bluuebunny/crossref_metadata_2025 huggingface dataset:
An observational study on variations of serum uric acid level in patients of depression and healthy controls and its correlation with hidden bipolarity
Authors: Shaswata Mandal  , Rudraprasad Acharya  , Meghadipa Mandal  , Anirban Chakrabarty
Published: January 2025

Background: Bipolar disorder (BD) is one of the most studied psychiatric disorders, this being one of the leading causes of disability in young individuals. In search for its predictive biomarker, serum uric acid (UA) level was seen to have a pathophysiologic role in the genesis of BD through oxidative stress and other mechanism.
Aims and Objectives: The aim of the study was to estimate serum UA levels in patients with 1st episode depression, to compare serum UA levels between patients and matched healthy controls and to compare serum UA levels between patients with and without hidden bipolarity and therefore, and to evaluate whether it can be used as a predictor of bipolarity.
Materials and Methods: A study was conducted in a tertiary care center in Eastern India for a duration of 3 months with a sample size of 92, comprising 46 cases with major depressive disorder (MDD) and 46 control groups of healthy subjects. Their serum UA levels were estimated. The study population was subjected to a mood disorder questionnaire (MDQ) and Montgomery–Asberg Depression Rating Scale (MADRS) scoring. All these data were tabulated in a master sheet and analyzed using Statistical Packages for the Social Sciences 25 software.
Results: The mean age of the study population was 32 years with 46 males and 46 females. The mean UA levels for MDD group was 5.27±1.14 mg/dL and for control group was 4.6±1.2 mg/dL, which was seen to be statistically significant (P=0.001). No statistically significant association was seen between the group with a high likelihood of bipolarity versus a low chance of bipolarity with respect to UA levels. A positive correlation was seen between MDQ scores and UA levels of depressed individuals (using Spearmen’s rho: rs=0.345, P=0.019), but not with their MADRS scores.
Conclusion: Serum UA levels are significantly higher in depressed patients as compared to healthy subjects. A non-statistical association was seen between UA levels and their bipolar tendencies, owing to a small sample size of comparable groups. However, a higher MDQ score was associated with high UA levels. A larger study population is needed to conclusively establish the predictive role of UA with respect to BD.
Fetomaternal outcomes in vaginal discharge during pregnancy: A prospective comparative study
Authors: Bansal P  , Jain S  , Singh P  , Goel N  , Dahiya P
Published: January 2025

Background: Vaginal discharge (VD) is a common symptom in women during the reproductive period, especially during pregnancy. Pathological VD during pregnancy is an important public health concern because it has a sociopsychological impact on women and influences fetomaternal outcomes.
Aims and Objectives: The study aims to estimate the prevalence of pathological discharge in pregnant women. The study also focuses on the demographic profile and various risk factors associated with pathological VDs and their consequences on fetal and maternal health.
Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology in a tertiary care center in Northern India. A total of 150 pregnant women with complaints of VD in the second and third trimesters with confirmation on speculum examination were recruited and evaluated for the etiology of discharge. Patients were followed until delivery and data regarding fetomaternal outcomes was collected.
Results: The prevalence of pathological VD among enrolled women was 39.33% and various etiologies were candidiasis (15.33%), bacterial vaginosis (10.66%), aerobic vaginitis (8.67%), and trichomoniasis (4.67%). These infections were significantly related to pre-term delivery and pre-term pre-labor rupture of membranes. Furthermore, the incidence of prematurity, and low birth weight neonates requiring neonatal intensive care unit care was significantly high in babies born to mothers with pathological VD.
Conclusion: Vaginal infections affect both maternal and neonatal health, thus, increasing the likelihood of poor perinatal outcomes. Hence, we propose that routine screening for pathological VD for all pregnant women should be introduced into standard antenatal care.
A comparative study of efficacy and tolerability of bepotastine besilate (1.5%) and olopatadine hydrochloride (0.1%) eye drops in allergic conjunctivitis in a tertiary care hospital of the southern part of India
Authors: Sudipto Chatterjee  , Vijendra R  , Soumyadeep Mahapatra  , Kiran Kumar L
Published: January 2025

Background: Allergic conjunctivitis is increasing with the rise in the levels of allergens. Drug therapy is usually needed in addition to avoidance of general allergens to treat this condition. Both bepotastine besilate and olopatadine hydrochloride ophthalmic solutions are newer additions in the treatment of allergic conjunctivitis having dual properties of second-generation antihistaminics along with mast cell stabilizing activity.
Aims and Objectives: The aim of the study was to compare the efficacy and tolerability of bepotastine besilate (1.5%) and olopatadine hydrochloride (0.1%) eye drops in patients presenting with allergic conjunctivitis in a tertiary care hospital of Southern part of India.
Materials and Methods: Sixty patients who were clinically diagnosed to be suffering from allergic conjunctivitis were selected as participants for the study. They were randomly distributed into two groups consisting of 30 patients each. One group received eye drop bepotastine (1.5%) and the other group received eye drop olopatadine (0.1%), with each patient receiving the medication twice daily for a duration of 2 weeks. During the first visit, all the patients were assessed for the signs and symptoms and subsequently re-assessed at weekly intervals for a period of 2 weeks. They were also advised to report occurrence of any unwanted drug reaction during the weekly follow-up visits.
Results: The above study showed the effectiveness of both bepotastine and olopatadine eye drops in decreasing the signs and symptoms of allergic conjunctivitis. Significant clinical improvement was found in all participants, whereas deterioration was found in none of them. Statistically significant improvement of itching and redness of eyes was observed with use of both the study drugs mentioned beforehand. Both the drugs were well tolerated by the patients. Statistically significant reduction of itching and foreign body sensation was found to be more in patients using bepotastine eye drops compared to those using olopatadine eye drops. Only two patients using bepotastine eye drops complained of having a mild burning sensation in eyes.
Conclusion: From this study, bepotastine and olopatadine eye drops have been observed to be safe and efficacious in allergic conjunctivitis. Bepotastine eye drop was found to be more efficacious to relieve itching and foreign body sensation compared to that of olopatadine eye drops.
Hepatitis B and/or C virus reactivation in patients receiving chemotherapy: An observational study
Authors: Nayan Navin , Velappan Arumugam
Published: January 2025

