bluuebunny/crossref_metadata_2025 huggingface dataset:
Instilling leadership skills in undergraduate medical students
Authors: Anuja Bhargava  , Faiz SM  , Saurabh Srivastava  , Rajeev Krishna Gupta  , Himanshu Sharma  , Aneesh Basheer  , Farzana Mahdi
Published: January 2025

Background: Leadership is the behavior of an individual when directing the activities of a group toward a shared goal. In the health-care system, doctors’ responsibilities extend beyond clinical treatment. They should be efficient to lead a team in the patient care setting and within the broader framework of health-care systems. Good medical leadership is vital in delivering high-quality health care. Incorporating leadership skills in medical undergraduates will help them act as leaders and members of the health-care team.
Aims and Objectives: The aims and objectives of the study are to enhance leadership skills and to assess the improvement in leadership skills of the participating medical undergraduate students.
Materials and Methods: In this prospective study, medical undergraduate students posted in otorhinolaryngology clinics took part in various activities in two subsequent community otorhinolaryngology programs. Students were given different roles and responsibilities in the community programs to improve their leadership skills. Students filled out a pre- and post-activity self-assessment leadership trait questionnaire form for each community program.
Results: 88 students participated in the study. The overall percentage leadership score increased significantly from the first pre-activity questionnaire (Q1) to the first post-activity questionnaire (Q2) (P<0.001) and from the first pre-activity questionnaire (Q1) to the second post-activity questionnaire (Q4) (P<0.001). All 14 traits showed significant grade changes from pre-activity to post-activity questionnaire.
Conclusion: Well-designed and well-evaluated leadership curricula are necessary to help undergraduate medical students develop leadership skills. Undergraduate medical education provides an ideal setting to introduce leadership competencies. This study highlights community engagement as a potent method for the delivery of medical leadership training.
Predictive superiority of abdominal obesity measures over body mass index in Indian hypertensive adults
Authors: Gupta Prakhar , Meena Kamal , Gupta Aankury , Gavli Jai
Published: January 2025

Background: Obesity has emerged as an epidemic and is known to be associated with multiple co-morbidities, contributing to increased morbidity and mortality. Body-mass index (BMI) has been traditionally used to assess obesity in an individual but abdominal obesity markers are being claimed to have a stronger association with adverse cardiovascular outcome as compared to BMI. However, there are only a few studies that have evaluated these indices in Asian Indians.
Aims and Objectives: The study was conducted to compare BMI and waist measurement based indices among hypertensive adults and their association with adverse cardiovascular outcomes. The secondary objectives were to determine any gender-based differences among anthropometric indices and improved predictability on adding waist-based indices to BMI.
Materials and Methods: An observational study was conducted to analyse association of anthropometric indices such as BMI, A body shape index (ABSI), Waist–hip ratio (WHR), Waist-to-height ratio (WHtR), Lean body mass-to-weight ratio, and Waist circumference (WC), with risk of cerebrovascular accidents (CVA) and coronary artery disease (CAD) in Indian hypertensive adults.
Results: In total, 400 participants were included and female subjects were noted to have higher prevalence of obesity in our study population. Only 33.25% patients had BMI in recommended range and the numbers were even lower for WHtR and WHR. BMI and ABSI were found to have a weak association with development of co-morbidities while measures of abdominal obesity such as WHR, WC, and WHtR were found to have consistently strong association with CVA and CAD with high sensitivity and negative predictive values.
Conclusion: More accurate markers of abdominal obesity can help in better assessment of cardiovascular risk among high-risk population to improve the overall outcome. Easy to use, outpatient-based markers such as WC, WHR, and WHtR appear to be better than BMI in risk assessment.
Pre-diagnostic “chronic life stressors” and their association with breast cancer outcomes: A cross-sectional observation study
Authors: Biju Azariah M  , Arumugam Velappan
Published: January 2025

Background: Breast cancer is widely studied for its psychosomatic aspects owing to its high prevalence among women and the impact of chronic life stressors on its development and outcomes.
Aims and Objectives: This study aimed to evaluate the association between previous chronic stressors and breast cancer diagnosis, duration of presentation to a health-care facility stage at presentation, tumor profile, treatment compliance, treatment-induced complications, and outcomes.
Materials and Methods: This cross-sectional observational study included 200 breast cancer patients. Patients were interviewed post-treatment to collect data on marital status, socioeconomic status, occupation, education, and emotional events, using the Holmes and Rahe stress scale. Scores were categorized as low-, medium-, or high-risk for disease development.
Results: Low-level chronic stress was the most prevalent in patients with stage I disease (93%), followed by stage II (87%), stage III (72%), and stage IV (52%). Moderate-level chronic stress increased with the disease stage, being the lowest in stage I (7%) and the highest in stage IV (48%), and this was significant (P=0.01). The median duration from symptom recognition to presentation was <4 weeks in 81–62% of patients with low and moderate stress, respectively. For those with moderate chronic stress, 62% presented within 4 weeks and 38% took >4 weeks, with a significant P=0.01.
Conclusion: Recognizing and addressing pre-diagnostic chronic stress is crucial for breast cancer management because it influences the cancer stage at diagnosis and the time of health-care presentation. Integrating psychosocial support into cancer care can improve treatment effectiveness and patient well-being.
Assessment of carotid artery hemodynamic profile in young patients presenting with acute coronary syndrome – a cross-sectional study from a tertiary care center in South India
Authors: Murugesan Kannan , Paramasivam Ramachandran , Ramamoorthy Hariharakrishnan , Kumaresan Kannan
Published: January 2025

