsia: A Retrospective Cross Sectional study at a tertiary care centre in South India
Vasant Kabbur ,
Vishal Kamate ,
Reshma Kamate ,
Satish Pidai ,
Veena Parakpatil
Pages 451 - 456
View PDF
Abstract
Background: Eclampsia is defined as the development of convulsions and/or unexplained coma during pregnancy or postpartum in patients with signs and symptoms of preeclampsia. Worldwide eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity. Preeclampsia and eclampsia are a continuum of multisystemic progressive disorder. Hence the importance of continued efforts in reviewing each woman with eclampsia and to analyze factors affecting the outcome. Aims of this study is to evaluate maternal and fetal outcome in patients of eclampsia and analyse factors affecting the outcome. Material and Methods: A retrospective observational study was conducted at the Department of Obstetrics and Gynecology at Belagavi Institute of Medical Sciences, Belagavi over a period of 2 years from January 2023 to December 2024. Case records of all patients admitted with Antepartum and Post partum Eclampsia admitted at BIMS Belagavi from January 2023 to December 2024 and patients developing Antepartum, Intrapartum or Post-partum eclampsia during the course of treatment at BIMS Belagavi were collected and the maternal characterstics including demography, clinical features, investigations, mode of delivery, complications and maternal-perinatal outcomes were studied and anlysed. The study involved 35 patients. Results: The study observed maternal ages spanning from 18 to 36 years. The most prevalent age group was 20-30 years, comprising 54%(n=19) of the population, while 37%(n=13) were between 18 -20 years age group. 71%(n=25) of our patients were primigravidas and 91%(n=32) were from rural areas. 88%(n=31) were not booked at our institution. Only17%(n=6) gave history of prodromal symptoms in our study. 71.5%(n=25) of patients preented with antepartum eclampsias and 28.5% had postpartum eclampsia. 66.8%(n=22) patients were term and 23% were preterm. 57%(n=20) patients had BP readings of more than 160 systolic or 110 diastolic at admission. 51%(n=18) had PRES on CNS imaging, and one patient each had Cortical Venous Thrombosis and Sub arachnoid haemorrhage. One patient had DIC and one had Acute kidney injury. There was no maternal mortality in our study but there were 3 stillbirths (8.5%). As much as 71%(n=25) of the patients were delivered by caesarean section. 42%(n=15) babies born to the eclamptic mothers were low birth weight and 20%(n=7) babies required NICU admission. There were 3 stillbirths (8.5%) and 3 neonatal deaths (9.3%) in our study Conclusion: Eclampsia is associated with high perinatal morbidity and mortality as also much increased maternal morbidity. Younger age group Nulliparous women who were unbooked and coming from rural areas were more vulnerable to this complication. Women at term pregnancy were more likely to develop this complication and a significant proportion of patients presented with postpartum eclampsia. Most patients had BPs in the Severe Preeclamsia range at admission. Early diagnosis of pregnancy induced hypertension and early referral of rural woman with preeclampsia to appropriate tertiary care centre can bring down the incidence of antepartum eclampsias. Post natal BP monitoring strictly at regular intervals till BP normalises and continuing antihypertensives till such a time should be advocated in order to reduce the rising incidence of postpartum eclampsias.
Research Article
Open Access
Age- and Gender-Related Variations in Sacroiliac Joint Morphology: A CT-Based Analysis of Anatomical and Degenerative Patterns in a Himachal Pradesh Population
Arvind Chopra ,
Anju Partap ,
Kunal Chawla ,
Yogesh Diwan ,
Kavita Negi ,
Shruti Thakur
Pages 441 - 450
View PDF
Abstract
Background: The sacroiliac joint (SIJ) is a critical load-transmitting articulation implicated in 15–30% of chronic low back pain. Variants such as accessory joints, bipartite iliac bones, crescentic morphology, and degenerative changes are increasingly detected on imaging. Data on age- and gender-related patterns remain limited, especially in South Asian populations. Materials and Methods: This retrospective cross-sectional study conducted in the Department of Anatomy and Department of Radiodiagnosis, IGMC, Shimla, analyzed CT scans of 108 adults (58 males, 50 females). Participants were stratified into three age groups (≤40, 41–60, >60 years). SIJ variants (accessory SI joint, bipartite iliac, crescentic, semi-circular defects, iliosacral complex, intra-articular new bone formation) and degenerative changes (sclerosis, cysts, narrowing, ankylosis) were recorded. Joint space width was measured bilaterally. Statistical comparisons were performed using chi-square, t-test, and ANOVA. Results: Bipartite iliac bones (left: 28.0% vs. 3.4%; right: 30.0% vs. 3.4%; p < 0.001) and crescentic iliac variants (left: 30.0% vs. 10.3%, p = 0.010; right: 18.0% vs. 5.2%, p = 0.034) were significantly more common in females. Semi-circular defects also showed female predominance on the left side (40.0% vs. 20.7%, p = 0.028). In contrast, degenerative changes were more frequent in males, with subchondral cysts significantly associated with females on the right (18.0% vs. 0.0%, p = 0.001). Age-stratified analysis revealed significant increases in accessory SI joints (p = 0.020 left, p = 0.004 right), semi-circular defects (p = 0.006 left, p = 0.027 right), iliosacral complexes (p = 0.045 left), and intra-articular new bone formation (p = 0.041 right) with advancing age. Degenerative changes, sclerosis, and asymmetry were strongly age-related, with asymmetry rising from 15.2% in ≤40 years to 48.1% in >60 years (p = 0.018). Notably, right joint space was significantly narrower in males compared to females (2.62 ± 0.45 mm vs. 2.93 ± 0.75 mm, p = 0.011), while left-sided space showed no difference. Conclusion: SIJ morphology is strongly influenced by age and gender. Females predominantly exhibit bipartite and crescentic variants, while males show greater degenerative remodeling and right-sided joint space narrowing. Recognizing these demographic patterns is essential to distinguish normal variants from pathology in clinical practice.
Research Article
Open Access
A comparative study of Proximal Femoral Nail (PFN) versus Dynamic Condylar Screw (DCS) in management of subtrochanteric fractures.
Sandeep Verma ,
Vivek Kumar ,
Omeshwar Singh ,
Swati Dogra
Pages 435 - 440
View PDF
Abstract
Background: Subtrochanteric femoral fractures, located within 5 cm distal to the lesser trochanter, pose significant surgical challenges due to high cortical bone content and substantial biomechanical stress. These injuries, common in both high-energy trauma and osteoporotic elderly falls, necessitate prompt and stable fixation to prevent complications. Among various implants, Proximal Femoral Nail (PFN) and Dynamic Condylar Screw (DCS) are frequently employed. While PFN offers intramedullary fixation with biomechanical superiority, DCS provides angular stability as an extramedullary device. This study aimed to compare the clinical and radiological outcomes of PFN and DCS in managing subtrochanteric fractures. Materials and Methods: A prospective observational study was conducted at GMC Jammu over 18 months, involving 81 patients with radiologically confirmed subtrochanteric fractures. After exclusions, 44 were treated with PFN, 32 with DCS, and 5 with DHS. Fractures were classified by Russell-Taylor’s system. Outcomes included operative time, blood loss, union time, postoperative complications, and functional scores using the Salwati and Wilson system. Statistical analysis was performed using SPSS v25.0, with p < 0.05 considered significant. Results: PFN was associated with significantly shorter hospital stays (mean: 11.3 vs. 15.6 days, p < 0.001) and faster union (13.4 weeks vs. 15.7 weeks, p < 0.001) than DCS. Complication rates—such as infection (4.5% vs. 12.5%), shortening, and implant failure—were lower in the PFN group. Functional outcomes were superior with PFN, with 77.3% achieving excellent scores compared to 62.5% for DCS. Conclusion: PFN offers better biomechanical stability, earlier fracture union, fewer complications, and improved functional recovery compared to DCS and DHS. It is a preferred fixation method in most subtrochanteric fractures.
Research Article
Open Access
Visual Disability in Himachal Pradesh, India: A Zonal Hospital Perspective
Arti Sareen ,
Vinay Gupta ,
Kusha ,
Jai Gupta
Pages 428 - 434
View PDF
Abstract
Background: Visual impairment and blindness remain major public health concerns globally, with a significant proportion attributable to preventable or treatable causes. In India, avoidable blindness accounts for over 80% of adult cases, underscoring the need for targeted interventions. Objective: To analyze the causes and severity of visual disability among applicants issued disability certificates at a district hospital, and to classify these causes into avoidable and non-avoidable categories. Methods:
A retrospective study was conducted using data from 100 patients issued Unique Disability Identity (UDID) cards at Zonal Hospital, Shimla, between April 2023 and March 2024. Patient demographics, visual acuity, and disability percentages were compiled and categorized according to the Ministry of Health and Family Welfare guidelines. Causes of visual impairment were further classified as avoidable or non-avoidable. Results: The mean age of patients was 41.9 years, with a male-to-female ratio of 1.85:1. Most patients (84%) had low vision (40–80% disability), while 15% were categorized as blind (90–100% disability). Pathological myopia (26%), amblyopia (20%), and trauma (15%) were the leading causes. Notably, 61% of visual disabilities were deemed avoidable with timely screening and intervention. Conclusion: The predominance of avoidable causes such as refractive errors and amblyopia highlights the urgent need for early eye screening, public awareness, and strengthened ophthalmic services at the grassroots level. Strategic policy implementation and inter-professional collaboration are essential to reduce the burden of preventable blindness.
Research Article
Open Access
The Role of Media Exposure and Trust in Healthcare Providers in Shaping COVID-19 Vaccination Behaviour: Evidence from a Community-Based Survey in Haryana
Anil Kumar Saddi,
Anil Kumar Pandey,
Nilesh Chatterjee
Pages 404 - 427
View PDF
Abstract
Background: In the face of the COVID-19 pandemic, public trust and access to accurate information emerged as critical determinants of vaccination behavior. In India, where both media exposure and the public healthcare system exhibit considerable diversity, understanding the interplay between these factors is essential for designing effective public health interventions. This study aimed to explore how patterns of media exposure and trust in healthcare providers influenced COVID-19 vaccination behavior among adults in four districts of Haryana. Specific objectives included assessing the type and frequency of media exposure among the population, evaluating the level of trust in healthcare providers, analyzing the impact of these factors on vaccine uptake and hesitancy, and identifying associations between these variables using inferential statistics. A retrospective cross-sectional survey was conducted in Panchkula, Nuh, Hisar, and Karnal districts of Haryana. A total of 840 adult participants (aged 18–60 years) were selected from outpatient departments across 28 health centers using a structured exit interview approach. Data were collected through a standardized questionnaire that captured demographic variables, exposure to COVID-19-related media content, trust in healthcare providers, and self-reported vaccination behavior. Although detailed results are reported separately, preliminary findings indicate a positive correlation between regular access to reliable media sources and higher vaccination rates. Differences in outcomes were also observed across districts, reflecting variability in both media consumption and health system engagement. The study highlights the influential role of both media exposure and trust in healthcare providers in shaping vaccination decisions at the community level. These findings emphasize the need to strengthen communication channels and reinforce the credibility of healthcare institutions to ensure the success of future immunization campaigns and public health emergencies. Strategic collaboration between media, government, and healthcare providers is vital to combat vaccine misinformation and build lasting health resilience.
Research Article
Open Access
Diagnostic Utility of the Pleural Fluid ADA/LDH Index in Tuberculous Pleural Effusion: A Cross-Sectional Study in a South Indian Cohort.
A F Md Nidaullah,
A Mrudula Srinivasulu,
B Sheshu Kumar
Pages 389 - 403
View PDF
Abstract
Background: Tuberculous pleural effusion (TPE) is the most common form of extrapulmonary tuberculosis and a frequent cause of exudative pleural effusion in high-burden countries. Direct detection of Mycobacterium tuberculosis by smear or culture has low yield, and pleural adenosine deaminase (ADA), though widely used, lacks specificity when parapneumonic effusion (PPE) or malignancy is present. Recent studies suggest that the pleural lactate dehydrogenase to ADA (LDH/ADA) ratio offers superior diagnostic discrimination. Aim: To evaluate the diagnostic accuracy of the pleural fluid LDH/ADA ratio for differentiating TPE from other exudative effusions in a high-burden Indian setting. Methods: A hospital-based cross-sectional study was conducted from June 2023 to May 2025 at a tertiary-care centre in South India. Adults (≥18 years) with exudative pleural effusion by Light’s criteria were enrolled. Pleural ADA and LDH were measured using standard enzymatic assays, and the LDH/ADA ratio calculated. The final diagnosis of TPE was established by smear or culture for M. tuberculosis, histopathology, or a compatible clinical–radiological picture with response to anti-tuberculous therapy. Receiver operating characteristic (ROC) curves determined the optimal LDH/ADA cut-off; sensitivity, specificity, and area under the curve (AUC) were calculated with 95 % confidence intervals. Results: Of 210 patients studied, 132 (62.9 %) had TPE and 78 (37.1 %) had non-tuberculous exudates (malignant or parapneumonic). Median pleural ADA was significantly higher in TPE [64 U/L, interquartile range (IQR) 48–82] than in non-TPE (32 U/L, IQR 24–42; p < 0.001), whereas LDH was lower [380 U/L (IQR 250–520) vs 820 U/L (IQR 520–1 300); p < 0.001]. ROC analysis showed excellent discriminatory performance for the LDH/ADA ratio with an AUC of 0.948. A threshold of <22.7 yielded 92.4 % sensitivity and 91.0 % specificity, closely matching global evidence where optimal cut-offs range from 16 to 24.Conclusion:The pleural LDH/ADA ratio is a rapid, inexpensive, and highly accurate biomarker for diagnosing tuberculous pleural effusion. A locally validated cut-off near 22 can be confidently applied in routine practice to guide early treatment decisions in resource-limited, tuberculosis-endemic settings.
