Research Article
Open Access
A study on the Utility of 18-f Fluoro- Deoxy-glucose Positron Emission Tomography in Brain Metastasis in South India.
Madhumalar. A ,
Arunan Murali
Pages 870 - 877
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Abstract
Background: Metastatic brain tumours are estimated to occur nearly ten times more frequently than primary malignant brain tumours. With its high spatial resolution and anatomical localisation, 18F-FDG PET/CT has emerged as a valuable imaging modality. This study aimed to evaluate the correlation between the metabolic activity (SUV max) of brain metastases and various prognostic factors such as the histological subtype of the primary tumour and imaging characteristics. Methodology: A hospital-based retrospective observational study was conducted in the Department of Radiodiagnosis at a tertiary care centre between October 2018 and September 2020. A total of 78 patients with brain metastases, referred for whole-body PET-CT for diagnostic and staging purposes, were included. PET-CT was performed using 18F-Fluoro-Deoxy-glucose (18F-FDG), and metabolic activity was assessed through maximum standardised uptake value (SUV max). Results: The lungs (53.8%) and breast (26.9%) were the most frequent primary sites. The frontoparietal lobes were the commonest location of brain metastases (61.5%). Solid-enhancing lesions showed higher FDG avidity, whereas peripheral-enhancing lesions were more commonly non-FDG avid. A statistically significant association was observed between SUV max and both CT morphology of the brain lesions (p < 0.05) and the primary tumour site. Conclusion: 18F-FDG PET/CT proves effective in identifying malignant brain lesions. Incorporating dedicated brain imaging into whole-body PET/CT protocols may enhance diagnostic accuracy and assist in prognosis and treatment planning for patients with metastatic brain disease.
Research Article
Open Access
Clinicopathologic, Radiographic, and Immunohistochemical Evaluation of Hepatic Mass Lesions with Emphasis on the Diagnostic Role of CD10 Expression in FNA Smears
Divya Panda ,
Chennupati Divya ,
S John Emmanuel Raju,
Sailaja Vallury ,
Santosh Kiran Garikipati,
Anyapu Ooha
Pages 861 - 869
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Abstract
Background: Hepatic mass lesions encompass a wide range of primary and secondary malignancies that pose significant diagnostic challenges. Fine-needle aspiration cytology (FNAC), complemented by radiologic and immunohistochemical (IHC) techniques, offers a rapid, accurate, and minimally invasive diagnostic approach. Among IHC markers, CD10, known for its characteristic canalicular staining pattern, has emerged as a useful marker for hepatocellular differentiation. Objective: To evaluate the clinicopathologic, radiographic, and immunohistochemical characteristics of hepatic mass lesions with emphasis on the diagnostic utility of CD10 expression in FNA smears. Materials and Methods: This prospective observational study was conducted over 24 months on 98 cases of clinically or radiologically suspected hepatic space-occupying lesions. FNAC under ultrasound guidance was performed, and smears and cell blocks were prepared for cytomorphologic and IHC evaluation using CD10, HepPar-1, and Arginase-1. Results: The majority of patients were between 51–70 years with a male predominance (M:F = 1.6:1). Hepatocellular carcinoma (39.8%) was the most common lesion, followed by metastatic adenocarcinoma (48%). CD10 showed distinct canalicular positivity in 84% of HCC cases, while metastatic lesions exhibited cytoplasmic or membranous staining. The sensitivity and specificity of CD10 in identifying hepatocellular differentiation were 84% and 92%, respectively. Conclusion: CD10, particularly with canalicular staining, serves as a reliable immunomarker in differentiating HCC from metastatic hepatic lesions on FNA smears. Integration of cytomorphology, imaging, and IHC markers substantially enhances diagnostic accuracy for hepatic malignancies.
Research Article
Open Access
Central venous catheter-related blood stream infections (CLABSIs): Incidence, risk factors and associated pathogens in Intensive Care Units (ICUs) at a tertiary care centre
Israr Ul Haq Lone,
Azka Sunain ,
Muskan Mansoor
Pages 854 - 860
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Abstract
Background: Central venous catheterization is commonly used in critically ill patients and may cause different complications, including infection. Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, and elderly patients. Aim: The aim of this study was to analyze the incidence of central line catheter-related bloodstream infection (CRBSI) in patients admitted in Intensive care units. Methods: This observational Study was carried out in the department fanaes thesiology and critical careme dicinein Government Medical College Srinagar over a period of one year. Patients who required central venous catheter were selected, relevant blood investigations were done before insertion of catheter and 48 hours after insertion. With the suspicion of new infection, physical examination and laboratory work-ups were carried out to identify the other source of infection. Results: A profile of 200 patients were selected with mean age of 48.0±14.89 years. The incidence of central line-associated bloodstream infection/catheter-related bloodstream infection (CLABSI/CRBSI) in this hospital based study in intensive care units came out to be 36.47%. In our study there was male predominance and sepsis seen in 39% of the patients. The predominant organism isolated in CLABSI/CRBSI patients was Staphylococcus aureus. Conclusion: By knowing the risk factors to cause catheter related infections, the risk of getting infections can be lowered by using aseptic technique during insertion and proper catheter care which would further reduce the morbidity and mortality related to central venous catheters. It can manifest with varying degrees of severity of sepsis. Organ Dysfunction, multi organ involvement, TLC abnormalities, oliguria, altered mental status, hypotension are all markers of poor prognosis.
Research Article
Open Access
Clinical Study-Functional Outcome of Clavicle Fractures Treated Conservatively and Operatively in Semi-Urban Population.
Pages 844 - 853
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Abstract
Background: Clavicle fractures represent a common skeletal injury, accounting for 2.6%–5% of all fractures and up to 45% of shoulder girdle injuries, with 70%–80% occurring in the midshaft. Traditionally, conservative treatment using slings or figure-of-eight bandages has been favored. However, displaced midshaft fractures often result in malunion or non-union, leading to cosmetic deformity, shoulder dysfunction, and reduced strength—particularly problematic in manual laborers whose occupations require overhead activity. Operative fixation with pre-contoured or locking plates provides an alternative to achieve anatomical reduction and faster functional recovery. Aim: To compare the functional outcomes of conservative versus operative management of displaced mid-third clavicle fractures in semi-urban manual laborers. Materials and Methods: This prospective comparative study was conducted at Bhaskar Medical College, Telangana, from July 2022 to December 2024, following ethical clearance. Fifty-two patients aged 16–60 years with displaced mid-third clavicle fractures were enrolled. Twenty patients were treated conservatively with clavicle brace and sling, while thirty-two underwent open reduction and internal fixation (ORIF) using pre-contoured plates. Patients were followed up monthly for 12 months with clinical and radiological evaluation. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score and Constant-Murley shoulder score. Statistical analysis compared outcomes between the two groups. Results: Radiological union was achieved in all surgically treated patients and in 19 of 20 conservatively managed patients. The mean time for fracture union was 14 ± 0.9 weeks in the operative group and 23 ± 1.08 weeks in the conservative group. At 12 months, the mean Constant-Murley score was 93.7 ± 5.8 for the operative group versus 88.2 ± 4.4 for the conservative group, while the mean DASH scores were 3.8 ± 2.4 and 7.4 ± 5.8, respectively. Operative fixation achieved earlier functional recovery (5.2 ± 1.1 weeks vs. 7.3 ± 1.3 weeks), higher patient satisfaction (100% vs. 60%), and fewer complications such as malunion, shortening, and cosmetic deformity. Conclusion: Open reduction and internal fixation with pre-contoured plates provides superior radiological and functional outcomes compared with conservative management in displaced mid-third clavicle fractures, particularly among manual laborers requiring early return to work. Operative treatment ensures predictable union, restores shoulder biomechanics, reduces non-union rates, and yields higher satisfaction with minimal complications.
Research Article
Open Access
Comparative study between silver nanoparticles dressing and conventional dressing in diabetic foot ulcer healing: A prospective randomized study
Dilipsinh Gulabsinh Vaghela,
Anis Vohra ,
Manish Bariya ,
Raiyabhai Garchar ,
Gaurav Chaudhary ,
Utkarsh Vinod Shrimali,
Jignesh N Fafal,
Naitik Y Patel,
Jyotika Udaysinh Solanki
Pages 837 - 843
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Abstract
Background: Diabetic foot ulcers (DFUs) pose significant challenges in wound management due to impaired healing and high infection risk. Silver nanoparticles (AgNPs) possess antimicrobial and regenerative properties that may enhance ulcer healing compared to conventional povidone-iodine (PI) dressings.Aim: To compare the efficacy of silver nanoparticles dressing versus conventional povidone-iodine dressing in diabetic foot ulcer healing. Methods: A prospective randomized controlled study was conducted involving 100 patients with Wagner grade I or II diabetic foot ulcers. Patients were randomized to receive either AgNP dressing (n=50) or conventional PI dressing (n=50). Wound parameters including surface area, volume, granulation tissue appearance, slough reduction, and healing outcomes were assessed weekly for 12 weeks. Statistical analyses were performed to compare healing rates and clinical outcomes between groups. Results: The AgNP group demonstrated significantly greater reductions in ulcer surface area (78.3% ± 8.9 vs. 62.5% ± 10.4; p<0.001) and volume (74.9% ± 9.2 vs. 59.1% ± 11.1; p<0.001). Time to granulation tissue appearance and slough clearance were shorter in the AgNP group (2.8 ± 0.9 vs. 4.5 ± 1.2 weeks and 4.2 ± 1.1 vs. 6.0 ± 1.4 weeks, respectively; p<0.001). Complete healing rates at 12 weeks were higher (74% vs. 50%; p=0.006), and hospital stay was shorter (14.8 ± 4.3 vs. 19.6 ± 5.1 days; p<0.001) in the AgNP group. Conclusion: Silver nanoparticles dressing significantly accelerates diabetic foot ulcer healing, promotes earlier granulation tissue formation, reduces wound size more effectively, and shortens hospital stay compared to conventional povidone-iodine dressing. AgNP dressings represent a valuable advancement in chronic wound management.
Research Article
Open Access
Comparison between Percutaneous Dilatational Tracheostomy Vs Surgical Tracheostomy in Critically Ill Patients
Jignesh Naranbhai Fafal,
Ritesh Patel ,
Himmatlal Nisarata ,
Gaurav Chaudhary ,
Utkarsh Vinod Shrimali,
Raiya Garchar ,
. Dilipsinh G. Vaghela,
Naitik Y. Patel
Pages 830 - 836
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Abstract
Background: Tracheostomy is frequently required in the ICU to facilitate prolonged ventilation and airway protection. Percutaneous dilatational tracheostomy (PDT) offers potential logistical and wound-related advantages over surgical tracheostomy (ST), but comparative outcomes vary across settings. Methods: Prospective comparative study at a tertiary-care centre. Sample size: 40 critically ill adults; PDT n=20 (50%) and ST n=20 (50%). Baseline demographics and neck anthropometry were recorded. Primary comparisons included procedural characteristics (setting, duration), intraoperative and postoperative complications, decannulation prior to discharge, and in-hospital mortality. Group differences were evaluated using Welch’s t-test or Fisher’s exact test, with effect sizes and 95% confidence intervals (CIs). Results: Groups were similar in age (40.13±15.32 vs 41.67±23.30 years; p=0.807), sex (male 85% vs 85%; p=1.000), indication (prolonged ventilation 80.0% vs 75.0%; p=1.000), neck girth (36.23±1.78 vs 36.17±1.93 cm; p=0.919), and crico-sternal distance (3.95±0.13 vs 3.96±0.14 cm; p=0.826). PDT was performed bedside in ICU more often (90.0% vs 10.0%; p<0.001). Procedure time trended shorter with PDT (9.67±2.71 vs 11.47±4.22 min; mean difference −1.80, 95% CI −4.47 to 0.88; p=0.179). Intraoperative events were infrequent and similar: minor bleeding 10.0% vs 20.0% (p=0.661), subcutaneous emphysema 5.0% vs 5.0% (p=1.000), false passage 10.0% vs 0.0% (p=0.487), conversion (PDT→open) 15.0% vs 0.0% (p=0.231), apnea 0.0% vs 5.0% (p=1.000), major bleeding 0.0% vs 5.0% (p=1.000). Postoperative complications were rare and comparable (e.g., tube block 10.0% vs 5.0%; p=1.000). Decannulation prior to discharge (10.0% vs 10.0%; p=1.000) and in-hospital mortality (80.0% vs 85.0%; p=1.000) did not differ significantly. Conclusions: In this single-centre cohort, PDT and ST yielded similar safety and clinical outcomes, with PDT demonstrating a clear logistical advantage through bedside feasibility and a nonsignificant trend toward shorter procedure time. PDT can be considered a safe, efficient first-line approach in suitable ICU patients when performed by experienced teams, while ST remains crucial for patients with difficult anatomy or other contraindications to percutaneous access.
Research Article
Open Access
Comparative Evaluation of 0.5% Hyperbaric Levobupivacaine versus 0.75% Hyperbaric Ropivacaine for Elective Infraumbilical Surgeries Under Spinal Anesthesia: A Randomized, Double-Blind Study
Ajanth Singaravelu ,
Manikandan Ravi ,
Pughal vendan Gnanaprkasam,
Soma Sundaram Annamalai
Pages 823 - 829
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Abstract
Background: Spinal anesthesia with levobupivacaine and ropivacaine is widely used for infraumbilical surgeries, but comparative data on their efficacy and safety remain limited. Objectives: To compare block characteristics, hemodynamic stability, and perioperative safety of 0.5% hyperbaric levobupivacaine versus 0.75% hyperbaric ropivacaine in elective infraumbilical procedures. Methods: In this prospective, randomized, double-blind study, 80 adult ASA I-II patients scheduled for elective infraumbilical surgeries were allocated to receive 3 mL of either 0.5% hyperbaric levobupivacaine or 0.75% hyperbaric ropivacaine intrathecally. Onset and duration of sensory and motor block, hemodynamic parameters, and adverse events were recorded and analyzed. Results: Levobupivacaine showed significantly faster onset of sensory (2.64 vs. 3.35 min, p=0.011) and motor block (6.88 vs. 9.60 min, p=0.004), and longer duration of analgesia (220.4 vs. 154.2 min, p<0.001) and motor block (189.1 vs. 129.3 min, p<0.001). Ropivacaine group had greater hemodynamic stability with fewer hypotensive episodes (8% vs. 20%, p=0.048). Both drugs were well tolerated with minimal adverse events. Conclusions: Both levobupivacaine and ropivacaine provide effective spinal anesthesia for infraumbilical surgeries. Levobupivacaine offers rapid onset and prolonged analgesia, suitable for longer surgeries, while ropivacaine provides better hemodynamic stability and faster recovery, favoring hemodynamically vulnerable patients.
Research Article
Open Access
Clinical Study of Allergic Contact Dermatitis with Patch Test
Kavya K B ,
Pradeep Hullatti ,
Nadiga Rajashekhar
Pages 814 - 822
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Abstract
Background: Allergic contact dermatitis accounts for almost 20% of contact dermatitis. It is a type iv delayed hypersensitivity reaction in response to the exogenous agents. It occurs only in sensitized individuals, and estimates vary from 1.7% to 6%. Allergic contact dermatitis is a very challenging problem in dermatology with considerable morbidity and economic impact. Patch test has been established as a useful tool for diagnosis of Allergic contact dermatitis. Early recognition and intervention is the best prognostic indicator for treatment of Allergic contact dermatitis. Accurate identification of offending allergen requires thorough history taking of potential exposures, clinical examination, histologic evaluation and patch testing are keys to diagnose contact dermatitis Aims And Objectives: To study the incidence of various allergens and its association with duration of exposure of an antigen in patients of Allergic contact dermatitis. Materials And Methods: Cross sectional observational study including 100 patients of suspected allergic contact dermatitis, attending out-patient Department of Dermatology of Chigateri and Bapuji Hospital attached to JJM Medical College, Davanagere, conducted over a period of 2 years from November 2019 to October 2021. Results: Out of 100 cases 51 were male, with M:F ratio of 1.04:1. Most patient fall in age category between 30-40years.Allergic contact dermatitis to hair dye tops the list followed by Kumkum, Parthenium, Jewellery etc. In our study the commonest allergen to be tested positive was PPD followed by Nickel, Parthenium etc Conclusion: Allergic contact dermatitis is one of the leading causes of skin diseases and significantly impacts quality of life. Patch test remains the gold standard for the diagnosis of allergic contact dermatitis. Finally, once suspected allergens have been identified, the mystery of ACD can only be solved by establishing the relevance of the allergen and appropriately instructing the patient in its avoidance.
Research Article
Open Access
Comparitive Study of Efficacy and Functional Outcome between Autologous Platelet Rich Plasma V/S Corticosteroid Intra Articular Injection in Early Osteoarthritis Knee In A Tertiary Care Hospital
Pradeep Hullatti ,
Kavya K B ,
Ramesh R
Pages 807 - 813
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Abstract
Background: Osteoarthritis [OA] is a, chronic, degenerative disease caused by inflammatory mediators rather than purely a process of wear and tear. OA is a most common joint disease in India and major cause of pain and disability in adults. Currently treatment of OA mainly focuses on relieving of symptoms and improving day to day physical activities. Non-Pharmacological, Pharmacological and Intra articular injections like PRP, corticosteroids, hyaluronic acid, autologous mesenchymal stem cells are different treatment modality. Since the protocol in terms of dosage, duration and follow up is not being standardized, I would like to do comparative study on autologous PRP vs corticosteroid intraarticular injection in patient with early OA of knee. Aims and Objectives: Compare efficacy and functional outcome of Intra articular Autologous PRP Vs Corticosteroid injection and complication associated with it. Methodology: It’s a prospective comparative study of 200 patient with Early stage of OA knee who satisfies the inclusion criteria coming to Orthopaedics Outpatient Department in Bapuji Hospital or Chigateri Government Hospital attached to J.J.M. Medical College, Davangere will be taken for this study after obtaining the informed and written consent from September 2019 to September 2021. Result: The most common age group involved in study is 51-60 years (33%) with 114 (57%) patients were female and M:F ratio of 0.754.There is a statistical significance (<0.05) between BMI and Grades of OA of knee. There is a statistically significant difference between the mean values of VAS and WOMAC scores at 24 weeks between the two groups according to independent t- test (p-value- <0.05) without any serious adverse effect. Conclusion: Multiple doses, intra-articular PRP injection is superior to that of Triamcinolone Acetonide. PRP holds a promising, effective, better solution in the management in OA knee
Case Series
Open Access
Effect of Botulinum Toxin A (BoNT-A) Injection Followed by Casting on Gross Motor Function for Lower Limb Spasticity in Children with Cerebral Palsy: A Case Series
Navin Sagar ,
Chethan C ,
Shipra Chaudhary ,
Gurpreet Singh
Pages 799 - 806
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Abstract
Background: Spasticity in the lower limbs of children with cerebral palsy significantly limits gross motor function and impacts quality of life. Objective: To assess the effect of botulinum toxin A (BoNT-A) injections followed by serial casting on the gross motor function of children with cerebral palsy experiencing lower limb spasticity. Methods: This case series describes 10 children (mean age 7.6 years, range 4-15 years; all male) with cerebral palsy and spastic diplegia treated with BoNT-A injection followed by serial casting. All patients received bilateral injections in hip adductors, hamstrings, and gastrocnemius muscles (60 muscle groups total). Modified Ashworth Scale (MAS) and Gross Motor Function Measure-88 (GMFM-88) scores were recorded at baseline, 1 month, and 3 months post-intervention. Results: Statistically significant improvements in GMFM-88 scores were observed from baseline to 3 months in the overall cohort (mean change: 3.48 ± 1.00 points, t (9) = 11.03, p < 0.001, Cohen's d = 3.49). The ambulatory group (GMFCS I-III, n=7) improved from 71.14 ± 2.41 to 74.95 ± 1.91 (p < 0.001, d = 3.76), while the non-ambulatory group (GMFCS IV-V, n=3) improved from 32.60 ± 0.53 to 35.33 ± 0.58 (p < 0.001, d = 5.92). Spasticity reduction was observed in 81.7% of muscle groups (49/60), with mean MAS decreasing from 1.49 ± 0.72 to 0.94 ± 0.62. No muscle groups demonstrated worsening spasticity. Conclusion: The combination of botulinum toxin A with serial casting produces statistically significant and clinically meaningful improvements in both spasticity and gross motor function in children with cerebral palsy across all functional levels, with very large effect sizes. The intervention is well-tolerated and should be considered as part of comprehensive rehabilitation management.
Research Article
Open Access
Supracutaneous Locking Compression Plate as an External Fixator for Grade I and II Open Distal Tibial Fractures: A Prospective Evaluation
Gopaladasu Venakata Naga Vineeth,
P. Bala Krishna Kanth,
Etikala Pranathi Priyanka,
Mulakalapalli Janaki Sri
Pages 789 - 798
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Abstract
Background: Open fractures of the distal tibia present a major challenge due to poor soft-tissue coverage and high infection risk. Conventional external fixators are bulky and uncomfortable, while internal fixation may jeopardize wound healing. Supracutaneous (externalized) locking compression plate (LCP) fixation offers a low-profile, stable construct that maintains soft-tissue access and biological integrity. Aim of the study was to evaluate the clinical and functional outcomes of supracutaneous LCP fixation in Gustilo–Anderson grade I and II compound distal tibial fractures and compare the findings with previously reported studies. Materials and Methods: A prospective observational study was conducted at the Department of Orthopedics, Mamata Medical College, Khammam, from January 2024 to June 2025. Twenty-five patients with grade I–II open extra-articular distal tibial fractures (AO/OTA 43-A/B) were treated with supracutaneous LCP fixation after thorough debridement. The plate-to-skin distance was maintained at 1–1.5 cm with 3–4 locking screws per fragment. Patients were followed for at least 12 months. Continuous variables were expressed as mean ± SD and categorical variables as percentages. Student’s t-test and Chi-square tests were applied with p < 0.05 considered significant. Results: The mean age was 42.6 ± 11.8 years. Mean union time was 18.6 ± 3.9 weeks. Superficial and deep infection rates were 12% and 4%, respectively. Delayed union occurred in 8% and nonunion in 4%. Mean Olerud–Molander and AOFAS scores were 82.4 ± 8.6 and 86.8 ± 7.4, respectively, with good-to-excellent outcomes in 84% of cases. No significant difference existed between Grade I and Grade II fractures (p > 0.05). Conclusion: Supracutaneous LCP fixation provides stable fixation, early mobilization, and satisfactory union with minimal complications in Grade I–II compound distal tibia fractures. It represents a reliable and less cumbersome alternative to conventional external fixation.
Research Article
Open Access
Comparative Study on Efficacy of Intralesional Injections of Triamcinolone and 5 Fluorouracil Vs Triamcinolone And Hyaluronidase In Treatment Of Keloids
Mohd Niaz Ahmed,
Krishna Priya Kaukuntla,
Kranthi Jagadevapuram ,
P. Malini
Pages 780 - 788
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Abstract
Background: Keloids are abnormal fibroproliferative scars that extend beyond the original wound, causing cosmetic disfigurement, pain, and pruritus. Intralesional therapies offer a minimally invasive option for management. Triamcinolone combined with 5-Fluorouracil (5-FU) is widely used for its anti-inflammatory and antiproliferative effects. Hyaluronidase, combined with triamcinolone, may enhance steroid dispersion and improve outcomes. This present study compares the efficacy and safety of intralesional triamcinolone with 5-FU versus triamcinolone with hyaluronidase in treating keloids. Methods: Keloids formed spontaneously, after trauma, inflammation, and due to other causes, and recurrences of the same. After the patient selection based on the inclusion and exclusion criteria, the demographic data and detailed history were taken, followed by general and cutaneous examination. Regimen A and Regimen B. Patients in Regimen A received a combination of intralesional 5-Fluorouracil (50mg/ml) and triamcinolone acetonide (40mg/ml) injection in the ratio of 3:2 Regimen B received a combination of intralesional triamcinolone acetonide (40mg/ml) and hyaluronidase injection (1500 IU/ml) in the ratio of 1:1. Results: A total of 60 patients were included in the study, with 30 each receiving Regimen A (Triamcinolone + 5-FU) or Regimen B (Triamcinolone + Hyaluronidase). Most patients were aged 21–30 years, with a male predominance in Regimen A. Lesions were most commonly on the chest, with pain being the most frequent symptom. Most keloids were due to infection and lasted 1–5 years. Regimen B showed better consistency in treatment response and fewer side effects, while Regimen A showed occasional excellent outcomes. Recurrence was rare, seen in only one patient from Regimen A. Conclusion: We found that both regimens have been found to have significant efficacy and safety in the treatment of keloids. Regimen A (Triamcinolone + 5-FU) remains a time-tested combination with consistent results, while Regimen B (Triamcinolone + Hyaluronidase) showed comparable outcomes with fewer adverse effects and no recurrence.
Case Report
Open Access
A Rare Case of Bilateral Distal Radius Fractures with Bilateral Elbow Fracture Dislocations: Case Report
K. Sairaghav ,
S. Srikanth ,
V. Sujith Kumar,
T. Dushyanth Rao
Pages 770 - 779
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Abstract
Background: Bilateral distal radius fractures combined with bilateral elbow fracture-dislocations are extremely rare and represent a major challenge in orthopedic trauma management. Case Presentation: A 25-year-old male construction worker sustained polytrauma following a fall from height, resulting in bilateral distal radius fractures and bilateral elbow fracture-dislocations, along with craniofacial injuries. The patient underwent staged surgical fixation using volar variable-angle locking plates for both distal radius fractures and K-wire fixation with lateral collateral ligament repair for elbow stabilization. Results: Postoperative follow-up at six weeks demonstrated satisfactory fracture reduction, stable fixation, and early radiological signs of union. Functional recovery of wrist and elbow motion was achieved, with restoration of joint congruity and no evidence of instability. Conclusion: This rare case highlights the importance of precise anatomical reduction, stable fixation, and coordinated multidisciplinary management in achieving favorable outcomes for complex upper-limb injuries, even in resource-limited settings.
Research Article
Open Access
AI-Powered 3D Printing in Dentistry: Revolutionizing Prosthodontic Fabrication
Kanchan Shyamlal Sahwal,
Ankita Gupta ,
Vidyut Theja Swargam,
Nivea T Francis,
Niveditha S Prasad,
Vinay Rao
Pages 765 - 769
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Abstract
Background: Artificial Intelligence (AI) combined with three-dimensional (3D) printing has greatly impacted the field of prosthodontics. When data-based modeling, computer-aided design (CAD) driven optimization and additive manufacturing meet in the field of dental prostheses and implants applications the result is the ability to produce micro-structured maxillofacial components with high accuracy morpho-colorful patients related features. Materials and Methods: This cross-sectional, technology-related descriptive study systematically reviewed the literature and case reports from 2015 to 2025 regarding the utilization of AI-based 3D printing systems in prosthodontics. For inclusion, peer-reviewed studies and clinical trials related to AI-aided digitized workflows, CAD/CAM integration and additive manufacturing were used. Exclusion criteria were: articles about studies, where AI was not used, and those that dealt exclusively with subtractive milling. Results: Computer AI 3D printing prevented human error, improved prosthetic fit and bio-compatibility with predictive algorithms, Quickened the return process by 45%. The accuracy of digital impressions and the automatically error correction on design files were enhanced by ML models. DNNs exhibited excellent predictive ability for occlusal morphology and prosthetic adaptation. Conclusion: Artificially intelligent 3-D printing in prosthodontics as a “game changer” has facilitated the manufacture of individualized, cost-effective and time-saving prostheses. It offers superior clinical predictability, precision and long-term performance in restorative dentistry.