Background: Coronary artery disease (CAD) prevalence in young individuals is rising, particularly in South Asian populations. Carotid artery hemodynamic parameters and their relation with CAD have not been studied much in young patients.
Aims and Objectives: The aim of the study was to study the relationship between Carotid artery hemodynamic parameters, and CAD severity in young patients.
Materials and Methods: A cross-sectional and single-center study was conducted involving consecutive patients undergoing coronary angiography due to acute coronary syndrome and aged under 40. Carotid ultrasonography and Doppler were performed to assess Carotid artery hemodynamic parameters. Gensini and SYNTAX scores were used to evaluate the severity and complexity of CAD. A total of 136 patients were included in the study.
Results: The mean age was 36.24±4.030 years, with 92 males. CAD patients demonstrated significantly increased carotid intima-media thickness (CIMT) (0.730±0.157 vs. 0.488±0.09; P<0.001) and resistive index (RI) in the right internal carotid artery (RICA) (P=0.004). Carotid blood flow velocities were significantly reduced in CAD patients, including peak systolic velocity (PSV) in both the RICA and left ICA (LICA) (P<0.05) and end-diastolic velocity of the RICA (P=0.049). Mean SYNTAX 9.526±6.762 and mean Gensini 23.403±18.58. CIMT correlated significantly with CAD complexity in terms of vessels involved (P=0.036) and of SYNTAX score (P=0.046). CIMT, PSV RICA, PSV LICA, and RI RICA are the significant CAD predictors.
Conclusion: CIMT and Carotid artery hemodynamic parameters are valuable predictors of CAD occurrence, severity, and complexity even in young individuals, highlighting their clinical utility in risk assessment for this population.
Evaluation of the effectiveness and safety of treatments used in patients suffering from chronic obstructive pulmonary disease
Authors: Jaymin S Chaudhari  , Manish N Solanki  , Chetna K Desai
Published: January 2025

Background: Chronic obstructive pulmonary disease (COPD) is now one of the top three causes of death worldwide. Despite the availability of various kinds of treatments, there is a paucity of data regarding potential treatment for COPD.
Aims and Objectives: This study has been carried out to evaluate the effectiveness and safety of treatments used for COPD.
Materials and Methods: A prospective, longitudinal, observational study was carried out at a tertiary care teaching hospital. A total of 105 patients were included and divided into two treatment groups: Group budesonide+formoterol (BF) and group fluticasone+salmeterol (FS) based on the treatment they received. Patients’ details were recorded in a pre-defined case record form. Effectiveness was evaluated and compared between the two treatment groups in terms of the number of exacerbations experienced, the mean reduction in COPD assessment test (CAT) score, and the mean change in forced expiratory volume 1 s (FEV1%) at the end of the study period. Safety was assessed by recording adverse drug reactions.
Results: Out of a total of 105 patients with COPD, 67 (63.80%) patients belonged to group BF and 38 (36.19%) patients belonged to group FS. Twenty-seven (40.30%) patients from Group BF (n=67) and 18 (47.37%) patients from group FS (n=38) developed exacerbations. No statistically significant difference between group BF and group FS was observed in terms of mean reduction in CAT score (P= 0.17) as well as mean change in FEV1% (P=0.38) from baseline to the end of 6 months of treatment.
Conclusion: Our study concludes that inhalational corticosteroids/long-acting beta-agonist combinations such as BF and FS are equally effective in terms of reduction in frequency and severity of exacerbation, reduction in CAT score, and improvement in lung functions (FEV1%).
Comparative study between fentanyl and dexmedetomidine as adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective and randomized study
Authors: Siddhi Banerjee  , Susanta Kumar Halder  , Tibar Banerjee  , Debojyoti Das  , Rajdeep Biswas  , Soma Chakraborty  , Debasish Saha
Published: January 2025

Background: Supraclavicular brachial plexus block (BPB) is being utilized extensively for upper limb surgeries. To improve block quality, several adjuvants have been used successfully. Fentanyl and dexmedetomidine has been evaluated as adjuvants for such block done using ropivacaine. However, block qualities have been modified to a variable extent with use of such adjuvants.
Aims and Objectives: Hence, the study was designed to compare fentanyl and dexmedetomidine as adjuvants during ropivacaine-induced supraclavicular BPB.
Materials and Methods: Sixty adults undergoing upper limb surgeries were randomly divided in to two groups to receive either fentanyl or dexmedetomidine as adjuvants to ropivacaine for supraclavicular BPB. The onset of sensory block was the primary outcome measure. Duration of sensory bloc, motor block characteristics, and adverse events were also evaluated.
Results: Considerably faster onset of sensory and motor blockade was found with the use of fentanyl as adjuvant over dexmedetomidine (sensory, 8.2±1.19 vs. 12.07±0.96, P<0.001; and motor, 7.0±0.43 vs. 30.43±1.41, P<0.001). However, the duration of sensory and motor blockade were found considerably prolonged with the use of fentanyl over dexmedetomidine.
Conclusion: Fentanyl can be a better alternative to dexmedetomidine as adjuvant to ropivacaine for supraclavicular BPB in view of faster onset of sensory and motor block. While prolonged duration of sensory block appears to be beneficial, the prolonged motor block can cause delay patient mobility.
Cardiovascular autonomic reactivity and inflammatory markers in patients with chronic migraine
Authors: Ayasha Nishad  , Abhishek Tiwari  , Waqas Alauddin  , Prajakta Radke
Published: January 2025