Research Article
Open Access
Synovial Fluid Lactate and Interleukin-6 as Diagnostic Markers in Septic Arthritis: A Pilot Study
A Mrudula Srinivasulu,
A F Md Nidaullah,
B Sheshu Kumar
Pages 376 - 388
View PDF
Abstract
Background: Septic arthritis is an orthopedic emergency that can cause rapid joint destruction and systemic sepsis if diagnosis is delayed. Synovial fluid culture remains the diagnostic gold standard but requires 48–72 hours and may be negative in up to 20 % of true infections. Rapid biochemical markers reflecting the inflammatory and metabolic milieu of the joint—specifically interleukin-6 (IL-6) and lactate—have shown promise but have not been prospectively evaluated together in Indian patients. Methods: In this prospective diagnostic-accuracy study conducted at a South-Indian tertiary-care hospital (January 2023–December 2024), 100 adults with acute native-joint effusion (≤ 2 weeks’ duration) underwent synovial aspiration before antibiotic therapy. Synovial IL-6 (quantitative ELISA), lactate (enzymatic assay), glucose, total protein, and white-blood-cell (WBC) count were measured, along with routine blood investigations (ESR, CRP, procalcitonin). Culture positivity for bacteria or fungi served as the reference standard. Receiver-operating-characteristic (ROC) analysis determined diagnostic performance. Results: Among 100 adults with acute native-joint effusion, 42 (42 %) had culture-confirmed septic arthritis. Septic patients were older (mean ± SD 53.8 ± 15.1 years) with near-equal sex distribution and presented after a median of 4 days of symptoms. The knee was the most frequently involved joint (60 %), and Staphylococcus aureus was the predominant pathogen (38 %), followed by coagulase-negative staphylococci (17 %) and β-hemolytic streptococci (14 %).Systemic inflammation was significantly higher in septic cases: ESR 68 ± 22 mm/hr, CRP 96 ± 40 mg/L, peripheral WBC 13.4 ± 4.6 ×10³/µL, and serum procalcitonin 1.8 ± 0.7 ng/mL (all p < 0.001 vs. non-septic).Synovial fluid analysis showed marked differences between septic and non-septic groups: lactate 12.1 ± 3.7 vs. 4.8 ± 2.0 mmol/L, IL-6 25 200 ± 9 800 vs. 7 500 ± 4 100 pg/mL, WBC 48 ± 20 vs. 15 ± 10 ×10³/µL, total protein 4.6 ± 1.0 vs. 3.4 ± 0.9 g/dL, and glucose 38 ± 12 vs. 65 ± 18 mg/dL (all p < 0.001).Receiver-operating-characteristic analysis identified lactate ≥ 10 mmol/L (AUC 0.90, sensitivity 76 %, specificity 88 %) and IL-6 ≥ 7 000 pg/mL (AUC 0.87, sensitivity 79 %, specificity 85 %) as the most accurate individual predictors. Synovial WBC ≥ 15 ×10³/µL performed slightly less well (AUC 0.80). Lactate and IL-6 correlated moderately (r = 0.58, p < 0.001), confirming their complementary diagnostic value. Conclusion: Synovial lactate and IL-6 are rapid, highly accurate biomarkers for septic arthritis. Lactate ≥ 10 mmol/L and IL-6 ≥ 7 000 pg/mL provide actionable data within hours—well before culture results—to confidently rule in infection (specificity > 85 %) and markedly reduce post-test probability when normal. Incorporating these assays into routine synovial analysis can accelerate targeted antimicrobial therapy, limit joint destruction, and is feasible for resource-limited settings.
Research Article
Open Access
Long Saphenous Vein Stripping Under Femoral Nerve Block for Chronic Venous Insufficiency: A Case Series Analysis
Sankalp ,
Niraj Kumar Srivastava,
Amit Chaudhary
Pages 373 - 375
View PDF
Abstract
Background: Femoral block is an effective but underused technique of anesthesia for varicose vein surgery, including Long Saphenous Vein Stripping (LSVS). We report 20 patients who underwent the Trendelenburg procedure with LSVS under a femoral block administered by the surgeo3n. Method: Hospital records of patients undergoing High Ligation and Stripping (HLS) from January 2024 to March 2025 for chronic venous insufficiency were analysed. Patients received ultrasound-guided femoral block by the operating surgeon using 2% lignocaine. Postoperatively, the intraoperative analgesic effect was assessed using the Numerical Pain Rating Scale (NPRS) to evaluate the effectiveness of the block. Results: The mean age was 32.6 years (SD 9.4). Males accounted for 90% (18/20) of the patients. Pain control was satisfactory, with one patient (5%) experiencing mild pain (mean 0.27, SD 0.88) during LSVS. There were no conversions to spinal anaesthesia in any patient. No complications occurred during femoral block administration, and no mortality was reported. Conclusion: Ultrasound-guided femoral block is a safe and effective technique for High Ligation and Stripping (HLS). It is easy to learn and replicate.
Research Article
Open Access
A Study on Osteometric Parameters of Humerus and Their Clinical Implications
Pavan P Havaldar,
Pramod Rangasubhe ,
Pratik Khona ,
Pandit Vinodh Bandela
Pages 366 - 372
View PDF
Abstract
Background: The humerus is a critical bone for upper limb function, and its precise dimensions are essential for orthopedic implant design, fracture management, and forensic identification. However, comprehensive morphometric data, particularly for diverse populations and obtained through standard tools, remains limited. Objectives: This study aimed to conduct a detailed morphometric analysis of 100 humeri using basic osteometric tools to establish population-specific data, analyze correlations between key parameters, and evaluate bilateral symmetry. Methods: A cross-sectional study was performed on 100 adult humeri (50 right, 50 left). Ten key parameters, including maximum length, mid-shaft circumference, vertical head diameter, and epicondylar width, were measured using an osteometric board and vernier calipers. Data were analyzed with descriptive statistics, Pearson's correlation, and paired t-tests. Results: The mean maximum humeral length was 30.5 ± 2.1 cm. A strong positive correlation was found between maximum length and mid-shaft circumference (r=0.72, p<0.01). A significant correlation was also observed between vertical head diameter and epicondylar width (r=0.56, p<0.01). No statistically significant differences were found between right and left sides for any parameter (p>0.05), indicating strong bilateral symmetry. Conclusion: This study provides a comprehensive morphometric profile of the humerus, highlighting significant correlations between its dimensions. The findings are directly applicable for designing orthopedic implants and prostheses, planning surgical procedures, and aiding forensic anthropological identification. The demonstrated bilateral symmetry validates the use of the contralateral side as a template in clinical and forensic reconstructions.
Research Article
Open Access
Reconstructive Approach for Post-Traumatic Eyelid Defects: Experience from a Tertiary Care Hospital
Partha Sarathi Barooah,
Dhrubajyoti Deka ,
Rajiv Kumar Das,
Thounaojam Jeffchand Luwang,
Ajanta Hazarika ,
Vehuto Puro
Pages 356 - 365
View PDF
Abstract
Background: Eyelids form a barrier between eyes and the external environment. Eyelid injuries can arise from a variety of causes such as road traffic accidents, workplace mishaps, or assaults. Management of eyelid injuries is vexing due to its complex anatomy. Restoration of near normal anatomical relationship of eyelid and surrounding structures is essential for a proper functional and aesthetic outcome.1
Eyelid injury leads to disruption of its vicinity and causes dry eye and corneal pathologies. The proper apposition of eyelids after a traumatic event is of utmost importance to maintain the structural and functional integrity. The tailored strategy based approaches of reconstruction with various flaps are very crucial for a favourable functional and acceptable aesthetic outcome. Objective: To evaluate the outcome of various reconstructive procedures used in reconstruction of eyelid defects. The other variable outcome included the aesthetic outcome, and final outcome in terms of functional approach and anatomical integrity. Methods: A retrospective observational case series study was undertaken for a period of 14 years (2011-2025). A series of 25 patients who attended the outpatient and emergency department of Assam Medical College and Hospital were examined and treated and results analysed. Results: Out of the 25 patients, majority are male (88%) and most falls in the age group of 30-39 years (40%). The right eye (68%) is affected more with most of the injuries equally involving the upper and lower eyelids (44%) each. Workplace mishaps (60%) are the most common mode of injury. Majority of the defects are repaired with advancement flap from local tissue (36%); while complex defects are repaired with Naso-jugal, Tenzel flap, Cheek advancement and Cutler-Beard flap or sometimes using combination of flaps (Naso-jugal +Tenzel, Naso-jugal + Mustarde like cheek advancement flaps) for proper aesthetic and functional result. Conclusion: Eyelid lid reconstruction using standard reconstruction techniques provide an acceptable functional and aesthetic outcome. The study advocates the reconstruction approach of eyelid defect based on tailored reconstruction depending on the individual scenario in each case and to observe the acceptable aesthetic and functional outcome with a follow up to one year.
Research Article
Open Access
Assessing the Knowledge, Attitudes, and Practices Regarding COVID-19 Vaccination Among Adults in Haryana: A Cross-sectional Community-Based Study
Anil Kumar Saddi,
Anil Kumar Pandey,
Nilesh Chatterjee
Pages 330 - 355
View PDF
Abstract
Background: The COVID-19 pandemic presented an unprecedented public health challenge, and vaccination emerged as a pivotal tool to curb transmission, reduce severe disease, and restore societal functioning. However, the success of any vaccination campaign relies heavily on public understanding, acceptance, and adherence. In India, where regional diversity and varying literacy levels coexist, assessing community-level awareness and behavioral patterns toward COVID-19 vaccination is vital. This study was conducted to explore the knowledge, attitudes, and practices regarding COVID-19 vaccination among adults in Haryana—a northern Indian state with both urban and rural populations and diverse sociocultural contexts. The primary objective of the study was to evaluate the level of knowledge pertaining to COVID-19 vaccines, including awareness of eligibility, dosing schedules, benefits, and side effects. A second objective was to assess the attitudes of the population, including trust in vaccine safety, perceptions of vaccine efficacy, and beliefs about governmental and scientific institutions. The third objective aimed to analyze actual vaccination practices, identifying behavioral trends, sources of information, and accessibility of services. Importantly, a fourth objective was to measure the prevalence and underlying factors associated with vaccine hesitancy in the population, considering sociodemographic variables and media influence. This cross-sectional, community-based study was conducted in four districts of Haryana, involving 840 adult participants selected from outpatient departments of public health facilities. Data were collected using a structured questionnaire covering demographic details, knowledge, attitude, practice, and media exposure. The findings of this study are intended to guide targeted health education campaigns, correct misinformation, and improve community engagement in vaccination programs.
Research Article
Open Access
The pCO₂/pH Ratio as a Predictor of Morbidity and Mortality in Children with Severe Lower Respiratory Tract Infections: A Prospective Observational Study
Isha Singh ,
Roop Sharma ,
Ramesh Chand Bairwa,
Rupesh Masand ,
Satvir Singh ,
Divya Chaudhary
Pages 325 - 329
View PDF
Abstract
Background: Lower respiratory tract infections (LRTIs) remain a leading cause of morbidity and mortality among children, particularly in developing countries. Identifying reliable prognostic markers is essential for timely management in pediatric intensive care units (PICUs). This study evaluates the pCO₂/pH ratio as a predictor of morbidity and mortality in children with severe LRTIs. Methods: A prospective observational study was conducted in the PICU of a tertiary care hospital from April 2023 to August 2024. A total of 120 children aged 1 month–18 years admitted with LRTIs were enrolled. Arterial blood gas (ABG) analysis was performed at admission to calculate the pCO₂/pH ratio. Clinical parameters, including ventilatory support, duration of hospital stay, PRESS (Pediatric Respiratory Severity Score), and outcomes, were recorded. Statistical analysis included correlation, logistic regression, and receiver operating characteristic (ROC) analysis. Results: The mean pH was 7.20 ± 0.22, and mean pCO₂ was 46.29 ± 11.14 mmHg. Mortality was 16.7%. The pCO₂/pH ratio showed significant correlations with duration of hospital stay (r = 0.268, p < 0.05), ventilatory support (r = 0.440, p < 0.001), and PRESS score (r = 0.437, p < 0.001). Logistic regression indicated an odds ratio of 10.39 (p < 0.001) for mortality prediction. ROC analysis demonstrated excellent predictive ability with an AUC of 0.981. The optimal cutoff value was 7.22, yielding 98% sensitivity and 70% specificity. Conclusion: The pCO₂/pH ratio is a strong predictor of morbidity and mortality in children with severe LRTIs. A cutoff value above 7.22 identifies patients at high risk of adverse outcomes, guiding early intensive management.