Background: Viral hepatitis reactivation occurs during various chemotherapy treatments. Patients with high serum titer levels of Hepatitis B virus (HBV) DNA before chemotherapy and those receiving intensive chemotherapy for hematological malignancies are particularly at risk.
Aims and Objectives: This study aimed to determine the incidence, predictors, and clinical significance of HBV and hepatitis C virus reactivations during chemotherapy.
Materials and Methods: This prospective observational study was conducted at a tertiary care center. Hepatitis B and C virus status was identified before the initiation of cancer treatment. Liver function was monitored in all patients before each cycle of chemotherapy. Patients with deranged liver function were subjected to repeated viral antigen tests and DNA/RNA titer levels.
Results: A total of 110 patients were identified as having hepatitis virus reactivation out of 1190 patients. The sites of malignancy were breast, 39.1% (43 patients); colorectal, 11.8% (13 patients); upper gastrointestinal, 10% (11 patients); ovary, 9.1% (10 patients); hematological malignancies, 8.2% (9 patients); lung, 5.6% (6 patients); genitourinary, 4.5% (5 patients); head-and-neck, 4.5% (5 patients); biliary tract, 3.6% (4 patients); brain tumor, 1.8% (2 patients); and others, 1.8% (2 patients). Most of the patients with reactivation received 5-FU/Capecitabine-based chemotherapy 37.3%, (41 patients), taxane plus platinum (10.9%, 12 patients), taxane only (10%, 11 patients), trastuzumab (8.2%, 9 patients), platinum-based (6.4%, 7 patients), tyrosine kinase inhibitors (6.4%, 7 patients), monoclonal antibodies (MABs) (3.6%, 4 patients), anthracyclines (2.7%, 3 patients), immunomodulators (2.7%, 3 patients), and other agents (11.8%, 13 patients).
Conclusion: We recommend that Hepatitis B and C virus Screening must me performed before chemotherapy and that non-reactive patients should be vaccinated.
Effect of students’ seminar as a revision strategy in biochemistry among I MBBS students in a medical college in Tamil Nadu
Authors: Sivakumar J  , Anitha G  , Dhinesh G
Published: January 2025

Background: Small group teaching is one of the components of competency-based medical education which was implemented in 2019 by NMC. Seminar is one of the methods of small group teaching which increases the engagement of students, self-directed learning, communication skills, and peer discussion.
Aims and Objectives: The present idea is to study the effect of students’ seminar as a revision strategy in Biochemistry among I MBBS students.
Materials and Methods: After obtaining the IEC approval, I MBBS students who are 250 in number will be divided into small groups. Each group will be given a particular seminar topic. All the students in the particular group will be instructed to present the topic on random basis. A total of 15 seminars will be conducted on particular topics. Pre-tests and post-tests (immediately after the seminar) will be conducted after the seminars along with pre-test and post-test questionnaires will be obtained and collated to understand how far the student’s acceptance of students’ seminar and its effectiveness.
Results: Our study results showed that that there is an increase in the percentage of marks in the post-evaluation and also more than 70% of the students responded positively to most of the queries in the feedback questionnaire.
Conclusion: Our study results showed that there is an increase in the percentage of marks in the post-evaluation and also more than 70% of the students responded positively to most of the queries in the feedback questionnaire.
Metabolic consequences on platelet parameters: Mean platelet volume and platelet distribution width in type 2 diabetes mellitus
Authors: Nakhro Nuneno , Khambra Poonam , Sharma Sonam , Singha T.Banikanta
Published: January 2025