Background: Common headache disorders, including tension-type migraines and cluster headaches, are related to malfunctions of the autonomic nervous system (ANS). Many autonomic signs of migraines aggravate the discomfort of the episode. Understanding the function and comorbidities of migraine patients depends on tests for assessing the cardiovascular autonomic responsiveness of the ANS.
Aims and Objectives: The aim and objective of this study is to evaluate the use of cardiovascular reflex testing in adults with chronic migraine and healthy controls. Investigating inflammatory markers in individuals suffering from chronic migraines and controls.
Materials and Methods: Thirty healthy controls and 30 people suffering from persistent migraines were part of the research. Cardiovascular reflex tests were performed. Inflammatory markers such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1, and IL-10 were also evaluated. SPSS edition 21 was used for the statistical analysis. For parameters with normal and atypical distributions, the Mann–Whitney test and the unpaired t-test, respectively, were used.
Results: Among 30 subjects, testing for autonomic reactivity related to chronic migraines revealed significantly lower values than those for control. Patients with chronic migraines had far more inflammatory markers, including TNF-α, IL-1, and IL-10.
Conclusions: Revealing autonomic dysfunction, the group with chronic migraines had a lower parasympathetic tone and sympathoexcitation than the healthy control group. Future studies should concentrate on ANS dysfunction as a biomarker for early warning signals for drug intake and migraine control.
Relation of low back pain with lumbosacral transitional vertebrae in Eastern Indian population
Authors: Dona Saha  , Asutosh Pramanik  , Gopal Chandra Mondal  , Suchismita Ghosh  , Madhushree Pal  , Falguni Mondal
Published: January 2025

Background: Lumbosacral transitional vertebrae (LSTV) or lumbarization of sacral vertebrae and sacralization of lumbar vertebrae are congenital variations. These are associated with alterations in anatomy and biomechanics of spinal and paraspinal structures, which lead to low back pain (LBP).
Aims and Objectives: This radiological study was designed to identify the prevalence of LSTV in patients presenting with LBP and to classify the anatomical variations in LSTV according to the Castellvi classification.
Materials and Methods: This hospital-based, cross-sectional, observational cohort study was conducted in the Department of Radiodiagnosis, in different medical colleges and hospitals of West Bengal. The study was done on 1500 patients aged 20–75 years with a history of LBP. Antero-posterior and lateral lumbosacral radiographs were done to identify LSTV.
Results: The present study in West Bengal shows that 24.1% of subjects had LSTV among LBP patients, Castellvi Type IIA (33.4%) being the most common anatomical variant, followed by Type IB (19.6%). Sacralization (22.3%) was found more common than lumbarization (1.8%).
Conclusion: LSTV comprises almost one-fourth of cases of low back ache which can be easily diagnosed by simple radiograph. It has important implications for surgery in the lumbosacral region.
Comparative study of intubating condition between rocuronium and vecuronium for endotracheal intubation in general anesthesia
Authors: Ganesh Choudhari  , Rahul Basavraj Swami  , Shiraj Shaikh
Published: January 2025

Background: Muscle relaxation in anesthesia serves two main purposes: Facilitating endotracheal intubation and achieving surgical relaxation. The period from the suppression of protective reflexes during induction to the completion of intubation is critical, with an increased risk of regurgitation. Ensuring a patent airway is fundamental to general anesthesia, commonly achieved through endotracheal intubation.
Aims and Objectives: This study aims to evaluate the onset time, tracheal intubation conditions, duration of action, and maintenance of anesthesia using vecuronium and rocuronium, monitored by train-of-four (TOF).
Materials and Methods: This double-blind, prospective, randomized study was conducted over 18 months on patients undergoing elective surgeries under general anesthesia at a tertiary hospital. Ethical committee approval and informed written consent from all participants were obtained. Patients were randomly assigned into two groups of 50 each.
Results: Demographic parameters between both groups were statistically insignificant (P>0.05). The mean onset time, defined as the interval between the end of muscle relaxant administration and completion of intubation, was 99.6±12.03 s in Group A (rocuronium) and 231.0±13.21 s in Group B (vecuronium), a statistically significant difference (P<0.001). Intubation conditions were excellent in 36 (72%) and good in 13 (26%) patients in Group A compared to excellent in 28 (56%) and good in 17 (34%) patients in Group B.
Conclusion: Rocuronium provides earlier excellent and good intubating conditions compared to vecuronium, with similar cardiovascular stability during and after intubation. Rocuronium’s rapid onset of action makes it more suitable for quick tracheal intubation in surgical patients under general anesthesia.
A prospective and retrospective observational study on residual gallbladder stones after cholecystectomy
Authors: Indranil Chakraborty  , Manojit Sarkar  , Arup Kumar Ghosh  , Amit Ray
Published: January 2025