Research Article
Open Access
Surgical Site Infections Following Emergency versus Planned Abdominal Surgeries: An Observational Study in a Tertiary Care Hospital in India
Pages 316 - 324
View PDF
Abstract
Background: Background: Surgical Site Infections (SSIs) remain a significant cause of postoperative morbidity, especially following emergency abdominal surgeries. This study aimed to compare the incidence, risk factors, microbial profile, and clinical features of SSIs in emergency versus planned abdominal surgeries in a tertiary care hospital. Methods: A total of 82 patients were included, with 41 undergoing emergency and 41 planned surgeries. Data on patient demographics, comorbidities, type and duration of surgery, wound classification, microbial isolates, and clinical signs were collected and analyzed. The incidence of SSIs, contributing risk factors, and organism profiles were compared between groups. Results: SSIs were significantly more frequent in emergency surgeries 17 (41.46%) compared to planned surgeries 6 (14.63%). The highest SSI rate in the emergency group was observed in the 31–45 years age group 7/12 (58.33%), while in the planned group, the ≥60 years group had the highest rate 3/8 (37.50%). Diabetes, anemia, and smoking were strongly associated with higher SSI incidence, particularly in emergency cases. Procedures such as intestinal perforation peritonitis repair 6/9 (66.67%) and peptic perforation repair 3/5 (60.00%) showed the highest infection rates. Dirty and contaminated wounds in emergency surgeries were associated with the greatest risk, whereas no infections occurred in similar wound categories in the planned group. Longer operative duration (≥60 minutes) was also linked to increased SSI rates in both groups. Escherichia coli was the most commonly isolated organism in emergency surgeries 10/17 (58.82%), while Staphylococcus aureus was more prevalent in planned cases 3 (50.00%). Clinical signs such as tachycardia, wound discharge, and fever were more commonly observed in emergency SSIs. Conclusion: Emergency abdominal surgeries are associated with a significantly higher risk of SSIs due to factors such as comorbidities, contaminated or dirty wound status, and longer operative durations. Implementation of targeted infection prevention strategies, timely prophylactic antibiotic use, optimization of patient health, and adherence to aseptic protocols are essential, particularly in emergency settings. Knowledge of local microbial patterns can further guide effective empirical treatment and improve surgical outcomes.
Research Article
Open Access
Efficacy of 5% Lidocaine Patch in Reducing Spinal Needle Insertion Pain: A Randomized Controlled Trial
Avinash Kumar ,
Narendra Singh Yadav,
Shahbaz Ahmad ,
Ankit Rao
Pages 308 - 315
View PDF
Abstract
Background: Spinal needle insertion can cause significant discomfort and anxiety in patients undergoing infraumbilical surgery. Topical anesthetics like EMLA have been used to mitigate pain, but limitations exist. This study evaluates the efficacy of a 5% lidocaine patch in reducing spinal puncture pain. Methods: A randomized controlled trial was conducted with 100 adult patients divided equally into two groups. Group L received a 5% lidocaine patch (5×7 cm containing 175 mg lidocaine) applied 30 minutes before spinal anesthesia, while Group C received a gauze piece covered with adhesive tape as placebo. Pain was assessed using the Numerical Rating Scale (NRS), and patient satisfaction was recorded. Hemodynamic parameters and adverse effects were monitored. Results: Both groups were comparable in demographic characteristics. The lidocaine group showed significantly lower mean NRS scores (2.08 ± 0.63) compared to the control group (2.88 ± 0.87, p < 0.0001). Patient satisfaction was higher in the lidocaine group, with 90% reporting excellent satisfaction, whereas only 8% in the control group did so (p < 0.0001). Minor skin reactions occurred in some patients of the lidocaine group, with no systemic adverse effects. Most patients in the lidocaine group expressed willingness for future spinal anesthesia. Conclusion: The 5% lidocaine patch is an effective, safe, and easy-to-use method for alleviating spinal needle insertion pain in infraumbilical surgery. It offers a promising alternative to traditional topical anesthetics, warranting further studies to confirm its broad clinical utility.
Research Article
Open Access
A Cross-Sectional Analysis of Behavioural Disorders in Children with Epilepsy in a Pediatric Neurology Clinic
Sanjiv Kumar Roy,
Varun Arjun
Pages 299 - 307
View PDF
Abstract
Background: Epilepsy in childhood is frequently associated with psychiatric and behavioural comorbidities that worsen functional outcomes. Data from semi-urban India remain scarce, particularly regarding the spectrum of disorders and their predictors. Objectives: To estimate the prevalence of behavioural disorders among children with epilepsy, examine their association with demographic and clinical factors, and identify independent predictors. Methods: This cross-sectional study included 100 children aged 3–16 years with physician-confirmed epilepsy attending the Pediatric Neurology Clinic of Varun Arjun Medical College and Rohilkhand Hospital, Shahjahanpur, between June and September 2025. Behavioural disorders were screened using the Strengths and Difficulties Questionnaire (SDQ) and confirmed clinically. Associations were analyzed using χ² tests, and predictors were assessed with binary logistic regression in SPSS version 26.0 and R 4.3.0.Results: The mean age of participants was 9.9 ± 3.8 years, and 58% were male. Focal epilepsy accounted for 48% of cases, generalized epilepsy 42%, and mixed type 10%. Nearly half of the cohort (48%) had at least one behavioural disorder. Disorder-specific prevalences were: ADHD 24%, anxiety 24%, depression 22%, autism spectrum disorder 13%, and oppositional defiant disorder 14%. In bivariate analyses, polytherapy and higher seizure frequency were associated with greater prevalence but did not reach significance. Socioeconomic disadvantage showed a near-significant gradient (p = 0.077). In multivariable analysis, lower socioeconomic status independently predicted behavioural disorders (adjusted OR 2.56; 95% CI 1.03–6.35; p = 0.043). Perinatal complications showed a positive but non-significant trend (OR 2.33; 95% CI 0.91–5.95). Conclusion: Almost one in two children with epilepsy in this semi-urban cohort had a behavioural disorder, most commonly ADHD, anxiety, or depression. Socioeconomic disadvantage independently increased risk, underscoring the importance of integrating behavioural screening and family-centered psychosocial support into pediatric epilepsy care, particularly for disadvantaged populations.
Research Article
Open Access
Hemodynamic Alterations in Portal Venous Doppler and Their Correlation with Capillary Leak Syndrome in Dengue Infection
Shruti Dharmadas Barki,
Vishruth Rasa
Pages 292 - 298
View PDF
Abstract
Background: Capillary leak syndrome (CLS) is the hallmark of severe dengue, resulting from endothelial dysfunction and increased vascular permeability. Early detection of plasma leakage is critical for guiding fluid therapy. Conventional sonographic markers such as gallbladder wall thickening (GBWT), pleural effusion, and ascites are useful but may appear late. Portal venous Doppler offers a physiologic assessment of splanchnic venous congestion through indices such as portal vein pulsatility index (PVPI) and portal vein congestion index (PVCI). Aim of the study was to evaluate hemodynamic alterations in portal venous Doppler and their correlation with CLS in dengue patients, and to compare the predictive performance of PVPI and PVCI with conventional sonographic markers. Material and Methods: This prospective observational study included 75 laboratory-confirmed dengue patients undergoing ultrasound and Doppler evaluation in the Department of Radiology. Hematological, biochemical, and sonographic parameters were recorded. PVPI and PVCI were calculated from spectral Doppler. Patients were stratified into CLS and non-CLS groups. Statistical analyses included t-test/Mann–Whitney U test, Chi-square/Fisher’s exact test, correlation analyses, and receiver operating characteristic (ROC) curves. Results: PVPI and PVCI were significantly higher in CLS patients compared to non-CLS. ROC analysis demonstrated excellent diagnostic performance (PVPI: AUC 0.962, cutoff 0.324, sensitivity 85.7%, specificity 97.5; PVCI: AUC 0.911, cutoff 0.152, sensitivity 88.6%, specificity 82.5). Conventional sonographic markers (GBWT, effusions, ascites) were also more frequent in CLS but showed lower discriminatory accuracy. Correlations between PVPI/PVCI and hematocrit, albumin, and IVC collapsibility were weak. Conclusion: Portal venous Doppler, particularly PVPI and PVCI, provides superior diagnostic accuracy for detecting CLS in dengue compared with traditional sonographic markers. Integrating Doppler indices with structural ultrasound parameters can enhance early risk stratification and optimize fluid management.
Research Article
Open Access
Solid Waste Management Practices among Household Residents of Urban and Slum Areas in Indore City: A Cross Sectional Study
Shivani Jain ,
Dolly Mehta ,
Navaneet Chansauria ,
Shivam Dixit
Pages 286 - 291
View PDF
Abstract
Background: The rapid pace of urbanization in India has led to a dramatic increase in solid waste generation, placing an enormous burden on public health systems and the environment. With daily municipal solid waste production exceeding 150,000 tonnes, the challenge of effective Solid Waste Management (SWM) has become major problem. Despite national initiatives like the Swachh Bharat Mission (SBM), which introduced decentralized waste collection, digital tracking systems, and community engagement models, implementation gaps remain—particularly in low-income and slum areas. Indore, though widely recognized for its innovative and successful SWM practices, still faces disparities in awareness, participation, and behaviour among different socioeconomic groups. This study aims to assess and compare the solid waste management practices and knowledge among urban and slum residents. Methodology- A cross sectional study was conducted among 250 people of >18 years of age group residing in urban and slum area of Indore city as study subjects for a duration of 6 months from August 2024 to January 2025. Study population includes 125 household residents from the urban area and 125 from the slum area. Comparison between rural and urban areas about solid waste management practices were assessed by several statistical tests. Data were analysed using SPSS 25 version. Result- 97.6% household residents in urban area and 52.8% in slum area were aware about waste segregation than slum residents. 60% of urban households used covered bins compared to 44.4% in slum areas. 61.6% waste were collected by Municipal van in urban area versus 18.4% in slum area. Awareness about Swachh Bharat Mission was markedly higher in urban (78%) versus slum areas (36%). Regarding sanitary napkin disposal, 81.6% of urban residents used municipal collection services, while only 28.8% of slum residents followed this method. Conclusion- The study reveals significant differences in SWM practices between urban and slum residents. Focused interventions such as community education and infrastructure improvement are urgently needed to promote equitable and sustainable waste management.
Research Article
Open Access
Study of Origin, Course, and Branching Pattern of Variations of Splenic Artery in Human Cadavers
Divyateja Somesula ,
N. Maheshwari ,
A Gangadhar Reddy
Pages 278 - 285
View PDF
Abstract
Background: The splenic artery exhibits a highly variable anatomy in its origin, course, and branching pattern. This variability is of paramount clinical importance, particularly with the rise of minimally invasive and spleen-preserving procedures such as laparoscopic splenectomy and partial splenic artery embolization. Detailed anatomical knowledge is essential to avoid intraoperative complications like hemorrhage and iatrogenic injury to the pancreas. This study was therefore undertaken to provide a detailed descriptive analysis of the anatomical variations of the splenic artery in a sample of human cadavers, with the goal of supplying valuable data for surgical and radiological applications. Methods: This cross-sectional observational study was conducted over a two-year period in the Department of Anatomy. A total of thirty properly embalmed adult human cadavers of mixed sexes were meticulously dissected according to standard anatomical procedures. The primary variables examined included the origin of the splenic artery, its anatomical course in relation to the pancreas, the number and origin of its major branches (including short gastric, pancreatic, and polar arteries), and its terminal branching pattern at the splenic hilum. The dissected vasculature was enhanced with red enamel paint to improve visual clarity and was documented using high-resolution digital photography. Results: The analysis revealed significant anatomical diversity. The splenic artery most originated from the celiac trunk (90% of cases), with the remainder arising from variant trunks such as the gastrolienal and hepatosplenic. Its course was predominantly suprapancreatic (66.67%), though other trajectories including retropancreatic were observed. All specimens consistently presented with short gastric and pancreatic branches arising from the main trunk. The terminal branching was classified as either distributed (50%) or bundled (43.33%), with a small number of cases showing no branching prior to the hilum. Polar arteries, which supply the splenic poles directly, were identified in a distinct minority of specimens, further highlighting the anatomical variability. Conclusion: This cadaveric study successfully delineates the diverse anatomical landscape of the splenic artery, documenting notable variations in its origin, course, and branching patterns. This detailed morphological data is directly applicable and highly beneficial for surgeons performing splenectomies and for interventional radiologists conducting embolization procedures. Preoperative awareness of these potential variations, potentially achieved through advanced imaging, is indispensable for minimizing intraoperative risks and optimizing procedural outcomes, ultimately contributing to safer and more effective clinical interventions..
Research Article
Open Access
Comparative evaluation of different irrigation activation systems (XP-Endo Finisher, EndoActivator, Ultrasonics, Laser) on smear layer removal in curved canals
Pages 272 - 277
View PDF
Abstract
Background: Effective removal of the smear layer is crucial for successful endodontic treatment, as it enhances disinfection and promotes a superior seal. In curved canals, achieving complete cleanliness, particularly in the apical third, remains a significant challenge. Various irrigation activation systems have been developed to improve irrigant delivery and debridement. Methods: Seventy-five extracted human mandibular molars with mesiobuccal canals having a curvature of 20°–40° were selected. After standardized instrumentation using ProTaper Gold rotary files up to F2, the samples were randomly assigned to five groups (n=15): Group 1 (XPF), Group 2 (EA), Group 3 (PUI), Group 4 (LAI), and Group 5 (Conventional Needle Irrigation - CNI, control). Final irrigation was performed using 17% EDTA followed by activation according to the group protocol. Teeth were sectioned longitudinally and examined under a scanning electron microscope (SEM). Smear layer removal was scored by two blinded examiners using a 5-point scale (1=no smear layer, 5=heavy smear layer). Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests (p < 0.05). Results: All activation systems performed significantly better than CNI in all canal thirds (p < 0.001). In the apical third, LAI (mean score: 1.67 ± 0.49) and PUI (1.80 ± 0.56) demonstrated the most effective smear layer removal, with no significant difference between them (p > 0.05). Both were significantly more effective than XPF (2.27 ± 0.60; p < 0.05), which in turn was significantly superior to EA (3.13 ± 0.74; p < 0.01). The CNI group showed the highest (worst) smear layer scores (4.60 ± 0.51). Similar trends were observed in the middle and coronal thirds, with effectiveness decreasing from coronal to apical in all groups. Conclusion: Within the limitations of this in vitro study, Laser-Activated Irrigation and Passive Ultrasonic Irrigation were the most effective systems for smear layer removal in curved root canals. The XP-Endo Finisher also showed commendable performance, significantly outperforming sonic activation and conventional irrigation. The choice of an advanced activation system is critical for achieving optimal canal cleanliness in complex anatomies.
