Indian Journal of Pharmaceutical and Biological Research

Comparative Efficacy and Safety of Ketamine-Dexmedetomidine (Ketodex) Versus Ketamine-Propofol (Ketofol) for Procedural Sedation in Pediatric Patients

Sangamsinh Solanki — 2026-06-18

Background: Pediatric procedural sedation requires safe, effective agents to ensure patient comfort while maintaining physiological stability. Combinations such as ketamine-dexmedetomidine (Ketodex) and ketamine-propofol (Ketofol) are increasingly utilized to balance the desirable effects of each component while mitigating their respective side effects.
Objective: This review aims to compare the safety and efficacy of Ketodex and Ketofol for procedural sedation in children aged 0–12 years.
Methods: A narrative synthesis of available clinical evidence, including meta-analyses and randomized controlled trials, was conducted to evaluate respiratory safety, hemodynamic stability, and recovery profiles.
Results: Comparative analysis demonstrates that Ketodex is associated with a significantly lower risk of respiratory depression, making it a safer option for patients with anticipated airway challenges. Conversely, Ketofol is consistently associated with a shorter recovery and discharge time, providing an advantage in fast-track surgical or procedural settings. Both combinations demonstrate similar hemodynamic stability, clinician satisfaction, and incidence of common adverse events such as nausea or vomiting.
Conclusion: The choice between Ketodex and Ketofol should be personalized based on the clinical priority, with Ketodex favored when respiratory safety is paramount and Ketofol preferred when rapid recovery and discharge are the primary objectives.

A Hospital-Based Study to Estimate the Prevalence of Dry Eye and Factors Attributed to IT

Vipul Kumar Nagar — 2026-06-20

Background: Dry eye disease (DED) is a multifactorial disorder affecting the ocular surface and tear film, leading to discomfort, visual disturbance, and reduced quality of life.
Aim: To estimate the prevalence of dry eye and identify associated risk factors among patients attending a tertiary care hospital.
Methods: A cross-sectional study was conducted in the Department of Ophthalmology, Government Medical College, Pali, over one year (2025). A total of 300 patients aged ≥18 years were included. Dry eye was diagnosed using a combination of McMonnies and HO dry eye questionnaire, Schirmer’s test, and Tear Film Break-Up Time (TBUT). Statistical analysis included chi-square test and logistic regression.
Results: The prevalence of dry eye was 16.3% (49/300). Females had higher prevalence (22.5%) compared to males (11.1%) (p=0.018). Increasing age, outdoor occupation, and environmental exposure were significantly associated (p<0.05). Mean Schirmer’s value in dry eye patients was 7.2 ± 2.1 mm, and mean TBUT was 7.8 ± 1.9 seconds.
Conclusion: Dry eye is a common yet under-recognized condition. Early detection and modification of risk factors can reduce disease burden.

Platelet-Rich Plasma (PRP) Augmentation in Arthroscopic Knee Meniscal Repair

Arvind Kumar Anal — 2026-06-20

Background: Meniscal injuries are among the most common orthopaedic issues, especially in young, physically active people. The meniscus is essential for load transfer, stress absorption, joint stability, and knee joint lubrication. However, its inherent healing capacity is limited, particularly in the inner avascular zones, resulting in unsatisfactory outcomes after restoration. In recent years, biological augmentation treatments such as platelet-rich plasma (PRP) have gained popularity due to their capacity to improve tissue recovery. PRP includes a high concentration of growth factors that increase cellular proliferation, angiogenesis, and extracellular matrix synthesis, which may improve meniscus repair outcomes.
Objective: To determine the efficacy of PRP augmentation in improving healing rates, lowering discomfort, and improving functional results in patients following arthroscopic meniscal repair.
Methods: A prospective observational study was undertaken over 11 months, with 50 patients undergoing arthroscopic meniscal repair. Patients were separated into two groups: the PRP group (n=25), who got PRP augmentation during surgery, and the control group (n=25), who had routine repair without PRP. Meniscal healing was clinically and radiologically evaluated, pain was measured using the Visual Analogue Scale (VAS), and functional ability was assessed using the Lysholm knee score method. Statistical analysis was conducted using suitable comparative tests, with a p-value <0.05 indicating statistical significance.
Results: The PRP group showed considerably greater healing rates than the control group (82% vs 62%, p<0.05). Furthermore, patients who received PRP reported reduced postoperative pain levels and improved functional results, as evidenced by higher Lysholm scores. These findings imply that PRP promotes biological healing and improves clinical recovery.
Conclusion: PRP augmentation in arthroscopic meniscal repair increases healing rates, decreases postoperative pain, and improves functional outcomes. It is a promising supplementary therapy in meniscus preservation techniques, with the potential to improve patient recovery and long-term joint health.

Clinical Profile and Hormonal Patterns in Women with Newly Diagnosed PCOD Attending a Tertiary Care Hospital

Kumari Jyoti Rani — 2026-06-20

Background: Polycystic ovarian disease is an endocrine condition of hormonal imbalance, irregular menstrual periods, and high androgen levels and is the most common endocrine disease in women of reproductive age. It commonly presents with metabolic derangements such as insulin resistance, obesity and dyslipidaemia, which may cause infertility and raise the risk of diabetes and cardiovascular disease in the long run.
Objective: To evaluate the clinical profile and hormonal patterns in newly diagnosed PCOD patients.
Methods: This cross-sectional study was conducted at PMCH, Patna, from September 2025 to February 2026, including 200 women diagnosed with PCOD. Clinical features, BMI, and hormonal parameters (LH, FSH, testosterone, prolactin) were assessed. Statistical analysis included chi-square test and t-test, with p<0.05 considered significant.
Results: The majority of patients were either overweight or obese (70%). The most prevalent symptom was irregular menstruation (70%). Increased LH levels were detected in 65% of patients and increased testosterone levels in 55% of individuals. BMI was significantly associated with hormonal imbalance (P<0.05).
Conclusion: PCOD is strongly associated with obesity and hormonal disturbances. Early diagnosis and lifestyle modification are crucial for management.

Morphological Variation in Lumbricals of Hand

Priyanshu — 2026-06-20

Background: The lumbrical muscles of the hand are unique intrinsic muscles responsible for coordinated finger movements and fine motor functions. Variations in their morphology, origin, insertion, and innervation may influence hand biomechanics and surgical outcomes.
Aim: To analyze the morphological variations of lumbrical muscles of the hand in terms of number, origin, insertion, and morphometry.
Materials and Methods: This cross-sectional cadaveric observational study was conducted in the Department of Anatomy, Jawaharlal Nehru Medical College, Bhagalpur, from 2023–2026. Forty hands obtained from 20 formalin-fixed adult cadavers were dissected. Morphological parameters including number of lumbricals, origin, insertion, muscle belly length, tendon length, and variations were documented. Measurements were taken using digital Vernier calipers. Statistical analysis was performed using Microsoft Excel and descriptive statistics.
Results: All four lumbricals were present in 80% of hands, while 12.5% showed only three lumbricals and 7.5% demonstrated supernumerary lumbricals. The first and second lumbricals were predominantly unipennate, whereas the third and fourth lumbricals were mainly bipennate. Accessory insertions and bifid insertions were observed in a few specimens. The mean muscle belly lengths of the first, second, third, and fourth lumbricals were 3.5 ± 0.5 cm, 3.3 ± 0.6 cm, 3.0 ± 0.5 cm, and 2.8 ± 0.5 cm respectively.
Conclusion: Considerable morphological variations exist in the lumbrical muscles of the hand. Awareness of these variations is important for anatomists, hand surgeons, and clinicians during surgical procedures, diagnosis of entrapment neuropathies, and rehabilitation.

Exploring the Link Between Hematological Disorders and Autoimmune Thyroid Diseases

Shrutika Srivastava — 2026-06-20

Background: Autoimmune thyroid disorders (AITDs), which include hypothyroidism and hyperthyroidism, are frequently accompanied with hematological abnormalities like anemia, leukopenia, and thrombocytopenia. Understanding this link is critical for early diagnosis and management.
Methods: This retrospective analysis comprised 100 patients diagnosed with autoimmune thyroid disease over the course of a year. Hematological markers were examined and linked with thyroid function. The Student’s t-test and the Chi-square test were used in the statistical analysis.
Results: Hematological abnormalities were seen in 62% of individuals. The most prevalent observation was anemia (40%), followed by leukopenia (15%), and thrombocytopenia (7%). A strong link was discovered between hypothyroidism and anemia (p=0.01). Patients with hematological disorders had considerably different thyroid profiles.
Conclusion: Autoimmune thyroid illnesses are strongly associated with hematological problems, particularly anemia. Routine hematological examination is advised in patients with thyroid dysfunction for early diagnosis and therapy.

Histopathological Spectrum of Prostatic Lesions and Correlation with Total Serum Prostate-Specific Antigen: A Prospective Observational Study

Danish Ansari — 2026-06-20

Background: Prostatic lesions range from benign hyperplasia to malignant lesions, with serum prostate-specific antigen (PSA) serving as an important biomarker for screening and disease monitoring. However, PSA levels often overlap between benign and malignant conditions, making histopathological confirmation essential.
Objective: To evaluate the histopathological spectrum of prostatic lesions and correlate findings with serum PSA levels.
Methods: This prospective observational study was conducted at DMCH from February 2025 to October 2025, including 90 patients presenting with lower urinary tract symptoms. Serum PSA levels were measured, and histopathological examination was performed on biopsy or resection specimens. Statistical correlation between PSA levels and histological diagnoses were analyzed.
Results: Benign prostatic hyperplasia (BPH) was the most common lesion (62.2%), followed by prostatitis (15.6%), carcinoma (16.7%), and prostatic intraepithelial neoplasia (PIN) (5.5%). Mean PSA levels were significantly higher in malignant lesions (36.8 ± 12.4 ng/mL) compared to benign conditions (6.2 ± 3.1 ng/mL) (p < 0.001). A strong positive correlation was observed between elevated PSA levels and malignancy.
Conclusion: PSA is a useful screening tool but lacks specificity. Histopathological examination remains the gold standard for diagnosis. Combined evaluation improves diagnostic accuracy.

Surgical Site Infections in Digestive Surgery: A Meta-Analysis of Hospitals in BBMCH BALANGIR

Sujeet Kumar Bramha — 2026-06-27

Objective: To study the characteristics of surgical site infections (SSI) in digestive surgery in BBMCH BALANGIR.
Patients and Methods: This was an analytical, crosssectional, and multicenter study conducted from March 1 to September 30, 2024, in the digestive surgery departments of GENERALSURGERY the BBMCH BALANGIR. All hospitalized patients aged at least 18 years who underwent abdominal surgery were included in the study. Patients were followed up within 30 days of surgery.M
Results: During the study period, 493 patients were included, 73 cases of SSI were recorded, representing a frequency of 14.8%. Was the center with the most cases of SSI were found in the university hospital (58 patients or 79.4%). The median age was 41 years. Male sex was predominant with a sex-ratio of 1.35. Among the SSIs, 74% were superficial; 20.5% deep and 5.5% organ. Acute generalized peritonitis was the most common pathology of infected patients (60.3%). Of the 73 samples analyzed, 70 cultures were positive, representing 95.8%. Escherichia coli were the most identified microorganism (36.5%), followed by non-coagulase Staphylococcus (15%) and Klebsiella pneumoniae (12.2%). Multivariate analysis showed that SSI was statistically associated with ASA score, operative mode, and NNISS score.
Conclusion: SSIs represent a major public health problem. Prevention relies on rigorous epidemiological surveillance and compliance with good perioperative hygiene practices.