Background: Diabetes mellitus encompasses metabolic disorders marked by chronic hyperglycemia, leading to various complications. It is considered a prothrombotic state associated with increased platelet reactivity. Parameters such as mean platelet volume (MPV) and platelet distribution width (PDW), which are indicative of platelet size, enzymatic activity, and prothrombotic risk, can be readily assessed during routine hematological analysis, facilitating early detection of this prothrombotic state.
Aims and Objectives: The study aimed to investigate the varied alterations in platelet parameters in type 2 diabetes mellitus (T2DM) patients and tried to elucidate these parameters’ predictive role in diabetes complications.
Materials and Methods: This prospective cross-sectional study was conducted between February 2022 and February 2024, involving 100 patients with T2DM and 100 healthy non-diabetic individuals. MPV, PDW, fasting blood glucose (FBS), and glycated hemoglobin (HbA1c) levels were measured and analyzed. Statistical analysis was carried out using the Student’s t-test, Mann–Whitney U-test, Chi-square test, and Spearman’s correlation tests in the Statistical Package for the Social Sciences software (version 21.0).
Results: Most of the patients were in the age group of 40–70 years with male predominance. In comparing the 100 diabetics and 100 non-diabetics groups, MPV and PDW levels were notably higher in diabetics (11.46±1.75 vs. 9.40±1.02 fl, 21±2.57 vs. 16.72±1.48%) with statistical significance (P<0.01). Similarly, FBS and HbA1C levels were elevated among diabetics (179.38±70.25 vs. 90.64±5.93, 7.83±2.24 vs. 5.02±0.64) along with a positive correlation between platelet indices (MPV and PDW) and FBS, HbA1c levels in patients with T2DM. In addition, diabetic patients with complications exhibit significantly higher MPV, PDW, FBS, and HbA1c levels compared to those without complications.
Conclusion: MPV and PDW levels show significant alterations in T2DM patients, with consistently elevated values, especially in those with complications. This underscores their potential importance as key indicators alongside glycemic indices such as FBS and HbA1c, in monitoring diabetes progression and anticipating associated complications.
Association of tobacco and alcohol consumption with hypertension among Hindu priests in Central India
Authors: Verma Arpit , Sharma Ruchika , Bijlwan Aanchal , Kale Saket
Published: January 2025

Background: Alcohol and tobacco use are among the major risk factors for causing hypertension in the adult population globally as well as in India. India being a religious country harbor’s large number of Hindu temples which are conventionally managed by a dedicated population of Hindu priests. The prevalence of alcohol and tobacco use in this special population of priests in India is not well established along with the associated risk of hypertension.
Aims and Objectives: First, to study the pattern of use of habit-forming substances; tobacco, alcohol, and cannabis derivatives among priests in central India. Second, to find the relationship between the use of tobacco smoking, chewing, and alcohol with hypertension.
Materials and Methods: The current study is a cross-sectional survey on Hindu priests of registered temples of a Pilgrimage city in Central India. The study utilizes a pre-tested semi-structured questionnaire for interviewing 440 study participants. It included a sociodemographic profile, history of use of habit-forming substances, the presence of known hypertension, and measurement of blood pressure.
Results: Out of 440 study participants; 280 (63.6%) were currently using habit-forming substances, whereas 160 (36.4%) number of participants had never used it. The current study found the prevalence of hypertension to be 31.9%. A statistically significant relationship of hypertension with the use of alcohol (χ2=44.2), tobacco chewing (χ2=106.1), and smoking (χ2=74.3) was found.
Conclusion: The current study concludes that the use of Habit-forming substances, especially alcohol, tobacco chewing, and smoking, are prevalent among priests which are known risk factors for hypertension in the general population. Hence all screening/interventions applicable for these risk factors should be applied to this special population of priests.
Impact of slouching on heart rate variability and cardiovascular health among medical students
Authors: Nisha Ghimire  , Soumitra Mukhopadhyay
Published: January 2025

Background: Medical students frequently adopt poor postures such as slouching potentially impacting health. Heart rate variability (HRV) serves as an indicator of autonomic nervous system function, correlated with cardiovascular health.
Aims and Objectives: The objective of the study was to compare HRV parameters among medical students in three postures: Sitting erect, easy pose (cross-legged), and slouching (stooping head and shoulders).
Materials and Methods: A comparative cross-sectional study enrolled 26 male medical students. Participants were instructed to maintain each posture for 5 min while HRV was recorded using a Polar V800. Time domain and frequency domain parameters among different postures were analyzed using Friedman’s test and post hoc tests for pairwise comparisons. P<0.05 was considered significant. Data were expressed as median interquartile range.
Results: Significant differences were observed in HRV parameters between postures. The easy pose demonstrated a significantly higher median value of root mean square of differences of successive RR intervals (48.28 ms vs. 35.35 ms) and pNN50% (24.40% vs. 13.62%) compared to slouching. Frequency domain analysis revealed a significantly higher median value of high-frequency (HF) power in easy pose (626.56 ms² vs. 378.15 ms²) and HF normalized unit (33.78 vs. 22.55) compared to slouching. A lower low frequency (LF)/HF ratio and (1.96 vs. 3.43) lower LF normalized unit (66.18 vs. 77.30) was also seen in easy pose. Although statistically not significant, the parasympathetic indicators of HRV were higher in erect sitting compared to slouching posture.
Conclusion: Among medical students, adopting the easy pose (cross-legged sitting) appeared to enhance HRV and thus increase parasympathetic activity, whereas adopting slouching postures decreased it.
Role of computed tomography enteroclysis in the evaluation of small bowel diseases
Authors: Safeeq Ahmed Meeran S  , Abinaya S  , Benin Reejan D
Published: January 2025