Case Report
Open Access
Concurrent Volvulus of The Sigmoid And Transverse Colon: A Rare Case Report
Surajit Sarkar ,
Raj Narayan Roy,
Dipan Mukhopadhyay
Pages 761 - 764
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Abstract
Background: We present a 77 year old Male Indian patient who presented with obstipation and respiratory distress. His straight x-ray abdomen showed grossly distended large bowels. A provisional diagnosis of sigmoid volvulus was presumed and the patient was taken up for an exploratory laparotomy. Intraoperatively, a sigmoid volvulus and simultaneous transverse colon volvulus was found. Concurrent sigmoid and transverse colon volvulus is an extreme rarity. Management usually includes exploration in our setup.
Case Report
Open Access
Effectiveness of Neoadjuvant Chemotherapy in Reducing Perioperative Blood Loss in an Extremely Rare Case of Paediatric Renal Ewings Sarcoma
Ratul Kundu ,
Anindita Saha ,
Ananya Sukul
Pages 757 - 760
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Abstract
Background: Ewing’s sarcoma is an aggressive tumour majorly involving bones. They are high-grade small round cell tumours and very rarely they may have extra-skeletal manifestations as peripheral primitive neuro ectodermal tumour (PNET), thoraco-pulmonary PNET or simply extra-skeletal Ewing’s sarcoma. Renal involvement of these tumours is extremely rare, characterised with very aggressive course and associated with poor prognosis. Being extremely rare, total 48 cases being reported till now, not many cases have reported the anaesthetic management in children suffering from renal Ewing’s sarcoma. Here we present the anaesthetic management as well as the role of neoadjuvant chemotherapy in a 2-year-old male child who underwent left sided nephrectomy for left renal Ewing’s sarcoma. The child presented with flank swelling for 6 month associated with hypertension. Pre-operatively hypertension was managed with Tab. Amlodipine 2.5mg. Surgery was done under general anaesthesia with endotracheal intubation in left sided up position. Pre-operatively the child also received 4 cycles of chemotherapy to reduce the size of the tumour to resectable condition. Surgical excision of such renal tumour could lead to profuse bleeding. Perioperative mortality rate ranged from 2.7 to 40% and the major complication included major intra-operative bleeding, pulmonary embolism, wound infection, and acute renal failure. However, preoperative chemotherapy changed the outlook of anaesthetic management as it not only did shrink the size of tumour but also made it well-circumscribed leading to minimal intra-operative blood loss. Profuse bleeding adversely affects perioperative outcome and more so in paediatric age group as they are more prone to develop DIC. Chemotherapy thus not only had a surgical benefit but also profoundly attributed towards anaesthetic management as well.
Research Article
Open Access
To Assess The Predictive Validity Of Leukocyte Count And Platelet Count In Predicting Clinical Cardiac Severity Of Scorpion Sting: An Observational Study.
D Sampath Kumar,
P. Sakthi Seethalakshmi,
P. Senthil Kumar
Pages 751 - 756
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Abstract
Background: Deaths due to scorpion sting are mainly attributed to pulmonary edema due to myocardial dysfunction. The stings are more prevalent in rural areas with poor facilities for treatment and transport, and the time elapsed is a significant prognostic factor. Here comes the need for simple predictive factors of severity that can be used for early referral and reduction in morbidity and mortality. Objective: To assess whether leucocytosis and/or thrombocytosis can be a predictive factor for assessing the clinical cardiac severity of scorpion sting. Method: This is a prospective observational, hospital-based study was conducted, enrolling one hundred cases of scorpion sting and suspected scorpion sting based on inclusion and exclusion criteria. A detailed history examination and rapid cardiopulmonary cerebral assessment were done. A CBC (complete blood count) was performed, immediately after admission and follow up conducted with ECG (electrocardiogram) and ECHO (echocardiogram) for each case. Statistical analysis was done using SPSS software. Results: The sensitivity of total leucocyte count in predicting cardiac toxicity is 91.30% and the specificity was 87%. The diagnostic accuracy was 89%. The negative predictive value was high 97% . Platelet count had the specificity of 93.5% and the sensitivity of 56%. Thus, total leucocyte count is more sensitive in predicting with high negative predictive value and thrombocytosis being more specific. Conclusion: Complete blood count is a very simple and widely available bedside test that provides results within minutes and does not require expertise. It can serve as a screening tool for predicting cardiac severity, facilitating early intervention and improved outcomes.
Research Article
Open Access
Clinical parameter and outcome of patients with ruptured liver abscess into thoracic cavity in a tertiary care center of north India: A retrospective analysis
Narendra Nath Das,
Ratnesh Kumar ,
Arpita Saxena
Pages 744 - 750
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Abstract
Background: In India liver abscess is a common problem. Majority of abscess are either amoebic or pyogenic. Rupture of liver abscess into thoracic cavity is a potentially life threatening condition. Material and methods: It is a retrospective descriptive study. Consecutive 70 patients with ruptured liver abscess into thoracic cavity who were referred to CTVS department and managed between January 2016 and December 2024. Clinical features, their management and their outcome are analyzed. Results: In our study group total 70 cases were taken into account. Among them 68(97%) were male and 2(3%) were female. 23% patients were having diabetes mellitus. 57% patients were alchoholic. Most common symptoms were fever with pain in chest and abdomen with dyspnea. All patients had right pyothorax and 40 patients (57%) showed thickening of pleura. In culture positive patients’ klebsiella was the most common causative organism followed by E.coli. ICD placement in right thoracic cavity was done in 60 cases (86%). In 30 cases (29%) were needed thoracotomy and drainage along with decortication of right lung. Discussion: Amoebic liver abscess is most common followed by pyogenic ones. Incidence of rupture liver abscess into thoracic cavity is very less. Most of the patients can be treated with percutaneous drainage of pus from both liver and thoracic cavity. Thoracotomy and decortication of the lung was needed when the percutaneous drainage is not sufficient or patients not amenable to percutaneous drainage. Conclusion: Liver abscess is mostly common in middle age male population and in developing countries. Alcohol consumption, diabetes mellitus are the risk factors associated with this disease. Multidisciplinary, patient-tailored approach in which combined therapeutic modalities like antimicrobial therapy, percutaneous drainage of pus and last but not the least surgical intervention is necessary for better prognosis.
Research Article
Open Access
Assessment of Maternal Lipid Profile and Fetal Growth Restriction
Sweta Raj ,
Manoj MG ,
Kuruba Ananya Anudeep
Pages 735 - 743
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Abstract
Background: Maternal lipid metabolism undergoes significant physiological changes during pregnancy, and alterations in lipid profile have been implicated in adverse pregnancy outcomes. However, the relationship between maternal dyslipidemia and fetal growth restriction (FGR) remains incompletely understood. Objective: This study aimed to assess the association between maternal lipid profile parameters and FGR. Methods: A prospective case-control study was conducted involving 240 pregnant women at 28-34 weeks of gestation, comprising 120 cases with FGR and 120 controls with appropriate-for-gestational-age (AGA) fetuses. FGR was defined as estimated fetal weight below the 10th percentile, validated by ultrasound. Maternal fasting lipid profiles, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and atherogenic indices, were recorded. Results: Women with FGR had significantly lower mean serum triglycerides (198.4 ± 42.6 mg/dL vs. 246.8 ± 51.2 mg/dL, p<0.001), TC (224.6 ± 38.4 mg/dL vs. 248.3 ± 42.1 mg/dL, p<0.001), and HDL-C (56.2 ± 12.4 mg/dL vs. 62.8 ± 14.2 mg/dL, p=0.001) in comparison with the controls. The TG/HDL-C ratio was significantly lower in FGR cases (3.72 ± 1.18 vs. 4.15 ± 1.32, p=0.008). Multivariate logistic regression revealed that TG levels <200 mg/dL were independently associated with FGR (adjusted OR = 3.24, 95% CI: 1.82-5.77, p<0.001). Birth weight indicated a positive correlation with maternal TG (r = 0.418, p<0.001) and TC (r = 0.321, p<0.001). Conclusion: Low maternal lipid levels, particularly hypotriglyceridemia, are significantly associated with FGR, suggesting impaired maternal-fetal lipid transfer may contribute to suboptimal fetal growth.
Research Article
Open Access
Study of Serum Homocysteine Levels in Ischemic Stroke
Manoj MG ,
Sreejith Paul V A
Pages 725 - 734
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Abstract
Background: Hyperhomocysteinemia has emerged as an independent risk factor for vascular diseases, including ischemic stroke. However, its relationship with stroke severity and subtypes requires further investigation. Objective: This study aimed to evaluate serum homocysteine levels in patients with acute ischemic stroke, compare them with healthy controls, and assess their correlation with stroke severity and subtypes. Methods: A hospital-based case-control study was conducted involving 150 acute ischemic stroke patients and 150 age- and sex-matched healthy controls. Fasting serum homocysteine levels were measured using chemiluminescence immunoassay. The severity of the stroke was evaluated utilizing the National Institutes of Health Stroke Scale (NIHSS). Stroke subtypes were categorized based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Traditional vascular risk factors were documented. Results: Mean serum homocysteine levels were significantly higher in stroke patients compared to controls (18.6 ± 7.4 μmol/L vs. 10.2 ± 3.1 μmol/L, p<0.001). Hyperhomocysteinemia (>15 μmol/L) was present in 64.7% of stroke cases versus 16.7% of controls (p<0.001). Homocysteine levels showed positive correlation with stroke severity (r = 0.482, p<0.001), with highest levels in severe stroke (NIHSS >15: 24.8 ± 8.6 μmol/L). Large artery atherosclerosis subtype demonstrated significantly higher homocysteine levels (21.4 ± 8.2 μmol/L) compared to other subtypes. Multivariate logistic regression revealed that hyperhomocysteinemia was independently associated with ischemic stroke (adjusted OR = 6.84, 95% CI: 3.92-11.94, p<0.001). Each 5 μmol/L increase in homocysteine conferred 1.72-fold increased stroke risk. Conclusion: Elevated serum homocysteine is significantly associated with ischemic stroke and correlates with stroke severity. These findings support homocysteine as a modifiable vascular risk factor warranting clinical attention.
Research Article
Open Access
Re-Evaluation of the Effectiveness of a Structured Support Group Program on Perceived Stress among Patients Undergoing Hemodialysis
Dhanya Michael ,
Molly John ,
Usha Samuel ,
Lakshmi ,
Rajee Reghunath
Pages 718 - 724
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Abstract
Background: Patients undergoing maintenance hemodialysis experience complex physiological and psychosocial stressors that adversely impact their well-being and adherence to treatment. Structured psychosocial interventions, such as peer support or group counseling, may help mitigate these stressors, though evidence from Indian settings remains limited. Objectives: To evaluate the effect of a structured support-group programme on perceived stress, physical stress, and psychosocial stress among patients undergoing maintenance hemodialysis. Methods: A quasi-experimental, two-group pre-test–post-test design was adopted. The study was conducted in the hemodialysis unit of a tertiary-care hospital in Kerala, India. A total of 60 patients meeting inclusion criteria were selected through purposive sampling and assigned equally to experimental (n = 60) and control (n = 60) groups. The experimental group received six weekly structured support-group sessions focusing on stress awareness, coping skills, peer sharing, and relaxation. The control group received routine care. Data were collected using the validated Hemodialysis Stressor Scale (HSS) at three time points: baseline (pre-test), post-test 1 (after six weeks), and post-test 2 (one month after post test 1). Descriptive statistics were expressed as mean ± SD. Within-group changes were analyzed using the Friedman and Wilcoxon signed-rank tests, and between-group comparisons used the Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: Participants’ mean age was 51.3 ± 7.5 years (experimental) and 52.3 ± 4.2 years (control), with male predominance (75% vs 60%). The experimental group showed a significant reduction in overall perceived stress from 37.35 ± 10.82 to 16.97 ± 9.51 (p < 0.001), while the control group showed minimal change (34.10 ± 13.92 to 29.75 ± 8.51, p > 0.05). Physical stress scores decreased from 7.82 ± 3.30 to 4.25 ± 1.93 (p < 0.001), and psychosocial stress from 29.53 ± 8.66 to 12.72 ± 8.55 (p < 0.001) in the experimental group. Between-group comparisons confirmed significant differences at post-test 2 (p < 0.001). Conclusion: The structured support-group programme effectively reduced perceived, physical, and psychosocial stress among hemodialysis patients. Incorporating regular peer-support sessions into dialysis care can enhance psychosocial well-being and treatment adherence.
Research Article
Open Access
Ultrasound-Guided Pigtail Catheter Drainage in Liver Abscess: A Clinical Study
Anand Ajaykumar ,
J.T Basavaraj ,
Najeeb Palakuzhiyil
Pages 711 - 717
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Abstract
Background: Liver abscess is a common intra-abdominal infection with significant morbidity, particularly among middle-aged males with a history of alcoholism. The introduction of ultrasound-guided percutaneous catheter drainage has transformed management by improving safety and clinical outcomes. Objective: To evaluate the efficacy, safety, and outcomes of ultrasound-guided pigtail catheter drainage in patients with liver abscess. Materials and Methods: This prospective study included 50 patients diagnosed with liver abscess based on clinical evaluation and ultrasonographic confirmation. After baseline hematological, biochemical, and radiological assessments, all patients underwent ultrasound-guided percutaneous drainage using a 16 Fr pigtail catheter. Key parameters such as clinical response, total drain output, duration of catheterization, hospital stay, and any procedure-related complications were systematically recorded and analyzed. Results: The majority of patients were males (78%) and middle-aged (31–50 years). Alcoholism was present in 32%. The most frequent symptoms were right upper quadrant pain (86%) and fever (76%). Hepatomegaly (52%) and tachycardia (44%) were the predominant clinical signs. Leucocytosis was present in 76%, hypoalbuminemia in 8%, and elevated alkaline phosphatase in 36%. Ultrasound localized abscesses predominantly in the right lobe (72%), followed by the left lobe (22%), and both lobes (6%). The mean abscess size was 7.5–10 cm in 62% of cases. Mean total drain output was 700–800 ml, and the average duration of catheter drainage was 5.6 days. Mean hospital stay was 7–8 days. Pus culture was positive in 44% of patients, commonly isolating E. coli and Klebsiella pneumoniae sensitive to amikacin and third-generation cephalosporins. No major complications occurred. The success rate was 100%, with all patients achieving symptom relief and radiological resolution. Conclusion: Ultrasound-guided pigtail catheter drainage is a safe, effective, and minimally invasive technique for managing liver abscess. It provides continuous evacuation, rapid recovery, shorter hospitalization, and negligible complications. The 16 Fr pigtail catheter is optimal for drainage of abscesses up to 10 cm, and this approach should be considered before surgical drainage.
Research Article
Open Access
Retrospective Analysis of Hanging and Near Hanging Cases to Form A Criteria to Take C Spine X Ray and CT Brain
Arthi ,
Rajakantham ,
C. N. Ilankumaran ,
V. P. Chandrasekaran
Pages 704 - 710
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Abstract
Background: Hanging and near-hanging are among the most common forms of deliberate self-harm in India. Despite routine practice of obtaining cervical spine X-rays and CT-brain scans for all such patients, the actual diagnostic yield and clinical utility of these investigations remain unclear. The present study aimed to analyse the clinical profile, risk–benefit balance, and radiological outcomes of these cases to develop evidence-based criteria for imaging. Methods: A retrospective analytical study was conducted on 100 patients with deliberate self-harm by hanging (partial or complete) who presented to the Emergency Department of SRM Medical College Hospital. Data were extracted from case records, including demographic details, clinical parameters (GCS, neurological findings, neck tenderness), radiological results, and complications during transfer. Statistical tests (χ², t-test, Fisher’s exact test, logistic regression) were applied to identify predictors of imaging yield. Results: Of the 100 cases, 68 % underwent imaging. The mean age was 36.8 ± 12.4 years, and males comprised 61.8 %. Clinically significant radiological findings were present in 35.3 % of imaged patients, including soft-tissue neck injury (20.6 %), hypoxic brain edema (13.2 %), and rare cervical fractures (2.9 %). Imaging altered management in 11.8 % of cases, while 8.8 % experienced complications during transfer. Lower GCS (< 9), focal neurological deficit, and neck tenderness were independent predictors of positive findings (adjusted OR = 4.20, 6.84, and 3.12, respectively; p < 0.05). The derived five-point criterion (GCS < 9, focal deficit, neck tenderness, complete hanging, age ≥ 60 years) showed an area under the curve of 0.78, with 83 % sensitivity and 62 % specificity for clinically significant injuries. Conclusion: Clinically severe or symptomatic patients merit targeted radiological evaluation, whereas routine imaging in alert, asymptomatic near-hanging victims may be safely avoided. The proposed criteria provide a rational, evidence-based framework for guiding imaging decisions and reducing unnecessary risk during patient transfer.
Research Article
Open Access
Endoscopic Retrograde Cholangiopancreatography in Situs Inversus Totalis- A Case Series from North India
Pages 698 - 703
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Abstract
Background: Situs inversus totalis (SIT) is a rare congenital anomaly characterized by mirror-image anatomy, posing challenges during endoscopic retrograde cholangiopancreatography (ERCP). Literature on ERCP in SIT is limited to sporadic case reports and small series. We report three cases of ERCP in SIT with emphasis on technical modifications, positioning, safety, and outcomes. Case Summary: Three patients with SIT presented with obstructive jaundice due to choledocholithiasis. ERCP was performed successfully in two patients in the left lateral position and one patient in the supine position. Selective CBD cannulation was achieved in all three patients; complete clearance was possible in two, while one required subsequent CBD exploration. No post-ERCP pancreatitis or major complications occurred. Case 1 underwent ERCP with CBD clearance, stenting, followed by laparoscopic cholecystectomy and stent removal. Case 2 had partial CBD clearance with stenting, followed by CBD exploration for complete clearance. Case 3 underwent ERCP with CBD clearance, stenting, laparoscopic cholecystectomy, and stent removal. Special maneuvering in the first part of the duodenum (D1), including temporary scope detachment, loop straightening, and reattachment, facilitated progression. In one case, precut sphincterotomy over a pancreatic duct (PD) stent proved safe and effective. Conclusion: ERCP in SIT is technically demanding but feasible with appropriate modifications. Key strategies include performing the procedure in left lateral or supine positions, applying special duodenal maneuvers, and considering precut sphincterotomy over PD stent as a safe rescue option for difficult cannulation.
Research Article
Open Access
Clinical Profile and Outcome Of Children With Severe Acute Malnutrition
Majeed Andleeb ,
Yousuf Shagufta ,
Tali Showkat Hussain
Pages 691 - 697
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Abstract
Background: Childhood malnutrition is major underlying cause of the under five year children deaths. Severe acute malnutrition (SAM) is the main contributing factor for under-five morbidity and mortality. Nutritional Rehabilitation Centre (NRC) provides a protocol-based management of SAM based on the guidelines laid down by the World Health Organization (WHO). This study was aimed to find the clinical profile and outcome of children admitted with SAM. Methods: This hospital-based cross-sectional study was conducted from April 2019 to March 2020. A total of 306 children aged between one month to five years who presented SAM admitted in the NRC of Maternal associated hospital of GMC, Anantnag. Results: Majority of the children were aged from seven to 12 months of life (n=91, 29.73), were females (n=176, 57.5%) and belonged to nuclear families with spacing between two children less than two years. SAM was more among illiterate and unskilled parents than literate and professionals. SAM was found more in lower and upper lower socioeconomic status. Acute gastroenteritis (AGE) (n=206, 67.32) and acute respiratory tract infection (ARTI) (n=158, 51.6) were common clinical presentations and hypoglycaemia (n=183, 59.80) and hypokalaemia (n=56, 18.30) were common metabolic derangements. Among the admitted children, most of them (n=119, 38.88%) had good weight gain (10 mg/kg/day), 136 (44.44%) had moderate weight gain (5-10gm/kg/day). Conclusion: Malnutrition in under five children is multifactorial with AGE and ARTI being common presentations. Early detection of moderate malnutrition and timely intervention helps in favourable outcomes in children with SAM.
Research Article
Open Access
Caesarean Section Rates by Robson’s Ten-Group Classification and Identification of High-Contribution Subgroups: A Prospective Observational Study.
Durgadas Asranna ,
Vishakha Asranna ,
Apurva Asranna
Pages 682 - 690
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Abstract
Background: The caesarean section (CS) rate has increased substantially worldwide, often exceeding the level recommended by the World Health Organization (WHO). Understanding the factors driving these trends is essential to optimise obstetric care and prevent unnecessary interventions. Robson’s Ten-Group Classification System provides a standardised framework to audit and compare CS rates within and between institutions. The present study aimed to evaluate CS rates using Robson’s classification and to identify the groups contributing most to the overall rate in a tertiary care hospital setting. Methods: This prospective observational study was conducted at Kasturba Hospital and the District Hospital, Tumakuru, Karnataka, between September 2022 and November 2024. All women admitted for confinement were included (n = 2,230). Data were collected using a structured proforma and classified into Robson’s ten groups based on parity, presentation, onset of labour, gestational age, plurality, and previous caesarean. Descriptive and inferential analyses were performed using RStudio (version 2023.03). The chi-square/Fisher’s exact test assessed associations, with p < 0.05 considered significant. Results: Among 2,230 women, the mean (±SD) maternal age and gestational age were 29.23 ± 4.01 years and 37.91 ± 2.08 weeks, respectively. Nulliparous women comprised 62.2% of the study population. The overall caesarean section rate was 51.5% (emergency 37.6%, elective 13.9%), and 48.5% delivered vaginally. According to Robson’s classification, Groups 1 (25.1%), 2a (20.8%), 3 (14.1%), and 5 (13.5%) were the predominant contributors to the total CS rate. Neonatal outcomes varied significantly with mode of delivery: NICU admission was highest among emergency CS (17.2%) and lowest among vaginal deliveries (6.7%) (p < 0.001). Maternal and perinatal mortality were minimal (0.08%). Conclusion: The overall CS rate in this study exceeded WHO recommendations, with Groups 1, 2a, 3, and 5 contributing most to the high burden. These findings highlight the need for targeted clinical audit and policy measures focused on these subgroups to safely reduce unnecessary primary caesareans while maintaining favourable perinatal outcomes. Ongoing institutional monitoring using the Robson classification should form a cornerstone of quality improvement in obstetric practice.
Research Article
Open Access
Novel Lab Method Demonstrating Ceftazidime-Avibactam and Aztreonam Synergy against Metallo-β-Lactamase-Producing Enterobacterales Infections: A Prospective Study
Jitendra Singh ,
Bhawini Vijayvergia ,
Rajesh Kumar Jangir
Pages 674 - 681
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Abstract
Background: Metallo-β-lactamase (MBL)-producing Enterobacterales pose a significant challenge in India due to their resistance to most β-lactam antibiotics, necessitating novel therapeutic strategies. This study evaluates a new laboratory technique to assess the synergistic potential of ceftazidime-avibactam (C/A) and aztreonam (AZT) against MBL-producing Enterobacterales in a tertiary care Indian hospital. Methods: A prospective study was conducted at district hospital a tertiary care hospital attached to GMC Chittorgarh, Rajasthan from March to August 2025, enrolling 50 patients with infections caused by MBL-producing Enterobacterales. Clinical samples (blood, urine, pus, respiratory secretions) were processed, and isolates were identified using standard biochemical tests and VITEK 2. MBL production was confirmed via the combined disc test with EDTA. A novel checkerboard assay assessed synergy, with fractional inhibitory concentration index (FICI) values ≤0.5 indicating synergy, 0.5 < FICI ≤ 4 indicating additive effects, and FICI > 4 indicating antagonism. Minimum inhibitory concentrations (MICs) for C/A and AZT were determined individually and in combination. Clinical outcomes were evaluated based on resolution of symptoms and follow-up cultures. Results: Of the 50 isolates, Klebsiella pneumoniae (52%) and Escherichia coli (38%) predominated. Synergy was observed in 68% (34/50) of isolates, with additive effects in 28% (14/50) and antagonism in 4% (2/50). Synergy was highest in K. pneumoniae (73%) compared to E. coli (63%). Median MICs decreased from 16 µg/mL to 4 µg/mL for C/A and from 8 µg/mL to 2 µg/mL for AZT in synergistic cases. Clinical improvement was noted in 82% (28/34) of patients with synergistic isolates within 7 days. The checkerboard assay proved reproducible and feasible for resource-limited settings. Conclusion: The C/A-AZT combination demonstrated significant in vitro synergy against MBL-producing Enterobacterales, with potential clinical benefits. The novel checkerboard assay offers a practical tool for synergy testing in Indian hospitals. Larger, multicenter studies are needed to validate these findings and optimize therapeutic regimens.
Research Article
Open Access
Study of Clinical Manifestations of Hirschsprung, Disease with Special Reference to the Role of Genetic Polymorphism of RET PROTO - Oncogene In Children
Nirup Kumar Biswas,
Sankar Roy ,
Nirup Kumar Biswas
Pages 666 - 673
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Abstract
Background: Introduction: Hirschsprung’s disease (HD) is a congenital disorder of the enteric nervous system characterized by the absence of ganglion cells in the distal bowel, leading to functional intestinal obstruction. Aims and Objectives: The study aimed to assess the clinical presentations and demographic characteristics of children diagnosed with Hirschsprung’s disease, while also evaluating the potential association between RET proto-oncogene polymorphisms and both the occurrence and severity of the disease. Methods: This prospective observational study (Feb 2015–Jan 2016) at I.P.G.M.E.&R., Kolkata, included 50 pediatric patients with clinically and radiologically suspected Hirschsprung’s disease, confirmed by full-thickness biopsy and pull-through surgery. Demographic, clinical, surgical, and postoperative outcome data were collected, and RET proto-oncogene polymorphisms (Ca rs1800860 and Ca rs1800861) were analyzed for genotype–phenotype correlations. Results: Results showed a predominance of neonates (56%) and males (70%). SSD was the most common surgical site (78%), and biopsy was the predominant procedure (64%). Genetic analysis revealed Ca rs1800860 as GG (78%) and AG (22%), and Ca rs1800861 as TT (62%), TG (28%), and GG (10%), with significant site-specific variation for Ca rs1800860 (p < 0.0001). Clinical features included C/F AD (82%, p < 0.05), C/F DPM (88%), C/F BV (66%), Cons (62%), and rare PERF GUT (4%). Most genotype–phenotype associations were not significant, except Ca rs1800861 with Cons (p = 0.0282). Conclusion: In conclusion, HD predominantly affects male children and presents with delayed meconium passage and abdominal distension. RET proto-oncogene variants, particularly intron 1 polymorphisms, play a key role in disease susceptibility and phenotypic variability, and molecular testing may improve diagnosis and early risk identification.