Aerobic Bacteriological Isolates of Burn Wound Infections and Their Antimicrobial Sensitivity Pattern in the Burn Unit of a Tertiary Care Hospital in Bihar: A Prospective Observational Study

Bindu Kumari — 2026-06-25

Background: Burn wound infections are among the leading causes of morbidity and mortality in burn patients due to loss of skin barrier, immunosuppression, prolonged hospitalization, and emergence of antimicrobial-resistant organisms. Continuous monitoring of the bacteriological profile and antimicrobial susceptibility pattern is essential for effective management of burn wound infections.
Aim: To study the aerobic bacteriological isolates of burn wound infections and evaluate their antimicrobial sensitivity pattern among patients admitted to the Burn Unit of Patna Medical College & Hospital (PMCH), Patna.
Materials and Methods: A hospital-based prospective observational study was conducted in the Burn Unit of PMCH, Patna, from October 2022 to September 2023. A total of 100 burn wound patients clinically suspected of wound infection were included. Wound swabs/pus samples were collected under aseptic precautions and processed using standard microbiological techniques for aerobic bacterial isolation and identification. Antimicrobial susceptibility testing was performed by Kirby–Bauer disc diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was performed using SPSS version 25.0.
Results: Among the 100 burn wound samples studied, bacterial growth was obtained in 79 samples, while 21 samples showed no growth. Of the culture-positive samples, 69 (87.34%) demonstrated monomicrobial colonization and 10 (12.66%) demonstrated polymicrobial colonization. A total of 89 bacterial isolates were recovered. Pseudomonas aeruginosa was the predominant isolate accounting for 41.57% of isolates, followed by Staphylococcus aureus (25.84%), coagulase-negative staphylococci (14.60%), Klebsiella pneumoniae (8.98%), Escherichia coli (5.61%), and Proteus mirabilis (3.37%). Gram-negative organisms constituted 59.55% of isolates, whereas Gram-positive organisms accounted for 40.45%. Imipenem demonstrated the highest sensitivity against Gram-negative isolates, while vancomycin and linezolid showed 100% sensitivity against Gram-positive isolates.
Conclusion: Pseudomonas aeruginosa was the predominant aerobic bacterial isolate recovered from burn wound infections in the present study, followed by Staphylococcus aureus. Gram-negative organisms were more common than Gram-positive organisms. Imipenem showed excellent activity against Gram-negative isolates, while vancomycin and linezolid remained highly effective against Gram-positive isolates. Regular bacteriological surveillance and rational antibiotic use are essential for effective management of burn wound infections and prevention of antimicrobial resistance.

A Study of Time Domain Parameters of Heart Rate Variability in Females in the Latent Phase of Labor and Postpartum Period in a Tertiary Care Centre of Central India

Mahesh Chandra Alawa — 2026-07-16

Background: Pregnancy and labor are associated with significant autonomic nervous system adaptations that facilitate maternal and
fetal well-being. Heart rate variability (HRV) is a non-invasive marker of autonomic regulation and provides valuable insights into
sympathetic and parasympathetic balance. However, changes in time-domain HRV parameters during the latent phase of labor and
the immediate postpartum period remain inadequately characterized.
Aim: To evaluate and compare time-domain parameters of heart rate variability in females during the latent phase of labor and the
postpartum period.
Methods: This observational study was conducted at Bundelkhand Medical College, Sagar, over a period of three months. A total of
100 healthy term pregnant women in the latent phase of labor were enrolled. HRV recordings were obtained during the latent phase
and repeated 48 hours postpartum. Time-domain parameters including mean RR interval, SDNN, RMSSD, NN50, and pNN50 were
analyzed and compared.
Results: Significant increases in SDNN, RMSSD, NN50, and pNN50 were observed during the postpartum period compared with
the latent phase of labor (p<0.001). Mean heart rate decreased significantly postpartum, indicating restoration of parasympathetic
activity. The findings suggest a shift from sympathetic predominance during labor to improved autonomic balance following delivery.
Conclusion: The postpartum period is associated with significant improvement in HRV parameters, reflecting recovery of autonomic
function after labor. Time-domain HRV analysis may serve as a useful tool for assessing maternal autonomic adaptations during the
peripartum period.

Evaluation of Iron Status Biomarkers and Cognitive Performance Among Pediatric Patients with Iron Deficiency Anemia

Dakshayani Patlolla — 2026-06-27

Background: Iron deficiency anemia (IDA) is the most common nutritional deficiency among children worldwide and is associated with impaired neurocognitive development. Iron plays a crucial role in neurotransmitter synthesis, myelination, and energy metabolism in the developing brain. Early identification of cognitive impairment associated with iron deficiency may facilitate timely intervention and improve developmental outcomes.
Objectives: To evaluate iron status biomarkers among pediatric patients with iron deficiency anemia and assess their association with cognitive performance.
Materials and Methods: A hospital-based cross-sectional study was conducted among 100 children aged 6–12 years attending the pediatric outpatient department of a tertiary care teaching hospital. Fifty children diagnosed with iron deficiency anemia constituted the study group, while fifty age- and sex-matched healthy children served as controls. Hemoglobin concentration, serum ferritin, serum iron, total iron-binding capacity (TIBC), and transferrin saturation were measured using standard laboratory methods. Cognitive performance was assessed using age-appropriate standardized cognitive assessment tools evaluating memory, attention, processing speed, and executive functions. Statistical analysis was performed using SPSS version 25.0. Independent t-test and Pearson correlation analysis were used to determine differences and associations. A p-value <0.05 was considered statistically significant.
Results: Children with iron deficiency anemia (IDA) had significantly lower hemoglobin (9.2 ± 1.1 vs. 12.8 ± 0.9 g/dL), serum ferritin (11.4 ± 4.2 vs. 42.8 ± 8.5 ng/mL), serum iron (38.7 ± 9.3 vs. 86.5 ± 12.1 μg/dL), and transferrin saturation (8.7 ± 2.1 vs. 27.4 ± 4.5%) compared to controls, while TIBC was significantly higher (445 ± 35 vs. 325 ± 28 μg/dL) (p<0.001). Cognitive performance scores, including attention, memory, processing speed, and executive function, were significantly lower in the IDA group (p<0.001). Overall cognitive performance showed positive correlations with hemoglobin (r=0.52, p<0.001) and serum ferritin (r=0.48, p<0.001), whereas TIBC demonstrated a negative correlation (r=-0.41, p=0.004). Cognitive scores declined progressively with increasing severity of anemia.
Conclusion: Pediatric patients with iron deficiency anemia exhibited significantly altered hematological and iron status biomarkers along with impaired cognitive performance compared to healthy controls. Lower hemoglobin and ferritin levels were significantly associated with poorer cognitive outcomes. These findings highlight the importance of early screening, diagnosis, and treatment of iron deficiency anemia to improve cognitive development and academic performance among children.

Comparative Study of Anisometropic Amblyopia treatment with Spectacles alone and Combined spectacles with Patching

Sajad Mohi Ud Din — 2026-06-27

Comparative study of anisometropic amblyopia treatment with spectacles alone and combined spectacles with patching
Purpose: To compare duration and amount of improvement with spectacles alone and spectacles with patching in anisometropic amblyopia.
Study Design: Prospective comparative interventional study
Methods: This prospective study was conducted at Department of Ophthalmology GMC Doda ,GMC Rajori, GMC Handwara , GMC Anatnag and District hospital pulwama J&K for period of five years. Difference in BCVA of 2 snellen lines or more in absence of any structural abnormality or visual pathway was considered indicative of amblyopia.
Inclusion criteria: Unilateral amblyopia, V/A < 6/9, Age 4 to 10 years, Anisometropia > 1D
Exclusion criteria: Stimulus deprivation amblyopia, Age <4 & >10 years, Bilateral Amblyopia, Already treated or under treatment amblyopia. 68 Amblyopic children were either treated with spectacles alone or with combined spectacle and patching. Follow up was done after every 2 months.
Results: Among 68 amblyopic children 30 were treated with spectacles alone and 38 were treated with combined spectacles and patching. Mean age at start of treatment in former was 6.2 +/-2.3 and 5.8 +/- 2.6 in combined group. Final V/A after treatment was 20/40 and 20/25 respectively among two groups. Mean time of amblyopia improvement was 7.3 +/- 4.1 and 6.2 +/- 3.5 in spectacles alone and combined spectacles and patching respectively.
Conclusion: Amblyopic children treated with combined spectacles and patching showed better results in amount as well as duration of treatment than those treated with spectacles alone.

Uterine Fibroids and Hysterectomy Route: Comparative Perioperative Outcomes of Abdominal, Vaginal, Laparoscopic, Robotic, and vNOTES Approaches

Goni Girija — 2026-06-29

Background: Uterine fibroids are the most prevalent benign pelvic tumour in women of reproductive age and up to 70% of women are affected by the age of 50. For symptomatic non-responsive fibroids, surgery to remove the uterus (hysterectomy) is the last resort. There are several surgical approaches: total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), total laparoscopic hysterectomy (TLH), laparoscopically-assisted vaginal hysterectomy (LAVH), robotic-assisted total laparoscopic hysterectomy (R-TLH), and the increasingly popular transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy. Although a lot of literature has been written, the best route selection is still not agreed.
Objectives: To systematically review and meta-analyze operative time, estimated blood loss (EBL), length of hospital stay (LOS), intraoperative and postoperative complication rates and conversion rates for all major hysterectomy approaches for the benign uterine fibroid indication (2022–2026).
Methods: Systematic review and meta-analysis in accordance with the PRISMA 2020 guidelines. Databases: PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus and Web of Science (January 2022–June 2026). Random-effects models (DerSimonian-Laird) were used; assessment of heterogeneity using the I² statistic.
Results: Nine studies (total of 1,116,000 patients) of minimally invasive hysterectomy (MIH) showed lower EBL, shorter LOS, and lower overall complication rates compared to TAH in each study. The most common approach was TLH (54.4% in high volume centers). Robotic hysterectomy vs. open: OR 0.42 (0.27–0.66) complications; 6.31-fold risk for transfusion in abdominal. R-TLH vs. C-TLH: similar peri-operative outcomes, with R-TLH having a slightly shorter LOS (MD −0.64 days, 95% CI: −1.10 to −0.17). TLH had a 7.54-fold greater risk of ureteral injury compared to TVH for large uteri (at or above 250 g). The vNOTES hysterectomy was demonstrated to be non-inferior to TLH, and had shorter operative time and better pain scores. Laparoscopic myomectomy demonstrated significantly reduced EBL (105 mL versus 317 mL), shorter operative time, and quicker recovery when compared with open myomectomy.
Conclusion: Hysterectomy is the standard of care for the treatment of uterine fibroids and minimally invasive procedures are the usual treatment. The ‘vaginal-first’ or ‘laparoscopic-first’ algorithm allows for the best possible outcomes while keeping surgical flexibility.A ‘vaginal-first algorithm’ or ‘laparoscopic-first algorithm’ with vNOTES as a teaching tool and safety net. Patient size, surgeon experience, patient comorbidities and fertility status should all be taken into account when developing the route of selection.

Morphometric Analysis of Foramen Magnum in Adult CT Images: A Cross-Sectional Study

Archana A — 2026-07-01

Background: The foramen magnum is a vital anatomical structure located at the base of the skull, transmitting the lower brainstem, vertebral arteries, meninges, and associated neurovascular structures. Accurate morphometric assessment of the foramen magnum is important in neurosurgery, radiology, anthropology, and forensic medicine. Computed tomography (CT) provides precise measurements of cranial base anatomy and facilitates evaluation of morphometric variations in living populations.
Aim: To evaluate the morphometric dimensions of the foramen magnum in adult CT images and establish baseline data useful for clinical, surgical, and forensic applications.
Materials and Methods: A cross-sectional observational study was conducted using CT images of adult patients attending the Department of Radiology, Government Medical College, Medak. Adult subjects between 18 and 79 years of age who underwent cranial CT examination were included. Patients with craniovertebral junction anomalies, fractures, neoplasms, or pathological conditions affecting the skull base were excluded. Morphometric parameters including anteroposterior diameter, transverse diameter, right oblique diameter, and left oblique diameter of the foramen magnum were measured using CT imaging. Data were analyzed using appropriate statistical methods, and morphometric differences between sexes were evaluated.
Results: Morphometric assessment demonstrated that the anteroposterior diameter was consistently greater than the transverse diameter in the majority of subjects. Male participants exhibited larger mean dimensions of the foramen magnum compared with female participants. Significant variations were observed among the measured parameters, reflecting normal anatomical diversity within the study population. The findings established normative morphometric values for the adult population studied and highlighted the utility of CT imaging in evaluating cranial base anatomy.
Conclusion: The present study provides valuable morphometric data regarding the dimensions of the foramen magnum in adults. These measurements may aid neurosurgeons in planning craniovertebral junction procedures, assist radiologists in anatomical assessment, and contribute to forensic identification and anthropological research. CT-based morphometric evaluation offers a reliable and non-invasive method for studying variations of the foramen magnum in living populations.