Background: Examining small bowel loops within the peritoneal cavity poses significant challenges because of their length and overlapping nature.
Aims and Objectives: This study aimed to evaluate the utility of computed tomography enteroclysis (CTE) in diagnosing small intestinal diseases and to understand its clinical application.
Materials and Methods: The study was conducted from November 2019 to October 2021 in 30 patients undergoing CTE treatment. The day before treatment, bowel preparation included a low-residue diet, lots of fluids, an overnight fast of 8–12 h, and laxatives. A 16-slice Aquilion Lightning computed tomography (CT) scanner was used in general hospitals, and a 128-slice GE Healthcare helical CT scanner was used in multispecialty hospitals.
Results: Among the 30 patients, 20 (66.7%) were male, and 10 (33.3%) were female, predominantly aged between 30 and 60 years old. Positive findings were noted in 23 patients (76.7%), including intestinal tuberculosis, inflammatory bowel disease, small bowel obstruction, and neoplastic lesions. Various small intestinal pathologies, such as non-specific edema, intussusception, and ischemic bowel disease, were also identified.
Conclusion: This raises the standard of current small bowel imaging by delivering suitable intestinal distension using the enteral volume challenge principle and helps identify and characterize small-bowel problems.
Accidental ingestion of scarf/hijab pins in Muslim females of Kashmir Valley
Authors: Mubashir Gani
Published: January 2025

Background: Hijab pin ingestion is common in the Kashmiri population, especially among young females. This is attributed to the tradition of wearing hijab in adolescent girls and young women.
Aims and Objectives: The present study was conducted to identify the incidence of hijab pin ingestion in the Muslim females of Kashmir Valley.
Materials and Methods: This study was conducted in the Department of General Surgery SKIMS Medical College, Bemina, Srinagar, from February 2022 to December 2023. It was a prospective study comprising 60 female patients above the age of 12 years having a history of accidental ingestion of hijab pins. History and clinical examination were followed by chest and abdominal radiographs. Data were collected and inferences were drawn.
Results: The study included 60 patients presenting to the emergency with a history of accidental ingestion of pin. The majority of patients, that is, 30 (50%) were 25–35 years of age. Most patients 40 (67%) were asymptomatic at presentation with 20 (33.33%) patients presenting to the hospital within2–3 h of ingestion. Foreign body (FB) had reached the small intestine in 22 (36.67%) patients at the time of presentation. Moreover, 1 (1.67%) patient had extraluminal migration of the FB. In our study, 46 patients had a normal passage of FB through the gastrointestinal tract. Most of the patients, that is, 46 (76.67%) were managed conservatively. Only 2 (6.67%) patients needed surgical intervention.
Conclusion: FB ingestion is common among the young females of Kashmir Valley. Adequate follow-up is necessary to prevent long-term complications.
Prevalence of coronary artery calcification in patients with end-stage renal disease undergoing dialysis and the association of various risk factors with the development of coronary artery calcification in this patient population
Authors: Avisek Maity
Published: January 2025

Background: Patients with end-stage renal disease (ESRD) on dialysis exhibit a significantly higher risk of coronary artery calcification (CAC) than age-matched normal individuals, contributing to elevated cardiovascular morbidity and mortality.
Aims and Objectives: This study designed to assess the prevalence of CAC in ESRD patients on dialysis and identify associated risk factors.
Materials and Methods: Fifty ESRD patients undergoing maintenance dialysis and twenty normal subjects were included in this cross-sectional observational study. Serum calcium, phosphate, and parathyroid hormone were measured in all ESRD patients and normal controls. Multi Row Spiral Computed Tomography was performed to determine CAC scoring (CACS).
Results: CACS was significantly higher in ESRD patients compared to normal subjects (mean CACS: 91.4±32.7 vs. 7.75±9.5 Agatston units, P<0.05). Elevated levels of calcium phosphate products, serum leptin, intact parathyroid hormone (iPTH), presence of diabetes mellitus, and longer duration of dialysis were correlated with increased incidence of CACS in ESRD patients, as indicated by higher odd’s ratios ranged from 1.10 to 6.93.
Conclusion: CAC is highly prevalent in ESRD patients on dialysis, emphasizing the need for stringent risk factor management. Our findings suggest that controlling calcium phosphate product, serum leptin, age, iPTH levels, and duration of dialysis may reduce CAC burden in this population, potentially mitigating cardiovascular risk and improving outcomes.
Impact of baseline body mass index on antidepressant response: A study in newly diagnosed patients at a tertiary care center in Kolkata
Authors: Uday Sankar Mandal  , Nandalal Mal  , Suchismita Mallick  , Abhishek Dandapath  , Aritra Bandyopadhyay  , Saswati Nath
Published: January 2025

Background: Depression, affecting 350 million globally, poses significant morbidity and mortality. The correlation between major depressive disorder (MDD) and obesity is noted, with studies indicating poorer treatment outcomes among obese individuals. Measuring weight and body mass index (BMI) could aid in predicting depression treatment outcomes, influencing drug efficacy due to their ease of measurement, amid the shared public health burden of MDD and obesity.
Aims and Objectives: The aims and objectives of the study are to evaluate baseline BMI’s impact on antidepressant response in newly diagnosed outpatient department (OPD) patients at a tertiary care center.
Materials and Methods: This longitudinal observational study was conducted with OPD patients at a tertiary care center, aged 18–65 years with newly diagnosed MDD. Assessment tools included the Diagnostic Criteria for Research accompanying the ICD-10, the Hamilton Rating Scale for Depression, and physical measurement devices. Sample size determination considered BMI groups: Normal to underweight (N1=120), overweight (N2=120), and obese (N3=70). The methodology involved patient history, examination, and follow-up assessments after 6 weeks, analyzing antidepressant response statistically.
Results: Obese patients exhibited reduced treatment response rates compared to normal and overweight counterparts. Responders had lower mean BMI. Gender disparities in obesity prevalence were noted. Limitations: The study’s limitations include a small sample size of 310 cases, single-center design, and potential selection bias in a tertiary care setting.
Conclusion: The findings underscore the complex relationship between BMI, depression severity, and treatment response. Obese individuals demonstrated higher initial depression scores and poorer treatment response, echoing previous research. The study highlights the need for personalized treatment approaches that consider individual BMI levels to optimize depression management strategies effectively.
A comparative study to access the impact of TAP block with wound infiltration in laparoscopic cholecystectomy
Authors: Ravi Kaushik  , Rajesh Kumar  , Narendra Singh Bafila  , Rachna Verma  , Sanni Deyol Gautam
Published: January 2025