Research Article
Open Access
A Study to Evaluate the Incidence and Clinical Characteristics of Ceftriaxone (3rd Generation Cephalosporin) Resistant Enteric Fever
Nikita A. Patel,
Nawaz Z. Patel,
Nimisha Pandya ,
Ritesh Parmar
Pages 658 - 665
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Abstract
Background: Enteric fever, caused by Salmonella enterica servers Typhi and Paratyphoid, continues to be a major public health problem in many low- and middle-income countries, particularly in South Asia and sub-Saharan Africa, despite improvements in sanitation and vaccination strategies. The global burden remains high, with more than 14 million new cases and over 135,000 deaths annually, disproportionately affecting children and young adults in endemic regions. Aims & Objectives: The present study aimed to investigate the incidence and clinical characteristics of ceftriaxone-resistant enteric fever among patients from in and around Vadodara. The objectives included assessing the demographic and clinical profiles of affected patients, evaluating the sensitivity patterns of ceftriaxone-resistant Salmonella Typhi isolates, and formulating evidence-based recommendations for the optimal choice of antibiotics in managing such cases. Materials & Methods: This was a prospective observational hospital-based study conducted in the Department of Pediatrics at GMERS Medical College, Gotri, Vadodara, Gujarat, over 18 months from January 2023 to July 2024. Result: In our study of 50 enteric fever patients, most were male and aged 5–10 years, presenting mainly with nausea, vomiting, and abdominal pain. Salmonella typhi was the predominant isolate, with high resistance to fluoroquinolones and notable ceftriaxone resistance. Ceftriaxone-resistant cases showed higher inflammation, more lymph node enlargement, and longer hospital stays compared to sensitive cases. Conclusion: Pediatric enteric fever was mostly seen in males, with gastrointestinal symptoms; Salmonella Typhi was predominant, and ceftriaxone resistance led to higher inflammation, more lymph node enlargement, and longer hospital stays.
Research Article
Open Access
Revalidating Preoperative Prediction Score and To Develop A More Accurate Prediction Score- To Predict Difficult Cholecystectomy
Naga Raja Ravi Kishore. T,
Ishrath Anjum ,
Zaid Mazhar Syed,
Satya Srividya Kalluri,
Asif Shah Harooni
Pages 648 - 657
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Abstract
Background: Laparoscopic cholecystectomy is the gold standard for symptomatic gallstone disease due to its minimally invasive nature and faster recovery. However, intraoperative challenges can increase the risk of conversion and complications. Predicting surgical difficulty preoperatively enables better planning and patient safety. This study aimed to design and validate a scoring system to predict laparoscopic cholecystectomy difficulty using clinical and imaging parameters. Materials and Methods: A prospective study was conducted on 50 patients undergoing laparoscopic cholecystectomy at Princess Esra Hospital and Owaisi Hospital & Research Centre, Hyderabad, after obtaining ethical clearance. Clinical, biochemical, and imaging findings were analyzed, and scoring parameters were formulated to predict surgical difficulty. Results and Observations: Most patients were young adults (19–30 years) and female (76%), presenting predominantly with right hypochondrial pain and dyspeptic symptoms. Imaging revealed gallbladder wall thickening, CBD stones, and inflammatory changes in select cases. A scoring system comprising 21 preoperative and 13 intraoperative parameters was developed, stratifying patients into three risk categories: Very Low (0–6), Low to Moderate (7–14), and Moderate to High (15–30). Higher scores correlated with increased surgical difficulty and conversion rates. Conclusion: Laparoscopic cholecystectomy remains the safest and most effective treatment for gallbladder disease. The proposed scoring system provides a simple and reliable tool to predict operative difficulty, allowing for better surgical planning, appropriate allocation of resources, and improved patient outcomes.
Case Report
Open Access
Pediatric Supracondylar Fracture of Humerus Fixation with Innovative Joystick Technique- A Case Report
Nazia Salma ,
P Balakrishna Kanth,
T Dushyanth Rao,
S. Bharat Kumar
Pages 640 - 647
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Abstract
Background: Supracondylar humerus fractures (SCHF) are the most common pediatric elbow fractures, with Gartland type-III being completely displaced and unstable. Achieving accurate reduction in these fractures is often difficult. This case report presents an innovative joystick technique using the proximal fragment to facilitate closed reduction and stable fixation. Case Presentation: A 6-year-old girl sustained a Gartland type-III SCHF of the left humerus following a fall. Closed reduction under fluoroscopy was performed using a 3 mm K-wire inserted laterally into the distal humerus to manipulate the proximal fragment as a joystick. Once satisfactory alignment was obtained, cross K-wire fixation was done, and an above-elbow slab applied. Results: The operation lasted 20 minutes with minimal fluoroscopy exposure. Postoperative radiographs at 2 and 4 weeks showed excellent alignment and healing. After K-wire removal at 4 weeks, full elbow motion was restored. Functional outcome assessed by Flynn’s criteria was excellent. Conclusion: The proximal joystick technique is a simple, safe, and effective modification for closed reduction of Gartland type-III SCHFs in children. It reduces operative time, improves reduction accuracy, and minimizes iatrogenic injury risk.
Research Article
Open Access
Comparative Clinical Profile of Dengue Patients with and Without Diabetes Mellitus: A Cross-Sectional Study
Jainam Dilipbhai Shah,
Shekh Shahajoddin Minajoddin,
Vishwas Arora
Pages 634 - 639
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Abstract
Background: Dengue fever is one of the most prevalent arboviral infections globally, with a wide clinical spectrum ranging from mild febrile illness to severe disease. The coexistence of type 2 diabetes mellitus (T2DM), a common metabolic disorder, has been linked to adverse outcomes in dengue. However, limited data are available on how diabetes influences the initial demographic and clinical presentation of dengue patients. Objectives: To compare the demographic characteristics, clinical features, vital signs, and metabolic profile of dengue patients with and without diabetes mellitus. Methods: This cross-sectional observational study was conducted in the Department of General Medicine, K. B. Bhabha Municipal General Hospital, Mumbai, between June 2023 and June 2024. A total of 100 patients with serologically confirmed dengue (25 diabetics and 75 non-diabetics) were enrolled using purposive sampling. Demographic variables, clinical features, anthropometric measures, vital signs, and glycemic indices were recorded. Diabetes was defined by previous diagnosis or HbA1c ≥ 6.5%. Data were analyzed using Epi Info CDC 7 software, with p < 0.05 considered statistically significant. Results: The mean age was higher in diabetics (42.8 ± 11.1 years) than in non-diabetics (38.8 ± 15.4 years), though not significant. Male predominance was seen in both groups (72% vs. 70.7%). Fever and headache were universal, while other symptoms such as myalgia, arthralgia, retro-orbital pain, and rash occurred with similar frequency. Abdominal pain was more common in diabetics (68% vs. 30.7%). Vital signs were comparable, except for systolic blood pressure, which was significantly lower among diabetics (120 ± 14 mmHg vs. 125 ± 15 mmHg, p = 0.037). As expected, diabetics had significantly higher fasting and postprandial blood glucose levels and poorer glycemic control, with over half demonstrating HbA1c ≥ 6.5%. Conclusion: The demographic and clinical profile of dengue was largely similar across groups; however, abdominal pain and lower systolic blood pressure were more frequent among diabetics, alongside poor glycemic control. These findings suggest that diabetes may subtly alter the clinical presentation of dengue, emphasizing the importance of early recognition and vigilant monitoring in this subgroup for timely risk stratification and management.
Research Article
Open Access
Epidemiological Trends of Cardiovascular and Respiratory Disorders in Adults: A Descriptive Analysis from a Hospital-Based Cohort
Mohammad Abdus Sattar Bhuiyan,
Ummal Wara Khan Chowdhury,
Mohammad Alwalid Sharker,
Muhammad Jalal Uddin,
Mohammad Ataullah ,
Md. Ahasanul Haque Razib,
Shah Md. Rehanul Islam,
Md. Masud Rana,
MD. Lemon Pervage,
Md. Nazmul Hossain
Pages 628 - 633
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Abstract
Background: Cardiovascular and respiratory disorders are the leading causes of morbidity and mortality worldwide, particularly in low- and middle-income countries such as Bangladesh, where the disease spectrum is shifting toward chronic non-communicable conditions. This study aimed to describe the epidemiological trends of cardiovascular and respiratory disorders in adults admitted to a tertiary hospital in Bangladesh. Methods: A cross-sectional observational study was conducted among 280 adult patients in the Department of Cardiology, Mymensingh Medical College and Hospital, Bangladesh, from January to December 2024. Data on demographic characteristics, clinical diagnoses, and comorbidities were collected using structured case record forms and analyzed using SPSS (version 25.0). Descriptive statistics were used to summarize the findings. Results: The mean age of the participants was 52.8 ± 13.4 years, with 58.9% males. Cardiovascular diseases accounted for 62.9% of the cases, with ischemic heart disease (38.2%) and hypertensive heart disease (26.8%) being the most common. Respiratory disorders comprised 37.1% of cases, dominated by chronic obstructive pulmonary disease (31.4%) and asthma (17.1%). Hypertension (46.1%) and diabetes mellitus (28.6%) were the most frequent comorbidities. Overweight and obesity were present in nearly half of all participants. Conclusion: Cardiovascular and respiratory diseases represent a growing burden among Bangladeshi adults, often coexisting with metabolic risk factors. These findings highlight the need for integrated hospital-based and community-level interventions focusing on early detection, lifestyle modifications, and chronic disease management to reduce cardiopulmonary morbidity and mortality.
Case Series
Open Access
A Case Series on Severe Animal Bite Injuries among Children Attending a Tertiary-Care Teaching Institute in Western Maharashtra, India
Amol Dilip Dhole,
J Rajshekhar Reddy,
Swathi Reddy K,
Harshal Tukaram Pandve
Pages 617 - 627
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Abstract
Background: Animal bites in children remain a significant public-health concern in India, particularly in rabies-endemic regions⁽¹⁾. This case series describes ten paediatric patients (aged 2–13 years) who presented with WHO Category III animal-bite injuries to a tertiary-care teaching institute in Western Maharashtra between May and August 2025. Eight cases involved dog bites and two involved cat bites, predominantly affecting the limbs and face. Eight children reported within six hours of exposure. All wounds were meticulously washed with soap and water, and each child received tetanus prophylaxis, local infiltration of rabies immunoglobulin (RIG), and a complete anti-rabies vaccine (ARV) regimen. None of the patients developed rabies or major complications during follow-up. Prompt wound care, timely RIG administration, and completion of the ARV schedule ensured full recovery. This series underscores the importance of community awareness, responsible pet ownership, and strict adherence to National Rabies Control Programme (NRCP) guidelines to prevent childhood rabies in endemic regions.
Case Report
Open Access
Evaluation of Skeletal and Dental Changes with Powerscope vs. Herbst Appliance: A Cephalometric Analysis
Asifa C K,
Sam Paul ,
Prince K Chacko,
Basil Joseph
Pages 609 - 615
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Abstract
Background: Introduction: Skeletal Class II malocclusion is one of the most prevalent orthodontic problems, often associated with mandibular retrusion. Functional appliances such as Power Scope and Herbst provide effective correction by promoting mandibular advancement. Case Report: Two female patients presenting with skeletal Class II malocclusion and increased overjet and overbite were treated with fixed appliances in combination with functional devices. The first case, a 16-year-old with increased overjet and overbite and mild crowding, was treated using a non-extraction protocol with PowerScope appliance. The second case, a 21-year-old with proclined upper and lower incisors, and increased overjet, was managed using a Herbst appliance followed by fixed orthodontic treatment. Results: Both patients achieved improved sagittal jaw relationship, normalized overjet and overbite, Class I molar relationship, and improved facial profile. Cephalometric evaluation revealed favorable skeletal and dentoalveolar changes. Conclusion: PowerScope and Herbst appliances are effective in correcting skeletal Class II discrepancies even in growing and young adult patients, when combined with fixed orthodontic.
Research Article
Open Access
Incidence, Risk Factors, and Outcomes of ERCP-Related Complications: A Three-Year Retrospective Analysis from a Tertiary Care Center in North India
Pages 609 - 616
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Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an indispensable therapeutic procedure for pancreatobiliary disorders. However, despite advances in endoscopic techniques and prophylactic strategies, ERCP is still associated with significant complications, including post-ERCP pancreatitis (PEP), bleeding, perforation, cholangitis, and occasionally procedure-related mortality. Indian data on ERCP complications remain limited. Objectives: To determine the incidence and pattern of ERCP-related complications, identify clinical and procedural risk factors, and evaluate short-term outcomes in patients undergoing ERCP over a three-year period at a tertiary center in North India. Methods: This retrospective study included all consecutive ERCPs performed between January 2022 and December 2024 at Apex Hospitals, Jaipur. Demographic, clinical, and procedural data were collected. Complications were defined per ASGE guidelines. Univariate and multivariate logistic regression analyses were used to identify independent predictors of complications. Results: Among 1000 ERCPs, overall complication rate was 7.4 %; PEP 4.2 %, bleeding 1.9 %, perforation 0.5 %, cholangitis 0.8 %, and procedure-related mortality 0.2 % Independent predictors included difficult cannulation, pancreatic duct contrast injection, precut sphincterotomy, and procedure duration >45 min. Most complications were mild to moderate and managed conservatively. Conclusion: In this large three-year Indian audit, ERCP-related complication rates were comparable to international standards. Procedural factors rather than patient demographics were key predictors. Structured training, prophylactic NSAIDs, and meticulous technique remain vital for minimizing adverse events
Research Article
Open Access
FNAC versus Core Needle Biopsy in Palpable Breast Lesions: Diagnostic Accuracy Compared With Histopathology
Abhay Arvind Raikhelkar,
Anand Bhinge ,
Khushboo Wadgaonkar
Pages 601 - 608
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Abstract
Background: Accurate preoperative diagnosis of palpable breast lesions is essential for optimal management. Fine Needle Aspiration Cytology (FNAC) and Core Needle Biopsy (CNB) are widely used diagnostic tools, but their relative accuracy remains debated. This study compares the diagnostic performance of FNAC and CNB against histopathology as the reference standard. Methods: A prospective comparative observational study was conducted on 200 female patients with palpable breast lumps attending a tertiary care hospital. Each patient underwent both FNAC and CNB, followed by histopathological examination of excised specimens. Diagnostic indices including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for both FNAC and CNB. Statistical analyses were performed using Chi-square and McNemar’s tests, with significance set at p < 0.05. Results: Histopathology confirmed malignancy in 45.5% (91/200) of cases. FNAC demonstrated sensitivity 87.9%, specificity 93.6%, PPV 92.0%, NPV 90.3%, and accuracy 91.0%. CNB showed higher diagnostic indices-sensitivity 94.5%, specificity 96.3%, PPV 95.6%, NPV 95.5%, and accuracy 95.5%. The difference in overall diagnostic accuracy between the two techniques was statistically significant (McNemar p = 0.035). Agreement with histopathology was substantial for FNAC (κ = 0.818) and almost perfect for CNB (κ = 0.909). Conclusion: Both FNAC and CNB are reliable diagnostic modalities for evaluating palpable breast lesions; however, CNB provides superior accuracy and agreement with histopathology. FNAC remains an effective preliminary diagnostic tool due to its simplicity and cost-effectiveness, whereas CNB should be preferred for equivocal, suspicious, or inadequately sampled cases to ensure definitive diagnosis and appropriate therapeutic planning
Research Article
Open Access
The Prevalence of Variations in the Branching Pattern of Aortic Arch: A Cadaveric Study
Shradha Iddalgave ,
Joshua P. Ajith,
Nagesh Kuppast
Pages 591 - 600
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Abstract
Background: Variations in the branching pattern of the arch of aorta has been well studied. The wide spectrum of variations in the anatomical arrangement of human aortic arch and its branches offer valuable information to catheterize aortic arch and its branches for safely performing the endovascular surgery This paper aims to further substantiate the fact that such variations do exist and hence the need to be aware of such variations with clinical implications. Materials & Methods: A total of 50 formalin fixed hearts from the Anatomy department of Shri Atal Bihari Vajpayee Medical College and Research Institute, Bangalore were observed for variations in the branching pattern of the aortic arch. Results: Of the 50 hearts examined, variations were observed in 4 i.e., 8% of them. 2(4%) of them were Left Vertebral artery(LVA) type, where the LVA directly arises from the aortic arch. The other 2(4%) were of Common Trunk type wherein the brachiocephalic branch and the left common carotid branch had a single common trunk arising from the aortic arch. Conclusion: The results show that the prevalence of such variations is not rare. The clinical relevance of this in catheterization, endovascular surgery and artery dissection needs to be well understood. This will prevent negligence, as such branching patterns may cause complications during procedures. The understanding and acknowledgement of its prevalence and importance is all the more essential as shown by the results of this paper.
Review Article
Open Access
Non-Opioid Pain Relief Methods in Surgery: Moving Towards Opioid-Free Anesthesia
Gopal Singh ,
Manju Bansal ,
Des raj ,
Dheeraj Singha
Pages 586 - 590
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Abstract
Background: Managing pain around the time of surgery is important for better recovery and fewer complications. Opioids have long been the main choice for pain relief during and after surgery. But due to the worldwide opioid crisis and side effects like breathing problems, nausea, vomiting, constipation, and the risk of long-term use, there’s growing interest in using multiple methods that reduce or avoid opioids. Non-opioid pain relief options include medicines, nerve blocks, and other therapies, which are increasingly used together to aim for opioid-free anesthesia (OFA) in some patients. This review looks at proven non-opioid drugs such as acetaminophen, NSAIDs, ketamine, dexmedetomidine, IV lidocaine, gabapentinoids, magnesium, and cannabinoids. It also highlights regional anesthesia techniques like spinal or nerve blocks guided by ultrasound as key parts of pain control. Additional methods like electrical nerve stimulation (TENS), acupuncture, music therapy, and mental health strategies are discussed too. Recent studies show that carefully planned opioid-free anesthesia can improve pain control, lower opioid use and side effects, and help patients recover faster after surgery. Future advances may include using artificial intelligence for personalized care, genetic testing to guide treatment, and new non-opioid drugs. Using non-opioid methods offers a safe and effective way to manage surgical pain while addressing the global opioid problem.
Research Article
Open Access
Clinico-Mycological Study of Candidiasis in a Tertiary Care Institute of South India
Aravinda M ,
Vasantha Kumari S,
Nikhat Shaheen Syed,
Madhu Babu Ch
Pages 581 - 585
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Abstract
Background: Candidiasis, a superficial or systemic fungal infection caused primarily by Candida albicans, constitutes a common clinical problem in both immunocompetent and compromised individuals. It exhibits a wide range of clinical presentations involving mucosal and cutaneous surfaces. Aims: To determine the clinical spectrum, demographic patterns, predisposing factors, and mycological diagnostic profile of candidiasis among patients attending a tertiary-care hospital in Telangana, India. Methods: A prospective observational study was conducted on 100 clinically suspected candidiasis cases at Kakatiya Medical College, Warangal. Each patient underwent detailed clinical evaluation and laboratory confirmation through direct microscopy (KOH mount, Gram stain) and culture on Sabouraud’s Dextrose Agar (SDA). Ethical clearance was obtained before study initiation. Results: The peak age incidence was 21–40 years (53%) with a slight female preponderance (55%). The most frequent type was vulvovaginal candidiasis (29%), followed by balanoposthitis (28%) and intertrigo (27%). Diabetes mellitus (22%), moisture exposure (14%), and HIV infection (9%) were major risk factors. Diagnostic positivity rates were 32% for KOH, 34% for Gram stain, and 24% for culture. Conclusion: Candidiasis remains a prevalent infection modulated by host factors and environment. Clinico mycological correlation facilitates accurate diagnosis and effective therapy. Control of diabetes and awareness of hygiene practices are key preventive measures..
Research Article
Open Access
Multinodular Goitre - Clinical Spectrum and Correlation between FNAC and Final HPE: A Retrospective Observational Study
Mohd Mujtaba Shahbaz,
Syed Shahid Irfan,
Ankita Biradar ,
Asif ,
Shaheed
Pages 576 - 580
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Abstract
Background: Multinodular goiter (MNG) remains one of the most common thyroid disorders, with variable clinical presentation and an inherent risk of malignancy. Cytological-histopathological correlation provides crucial diagnostic validation for accurate management. Aim: To study the clinical spectrum and cytological-histopathological correlation among patients with multinodular goiter undergoing total thyroidectomy. Methods: A retrospective observational study was conducted on 45 patients who underwent total thyroidectomy for MNG at a tertiary care center over two years. Demographic, clinical, and cytological data were collected and correlated with final histopathology findings. Statistical analysis was performed using chi-square and proportion tests, with p < 0.05 considered significant. Results: The mean age of patients was 45.4 years, with a female-to-male ratio of 4.6:1. Most cases were asymptomatic (86.7%). FNAC revealed colloid nodules in 57.8%, follicular neoplasms in 31.1%, and thyroiditis in 4.4%. Histopathological examination confirmed malignancy in 22.2% of cases, predominantly papillary carcinoma. A significant correlation was noted between follicular cytology and malignancy (p = 0.014). Conclusion: MNG continues to be a prevalent thyroid disorder with a notable malignancy rate. FNAC remains a valuable diagnostic tool, but histopathological confirmation is essential. Total thyroidectomy serves as a safe and definitive treatment when performed with meticulous surgical technique and preoperative evaluation.
Research Article
Open Access
Safety and Efficacy Comparison of Bipolar and Monopolar Cautery Techniques in Transurethral Resection of the Prostate
Abhay Ganar ,
Pankaj Ramesh Bhople,
Rupali Kiran
Pages 568 - 575
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Abstract
Background: Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for benign prostatic hyperplasia (BPH). Traditional monopolar TURP, though effective, carries risks such as dilutional hyponatremia and TUR syndrome due to the use of hypotonic irrigants. Bipolar cautery, using isotonic saline, offers potential advantages in safety without compromising efficacy. Aim: To compare the safety and efficacy of bipolar versus monopolar cautery techniques in transurethral resection of the prostate. Materials and Methods: This prospective comparative study included 70 patients with BPH, divided equally into two groups: Group GM (Monopolar using 1.5% glycine, n=35) and Group NSB (Bipolar using 0.9% normal saline, n=35). Pre- and post-operative serum sodium and potassium levels, irrigant volume, resection time, and intra-/post-operative complications were analyzed. Data were statistically compared using the Welch t-test and Fisher’s exact test with a significance threshold of p < 0.05. Results: The mean resection time was similar between groups (38.37 ± 8.02 min vs. 38.65 ± 36.38 min; p=0.965). The mean irrigant volume was significantly lower in the bipolar group (9.60 ± 1.88 L vs. 10.94 ± 3.22 L; p=0.038). Post-operative hyponatremia occurred in 42.9% of NSB patients compared to 77.1% in GM (p=0.0068). Symptomatic TUR syndrome was reduced in the bipolar group (14.3% vs. 34.3%; p=0.093). No significant differences were found in post-operative potassium levels or hemodynamic parameters between the groups. Conclusion: Bipolar TURP provides comparable resection efficiency to monopolar TURP while significantly reducing the risk of dilutional hyponatremia, TUR syndrome, and intraoperative complications. The use of isotonic saline as an irrigant makes bipolar cautery a safer and more reliable technique for TURP, particularly in patients at higher risk for fluid absorption-related complications.
Research Article
Open Access
Effect of NSAID on Renal Function in Laparoscopic Donor Nephrectomy
Mohd Mdutjana Shahbaz,
Pradeep Kulkarni ,
Syed Shahid Irfan,
Ankita Biradar
Pages 562 - 567
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Abstract
Background: Laparoscopic donor nephrectomy (LDN) is the preferred approach for kidney retrieval in live donors, offering faster recovery and reduced postoperative morbidity. However, the peri-operative use of nonsteroidal anti-inflammatory drugs (NSAIDs) remains controversial due to their potential nephrotoxic effects through inhibition of prostaglandin-mediated renal autoregulation. This study aimed to evaluate the impact of peri-operative NSAID administration on renal function in donors undergoing LDN. Materials and Methods: A prospective audit was conducted at the Department of Urology, Kovai Medical Center and Hospital, Coimbatore, from September 2017 to March 2018. A total of 107 consecutive donors were included, of whom 63 received NSAIDs as part of multimodal analgesia and 44 did not. Serum creatinine was measured preoperatively, within 48 hours postoperatively, and at one-month follow-up. Renal dysfunction was defined as an increase in serum creatinine >0.3 mg/dL or >50% from baseline within 48 hours. Data were analyzed using SPSS version 20, and intergroup comparisons employed Fisher’s exact and t-tests. Results: Immediate postoperative renal dysfunction occurred in 16/63 (25.4%) of the NSAID group versus 6/44 (13.6%) of the non-NSAID group (p = 0.154). Persistent renal impairment at one month was observed in 7.9% and 4.5%, respectively (p = 0.697). The relative risk of dysfunction associated with NSAID exposure was 1.86 (95% CI: 0.79-4.38). Among those with early dysfunction, renal recovery by one month was comparable (68.8% NSAID vs. 66.7% non-NSAID; p = 1.000). Conclusion: Although NSAID use was associated with a higher incidence of early renal dysfunction, most cases were transient, with no significant long-term difference at one month. Careful peri-operative patient selection, optimization of fluid management, and avoidance of prolonged NSAID exposure are recommended to minimize renal risk.
Research Article
Open Access
Compression Cervical Myelopathy due to Spondylosis: A Clinicoradiological assessment of Surgical Intervention
Kundan Kumar ,
Avdhesh Shukla ,
Vivek Kankane ,
Avinash Sharma ,
Himanshu Verma
Pages 554 - 561
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Abstract
Background: Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction in adults, particularly affecting middle-aged and elderly populations. It is caused by degenerative changes in the cervical spine that lead to compression of the spinal cord. Symptoms can range from subtle numbness and clumsiness to severe motor and sensory deficits, significantly impacting quality of life. Surgical decompression, particularly through anterior cervical discectomy and fusion (ACDF), is often necessary for patients with moderate to severe symptoms. This study aims to analyze the clinical and radiological outcomes of CSM patients undergoing surgical decompression. Method: This prospective observational study was conducted at J.A. Group of Hospitals and G.R. Medical College in Gwalior, MP, from 2023 to 2025. Thirty patients diagnosed with CSM, based on X-ray, CT, and MRI findings, were included. Preoperative assessments included clinical examinations, including the Nurick Grade and modified Japanese Orthopaedic Association (mJOA) score, and radiological evaluations. Surgical approaches, either anterior or posterior, were selected based on clinical and radiological factors. Postoperative assessments were performed at multiple follow-up intervals to evaluate functional recovery and radiological improvements. Results: The majority of patients were aged between 40-60 years, with a slight female predominance. The most common symptoms were paraparesis and limb weakness, followed by gait disturbances. The predominant surgical approach was anterior cervical discectomy and fusion (ACDF). Postoperatively, 87% of patients showed improvement in functional and neurological status. Radiological improvements, including increased canal diameter and cross-sectional area of the spinal cord, were noted in most patients. Complication rates were low, with minimal incidents of infection, hematoma, and cerebrospinal fluid leaks. Conclusion: Surgical decompression for cervical spondylotic myelopathy, particularly using anterior approaches like ACDF, leads to significant functional and radiological improvements. Early intervention is critical to prevent the progression of neurological deficits. The study underscores the safety and efficacy of surgical decompression, with low complication rates, but also emphasizes the need for individualized treatment approaches to optimize outcomes.