Morphological and Morphometric Study of Atlas (C1) and Axis (C2) Vertebrae in Human Skeletons

Ashwani Kumar Sharma — 2026-07-02

Background: The atlas (C1) and axis (C2) vertebrae are specialized cervical vertebrae that facilitate head movement and provide stability to the craniovertebral junction. Detailed morphometric knowledge of these vertebrae is essential for neurosurgical procedures, spinal fixation techniques, and forensic investigations.
Aim: To analyze the morphological variations and morphometric dimensions of atlas and axis vertebrae in human skeletal specimens and evaluate their clinical significance.
Methods: A retrospective osteological study was conducted in the Department of Anatomy, Government Medical College, Jammu, over 3 months. Thirty dry human vertebrae (15 atlas and 15 axis vertebrae) were examined. Various morphometric parameters including transverse diameter, anteroposterior diameter, vertebral canal dimensions, superior articular facet measurements, dens dimensions, and vertebral foramen dimensions were recorded using digital Vernier calipers. Morphological variations were documented. Statistical analysis was performed using SPSS version 26. Student’s t-test and Pearson correlation analysis were applied, with p<0.05 considered statistically significant.
Results: The mean transverse diameter of the atlas was 76.4 ± 4.8 mm, while the mean anteroposterior diameter measured 44.2 ± 3.5 mm. The average length of the dens in axis vertebrae was 15.8 ± 1.7 mm and the mean width was 9.1 ± 1.2 mm. Morphological variations were observed in 26.7% of specimens. Significant positive correlations were found between vertebral body dimensions and dens measurements (p<0.001).
Conclusion: Atlas and axis vertebrae exhibit significant morphometric variability. These findings provide valuable anatomical data for craniovertebral junction surgery, cervical instrumentation, and forensic anthropology.

Perception of Self-Directed Learning as a Learning Technique in Anatomy among Phase I MBBS Learners

B. Manasa — 2026-07-06

Background: With the implementation of Competency-Based Medical Education (CBME) in India, Self-Directed Learning (SDL) has become an essential component of undergraduate medical education, promoting active learning, critical thinking, and learner autonomy. Anatomy, being a foundational subject with extensive competencies, requires effective learning strategies beyond conventional didactic teaching. However, first-year MBBS learners often face challenges in adapting to SDL due to limited prior exposure and dependence on teacher-centered learning approaches.
Objectives: To assess the perception of Self-Directed Learning (SDL) as a learning technique in Anatomy among Phase I MBBS learners.
Methods: A cross-sectional observational study was conducted among 100 Phase I MBBS students of the 2025 batch at Government Medical College, Jangaon. Prior to the SDL session, learner readiness was assessed using a structured questionnaire administered through Google Forms. Students were provided with clearly defined learning objectives and an assessment checklist five days before the scheduled SDL session. They were instructed to independently prepare notes incorporating diagrams, flowcharts, and tables based on the given objectives. Practical demonstration of the topic was conducted in the dissection hall in small groups two days before the SDL session. Following the session, students’ perceptions regarding SDL were assessed using a 2-point Likert scale questionnaire along with an open-ended feedback question.
Results: The study revealed that 97% of learners reported clarity regarding their learning goals, while 95% expressed enjoyment and satisfaction with the SDL sessions. However, 52% reported difficulty in effectively managing their learning time. Open-ended responses indicated that students found SDL informative, engaging, and helpful in improving conceptual understanding and independent thinking, though some expressed challenges with difficult anatomical terminology and self-learning adjustments.
Conclusion: Self-Directed Learning appears to be an effective and well-accepted learning strategy among Phase I MBBS learners in Anatomy when implemented systematically with clearly defined learning objectives and structured assessment guidance. SDL may enhance learner engagement, conceptual understanding, and self-learning skills in early medical education.

Comparative Analysis of Tear Film Parameters in Patients With and Without Meibomian Gland Dysfunction: A Prospective Observational Study

Subhashree Mohanta — 2026-07-11

Background: Meibomian gland dysfunction (MGD) is recognized as the leading cause of evaporative dry eye disease and contributes significantly to tear film instability and ocular surface inflammation. Alterations in tear film parameters such as tear break-up time (TBUT), Schirmer’s test values, Ocular Surface Disease Index (OSDI), lower tear meniscus height, and meibography findings are frequently observed in patients with MGD. Comparative assessment of these parameters in patients with and without MGD is essential for understanding disease severity and optimizing management strategies.
Aim: To compare tear film parameters between patients with and without meibomian gland dysfunction.
Materials and Methods: This prospective observational study was conducted in the Department of Ophthalmology, SCB Medical College and Hospital, Cuttack, Odisha, over a period of 1.5 years from September 2022 to May 2024. A total of 269 patients presenting with symptoms suggestive of dry eye disease were enrolled. Patients were divided into two groups according to meibomian gland status: MGD group (n=155) and Non-MGD group (n=114). Clinical evaluation included slit lamp examination, Schirmer’s test, tear break-up time, fluorescein staining, OSDI scoring, blink rate, blink interval, lower tear meniscus height, Marx line score, and meibography. Statistical analysis was performed using R version 4.3.2. Continuous variables were expressed as mean ± standard deviation and compared using Student’s t-test. Categorical variables were analyzed using Chi-square test. A p-value <0.05 was considered statistically significant.
Results: Patients with MGD demonstrated significantly lower TBUT values (8.12±2.11 s vs 11.89±1.84 s, p<0.001), lower Schirmer’s test scores (12.41±3.84 mm vs 16.93±3.17 mm, p<0.001), and reduced lower tear meniscus height (0.24±0.08 mm vs 0.36±0.10 mm, p<0.001). OSDI scores and Marx line scores were significantly higher among MGD patients (58.61±11.27 vs 41.48±9.36; p<0.001 and 1.87±1.02 vs 0.71±0.74; p<0.001 respectively). Meibography grades and fluorescein staining severity were also significantly associated with MGD.
Conclusion: Meibomian gland dysfunction is associated with significant deterioration of tear film parameters and increased symptom severity. Early diagnosis and intervention are essential to prevent progression of ocular surface disease and improve quality of life.

Corticosteroids and Antibiotics Utilization in COPD Exacerbation: A Prospective Observational Study from a Tertiary Care Hospital

More Yash U — 2026-07-13

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, with exacerbations significantly impacting disease progression, hospitalization rates, and mortality risk. The GOLD 2025 guidelines emphasize the critical role of corticosteroids and antibiotics in managing COPD exacerbations, yet prescribing practices in rural Indian healthcare settings remain inadequately documented.
Objective: This study aimed to assess the prescribing patterns of corticosteroids and antibiotics among patients with COPD exacerbations at a tertiary care hospital in rural Maharashtra, India, and evaluate adherence to GOLD 2025 treatment guidelines.
Methods: A prospective observational study was conducted over six months (June to November 2025) at Vilasrao Deshmukh Government Medical College and Hospital, Latur, Maharashtra. Patients aged ≥40 years with clinically confirmed COPD exacerbations were enrolled. Data on demographic characteristics, corticosteroid utilization (type, route, dose, duration), antibiotic prescribing patterns (class, specific agents), and therapy combinations were collected using a structured proforma. Descriptive statistics were employed for data analysis.
Results: Among 50 enrolled patients, the majority were aged ≥60 years (76%), with a nearly equal gender distribution (48% male, 52% female). Corticosteroid therapy was administered to 86% (n=43) of patients, with dual therapy (44%) and triple therapy (40%) being the predominant regimens. Antibiotics were prescribed rationally, with penicillins (35%) and macrolides (31%) being the most commonly utilized classes. Azithromycin (56%) and amoxicillin-clavulanate (44%) were the most frequently prescribed specific agents. The prescribing patterns demonstrated substantial alignment with GOLD 2025 recommendations, though opportunities for improvement were identified in eosinophil-guided inhaled corticosteroid prescribing and antimicrobial stewardship.
Conclusion: This study reveals that corticosteroid and antibiotic prescribing practices at the study hospital largely adhere to GOLD 2025 guidelines, reflecting appropriate clinical management of COPD exacerbations. However, gaps persist in consistent documentation of blood eosinophil counts and optimization of inhaled corticosteroid therapy. Enhanced disease awareness initiatives, regular prescription audits, and strengthened antimicrobial stewardship programs are essential to further improve COPD management outcomes in resource-limited rural Indian settings.

Antimicrobial Susceptibility Pattern of Pseudomonas aeruginosa Isolated from ICU Patients

Adwityama . — 2026-07-15

Background: Pseudomonas aeruginosa is a major cause of healthcare-associated infections in intensive care units (ICUs) and is associated with significant morbidity, mortality, and antimicrobial resistance. Continuous surveillance of susceptibility patterns is essential for guiding empirical therapy and infection control practices.
Aim: To determine the antimicrobial susceptibility pattern of Pseudomonas aeruginosa isolated from ICU patients and evaluate the prevalence of multidrug-resistant strains.
Methods: A prospective observational study was conducted at Patna Medical College and Hospital (PMCH) from July 2025 to March 2026. A total of 100 non-duplicate Pseudomonas aeruginosa isolates obtained from ICU patients were included. Clinical specimens including endotracheal aspirates, sputum, urine, blood, wound swabs, and pus samples were processed using standard microbiological techniques. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method according to CLSI guidelines. Resistance patterns and multidrug resistance (MDR) rates were analyzed.
Results:Respiratory samples constituted the majority of isolates (42%). Highest susceptibility was observed for colistin (98%), polymyxin B (96%), and ceftolozane-tazobactam (88%). Resistance was highest against ciprofloxacin (62%), levofloxacin (58%), and ceftriaxone (74%). Multidrug-resistant Pseudomonas aeruginosa was identified in 38% of isolates. Carbapenem resistance was observed in 32% of isolates and was significantly associated with prolonged ICU stay (p=0.004).
Conclusion: Pseudomonas aeruginosa isolated from ICU patients demonstrated high resistance to commonly used antibiotics while retaining susceptibility to polymyxins. The substantial prevalence of MDR strains highlights the need for antimicrobial stewardship, routine surveillance, and rational antibiotic utilization.

Study Of Capecitabine in Patients With Solid Tumours At a Tertiary Care Centre

Yuganshu Gupta — 2026-07-15

Background:Capecitabine, an orally administered fluoropyrimidine prodrug of 5-fluorouracil (5-FU), has become an integral component of systemic therapy for several solid malignancies because of its efficacy, favourable toxicity profile, and convenience of administration. Although its role has been extensively investigated in colorectal and breast cancers, real-world evidence regarding its effectiveness and tolerability across diverse solid tumours in the Indian population remains limited. This study aimed to evaluate the efficacy, safety, and tolerability of capecitabine in patients with solid tumours treated at a tertiary cancer care centre.
Methods: This observational study included adult patients with histopathologically confirmed solid malignancies who received capecitabine either as monotherapy or in combination with other anticancer modalities at the Department of Oncology in a tertiary care centre. Baseline demographic, clinicopathological, treatment, and laboratory data were recorded. Patients were prospectively followed to assess treatment response, adverse events, dose modifications, treatment interruptions, and survival outcomes. Tumour response was evaluated according to standard response assessment criteria (RECIST 1.1), while treatment-related toxicities were graded using the Common Terminology Criteria for Adverse Events. Statistical analyses were performed using appropriate descriptive and inferential methods, with a p-value <0.05 considered statistically significant.
Results: A total of 94 patients with solid malignancies were enrolled, with a median age of 48 years; 79% were female, and 84% had metastatic disease treated with palliative intent. Breast cancer was the most common malignancy (48.9%). Dose reduction due to toxicity was required in 72.3% of patients, while treatment discontinuation due to adverse events occurred in only 5.3%. Hand-foot syndrome (31.9%), anaemia (28.7%), and diarrhoea (21.3%) were the most frequent toxicities, with Grade 3/4 haematological toxicity observed in only 4.3%. Among the 78 evaluable patients, stable disease was achieved in 55.1%, partial response in 10.3%, and progressive disease in 34.6%. The highest disease control was observed in ovarian and cervical cancers, whereas head and neck cancers demonstrated the poorest response.
Conclusion: Capecitabine is an effective, safe, and well-tolerated therapeutic option for patients with a variety of solid malignancies in routine clinical practice. Its favourable toxicity profile, ease of oral administration, and acceptable treatment outcomes make it an attractive alternative to continuous intravenous fluoropyrimidine therapy. Early recognition and prompt management of treatment-related toxicities, particularly hand-foot syndrome and gastrointestinal adverse events, facilitate treatment continuation and optimize patient outcomes.