Background: A small number of post-cholecystectomy syndrome cases result from residual stones in a lengthy cystic duct or recurrence of lithiasis in a remaining gallbladder (GB) tissue. In laparoscopic procedures, up to 13.3% may involve incomplete GB removal due to surgical complexities and anatomical variations such as adhesions or challenging morphology.
Aims and Objectives: (1) To assess the incidence of retained stones in patients undergoing cholecystectomy, (2) to compare incidences among open and laparoscopic cholecystectomies, (3) to study various presenting ways and different investigational methods helping in early diagnosis and proper management, and (4) to study different operative interventions for different cases.
Materials and Methods: This was a prospective and retrospective observational study. After getting ethical committee approval and informed consent, 35 patients were included in the study. The study was carried out in the Department of General Surgery at I.P.G.M.E.R./S.S.K.M. Hospital, Kolkata.
Results: Most patients were post-open cholecystectomy cases. The incidence of retained GB stones was 4.48%, with females affected 2.8 times more than males. Common symptoms were pain abdomen (80%) and fever (25%). Ultrasonography diagnosed stump calculi in 85.71% of cases; magnetic resonance cholangiopancreatography (MRCP) was preferred when ultrasound was inconclusive.
Conclusion: Cases underwent subtotal cholecystectomy or had long cystic duct stumps in rural hospitals, referred to tertiary hospital for further management. Symptoms included pain abdomen, fever, and sometimes jaundice. MRCP confirmed diagnoses before open re-exploration; completion cholecystectomy addressed residual stones for symptom relief and cure.
Prevalence of depressive symptoms among first-year undergraduate students of government medical and engineering colleges in Thiruvananthapuram city
Authors: Jisnu Janardhanan  , Rithwik Santhosh  , Ashoka  , Shafeen Hyder
Published: January 2025

Background: Depression is a major health issue globally and is on par with lifestyle diseases such as diabetes and hypertension when it comes to morbidity. The first year in professional college is a critical transition period encompassing drastic biological, social, emotional, and academic changes which could be potential stressors for precipitating depressive symptoms.
Aims and Objectives: The current study aims to find the prevalence of depressive symptoms among 1st-year undergraduate students of Government medical and engineering colleges in Thiruvananthapuram city.
Materials and Methods: The cross-sectional study included 88 medical students and 212 engineering students. Patient Health Questionnaire-9 was used to assess depressive symptoms, brief resilience scale to assess resilience, and CRAFFT 2.0 to screen for substance use. SPSS was used for the analysis of data; Chi-square test was used for the comparison of proportion and t-test for comparing means.
Results: 28% of total study subjects reported depressive symptoms. One in three medical students reported depressive symptoms while one in four engineering students reported depressive symptoms. Low resilience had negative association and history of substance use had positive association with the presence of depressive disorders.
Conclusion: A significant number of students in professional colleges have depressive symptoms, either diagnosed or undiagnosed. Steps can be taken in the direction of reducing academic distress, promoting extra-curricular activities, setting up student support programs in institutions, legal policies to limit substance misuse among students, and creating awareness about positive parenting styles which give adequate importance to self-care and being mindful.
Study of factors leading to cancellation of elective surgeries in a tertiary care hospital
Authors: Verma Surender , Kumar Gaurav , Yadav Sunil Kumar , Verma Anjali , Lanah L Simon Seiwa
Published: January 2025

Background: The postponement of elective surgeries is a major problem that increases the time for patients on surgical waiting lists and can negatively affect psychologically and physically to patients and their families. Cancellation rates reported within the literature are highly variable with considerable differences depending on type of hospital, national health care systems or policies, geographical region, patient population, providers, and also the perioperative management practices present at specific institution.
Aims and Objectives: The current study was to thoroughly understand the causes to minimize such cancellations in our institute.
Materials and Methods: A prospective observational study was conducted in the Department of General Surgery in a tertiary care teaching hospital in North India. All the patients admitted for elective surgeries in the Department of General Surgery over a period of December 1st, 2022–May 30th, 2023 were noted and out of them, details of patients in whom surgery was cancelled were taken and they were followed for 2 months.
Results: Out of a total 1065 patients, 92 patients got cancelled during the study period. Out of them, 67 patients (67.8%) were cancelled on the scheduled date of surgery or after reaching operation theatre whereas, 25 patients (27.2%) were cancelled on day before scheduled date of surgery. Maximum number of cancelled patients were of cholelithiasis planned for laparoscopic cholecystectomy followed by inguinoscrotal swellings. Maximum number of patients were deferred due to administrative-related factors, followed by medical related factors.
Conclusion: This study will act as a quality improvement initiative by reducing the surgery cancellation rate thus improving utilization of limited resources and valuable time to provide better health care services in our institute. Such cancellations can be minimized by better planning and active inter-departmental communication regarding proposed plan of surgery.
Demographic profile and clinical spectrum of gallstone disease in a rural tertiary care center: A retrospective observational study
Authors: Ajender Singh  , Mukesh Kumar  , Sanjeev Singla  , Pushpendra Malik  , Chanderbhan
Published: January 2025