Research Article
Open Access
A Prospective Study and Analysis of Ventriculoperitoneal Shunt Surgery: Their Indication and Complication in a single Tertiary Care Centre
Himanshu Verma ,
Avdhesh Shukla ,
Vivek Kankane ,
Avinash Sharma ,
Kundan Kumar ,
Ajay Mathur
Pages 546 - 553
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Abstract
Background: Ventriculoperitoneal (VP) shunt surgery is a widely performed neurosurgical procedure used to treat hydrocephalus, a condition marked by the abnormal accumulation of cerebrospinal fluid (CSF) within the cerebral ventricles. Hydrocephalus can arise from various etiologies, including congenital malformations, tumors, infections, and post- surgical conditions. Despite being an effective treatment, VP shunt surgery is associated with a range of complications, including shunt malfunction, infections, and displacements, which may significantly impact patient morbidity and healthcare costs. Method: This prospective cohort study was conducted at a single tertiary care center, analyzing 100 patients who underwent VP shunt surgery between January 2023 and December 2024. Data collected included preoperative demographic information, clinical symptoms, diagnostic imaging, intraoperative details, and postoperative follow-ups. The study aimed to evaluate the primary indications for VP shunt insertion, as well as the incidence and types of complications, both early and late, in the postoperative period. The outcomes of the surgery were tracked across various age groups and hydrocephalus etiologies. Results: The majority of patients were children, with a predominance of those aged 1-5 years. The most common indications for surgery were acquired hydrocephalus (60%) and congenital hydrocephalus (40%). Postoperative complications included shunt malfunction (15%), infections (10%), and shunt displacement (8%), while 46% of patients experienced no complications. A majority of patients had functioning shunts at follow-up (70%), with 75% showing normal radiological findings. Younger age and acquired hydrocephalus were significant risk factors for postoperative complications. Notably, post-surgical infections were linked to poorer outcomes, underscoring the importance of infection prevention strategies. Conclusion: This study confirms that VP shunt surgery is generally successful, with favorable outcomes in the majority of cases. However, complications, particularly in younger patients and those with acquired hydrocephalus, remain a significant challenge. These findings highlight the need for careful preoperative planning, individualized patient care, and rigorous postoperative follow-up to minimize complications and improve long-term outcomes. Enhanced infection control measures and continuous monitoring for shunt function are crucial for reducing morbidity and optimizing recovery in high- risk patient groups.
Research Article
Open Access
To Assess the Functional and Aesthetic Outcomes of Le Fort I Osteotomy with Maxillary Advancement in Patients with Cleft Lip and Palate
Shifali Joshi ,
GS kalra ,
Manish Singhal
Pages 539 - 545
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Abstract
Background: Facial clefts, including cleft lip and palate, are among the most common congenital deformities, affecting approximately 1 in 700 live births worldwide. AIM: To evaluate the effectiveness of Le Fort I osteotomy with maxillary advancement in correcting maxillary hypoplasia and improving clinical, functional, and aesthetic outcomes in patients with a history of cleft lip and palate repair. Methodology: A prospective study was conducted from June 2023 to June 2025, involving a study population of 30 patients. All patients underwent maxillary advancement using the Le Fort I osteotomy technique. Result: The study demonstrated favorable outcomes following Le Fort I osteotomy with maxillary advancement in patients with cleft-related maxillary hypoplasia. All 30 patients showed significant improvement in facial profile, occlusion, mastication, and self-confidence. The amount of advancement ranged from 5 mm to 8 mm, with no cases of relapse observed. Minor complications included pain (in 27 patients), facial edema (3 patient) all of which were manageable. Postoperative stability was maintained with no signs of infection, malunion, or skeletal instability. Conclusion: Le Fort I osteotomy with maxillary advancement is an effective solution for correcting maxillary hypoplasia in cleft lip and palate patients. It significantly improves facial aesthetics, occlusion, and functional outcomes. This procedure also enhances psychosocial well-being and overall quality of life.
Research Article
Open Access
Study on Obstructive Sleep Apnea in Patients of Idiopathic Pulmonary Fibrosis Admitted In Medical College Hospital, Kolkatta
Ramanuj Sinha mahapatra,
Archisman Bhattacharjee ,
Shayanti Golder ,
Kajal Kumar Patra
Pages 530 - 538
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Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is frequently associated with obstructive sleep apnoea (OSA), which may exacerbate hypoxemia and impair clinical outcomes. This study aimed to assess the prevalence, severity, and associated clinical correlates of OSA in IPF patients. Methods: This cross-sectional, observational study was conducted over 18 months at a tertiary care respiratory centre in Kolkata. Sixty-four adult patients with confirmed IPF were evaluated using Type III polysomnography. Clinical, spirometric, and arterial blood gas parameters were recorded. Statistical analyses were performed using SPSS v20, with p < 0.05 considered significant. Results: OSA was present in 70.3% of IPF patients, with moderate and severe OSA comprising 35.9% and 29.7%, respectively. Patients with OSA had significantly lower mean FVC% (58.7% vs. 68.3%, p = 0.001) and PaO₂ (70.08 mmHg vs. 81.63 mmHg, p = 0.001). Higher BMI and neck circumference were observed in severe OSA cases (p = 0.031 and p = 0.029, respectively). Hypertension was significantly more common among OSA patients (65.2% vs. 26.3%, p = 0.001). Polysomnographic parameters including AHI, desaturation index, and minimum SpO₂ showed significant differences between OSA and non-OSA groups (p < 0.001). Conclusion: OSA is highly prevalent among IPF patients and is associated with reduced lung function, oxygenation, and increased cardiovascular comorbidity. Routine OSA screening in IPF patients may facilitate early intervention and improve clinical outcomes.
Research Article
Open Access
Knowledge, Attitude and Practices Regarding Milk Bank among Mothers in the SNCU of A Tertiary Care Center of Odisha
Pusparaj Aditinandan Pradhan,
Gayatri Ray ,
Deshish Kumar Panda,
Asha Prakash Mohapatra,
Duvvada Manasa
Pages 525 - 529
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Abstract
Background: Breastmilk is universally recognized as the optimal source of nutrition for infants, especially in the first six months of life. When maternal breastfeeding is not feasible due to medical or social reasons, donor human milk (DHM) from human milk banks serves as the best alternative. Despite its benefits, awareness and acceptance of milk banking remain limited among mothers of neonates admitted to Special Newborn Care Units (SNCUs). Objective: To assess the knowledge, attitude, and practices (KAP) regarding human milk banking among mothers donating milk at the Comprehensive Lactation Management Centres (CLMCs) of PGIMER and Capital Hospital, Bhubaneswar, Odisha. Methods: A cross-sectional study was conducted from December 2023 to November 2024 among 147 mothers who met the inclusion criteria. Data were collected using a structured, pre-tested questionnaire through one-on-one interviews. Statistical analysis was performed using IBM SPSS V21. Results: Among the 147 participants, 95.4% were unaware of milk banks prior to hospitalization. While 93.1% acknowledged DHM's role in growth recovery, 72.1% were unaware of its superiority over formula when MOM is unavailable. Significant associations were found between knowledge and variables such as employment status (p=0.0009), parity (p=0.0001), and age (p=0.018). Attitude towards donation was significantly influenced by education (p=0.03), while acceptance of DHM was also linked to education (p=0.004). Despite high willingness to donate (73.5%), only 47.6% were willing to accept DHM for their own babies. All mothers practiced safe and hygienic milk expression, with no safety concerns reported. Conclusion: The study highlights substantial gaps in knowledge and acceptance of DHM among mothers, despite positive attitudes towards donation. Targeted awareness campaigns, policy formulation, and integration of milk banking education into maternal care services are essential to bridge the demand-supply gap.
Research Article
Open Access
Comparative Evaluation of Dexmedetomidine and Midazolam as Premedication for Attenuation of Stress Response
Pankaj Ramesh Bhople,
Ashutosh Vijay Jaiswal,
Abhay Ganar
Pages 517 - 524
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Abstract
Background: The surgical stress response involves complex neuroendocrine and hemodynamic alterations that can adversely affect perioperative outcomes. Premedication plays a crucial role in minimizing this stress response. Dexmedetomidine, a selective α2-adrenergic agonist, provides sedation, anxiolysis, analgesia, and sympatholysis without respiratory depression, whereas midazolam, a benzodiazepine, primarily offers anxiolysis and sedation with limited sympatholytic effect. Aim: To compare the efficacy of dexmedetomidine and midazolam as premedication agents in attenuating perioperative stress responses. Methods: A prospective, randomized, double-blind study was conducted on 200 adult patients (n=100 per group) undergoing elective surgeries under general anesthesia. Group D received dexmedetomidine 1 μg/kg IV over 10 min, while Group M received midazolam 0.05 mg/kg IV over 10 min, 15 min before induction. Hemodynamic parameters (HR, MAP), serum cortisol levels, sedation, anxiolysis, and recovery profiles were recorded at predefined intervals. Statistical analysis was performed using t-tests and chi-square tests with p < 0.05 considered significant. Results: Dexmedetomidine significantly attenuated rises in HR and MAP after intubation (p < 0.001) and reduced anesthetic and opioid requirements compared to midazolam. Serum cortisol rise was markedly lower in the dexmedetomidine group (30.1 ± 14.8%) than in the midazolam group (70.2 ± 18.3%, p < 0.0001). Sedation and anxiolysis scores were superior with dexmedetomidine, accompanied by higher patient satisfaction and longer pain-free interval. Incidences of bradycardia and hypotension were minimal and clinically insignificant. Conclusion: Dexmedetomidine is a more effective premedication than midazolam for attenuating perioperative stress responses, providing better hemodynamic stability, hormonal suppression, sedation, and patient satisfaction with acceptable safety.
Research Article
Open Access
Concurrent Reduced Brain FDG Uptake as a Prognostic Marker in Cancer Patients Undergoing Initial 18F-FDG PET/CT: A Prospective Observational Study
Prathap. H J,
Roshni Bhandary ,
Shakti Zerial ,
Rahul A. S,
Arnaaz Maldhar ,
Murahari Revanth Kumar,
. Apoorv Verma ,
Shwetal Pawar ,
Bhoomika Doddamalle Narayanswamy
Pages 510 - 516
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Abstract
Background: Concurrent reduction in cerebral FDG uptake, occasionally observed on staging PET/CT scans, may reflect systemic metabolic competition between the brain and hypermetabolic tumors. This study aimed to explore its prognostic significance in cancer patients undergoing baseline 18F-FDG PET/CT. Materials and Methods: A prospective observational study was conducted in 33 histologically proven cancer patients undergoing initial staging PET/CT. Patients were grouped based on brain SUVmax: Group A (<5), Group B (5–7), and Group C (>7). Quantitative parameters including SUVmax (tumor and brain), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were recorded. Survival outcomes were assessed using Kaplan–Meier curves and log-rank tests. Statistical analyses were performed with SPSS v21.0, with p < 0.05 considered significant. Results: Mean tumor SUVmax (19.59 ± 9.15) significantly exceeded brain SUVmax (7.90 ± 4.11; p = 0.0238). Patients with reduced brain uptake (Group A) demonstrated higher whole-body MTV (773.2 ± 537.9 mL) and TLG (6794.2 ± 3420.8) compared to Groups B and C. Mortality was 100% in Group A, 83.3% in Group B, and 33.3% in Group C (χ² = 11.39, p = 0.003). Though log-rank survival comparison did not reach statistical significance (p = 0.191), the trend indicated shorter survival with lower brain SUVmax. Conclusion: Decreased brain FDG uptake concurrent with high tumoral metabolism on baseline PET/CT correlates with higher metabolic tumor burden and poorer short-term survival. The “cold brain” phenomenon may thus represent a surrogate marker of adverse systemic metabolic status and aggressive disease.
Research Article
Open Access
Assessment of Craniocerebral Trauma Using Computed Tomography: A Clinical and Radiological Study
Devendra Rahangdale ,
Sargar Praful Shantaram,
Devvrat Dubey
Pages 499 - 509
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Abstract
Background: Traumatic Brain Injury (TBI) is a leading cause of mortality and long-term disability worldwide, particularly among young and middle-aged individuals. Rapid diagnosis and prognostication using clinical and radiological parameters are vital for improving patient outcomes. This study aimed to evaluate the clinical presentation, computed tomography (CT) findings, and Glasgow Coma Scale (GCS) scores in patients with TBI, and to assess their correlation with midline shift and outcomes. Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of Radiodiagnosis at Sri Rawatpur Sarkar Institute of Medical Sciences, Naya Raipur 15 months. A total of 100 patients with craniocerebral trauma who underwent CT head imaging were included after obtaining informed consent. Data regarding demographics, clinical features, GCS scores, and CT findings were recorded and analyzed using SPSS version 26. Statistical tests including Chi-square and Pearson’s correlation were applied, with a p-value <0.05 considered significant. Results: The majority of patients were males (80%), with the highest incidence in the 31–50 years age group (51%). Road traffic accidents were the predominant cause of injury (60%), followed by falls (22%) and assaults (13%). The most common CT findings were skull fractures (42%), cerebral edema (38%), and epidural hemorrhage (33%). A strong inverse correlation was observed between GCS scores and midline shift (r = –0.800; p < 0.001). Patients aged ≥60 years and those with severe GCS scores (3–8) had a higher incidence of >5 mm midline shift (p = 0.000). Overall, 70% of patients recovered completely, 16% improved partially, and 14% succumbed to their injuries. Mortality was highest in cases with GCS ≤8, midline shift >5 mm, and diffuse axonal injury. Conclusion: The study highlights the prognostic significance of integrating GCS scoring with CT imaging parameters in the management of TBI. A strong negative correlation between GCS score and midline shift underscores their combined utility in assessing severity and predicting outcomes. Early clinical evaluation and radiological assessment remain essential for guiding timely intervention, improving prognosis, and reducing TBI-related mortality.
Research Article
Open Access
Association of alcohol dependence severity with age of onset and family history
Sagar Kulkarni ,
Aishwarya Reddy ,
Sachin Ghatge
Pages 493 - 498
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Abstract
Background: The age of onset of alcohol use and family history of alcohol dependence, both are seen to influence a person’s risk of becoming alcohol dependent. A study for Indian population regarding the same is warranted. Aim: To determine the association between age of onset/family history and severity of alcohol dependence. Settings and Design: 60 consecutively admitted, 18-60 year-old men with alcohol dependence in a tertiary care institute, were recruited. Materials and methods: Subjects were administered Alcohol Use Detection Inventory Test, Clinical Institute Withdrawal Assessment-Ar, Short Alcohol Dependence Data and Family Interview for Genetic Studies. Family history density was calculated. Statistical Analysis: Microsoft excel-365 and SPSS-29 were used Results: Both family history and age of onset of alcohol use were positively correlated with severity of alcohol dependence. Although the impact of family history was much more significant than that of the age of onset on the severity scores. Conclusion: This study, with enhanced methodology, using a general hospital sample of alcohol dependent subjects concludes that family history of alcohol use is a better predictor of severity of alcoholism, than age of onset of alcohol use alone. Family history of alcohol use may also influence the environment leading a person to initiate alcohol use at a younger age and become severely dependent at much later age.
Research Article
Open Access
Clinicopathological correlation in patients with psoriasis: a cross sectional study from a tertiary centre in North India
Shikha Dubey ,
Vishwa Prakash Tiwari,
Bhavya Dubey
Pages 487 - 492
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Abstract
Background: Psoriasis shows heterogeneous clinical patterns with characteristic histopathology, yet quantified clinicopathological concordance from Indian cohorts remains limited. Objective: To determine correlations between key clinical characteristics (age, sex, site, duration, signs) and histopathological features in psoriasis. Methods: Cross sectional analysis of 50 consecutive, untreated biopsy proven psoriasis cases. Clinical variables recorded: age, sex, dominant site (extensor, flexor, palmar, scalp, erythrodermic), duration (<6, 6–11, 12–24, >24 months), and signs (plaques, silvery scales, Auspitz, grattage). Histopathology (H&E) assessed predefined features: dilated vascular channels, regular acanthosis, hyperkeratosis, parakeratosis, hypogranulosis, Munro microabscesses, spongiform pustules of Kogoj, clubbing of rete ridges, suprapapillary thinning, perivascular mononuclear infiltrate; perilesional changes recorded. Associations tested with χ² (p<0.05). Results: Mean age distribution peaked at 31–40 years (28%); males 64%. Extensor dominance 54%; duration <6 months and >24 months each 32%. Common signs: plaques 94%, silvery scales 80%, Auspitz 80%. Frequent histology: suprapapillary thinning and hypogranulosis (each 92%), dilated vascular channels (90%), hyperkeratosis and Kogoj pustules (each 78%). Perilesional hyperkeratosis 68%, vascular dilatation 44%, acanthosis 32%. Conclusion: Classic histologic features were highly prevalent and broadly aligned with extensor predominant plaque psoriasis. Ready to use correlation templates (site/duration/signs vs histopathology) are provided to quantify clinicopathological agreement for programmatic reporting.
Research Article
Open Access
Study of indicators of outcomes and complications in neonates on mechanical ventilation in a tertiary care hospital
Shashi Vinod ,
Gemini Verma ,
Akash Verma
Pages 480 - 486
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Abstract
Background: Mechanical ventilation is an essential intervention for critically ill neonates with respiratory failure and other life-threatening conditions. It provides temporary support for oxygenation and ventilation while underlying diseases are treated. However, despite being lifesaving, mechanical ventilation is often associated with significant morbidity and mortality due to factors related to the neonate’s maturity, perinatal risk factors, underlying diagnosis, and ventilation-related complications. Identifying these determinants of outcome is crucial to optimize survival and reduce adverse effects in neonatal intensive care units. Methods: This prospective observational study was conducted in the NICU and SNCU of UPUMS Saifai from January 2020 to June 2021. A total of 150 consecutively ventilated neonates were enrolled after parental consent. Demographic, clinical, and perinatal details along with diagnosis, mode of ventilation, extubation status, and complications were recorded. Data were analyzed using SPSS, with p<0.05 considered significant. Results: in this study, the most ventilated neonates were <3 days old (72.0%), male (63.3%), and term (59.3%). Survival was highest with SIMV (84.2%) and lower with AC and PSV (p=0.005). Cyanosis, positive sepsis screen, and failure to extubate were strong predictors of mortality (p≤0.016). Outcomes varied by diagnosis, with best survival in meningitis/sepsis (92.6%) and MAS (83.3%) and lowest in RDS (62.0%) (p=0.034). Complications such as tube block, pneumothorax, and pulmonary hemorrhage were also associated with poor survival (p<0.001). Conclusion: Survival in ventilated neonates was influenced by ventilation mode, diagnosis, sepsis status, extubation success, and complications. Early recognition of risk factors and prevention of complications are key to improving outcomes.
Research Article
Open Access
Outcome of Patients with Critically ILL Cirrhosis by Comparison of Modified QSOFA Score with Apache III Score
Chinthoju Akshay Kumar,
Pralhad Kelavkar ,
Rajesh Khyalappa
Pages 470 - 479
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Abstract
Background: Liver cirrhosis is when fibrotic tissue and regenerating nodules irreversibly replace the liver parenchyma we consider it as liver cirrosis, which is an advanced stage of chronic liver disease. Approximately 8% of patients who are admitted to the hospital with liver cirrhosis die there overall; in patients with decompensated liver cirrhosis, this number increases to 35%. The five-year survival rate for patients with decompensated cirrhosis is about 14%, and for the best care, they frequently need to be sent to an intensive care unit (ICU). Despite improvements in medical technology, the clinical results of cirrhosis patients in the intensive care unit are getting better. However, the mortality rates for cirrhosis patients under ICU management are still high, ranging from 34.7% to 90%. Methodology- Prior to the study's start, written informed consent was acquired from each patient who met the inclusion and exclusion criteria. Lab tests, clinical observations, and pertinent history were documented. The results of the application of MODIFIED QSOFA, APACHE III, and CHILD-PUGH scores were measured and contrasted. Results- A significant positive link was found between the Child Turcotte Pugh score and the result, as indicated by the correlation coefficient of 0.902. The child Turcotte Pugh score odds ratio was 2.464, whereas the AUC value was 0.82 (95% CI: 1.666 to 3.644) (p < 0.001). The Modified QSOFA score showed a substantial positive correlation with the result, as indicated by the correlation coefficient of 1.16. While the AUC value was 0.89 (95% CI: 2.106, 4.833) (p < 0.001), the odds ratio for Modified QSOFA was 3.190, indicating that the probabilities of mortality increased by almost 3.19 times for every unit rise in Modified QSOFA score. patients who were discharged had a mean score of 50.27 with a standard deviation of 17.32. The difference in APACHE III scores between the two groups was statistically significant (P = 1.60 E-14). Conclusion- With the highest sensitivity, specificity, and accuracy, the APACHE III score was found to be the most accurate and trustworthy indicator of outcomes in critically ill cirrhotic patients. Because of its simplicity and excellent association with results, the Modified qSOFA score also turned out to be a useful instrument.
Research Article
Open Access
Morphometric Study of Humerus Segments in Indian Population: Clinical Implications
N. Nagabhushanam ,
Hari Krishna N S,
Chandragirish Shivashankar ,
Pandit Vinodh Bandela
Pages 463 - 469
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Abstract
Background: The humerus, as the longest bone of the upper limb, plays a critical role in orthopedic interventions, particularly for fracture management and reconstruction. Accurate estimation of total humeral length from fragmented segments is essential for preoperative planning, prosthetic fitting, and optimizing surgical outcomes, especially in populations with ethnic-specific morphometric variations. Prior studies have highlighted population differences in humerus dimensions, underscoring the need for contemporary, region-specific data to enhance clinical precision. To determine mean measurements of humerus segments in a contemporary Indian population, compare them with prior studies, and develop regression equations for estimating total humeral length from fragments, with a focus on clinical applications in orthopedic fracture management and reconstruction. Methods: One hundred adult dry humeri (52 left, 48 right; sex-aggregated) from an Indian bone archive were measured using an osteometric board and digital caliper. Five segments were assessed: humeral head to greater tuberosity (HA), head to surgical neck (HB), proximal to distal olecranon fossa (HC), distal olecranon fossa to trochlea (HD), and proximal olecranon fossa to proximal trochlea (HE); plus maximum length (HL). Means and standard deviations were calculated. Pearson correlations and simple linear regressions (p < 0.05) were performed separately by side using SPSS v27.0. Results: Mean HL was 299.6 ± 2.3 mm (left) and 310.1 ± 2.9 mm (right). Segment means (mm): HA 5.5 ± 1.3 (left)/6.0 ± 1.0 (right); HB 37.5 ± 1.9/37.2 ± 2.2; HC 18.9 ± 1.7/19.9 ± 1.9; HD 17.2 ± 1.5/17.4 ± 1.7; HE 35.8 ± 2.2/36.8 ± 2.0. Significant correlations (r, p < 0.05) were found for left HB (0.333, 0.017), HC (0.403, 0.003), HD (0.429, 0.002), HE (0.307, 0.028); right HB (0.449, 0.001). Regression formulas: e.g., left HL = 289.34 + 0.55(HC); right HL = 287.84 + 0.6(HB). Conclusion: Indian humerus segments show population-specific variations (generally lower than Turkish norms), enabling reliable HL estimation from proximal/distal fragments. These data support preoperative planning for humerus fractures, optimizing implant placement and reconstruction in clinical orthopedics. Sex-disaggregated studies are recommended for enhanced precision.
Research Article
Open Access
Clinicopathological study of ocular adnexal lesions: A Prospective study
Nancy Sharma ,
Manpreet kour ,
Malvika Sharma
Pages 459 - 462
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Abstract
Background: The most common primary eyelid malignancy is basal cell carcinoma (BCC), squamous cell carcinoma (SqCC), sebaceous gland carcinoma (SGC), malignant melanoma, and Merkel cell carcinoma. Eyelid carcinoma is the most common malignant lesion of eyelid region, and may involve either skin or tarus or inner layer of eyelid. The prevalence of these malignant lesion vary according to the geographical region. The aim of the study was to correlate the diagnosis of various ocular adnexal lesions with the histological diagnosis. Methods: This prospective study conducted over a period of 18 months in patients with ocular adnexal skin lesions. All the patients underwent incision biopsy of the lesion biopsy material was sent for histopathology examination. The histological profile of the tumour was confirmed by the report. Results: The mean age in our study was 32.7±18.4 years with age range of 18 to 78 years, with 73 females (56%) and 57 males (43.8%). 111 (85.3%) were benign lesions and 19 (14.6%) were malignant lesions. Right eye was involved in more cases (n=68, 52.3%) as compared to left eye (n=62, 47.6%). Upper eye lid was involved more (n=66, 50.7%) than lower eye lid (n=64, 49.2%). Epidermal cyst was most common lesion (n=29, 22.3%), followed by dermoid cyst (n=17, 13.7%). Sebaceous gland carcinoma was most (n=10, 7.6%) malignant lesion, followed by basal cell carcinoma (n=5, 3.8%). Conclusions: All excised eyelid lesions must be submitted for histopathologic confirmation to achieve 100% accuracy in diagnosis and treatment. Early diagnosis remains essential for adequate functional and cosmetic lid reconstruction.
Research Article
Open Access
A Study Evaluating the Effectiveness of Multimodal Pain Management in Reducing Postoperative Pain and Accelerating Recovery after Cardiac Surgery
. Vivek Rawat ,
Vipin Sisodia ,
. Mahesh Narendra Jain
Pages 453 - 458
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Research Article
Open Access
MRI evaluation of symptomatic pelvic floor weakness in females
Sneha Rathod ,
Sudhanva DJ
Pages 445 - 452
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Abstract
Background: Pelvic floor weakness in females is a common and multifactorial condition leading to prolapse, urinary and fecal incontinence, and impaired quality of life. Conventional clinical examination often underestimates the extent and compartmental involvement of the dysfunction. Magnetic Resonance Imaging (MRI) provides a detailed, multiplanar, and dynamic assessment of the pelvic floor anatomy and its functional integrity. Aim: To evaluate the causes, imaging characteristics, and dynamic MRI findings of symptomatic pelvic floor weakness in females. Methods: This cross-sectional observational study was conducted among 50 symptomatic female patients referred for MRI evaluation of pelvic floor dysfunction. Detailed clinical history including parity, BMI, prior hysterectomy, constipation, and urinary symptoms was recorded. MRI was performed using T2-weighted static and dynamic sequences at rest and during straining. Parameters such as descent of pelvic organs relative to the pubococcygeal line (PCL), H-line and M-line measurements, and anorectal angle were analyzed. Statistical comparisons between subgroups were performed using Welch’s t, χ², and ANOVA tests with 95% confidence intervals. Results: MRI detected prolapse in 36 (72%) patients, predominantly involving the anterior (62%) and middle (58%) compartments. Age and BMI were significantly higher in the prolapse group (p < 0.01), and multiparity showed strong association (p = 0.017). Levator ani avulsion (66.7%) and endopelvic fascial tears (58.3%) were frequent in severe prolapse. Dynamic MRI revealed significant increases in H-line (+1.2 cm), M-line (+1.6 cm), and anorectal angle (+18.2°) during strain (p < 0.001). Rectal descent (62%) and cystocele (54%) were the most common findings. Conclusion: MRI effectively identifies the anatomical and functional abnormalities underlying pelvic floor weakness, quantifies the degree of organ descent, and characterizes muscular and fascial injuries with high precision. It should be considered an essential diagnostic adjunct in evaluating symptomatic females and in guiding individualized surgical management.
Research Article
Open Access
Clinical Profile, Etiology, and Surgical Outcomes of Urogynecologic Fistulae: A Prospective Observational Study from a Tertiary Centre in South India
Harish D. Khade,
G. Manohar ,
Aditya J Mise
Pages 435 - 444
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Abstract
Background: Urogynecologic fistulae (UGF) represent one of the most devastating yet preventable morbidities affecting women in low- and middle-income countries. They arise predominantly from obstructed labor and iatrogenic injuries during gynecologic or obstetric procedures, causing continuous urinary leakage and profound psychosocial distress. Despite advances in surgical repair, the epidemiologic shift from obstetric to iatrogenic causes necessitates contemporary regional data. Materials and Methods: A prospective observational study was conducted in the Department of Urology, Government General Hospital, Guntur, between January 2023 and January 2025. Thirty consecutive female patients with clinically and radiologically confirmed UGF were evaluated. Data on demographics, antecedent events, fistula characteristics, operative techniques, postoperative complications, and short-term outcomes were analyzed using SPSS version 26. Surgical approaches included vaginal flap repair, abdominal O’Connor repair, ureteric reimplantation, and stenting where indicated. Outcomes assessed were fistula closure, continence, and recurrence at six months. Results: The mean patient age was 38.6 years; 63.3 % were aged 30–49 years. Vesicovaginal fistula constituted 86.7 % of cases, ureterovaginal 10 %, and combined 3.3 %. Etiologies included obstructed labor (33.3 %), lower-segment cesarean section (23.3 %), hysterectomy (23.3 %), and radiotherapy (10 %). O’Connor repair was performed in 46.7 % and vaginal flap repair in 30 %. The overall success rate was 93.3 %, with urinary tract infection as the commonest complication (26.7 %). Conclusions: Urogynecologic fistula continues to reflect gaps in obstetric and surgical safety. Standardized procedures such as O’Connor and vaginal flap repairs provide excellent closure and continence outcomes. Strengthening intrapartum care and prompt referral remain essential for prevention and improved quality of life.