Neoadjuvant pembrolizumab with paclitaxel and carboplatin in locally advanced esophageal and esophagogastric junction carcinoma: short-term outcomes of a single-center retrospective cohort

Yuganshu Gupta — 2026-07-15

Background: The addition of anti–PD-1 therapy to chemotherapy has become standard in advanced esophageal cancer and, as adjuvant nivolumab, after chemoradiotherapy and R0 resection. Its role in the neoadjuvant setting is still being defined, and real-world data from routine practice, particularly where chemoradiotherapy capacity is limited, remain sparse. We describe short-term outcomes of neoadjuvant pembrolizumab combined with paclitaxel and carboplatin in patients treated at a single center.
Methods: We retrospectively identified 14 consecutive patients with locally advanced esophageal or esophagogastric junction (EGJ) carcinoma who received neoadjuvant pembrolizumab 200 mg every 3 weeks with paclitaxel and carboplatin, with planned esophagectomy. The primary endpoint was pathological complete response (pCR, ypT0 ypN0). Secondary endpoints were the radiographic objective response, R0 resection, treatment completion, adverse events (CTCAE v5.0), postoperative morbidity, and short-term disease status. Continuous variables are summarized as median (range) and categorical variables as counts (percentages); no inferential testing was performed given the sample size.
Results: Twelve of 14 patients (85.7%) had squamous cell carcinoma; 9 (64.3%) had clinical stage III disease. All cycles were delivered as pembrolizumab plus paclitaxel–carboplatin; 6 patients (42.9%) completed all three planned cycles and 9 (64.3%) had at least one dose delay. A radiographic objective response was recorded in 9 patients (64.3%). Ten patients (71.4%) underwent esophagectomy, all with R0 resection; the four remaining patients did not proceed to surgery because of progressive disease (1), medical unfitness (2), or patient refusal (1). pCR occurred in 3 of 14 patients on an intention-to-treat basis (21.4%) and in 3 of 10 resected patients (30.0%); all three had had a complete clinical response and the highest PD-L1 combined positive scores in the cohort. Grade 3–4 adverse events occurred in 6 patients (42.9%) and immune-related adverse events in 5 (35.7%), including one grade 3 immune hepatitis and one grade 2 pneumonitis. After a median follow-up of 7.8 months (range 3.0–11.2), no deaths had occurred and two patients had developed recurrence.
Conclusions: In this small cohort, neoadjuvant pembrolizumab with paclitaxel and carboplatin was deliverable and permitted R0 resection in all operated patients, with a pCR rate consistent with early-phase neoadjuvant chemoimmunotherapy experience. Toxicity was not negligible and limited full-course delivery in more than half of patients. The sample size, absence of a comparator, and immature follow-up preclude conclusions about efficacy or survival; the findings are hypothesis-generating.

Learning Beyond the Classroom: Early Clinical Placement Experiences among Undergraduate Medical Students

Gauravv Anand — 2026-07-15

Early clinical placements are a crucial stage in undergraduate medical education, helping students integrate theoretical knowledge with clinical practice while developing confidence and professional identity. This mixed-methods cross-sectional study explored the experiences of 32 third-year medical students at Brunel Medical School during their first clinical placements across five NHS Trusts. Data were collected using an online questionnaire with Likert-scale and open-ended questions and analysed using descriptive statistics and thematic analysis.
Most students perceived the clinical environment as welcoming (94%) and supportive (88%), with 78% reporting that clinicians’ teaching enhanced learning. Although students initially experienced uncertainty, a steep learning curve, and challenges balancing academic and clinical responsibilities, these experiences promoted independence and self-directed learning. Early clinical exposure increased confidence in patient interactions (88%), strengthened professional identity (94%), and improved the application of theoretical knowledge to practice (88%). Qualitative findings highlighted the value of supportive supervision, constructive feedback, authentic patient encounters, and an inclusive learning environment. Students recommended more simulation-based training, structured bedside teaching, consistent feedback, better integration of academic and clinical learning, and formal mentorship. Overall, supportive and well-structured early clinical placements are essential for preparing medical students for clinical practice.

Sleep Quality And Its Relation To Sleep Hygiene Awareness Among Undergraduate Medical Students In Haldwani, District-Nainital

Rupali Gupta — 2026-07-16

Background: Sleep is a vital part of an individual’s life. Thus, good sleep practices, i.e., sleep hygiene, are the key to good health, and deviations from these may result in many problems. Such deviations are common among college students and are often attributed to lifestyle changes that cause variations in their daily sleep schedules, leading to poor sleep quality.The aim of the study is to assess the sleep hygiene awareness and sleep quality among medical students and association of sleep hygiene awareness and sleep quality among them.
Methodology: This descriptive, institution-based cross-sectional study was conducted among undergraduate medical students of Government Medical College, Haldwani, District Nainital.Two validated instruments were used: the Pittsburgh Sleep Quality Index (PSQI) and the Sleep Belief Scale (SBS). The questionnaire was administered as a Google Form, and the data were analyzed using SPSS version 20.0.0.
Result: Among medical students, female (57.3%) were more than males (42.73%), 288(63.44%) participants had good sleep quality while166(36.56%) were having poor sleep quality. 301(66.30%) students were having intermediate followed by excellent awareness 111(24.45%) on sleep hygiene.72 (64.86%) good sleeper and 39 (35.14%) poor sleeper got excellent score in SH awareness.
Conclusion: This study revealed that poor sleep quality was found among 1/3rd of the medical students.2/3rd of the participants showed moderate level of awareness with respect to sleep hygiene. Moreover, no significant association was found between SH awareness and good sleep quality. But,there is strong need to implement sleep hygiene education programs among medical students so as to improve their academic performance and overall wellbeing.

Uterine balloon tamponade in the management of refractory postpartum haemorrhage: A Prospective Observational Study

Ritu — 2026-07-22

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, particularly in low-resource settings. Uterine balloon tamponade (UBT) has emerged as a simple, cost-effective intervention for refractory PPH.
Objective: To evaluate the effectiveness and safety of uterine balloon tamponade in managing refractory postpartum hemorrhage.
Methods: This prospective observational study was conducted in the Department of Obstetrics & Gynaecology at PMCH, Patna, from March 2025 to February 2026. A total of 51 women with refractory PPH not responding to first-line medical management were included. Data regarding demographic profile, cause of PPH, mode of delivery, success rate of UBT, need for surgical intervention, and complications were recorded and analysed.
Results: The success rate of UBT in controlling hemorrhage was 82.4%. Uterine atony was the most common cause (64.7%). Surgical intervention was avoided in 76.5% of cases. Complications were minimal, with pain (11.8%) being the most common complication, followed by infection (7.8%) and balloon displacement (5.9%). Statistically significant association was found between early UBT insertion and successful outcome (p<0.05).
Conclusion: UBT is an effective, safe, and minimally invasive method for managing refractory PPH and can significantly reduce the need for surgical interventions.

Quantitative Assessment of Tibial Condylar Dimensions in Human Dry Bones

Kumari Ayushree — 2026-07-22

Background: The proximal tibia serves an important function in weight transmission and contributes significantly to the stability of the knee joint. Precise morphometric data of tibial condyles are essential for designing knee prostheses and improving outcomes of arthroplasty procedures. Variations in condylar dimensions across populations necessitate region-specific anatomical data.
Objective: To perform a quantitative assessment of tibial condylar dimensions in human dry bones and evaluate side-wise differences.
Methods:This cross-sectional study included 50 adult dry tibiae (25 right and 25 left) collected from the anatomy and forensic department. Measurements such as anteroposterior (AP) and transverse diameters of both condyles, along with total condylar dimensions, were obtained using a digital Vernier caliper. Statistical analysis included calculation of mean, standard deviation, and p-values to assess side differences.
Results:The medial condyle AP diameter averaged 39.40 ± 4.58 mm (right) and 41.29 ± 4.69 mm (left), showing no statistically significant difference. However, the lateral condyle AP diameter was significantly greater on the left (38.62 ± 3.23 mm) compared to the right (35.98 ± 3.86 mm) (p < 0.01). Total condylar AP diameter also demonstrated a significant side difference (p < 0.01), while transverse diameters and total condylar area did not show statistically significant variation.
Conclusion: The study provides valuable morphometric data on tibial condyles, highlighting significant side differences in certain parameters. These findings are clinically relevant for the design of knee prostheses and can help improve surgical outcomes in knee arthroplasty.

Timing of Definitive Fixation in Orthopedic Trauma: Early Versus Delayed Surgery and Its Impact on Outcomes

Sudeep Kumar Samanta — 2026-07-22

Background:In orthopaedic trauma, the timing of definitive fixation continues to be a crucial factor in determining results. While delayed fixation may be required in individuals who are unstable, early fixing is thought to minimise problems and hospital stays.
Methods:A total of 100 trauma patients were included and categorized into early fixation (<48 hours) and delayed fixation (>48 hours). Outcomes assessed included complications, length of hospital stay, infection rates, and functional recovery.This retrospective study examined the effects of early versus delayed fixation at IMS and SUM Hospital Campus 2 over a 1.5-year period (July 2024–December 2025).
Results:Significantly shorter hospital stays (p<0.001) and decreased complication rates (p=0.03) were linked to early fixation. Although not statistically significant, infection rates were lower in the early group. Early fixation produced higher functional results (p=0.02).
Conclusion: According to the study, early definitive fixation helps patients who are clinically stable recover more quickly by allowing for early mobilisation and lowering problems associated with immobilisation. It improves overall patient prognosis and lessens the burden of healthcare since it is linked to shorter hospital stays, reduced risk of non-union and infection, and better functional outcomes.

Morphometric Evaluation of Glenoid Cavity Dimensions and Its Relevance in Shoulder Arthroplasty

K Ephraim Vikram Rao — 2026-07-24

Background: The glenoid cavity is an important component of the shoulder joint, providing articulation with the head of the humerus and contributing to joint stability and mobility. Accurate knowledge of its morphometric dimensions is essential for successful shoulder arthroplasty, prosthesis design, and the management of glenohumeral disorders. Population-specific anatomical data are valuable for improving surgical outcomes.
Objectives: To evaluate the morphometric dimensions and morphological variations of the glenoid cavity in adult human scapulae and assess their clinical significance in shoulder arthroplasty.
Materials and Methods: A descriptive cross-sectional osteometric study was conducted in the Department of Anatomy, Government Medical College, Yadadri (Bhuvanagiri) Telangana, Government medical college, Vikarabad, Telanagana and Sree Uthradom thirunal Academy of Medical Sciences, Thiruvananthapuram, Kerala on 100 dry adult human scapulae (50 right and 50 left). The maximum superoinferior diameter, maximum anteroposterior diameter, upper anteroposterior diameter, and Glenoid Index were measured using a digital Vernier caliper. The glenoid cavity was classified into pear, oval, and inverted comma shapes. Data was analyzed using descriptive statistics, and side-wise comparisons were performed using the independent t-test, with p < 0.05 considered statistically significant.
Results: The mean superoinferior diameter was 36.8 ± 3.2 mm, the mean maximum anteroposterior diameter was 27.4 ± 2.6 mm, and the mean Glenoid Index was 74.5 ± 5.8. Pear-shaped glenoid cavities were the most common (52%), followed by inverted comma (30%) and oval (18%). No statistically significant difference was observed between the right and left sides (p > 0.05). The findings demonstrated anatomical variations that may influence prosthetic sizing and surgical planning.
Conclusion: The present study provides valuable morphometric data on the glenoid cavity in the Telangana population. These findings can assist orthopedic surgeons in preoperative planning, appropriate prosthesis selection, and improving the outcomes of shoulder arthroplasty while serving as a useful reference for anatomists and biomedical engineers.

