Research Article
Open Access
A Comparison of Post Operative Analgesic Efficacy between Dexamethasone and Dexmedetomidine as Adjuvant Of 0.2% Ropivacaine in USG-Guided Transversus Abdominis Plane Block In Total Laparoscopic Hysterectomy
Priyanka Tetarwal ,
Adarsh Chandra Swami
Pages 1048 - 1057
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Abstract
Background: Postoperative pain following laparoscopic surgeries can be comparable to or even more severe than pain after open procedures, necessitating early and effective multimodal analgesia. Although local anesthetics such as ropivacaine are widely used in ultrasound‑guided transversus abdominis plane (TAP) blocks, their analgesic duration is limited. Adjuvants like dexamethasone and dexmedetomidine have shown potential in prolonging peripheral nerve block analgesia, yet evidence comparing their efficacy in TAP blocks remains limited. Aim: To compare the postoperative analgesic efficacy of dexmedetomidine versus dexamethasone as adjuvants to ropivacaine in ultrasound‑guided TAP block among patients undergoing total laparoscopic hysterectomy. Methods: The sample size was calculated at 80% study power and α- error of 0.05. Assuming Standard Deviation (σ) of 202.31 minutes for time to first analgesic consumption in Ropivacaine group as found in the study by Singlaet al⁹, for minimum detectable mean difference of 120 minutes (M1- M2) in time to first analgesic consumption, 45 patients in each group were required as sample size. This was further enhanced and rounded off to 50 patients in each group in final sample size for present study, anticipating 10% attrition. Results: Baseline demographic characteristics were comparable between groups (p>0.05). Group B demonstrated a significantly longer duration of analgesia (691.64 ± 35.66 min) compared with Group A (583.44 ± 30.91 min; p<0.0001). Rescue analgesic consumption was significantly lower in Group B (87 ± 27.77 mg) than in Group A (145.50 ± 17.99 mg; p<0.0001). Patient satisfaction scores were higher in Group B (3.18 ± 0.69) compared with Group A (2.92 ± 0.52; p=0.0359). VAS scores, heart rate, systolic and diastolic blood pressure, and mean arterial pressure showed significant intergroup differences at 6 and 24 hours. The incidence of adverse effects—primarily nausea, vomiting, and mild over‑sedation—was similar between groups, with no statistically significant difference (p>0.05).Conclusion: Given the inconsistent analgesic duration of ropivacaine alone and the promising yet variably reported benefits of dexamethasone and dexmedetomidine, this study aims to determine the superior adjuvant for optimizing postoperative pain control in total laparoscopic hysterectomy patients receiving USG‑guided TAP block
Research Article
Open Access
Analysis of Factors Related To Failure of Endodontically Treated Teeth- A Cross-Sectional Study
Pages 1040 - 1047
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Research Article
Open Access
Evaluation of emergency laparotomy for ileocaecal emergencies a clinicopathology, prognosis, and outcome based study
Dr. Arshiya Fatima ,
Dr. Zaid Mazhar Syed ,
Dr. Syed Mohammed Sajjad Husayni
Pages 1034 - 1039
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Abstract
Background and Objectives: Ileocaecal emergencies, such as perforation, blockage, and inflammatory or viral diseases, continue to be prevalent causes of acute abdomen necessitating immediate laparotomy. These disorders are linked to considerable morbidity and mortality, particularly when diagnosis or management is postponed. The current study sought to assess the clinicopathological characteristics, surgical findings, postoperative complications, prognosis, and overall outcomes of patients receiving emergency laparotomy for ileocecal crises.
Materials and Methods: Most of the 60 patients were men, and the age group with the most cases was 30 to 50 years old. 95% of the symptoms were stomach pain, followed by vomiting (72%) and stomach distension (60%). The most common causes of ileocaecal emergencies were ileal perforation (40%), typhoid perforation (25%), intestinal blockage (20%), and tuberculosis-related pathology (15%). Loop ileostomy, resection with anastomosis, and primary closure were some of the most common methods used. 35% of patients had complications after surgery, with infections at the surgery site being the most prevalent. Results: Among the 60 patients, the majority were males, with the highest incidence in the 30–50-year age group. The most common presenting symptoms were abdominal pain (95%), vomiting (72%), and abdominal distension (60%). The leading causes of ileocaecal emergencies were ileal perforation (40%), typhoid perforation (25%), intestinal obstruction (20%), and tuberculosis-related pathology (15%). Primary closure, resection with anastomosis, and loop ileostomy were the commonly performed procedures. Postoperative complications occurred in 35% of patients, with surgical site infection being the most frequent. The overall mortality rate was 10%, primarily associated with delayed presentation, septic shock, and extensive peritoneal contamination. Early surgical intervention significantly improved outcomes. Conclusion: Ileocaecal emergencies remain significant clinical issues necessitating rapid diagnosis and quick surgical intervention to mitigate morbidity and mortality. Early presentation, vigorous resuscitation, and suitable surgical interventions are crucial factors influencing positive outcomes. Improving perioperative care and making early referral systems stronger can make patients' chances of getting better even better.
Research Article
Open Access
Expert Comparative Analysis of Outcomes in Total Knee Arthroplasty: Subvastus Approach Versus Medial Parapatellar Approach
Dr. S Reddi Hari Kumar ,
Dr. Bathina Sri Prabhav ,
Dr. Mohan Yadav Anna ,
Dr. S.P. Prasanth ,
Dr.B. Ramamurthy ,
Dr. D. Kranthi kumar
Pages 1029 - 1033
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Abstract
Background: Total Knee Arthroplasty (TKA) is a high-volume surgical intervention essential for alleviating pain and restoring mobility in patients with end-stage knee arthritis. Objective of evaluating and contrasting the outcomes of two surgical techniques—the subvastus approach and the medial parapatellar approach—in patients undergoing total knee replacement (TKR). Methods: This investigation was conducted as a prospective, comparative clinical trial. The study followed a non-randomized design, with 60 participants assigned to either group based on the operating surgeon’s assessment and preoperative consultation. Postoperative assessments focused on pain, range of motion, muscle strength, hospital stay duration, complication rates, and patient satisfaction, enabling a comprehensive comparison of the two approaches. Results: The subvastus group experienced significantly lower pain levels in the early postoperative period (at 1 and 3 months) compared to the medial parapatellar group. By the 6-month and 12-month follow-ups, pain levels were similar in both groups Postoperative range of motion (ROM) was assessed at the same intervals as pain levels. Group A (subvastus) showed significantly better early postoperative ROM at 1 and 3 months, while both groups showed similar ROM at 6 and 12 months. Conclusions: The study demonstrates that the subvastus approach provides notable short-term advantages compared to the medial parapatellar approach in total knee replacement (TKR). These findings indicate that while the subvastus approach may be particularly beneficial for individuals seeking a quicker recovery, both surgical techniques are safe and effective for achieving long-term success.
Research Article
Open Access
Nutritional Status and Anemia Among Hospitalized Adolescents: A Cross-Sectional Study at SVPPGIP and Sishu Bhaban, Cuttack
Dr Chinmay Barik ,
Dr. Dibya Ranjan Panda ,
Dr Satya Brata Thakur
Pages 1023 - 1028
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Abstract
Background: Adolescence (10–15 years) is a period of rapid growth, making it highly susceptible to nutritional imbalances, yet it remains an under-researched group in hospital settings. In India, the double burden of undernutrition and emerging overnutrition, coupled with high rates of anemia, significantly impacts morbidity. This study aimed to estimate the prevalence of undernutrition, overnutrition, and anemia in hospitalized adolescents and explore the association of these nutritional parameters with the primary admission diagnosis and the length of hospital stay (LOS). Methods: A cross-sectional study was conducted on 500 consecutively admitted patients aged 10–15 years at SVPPGIP and Sishu Bhaban, Cuttack. Anthropometric measurements (weight, height) were taken at the bedside, and Body Mass Index (BMI)-for-age z-scores were calculated using WHO standards to classify nutritional status (underweight: z<−2SD; overweight/obese: z>+1 SD). Anemia was defined using routine hemoglobin (Hb) values from medical records (Hb <12.0 g/dL for 12–15-year-old females; Hb <11.5 g/dL for 10–11-year-old children and 12–15-year-old males). Simple dietary intake (frequency of main food groups) and menstrual history in girls were assessed via a brief questionnaire. Chi-square tests and ANOVA were used for statistical analysis. Results: The study included 500 adolescents (48% female, 52% male). The prevalence of undernutrition was 38.2%, while overweight/obesity was observed in 12.4%, confirming the double burden of malnutrition. The overall prevalence of anemia was alarmingly high at 62.0%, with severe anemia (Hb <7.0 g/dL) in 5.6%. Patients admitted with infectious diseases had the highest rate of undernutrition (45.5%). Anemia was significantly associated with a diagnosis of chronic diseases (e.g., renal/haematological disorders) (χ2=18.25,p<0.001) and with a prolonged LOS. The mean LOS for anemic adolescents was 6.1±2.0 days, significantly longer than for non-anemic adolescents (4.5±1.5 days) (p<0.001). A poor dietary pattern, characterized by low consumption of iron-rich and protein-rich foods, was reported by over 70%of anemic girls. Conclusion: Malnutrition, particularly anemia, is highly prevalent among hospitalized adolescents in this setting and is strongly linked to morbidity and prolonged hospitalization. Screening for and aggressively managing nutritional deficiencies must be integrated into routine inpatient care protocols to improve recovery and reduce the burden of hospital stay.
Research Article
Open Access
Clinical and Etiological Profile of Altered Mental Status in Elderly Patients Attending a Tertiary Care Hospital in Odisha: A Prospective Observational Study
Dr Soumya Priyadarsini ,
Dr Premakanta Mohanty ,
Dr Susanta Kumar Bhuyan ,
Dr. Jibanjyoti Das ,
Dr Namita Mohapatra
Pages 1015 - 1022
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Abstract
INTRODUCTION: Altered mental status (AMS) in elderly patients is a common neurological emergency with diverse and often multifactorial causes, including vascular, metabolic, infectious, and nutritional factors. Early recognition of its clinical and etiological profile is crucial to reduce morbidity and mortality in resource-limited settings. Methodology: This prospective observational study was conducted in the Emergency Department and Medical Intensive Care Unit of PGIMER & Capital Hospital, Bhubaneswar, Odisha, from May 2024 to October 2024. A total of 140 consecutive patients aged ≥65 years presenting with acute or subacute AMS were enrolled. Terminally ill, chronically comatose, and trauma-related AMS cases were excluded. Results: Most patients (87.1%) had at least one comorbidity; the commonest combinations were diabetes mellitus with hypertension (27.9%) and isolated hypertension (20.0%). Anemia was present in 59.3% of patients, while hyponatremia of any severity was found in 50.7%. Hypoalbuminemia (<3.5 g/dL) was highly prevalent (87.1%). Cerebrovascular accidents (CVA) were the leading etiology of AMS, with infarcts in 25.0% and intracerebral hemorrhage in 10.0% of patients. Discussion: The findings highlight that AMS in the elderly is predominantly associated with vascular events (especially stroke), metabolic derangements (anemia, hyponatremia, hypoglycemia), sepsis, and poor nutritional status. The high burden of comorbidities, particularly cardiovascular and metabolic diseases, likely amplifies vulnerability to AMS. Conclusion: In this tertiary-care setting, AMS in elderly patients was largely driven by CVA, septic encephalopathy, and metabolic and nutritional abnormalities. Systematic evaluation of comorbidities, early correction of metabolic and infectious triggers, and structured neurological assessment using tools like RASS can improve outcomes and potentially reduce mortality in this high-risk group.
Research Article
Open Access
ACCURACY OF PRE-OPERATIVE SCORING IN PREDICTING DIFFICULTY LEVEL OF LAPAROSCOPIC CHOLECYSTECTOMY.
Dr. Syed Mohammed Sajjad Husayni ,
Dr. Arshiya Fatima ,
Dr. Zaid Mazhar Syed
Pages 997 - 1008
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Abstract
Background: Difficult laparoscopic cholecystectomy (DLC) remains a major intraoperative challenge, especially in resource-limited settings where early identification of high-risk cases is crucial for minimizing bile duct injury, operative delays, and conversion to open procedures. Although several predictive systems exist, most are derived from mixed populations or rely on subjective parameters, limiting their applicability in newly developing laparoscopic units. Objective: To validate a preoperative scoring system for predicting difficult laparoscopic cholecystectomy and to establish a modified intraoperative grading score incorporating comprehensive operative parameters. Methods: A prospective cross-sectional study was conducted on 150 patients undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis. Preoperative variables were scored using a modified predictor scale, while intraoperative difficulty was graded using an expanded objective score incorporating adhesions, gallbladder distension, BMI, prior surgical scarring, bile/stone spillage, ductal injury, conversion, and ligature method. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and ROC analysis. Multivariate logistic regression identified independent predictors of difficult LC. Results: Based on intraoperative scoring, 28.7% of patients experienced moderate–severe difficulty. The preoperative score demonstrated excellent discriminatory ability (Sensitivity 94.8%, Specificity 96.2%, AUC 0.945). The intraoperative score also performed strongly (Sensitivity 95.8%, Specificity 98.1%, AUC 0.939). Independent predictors of difficult LC included age ≥50 years, history of acute cholecystitis, BMI >30, palpable gallbladder, impacted stone, adhesions burying the gallbladder, dissection time >90 min, bile/stone spillage, and suture ligature requirement. Conclusion: Both the preoperative and modified intraoperative scoring systems demonstrated high diagnostic accuracy and reliability for predicting difficult LC. These scoring tools are simple, objective, reproducible, and particularly valuable in resource-limited settings for optimizing surgical scheduling, assigning appropriate expertise, improving patient counseling, and reducing intraoperative complications. Implementation of these scores may enhance safety and standardize difficulty assessment across surgical teams.
Research Article
Open Access
OUTCOME OF AUTOLOGOUS PLATELET RICH PLASMA (PRP) INJECTION IN OSTEOARTHRITIS KNEE: A PROSPECTIVE OBSERVATIONAL STUDY
Dr. Saumen Kumar De ,
Dr. MD Anwar Sadat Halder ,
Dr. Subhadeep Batabyal
Pages 985 - 989
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Abstract
Background: Osteoarthritis (OA) of the knee is one of the most common degenerative joint disorders worldwide, leading to pain, stiffness, reduced mobility, and considerable impairment in quality of life especially in older adults. In this context, regenerative therapies aiming to modulate the joint environment and promote tissue healing have gained interest. Aims: To evaluate the effectiveness of autologous platelet-rich plasma (PRP) injections in reducing pain and improving functional outcomes in patients with knee osteoarthritis. Materials & Methods: This prospective observational study was conducted at Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education & Research (IPGME& R) and SSKM Hospital, Kolkata, West Bengal, India, over a duration of one year (from 1st February 2018 to 31st January 2019). A total of 100 patients with symptomatic knee osteoarthritis were enrolled. Result: The parameter showed a significant increase over time. The mean value rose from 110.5 ± 12.2 at baseline to 115.3 ± 11.8 at 1 month (p = 0.002), 120.8 ± 11.0 at 3 months (p < 0.001), and 123.5 ± 10.5 at 6 months (p < 0.001). Conclusion: We concluded that autologous platelet-rich plasma (PRP) injections showed notable and long-lasting therapeutic improvements over a six-month period in this prospective observational trial of patients with osteoarthritis of the knee. Patients reported both immediate and long-term pain relief as a result of the operation. While objective measurements of joint strength and mobility shown significant improvements, functional capacity and everyday activity performance also significantly improved.
Research Article
Open Access
HISTOPATHOLOGICAL SPECTRUM OF SKIN AND SOFT TISSUE TUMORS
Dr Kajjam Prasantha Lakshmi ,
Dr Sonam S Nandyal ,
Dr Ramu R ,
Sharvani R Setty ,
Dr Narayana Murthy C
Pages 976 - 984
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Abstract
Background: Skin and soft tissue tumors encompass a diverse group of tumors arising from various cell lineages including epithelial, adnexal, melanocytic and mesenchymal origins. Histopathological examination remains the gold standard for diagnosis; however overlapping morphological features often pose a diagnostic challenges. AIMS & OBJECTIVES To study the frequency and morphological spectrum of skin and soft tissue tumors . METHODOLOGY A single centric cross-sectional study was conducted over a period of 3 years between July 2021 to June 2024. Among all biopsies received, 218 cases were diagnosed as skin and soft tissue tumors. H&E stained slides were retrieved and analyzed to determine demographic profile, site distribution and histomorphological characteristics of these tumors. RESULTS We found the male to female ratio of 1.1:1, where in the age range of the patients ranged from 2-87 years with majority of the tumors were seen in 5th and 6th decade (59.2%). Benign tumors were more common (64%) than malignant ones. Among 138 benign tumors, soft tissue tumors were most common (89/138, 40.8%) followed by adnexal tumors (36/138). Among 80 malignant tumors, epidermal carcinomas (38/80, %) were more common followed by soft tisue sarcomas (26/80). CONCLUSION Our study highlights that skin and soft tissue tumors constitute a relatively common and diverse group of neoplasms, with the majority being benign in origin with wide age range.
Research Article
Open Access
Comparison of Clinical and Functional Outcomes Between Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Prospective Comparative Study from India
P. Prem Kumar ,
Sri Aditya B ,
Sandeep Sriram ,
Umesh Sunkari ,
Sadhan Palakuri
Pages 967 - 975
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Abstract
Background: Knee osteoarthritis is a major global cause of disability, and its prevalence is rising in India due to increasing life expectancy, lifestyle transitions, and cultural joint-loading practices. Total knee arthroplasty (TKA) is considered the definitive treatment for advanced disease; however, the optimal management of the posterior cruciate ligament (PCL) remains controversial, particularly in populations with advanced deformity and high functional expectations. Aim To compare clinical and functional outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty in an Indian patient population. Methods This prospective comparative study included 30 patients undergoing TKA between October 2024 and September 2025. Patients were grouped based on implant type: CR (n=6) and PS (n=24). Functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Functional Knee Score at baseline and final follow-up. Statistical analysis included t-tests and correlation analysis using SPSS 17 software. Results
Both groups demonstrated significant postoperative improvement. The PS cohort achieved significantly higher postoperative KSS (87.2 vs 78.4; p=0.021), Functional Knee Score (100.2 vs 92.4; p=0.018), and greater WOMAC improvement (72.8% vs 63.5%; p=0.042) compared to the CR cohort. A strong positive correlation was observed between KSS improvement and WOMAC gain (r=0.72, p<0.01). Age and BMI demonstrated weak, non-significant negative associations with functional outcomes. Conclusion Both CR and PS TKA designs produced significant postoperative improvement; however, posterior-stabilized implants demonstrated superior early functional outcomes. Implant selection should be individualized based on deformity severity, ligament condition, and patient expectations. Larger long-term multicenter trials are recommended to validate these findings.
Research Article
Open Access
“Correlation Of Pre-Operative High-Resolution Computed Tomography (Hrct) Findings With Intra-Operative Findings Of Cholesteatoma: An Observational Study”
Dr. Smita Nagle ,
Dr. Rajat Pangtey ,
Dr. Shrinivas Chavan ,
Dr. Aashrey Reddy ,
Dr. Kaushik Pedamkar
Pages 960 - 966
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Abstract
Background: Cholesteatoma is a benign but locally destructive lesion associated with chronic otitis media, leading to ossicular erosion and potential intracranial complications. Early diagnosis and surgical intervention are vital. High-resolution computed tomography (HRCT) has emerged as an essential tool for preoperative evaluation, till date its diagnostic correlation with intraoperative findings requires further validation. Therefore, we evaluated the correlation between pre-operative HRCT findings and intra-operative observations in patients diagnosed with cholesteatoma. METHODOLOGY: This observational, cross-sectional study was conducted at a tertiary care center and included 104 patients clinically diagnosed with cholesteatoma. Patients underwent detailed clinical, otoscopic, and HRCT evaluation before surgery. Intraoperative findings were compared with HRCT data to assess diagnostic accuracy. Sensitivity, specificity, and predictive values were calculated for various anatomical structures. RESULTS: The study population had a mean age of 36.87 years, with a male predominance (57.69%). HRCT correctly identified cholesteatoma in 64 cases, demonstrating a sensitivity of 68.08%, specificity of 60%, a high positive predictive value of 94.12%, and a low negative predictive value of 16.67%. HRCT showed excellent correlation with intraoperative findings for scutum erosion, Prussak’s space involvement, and tegmen tympani erosion, with high kappa coefficients indicating strong agreement. However, HRCT underreported stapes erosion compared to intraoperative findings, reflecting its limited sensitivity for smaller ossicular involvement. CONCLUSION: HRCT is a reliable, non-invasive tool with high diagnostic accuracy for preoperative assessment of cholesteatoma. Its strong correlation with intraoperative findings supports its role in surgical planning.
Research Article
Open Access
PRP VS PROLOTHERAPY IN GRADE 2 & 3 OSTEOARTHRITIS KNEE
Pages 954 - 959
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Abstract
Background: Osteoarthritis (OA) of the knee is a highly prevalent degenerative joint disease characterised by progressive articular cartilage breakdown, sub‑chondral bone changes, synovial inflammation, and resultant pain, stiffness, and functional limitation. Aims: The aim of the study was to compare the efficacy and safety of intra-articular Platelet-Rich Plasma (PRP) versus Prolotherapy in patients with Grade 2 and3knee osteoarthritis and to assess their effects on pain relief and functional improvement. Materials & Methods: The study was a prospective interventional comparative study conducted over one year (from 1st November 2023 to 31st Octber 2024), including a total of 72 patients with Grade II and III knee osteoarthritis, in PRP group 36 number of patients (n=36) and in Prolotherapy group 36 number of patients (n=36). Result: At 1 month, the PRP group reported significantly lower pain than the Prolotherapy group (4.6 ± 1.0 vs 5.3 ± 1.1, p=0.01). This difference became more pronounced at 3 months (3.8 ± 0.9 vs 5.1 ± 1.0, p<0.001) and persisted at 6 months (3.5 ± 1.1 vs 4.8 ± 1.2, p<0.001). At baseline, scores were comparable (61.5 ± 8.2 vs 60.7 ± 8.4, p=0.72). Conclusion: We concluded that 72 patients with Grade 2 and 3 knee osteoarthritis, we compared intra-articular PRP and Prolotherapy. PRP proved to be more effective in reducing pain and improving function. Age, sex, BMI, length of symptoms, Kellgren-Lawrence grade, VAS, and WOMAC scores were among the baseline parameters that were similar between groups, guaranteeing a fair comparison.
Research Article
Open Access
Can intrapartum CTG be a predictor of fetal outcome ?
Dr Shivamurthy H M ,
Dr. Priyanka Bukyalkar ,
Dr Thejaswini B L ,
Dr Ankitha B N ,
Dr Vaanya Chaudhary ,
Naveen K S ,
Manju Naik
Pages 950 - 953
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Abstract
Background: Non-reassuring fetal status (NRFS) during labour is a major cause of emergency caesarean section and is commonly attributed to fetal hypoxia and metabolic acidosis. Cardiotocography (CTG) is routinely used for intrapartum fetal monitoring, and abnormal CTG patterns particularly decelerations and decreased baseline variability are strongly associated with fetal distress. However, the degree to which CTG abnormalities correlate with intraoperative findings and neonatal outcomes remains an important clinical question. Aim: To correlate non-reassuring CTG findings with intraoperative observations and immediate neonatal outcomes among women undergoing emergency caesarean section for NRFS. Materials and Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology, Subbaiah Institute of Medical Sciences, Shivamogga, over six months (March-August 2025). A total of 49 term, singleton pregnancies undergoing emergency caesarean section for NRFS on CTG were included. CTG abnormalities were classified into decelerations and decreased variability. Intraoperative findings meconium-stained liquor, nuchal cord, or no abnormality were recorded. Neonatal outcomes were assessed using APGAR scores at birth and 5 minutes, and NICU admissions. Results: Of 49 participants, 61.22% were primigravidae. CTG abnormalities included decelerations in 61.23% and decreased variability in 38.77%. Meconium-stained liquor was noted in 56.67% of the deceleration group and 57.89% of decreased variability group.
Research Article
Open Access
Demography, bleeding pattern, ultrasound features and histopathogic correlation in cases of Abnormal Uterine Bleeding among Women Aged 20-40 years
Dr. Shivamurthy H. M ,
Dr. N. Soujanya ,
Dr. Teekshana Chowdary ,
Dr. Rashmi C Sindhe ,
Dr. Husena Abbas Gheewala ,
Naveen K S ,
Manju Naik
Pages 944 - 949
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Abstract
Background: Women between 20 and 40 years represent the prime reproductive age group, where they are usually active in careers, family responsibilities, and social roles. Menstrual disturbances in this age group often have direct implications for conception, maintenance of pregnancy, and overall reproductive health. AUB, by causing anemia, fatigue, and psychological stress, can significantly impair quality of life and productivity. From a clinical perspective, the etiology of AUB differs with age. In adolescents, bleeding is commonly due to anovulatory cycles, while in perimenopausal women, it may be a warning sign of endometrial hyperplasia or malignancy. By studying the 20–40 year group, focus is placed on a distinct population where structural causes are common. This helps in understanding patterns specific to this age bracket. Aim: to study Demographic features, bleeding pattern, Ultrasound features and histopathogic correlation in cases of Abnormal Uterine Bleeding among Women Aged 20-40 years. Methods: This observational study was conducted in the Department of Obstetrics and Gynecology, Subbaiah Institute of Medical Sciences, Shivamogga, over 6 months. Women presenting with AUB, between 20-40 years Age were included, their demography, complaints, ultrasonography & Histopathology were done Results: Among women in Reproductive age group studied, AUB is more common in age group 36-40 years(46.5%) & in multiparous women(96.5%). Heavy menstrual bleeding (44%) was the most common presentation. Patients presenting with Heavy & Irregular menstrual cycles(29%) were next, followed by Prolonged bleeding. Ultrasound revealed fibroids (25.5%) & adenomyosis(14%) as the commonest finding. Conclusion: In Reproductive age group women, AUB commonly presents as heavy or irregular bleeding, often associated with structural lesions such as fibroids,adenomyosis & endometrial hyperplasia. Early evaluation is essential to correct anemia, detect pathology, and guide individualized management. Category: Department of Obstetrics and Gynaecology.
Research Article
Open Access
Surgical Approaches and Outcomes in Non-Traumatic Small Intestinal Perforation: A Clinical Study
Dr. Avula Raghuvaran Mudhiraj ,
Dr. Sambari Chakradhar ,
Dr. Proddaturi Phani Teja
Pages 936 - 943
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Abstract
Non-traumatic small intestinal perforations (SIP) are common in areas endemic to typhoid and tuberculosis. It is a life-threatening emergency with a high degree of morbidity and mortality if not managed adequately. The crucial part of the outcome depends on early diagnosis and management. This study aimed to determine the etiological patterns, surgical management, and postoperative outcomes in patients reporting to our hospital with small intestinal perforation. Methods: This cross-sectional study was conducted in 40 patients with a diagnosis of intestinal perforations. Detailed clinical findings, imaging results, and surgical procedures were analyzed, and postoperative outcomes were recorded in a predesigned pro forma. Surgical procedures for management carried out, such as primary closure, resection, and anastomosis, or resection with stoma, were noted with intraoperative findings. The outcomes were analyzed by SPSS version 25 for inferential statistics. Results: The etiology of perforations in our cases showed that 45% were due to typhoid fever, 25% due to tuberculosis. The site of perforation showed that the ileum was the common area involved in 65% cases. The primary closure was done in 50% of cases. Resection and anastomosis were performed in 40% and stoma creation was done in 10% cases based on the findings. The overall morbidity was 45% with surgical site infections as the most reported complication. Asastomotic leaks occurred in 7.5% of those who underwent resection (p = 0.041). Those who underwent resection had a longer duration of stay in the hospital and an increased time for starting oral food intake. Conclusion: Non-traumatic small intestinal perforation is a common cause of surgical emergencies in areas endemic to typhoid and tuberculosis. Major challenges for management were delayed presentation and extensive contamination. In all the surgical procedures, primary closure results in better and faster postoperative recovery. .
Research Article
Open Access
A Rare Case of Second Branchial Cleft Cyst Presenting as A Deep Cervical Swelling in an Elderly Male: A Clinicopathological Correlation
Dr. Shreyas S. ,
Dr. Shivakumar T ,
Dr. Pavan B. M.
Pages 917 - 922
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Abstract
Background: Branchial cleft cysts are benign epithelial cysts that typically arise in the skin and subcutaneous tissues but are rarely encountered in the deep cervical spaces. Their unusual anatomical location may mimic more common congenital or neoplastic cystic lesions of the neck, contributing to significant diagnostic uncertainty, particularly in older adults where cystic metastases are an important concern. Case Presentation: We report the case of a 72-year-old male who presented with a progressively enlarging, painless right lateral neck swelling over three months. Examination revealed a soft, fluctuant mass located deep to the sternocleidomastoid muscle. Contrast-enhanced CT demonstrated a well-defined, hypodense, non-enhancing cystic lesion within the carotid space, compressing the internal jugular vein. Ultrasound revealed an avascular cystic mass. Initial differentials included second branchial cleft cyst, cystic lymph node, and nerve sheath tumor. Fine-needle aspiration cytology (FNAC) yielded keratinous debris and anucleate squames consistent with an Branchial cleft cyst. The patient underwent complete surgical excision of the cyst under general anesthesia, and the specimen was removed intact without rupture. Postoperative recovery was uneventful, and no recurrence was observed. Conclusion: Deep cervical BCC are rare and may closely resemble congenital or metastatic cystic lesions on imaging. This case highlights the importance of a multimodal approach combining clinical examination, imaging, and cytological findings to achieve an accurate diagnosis. Surgical excision remains the definitive treatment, providing both confirmation of pathology and prevention of recurrence. Awareness of this atypical presentation is essential to avoid misdiagnosis and unnecessary oncologic workup in elderly patients presenting with lateral neck swellings.
Research Article
Open Access
A Comparative Analysis of Propofol–Ketamine Versus Propofol–Butorphanol for Procedural Sedation in Short Urological Interventions
Pages 908 - 917
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Abstract
Background: Short urological procedures such as cystoscopy, double-J stent removal, urethral dilatation, transurethral biopsy of the prostate, ureteroscopy, and extracorporeal shock wave lithotripsy (ESWL) frequently utilize procedural sedation due to its rapid onset, faster recovery, and avoidance of airway instrumentation. Propofol is widely preferred for its rapid hypnotic action but is limited by risks of hypotension and respiratory depression when used alone. Combining propofol with either ketamine or butorphanol offers the potential to enhance sedation quality, provide superior analgesia, and reduce adverse hemodynamic events. Comparative evidence specific to urological procedures remains limited. Aim: To compare the sedative efficacy, hemodynamic profile, respiratory events, recovery characteristics, and perioperative outcomes of propofol–ketamine versus propofol–butorphanol combinations for procedural sedation in short-duration urological interventions. Methods: This prospective comparative study enrolled adult patients undergoing short urological interventions not requiring general or neuraxial anesthesia. Participants were allocated to receive either propofol–ketamine (PK group) or propofol–butorphanol (PB group). Parameters assessed included onset of sedation, intraoperative hemodynamic fluctuations, requirement for airway interventions, oxygen desaturation episodes, recovery time, postoperative adverse events, patient recall of intraoperative events, and satisfaction ratings from both patients and surgeons. Results: Both combinations achieved effective sedation for all procedures. The PK group showed greater cardiovascular stability, with fewer episodes of hypotension due to ketamine’s supportive sympathetic activity. The PB group demonstrated smoother sedation with reduced incidence of emergence reactions and lower airway intervention requirements. Oxygen desaturation was infrequent in both groups. Recovery was rapid with both regimens; however, the PB group exhibited slightly faster cognitive and psychomotor restoration. Postoperative nausea, vomiting, hallucinations, and recall of intraoperative events were minimal across both groups. Patient and surgeon satisfaction scores were high and comparable. Conclusion: Both propofol–ketamine and propofol–butorphanol are safe and effective options for procedural sedation in short urological procedures. Propofol–ketamine offers enhanced hemodynamic stability and strong analgesic depth, while propofol–butorphanol provides smoother emergence with fewer psychomimetic effects. Either regimen adequately supports the goals of short procedural anesthesia: reliable sedation, minimal airway manipulation, rapid recovery, and a favorable safety profile.