Research Article
Open Access
Emphysematous Pyelonephritis – Reappraisal of Prognostic Factors, Analysis of Outcomes with Minimally Invasive Treatments, and Long-Term Renal Outcomes
Aditya J. Mise,
G. Manohar ,
Harish D. Khade
Pages 426 - 434
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Abstract
Background: Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing infection of the kidney, strongly associated with diabetes mellitus and characterized by gas within the renal parenchyma and surrounding tissues. Advances in imaging and minimally invasive therapies have improved outcomes, but prognostic factors remain incompletely defined. Objective: To analyze clinical, biochemical, and radiological prognostic factors, assess treatment strategies, and evaluate renal outcomes in patients with EPN. Methods: A prospective observational study was conducted at Government General Hospital, Guntur, from September 2023 to July 2025. Forty-two patients diagnosed with EPN were evaluated. Clinical features, risk factors, biochemical parameters, CT findings, and microbiology were documented. Patients underwent stepwise management—conservative, minimally invasive (DJ stenting ± PCN/PCD), or extensive surgery. Outcomes at discharge and 6 months were classified as renal salvage with preserved function, impairment, dialysis dependence, nephrectomy survival, or death. Results: Mean age was 52 years; 83% were female. Diabetes was present in 95%. Fever (90.5%), flank pain (76.2%), and vomiting (71.4%) were the commonest symptoms. E. coli (54.8%) was the predominant isolate. On CT, Class II (38.1%) was most frequent; advanced disease (Class III B/IV) comprised 26.2%. Minimally invasive therapy was the mainstay; only 14.3% required nephrectomy. At follow-up, 73.8% achieved renal salvage with preserved function, while mortality was 4.8%. Prognostic factors significantly associated with poor outcomes were altered sensorium, dialysis requirement, hypoalbuminemia, thrombocytopenia, and higher CT class. Conclusion: Stepwise minimally invasive therapy achieves high renal salvage even in select high-grade EPN. Prognosis depends more on systemic clinical and biochemical factors than baseline risk factors. Early recognition and risk-stratified intervention remain key to optimizing survival and renal preservation.
Research Article
Open Access
Early Diagnostic Value of Biochemical and Hematological Parameters in Hepatitis C Virus Infection
A Mrudula Srinivasulu,
Jaswanth Kumar Papineni,
B Sheshu Kumar
Pages 416 - 425
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Abstract
Background: Hepatitis C virus (HCV) infection remains a significant global health burden, particularly in low- and middle-income countries where access to molecular diagnostics is limited. Although nucleic acid testing (NAT) remains the gold standard for diagnosis, its high cost restricts widespread application. Identifying routine biochemical and hematological parameters that can serve as early predictive markers could substantially improve detection and management in resource-limited settings. Aim: To evaluate the diagnostic potential of commonly available biochemical and hematological parameters as early predictive biomarkers of HCV infection among high-risk adults in a tertiary-care hospital. Methods: A hospital-based case–control study was conducted involving 300 participants divided into three groups: Group A (diabetes mellitus with HCV; n=100), Group B (diabetes mellitus only; n=100), and Group C (healthy controls; n=100). Venous blood samples were analyzed for hepatic enzymes (SGOT, SGPT, ALP, LDH), bilirubin fractions, iron and ferritin, glycemic indices, and inflammatory markers (CRP, ESR). Hematological indices (NLR, PLR, HPR) were derived from complete blood counts. Statistical analysis employed t-test, correlation analysis, and receiver-operating characteristic (ROC) curves to assess diagnostic performance, with p<0.05 considered significant. Results: Patients with concurrent diabetes and HCV infection exhibited significantly higher mean levels of CRP (18.9 ± 13.8 mg/L), Ferritin (185.3 ± 96.7 µg/L), LDH (472 ± 149 U/L), and Direct Bilirubin (0.48 ± 0.29 mg/dL) than diabetes-only and control groups (p<0.001). ROC analysis identified CRP (AUC = 0.89), Ferritin (AUC = 0.87), LDH (AUC = 0.84), and Direct Bilirubin (AUC = 0.82) as the most powerful discriminators of HCV infection among diabetics. Strong positive correlations were observed between HbA1c and CRP (r = 0.52), CRP and Ferritin (r = 0.59), and LDH and Bilirubin (r = 0.48), indicating interlinked inflammatory and hepatic injury pathways. Conclusion: Routine laboratory parameters—particularly CRP, Ferritin, LDH, and Direct Bilirubin—demonstrate high diagnostic accuracy and strong inter-correlation in identifying diabetic patients with concurrent HCV infection. These markers can serve as cost-effective, non-invasive screening tools, bridging the diagnostic gap where molecular testing is unavailable. Their integration into primary evaluation protocols can facilitate earlier diagnosis, prompt antiviral initiation, and improved disease surveillance within the WHO’s 2024–2025 global hepatitis elimination framework.
Research Article
Open Access
Interrelationship of Inflammatory and Biochemical Markers in Diabetic Patients with Urinary Tract Infection
Jaswanth Kumar Papineni,
A Mrudula Srinivasulu,
B Sheshu Kumar
Pages 405 - 415
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Abstract
Background: Urinary tract infections (UTIs) are among the most frequent bacterial infections worldwide, with a notably higher incidence in individuals with diabetes mellitus. Chronic hyperglycemia causes glycosuria and impairs immune defense mechanisms, fostering bacterial colonization and recurrent infections. Diabetic microangiopathy and renal impairment further aggravate susceptibility and delay recovery. Aim: To evaluate the relationship between inflammatory and biochemical parameters in patients with diabetes mellitus and urinary tract infections (UTIs), and to determine how the duration and control of diabetes influence renal function, infection recurrence, and pathogen distribution. Methods: A retrospective–prospective observational study was conducted on 120 diabetic patients (60 males, 60 females; aged 18–95 years) between July 2024 and July 2025. Data included biochemical indices (glucose, HbA1c, urea, creatinine, proteinuria), inflammatory markers (CRP, ESR, leukocyte count), and urine culture profiles. Statistical analyses were performed using descriptive measures and Pearson correlation tests, with p < 0.05 considered significant. Results: Older adults (≥ 65 years) constituted 42.5% of participants. Mean HbA1c was 9.9 ± 2.5%, indicating poor glycemic control in over 70% of patients. Renal markers (urea, creatinine, proteinuria) showed a positive correlation with diabetes duration (r = 0.41–0.47, p < 0.01). Inflammatory markers were significantly higher in culture-positive cases (CRP = 58.2 mg/L vs 22.6 mg/L; p < 0.01). Escherichia coli was the predominant pathogen (30%), followed by Enterococcus faecalis and Candida albicans. Recurrence rates rose with increasing HbA1c and CRP levels, confirming that uncontrolled glycemia and systemic inflammation promote reinfection. Conclusion: UTIs in diabetic patients are closely linked to poor glycemic control, prolonged disease duration, and renal dysfunction. E. coli remains the principal pathogen, and recurrent infections are common. Regular urine cultures, strict glycemic regulation, renal monitoring, and culture-guided antimicrobial therapy are essential to prevent recurrence and preserve kidney function.
Research Article
Open Access
Prevalence and Clinical Profile of Osteoarthritis Knee among Patients Attending the Orthopedics Outpatient Department at a Tertiary Care Hospital
Ramya Teja ,
Praveen Vidya Sagar Bandi,
Avinash Rathod
Pages 399 - 404
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Abstract
Background: Osteoarthritis (OA) of the knee is one of the most prevalent musculoskeletal disorders causing chronic pain and functional limitation among adults, particularly in the aging population. This study aimed to assess the prevalence and clinical profile of knee OA among patients attending the orthopaedic outpatient clinic. Methods: A cross-sectional study was conducted among 150 patients clinically diagnosed with knee OA. Data on demographic parameters, risk factors, clinical symptoms, radiographic grading (Kellgren–Lawrence), and functional disability (WOMAC score) were collected and analyzed using descriptive statistics. Associations between radiological severity and clinical variables were examined using the chi-square test, with p < 0.05 considered significant. Results: The overall prevalence of knee OA among orthopaedic outpatients was 27.3%. The mean age of participants was 57.8 ± 8.9 years, with the majority aged 51–60 years (42%). Females (64%) were more commonly affected than males (36%). The leading risk factors were obesity (56%), hypertension (44%), and diabetes mellitus (32%); 60% of women were postmenopausal. Pain on activity (100%), stiffness (78%), and crepitus (65%) were the predominant symptoms. Bilateral involvement was seen in 68% of patients. Grade II (46%) was the most frequent radiological stage, and moderate disability (58%) was the commonest functional category. Radiological severity correlated significantly with age, BMI, and symptom duration (p < 0.05). Conclusion: Knee osteoarthritis is highly prevalent, particularly among postmenopausal women and obese individuals. Early identification of modifiable risk factors and lifestyle interventions can help delay disease progression and improve quality of life.
Research Article
Open Access
Clinical Profile and Functional Outcome of Distal Radius Fractures Managed Conservatively: A Prospective Observational Study
Avinash Rathod ,
Praveen Vidya Sagar Bandi,
Poloju Sathish Kumar
Pages 393 - 398
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Abstract
Background: Distal radius fractures are among the most common upper limb injuries, particularly in middle-aged and elderly individuals. Conservative management remains a preferred approach in stable and minimally displaced fractures. This study aimed to evaluate the clinical profile and functional outcome of distal radius fractures treated conservatively. Methods: A prospective observational study was conducted on 50 patients with distal radius fractures managed conservatively at a tertiary care hospital. All patients were evaluated clinically and radiologically at presentation and followed up for 12 weeks. Fractures were classified according to the AO system. Functional outcome was assessed using the Gartland and Werley demerit scoring system, and range of motion was measured with a goniometer. Data were analyzed descriptively and presented as frequencies, percentages, and mean ± standard deviation. Results: The majority of patients were aged 41–50 years (28%) and over 50 years (36%), with males comprising 64% of cases. The right wrist (58%) and fall on outstretched hand (68%) were the predominant patterns of involvement. AO type A2 fractures (32%) were most frequent, and 84% of patients had no associated injuries. At 12 weeks, functional outcome was excellent in 44%, good in 36%, fair in 16%, and poor in 4%, with a mean Gartland and Werley score of 6.4 ± 4.1. Complications included wrist stiffness (12%), residual deformity (10%), and malunion (6%). The mean wrist flexion and extension were 65° ± 12° and 60° ± 14°, respectively, and mean grip strength reached 82% ± 10% of the contralateral side. Conclusion: Conservative management of distal radius fractures results in favorable functional outcomes with minimal complications when proper reduction and immobilization are achieved. Regular follow-up and early mobilization play a vital role in optimizing recovery.
Research Article
Open Access
Targeting the PD-1/PD-L1 Axis on Solid Cancer for Cancer Treatment: A Review on Nanotechnology
Thanadar Ajmiree Flora,
Thanadar Tamjeeda Tapu
Pages 381 - 392
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Abstract
Background: The emergence of immune checkpoint inhibitors has revolutionized cancer treatment, particularly through the targeting of the PD-1/PD-L1 axis, which plays a crucial role in the regulation of immune responses. This review explores the potential of nanotechnology in overcoming existing barriers in solid tumor immunotherapy, focusing on innovative approaches to optimize PD-1/PD-L1 blockade. Methods: This study employs a systematic and methodical approach to review the potential of nanotechnology in targeting the PD-1/PD-L1 axis for the treatment of solid tumors. The results synthesize findings from 20 studies on nanoparticle-mediated PD-L1 inhibition in cancer immunotherapy, focusing on the roles of nanoparticles in tumor regression and size reduction. The study employs a narrative literature review methodology. By synthesizing and critically analyzing the published research, the review aims to offer a comprehensive understanding of how nanotechnology has been applied to modulate the PD-1/PD-L1 axis in solid tumors. Results: The review indicates that nanoparticles play a crucial role in cancer treatment, with 85% of studies showing tumor regression through effective delivery of PD-L1 inhibitors. Tumor size reduction was observed in 75% of studies, while 50% explored combination therapies that enhance outcomes. Additionally, 15% investigated dual immune checkpoint blockade, boosting immune responses in aggressive cancers. Finally, 90% of studies demonstrated that nanoparticles stimulate durable immune responses alongside tumor shrinkage, improving overall survival rates. Conclusion: The study highlights nanoparticles as a versatile platform in cancer immunotherapy, effectively promoting tumor regression, enhancing PD-L1 inhibitor bioavailability, and supporting combination therapies. Their targeted delivery minimizes systemic toxicity and optimizes immune activation, emphasizing their significant potential to advance treatment outcomes across various cancer types.
Research Article
Open Access
A Comparative Study of Wound Healing and Complications with the Use of 1-0 VICRYL vs. 1-0 Prolene for Rectus Closure
Athar Mohd Atharuddin,
Neda faraz ,
Arshiya Fatima
Pages 372 - 380
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Abstract
Background: Surgery and sutures are inseparable. Down the ages, newer and more efficacious suture materials and techniques have been introduced. Among all wound closures, abdominal wound closure is the most challenging task for a surgeon. There are different techniques according to suture material, suturing technique and length of suture material that have been suggested optimal for rectus closure. These prospects are still under study and are controversial. This study was to compare the efficacy of vicryl and prolene for rectus closure by studying the wound healing and complication rates (wound infection, wound dehiscence, burst abdomen etc). Materials and Methods: The present prospective comparative study was conducted on patients admitted for surgeries in the Department of General surgery, Deccan College Of Medical Sciences, Hyderabad. for a period of 18 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. During present study total 50 patients meeting inclusion criteria were enrolled into the study. Results and observations: There was no statistical difference between the groups in terms of age (p: 0.1358); gender (p: 1.131); diabetic status (p: 1.1532); BMI (p: 1.1611); type of surgery (p: 0.8321); duration of surgery (p: 0.8321); intra operative hypotension prevalence (p: 0.1352); type of incisions (p: 1.3521); type of surgical site infections (p: 0.06). The incidence of burst abdomen (p: 0.01) was high in group B, day of burst abdomen incidence (p: 0.02), incidence of surgical site infections high in group B (p: 0.01); rate of wound healing was slow in group B (p: 0.001) Conclusion: From the present study we conclude that non-absorbable suture (prolene) was better in terms of wound healing and cosmesis as compared to absorbable suture used (vicryl) taking into consideration the points: wound dehiscence, burst abdomen incidence, surgical site infections incidence was higher in group B comparatively. Group B subjects had a slower rate of wound healing comparatively.
Case Series
Open Access
Multisystem inflammatory syndrome of neonates: a post-COVID complication?
Mohammad Fahad Mohiuddin,
Ahlaam Arif ,
Fatima Nasir ,
Syed Mohammed Nusrath Qurram,
Mohd Muthiuddin Muzammil
Pages 365 - 371
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Abstract
Background: We describe three infants around 1 month old who presented with similar complaints of high-grade fever and gastrointestinal symptoms. They were investigated for COVID 19 suspecting multisystem inflammatory syndrome in children (MIS-C). The inflammatory markers were reviewed and elevated D-Dimer, S ferritin, lactate dehydrogenase and C-reactive protein indicated the possible diagnosis of MIS-C. Intravenous immunoglobulin and steroids were given and they showed remarkable improvements and were discharged. This report supports the possibility of post COVID MIS-C through vertical transmission of Covid-19.
Research Article
Open Access
Predictive Role of Uterine Artery Doppler, Serum Papp-A, Β-HCG, And Mean Arterial Pressure In Early Detection Of Preeclampsia: A Prospective Observational Study
Rejeesh S Ravi,
Sonalica Suresh ,
Kalpana G ,
Noori Khalid
Pages 358 - 364
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Abstract
Background: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Early prediction and timely intervention are essential to reduce adverse outcomes. Uterine artery Doppler, serum pregnancy-associated plasma protein-A (PAPP-A), β-human chorionic gonadotropin (β-hCG), and mean arterial pressure (MAP) have been proposed as early predictors of preeclampsia. Aim: To evaluate the predictive role of uterine artery Doppler, serum PAPP-A, β-hCG, and mean arterial pressure in early detection of preeclampsia. Methods: A prospective observational study was conducted on 400 pregnant women recruited in the first trimester. Maternal history, mean arterial pressure, uterine artery Doppler indices, and serum levels of PAPP-A and β-hCG were assessed. Participants were followed until delivery for development of preeclampsia. Statistical analyses included mean comparisons, ROC curve analysis, sensitivity, specificity, and predictive values. Results: Preeclampsia developed in 28 women (7.0%). Compared with normotensive women, those with preeclampsia had significantly higher first-trimester MAP (87.9 ± 4.04 vs. 84.22 ± 5.28 mmHg, p<0.001) and uterine artery PI in both trimesters, and significantly lower PAPP-A (1.01 ± 0.29 vs. 1.59 ± 0.50 MoM, p<0.001) and β-hCG (1.66 ± 0.56 vs. 2.58 ± 0.92 MoM, p<0.001). ROC analysis showed the best predictive performance for first-trimester uterine artery PI >1.745 (AUC 0.94, sensitivity 85.7%, specificity 89.0%). PAPP-A <1.085 MoM (AUC 0.90) also demonstrated strong predictive value. Aspirin prophylaxis in high-risk women showed a trend toward reducing early-onset preeclampsia. Conclusion: First-trimester uterine artery Doppler and PAPP-A are highly reliable predictors of preeclampsia, with MAP and β-hCG providing additional support. Early risk stratification enables timely prophylactic interventions such as aspirin, potentially mitigating disease severity.
Review Article
Open Access
Impact of Preoperative Chest Imaging On Predicting Anaesthesia-Related Pulmonary Complications: A Systematic Review
Prateek Singh ,
Seema ,
Abhinav Dagar ,
Swati Arya ,
Nidhi Dahiya ,
Kajal
Pages 354 - 357
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Abstract
Background: Postoperative pulmonary complications (PPCs) are among the most frequent causes of perioperative morbidity and mortality. Whether preoperative chest imaging adds predictive value for such complications remains uncertain. Methods: We performed a systematic review in accordance with PRISMA 2020 guidelines. PubMed and guideline repositories were searched through October 3, 2025, to identify studies assessing preoperative chest radiography (CXR), computed tomography (CT), or lung ultrasound (LUS) as predictors of PPCs in adult surgical patients. Outcomes of interest included pneumonia, atelectasis, respiratory failure, bronchospasm, and aspiration. Results: Thirty-two studies met the inclusion criteria. Routine preoperative CXR demonstrated abnormalities in 2.5–37% of patients but influenced perioperative management in ≤2% and showed no independent predictive value for PPCs after adjustment for clinical risk indices. CT offered incremental prognostic information mainly in thoracic surgical patients or those with significant underlying pulmonary disease (COPD, interstitial lung disease). LUS was feasible as a bedside tool, with one multicenter study reporting modest discrimination (AUROC ≈0.65), though evidence remains limited. Across studies, validated clinical risk models (e.g., ARISCAT) consistently outperformed imaging for risk stratification.
Conclusions: Routine preoperative chest imaging does not reliably predict PPCs and should not be used indiscriminately. Selective use of imaging is warranted in symptomatic patients, those with abnormal examination findings, or specific high-risk surgical contexts. Clinical risk indices remain the cornerstone for perioperative pulmonary risk prediction.
Research Article
Open Access
Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvant to Hyperbaric Bupivacaine in Orthopedic Lower-Limb Surgeries: A Double-Blind Randomized Control Study
Shraddha Patil ,
Varsha Ramesh Kalkani,
Phalguni R P,
Sushma K S,
Madhuri S Kurdi
Pages 345 - 353
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Abstract
Background: Majority of orthopedic lower-limb surgeries are performed under spinal anaesthesia. Various adjuvants are used in concert with local anaesthetics to extend intraoperative and postoperative analgesia. Dexmedetomidine, an alpha-2 adrenergic agonist, is increasingly being used as a neuraxial adjuvant. Aims: To compare the efficacy of Dexmedetomidine and Fentanyl as adjuvant to hyperbaric Bupivacaine in orthopedic lower-limb surgeries. Materials and Methods: Sixty-four patients undergoing elective orthopedic lower-limb surgeries were randomly allocated to two groups (32 each), after fulfilling inclusion criteria. Via intrathecal approach, the patients received 2.5ml Hyperbaric Bupivacaine 0.5% plus 5 µg Dexmedetomidine (D group), 25 µg Fentanyl (F group) respectively. Block characters, side effects and hemodynamic variables were compared. Results: Patients in group D had significantly longer sensory and motor blockade than in group F. Group D showed faster onset time for highest sensory level and Bromage 3 motor block. The mean time of two segment sensory regression was 143±15mins in group D compared to 86±9mins in group F (p<0.01). The group D showed prolonged time for sensory regression to S1, regression of motor block to Bromage 0 and delayed requirement of rescue analgesia. Conclusion: Dexmedetomidine, used as an adjuvant to hyperbaric Bupivacaine for spinal anaesthesia in orthopedic lower-limb surgeries, as compared to Fentanyl, provides longer duration of sensory and motor blockade with longer postoperative analgesia.
Research Article
Open Access
Prevalence of Myopia in School-Aged Children: A Cross-Sectional Study in Different Educational Settings
Doula Maruti Thengil,
Sachin Sundarrao Pandhare,
Sharad Sanjay Jadhav
Pages 338 - 344
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Abstract
Background: Myopia has become a significant public health issue worldwide, particularly among school-aged children. Educational setting, lifestyle habits, and environmental exposure have been increasingly recognized as influencing factors in the development of myopia. Aim: To determine the prevalence of myopia among school-aged children across different educational settings and identify associated demographic and behavioral risk factors. Methods: A cross-sectional study was conducted among 500 students aged 6-16 years enrolled in government, private, and semi-urban schools. Visual acuity was assessed using Snellen’s chart, and refractive error was determined through objective and subjective refraction. Myopia was defined as a spherical equivalent of ≤ -0.50 D. Data on screen time, near work, outdoor activities, and parental myopia were collected using structured questionnaires. Statistical analysis included Chi-square tests, t-tests, and multivariate logistic regression using SPSS version 26.0, with significance set at p<0.05. Results: The overall prevalence of myopia was 23.6% (95% CI 20.1-27.5). Prevalence was highest in private schools (33.5%), followed by semi-urban (21.1%) and government schools (16.8%) (χ²=13.89, p=0.0077). Myopic children had significantly greater screen time (3.30 ± 1.00 h/day) and near work duration (3.40 ± 1.20 h/day) but less outdoor activity (1.10 ± 0.60 h/day; p<0.001). Parental myopia showed a strong association-children with one or both myopic parents had 1.9-fold and 4.1-fold higher odds, respectively. Multivariate analysis identified screen time, reduced outdoor activity, near work, parental myopia, and private-school attendance as independent predictors of myopia. Conclusion: The study highlights a substantial prevalence of myopia among school-aged children, with educational setting, behavioral patterns, and family history playing major roles. Preventive strategies emphasizing outdoor activities, screen-time regulation, and early vision screening should be integrated into school health programs to curb the rising trend of myopia in children.
Research Article
Open Access
Comparative Analysis of Visual Acuity Outcomes in Cataract Surgery: Phacoemulsification vs. Manual Small Incision Cataract Surgery
Doula Maruti Thengil,
Sachin Sundarrao Pandhare,
Sharad Sanjay Jadhav
Pages 331 - 337
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Abstract
Background: Cataract remains the leading cause of reversible blindness globally. With the evolution of surgical techniques, both phacoemulsification and manual small incision cataract surgery (MSICS) are widely practiced, but their comparative effectiveness in visual outcomes continues to be evaluated, particularly in resource-limited settings. Aim: To compare the visual acuity outcomes in cataract surgery performed by phacoemulsification and MSICS. Methods: This prospective comparative study was conducted on 250 patients (125 in each group) at a tertiary-care hospital. All patients underwent detailed preoperative evaluation and were operated on under standard aseptic precautions. Postoperative assessments of uncorrected (UCVA) and best-corrected visual acuity (BCVA) were performed on day 1, week 1, and one month. Intraoperative and postoperative complications were also recorded. Statistical analyses included Welch’s t-test, chi-square test, and 95% confidence intervals, with p < 0.05 considered significant. Results: The mean postoperative UCVA at one month was significantly better in the phaco group (0.18 ± 0.12 LogMAR) compared to the MSICS group (0.26 ± 0.15 LogMAR, p < 0.001). The mean BCVA at one month was similar between groups (0.06 ± 0.08 vs. 0.08 ± 0.09 LogMAR, p = 0.064). Early postoperative UCVA and BCVA were significantly better in the phacoemulsification group, reflecting faster visual rehabilitation. The overall complication rates were low and not statistically different between the two groups. Conclusion: Phacoemulsification offers superior early postoperative uncorrected visual outcomes and faster recovery, while MSICS provides comparable final best-corrected visual acuity with similar safety. Both techniques are effective, and the selection should be guided by resource availability, patient affordability, and surgeon expertise.
Research Article
Open Access
Comparative Efficacy of Intrathecal Bupivacaine with Pethidine vs. Fentanyl for Postoperative Analgesia after Herniorrhaphy: A Randomized Double-Blinded Study
Ankit ,
Anumeha Jain ,
Vikram A. Singh,
Sampat G Rathod
Pages 326 - 330
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Abstract
Background: Effective postoperative pain control following herniorrhaphy is fundamental to patient satisfaction and early mobilization. This study aims to compare the analgesic efficacy, block characteristics, and safety profile of intrathecal pethidine versus fentanyl as adjuvants to bupivacaine. Methods: This prospective, randomized, double-blind study included 72 ASA physical status I-II adult patients scheduled for elective herniorrhaphy. Patients were randomly allocated to receive either 2.5 mL of 0.5% hyperbaric bupivacaine (12.5 mg) with 0.5 mL of pethidine (25 mg) (Group B+P, n=36) or 2.5 mL of 0.5% hyperbaric bupivacaine (12.5 mg) with 0.5 mL of fentanyl (25 mcg) (Group B+F, n=36). The primary outcome measures were the duration of effective postoperative analgesia and the onset and duration of sensory and motor blockade. Secondary outcomes included hemodynamic stability, incidence of intraoperative adverse events, and postoperative pain scores assessed by the Visual Analogue Scale (VAS). Statistical analysis was performed using independent t-tests and chi-square tests, with a significance level set at p<0.05. Results: Demographic profiles were comparable between the two groups. The duration of effective analgesia was significantly longer in Group B+F (288.19 ± 73.23 min) compared to Group B+P (240.44 ± 21.20 min, p=0.002). The durations of sensory block (273.17 ± 61.38 min vs. 234.33 ± 33.27 min, p=0.001) and motor block (228.39 ± 42.25 min vs. 195.0 ± 11.62 min, p<0.001) were also significantly prolonged in the fentanyl group. Postoperative VAS scores were significantly lower in Group B+F. The incidence of intraoperative hypotension was markedly higher in Group B+P (52.8%) compared to Group B+F (5.6%; p<0.001). Other adverse effects were minimal and comparable in both groups. Conclusion: The addition of 25 mcg of fentanyl to intrathecal bupivacaine provides superior postoperative analgesia, longer sensory and motor block durations, and a more stable hemodynamic profile compared to 25 mg of pethidine. This combination is a preferable choice for optimizing patient outcomes in herniorrhaphy.