Reproductive Risk Factors and Their Association with Breast Cancer in Women of Central India

Sriyansh Jain — 2026-07-24

Background: Breast cancer is the most common malignancy among women worldwide and represents a major public health challenge in India. Reproductive factors influence cumulative estrogen exposure and may significantly affect breast cancer risk. Understanding these associations is important for identifying high-risk women and developing preventive strategies.
Aim: To evaluate reproductive risk factors and their association with breast cancer among women attending a tertiary care center in Central India.
Methods: A prospective observational study was conducted at Bundelkhand Medical College, Sagar, over 18 months. A total of 170 women were enrolled, including 85 histopathologically confirmed breast cancer cases and 85 age-matched controls without breast malignancy. Data regarding age at menarche, age at first childbirth, parity, breastfeeding duration, menopausal status, age at menopause, and family history were collected and analyzed.
Results: Early menarche (<12 years), late age at first childbirth (>30 years), nulliparity, shorter duration of breastfeeding (<12 months), and late menopause (>50 years) were significantly associated with breast cancer (p<0.05). Women with a family history of breast cancer had a significantly higher risk of disease (OR=3.2, p=0.002). Multivariate analysis identified late age at first childbirth and short breastfeeding duration as independent predictors of breast cancer.
Conclusion: Several reproductive factors are significantly associated with breast cancer risk among women in Central India. Promotion of breastfeeding and identification of women with adverse reproductive profiles may facilitate early screening and risk reduction strategies.

Ocular Manifestations in Patients with Chronic Obstructive Pulmonary Disease Attending a Tertiary Care Centre

Sheel Mani — 2026-07-24

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive inflammatory airway disorder associated with significant systemic manifestations. Chronic hypoxia, smoking, oxidative stress, and vascular abnormalities in COPD can affect ocular structures and lead to various ophthalmic complications. Early identification of ocular manifestations in COPD patients is important to prevent visual morbidity and improve quality of life.
Aim: To evaluate the ocular manifestations in patients with Chronic Obstructive Pulmonary Disease attending a tertiary care centre.
Materials and Methods: A retrospective observational study was conducted at Government Medical College and Hospital, Purnea, Bihar, India, from April 2025 to March 2026 among 110 diagnosed COPD patients. Detailed ophthalmological examination records including visual acuity, slit-lamp examination, intraocular pressure measurement, and fundoscopy were reviewed. Data regarding demographic characteristics, smoking history, severity of COPD, and ocular manifestations were analyzed. Statistical analysis was performed using SPSS version 26.0. A p-value <0.05 was considered statistically significant.
Results: The majority of patients belonged to the age group of 51–60 years (38.2%). Male predominance was observed (72.7%). Cataract (40.9%) was the most common ocular manifestation followed by dry eye disease (30.0%), hypertensive retinopathy (18.2%), glaucoma (12.7%), and diabetic retinopathy (10.9%). Dry eye disease was significantly associated with smoking history and severe COPD (p<0.05). Increased intraocular pressure was observed in patients receiving prolonged corticosteroid therapy (p=0.021).
Conclusion: Ocular manifestations are common among COPD patients, with cataract and dry eye disease being the predominant findings. Regular ophthalmic screening in COPD patients is essential for early diagnosis and management of vision-threatening complications.

Study of Causes and Management of Gastrointestinal Perforation in East Bihar: A Prospective Observational Study

Deepak Kumar — 2026-07-25

Background: Gastrointestinal (GI) perforation is one of the most common surgical emergencies worldwide and remains associated with considerable morbidity and mortality despite advances in perioperative care. The etiological spectrum varies geographically owing to differences in socioeconomic conditions, infectious diseases, dietary habits, and healthcare accessibility. In Eastern India, peptic ulcer disease, enteric fever, intestinal tuberculosis, and appendicular pathology continue to be major causes of gastrointestinal perforation. Early diagnosis, prompt resuscitation, appropriate antimicrobial therapy, and timely surgical intervention are essential for improving patient outcomes. Understanding regional disease patterns is important for optimizing management strategies and reducing postoperative complications.
Objective: To evaluate the causes, clinical presentation, surgical management, postoperative complications, and short-term outcomes of gastrointestinal perforation among patients presenting to a tertiary care teaching hospital in East Bihar.
Methodology: A prospective observational study was conducted in the Department of General Surgery, Jawaharlal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, Bihar, between January 2024 and January 2026. One hundred consecutive adult patients with intraoperatively confirmed gastrointestinal perforation who underwent emergency surgery were enrolled. Demographic characteristics, etiological factors, clinical presentation, laboratory investigations, operative findings, surgical procedures, postoperative complications, duration of hospital stay, and mortality were recorded using a structured case record form. Statistical analysis was performed using IBM SPSS Statistics Version 26.0. Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were presented as frequencies and percentages. Student’s t-test, Chi-square test, Fisher’s exact test, one-way ANOVA, and multivariable logistic regression were applied where appropriate. A two-sided p-value <0.05 was considered statistically significant.
Results: Among the 100 enrolled patients, the mean age was 44.8 ± 15.6 years, and 77% were males. The highest proportion of patients belonged to the 41–50-year age group (28%). Peptic ulcer disease (32%) was the leading etiology, followed by typhoid perforation (17%) and appendicular perforation (14%). Traumatic gastrointestinal perforation accounted for 5% of cases. Duodenal perforation (29%) was the most common anatomical site, followed by ileal perforation (27%). Graham’s omental patch repair (33%) was the most frequently performed surgical procedure. Postoperative complications occurred in 59% of patients, with surgical site infection (27%) being the most common complication. The overall in-hospital mortality rate was 10%. Multivariable logistic regression identified shock at presentation (Adjusted OR 6.31; 95% CI 2.08–19.14; p=0.001), delay in surgery >24 hours (Adjusted OR 4.82; 95% CI 1.71–13.61; p=0.003), serum albumin <3 g/dL (Adjusted OR 3.92; 95% CI 1.31–11.73; p=0.015), and age >60 years (Adjusted OR 2.87; 95% CI 1.05–7.81; p=0.039) as independent predictors of mortality.
Conclusion: Peptic ulcer disease remains the leading cause of gastrointestinal perforation in East Bihar, with duodenal perforation being the most common anatomical site. Delayed presentation, septic shock, hypoalbuminemia, and advanced age significantly increase postoperative mortality. Early diagnosis, aggressive resuscitation, timely surgical intervention, and meticulous postoperative care remain essential for improving clinical outcomes.

The Food–Mood Connection: Exploring the Bidirectional Relationship Between Nutrition and Mental Health

Arjun Dugar — 2026-07-29

Mental health disorders, particularly depression and anxiety, have become major public health concerns worldwide, increasing the need for effective and accessible preventive strategies. Among the various lifestyle factors that influence psychological well-being, diet has gained considerable attention because it is both modifiable and closely linked to brain function. This review examines the food–mood connection, highlighting the dynamic and reciprocal relationship between dietary habits and emotional health. While emotions can influence appetite, food preferences, and eating behaviour, the foods people consume also affect mood through a range of biological and psychological mechanisms. The review discusses the influence of food colour, nostalgic food experiences, cultural dietary patterns, and food cravings on emotional well-being and food choices. It also explores the biological pathways that underpin this relationship, including the gut–brain axis, neurotransmitter regulation, chronic low-grade inflammation, and the role of essential nutrients in maintaining normal brain function. Current evidence indicates that dietary patterns rich in fruits, vegetables, whole grains, legumes, fermented foods, and healthy fats support gut microbial balance, reduce inflammation, and promote positive mental health. In contrast, frequent consumption of ultra-processed foods has been associated with impaired gut health and an increased risk of mood disorders. Overall, the available evidence suggests that nutrition should be recognised as an important component of mental health promotion, with healthy dietary practices serving as a practical and cost-effective complement to conventional approaches for improving emotional well-being.

Role of High Sensitivity CRP as an Early Biomarker of Subclinical Inflammation in Metabolic Syndrome

Shahnawaz Hasan — 2026-07-24

Background: Metabolic syndrome (MetS) is a major public health concern characterized by central obesity, insulin resistance, dyslipidemia, and hypertension. Chronic low-grade inflammation has been recognized as a central mechanism underlying the pathogenesis of MetS. High sensitivity C-reactive protein (hs-CRP) is an established inflammatory biomarker that may help in early detection of subclinical inflammation and cardiovascular risk.
Aim: To evaluate the role of hs-CRP as an early biomarker of subclinical inflammation in metabolic syndrome.
Materials and Methods: This hospital-based observational cross-sectional study was conducted at Jawaharlal Nehru Medical College, Bhagalpur, Bihar, from 2024–2026 among 180 participants. Ninety diagnosed cases of metabolic syndrome and ninety healthy controls were included. Anthropometric measurements, blood pressure, fasting blood glucose, lipid profile, and hs-CRP levels were assessed. Statistical analysis was performed using SPSS version 26.0. Student’s t-test, chi-square test, Pearson correlation analysis, and multivariate regression were used. A p-value <0.05 was considered statistically significant.
Results: Mean hs-CRP levels were significantly elevated among MetS patients (5.92 ± 2.14 mg/L) compared to controls (1.48 ± 0.76 mg/L) (p<0.001). hs-CRP showed positive correlation with BMI (r=0.58), waist circumference (r=0.61), fasting blood glucose (r=0.52), triglycerides (r=0.49), and systolic blood pressure (r=0.46). hs-CRP levels progressively increased with increasing number of metabolic syndrome components.
Conclusion: hs-CRP is significantly elevated in metabolic syndrome and strongly correlates with various metabolic risk factors, suggesting its role as an early biomarker of subclinical inflammation and cardiovascular risk assessment.

Morphometric study of proximal and distal end of radius and its clinical significance

Rajnish — 2026-07-30

Background: The radius is a forearm bone that plays an important role in the elbow and wrist joints. Morphometric changes in its proximal and distal ends have clinical implications for orthopedic treatments, prosthesis design, and fracture management.
Aim: To analyze the morphometric parameters of the proximal and distal ends of the radius and evaluate their clinical significance.
Materials and Methods: A 1.5-year prospective observational study was undertaken on 50 dry adult human radii (27 right-sided and 23 left-sided). The proximal length, distal width, radial head diameter, and styloid process length were all measured with a digital verniercaliper. Student’s t-test was used for statistical analysis, and p-values < 0.05 were considered significant.
Results: The mean values of all parameters were slightly higher on the right side compared to the left. However, no statistically significant differences were observed (p > 0.05). The findings indicate bilateral symmetry in radial morphometry.
Conclusion: The study gives important morphometric data for orthopedic implant design and surgical planning. The observed symmetry suggests that standard implants may be used bilaterally, but population-specific data are still required.

Effects of Anti-Inflammatory Pharmacotherapy on CRP and IL-6 Levels in Cardiovascular Disease: A Systematic Review

Pooja Singh — 2026-07-30

Background: Chronic low-grade inflammation plays a pivotal role in the development and progression of cardiovascular disease (CVD). Persistent elevation of inflammatory biomarkers, particularly C-reactive protein (CRP) and interleukin-6 (IL-6), has been associated with endothelial dysfunction, atherosclerotic plaque progression, adverse cardiovascular events, and poor clinical outcomes. Growing evidence suggests that anti-inflammatory pharmacotherapies may modulate these biomarkers and improve cardiovascular prognosis.
Objective: To systematically review the available evidence regarding the effects of pharmacological interventions on CRP and IL-6 levels in patients with cardiovascular disease.
Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed, Scopus, Embase, Web of Science, and the Cochrane Library were searched for studies published between January 2000 and December 2025. Randomized controlled trials, cohort studies, and observational studies involving adult patients with cardiovascular disease were eligible for inclusion if they evaluated pharmacological modulation of CRP and/or IL-6. Data extraction and quality assessment were performed using standardized methods.
Results: Studies included in the review demonstrated that several pharmacological interventions, including statins, canakinumab, colchicine, and IL-6-targeted therapies, were associated with significant reductions in CRP and/or IL-6 levels. Greater reductions in inflammatory biomarkers were generally associated with improved cardiovascular outcomes and reduced risk of recurrent cardiovascular events. However, variability in study design, patient populations, therapeutic regimens, and follow-up duration contributed to heterogeneity among findings.
Conclusion: Current evidence supports the role of anti-inflammatory pharmacotherapy in reducing CRP and IL-6 levels among patients with cardiovascular disease. Targeted modulation of inflammatory pathways may contribute to improved cardiovascular outcomes. Nevertheless, further large-scale studies are required to establish optimal biomarker-guided therapeutic strategies and long-term clinical benefits.