Research Article
Open Access
Open Heart Surgery in patients with HBE Trait
Evanisha Marbaniang ,
Nabajeet Baruah ,
Partha Pratim Baruah,
Debabrata Gohain ,
James Thiek
Pages 267 - 271
View PDF
Abstract
Background: Hemoglobin E (HbE) is a common hemoglobin variant in Southeast Asia, with high prevalence in northeastern India. While generally benign in its trait form, its implications during major surgical procedures such as open heart surgery remain underexplored. Objective: To evaluate perioperative outcomes in patients with HbE trait undergoing valvular heart surgery. Methods: A prospective non-randomized controlled study was conducted at CN Center, Gauhati Medical College and Hospital, Assam, from January 2024 to January 2025. Twenty-six patients with HbE trait undergoing valvular heart surgery were assessed for demographic data, hemoglobin levels, liver function tests, transfusion requirements, and postoperative complications. Standardized anesthesia and cardiopulmonary bypass protocols were followed. Results: The cohort included 14 males and 12 females with a mean age of 33 years. Preoperative hemoglobin averaged 8.2 g/dL, with 6 patients requiring optimization. Postoperative hemoglobin levels remained above 9 g/dL. All patients exhibited transient postoperative hyperbilirubinemia, which normalized on follow-up. Minor complications included haematuria (3 patients) and intrathoracic collection (2 patients), both resolved without major intervention. No excessive bleeding or hemolytic crisis was observed. Conclusion: Valvular heart surgery can be safely performed in patients with HbE trait, with outcomes comparable to those without the trait. Careful intraoperative management, including adequate oxygenation and avoidance of acidosis, is essential. Routine preoperative transfusion is not recommended.
Research Article
Open Access
Angiogenic Potential of Ficus Religiosa Leaves: Results of an In-Vitro Study with Chicken Embryo Chorioallantoic Membrane (CAM) Model
Priyanka Mirdha ,
Vijaykumar Gupta ,
Amita Verma ,
Anant Patil
Pages 258 - 266
View PDF
Abstract
Background: Objective: To determine the angiogenic potential of Ficus religiosa. Material and method : The angiogenic potential Ficus religiosa was determined by using chicken embryo chorioallantoic membrane model. The pro-angiogenic potential was ascertained by varying the concentration of the hot methanolic extract of Ficus religiosa leaves. The fertilized chicken eggs were procured on zero embryonic development day (EDD) and until the seventh day, the growth of embryo was monitored daily. On the 8th EDD, the sample was loaded onto CAM. The embryonic development and angiogenesis effect was monitored daily until the 11th day. The method used were the focal application method and AbGel™ sponge application method, the angiogenic potential was compared to Plermin™ a potent proangiogenic drug approved by USFDA. Results: Ficus religiosa didn’t show any angiogenic potential in all its tested concentrations (165 mcg, 330 mcg, 495 mcg and 660 mcg/disc). There is no or minimal growth in blood vessels was found in all the samples. Photographic evaluation also shows no changes in angiogenesis with Ficus religiosa leaves extract. On the contrary, remarkable growth of blood vessels was observed in the Plermin control group and it is measured by counting the number of blood vessels in photographic evaluation. Conclusion: Ficus religiosa does not exhibit angiogenic potential in the chorioallantoic membrane (CAM) model.
Research Article
Open Access
The Efficacy and Safety of Intra-Articular Injection of Corticosteroids in Multimodal Analgesic Cocktails in Total Knee Arthroplasty
Piyush Shukla ,
Manoj Kumar Sahoo,
. Nitin Lalbabu Singh,
M C Prashant ,
Rahul Tiwari ,
Tohid Ali
Pages 250 - 257
View PDF
Abstract
Background: Optimal perioperative pain management in total knee arthroplasty (TKA) is essential to enhance recovery and reduce opioid dependence. Intra-articular (IA) multimodal cocktails are widely used, but the additional benefit and safety of corticosteroid inclusion remain debated. Objective: To evaluate the efficacy and safety of adding corticosteroid to an IA multimodal analgesic cocktail in primary TKA. Methods: In this prospective, randomized, double-blind trial, 140 patients undergoing primary TKA were allocated to receive either a standard IA cocktail (ropivacaine, ketorolac, epinephrine) with corticosteroid (betamethasone 7 mg) or an identical steroid-free cocktail at wound closure. The primary outcome was pain on movement at 24 hours (0–10 NRS). Secondary outcomes included pain scores at rest/movement up to 72 hours, opioid consumption, functional recovery, length of stay, and safety (hyperglycemia, wound complications, prosthetic joint infection).Results: The steroid group had significantly lower 24-hour movement pain (3.1 vs 4.6, p < 0.001) and reduced opioid use (34.6 vs 49.2 mg OME, p < 0.001). Functional recovery was superior, with earlier straight-leg raise (21.5 vs 28.3 h, p < 0.001) and greater knee flexion at discharge (95.8° vs 89.7°, p < 0.001). No increase in wound complications or infections was observed; transient hyperglycemia was slightly more common. Conclusion: Intraoperative IA corticosteroid addition significantly improves early analgesia and functional recovery in TKA without compromising short-term safety.
Research Article
Open Access
A Study To Assess The Level Of Stress And Stress Impact On Health Among Health Care Workers In A Government Medical College Anantnag, Jammu And Kashmir
Fouzia Nazir ,
Rukhsana Taj ,
Joziea Farooq ,
Umara Giyas
Pages 242 - 249
View PDF
Abstract
Background: Burnout and elevated stress levels are affecting up to 70% of healthcare workers, compromising the quality of patient care. Prior studies predominantly focus on specific settings or pandemic-related stress, limiting a broader understanding of the diverse stressors healthcare workers face. This study aimed to identify and assess the primary self-reported stressors of healthcare workers. Between June 2018 and April 2019, 2,310 U.S. healthcare professionals responded to an open-ended survey question: “What are your biggest stressors over the last few weeks?” A summative content analysis was conducted to examine the responses. The findings revealed three categories of stressors: work-related stressors (49%), personal life stressors (32%), and those affecting both work and personal life (19%). These results highlight the multifaceted nature of stress among healthcare workers. Future research and clinical interventions should address these varied sources of stress to better support healthcare professionals.
Research Article
Open Access
Study On Clinical and Biochemical Correlation with Different Findings of MRI Brain in Eclampsia in Rural Tertiary Referral Centre in Darjeeling District.
Monika Yadav ,
Tanmay Mandal
Pages 236 - 241
View PDF
Abstract
Background: Eclampsia, a severe complication of preeclampsia, is a life-threatening condition characterized by seizures in pregnant women with hypertension and proteinuria. MRI plays a crucial role in identifying neurological complications associated with eclampsia. This study analyzes clinical and biochemical parameters of eclamptic patients and correlates them with MRI findings to improve diagnostic accuracy and patient management. The research aims to enhance early detection and guide therapeutic interventions for eclamptic complications in resource-limited settings. AIM: To study the biochemical clinical correlation with the MRI Brain findings of patients with Eclampsia admitted in North Bengal Medical College and Hospital. Material and Methods: Observational study analyzed MRI brain findings and correlation with eclampsia in patients admitted to North Bengal Medical College from July to December 2021. Patients with seizures, high blood pressure, and elevated urine albumin levels were included. Exclusions included pre-existing seizure disorders, metabolic seizures, and other conditions. Fifty patients were included in a study using total enumeration sampling. Data collection included socio-demographic details, clinical history, biochemical investigations, MRI findings, treatment interventions, and patient outcomes. Results: MRI findings in eclampsia include PRES (68%), cerebral edema (56%), infarcts, and microhemorrhages. Normal MRI findings indicate early or mild-stage eclampsia in 12% patients. Conclusion: MRI brain imaging in eclamptic patients reveals PRES as the most common abnormality, correlating with severe hypertension and proteinuria. Early diagnosis and intervention improve maternal and fetal outcomes, emphasizing the need for increased access to neuroimaging, especially in rural areas.
Research Article
Open Access
Role of Fine Needle Aspiration Cytology in Evaluation and Diagnosis of Head and Neck Lesions: A Retrospective Study at Tertiary Care Centre in Western India
Zeal Dhamsaniya ,
Gauravi Dhruva ,
Amit Agravat
Pages 228 - 235
View PDF
Abstract
Background: Fine needle aspiration cytology (FNAC) is a very simple, quick, cost effective and minimally invasive technique used to diagnose different type of swellings occuring in lymph node, thyroid gland, soft tissue and salivary gland in head and neck region. Aims and Objectives: To evaluate role and utility of FNAC in diagnosis of palpable head and neck lesions Methods: This study included 416 patients presented with palpable swelling in head and neck region at P.D.U. Medical College and Hospital, Rajkot from July 2024 to July 2025. FNAC procedure was been performed and smears were stained with H & E stain and Geimsa stain and subsequently cytopathology reporting was done. Results: Out of 416 cases, Lymph node (59%) was most common site of aspiration where TB lymphadenitis (52%) was most common diagnosed lesion. Thyroid gland lesions constitute (24%) followed by salivary gland lesions 10% and soft tissue lesions 5%. FNAC was inconclusive in 2% cases. Conclusion: FNAC serves as a guide to appropriate therapeutic management whether to locally excise a benign tumor or plan radical surgery and helps as an adjunct to histopathology.
Research Article
Open Access
Expanded Dengue Syndrome: A Retrospective Study of Seasonal Surges in Rural India
Gunavathy Nagesh Jakaraddi,
Nagesh D. Jakaraddi,
Rakesh P. S,
Anil Kumar Ourasang,
Abdul Qadir Zeeshan
Pages 221 - 227
View PDF
Abstract
Background: Dengue fever is an escalating global health concern, with increasing reports of atypical manifestations collectively known as expanded dengue syndrome. Among these, severe dengue hepatitis can progress to acute liver failure and multi-organ dysfunction, representing a significant cause of morbidity and mortality. Aim: This study aims to describe the clinical characteristics, management, and outcomes of patients with severe dengue hepatitis admitted to a tertiary care center in a rural region of northern Karnataka, India. Methods: We conducted a structured, retrospective medical record review of patients admitted between June and August 2024. The study population included febrile patients from a specific rural belt with thrombocytopenia and positive NS1-protein or dengue IgM tests. Severe hepatitis was defined as alanine aminotransferase (SGPT) or aspartate aminotransferase (SGOT) levels exceeding 1000 IU/L. Results: Out of 808 dengue-positive patients, 10 were identified with severe hepatitis and included for analysis. All 10 patients presented with coagulopathy (mean INR 2.38) and multi-organ failure, with acute kidney injury in 75% and respiratory failure in 60%. Clinical presentations were varied, with shock observed in 80% of patients. Mortality was 40% (4/10 patients), with non-survivors experiencing refractory shock, severe metabolic acidosis, and persistently high lactate levels. Conclusion: Severe dengue hepatitis is a life-threatening complication with a high mortality rate. This study highlights its increasing incidence and the clinical challenges posed in resource-limited, rural settings.
Research Article
Open Access
Comparison of the Efficacy of Topical Netarsudil with Topical Timolol in Patients of Primary Open Angle Glaucoma
Megha Kashyap ,
Chetanya Gupta ,
Jaya Devendra ,
Aabhas Kumar
Pages 214 - 220
View PDF
Abstract
Background: Glaucoma is an umbrella term for eye conditions that damage the optic nerve and can lead to a loss of vision. It is the leading cause of irreversible blindness worldwide and is associated with a reduced quality of life. Netarsudil (0.02%), a relatively newer drug, is a Rho-Kinase Inhibitor. It appears to increase outflow of aqueous humor through the trabecular meshwork, and also to reduce pressure in the veins of the episcleral layer. Timolol (0.5%) is a well-known and widely used eyedrop to reduce Intraocular Pressure (IOP). It is a β-adrenergic antagonist, approved by FDA in 1978, works by reducing aqueous production. Objective: Comparison of the efficacy of topical Netarsudil with topical timolol in patients of Primary Open-Angle Glaucoma (POAG). Materials and Methods: 90 patients of both genders aged 20-65 years satisfying the inclusion criteria were included. They were distributed in two groups; one group was instilled topical Netarsudil while the other instilled topical Timolol. The IOP of both the groups was measured using Goldmann’s Applanation tonometry and later compared. Result: Both treatment regimens effectively lowered IOP, which was observed multiple times over a duration of six months of study, where it showed that Netarsudil was non-inferior to Timolol in efficacy. Conclusion: This study highlights that both Netarsudil and Timolol are effective in the management of POAG, yielding significant reductions in IOP without notable differences in efficacy. This supports the notion that clinicians can employ either treatment option based on specific patient profiles, preferences, and tolerability, without concerns of compromising therapeutic outcomes.