Research Article
Open Access
SYNCHRONOUS OCCURRENCE OF TWO DIFFERENT HISTOLOGICAL VARIANTS OF RENAL CELL CARCINOMA IN THE SAME KIDNEY: A RARE PHENOMENON
Gaurav Kochhar ,
Sampathkumar R N ,
Sharanabasappa B Rudrawadi ,
R Keshavamurthy
Pages 903 - 907
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Abstract
Introduction: Renal cell carcinoma (RCC) accounts for the majority of renal malignancies and demonstrates considerable morphological and genetic heterogeneity. The synchronous occurrence of two distinct histological variants of RCC in the same kidney is exceptionally rare and poses diagnostic and therapeutic challenges.Methodology This is a cases series study was conducted in Institute of Nephro urology Bangalore from 2013 to 2017. A 64-year-old male chronic smoker presented with dull right loin pain for three months. Ultrasonography and contrast-enhanced CT of the kidney, ureter and bladder region revealed two distinct renal masses located in separate poles of the right kidney. Radical nephrectomy was performed. Histopathology and immunohistochemistry confirmed clear cell RCC in one pole and papillary RCC in the other. Postoperative evaluation confirmed two synchronous RCC subtypes without evidence of nodal or metastatic spread. CK7 immunostaining was negative in clear cell RCC and positive in papillary RCC. Follow-up was uneventful, and the patient remains disease-free at six months.Conclusion: The coexistence of clear cell and papillary RCCs within a single kidney represents a rare clinical entity. Due to its uncommon presentation, no standard management protocol exists; individualized surgical decision-making remains the cornerstone.
Research Article
Open Access
Anemia prevention strategies in children: A study on the role of community health centers in nutritional interventions
Dr. Rajesh Kumar Teckchandani ,
Dr. Uchit Patel
Pages 893 - 902
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Abstract
Background: Childhood anemia remains highly prevalent in India, including Gujarat, with multisectoral policies emphasizing iron-folic acid (IFA), deworming, nutrition counselling, and food fortification. We evaluated whether a Maninagar Sub-District Hospital, Ahmedabad-led, multi-platform package could improve program coverage and child hematologic outcomes in urban Ahmedabad.
Methods: We conducted a pragmatic pre-post implementation evaluation in Maninagar Sub-District Hospital catchments (3-month scale-up; 6-month follow-up). Repeated cross-sections were drawn at baseline and endline using multistage cluster sampling of households mapped to Anganwadi areas. Interventions included age-appropriate IFA supplementation, biannual deworming, caregiver counselling aligned with national materials, and facilitated uptake of fortified staples. Capillary haemoglobin (Hb) was measured using standardized procedures and 2024 WHO thresholds. Primary outcomes were mean Hb and anemia prevalence/severity; secondary outcomes were coverage/adherence indicators and implementation fidelity. Survey-weighted tests compared periods; log-binomial (or Poisson-robust) models estimated adjusted prevalence ratios (APRs) controlling for age, sex, recent illness, socioeconomic status, and Maninagar Sub-District Hospital clustering.
Results: A total of 1, 200 children were assessed at baseline and 1, 180 at endline with similar age/sex distributions. Mean Hb increased from 10.5±1.4 to 11.1±1.3 g/dL (p<0.001). Overall anemia declined from 73% to 62% (absolute change −11.0 percentage points; p<0.001), with the largest decrease in moderate anemia (35%→27%). Endline vs baseline APR for anemia was 0.85 (95% CI 0.79-0.92; p<0.001). Coverage improved for IFA receipt 41%→74%, IFA adherence ≥4 doses/week 23%→56%, deworming 38%→71%, caregiver counselling 29%→68%, and fortified-staple uptake 21%→49%. Implementation fidelity strengthened (elimination of IFA stock-outs; counselling sessions increased monthly). Age and recent illness were independent risk factors; sex was not.
Conclusions: A Maninagar Sub-District Hospital-led, guideline-concordant package produced coherent gains in coverage, fidelity, and child hematologic outcomes over nine months in urban Ahmedabad. Embedding updated haemoglobin thresholds in routine records, assuring commodity availability, intensifying counselling for adherence, and deepening fortification linkages appear central to accelerating anemia reductions. Sustained, multi-year implementation with strengthened measurement and seasonal intensification is warranted.
Research Article
Open Access
Non-Neoplastic and Neoplastic Endometrial Pathologies in Abnormal Uterine Bleeding: A Systematic Review and Meta-Analysis
Santosh Jayant ,
Kirti Hada
Pages 888 - 892
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Abstract
Background: Abnormal uterine bleeding (AUB) is a commonly encountered gynecological complaint, often requiring histopathological evaluation of the endometrium to differentiate between non-neoplastic and neoplastic causes. Early detection of atypical hyperplasia and endometrial carcinoma is essential for appropriate management. Aim: To evaluate and compare the spectrum of non-neoplastic and neoplastic endometrial pathologies in women presenting with AUB. Materials and Methods: A cross-sectional study was conducted over one year in the Department of Pathology, Amaltas University, Dewas. A total of 180 endometrial samples obtained through biopsy, curettage, and hysterectomy were included. Standard histopathological processing and H&E staining were performed. All lesions were classified as non-neoplastic or neoplastic, and their frequency distribution was analyzed. Results: Out of 180 cases, 162 (90%) were non-neoplastic and 18 (10%) were neoplastic. The most common non-neoplastic lesions included proliferative endometrium (28%), secretory endometrium (18%), disordered proliferative endometrium (14%), and hyperplasia without atypia (12%). Among neoplastic lesions, atypical hyperplasia constituted 6% of cases and endometrial carcinoma 4%. Neoplastic lesions were predominantly seen in women aged ≥45 years. Conclusion: Non-neoplastic lesions form the majority of AUB cases; however, a significant proportion (10%) represent premalignant or malignant pathology. Histopathological examination remains the gold standard for diagnosis and plays a critical role in guiding clinical management.
Research Article
Open Access
Efficacy of Botox Injection vs. Conventional Analgesics in Managing Diabetic Neuropathic Pain: A Comparative Study
Dr Vinodkumar Mohabe ,
Dr Rajendra Vaidya ,
Dr Sagar Khandare3
Pages 881 - 887
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Abstract
Background: Diabetic neuropathic pain (DNP) is a common and disabling complication of diabetes mellitus. Conventional pharmacological treatments often provide suboptimal relief and are associated with systemic side effects. Botulinum toxin (BoNT-A) has emerged as a promising alternative for neuropathic pain. Aim: To compare the efficacy of botulinum toxin injection versus conventional analgesics in the management of diabetic neuropathic pain. Methods: This prospective, randomized comparative study included 80 patients with painful diabetic neuropathy, allocated into two groups (n=40 each). Group A received subcutaneous BoNT-A injections, while Group B received conventional analgesics (gabapentinoids, duloxetine, or tricyclic antidepressants). Pain severity was assessed using the Visual Analog Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI). Functional outcomes were evaluated using the Brief Pain Inventory (BPI), SF-12 physical and mental scores, sleep quality (PSQI), and 6-minute walk test. Adverse events and patient satisfaction were also recorded. Data were analyzed using appropriate statistical tests with p < 0.05 considered significant. Results: Both groups were comparable at baseline for demographic and clinical variables. At 12 weeks, BoNT-A produced a significantly greater reduction in VAS (-3.2 ± 1.1 vs. -2.1 ± 1.0; p<0.001) and NPSI scores (-11.6 ± 4.7 vs. -7.8 ± 4.3; p<0.001). The BoNT-A group showed faster pain relief, lower rescue analgesic use, and higher ≥50% responder rates (47.5% vs. 25.0%; p=0.029). Functional outcomes and quality-of-life measures improved more significantly in the BoNT-A group, including BPI, SF-12 PCS/MCS, PSQI, and 6-minute walk distance (all p<0.01). Adverse events were fewer with BoNT-A, with mainly local injection-site pain, while conventional therapy had higher rates of drowsiness and dry mouth. Patient satisfaction was higher in the BoNT-A group (7.9 ± 1.4 vs. 6.3 ± 1.7; p<0.001). Conclusion: Botulinum toxin injection provided superior pain relief, functional improvement, and patient satisfaction, with fewer systemic side effects compared to conventional analgesics. It may represent an effective and well-tolerated alternative for patients with diabetic neuropathic pain.
Research Article
Open Access
Modified Alvarado Score Versus Ultrasonographic Findings: Which Predicts Histopathology-Confirmed Acute Appendicitis More Accurately?
Dr. Ashutosh Jaiprakash Uapdhyay ,
Dr. Arvind Ade ,
Dr. Ravi Khandare
Pages 874 - 880
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Abstract
Background: Background: Acute appendicitis remains one of the most common surgical emergencies, yet timely and accurate diagnosis can be challenging. Clinical scoring systems such as the Modified Alvarado Score (MAS) and imaging modalities like ultrasonography (USG) are widely used, but their relative diagnostic performance varies across settings. Histopathology remains the gold standard for confirming appendicitis. Aim: To compare the diagnostic accuracy of the Modified Alvarado Score and ultrasonographic findings against histopathology in patients with suspected acute appendicitis. Materials and Methods: A diagnostic accuracy study was conducted on 433 patients presenting with symptoms suggestive of acute appendicitis at a tertiary-care center. All patients underwent detailed clinical evaluation, MAS calculation, and abdominal ultrasonography prior to surgical intervention. The excised appendix was subjected to histopathological examination, which served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for both MAS and USG. Results: Histopathology confirmed acute appendicitis in 87.3% of cases. MAS ≥7 demonstrated higher sensitivity (86.7%) and overall diagnostic accuracy (87.3%) compared to ultrasonography, which showed a sensitivity of 79.9% and accuracy of 77.4%. Both modalities exhibited high PPV (93.2%). USG displayed slightly higher specificity than MAS, but the difference was not statistically significant. Concordance between MAS and USG was substantial (κ = 0.64), and combined assessment yielded improved diagnostic confidence. Conclusion: The Modified Alvarado Score outperformed ultrasonography in predicting histopathology-confirmed appendicitis and remains a valuable initial diagnostic tool, particularly in resource-limited settings. Ultrasonography provides useful adjunctive information, especially in atypical cases or where MAS alone is inconclusive. Integrating both modalities enhances diagnostic accuracy and may reduce negative appendectomy rates.
Research Article
Open Access
Diagnostic Accuracy of the Modified Alvarado Score in Acute Appendicitis: A Prospective Evaluation Against Histopathology
Dr. Ashutosh Jaiprakash Uapdhyay ,
Dr. Ravi Khandare ,
Dr. Pravin Dandi
Pages 867 - 873
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Abstract
Background: Acute appendicitis is a common surgical emergency, and timely diagnosis is essential to prevent complications and reduce negative appendectomy rates. The Modified Alvarado Score (MAS) is widely used as a rapid clinical assessment tool, but its diagnostic performance continues to be debated across various populations. This study aimed to evaluate the diagnostic accuracy of MAS against postoperative histopathology, the gold standard for confirming appendicitis. Aim: To evaluate the diagnostic accuracy of the Modified Alvarado Score in diagnosing acute appendicitis using postoperative histopathology as the gold standard. Materials and Methods: This prospective study was conducted on 433 patients clinically suspected of having acute appendicitis. All patients underwent detailed clinical evaluation, MAS computation, and open appendectomy. The excised specimens were subjected to standard histopathological examination. Diagnostic performance metrics-including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy-were calculated. Statistical analyses included chi-square test, t-test, and Spearman correlation, with p < 0.05 considered significant. Results: The mean age of patients was 29.8 ± 10.6 years, with males constituting 61.4% of the cohort. Histopathological examination confirmed acute appendicitis in 381 patients (88%). MAS ≥7 demonstrated 92.4% sensitivity, 67.3% specificity, 95.4% PPV, 54.7% NPV, and an overall accuracy of 89.6%. A strong positive correlation was observed between MAS and histopathology (ρ = 0.71, p < 0.001). The negative appendectomy rate was markedly lower in patients with MAS ≥7 (4.8%) compared to those with MAS <7 (43.2%). Conclusion: MAS is a highly sensitive and clinically effective diagnostic tool for acute appendicitis. A score ≥7 significantly enhances diagnostic accuracy, correlates strongly with histopathological findings, and substantially reduces negative appendectomy rates. MAS remains particularly valuable in emergency and resource-limited settings.
Research Article
Open Access
STUDY OF VESICOURETERIC REFLUX IN CHILDREN
Dr Thavendra Dihare ,
Dr Maheshkumar Manilal Vaghela ,
Dr Rakesh S. Josh ,
Dr Jaishri Ramji
Pages 860 - 866
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Abstract
Introduction: Urinary tract infection is a common presentation of VUR. It is also found in bladder dysfunction and bladder outlet obstruction. A prospective study of VUR from neonate to 12 years of age was conducted from October 2013 to July 2016.Materials and methods: The VUR was diagnosed by VCUG. VCUG was performed in the patients who had antenatally detected hydronephrosis, congenital urinary tract abnormality, dilatation of the upper tract on ultrasound, male patients having ≥ 2 episodes of documented UTI and female patients with febrile UTI. Patients with congenital anomalies of ano-rectal malformation, spinal dysraphism and exstrophy- epispadias complex were also screened for VUR. Age, gender, demographic data, grade of reflux, type of reflux (primary or secondary), correlation with urinary tract infection, incidence of renal scarring at diagnosis, type of management, surgical procedure, complications, and resolution of reflux were recorded. Detailed history of acute episodes, previous episodes of UTI, antenatal hydronephrosis, reflux in siblings, voiding dysfunction (dribbling, incontinence) and bowel dysfunction (constipation or encopresis) were noted. Uroprophylaxis was initiated for all cases. Surgical management was given in selective cases. Result: VCUG was done in 855 patients. VUR was found in 250 patients.VUR was diagnosed in 129 (51.6%) patients within <1 year, 85 (34%) patients within 1- 5 years, and 36 (14.4%) patients after 5 years. There were 110(44 %) male and 140(56 %) female patients.VUR was present in 66.6% patients with recurrent UTI. Grade I, II, III, IV, and V were found in 28 (11.2%), 89 (35.6%), 65 (26%), 43 (17.2%), and 25 (10%) patients, respectively. Renal scarring was seen in 65/250 (26%) at the time of diagnosis. Medical management was given to 211 patients, while 34 patients underwent surgical management for VUR. Five patients were lost to follow-up. Conclusion: VUR is a common pediatric urologic anomaly that requires close follow-up and management to prevent renal damage. Surgery is indicated in high-grade reflux and secondary VUR.
Research Article
Open Access
EVALUATION OF HEALING AND COMPLICATION RATES IN DIABETIC FOOT ULCERS WITH ADVANCED WOUND CARE TECHNIQUES
Dr. Gajanan Pande ,
Dr. Sandip Tayade
Pages 855 - 859
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Abstract
Background: Introduction: One severe and frequent side effect of diabetes mellitus is diabetic foot ulcers (DFUs), which can result in extended hospital stays, higher medical expenses, and an increased risk of lower limb amputations. Aims: To assess the effectiveness of advanced wound care techniques in promoting healing of diabetic foot ulcers and to evaluate the rate and types of complications occurring during the treatment period. Additionally, the study aims to identify key risk factors influencing healing outcomes in these patients.Materials & Methods: This is a prospective observational study conducted from 1st February 2023 to 31st January 2024, including a sample of 50 patients with diabetic foot ulcers.Result: In this study of 50 diabetic patients, the majority were male (60%) and overweight (60%), with Type 2 diabetes being more common (70%). Most patients exhibited poor glycemic control (86% with HbA₁c >7%), and clinical infection was present in 60%. Statistically significant associations were observed for gender, BMI, diabetes type, treatment modality, glycemic control, and infection (p ≤ 0.0455).Conclusion: We concluded that the majority of patients with Type 2 diabetes were male, overweight, and had poor glycemic control in this study assessing healing and complication rates in diabetic foot ulcers with advanced wound care. Key risk factors influencing healing were highlighted by the prevalence of clinical infection and peripheral neuropathy, as well as long-standing diabetes and prolonged wound duration.
Research Article
Open Access
Respiratory Health Ill Effects Among Domestic and Hospital Setting Cleaners: A Cross-Sectional Study
Dr. Sanjana Shiny Karnati ,
Dr. Satish Chandra K ,
Dr. Prasad C.N
Pages 841 - 854
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Abstract
Background: Cleaning workers are under constant exposure to various chemical agents which are detrimental to respiratory health. This study aimed to evaluate various respiratory ill effects of cleaning in domestic and hospital setting cleaners. Methods: A hospital-based cross-sectional observational study was conducted among 102 cleaners working at Prathima Institute of Medical Sciences and domestic settings in Karimnagar district, Telangana state, from January 2022 to May 2024. Data were collected using a standardized questionnaire, spirometry, and six-minute walk test (6MWT). Results: Among 102 subjects (61.8% females, mean age 44.64±11.13 years), 69.7% had respiratory disease. Common symptoms included nasal allergies (18.6%), cough (14.9%), and breathlessness (10.8%). Spirometric abnormalities were detected in 78.4% of those who performed the test: Small Airway Disease (SAD) 41.7%, Chronic Obstructive Pulmonary Disease (COPD) 27.8%, and Bronchial Asthma 8.8%. Female cleaners showed higher prevalence of obstructive airway diseases. Working ≥10 hours/day showed statistically significant association with SAD (p=0.014). Phenyl (21.5%) and bleach (18.2%) were the most commonly used cleaning products, with 87.1% using multiple agents. Conclusion: Cleaning workers have high prevalence of respiratory diseases, particularly obstructive airway diseases. Duration and intensity of exposure to cleaning products are significant risk factors. Regular spirometric screening and provision of respiratory protective equipment are recommended for all cleaning workers.
Research Article
Open Access
Morphometric Analysis of Humeral Segments in Contemporary Indian Adults
P. David Anand Kumar ,
K. Praveena kumari ,
Mohammad Tahir K Qureshi ,
Balakrishna J
Pages 834 - 840
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Abstract
Background: The humerus displays population-specific morphometric variations due to genetic, nutritional, and environmental influences, essential for anatomical references and fragment reconstruction. Indian data, often from older studies (e.g., mean lengths 299-310 mm), lack contemporary segmental details and high-precision tools, limiting applications in anthropology and biomedicine. The present study was conducted to quantify humeral segments in contemporary Indian adults using osteometric board and vernier calipers, derive side-specific regressions for total length estimation from fragments, and compare with prior datasets. Materials and Methods: In this cadaveric study, 100 dry adult humeri (50 left/right; sex-aggregated) were measured with osteometric board (0.1 mm precision) and vernier calipers (0.01 mm). Segments included HA (head to greater tuberosity), HB (head to surgical neck), HC (olecranon fossa height), HD (distal olecranon to trochlea), HE (proximal olecranon to proximal trochlea), and HL (maximum length). Descriptive statistics, Pearson correlations, and linear regressions (p < 0.05) were computed side-separately via SPSS v28.0. Results: Mean HL: 302.4 ± 18.7 mm (left)/308.9 ± 19.2 mm (right). Segments (mm): HA 6.2 ± 1.4/6.5 ± 1.2; HB 38.1 ± 4.1/37.8 ± 4.3; HC 19.5 ± 2.8/20.2 ± 3.1; HD 17.5 ± 2.0/17.7 ± 2.3; HE 36.2 ± 4.0/37.1 ± 4.2. Significant correlations: left HD (r=0.412, p=0.004), HC (0.389, 0.007), HB (0.356, 0.015); right HB (0.458, 0.001). Formulas: left HL=285.2 + 0.62(HD); right HL=289.1 + 0.52(HB) (R²=0.14-0.21). Conclusion: Indian humeral segments are compact (1-2% shorter than Turkish norms), with low variability supporting reliable fragment prediction. These models advance population databases for anthropology and biomedicine; sex-stratified imaging studies are needed for refinement.
Research Article
Open Access
A Comparative Study of Prediction of Outcomes by Glasgow Blatchford Score Versus Complete Rockall Score in Non-Variceal Upper Gastrointestinal Bleeding
Dr. Vijayabhasker ,
Dr. K.Divya
Pages 827 - 833
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Abstract
Background: Introduction: Non-variceal upper gastrointestinal hemorrhage (NVUGIH) remains a major cause of emergency admissions and morbidity. Risk stratification tools such as the Glasgow-Blatchford Score (GBS) and Complete Rockall Score (CRS) are widely used to assess the need for intervention and predict clinical outcomes. However, their relative effectiveness in predicting prognosis continues to be debated. Aims: This prospective analytical study aimed to evaluate and compare the predictive accuracy of GBS and CRS in determining mortality, rebleeding, and need for surgical or interventional management among NVUGIH patients. Materials & Methods: A total of 220 patients (>18 years) presenting with hematemesis, melena, coffee-ground vomiting, or positive fecal occult blood test, and subsequently confirmed by endoscopy to have non-variceal bleeding, were enrolled between January 2019 and May 2020 at Gleneagles Global Health City, Chennai. Patients with variceal bleeding, coagulopathies, bleeding disorders, and age <18 years were excluded. Clinical evaluation, laboratory parameters, and endoscopic findings were documented. Both scores were calculated and correlated with patient outcomes using ROC curves and AUC values.Results demonstrated that CRS was superior to GBS in predicting mortality (AUC: 0.804 vs. 0.622). However, both GBS and CRS showed poor predictive value for rebleeding (AUC: 0.548 vs. 0.528) and need for surgery (AUC: 0.547 vs. 0.504). Conclusion: CRS has better prognostic value for mortality, whereas both scores demonstrate limited accuracy in predicting rebleeding and surgical intervention. Risk stratification using these scoring systems remains useful for overall management decisions in NVUGIH.
Research Article
Open Access
A STUDY OF COMPLICATIONS OF VARIOUS TYPES OF HERNIAS IN OUR INSTITUTION
Dr. Vijayabhasker ,
Dr. K. divya
Pages 821 - 826
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Abstract
Background: Introduction: Inguinal hernia is a common surgical condition with a demographic profile and clinical presentation that varies with age and sex. Understanding its epidemiology, type distribution, and postoperative outcomes is crucial for optimal management. Aims and objectives: This study aimed to analyze the age and sex distribution, types, laterality, and postoperative complications of inguinal hernia in a clinical cohort. Materials and methods: A retrospective analysis was conducted on data from 247 and 200 patients across two study groups, examining age, hernia type, laterality, and complications. Results: The majority of patients (49.4-49.5%) were aged 40-60 years. Indirect inguinal hernia was the most common type overall (68-73%), particularly in patients under 40. Direct hernias increased with age, comprising 21 cases in those over 60. Right-sided hernias predominated (69.5%). The most frequent postoperative complications were sensory disturbance (19.4%), seroma (17.6%), and funiculitis (16%). A critical finding was that strangulated hernias (100%) were exclusively associated with a hernia duration of less than one year. Conclusion: The peak incidence of inguinal hernia occurs in middle age, with indirect hernias being most common overall, while direct hernias increase in prevalence among the elderly. The high frequency of right-sided hernias and specific postoperative complications provides valuable clinical insight. Most importantly, the risk of strangulation, the most severe complication, is highest within the first year of hernia onset, underscoring the need for timely surgical intervention.
Systematic Review
Open Access
Evaluating Diagnostic Tools for Female Genital Tuberculosis: A Systematic Review and Meta-Analysis of Histopathology, GeneXpert, and Culture
Mansi Raj ,
Akshaya Khattri ,
Aalima
Pages 814 - 820
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Abstract
Background: Female genital tuberculosis (FGTB) is a major cause of infertility and pelvic morbidity in high-burden regions, yet its diagnosis remains challenging due to non-specific symptoms and paucibacillary disease. Accurate identification relies on laboratory tests with variable diagnostic performance. Objective: To evaluate and compare the diagnostic accuracy of histopathology, GeneXpert MTB/RIF, and mycobacterial culture in confirming FGTB. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases including PubMed, Scopus, Web of Science, Google Scholar, Embase, and Cochrane Library were searched (1990–2024). Studies reporting diagnostic accuracy data were included. Pooled sensitivity, specificity, predictive values, and heterogeneity (I²) were calculated using a random-effects model. Results: Twenty-eight studies comprising 7,934 women were included. Histopathology showed the highest pooled sensitivity (71%) and moderate specificity (84%). GeneXpert MTB/RIF demonstrated low sensitivity (28%) but excellent specificity (98%). Mycobacterial culture exhibited the lowest sensitivity (21%) but perfect specificity (100%). Considerable heterogeneity was observed across studies, largely due to variations in sampling methods, reference standards, and laboratory techniques.
Conclusion: Histopathology remains the most sensitive tool for diagnosing FGTB, while GeneXpert offers rapid and highly specific confirmatory testing and rifampicin resistance detection. Mycobacterial culture, although limited by low sensitivity and long incubation time, provides definitive diagnosis when positive. A multimodal diagnostic approach integrating histopathology, GeneXpert, and culture is recommended to improve diagnostic accuracy and guide timely clinical management of FGTB.
Systematic Review
Open Access
Systematic Review and Meta-Analysis of the Accuracy of Transvaginal Sonography ± Color Doppler in the Early Diagnosis of Ectopic Pregnancy
Shashi Shukla ,
Rikin Raj ,
Mansi Raj
Pages 809 - 813
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Abstract
Background: Early diagnosis of ectopic pregnancy is critical for reducing maternal morbidity and mortality. Transvaginal sonography (TVS) is the primary imaging modality used, and the addition of color Doppler may enhance diagnostic accuracy.
Objective: To evaluate the pooled diagnostic performance of TVS alone and TVS combined with color Doppler in the early detection of ectopic pregnancy. Methods: A systematic search of major databases was conducted for studies published between 2000 and 2024 assessing the diagnostic accuracy of TVS ± Doppler. Twenty-seven studies involving 18,462 women met inclusion criteria. Pooled sensitivity, specificity, diagnostic odds ratios, and SROC values were calculated using a random-effects model. Results: TVS alone demonstrated a pooled sensitivity of 0.87 and specificity of 0.92. The addition of color Doppler improved sensitivity to 0.93 and specificity to 0.95. The diagnostic odds ratio and AUC values were higher for the combined modality, indicating superior discriminatory capability. Color Doppler particularly enhanced detection of peritrophoblastic flow and improved differentiation from adnexal mimics. Conclusion: TVS is a reliable first-line tool for diagnosing ectopic pregnancy, and incorporating color Doppler significantly enhances accuracy. Routine use of Doppler in early pregnancy evaluation can improve diagnostic confidence, support timely intervention, and reduce complications.
Research Article
Open Access
Comparing the effects of vein finder technology (near-infrared [NIR] technology) and traditional venipuncture on safe vascular access in orthopedic patients in the preoperative period
Pages 798 - 808
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Abstract
Background: Reliable peripheral venous access is essential during preoperative preparation in orthopedic patients, yet achieving first-attempt cannulation may be challenging due to factors such as oedema, obesity, scarring, ageing-related vascular changes, and repeated prior venipuncture. Near-infrared (NIR) vein-finder devices offer real-time visualization of superficial venous networks and may improve cannulation success and safety. Evidence from critical-care and emergency settings is mixed, and data specific to orthopedic surgical patients are limited. Aim: To compare the effectiveness of NIR vein-finder–assisted venipuncture versus the traditional landmark technique for establishing safe peripheral vascular access in adult orthopedic patients during the preoperative period. Methods: This prospective, parallel-group, randomised controlled study evaluated two vascular-access methods: (1) NIR-guided venipuncture using a portable vein-finder and (2) conventional landmark-based venipuncture. Adult orthopedic patients scheduled for elective or semi-elective surgery were randomised in a 1:1 allocation. Trained nurses performed all attempts with a maximum of five attempts per patient. The primary endpoint was first-attempt success, defined by successful venous entry, full catheter advancement, and unhindered saline flush. Secondary outcomes included total number of attempts, time required for insertion, nurse-reported procedural ease, patient-reported pain scores, and early local complications such as venitis, haematoma, thrombophlebitis, or extravasation. Results: The NIR group demonstrated a higher first-attempt success rate, required fewer total attempts, and showed reduced insertion time compared with the landmark technique. Procedural pain scores were lower in conscious patients undergoing NIR-assisted cannulation. Local complications over the short follow-up period were less frequent in the NIR group, indicating safer vascular access. These findings suggest that vein-mapping technology provides significant clinical advantage in orthopedic patients, particularly in those with difficult venous access predictors such as obesity, oedema, and advanced age. Conclusion: NIR vein-finder technology improves first-attempt success, reduces procedural difficulty, and enhances vascular-access safety in orthopedic preoperative patients compared with traditional venipuncture. Incorporating NIR devices into routine preoperative nursing practice may improve patient comfort, streamline workflow, and reduce complications.
Research Article
Open Access
Fetomaternal Morbidity and Mortality Associated with Placenta Previa: A Tertiary Care Experience from Kurnool
Suguna Sree K ,
Soma Shilpa P ,
Kiranmayee Y ,
Vara Lakshmi B
Pages 791 - 797
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Abstract
Background: Placenta previa (PP) is a potentially life-threatening obstetric condition characterised by implantation of the placenta over or near the internal cervical os, often leading to antepartum haemorrhage. The increasing rates of caesarean deliveries and delayed childbearing have amplified the risk of PP and its sequelae, including placenta accreta spectrum, haemorrhagic shock, and adverse neonatal outcomes. Objective: To evaluate fetomaternal morbidity and mortality associated with placenta previa in patients managed at a tertiary care hospital in Kurnool. Methods: This prospective observational study included 40 women diagnosed with placenta previa after 28 weeks of gestation from January 2024 to February 2025. Inclusion criteria encompassed ultrasound-confirmed PP, intraoperative detection during caesarean delivery, or asymptomatic cases with radiological evidence. Maternal outcomes assessed included antepartum/postpartum haemorrhage, transfusion requirements, surgical interventions (placental bed packing, uterine artery/internal iliac ligation, embolisation, caesarean hysterectomy), ICU admission, and mortality. Neonatal outcomes included gestational age at birth, birth weight, Apgar scores, NICU admission, morbidity, and perinatal mortality. Data were analysed using SPSS 20, with p ≤0.05 considered statistically significant. Results: Among 10,800 deliveries, 40 cases (0.37%) were complicated by placenta previa. Most patients were aged 20–30 years (82.5%) and multiparous (95%). Placenta accreta was observed in 4 (10%) and percreta in 1 (2.5%) patient. Antepartum bleeding was the most common presentation (62.5%). Preterm delivery occurred in 72.5% of cases, and all patients underwent caesarean section. Postpartum haemorrhage occurred in 50% of patients, with 37.5% requiring internal iliac ligation and 20% undergoing emergency caesarean hysterectomy. All patients received blood transfusions, with 30% requiring massive transfusion, and 12.5% required ICU admission. Maternal mortality was 2.5%. Neonatal outcomes included NICU admission in 5% and perinatal mortality of 5%. Conclusion: Placenta previa remains a significant contributor to maternal and neonatal morbidity, particularly among multiparous women with prior uterine surgery. Early antenatal detection, meticulous surgical planning, and a multidisciplinary approach are crucial to optimising outcomes. Preterm delivery and haemorrhagic complications are frequent, underscoring the importance of preparedness for both maternal and neonatal care.
Research Article
Open Access
Histopathological study of non-neoplastic and neoplastic lesions of the nasal cavity
Dr Susanna Yesamal Samuel ,
Dr Sharvani R Setty ,
Dr Ramu R ,
Dr Fathima S
Pages 782 - 790
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Abstract
Background: Lesions of the nasal cavity (NC) and paranasal sinuses (PNS) encompass a wide range of inflammatory, benign, and malignant conditions. Accurate diagnosis is essential for effective treatment and prognosis. Objective: To analyse the histopathological spectrum of lesions in the nasal cavity and paranasal sinuses and correlate clinical features with pathological diagnosis. Methods: A retrospective study of 150 biopsy cases from NC and PNS was conducted in the Department of Pathology at Basaveshwara Medical College. Clinical data, radiological findings, and histopathological results were reviewed. Results: Inflammatory lesions were predominant (84%), with sinonasal polyps being the most common (50.66%). Fungal infections such as mucormycosis and aspergillosis were noted. Benign neoplasms (14%) included inverted papilloma and haemangioma, while malignant tumours were rare (2%), comprising squamous cell carcinoma and olfactory neuroblastoma. Nasal obstruction was the most frequent clinical presentation. Conclusion: Histopathological evaluation remains the gold standard for diagnosis of NC and PNS lesions, aiding in differentiation between inflammatory and neoplastic conditions, which is critical for guiding treatment.
Research Article
Open Access
A Randomized Clinical Trial Comparing Injection Anti Vascular Endothelial Growth Factor (ANTIVEGF) With Macular Grid Laser Photocoagulation in The Management of Center Involved Diabetic Macular Edema
DR. LOGANAYAKI. P ,
Dr G SATHYA ,
Dr D SAKTHI PRIYA
Pages 770 - 781
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Abstract
Background: Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME) are leading causes of visual impairment worldwide, primarily resulting from microvascular complications of chronic hyperglycemia. The macula, responsible for central vision, is particularly vulnerable to metabolic and vascular injury in diabetes. AIM: To analyse and compare the outcomes of treatment in center involved diabetic macular oedema based on mean average change in Best corrected visual acuity from baseline to month 1 through 6 months. OBJECTIVES
1. To determine the best modality of management with respect to mean average change in best corrected visual acuity from baseline.