Background: The transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. This study investigated whether the subcostal transversus abdominis block was superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery.
Aim and Objectives: To investigated whether the subcostal transversus abdominis block is superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery.
Materials and Methods: All patients were randomly assigned to two equal groups (n=30) using computer-generated randomization. Patients in Group 1 (TAP group) received a TAP block by administration of 10 mL of 0.5% bupivacaine on each side just before completion of surgery, and patients in Group 2 (local wound infiltration [LWI] group) received 10 mL of 0.5% bupivacaine as a local infiltrate at the local site just before completion of surgery. The pain was measured using a Visual Analog Scale (VAS) at intervals of 30 min to 24 h after the procedure.
Results: The mean VAS score was significantly lower in group 1 as compared to group 2 at 2 h and 4 h. Whereas the VAS score was not significantly different post-operative 30 min, 6 h, 12 h, and 24 h. The mean first rescue analgesia was significantly more in Group 1 than in Group 2 (P<0.001).
Conclusion: The TAP block patients had significant VAS scores at 2 and 4 h postoperatively compared to the LWI patients. The TAP group had a significantly longer median time to first emergency analgesia compared to the LWI group, with a higher proportion of patients requiring only one dose of emergency analgesia.
Decoding microbial keratitis: Epidemiology, clinical spectrum, and treatment outcomes in a tertiary care setting
Authors: Nikhil B Adroja  , Dipali P Parmar  , Pradnya K Bhole  , Kinjal Y Trivedi
Published: January 2025

Background: Infectious keratitis poses a significant public health challenge worldwide, with variable incidence rates reported globally. Timely diagnosis and intervention are crucial to prevent ocular morbidity and potential blindness.
Aims and Objectives: This study aimed to study and investigate the epidemiology, risk factors, etiology, clinical progression, microbiological findings, and treatment outcomes of microbial keratitis in a tertiary care center in western India.
Materials and Methods: We conducted a prospective observational study from July 2020 to July 2022, enrolling 90 patients with suspected microbial keratitis. Clinical data were collected, and statistical analysis was performed using SPSS 26.0, with P<0.05 considered statistically significant.
Results: Most patients were males (67.80%) and laborers (27.8%) from urban areas, with fungal keratitis being more prevalent in rural regions. No statistically significant associations were found between keratitis type and demographic factors, such as age, gender, occupation, or socioeconomic status. Bacterial keratitis was more common in urban areas. Delayed presentation was linked to larger ulcers and worse visual outcomes. Fungal keratitis presented with smaller but deeper ulcers compared to bacterial keratitis. We found 8.06% positivity rate for Gram and KOH stain each. Microbiological cultures identified bacteria and fungi in 11.29% and 20.97% samples, respectively. Treatment varied from topical medications to surgery, with 26.67% of patients receiving both.
Conclusion: Our findings underscore the importance of prompt diagnosis, targeted treatment, and comprehensive microbiological workup in managing microbial keratitis to prevent vision and eye loss. Further research is warranted to enhance understanding and optimize management strategies for this sight-threatening condition.
To validate and correlate radiologic grading of central and foraminal stenosis post-surgical decompression on degenerative lumbar canal stenosis
Authors: Niraj Narayan Singh  , Kumar Rohit  , Mahipal Ajitsinh Padhiyar
Published: January 2025

Background: Lumbar canal stenosis (LCS) is characterized as a narrowing of the canal diameter with age, which can lead to degenerative bone and soft-tissue changes.
Aims and Objectives: The aim of the study is to validate the radiologic grading of central and foraminal through correlation with outcome after surgical decompression in degenerative LCS.
Materials and Methods: A total of 23 patients with degenerative LCS who satisfied inclusion criteria and consented to participate in the study were selected and their Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain were recorded and their magnetic resonance imaging (MRI) was graded.
Results: LCS is the reduction in the dimension of the central or lateral lumbar canal that occurs most frequently as a result of chronic degenerative changes at the lumbar motion segments. In our study, ODI has comparable improvement in all groups and it does not correlate with the severity of stenosis. However, VAS for leg pain has a greater prevalence in the shorter durations group (<60 months) which had an average of 8.0. If VAS for leg pain was more preoperatively, a better outcome was seen postoperatively.
Conclusion: Decompression surgery for degenerative LCS shows significant improvement in ODI and VAS for back pain and leg pain irrespective of the severity of the stenosis by MRI grading or the severity of symptoms as assessed by VAS or ODI.
Detection of antibiogram pattern and prevalence of blaNDM and blaVIM genes among carbapenem resistant Eschericia coli isolates in a tertiary care hospital
Authors: Sanchayita Kanta  , Banya Chakraborty  , Anusri Tripathi  , Sumoyee Mukherjee
Published: January 2025