Background: Gallstone disease is a major public health problem worldwide irrespective of age. The incidence of gallstone disease shows considerable geographical and regional variations.
Aims and Objectives: The aim and objectives are to study the correlation between demographic profile and clinical spectrum of gallstone disease and to study the clinical spectrum of gallstone disease at a rural tertiary care hospital to assess the demographic profile of gallstone disease patients.
Material and Methods: The present retrospective observational study was conducted in the Department of General Surgery, BPS Medical College for Women, Khanpur Kalan, District, Sonipat. A total of 342 patients with gallbladder disease were included.
Results: Out of 342 patients, 294 were female and 48 were male. The most common presenting symptoms among gallstone diseases were right hypochondrium pain in 307 (89.8%) patients, followed by epigastric pain in 24 (7%) patients, and nausea in 11 (3.2%). Ultrasonography suggests that the highest number of patients were associated with multiple gallstones in 203 (59%) patients out of which 170 were females and 33 were males; single stones were associated with 139 (40.6%) patients out of which 124 were females and 15 were male followed by double calculi in 5 (1.5%) patients.
Conclusion: Gallbladder stone disease is more common in females. It can affect any age group. The maximum number of gallstone disease patients present with pain in the right hypochondrium and nausea. Maximum patients had multiple calculi gallbladder disease. Gallstone disease with chronic symptoms affects the liver function and anatomy of the Calot’s triangle that may affect the surgical procedure outcomes and hospital stay.
Classic polyarteritis nodosa presenting initially as a case of cutaneous polyarteritis nodosa: A case report
Authors: Sabina Adhikari
Published: January 2025

Classic polyarteritis nodosa (PAN) is an uncommon form of aggressive systemic vasculitis involving small-to-medium sized arteries usually of renal vasculature and other visceral organs but characteristically sparing the lung vasculature. Cutaneous PAN (c-PAN) is still a rare type of small-to-medium vessel vasculitis with involvement of skin without any systemic or visceral involvement. However, extracutaneous features such as arthritis, arthralgia, myopathy, and myositis can co-exist with the cutaneous features. c-PAN can be confirmed histopathologically by the presence of polymorphonuclear leukocytes around the medium-sized vessels with evidence of fibrinoid necrosis and luminal thrombi at the bifurcations. While c-PAN has a benign but chronic course and can be managed with low doses of short-course oral steroids or anti-inflammatory drugs, systemic involvement has an aggressive course and needs adequate and prompt immunosuppression with high dose oral steroids, cyclophosphamide, rituximab, or other immunosuppressive. We present a case of a 33-year-old male who landed in our OPD with features of c-PAN and on further investigative workup was found to have a renal infarct.
Torsion of paraovarian cyst: An enigma
Authors: Latika  , Pushpa Dahiya
Published: January 2025

Paraovarian cysts are extremely rare and represent approximately 10% of adnexal masses. They are found commonly in women of reproductive age group and arise from the mesothelium. Paraovarian cyst is an entity which is rarely diagnosed preoperatively and often remains undiagnosed and missed out even by radiologists. Most often they remain asymptomatic but when large in size may present with complications such as torsion, hemorrhage, and infection. Isolated torsion of paraovarian cyst is extremely rare. Its diagnosis is often missed out leading to complications.
Bilateral superficial cervical plexus block as sole anesthesia for parathyroid surgeries in chronic kidney disease patients
Authors: Kanika Agarwal  , Nidhi Sharma  , Aseem Sharma  , Manish Banjare
Published: January 2025

Chronic kidney disease (CKD), especially in stages III, IV, V patients presenting for surgical removal of parathyroid glands, has special concerns regarding anesthesia. Their renal disease restricts the choice of drugs that can be used for general anesthesia induction and management. Bilateral superficial cervical plexus block (SCPB) under ultrasound guidance can be an alternative mode of anesthesia in parathyroid surgeries in these patients. The aim of the present case series was to evaluate the effectiveness of bilateral SCPB in CKD (stages III, IV, V) patients undergoing parathyroid surgeries in terms of hemodynamic stability, intraoperative and post-operative analgesia, and surgeon’s satisfaction. In the present case series, USG-guided bilateral SCPB was performed under aseptic precautions and 10 mL of local anesthetic was injected on each side. Effect was confirmed with wet swab and blunt pin prick. Then, patient was handed over to the surgeon. Continuous hemodynamic monitoring was done and time of first rescue analgesia was noted. Bilateral SCPB proved to be a good alternative mode of anesthesia for CKD (stages III, IV, V) patients undergoing parathyroid surgeries.
A study on clinicoradiological correlation in patients with intrauterine contraceptive device
Authors: Divangini Yadav  , Rachna Chaurasia
Published: January 2025