2. To evaluate the time course of mean change in best corrected visual acuity from baseline. METHODOLOGY: Patients presenting to the Vitreo-Retina services of RIOGOH were evaluated through detailed history, systemic, and comprehensive ocular examinations, including visual acuity, slit-lamp, and fundus evaluation. Necessary investigations such as OCT, fundus fluorescein angiography, blood sugar profile, HbA1c, lipid profile, and renal parameters were performed. Patients with centre-involved diabetic macular edema were randomly assigned to receive either intravitreal anti-VEGF injection (45 eyes) or macular grid laser treatment (45 eyes) and were followed up to assess post-treatment outcomes. RESULTS: In our study the predominant age group affected is the 41 – 50 years was 36.5% followed by 51 – 60 years range 34.6% and 61-70years was 15.4%. AntiVEGF group showed no loss of ETDRS letters from baseline during the follow up period of 6 months whereas in the laser group 11 eyes (29.7%) out of 37 eyes showed loss of ETDRS letters (p<0.01) which is statistically significant. CONCLUSION: Diabetic Retinopathy and Diabetic Macular Edema are major causes of preventable blindness among individuals with long-standing diabetes. Good glycemic and blood pressure control significantly reduce the risk of visual loss. Understanding the anatomy of the macula is vital for detecting early pathological changes and guiding management.
Research Article
Open Access
Comparison of Clinical Grades of Meibomian Gland Dysfunction with Meibography Degrees of Gland Loss
Dr Ashwini K G ,
Dr Nuthan Babu B, ,
Dr Niranjan V ,
Dr Thimmasamudram Vineela
Pages 763 - 769
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Abstract
Background: Meibomian Gland Dysfunction (MGD) is a leading cause of evaporative dry eye disease. Clinical evaluation of MGD is often subjective and may not reflect the true structural status of the meibomian glands. Infrared meibography offers an objective means to visualize and quantify gland dropout, providing a more comprehensive assessment of disease severity. Aim: To compare the clinical grades of Meibomian Gland Dysfunction with the meibography degrees of gland loss. Materials and Methods: A cross-sectional observational study was conducted on 115 patients diagnosed with MGD at Sankara Eye Hospital, Shimoga. Clinical grading was performed based on lid margin findings and meibum expressibility. Non-contact infrared meibography using the Sirius topographer (CSO, Italy) was used to assess the degree of gland loss. The correlation between clinical and meibography grades was analyzed using the Chi-square test and Spearman’s correlation coefficient. Results: Most patients (68%) had moderate to severe MGD (Grades 2 and 3). The majority showed 33–66% gland loss on meibography. A strong positive correlation was observed between clinical grade and meibography grade (r = 0.892, p < 0.001). Higher clinical grades corresponded with greater gland dropout, confirming that structural and functional changes progress together. Conclusion: Meibography is a valuable diagnostic adjunct that correlates strongly with clinical grading in MGD. It provides an objective evaluation of gland loss, enabling early detection and better disease monitoring. Incorporating meibography into standard assessment protocols can enhance the diagnosis and management of MGD, particularly in Indian clinical settings.
Research Article
Open Access
Association of Clinical Grades of Meibomian Gland Dysfunction with Dyslipidaemia: A Cross-sectional Observational Study from South India
Dr Ashwini K G ,
Dr Nuthan Babu B, ,
Dr Niranjan V, ,
Dr Thimmasamudram Vineela
Pages 757 - 762
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Abstract
Background: Meibomian Gland Dysfunction (MGD) is a major cause of evaporative dry eye disease and has been increasingly linked to systemic lipid abnormalities. Since meibomian gland secretions are lipid-rich, changes in serum lipid levels may influence gland function and disease severity. Aim: To study the association between clinical grades of Meibomian Gland Dysfunction and dyslipidemia. Materials and Methods: A cross-sectional study was conducted on 115 patients with clinically diagnosed MGD at Sankara Eye Hospital, Shimoga. MGD was graded clinically from 0 to 3 based on gland expressibility and secretion quality. Fasting serum lipid profile including total cholesterol, triglycerides, HDL, LDL, and VLDL was estimated. Data were analyzed using the Chi-square test, with p ≤ 0.05 considered significant. Results: The mean age of the study population was 60.3 ± 10.4 years, with 70.4% males. Higher MGD grades were associated with elevated total cholesterol levels (p = 0.010). No significant association was found between MGD grades and triglycerides, HDL, or VLDL levels. Conclusion:A significant correlation was observed between total cholesterol and MGD severity, indicating that dyslipidemia may play a role in the pathogenesis of MGD. Screening for lipid abnormalities in patients with chronic MGD may aid in early detection and management of systemic dyslipidemia.
Research Article
Open Access
Clinical Variants and Therapeutic Approaches in Breast ANDI: An Observational Analysis
Dr. Sheik Salman Raghib ,
Dr. Tajma Afzal ,
Dr. Biswadeep Lenka
Pages 750 - 756
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Abstract
Background: Breast Aberrations of Normal Development and Involution (ANDI) cover a range of benign and malignant disease, including hormone receptor-positive (HR+)/HER2-negative advanced breast cancer. CDK4/6 inhibitors have transformed therapy; however, resistance is the predominant clinical obstacle. This investigation assesses clinical variants and therapy following CDK4/6 inhibitor progression, with emphasis on biomarker-targeted treatment regimens. Methods: A retrospective observational analysis of HR+/HER2- breast cancer patients with disease progression after CDK4/6 inhibitor treatment was carried out. Patient information was evaluated for response to treatment, progression-free survival (PFS), and molecular biomarkers such as PI3K pathway mutations and CDK6 overexpression. Treatment options included endocrine therapy adjustment, chemotherapy, and targeted therapies like PI3K inhibitors. Statistical comparison was made with earlier published clinical trials. Results: Median PFS differed across treatment arms: 7.8 months in endocrine-modifying therapy, 5.2 months for chemotherapy, and 9.3 months with PI3K inhibitors. On molecular analysis, 35% of resistant patients showed PI3K pathway mutation and 40% showed overexpression of CDK6. Treatment based on biomarkers produced better results and supported results in postMONARCH and MONARCH 3 trials. Conclusion: Our results highlight the importance of tailored treatment regimens according to molecular profiling. Targeted agents, especially PI3K inhibitors, provide better outcomes than chemotherapy. Future studies must aim at new combination strategies to overcome resistance and improve long-term survival in breast ANDI patients.
Research Article
Open Access
A study of clinical presentation of celiac disease in a tertiary care hospital
Dr Shashank Shankar Bagali ,
Dr Rakesh MN ,
Dr Kapil Garg
Pages 741 - 749
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Research Article
Open Access
Comparison of Gallbladder Retrieval with and Without an Indigenous Endobag during Laparoscopic Cholecystectomy: A Prospective Randomized Study
Dr. Pareshkumar Rajsinh Damor ,
Dr. Bhargav Darji ,
Dr. Bharat Dharajiya
Pages 735 - 740
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Abstract
Background: Spillage of bile and gallstones during laparoscopic cholecystectomy may increase postoperative morbidity, including port-site infection and abscess formation. Commercial retrieval bags reduce contamination but increase the economic burden. Indigenous specimen bags offer a low-cost alternative.
Objective: To compare direct gallbladder extraction versus extraction using an indigenous sterile female-condom endobag with respect to operative ease, intraoperative spillage, postoperative complications, and overall outcomes. Methods: A prospective randomized study was conducted from December 2018 to September 2019 including 60 patients undergoing elective laparoscopic cholecystectomy. Patients were randomized into Group A (direct extraction) and Group B (endobag extraction). Intraoperative spillage, postoperative port-site complications, operative time, and hospital stay were recorded and statistically analyzed. Results: Bile spillage (13.33%) and stone spillage (3.33%) occurred exclusively in Group A; none occurred in Group B. Port-site infection was significantly higher in Group A (13.33%) than in Group B (3.33%). No port-site hernia, postoperative bleeding, or mortality occurred. Mean hospital stay was comparable between groups. Conclusion: The indigenous sterile female-condom endobag eliminates bile and stone spillage, significantly lowers port-site infection rates, and offers a cost-effective, safe, and simple alternative to commercial retrieval systems.
Research Article
Open Access
A Prospective Comparative Study of Modified “Far-Near-Near-Far” Versus Continuous Interlocking Closure of Midline Laparotomy
Dr. Pareshkumar Rajsinh Damor ,
Dr. Bharat Dharajiya
Pages 729 - 734
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Abstract
Background: Midline laparotomy is a common surgical approach, yet postoperative wound complications—particularly wound dehiscence—remain a significant cause of morbidity. Various fascial closure techniques have been proposed to improve outcomes. This study compares the traditional continuous interlocking technique with the modified Smead-Jones “Far-Near-Near-Far” method in terms of postoperative wound integrity and recovery. Materials and Methods: This randomized prospective study included 106 patients undergoing midline laparotomy at Sir Sayajirao General Hospital and Baroda Medical College between May 2018 and July 2019. Six patients who died in the early postoperative period were excluded, leaving 100 subjects divided equally into two groups: Group A (continuous interlocking closure) and Group B (modified Smead-Jones closure). Outcomes assessed included wound dehiscence, surgical site infection (SSI), operative time, hospital stay, and incisional hernia at six-month follow-up. Statistical analysis was performed using chi-square and relative risk calculations. Results: Wound dehiscence occurred in 18% of patients in the continuous interlocking group versus 4% in the modified Smead-Jones group (p = 0.025). SSI was noted in 36% of Group A and 20% of Group B (p = 0.07). Operative time for fascial closure per 10 cm was shorter in the modified technique (5.8 min) compared with the conventional method (6.5 min). Hospital stay was reduced in the study group (13 days vs. 16 days). Incisional hernia incidence at six months was comparable (10% vs. 8%). Conclusion: The modified Smead-Jones “Far-Near-Near-Far” closure technique significantly reduces wound dehiscence and improves postoperative recovery compared with the continuous interlocking method. It is an efficient, reliable alternative for midline laparotomy closure without increasing postoperative complications.
Research Article
Open Access
Diagnostic accuracy comparison of histopathology, GeneXpert, and culture for female genital tuberculosis: a systematic review and meta-analysis
Jyoti Mishra ,
Sayantani Ghosh Hazra ,
Vikas Malgotra
Pages 720 - 728
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Abstract
Background: Female genital tuberculosis (FGTB) is an important but underdiagnosed cause of infertility, particularly in resource-limited settings, where optimal diagnostic strategies remain uncertain. This systematic review and meta-analysis compared the diagnostic accuracy of histopathology, GeneXpert (Xpert MTB/RIF), and culture for FGTB in women. A comprehensive search of PubMed, Google Scholar, Embase, and other databases up to July 2023 was performed following PRISMA-DTA guidelines. Studies evaluating histopathology, GeneXpert, and/or culture for FGTB in human female genital samples, with any appropriate reference standard, were included. Data on study characteristics and 2×2 contingency tables were extracted, and risk of bias was assessed using the QUADAS-2 tool. Pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios (DOR), and area under the receiver operating characteristic curve (AUC) were calculated using a random-effects model. Forty-one studies were included in the qualitative synthesis, of which eight contributed to quantitative analyses, encompassing 2845 histopathology, 2194 GeneXpert, and 2064 culture-based evaluations. When culture was used as the reference standard, histopathology demonstrated high specificity (≈99.5%) with moderate sensitivity (≈64.8%), while GeneXpert showed slightly higher sensitivity (≈66.5%) but lower specificity (≈90.8%). Culture itself exhibited very high sensitivity (≈96.7%) but only moderate specificity (≈84.3%) when assessed against composite or alternative reference standards. Overall, histopathology yielded the highest DOR among the three modalities, indicating superior discriminative ability, whereas GeneXpert provided rapid, moderately accurate results that may be particularly useful for ruling out disease. Culture remained the most sensitive but was limited by longer turnaround time and infrastructure requirements. In conclusion, culture offers the best sensitivity for detecting FGTB, while histopathology provides excellent specificity and overall higher diagnostic odds than GeneXpert. In resource-constrained settings, histopathology should remain the cornerstone of FGTB diagnosis, complemented by GeneXpert and culture where available. A multimodal diagnostic approach, integrating histopathology with rapid molecular testing and culture, is likely to provide the most accurate and timely diagnosis for women with suspected FGTB.
Research Article
Open Access
Comparative Diagnostic Accuracy of Histopathology, GeneXpert, and Culture in Female Genital Tuberculosis: A Systematic Review and Meta-analysis
Aamir Ali ,
Gopinath Reddy V ,
Sheetal Sharma
Pages 714 - 719
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Abstract
Background: Female genital tuberculosis (FGTB) is a significant cause of infertility and chronic pelvic disease in women from endemic regions. Due to nonspecific clinical presentation and low bacillary load, effective diagnosis remains a challenge. Histopathology, GeneXpert, and culture are commonly used for diagnostic evaluation; however, their comparative diagnostic accuracy has not been systematically summarized. Aim: To compare the diagnostic accuracy of histopathological examination, GeneXpert MTB/RIF assay, and mycobacterial culture in detecting female genital tuberculosis through a systematic review and meta-analysis. Methods: An electronic search was conducted in PubMed, Scopus, Embase, Web of Science, and Cochrane Library for studies published between January 2000 and December 2024. Prospective and retrospective cross-sectional diagnostic accuracy studies were included. Random-effects meta-analysis was performed to derive combined sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios. Summary ROC curves and heterogeneity analysis were conducted. Results: Twenty-eight studies (n = 3,942 women) were included. Pooled sensitivity and specificity were highest for GeneXpert (sensitivity 79%, specificity 96%), followed by histopathology (sensitivity 68%, specificity 90%), and culture (sensitivity 48%, specificity 97%). Combined use of histopathology and GeneXpert increased diagnostic yield to 91%. Heterogeneity was moderate to high among all diagnostic modalities (I²: 56–78%). Subgroup analysis in infertility cases demonstrated higher accuracy. Conclusion: GeneXpert offers the best single-test diagnostic performance for FGTB, whereas histopathology remains a valuable screening method. Culture, despite high specificity, has a low yield and prolonged turnaround time. A combined approach using histopathology and GeneXpert provides optimal diagnostic outcomes. Implementation of molecular testing should be prioritized within diagnostic algorithms.
Research Article
Open Access
Correlation Between Serum TSH Levels and Lipid Profile in Newly Diagnosed Hypothyroidism
Pages 709 - 713
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Abstract
Background: Thyroid hormones play a fundamental role in regulating lipid metabolism through their effects on LDL receptor activity, cholesterol synthesis, and triglyceride turnover. Hypothyroidism, whether overt or subclinical, is associated with metabolic disturbances that predispose patients to dyslipidemia and cardiovascular risk. Although several studies have reported lipid abnormalities in hypothyroidism, the degree to which serum TSH correlates with specific lipid fractions in newly diagnosed, untreated patients remain clinically relevant. The aim of the study is to evaluate the correlation between serum TSH levels and lipid profile parameters in newly diagnosed hypothyroid patients and to compare lipid patterns between euthyroid and hypothyroid individuals. Materials and Methods:
A cross-sectional observational study was conducted in the Department of Medicine, Shantaba Medical College & Hospital, Amreli, Gujarat, after obtaining ethical clearance. A total of 180 participants aged 20–60 years were enrolled, including 90 euthyroid and 90 newly diagnosed hypothyroid patients. Thyroid function tests (TSH, Free T3, Free T4) and fasting lipid parameters (total cholesterol, triglycerides, LDL-C, HDL-C) were measured using standard biochemical methods. LDL-C was calculated using the Friedewald formula. Statistical analysis included descriptive statistics, group comparisons, and Pearson correlation coefficients; p < 0.05 was considered significant. Results: Hypothyroid patients exhibited significantly higher total cholesterol (256.8 ± 47.2 mg/dL), LDL-C (165.9 ± 38.6 mg/dL), and triglycerides (186.4 ± 54.8 mg/dL) compared with the euthyroid group (187.5 ± 21.8 mg/dL, 115.3 ± 19.1 mg/dL, 129.7 ± 30.4 mg/dL respectively; p < 0.001). HDL-C levels were significantly lower in hypothyroid subjects (45.3 ± 8.9 mg/dL vs. 52.9 ± 8.1 mg/dL). In the hypothyroid group, TSH showed strong positive correlations with total cholesterol (r = 0.67) and LDL-C (r = 0.61), and a moderate correlation with triglycerides (r = 0.46). HDL-C demonstrated a weak inverse correlation (r = –0.21). Conclusion: Newly diagnosed hypothyroidism is associated with a distinctly atherogenic lipid profile. Rising TSH levels strongly correlate with elevations in total cholesterol and LDL-C and moderately with triglycerides, supporting the need for routine lipid assessment at diagnosis. Early identification and treatment of thyroid dysfunction may reduce long-term cardiovascular risk.
Research Article
Open Access
Assessing the Predictive Validity of the Acromio-Axillo-Suprasternal Notch Index for Identifying Difficult Laryngoscopic Views
Shabbir Ali Jafarali Mulla ,
Sunitha S ,
Ruhi Salma Naagar
Pages 704 - 708
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Research Article
Open Access
Comparative Evaluation of AI Algorithms for Peri-Implantitis Detection and Management
Dr. Kapil Laddha ,
Bharani K Bhattu ,
Dr. Manish Jain
Pages 699 - 703
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Abstract
Background: Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation of the peri-implant mucosa and progressive loss of supporting bone. Early detection is critical for effective management and implant survival. While Artificial Intelligence (AI), specifically Convolutional Neural Networks (CNNs), has shown promise in dental radiography, there is a paucity of research comparing the efficacy of different algorithmic architectures in distinguishing varying severities of peri-implant bone loss. Methods: A dataset of 1,500 digital periapical radiographs was curated and annotated by consensus of three experienced periodontists. The images were categorized into three groups: Healthy/Mucositis, Mild/Moderate Peri-implantitis (requiring non-surgical management), and Severe Peri-implantitis (requiring surgical intervention). The dataset was split into training (80%), validation (10%), and testing (10%) sets. Three models (VGG-16, ResNet-50, and Hybrid U-Net) were trained. Performance metrics included Accuracy, Sensitivity, Specificity, Intersection over Union (IoU), and F1-score. Results: The Hybrid U-Net model demonstrated superior performance with an overall accuracy of 96.4% ± 1.2%, significantly higher than ResNet-50 (91.8% ± 1.5%) and VGG-16 (88.2% ± 2.1%) (p<0.01). In detecting early bone loss (Mild/Moderate group), the Hybrid U-Net achieved a sensitivity of 94.5%, compared to 87.2% for ResNet-50. VGG-16 showed the highest computational time. There was a statistically significant difference in the Area Under the Curve (AUC) favoring the Hybrid model (0.98 vs. 0.93 and 0.89, respectively). Conclusion: While all tested AI models demonstrated diagnostic utility, the segmentation-based Hybrid U-Net architecture significantly outperformed standard classification networks (VGG-16 and ResNet-50) in detecting subtle marginal bone changes. This suggests that architecture-specific optimization is required for AI to serve as a reliable clinical decision support tool for peri-implantitis management.
Research Article
Open Access
Visual And Orbital Complications Of Acute Fungal Sinusitis Including COVID-Induced Mucormycosis: A Systematic Literature Review And Meta- Analysis
Dr. Neha Adlakha ,
Dr. Garima Yadav ,
Dr. Mayank Yadav ,
Dr. Manpreet Kaur ,
Dr. Nishtha Saini ,
Dr. Priyanka Saini
Pages 687 - 698
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Abstract
Background: Acute invasive fungal sinusitis (AIFS) — particularly rhino-orbital- cerebral mucormycosis (ROCM) causes devastating visual and orbital complications. COVID-19 pandemic precipitated a surge in COVID-associated mucormycosis (CAM), leading to increased reports of vision loss, orbital involvement, cavernous sinus thrombosis, and related morbidity. This systematic review and meta-analysis aimed to quantify the frequency, patterns, and outcomes of visual and orbital complications of AIFS (including CAM) from studies published between January 1, 2000 and September 30, 2025. Methods: We performed a comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library for studies reporting visual and/or orbital outcomes in patients with acute fungal sinusitis (mucormycosis, invasive aspergillosis and other angioinvasive fungi) from 2000–2025. Search terms combined synonyms for “invasive fungal sinusitis”, “mucormycosis”, “rhino- orbital”, “visual loss”, and “COVID-19”. Two reviewers independently screened titles/abstracts, reviewed full text, and extracted data. Risk of bias was assessed with Newcastle-Ottawa Scale for observational studies and a modified quality tool for case series. Pooled event rates were calculated using random-effects meta- analysis and heterogeneity quantified with I². Pre-specified subgroup analyses included COVID-associated vs non-COVID AIFS, diabetes status, early vs delayed surgical intervention, and antifungal regimen. Results: A total of 85 studies (published 2000–2025) met inclusion criteria and were included in the qualitative and quantitative synthesis, comprising approximately 7,500 patients (range: small case series to large multicenter cohorts). The included literature set comprised observational cohorts (n≈24), multi-institutional registries (n≈6), case series (n≈35) and case reports aggregated for sensitivity analyses. Pooled prevalence of any orbital involvement among AIFS cases was 48% (95% CI 41–56%, I²=78%). Complete or profound visual loss (defined as best-corrected visual acuity ≤20/200 or no light perception) occurred in 22% of affected patients (95% CI 17–28%, I²=71%). Cavernous sinus thrombosis and central retinal artery occlusion (CRAO) were reported in 7% (95% CI 4–11%) and 4% (95% CI 2–7%) respectively.
COVID-associated mucormycosis cases had higher pooled rates of orbital involvement (56% vs 41%) and visual loss (28% vs 18%) compared with non- COVID cohorts; these differences persisted in sensitivity analyses restricted to studies with low-to-moderate risk of bias. Heterogeneity was substantial across analyses, driven by geographic setting (large contribution from India), differences in case ascertainment, and varying thresholds for surgical aggressiveness. Conclusions: Acute invasive fungal sinusitis, and CAM
in particular, carries a high risk of orbital involvement and irreversible visual loss.Our meta-analysis (85 studies, ~7,500 patients) indicates nearly half of AIFS cases involve the orbit and more than one in five patients suffer severe visual loss. Early recognition, prompt antifungal therapy, and timely surgical debridement remain critical to preserve vision and reduce mortality. The pronounced geographic clustering and pandemic-era surge underscore the need for regionally tailored clinical pathways, rapid diagnostic strategies, and prospective multicenter studies to define optimal management algorithms.
Research Article
Open Access
Topical Trichloroacetic Acid in the Management of Septal Pyogenic Granuloma: A Case-Based Perspective
Dr Varakantham Monica Reddy ,
Dr. P. Siva Subba Rao ,
Dr. Kadipireddy Samatha Reddy ,
Dr. Payal jaiprakash Rana ,
Dr. Sravani Chukkapally, ,
Dr. Nagineni Venkata Vineela
Pages 681 - 686
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Abstract
Background: Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular lesion commonly caused by local irritation, trauma, or hormonal influences. Its occurrence on the nasal septum is rare but can present with recurrent epistaxis and nasal obstruction, often leading to surgical excision. This case study demonstrates the efficacy of topical trichloroacetic acid (TCA) as a minimally invasive and cost-effective alternative for treating septal pyogenic granuloma. A 32-year-old male presented with recurrent nasal bleeding and obstruction for two weeks. Clinical examination revealed a reddish, friable, polypoidal lesion on the anterior nasal septum, consistent with pyogenic granuloma. Serial applications of 10% TCA under local anesthesia resulted in complete resolution by the fourth week, with healthy mucosal healing and no recurrence at three months. This case highlights that topical TCA is a safe and effective outpatient treatment option that avoids the risks associated with surgical excision.
Research Article
Open Access
Surgical and Functional Outcomes of Transforaminal Lumbar Interbody Fusion in Adult Degenerative Lumbar Spondylolisthesis: A Prospective Observational Study
Pages 674 - 680
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Abstract
Background: Adult degenerative lumbar spondylolisthesis (ADLS) commonly causes chronic low back pain and radiculopathy. Transforaminal Lumbar Interbody Fusion (TLIF) enables decompression, reduction, and fusion through a single posterior approach with potential biomechanical advantages. This study evaluated surgical and functional outcomes following TLIF in ADLS patients. Materials and Methods: A prospective observational study was conducted in the Department of Neurosurgery, MKCG Medical College and Hospital, Berhampur (December 2019–December 2021). Fifty adults (45–60 years) with degenerative lumbar spondylolisthesis (Grade III–IV or Grade I–II unresponsive to conservative therapy) underwent TLIF. Pain, disability, and quality of life were assessed preoperatively and at 10 days, 1 month, and 6 months postoperatively using the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36). Data were analyzed using SPSS 25; p < 0.05 was considered significant. Results: The mean age was 51.36 ± 4.5 years; 60% were male. Mean operative time was 3.5 hours with average blood loss of 230 ml. Complete correction of slip was achieved in all Grade I–II cases and partial correction in higher grades. No screw breakage, infection, neurological deficit, or slip progression occurred. SF-36 scores improved from 1536.4 preoperatively to 2576.3 at 6 months (p < 0.001). VAS and ODI scores also showed significant and sustained improvement. Discussion and Conclusion:
TLIF proved to be a safe, effective, and biomechanically superior technique for managing degenerative and high-grade spondylolisthesis. It provided stable fusion, significant pain relief, improved function, and enhanced quality of life with minimal complications. Further long-term studies are warranted to confirm durability of outcomes.
Research Article
Open Access
CLINICAL, RADIOLOGICAL, AND ETIOLOGICAL PATTERN OF PATIENTS WITH INTERSTITIAL LUNG DISEASE
Dr. Devaragatla Ravikiran ,
Dr. K Venkatesh ,
Dr. Nakka Rajendra Prasad
Pages 667 - 673
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Abstract
Background: Interstitial lung disease (ILD) is a group of heterogeneous disorders with varying degrees of lung inflammation and fibrosis of the lung parenchyma. Its burden is increasing due to exposure to environmental risk factors. Therefore, accurate identification of clinical radiological and etiological patterns is required for precise diagnosis and management. Methods: This cross-sectional study was done in 45 cases of ILD based on the clinical, radiological, and pulmonary criteria. The demographic and exposure history, as well as duration of symptoms, were recorded in a restructured questionnaire. They were subjected to Pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) scans. Final etiological diagnoses were established through multidisciplinary discussion (MDD) involving Pulmonologists, Physicians and Radiologists. Results: The mean age of the cohort was 62.4 ± 10.8 years, with a male predominance (57.8%). Dyspnea (100%) and dry cough (91.1%) were the most common symptoms. Restrictive ventilatory defect was observed in 77.8% of cases, and reduced DLCO was common. On HRCT, usual interstitial pneumonia (UIP) was the predominant pattern (26.7%), followed by probable UIP (22.2%) and nonspecific interstitial pneumonia (NSIP) (20%). Etiologically, idiopathic interstitial pneumonias accounted for 53.3% of cases, with idiopathic pulmonary fibrosis (IPF) being most frequent (40%). Conclusion: Idiopathic interstitial pneumonias, especially IPF, were the most prevalent ILD subtype, followed by CTD-associated ILD and hypersensitivity pneumonitis. The study highlights the importance of HRCT pattern recognition and MDD for accurate diagnosis and classification of ILD, facilitating early intervention and improved outcomes.
Research Article
Open Access
Role of Antenatal Corticosteroids in Late Preterm and Early Term Deliveries — Neonatal Respiratory Outcomes
Sunita Vishwanath Bansode,
Amit Yadav ,
Kiranpreet
Pages 659 - 666
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Abstract
Background: This study aimed to evaluate maternal and neonatal outcomes by analyzing clinical data from hospital records. Patients presenting with non-reassuring fetal heart rate patterns at admission, cervical cerclage, congenital anomalies, chromosomal abnormalities, or multifetal pregnancies were excluded to ensure homogeneity. This accounts for 1–11% of all live births worldwide, with rates ranging from around 5% in some European countries to 18% in some African countries Preterm births are further categorized based on gestational age at birth. Births that occur between 34+0 and 36+6 weeks gestation are defined as late preterm births and account for approximately 70–75% of all preterm births Respiratory complications associated with preterm birth, such as respiratory distress syndrome (RDS), the need for respiratory support, necrotizing enterocolitis and intraventricular hemorrhage, are among the greatest challenges for these new borns. Methods: Patients with non-reassuring fetal heart rate patterns at admission, cervical cerclage, congenital anomalies, chromosomal abnormalities, or multifetal pregnancies were excluded. Maternal and neonatal data were obtained from the hospital’s medical record system: Maternal Characteristics: Maternal age, body mass index (BMI), history of preterm birth, prior cesarean delivery, hypertensive disorders, diabetes, preterm premature rupture of membranes (PPROM), preterm labor, intrauterine growth restriction (IUGR), oligohydramnios, mode of delivery (cesarean or vaginal), and other obstetric history. Results: This study aimed to evaluate maternal and neonatal outcomes by analyzing clinical data from hospital records. Patients presenting with non-reassuring fetal heart rate patterns at admission, cervical cerclage, congenital anomalies, chromosomal abnormalities, or multifetal pregnancies were excluded to ensure homogeneity. Maternal characteristics assessed included age, body mass index (BMI), history of preterm birth, prior cesarean delivery, hypertensive disorders, diabetes, preterm premature rupture of membranes (PPROM), preterm labor, intrauterine growth restriction (IUGR), oligohydramnios, and mode of delivery. These variables were systematically extracted to identify potential associations with neonatal outcomes and to inform obstetric management strategies. Conclusion: Antenatal corticosteroid administration in women at risk of late preterm delivery (34–36 weeks) significantly improves neonatal respiratory adaptation and reduces NICU admissions without increasing maternal morbidity. The transient rise in neonatal hypoglycemia remains the primary side effect, necessitating appropriate postnatal monitoring
Research Article
Open Access
Prevalence and Distribution of Refractive Errors among school children in Vizianagaram district, India: A Cross-sectional analysis
Pavani Jerry ,
Ch Lakshmi Saranya,
V Rajeswar Rao,
Sai Sri Lalam
Pages 653 - 658
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Abstract
Background: Refractive errors are among the leading causes of preventable visual impairment in children and often remain undetected during the school years. Early identification through school-based screening programmes significantly reduces long-term morbidity by enabling timely correction and preventing academic and functional limitations. Objectives: To determine the prevalence and distribution of refractive errors among school-going children aged 10–17 years in the Vizianagaram district of Andhra Pradesh. Methods: A school-based cross-sectional study was carried out under the National Programme for Control of Blindness (NPCB) from August to November 2024. Twenty-seven government and private schools were included as part of the scheduled screening activity. Visual acuity assessment using Snellen’s chart (6 m) was followed by subjective refraction and cycloplegic evaluation where necessary. Refractive errors were classified using RESC criteria. Data were recorded using the NPCB screening format and analysed using descriptive statistics. Results: A total of 5893 children were screened (mean age 13.63 ± 1.79 years). Defective vision (<6/9) was identified in 416 students, and refractive errors accounted for 386 cases, yielding a prevalence of 6.5%. Girls constituted 71.7% of affected children. Myopia was the most frequent refractive error (84%), followed by astigmatism (15%) and hypermetropia (0.25%). Only 6.73% of affected students were using corrective spectacles. Myopia showed a marked rise in the 14–17-year age group. Conclusion: The study highlights a substantial burden of uncorrected refractive errors, dominated by myopia, and a strikingly low rate of spectacle use. Strengthened school-based screening, improved spectacle provisioning, and targeted awareness initiatives are essential to mitigate avoidable visual impairment.
Research Article
Open Access
Safety and efficacy of percutaneous balloon Mitral valvotomy in severe mitral stenosis with moderate mitral regurgitation
Mahesh Narendra Jain,
Vipin Sisodia ,
Vivek Rawat
Pages 646 - 652
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Abstract
Background: Percutaneous balloon mitral valvotomy (PBMV) has become a pivotal intervention for mitral stenosis (MS), particularly in regions with high rheumatic heart disease prevalence. Traditionally, moderate or severe mitral regurgitation (MR) has been considered a contraindication for PBMV due to concerns about exacerbating MR. However, recent evidence suggests that PBMV may be safe and effective in carefully selected patients with severe MS and moderate MR. This study aims to evaluate the safety, efficacy, and long-term outcomes of PBMV in such patients. Methods: A prospective observational study was conducted at the Pacific Institute of Medical Sciences, Udaipur, India, from April 2023 to March 2025. One hundred patients with severe MS and moderate MR were enrolled and underwent PBMV. Pre-procedural assessment included clinical, echocardiographic, and laboratory evaluations. The procedure was performed under local anesthesia, with the success defined as a significant increase in mitral valve area and a reduction in pressure gradient. Post-procedural outcomes, including complications and improvements in NYHA functional class, were assessed immediately and during follow-up at 1 month, 6 months, and 1 year. Results: The procedure had a 95% success rate. Significant reductions in mitral pressure gradient (from 18 mmHg to 6 mmHg) and mitral valve area (from 0.9 cm² to 1.8 cm²) were observed. Moderate MR improved in 60% of patients. Major complications (stroke, tamponade) occurred in 5% of patients. At 6 months to 1-year follow-up, 75% of patients showed functional improvement by at least one NYHA class, with no deaths or need for repeat procedures. Patient satisfaction was high, with 85% reporting positive outcomes. Conclusion: PBMV is a safe and effective procedure for patients with severe MS and moderate MR, offering significant symptomatic relief and improvement in functional status. While complications are possible, the procedure's overall success and long-term outcomes support its selective use in this challenging patient population.