Evaluation of Bilirubin Level in Exclusively Breastfed Versus Formula-Fed Infants: A Retrospective Comparative Study

Santosh Kumar Swain — 2026-08-01

Background: Neonatal jaundice is one of the most common clinical conditions encountered during the neonatal period, affecting approximately 60% of term and 80% of preterm newborns. Feeding practices play a significant role in bilirubin metabolism and may influence the incidence and severity of neonatal hyperbilirubinemia. Exclusive breastfeeding has been associated with a higher frequency of physiological jaundice compared to formula feeding.
Aim: To compare serum bilirubin levels among exclusively breastfed and formula-fed infants and evaluate the association between feeding pattern and neonatal hyperbilirubinemia.
Materials and Methods; A retrospective comparative study was conducted at the Department of Pediatrics, DRIEMS Medical College and Hospital, Tangi, Cuttack, Odisha, over a one-year period. Medical records of 100 neonates were reviewed, including 50 exclusively breastfed infants and 50 formula-fed infants. Demographic characteristics, gestational age, birth weight, age at bilirubin estimation, total serum bilirubin (TSB) levels, and requirement for phototherapy were analyzed. Statistical analysis was performed using SPSS version 26. Independent t-test, Chi-square test, and logistic regression analysis were used. A p-value <0.05 was considered statistically significant.
Results: The mean total serum bilirubin level was significantly higher among exclusively breastfed infants (13.28 ± 3.14 mg/dL) compared to formula-fed infants (9.86 ± 2.71 mg/dL) (p<0.001). Hyperbilirubinemia requiring phototherapy occurred in 18 (36.0%) breastfed infants and 7 (14.0%) formula-fed infants (p=0.011). Exclusive breastfeeding was independently associated with elevated bilirubin levels (OR=3.46, 95% CI:1.34–8.92, p=0.010).
Conclusion: Exclusively breastfed infants demonstrated significantly higher bilirubin levels and a greater requirement for phototherapy compared to formula-fed infants. Careful monitoring of bilirubin levels among breastfed neonates may facilitate early identification and management of neonatal jaundice.

Association Between Duration of Type 2 Diabetes Mellitus and Decline in Pulmonary Function: A Cross-sectional Observational Study

Sunil Kumar Yadav — 2026-08-05

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycaemia resulting from insulin resistance and progressive β-cell dysfunction. Although the classical complications of diabetes involve the retina, kidneys, nerves, and cardiovascular system, increasing evidence suggests that the lungs may also represent an important target organ affected by chronic hyperglycaemia. The extensive pulmonary microvascular network and connective tissue matrix are susceptible to non-enzymatic glycation, oxidative stress, and microangiopathic changes associated with long-standing diabetes. These pathological alterations may result in progressive deterioration of pulmonary function. The present study was conducted to evaluate the association between duration of T2DM and decline in pulmonary function among diabetic patients attending a tertiary care centre.
Methods: A hospital-based cross-sectional observational study was conducted among 171 patients with T2DM attending the Department of Medicine, Government Bundelkhand Medical College and Hospital, Sagar, Madhya Pradesh, over a period of 18 months. Demographic, anthropometric, clinical, and biochemical parameters were recorded. Pulmonary function tests (PFTs) were performed using computerized spirometry. The association between duration of diabetes and pulmonary dysfunction was analysed using appropriate statistical methods. A p-value <0.05 was considered statistically significant.
Results: Among the 171 participants, 57.9% had diabetes duration greater than five years. Pulmonary dysfunction was observed in 60.8% of participants, with a restrictive pattern being the most common abnormality (43.3%). Patients with diabetes duration greater than five years showed significantly higher prevalence of abnormal pulmonary function tests compared with those having diabetes duration ≤5 years (74.0% vs. 43.1%; p=0.002). Multivariate logistic regression demonstrated that longer duration of diabetes independently predicted pulmonary dysfunction (Adjusted OR=2.48; 95% CI: 1.32–4.67; p=0.005).
Conclusion: Longer duration of T2DM is significantly associated with decline in pulmonary function. Routine pulmonary function assessment may facilitate early detection of respiratory impairment in patients with longstanding diabetes mellitus.

The Association between Vitamin D Level and Uterine Fibroid in Premenopausal Women in a Tertiary Care Centre: A Hospital-Based Analytical Case-Control Study

Navidha Arora — 2026-08-03

Background: Uterine fibroids are the most common benign smooth muscle tumors of the uterus and constitute a major cause of gynecological morbidity among women of reproductive age. Although their exact pathogenesis remains incompletely understood, increasing evidence suggests that vitamin D deficiency may contribute to fibroid development through its effects on cellular proliferation, apoptosis, extracellular matrix remodeling, and angiogenesis. Since vitamin D deficiency is highly prevalent among Indian women, understanding its relationship with uterine fibroids may provide opportunities for preventive and therapeutic interventions.
Objective: To evaluate the association between serum vitamin D levels and uterine fibroids among premenopausal women attending a tertiary care hospital and to assess the relationship between vitamin D status and fibroid characteristics.
Materials and Methods: A hospital-based analytical case-control study was conducted in the Department of Obstetrics and Gynaecology, MDM Hospital, Dr.Sampurnanand Medical College, Jodhpur, Rajasthan, over a period of six months. Fifty premenopausal women were enrolled, comprising 25 ultrasound-confirmed uterine fibroid cases and 25 age-matched controls without fibroids. Demographic, clinical, menstrual, and obstetric characteristics were recorded using a structured proforma. Serum 25-hydroxyvitamin D concentration was estimated by standard laboratory methods and categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), and sufficient (≥30 ng/mL). Fibroid characteristics including type, number, and volume were assessed by ultrasonography. Statistical analysis was performed using SPSS software. Categorical variables were analyzed using the Chi-square test, while continuous variables were compared using the independent t-test. A p-value <0.05 was considered statistically significant.
Results: The mean age of cases and controls was 38.36 ± 3.67 years and 37.92 ± 4.79 years, respectively (p=0.452). Mean serum vitamin D levels were significantly lower among women with uterine fibroids than controls (12.43 ± 4.20 vs. 17.19 ± 5.65 ng/mL, p=0.001). Vitamin D deficiency was significantly more common in cases than controls (32.0% vs. 4.0%; p=0.028). Mean haemoglobin levels were also significantly lower among cases (10.08 ± 1.46 g/dL) than controls (11.18 ± 1.93 g/dL; p=0.029). Intramural fibroids constituted the commonest subtype (68%), while single fibroids were observed in 64% of cases. Significant associations were identified between vitamin D status and fibroid type (p=0.013) as well as fibroid number (p=0.031). However, no statistically significant association was observed between vitamin D status and fibroid volume (p=0.499).
Conclusion: Premenopausal women with uterine fibroids demonstrated significantly lower serum vitamin D levels than women without fibroids. Vitamin D deficiency was associated with the presence of uterine fibroids and showed significant relationships with fibroid type and multiplicity. These findings suggest that vitamin D deficiency may represent an important modifiable risk factor in uterine fibroid pathogenesis. Larger prospective multicentric studies are warranted to establish causality and evaluate the potential role of vitamin D supplementation in the prevention and management of uterine fibroids.

Intravenous Dexmedetomidine Versus 0.5% Ropivacaine Scalp Block for Attenuation of Hemodynamic Response to Skull-Pin Insertion in Adult Craniotomy: A Prospective Randomized Double-Blind Study

Aayushi Ambilkar — 2026-08-04

Background: Skull-pin fixation during craniotomy is associated with intense nociceptive stimulation leading to abrupt sympathetic activation, resulting in tachycardia, hypertension, and increased intracranial pressure. Effective attenuation of this hemodynamic response is essential in neurosurgical anaesthesia. This study compared the efficacy of intravenous dexmedetomidine infusion with 0.5% ropivacaine scalp block in attenuating hemodynamic responses following skull-pin insertion during elective craniotomy.
Materials and Methods: In this prospective randomized double-blind comparative study, 130 adult patients undergoing elective craniotomy under general anaesthesia were allocated into two groups. Group D (n=65) received intravenous dexmedetomidine infusion, while Group S (n=65) received bilateral scalp block with 0.5% ropivacaine. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, before induction, before pinning, and at 0-10 minutes after skull-pin insertion.
Results: Demographic variables including age, weight, sex distribution, and ASA physical status were comparable between the two groups. Baseline HR was comparable between Group D and Group S (86.62 ± 16.43 vs 83.49 ± 17.26 beats/min; p=0.29). Following skull-pin insertion, HR values were significantly higher in Group D at 1-8 minutes post pinning compared with Group S (p <0.05). Similar trends were observed for SBP, DBP, and MAP, suggesting superior attenuation of hemodynamic responses with scalp block using 0.5% ropivacaine. Both techniques were clinically effective and associated with acceptable hemodynamic stability.
Conclusion: Scalp block with 0.5% ropivacaine demonstrated superior attenuation of the hemodynamic response to skull-pin insertion compared with intravenous dexmedetomidine infusion in adult patients undergoing elective craniotomy. Both interventions were safe and effective, although scalp block provided better control of sympathetic responses during skull-pin application.

Predicting Weaning Outcome in Mechanically Ventilated ICU Patients Using the Rapid Shallow Breathing Index, Ultrasound-Guided Diaphragm Thickening Fraction, and Their Combination: A Prospective Cohort Study

Sunil Sorout — 2026-08-04

Background: Timely liberation from mechanical ventilation is a central goal in intensive care, as both premature and delayed extubation
carry avoidable risk. The rapid shallow breathing index (RSBI) is widely used but limited by low specificity, while diaphragm ultrasound
offers a bedside measure of respiratory muscle performance. We compared RSBI, the diaphragm thickening fraction index (DTFI),
and their combination for predicting weaning outcome.
Methods: This single-centre prospective observational study enrolled 157 adults ventilated for at least 24 hours in a mixed medical–
surgical ICU who were ready for their first spontaneous breathing trial (SBT). After tolerating an SBT, RSBI was recorded and the
diaphragm thickening fraction was measured with ultrasound in the zone of apposition. Weaning success was defined as unassisted
breathing sustained for 48 hours. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves.
Results: Weaning failed in 21 patients (13.4%). Age, BMI, duration of ventilation, ICU stay, haemodynamics and gas-exchange
variables did not differ between groups. RSBI was similar in patients who failed and succeeded (69.94 vs 67.35 breaths/min/L; p =
0.369), whereas DTFI was markedly lower in the failure group (24.98% vs 39.02%; p < 0.001). Areas under the curve were 0.423 for
RSBI, 0.750 for DTFI and 0.765 for the combination. At RSBI ≤ 105, sensitivity was 100% but specificity only 5%; at DTFI ≥ 26%,
sensitivity was 83% and specificity 57%. Combining the two did not improve on DTFI alone.
Conclusion: DTFI predicted weaning outcome substantially better than RSBI and performed comparably to the combined index.
Diaphragm ultrasound is a simple, reproducible bedside adjunct that can strengthen the assessment of weaning readiness in critically
ill patients.