Research Article
Open Access
Oral Squamous Cell Carcinoma: Demographic and Clinicopathological Features From A Tertiary Care Centre -An Institutional Based Retrospective Study
Muhammed Ashif EP,
Akhilesh A V ,
Ikram Bin Ismail P T
Pages 208 - 213
View PDF
Abstract
Background: Oral squamous cell carcinoma (OSCC) represents the predominant oral malignancy, accounting for 80–90% of all oral malignancies, with its incidence varying globally based on region and demographics. While OSCC typically affects individuals over 40, recent studies, particularly from Kerala, India, report a rising incidence among young adults. There is limited research on the age, gender, and clinical site distribution of oral cancer in the Malabar region of Kerala. This research aims to address that gap by analysing trends over a five-year period at a tertiary care centre, contributing insights to assist in prevention, early diagnosis, and management of oral cancer. Materials and Methods: The records of individuals histologically diagnosed with squamous cell carcinoma of the oral cavity at the Department of Oral and Maxillofacial Surgery, Government dental college Kozhikode between 2020-2024 were retrospectively reviewed. The gathered data were analysed for demographic details like age, gender and clinico-pathological details including clinical site, tumour differentiation. Results: A total of 1,116 patients were diagnosed with oral OSCC during the study period. 734 cases (65.8%) were reported in males, while 382 cases (34.2%) were reported in females. Out of a total of 1,116 diagnosed cases, 464 cases were reported in the buccal mucosa, making it the most predominantly affected location. The tongue was the second most commonly affected location, with 393 reported cases. Discussion: Historically seen as an disease of the elderly, OSCC is increasingly being reported among younger individuals. In this study, 1,116 OSCC cases were analysed, showing a higher prevalence in males (65.8%) and the buccal mucosa as the most affected site, followed by the tongue and alveolus. Most tumours were moderately differentiated, with a higher proportion of poorly differentiated cases seen in younger patients and the tongue, suggesting more aggressive disease in these groups. Site and tumour differentiation varied by age and gender, indicating possible influences of behaviour and risk factor exposure. Conclusion: Our study highlights a high incidence of OSCC among young adults, with the tongue being the most commonly affected site, emphasizing the need for further research into underlying causes. To better understand the true scale and nature of OSCC in the country, larger, comprehensive studies involving both institutional and community settings are crucial for developing effective prevention and control strategies.
Research Article
Open Access
Study of Clinico-Aetiological Profile and Outcome of Paediatric Shock in a Tertiary Care Hospital
Sakshi Agarwal ,
Priya Marwah ,
Ramesh Chand Bairwa,
Roop Sharma ,
Rupesh Masand
Pages 199 - 207
View PDF
Abstract
Background: Shock is a life-threatening condition representing circulatory failure where oxygen and nutrient delivery to tissues is insufficient to meet metabolic demands. It affects approximately 2% of hospitalized children globally and is a significant contributor to pediatric intensive care unit (PICU) admissions. Early recognition and intervention are vital for improving survival rates in critically ill children. Methodology: This prospective observational study was conducted at the Pediatrics Department, Mahatma Gandhi Medical College & Hospital, Jaipur, from April 1, 2023, to September 30, 2024. The study included 210 children aged 1 month to 18 years presenting with shock. Detailed clinical assessment, laboratory investigations and PELOD-2 scoring were performed. Statistical analysis was conducted using SPSS version 23.0 with p<0.05 considered significant. Results: Among 210 patients, 122 (58.09%) were female and 88 (41.91%) were male. Septic shock was the most prevalent etiology (50%), followed by hypovolemic shock (32.9%). Compensated shock was observed in 156 (74.3%) patients, while 54 (25.7%) had decompensated shock. The overall mortality rate was 26.2% (55 patients). Mortality was significantly higher in decompensated shock (90.7%) compared to compensated shock (3.8%) (p=0.001). PELOD-2 score ≥8 was associated with 76.1% mortality. Patients with five organ dysfunctions had 59% mortality. Respiratory distress was present in 92.6% of decompensated shock cases.
Conclusion: This study demonstrates that shock severity, etiology and number of organ dysfunctions are significant predictors of mortality in pediatric shock. PELOD-2 scoring system proves to be an excellent prognostic tool. Early recognition and aggressive management of decompensated shock are crucial for improving survival rates.
Research Article
Open Access
Trends in Admissions and Mortality in a Medical Intensive Care Unit: A Prospective Study from a Tertiary Care Center in Central India.
Tejas Jindal ,
Dharmendra Jhavar ,
Aman Yadav
Pages 190 - 198
View PDF
Abstract
Background: Understanding patterns of intensive care unit (ICU) utilization and mortality is essential for optimizing critical care services, especially in low- and middle-income countries. This study aimed to analyze admission trends, predictors of mortality, and outcomes in a Medical Intensive Care Unit (MICU) of a tertiary care hospital in Central India. Methods: A prospective observational study was conducted over one year, enrolling 2,400 adult patients aged 18–60 years admitted to the MICU. Demographic, clinical, and laboratory data were collected using a standardized form. Severity was assessed using APACHE II and SOFA scores. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of mortality. Results: Among 2,400 MICU patients (mean age 39.4 ± 14.1 years; 63.3% male), the overall mortality rate was 16.8%. Leading causes of admission included gastrointestinal (21%), neurological (18.7%), and infectious conditions (14.6%). Mortality was significantly associated with older age, male gender (p = 0.02), smoking (aOR: 5.85), and sepsis (aOR: 2.03). Non-survivors had higher SOFA (9.40 vs. 2.93) and APACHE II (24.91 vs. 8.13) scores (p < 0.001). Interventions such as invasive ventilation (CFR: 0.47) and multiple inotropes (CFR: 0.46) were linked to higher mortality. Sepsis and MODS were major contributors to death. Conclusion: This study highlights the high burden of critical illness among younger adults and identifies key clinical and intervention-related factors influencing mortality in MICU settings. Early risk stratification using validated scoring systems and timely intervention may improve outcomes. These findings can guide resource allocation and ICU protocol optimization in resource-limited settings.
Research Article
Open Access
Comparison of the Efficacy of Intrathecal Buprenorphine in Two Varying Doses with Hyperbaric Bupivacaine in Adults for Infra-Umbilical and Lower Limb Surgeries under Spinal Anesthesia
Shirley Stephen ,
Narender Bhandari ,
Prashanti Konkala
Pages 175 - 189
View PDF
Abstract
Comparison of the Efficacy of Intrathecal Buprenorphine in Two Varying Doses with Hyperbaric Bupivacaine in Adults for Infra-Umbilical and Lower Limb Surgeries under Spinal Anesthesia
Research Article
Open Access
Role of Psychometric Hepatic Encephalopathy Score (PHES) In Detecting Minimal Hepatic Encephalopathy in Patients with Liver Cirrhosis
shrikanth ,
Ajay Kumar Nandmer,
Vijay Kumar Nandmer,
Simmi Dube
Pages 168 - 174
View PDF
Abstract
Background: Minimal hepatic encephalopathy (MHE) is a subclinical manifestation of hepatic encephalopathy (HE), seen in up to 80% of cirrhotic patients. It presents with subtle neurocognitive deficits undetectable by routine neurological exams. Psychometric Hepatic Encephalopathy Score (PHES) is a validated tool for detecting MHE. This study aimed to evaluate the utility of PHES in diagnosing MHE in cirrhosis patients in Central India. Methods: A comparative cross-sectional observational study was conducted at Gandhi Medical College and Hamidia Hospital, Bhopal, over 18 months. Seventy cirrhotic patients without overt HE and 70 age- and sex-matched healthy controls were included. All participants underwent PHES testing (NCT-A, NCT-B, DST, SDT, LTT) and EEG. A PHES score of < -4 was diagnostic of MHE. Statistical analysis was performed using SPSS v20. Results: Mean PHES score was significantly lower in cirrhotics (-5.97±4.89) than controls (-0.21±1.39) (p<0.001). MHE was detected in 57.1% of cirrhotic patients and 1.4% of controls (p<0.001). EEG changes suggestive of HE were present in 7 cases, all of whom had MHE. However, PHES also identified MHE in 52.4% of cases with normal EEG, indicating superior sensitivity. Conclusion: PHES is an effective and practical bedside tool for detecting MHE in cirrhotic patients. It can identify subclinical cognitive impairment missed by EEG, facilitating early diagnosis and intervention to prevent progression to overt HE. Routine use of PHES in cirrhotic patients could improve clinical outcomes and quality of life.
Research Article
Open Access
Clinicopathological and Radiological Analysis of Infective Bone Lesions
Lokesh Mallikarjunaiah ,
Gopinath Rajesh ,
Ravi Shankar M,
Hemalatha B S,
Kushi Lokesh ,
Sathvik R L
Pages 163 - 167
View PDF
Abstract
Background: Infective bone lesions are a significant cause of morbidity and require timely diagnosis for effective management. Clinical presentation can be variable, and radiological and microbiological evaluations are essential to guide therapy. This study aimed to analyze the clinicopathological and radiological characteristics of infective bone lesions in a tertiary care hospital setting. Material and Methods: A prospective observational study was conducted, including 100 patients with clinically suspected infective bone lesions. Demographic and clinical data were recorded. All patients underwent radiological evaluation (X-ray, CT, or MRI) and histopathological and microbiological analysis of biopsy or surgical specimens. Associations between clinical, radiological, and microbiological findings were analyzed using chi-square or Fisher’s exact test, with p < 0.05 considered statistically significant. Results: The mean age of patients was 38.5 ± 16.2 years, with 60% males and 62% from rural areas. Diabetes mellitus was present in 22%, and 36% had a history of trauma (Table 1). Clinically, localized pain (92%) and swelling (78%) were most common; sinus formation occurred in 27% (Table 2). Radiologically, osteolytic lesions (48%) and cortical destruction (42%) predominated, with soft tissue involvement in 40%; CT/MRI was performed in 52% of cases (Table 3). Histopathology confirmed infection in 85% of patients, with culture positivity in 68%. The most frequent pathogen was Staphylococcus aureus (42%), followed by Streptococcus spp. (12%), Pseudomonas spp. (6%), and fungal isolates (8%); 32% had negative cultures (Table 4).Conclusion: Infective bone lesions exhibit diverse clinical, radiological, and microbiological profiles. Early recognition of common clinical and radiological features, combined with histopathological and microbiological evaluation, is crucial for accurate diagnosis and effective management.
Research Article
Open Access
Clinical Profile of Dermatological Manifestations in Patients with Metabolic Syndrome: A Cross-Sectional Study
Samba Raju Vallala,
Komire Jayasree
Pages 157 - 162
View PDF
Abstract
Background: Metabolic syndrome is a cluster of interrelated risk factors including central obesity, dyslipidemia, hypertension, and impaired glucose tolerance. Dermatological manifestations often serve as early clinical indicators, yet their profile in patients with metabolic syndrome remains underexplored. Aim: To evaluate the spectrum and associations of dermatological manifestations among patients with metabolic syndrome. Methods: This cross-sectional study included 100 patients diagnosed with metabolic syndrome based on standard criteria. Detailed demographic, clinical, and biochemical data were recorded. All participants underwent comprehensive dermatological examination. Statistical analysis was performed to assess associations between skin findings and individual components of metabolic syndrome, with significance set at p < 0.05. Results: The mean age of participants was 49.6 ± 10.8 years, with a male predominance (58%). The most common dermatological manifestation was acanthosis nigricans (48%), followed by skin tags (41%), xanthelasma palpebrarum (12%), and psoriasis (10%). Less frequent findings included seborrheic keratosis (8%), palmoplantar hyperkeratosis (6%), ichthyosis vulgaris (4%), alopecia androgenetica (3%), urticaria (2%), and lichen planus (2%). Acanthosis nigricans demonstrated a significant association with obesity (p < 0.05). Hypertriglyceridemia and low HDL cholesterol were correlated with skin tags and xanthelasma, while psoriasis and seborrheic keratosis were observed more commonly among hypertensive patients. Impaired fasting glucose and diabetes were frequently linked with acanthosis nigricans and psoriasis. Conclusion: Acanthosis nigricans and skin tags were the most frequent cutaneous markers in patients with metabolic syndrome. Recognition of such dermatological manifestations may facilitate early detection and intervention in individuals at risk of cardiometabolic complications.
Research Article
Open Access
A Clinical Profile of Chronic Suppurative Otitis Media and Its Complications in a Tertiary Care Hospital
Gaddala Sruthi ,
Pabbu Yadagiri Goud
Pages 151 - 156
View PDF
Abstract
Background: Chronic suppurative otitis media (CSOM) is a persistent infection of the middle ear and mastoid cavity, often associated with recurrent discharge and varying degrees of hearing loss. Despite advances in medical and surgical care, it remains a significant cause of morbidity in developing countries, particularly due to its complications. Aim: To evaluate the demographic characteristics, clinical profile, and complications of CSOM in patients presenting to a tertiary care hospital. Methods: A cross-sectional observational study was conducted on 100 patients diagnosed with CSOM. Detailed history, clinical examination, and audiological evaluation were performed. The disease was categorized into tubotympanic and atticoantral types. Complications were documented and analyzed descriptively. Results: The mean age of presentation was 27.4 years, with the majority of patients in the 11–30 year age group (52%). Males (58%) were more affected than females (42%). Ear discharge was the universal symptom (100%), followed by hearing loss (88%), earache (36%), tinnitus (18%), and vertigo (10%). The tubotympanic type was more common (68%) compared to the atticoantral type (32%). Hearing loss was predominantly conductive (72%), while 16% had mixed loss. Complications occurred in 22% of cases, with mastoiditis (9%) being the most frequent, followed by facial nerve palsy (5%), labyrinthitis (3%), intracranial abscess (3%), and meningitis (2%). Conclusion: CSOM predominantly affects young adults and is commonly associated with conductive hearing loss. Despite being largely preventable, complications remain prevalent, highlighting the need for early diagnosis, timely treatment, and improved awareness.