The aim of this study was to present the spectrum of radiological findings in patients with intrauterine contraceptive device (IUCD). The study was conducted over a period of 14 months (June 2022–August 2023) in the Department of Radiodiagnosis, M.L.B. College, Jhansi. A prospective study was conducted in the Department of Radiology in MLB Medical College Jhansi in 120 cases with IUCD, referred from various departments. These patients were primarily evaluated on transabdominal and transvaginal sonography (3D, 4D) (ultrasound machine-Medison sono Ace-X8, Vivid T8, and Hitachi Aloka SSDF-31), which is the first-line imaging for the evaluation of IUCD position. Out of 120 cases, in 100 cases, findings were confirmed on USG and the rest cases require further radiological modalities such as X-ray, CT scan, and MRI which were used accordingly the presenting symptoms of the patient and findings of ultrasound. As in one of our case, X-ray pelvis has shown completely inverted IUCD.
Sigma metrics – a good quality control guide to assess analytical performance of a clinical chemistry laboratory
Authors: Lincy Raj C  , Poornima RT  , Malawadi BN
Published: January 2025

Background: Clinical laboratories function to deliver accurate, reliable, and timely reported results which are used in decision-making, diagnosis, and monitoring. Sigma metrics help to assess analytic methodologies and provide benchmarks for laboratories to design protocols for internal quality control (IQC), address poor assay performance, and assess the efficiency of existing laboratory processes. Thus, this study was undertaken to estimate the coefficient of variation (CV%), bias%, and total allowable error (TEa) of quality control (QC) samples using EM 200, to compare the TEa using Clinical Laboratories Improvement Act (CLIA) guidelines, and to analyze the sigma metrics of level 1 QC samples.
Aims and Objectives: The aims and objectives of the study are to estimate the CV%, Bias%, TEa of QC samples using EM 200, to compare the TEa using CLIA guidelines, and to analyze the sigma metrics of level 1 QC samples.
Materials and Methods: A cross-sectional study was carried out in the Central Biochemistry Lab, Karwar Institute of Medical Sciences, Karwar. IQC data level 1 of 15 analytes was analyzed using EM200 for 3 months. CV% is calculated from internal quality data, whereas bias% is obtained from an external quality assurance program. Sigma metrics were calculated using bias% and CV%. TEa was calculated and compared with CLIA guidelines.
Results: We have < 3 sigma values (unstable, unacceptable) for urea, creatinine, BID, serum glutamic oxaloacetic transaminase, serum glutamate pyruvate transaminase (SGPT), protein, cholesterol, calcium, 3–6 (ideal) for glucose, uric acid, total bilirubin, alkaline phosphatase, albumin, high-density lipoprotein, and >6 (excellent) for triglycerides. TEa observed less than or close to CLIA suggests quality requirement met, and TEa observed more than CLIA (urea, creatinine, BID, SGPT, protein, and calcium) suggests methodologies need evaluation.
Conclusion: Sigma metrics help to assess analytical methodologies and augment laboratory performance. Each and every laboratory can use sigma metrics as a guideline for QC strategy and a self-assessment tool for proper functioning.
Establishment of reference intervals of oxidized low-density lipoprotein cholesterol in a population of West Bengal
Authors: Kapil Deb Lahiri  , Amit Kumar Gupta  , Utpal Kumar Biswas
Published: January 2025

Background: Elevated oxidized low-density lipoprotein (Ox-LDL) was significantly associated with the atherosclerotic cardiovascular disease as well as retinal vascular diseases but there were no studies to show the reference range of Ox-LDL levels in any Indian population.
Aims and Objectives: The aim of this study was to formulate the reference intervals of Ox-LDL cholesterol in a population of West Bengal.
Materials and Methods: Ox-LDL levels of 434 apparently healthy individuals were estimated based on the history, clinical examination, and laboratory investigations. Statistical analysis was performed using the statistical package for the social sciences software.
Results: The reference range of Ox-LDL levels for all ages was 34.1±4.9 mol/L in healthy male and 34.5±4.5 mol/L in healthy female. The 2.5th and 97.5th percentile values of Ox-LDL level in the reference population were 27 (0.90 CI = 26.4–27.6) and 42 (0.90 CI = 41.4–42.6), respectively.
Conclusions: Reference intervals for Ox-LDL may help clinicians to predict the future risk for coronary heart disease and retinal vascular disease by taking medical decision limits and also open up the scope for further research for other laboratories to formulate their own reference interval of Ox-LDL.
Comparison between mini-percutaneous nephrolithotomy and retrograde intra renal surgery for the management of lower calyceal calculi of size less than 1.5 cm : Our institutional experience
Authors: Jayaprakash Narashimman  , Pugazhenthi Periasamy  , Mahendran Ganesamoorthy  , Thiruvarul PV  , Kiran Ramapurath
Published: January 2025