Research Article
Open Access
Efficacy of Cerebroprotein Hydrolysate as a Neuroprotective Agent in Acute Spinal Cord Injury: A Prospective Study
I.D. Chaurasia ,
Gaurav Gupta ,
Rakesh Shukal ,
Ishant Chaurasia ,
Mahim Koshariya
Pages 638 - 645
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Abstract
Background: Spinal cord injury is an extremely serious and world most disasterous type of physical trauma that can have a lasting and significant impact on most aspects of daily life leading to a grievous clinical situation. This can have major functional, medical, financial, social and physiological effect for which there is no effective treatment till today. Anyone who survived from such injury used to live with morbidily and other complication. In case of acute spinal cord injury methylprednisolone is a standard treatment option. It can result in Tetraplegia /quadriplegia, paraplegia and other lifetime disabilities. Cerebroproteinhydrolysate a neuropeptide synthetic preparation having neurotropic and neuroprotective role, being successfully used in the treatment of Alzheimers disease, in acute cerebrovascular strokes, traumatic brain injury with proven benefits. Few studies support its role in spinal cord injury benefits.. Cerebroproteinhydrolysate is a mixture of different neurotrophic factors such as BDNF, GDNF and NGF used to treat the normal SCI our experience showed that Cerebroprotein hydrolysate resulted in good neuroprotection. This prospective study was conducted in the neurosurgery unit of surgery department in Gandhi medical college &Associated Hamidia Hospital Bhopal in this study 240 patients of acute spinal cord injury were enrolled who reported in the emergency department within 8 hours of traumatic injury. We assessed the efficacy and safety of cerebroproteinhydrolysate (cerehenz) in the treatment of traumatic acute spinal cord injury and its outcome. Cerebroproteinhydrolysate treated group was compared to the conventional therapy (controlled) group. There was a statistically significant (p value=0.001) seen in improvement in terms of functional outcome in patients treated with cerebroproteinhydrolysate. These patients have significant motor and partial sensory recovery including the sensations of touch, pressure, vibration and pain: from A to B score on ASIA scale. Initial prehospital management of traumatic acute spinal cord injury is crucial for the morbidity and mortality following acute SCI. For a long time no proper and promising treatment for SCI was available. This study shows that cerebroprotienhydrolaste has beneficial outcomes as immediate neuroprotective therapy and ensuring the spinal cord perfusion pressure augmentation has no complications and the results are promising. Our results suggest that patients with traumatic acute spinal cord injuries when treated with cerebroproteinhydrolysate are benefitted significantly in regards to functional outcome and it can be safely used. The prediction of neurological and functional outcomes after spinal cord injury (SCI) is essential to answer patients' questions regarding their functional potential and to understand the amount of resources required during inpatient rehabilitation and after discharge. Though a large size randomized control trials are required to authenticate its potential benefits.
Research Article
Open Access
Pattern of presentation and management outcomes in Pediatric acute Appendicitis: A Prospective Observational study
V. Saikrishna ,
Inugala Anusiri
Pages 632 - 637
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Abstract
Background: Acute appendicitis remains one of the most frequent surgical emergencies in children. Its clinical presentation varies widely across age groups, and delays in diagnosis may increase the risk of complications. This study aimed to describe the pattern of presentation and evaluate management outcomes in children with acute appendicitis. Objectives: To assess demographic characteristics, clinical features, imaging findings, and treatment outcomes in pediatric acute appendicitis. Methods: A prospective observational study was conducted over one year and included 50 children diagnosed with acute appendicitis. Demographic details, presenting symptoms, examination findings, laboratory parameters, and ultrasonography results were recorded. Each child was classified as having uncomplicated or complicated appendicitis. Management strategies surgical or conservative were documented, along with postoperative outcomes. Data were summarized using descriptive statistics. Results: The mean age of the cohort was 9.3 ± 2.8 years, with a slight male predominance. Most children presented after more than 24 hours of abdominal pain, and vomiting and fever were common. Guarding and rebound tenderness were frequently observed. Leukocytosis and neutrophilia supported the diagnosis in the majority. Ultrasonography demonstrated a non-compressible, thickened appendix in 76% and peri-appendiceal fluid in 30%. Uncomplicated appendicitis accounted for 68% of cases, while 32% had complicated disease. Surgical treatment was undertaken in 84%, with laparoscopy being the predominant approach. Conservative management succeeded in six of eight children. Postoperative complications were minimal, with only four wound infections and one abscess. No mortality occurred. Conclusion: Most children recovered well following timely intervention. Complicated appendicitis was linked to delayed presentation and higher morbidity, highlighting the need for early evaluation and prompt management
Research Article
Open Access
Association of metabolic risk Factors with pre diabetes among adults attending a tertiary care center in Maharashtra: An observational study
Dr. Harishchandra Jaidas Gavit ,
Dr.Vijay Rajput Kokani
Pages 626 - 631
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Abstract
Background: Introduction: Type 2 Diabetes mellitus (T2DM) is often preceded by a state of abnormal blood sugars called as pre diabetic state. Pre diabetic state depicts the tip of iceberg. It is term coined to include two intermediate conditions- impaired fasting glucose and/or impaired glucose tolerance. An addition to this duo is elevated glycated haemoglobin has been recently added. Prevalence of this state is rising across the world and it has been estimated that by the year 2030, more than 470 million people will develop pre diabetes. Early diagnosis of pre diabetic state and associated risk factors will help intervene early. There is insufficient data of association of various metabolic factors with pre diabetes and hence this study was conducted to understand the association of metabolic risk factors with pre diabetes among adults attending our tertiary care center. Methods: A cross- sectional study was conducted amongst 148 patients attending the department of medicine of tertiary care hospital. The patients with prior history of diabetes mellitus, use of drugs which interfere with the glucose metabolism such as angiotensin converting enzyme inhibitors, angiotensin receptor blockers and thiazide diuretics and use of lipid lowering agents were excluded from the study. Data was collected using pretested and pre designed case record form. A patient was said to be pre diabetic, if any of the three parameters were present. The three parameters were fasting blood sugar between 100 to 125mg/dl, 2 hours plasma glucose between 140 to 199mg/dl and or glycosylated haemoglobin between 5.7 to 6.4%. Results: We have included 150 cases in the present study. The mean age of the study subjects was 43.01 ± 10.41 years with female preponderance. The prevalence of the pre diabetes in the present sample was 56%. Univariate analysis of the present sample revealed that body mass index (p<0.001), waist: hip ratio (p<0.001), total cholesterol (p<0.001), triglycerides (0.0001), high density lipoprotein (p<0.001), low density lipoprotein (0.0073) and very low -density lipoprotein (p<0.001) were associated with pre diabetic state. Those factors which were having significance value less than 0.10 based on univariate analysis were subjected to binary logistic regression analysis. We found higher body mass index (p=0.0010), higher waist: hip ratio (<0.001), lower high -density lipoprotein (p=0.0018) and higher very low -density lipoprotein (p=0.035) were significant factors which were associated with pre diabetes. Conclusion: More than half of the patients were pre diabetic in the present study. Higher body mass index (Generalised obesity), higher waist: hip ratio (Centralised obesity), lower HDL and higher VLDL was significant predictors associated with pre diabetic state in the present study. Approach to lifestyle modifications and early identifications of these risk factors will help the patient to stop the transition of disease from pre diabetic state to frank T2DM.
Case Report
Open Access
Incarcerated Gravid Uterus
Dr. Aparna Kulkarni ,
Dr Asha Gokhale
Pages 622 - 625
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Abstract
Aim and Background: To highlight the clinical challenges associated with incarcerated gravid uterus in early pregnancy, particularly in the presence of a large uterine fibroid. Incarcerated gravid uterus is a rare obstetric condition wherein the uterus becomes trapped in the pelvis between the sacral promontory and pubic symphysis. Risk factors include retroversion of the uterus, large uterine fibroids, endometriosis, and pelvic adhesions. Large fibroids can distort pelvic anatomy complicating clinical evaluation, and ultrasonographic interpretation during pregnancy. Case Description: A 37-year-old primigravida presented at 13 weeks’ gestation with heavy vaginal bleeding. Ultrasound done elsewhere reported a large posterior subserosal fibroid (13.5 x 9 cm) with a normal-appearing fetus. Combined screening reported abnormal biochemistry with high risk for Trisomy 13 and 18. On admission, clinical examination suggested inevitable miscarriage with anteriorly displaced cervix. Patients bleeding subsided significantly after she expelled a large clot. Ultrasound revealed an enlarged retroverted uterus with an empty cavity, suggestive of complete miscarriage. Three weeks later, she spontaneously expelled the fetus at home and underwent curettage for retained products. Retrospectively, the case was diagnosed as incarcerated gravid uterus complicated by fibroid-induced anatomical distortion, which misled sonographic interpretation. Conclusion: This case highlights poor outcome in an incarcerated gravid uterus due to presence of a large fibroid. The case also underscores the difficulty in assessment of intrauterine pregnancy and miscarriage when a large fibroid causes uterine incarceration displacing the cervix anteriorly completely distorting pelvic anatomy. Clinical Significance: Awareness of this rare but significant condition is crucial for imaging specialists and obstetricians. Recognition of risk factors such as fibroids and retroverted uterus, understanding potential placental dysfunction due to large fibroid and understanding ultrasound limitations in distorted anatomy, can aid patient counselling and appropriate management.
Research Article
Open Access
Analysis of the Association of Severity Mebomian Gland Association and
Dyslipidemia – Cross-sectional Observational Study
Dr Murali Krishna Damdamraju ,
Dr Amrutha Priyadarsini P ,
Dr Ratla N.Bharath Singh Naik
Pages 616 - 621
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Abstract
Background: Meibomian gland dysfunction (MGD) is a chronic abnormality of the
meibomian glands resulting in altered tear film, leading to symptoms of dry eye,
irritation, and ocular surface disease. Dyslipidemia has been implicated as a
potential contributing factor in MGD, but evidence remains limited. Purpose: This
study aimed to evaluate the association between the severity of MGD and
dyslipidemia in the population of Machilipatnam, India. Methods: A cross-sectional
observational study was conducted involving 125 patients diagnosed with MGD at
the Department of Ophthalmology, Government General Teaching Hospital,
Machilipatnam. Subjects underwent comprehensive ophthalmic evaluation
including meibomian gland assessment and lipid profile analysis. MGD severity
was graded based on clinical parameters, and serum lipid levels—including total
cholesterol (TC), low-density lipoproteins (LDL), very low-density lipoproteins
(VLDL), high-density lipoproteins (HDL), and triglycerides (TG)—were measured.
Statistical analysis assessed correlations between serum lipid abnormalities and
MGD severity. Results: Among the 125 participants (65 females, 60 males), lipid
abnormalities were prevalent and correlated with increasing MGD severity.
Elevated TC, LDL, VLDL, and triglycerides showed a significant association with
advanced MGD stages (p < 0.001). Reduced HDL levels were observed in more
severe MGD cases. No significant correlation was found between occupation type
and MGD severity. The results suggest a strong link between dyslipidemia and
MGD progression. Conclusion: This study demonstrates a significant association
between dyslipidemia and the severity of meibomian gland dysfunction. Monitoring
and management of lipid abnormalities may be important in the comprehensive
treatment of MGD.
Research Article
Open Access
Clinical Empathy Among Second-Year Medical Students Using the Jefferson Scale of Empathy
Sasikala ,
Kammineni Anjaneyulu
Pages 612 - 615
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Abstract
Background: Empathy is a core component of effective clinical practice and is associated with improved patient satisfaction, adherence, and clinical outcomes. Measuring empathy early in medical education helps assess students’ readiness for patient-centered care. This study evaluated the level of clinical empathy among second-year MBBS students using the Jefferson Scale of Empathy–Student Version (JSE-S). Methods: A cross-sectional study was conducted among 95 second-year MBBS students. The JSE-S, a validated 20-item instrument, was administered to assess total empathy and its three domains: Perspective Taking, Compassionate Care, and Standing in the Patient’s Shoes. Demographic variables included age, gender, and residential background. Data were analyzed using descriptive statistics, independent t-test, and Pearson’s correlation. Results: Of the 95 participants, 52 (54.7%) were females and 43 (45.3%) were males, with a mean age of 19.8 ± 0.7 years. The mean total empathy score was 108.6 ± 12.4. Female students demonstrated significantly higher empathy (111.3 ± 11.8) than males (105.4 ± 12.7; p = 0.03). The mean domain scores were: Perspective Taking (60.5 ± 7.4), Compassionate Care (40.2 ± 6.1), and Standing in the Patient’s Shoes (7.9 ± 1.8). Most students (56.8%) exhibited moderate empathy levels. No significant association was observed between empathy scores and age or residential background. Strong and moderate positive correlations were noted among the three empathy domains. Conclusion: Second-year medical students demonstrated moderate levels of empathy, with females showing significantly higher scores. The strong inter-domain correlations reflect the multidimensional nature of empathy. Early incorporation of empathy-enhancing strategies in the curriculum may help strengthen patient-centered competencies.
Research Article
Open Access
Assessment of clinical outcome in patients of Acute kidney Injury undergoing renal replacement therapy in medical ICU
Vinay Sondur ,
Himanshu Sharma ,
Arvind Chouhan ,
Yash Sawlani ,
Simmi Dube
Pages 604 - 611
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Abstract
Acute kidney injury (AKI), also referred to as acute renal failure, is a rapid and often reversible decline in kidney function that occurs over a short period, typically ranging from hours to days. It is characterized by elevated creatinine levels and/or reduced urine output. AKI disrupts the body’s electrolyte balance, fluid regulation, acid-base balance, and waste excretion, and if not detected and treated early, it can lead to life-threatening complications. AKI is commonly seen in hospitalized patients, affecting up to 7% of hospital admissions and 30% of ICU admissions.[1] It significantly contributes to prolonged hospital stays and increased patient morbidity.[2]
According to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, AKI encompasses a broad spectrum of kidney dysfunction, from mild increases in blood creatinine to complete renal failure requiring renal replacement therapy (RRT).[3] In ICU settings, AKI is often caused by a combination of factors, including sepsis, ischemia-reperfusion injury, nephrotoxic medications, and pre- existing chronic conditions. The mortality rate among ICU patients with AKI ranges from 25% to 50%, with worse outcomes for those requiring RRT. Additionally, AKI survivors are at higher risk of developing chronic kidney disease (CKD) or progressing to end-stage renal disease (ESRD), underscoring the long-term effects of this acute condition.[4]
Various renal replacement therapies (RRTs) are used to treat severe AKI, including intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), and prolonged intermittent RRT.[5] There is a notable gap in the available data on AKI in Indian ICUs. Existing research from India largely consists of single-center studies on critically ill patients. The purpose of this current study is to assess the impact of renal replacement therapy on the clinical outcomes of AKI patients in medical ICUs undergoing RRT (IHD) and to identify the causes of AKI in these patients and correlate them with their outcomes.
Research Article
Open Access
Humerus Interlocking Nailing in the Management of Diaphyseal Fracture Humerus – A Retrospective Study
Dr Mahadeo Ghuge ,
Dr Sanjeev Bhandari ,
Dr Shashikant Ganjale
Pages 597 - 603
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Abstract
Background: Diaphyseal fractures of the humerus are common injuries, frequently associated with high-energy trauma and significant functional disability. Intramedullary interlocking nailing has become a preferred surgical option due to its minimally invasive nature, preservation of soft tissues, and ability to allow early mobilization. This study evaluates the clinical outcomes, union rates, and complications associated with humeral interlocking nailing in a government medical college setting. Methods: A retrospective study was conducted at Government Medical College & Hospital, Washim, including 50 patients who underwent intramedullary interlocking nailing for humeral shaft fractures between March 2021 and February 2024. Demographic details, fracture characteristics, operative variables, union time, functional outcomes, and postoperative complications were reviewed. Radiological union was categorized as normal (≤16 weeks), delayed (16–24 weeks), or non-union (>24 weeks). Functional outcomes were assessed from documented follow-up records. Data were analyzed using descriptive statistics and chi-square tests. Results: Of the 50 patients, 47 (94%) completed follow-up and 3 (6%) were lost to follow-up. The mean age was 43.8 years, with 62% males. Type 12-A fractures were most common (46%), and an antegrade approach was used in all cases. Normal union occurred in 36 patients (76.6%), delayed union in 7 (14.9%), and non-union in 4 (8.5%). Good to excellent functional outcomes were documented in 85.1% of patients. Shoulder impingement (12.8%) was the most common complication, followed by superficial infection (8.5%) and radial nerve palsy (6.4%), all of which recovered spontaneously or with conservative management. More complex fractures (AO 12-C) showed a significantly higher rate of delayed/non-union. Conclusion: Intramedullary interlocking nailing offers reliable fracture stabilization, high union rates, and favourable functional outcomes for diaphyseal humerus fractures, with manageable complications. The technique remains a strong surgical option, particularly in high-volume public hospitals where early mobilization and minimally invasive procedures are highly advantageous.
Research Article
Open Access
DEXMEDETOMIDINE AS AN ADJUVANT TO SPINAL ANAESTHESIA FOR LOWER LIMB SURGERIES: A COMPARITIVE STUDY OF TWO DIFFERENT DOSES
Dr Abdul Shabeer ,
Dr Lakshmi Bhargavi. G ,
Dr Danish M Jeeralbhavi
Pages 587 - 596
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Abstract
Background: Introduction: Dexmedetomidine, a highly selective α2-adrenergic agonist, is increasingly used as an intrathecal adjuvant to enhance the efficacy of spinal anaesthesia. While it prolongs sensory and motor blockade and improves postoperative analgesia, the optimal dose balancing efficacy and hemodynamic stability remains uncertain. Aim was to compare the clinical effects of 5 µg versus 10 µg intrathecal dexmedetomidine added to 0.5% hyperbaric bupivacaine in patients undergoing elective lower limb surgeries. Materials and Methods: Sixty ASA I–II patients were randomized into two groups. Group A received 15 mg hyperbaric bupivacaine + 5 µg dexmedetomidine; Group B received the same dose of bupivacaine + 10 µg dexmedetomidine. Block characteristics, hemodynamics, postoperative analgesia, and adverse effects were recorded. Results: Group B demonstrated significantly faster onset and longer duration of sensory and motor blockade compared to Group A (p < 0.05). Time to first rescue analgesia was significantly prolonged and total 24-hour analgesic requirement reduced in Group B (p < 0.05). However, Group B showed higher incidence of bradycardia, hypotension, oxygen supplementation, and need for vasopressors (p < 0.05). Sedation scores and SpO₂ remained comparable between groups. Conclusion: Intrathecal dexmedetomidine enhances block characteristics and postoperative analgesia in a dose-dependent manner. Although 10 µg provides longer analgesia, it is associated with greater hemodynamic instability. A dose of 5 µg appears more suitable for routine spinal anaesthesia in elective lower limb surgeries, offering effective analgesia with better safety.
Research Article
Open Access
Clinical Outcomes of Surgical Necrosectomy in Acute Infective Necrotizing Pancreatitis: A Prospective Evaluation from a Low-Volume Tertiary Centre
Dr. Sumesh Kaistha ,
Dr Shashank Mishra
Pages 579 - 586
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Abstract
Background: Acute infective necrotizing pancreatitis is a life-threatening condition requiring timely intervention to prevent systemic complications. While minimally invasive step-up approaches are increasingly preferred, open surgical necrosectomy continues to be widely practiced in low-volume and resource-constrained centres. This prospective study evaluates the clinical outcomes, morbidity, mortality, and recovery profile of patients undergoing surgical necrosectomy in such a setting. Aim: To evaluate the clinical outcomes of surgical necrosectomy in patients with acute infective necrotizing pancreatitis at a low-volume tertiary care centre. Methods: A prospective observational study was conducted among 20 patients undergoing surgical necrosectomy for infected necrotizing pancreatitis. Baseline characteristics, extent of necrosis, inflammatory markers, postoperative systemic and local complications, ICU parameters, and mortality were recorded. Statistical analyses included t-tests, chi-square tests, and confidence interval estimation, with p < 0.05 considered significant. Results: The mean age of patients was 48.7 ± 11.3 years, with males comprising 65% of the cohort. A majority (80%) had ≥30% necrosis, and 55% presented with baseline organ failure. Postoperative morbidity included sepsis (45%), AKI (35%), pancreatic fistula (25%), and wound infection (40%). The mean ICU stay was 9.4 ± 3.8 days, and the mean hospital stay was 28.7 ± 9.2 days. The overall mortality rate was 30%. Significant predictors of mortality included >50% necrosis (p = 0.036), baseline organ failure (p = 0.041), AKI (p = 0.036), and elevated CRP and WBC levels (p < 0.05). Conclusion: Surgical necrosectomy remains an essential intervention for severe infected necrotizing pancreatitis in low-resource settings. However, morbidity and mortality remain high and are strongly linked to disease severity, organ failure, and inflammatory burden. Optimizing perioperative management and early recognition of high-risk features may improve outcomes.
Research Article
Open Access
The Relationship Between Glycaemic Control and Non-Alcoholic Fatty Liver Disease in Type II Diabetes Patients: A Prospective Observational Study
Pages 573 - 578
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Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common hepatic comorbidities in individuals with type 2 diabetes mellitus (T2DM). Poor glycaemic control, insulin resistance, and metabolic dysregulation play central roles in its development. This study evaluated the relationship between glycaemic control and NAFLD among T2DM patients. Methods: A prospective observational study was conducted among 180 adults with T2DM at a tertiary care centre, over 12 months. Clinical, anthropometric, and biochemical parameters including HbA1c were collected. NAFLD was assessed and graded by ultrasonography. Statistical analysis included chi-square test, Pearson correlation, and multivariate logistic regression. Results: NAFLD prevalence was 62.7%. Poor glycaemic control (HbA1c ≥ 8%) was significantly associated with NAFLD (p = 0.002). Mean HbA1c increased with NAFLD severity: Grade 0 (7.1 ± 1.0%), Grade 1 (7.9 ± 1.2%), Grade 2 (8.6 ± 1.3%), Grade 3 (9.2 ± 1.4%). HbA1c demonstrated a moderate positive correlation with NAFLD grade (r = 0.46, p < 0.001). Independent predictors of NAFLD included BMI ≥ 27 kg/m² (OR 3.4; 95% CI 1.8–6.3), elevated triglycerides (OR 2.2; 95% CI 1.3–4.8), and poor glycaemic control (OR 2.9; 95% CI 1.5–5.1). Conclusion: Poor glycaemic control significantly increases the risk and severity of NAFLD in T2DM patients. Early assessment of hepatic steatosis should be incorporated into diabetes management to reduce long-term cardiometabolic and hepatic complications.
Research Article
Open Access
Comparative Analysis of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Early Outcomes in Acute Ischemic Stroke: Insights from a Central Indian Cohort
Harsh Khandelwal ,
Dharmendra Kumar Mekle,
Manjula Gupta ,
Santosh Hiremath ,
Simmi Dube
Pages 564 - 572
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Abstract
Background: Acute ischemic stroke (AIS) continues to represent a major public health concern in India, necessitating the development of early prognostic tools to evaluate stroke severity and predict clinical outcomes. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as cost-effective inflammatory biomarkers, have shown potential as prognostic indicators. This study aimed to assess the predictive value of NLR and PLR in determining the severity and short-term prognosis of AIS. Methods: This prospective observational study was conducted at a tertiary care hospital in Central India over an 18-month period and recruited 102 patients clinically and radiologically diagnosed with AIS within 72 hours of symptom onset. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and patients were classified as having minor to moderate stroke (NIHSS <16) and moderately severe to severe stroke (NIHSS ≥16). NLR and PLR values were calculated for each patient at the time of admission and at day 7 or discharge (if earlier) to determine the correlation of these values with the short-term prognosis of stroke patients. Statistical analysis was done using IBM SPSS software version 20 and a p value < 0.05 was considered statistically significant. Results: Moderately severe to severe stroke was observed in 60/102 (58.8%) patients. This subgroup demonstrated significantly elevated mean NLR and PLR values (p=0.001 and p=0.03, respectively) at admission compared to the mild to moderate stroke subgroup. NLR exhibited strong predictive accuracy for severe stroke (AUC=0.879; cutoff: 5.4; sensitivity: 81.7%; specificity: 81%), whereas PLR showed comparatively lower predictive value (AUC=0.648). Neither biomarker demonstrated a statistically significant association with short-term outcomes (p>0.05). Conclusions: Although both NLR and PLR showed statistically significant correlation with stroke severity, NLR emerged as a relatively superior biomarker in predicting the stroke severity as well as short-term prognosis of patients with AIS. Incorporation of this economically viable biomarker into stroke evaluation protocols may facilitate early risk stratification and inform clinical decision-making.
Research Article
Open Access
Clinical Implications of Hepatic Venous Pressure Gradient in Staging and Prognosis of Liver Cirrhosis with Portal Hypertension
Rahul Bhagwat Mane,
Mohankumar Nagane ,
Ganesh Sureshrao Narwane,
Anand Bhide
Pages 557 - 563
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Abstract
Background: The hepatic venous pressure gradient (HVPG) is the gold-standard measure of portal pressure. While its prognostic value is well-established in Western populations, prospective data validating its utility for staging and predicting outcomes in specific Indian cohorts, where etiologies of liver disease may differ, is limited. Methods: We enrolled 120 adult patients with diagnosed liver cirrhosis and portal hypertension. All patients underwent a baseline clinical, biochemical, and endoscopic evaluation, along with a standardized HVPG measurement. Patients were followed for 12 months for the primary endpoints of first clinical decompensation (new-onset ascites, variceal hemorrhage, or overt hepatic encephalopathy) and all-cause mortality. Results: The mean baseline HVPG for the cohort (N=120) was 15.8 ± 5.5 mmHg. A strong positive correlation was observed between HVPG and the severity of liver disease. The mean HVPG increased significantly across Child-Pugh classes: 8.5 ± 2.1 mmHg for Class A, 14.2 ± 3.5 mmHg for Class B, and 19.8 ± 4.2 mmHg for Class C (p<0.001). Patients who experienced clinical decompensation during follow-up (n=41) had a significantly higher baseline HVPG than those who remained compensated (19.1 ± 3.9 mmHg vs. 13.7 ± 4.8 mmHg; p<0.001). Using a threshold of ≥16 mmHg, the 1-year incidence of decompensation was 56.9% in the high-HVPG group versus 14.3% in the low-HVPG group (p<0.001). The 1-year mortality rate was also significantly higher in patients with HVPG ≥16 mmHg (25.9% vs. 4.8%; p=0.002). In multivariate Cox regression analysis, an HVPG ≥16 mmHg was an independent predictor of both clinical decompensation (Hazard Ratio: 4.2; 95% CI: 2.1-8.5; p<0.001) and mortality (HR: 5.1; 95% CI: 1.4-18.2; p=0.012), after adjusting for MELD score and serum albumin. Conclusion: In this prospective Indian cohort, baseline HVPG strongly correlates with the clinical stage of liver cirrhosis and serves as a powerful, independent predictor of 1-year clinical decompensation and mortality. The HVPG threshold of 16 mmHg effectively stratifies patients into high- and low-risk categories, highlighting its crucial role in prognostic assessment and guiding management strategies for patients with advanced liver disease.
Research Article
Open Access
Association Between Diabetes Mellitus and Osteoarthritis: A Cross Sectional Study on Clinical Correlation and Metabolic Links
Dr Satish Kumar Mahapatra ,
Dr Girija Shankar Prasad Patro ,
Dr Ajaya Bhatta
Pages 552 - 556
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Abstract
Background: Osteoarthritis (OA) is the most common form of arthritis and a leading cause of pain, disability, and reduced quality of life in older adults. Recent evidence suggests that metabolic factors, particularly diabetes mellitus (DM), may influence the pathogenesis and progression of OA beyond the mechanical effects of obesity. This study aims to investigate the clinical association between OA and blood glucose status and to explore the potential metabolic link between the two conditions. Methods: A cross-sectional study was conducted on 150 patients diagnosed with osteoarthritis between February 2020 and December 2021 in MKCG medical college and Hospital, Odisha, India. Clinical evaluation, detailed medical history, and laboratory investigations were performed. The diagnosis of diabetes mellitus followed the World Health Organization (WHO) criteria. Data were analyzed using descriptive statistics. Results: Of the 150 patients, 78 (52%) were males and 72 (48%) were females. The highest prevalence of OA was observed among individuals aged 41–60 years (49.33%), followed by those aged 61–80 years (36%). Blood glucose assessment revealed that 119 patients (79.33%) had normal levels (70–140 mg/dl), while 17 (11.33%) had moderately elevated levels (140–200 mg/dl) and 14 (9.33%) exhibited significantly increased glucose levels (>200 mg/dl). Discussion: The findings demonstrate a significant overlap between OA and elevated blood glucose levels, supporting the hypothesis that diabetes contributes to OA pathophysiology beyond mechanical stress. These results align with previous studies reporting increased OA prevalence among diabetic individuals and highlight the role of metabolic dysregulation, oxidative stress, and advanced glycation end-products (AGEs) in joint degeneration. Conclusion: This study reveals a substantial coexistence of OA and hyperglycemia, underscoring the potential role of diabetes as a metabolic risk factor in OA development and progression. Further research is required to elucidate underlying mechanisms and to inform targeted management strategies addressing both conditions simultaneously.
Research Article
Open Access
Role of Central Venous-Arterial Carbon Dioxide Difference (Pc02 Gap) In Predicting Outcome in Septic Shock
Dr. Moloy Kanti Makhal ,
Dr. Asim Kumar Kundu ,
Dr. Liton Sarkar
Pages 545 - 551
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Abstract
Background: Introduction: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection that may progress to septic shock if untreated. Traditional markers like ScvO₂ and lactate clearance have limitations in assessing tissue perfusion, while the venous-to-arterial carbon dioxide difference (PCO₂ gap) offers a promising alternative indicator. This study aims to evaluate the role of the PCO₂ gap in predicting outcomes in septic shock and its correlation with mean arterial pressure, serum lactate, and cardiac output. Aims: The study aims to evaluate the correlation between PCO₂ gap and outcomes in septic shock, including fluid and vasopressor requirements, mean arterial pressure, serum lactate, cardiac output, and hospital mortality within the first six hours of admission. Materials and Methods: The prospective observational study was conducted in the Critical Care Unit, IPGMER, Kolkata, from February 2024 to January 2025, including 50 adult patients with septic shock. Results: In this study of 50 patients, pneumonia was the most common infection (64%), with 98% requiring fluid bolus, 78% vasopressors, and 72% mechanical ventilation, and overall hospital mortality was 58%. A high PCO₂ gap was observed in 66% of patients and was associated with higher mortality (75.9% vs 24.1%), greater need for vasopressors, and more frequent mechanical ventilation. Over time, PCO₂ gap slightly declined, MAP improved, lactate showed variable trends, and cardiac output remained stable, reflecting gradual hemodynamic stabilization. Conclusion: High PCO₂ gap in septic patients was linked to increased mortality, greater vasopressor use, and more frequent mechanical ventilation, while MAP improved and cardiac output remained stable. Monitoring PCO₂ gap alongside lactate and hemodynamics may help guide resuscitation and predict outcomes.
Research Article
Open Access
Knowledge on Menstrual Hygiene Practices Among Adolescent and Young Girls in an Urban Based Degree College
Dr Divya Teja Bommireddy ,
Dr G Sudha Rani ,
Dr Dr. Pudami Rajyalakshmi ,
Dr Padmaja
Pages 538 - 544
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Abstract
Background: Menstrual hygiene is a crucial aspect of adolescent health, yet it remains surrounded by taboos, misconceptions, and poor practices in many parts of India. Inadequate knowledge and unhygienic practices can lead to reproductive tract infections, school absenteeism, and poor quality of life. This study aimed to assess the knowledge, awareness, and practices related to menstrual hygiene among adolescent and young girls in an urban-based degree college in Nandyal, Andhra Pradesh. Methods: A descriptive cross-sectional study was conducted from 23rd to 31st March 2025 among 282 female students. Data were collected using a pretested, self-administered, close-ended questionnaire distributed via Google Forms. Descriptive statistics were used to assess the level of knowledge and practices, and logistic regression analysis was applied to identify factors associated with poor menstrual hygiene using IBM SPSS version 25. Results: The majority of participants were aged 18–19 years (49.3%), with 57.4% belonging to the Muslim community. Mothers were the primary source of menstrual information (67.3%). While 80% recognized menstruation as a natural phenomenon, only 60% knew the normal cycle length (21–35 days). Overall, 85.1% demonstrated good menstrual hygiene practices—65.6% changed absorbents every six hours, 75% washed genitalia regularly, and 85.1% disposed of absorbents hygienically. However, nearly half (50.7%) still followed menstrual taboos, and 55.6% reported absenteeism during menses. Multivariable analysis revealed that maternal (AOR=2.9, p=0.004) and paternal illiteracy (AOR=2.4, p=0.02) were significant predictors of poor hygiene practices. Conclusion: Despite fair awareness, misconceptions and restrictions surrounding menstruation persist. Maternal education significantly influences hygienic practices. Incorporating menstrual health education into school curricula, empowering mothers as accurate information sources, and addressing sociocultural taboos are essential to ensure menstrual dignity and improve adolescent reproductive health.