Research Article
Open Access
A Comparative Study of Multiple Antibiotic Resistant To Infections in Diabetic versus Nondiabetic Wounds in a Tertiary Care Hospital
Rakesh Mahesh ,
Syed Mohsin Ahmed,
Kishore Mavinakattekoppal Sreekantaiah
Pages 144 - 150
View PDF
Abstract
Background: The prevalence of diabetes has been increasing worldwide1.Among the total of the diabetic population, about 15% to 20% patients have been experiencing a Multidrug-resistant organisms (MDROs) in their lifetime2. Around 15% to 27% of patients require either minor/major amputations of their lower limbs. This demonstrates that diabetic patients are highly susceptible to MDROs their lifetime. People who are healthy are at low risk for developing MDRO infections. Aims and Objectives: This study aims to compare the resistance pattern to multiple antibiotics used in wound infection among diabetic and non-diabetic patients and also to assess most common organism causing wound infection. Materials and Methods: A total of 100 diabetic and non-diabetic patients with infected wounds aged between 18 and 89 years, attending the surgical outpatient department or admitted to surgical wards, having positive wound cultures were enrolled in the study after obtaining consent. Other laboratory reports such as haemoglobin percentage, random blood sugar (RBS), and total leukocyte count were noted. Data obtained were analysed using SPSS.v.20. Results: The diabetics (n = 40) had significantly higher RBS levels [186.86 (±75.37) mg/dl] compared to non-diabetics (n = 40) [93.87 (±41.59) mg/dl] (P < 0.0001). The diabetics had significant history of previous antibiotic usage in the past (72%), compared to non-diabetics (58%) (P = 0.003). Gram-negative bacilli most commonly infected diabetics compared to Gram-positive cocci in non-diabetics. Staphylococcus aureus (67%) was the most commonly isolated organism among both diabetics (24%) and non-diabetics (43%). Pseudomonal infections were higher in diabetics (22%) compared to non-diabetics (10%). Diabetics (87%) showed significantly higher prevalence of resistance to multiple antibiotics compared to non-diabetics (69%) (P = 0.002). Antimicrobial agent most frequently reported sensitive, and resistant to most infection causing organisms was amikacin (75%) and ampicillin (93%), respectively, in both groups. Conclusion: Both Diabetic and Non-Diabetic patients were showing resistance to Ciprofloxacin, sensitivity to Imipenem. But incidence of multiple drug resistance is higher in Diabetics which is statistically insignificant. S. aureus is the most commonly isolated organism among both groups.
Research Article
Open Access
A Prospective Observational Study to Assess the Antimicrobial Stewardship in Medical Intensive Care Unit in a Tertiary Care Hospital
Lakshmish Nagaraj ,
Kishore Mavikattekoppal Sreekantaiah,
Vikas L ,
Hemanth Kumar K H,
akshith N ,
Abhinav Prashanth
Pages 136 - 143
View PDF
Abstract
Background: Primary Objective: To assess the rational use of antibiotics in patients admitted to the Medical Intensive Care Unit (MICU) through antimicrobial stewardship (AMS). Secondary Objective: To evaluate the antimicrobial utilization pattern in the MICU. Methodology: This prospective, observational, questionnaire-based study was conducted over six months in the MICU of KR Hospital, Mysore, by the Department of Pharmacology in collaboration with the Department of General Medicine. A total of 150 patients aged >18 years, admitted or transferred to the MICU and prescribed antimicrobials, were included using purposive sampling. Patients were excluded if they had a stay <48 hours, discontinued antibiotics due to negative cultures or early resolution, or lacked consent. The study was conducted in three phases—Pre implementation, Implementation and Post implementation. During the observational phase, antimicrobial prescriptions were evaluated for appropriateness without any recommendations. In the Pre implementation phase, stewardship recommendations were made based on guidelines. The Post implementation phase assessed sustained prescribing behaviours without further interventions. Data were collected using a WHO-based antimicrobial stewardship questionnaire, including demographic details, comorbidities, lab results, antibiotic usage, and outcomes. Key indicators analysed included Days of Therapy (DOT), DOT per 1000 patient days (DOT/1000 PD), mean ICU/hospital stay, number of antibiotics per patient, mortality, and adverse drug reactions. Results: Of the 150 patients, 53.3% were male and 46.6% female. Most patients belonged to the 41–60 years age group, and the most frequent diagnoses were CKD with volume overload urosepsis (8%) and NS1-positive fever with thrombocytopenia (7.3%). Post- implementation analysis showed a reduction in DOT from 1434 to 1136 and DOT/1000 PD from 3175.24 to 2524.14, indicating improved antibiotic utilization. The number of empirical therapies reduced (38 to 25), while empirical plus lab-based therapy increased significantly (15 to 35), promoting culture-guided prescribing. Commonly prescribed antibiotics included ceftriaxone and piperacillin-tazobactam. DOT decreased for most antibiotics post-intervention except for meropenem and doxycycline. Though these changes were not statistically significant (p > 0.05), trends suggested a shift toward rational antibiotic use. The use of culture and sensitivity testing significantly increased from 9.4% to 24% (p = 0.015). De-escalation practices improved (12% to 24%), and escalation rates increased significantly (82.6% to 98.6%, p = 0.0007), indicating better response to clinical needs. A significant reduction in mortality (12% to 2.7%, p = 0.028) and increased ward transfers (88% to 97.3%) were observed post-intervention. Conclusion: This study demonstrates that antimicrobial stewardship interventions significantly improved the rational use of antibiotics in a tertiary care MICU. Reductions in empirical antibiotic use, improved culture-based prescribing, and enhanced clinical outcomes, including reduced mortality, support the need for structured AMS programs. Despite limitations such as a single-center scope and short duration, the findings underscore AMS as a critical tool in combating antimicrobial resistance and improving patient outcomes in critical care settings.
Case Report
Open Access
Multilevel Cervical Corpectomy in Rheumatoid Arthritis with Cervical Myelopathy and Osteoporosis
Hrishikesh Patil ,
Vraj Shah ,
Raviraj Patel ,
Mohit Sai Teja,
Chinmay Tiwari ,
Salim Lad
Pages 132 - 135
View PDF
Abstract
Background: Corpectomy is a surgical intervention that involves resecting part or all of a vertebral body to alleviate pressure on neural structures. This procedure is typically indicated in patients with degenerative spinal disorders, neoplasms, or trauma. We report a rare case involving a male patient who underwent a C4–C5 corpectomy and cervical stabilization using a C5–C6 3D expandable cage. The patient suffered from extensive cervical spine degeneration secondary to rheumatoid arthritis, accompanied by cervical myelopathy and osteoporosis. Imaging revealed critical spinal canal stenosis, highlighting a high risk for tetraplegia. This report illustrates a surgical approach that effectively managed the pathological features, emphasizing the importance of individualized surgical planning and interdisciplinary collaboration for optimal outcomes.
Research Article
Open Access
The Impact of Lifestyle Factors on Menstrual Irregularities in Adolescent Girls: A Prospective Observational Study
T. Kumuda ,
Perumalla Ratna kumari,
Mulla Jaitun Ruman
Pages 124 - 131
View PDF
Abstract
Background: Menstrual irregularities are highly prevalent among adolescent girls, affecting their physical, mental, and social well-being. While medical causes are known, the influence of modifiable lifestyle factors in the Indian context remains underexplored. To determine the prevalence of menstrual irregularities and to evaluate their association with key lifestyle factors, including Body Mass Index (BMI), diet, sleep habits, and social media usage. Methods: A prospective observational study was conducted over six months (January–June 2025) in the Department of Obstetrics and Gynaecology at Government General Hospital, Kurnool. A total of 91 adolescent girls (aged 11–19 years) presenting with menstrual complaints were enrolled using a random sampling method. Participants with medical or bleeding disorders were excluded. Data were collected using a pre-tested structured questionnaire covering demographic details, menstrual history, and lifestyle factors (diet via FFQ, sleep patterns, screen time, and BMI). Ultrasonography was performed to detect pathologies like polycystic ovarian syndrome (PCOS). Data were analysed using SPSS version 22, employing descriptive statistics and Chi-square tests, with a p-value <0.05 considered statistically significant. Results: The mean age of participants was 15.8 (±2.1) years. The most common menstrual irregularity was an irregular cycle (61.5%, n=56), followed by menorrhagia (20.8%, n=19), amenorrhea (14.2%, n=13), and polymenorrhagia (3.2%, n=3). PCOS was identified in 8.8% (n=8) of cases. A strong association was found between lifestyle factors and menstrual irregularities. High junk food consumption (n=37) and excessive social media usage (n=46) were most prevalent in the 17-19 age group. Sleep disturbances were reported by 15.4% (n=14) of participants. The majority of the study population belonged to lower socio-economic classes (Class IV: 67%, n=61).Conclusion: Menstrual irregularities, particularly irregular cycles, are common among adolescent girls. Modifiable lifestyle factors, including poor diet, high social media usage, and sleep disturbances, show a significant association with these irregularities. There is a pressing need for targeted health education and early lifestyle interventions, especially in lower socio-economic groups, to improve adolescent menstrual health and prevent long-term gynecological complications.
Research Article
Open Access
Clinical Profile and In-Hospital Outcomes of Acute Decompensated Heart Failure in a Tertiary Care Center: A Cross-Sectional Observational Study
Rohitaswa Mandal ,
Ramanuj Bhattacharya ,
Paramita Bhattacharya ,
Manuj Kumar Sarkar,
Sourabh Dutta
Pages 115 - 123
View PDF
Abstract
Background: Acute decompensated heart failure (ADHF) is a major contributor to hospital admissions and cardiovascular mortality, particularly in resource-limited regions such as India. Despite its rising prevalence, data on the clinical profile and in-hospital outcomes of Indian patients remain limited. Objectives: To assess the clinical characteristics, aetiological factors, and short-term outcomes of patients admitted with ADHF, with a focus on differences between reduced and preserved ejection fraction. Methods: This cross-sectional observational study included 79 patients admitted with ADHF to a tertiary centre in Kolkata between September 2019 and January 2021. Patients were stratified into HFrEF (<40%) and HFpEF (>50%) groups. Demographic, clinical, and laboratory profiles were recorded, and associations with mortality and hospital stay were analysed. Results: Of the 79 patients, 50 (63.3%) had HFrEF and 29 (36.7%) had HFpEF. The mean age was 67.2 ± 6.4 years, and 60.8% were male. Shortness of breath was universal (100%). HFrEF was significantly associated with older age (p = 0.03), coronary artery disease (p = 0.012), dilated cardiomyopathy (p = 0.003), pneumonia (p = 0.002), iron deficiency anaemia (p = 0.045), and prior chronic heart failure (p = 0.001). Overall in-hospital mortality was 17.7%, higher in HFrEF (26%) than HFpEF (3.5%; p = 0.02). Independent predictors of mortality were advanced age (p = 0.013), dilated cardiomyopathy (p < 0.001), and reduced LVEF (p = 0.03). The Delta Neutrophil Index was elevated in non-survivors and in patients with pneumonia (p < 0.001), while NT-proBNP, though raised, was not predictive of mortality (p = 0.13). Conclusion: HFrEF accounts for the majority of ADHF admissions in this cohort and is associated with substantially higher in-hospital mortality. Advanced age, dilated cardiomyopathy, and reduced LVEF were significant predictors of death, while the Delta Neutrophil Index emerged as a novel prognostic marker. These findings highlight the need for early risk stratification and context-specific management strategies for ADHF in India.
Research Article
Open Access
A Study of Functional Outcome of Cemented Versus Uncemented Bipolar Hemi-Arthoplasty in Patients above 65 Years of Age with Fractures Neck of Femur
Venlatraman G ,
Razia A.R ,
Ganesh Babu N
Pages 110 - 114
View PDF
Abstract
Background: The occurrence of femoral neck fractures is quite common in elderly individuals and poses a major public health issue. Bipolar hemiarthroplasty has become a standard surgical treatment for elderly patients (aged over 65 years) with displaced fractures of the femoral neck. The Aim of this study is to compare the functional outcomes of cemented versus uncemented bipolar hemiarthroplasty in patients older than 65 with femoral neck fractures. Materials and Methods: Following IEC approval, this prospective comparative study was carried out among individuals meeting inclusion criteria in the Department of Orthopaedics at a tertiary care hospital over three years. A total of 26 patients were enrolled and randomly assigned to two groups: Group A (Cemented Bipolar Hemiarthroplasty) and Group B (Uncemented Bipolar Hemiarthroplasty). Functional outcomes were measured using the Modified Harris Hip Score at discharge, and at 6 weeks, 3 months, and 6 months post-surgery. Data analysis was performed using SPSS version 21.00.Results: Out of 26 patients 13 cases of cemented & 13 cases of uncemented bipolar prosthesis fixation done, whose mean age was 69.83 ± 3.2 years, 69.6 ± 4.1 years in group A and Group B respectively. The Modified Harris Hip Score at discharge was 90.2 ± 1.32 in cemented bipolar hemiarthroplasty group and 87.9 ± 1.24 in uncemented bipolar hemiarthroplasty group which improved at follow-up. Conclusion: This study was able to shows that both uncemented & cemented bipolar hemiarthroplasty had a good functional outcome with minimal variations.