Background: The treatment of lower calyceal calculi with a size <1.5 cm remains a subject of debate. Mini-percutaneous nephrolithotomy (Mini PCNL) and retrograde intrarenal surgery (RIRS) are both effective options, but there is a need for comparative analysis to determine the optimal approach. Mini-perc has the advantage of direct visualization and efficient fragmentation and clearance, while RIRS is a minimally invasive technique with excellent visualization and minimal morbidity.
Aims and Objectives: This study aims to evaluate and compare the efficacy, safety, and outcomes of mini-perc PCNL and RIRS in the management of lower calyceal calculi.
Materials and Methods: This retrospective comparative cohort study included a total of 72 patients with lower calyceal calculi <1.5 cm. Thirty-six patients underwent mini-perc, and 36 patients underwent RIRS.
Results: No significant differences were observed in patient demographic characteristics, stone size, or stone location between the mini-perc and RIRS groups. The mini-perc group had a significantly higher stone-free rate (SFR) (94.4%) compared to the RIRS group (86.1%) (P<0.05). The mini-perc technique had a higher success rate in first-session stone clearance (88.9%) compared to RIRS (77.8%) (P<0.05). The mini-perc group had a longer operative time, higher estimated blood loss, and a longer post-operative hospital stay compared to the RIRS group (P<0.05).
Conclusion: Both mini-perc and RIRS techniques are effective for managing lower calyceal calculi <1.5 cm. Mini-perc offers a SFR and a better success rate in first-session stone clearance compared to RIRS. However, mini-perc procedures are associated with longer operative time, higher estimated blood loss, and a longer post-operative hospital stay.
Evaluation of the influence of elective postings in accordance with the competency-based undergraduate medical education pattern on the development of research abilities in students
Authors: Bhanupriya Shivshankar Pande  , Patel Shraddha , Amit J Patil  , Sonal R Deshpande  , Aashutosh Ramakant Patel  , Mohammed Usman Shaikh
Published: January 2025

Background: As per the revised competency-based medical education guidelines given by the National medical council of India, students are offered elective posting after the first part of 3rd phase of the medical professional course. This has been started from the year 2023. There will be various postings offered and at end of the posting they will be assessed on various domains.
Aims and Objectives: Our study aims to assess the impact of elective posting on the research skills and students’ perception toward it. It also aims to identify the best methods to implement elective postings.
Materials and Methods: In the year 2023, using a complete enumeration technique 86 students from the third phase of MBBS at a medical college in Maharashtra, India, were registered for the 2 months of elective and would be questioned twice following consent using a pre-validated questionnaire. The first interview will take place following the completion of the first block of elective posting, and the second interview will take place following the conclusion of the second block of elective posting.
Results: We observed a statistically significant difference when two blocks were compared on the domains of efforts. Students have reported higher efforts toward clinical and surgical postings. We also observed that students reported a statistically significant level of frustration in block two. In our study, we found that research work was taken more during the second block as students were sensitized in the first block regarding research.
Conclusion: In our study, we have observed that research activities are taken up and processed for presentation using biostatistics in the second block of elective if resource material and support are provided in the block one. Students develop a better understanding of research with proper training.
Evaluating the effectiveness and safety of empagliflozin versus liraglutide in managing diabetic dyslipidemia: An observational study
Authors: Motakatla Usha Rani  , Chitra Karuppiah  , Penupothu Sree Nagamani
Published: January 2025

Background: Diabetic dyslipidemia poses a significant risk factor for cardiovascular complications in patients with diabetes mellitus. Empagliflozin and liraglutide are two commonly used medications in diabetes management, yet their comparative efficacy and safety in treating diabetic dyslipidemia remain under-explored.
Aims and Objectives: This study aimed to assess the effectiveness and safety of Empagliflozin versus liraglutide in managing diabetic dyslipidemia.
Materials and Methods: The study enrolled 100 participants with diabetes and dyslipidemia, divided equally into empagliflozin and liraglutide treatment groups. Baseline characteristics, including age, gender distribution, ethnicity, and duration of diabetes, were assessed and compared between the groups. Lipid profiles, encompassing total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, were evaluated at baseline and after 6 months of treatment. Safety outcomes, such as the occurrence of mild gastrointestinal symptoms, hypoglycemia, and serious adverse events, were also monitored.
Results: Both treatment groups exhibited comparable baseline characteristics. Following 6 months of treatment, both empagliflozin and liraglutide demonstrated significant improvements in lipid profiles. Reductions in total cholesterol, LDL cholesterol, and triglycerides, along with increases in HDL cholesterol, were observed in both groups. Moreover, there were no significant differences in the occurrence of adverse events between the two treatment groups, indicating similar safety profiles.
Conclusion: This study provides evidence supporting the effectiveness and safety of empagliflozin and liraglutide in managing diabetic dyslipidemia. These findings highlight the potential of both medications as viable therapeutic options for patients with diabetes and dyslipidemia.
Clinical pattern of vernal keratoconjunctivitis in children – A cross-sectional study
Authors: Roopa K  , Ramalakshmi Badugu  , SreeLakshmi Pallamreddy  , Suhasini J
Published: January 2025