Research Article
Open Access
ULTRA SOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK WITH LEVOBUPIVACAINE AND ROPIVACAINE FOR POST OPERATIVE ANALGESIA IN LAPAROSCOPIC ABDOMINAL SURGERIES UNDER GENERAL ANAESTHESIA
Dr. Thottikat Kaarthika ,
Dr. OWK Mrunalini ,
Dr. Gopavajhula Venkata Suryanarayana ,
Dr. Manjula V. Ramsali ,
Dr. Pujari Prathibha Rani
Pages 532 - 538
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Abstract
Background and Aims: Postoperative pain after laparoscopic abdominal surgeries remains a major concern despite minimal surgical trauma. The transversus abdominis plane (TAP) block has emerged as an effective regional analgesic technique that reduces opioid requirements and enhances recovery. This study aimed to compare the efficacy of 0.2% levobupivacaine and 0.2% ropivacaine administered as ultrasound-guided TAP blocks for postoperative analgesia following laparoscopic abdominal surgeries under general anaesthesia. Methods: A prospective, randomized, double-blind study was conducted on 60 ASA I–II patients aged 18–60 years scheduled for elective laparoscopic abdominal surgeries. Patients were randomly allocated into two groups of 30 each:
• Group L: received 0.2% levobupivacaine 20 mL per side,
• Group R: received 0.2% ropivacaine 20 mL per side. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 1, 2, 4, 6, 8, 12, and 24 hours. The time to first rescue analgesia, total fentanyl consumption (µg) in 24 hours, and any adverse effects were recorded. Statistical analysis was performed using the independent t-test and Chi-square test, with p < 0.05 considered significant. Results: Demographic characteristics were comparable between groups. Mean duration of analgesia was significantly longer in Group R (10.45 ± 1.72 hours) than in Group L (7.12 ± 1.35 hours) (p < 0.001). VAS scores were consistently lower in Group R from 4 hours onward (p < 0.05). Total fentanyl consumption was significantly reduced in Group R (78.7 ± 18.6 µg vs 110.3 ± 24.5 µg, p < 0.001). No significant complications were observed. Conclusion: Ultrasound-guided TAP block using ropivacaine 0.2% provides longer-lasting analgesia, reduced opioid requirement, and better patient satisfaction compared with levobupivacaine for postoperative pain relief in laparoscopic abdominal surgeries.
Research Article
Open Access
Gut-Microbiome–Derived Metabolites, Autonomic Function, and Cardiometabolic Risk in Indian Adults: An Integrative Biochemistry–Physiology–General Medicine Cohort Study
Dr. Rahul Tiwari ,
Dr. Anupama Vithalkumar Betigeri ,
Dr. Greeshma B Kotian ,
Dr. Radhika Shenoy ,
Dr. Heena Dixit Tiwari
Pages 525 - 531
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Abstract
Background: Gut-microbiome–derived metabolites such as trimethylamine-N-oxide (TMAO) and short-chain fatty acids (SCFAs) have emerged as biochemical mediators linking diet, metabolism, and cardiovascular risk. The autonomic nervous system (ANS), particularly vagal tone, modulates inflammatory and metabolic pathways; however, integrative human data on gut–autonomic–metabolic interactions remain scarce in Indian adults.Objectives:To investigate associations between microbial-derived metabolites, autonomic function, and cardiometabolic risk factors, and to evaluate whether autonomic function mediates the relationship between metabolites and cardiometabolic risk.Methods:A cross-sectional cohort of 210 Indian adults (25–60 years) underwent anthropometric, biochemical, and autonomic assessments. Plasma levels of TMAO and SCFAs (acetate, propionate, butyrate) were quantified by UPLC–MS/MS. Autonomic function was evaluated using 5-minute heart rate variability (HRV) and standard reflex tests. Multivariable regression and mediation analyses were used to explore associations among metabolites, HRV indices, and a composite cardiometabolic risk z-score.Results:
Mean BMI was 26.8 ± 4.1 kg/m² and mean waist circumference 90.4 ± 9.2 cm. TMAO correlated inversely with RMSSD (r = −0.31, p < 0.001) and positively with HOMA-IR and triglycerides (p < 0.01). Butyrate correlated positively with RMSSD (r = 0.34, p < 0.001). In multivariable models, TMAO independently predicted higher cardiometabolic risk (β = 0.31, p < 0.001), whereas butyrate predicted lower systolic blood pressure (β = −0.21, p = 0.006). RMSSD mediated 26 % of the TMAO–risk association (p = 0.01).Conclusion:Elevated TMAO and reduced SCFAs were linked to autonomic imbalance and greater cardiometabolic risk. Autonomic dysfunction partially mediated the microbiome–metabolite–risk relationship, suggesting a novel gut–autonomic–cardiometabolic axis in Indian adults. Targeting microbial metabolism and autonomic regulation may aid early cardiometabolic prevention strategies.
Case Series
Open Access
An Observational Study of Levetiracetam induced Neuropsychiatric Adverse Effects in Children
Dr. Nawaz Patel, ,
Dr. Divyaben Prajapati ,
Dr. Dhaval Bhatt
Pages 520 - 524
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Abstract
Background: Levetiracetam is a second-generation antiepileptic medication that is chemically unrelated to other antiepileptic drugs. It is used to treat a wide range of seizure disorders. As Levetiracetam is generally well-tolerated with minimal adverse effect, it is used as first-line antiepileptic drug in pediatric population. The development of acute neuropsychiatric manifestations following initiation of the therapy or changes in dosing is reported. The mechanism by which Levetiracetam induces neuropsychiatric manifestations remains unknown. But termination of Levetiracetam therapy has been rarely reported. In this case series, we present seven patients with history of seizure disorder who developed behavioral abnormalities and aggression following increases in his Levetiracetam dosing. Our observations suggest that Levetiracetam remains a safe and effective first-line antiepileptic whose adverse behavioral side effect profile can be properly managed with close patient monitoring and dose titration.
Research Article
Open Access
Outcome of Tubal Recanalization in Women Seeking Sterilization Reversal at a Tertiary Care Center
Dr. Tejaswini Janardhan ,
Dr. Manohar R ,
Dr. Sandyashree P K
Pages 514 - 519
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Abstract
Background: Female sterilization is a prevalent contraceptive method in India; however, a segment of women pursue reversal due to evolving reproductive objectives. Tubal recanalization provides a cost-efficient alternative to assisted reproductive technologies. This study sought to assess reproductive outcomes and prognostic factors linked to tubal recanalization in a tertiary care environment. Methods: A prospective observational study was performed involving 49 women aged 20–40 years who had undergone sterilization and subsequently pursued fertility restoration. Eligible participants underwent recanalization, with the type of anastomosis, reconstructed tubal length, and sterilization method meticulously documented. For 12 months, the patients were monitored, and the pregnancy outcomes were categorized as intrauterine conception, miscarriage, or ectopic pregnancy. Statistical analysis was conducted using SPSS v25.0. Results: After recanalization, 13 (26.53%) of the 49 women became pregnant. Women aged 26–30 had the most conceptions (61.54%), but age did not have a statistically significant effect (p = 0.882). Laparoscopic sterilization had an 84.62 percent pregnancy rate, while open tubectomy had a 15.38 percent pregnancy rate (p = 0.127). Conception was most prevalent (76.92%) when sterilization and reversal occurred 3–6 years apart, although this finding was not statistically significant (p = 0.585). Final tubal length exceeding 4 cm (p = 0.041) and isthmo-isthmic anastomosis (p < 0.001) are significantly associated with successful conception. Conclusions: Tubal recanalization is still a safe and affordable way to restore fertility. The best results happen in younger women who have a tubal length of at least 4 cm and a proximal (isthmo-isthmic) anastomosis, especially after laparoscopic sterilization.
Research Article
Open Access
Effect of Prolonged Screen Exposure on Physical Activity Levels and Obesity in Children
Dr Priyanka R. Boghani ,
Boghani Vivekkumar Rameshbhai
Pages 510 - 513
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Abstract
Background:The increasing use of digital devices has led to prolonged screen exposure among children, contributing to reduced physical activity, poor sleep quality, unhealthy dietary habits, and rising obesity rates. Objectives: To assess the relationship between prolonged screen exposure, physical activity levels, sleep duration, dietary behaviours, and obesity among children aged 5–15 years. Methods: A cross-sectional study was carried out over six months among 265 children aged 5–15 years attending a tertiary care hospital. Screen time was categorized as <2 hours/day and ≥2 hours/day. Anthropometric parameters were recorded, BMI-for-age percentiles were used for classification, and physical activity was assessed using WHO guidelines. Statistical analysis was done using the Chi-square test with p < 0.05 considered significant. Results: Of 265 children, 61.5% had screen exposure ≥2 hours/day. Physical activity was significantly lower among high screen-time children (p < 0.001). Overweight and obesity were more prevalent among the ≥2 hours/day group (25.8% and 23.9%, respectively). High screen-time children also had shorter sleep duration and consumed more energy-dense snacks. All associations were statistically significant. Conclusion: Prolonged screen exposure significantly affects children’s physical activity, sleep, dietary behaviour, and BMI. Reducing screen time and promoting active lifestyles are essential to prevent childhood obesity.
Research Article
Open Access
Evaluation of toxicity and tumor response in Breast Cancer patients undergoing dose dense Chemotherapy and assessment of compliance and tolerance to the treatment
Chennareddy Sai Madhuri ,
Govindu Ashalatha ,
K.Sandhya Rani ,
Murahari Mary Mamatha*
Pages 503 - 509
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Abstract
Background: Breast cancer is the most common malignancy among Indian women, with an age-adjusted incidence rate of 25.8 per 100,000 and mortality of 12.7 per 100,000. Dose-dense chemotherapy regimens, such as anthracycline-cyclophosphamide (AC), have demonstrated improved disease-free and overall survival compared to conventional schedules. Methods This cross-sectional study enrolled 42 eligible breast cancer patients (ECOG performance status 0-2) undergoing neoadjuvant or adjuvant dose-dense AC chemotherapy (doxorubicin 60 mg/m² + cyclophosphamide 600 mg/m² IV every 2 weeks for 4 cycles, followed by taxane-based therapy if indicated) at the Department of Radiotherapy, Kurnool Medical College, over 18 months. Patients provided informed consent and were assessed prospectively using a structured proforma. Toxicity was graded per Common Terminology Criteria for Adverse Events (CTCAE) v5.0 across 8 cycles. Compliance was measured by treatment completion rates, and tolerance by patient-reported symptoms and absence of dose delays/reductions. Tumor response in neoadjuvant cases was evaluated using RECIST 1.1 criteria via clinical examination, mammography, and ultrasound pre- and post-chemotherapy. Results The cohort had a mean age of 51 years (range 25-70); 69% were postmenopausal, 43% had comorbidities (e.g., hypertension, diabetes), and 10% reported addictions (e.g., tobacco). All 42 patients (100%) completed the planned regimen with no dose reductions or delays, indicating excellent compliance and tolerance. Haematological toxicities were minimal (grade 3/4 neutropenia 2-5% per cycle, prevented by routine G-CSF; no febrile neutropenia). Non-haematological toxicities were predominantly grade 1-2: nausea (50-58% across cycles), vomiting (43-55%), alopecia (40%), nail discoloration (12-24%), oral mucositis (9-13%), and diarrhoea (10-12%). Fatigue was reported in 80% (grade 1-2). In the neoadjuvant subgroup (n=20), tumor response included complete response in 10%, partial response in 60%, stable disease in 25%, and progressive disease in 5%. Conclusion Dose-dense AC chemotherapy is safe, feasible, and highly tolerable in Indian breast cancer patients, with low severe toxicity and perfect compliance when supported by G-CSF and proactive symptom management. These findings endorse its adoption in resource-constrained environments, though larger multicenter trials are needed to confirm tumor response rates and long-term outcomes.
Research Article
Open Access
ASSESSMENT OF THE USEFULNESS OF IMAGING MODALITIES IN THE EVALUATION OF MUSCULOSKELETAL LESIONS
Dr. Priyanka Yadav ,
Dr. Vineet Mishra ,
Dr. Mayank Yadav
Pages 498 - 502
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Abstract
Background: Musculoskeletal (MSK) lesions encompass a broad spectrum of benign, malignant, and non-neoplastic conditions. Inappropriate or excessive use of imaging modalities contributes to unnecessary healthcare costs, patient radiation exposure, and delays in management. Evidence on the utility of imaging in MSK lesions from the Indian subcontinent remains limited. Objective: To assess the usefulness of major imaging modalities—radiography, CT, MRI, sonography, skeletal survey, and 18F-FDG PET/CT—in the diagnostic work-up and management of MSK lesions, and to determine agreement between two experienced radiologists regarding imaging utility. Methods: This prospective analytical study evaluated 58 radiological investigations of 21 patients with suspected MSK lesions referred to a tertiary hospital in Delhi from January 2021 to August 2022. All available imaging was independently assessed by two radiologists for usefulness in diagnosis and management. Agreement was calculated using Cohen’s kappa statistics. Final diagnoses were established histologically or via clinico-radiological follow-up. Results: Among 21 patients, 15 (72%) lesions were benign and six (28%) malignant. A total of 27 radiographs, 15 MRIs, 12 CT scans, two skeletal surveys, one sonography, and one PET/CT were evaluated. Radiography showed almost perfect inter-observer agreement (κ = 0.92), MRI showed moderate agreement (κ = 0.76), while CT demonstrated weak agreement (κ = 0.57). Radiography alone correctly identified 80% of benign and 75% of malignant tumors. A well-defined margin was significantly associated with benignity (p = 0.004), while soft-tissue mass on imaging was significantly associated with malignancy (p = 0.001). Overall diagnostic concordance with final diagnosis was 90.4%. Conclusion: Radiography remains the most valuable and reliable initial imaging modality for MSK lesions, demonstrating high diagnostic accuracy and inter-observer agreement. MRI is useful primarily for local staging, whereas CT provides limited additional diagnostic value except in select cases. Rationalizing imaging work-up can prevent unnecessary investigations, reduce costs, and improve patient care.
Research Article
Open Access
CORRELATION OF DERMOSCOPIC AND RADIOLOGICAL FINDINGS IN CUTANEOUS METASTASES
Dr. Divya Vupperla ,
Dr. Praveen Elaprolu ,
Dr. Shubham Prahlad Payghan
Pages 487 - 497
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Abstract
Background: Cutaneous metastases are uncommon manifestations of internal malignancies and often indicate disseminated disease. Although dermoscopy and radiological imaging are increasingly used in dermatologic oncology, most studies evaluate these modalities independently. There is limited data correlating dermoscopy, ultrasonography and histopathology in the same cohort, especially in Indian populations. Aim of the study was to describe the dermoscopic and radiological features of biopsy-proven cutaneous metastases and assess their correlation with histopathological findings. Materials and Methods: A cross-sectional observational study was conducted in the Departments of Dermatology (DVL) and Radiology at a tertiary hospital. Fifty patients with clinically suspected cutaneous metastatic lesions underwent dermoscopic evaluation, high-frequency ultrasonography with Doppler imaging, and histopathological confirmation. CT and MRI were reviewed where available. Dermoscopic features included background colour, vascular morphology and structureless areas. Ultrasound parameters included echotexture, margins, depth and vascularity. Immunohistochemistry was performed when required. Data were analysed using descriptive and correlation statistics. Results: Breast carcinoma was the most common primary malignancy (42 percent), followed by lung (20 percent) and gastrointestinal cancers (14 percent). Multiple nodules (64 percent) over the trunk (52 percent) were the predominant presentation. Dermoscopy showed linear-irregular (44 percent) and polymorphous (30 percent) vessels over pink or erythematous backgrounds, with white structureless areas in 28 percent. Ultrasonography demonstrated hypoechoic lesions with irregular margins (68 and 58 percent respectively), and increased internal vascularity in 56 percent. Adenocarcinoma was the predominant histological subtype (52 percent). Strong correlation was observed between vascular dermoscopic patterns and Doppler flow in 84 percent of cases; three-way concordance among dermoscopy, radiology and histopathology occurred in 72 percent. Conclusion: Cutaneous metastases most commonly arise from breast and lung carcinomas and present as multiple firm nodules with characteristic dermoscopic vascular patterns and hypoechoic infiltrative features on ultrasonography. Combined dermoscopic and radiologic evaluation provides valuable non-invasive diagnostic clues and correlates strongly with histopathology. Multimodal imaging may assist in earlier recognition and targeted biopsy, particularly in advanced oncology settings.
Research Article
Open Access
Androgen Insensitivity Syndrome: A Case Report Highlighting Physiological and Psychological Perspectives
Dr. Lucky Gupta ,
Dr Neena Sharma
Pages 482 - 486
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Abstract
Background: Hermaphroditism refers to a set of conditions marked by discrepancies between external and internal reproductive organs. Over time, as literature has evolved, the term hermaphroditism has been succeeded by the emergence of newer terminology such as intersex disorders or disorders of sexual development. Case Illustration: A two-and-a-half-year-old baby with ambiguous genitalia reported in the OPD. The baby did not conform to the usual pattern of normal people. Thorough systemic examination and laboratory investigations along with diagnostic procedures guided towards the establishment of diagnosis. The case was diagnosed as Partial Androgen Insensitivity Syndrome and treated to establish female gender identity.
Research Article
Open Access
Comparative Evaluation of a Split-Bolus Hybrid CT Urography Protocol and Standard Triple-Phase CT Urography for the Assessment of Hematuria
Harshal Arun Badgujar,
Amogh Avinash Jagtap,
Aniruddha Diliprao Patil
Pages 476 - 481
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Abstract
Background: Multiphase computed tomography urography (CTU) is the imaging standard for evaluating hematuria, but it is associated with a significant radiation dose. Low-dose "hybrid" protocols, such as the split-bolus technique, have been developed to reduce radiation exposure, but their comparative diagnostic efficacy against standard protocols requires robust validation. Methods: This prospective, randomized controlled study included 180 adult patients referred for CTU for the evaluation of hematuria. Patients were randomized (1:1) to either a standard triple-phase protocol (Group A, n=90; non-contrast, nephrographic, and excretory phases) or a hybrid split-bolus protocol (Group B, n=90; non-contrast and a single combined nephrographic-excretory phase). Two blinded radiologists independently reviewed the scans. The primary endpoints were diagnostic accuracy for significant urinary tract pathology (urothelial carcinoma, renal cell carcinoma, urolithiasis) and the mean effective radiation dose. Secondary endpoints included subjective image quality scores for renal parenchymal and urothelial opacification. A composite reference standard including histopathology, cystoscopy, and clinical/imaging follow-up was used. Results: Significant pathology was identified in 61 patients (33.9%). The overall per-patient diagnostic sensitivity and specificity for significant findings were not statistically different between the two groups. For Group A (Standard CTU), sensitivity was 96.7% and specificity was 98.3%. For Group B (Hybrid CTU), sensitivity was 93.5% and specificity was 96.6% (p=0.68 for sensitivity; p=0.55 for specificity). The mean effective radiation dose was significantly lower in the hybrid group (10.2 ± 2.8 mSv) compared to the standard group (18.5 ± 4.1 mSv), representing a mean reduction of 44.9% (p<0.001). Subjective image quality scores for renal parenchymal enhancement were comparable (4.7 ± 0.4 vs. 4.6 ± 0.5; p=0.21), while urothelial opacification was slightly lower but still diagnostically adequate in the hybrid group (4.2 ± 0.7 vs. 4.8 ± 0.3; p=0.02). Conclusion: The hybrid split-bolus CTU protocol provides comparable diagnostic accuracy to the standard triple-phase protocol for detecting significant urinary tract pathology in patients with hematuria. It achieves this with a nearly 45% reduction in radiation dose, without a clinically significant compromise in image quality. This supports the adoption of the split-bolus technique as the primary CTU protocol for the routine evaluation of hematuria.
Research Article
Open Access
A STUDY ON HEMOTOXIC SNAKE ENVENOMATION INDUCED ACUTE KIDNEY INJURY AND ITS OUTCOMES: A PROSPECTIVE FOLLOW UP STUDY
Dr.M.Saravanan ,
Dr.M.Karthikeyan ,
Dr.S.Pradeep Kumar
Pages 470 - 475
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Abstract
Background: Snakebite is a critical public health issue, particularly in rural regions of tropical and subtropical countries, affecting farmers, plantation workers, construction workers, snake charmers, hunters, and migrant populations. Urbanization and deforestation have exacerbated the problem, making snakebite a significant health concern. In India, snakebite-related mortality is alarmingly high, necessitating urgent attention. The World Health Organization (WHO) estimates that 81,000 – 138,000 deaths occur annually worldwide due to snakebites, with approximately three times as many survivors suffering from amputations and permanent disabilities. The Million Death Study (MDS) in India has documented cause-specific mortality patterns, highlighting the importance of early administration of Anti-Snake Venom (ASV) to reduce mortality and morbidity in envenomation cases. Methods: This prospective follow-up study focuses on acute kidney injury (AKI) induced by hemotoxic snake envenomation and its long-term outcomes. The study population included patients diagnosed with AKI following snakebite, with an emphasis on evaluating the incidence of chronic kidney disease (CKD) post-recovery. Data were collected on risk factors such as multiple AKI episodes, baseline CKD, and the severity of AKI. Follow-up nephrology care was assessed to determine its impact on long-term renal outcomes. Results: The study revealed a significant correlation between AKI and CKD, with evidence indicating that even AKI patients with apparent full recovery are at an independent risk for developing CKD later in life. Risk factors such as multiple AKI episodes, pre-existing CKD, and the severity of AKI were identified as reliable predictors of CKD progression. Conclusion: The findings highlight the long-term renal risks associated with hemotoxic snake envenomation-induced AKI. Even after apparent recovery, AKI survivors are at heightened risk for CKD, emphasizing the need for systematic follow-up nephrology care to mitigate long-term complications.
Research Article
Open Access
A STUDY ON QT DISPERSION AND THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION
Dr.M.Karthikeyan ,
Dr.D.Johny Abraham ,
Dr.S.Pradeepkumar 3
Pages 463 - 469
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Abstract
Background: Myocardial infarction is a major manifestation of ischemic heart disease, a leading cause of death in developed nations and the third globally. QTc dispersion is an important marker of ventricular repolarization variations and arrhythmogenic risk. This study examines the effects of thrombolytic therapy on QTc dispersion in acute myocardial infarction Materials and methods: 88 patients admitted to Government Dharmapuri medical college and hospital, Dharmapuri for acute MI in the year between February to July in the year 2021 were included in the study. Over a period of 8±2 days, all patients underwent monitoring, with standard 12-lead ECGs conducted upon admission and before discharge. QT interval, QTc interval, and QT and QTc dispersion parameters were calculated from these ECGs. Results: Analysis revealed significant variations in QT parameters between patients treated and not treated with thrombolytic therapy. Patients receiving thrombolytic therapy exhibited greater reductions in QT parameters by day 8±2 compared to those without treatment. Additionally, anterior wall infarctions demonstrated significantly higher QT and QTc dispersions compared to inferior wall infarctions, with these differences being statistically significant. Conclusion: In the early stages of acute myocardial infarction, patients, especially those diagnosed with anterior myocardial infarction, exhibited significantly elevated QT and QTc dispersions. Thrombolytic treatment resulted in substantial reductions in these dispersions compared to untreated individuals. Typically peaking within the initial hours of the condition, these dispersions subsequently decline following successful thrombolysis, underscoring their significance in risk assessment for malignant ventricular tachyarrhythmias and reinforcing the efficacy of thrombolytic therapy.
Research Article
Open Access
A Study of Relation of HbA1c to Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus and Without Overt Heart Disease
Dr.S.Pradeep Kumar ,
Dr.M.Saravanan ,
Dr.D.Johny Abraham
Pages 457 - 462
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Abstract
Background: Introduction: Diabetes is usually irreversible and, although patients can have a reasonably normal lifestyle, its late complications result in reduced life expectancy and major health costs. Materials & Methods: This was a prospective study done among all the patients with Type-2 Diabetes Mellitus individuals selected from General Medicine out- patient and in-patient department in the Government Dharmapuri Medical College & Hospital, Dharmapuri, Tamil Nadu, India in the September 2024 – March 2025,They were divided into two groups according to the Glycemic status one group consisted of HbA1c levels < 7, and the other group consisted of HbA1c levels > 7. All of them were subjected to echocardiography. Results: In the present study, most of the participants belonged to >50 years age group. Out of the 50 participants in the study, 26 (52%) were male and 24(48%) were female. 14 participants out of 25 in group 1 were observed to have LV diastolic dysfunction. Out of which 11 (44%) were having grade 1 LVDD and 3(12%) were having grade 2 LVDD. 11 (44%) participants whose HbA1c was <7, were not diagnosed to have a LVDD.21 participants out of 25 in group 2 were observed to have LV diastolic dysfunction. Out of which 13 (52%) were having grade 1 LVDD and 8(32%) were having grade 2 LVDD. 4 (16%) participants whoseHBA1C was >7, were not diagnosed to have a LVDD. Conclusions: In patients with type 2 diabetes without clinical evidence of heart disease and HbA1c >7, there was a diastolic dysfunction with higher transmitral A/E ratio, more prolonged isovolumic relaxation time in comparison with patients with type 2 diabetes without clinical evidence of heart disease and hemoglobin A1C<7 subjects.
Research Article
Open Access
An Assessment of the Risk factors and concerns of Postpartum depression among mothers attending tertiary care centre: A Hospital Based Study.
Dr. Sonika Sangra ,
Dr Shallu Jamwal ,
Dr Sujata Gupta
Pages 451 - 456
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Abstract
Background: Introduction: Postpartum depression (PPD) is a nonpsychotic mental health condition associated with child birth. It poses a major global public health challenge as it remains unrecognized most of the time and impairs both the immediate and long-term health of both the mother and child. The study was conducted to estimate the prevalence and associated risk factors for PPD. Materials & Methods : A cross-sectional study was conducted among 150 women who delivered babies within the past 1–12 months and attending a tertiary care hospital during September 2023 to February 2024. Basic sociodemographic variables (age, duration of postpartum period, residence, religion, education, occupation, birth spacing, complication during pregnancy, desired gender of child, birth weight of baby) related to pregnancy were collected. The Edinburgh Postnatal Depression Scale was used to estimate the prevalence of PPD. Results : The prevalence of PPD in the study was 10%. The mean age of women was 23.4 years. Sociodemographic factors such as education of the woman ,whether pregnancy is planned or not ,History of abortion and pregnancy outcome were significantly associated with postpartum depression (p <0.05) Conclusion: PPD affects many women, emphasizing the need for effective measures.Thus, the sensitization of the primary healthcare providers and early screening and counseling of the mothers and their families is essential for reduction of associated morbidities and unfavorable outcomes.
Research Article
Open Access
A STUDY ON ASSESSMENT OF IMPLEMENTATION OF NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES MELLITUS, CARDIOVASCULAR DISEASES AND STROKE (NPCDCS) AT SUB CENTRE LEVEL IN A DISTRICT
Dr. Baby Sarvani Otturu ,
Dr. Sai Sravan Kumar Reddythala ,
Dr. Shaik Khader Mohammad Ali ,
Kurapati Kavyasree ,
Dr. Veeresh Babu Halvi ,
Dr. Arepalli Sreedevi
Pages 437 - 450
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Abstract
Background: In India National programme for prevention and control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) programme was launched in 2011 to reduce the burden of Non-Communicable diseases (NCDs). In Andhra Pradesh NPCDCS Programme was launched in 2010-12 i.e., in the first phase. In Ananthapuramu district programme was launched in 2016. Aim& Objective 1.To assess the implementation of NPCDCS programme at Sub centre level 2.To enumerate challenges faced by health care providers at sub centre level. Methodology: A Facility based cross-sectional study was done for the Assessment of National Programme for Cancer, Diabetes, Cardiovascular diseases and Stroke among sub centres of randomly selected 10 PHCs in Ananthapuramu district. Results: The proportion of health facilities with required Human resources accounts to 86.67%. In the present study, screening is being done using an app NCD-CD which screens the population for both Communicable diseases and non-communicable diseases. Among the population covered by 10PHCs during my study period prevalence of Hypertension was 10.07%,Prevalence of Diabetes mellitus was 9.10%, Prevalence of Hypertension with diabetes mellitus was1.05%and,138(0.07%)were having cancer. The present study concluded that, the challenges faced by the Health care providers include inadequate resources, inadequate training, low awareness among the community, technical issues, over burden, work beyond schedule time, covid pandemic duties, and low adherence of patients towards treatment. Conclusion: The present study concluded that, Some of the sub centres were having partially filled HCPs posts, which disturbs the services. Majority of sub centres were having functional equipment. There was no conduction of screening and awareness camps, only survey was being conducted with NCD- CD app. As the training sessions were not conducted periodically, recently recruited staffs were not trained for the conduction of NCD camps. The HCPs were over burdened, so that they were unable to give quality of services.
Research Article
Open Access
Dieulafoy's Lesion: A Rare Cause of Upper GI Bleed
Dr Meedimale Sandeep Reddy ,
Dr Aneesh Amte
Pages 433 - 436
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Abstract
Background: Sepsis Background: Dieulafoy’s lesion is a rare but potentially life-threatening cause of upper gastrointestinal bleeding. It arises from an abnormally large, tortuous submucosal artery that erodes through the seemingly normal mucosa. Because the surrounding mucosa appears normal and is deceptive, diagnosis is often delayed or missed on initial endoscopy. Case Presentation: We report a case of a 80 year-old male presenting with acute upper gastrointestinal bleeding manifested by dark coloured vomitus and melena. Endoscopy revealed a fresh clot with ooze noted noted in distal second part of the duodenum, consistent with a Dieulafoy’s lesion. Endoscopic hemostasis was successfully achieved using adrenaline injection. Conclusion: Dieulafoy’s lesion, though uncommon, should be considered in cases of unexplained massive gastrointestinal hemorrhage. Prompt endoscopic recognition and combined hemostatic therapy are effective in preventing morbidity and recurrence.
Research Article
Open Access
Anatomical Variations and Morphological Spectrum of the Palmaris Longus Muscle in Cadavers and Their Clinical and Surgical Significance
Dr Shabna C ,
Dr Hema Haris ,
Dr Reshma A R ,
Dr Sama Abdulkadar
Pages 425 - 432
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Abstract
Background: The palmaris longus (PL) muscle is among the most variable muscles in the human body. Though functionally insignificant, its morphological variants bear considerable clinical and surgical importance, particularly in reconstructive, orthopedic, and plastic surgeries. Aim: To study the anatomical variations and morphological spectrum of the palmaris longus muscle in cadavers and analyze their clinical and surgical significance. Materials and Methods: This descriptive cadaveric study was conducted on 72 adult cadavers of both sexes in the Department of Anatomy. Each upper limb was dissected to identify the PL, record its presence or absence, and document variations in origin, course, insertion, and morphology. Observations were measured, photographed, and statistically analyzed using chi-square and t-tests, with p < 0.05 considered significant. Results: PL was bilaterally present in 80.6% of specimens, unilaterally absent in 13.9%, and bilaterally absent in 5.6%. Morphological variants were noted in 23.6%, including accessory slips (8.3%), tendinous or digastric origin (4.2%), reversed belly (2.8%), and insertion into the abductor pollicis brevis (5.6%). No significant sex or side predilection was observed (p > 0.05). Usable PL tendon for grafting was present in 77.8% of cadavers, with morphological variations significantly reducing graft suitability (p = 0.019). Rare reversed and deep insertions were associated with potential risk of median nerve compression. Conclusion: The PL shows wide anatomical variation in morphology and insertion. Despite being functionally redundant, it remains a valuable graft source for reconstructive surgeries. Knowledge of its variants aids surgeons in avoiding complications and optimizing donor-site selection..
Research Article
Open Access
"Placental Location and outcome of pregnancy in Government Maternity Hospital "
Kamatham Aneesha ,
Ch. Rama
Pages 422 - 424
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Abstract
Background: Placental location plays a crucial role in pregnancy outcomes by influencing uteroplacental blood flow, mode of delivery, and neonatal health. This hospital-based study aimed to evaluate the association between placental position and maternal as well as neonatal outcomes among antenatal women in a tertiary care setting. Methods: A prospective observational study was conducted at the Government Maternity Hospital, Tirupati, over one year. A total of 133 pregnant women (>28 weeks gestation) were enrolled. Placental location was determined by ultrasonography and categorized as anterior, posterior, fundal, lateral, or others. Maternal and neonatal outcomes including preeclampsia, gestational hypertension, preterm birth, mode of delivery, and low birth weight were recorded and analyzed using SPSS v24. Results: Among 133 participants, anterior placenta was most common (47.4%), followed by posterior (35.3%) and fundal (11.3%). Gestational hypertension occurred in 21.1%, preeclampsia in 21.1%, and preterm delivery in 30.8% of cases. While anterior and posterior placentae showed higher rates of preterm birth and low birth weight, statistical significance was not reached (p>0.05). Mean birth weight was 2.60±0.57 kg. No strong correlation between placental location and maternal or neonatal complications was established. Conclusion: Although placental location did not show statistically significant associations with adverse outcomes, anterior and posterior locations showed a clinical trend toward increased preterm birth and low birth weight. Routine ultrasound assessment of placental position remains essential for risk stratification and delivery planning.