Research Article
Open Access
Incidence of Parotid Tail Involvement in Oral Cavity Carcinoma
Pooja Kaushik ,
Arun Parkash Sharma,
Md. Ekbal Ansari,
Raphella Khan ,
Sanajeet Kumar Singh,
Deepti Agarwal ,
Seema Monga ,
Rubeena Mohroo
Pages 99 - 109
View PDF
Abstract
Background: Oral cavity site includes lips, tongue, gingiva, hard palate, buccal mucosa and floor of the mouth. Oral cavity cancers (mostly squamous cell carcinoma) commonly metastasize to cervical lymph nodes. The parotid gland tail lies in close anatomical relation to the posterolateral buccal mucosa, retromolar trigone and lower alveolus; involvement of this may be by direct extension, lymphatic metastasis in the intraparotid or periglandular nodes, or even by skip metastasis.Presently reported incidence of parotid tail involvement varies between series hence the need for a clear prospective estimate with clinicopathological correlates will be useful to guide management and to develop guidelines so as to include parotid tail resection in all cases to reduce the risk of recurrence and improving the survival rate. Aims & Objectives Aim: To estimate the incidence of parotid tail involvement in patients undergoing surgery for oral cavity cancers.Objectives:1.To identify clinicopathological predictors like size, site and type of primary lesion associated with parotid tail involvement if any.2. To correlate the grade of primary lesion with the parotid tail involvement.3. To correlate the demographic profile of patients with the involvement of parotid tail. Methodology Study Type: Prospective observational single centre study. Duration: 18 months from November 2022 to May 2024 at a Tertiary care Head & Neck and Oncology Centre. Observations & Result: In our study of 40 pateints with various stages of oral cavity cancer who underwent primary surgical excision no involvement of the tail of the parotid was detected histo-pathologically. Conclusions: Incidence of involvement of parotid tail in patients with oral cavity squamous cell carcinoma is very low and hence its preservation i.e. non resection to limit the morbidity of marginal mandibular nerve should be considered strongly.
Research Article
Open Access
Study of Interorbital Distance as a Predictor of Gestational Age in the Second and Third Trimesters and Its Correlation with Femur Length
Aqra Ali ,
Tarim Usman ,
Jeevan Prakash ,
Areeb Ali Siddiqui
Pages 93 - 98
View PDF
Abstract
Background: Accurate assessment of gestational age (GA) is vital for optimal obstetric care. Conventional fetal biometric parameters, including femur length (FL), biparietal diameter (BPD), and head circumference (HC), may be limited in cases of uncertain maternal dates, abnormal fetal position, or growth restriction. Interorbital distance (IOD), measuring the distance between fetal orbits, has been proposed as a complementary parameter for GA estimation. Objective: To evaluate IOD as a predictor of GA in the second and third trimesters and its correlation with FL. Materials and Methods: A cross-sectional study was conducted on 270 singleton pregnancies between 13 and 36 weeks of gestation. Fetal measurements, including IOD, FL, BPD, and HC, were obtained via ultrasonography. Pearson’s correlation assessed associations between IOD and other fetal parameters. Multiple linear regression determined independent predictors of GA. Statistical significance was set at p < 0.05. Results: Mean maternal age was 34.61 ± 5.32 years. Mean fetal measurements were FL 4.75 ± 1.39 cm, IOD 0.44 ± 0.09 cm, BPD 6.48 ± 1.59 cm, and HC 24.40 ± 5.74 cm. IOD correlated strongly with GA (r = 0.964) and other parameters: FL (r = 0.959), BPD (r = 0.961), and HC (r = 0.969), all p < 0.001. Regression analysis showed FL, BPD, and HC independently predicted GA (p < 0.01), while IOD was not independent (p = 0.532). Conclusion: IOD shows strong correlations with GA and conventional fetal parameters, supporting its role as a complementary measure in fetal biometry. Its use may improve GA estimation when standard parameters are limited.
Research Article
Open Access
Obstetric and Gynecological Outcomes in Women with Polycystic Ovary Syndrome: A Prospective Study in a North Indian Tertiary Care Hospital
Saishna Gupta ,
Divya Deepak ,
Kriti Narang ,
Tanya Khajuria ,
Sushain Kalsotra
Pages 83 - 92
View PDF
Abstract
Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, associated with adverse reproductive and obstetric outcomes. Despite increasing recognition, limited data from North India examine its real-world implications in pregnancy. Objectives: To evaluate obstetric and gynecological outcomes in women with PCOS attending a tertiary care hospital in North India. Methods: A prospective observational study was conducted from January 2025 to June 2025, including 520 women diagnosed with PCOS using Rotterdam criteria. Maternal demographics, obstetric complications, mode of delivery, and neonatal outcomes were recorded. Results: The mean age was 28.8 years, and mean BMI was 29.3 kg/m². Infertility was observed in 51.2% of women. Miscarriage occurred in 52.3% and preterm births in 53.5%. Gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) were seen in 45.6% and 51.2% respectively. Cesarean section rate was 48.3%, and 52.1% of neonates required NICU admission. Conclusion: Women with PCOS demonstrated significantly higher risks of infertility, miscarriage, preterm birth, GDM, PIH, and cesarean delivery. The findings highlight the need for multidisciplinary management and preconception counseling in this population
Research Article
Open Access
From Indication to Immobilization: Insights into Hip Spica Use Among Paediatric Orthopaaedic Surgeons in India
Shravan YC ,
Dev Anand Galagali,
Mahesh M
Pages 77 - 82
View PDF
Abstract
Background: Hip spica casting remains a cornerstone in the management of paediatric hip pathologies across India. Despite its widespread use, variations in technique, materials, and setup persist among practitioners. Objective: To evaluate current practices among paediatric orthopaedic surgeons in India regarding hip spica application, including indications, materials used, and the use of spica tables and connecting bars. Methods: A cross-sectional survey was conducted among 40 paediatric orthopaedic surgeons across India who had completed at least one year of fellowship training. Data were collected via online questionnaires and telephonic interviews, focusing on spica application techniques, materials, and setup preferences. Results: Trauma-related indications were universal (100%), followed by developmental dysplasia of the hip (90%). Hybrid casts were preferred by 78% of respondents, while only 5% used fiberglass exclusively. Spica tables were available to 45% of surgeons, whereas others used customized setups or wooden planks. A connecting bar was used by 70% of respondents, primarily for older, heavier, or hyperactive children. The average time for spica application was 27 minutes, with hybrid casts requiring the least time. Conclusion: Hybrid casting and cost-effective setups such as wooden planks are widely adopted across India. The use of connecting bars is selective, based on patient characteristics. These findings offer valuable insights for standardizing training and optimizing resource use in paediatric orthopaedic practice.
Research Article
Open Access
Comparision of Open Vs Laparoscopic Repair of Ventral Hernia- A Single Centre Experience
Krishna Kumar T K,
Tejas A P,
Prajwal Shastry
Pages 71 - 76
View PDF
Abstract
Background: Ventral hernia is a common surgical condition managed either by open mesh repair or laparoscopic repair. While laparoscopic repair has gained popularity worldwide for its minimally invasive benefits, open repair remains widely practiced in India due to cost constraints and limited availability of laparoscopic expertise. Objective: To compare the outcomes of open versus laparoscopic repair of ventral hernia in terms of intraoperative parameters, postoperative complications, recovery outcomes, and short-term recurrence. Methods: A total of 80 patients with primary or incisional ventral hernia were enrolled and allocated into two groups: open repair (n=40) and laparoscopic repair (n=40). Baseline demographic and clinical characteristics were recorded. Outcomes compared included operative time, intraoperative blood loss, postoperative pain (VAS), wound complications, length of hospital stay, return to normal activity, and recurrence at 6-month follow-up. Statistical analysis was performed using SPSS v20.0, with p<0.05 considered significant. Results: Baseline characteristics were comparable between groups. Laparoscopic repair required significantly longer operative time (120 ± 30 vs. 95 ± 25 minutes, p<0.001), but had lower blood loss (80 ± 40 vs. 150 ± 60 mL, p<0.001). Wound infection was significantly reduced in the laparoscopic group (5% vs. 22.5%, p=0.01). Patients undergoing laparoscopic repair had faster recovery, with shorter mean hospital stay (2.8 ± 1.1 vs. 5.2 ± 1.8 days, p<0.001), earlier return to normal activity (7.5 ± 3.0 vs. 18.2 ± 5.0 days, p<0.001), and reduced analgesic requirement. Seroma, ileus, and pulmonary complications were comparable. Recurrence at 6 months was low and not significantly different (2.5% vs. 7.5%, p=0.62).Conclusion: Laparoscopic repair of ventral hernia, though technically more demanding and associated with longer operative times, provides superior short-term outcomes compared to open repair, with reduced wound complications, faster recovery, and similar recurrence rates. It should be considered the preferred option in suitable patients where expertise and facilities are available.
Research Article
Open Access
Diagnostic Challenges and Management of Stump Appendicitis- A Experience from Tertiary Care Centre
Krishna Kumar T K,
Tejas A P ,
Prajwal Shastry
Pages 65 - 70
View PDF
Abstract
Background: Stump appendicitis is a rare delayed complication of appendectomy, defined as inflammation of residual appendiceal tissue. It often presents a diagnostic challenge, leading to delayed treatment and increased morbidity. Methods: This retrospective observational study was conducted at a tertiary care center. A total of 60 patients diagnosed with stump appendicitis were included. Data regarding demographics, clinical presentation, diagnostic modalities, operative findings, management, and outcomes were analyzed. Statistical analysis was performed using SPSS version 25.0, with p<0.05 considered significant. Results: The mean age was 34.8 years, with male predominance (63.3%). Right iliac fossa pain was present in all patients, with fever (70%) and nausea/vomiting (56.7%) being common associated symptoms. Ultrasonography detected stump appendicitis in 53.3% of cases, while CT abdomen had a sensitivity of 93.3% (p<0.01). Residual stump length >5 mm was found in 46.7% of cases and was significantly associated with perforation (p=0.03). Laparoscopic completion appendectomy (63.3%) was associated with shorter hospital stay (5.1 ± 1.3 days vs 7.8 ± 2.1, p<0.001) and lower surgical site infections (7.9% vs 27.3%, p=0.04) compared to open surgery. There was no mortality in the series. Conclusion: Stump appendicitis should be suspected in patients with right iliac fossa pain and prior appendectomy. CT abdomen is the investigation of choice, and leaving a stump <5 mm during the initial appendectomy can prevent recurrence. Laparoscopic completion appendectomy offers superior outcomes compared to open surgery and should be preferred where feasible.
Research Article
Open Access
Prospective Study Comparing Laparoscopic Repair of Perforated Peptic Ulcer and Conventional Laparotomy
Krishna Kumar T K,
K Tirumala Prasad,
Juluri Srinivas ,
Satya Kumar
Pages 58 - 64
View PDF
Abstract
Background: Perforated peptic ulcer (PPU) remains a surgical emergency associated with high morbidity and mortality. While laparoscopic repair has gained acceptance for elective upper gastrointestinal procedures, its role in PPU is still debated. Objective: To compare laparoscopic repair with conventional laparotomy for PPU in terms of post-operative outcomes. Methods: A prospective randomized study was conducted at Tirumala Hospitals, Vizianagaram, Andhra Pradesh, from June 2011 to June 2013. Seventy-one patients with PPU were randomized to undergo either laparoscopic repair (n=34) or open laparotomy (n=37). After intraoperative exclusions, 62 patients were analyzed (laparoscopy: 30, open: 32). Post-operative outcomes were compared, including pain scores, wound infection, sepsis, chest infection, time to oral feeds, hospital stay, return to normal activity (RTNA), and mortality. Results: Mean age was significantly lower in the laparoscopy group (34.7±14.1 vs. 45.6±12.6 years, p<0.05). Post-operative pain was significantly lower in the laparoscopic group on day 1 (p=0.013) and day 5 (p=0.002). Wound infection was higher in the open group (25% vs. 3.3%, p=0.016). Mean time to oral feeds was shorter in the laparoscopic group (4.0±1.1 vs. 6.4±0.9 days, p<0.001). Mean hospital stay was shorter (8.4±2.9 vs. 11.4±3.7 days, p=0.001), and RTNA was faster (8.1±2.6 vs. 12.9±2.9 days, p<0.001) in the laparoscopic group. Mortality occurred in two patients (6.3%) in the open group, with none in the laparoscopic group. Conclusion: Laparoscopic repair of PPU is a safe and effective alternative to laparotomy, offering benefits of reduced post-operative pain, fewer wound infections, shorter hospital stay, and faster recovery. Wider adoption may be limited by surgical expertise and cost factors
Research Article
Open Access
External Validation of IOTA Simple Rules and ADNEX Model for Risk Stratification of Adnexal Masses: A Multicentre Study from India
Nupur Ghosh ,
Sayani Das ,
Kajal Kumar Patra,
Kaustav Halder ,
Geetanjali Koley
Pages 50 - 57
View PDF
Abstract
Background: Adnexal masses are a frequent diagnostic challenge in gynaecology, and accurate differentiation between benign and malignant lesions is critical for surgical planning. The International Ovarian Tumour Analysis (IOTA) Simple Rules and the Assessment of Different Neoplasia in the adnexa (ADNEX) model are validated tools in European populations, but external validation in Indian women is limited. Objectives: To validate the diagnostic performance of the IOTA Simple Rules and ADNEX model in Indian women with adnexal masses, and to assess inter-observer reproducibility and calibration of the ADNEX model. Methods: In this multicentre prospective study (Burdwan and Barasat Government Medical Colleges, January–December 2024), 300 women with adnexal masses scheduled for surgery underwent standardized ultrasonography. Masses were evaluated using IOTA Simple Rules and the ADNEX model (with CA-125). Histopathology served as the gold standard. Diagnostic accuracy was assessed using sensitivity, specificity, predictive values, and AUC. Subgroup analyses were performed for menopausal status. Inter-observer agreement for IOTA was evaluated using Cohen’s kappa. Calibration of ADNEX was tested against observed malignancy rates. Results: Histopathology confirmed 220 benign (73.3%) and 80 malignant (26.7%) tumours. IOTA Simple Rules achieved sensitivity 88.8%, specificity 80.0%, and AUC 0.84 (95% CI: 0.79–0.89). ADNEX showed higher sensitivity (91.3%), specificity (85.5%), and AUC 0.92 (95% CI: 0.88–0.95). Subgroup analysis demonstrated better performance in postmenopausal (ADNEX AUC 0.94) compared with premenopausal women (AUC 0.89). Inter-observer agreement for IOTA was substantial (κ = 0.77). ADNEX calibration aligned closely with observed outcomes (7% low-risk, 29% intermediate, 70% high-risk).Conclusion: Both IOTA Simple Rules and the ADNEX model are accurate tools for evaluating adnexal masses in Indian women. ADNEX provides superior discrimination and reliable calibration, particularly in postmenopausal women, supporting its use in routine clinical practice.