Research Article
Open Access
Diagnostic Utility of Pleural Fluid Neopterin Levels in Differentiating Tuberculous from Malignant Pleural Effusions: A Cross-sectional Study
Nazia N Siddiqua,
Ramesh K Kumar,
Noor M. Jahan
Pages 318 - 325
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Abstract
Background: Pleural effusions present significant diagnostic challenges, particularly in distinguishing tuberculous from malignant etiologies. Neopterin, a biomarker of cellular immune activation, may provide diagnostic utility in this clinical scenario. Objectives: To evaluate the diagnostic efficacy of pleural fluid neopterin levels in differentiating tuberculous pleural effusions (TPE) from malignant pleural effusions (MPE) compared to adenosine deaminase (ADA). Methods: A cross-sectional observational study was conducted at Government General and Chest Hospital, Hyderabad, India, from December 2015 to November 2017. Eighty patients with moderate to massive pleural effusions underwent comprehensive evaluation including pleural fluid neopterin and ADA measurement using ELISA and colorimetric methods, respectively. Results: Among 80 patients (75% male, mean age 49.6±15.2 years), tuberculosis was the predominant etiology (63.8%), followed by malignancy (33.8%). Mean pleural fluid neopterin levels were significantly elevated in tuberculous effusions compared to malignant effusions (7.92±7.40 vs 4.48±1.60 nmol/L, p<0.05). Similarly, ADA levels were higher in tuberculous effusions (82.65±49.25 vs 56.07±47.47 IU/L, p<0.05). Neopterin demonstrated 70.0% sensitivity and 48.1% specificity at a cut-off of 4.3 nmol/L, while ADA showed 73.5% sensitivity and 59.3% specificity at 54.0 IU/L. The area under the ROC curve for neopterin was 0.629 (95% CI: 0.501-0.756). Conclusions:
Pleural fluid neopterin levels are significantly elevated in tuberculous pleural effusions compared to malignant effusions, providing comparable diagnostic utility to ADA. However, its moderate specificity limits standalone diagnostic application, suggesting potential utility as an adjunctive biomarker in pleural fluid analysis.
Research Article
Open Access
Efficacy of Erector Spinae Plane Block with Port Site Infiltration on Analgesia and Opioid Consumption after Laparoscopic Cholecystectomy
Milan Sutariya ,
Anumeha Jain ,
Manish Gupta
Pages 313 - 317
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Research Article
Open Access
Assessment of Psychiatric Morbidity and Quality Of Life in Women with Polycystic Ovary Syndrome: A Comparative Observational Study
Dhruv K. Chaudhary,
Mahesh Suthar ,
Laukik N Darji
Pages 307 - 312
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Abstract
Background: Objectives: To assess the prevalence and severity of depression and anxiety in women with PCOS and compare the quality of life between women with PCOS and age-matched healthy controls. Materials and Methods: A comparative observational study was conducted on 180 women aged 18–45 years, comprising 90 PCOS cases diagnosed using Rotterdam 2004 criteria and 90 age-matched controls without PCOS. Psychological morbidity was screened using the GHQ-28 and confirmed by DSM-5 criteria. Depression and anxiety severity were assessed using the HAM-D and HAM-A scales, respectively. Quality of life was evaluated using the WHOQOL-BREF instrument. Data were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Results: PCOS participants had significantly higher rates of GHQ positivity (44.4% vs. 21.1%), depression (25.6% vs. 10.0%), and anxiety (16.7% vs. 5.6%) compared to controls (p < 0.05 for all). Depression was mainly mild to moderate, and anxiety was mild in over half of the affected cases. Hirsutism and infertility were notably associated with psychological morbidity. WHOQOL-BREF scores showed significantly lower scores in the psychological and social domains among PCOS cases (p = 0.043 and p = 0.003, respectively), indicating poorer emotional and interpersonal well-being. Conclusion: Women with PCOS are at a higher risk of psychiatric morbidity, particularly depression and anxiety, which adversely affect their quality of life. Routine psychological assessment and mental health support should be integral to PCOS management to ensure comprehensive care.
Research Article
Open Access
Comparative studies of adhesion formation after OBGYN surgery vs general abdominal surgeries
Anuradha ,
Sameer Gupta ,
Gaurav Mishra
Pages 302 - 306
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Abstract
Background: Postoperative complications Adhesion formation is among the most frequent adverse events following the obstetric, gynecologic (OBGYN) and general abdominal surgery, and it has a significant negative effect on morbidity, surgical outcomes, and healthcare expenses. Adhesions are known to cause chronic pain in the pelvis, infertility, bowel obstruction and repeat surgeries that are difficult to carry out. The study will be used to compare incidence, severity and clinical outcomes of adhesions between these groups of surgery. Methods: A retrospective cohort study was carried out with 120 individuals having either OBGYN surgeries (hysterectomies, ovarian cystectomies, tubal ligations, endometriosis surgeries) or general abdominal surgeries (endometriosis surgeries, appendectomies, cholecystectomies, hernia repair surgeries, and bowel resections) between 2020 and 2023. Follow-up evaluation of adhesion was done in terms of clinical symptoms, imaging, and laparoscopy. Adhesions were classified according to clinical effects and were mild, moderate or severe. Findings: 60% of the OBGYN patients and 80 percent of the general abdominal surgery patients exhibited adhesion formation (greater percentage of mild adhesions in the latter). The adhesions were more severe in case of OBGYN operation (30%) than in general abdominal surgeries (26.7%). The complications associated with adhesion included bowel obstruction, chronic pain, and infertility in 36.7-percent of OBGYN patients and 56.7-percent of those in the abdominal group and infertility, respectively. The mean length of stay in the hospital among the OBGYN patients (4-7 days) was higher than the general abdominal surgery patients (3-5 days). Multivariate analysis revealed that surgical complexity, as well as handling of tissues, was a key risk factor. Conclusion: Adhesion formation is a serious postoperative issue of both OBGYN and general abdominal surgeries with more serious complications in the latter, especially those that interfere with reproductive health. The results show that to decrease adhesion morbidity among such patients, better preventive strategies, cautious surgeon practices and better planning of management are required.
Case Series
Open Access
Reconstructing the Oncologic Perineum: A Case Series on Gracilis Myocutaneous Flap Outcomes
Deepak Singh Panwar,
Vinod Sharma ,
Kamal Kishor Lakhera,
Suresh Singh ,
Pinakin Patel
Pages 295 - 301
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Abstract
Background: Perineal defects following malignant tumor resection present significant reconstructive challenges, especially in previously irradiated fields. While free tissue transfers and local advancement flaps have their established roles, the gracilis myocutaneous flap offers a unique set of advantages like proximity, versatility, and reliability as it has a robust blood supply and relatively straightforward surgical technique. We report our institutional experience over four years. Materials and Methods: In this retrospective analysis, demographic and disease profiles of 20 patients with perineal defects were reconstructed with a gracilis flap between January 2021 and January 2025. Data included demographics, diagnosis, defect size, prior radiotherapy, flap details, complications, and follow-up. Complications and functional outcomes were analyzed. Results: Twenty patients underwent gracilis flap reconstruction. Mean patient age was 49.95 years (range: 34–65), with a female predominance (55%). Vulvar squamous cell carcinoma was the most common indication (40%), followed by rectal adenocarcinoma (30%). Defects ranged from 7×5 cm (35 cm²) to 24×8 cm (192 cm²), mean ~83.55 cm²; 70% had prior radiotherapy. Flap survival rate was 95%. Donor site complications occurred in 25% (seroma 15%, infection 10%), and recipient site complications in 40% (partial necrosis 20%, wound dehiscence 10%, recurrence 5%, complete flap loss 5%). One complete flap loss required salvage with a gluteal flap. All surviving flaps were healthy at last follow up with minimal donor site morbidity. Conclusion: This case series provides valuable insights into the successful use of the gracilis myocutaneous flap for perineum defects following malignant tumor resection. The documented complications are minimal in comparison to the overall positive outcomes, making the gracilis myocutaneous flap a viable and reliable option for reconstruction in this specific clinical scenario.
Case Report
Open Access
Oncocytic Variant of Mucoepidermoid Carcinoma Parotid – A Surgical Case Report
Avinash Kumar ,
Garima Sinha ,
Mansi Sharma ,
Sonal Srivastava ,
Kavya Acharya
Pages 291 - 294
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Abstract
Background: Oncocytic changes in salivary glands can be seen in Warthins, Pleomorphic adenoma, and Acinic cell carcinoma. Mucoepidermoid carcinoma rarely show significant oncocytic changes and oncocytic variant of mucoepidermoid carcinoma is very rare. In my case preoperative diagnosis on FNAC was mucoepidermoid carcinoma. Only on histology tumour showed predominantly oncocytic cells in a background of goblet and mucus secreting cells.
Mucoepidermoid carcinoma (MEC) formed by three principle cell types which are mucinous, squamous and intermediate cells. MEC can also be classified into high grade (fast growing) and low grade (slow growing) salivary gland tumour. MEC is the most common type of salivary gland cancer most commonly seen in parotid and uncommon in submandibular or minor salivary glands. They are usually low grade but they can also be intermediate or high grade. Low grade tumours rarely metastasise. MEC accounts for 50 percent of all parotid malignancies. Female preponderance with mean 45 years presentation is most commonly seen. Clinical behaviour of mucoepidermoid carcinoma ranges from indolent to rapid with metastatic spread. Oncocytic variant of mucoepidermoid carcinoma is very rare .Here we report a case of 28 year old male with right side parotid swelling since last 2 years.
Research Article
Open Access
Systematic Review of Microbiological Profile and Treatment Outcomes in Pediatric Osteoarticular Infections
Pooja Singh ,
Lalit Pratap Singh,
Manish Kumar
Pages 282 - 290
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Abstract
Background: Osteoarticular infections (OAIs), encompassing osteomyelitis and septic arthritis, are major causes of morbidity in the pediatric population. Despite improvements in diagnostic imaging and antibiotic therapy, these infections continue to pose clinical challenges due to delayed diagnosis, emerging antimicrobial resistance, and evolving microbial patterns. This systematic review aimed to analyze the microbiological spectrum, antimicrobial resistance trends, and treatment outcomes of pediatric OAIs reported over the past 15 years. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches were performed in PubMed, Scopus, and Web of Science databases for studies published between January 2010 and June 2025. Eligible studies included patients under 18 years with confirmed osteomyelitis, septic arthritis, or combined osteoarticular infection, reporting data on microbiological etiology, antibiotic susceptibility, and treatment outcomes. Data were extracted on causative organisms, antimicrobial sensitivity, empirical regimens, surgical interventions, and clinical outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Results: Thirty-seven studies comprising a total of 7,846 pediatric patients were included. Staphylococcus aureus was the predominant pathogen (62.4%), with methicillin-resistant S. aureus (MRSA) accounting for 22.7% of isolates. Kingella kingae was the second most common organism (14.5%), particularly in children under five years, identified mainly through molecular methods. Gram-negative bacilli, including Pseudomonas aeruginosa and Escherichia coli, represented 8.9% of cases. MRSA isolates showed high susceptibility to vancomycin and linezolid, while K. kingae remained uniformly sensitive to β-lactams. The mean duration of intravenous antibiotic therapy ranged from 10 to 14 days, followed by 3 to 6 weeks of oral therapy. Surgical intervention was required in 48% of patients. Overall, 91.3% achieved complete recovery, while 8.7% developed complications such as growth disturbances, chronic osteomyelitis, or residual joint stiffness. Conclusion: Staphylococcus aureus remains the leading cause of pediatric osteoarticular infections, though Kingella kingae and resistant organisms are increasingly recognized. Early diagnosis, pathogen-directed antimicrobial therapy, and timely surgical management are key to achieving favorable outcomes. Standardization of diagnostic protocols, regular surveillance of antimicrobial resistance, and incorporation of molecular diagnostics are essential to optimize future management strategies.
Research Article
Open Access
Bagodi B, Rathod SS, Reddy K. A comparative study of intrathecal nalbuphine with intrathecal buprenorphine as an adjuvant to intrathecal bupivacaine for postoperative analgesia in lower abdominal surgeries.
Bhagyashree Bagodi ,
Sneha S Rathod,
Kailash Reddy
Pages 271 - 281
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Abstract
Background: To compare intrathecal Nalbuphine with intrathecal Buprenorphine as an adjuvant to intrathecal Bupivacaine for postoperative analgesia in patients of lower abdominal surgeries and to assess hemodynamic parameters and adverse effects associated with the intrathecal nalbuphine and intrathecal buprenorphine. Material And Methods: 100 patients belonging to ASA physical status I & II of both sexes aged 18-45years scheduled for elective lower abdominal surgeries randomly received hyperbaric bupivacaine 0.5% 3 ml (group B, n = 50) with buprenorphine 60 micrograms, or hyperbaric bupivacaine 0.5% 3 ml (group N, n = 50) with nalbuphine 0.8mg. The time of onset of sensory and motor block, hemodynamic status, duration of analgesia, visual analogue score and adverse effects if any were compared between both the groups. Results: The time of onset of sensory block, motor block and Hemodynamic changes did not differ in patients of either group (p >0.05). The mean time for Effective analgesia (VAS 0-3) was 297.14 ±75.46 min in group N as compared to 379.8 ± 95.2 min in group B. This was statistically and clinically significant in this study (P<0.0001). The mean duration of requirement of first rescue analgesia in Group N 342.2±39.72 and Group B 418.9±40.43 showed statistically significant difference (P<0.0001), this has highlighted the fact that Group B had prolonged post-operative analgesia. Conclusion: Intrathecal Buprenorphine 60μg when compared to intrathecal Nalbuphine 0.8 mg causes prolonged duration of postoperative analgesia.
Research Article
Open Access
Clinical Profile and Outcome of Patients on Mechanical Ventilation in Pediatric Intensive Care Unit (PICU) In a Tertiary Care Centre
Nallapaneni Sai Lakshmi,
Nelavoi Narendra ,
Ramesh Nidiganti ,
Manohar Badur ,
Rajashaker Venkatappa
Pages 267 - 270
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Abstract
Background: Mechanical ventilation is a life-saving intervention in paediatric intensive care but is associated with significant morbidity and mortality. Objective: To assess the clinical profile, complications, and outcomes of children admitted to a tertiary care PICU and treated with mechanical ventilation. Methods: A prospective study was conducted in the PICU of SVRR Government General Hospital, Tirupati, including 157 children aged 1 month–12 years who required mechanical ventilation. Data on demographics, etiology, intubation details, complications, and outcomes were analysed using SP Results: Infants comprised the majority (56.7%). The commonest indication for intubation was respiratory failure (26.1%), followed by circulatory dysfunction (12.7%). Complications occurred in 12% of cases, with ventilator-associated pneumonia being most common (10.8%). Mortality was 69.4%, significantly higher among infants (p=0.042) and males (p=0.015). Conclusions: Mortality among ventilated children remains high, especially in infants and those with respiratory causes. Early recognition, improved weaning practices, and strict infection control could improve outcomes.
Research Article
Open Access
Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery
G Beesanna ,
P Haricharan ,
S Chaitanya Vani,
Praneeth
Pages 262 - 266
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Abstract
Background: The Tubercle of Zuckerkandl (ZT), is described as a posterior extension of the lateral lobe that consists solely of thyroid tissue. Its significance was highlighted by Pelizzo in the 1980s, who identified ZT as a key anatomical landmark for the safe identification of the recurrent laryngeal nerve (RLN). However, there is limited data from prospective studies focusing on cancer cases and analyzing in situ thyroid specimens. Aim: The study aimed to identify the incidence of ZT and its relationship with the RLN during the surgical dissection of thyroid gland lobes among patients at a tertiary-care center. Methodology: It is a prospective observational study conducted among 110 patients undergoing thyroidectomy from February 2024- February 2025. The same team documented the findings to maintain uniformity, noting the presence of ZT, it’s grade in relation to the lobe and relationship with RLN. Results: ZT was identified in 86% (95 out of 110) of cases. ZKT was found posterior to the RLN in 95.45% cases and anterior to the nerve in 1.8% cases and lateral in 2.78% cases. The relationship between recurrent laryngeal nerve and ITA was studied. Thus, ZT is an important landmark for identification of RLN during thyroidectomy.
Research Article
Open Access
Effect of a 10-Week Tailored Lifestyle Intervention on Anthropometric Outcomes among Indian Women with Polycystic Ovary Syndrome Attending a Tertiary Care Outpatient Clinic
Harshita Bhakat ,
Bhakti Kharate
Pages 254 - 261
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Abstract
Background: Lifestyle modification is central to managing non-communicable diseases, including Polycystic Ovary Syndrome (PCOS), yet its adoption remains limited. Most existing studies emphasize fertility, with a paucity of research in Indian settings, further hindering adaptation. This study evaluates tailored lifestyle intervention effects on anthropometric parameters in Indian women with PCOS. Objective: To evaluate the effect of a 10-week structured, individualized lifestyle intervention compared to no intervention, on anthropometric parameters in women with PCOS. Methods: This prospective interventional study enrolled 60 women aged 18–40 years with PCOS, alternately allocated to a modification group (n=30) receiving a 10-week individualized diet plan, progressive exercise programme and behavioural support, or an observation group (n=30) receiving no intervention. Primary endpoints included changes in weight, BMI, waist and hip circumference, and waist-hip ratio (WHR). Data were analyzed using paired t-tests, ANOVA, and Wilcoxon tests. Results: The intervention group showed significant reductions in weight (64.10 to 60.03 kg, p<0.001), BMI (26.24 to 24.58 kg/m², p<0.001), and WHR (0.86 to 0.84, p<0.001) and slight decline in waist and hip circumferences, while the observation group experienced significant weight and BMI increases and slight increase in waist and hip circumferences. Discussion: A short, multi-component, culturally appropriate lifestyle programme produced clinically and statistically significant reductions in overall and central adiposity in women with PCOS, likely via improved energy balance and insulin sensitivity. Conclusion: Tailored lifestyle interventions should be prioritized in clinical practice to reduce obesity-related morbidity and improve metabolic health in Indian women with PCOS.
Case Report
Open Access
A Rare Variant of Schatzker Type II Tibial Plateau Fracture Managed by Pin Leverage Technique: A Case Report
Adimulam Nagarjuna ,
P. Bala Krishna Kanth,
Raja Tarun Nekkalapudi,
Takkallapalli Dushyanth Rao
Pages 246 - 253
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Abstract
Background: Schatzker type II tibial plateau fractures with posterolateral depression present technical challenges for reduction and fixation. Traditional elevation through a medial metaphyseal window may be difficult in such orientations. This report describes a minimally invasive percutaneous pin leverage technique for elevation of the depressed fragment. Case Presentation: A 52-year-old female sustained a left tibial plateau fracture after a domestic fall. Initial conservative management failed to identify an intra-articular fragment. Radiographs showed a posterolateral split-depression fracture (Schatzker II). Through a small lateral incision, a 4 mm Steinmann pin was inserted and leveraged under fluoroscopy to elevate the depressed surface, followed by fixation with cancellous screws. Post-operatively, the knee was immobilized in a hinged brace with non-weight bearing for 12 weeks. Gradual motion began at 4 weeks. At 12 months, the patient achieved pain-free full weight bearing, knee motion 0–120°, and stable alignment. Discussion: The pin leverage technique allows controlled reduction without creating a metaphyseal window or requiring bone grafting. It is best suited for isolated lateral plateau depressions with a single large posterior or central fragment and is not recommended for comminuted or osteoporotic fractures. In conclusion, percutaneous pin leverage offers a simple, safe, and effective alternative for selected Schatzker II fractures, achieving good reduction and functional recovery with minimal soft-tissue trauma.
Review Article
Open Access
Literature Review on Antipsychotic-Induced Hyperprolactinemia
Nivedhya. J ,
Mervin. K Soman
Pages 243 - 245
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Abstract
Background: Antipsychotic-induced hyperprolactinemia (AIH) is one of the most prevalent endocrine adverse effects of antipsychotic therapy. It results mainly from dopamine D2 receptor blockade in the tuberoinfundibular pathway, leading to disinhibition of prolactin release from the anterior pituitary.
While often overlooked, AIH carries significant short- and long-term clinical consequences. This review summarizes the current literature on the epidemiology, pathophysiology, clinical implications, diagnostic strategies, and evidence-based management of AIH.
Case Series
Open Access
Is it the time for meticulous assessment of patients with breast cancer during chemotherapy to prevent drug induced interstitial lung disease
Suranjan Maitra ,
Avishek Das ,
Pabitra Das ,
Amitabha Manna ,
Aloke Ghosh Dastidar
Pages 235 - 242
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Abstract
Background: The usage of different pharmaceutical agents to treat diseases, including malignancies, often leads to various pulmonary complications, such as interstitial pneumonitis. With the increasing incidence of malignancies and the advent of new chemotherapeutic and immunological therapies, it is crucial for oncologists to quickly identify these complications to initiate appropriate interventions, so that the morbidity and mortality associated with these conditions can be reduced in due time. In the current standard of care, Taxanes and Trastuzumab are chemotherapeutic agents which are very commonly used to treat breast cancers. We present a case series of eight patients who experienced pulmonary toxicity after receiving docetaxel, with or without trastuzumab. Although existing literature reports cases that progress to respiratory failure and require intubation, our patients showed favourable outcomes with conservative supportive care. May be, routine pulmonary checks during the chemotherapy in due treatment course of breast cancers is a need of the moment. A large-scale study is warranted for the development of a guideline to cater such complications.
Research Article
Open Access
Cadaveric Morphometry of the Left Coronary Artery: Anatomical Insights for Clinical and Surgical Applications
Bhavya P ,
D Srivani ,
Prathibha K ,
C. Sreekanth
Pages 230 - 234
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Abstract
Background: Detailed knowledge of coronary arterial anatomy is crucial for interpreting angiographic findings and planning revascularization procedures and understanding the pattern of atherosclerotic involvement. Population-based morphometric variations of the left coronary artery (LCA) can influence both diagnostic and surgical outcomes, yet regional data remain limited. Objectives: To analyze the morphometric features and branching patterns of the left coronary artery in adult human cadaveric hearts and to assess their relevance to clinical practice. Materials and Methods: The present study was conducted on 53 formalin-fixed human hearts obtained from the Department of Anatomy, SVIMS–SPMC(W), Tirupati Results: In the present study, the mean length and standard deviation of the LCA is 15.92 ± 4.24, the mean outer diameter & standard deviation of the LCA is 4.52 ± 0.76. The mean length and standard deviation of the LAD is 105.17 ± 25.68, the mean outer diameter and standard deviation of LAD is 3.54 ± 0.63, whereas the mean length and standard deviation of CA is 53.77 ± 14.46, the mean outer diameter and standard deviation of CA is 2.86 ± 0.63 are observed. Conclusions: The present study highlights the morphometric variability of the LCA and its branches, thus emphasizing its clinical relevance.
Research Article
Open Access
Cross-Sectional Study of the Efficacy of Metformin Versus Lifestyle Modifications in Managing Gestational Diabetes
N S Prasanthi Singitham,
D Bhargava
Pages 222 - 229
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Abstract
Background: Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder of pregnancy associated with increased maternal and neonatal morbidity. The optimal management strategy, especially in low-resource settings, remains debated. This study aimed to compare the efficacy, safety, and patient satisfaction between metformin therapy and lifestyle modification in achieving glycemic control among women with GDM. Methods: A cross-sectional comparative study was conducted among 140 pregnant women diagnosed with GDM between 24 and 34 weeks of gestation. Participants were divided equally into two groups: metformin therapy (n=70) and lifestyle modification (n=70). Fasting and postprandial glucose levels, time to achieve glycemic targets, HbA1c at 34–36 weeks, maternal and fetal outcomes, and patient satisfaction were assessed. Statistical analysis included Welch’s t-test and Chi-square test, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between both groups. Metformin achieved significantly better glycemic control, with lower fasting (88.6 ± 8.9 vs 92.4 ± 9.7 mg/dL; p = 0.016) and postprandial glucose levels (112.7 ± 12.6 vs 118.9 ± 13.4 mg/dL; p = 0.005), and shorter time to achieve targets (9.8 ± 4.1 vs 13.2 ± 5.0 days; p < 0.001). HbA1c at 34–36 weeks was lower in the metformin group (5.54 ± 0.33 vs 5.68 ± 0.36; p = 0.016). Fewer women on metformin required rescue insulin (15.7% vs 30.0%; p = 0.044). Maternal and neonatal outcomes—including preeclampsia, cesarean delivery, neonatal hypoglycemia, and NICU admissions—were comparable. Treatment satisfaction was significantly higher in the metformin group (p = 0.006), with better adherence and tolerability. Conclusion: Metformin provides superior glycemic control with good maternal and neonatal safety, minimal side effects, and higher patient satisfaction compared to lifestyle modification alone. It represents an effective and practical oral alternative for GDM management, especially in populations where adherence to lifestyle therapy or insulin administration is limited.
Research Article
Open Access
Morphometric Analysis of the Proximal Humerus and its Neurological Implications in a Karnataka Population
Chandrakala S.P ,
Prajna K ,
Nagashree M. V,
Pandit Vinodh Bandela
Pages 215 - 221
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Abstract
Background: The proximal humerus is a critical site for neuromuscular control and is traversed by the axillary nerve and posterior circumflex humeral artery. Precise morphometry of this region is essential to understand the vulnerability of these structures during trauma and surgical interventions. This study aimed to quantify key parameters of the proximal humerus in a Karnataka population and elucidate their direct neurological significance. Methods: A descriptive cross-sectional study was conducted on 108 dry, adult human humeri (60 right, 48 left) sourced from anatomy departments of medical colleges in Chamarajanagar and Bangalore, Karnataka. Measurements were taken using a digital vernier caliper (0.01 mm precision). Key parameters included the distance from the apex of the greater tubercle to the surgical neck, the vertical and transverse diameters of the surgical neck, and the distance from the superior head to the inferomedial surgical neck. Data were analyzed using SPSS version 25. Results: The mean distance from the greater tubercle apex to the surgical neck was 25.4 ± 2.1 mm (right) and 25.8 ± 1.9 mm (left). The vertical diameter of the surgical neck was 40.2 ± 3.3 mm (right) and 39.7 ± 3.6 mm (left). The transverse diameter was 28.5 ± 2.4 mm (right) and 28.9 ± 2.2 mm (left). The critical neurovascular path, measured as the distance from the superior head to the inferomedial surgical neck, was 61.5 ± 4.8 mm (right) and 60.9 ± 5.1 mm (left). No significant bilateral differences were observed (p > 0.05). Conclusion: This study provides precise morphometric data for the proximal humerus, defining a "safe zone" of approximately 25-26 mm from the greater tubercle where the axillary nerve is most vulnerable. These population-specific measurements from Karnataka are crucial for minimizing iatrogenic nerve injury during shoulder arthroscopy, open reduction of proximal humerus fractures, and during surgical approaches to the shoulder, thereby improving patient safety and surgical outcomes.