Background: Vernal keratoconjunctivitis (VKC), a chronic and bilateral allergic eye condition, predominantly affects young males and is more prevalent in hot, humid regions with high allergen exposure. It manifests with itching, light sensitivity, burning sensations, and tearing. The three main clinical forms include limbal or bulbar, palpebral or tarsal, and mixed presentations.
Aims and Objectives: This study aimed to describe the clinical patterns of VKC in children at a tertiary care hospital in Andhra Pradesh.
Materials and Methods: This cross-sectional observational study was conducted in a hospital setting at the Department of Ophthalmology, SV Medical College in Tirupati, Andhra Pradesh, between January 2021 and January 2022. Ninety children aged 5–12 years with symptoms of allergic conjunctivitis were enrolled in the study. The Bonini grading system was used to grade the severity of the disease based on clinical manifestations at the time of initial presentation.
Results: Mean age of disease onset was 8.6±2.3 years, with a male-to-female ratio (M: F) of 2.1:1. The majority of the subjects experienced seasonal occurrence 69 (77.0%), whereas 21 (23%) had perennial occurrence. The commonly reported symptoms included itching (83%), redness (73%), watering (73%), and discharge (47%). A significant number of patients (60, 69%) had a mixed type of disease that affected both the tarsal and bulbar conjunctiva.
Conclusion: VKC predominantly affects young males, displaying a seasonal distribution and showing less allergic association, consistent with patterns observed in other tropical regions. Most patients had mild VKC at presentation, and a mixed-form pattern was most frequently observed.
Anatomical variations and clinical significance of the pyramidalis muscle: A detailed morphometric analysis in cadaveric population
Authors: Pratyusha Challa  , Ranzeetha D  , Pavana Kumari KV  , Lakkireddy Vasanthi  , Srinidhi Kondepudi
Published: January 2025

Background: The pyramidalis muscle, often considered a minor muscle of the anterior abdominal wall, has variable presence and morphology across populations. Its clinical significance, particularly in surgical interventions involving the suprapubic region, necessitates a detailed understanding of its anatomical features.
Aims and Objectives: This study aimed to assess the incidence, morphometric variations (length, width, and thickness), and clinical relevance of the pyramidalis muscle in the cadaveric population, offering insights that could enhance surgical outcomes in the suprapubic region.
Materials and Methods: It conducted on 60 formalin-fixed cadavers from the Department of Anatomy at Guntur Medical College, Guntur, and Government Medical College, Ongole. This study utilized digital Vernier calipers and measuring tape for precise morphometric analysis. Parameters such as presence, number of bellies, length, width, thickness, and the Pyramidalis Pubo Umbilical Index were meticulously recorded.
Results: The pyramidalis muscle was present in 83.3% of the cases, with 80% bilateral and 3.3% unilateral occurrences. The mean length was 66.2 mm on the right and 64.4 mm on the left. The width at the base averaged 23.4 mm (right) and 22.5 mm (left), with a consistent mean thickness of 4.1 mm on both sides. The Pyramidalis Pubo Umbilical Index was 39.82 (right) and 39.2 (left), indicating little variation between sides.
Conclusion: The pyramidalis muscle exhibits a high incidence rate and specific morphometric characteristics in the cadaveric population. These findings underscore its potential impact on surgical approaches in the suprapubic area, providing valuable anatomical insights for healthcare professionals.
Comparison between ultrasonography and capnography for ascertaining placement of endotracheal tube in patients undergoing general anesthesia – A prospective observational study
Authors: Lahiri Swati , Asim Kumar Kundu  , Manjushree Ray
Published: January 2025

Background: Confirmation of the position of the endotracheal tube (ETT) is an essential step for verification of intubation. Failure to diagnose esophageal intubation may lead to fatal consequences. Capnography is the gold standard for confirmation of ETT position, but it is practically impossible to be performed in all situations. Ultrasonography (USG) or “visual stethoscope” can be used as an effective alternative for all intubators in all situations.
Aims and Objectives: The study was conducted to evaluate the ultrasonography (USG) technique with respect to its efficacy to detect the proper endotracheal position of ETT compared to end-tidal capnography among patients undergoing general anesthesia; to compare the time taken by the USG technique with that of capnography for detection of proper placement of ETT; to assess the feasibility of USG to detect accidental esophageal intubation.
Materials and Methods: This prospective comparative cross-sectional observational study was conducted on 68 patients. Both capnography and upper airway USG were performed immediately after intubation to confirm the ETT placement. Sensitivity, specificity, and positive and negative predictive values of upper airway USG were determined against capnography as the reference method. The time required to determine ETT placement by the two methods was found out and compared. Agreement between the methods was assessed with kappa statistics.
Results: USG detected all three cases of esophageal intubation but could not detect two patients with correct tracheal intubation. Upper airway USG had a sensitivity of 96.92% (95% confidence interval [CI]: 93.54–100%), specificity of 100%, positive predictive value of 100%, and negative predictive value of 60% (95% CI: 50.4–69.6%). The Kappa value was found to be 0.735, indicating a good agreement between upper airway USG and capnography for confirmation of ETT placement. Time taken for confirmation of ETT by capnography was 21.68±2.63 s versus 11.44±1.38 s for upper airway USG (P<0.001). USG demonstrated bilateral lung sliding in 60 (88.2%) patients, unilateral lung sliding in 3 (4.4%) patients, and lung sliding was absent in 5 (7.4%) patients.
Conclusion: Real-time upper airway USG is an alternative method of confirmation of ETT that is not only sensitive and accurate but is faster than the current gold standard method, capnography.