Research Article
Open Access
Association Of Early Caffeine Administration And Outcome In Preterm Neonate In Nicu Of A Tertiary Care Teaching Hospital Of Rural North India
Dr Gorijavolu Hemanth ,
Dr Ashwani kumar ,
Dr Harita Kirpal ,
Dr Jaswir Singh ,
Dr Baljeet Maini
Pages 412 - 421
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Abstract
Background: Introduction: Prematurity is a major global health issue associated with significant neonatal morbidity and mortality. Apnea of prematurity (AOP) is a common complication in preterm neonates due to immature respiratory control. Caffeine citrate, a methylxanthine derivative, is widely used to stimulate respiratory drive and reduce apnea episodes. Early caffeine administration within the first 48 hours of life has been proposed to improve respiratory and neurodevelopmental outcomes in preterm infants. Materials and Methods: This prospective observational study was conducted in the Neonatal Intensive Care Unit at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Seventy-five preterm neonates (<37 weeks gestation) requiring caffeine therapy were enrolled and divided into two groups: early caffeine administration (within 48 hours of birth) and late caffeine administration (after 72 hours). Data on demographic parameters, respiratory support needs, incidence of BPD, intraventricular hemorrhage (IVH), neurodevelopmental assessments (using Hammersmith Neonatal Neurological Examination and Bayley Scales), and NICU stay duration were collected and analyzed. Results: Early caffeine administration was associated with a significant reduction in duration of mechanical ventilation (p=0.026) and lower incidence of severe IVH compared to late administration (p=0.005). Neurodevelopmental outcomes at NICU discharge were significantly better in the early caffeine group, evidenced by higher mean HNNE scores and a greater proportion of infants with optimal neurological scores (p=0.02). At 6-month follow-up, early caffeine recipients showed improved motor outcomes (p=0.02). No significant differences were found in length of NICU stay or incidence of sepsis between the groups. Conclusion: Early caffeine administration within the first 48 hours of life in preterm neonates is associated with improved respiratory and neurodevelopmental outcomes, including reduced mechanical ventilation duration and lower rates of severe IVH. These findings support the clinical benefit of prompt caffeine therapy initiation in preterm infants to optimize long-term health and developmental trajectories.
Research Article
Open Access
A Study to Assess Serum Calcium and Vitamin D Levels in Children on Antiepileptic Therapy
Dr Ashima Singh ,
Dr Ashwani kumar ,
Dr Nidhi Chadha ,
Dr Baljeet Maini ,
Dr Jaswir Singh
Pages 405 - 411
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Abstract
Background: Introduction: Epilepsy is a prevalent chronic neurological disorder in children, and long-term antiepileptic drug (AED) therapy—especially with enzyme-inducing AEDs—can adversely impact bone metabolism. This study aimed to evaluate serum calcium and vitamin D levels in pediatric patients on AED monotherapy. Materials and Methods: This cross-sectional study was conducted from June 2023 to January 2025 in the Department of Paediatrics, Maharishi Markandeshwar University. A total of 150 children aged 4–18 years with epilepsy on AED monotherapy for at least three months were included. Serum calcium and 25-hydroxyvitamin D levels were measured using standard methods. Data were analyzed using SPSS and Jamovi, with a p-value <0.05 considered statistically significant. Results: Hypocalcemia was observed in 10% of participants, with carbamazepine users showing the lowest mean calcium (8.66 mg/dL). Vitamin D deficiency was widespread (65.3%), especially among carbamazepine (100%) and valproate (78.7%) users. Levetiracetam showed the most favorable biochemical profile. Prolonged therapy duration (>3 years) was associated with significantly lower calcium and vitamin D levels (p<0.05). Conclusion: AED use, particularly enzyme-inducing and long-duration therapies, significantly affects calcium and vitamin D metabolism. Routine monitoring and preventive strategies are essential to safeguard bone health in pediatric epilepsy patients.
Research Article
Open Access
Gender Differences in Psychosocial Problems of Adolescents: Insights from a Community-Based Study
Dr Sandhya Gokul Ingole ,
Dr R M Gokhale
Pages 399 - 404
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Abstract
Background: Adolescence is a crucial developmental period where psychosocial problems can profoundly impact future wellbeing. Gender differences influence the nature and extent of these problems. Objectives: To assess the prevalence and gender differences in psychosocial problems among adolescents in a community setting. Methods: A cross-sectional study was conducted among 340 junior college students (170 boys and 170 girls) aged less than 20 years from two rural colleges. Psychosocial problems were assessed using a structured and validated questionnaire covering behavioral, emotional, educational, and social domains. Data analysis included Chi-square tests and t-tests to examine gender differences. Results: The overall prevalence of psychosocial problems was 24.2%, with 23.3% in boys and 25% in girls. Significant gender differences were noted in the late adolescence age group and educational standard with girls showing higher problems. Social problems were significantly higher in girls compared to boys. Parental addiction was significantly associated with increased psychosocial problems in both sexes. Conclusions: While the overall prevalence of psychosocial problems was similar between genders, distinct gender-specific differences were observed in domains and associated factors, emphasizing the need for targeted interventions.
Research Article
Open Access
The Weight of Compassion: A Cross-Sectional Study Exploring Caregiver Burden and Quality of Life Among Primary Caregivers of Children with Intellectual Disability in Goa, India
Nihal Baliga ,
Mesha Bene ,
Nayana Naik
Pages 381 - 390
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Abstract
Background: Parents caring for children with intellectual disability (ID) experience substantial caregiving demands that can diminish their quality of life (QOL). This study examined caregiver burden and quality of life among primary caregivers of children with Intellectual Disability in a tertiary-care setting in Goa, India. Methods: Cross-sectional study of 50 primary caregivers of children/adolescents with Intellectual Disability (Internation Classification of Diseases ICD-10). Caregiver burden was assessed using the Zarit Burden Interview (ZBI) and quality of life using the World Health Organization Quality of Life- Brief version (WHOQOL-BREF). Descriptive and inferential statistics were computed; p < 0.05 was considered significant. Results: A majority of caregivers were mothers. Most caregivers rated overall QOL as “neither poor nor good” (70%), with 16% “good” and 12% “poor.” Domain means (WHOQOL-BREF) for ID caregivers were: social 72.24 ± 12.03, physical 52.90 ± 10.56, psychological 49.72 ± 12.21, and environmental 49.22 ± 8.24. Interpersonal and financial stressors were associated with significantly lower QOL in physical and psychological domains (p = 0.028; 0.036 and p = 0.010; 0.034 respectively). 78 % of caregivers were aware of government disability benefits, however only 44 % availed the benefits Burden categories showed 6% little or no burden, 74% mild to moderate, 20% moderate to severe, and 0% severe to profound. A significant association was seen between burden of care score and severity of intellectual disability with p-value of 0.005 and a significant negative correlation was observed between caregiver burden and all QOL domains. Conclusion: Caregivers of children/adolescents with ID exhibit meaningful burden and impairments in QOL, particularly in physical, psychological, and environmental domains. Structured psychoeducation, social support, and financial assistance may improve caregiver outcomes.
Research Article
Open Access
To Determine the Clinical, Serological and Molecular Parameters in the Diagnosis of Hepatitis C Infection in Clinically HCV Suspected Patients
Smeet Jyoti Kalita,
Babita Sharma ,
Pooja Baruah
Pages 378 - 380
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Abstract
Background: Hepatitis C virus (HCV) is the common cause of post transfusion hepatitis in developing countries. Hepatitis C virus infection occurs worldwide. Every year, 3-4 million people are infected with HCV with more than 3.5 lakhs deaths. Higher prevalence rates have been documented from Africa (up to 10%), followed by South America & Asia. In India, the prevalence is about 1 %. Various modes of transmission of HCV are Parenteral, Vertical transmission and sexual transmission. However, Hepatitis C virus doesnt spread through breast milk, food or casual contacts including hugging or kissing. Incubation period is about 15-160 days (average 50 days). About 20% of people develop acute hepatitis characterized by symptoms similar to that of other Hepatitis viruses. About 75-80% directly develops chronic disease out of which 60-70% develops chronic Hepatitis, 5-20% develops cirrhosis and 1-5% develops Hepatocellular carcinoma. The present study was done to determine the common clinical features, serological and molecular parameters in the diagnosis of Hepatitis C Virus infection in clinically suspected patients. Materials & Methods: This study was carried out in the department of Microbiology and Molecular Diagnostics in association with the Department of Pathology at Krsnaa Diagnostics Ltd, Guwahati, Assam over a period of 3 months from May, 2024 till July, 2024. This study was conducted among 687 patients, who were clinically suspected for HCV infection and screened for Hepatitis C ICT (HCV TRIDOT Card) serological test as well as HCV real time PCR molecular test with viral count quantification. The collected data was entered into MS excel followed by the analysis using SPSS version 21 (licensed to KDL). Results: In our study, we noted that, out of a total of 687 HCV suspected patients, 627(91%) patients were in the age group of 13-35 years, followed by 56 (8%) patients were in the age group of 36-59years, followed by 04(1%) patients were in the age group of >60 years. Number of intravenous drug users was 179, which signifies that 26% of study subjects were Intravenous drug users. Conclusion: Out of 687 samples, 627 were males & 60 were females. Out of total 687 patients, 446 came out to be reactive by rapid ICT card test and 241 came out to be HCV non reactive. 464 Came out to be reactive by real time PCR and 223 came out to be non reactive. Samples which came out to be HCV reactive by PCR but not reactive by ICT rapid card test were 18.
The PCR results average log value was 5.07548 & average CT value was 26.80.
Research Article
Open Access
Perception and Impact on the Mental Well-Being of Children (Classes 4–7) Following the Pahalgam Incident
Dr. Sandhya Khadse ,
Dr. Arika Pareek ,
Dr. Prashant Weekey
Pages 369 - 378
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Abstract
Introduction: Children are among the most psychologically vulnerable during crises and traumatic events. The Pahalgam incident, a significant and distressing event, likely had emotional and cognitive implications for children exposed directly or indirectly. Understanding their perception and psychological response is essential for effective mental health intervention and support. Aims: To assess the level of awareness, emotional impact, perception of safety, and coping mechanisms among children (Classes 4–7) following the Pahalgam incident, and to evaluate the roles of family, school, and media in shaping their responses. Materials and Methods: A descriptive, cross-sectional study was conducted among 164 students aged 9–14 years from Classes 4 to 7. A pre-tested, semi-structured questionnaire assessed demographics, awareness of the incident, emotional responses, coping strategies, and communication with parents and teachers. Data were analyzed using descriptive statistics. Result: Among the 164 participants, 92.7% were aware of the Pahalgam incident, primarily through television (32.9%) and parents (28%). Emotional responses included anger (41.5%), sadness (38.4%), and fear (6.7%), while 45.7% reported mood or sleep disturbances. Only 7.3% of students reported that teachers discussed the event in school. While 68.9% had conversations with parents about the incident, only 36% felt emotionally reassured. Additionally, 54.3% had actively tried to find out more information about the incident. Conclusion: The Pahalgam incident had a considerable emotional impact on children, with significant levels of sadness, anger, and anxiety. Limited school engagement and insufficient explanation about safety drills added to confusion and fear. Strengthening child-focused crisis communication, parental guidance, and school-based mental health support is crucial to mitigating the psychological effects of such incidents.
Research Article
Open Access
Association of Nuchal Translucency Thickness with First-Trimester Maternal Serum Biomarkers in Pregnancies with NT ≥ 3 mm: A Prospective Observational Study
Dr Sehar Mushtaq Kanyu ,
Dr Munib ul Rehman ,
Dr Sauliha Rafiq ,
Dr Mahak Mushtaq Kanyu
Pages 361 - 368
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Abstract
Background: Enlarged nuchal translucency (NT) in the first trimester is a well-recognized marker for chromosomal and structural abnormalities. The contribution of maternal serum biomarkers: free β-hCG, PAPP-A, and alpha-fetoprotein (AFP) to risk assessment in pregnancies identified with NT ≥ 3 mm remains uncertain. This study aimed to evaluate the association between NT thickness and these serum biomarkers in a high-risk cohort. Methods: A prospective observational study was conducted over 18 months at the Department of Anatomy, Government Medical College, Srinagar. Out of 22,679 women screened between 11 and 14 weeks of gestation, 22 fetuses (0.1%) were identified with NT ≥ 3 mm and formed the study cohort. NT was measured using standardized transabdominal ultrasonography. Maternal serum free β-hCG (IU/L), PAPP-A (MoM), and AFP (ng/mL) were analyzed. Correlation coefficients between NT and each biomarker were calculated using Pearson’s correlation, with p < 0.05 considered statistically significant. Results: The mean NT thickness was 4.36 ± 0.61 mm (range: 3.40–5.40 mm). The mean maternal serum free β-hCG level was 123.87 ± 68.65 IU/L (range: 29.80–231.00 IU/L), the mean PAPP-A concentration was 57.25 ± 59.73 MoM (median: 44.70; range: 15.20–302.00 MoM), and the mean AFP level was 37.75 ± 17.38 ng/mL (median: 25.59; range: 20.12–68.91 ng/mL). Correlation analysis showed no significant association between NT and free β-hCG (r = 0.027, p = 0.904), a weak positive but non-significant association between NT and PAPP-A (r = 0.111, p = 0.622), and a weak non-significant association between NT and AFP (r = 0.156, p = 0.486). Conclusion: Within the subgroup of pregnancies with NT ≥ 3 mm, maternal serum free β-hCG, PAPP-A, and AFP levels did not demonstrate significant correlations with NT thickness. These findings suggest that, once NT is enlarged, it remains the principal predictor of early fetal risk, and serum biomarkers provide limited additional value.
Research Article
Open Access
Functional outcome of primary anterior sagittal anorectoplasty (ASARP) in female anorectal malformations with vestibular fistula
Maneesha U R ,
Binu MK ,
Sam Varkey ,
Shinaz Sadiq
Pages 355 - 360
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Abstract
Background: Anorectal malformations (ARM) constitute one of the most common congenital anomalies in children, with vestibular fistula being the predominant type among females. The advent of anterior sagittal anorectoplasty (ASARP) has simplified the approach to these anomalies, offering single-stage correction with favorable cosmetic and functional outcomes. Objective: To evaluate the functional outcomes and postoperative complications following primary ASARP in female children with vestibular fistula. Methods: A retrospective follow-up study was conducted on 34 female patients who underwent primary ASARP at the Department of Pediatric Surgery, Government Medical College, Thiruvananthapuram, from 2008 to 2017. Functional outcomes were assessed using the Kelly scoring system, along with parameters such as staining, soiling, anal sphincter tone, bowel movement frequency, and constipation. Postoperative and intraoperative complications were documented from hospital records and follow-up visits. Results: The mean age at surgery was 12.74 ± 12.05 months, and the mean current age was 17.12 ± 15.63 months. Rectovestibular fistula was the most common anomaly (55.9%). The mean Kelly score was 5.62 ± 0.65, with 91.2% achieving good continence (≥5). Soiling was absent in all, and 73.5% had no staining. Sphincter tone was strong in 88.2%, and constipation occurred in 20.6%. Postoperative complications were minimal (11.8%), comprising wound infection (5.9%), wound dehiscence (2.9%), and stenosis (2.9%). No mortality was reported.
Conclusion: Primary ASARP provides excellent functional outcomes with minimal postoperative morbidity and should be considered a safe, single-stage definitive procedure for female vestibular-type ARM.
Research Article
Open Access
PERITONEAL INCLUSION CYST IN A FEMALE WITH MULTIPLE ABDOMINAL SURGERIES: A CASE REPORT
Dr. Goli Apoorva ,
Prof. Dr. Tirou Aroul T ,
Prof. Dr. Robinson Smile S
Pages 350 - 354
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Abstract
Background: Peritoneal inclusion cysts are reactive fluid-filled lesions. They are rare and only a few case reports have been found in literature. They have a low risk of malignant transformation but a high rate of recurrence. Higher incidence is noted in female population in reproductive age group with prior history of multiple abdominal surgeries. A 40-year old woman with history of multiple abdominal surgeries presented with complaints of lower abdominal pain ,distension and difficulty in micturition. MRI was done and peritoneal inclusion cyst was considered. She underwent exploratory laparotomy and surgical excision of the cyst along with the ovary. Cystic fluid was negative for malignant cells and histopathological examination of excised cyst wall along with the ovary was consistent with features of peritoneal inclusion cyst.
Research Article
Open Access
An evaluation of factors affecting the delivery of enteral nutrition in pediatric intensive care
Arti Choudhary ,
Rashmi Agarwal ,
Vikash Gurjar
Pages 343 - 349
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Abstract
Background: Objective: To identify factors associated with delayed enteral nutrition (EN) and interruptions to enteral nutrition (EN) and to find avoidable reasons for interruptions to enteral nutrition (EN) in the paediatric intensive care unit. Design, Setting, and Measurements: Children admitted to the PICU of MGM Medical College and Hospital Aurangabad who were on enteral feed were enrolled and studied for over 3 months. Clinical characteristics, anthropometric measurements, and time to reach caloric goals were noted. Daily nutrient intake and time of starting EN after admission and the number and duration of interruptions to EN were recorded in patients. Results: Daily records of nutrient intake were obtained in 50 consecutive patients on EN. Fifty patients had a total of 381 EN days (median, 2 days). The median time to EN initiation was 32.5 hrs. However, EN was subsequently interrupted in all patients at an average of 2.36 times per patient, for a total of 118 episodes accounting for 2048 hrs of EN deprivation in this cohort. Of the 118 episodes of EN interruption, 82.23% were deemed avoidable. Patients with neurological and respiratory problems were at the highest risk of EN interruptions.
Conclusions: Many causes of delayed EN and EN interruptions are avoidable in critically ill children. Knowledge of existing barriers to EN, such as those identified in this study, will allow appropriate interventions to optimize nutrition provision in the PICU.
Research Article
Open Access
Antimicrobial resistance of bacterial isolates from respiratory secretions of ventilated patients in PICU and NICU of a tertiary care centre
Rashmi Agarwal ,
Vikash Gurjar ,
Arti Choudhary
Pages 337 - 342
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Abstract
Background: Ventilator-associated pneumonia (VAP) remains a significant cause of morbidity and mortality in pediatric and neonatal intensive care units. Identifying prevalent pathogens and their antimicrobial susceptibility patterns is essential for rational antibiotic use and improved outcomes. Aim: To determine the antimicrobial resistance patterns of bacterial isolates from endotracheal (ET) secretions of ventilated patients in the PICU. Methods: This retrospective observational study was conducted at a tertiary care hospital in Indore over two years (April 2020 – March 2022). Patients aged 0–15 years, ventilated for more than 48 hours, and with suspected VAP (CPIS >6) were included. ET secretions were collected under aseptic precautions for culture and sensitivity testing. Multidrug resistance (MDR) was defined as per CLSI 2011 guidelines. Results: Of 253 ventilated patients, 113 met the inclusion criteria. ET cultures were sent for 88 patients; 41 samples from 39 patients showed significant bacterial growth. Culture positivity rate was 46%. Nine patients (23%) developed VAP. Among 41 isolates, 31 (75.6%) were MDR. Gram-negative bacteria dominated, with high resistance to third-generation cephalosporins and aminoglycosides. Staphylococcus spp. isolates showed significant resistance, including methicillin resistance. Conclusions: A high prevalence of MDR organisms was found among ventilated pediatric patients, emphasizing the need for rational antibiotic protocols tailored to local microbial profiles. Regular surveillance, early microbiological diagnostics, and strict infection control practices are key to reducing VAP incidence and improving clinical outcomes.
Research Article
Open Access
EFFICACY OF GeneXpert MTB/RIF ASSAY IN CSF FOR DIAGNOSIS OF NEURO TUBERCULOSIS
Vikash Gurjar ,
Rashmi Agarwal ,
Arti Choudhary ,
Gajanand Singh Tanwar
Pages 330 - 336
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Abstract
Background: Neuro-tuberculosis continues to represent a major pediatric health challenge despite significant advancements in tuberculosis (TB) control globally. AIM: To study the efficacy of the geneXpert MTB/RIF assay in cerebrospinal fluid for diagnosis of neurotuberculosis. Methodology: The present hospital-based prospective observational study was conducted in the Department of Paediatrics at PBM Hospital, S.P. Medical College, Bikaner, over a duration of one year. Result: The study demonstrated that fever and excessive crying were universally presenting symptoms in pediatric neurotuberculosis, with most cases showing abnormal neurological features, stage II disease, and low BCG vaccination coverage. MRI abnormalities and Gene Xpert positivity were limited, yet gene-positive cases showed significantly higher CSF cell counts and sugar levels but lower protein levels, highlighting key diagnostic differences. Conclusion: The study concludes that while Xpert-MTB/RIF shows low positivity in pediatric TBM, it remains a promising supportive diagnostic tool, especially in severe cases. Further research is necessary to validate its role and improve early detection and management strategies.
Research Article
Open Access
Incidence and Pattern of Retinopathy of Prematurity in Neonates and Infants with Risk Factors at a Tertiary Care Hospital in Himachal Pradesh: A Prospective Observational Study
Dr. Naman Sharma ,
Dr. Richa Sharma ,
Dr. Chander Shekhar
Pages 322 - 329
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Abstract
Background: Retinopathy of prematurity (ROP) is an important cause of preventable childhood blindness, particularly in low- and middle-income countries. Regional variations in incidence and risk factors necessitate localized studies to guide screening strategies. Objective: To determine the incidence, pattern, and risk factors associated with ROP in preterm and low birth weight neonates admitted to a tertiary care hospital in Himachal Pradesh. Methods: A prospective observational study was conducted in the NICU of Shri Lal Bahadur Shastri Government Medical College, Mandi, over one year (2023–24). Two hundred neonates with gestational age <34 weeks, birth weight <2000 g, or unstable clinical course were screened for ROP using indirect ophthalmoscopy at four weeks of age. Disease staging followed the International Classification of ROP (ICROP). Maternal and neonatal variables were analyzed using chi-square and logistic regression. Results: The incidence of ROP was 27.5% (n=55/200). Zone 1 involvement was most common (67.3%). Stage 1 ROP accounted for 65.5% of cases, Stage 2 for 30.9%, and Stage 3 for 3.6%. Plus disease was present in 14.5% of neonates. Significant risk factors included gestational age <34 weeks (p<0.001), birth weight <1500 g (p<0.001), prolonged oxygen therapy >7 days (OR 5.5, p<0.001), respiratory distress syndrome (OR 3.5, p=0.005), and sepsis (OR 2.0, p=0.04). No infant progressed to Stage 4 or 5 disease. Conclusion: ROP incidence in this setting (27.5%) is comparable to other Indian studies. Prematurity, low birth weight, prolonged oxygen exposure, RDS, and sepsis were major contributors. Early screening and judicious oxygen use are crucial to prevent sight-threatening disease in resource-limited regions.
Research Article
Open Access
Clinical Profile of the Pattern of Dyslipidaemia and Ischaemic Heart Disease in Patients with Type 2 Diabetes Mellitus
DR. P.BHARANI ,
DR.R. SIVARAMAN ,
DR .J.KIRUTHIKA
Pages 314 - 321
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Abstract
Background: Type 2 diabetes mellitus (T2DM) is closely linked to accelerated atherosclerosis through complex lipid abnormalities and insulin resistance. Dyslipidaemia, marked by elevated triglycerides, low HDL cholesterol, and predominance of small dense LDL particles, plays a central role in the development of ischaemic heart disease (IHD). The burden of this dual pathology continues to rise across Indian populations, where metabolic risk clustering occurs at an earlier age and with greater intensity. Aim: To describe the clinical and biochemical profile of dyslipidaemia among adults with T2DM and to determine the association between specific lipid abnormalities and the presence of IHD. Materials and Methods: A cross-sectional descriptive study was conducted among 100 T2DM patients attending the diabetic clinic and medical wards of Government Stanley Medical College and Hospital, Chennai, from April 2024 to March 2025. Clinical data included duration of diabetes, blood pressure, body mass index, waist–hip ratio, and smoking status. Biochemical variables included fasting and post-prandial glucose, HbA1c, total cholesterol, LDL-C, HDL-C, triglycerides, and VLDL. Resting ECG and echocardiography were used to identify IHD. Statistical tests included chi-square and Pearson’s correlation, with p < 0.05 considered significant. Results: The mean age was 56.3 ± 8.4 years (62% male). Dyslipidaemia was present in 82% of participants. The most common pattern was mixed dyslipidaemia (38%), followed by isolated hypertriglyceridaemia (25%) and low HDL cholesterol (19%). IHD was documented in 36% of cases. Those with IHD showed significantly higher mean triglycerides (212 ± 68 mg/dL) and lower HDL-C (38.6 ± 7.1 mg/dL, p < 0.01). Duration of diabetes ≥ 10 years was strongly associated with IHD (χ² = 12.4, p = 0.001). Multivariate analysis revealed serum triglycerides and HDL-C as independent predictors of IHD after adjusting for age and BMI. Conclusion: Dyslipidaemia is highly prevalent among T2DM patients, and mixed lipid abnormalities substantially increase the risk of ischaemic heart disease. Routine lipid profiling and aggressive management of triglycerides and HDL cholesterol should form an integral part of diabetes care to prevent cardiovascular events.
Research Article
Open Access
Impaired Pulmonary Function among Patients with Metabolic Syndrome: A Cross-Sectional Study from a Tertiary Hospital in South India
DR. P.BHARANI ,
DR J.KIRUTHIKA ,
DR.A. SATHYA
Pages 306 - 313
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Abstract
Background: Metabolic syndrome (MetS) represents a constellation of interrelated metabolic abnormalities, including abdominal obesity, insulin resistance, hypertension, and dyslipidemia, that collectively elevate cardiometabolic risk. Increasing evidence suggests that these metabolic disturbances can also impair lung function. Yet, in Indian adults, the extent of pulmonary compromise among MetS patients remains underexplored. Methods: A hospital-based cross-sectional study was conducted among 106 adults diagnosed with MetS according to NCEP-ATP III criteria in the Department of General Medicine, Government Stanley Medical College, Chennai. Anthropometric indices, fasting blood glucose, lipid profile, and blood pressure were assessed. Pulmonary function was evaluated by spirometry, measuring FEV₁, FVC, FEV₁/FVC, and FEF₂₅–₇₅. Data were analyzed using SPSS v25 with ANOVA and chi-square tests; p<0.05 was considered significant. Results: Mean participant age was 50.9 ± 9.9 years, with 55.7% males. Normal spirometric pattern was seen in 58.5%, while 17.9% showed restrictive, 10.4% obstructive, and 10.4% mixed defects; 2.8% had small airway disease. Impaired lung function correlated significantly with fasting blood sugar, waist circumference, triglycerides, and systolic blood pressure (p<0.05), but not with HDL cholesterol. Restrictive changes predominated among males and those with ≥4 MetS components. Conclusion: Metabolic syndrome is associated with measurable reductions in pulmonary function, particularly of a restrictive pattern, likely due to central adiposity and insulin-resistance–related inflammation. Early spirometry screening can identify subclinical respiratory compromise, allowing timely lifestyle and pharmacologic interventions to prevent progressive lung decline.
Research Article
Open Access
Knowledge, Attitude, and Practice (KAP) Regarding Medicolegal Cases among MBBS Students in NSCB Medical College, Jabalpur, Madhya Pradesh : A Cross-Sectional Study
Dr Vijay Ajmera ,
Dr Radhika Hande ,
Dr Vinod Patiram Bhalerao
Pages 301 - 305
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Abstract
Background: Medicolegal cases (MLCs) are integral to medical practice, yet undergraduate medical students often have limited exposure. This study aimed to assess the knowledge, attitude, and practice (KAP) of MBBS students regarding MLCs in Madhya Pradesh. Methods: A cross-sectional survey was conducted among 200 MBBS students using a pre-validated KAP questionnaire. Data were analyzed to determine frequencies, percentages, and graphical distributions of responses. Results: Majority of participants were aged 21–23 years (56%) and academic interns (36.5%). Most students demonstrated adequate knowledge regarding MLC definitions (75.5%), scenarios requiring registration (82%), and responsible personnel (64.5%). Positive attitudes towards compulsory MLC training were noted (48.5% strongly agree). However, practical exposure was limited: only 43% observed MLC registration during postings and 49.5% never attended an autopsy. Conclusion: MBBS students in NSCB Medical College, Jabalpur Madhya Pradesh show good theoretical knowledge and favorable attitudes towards MLCs, but hands-on experience is lacking. Structured practical training should complement theoretical teaching to bridge this gap.
Research Article
Open Access
Study of Event Related Potentials and Psychometric Tests as a Tool for Evaluation of Cognitive Function in Diabetes Mellitus
Sindhuja A ,
Vidya M Nadiger ,
Srinivas K ,
Kavyashree H M
Pages 292 - 300
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Abstract
Background: objectives The complete syndrome of diabetes mellitus, related metabolic aberrations and diabetic complications is posing a major threat in the 21st century. Cognitive dysfunction is a well-known complication of diabetes which continues to be investigated. The objective of this study was to evaluate the cognitive functions using comprehensive neuropsychological and electrophysiological tests in diabetics and non diabetics and find out the usefulness of psychometric tests in assessing cognitive dysfunction. Methodology The study was conducted on 50 diabetics and 50 non diabetics aged between 40 and 59 years. Cognition was assessed using psychometric tests and electrophysiological tests. Psychometric tests included MMSE, FWSTMT and CDT. Electrophysiological test included P300 potential which was recorded using RMS EMG EP MARK II equipment in the auspices of Department of Physiology, S.S.Institute of Medical Sciences & Research Centre, Davangere. P300 data analysis was done using Student unpaired T test to compare the mean of two groups. Chi Square test was used to analyze MMSE and CDT. Fischer exact test was used to analyze FWSTMT. Differences were considered significant at P<0.001. Results The absolute peak latencies of P3 component of endogenous cognitive evoked potentials was significantly prolonged among diabetics (334.8 + 20.8) as compared to controls (285.7 + 14.9). We did not detect statistically significant difference between groups when analyzed for N2 in Cz and Fz. Psychometric tests did not reveal cognitive deficits in diabetics. Interpretation and conclusion This study identifies prevalence of cognitive dysfunction in diabetic patients when assessed using electrophysiological tests. Psychometric tests were not sensitive to detect subtle cognitive changes. Good cognitive function is critical to safely manage diabetes and draws attention to various challenges in their management. Clinicians should consider screening for cognitive function in diabetics using P300, as it is effective in detecting subtle changes much before their clinical manifestation.
Research Article
Open Access
A 3-Dimensional Approach to Correct Depressed Scars and Peri-Scar Area Deformity Using Subcision and Autologous Fat Grafting - A Prospective Observational Study
Dr. Deepika Sinha Mishra ,
Dr. Dakshesh Shah ,
Dr. Krishnanand Dhruw
Pages 270 - 283
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Abstract
Background: Fat grafts have commonly been used as “natural fillers” for depressed scar correction. However, peri-scar area deformity gets ignored, causing sub-optimal results. Our aim was to develop a 3-dimensional approach to address the scar area with peri-scar deformity, and correct it using subcision and fat grafting. Methodology: 10 patients with 11 depressed scars underwent subcision and fat grafting in scar and peri-scar area by Coleman's technique after meticulous pre-operative planning and measurement of volume of fat graft required for correcting it. The Patient and Observer Scar Assessment Scale Score (POSAS) and the Modified Vancouver Scar Scale Score were used for pre- and post-operative comparison. Additionally, we added other scoring parameters to assess results relevant to this study. Results: The Modified Vancouver Scar Scale Score and POSAS Scores showed significant reduction post-operatively. There was significant peri-scar area deformity correction noted on follow up. The estimated volume deficit at scar site at 6 months follow up also showed a significant reduction compared to pre-operative value.
Conclusion: A 3-D approach to correct a depressed scar and peri-scar area deformity using subcision and fat grafting can lead to more satisfactory cosmetic outcomes.