Gallbladder Polyps: Risk Stratification and Surgical Outcomes in the Era of Advanced Imaging

Vinod Kumar — 2026-08-04

Background: Gallbladder polyps are increasingly detected due to the widespread use of high-resolution abdominal ultrasonography and cross-sectional imaging. Although most gallbladder polyps are benign cholesterol polyps with negligible malignant potential, a small proportion represents adenomatous lesions or early gallbladder carcinoma. Accurate risk stratification based on clinical characteristics and imaging features is essential to identify patients who would benefit from cholecystectomy while avoiding unnecessary surgery in those with low-risk lesions. Recent advances in imaging modalities have improved the characterization of gallbladder polyps; however, their impact on surgical decision-making and postoperative outcomes remains an area of ongoing investigation.
Aim: To evaluate the role of clinical and imaging-based risk stratification in the management of gallbladder polyps and to assess surgical and histopathological outcomes in patients undergoing cholecystectomy.
Methods: A prospective hospital-based observational cohort study was conducted in the Department of General Surgery, Jawaharlal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, Bihar, from January 2024 to December 2025. A total of 100 consecutive patients diagnosed with gallbladder polyps on abdominal ultrasonography were enrolled. Clinical presentation, demographic characteristics, laboratory investigations, ultrasonographic findings, and advanced imaging findings where indicated were recorded. Patients were stratified into low-, intermediate-, and high-risk categories according to established imaging and clinical risk factors. Patients meeting surgical criteria underwent laparoscopic or open cholecystectomy, and postoperative outcomes and histopathological findings were analysed. Statistical analysis was performed using chi-square test, Student’s t-test, one-way ANOVA, logistic regression, and receiver operating characteristic (ROC) analysis.
Results: Among the 100 enrolled patients, the mean age was 48.6 ± 13.2 years, and 58% were females. Solitary polyps were identified in 62% of patients, while 38% had multiple polyps. Polyps measuring ≥10 mm were observed in 28% of patients. Seventy-two patients underwent cholecystectomy based on predefined surgical indications. Histopathological examination revealed cholesterol polyps in 48.6%, adenomatous polyps in 26.4%, adenomyomatosis in 12.5%, inflammatory polyps in 6.9%, and gallbladder adenocarcinoma in 5.6% of surgical specimens. Increasing polyp size, sessile morphology, patient age ≥60 years, and focal gallbladder wall thickening were independently associated with neoplastic pathology (p<0.05). Patients undergoing laparoscopic cholecystectomy demonstrated favourable perioperative outcomes with low postoperative complication rates.
Conclusion: Risk stratification incorporating clinical factors and advanced imaging characteristics effectively identifies patients at increased risk of neoplastic gallbladder polyps. Appropriate patient selection for cholecystectomy facilitates early diagnosis of premalignant and malignant lesions while reducing unnecessary surgical intervention in low-risk patients. Advanced imaging serves as a valuable adjunct to conventional ultrasonography in optimizing management decisions.

In Vitro Activity of Ceftazidime-Avibactam Against Carbapenem-Resistant Enterobacterales: A Prospective Study from a Tertiary Care Centre in Patna, India

Shiwani Mishra — 2026-08-05

Background: Carbapenem-resistant Enterobacterales (CRE) represent a critical therapeutic challenge with limited treatment options. Ceftazidime-avibactam (CZA), a novel β-lactam/β-lactamase inhibitor combination, has shown promising in vitro activity against CRE. This study aimed to evaluate the in vitro susceptibility of CZA against CRE isolates at a tertiary care hospital in eastern India.
Methods: In this prospective cross-sectional study conducted at the Department of Microbiology, IGIMS, Patna, 450 non-duplicate CRE isolates were collected from various clinical samples over nine months. Species identification was performed by conventional biochemical methods and MALDI-TOF MS. Carbapenem resistance was confirmed by Kirby-Bauer disc diffusion (KBDD) and VITEK-2. CZA susceptibility was tested by KBDD and E-test and interpreted per CLSI 2024 guidelines.
Results: Of 450 clinical isolates, 180 (40%) were CRE. Klebsiella pneumoniae (49.4%) was the predominant species, followed by Escherichia coli (25.6%) and Enterobacter cloacae (12.8%). The ICU contributed the highest proportion of CRE (30.6%). By disc diffusion, 63.3% of CRE isolates were susceptible to CZA. E-test MIC analysis confirmed susceptibility in 65.0% of isolates (MIC90 = 8 mg/L). Overall categorical agreement between the two methods was 92.2%. Among K. pneumoniae isolates, CZA susceptibility was 58.4%, while E. coli showed the highest susceptibility (69.6%).
Conclusion: CZA demonstrated clinically significant in vitro activity against CRE isolates, with susceptibility rates exceeding 60%. These findings support CZA as a viable therapeutic option for CRE infections in the Indian clinical setting. Routine susceptibility testing of CZA is recommended for CRE isolates to guide optimal treatment decisions.

Comparative Study of Primary Closure Versus T-Tube Drainage Following Common Bile Duct Exploration in Patients with Choledocholithiasis

Chandrashekar B — 2026-08-05

Background:Choledocholithiasis is a common biliary disorder that frequently requires common bile duct (CBD) exploration when endoscopic management is unsuccessful or unavailable. Traditionally, T-tube drainage has been employed following CBD exploration to facilitate biliary decompression and postoperative cholangiography. However, primary closure of the CBD has emerged as an alternative approach that may reduce postoperative morbidity, shorten hospital stay, and improve patient comfort. This study compares the outcomes of primary closure and T-tube drainage following CBD exploration in patients with choledocholithiasis.
Objectives: To compare the safety and efficacy of primary closure versus T-tube drainage following common bile duct exploration in patients with choledocholithiasis, with respect to postoperative complications, biliary leakage, operative time, duration of hospital stay, and overall patient outcomes.
Materials and Methods: A comparative study was conducted on patients diagnosed with choledocholithiasis who underwent common bile duct exploration. Patients were allocated into two groups: Group A underwent primary closure of the CBD, while Group B underwent T-tube drainage after exploration. Demographic characteristics, operative findings, postoperative complications, duration of hospital stay, biliary leakage, wound infection, and need for re-intervention were recorded and analyzed using appropriate statistical methods. A p-value of <0.05 was considered statistically significant.
Results: Both techniques achieved successful ductal clearance. The primary closure group demonstrated a significantly shorter postoperative hospital stay and earlier recovery compared with the T-tube drainage group. The incidence of postoperative biliary leakage and other complications was comparable between the two groups, with no significant difference in retained stones or mortality. Overall, primary closure was associated with improved postoperative recovery and reduced morbidity without compromising patient safety.
Conclusion: Primary closure following common bile duct exploration is a safe and effective alternative to T-tube drainage in selected patients with choledocholithiasis. It offers the advantages of reduced hospital stay, faster postoperative recovery, and avoidance of T-tube-related complications while maintaining comparable surgical outcomes. Careful patient selection and meticulous surgical technique are essential for achieving optimal results.

Assessment and Comparison of Scoring Systems—SAPS III, APACHE II, and SOFA for Prediction of Mortality in Patients with Sepsis in a Mixed Medical and Surgical Indian ICU

Bagathi Santhosh Kumar — 2026-08-05

Background: Sepsis is a leading cause of intensive care unit (ICU) morbidity and mortality. Severity-of-illness scoring systems aid risk stratification, but most were derived from Western cohorts and require validation in Indian ICU settings.
Aim: To assess and compare the accuracy of the Simplified Acute Physiology Score (SAPS) III, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores for predicting mortality in patients with sepsis admitted to a mixed medical–surgical Indian ICU.
Methods: This prospective, single-centre, observational study enrolled 118 adults with sepsis admitted to a 40-bed mixed medical–surgical ICU over 18 months. SAPS III, APACHE II and SOFA scores were calculated within 24 hours of admission. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC), and sensitivity, specificity, positive and negative predictive values (PPV, NPV) and accuracy were computed at the optimal Youden’s index cut-off for each score.
Results: Overall in-hospital mortality was 39.8% (47/118). Mean SAPS III, APACHE II and SOFA scores were significantly higher among non-survivors than survivors (61.68 vs 49.23, 21.98 vs 16.39, and 7.91 vs 5.39 respectively; p<0.001 for SAPS III and SOFA, p=0.001 for APACHE II). The AUROC for SAPS III (0.73) was higher than that of APACHE II (0.66) and SOFA (0.66). At the optimal cut-off (≥60), SAPS III showed sensitivity 51.06%, specificity 85.92%, PPV 70.59%, NPV 72.62% and accuracy 72%. Presence of comorbidity was significantly associated with mortality (p=0.023), and lower Glasgow Coma Scale, higher serum creatinine and higher bilirubin were significantly associated with death.
Conclusion: SAPS III demonstrated better discriminatory ability than APACHE II and SOFA for predicting mortality in this mixed medical–surgical Indian ICU cohort of septic patients, though its sensitivity remained modest. A combination of scores, along with clinical judgement, is recommended for prognostication in resource-limited ICU settings.

Association Between Vascular Endothelial Growth Factor Gene Polymorphism and Bladder Cancer Risk and its Relationship to Serum Ca19.9, Mmp9 and Timp1 Levels: A Case–Control Study From a Tertiary Care Centre

Nabanita Baidya Biswas — 2026-08-08

Background: Bladder cancer represents one of the most frequently diagnosed malignancies of the urinary tract and contributes substantially to cancer-related morbidity and mortality worldwide. The development and progression of bladder cancer involve complex interactions between genetic susceptibility, environmental exposures, angiogenesis, extracellular matrix remodeling, and tumor-associated molecular alterations. Vascular endothelial growth factor (VEGF), a key regulator of tumor angiogenesis, plays an important role in tumor growth, invasion, and metastatic potential. Functional genetic variations within the VEGF gene may influence VEGF expression and thereby modify individual susceptibility to bladder cancer. In addition, circulating biomarkers such as carbohydrate antigen 19.9 (CA19.9), matrix metalloproteinase-9 (MMP9), and tissue inhibitor of metalloproteinase-1 (TIMP1) have been implicated in tumor progression and extracellular matrix degradation.
Objectives: To evaluate the association between VEGF gene polymorphism and risk of bladder cancer and to assess its relationship with serum levels of CA19.9, MMP9, and TIMP1 among bladder cancer patients.
Materials and Methods: This original research study was conducted as a hospital-based case–control study in the Department of Urology and biochemistry, Calcutta National Medical College, Kolkata, from 2020 to 2023. A total of 150 participants were enrolled, including 75 histopathologically confirmed bladder cancer patients (cases) and 75 age- and sex-matched healthy individuals (controls). Peripheral blood samples were collected for genetic analysis of VEGF polymorphism and estimation of serum CA19.9, MMP9, and TIMP1 levels. Genotyping was performed using polymerase chain reaction-based methods. Serum biomarker concentrations were assessed using standardized immunoassay techniques. Statistical analysis was performed using SPSS software. Associations between genetic variants, biomarker levels, and bladder cancer risk were evaluated using appropriate statistical tests.
Results: Bladder cancer patients demonstrated a significantly higher frequency of the VEGF risk genotype compared with controls. The VEGF polymorphism was significantly associated with increased bladder cancer susceptibility (OR=2.74, 95% CI: 1.32–5.69, p=0.006). Serum CA19.9, MMP9, and TIMP1 levels were significantly elevated among cases compared with controls (p<0.001). Patients carrying the VEGF variant genotype showed significantly higher circulating MMP9 and TIMP1 concentrations compared with wild-type carriers. A positive correlation was observed between MMP9 and TIMP1 levels among bladder cancer patients (r=0.62, p<0.001).
Conclusion: The present study suggests that VEGF gene polymorphism may contribute to increased susceptibility to bladder cancer and may influence tumor-associated biomarker expression. Altered VEGF-mediated angiogenic pathways together with increased MMP9 and TIMP1 levels may play an important role in bladder cancer progression. VEGF polymorphism combined with serum biomarkers may serve as a potential molecular tool for risk assessment and disease characterization.