Background: Clinical significance of Eschericia coli is due to its capacity to develop resistance against many antibiotics specially carbapenem by producing carbapenemase which limits treatment options. blaNDM and blaVIM genes are responsible for this multi-drug-resistance. This is an alarming condition for society as well as clinician because they are very difficult to treat due to limited options of antibiotics and its high virulence.
Aims and Objectives: The study was conducted to detect antibiogram pattern and prevalence of blaNDM and blaVIM genes among carbapenem resistant E. coli isolates in a tertiary care hospital. Our study will also help to identify molecular basis of Carbapenem resistance including treatment guideline.
Materials and Methods: Cross-sectional study was performed during January’2021 to June’2022 time period. Identification of E. coli was followed by standard protocol and antibiotic sensitivity was done by Kirby-Bauer disk-diffusion method following CLSI guideline, using VITEK-2D-SYSTEM. Detection of genes was done by polymerase chain reaction (PCR).
Results: Out of 1867 samples, 161 isolates were identified as E. coli, among which 90 were resistant to carbapenem. Among those, 50 (31%) were resistant to all three carbapenems. Among those, 100% were resistant to ampicillin, amoxycillin-clavulanic acid, cefuroxime, cefuroxime-axetil, cefoperazone-sulbactam, ceftriaxone, cefepime, piperacillin-tazobactam, nalidixic acid, ciprofloxacin; 52% were resistant to amikacin; 54% were resistant to gentamicin; 86% were resistant to cotrimoxazole; 22% were resistant to nitrofurantoin and 96% were sensitive to tigecycline; 100% were intermediate sensitive to colistin. blaNDM gene is detected in 17 (34%) isolates and blaVIM gene is detected in 2 (4%) isolates by PCR.
Conclusion: E. coli leads to common clinical presentations such as urinary tract infection, blood stream infection, pneumonia, and wound infection. High burden of carbapenem resistant E. coli was associated with urinary indoor samples. Rising incidence of multi-drug-resistance occurs due to lack of infection control measures, irrational use of antibiotics. Continuous surveillance will prevent development of multi-drug-resistance and help to improve treatment guideline.
Study of etiology, clinical profile, and outcome of altered sensorium patients admitted in a tertiary care hospital
Authors: Sudhir  , Avinash HR  , Yashawant NS
Published: January 2025

Background: Altered sensorium is one of the most common presentations in patients coming to the emergency room. It includes decreased level of consciousness, attention disorder, arousal disorder, and cognitive disorder. The causes of altered sensorium can be varied, some of which are cerebrovascular diseases, alcoholism, cerebral trauma, hypoglycemia, epilepsy, drug intoxication, and neuroinfection. 4–10% of the patients presenting to the emergency department may have altered mental status. The outcome is dependent on early identification and effective treatment using investigations and imaging technologies, and it might range from full recovery to permanent damage to death.
Aims and Objectives: (1) To study clinical profile and etiology in altered sensorium patients. (2) To assess outcomes in altered sensorium patients.
Materials and Methods: In this prospective cross-sectional study, clinical examination and investigations are done and data are collected using pro forma for patients fulfilling the inclusion criteria. In this study, all altered sensorium patients were evaluated by detailed history, clinical examination, Glasgow Coma Scale (GCS), laboratory investigations, computed tomography brain, and other investigations. All patients were followed up till discharge or death of the patient in the hospital.
Results: There were 270 patients who presented with encephalopathy, 184 (68%) were males. The majority of these patients 60 (22.2%) were in the age group of 51–60 years old. The most common cause is neurological in 109 (40.3%) patients, metabolic in 64 (24%) patients, and sepsis in 50 (19%) patients. Ischemic stroke 83 (76%) is the most common neurological cause. Hepatic encephalopathy was the most common cause of metabolic encephalopathy present in 21 (32%) patients. Pneumonia was the most common infection. There were 114 (42.2%) deaths. Septic encephalopathy is the most common cause of mortality. Early presentation to the hospital, higher GCS, and conscious level at presentation were good prognostic markers of outcome in patients, while septic encephalopathy was found to have the worst prognosis.
Conclusion: The common etiologies of encephalopathy are neurological followed by metabolic and sepsis. Early presentation to the emergency room within 6 h of symptom onset, higher GCS, neurological and metabolic causes are associated with a good prognosis. The mortality rate was 42.2%. Septic encephalopathy is the most common cause of death with pneumonia being the most common source of infection.
Nasogastric tube insertion in anesthetized, intubated adult patients: A comparison between combined lateral position with throat pack in situ and lateral position alone
Authors: Rajdeep Biswas  , Soma Chakraborty  , Sangita Mandal  , Subha Sankar Das  , Sarfraaz Rahman  , Mandal Mohanchandra
Published: January 2025