Research Article
Open Access
Study of Laparoscopic Surgery Versus Laparotomy in the Management of Ovarian Torsion at A Tertiary Hospital
Dr Prabhavathi C ,
Dr. Sri Prathiba Mahalakshmi Nagarajan ,
Dr. Sivachandran Kabilan
Pages 264 - 269
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Abstract
Background: Adnexal torsion refers to the twisting of the ovary or ipsilateral fallopian tube or both, along the axis of their vascular pedicle. Present study was aimed to review role of laparoscopic surgery versus laparotomy in the management of ovarian torsion. Material and Methods: Present study was single-center, prospective, observational study, conducted in female patients with twisted ovary, diagnosed by clinical examination, ultrasonography and colour Doppler, confirmed intraoperatively. Results: In present study, 54 cases of ovarian torsion were studied. Majority were from 21-30 years age group (42.59 %), followed by < 20 years age group (20.37 %) & 11 (20.37 %) were postmenopausal. Common risk factors noted were presence of ovarian mass (94.44 %), parity > 2 (40.74 %), H/o tubal ligation (20.37 %) & PCOS (12.96 %). In present study common symptoms noted were acute abdomen (77.78 %), acute abdomen ± vomiting (64.81 %), chronic abdominal pain (>7 days) (20.37 %) & fever (12.96 %). USG diagnosis of torsion was given in 77.78 % cases. Ultrasonography imaging findings were simple/Hemorrhagic cyst (46.30 %), complex adnexal mass (42.59 %) & dermoid cyst (11.11 %). Mean diameter of the cysts was 7.8 ± 4.6 cm. USG Doppler was suggestive of absent blood flow (57.41 %) in majority of cases, low peripheral vascularity (20.37 %), & normal vascularity (22.22 %) was also noted. CT/MRI was done in 3 cases (5.56 %) to confirm diagnosis. Among them, 32 underwent laparotomy while 22 underwent laparoscopic surgery. Comparable distribution was noted for laterality & size of ovarian mass. Laparoscopy group had more conservative surgeries (p-<0.001), less radical surgeries (p-<0.001), less h Conclusion: Timely Laparoscopic approach remains the gold standard for the management of adnexal torsion and enables quick recovery, less hospital stay & complications.
Research Article
Open Access
Enhanced SD-OCT Based Classification for Diabetic Macular Edema: A Prospective Observational Study
Yamini Patial ,
Vivek Som
Pages 257 - 263
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Abstract
Background: Diabetic macular edema (DME) is a leading cause of vision loss in diabetic retinopathy (DR) patients. Spectral domain optical coherence tomography (SD-OCT) enables precise morphological classification, critical for diagnosis and treatment planning. Objective: To establish a comprehensive SD-OCT-based classification system for DME and evaluate its clinical correlations with visual acuity, central foveal thickness, and risk factors. Methods: A prospective observational case-series (90 eyes/48 patients with DR, Dec 2013–Nov 2015, Gandhi Medical College, Bhopal) included complete ophthalmic workup and SD-OCT imaging, analyzing DME patterns, visual acuity, central foveal thickness, diabetes duration, HbA1c. Classification followed established morphologic criteria and correlated with clinical variables. Results: SD-OCT detected DME in 91.11% of eyes, compared to 77.7% by slit-lamp biomicroscopy (p=0.0224). Cystoid macular edema was most common (33.75%), followed by serous detachment (26.25%), vitreomacular traction (21.25%), spongy pattern (13.75%), and epiretinal membrane traction (5%). Significant correlation was found between central foveal thickness and visual acuity (r=0.46, p=0.002531). Serous detachment predicted the worst visual acuity (mean log MAR 0.84) and highest mean foveal thickness (618.61 μm). Longer diabetes duration (≥10 years) and deranged HbA1c significantly increased DME risk.[1][2][3][4] Conclusion: SD-OCT offers superior sensitivity for early DME detection. The six-type OCT-based classification correlates well with anatomical findings and functional vision, guiding management and prognosis.
Research Article
Open Access
Clinicopathological Profile of Hematological Malignancies at Tertiary Care Centre: A Cross-Sectional Study
Chander Dutti ,
Prikshit Mittal ,
Gull Mohammad B ,
Ram Krishna ,
Anushree Chaturvedi ,
Bhupendra Singh C
Pages 246 - 256
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Abstract
Background: Clinical manifestations of haematological malignancies range from vague systemic signs to sudden multi-organ failure. The study was conducted to determine the prevalence and clinicopathological profile at a Tertiary Care Centre to better understand the nature of the disease and improve treatment outcomes. OBJECTIVES: The objectives of the research were to assess the clinical features and pathological profile and the distribution of various hematological malignancies. MATERIAL AND METHODS- This retrospective observational study included 158 cases with relevant clinical features and hematological findings in the Department of Medical Oncology of our tertiary care centre. This study period spanned two years, from January 2023 to December 2024. RESULTS- Most patients belong to the age group 51-60 years (22.8%). The average median age for diagnosis was 50 years. The number of males was more than females (53.8% vs 46.2%). The majority of them were unskilled workers, followed by semi-skilled workers. Fever (93%) was the most frequently reported symptom, while the pallor (95.4%) was the most common clinical sign. CONCLUSION- This retrospective study highlights the diverse clinicopathological spectrum of hematological malignancies encountered at a tertiary care centre. The findings underscore the presence of certain malignancies such as leukemia and lymphoma, with a noticeable variation in age distribution, gender prevalence, and clinical presentation. Early diagnosis based on hematological, histopathological, and immunophenotypic parameters is critical for timely and effective treatment planning. The study emphasizes the need for continuous surveillance, improved diagnostic infrastructure, and standardized treatment protocols to enhance patient outcomes. Further prospective studies with large sample size are required for better understanding of the evolving trends and to guide evidence-based clinical practice.
Research Article
Open Access
A Prospective Observational Study on the Incidence of Carcinoma Gall Bladder in Cases of Gall Stone Disease Undergoing Simple Cholecystectomy
Surajit Sarkar ,
Raj Narayan Roy,
Dipan Mukhopadhyay
Pages 240 - 245
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Abstract
Background: Gallstone disease, common in India, can lead to carcinoma gallbladder due to chronic mucosal irritation. The rate of incidental carcinoma found after cholecystectomy differs by region, highlighting the importance of early detection for improved prognosis. Aims and Objectives: The present study aimed to determine the incidence of carcinoma gallbladder in patients undergoing simple cholecystectomy for gallstone disease and to analyze the demographic and clinicopathological profile of these cases. Methods: This prospective observational study was conducted at Calcutta National Medical College & Hospital from November 2017 to April 2019, including 200 patients with symptomatic, ultrasonography-confirmed gallstone disease undergoing elective cholecystectomy. Data on clinical, demographic, and histopathological parameters were analyzed to determine the incidence and associations of incidental gallbladder carcinoma. Results: In this study of 200 patients with gallstone disease, the majority (26.5%) were aged 26–35 years, and females accounted for 68.5% (p < 0.0001). Over half of the patients (57.5%) had symptoms lasting less than 6 months (p < 0.0001). Open cholecystectomy was performed in 51.5% and laparoscopic in 48.5% (p = 0.5485). Histopathology revealed chronic cholecystitis in 76%, acute on chronic cholecystitis in 8.5%, and cholesterosis in 7.5% (p < 0.0001). Incidental gallbladder carcinoma was found in 4 cases (2%), predominantly in females and those with disease duration >12 months (p = 0.015). Conclusion: Though rare, incidental carcinoma gallbladder in cholecystectomy specimens is clinically important. Routine histopathology, especially in elderly females with long-standing or large stones, enables early detection and better outcomes.
Review Article
Open Access
A review of intraoperative complications of phacoemulsification in hard cataract.
Mavnika Boopalan ,
Machireddy R Sekharreddy,
Soumya Singh
Pages 235 - 239
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Abstract
Background: Phacoemulsification is the preferred technique for cataract surgery, but sometimes it is challenging as in case of hard cataracts. In this review we will discuss various intraoperative complications of phacoemulsification while handling hard cataract and ways to manage them. Methods: An extensive literature writing search was done using search engines like PubMed and Google scholar using significant terms/ key words “Phacoemulsification, intra-operative complications, hard cataract”. Results: A total of 34 studies were included in the review. The various etiological factors were discussed in detail. The most common factors were noted. Conclusions: There are myriad factors involved in the occurrence of postoperative dry eye of which transection of corneal nerves during surgery and the use of post-operative topical medication with preservatives, rank as the two most important causes.
Research Article
Open Access
Association between Serum Uric Acid Levels and Preeclampsia in Pregnant Women
Anu Kumari Baitha,
Ashish Dulani
Pages 229 - 234
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Abstract
Background: Preeclampsia is a multisystem hypertensive disorder unique to pregnancy that arises from abnormal placentation, oxidative stress, and endothelial dysfunction. Serum uric acid (SUA) reflects these underlying pathophysiological processes and has been proposed as a prognostic biomarker for disease severity and adverse outcomes. This study aimed to evaluate the diagnostic performance of elevated SUA levels in identifying preeclampsia among antenatal women. Method: A hospital-based analytical cross-sectional study was conducted on 500 pregnant women, comprising 250 diagnosed cases of preeclampsia and 250 normotensive controls matched by gestational age. Serum uric acid was measured using the enzymatic uricase-peroxidase method, and a cut-off value of >6.2 mg/dL was used for analysis. Diagnostic performance was assessed using sensitivity, specificity, predictive values, diagnostic accuracy, and receiver operating characteristic (ROC) analysis. Results: SUA levels >6.2 mg/dL were observed in 72.4% of preeclampsia cases compared to 12.4% of normal pregnancies (p < 0.001). The test demonstrated sensitivity 72.4%, specificity 87.6%, positive predictive value 85.3%, negative predictive value 76%, and diagnostic accuracy 83.3%. Younger age groups (≤19 years) showed higher prevalence of elevated SUA (77.9%). The ROC analysis indicated an area under the curve >0.80, signifying good discriminatory ability of SUA for detecting preeclampsia. Conclusion: Serum uric acid levels above 6.2 mg/dL show significant association with preeclampsia and offer good diagnostic accuracy, highlighting their role as a useful rule-in marker. Although SUA should not replace standard diagnostic criteria, it can serve as a cost-effective adjunct for risk stratification and early identification of high-risk pregnancies, particularly in resource-limited settings.
Research Article
Open Access
Stapled Haemorrhoidopexy Vs Milligan-Morgan Haemorrhoidectomy In Rural India: Comparing Costs And Long-Term Recurrence Rates
Pradeep Chowdary Chekuri,
Sivaji Ghose ,
Mili Das Chowdhary,
Rahul Umakant Apet
Pages 219 - 228
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Abstract
Background: Hemorrhoidal disease is common in rural India, where treatment decisions must balance clinical outcomes with economic feasibility. Milligan-Morgan hemorrhoidectomy (MMH) and stapled hemorrhoidopexy (SH) are widely used surgical options, but their comparative cost-effectiveness and recurrence rates remain crucial considerations for rural populations. Objectives: To compare operative parameters, cost, postoperative outcomes, and six-month recurrence rates between MMH and SH in patients with Grade III and IV hemorrhoids. Methods: A prospective randomized comparative study was conducted on 66 patients (33 per group) in a rural tertiary care hospital from January 2023 to June 2024. Group A underwent MMH and Group B underwent SH. Primary outcome was recurrence; secondary outcomes included operative time, blood loss, postoperative pain (VAS), hospital stay, time to return to work, cost, and complications. Data were analyzed using t-tests and chi-square tests. Results: SH significantly reduced operative time (25 ± 4 vs 35 ± 5 min), blood loss, pain scores, and hospital stay, and allowed earlier return to work. Patient satisfaction was higher in SH group despite threefold higher costs. Recurrence was slightly higher in SH (6%) compared to MMH (3%) but was not statistically significant. Conclusion: SH offers superior short-term recovery benefits but is less cost-effective. MMH remains more practical for rural populations due to lower costs and comparable recurrence rates.
Research Article
Open Access
Negative pressure wound therapy in post-laparotomy and post -cesarean wound infections.
Sameer Gupta ,
Anuradha ,
Sudhanshu Mishra
Pages 213 - 218
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Abstract
Background: Negative pressure wound therapy on closed incisions reduces surgical site infection and wound complications in high risk laparotomy and cesarean patients by improving perfusion, reducing edema/exudate, and protecting the incision environment. Methods: Prospective observational study (2017–2019) at a tertiary center including 100 adults (post laparotomy n=50; post cesarean n=50) receiving NPWT immediately post closure for 3–7 days; outcomes included infection categories, wound closure, infection reduction, re intervention, and complications, analyzed with descriptive statistics and group comparisons (p<0.05). Results: Mean age 32.6 ± 7.1 years (laparotomy 35.4 ± 7.6; cesarean 29.8 ± 6.2); obesity 21%, hypertension 15%, diabetes 10%; emergencies 50% in laparotomy vs 20% in cesarean. Infections: superficial 25%, deep 13%, infected seroma 8%; 54% had no infection; wound closure 94% (92% laparotomy; 96% cesarean); infection reduction 82.5% (80% vs 85%); re intervention 7.5% (10% vs 5%); complications were infrequent (pain 10%, skin irritation 8%, inadequate seal 6%, bleeding 5%) and consistent with published tolerability profiles. Conclusion: NPWT on closed laparotomy and cesarean incisions was associated with high closure rates, substantial infection reduction, low re interventions, and acceptable safety, supporting targeted use in risk enriched postoperative pathways with attention to local SSI baselines and implementation factors.
Research Article
Open Access
Clinico-Histopathological Study of Granulomatous Lesions of Skin – A Cross-Sectional Observational Study
S.S. Sabitha Rani,
Sugunadhar S
Pages 206 - 212
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Abstract
Background: Granulomatous lesions of skin include a broad category of infectious and non-infectious diseases of skin. They are often present with overlapping clinical and histopathological features. Therefore, the diagnosis requires attention to clinicopathological correlation by using special stains and other investigations. The current study was designed to evaluate the clinical profile, histopathological pattern, and etiological spectrum of granulomatous lesions of skin to assess the agreement with clinical and histopathological diagnosis. Methods: This cross-sectional study was conducted in 60 cases presenting with granulomatous skin lesions who were referred for diagnosis by histopathology. Evaluation of history and examination was recorded in a proforma. Skin biopsies were processed and examined histopathologically initially by using hematoxylin and eosin (H&E) staining. Special stains such as Ziehl–Neelsen, Fite–Faraco, Periodic Acid–Schiff (PAS), and Gomori Methenamine Silver (GMS) were used based on the requirement as indicated in the cases. Statistical analysis of histopathological correlation was done to determine agreement. Results: The mean age of the participants was 45.2 ± 16.8 years, slightly higher than that of the male cases, with 53.3%. Infectious granulomatous dermatosis was found to be present in 58.3% cases, and the rest were infectious in nature. The common infectious cases were leprosy in 33.3% of cases, followed by cutaneous tuberculosis in 16.7% of cases. Tuberculoid granulomas are the common histological pattern in 30% of cases, followed by sarcoidal (16.7%) and necrobiotic (13.3%) cases, respectively. The use of a special stain for confirmation of etiological agents was required in 65% of cases. The assessment of clinicopathological correlation was done in the study, and it was found that 63.3% of cases had good correlation. The use of Cohen's Kappa value was 0.65, indicating good agreement between clinical and histopathology outcomes. Conclusion: The most common etiologies of granulomatous dermatological lesions are infectious ones, and mostly leprosy and cutaneous tuberculosis are the two major causes. The cornerstone of proper diagnosis and proper treatment has remained histopathology enhanced with special stains and clinical correlation.
Research Article
Open Access
Study of obesity and hypertension in school going children aged 10 to 16 years
Bramhini Sura ,
Vishnu Anjan Nareddy,
Naveen SR
Pages 196 - 205
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Abstract
Background: To estimate the prevalence of obesity and hypertension in school children and to study the relationship of blood pressure with body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and triceps skinfold thickness (TSFT). Methods: A total of 854 children (410 rural, 444 urban; 431 females, 423 males) were studied. Anthropometric measurements and blood pressure were recorded. Obesity, overweight, thinness, and hypertension prevalence were analyzed, and correlations between body fat indices and blood pressure were evaluated using Pearson correlation and ROC analysis. Results: Among 854 children, 15 (1.76%) were obese, 53 (6.21%) were overweight, 129 (15.10%) were thin, and 53 (6.21%) were severely thin. Hypertension and prehypertension were observed in 19 (2.23%) and 23 (2.69%) children, respectively. Obese children had the highest prevalence of hypertension (46.67%) and prehypertension (33.33%). Positive correlations were observed between BMI and systolic BP (r = 0.544) and diastolic BP (r = 0.465), WC and systolic BP (r = 0.524) and diastolic BP (r = 0.456), and WHtR and systolic BP (r = 0.374) and diastolic BP (r = 0.382). ROC analysis showed that BMI (AUC: 0.78 for SBP, 0.68 for DBP), WC (AUC: 0.76 for SBP, 0.72 for DBP), and WHtR (AUC: 0.62 for SBP, 0.63 for DBP) had discriminatory ability to predict high blood pressure. These correlations were consistent across gender and urban/rural populations. Conclusion: The overall prevalence of obesity and hypertension among school children was 1.76% and 2.23%, respectively. Body fat indices, including BMI, WC, WHtR, and TSFT, are positively correlated with both systolic and diastolic blood pressure. Increases in these indices are associated with higher blood pressure, highlighting their utility in early identification of children at risk for hypertension.
Research Article
Open Access
The Clinicopathological Spectrum of Anaplastic Large Cell Lymphoma (ALCL) and Immunohistochemical (IHC) Profile in a Tertiary Care Centre
Pages 188 - 195
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Abstract
Background: The diagnosis of Anaplastic Large Cell Lymphoma (ALCL) includes its histomorphology and the expression of Immunohistochemical markers. However, the studies available on the clinicopathological features, histomorphology, and the evaluation of ALK expression have not been done adequately in India. This study aimed to study the clinicopathological profile of ALCL along with categories of ALCL based on IHC staining. Methodology: This retrospective study was done for all patients of ALCL, where standard IHC was performed, and these patients were studied. Cases were excluded where IHC was unavailable/insufficient data/no blocks, or inadequate clinical information. Data were collected from the records/slides from the Department of Pathology, SJMC. Demographic/clinical details from the Medical Record Department (MRD), SJMCH. Results: N=39 ALCL cases were studied. Most cases were ≤10 years (20.5%) and 11–20 years (20.5%). Males (74.4%) were more affected. Fever was reported in 71.8%. Nodal and extranodal involvement occurred in 25.6%. Serum LDH >450 IU/L in 79.5%. "Common pattern" was the most frequent (82.1%). All showed "hallmark" cells (100%). ALK-positive cases were 82.1%. CD3 was positive in 69.2% and negative in 30.8%. Cytoplasmic and nuclear ALK staining was seen in 53.1%, only cytoplasmic in 37.5%, and only nuclear in 9.4%. Skin was the most common extranodal site (23%). One pc-ALCL case (2.56%) was identified. Conclusion: In this study, most patients diagnosed with Anaplastic Large Cell Lymphoma (ALCL) were younger than 20 years, with a male predominance. Fever and nodal involvement were the most frequent clinical presentations, while the skin was the most common extranodal site. Histologically, the common pattern was predominant, followed by the Hodgkin-like variant, with hallmark cells seen in all cases. Sinusoidal involvement and architectural effacement of the lymph nodes were seen in more than half of the lymph nodes involved.
Research Article
Open Access
A Retrospective study on outcome of fistula in ano surgery in a tertiary care centre in Tamil Nadu
Sivachandran Kabilan ,
J. S. Mathavi ,
Habeeb Mohammed S
Pages 182 - 187
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Abstract
Background: Fistula-in-ano is a common anorectal condition that significantly affects quality of life. Surgical management options include fistulotomy, fistulectomy, and seton placement. This study evaluates the outcomes of these surgeries in terms of recurrence, wound healing, and complications. Materials and Methods: A retrospective observational study was conducted at Melmaruvathur Adhiparasakthi Institute of Medical Sciences, Tamil Nadu. Sixty patients who underwent fistula-in-ano surgery between 2018 and 2023 were included. Outcomes like recurrence rate, wound healing, and postoperative pain were analyzed using descriptive and comparative statistics. Results: Fistulectomy had the lowest recurrence rate (5%), the fastest wound healing (5-6 weeks), and the least postoperative pain. Fistulotomy showed a 10% recurrence rate with an 8-week healing time, while seton placement had the highest recurrence (30%) and longest healing (10-12 weeks). No anal incontinence was reported. Conclusion: Fistulectomy was the most effective treatment for low anal fistulas, offering superior outcomes in recurrence and recovery compared to fistulotomy and seton placement. Further studies are needed to evaluate long-term results.
Research Article
Open Access
Hematological Interplay of RBC and Platelet Parameters in Moderate and Severe Anemia: A tertiary care based study
Neelanjana De ,
Jashan Sandhu ,
Anureet Kaur
Pages 174 - 181
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Abstract
Anaemia remains a major global health issue, particularly in developing countries like India, where it significantly affects health and productivity. Although red blood cell (RBC) parameters are central to diagnosis, platelet parameters also reflect bone marrow function and may provide additional diagnostic insights as both arise from a common progenitor (Megakaryocyte/ Erythroid Progenitor). This study aimed to evaluate the correlation between RBC parameters and platelet parameters in patients with moderate and severe anaemia. Materials and Methods: A retrospective observational study was conducted on 400 patients aged ≥15 years with moderate (Hb- 8-10.9 g/dL) or severe anaemia (Hb- <8 g/dL) as per WHO; at Gian Sagar Medical College and Hospital, Rajpura. Patients with pregnancy, recent transfusion, hematologic disorders, or chronic systemic diseases were excluded. Hematological data were obtained using an automated analyzer (Nihon Kohden MEK-6420P, Japan). RBC parameters (Hb, RBC count, Hct, MCV, RDW) and platelet parameters (Plt count, PCT, MPV, PDW) were analyzed. Correlations were assessed using Pearson’s coefficient with p < 0.05 considered significant. Results: The mean hemoglobin concentration of the study cohort was 8.4 ± 1.2 g/dL, mean RBC count 3.1 ± 0.7 million/µL, MCV 78.2 ± 9.4 fL. The mean platelet count was 280 ± 85 ×10³/µL, with thrombocytopenia observed in 23% and thrombocytosis in 5% of patients. Comparison between moderate and severe anaemia groups revealed significant reductions in Hb, RBC, and Hct (p < 0.05), but platelet parameters showed no significant difference. Correlation analysis demonstrated a strong negative relationship between MCV and platelet count (r = –0.39, p < 0.0001) and between RBC and PDW (r = –0.36, p < 0.0001), while MCV exhibited a strong positive correlation with PDW (r = 0.61, p < 0.0001). These findings suggest that platelet distribution width dynamically reflects changes in red cell morphology and marrow activity. Conclusion: This study highlights a significant association between several RBC and Platelet parameters. The results support the concept of a coordinated marrow response, where alterations in red cell and platelet morphology occur concurrently. Routine inclusion of platelet indices in anaemia assessment can provide a more comprehensive understanding of marrow physiology, especially in iron-deficiency states.
Research Article
Open Access
Return-to-Sport Outcomes after Surgical Versus Non-Surgical Treatment of Grade III Medial Collateral Ligament (MCL) Injuries in Adults: A Systematic Review and Meta-analysis
Sanyam Kulshrestha ,
Aastha Sehgal ,
Kshitij Sehgal ,
Mayowa Timilehin ,
Mohamed Attian ,
Carlos Wagner Leal,
Kelson Koiti Ogata
Pages 166 - 173
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Abstract
Background: Grade III injuries of the medial collateral ligament (MCL) of the knee, characterized by complete ligament disruption, are often encountered in athletic and trauma populations and present a treatment dilemma between surgical repair and conservative management. While prior meta-analyses have focused on ligament stability and functional knee scores, return-to-sport (RTS) outcomes and range of motion (ROM) recovery, which are both crucial to patient-centered decision-making, have not been systematically evaluated. This meta-analysis aims to assess whether surgical intervention leads to a higher rate or faster return to pre-injury sport or activity levels, and greater ROM recovery, compared to non-surgical treatment in adults with acute Grade III MCL injuries. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive literature search was performed across MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception to July 2025. Eligible studies included randomized controlled trials (RCTs) involving adults (18 years and older) with acute, isolated or combined Grade III MCL injuries, comparing surgical repair or reconstruction with non-surgical management such as bracing or physiotherapy. The primary outcomes were the rate and timing of return to sport or pre-injury activity level, and range of motion recovery. Secondary outcomes included functional performance such as the one-leg hop test, and complication rates. Data extraction and risk of bias assessment were performed independently by two reviewers using the Cochrane Risk of Bias 2.0 tool. Pooled analyses were conducted using a DerSimonian and Laird random-effects model, with heterogeneity assessed via I² statistics. Results: Three randomized controlled trials comprising a total of 144 adult patients were included in the meta-analysis, with 73 patients undergoing surgical treatment and 71 receiving non-surgical (conservative) management. Follow-up periods ranged from 12 to 27 months. All studies reported on return-to-sport (RTS) and range of motion (ROM) outcomes. There was no statistically significant difference in RTS rates between the surgical and non-surgical groups (Risk Ratio [RR] 1.04, 95% Confidence Interval [CI] 0.92 to 1.17, p = 0.48, I² = 15.7%). Pooled analysis of patients achieving full ROM also showed no significant difference between treatment groups (RR 1.06, 95% CI 0.95 to 1.18, p = 0.26, I² = 22.4%). Secondary outcomes such as hop test performance and complication rates were reported inconsistently across studies and were not pooled. Discussion and Conclusion: The results of this meta-analysis indicate that, based on current randomized controlled trial data, there is no statistically significant difference between surgical and non-surgical management of Grade III MCL injuries with respect to return-to-sport rates or range of motion recovery. In practical terms, this suggests that neither treatment modality demonstrates clear superiority in promoting functional recovery. However, this absence of statistical significance does not confirm that the two approaches are clinically equivalent. Rather, it highlights limitations in the current evidence. The studies included in this analysis may have been underpowered to detect meaningful differences, with relatively small sample sizes and moderate variability in surgical technique, rehabilitation protocols, and outcome definitions. Additionally, wide confidence intervals and low event counts could have contributed to non-significant findings. These results underscore the need for further high-quality, adequately powered trials with standardized RTS and functional outcome metrics. Until then, treatment decisions for Grade III MCL injuries should continue to be individualized based on patient goals, comorbidities, injury complexity, and surgeon experience.
Research Article
Open Access
A Study on Fertility Awareness and Approach towards Family Planning Amongst the Patients Attending the OPD of A Tertiary Care Hospital
Priyadharshini Rajendran ,
Mamtha Thirumurugan ,
Artheeswari R
Pages 159 - 165
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Abstract
Background: Awareness of fertility cycles and access to contraceptive services play a decisive role in reducing unintended pregnancies, limiting unsafe abortions, and improving maternal outcomes. In Assam, where maternal mortality remains high and unmet contraceptive need is above 12%, understanding women’s knowledge and practices is essential for effective interventions. Aim: To examine fertility awareness and family planning practices among women attending the outpatient department of a tertiary hospital in Assam, and to explore barriers contributing to unmet contraceptive needs. Methods: This cross-sectional study involved 300 women aged 15–49 years who attended the Obstetrics and Gynaecology OPD of Assam Medical College between April 2018 and March 2019. Participants were chosen using systematic random sampling. Data were collected through structured interviews covering socio-demographic details, awareness of fertility, knowledge and attitudes toward contraception, and current practices. Ethical approval was obtained from the Institutional Ethics Committee (AMC/EC/PG/2018). Statistical analysis included descriptive measures and Chi-square/t-tests, with p < 0.05 considered significant. Results: Most participants had limited awareness of fertility periods and misconceptions about contraceptive methods. Educational attainment and parity showed significant associations with contraceptive use (p < 0.05). Barriers included fear of side effects, cultural norms, and partner opposition. Conclusion: Fertility awareness and contraceptive use remain suboptimal. Integrating culturally sensitive counselling into outpatient services could reduce unmet needs and strengthen maternal health outcomes.
Research Article
Open Access
Effect of Enhanced Recovery after Surgery (ERAS) Protocol on Maternal Outcomes Following Emergency Caesarean Delivery: A Randomized Controlled Trial
Mamtha Thirumurugan ,
Priyadharshini Rajendran ,
P. M. Vandhana
Pages 153 - 158
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Abstract
Background: Emergency caesarean delivery often leaves little scope for physiological optimization before surgery. Here, every hour saved in recovery counts. The Enhanced Recovery After Surgery (ERAS) framework, once tailored for abdominal and orthopedic procedures, is now finding a place in obstetrics. Its philosophy, minimizing perioperative stress and restoring normal function early, has shown promise in elective caesareans, but its role in emergencies remains uncertain. This trial was designed to explore whether ERAS-based care could tangibly improve maternal outcomes following emergency caesarean section. Methods: A randomized controlled study was undertaken at Vels Medical College and Hospital, Tiruvallur, Tamil Nadu, over a period of six months (January 2024–October 2025). One hundred women who underwent emergency caesarean delivery were randomized equally into two arms. The ERAS group (n=50) received multimodal care, early feeding, mobilization within six hours, multimodal non-opioid analgesia, and early catheter removal, while the control group (n=50) followed standard postoperative routines. Recovery parameters, including pain (Visual Analogue Scale), time to ambulation, duration of hospital stay, return of bowel function, and satisfaction, were compared. Statistical analysis was performed using the chi-square and independent t-tests, with p<0.05 regarded as significant. Results: Women under the ERAS protocol walked nearly twice as early (7.8 ± 2.4 hours) as those in conventional care (16.2 ± 3.1 hours, p<0.001). Oral intake was reintroduced earlier (4.6 ± 1.7 vs. 10.5 ± 2.6 hours, p<0.001). Average hospital stay was shorter by about one full day (2.3 ± 0.8 vs. 3.4 ± 0.9 days, p=0.002). Pain levels were consistently lower in the ERAS group at both 6 and 24 hours post-surgery (VAS 3.2 ± 1.1 vs. 5.6 ± 1.4 and 2.4 ± 1.0 vs. 4.8 ± 1.3, p<0.001). Satisfaction scores were markedly higher (92% vs. 74%, p=0.01), while wound-related or readmission complications showed no statistical difference. Conclusion: Applying the ERAS pathway to emergency caesarean delivery clearly improved early recovery, reduced discomfort, and increased patient satisfaction without compromising safety. Such structured perioperative protocols, when integrated into tertiary obstetric practice in India, may redefine standards of maternal care and resource utilization.
Research Article
Open Access
Clinico-Epidemiological Patterns of Adverse Cutaneous Drug Reactions in a Tertiary Hospital: A Prospective Observational Study
T. Ramya ,
R. Subha ,
Jamuna
Pages 145 - 152
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Abstract
Background: Adverse cutaneous drug reactions (ACDRs) remain an important cause of avoidable hospital morbidity. Their presentations range from mild, self-limiting rashes to life-threatening syndromes such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) [1,2]. Despite frequent encounters in Indian tertiary hospitals, local epidemiological evidence remains sparse. Objectives: To document the clinical spectrum, timing, and drug associations of ACDRs observed in a tertiary-care dermatology unit during the Department of Dermatology Venerology& Leprosy, KAP Vishwanadham Government Medical College & Hospital, Tiruchirappalli, Tamil Nadu, India, in the year 2023 Methods: A prospective observational approach was adopted. Seventy-five consecutive patients with clinically confirmed ACDRs were enrolled. Demographic characteristics, type of eruption, mucosal involvement, lag time between drug intake and symptom onset, and the suspected drugs were analyzed descriptively. Results: Participants had a mean age of 41.9 ± 15.9 years, and males comprised 58.7 % of cases. Fixed drug eruption was the most frequent presentation (22.7 %), followed by bullous FDE (17.3 %), exanthematous drug eruptions (10.7 %), urticaria (10.7 %), and SJS (9.3 %). Paracetamol (20 %), phenytoin (16 %), and anti-tuberculosis therapy (12 %) were the leading culprits. Most reactions occurred within the first 48 hours after drug exposure. Mucosal involvement was observed in 18.7 % of cases, most often on the lips. Conclusions:
The findings highlight FDE and bullous variants as predominant forms of ACDR, with paracetamol and anticonvulsants as key triggers. Early-onset clustering underlines the importance of medication review within the first two days of therapy initiation.
Research Article
Open Access
Comparative evaluation of dentinal tubule penetration and retreatability of AH Plus, MTA Fillapex, and BioRoot RCS using CLSM and FESEM (in-vitro study)
Khushboo Jain ,
Rubi Kataki ,
Debosmita Roy ,
Pallavi Yaduka
Pages 127 - 136
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Abstract
Background: Effective obturation of the root canal system requires sealers that exhibit strong dentinal tubule penetration yet remain retrievable during retreatment. Newer bioceramic sealers offer enhanced bonding and bioactivity, but their retreatability remains under evaluation. Aim: To compare the dentinal tubule penetration and retreatability of AH Plus, MTA Fillapex, and BioRoot RCS using confocal laser scanning microscopy (CLSM) and field emission scanning electron microscopy (FESEM). Methods: Sixty extracted human single-rooted teeth were prepared and randomly divided into two groups (n=30 each): sealer penetration and retreatment, each subdivided by sealer type (n=10). Sealers were fluorescently labeled, placed using lateral condensation, and analyzed after 14 days using CLSM for penetration depth and residual sealer. Select samples underwent qualitative FESEM evaluation. Results: All sealers showed greater penetration and residual material in the coronal third compared to apical (p < 0.001). BioRoot RCS showed the greatest penetration in coronal (2235.06 ± 56.02 µm) and apical thirds (1364.03 ± 20.46 µm), while MTA Fillapex was highest in the middle third (1757.49 ± 12.59 µm). During retreatment, BioRoot RCS exhibited the most residual sealer in coronal and middle thirds, whereas AH Plus retained the most in the apical third. Conclusion: BioRoot RCS achieved the highest dentinal penetration and was least retrievable, followed by MTA Fillapex and AH Plus. Complete sealer removal was not achieved with any material, indicating that deeper penetration may compromise retreatability.