Research Article
Open Access
Evaluation of the Raja Isteri Pengiran Anak Saleha (RIPASA) and Modified Alvarado Scoring Systems for Acute Appendicitis Diagnosis
Arpan Kumar Patel,
Y. Mutheeswaraiah ,
M.C. Narendra ,
Addepalli Naga Sowmya,
Raja Mani. K,
M Nagarjuna
Pages 205 - 214
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Abstract
Background: Acute appendicitis is the predominant aetiology of an acute abdomen necessitating surgical intervention, with a lifetime risk of approximately 7%. The associated symptoms and signs have become a paradigm for clinical teaching. In this study, we were validating the sensitivity, specificity, and clinical accuracy of the RIPASA scoring system compared to the modified Alvarado scoring system in the diagnosis of acute appendicitis, and their specificity, sensitivity, positive predictive value, and negative predictive value in relation to the ultrasound abdomen, pelvis, and also to the histopathology report. Methodology: This is a Prospective study conducted in the Department of General Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, during the year 2021-2022. Patients presenting with clinical suspicion of acute appendicitis were screened for inclusion in the study. All adult patients (18 years or older) with a clinical suspicion of acute appendicitis were included in the study. Patients under 18 and over 60, pregnant women, and those with diffuse abdominal discomfort, appendicular abscesses/masses, or diagnostically inconclusive acute appendicitis based on clinical examination and abdominal ultrasound were excluded. Results: The RIPASA score outperforms the modified Alvarado score in sensitivity (93% vs 89%), negative predictive value (50% vs 41%), and diagnostic accuracy (91% vs 88%). It is also nearly comparable to MASS in terms of PPV (96% vs 98%). Conclusion: The parameters in the RIPASA scoring system can be easily and quickly determined with a brief clinical history and examination, and a few laboratory investigations (leukocyte count, Urinalysis). The RIPASA score is currently a more effective diagnostic system than the others among the Indian population, which can be easily obtained using simple clinical and laboratory data, without the need for expensive imaging studies such as a CT scan.
Case Series
Open Access
Clinical Presentation and Laboratory Profile of Paediatric Chronic Myeloid Leukaemia: Insights from a series of five cases
Anugrah Joshi ,
Kashish Aggarwal ,
Vandana Bhatti
Pages 201 - 204
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Abstract
Background: Chronic myeloid leukaemia (CML) is rare in children, accounting for only a small proportion of paediatric leukaemia. Compared to adults, paediatric CML often presents with higher leukocyte counts, splenomegaly, and a more aggressive course. Lifelong tyrosine kinase inhibitor (TKI) therapy also poses unique challenges in this age group due to growth and long-term toxicity concerns. Reporting such cases adds to the understanding of disease behaviour in children. We present a series of five paediatric patients (age range: 10–16 years) diagnosed with CML. There was male preponderance with M:F ratio of 2:1. The most common presenting complaints included fever (2/5, 40%), generalized weakness (2/5, 40%) and weight loss (1/5, 20%). Splenomegaly was noted in three out of five cases (60%) and hepatomegaly was noted in four out of five cases (80%), while one patient had no organomegaly. In all five cases, Complete blood counts (CBC) revealed leucocytosis with > 3,00000/cu.mm in four out five patients (80%) along with left-shifted myeloid series, and peripheral smear findings were consistent with CML in all patients (5/5, 100%). Bone marrow aspiration and trephine biopsy in all patients showed hypercellularity with myeloid predominance, blast count <5%, and the presence of dwarf megakaryocytes. Molecular analysis confirmed BCR-ABL fusion positivity in all cases (100%). This case series highlights the clinical, haematological, and molecular features of paediatric CML in our setting, underscoring the rarity of the disease and the need for tailored management strategies distinct from adult CML.
Research Article
Open Access
Assessment of In-Patient’s Satisfaction and Determinants of Hospital Service Quality in a Tertiary Care Hospital of Punjab, India
Gautam Adhakari ,
Harshpreet Singh ,
Gurkirat Singh ,
Varun Malhotra
Pages 192 - 200
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Abstract
Background: Patient satisfaction serves as a key indicator of healthcare quality and reflects the overall efficiency, empathy, and responsiveness of hospital services. Measuring satisfaction among in-patients provides critical insight into the strengths and weaknesses of healthcare delivery, particularly in tertiary hospitals catering to mixed rural and urban populations. This study assessed satisfaction levels among in-patients at Adesh Hospital, Bathinda, and identified areas influencing dissatisfaction. Materials and Methods: A descriptive cross-sectional study was conducted among 130 in-patients admitted to various wards of Adesh Hospital, Bathinda, Punjab. Participants aged 18 years and above who had completed at least 24 hours of hospital stay were included. Data were collected using a validated, semi-structured questionnaire through face-to-face interviews after obtaining informed consent. The questionnaire covered socio-demographic details and satisfaction across clinical, administrative, infrastructural, and ancillary domains. Data were compiled and analyzed using Microsoft Excel and summarized as frequencies and percentages. Results: The majority of respondents were aged 31–40 years (40.8%), male (66.9%), and from rural areas (60%). Most participants expressed high satisfaction with hospital services. Cleanliness (93.1%), payment (96.2%), and security (95.4%) services were rated very good. Clinical care by doctors (83.8%) and nurses (81.5%) received high ratings, indicating strong interpersonal and professional quality. Diagnostic and pharmacy services also performed well, with 90.8% satisfaction in pharmacy, 90.0% in laboratory, and 87.7% in radiology services. Among infrastructural facilities, lighting (89.2%) and washroom (70.8%) services were satisfactory, while linen (64.6%) and lift (56.9%) required improvement. Hospitality domains showed moderate satisfaction—dietary (67.7%), canteen (66.9%), parking (72.3%), and night-stay facilities for attendants (50%)—indicating gaps in comfort and accessibility. Overall, over 85% of respondents reported being satisfied with the hospital’s healthcare delivery and administrative efficiency. Conclusion: The study revealed a high overall level of in-patient satisfaction, particularly with medical care, cleanliness, and administrative services, reflecting effective patient-centered practices at Adesh Hospital. However, improvements in non-clinical amenities such as dietary services, parking, and attendant facilities are recommended to further enhance patient experience and institutional performance.
Research Article
Open Access
Prevalence of Celiac Disease In Patients With Type 1 Diabetes Mellitus: A Cross Sectional Study From North West Rajasthan
Veer Bahadur Singh,
Mool Chand Suthar,
Rakesh Kumar ,
Babu Lal Meena,
Ravi Dutt ,
Saranshi Singh ,
Saransh Singh ,
Abhishek Kawatra
Pages 186 - 191
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Abstract
Background: Celiac disease CD) and Type 1 Diabetes Mellitus T1DM) frequently co-occur due to shared genetic susceptibility, particularly HLA DQ2 and HLA DQ8 alleles. While global studies report CD prevalence of 2 11% in T1DM patients, regional data from North West Rajasthan remains limited. Objective: To determine the prevalence of celiac disease in patients with Type 1 Diabetes Mellitus and assess associated clinical and demographic factors in North West Rajasthan. Methods: A cross-sectional study was conducted at S.P. Medical College, Bikaner, from February to July 2025. One hundred T1DM patients were screened using anti-tissue transglutaminase (tTG) IgA antibodies. Patients with positive serology (10 U/mL) underwent upper gastrointestinal endoscopy with duodenal biopsy for histological confirmation using Marsh-Oberhuber classification. Results: Biopsy-confirmed celiac disease was diagnosed in 12 patients (12.0% prevalence). Female patients showed significantly higher prevalence than males 22.7% vs 3.6%, p=0.009, representing a 6.3-fold increased risk. Iron-deficiency anemia was the most discriminating clinical feature 83.3% vs 10.2%, OR 43.89, p<0.001 . All CD patients had villous atrophy (Marsh 3a-3c), with Marsh 3a being most common (41.7%). TTG IgA testing demonstrated perfect diagnostic performance (100% sensitivity and specificity). Family history of celiac disease was strongly associated with CD diagnosis 66.7% vs 0%, p<0.001. Peak prevalence occurred in patients with 11-20 years of diabetes duration 22.7- 25.0%. Conclusion: North West Rajasthan demonstrates high celiac disease prevalence (12%) in T1DM patients, comparable to other high-prevalence regions globally. The pronounced female predominance, atypical presentations dominated by iron-deficiency anemia, and strong genetic clustering support implementation of routine screening protocols. TTG IgA testing provides excellent diagnostic accuracy for this population. Early detection through systematic screening is essential to prevent long-term complications and optimize patient outcomes.
Research Article
Open Access
Prevalence and Clinical Profile of Thyroid Dysfunction in Type 1 Diabetes Mellitus: A Cross Sectional Study from North West Rajasthan, India
Veer Bahadur Singh,
Rahul Goyal ,
Rakesh Kumar ,
Babu Lal Meena,
Ravi Dutt ,
Saranshi Singh ,
Saransh Singh ,
Abhishek Kawatra
Pages 180 - 185
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Abstract
Background: Type 1 diabetes mellitus (T1DM) is strongly associated with autoimmune thyroid disease (AITD), yet comprehensive Indian data remain limited.
Objective: To determine the prevalence and clinical spectrum of thyroid dysfunction in T1DM patients from North West Rajasthan and identify demographic correlates. Methods: Cross-sectional study of 100 T1DM patients aged 15 45 years. Thyroid function TSH, FT4, auto antibodies (anti-TPO, anti-TG) and clinical parameters were assessed. Statistical analysis included chi-square tests and ANOVA. Results: Overall thyroid dysfunction prevalence was 29% and 95% CI 20.8-38.6%, with subclinical hypothyroidism predominating at 16%. No female predominance was observed (males 30.6% vs females 27.5%, p=0.898). Age showed significant association with thyroid dysfunction (p=0.048), particularly overt hypothyroidism (mean age 38.9 ±6.1 years) vs 28.4 ±8.4 years for subclinical, p<0.05. Diabetes duration showed no correlation with dysfunction prevalence. Thyroid antibody positivity was 37%, with both antibodies positive showing highest dysfunction rate (40%). Conclusions: Thyroid dysfunction affects nearly one-third of T1DM patients in this region, with unique epidemiological patterns including absence of female predominance. Age-based screening appears more relevant than duration-based approaches. These findings have important implications for screening protocols in Indian T1DM populations.
Research Article
Open Access
Association between Serum Ferritin and Duration of Type 2 Diabetes Mellitus: A Cross-Sectional Study
Veer Bahadur Singh,
Shivananda Sonavane ,
Rakesh Kumar ,
Babu Lal Meena,
Saranshi Singh ,
Saransh Singh ,
Arjun Rao Gandra,
Abhishek Kawatra
Pages 173 - 179
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Abstract
Background: Iron metabolism dysregulation has emerged as a potential contributor to diabetes progression, but the relationship between serum ferritin levels and diabetes duration remains poorly characterized, particularly in South Asian populations. Objective: To evaluate the association between serum ferritin levels and duration of Type 2 diabetes mellitus (T2DM) and identify clinically actionable ferritin thresholds for risk stratification. Methods: This cross-sectional study included 100 patients with established T2DM from a tertiary care center in North West India. Participants were stratified into three duration-based groups: 5 years (n=35), 5-10 years (n=38), and 10 years (n=27). Serum ferritin was measured using enzyme-linked immunosorbent assay, fasting plasma glucose using glucose oxidase method, and glycated hemoglobin using high-performance liquid chromatography. Statistical analyses included correlation assessment, multiple regression modeling, and threshold analysis. Results: Mean ferritin levels increased progressively across duration groups: 137.7 ±15.8 ng/mL(5 years), 155.5 ± 16.0 ng/mL(5-10 years), and 190.6 ± 25.1 ng/mL (10 years) P= 0.001. A very strong positive correlation was observed between ferritin and diabetes duration (r=0.8429, P = 0.001), representing the strongest association reported in the literature to date. Ferritin levels correlated significantly with fasting glucose (r=0.7616, P =0.001) and HbA1c (r=0.8105, P=0.001). Multiple regression analysis identified diabetes duration as the only independent predictor of ferritin levels (β =4.63 ng/mL per year, R² =0.72 . Using 160 ng/mL as threshold, patients with elevated ferritin had significantly higher rates of poor glycemic control compared to those with lower levels 66% vs 14%, P =0.001 . This threshold demonstrated 82.5% sensitivity and 71.7% specificity for predicting poor glycemic control. Conclusions: Serum ferritin demonstrates a robust, duration-dependent association with T2DM progression. The 160 ng/mL threshold provides excellent discrimination for identifying patients with suboptimal metabolic control, supporting ferritin's potential utility as a biomarker for diabetes management and risk stratification in clinical practice.
Research Article
Open Access
Role of MRI Diffusion Tensor Imaging In the Assessment of Traumatic Spinal Cord Injuries
Samai Puhazhendi ,
Vinoth Rayar ,
Prakash Asokan
Pages 168 - 172
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Abstract
Background: Traumatic spinal cord injury (TSCI) results in axonal and myelin disruption, creating microstructural alterations not fully visualized by conventional MRI. Diffusion tensor imaging (DTI) measures anisotropic water motion—with fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity RD as most prominent parameters—and seems to be able to characterize lesions and a prognosis. Materials and Methods: This is a Prospective single-center cohort conducted at Srinivasan Medical college and Hospital, Samayapuram, Trichy with standardized DTI protocol and 6-month follow-up. Using standardized cervical DTI (1.5T, single-shot EPI with a reduced FOV), we performed scoping clinical study in adult patients with acute–subacute TSCI and healthy controls. Inclusion: Ages between 18 and 70 years, closed traumatic spinal cord injury (TSCI) within30 days; lesion level between C2 and T1; American Spinal Injury Association (ASIA) degree of impairment A-D. Exclusion: previous myelopathy, metallic precautions, hemodynamic instability, motion-affected scans. Regions of interest (ROIs) were positioned at epicenter, ±10 mm from epicenter (peri-lesional) and normal-appearing remote level. The results were DTI measures and their relationship to AIS and 6-month motor scores. Results: A total of 50 patients and 25 controls were included in the analysis. FA decreased in epicenter (−41%) and peri-lesion (−18%) vs controls; converged with MD, RD increases; convergent signal. AD declined slightly.FA at the epicenter predicted 6-month motor score (r = 0.62) and conversion from AIS A/B to C/D (AUC 0.86). Multivariable models combining FA+RD with baseline AIS improved prognostic accuracy (adj. R² = 0.58). Conclusion: DTI sensitively detects microstructural injury beyond conventional MRI and has strong prognostic value in TSCI. Standardized acquisition, harmonized analysis, and multi-center validation are needed before routine adoption.
Research Article
Open Access
Incidence, Predictors, and Outcomes of Acute Kidney Injury Among Snakebite Victims in Northern India: A Prospective Observational Study
Babu Lal Meena,
Gaurav Kumar ,
Rakesh Kumar ,
Veer Bahadur Singh,
Ravi Dutt ,
Ved Prakash Meghwal,
Ravi Dutt ,
Mool Chand Suthar,
Shivananda Sonavane ,
Abhishek Kawatra
Pages 164 - 167
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Abstract
Background: Snakebite is a major health hazard in rural India, with acute kidney injury (AKI) being a leading cause of morbidity and mortality. Objective: To evaluate the incidence, clinical correlates, and outcomes of AKI among snakebite patients in northern India. Methods: A prospective observational study was conducted on 117 patients admitted of snakebite envenomation in a tertiary care hospital in Bikaner, Rajasthan. Demographics, clinical features, laboratory parameters, and outcomes were recorded. AKI was defined according to KDIGO criteria. Results: AKI developed in 20(17.09%) patients. Significant predictors included delayed hospital presentation (>2 hours, p=0.001), hematuria (p=0.04), oliguria (p=0.003), and thrombocytopenia (p<0.0001). Lower limb bites (76%) predominated, with right-sided bites showing higher AKI risk (p=0.0001). 75% of AKI patients required dialysis, 50% remained dialysis dependent and mortality was 10%. Conclusion: AKI remains a serious complication of snakebite. Early hospital presentation and rapid anti-snake venom administration are key to reducing morbidity. Regional variations in AKI incidence highlight the necessity of multicenter studies.
Research Article
Open Access
Histomorphological Study of Placental Vascular Patterns in Normal versus Preeclamptic Pregnancies: A Comparative Analysis
Debasis Biswas ,
Barnali Maiti ,
Shubham Bhattacharya ,
Kajal Kumar Patra
Pages 155 - 163
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Abstract
Background: Preeclampsia is linked to impaired placental vascular development and maternal vascular malperfusion, contributing to adverse perinatal outcomes. Quantitative placental histology may offer objective insights into disease mechanisms. Objectives: To compare placental vascular features in normal versus preeclamptic pregnancies and evaluate their association with fetal birthweight and spiral artery remodeling. Methods: This comparative study analyzed 50 placentas (25 normal, 25 preeclamptic). Quantitative metrics included capillaries per terminal villus, vessel density, syncytial knots, perivillous fibrin, avascular villi, and spiral artery remodeling score. Statistical analysis involved t-tests, Pearson correlations, and logistic regression. Results: Preeclamptic placentas showed significantly lower gestational age, placental weight, and birthweight (all p < 0.001). Capillaries per villus (4.40 vs. 5.81) and vessel density (94.4 vs. 117.1/mm²) were reduced (p ≤ 0.001), while syncytial knots, perivillous fibrin, and avascular villi were increased (p < 0.001). Spiral artery remodeling was significantly impaired (1.49 vs. 2.23; p < 0.001). Birthweight positively correlated with capillary count and negatively with syncytial knots and fibrin deposition. A logistic model using histological markers showed excellent discrimination (AUC = 0.985). Conclusion: Preeclampsia is characterized by reduced villous vascularity, increased hypoxic lesions, and deficient arterial remodeling. Quantitative placental histology may aid in identifying placental dysfunction and improving diagnostic precision in hypertensive pregnancies.
Research Article
Open Access
Factors Influencing Contraceptive Choice among Married Women in Asansol, West Bengal
Khyati Rathore ,
Kesha Salvi ,
Vidhiben V. Patel
Pages 148 - 154
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Abstract
Background: Contraceptive use is a key determinant of maternal and child health. Despite wide availability of methods in India, variations persist in uptake and choice, influenced by socioeconomic, cultural, and demographic factors. Objectives: To assess contraceptive prevalence, method choice, and determinants among married women in Asansol, West Bengal. Methods: A cross-sectional study of 330 married women aged 18–45 years was conducted in the Obstetrics and Gynecology Department, Asansol District Hospital (June 2016–May 2017). Data were collected via structured questionnaires. Statistical analysis included descriptive statistics, Z tests, Chi-square tests, and ANOVA. Results: Overall contraceptive prevalence was 86.7%. Female sterilization was the most common method (23.6%), followed by natural methods (22.7%) and oral pills (16.7%). Only 0.9% reported male sterilization. Method choice was significantly associated with age (χ²=64.5; p<0.0001) and socioeconomic status (χ²=44.8; p<0.0001). Joint decision-making by couples was most common (40.3%). Conclusion: Contraceptive use in this cohort was high, with female sterilization predominant. Age, education, and socioeconomic status significantly influenced method choice. Counselling strategies should address male participation and method diversification
Research Article
Open Access
Regional insights of Glomerulonephritis- Epidemiological Profile, Clinical Spectrum and Outcomes: A Single Centre Study from Bangladesh
Rezwanur Rahman ,
Sonia Mahjabin ,
Tarim Mahmood ,
Muntasir Ebne Mobin
Pages 139 - 147
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Abstract
Background: Glomerulonephritis (GN) remains a leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in low- and middle-income countries like Bangladesh. While regional studies have suggested significant variability in the subtypes of GN, contemporary data on its clinical presentation, histopathological patterns, and treatment outcomes are scarce. This study aimed to evaluate the demographic profiles, clinical manifestations, renal biopsy findings, and short-term outcomes of GN. Methods: This retrospective, observational study was conducted at Bangladesh Medical College Hospital, Dhaka, Bangladesh between June 2018 and June 2025. A total of 498 patients aged ≥12 years with histologically adequate native kidney biopsy samples who completed minimum 12 months of treatment were included in the study. Data on socio-demographics, clinical presentation, histopathology, treatment, and outcomes were collected and analyzed using SPSS v26. Renal biopsies were evaluated using light microscopy and immunofluorescence. Outcomes were assessed after 12 months of follow-up. Results: The mean patient age was 33.8 ± 5.9 years, with a slight male predominance (58.2%) and the bulk residing in rural zones (64.3%). Nephrotic syndrome was the most common clinical presentation (47.9%), followed by mixed nephritic–nephrotic features (17.5%). Primary GN accounted for 84.3% of cases, with mesangioproliferative GN (27.4%) and diffuse membranoproliferative GN (21.4%) as the most frequent subtypes. Lupus nephritis (LN) was the leading cause of secondary GN (6.2%). Class IV LN was the most common histological subtype. Extra-renal features among lupus patients included arthritis (100.0%), oral ulcers (86.4%) and malar rashes (81.8%). Among patients with mesangioproliferative GN, 83.7% achieved complete remission, while 10.1% progressed to ESRD. In LN cases, 62.1% achieved remission, 20.7% progressed to ESRD, while 17.2% experienced relapse. Conclusion: Primary GN, particularly mesangioproliferative and membranoproliferative subtypes, predominates among biopsy-proven cases in Bangladesh, with nephrotic syndrome being the most frequent clinical presentation. While remission rates are relatively favorable, especially in primary GN, but in LN cases, high relapse and progression rates ring the bell for early histologic confirmation and resource-appropriate immunosuppressive strategies.
Research Article
Open Access
Association between Refractive Errors and Headache in patients attending Ophthalmology department of a tertiary care teaching hospital
Sahiti Janaswamy ,
A. Narasimha Rao,
V. Hima Bindhu,
R. Suryanarayana Raju,
A. Tarakeswara Rao
Pages 133 - 138
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Abstract
Background: Headache is one of the most frequent complaints encountered in ophthalmic practice. Ocular causes such as refractive errors significantly contribute to headache incidence. Uncorrected refractive errors, including myopia, hypermetropia, and astigmatism, can lead to visual strain and discomfort. Understanding the relationship between headache and refractive errors is important for accurate diagnosis and effective management. To determine the association between refractive errors and headache and to evaluate the effect of refractive correction on symptomatic relief in patients attending the Ophthalmology Outpatient Department. Methods: A hospital-based, prospective, cross-sectional study was conducted in the Department of Ophthalmology, GVPIHC & MT, Visakhapatnam, over a period of three months. Three hundred patients aged 18–35 years presenting with headache were enrolled after applying inclusion and exclusion criteria. Detailed history, visual acuity testing, autorefractometry, cycloplegic refraction, and post-mydriatic subjective refraction were performed. Patients with ocular or systemic pathologies causing headache were excluded. Statistical analysis was done using SPSS software. Results: Of the 300 subjects, 69% were females and 31% were males, with the majority aged 25–30 years (39%). The most common site of headache was the frontal region (52.3%). Refractive errors were detected in 105 patients (35%), of which astigmatism (42.85%) was most frequent, followed by simple hypermetropia (35.23%) and simple myopia (21.9%). After correction with appropriate spectacles, 73 patients (69.5%) reported significant symptomatic relief, including reduction in headache and asthenopic symptoms. Most patients (53.3%) required less than 1 diopter correction. Conclusion: Refractive errors are an important ocular cause of headache, particularly among young adults. Astigmatism and hypermetropia are the most common types associated with headache. Proper refractive correction significantly alleviates headache and related visual discomfort. Routine ophthalmic evaluation, including refraction, should be performed in all patients presenting with headache to ensure timely diagnosis and management.
Research Article
Open Access
The Role of 24-Hour Holter Electrocardiogram in the Early Detection of Atrial Fibrillation in Newly Diagnosed Acute Ischemic Stroke Patients
Harikrishnan K ,
Pramod PC ,
Ks mohanan ,
V L ,
Rajan Joseph Manjuran
Pages 126 - 132
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Abstract
Background: Stroke is a leading cause of death and disability globally, with atrial fibrillation (AF) recognized as a significant risk factor due to its association with increased stroke recurrence and mortality. Timely detection of AF is crucial to prevent recurrent strokes and improve outcomes. This study primarily aimed to evaluate the utility of 24-hour Holter monitoring for AF detection in acute ischemic stroke patients. Methods: This retrospective observational study examined data from 100 patients admitted with acute ischemic stroke to a tertiary-care hospital over a one year period. Patients with pre-existing AF, transient ischemic attacks, unconfirmed diagnoses, and missing Holter reports were excluded. A total of 100 patients were included in the analysis. The study investigated diagnosed AF cases, the relationship between AF and stroke risk factors, and other Holter findings. Results: The average age of participants in this study was 67.35 years, with the majority (37%) falling between the ages of 71 and 80, showing that the study population was largely old. Males made up 74% of the study population, demonstrating a male predominance.
In terms of risk factors, hypertension (84%) was the most prevalent co morbidity, followed by type 2 diabetes (52%), dyslipidemia (41%), and coronary artery disease (35%). Participants reported an increased prevalence of addictive habits, with 43% smoking and 29% drinking. The most prevalent arrhythmias found during Holter monitoring were ventricular premature complexes (VPCs, 40%) and atrial fibrillation (34%). Others, such as sinus tachycardia (16%), supraventricular premature complexes (14%), and First-degree AV block were (13%). When connections between risk variables and Holter data were investigated, there were no statistically significant relationships between hypertension, diabetes, dyslipidemia, or coronary artery disease and Holter findings. Conclusion: The study highlights the limited utility of 24-hour Holter monitoring in detecting AF in acute ischemic stroke patients, advocating for extended monitoring durations. To improve AF detection, potential strategies include using longer monitoring periods and optimizing hospital workflows to reduce delays in attaching Holter devices. These approaches can minimize the risk of underdiagnosing paroxysmal AF, thereby preventing recurrent strokes and improving patient outcomes.
Research Article
Open Access
Spectrum of bacterial and fungal infections in oral cavity and respiratory tract cancer patients
Esha Singh ,
Vinod Kumar Mehta,
Vineeta Sharma ,
Rajnish Sood ,
Garima Sharma ,
Parul Sharma ,
Santwana Verma ,
Hitesh Kumar
Pages 116 - 125
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Abstract
Background: Cancer patients with oral cavity and respiratory tract malignancies are prone to opportunistic infections due to tumor-related and treatment-induced immune-suppression. Identifying prevalent pathogens and their resistance profiles is critical for guiding empirical therapy. Objective: This study assessed the prevalence, spectrum and resistance profile of bacterial and fungal pathogens in oral and respiratory cancer patients. Material and methods: A Cross-sectional study was conducted at Indira Gandhi Medical College, Shimla (June 2021 to May 2022). Clinical samples (blood, sputum, throat swabs, and bronchoalveolar lavage) were processed by standard microbiological methods and BD PhoenixTM100 system. Antimicrobial susceptibility was interpreted as per Clinical and Laboratory Standards Institute guidelines 2022. The data generated was entered on Microsoft Excel spreadsheet and analyzed using EPI Info version 7. Results: Of the total of 100 patients 86 were respiratory tract 14 oral cavity cancer patients with male predominance [87%and 93% respectively]. Infections occurred in 77% patients. Gram negative bacteria (66%) predominated, with Escherichia coli most frequent in respiratory tract cancers and Klebsiella pneumonia and Pseudomonas aeruginosa in oral cavity cancers. Gram positive isolates were mainly Staphylococcus species. Candida albicans(76%) was the leading fungal pathogen. Gram positive were 100% sensitive to linozolid and Gram negative were most susceptible to carbpenems and aminoglycosides with Acinetobacterbaumannii and Klebsiella pneumonia exhibiting multidrug resistance. Infections were more frequent after chemo-radiotherapy compared with chemotherapy or radiotherapy alone. Discussion: Gram negative bacilli dominated the infectious spectrum in these cancers, consistent with global epidemiological shift. High prevalence of multidrug resistance highlights the need for antimicrobial stewardship and stringent infection control measures. Conclusion:
Rising multidrug resistance underscores the need for regular surveillance of pathogens and resistance pattern for empirical therapy.