Comparison of Segmental Thoracic Spinal Anaesthesia Versus General Anaesthesia in Laparoscopic Cholecystectomy

Vikas Kumar — 2026-08-08

Background: Laparoscopic cholecystectomy is commonly performed under general anaesthesia. Recently, segmental thoracic spinal anaesthesia has emerged as a feasible alternative with potential advantages including reduced postoperative pain, nausea, and shorter recovery time.
Aim: To compare the efficacy and safety of segmental thoracic spinal anaesthesia with general anaesthesia in patients undergoing laparoscopic cholecystectomy.
Methods: This comparative observational study was conducted at Sheikh Bhikari Medical College, Hazaribagh, Jharkhand over 12 months. A total of 100 patients undergoing elective laparoscopic cholecystectomy were included and divided into two groups: Group A received segmental thoracic spinal anaesthesia and Group B received general anaesthesia. Parameters assessed included intraoperative hemodynamics, postoperative pain, complications, duration of hospital stay, and patient satisfaction. Statistical analysis was performed using chi-square test and Student’s t-test with p<0.05 considered significant.
Results: Postoperative pain scores were significantly lower in the spinal anaesthesia group compared to the general anaesthesia group (p=0.01). Incidence of postoperative nausea and vomiting was lower in Group A (12%) than Group B (34%) (p=0.02). Hospital stay was significantly shorter in the spinal anaesthesia group. Hemodynamic stability was comparable between groups.
Conclusion: Segmental thoracic spinal anaesthesia is a safe and effective alternative to general anaesthesia for, offering better postoperative analgesia, reduced nausea, and shorter hospital stay.

Comparative Study for the Safety of Circumcision by Classical Method and by Plastibell in Children

Abdul Khalique — 2026-08-13

Background: Circumcision is one of the most commonly performed surgical procedures in children. Classical (dissection) circumcision and the Plastibell device are among the most widely used techniques, but there is limited consensus on which offers the better safety profile across different paediatric age groups.
Aim: To compare the safety of circumcision by the classical (dissection) method and by the Plastibell device in children, and to assess whether complication rates vary with age.
Materials and Methods: This prospective comparative study was conducted in the Department of General Surgery, Victoria Hospital, Bengaluru, over a 3-month period (March–May 2026). A total of 100 boys ≤5 years presenting for circumcision were included, 50 undergoing the classical technique and 50 undergoing Plastibell circumcision. Patients were followed up postoperatively, and complications — bleeding, surgical site infection, adhesion, and delayed ring separation (Plastibell only) — were recorded and compared between groups and across age categories.
Results: The overall complication rate was significantly lower with the classical technique than with Plastibell (10% versus 28%, p=0.008). Individual complication types — bleeding, surgical site infection, and adhesion — did not differ significantly between groups. Complication rates increased with age in both groups, most markedly with Plastibell (7.7% in neonates to 50.0% at 5 years), although the age-stratified differences between techniques did not reach statistical significance at any individual age category (all p>0.05).
Conclusion: Plastibell circumcision is safe and broadly comparable to the classical technique in children when complications are examined within specific age categories, though its overall complication rate is higher. Complication rates rise with increasing age up to 5 years, and this trend is more pronounced with Plastibell, supporting closer postoperative follow-up in older children undergoing this technique.

Comparison of Creatinine and Cystatin C-based Estimated Glomerular Filtration Rate in Relation to Glycemic Control Among Patients With Type 2 Diabetes Mellitus

Mariam Mahek Moizuddin — 2026-08-01

Background & Objectives: Diabetic kidney disease (DKD) is a major complication of type 2 diabetes mellitus (T2DM) leading to end-stage renal disease (ESRD). Early identification of declining renal function is vital to prevent disease progression. Estimated glomerular filtration rate (eGFR) calculated using serum creatinine or serum cystatin C serves as a key indicator of kidney function. This study aimed to compare creatinine-based (MDRD equation) and cystatin C-based (CKD-EPI 2012 equation) eGFR in relation to glycemic control (HbA1c) in patients with type 2 diabetes mellitus and healthy controls.
Materials & Methods: This cross-sectional case–control study included 150 participants aged 25–70 years, comprising 75 clinically diagnosed T2DM patients (cases) and 75 apparently healthy individuals (controls). Patients with hypertension, known chronic kidney disease, hepatic/muscular disorders, or those undergoing dialysis were excluded. Serum creatinine (enzymatic method) and serum cystatin C (immunoturbidimetric assay) were analyzed on a Beckman AU5800 clinical chemistry analyzer. Glycated hemoglobin (HbA1c) was measured by high-performance liquid chromatography (HPLC). eGFR was calculated using the MDRD equation for creatinine and the 2012 CKD-EPI equation for cystatin C. Statistical analyses included independent Student’s t-test, paired t-test, Pearson’s correlation, and Receiver Operating Characteristic (ROC) curve analysis.
Results: Mean HbA1c, serum creatinine, and serum cystatin C levels were significantly higher in T2DM cases than in healthy controls. Mean eGFR was significantly lower in diabetic patients compared to controls with both the MDRD equation (84.84 mL/min/1.73 m² vs. 98.07 mL/min/1.73 m²) and the CKD-EPI cystatin C equation (79.2 mL/min/1.73 m² vs. 90.35 mL/min/1.73 m²). A paired t-test demonstrated no statistically significant difference between eGFR calculated by MDRD and CKD-EPI (p = 0.318). Both eGFR estimates showed a significant inverse correlation with HbA1c (p < 0.05). ROC curve analysis showed excellent and comparable diagnostic performance for detecting early renal impairment (eGFR< 90 mL/min/1.73 m), with an area under the curve (AUC) of 0.95 (95% CI: 0.93–0.98) for creatinine-based eGFR and 0.96 (95% CI: 0.93–0.98) for cystatin C-based eGFR.
Conclusion: Both creatinine-based (MDRD) and cystatin C-based (CKD-EPI) eGFR equations provide comparable clinical performance in evaluating renal function in patients with type 2 diabetes mellitus. Poorer glycemic control correlates with declining GFR, highlighting the value of early eGFR assessment alongside glycemic monitoring to identify individuals at risk of diabetic kidney disease.

Comparative Evaluation of Ring Finger Dermatoglyphics and Atd Angle in Individuals with Intellectual Disability

Rajani Yadav — 2026-08-06

Background: Dermatoglyphics, the study of epidermal ridge patterns, reflects genetic and prenatal developmental influences. Since epidermal ridges and the nervous system develop simultaneously, dermatoglyphic variations may serve as valuable, non-invasive markers for early screening and identification of intellectual disability. Objective:The objective of the present study was to evaluate and compare dermatoglyphic patterns of ring finger and ATD angles in intellectually disabled individuals and healthy controls, and to identify characteristic dermatoglyphic variations that may aid in the early screening and understanding of neurodevelopmental abnormalities associated with intellectual disability. Methods: A cross-sectional case-control study was performed in August 2024 to December 2025 in the J.L.N. Medical College and Associated Hospital and evaluated dermatoglyphic patterns in 200 intellectually disabled individuals and 100 controls using standardized ink-print analysis of fingers and palms. Results: The study evaluated 200 intellectually disabled individuals and 100 healthy controls aged 8–45 years. Arch patterns on the left ring finger were significantly higher in cases (8%) than controls (2%) (p=0.034), while the right ring finger showed a similar trend (7% vs 2%). Mean ATD angles were significantly increased in cases (left: 52.84±8.96°, right: 51.76±9.14°) compared to controls (p<0.001), suggesting characteristic dermatoglyphic abnormalities in intellectual disability. Conclusion: The present study demonstrated significant dermatoglyphic variations in intellectually disabled individuals, particularly increased arch patterns and higher ATD angles. These findings support the association between abnormal epidermal ridge development and intellectual disability. Dermatoglyphic analysis may serve as a simple, economical, and non-invasive adjunctive tool for early screening and identification.

A Study on The Relationship of Endometrial Thickness and Abnormal Uterine Bleeding in Women of Reproductive Age Group

Garima Singh — 2026-08-06

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint that significantly affects women’s health and quality of life. Endometrial thickness measured by transvaginal ultrasonography serves as a useful non-invasive marker of endometrial pathology. Evaluating its relationship with AUB may improve diagnostic accuracy and reduce unnecessary invasive procedures.
Aim: To evaluate endometrial thickness and its association with abnormal uterine bleeding in reproductive-age women.
Method: After informed consent, demographic, menstrual, obstetric, clinical, laboratory, and sonographic data were collected using a structured proforma. Endometrial thickness was measured by ultrasonography, with menstrual cycle day recorded. Data were analyzed using SPSS version 27 and expressed as mean ± standard deviation.
Results: Among 90 women, mean age was 33.78±5.01 years and mean endometrial thickness 13.28±4.03 mm. Heavy menstrual bleeding predominated. Fibroid was the commonest abnormality. Increased BMI correlated with greater endometrial thickness, while hyperplasia and combined lesions were associated with higher thickness values.
Conclusion: The present study demonstrated a significant association between endometrial thickness and abnormal uterine bleeding. Most patients had moderately increased endometrial thickness, with heavy menstrual bleeding as the commonest symptom. Higher thickness was associated with fibroids, adenomyosis, hyperplasia, PCOD, and increased BMI, supporting ultrasonography as a valuable non-invasive diagnostic tool.

Triglyceride-Glucose Index and Indian Diabetes Risk Score among Young Adults: A Cross-Sectional Study

Santosh Mote — 2026-08-14

Background: Diabetes mellitus is an increasing public health concern, and identification of individuals at risk during early adulthood
may facilitate timely preventive interventions. The Triglyceride-Glucose (TyG) Index is a simple biochemical surrogate marker of
insulin resistance, whereas the Indian Diabetes Risk Score (IDRS) provides a practical assessment of diabetes risk using demographic,
anthropometric, behavioural and family-history factors.
Methods: A cross-sectional study was conducted among 272 undergraduate medical students at a government tertiary care teaching
hospital over 18 months. Participants aged ≥18 years who were willing to participate were included, while students with diabetes,
cardiovascular disease or steroid use were excluded. Sociodemographic and lifestyle information was collected using a structured
questionnaire. Anthropometric measurements, including body mass index and waist circumference, were recorded. Fasting blood
samples were analysed for glucose and triglycerides. The TyG Index was calculated as ln [fasting triglycerides (mg/dL) × fasting
glucose (mg/dL)/2]. Diabetes risk was assessed using IDRS. Correlations between TyG Index and IDRS components were evaluated,
with p<0.05 considered statistically significant.
Results: The mean age of participants was 19.97 ± 1.02 years. Females constituted 69.5% and males 30.5% of the study population.
Mean BMI was 22.09 ± 4.20 kg/m² and mean waist circumference was 85.99 ± 7.56 cm. Mean fasting blood glucose, triglycerides
and TyG Index were 90.45 ± 10.15 mg/dL, 115.85 ± 36.61 mg/dL and 8.494 ± 0.412, respectively. According to IDRS, 61.8% had
low risk, 36.8% moderate risk and 1.5% high risk. No significant correlation was observed between TyG and total IDRS (r=0.025,
p=0.678), waist score (r=0.048, p=0.428), physical activity score (r=0.003, p=0.960), or family-history score (r=−0.002, p=0.979).
Conclusion: TyG Index was not significantly associated with IDRS or its assessed components among these young adults. Further
longitudinal studies are warranted.

A Prospective Observational Study Of Association Of Stress Hyperglycaemia Ratio (SHR) And The Clinical Outcomes In Critically Ill Patients

Boddu Jyotirmayi — 2026-08-08

Background: Stress hyperglycaemia ratio (SHR), which adjusts admission blood glucose for chronic glycaemic status using HbA1c, is a more reliable marker of acute metabolic stress than admission blood glucose alone. Prospective evidence from heterogeneous critically ill patients in the Indian ICU setting remains limited.
Objectives: To evaluate the association between SHR and clinical outcomes, including in-hospital mortality, ICU length of stay, mechanical ventilation, vasopressor requirement in critically ill adults.
Methods: A prospective observational study was conducted amongcritically ill adults in medical ICU of a tertiary care hospital. SHR was calculated using admission blood glucose and HbA1c. Clinical outcomes included mortality, ICU length of stay, mechanical ventilation, vasopressor requirement, and APACHE score. Statistical significance was defined as p<0.05.
Results: The mean age was 58.5±12 years. Overall in-hospital mortality was 23.5%. Mean SHR was significantly higher among non-survivors than survivors (1.46 vs. 1.10; p<0.001). Mortality increased progressively as SHR increases. Patients requiring mechanical ventilation and vasopressor support also demonstrated higher SHR values.
Conclusions: SHR is a simple and readily available biomarker for early risk stratification in critically ill patients. Routine assessment of SHR may improve prognostication and guide early clinical decision-making.