Research Article
Open Access
Parental Perceptions and Practices Regarding Newborn Supplementation
Arika Pareek ,
Vedashree Deshpande ,
. Prashant Weekey
Pages 119 - 126
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Abstract
Background: Newborn supplementation, particularly with essential micronutrients such as Vitamin D, plays a crucial role in infant growth and development. Despite clinical recommendations, caregiver awareness, adherence, and cultural practices can significantly influence supplementation patterns. Understanding parental perceptions is essential for improving uptake and efficacy of such interventions. Aims: To assess and analyse parental perceptions, knowledge, and practices related to newborn supplementation, and to identify the factors influencing their decisions regarding the administration of supplements such as vitamin D, vitamin K, and other essential micronutrients. Materials and methods: The present study was a Descriptive Study. This Study was conducted from 1 Year at Department of Paediatrics, Mahatma Gandhi Mission Medical College, Plot No14, Sector 8, Nerul, Navi Mumbai, Maharashtra 400706. Study population 380 parents of newborns. Result: Out of 380 participants, 75.8% were aware of supplementation, and 58.9% were aware of Vitamin D supplementation. Healthcare providers were the most cited source of information (35.8%). Vitamin D was the most commonly administered supplement (58.9%), followed by calcium and gripe water. Cultural practices such as pre-lacteal feeding (48.9%) and Janam Ghutti use (24.2%) were prevalent. Positive effects of supplementation were perceived by 55.8% of parents. While 62.9% were aware of government-provided supplements, only 43.2% reported receiving them free of cost.
Conclusion: Despite good awareness, gaps remain in understanding, accessibility, and cultural acceptance. Strengthening health education and culturally sensitive counseling is vital for improving supplementation practices.
Research Article
Open Access
Comparative Study of Topical Application of Injection Tranexamic Acid and Anterior Nasal Packing in the Management of Epistaxis
Antony Thomas ,
Jeffy Elizabeth samuel,
Harikumar B
Pages 110 - 118
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Abstract
Background: Epistaxis, or nasal bleeding, is a common otolaryngological emergency, accounting for up to 10% of all ENT presentations. The majority of cases originate from Kiesselbach’s plexus in the anterior nasal septum and are generally benign but can cause significant patient distress. Traditional management involves anterior nasal packing, which, while effective, is uncomfortable, carries a risk of mucosal trauma, infection, and rebleeding upon removal. In recent years, tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential topical therapeutic alternative that promotes hemostasis by stabilizing the fibrin clot. Objectives: This study aimed to compare the efficacy, patient comfort, recurrence rates, and complications associated with the topical application of injection tranexamic acid versus conventional anterior nasal packing in the management of anterior epistaxis.
Methods: A prospective comparative study was conducted on 120 patients presenting with anterior epistaxis at a tertiary care center over a period of 12 months. Participants were randomly allocated into two equal groups. Group A received topical application of injection tranexamic acid (500 mg in 5 mL) applied over the bleeding site using a soaked pledget, while Group B underwent conventional anterior nasal packing using lubricated ribbon gauze impregnated with antibiotic ointment. The time to bleeding control, patient discomfort (assessed on a visual analog scale), duration of hospital stay, recurrence within 48 hours, and complications were recorded. Data were statistically analyzed using SPSS version 26, and p-values < 0.05 were considered significant. Results: Hemostasis was achieved significantly faster in Group A (mean 4.6 ± 1.2 minutes) compared to Group B (mean 8.9 ± 2.7 minutes, p < 0.001). Patient discomfort scores were notably lower in the TXA group (mean 2.3 ± 1.1) than in the packing group (mean 6.8 ± 1.6, p < 0.001). Recurrence of bleeding within 48 hours was observed in 6.7% of Group A and 13.3% of Group B, though this difference was not statistically significant. The incidence of mucosal trauma, infection, and post-removal bleeding was higher in the nasal packing group. The mean duration of hospital stay was shorter in Group A (0.9 ± 0.4 days) compared to Group B (2.1 ± 0.7 days, p < 0.001). Conclusion: Topical application of injection tranexamic acid is an effective, safe, and patient-friendly alternative to conventional anterior nasal packing for anterior epistaxis. It provides faster hemostasis, significantly greater comfort, and fewer complications while maintaining comparable recurrence rates. The findings support the routine use of topical TXA as a first-line treatment option in suitable cases of anterior nasal bleeding.
Research Article
Open Access
A Clinical Study on Faciomaxillary Trauma in a Tertiary Care Center, Mysore.
Jeffy Elizabeth samuel,
Antony Thomas
Pages 103 - 109
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Abstract
Background: Faciomaxillary fractures constitute a significant disease burden to the society. They are clinically and aesthetically important owing to their close vicinity to vital structures and structures of cosmetic value respectively1and are clinically highly significant for number of reasons. Objectives- Our study aims at analysing the aetiology, distributions within sexes and various age groups, manifestations, anatomical distribution and management of faciomaxillary trauma presenting to ENT OPD, plastic surgery OPD and emergency department of K.R. Hospital, Mysore Methods- 95 patients with faciomaxillary trauma who came to casualty, outpatient department of Ear, Nose and Throat, department of Plastic Surgery, Krishna Rajendra Hospital, Mysore attached to Mysore Medical College and Research Institute, Mysore, from January 2020 to June 2021 were enrolled into the study. Aetiology, distributions within sexes and various age groups, manifestations, anatomical distribution and management of faciomaxillary trauma data has been collected after careful clinical and radiographic examinations. Data obtained was analysed using appropriate statistical test. Based on epidemiological data, clinical and imaging findings, treatment modalities and outcome of patients were also analysed. Results- A total of 95 patients presenting with 138 maxillofacial fractures were analysed. Most of them [34 (35.8%)] were young adults aged 18-25. Men [83 (87.37%)] were more affected than women. Road traffic accidents remain the main aetiology causing fractures in 57 (60%). Mandible was more frequently involved with 66 (42.03%) fractures, and condyle being the most common site. A total of 52 (54.7%) patients underwent open reduction with internal fixation under general anaesthesia. Conclusion- With increasing incidence of RTAs, there is a need to understand the pattern, review our management techniques and hence be able to provide appropriate and individualized management to those in need of it.
Research Article
Open Access
A Prospective Study to Analyse the Outcomes of Various Factors Affecting Cochlear Implant Surgery in a Tertiary Care Hospital
Rekha kumari ,
Mohammed Nadeem Shaikh,
Navneet Prasad Mathur
Pages 94 - 102
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Abstract
Background: Hearing impairment affects the ability of learning spoken language in children and hampers their social, psychological and emotional life. A cochlear implant is surgically implanted electronic device that helps in social rehabilitation of the patient with hearing loss. In this context the present study aims to evaluate various factors affecting outcome in cochlear implant surgery. A prospective study of 15 patients was carried out by means of information obtained from patients who underwent Cochlear Implant Surgery, being evaluated using 3 parameters- Revised CAP score (CAP), Meaningful Auditory Integration Scale (MAIS), speech intelligibility rating (SIR) at various intervals postoperatively and outcome was seen. The Mean Revised CAP Score was raised from 0.47±0.49 preoperatively to 3.90±0.61 at 6 months and 7.84±0.66 at 12 months respectively. The mean SIR score was raised from 1.0±0.0 preoperatively to 2.33±0.47 at 6 months and 2.46 ±0.49 at 12 months. Similarly, the mean MAIS score was raised from 2.0±2.01 preoperatively to 25.53±1.40 at 6 months and 32.20±0.77 at 12 months i.e., the patient start using his environmental sounds in more meaningful way when compared to start of speech therapy. Statistically, significant difference was found between the preoperative and postoperative revised CAP, SIR and MAIS Score which implies that Cochlear Implant surgery is a safe surgery with very less complications.
Research Article
Open Access
To correlate the findings of Diagnostic Nasal Endoscopy and Computed Tomography scan of nose and paranasal sinus in the evaluation of Chronic rhinosinusitis (CRS) - A Cross-sectional study
Abhishek Goyal ,
Divya Aggarwal ,
Divya Gupta ,
Puneet Gupta
Pages 85 - 93
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Abstract
Background: Aim- To correlate the findings of diagnostic nasal endoscopy (DNE) and CT scan of nose and paranasal sinus in evaluation of chronic rhinosinusitis (CRS)
Methodology: All the patients attending ENT OPD fullfiling the inclusion criteria and met no exclusion criteria were enrolled in the study during the period of January 2024 to August 2024. All patients underwent comprehensive otorhinolaryngological examination including DNE and non-contrast CT scan of nose and paranasal sinuses.
Result: The highest congruence between DNE and CT scan was seen in findings like osteomeatal complex (OMC) occlusion (94.28%), paradoxically curved middle turbinate (92.85%), and septal deviation (92.14%), suggesting these are reliably detected by both methods. A lower congruence was observed in findings like accessory maxillary ostium (82.85%). High sensitivity observed for conditions like OMC occlusion (96.92%), septal deviation (96.43%), paradoxically curved middle turbinate (96.15%), and finding abnormal uncinate process (96.15%) as compared to CT scan. High specificity values indicate that DNE accurately rules out these conditions in most cases, notably OMC occlusion (92%), nasal polyp (90.91%) and paradoxically curved middle turbinate (90.91%) as compare to CT scan. Conclusion: Both DNE and CT scan are essential preoperative investigations before undergoing functional endoscopic sinus surgery (FESS). While DNE provides a real-time assessment of mucosal pathology, CT imaging serves as a ―road map for the surgeon, offering detailed visualization of sinus structures and guiding surgical planning to minimize complications.
Research Article
Open Access
Study of Percutaneous Nephrolithotomy, Outcome and Analysis with Renal Clearance
Eliza Kapadia ,
Dharmendra Malviya
Pages 80 - 84
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Abstract
Background: Percutaneous nephrolithotomy (PCNL) is the standard of care for renal calculi >2 cm and complex stones. This prospective study of 60 patients evaluates outcomes, complications, stone-free rate, hospital stay, and recovery following PCNL, with attention to renal function and clearance outcomes where available. Methods: Sixty consecutive patients undergoing PCNL between March 2021 and September 2022 were prospectively studied. Standardized technique included ureteral catheter placement, prone positioning, fluoroscopic calyceal puncture, tract dilation to 30F, and use of a 24-F nephroscope. Primary outcomes included stone-free rate (SFR) assessed by KUB/CT, intra- and post-operative complications, duration of surgery, hospital stay, and time to recovery. Data were analyzed descriptively; Fisher’s exact test was used where appropriate. Results: The cohort had a male: female ratio of 3:2 with mean age concentrated in 31–40 years. Stone-free rate after primary PCNL was 85% (51/60). Intra-operative complications occurred in 16.7% (10/60) — hemorrhage (13.3%) being most common. Post-operative complications occurred in 13.3% (8/60), with surgical site infection (5%) most frequent. Mean operative time was 69.0 ± 9.8 minutes. Mean hospital stay was 2.57 ± 0.99 days; 93.3% were discharged within 3 days. Patient satisfaction was high (81.7%). No mortalities were observed. Conclusion: In this single-center series, PCNL demonstrated an 85% stone-free rate with acceptable complication rates and short hospitalization. Findings support PCNL as a safe and effective modality when performed by experienced surgeons. Renal clearance data were not retrievable from the accessible thesis excerpts and are noted as a limitation; inclusion of specific renal clearance outcomes will be added if provided.
Review Article
Open Access
Rapid Sequence Intubation Protocols in Emergency Medicine: A Systematic Review of Practices and Clinical Outcomes.
Zuhaib Ahmed Wani,
Nitesh Kumar ,
Kapil Gupta ,
Anand Dev ,
Gagan Gunjan
Pages 63 - 79
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Abstract
Background: Rapid sequence intubation (RSI) is a high-stakes intervention in emergency and prehospital care. Protocolised approaches, including checklists, equipment changes, and operator training, have been proposed to improve first-pass success (FPS) and reduce complications such as hypoxemia, but their aggregate effect across diverse settings remains unclear. Objectives: To systematically review and synthesise evidence on the impact of protocolised RSI interventions compared with usual care on FPS and peri-intubation hypoxemia. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 (PROSPERO registration number 2025 CRD420251136118). The review was framed using the PICO format: adult patients undergoing emergency or prehospital RSI (Population); protocolised RSI interventions such as standard operating procedures, pre-intubation checklists, mandatory bougie use, or videolaryngoscopy protocols (Intervention); non-standardised or clinician-dependent practice (Comparator); with FPS as the primary outcome and peri-intubation hypoxemia as the secondary outcome (Outcomes). We searched PubMed, Embase, CENTRAL, and grey literature, supplemented by manual reference screening. Data extraction was performed in duplicate, effect sizes were calculated where possible, and risk of bias was assessed using Cochrane RoB 2.0 and ROBINS-I tools. Results: Ten studies met inclusion criteria, encompassing >7,300 RSI episodes across emergency departments, helicopter emergency medical services (HEMS), and ground EMS in eight countries. Interventions included protocol bundles (n=4), checklist implementation (n=3), routine bougie use (n=1), videolaryngoscopy with bougie (n=1), and a low-dose rocuronium strategy (n=1). Across six studies with complete pre–post data, mean FPS increased from 72.7% to 84.4% (absolute improvement +8.9%). The largest gains were observed in ED-based protocol bundles (+23.0%) and routine bougie use (+7.0%), with more modest improvements from checklist and operator-model changes (+2–3%). Pooled analysis of seven studies reporting hypoxemia demonstrated a significant reduction (RR 0.77, 95% CI 0.65–0.91), although baseline incidence and definitions varied. Risk of bias was moderate in most studies (n=6), low in three, and high in one, reflecting the predominance of before–after observational designs. Conclusions: Protocolised RSI interventions are associated with clinically meaningful improvements in FPS and modest reductions in hypoxemia in both ED and prehospital settings. Multifaceted interventions, particularly protocol bundles and mandatory bougie use, appear most effective. However, the overall certainty of evidence remains limited by study design, underscoring the need for future high-quality randomised or controlled studies.
Case Report
Open Access
Persistent Secondary Postpartum Hemorrhage as a Complication of Pregnancy with Submucosal Fibroid: A Case Series
Sripathi Anusha ,
Renu Sahani ,
Shobha ,
Firdous Fatima ,
Komala Pedda
Pages 59 - 62
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Abstract
Background: Uterine fibroids are the most common benign tumors of the reproductive tract and may complicate pregnancy depending on their size and location. Submucosal fibroids, though less frequent, can distort the uterine cavity and cause adverse obstetric outcomes. While atonic postpartum hemorrhage (PPH) is a recognized complication, persistent secondary PPH due to submucosal fibroids is exceedingly rare. Objective: To describe varied clinical presentations and management challenges of persistent secondary PPH in pregnancies complicated by submucosal fibroids. Methods: This case series includes three patients with submucosal fibroids complicating pregnancy, managed at Gandhi Hospital, Secunderabad, between August 2023 and August 2025. Clinical presentation, imaging findings, surgical management, and outcomes were analyzed. Results: All three cases demonstrated partial or complete placental implantation overlying the fibroid, leading to subinvolution of the placental bed and reopened vascular sinuses. Two patients were successfully managed with uterine artery embolization (UAE), while one required peripartum hysterectomy due to intractable hemorrhage. Imaging confirmed high vascularity of submucosal fibroids as the bleeding source. Conclusion: Submucosal fibroids can present as rare causes of persistent secondary PPH due to placental site subinvolution and abnormal vascular persistence. Antenatal recognition and multidisciplinary planning—including interventional radiology and adequate blood bank support—are essential. Pre-pregnancy hysteroscopic resection should be considered for large, cavity-distorting fibroids to prevent life-threatening hemorrhagic complications.
Research Article
Open Access
Injury Patterns among Road Traffic Accident Cases Presenting To a Secondary Care Rural Health Centre In India
Prashant Kumar Tripathi,
Prateek Pathak ,
Pooja Mishra
Pages 53 - 58
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Abstract
Background: Injury is a significant global health burden and can result in mortality if not attended to on time. Trauma system refers to a collection of services provided by various super-specialties. According to the WHO-World Bank Report, RTA will rise from ninth place to the third biggest cause of mortality. Aims: To analyze the patterns and severity of injuries among road traffic accident cases presenting to a secondary care rural health centre in India. Materials and Methods: This prospective, longitudinal, and observational study was conducted over a period of one year at Maa Vindhyawasini Autonomous State Medical College, Mirzapur, Uttar Pradesh. A total of 100 patients involved in road traffic accidents presenting to the emergency department of the secondary care rural health centre were enrolled as the study population. Data on injury patterns, severity, and associated factors were collected and analyzed to identify trends and outcomes. Results: Out of 100 road traffic accident cases analyzed, injury patterns varied significantly across age groups, with limb fractures and head injuries most common in patients under 18, while head injuries predominated in adults aged 18–40 and those over 40 (p = 0.032). Injury severity also differed by road user type, with pedestrians sustaining the most severe injuries (mean ISS 22.5), followed by two-wheeler riders and car occupants (p = 0.004). Gender differences were noted, as males experienced higher rates of head injuries (40%) and polytrauma compared to females (p = 0.021). Use of safety gear significantly reduced head injuries (16.7% vs. 64.3%, p < 0.001). Additionally, injury patterns varied by time of day, with more limb injuries during daytime and more head injuries at night (p = 0.048). Conclusion: This study highlights key injury patterns and severity in road traffic accidents, showing significant differences based on age, gender, type of road user, safety gear use, and time of day. Head injuries were most common and severe, especially among males, adults aged 18–40, and those not wearing helmets or seatbelts. Pedestrians faced the highest injury severity, while car occupants had less severe injuries. The protective effect of safety gear was clear, and night-time accidents resulted in more serious head trauma. These findings stress the importance of targeted safety measures and strict enforcement of protective gear to reduce RTA-related injuries.
Case Report
Open Access
Clinical Utility of Repetitive Transcranial Magnetic Stimulation in the Treatment of Dystonia: A Rare Case Report
Tridev Ravi Kashyap,
G. Prasad Rao,
Aswin ,
S. K. Jaiswal
Pages 48 - 52
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Abstract
Background: movements or abnormal postures. Treatment options remain limited, particularly for refractory or segmental forms. Here, we present a rare case of a 22-year-old female diagnosed with dystonia secondary to PINK1 gene mutation, suggestive of an autosomal recessive Parkinsonian syndrome. The patient presented with contractions of the fingers of the left hand and toes of the left foot for ten years, along with persistent pain and neck stiffness. Conventional pharmacotherapy yielded limited improvement. Repetitive Transcranial Magnetic Stimulation (rTMS) was initiated using both Deep TMS and figure-of-8 coil stimulation over a five-day period. Assessments using the Fahn-Marsden Dystonia Scale, Global Dystonia Severity Rating Scale, and PEG Scale demonstrated significant improvement post-intervention: movement scale score reduced from 22 to 2, disability score from 7 to 3, global severity from 31 to 7, and pain score from 27 to 8. The patient reported functional improvement and pain relief, confirmed by objective scale reductions. This case underscores the clinical potential of rTMS as an adjunctive neuromodulatory approach in dystonia management.
Research Article
Open Access
Hamulotomy in Cleft Palate Patients – A Clinical Study
P C Mathew ,
Manoj Goyal ,
Neeti Mittal
Pages 42 - 47
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Abstract
Background: Cleft palate patients are predisposed to otitis media with effusion and conductive hearing loss due to Eustachian tube dysfunction. During palatoplasty, pterygoid hamulotomy is often performed to relieve flap tension, though concerns persist regarding its potential effect on middle ear physiology. Aim: To evaluate whether hamulotomy performed during palatoplasty influences postoperative hearing and middle ear function. Materials and Methods: In this prospective, randomised clinical study, 100 non-syndromic cleft palate patients aged 10–24 months were allocated to two groups: Group A (hamulotomy) and Group B (control). Tympanometry and transient evoked otoacoustic emissions (OAE) were recorded pre-operatively and at 1 and 6 months post-surgery. Data were analysed using SPSS v27.0; p < 0.05 was considered significant. Results: Ninety-six children completed follow-up. Both groups showed significant improvement in tympanometric (Type A curves: 83.3 % vs 79.2 %) and OAE pass rates (87.5 % vs 83.3 %) at 6 months (p > 0.05). No significant inter-group differences were observed in hearing outcomes or postoperative complications. Conclusion: Hamulotomy facilitates tension-free palatal closure without adversely affecting hearing or middle ear ventilation. It can be safely employed during palatoplasty in non-syndromic cleft palate patients.
Research Article
Open Access
Fall-Related Injuries among Older Adults in Rural India Presented In Emergency: Prevalence and Associated Risk Factors
Prashant Kumar Tripathi,
Prateek Pathak ,
Pooja Mishra
Pages 36 - 41
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Abstract
Background: Falls among older adults in rural India are a major public health concern, often causing fractures, head trauma, and soft tissue injuries. Both intrinsic factors (age, gender, and chronic illnesses, walking aids) and extrinsic factors (poor lighting, uneven surfaces) increase fall risk. Data on fall-related injuries in rural emergency settings remain limited. Aims: The aim of the study is to determine the prevalence and identify the associated risk factors of fall-related injuries among older adults presenting to emergency departments in rural India. Materials and Methods: The present study was a hospital-based cross-sectional observational study conducted over a period of 12 months, from 1 July 2024 to 30 June 2025, in the emergency departments of Maa Vindhyawasini Autonomous State Medical College Mirzapur Uttar Pradesh in India. The study population comprised older adults aged 60 years and above who presented with fall-related injuries, with a total sample size of 50 patients included for analysis. Results: In our study of 50 older adults from rural India, 36% experienced falls in the past year, mostly single incidents. Age, gender, and comorbidities were not significantly associated with falls, whereas uneven flooring was a significant risk factor (p = 0.02). The most common injuries were bruises (38.9%) and fractures (33.3%). Conclusion: In our study of 50 rural older adults, 36% experienced falls, mostly single incidents. Age, gender, and comorbidities were not significant, while uneven flooring was a key risk factor. Bruises and fractures were the most common injuries, underscoring the need for home modifications and fall prevention programs.
Research Article
Open Access
Morphometric Variations in Clavicle Dimensions: Length, Angles, Curvatures, and Clinical Implications
Swetha B ,
Nagabhushanam N ,
Hema N ,
Pandit Vinodh Bandela
Pages 29 - 35
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Abstract
Background: The clavicle, a uniquely shaped long bone in the human skeleton, plays a critical role in shoulder girdle mechanics and is frequently fractured, particularly in the middle third. These fractures, while often managed conservatively, can lead to significant morbidity, non-union rates, and complications when displaced. Global research emphasizes the need for precise morphometric data to optimize fracture fixation strategies, such as plating and intramedullary nailing. Key anatomical variations include overall length, cross-sectional width, axial bending (most pronounced at the acromial end), and curvatures (medial and lateral), which influence the design of fixation devices. This study aimed to quantitatively assess clavicular dimensions. specifically total length, medial angle (formed by the medial curvature relative to the shaft), and lateral angle (formed by the lateral curvature relative to the shaft). Methods: A total of 320 dry adult clavicles (185 male and 135 female) were sourced from the osteology collections of first-year MBBS students across multiple medical colleges in South India. Measurements were performed using standardized manual techniques: length was determined with a digital caliper along the superior border from sternal to acromial end; medial and lateral angles were measured with a protractor aligned to the shaft's midline. Data were analyzed descriptively, calculating means, standard deviations, and ranges, with comparisons between sexes and sides using unpaired t-tests (p < 0.05 considered significant). Results: Male clavicles demonstrated significantly greater mean length (142.90 ± 10.59 mm) compared to females (132.30 ± 10.44 mm; p < 0.001), reflecting sexual dimorphism. Side-specific analysis revealed minimal asymmetry: right male clavicles averaged 142.10 ± 11.70 mm versus left 143.80 ± 9.55 mm; right female 131.12 ± 12.22 mm versus left 131.10 ± 9.02 mm (no significant side differences, p > 0.05). Medial angle ranges were 136°–163° (right) and 135°–166° (left), indicating greater variability on the left. Lateral angles ranged from 122°–162° (right) and 126°–168° (left), with left-sided angles showing broader dispersion. Overall, curvatures exhibited subtle bilateral differences, with left clavicles displaying slightly more pronounced lateral bending, potentially influencing plate adaptation during surgery. Conclusion: These morphometric findings underscore the importance of gender- and side-specific clavicular dimensions in enhancing the precision of orthopedic fixation devices, reducing intraoperative bending needs, and minimizing complications like non-union or implant failure. The data contribute to a normative database for South Indian populations, benefiting orthopedic surgeons in treatment planning, anatomists in educational models, and anthropologists/forensic experts in skeletal profiling. Future studies incorporating 3D modeling could further refine these parameters for personalized implants.
Research Article
Open Access
Effectiveness of the Jigsaw Method as an Add-on to Traditional Teaching in Learning Histology among First-Year MBBS Students.
Sandhya Vikas Yatagiri,
Veena Srinivas Harwalkar,
Ashwini Bala Saheb Nuchhi,
Ravi Siddanagouda Bulagouda,
Shaik Hussain Saheb
Pages 23 - 28
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Abstract
Background: Despite advancements in pedagogical strategies, traditional didactic lectures remain the cornerstone of medical education, often limiting student engagement and collaborative learning. The Jigsaw method, a cooperative learning technique, encourages active participation by dividing students into "expert" groups to master subtopics before teaching peers in "parent" groups. This study evaluates the effectiveness of the Jigsaw method as an adjunct to traditional teaching in enhancing histology comprehension and retention among first-year MBBS students. Aim: The present study was conducted to compare the academic performance of students taught via the Jigsaw method versus traditional lectures, to assess student perceptions of the Jigsaw method’s impact on collaborative learning and knowledge retention and to evaluate the reproducibility of outcomes through a crossover study design. Methods: A comparative interventional study conducted with 139 first-year MBBS students randomly allocated into Group 1 (control: traditional teaching) and Group 2 (intervention: Jigsaw method). Both groups received a histology lecture followed by a pre-test. Group 2 underwent the Jigsaw activity, where students formed expert groups to study subtopics and later taught their parent groups. Post-tests were administered to both groups. In Phase 2, the groups crossed over to validate results. Data were analysed using Wilcoxon signed-rank tests (within-group) and Mann-Whitney U tests (between-group). Student feedback was collected via a 5-point Likert scale survey. Results:
• Phase 1: The Jigsaw group (Group 2) showed a significant improvement in post-test scores (mean ± SD: 22.06 ± 2.952) compared to pre-test scores (13.87 ± 3.459; p = 0.001) and outperformed the control group (15.91 ± 4.428; p = 0.001).
• Phase 2 (Crossover): Results were replicated, with Group 1 (now Jigsaw) demonstrating higher post-test scores (13.10 ± 2.632 vs. pre-test: 8.60 ± 3.224; p = 0.001).
• Student Feedback: Over 85% of participants agreed/strongly agreed that the Jigsaw method enhanced understanding (60.2%), teamwork (56.4%), and engagement (53.4%). A majority (55.6%) requested more such sessions.
Conclusion: The Jigsaw method significantly improves histology learning outcomes and fosters collaborative skills compared to traditional lectures. Its integration into medical curricula is recommended to promote active learning and peer interaction.
Research Article
Open Access
Study of E-Cadherin and p53 immuno-histochemical expression in normal and malignant oral epithelium
Pages 14 - 22
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Abstract
Background: Oral cancer ranks among the most prevalent cancers globally. The expression of E-cadherin and p53 plays a crucial role in understanding tumor characteristics such as local invasiveness, metastatic potential, and cellular proliferation. Early detection of high-risk cases for distant metastasis is vital to improving patient prognosis. This study aims to systematically evaluate the immunohistochemical expression of E-cadherin and p53 in both normal and neoplastic oral epithelium, comparing their levels across various tumor grades to assess their potential as independent or combined predictors of the biological behavior of oral epithelial tumors. Methodology: A descriptive study was conducted at the Department of Pathology, Gandhi Hospital, from October 2019 to October 2021, including 60 cases of normal oral epithelium and OSCC diagnosed by H&E staining. Immuno-histochemical staining for E-Cadherin and p53 was performed, and data were analyzed using SPSS 22. Inclusion criteria covered all properly fixed tumor specimens; exclusions included other oral cancers and inadequate biopsies. Results: Among the 60 cases, males predominated (77%), with most patients aged 51–60 years. The tongue was the most common lesion site (40%). E-Cadherin was positive in 82.85% of cases but showed reduced expression in neoplastic tissue. p53 positivity was observed in 77% of cases. A statistically significant correlation was noted between tumor differentiation and marker expression: E-Cadherin positivity decreased from well-differentiated (57.14%) to poorly differentiated tumors (5.7%) (p=0.004), while p53 positivity also correlated significantly with differentiation (p<0.001). p53levels increased as pathological grade increased. Conclusion: Altered expression of E-Cadherin and p53 is significantly associated with tumor differentiation in OSCC, highlighting their potential as diagnostic and prognostic biomarkers in oral malignancies.
Research Article
Open Access
Efficacy of Intra-Articular Corticosteroid Injection in the Management of Idiopathic Frozen Shoulder
Sanjay Singh Rawat,
Vishnu Meena
Pages 8 - 13
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Abstract
Background: Frozen shoulder (FS), also known as adhesive capsulitis (AC), is a painful disorder of the shoulder joint characterized by gradual onset and progressive restriction of both active and passive shoulder movements. AIM: To evaluate the efficacy, advantages, and disadvantages of intra-articular steroid injection in idiopathic frozen shoulder unresponsive to NSAIDs, using VAS, SPADI, and Oxford Shoulder Score for outcome assessment. Methodology: This prospective study was conducted on the Indian population using radiographic tools at the Orthopedic and Physiotherapy Departments of Medical College and Associated Group of Hospitals, Kota, from November 2022 to January 2024. Result: In this study of 45 patients with idiopathic frozen shoulder, most were middle-aged housewives with the dominant arm affected, presenting mainly with shoulder pain. Corticosteroid injection with physiotherapy produced significant, consistent improvement in pain, function, and range of motion over 12 weeks, confirming its short-term efficacy. Conclusion: Corticosteroid injections are effective for short-term pain relief and functional improvement in adhesive capsulitis, especially when combined with physiotherapy in the early disease stages.
Research Article
Open Access
Assessment of Cardiac Autonomic Dysfunction in Rheumatoid Arthritis
Maria Davis ,
Surumi A Rahim
Pages 1 - 7
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Abstract
Background: Rheumatoid arthritis (RA) is a persistent inflammatory condition linked to heightened cardiovascular morbidity and mortality. Cardiac autonomic dysfunction may elevate cardiovascular risk but is still inadequately investigated in RA patients. Methodology: This case-control study comprised 80 RA patients diagnosed by ACR/EULAR 2010 criteria and 80 age- and sex-matched healthy controls. The evaluation of cardiac autonomic function was conducted using 24-hour Holter monitoring and heart rate variability analysis. Time-domain parameters (SDNN, RMSSD, pNN50) and frequency-domain parameters (LF, HF, LF/HF ratio) were assessed. The DAS28-ESR score was utilized to evaluate disease activity. The statistical analysis comprised independent t-tests and Pearson correlation coefficients. Results: Patients with RA exhibited markedly reduced heart rate variability measures in comparison to the control group. In rheumatoid arthritis (RA) patients, SDNN measured 98.4 ± 24.6 ms, compared to 142.3 ± 28.4 ms in the control group (p < 0.001). RMSSD measured 24.8 ± 8.2 ms compared to 38.6 ± 10.4 ms (p < 0.001). The LF/HF ratio was markedly increased in RA patients (2.8 ± 0.9 compared to 1.6 ± 0.5, p < 0.001), signifying sympathetic dominance. Cardiac autonomic dysfunction exhibited a strong correlation with disease duration (r = -0.52, p < 0.001) and DAS28-ESR score (r = -0.48, p < 0.001). The prevalence of autonomic dysfunction was 62.5% in RA patients compared to 18.8% in the control group (p < 0.001). Conclusion: Patients with RA demonstrate considerable cardiac autonomic dysfunction, marked by diminished heart rate variability and sympathovagal imbalance. The activity and length of illness are critical factors influencing autonomic dysfunction, indicating the necessity for early cardiovascular risk evaluation in the management of RA.