Research Article
Open Access
Non-Invasive Hepatic Steatosis Assessment by Ultrasound Fat Quantification: Comparison with Magnetic Resonance Imaging Proton Density Fat Fraction.
Supriya Sundar Mishra,
Anamika Shahi
Pages 108 - 116
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Abstract
Non-alcoholic fatty liver disease (NAFLD) which affects around 25% of the global population, is a common liver disorder (1–3). It ranges from simple steatosis, characterized by hepatic fat accumulation above 5%, to non-alcoholic steatohepatitis (NASH), which may progress to hepatocellular cancer (4, 5). The rising prevalence of NAFLD, fuelled by obesity, and metabolic syndromes, underscores the necessity for effective, non-invasive methods to diagnose and monitor liver fat, particularly in early stages when interventions can alter disease progression (6).
Although liver biopsy remains the traditional standard for diagnosing hepatic steatosis, its invasive nature, risk of complications, and potential sampling errors limit its use for large-scale screening or follow-up (7, 8). MRI-proton density fat fraction (MRI-PDFF) offers a highly accurate, non-invasive alternative with strong sensitivity and specificity (9). However, its high cost, limited availability, and longer scan times restrict routine clinical application, especially in resource-limited settings (10).
Ultrasound-based methods provide a more accessible option for assessing liver fat. While conventional B-mode ultrasound is widely used, it has limited accuracy for mild-to-moderate steatosis due to subjective interpretation (11, 12). Advanced quantitative ultrasound (QUS) techniques, including Tissue Attenuation Imaging (TAI), Tissue Scatter Distribution Imaging (TSI), and Ultrasound-Derived Fat Fraction (UDFF), offer objective measurements of hepatic fat by analyzing signal attenuation and scattering (9, 13-15, 21–23). UDFF, in particular, correlates strongly with MRI-PDFF and provides a percentage-based estimate of liver fat (13, 24-26). This study evaluates the diagnostic performance of TAI, TSI, and UDFF against MRI-PDFF in patients with NAFLD, aiming to identify reliable, accessible alternatives for screening and monitoring hepatic steatosis (HS) across diverse populations (17–20, 25).
Case Report
Open Access
Maxillary Osteomyelitis: Case Series and Management Outcomes
Suni Purushothaman ,
Supriya Patil
Pages 102 - 107
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Abstract
Background: Maxillary osteomyelitis is a rare but severe infectious condition characterized by progressive bony destruction and potential complications such as cranial cavity infections or facial deformities. Unlike the mandible, the maxilla's rich vascularity and porous nature typically limit infection spread, making maxillary involvement uncommon. This study presents a case series to evaluate clinical presentations, contributory factors, management strategies, and outcomes of maxillary osteomyelitis. Methods: This retrospective case series was conducted at MGM Hospital, Kamothe, including four patients diagnosed with maxillary osteomyelitis. Data were collected from clinical records, including demographic details, clinical presentation, imaging studies, and histopathological findings. Management involved empirical broad-spectrum antibiotics, antifungal therapy, and surgical interventions such as debridement and maxillectomy. Follow-up assessments focused on clinical improvement, radiological evidence of bone healing, and complication monitoring. Results: Common clinical features included facial pain, swelling, and, in advanced cases, altered sensorium and nasal obstruction. Two patients had Type 2 Diabetes Mellitus, emphasizing its role as a significant predisposing factor. Imaging consistently revealed bony erosions of the maxillary sinus, with varied extent and severity. Histopathological examination confirmed chronic osteomyelitis in all cases, with additional findings of mucormycosis, aspergilloma, and squamous cell carcinoma in specific patients. Treatment approaches, including antimicrobial therapy and surgical management, resulted in favorable outcomes, with all patients showing clinical improvement. Conclusion: Maxillary osteomyelitis, though rare, requires early recognition and a tailored management approach. Multidisciplinary strategies, particularly in immunocompromised patients and those with dual pathologies, are essential for achieving optimal clinical outcomes and preventing severe complications.
Case Report
Open Access
Congenital and Developmental Orthopedic Disorders in Children: Advances in Detection, Management, and Future Directions
Pages 95 - 101
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Abstract
Background: Congenital and developmental orthopedic disorders are major causes of childhood morbidity and result in long-term disability if not diagnosed and treated in early stages. Developmental dysplasia of the hip (DDH), clubfoot, Blount's disease, Perthes disease, and slipped capital femoral epiphysis (SCFE) are the most common entities within this category. Progresses in screening programs, imaging techniques, and conservative treatments like the Ponseti technique have transformed early management. Surgical interventions continue to play a crucial role in complicated or late-presenting conditions, whereas molecular genetics is redefining our knowledge of skeletal dysplasias and providing avenues for precision medicine. The disparities in access to early intervention continue to be an issue, especially in low-resource environments. This review integrates the evidence for epidemiology, detection, management, outcomes, and future directions regarding congenital and developmental orthopedic disorders in children.
Research Article
Open Access
Estimation and Comparison of Serum Uric Acid Levels in Preeclampsia Patients and Normotensive Pregnant Women
Pages 88 - 94
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Abstract
Background: Preeclampsia affects 2-8% of pregnancies worldwide and remains a leading cause of maternal and fetal morbidity and mortality. Serum uric acid has emerged as a promising biomarker for early detection and risk stratification in preeclampsia due to its association with disease severity and adverse outcomes. This study aimed to estimate and compare serum uric acid levels between preeclampsia patients and normotensive pregnant women to evaluate its diagnostic utility. Methods: A comparative case-control study was conducted at Patna Medical College and Hospital from September 2014 to December 2015. The study included 250 pregnant women with clinically diagnosed preeclampsia and 250 apparently healthy pregnant controls, all in their third trimester (28-40 weeks). Fasting venous blood samples were collected and serum uric acid levels were measured using the Uricase-Peroxidase method. Statistical analysis included Student's t-test, Pearson's correlation coefficient, and diagnostic accuracy parameters. Results: The mean serum uric acid level was significantly higher in preeclampsia cases (6.7 ± 1.1 mg/dL) compared to controls (4.26 ± 1.03 mg/dL) with p < 0.05. Using a cut-off value of 6.2 mg/dL, the diagnostic performance showed sensitivity of 72.4%, specificity of 87.6%, positive predictive value of 85.3%, negative predictive value of 76%, and diagnostic accuracy of 83.3%. A significant positive correlation was observed between serum uric acid levels and diastolic blood pressure (r = +0.606, p < 0.05) in preeclampsia cases. Conclusion: Serum uric acid levels are significantly elevated in preeclampsia patients compared to normotensive pregnant women and demonstrate good diagnostic accuracy. The strong correlation between uric acid levels and diastolic blood pressure suggests its potential role in disease pathogenesis. These findings support the clinical utility of serum uric acid as a cost-effective biomarker for preeclampsia screening and monitoring, particularly valuable in resource-limited settings where early detection can improve maternal and fetal outcomes.
Research Article
Open Access
Correlation of Respiratory Function Tests with Body Fat Percentage and BMI: A Cross-Sectional Study
Amit Kumar ,
Annapurna Gupta
Pages 81 - 87
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Abstract
Background: Body Mass Index (BMI) is a widely used indicator of body composition, but its relationship with actual body fat and respiratory parameters remains a subject of ongoing research. Growing evidence links increased adiposity with compromised pulmonary function and cardiovascular risks, necessitating a deeper evaluation of body fat estimation methods beyond BMI. Methods: A descriptive cross-sectional study was conducted on 100 participants (45 males and 55 females), categorized into three BMI groups. Body fat percentage was estimated using Bio-Impedance, Deurenberg, and Siri formulas. Pulmonary function tests (PEFR, FEV1, FVC) and cardiovascular parameters (heart rate) were evaluated. Correlation analyses were performed between body fat estimates and physiological measures across BMI categories. Results: Body fat percentage increased significantly with increased in BMI in both genders (p < 0.001). Males showed a negative correlation between PEFR and body fat across all estimation methods, while females showed a mild positive correlation. Strong positive correlations were found between heart rate and body fat, particularly using the Deurenberg formula in females (r = +0.8767) and Bio-Impedance in males (r = +0.7004). Pulmonary function (FEV1 and FVC) showed weak negative correlations with BMI and body fat, more pronounced in males. Conclusion: This study highlights that while BMI is a useful general measure, body fat percentage--especially as estimated by the Deurenberg formula--provides more nuanced insights into cardiopulmonary health risks. Gender differences in correlations further suggest the need for sex-specific assessments. Incorporating direct body fat estimation in clinical settings may enhance early detection of obesity-related impairments.
Research Article
Open Access
Evaluation of Intraoperative Fluoroscopy Versus Postoperative CT in Assessing Reduction Quality in Distal Radius and Ankle Fractures
Kunal Subhas Mukherjee,
Bikash Chandra Mondal,
Prasanna Kumar Pandey
Pages 75 - 80
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Abstract
Background: Anatomical reduction of intra-articular fractures of the distal radius and ankle is critical for optimizing functional outcomes and minimizing post-traumatic arthritis. Intraoperative fluoroscopy is the standard imaging modality used to assess reduction, but its two-dimensional nature may have limitations. Methods: We retrospectively reviewed 150 patients (75 distal radius, 75 ankle fractures) with intra-articular fractures treated with ORIF who received both intraoperative fluoroscopy and a routine postoperative CT scan within 48 hours of surgery. Two blinded reviewers (an orthopaedic surgeon and a musculoskeletal radiologist) independently evaluated both sets of images for each patient. Reduction quality was categorized as 'acceptable' (articular step-off ≤2 mm and articular gap ≤2 mm) or 'unacceptable'. Postoperative CT was considered the gold standard. Results: Overall, intraoperative fluoroscopy identified 12 of 150 fractures (8.0%) as having an unacceptable reduction. In contrast, postoperative CT identified 38 fractures (25.3%) as unacceptable. Of the 138 fractures deemed acceptable by fluoroscopy, 29 (21.0%) were re-classified as unacceptable by CT. This discrepancy was statistically significant (p<0.001). For these 29 discrepant cases, the mean articular step-off measured on CT was 2.8 ± 0.6 mm, whereas it was not clearly identified on fluoroscopy. The sensitivity of fluoroscopy to detect an unacceptable reduction was only 23.7%, with a specificity of 97.3%. Conclusion: Intraoperative fluoroscopy significantly underestimates the incidence of articular malreduction when compared to postoperative CT for both distal radius and ankle fractures. The 2D projection and superimposition inherent to fluoroscopy can mask clinically significant step-offs and gaps. Postoperative CT provides a more accurate and reliable assessment of articular congruity and should be strongly considered for complex intra-articular fracture patterns to ensure optimal surgical outcomes.
Research Article
Open Access
Therapeutic Role of Intravenous Prostaglandin E1 Infusion In The Management Of Critical Limb Ischemia
Pravin Pandurang Salunkhe,
Samrat Sukumar Madnaik,
Sayali Pravin Salunkhe
Pages 69 - 74
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Abstract
Background: Critical Limb Ischemia (CLI) represents the advanced stage of peripheral arterial disease, characterized by chronic ischemic rest pain, non-healing ulcers, or gangrene, and carries a high risk of limb loss and mortality. Many patients are unsuitable for revascularization due to comorbidities, poor distal run-off, or anatomical limitations. Aims: To evaluate the therapeutic role of intravenous Prostaglandin E1 infusion in improving limb salvage, ischemic rest pain, and functional outcomes in patients with inoperable CLI. Materials and Methods: This prospective interventional study included 30 patients diagnosed with CLI (Rutherford category IV–VI) who were not candidates for surgical or endovascular revascularization. All patients received intravenous infusion of PGE1 (100 µg/day in 50 mL normal saline over 16–18 hours for 5 consecutive days every month, up to 6 months) along with standard medical management. Patients were followed monthly and evaluated for limb salvage, pain relief (VAS score), ulcer healing, functional status, and amputation rates. Statistical analysis was performed using SPSS, with p < 0.05 considered significant. Result: Out of 30 patients, 18 (60%) achieved limb salvage, with complete resolution of rest pain and functional recovery; 6 (20%) were partial responders, showing pain relief and limited improvement without complete healing; and 6 (20%) required below-knee amputation. Rest pain resolution was significantly associated with limb salvage (p < 0.0001). At 6 months, 14 patients (46.7%) became asymptomatic in routine work, 4 (13.3%) had mild exertional pain, and 12 (40%) remained symptomatic or amputated. No above-knee amputations were required. Conclusion: Intravenous PGE1 infusion offers a safe and effective therapeutic option in patients with inoperable CLI, significantly improving limb salvage, relieving ischemic pain, and enhancing functional outcomes, thereby reducing the need for major amputations.
Research Article
Open Access
Regression of Mastalgia, Fibroadenoma, and Fibroadenosis with Centchroman: A Prospective Randomized Trial
Ratnesh Kumar ,
Aradhana Singh ,
Anubhav Goel ,
Deep Shikha
Pages 64 - 68
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Abstract
Background: Benign breast conditions such as mastalgia, fibroadenoma, and fibroadenosis are prevalent among reproductive-age women, often impairing quality of life. Centchroman (Ormeloxifene), a selective estrogen receptor modulator (SERM), has emerged as a promising non-hormonal treatment with favorable safety and efficacy profiles. Objective: To evaluate the efficacy of Centchroman in the regression of mastalgia, fibroadenoma, and fibroadenosis, and to assess its safety. Methods: This randomized controlled trial was conducted at Sarojini Naidu Medical College, Agra, over 18 months (April 2023–October 2024). A total of 150 women aged 20–40 years with benign breast conditions were randomized into two groups: Group A received Centchroman (30 mg on alternate days initially, then every third day), and Group B received placebo. Pain reduction was assessed using the Visual Analog Scale (VAS), and fibroadenoma size was evaluated via ultrasonography at 2, 4, 8, 12, and 24 weeks. Adverse events were recorded. Results: The Centchroman group demonstrated a significant reduction in VAS scores from baseline (6.8 ± 1.2) to 2.5 ± 1.0 at 12 weeks (p < 0.001), with a sustained response at 24 weeks (2.7 ± 1.1). Regression of fibroadenoma was noted in a substantial number of cases in Group A, with complete resolution in a significantly higher proportion compared to placebo. Side effects were minimal and included delayed menstruation in some patients. Conclusion: Centchroman is an effective, safe, and well-tolerated non-surgical option for managing mastalgia and fibroadenoma. Its tissue-selective anti-estrogenic action provides significant symptom relief with minimal adverse effects, making it a valuable agent in treating benign breast diseases.
Research Article
Open Access
To Study Clinical Presentation and Surgical Outcome of Intradural Extramedullary Spinal Tumour in Tertiary Care Hospital in Eastern India
Rakesh Kumar Das,
Sanghamitra Sarkar ,
Surajit Swargiary ,
Sumit Deb
Pages 53 - 63
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Abstract
Background: Spinal tumours constitute about 15 % of all central nervous system tumours. Intradural-extramedullary (IDEM) tumors are the most common primary neoplasm in the spine, accounting for approximately 70% of primary spinal tumors. Today, with the advancement of early detection and microsurgical techniques, they are considered one of the gratifying parts of neurosurgery. Materials and Methods: A prospective observational single centre study done in Calcutta National Medical College and Hospital, Kolkata. Preoperative functional status using the Nurick’s grading scales and the location of the tumours on sagittal and axial MRI images were recorded. Total excision of tumour with the help of operating microscope through a posterior approach was attempted with a goal of preserving neurological function. Results: Primary IDEM tumours of the spinal cord are usually benign. They usually present with a characteristic motor and sensory symptoms leading to clinical localisation of lesions. MRI is the modalities of choice for further delineation of the tumours. IDEM tumours are amenable to microsurgical gross total resection through one-stage posterior approach by laminectomy with the use of operating microscope. Good clinical and surgical outcome with a higher degree of patient satisfaction can be achieved irrespective of age, sex, duration of illness or neurological status of patients at presentation. Conclusion: Thorough perioperative planning, meticulous microsurgical techniques and early mobilization and rehabilitation are essential for good clinical outcomes.
Research Article
Open Access
Cytohistological Correlation of Thyroid Lesions: A Study at a Tertiary Care Centre in South India
Sabbineni Ramya ,
Puppala Srilatha ,
P. Vijaya Praveen Kumar
Pages 46 - 52
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Abstract
Background: Fine-needle aspiration cytology (FNAC) is the cornerstone in the initial assessment of thyroid lesions. Despite its high diagnostic accuracy, histopathology remains the definitive modality. This study aims to evaluate the cytohistological correlation of thyroid lesions and determine the diagnostic accuracy of FNAC. Methods: This retrospective study was conducted in the Department of Pathology, Government Medical College, Nalgonda, over a period of two years. A total of Sixty cases who underwent FNAC followed by thyroidectomy were included. Cytological diagnoses were categorized using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC, 2023). Histopathological diagnoses were compared to cytology results, and statistical analysis was performed to determine sensitivity, specificity, and diagnostic accuracy. Results: Of 60 cases, the most frequent cytological diagnosis was Bethesda Category II (benign, 55%) reported in 33 cases and Bethesda VI (Malignancy, 20%) was reported in 12 cases. Histopathological correlation showed 91.7% concordance in Bethesda VI, and 93.9% in Bethesda II. FNAC demonstrated a sensitivity of 90%, specificity of 93.9%, positive predictive value of 90%, negative predictive value of 93.94%, and an overall diagnostic accuracy of 92.45%.Conclusion: FNAC remains a reliable and efficient diagnostic tool for thyroid lesions. However, cytohistological correlation highlights the importance of histopathological confirmation in indeterminate and suspicious cases.
Research Article
Open Access
Comparative Study of Audiological Findings in Noise-Induced Hearing Loss versus Age-Related Hearing Loss
Pages 39 - 45
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Abstract
Background: Noise-induced hearing loss (NIHL) and age-related hearing loss (ARHL) are the most common causes of acquired sensorineural hearing loss, yet their clinical and audiological profiles differ significantly. Differentiating between the two conditions is critical for prevention, diagnosis, and rehabilitation. Aim: To compare audiological findings in patients with noise-induced hearing loss versus age-related hearing loss. Methods: A prospective comparative study was conducted on 80 patients attending a tertiary care hospital, with 40 in the NIHL group and 40 in the ARHL group. Detailed clinical evaluation was followed by pure tone audiometry (PTA), speech audiometry, and advanced tests including otoacoustic emissions (OAE) and auditory brainstem response (ABR). Statistical analysis included t-tests and chi-square tests, with significance set at p<0.05. Results: NIHL patients were significantly younger (mean 47.8 ± 7.3 years) than ARHL patients (68.9 ± 5.9 years, p<0.001) and had higher rates of noise exposure (67.5% vs. 17.5%, p<0.001) and tinnitus (72.5% vs. 37.5%, p=0.002). ARHL patients showed significantly greater PTA thresholds at 0.5, 1, 2, and 6 kHz (all p<0.001), with NIHL exhibiting a 4-kHz notch. Speech reception thresholds were higher in ARHL (35.7 ± 7.1 dB HL vs. 29.8 ± 6.3 dB HL, p<0.001), and speech discrimination scores were poorer (74.1% vs. 82.6%, p<0.001). ABR revealed prolonged Wave V latencies and I-V interpeak intervals in ARHL (p<0.001), while OAE positivity was higher in NIHL, though not statistically significant. Conclusion: NIHL and ARHL demonstrate distinct audiological signatures. NIHL is characterized by younger age, noise exposure, tinnitus, and a 4-kHz notch, whereas ARHL is associated with progressive high-frequency loss, poorer speech discrimination, and delayed neural conduction. Comprehensive audiological testing remains essential for differentiation, prevention, and tailored rehabilitation.
Research Article
Open Access
Study of Association between Pre Operative Vitamin D3 Levels and Occurrence of Hypocalcemia after Total Thyroidectomy in Patients with Benign Thyroid Diseases
Martin Emerald Palaparthi,
B. Ramakrishna ,
Y. Mutheeswaraiah ,
B. Alok Sachan,
Aparna R Bitla
Pages 33 - 38
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Abstract
Background: Hypocalcemia is the most common complication following total thyroidectomy, with transient rates up to 50%. Vitamin D plays a central role in calcium absorption and homeostasis, and deficiency has been proposed as a risk factor for postoperative hypocalcemia. However, evidence remains inconclusive. Objective: To evaluate the association between preoperative vitamin D levels and the occurrence of hypocalcemia after total thyroidectomy in patients with benign thyroid diseases. Methods: A prospective observational study was conducted on 41 patients undergoing total thyroidectomy at a tertiary care center between November 2022 and October 2023. Preoperative serum 25-hydroxyvitamin D, calcium, and albumin levels were measured, and patients were stratified into four vitamin D categories. Postoperative hypocalcemia was assessed biochemically and clinically for three consecutive days. Statistical analysis included Chi-square and Fisher’s exact tests. Results: The incidence of postoperative hypocalcemia was 26.8%. Although vitamin D deficiency was highly prevalent (73.2%), no statistically significant correlation was observed between vitamin D status and hypocalcemia (p=0.953). All cases of hypocalcemia occurred in female patients. Preservation of all four parathyroid glands was significantly protective (p=0.049). Conclusion: Preoperative vitamin D status alone does not predict post-thyroidectomy hypocalcemia. Parathyroid gland preservation remains the key determinant of calcium outcomes.
Research Article
Open Access
Integrating Artificial Intelligence in Teledentistry for Better Diagnosis
Priya Nagar ,
Priyanka T S ,
Vikas Vaibhav ,
Kuldeep Singh ,
Aswathi S ,
Sanket Dadarao Hiware
Pages 27 - 32
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Abstract
Background: Teledentistry rapidly expanded after COVID-19, enabling remote triage, screening and follow-up. Artificial intelligence (AI)—particularly deep learning applied to photographs and radiographs—promises to raise diagnostic accuracy, standardize decision-making and extend high-quality care to underserved settings. Materials and Methods: We conducted a scoping review (2015–2025) of English-language studies and reviews on AI-enabled teledentistry (searches in PubMed, Scopus, Web of Science). Inclusion: diagnostic applications using asynchronous (store-and-forward) images or synchronous video, with or without radiographs. Exclusion: editorials, in-vitro only, and non-diagnostic telehealth. Outcomes extracted: sensitivity/specificity/accuracy, workflow, and implementation barriers. Results: Twenty-eight eligible sources (systematic reviews, meta-analyses, trials and narrative syntheses) showed: (i) AI-assisted caries detection achieves pooled sensitivity ~0.71–0.87 and specificity ~0.89–0.96 depending on lesion depth and modality;4–8 (ii) non-AI teledentistry photo-based caries detection shows sensitivity 48–98.3% and specificity 83–100%; (iii) hybrid models combining AI triage + teleconsults improve access and maintain diagnostic performance comparable to clinic visits. Conclusion: AI can materially improve the diagnostic yield of teledentistry—especially for caries, periodontal changes and opportunistic oral lesion screening—provided external validation, bias control and safe deployment.
Research Article
Open Access
Is Nail Plate Dual Osteosynthesis better for comminuted distal femur fractures: A Prospective study
Shreekantha KS ,
Ashwin Suresh ,
Bhoomika Saxena ,
Hitesh Krishna Malavat,
Hareb Mohammed Ali,
Ankit Sahu
Pages 15 - 26
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Abstract
Background: Distal femur fractures represent 4–6% of all femoral fractures, and they have a bimodal age distribution as higher energy trauma in younger patients, and lower energy falls in the elderly. Comminuted fractures are particularly challenging due to metaphyseal bone loss, articular involvement, and risk of non-union or varus collapse. While plate fixation ensures stability in osteoporotic bones, it often requires prolonged restricted weight-bearing. Intramedullary nailing provides load-sharing and early mobilization but has limitations in providing adequate stability, while plating has poor stability to axial loading in comminuted fractures. The nail-plate combination (NPC) construct offers the biomechanical advantages of both implants and may allow early mobilization with reduced implant failure. Materials and Methods: We performed a prospective study of 30 patients (>18 years) with distal femur fractures managed by NPC fixation at Dr. B.R. Ambedkar Medical College and Hospital between July 2023 and June 2025 fulfilling the inclusion and exclusion criteria. Patients comprised closed fractures and Gustilo-Anderson type I/II open fractures. Exclusion criteria comprised pathological fractures, Type III open fractures, vascular injuries, floating knee, and unfit cases. The method of surgical fixation was a distal femur nail, with auxiliary lateral locking plate fixed to the nail with screws to act as a single construct. The patients were followed clinically and radiographically in the long term, with a mean follow-up of 18 months. The assessment of functional outcome was done on basis of Neer’s scoring system. Results: Thirty traumatic type II lesions were observed in 18 men and in 12 women with a mean age of 59.2 years; the trauma that caused the lesion was high-energy in nature in 20 cases but low-energy in the remaining ten. The average time to radiographic union was 14.8 weeks;); 46.7% united at 14 weeks and 33.3% at 16 weeks. Two cases with infection and wound debridement showed delayed union (20 weeks). No implant failures were reported. According to Neer’s score, 56.7% achieved excellent, 33.3% good, 6.7% fair, and 3.3% poor results. At 6 months, mean knee flexion was 114°, with 20 patients achieving >90° flexion. Conclusion: The nail-plate combined fixation is a reliable way to treat comminuted distal femur Fractures, providing stable fixation, early union, and satisfactory functional outcomes. By permitting safe early mobilization, it reduces morbidity, especially in elderly patients, and since it may reduce the complications of long periods in traction.NPC fixation thus represents an effective and safe option in complex distal femur fractures.
Research Article
Open Access
Diagnostic Utility of Ultrasound Guided Fine Needle Aspiration Cytology of Breast Masses at a Tertiary Care Centre in Western Rajasthan
Pages 7 - 14
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Research Article
Open Access
Influence of Pre-Treatment Body Mass Index on Head and Neck Cancer Patient Receiving Chemo-radiation: A Prospective, Observational Study
Giridhari Saha ,
Shatarupa Chattopadhyay Dutta,
Suranjan Maitra ,
Partha Dasgupta
Pages 1 - 6
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Abstract
Background: This investigation explored the effect of pre-treatment Body Mass Index (BMI) on treatment response in patients with head and neck squamous cell carcinoma (HNSCC) who received definitive concurrent chemoradiation. Methods: A prospective, observational study was undertaken in 149 patients. Pre-treatment BMI was measured and defined as underweight (<18.5 kg/m²), normal (18.5-24.9 kg/m²), or overweight/obese (≥25 kg/m²). Platinum-based chemoradiation was administered to all patients. The main outcome was locoregional control, measured during follow-up. Statistical analysis was conducted using the chi-square test. Results: The majority of the cohort was male (82.6%) and had a median age of 54 years. The most frequent primary site was oropharynx (40.3%). The distribution of BMI was as follows: 8.1% underweight, 52.3% normal, and 39.6% overweight/obesity. A strong correlation between pre-treatment BMI and locoregional control was observed (p=0.03). Patients with a BMI ≥25 kg/m² had the lowest incidence of locoregional failure (2.7%), as compared to 10.1% for those in the normal BMI group and 3.4% for the underweight group. Conclusion: Pre-treatment BMI was a prognostic indicator for locoregional control in patients with HNSCC treated with chemoradiation. Increased BMI (≥25 kg/m²) correlated with better treatment outcomes, confirming the significance of nutritional status evaluation in this group of patients.