Research Article
Open Access
Systemic Inflammatory Markers as Predictors of Preeclampsia: A Cross-Sectional Analysis of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios
Swetha N ,
M P A Sai Lakshmi
Pages 40 - 49
View PDF
Abstract
Background: Preeclampsia (PE) is a hypertensive disorder of pregnancy that complicates 2–8% of gestations and remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Systemic inflammatory response (SIR) markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), derived from complete blood counts (CBC), have been proposed as simple and cost-effective predictors of PE. This study aimed to evaluate NLR, PLR, platelet count, and red cell distribution width (RDW) in women with PE compared to gestationally matched normotensive controls. Materials and Methods: A cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bengaluru, from January 2021 to July 2022. Eighty-four pregnant women beyond 20 weeks of gestation were enrolled, including 42 with PE and 42 normotensive controls. Sociodemographic and clinical details were collected, and 2 mL of peripheral venous blood was analyzed using an automated hematology analyzer (Sysmex XN-1000, Transasia). NLR and PLR were calculated, and comparisons between groups were made using Student’s t-test and Chi-square test, with p <0.05 considered statistically significant. Results: The mean age of PE patients was significantly higher than controls (27.17 ± 4.29 vs. 24.79 ± 3.38 years, p <0.001). Primigravidity was more frequent among PE women (52.4% vs. 33.3%). Mean platelet count was lower in the PE group (2.34 ± 0.79 lakh/µL) compared to controls (2.48 ± 0.74 lakh/µL), though not statistically significant. NLR was marginally higher in PE (4.81 ± 3.37) versus controls (4.24 ± 1.97), while PLR was slightly lower (112.02 ± 60.30 vs. 119.37 ± 43.87), with no significant intergroup differences. Within PE subgroups, PLR was significantly reduced in severe PE (84.50 ± 41.96) compared to mild PE (125.79 ± 63.91, p = 0.03). Obstetric outcomes showed higher rates of intrauterine growth restriction (IUGR) in PE (31.0% vs. 4.8%, p = 0.04) and greater need for emergency cesarean section (71.4% vs. 7.1%). NICU admissions were more frequent among neonates of PE mothers (38.1% vs. 21.4%), though not statistically significant (p = 0.09). Conclusion: Although NLR and PLR did not differ significantly between groups, trends toward elevated NLR and reduced PLR in severe PE suggest their potential role as inexpensive, rapid, and accessible inflammatory markers in predicting disease severity. Larger multicenter studies with standardized cut-off values are warranted to validate their diagnostic and prognostic utility, particularly in low-resource settings.
Research Article
Open Access
A Comparative Study of Graft Uptake in Type 1 Tympanoplasty with and Without Autologous Platelet-Rich Fibrin
G V V S S S Balakrishna Raju,
K. Siri Krishna,
M. Bhargavi
Pages 35 - 39
View PDF
Abstract
Background: Chronic suppurative otitis media (CSOM) frequently leads to tympanic membrane perforations and conductive hearing loss. Type 1 tympanoplasty is a standard surgical solution, and Autologous Platelet-Rich Fibrin (PRF) has been proposed to enhance healing and graft uptake. Objective: To compare graft uptake rate and hearing outcomes following Type 1 tympanoplasty with and without autologous PRF. Methods: Forty patients (aged 12–45 years) with inactive mucosal CSOM (dry ears ≥6 weeks) were randomized: Group 1 (n=20, PRF), Group 2 (n=20, no PRF). Both groups underwent underlay type I tympanoplasty via postauricular approach, using temporalis fascia. PRF (10 ml blood, centrifuged at 2,700 rpm, 12 min) was placed over the graft in Group 1. Main outcomes were graft uptake at 3 months and hearing gain (≥10 dB by pure tone audiometry). Results: Graft uptake was significantly better with PRF: success in 100% (20/20) vs. 80% (16/20) without PRF (p = 0.03). Hearing improvement ≥10dB occurred in 90% (PRF) and 70% (no PRF) (p = 0.236). No complications related to PRF. Conclusion: PRF use in Type 1 tympanoplasty significantly enhances graft uptake and trends towards better hearing results. PRF is safe, economical, and easily introduced into routine tympanoplasty
Research Article
Open Access
Osteosarcoma of the Jaw: Still in a Pool of Diagnostic and Treatment Dilemma
Ritik Bansal ,
Anjani Gupta ,
Amol Bansal
Pages 27 - 34
View PDF
Abstract
Background: Osteosarcoma of the jaw (OSJ) is a less common malignant mesenchymal-origin tumor that represents less than 10 percent of all cases of osteosarcoma. In comparison with its long-bone counterpart, OSJ is less progressive, less likely to metastasize, and has a relatively more favorable outcome. Its diagnosis and treatment, however, remains a source of major dilemma. Clinically, the OSJ presents with swelling, pain, tooth movement, or paraesthesia, symptoms that may resemble the appearance of odontogenic lesions or benign lesions of the jaw and lead to a delay in diagnosis. The radiographic appearance is non-specific and the typical sunburst appearance is rarely noted in the jaws. Histopathological heterogeneity also makes it more difficult to differentiate with other sarcomas, and molecular and genetic markers are promising but not adopted in practice yet. Tumor-free radical excision of the tumor is the mainstay of treatment. However, the fact that most critical structures are close to each other limits achievement of maximum excision in the maxillofacial skeleton leading to recurrence. Chemotherapy has been well established in long-bone osteosarcoma and is still debated in OSJ because of low chemosensitivity, and radiotherapy is applied sparingly despite radioresistance and local toxicity concerns. Regardless of the fact that overall survival is better than with appendicular osteosarcoma, high recurrence rates and functional impairment following radical surgery are critical issues. This review notes the diagnostic uncertainties and treatment uncertainties that still remain in relation to OSJ as well as the significance of multidisciplinary management. Innovative molecular biology, targeted therapy, and biomarker development promises the future, but the additional large-scale and multicentric studies are necessary to develop the standard diagnostic and treatment protocols.
Research Article
Open Access
Sleeping Pattern in Students of a Medical College in Odisha and Their Association with Usage of Digital Devices: A Cross Sectional Study
Shradha Suman ,
Nupur Pattanaik ,
Swapnesh Mishra ,
Anshuman Pattanaik
Pages 23 - 26
View PDF
Abstract
Background: Medical students carry a large academic load which could potentially contribute to poor sleep quality above and beyond already experienced by modern society. (1,2) Several potential causes have been identified for the poor sleep quality based on various studies that have taken place in the past and to add to all these factors is the constant increase in usage of digital devices among the recent batches who have joined medical colleges . According to one study, 96% of medical students in India own smart phones. (5) The study which was conducted aimed at finding an association between sleeping patterns of students in medical colleges and their association with usage of digital devices. A total of 350 students from 2020, 2021 and 2022 admission batches were asked to take a predesigned, pretested, semi structured self-administered questionnaire including information on socio demographic profiles and lifestyle questions, between the months of March 2024 to April 2025.The data collected was assessed and tabulated. The Pittsburgh Sleep Quality Index (PSQI) scale was applied along with Internet Addiction Test (IAT) and both the data were tabulated and compared. Statistical analysis was performed using SPSS version 23.0. It was observed that there is a very strong correlation between poor sleep quality and usage of digital devices especially prior to sleep,( p <0.01). This correlation increased with the increase in duration of usage. Scores of IAT were assessed in relation to sleep quality, showing that with an increased average total score of internet addiction (39.93 ± 10.36), there was an increasing occurrence of poor sleep quality (P < 0.05). A sizable percentage of students also wanted to adopt changes to improve their sleep quality because they understand its an essential lifestyle modification that will help them lead a better life.
Research Article
Open Access
Meibominan Gland Carcinoma: Outcomes after Multimodality Treatment
Anjani Gupta ,
Ritik Bansal ,
Amol Bansal
Pages 17 - 22
View PDF
Abstract
Background: Objective: To evaluate outcomes of multimodality therapy including neoadjuvantly administered chemotherapy, surgery, and radiation therapy for patients with meibomian gland adenocarcinoma. Methods: Retrospective observational evaluation was conducted for cases of 42 histopathologically proven meibomian gland carcinoma patients from a decade-old tertiary eye oncology center. Clinical staging was established through AJCC 8th edition. Individualized multimodality therapy was given that included neoadjuvant chemotherapy for advanced disease, surgical resection or exenteration, and adjuvant radiotherapy accordingly. Overall survival, disease-free survival, and eye salvage were the main outcomes. Results: Mean age was 58.6 years, and there was a female predominance (64.3%). Neoadjuvantly, chemotherapy was administered in 29 patients, with complete or partial response in 86.2%. Surgery was performed in 85.7% cases, and adjuvant radiotherapy was administered in 26.2%. Overall survival at a median follow-up of 46 months was 78.6%, disease-free survival was 66.7%, and eye salvage was established in 80.9%. Recurrence was observed in 16.7% cases, and lower disease-free survival was observed in T4 tumors in relation to T2 and T3. Kaplan–Meier analysis established superior survival in patients treated with multimodality therapy in relation to those treated by surgery. Conclusion: Multimodal therapy has positive oncologic and functional outcomes for meibomian gland carcinoma, allowing for improved survival and eye salvage in relation to conventional surgical therapy. These findings favor inclusion of systemic chemotherapy in treatment protocols for advanced disease, yet prospective trials in more patients are required for demonstration of long-term benefit.
Research Article
Open Access
Factors Affecting Outcome of Emergency Operated Surgical Patients during the COVID-19 Pandemic
Sandhya Iyer ,
Mansha Singh ,
Ashay Patil
Pages 10 - 16
View PDF
Abstract
Background: COVID-19 emerged as a viral pandemic in the year 2019. The practice and scope of surgery and medicine transformed radically as the virus spread across the world. There is an urgent need to understand the outcomes of COVID-19 infected patients who undergo surgery. A significant patient safety concern relates to the notion that asymptomatic carriers of the SARS-CoV-2 virus may deteriorate in respiratory function, subsequent to endotracheal intubation for general anaesthesia, and require prolonged mechanical ventilation, which has been associated with increased mortality in COVID-19 .We did a retrospective study to compare mortality in COVID 19 positive vs COVID 19 negative patients who underwent emergency surgery .This study was an effort to understand the impact of COVID 19 infection on morbidity and mortality of emergency operated surgical patients, with the hope that it will enable us to form guidelines for elective surgery in Covid positive patients. With the resurgence of cases in India this study is highly relevant and can provide valuable information for guiding emergency surgical care and resource allocation. Objective- To evaluate the influence of Covid 19 infection on post operative outcomes of emergency operated surgical cases. Patients and Methods- Historical patient records were analyzed of all patients undergoing emergency general surgery at a tertiary hospital in a metropolitan city in India from 11th March,2020 to 11th March,2022.Data was collected to compare post operative outcome in terms of mortality and morbidity in Covid positive and Covid negative patients. Results -300 Covid positive patients were operated for emergency surgery and these were compared with the 300 Covid negative patients undergoing emergency surgery. We observed that 108 (36%) of the Covid positive patients died in the hospital, while 189 were discharged after recovery. On the other hand, only 59 patients (19.67%) in the Covid negative group died, while 239 (79.67%) were discharged. Conclusion: Cardiac arrest, sepsis/shock, respiratory failure, pneumonia, acute respiratory distress syndrome, and acute kidney injury were more common in those with COVID-19 infection.
Research Article
Open Access
Epidemiological Trends and Risk Factors of Retinopathy of Prematurity in Preterm Infants: A Hospital-Based Study
S Ashwani Siddardha,
B Nishanth Naik
Pages 1 - 9
View PDF