Background: Although the proper placement of nasogastric tube (NGT) is usually a simple procedure, it may be challenging one in case of its placement in anesthetized intubated patients. At times, it may be tiresome even for the expert anesthesiologist. Different techniques have varying success rates. Many novel techniques are entering the avenue to be tested. Combinations of different techniques are showing improved success rates over individual techniques.
Aims and Objectives: This interventional study primarily aimed at comparing the success rates of proper placement of NGT in the first attempt between the “combined lateral position with throat pack in situ” and “lateral position alone.”
Materials and Methods: The present study was performed on 180 adults (≥18 years), posted for abdominal surgeries requiring NGT insertion. Patients received NGT placement using the “combined lateral position with throat pack in situ” technique (Group A, n=80) or lateral position alone (Group B, n=80). The proportion of patients in whom correct placement of NGT was possible in the first attempt using either of the techniques (primary outcome), the procedure time for successful placement of NGT, and the incidence of adverse events were compared between the groups.
Results: Correct placement of NGT in the first attempt was possible in considerably higher proportions of patients using the combined technique over lateral position alone (87.5% vs. 68.75%, P=0.007). The procedure time was comparable in both groups (23.7±6.6 vs. 25.2±5.2, combined vs. lateral position alone, P=0.093). Coiling was found to be considerably reduced in the combined method compared with the “lateral position alone” (8.75% vs.17.5%, P=0.03).
Conclusion: Combined lateral position with throat pack in situ technique can be a better alternative to “lateral position alone” for NGT insertion in anesthetized, intubated adult patients.
Clinical assessment of ectopic pregnancy in a tertiary care hospital: An observational study
Authors: Pradip Kumar Saha  , Subrata Samanta  , Niharika Sarkar  , Shreya Sharma
Published: January 2025

Background: Ectopic pregnancy is defined as pregnancy that occurs outside normal uterine cavity that occurs due to implantation of fertilized ovum in an aberrant site which is conducive to its growth and development. In developing countries like India, late presentations with tubal rupture and hemodynamic instability, late presentations with tubal rupture causes first trimester maternal morbidity and mortality. For early diagnosis, a clinician should be well aware about the various presentations of ectopic pregnancy.
Aims and Objectives: (a) To estimate the incidence, risk factors, clinical manifestations and outcome following different management protocol. (b) To estimate the morbidity and mortality with respect to different types of presentation and management. (c) To understand the need for clinical assessment in order to diagnose early and provide urgent intervention and also to lean toward the possibility of conservative approach in order to preserve fertility.
Materials and Methods: The current study was a time bound, Observational descriptive study with Longitudinal design. It was conducted in the Department of Obstetrics and Gynecology, R. G. Kar Medical College and Hospital, between March 2021 and August 2022. One hundred and thirty-eight participants, suspected to have ectopic pregnancy were enrolled for the study. Data collection was done by detailed history taking and physical examination. The basic investigations including hemoglobin, ABO and Rhesus typing, urine pregnancy test, and ultrasound (USG) examination were done. All data were collected on a structural data form and analyzed for descriptive statistics. Post-operative histopathological examination (HPE) reports were collected and final diagnosis was made.
Results: About 63.8% of the study population belonged to 21–30 years of age. About 63.7% patients presented with >5–8 weeks of amenorrhea. About 18.1% of the study population were sterilized and the duration between the sterilization and the occurrence of ectopic was 4–10 years in 64% patients. The most common risk factor was h/o Previous C-section (31.8%). The most common clinical symptom was abdominal pain present in 131 (94.9%), 44 (31.9%) participants had all the three classical symptoms with 100% specificity. On examination, forniceal fullness/tenderness was the most specific finding. The most common USG finding was Adnexal mass with empty Uterine cavity with Free fluid (49.2%). Most of the patients were managed with Partial Salpingectomy (30.4%). The final diagnosis of ectopic was made in 129 patients, which was confirmed by HPE reports in 124 patients. Five patients underwent medical treatment.
Conclusion: Early diagnosis before rupture and referral are the key factor in reducing the maternal morbidity and mortality.
Extrachromosomal DNA : New Players in Oncology
Authors: Ruby Dhar  , Arun Kumar  , Subhradip Karmakar
Published: January 2025

DNA that is found outside the main chromosomes in a cell's nucleus is known as extrachromosomal DNA. This type of DNA is not part of the standard 23 pairs of chromosomes in humans and instead exists as standalone circular or linear DNA structures. Unlike bacterial plasmids, extrachromosomal DNA in human cells contains important genetic material and holds particular significance in cancer cells. Critical characteristics of ecDNA in Cancer is that they frequently harbour amplified versions of oncogenes such as MYC, EGFR, and CCND1. These oncogenes propel the growth and survival of tumors. Cancer cells utilize ecDNA to generate multiple copies of these oncogenes, amplifying their expression without requiring alterations to the chromosomal structure. This amplification grants the cancer cells a competitive edge in growth. ecDNA plays a crucial role in the advancement and growth of cancer, as it amplifies oncogenes, genetic diversity, and resistance to treatments. Its adaptable and ever-changing characteristics empower cancer cells to adjust to external influences such as medication. Gaining insights into ecDNA's operations and impacts could lead to new possibilities for diagnosing and treating cancer, as well as developing therapies aimed at this distinct DNA structure.
Role of ultrasound and color Doppler in diagnosis of ectopic pregnancy and to differentiate from corpus luteum cyst of pregnancy
Authors: Pooja Chowdary  , Anilkumar Sakalecha  , Anees Dudekula  , Madan Kumar KN
Published: January 2025

Background: Ectopic pregnancy is the leading cause of direct maternal deaths. Ectopic pregnancy and corpus luteum cyst are two most common differential diagnoses in a patient with urine pregnancy test (UPT) positive and no sonographic evidence of intrauterine pregnancy. Internal echotexture and color Doppler features of the cyst wall are also considered in an attempt to differentiate the tubal ring of an ectopic pregnancy from that of a corpus luteum.
Aims and Objectives: The aim of this study was to diagnose the presence of ectopic pregnancy and to differentiate ectopic pregnancy from corpus luteum cyst using grayscale ultrasound and color Doppler findings.
Materials and Methods: The prospective study was conducted in 46 patients who were referred to the Department of Radiodiagnosis in R.L Jalappa Hospital with UPT positive and clinical features suggestive of ectopic pregnancy.
Results: Out of 46 patients, 33 were diagnosed with ectopic pregnancy and 13 with corpus luteum cyst. Ectopic pregnancies had thicker walls as compared to corpus luteum cysts. Most of the ectopic pregnancies had hyperechoic walls as compared to ovaries (63.6%) and endometrium (60.6%). Free fluid with echoes was seen in the pelvis in 59.4% ectopic pregnancies whereas most of the corpus luteum cysts (69.2%) had no free fluid. Most of the corpus luteum cysts (61.5%) had clear internal echotexture whereas ectopic pregnancies were mostly lacy or solid. Yolk sac was seen exclusively in ectopic pregnancy (30.3%). RI 0.7 was found to be highly specific for diagnosing ectopic pregnancy.
Conclusion: Significant ultrasound parameters that aid in differentiating between the two include the thickness of the mass’s wall, the wall’s echogenicity in relation to the ovary and endometrium, the internal echotexture of the cystic mass, the presence of the yolk sac, and the presence of free fluid with echoes. It was shown that RI 0.7 has a very good specificity in identifying ectopic pregnancy.
A retrospective observational study on ovarian tumors and analysis of demographic factors and histopathological findings in a tertiary care center, Theni, Tamil Nadu
Authors: Priya R  , Mahalakshmi Aravazhi  , Buvaneshwari K
Published: January 2025

Background: Ovarian cancer is a significant global health concern, ranking 5th among cancer deaths among women and causing more deaths than any other cancer of the female reproductive system. It is the second most common gynecological cancer in India, with a high disease-related mortality rate owing to its asymptomatic nature in the early stages.
Aims and Objectives: This retrospective hospital-based observational study aimed to identify the demographic features of women with ovarian tumors detected by ultrasonography and their correlation with histopathology.
Materials and Methods: This retrospective hospital-based observational study included 139 women who underwent surgery for ovarian tumors at a tertiary care center in South India between September 2022 and August 2023. Patient details were collected from the gynecological outpatient department, surgical procedures, and final histopathological reports. Descriptive analysis was performed using frequencies and proportions for categorical variables, and the Chi-square test was used to test the statistical significance of the cross-tabulation between categorical variables.
Results: Most ovarian tumors were found in multiparous women aged 41–60 years 69 patients, (49.6%), and most were unilateral or cystic. Benign serous cystadenoma was the most common tumor type (n=51, 36.7%), whereas serous cystadenocarcinoma was the most common malignant tumor (n=10, 7.2%). There were statistically significant differences in age group, size, consistency, and laterality according to histopathological examination (P<0.05).
Conclusion: This study provides valuable information on the demographic factors and histopathological findings of ovarian tumors in a tertiary care center in South India.
Asian flushing, ADH1B, aldehyde dehydrogenase 2 genotypic status among the unique ethnic population of the Himalayan state of Sikkim, India
Authors: Bhutia Yazum , Dutta Sanjiba , Sherpa Mingma
Published: January 2025

Background: Alcohol induced flushing a phenotypic instrument variable also known as “Asian flush” was first reported by Wolff (1972), commonly seen among East Asians. This phenotype is indicative of inactive aldehyde dehydrogenase 2 (ALDH2) and high activity of alcohol dehydrogenase (ADH1B).
Aims and Objectives: This study aimed to examine the sensitivity and specificity of the simple flushing questionnaire for identifying inactive ALDH2 and to examine the flushing, ADH1B and ALDH2 status across the three unique ethnic groups in Sikkim, India.
Materials and Methods: Two hundred and fifty consenting adults (age, ≥18 years) visiting the referral hospitals in East Sikkim were enrolled. Flushing questionnaire was assessed among the 201 alcohol users, who were categorized as “non-flusher,” “current flusher,” and “former flusher.” ALDH2 and ADH1B genotyping were done on the all 250 subjects by polymerase chain reaction - restriction fragment length polymorphism blinded from flushing response status.
Results: In the study, 201 were alcohol users and 49 were non-alcohol users. The sensitivity and specificity of the flushing questionnaire against inactive ALDH2 genotypes were 84.6% and 93%, and the positive predictive value was 45.8%. 19.5% Bhutia/Sherpa, 8.3% Nepalese and 11.1% Lepcha reported current flushing. Only two Bhutia reported former flushing while remaining were “non-flushers.” ALDH2 (6%) and ADH1B (4.4%) genotypes, respectively, were seen with allele frequency of 0.06 for ALDH2*1/2*2, and 0.004 for ADH1B*2/*2, 0.044 for ADH1B*1/*2. ALDH2*2/*2 were not observed in this study.
Conclusion: Alcohol induced flushing, ALDH2 and ADH1B genotype is reported across the ethnicity, among Sikkimese people, and this flushing is the first report from India.