bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical profile of lung cancer in Southern India with special reference to initial presentation and acceptance of treatment: A single-center study
Authors: Jat RR  , Arumugam V
Published: January 2025

Background: Lung cancer ranks as the second-most common cancer globally and remains the leading cause of cancer-related deaths. Despite a global decline in mortality due to reduced smoking, its incidence is rising in India.
Aims and Objectives: This study retrospectively examines the clinical profiles of lung cancer patients at their initial presentation and treatment acceptance.
Materials and Methods: This retrospective analysis used a database of 185 lung cancer patients reported at the Regional Cancer Centre, Tirunelveli, from January 2021 to December 2022. Clinical records of confirmed lung cancer cases were reviewed, focusing on demographic details, smoking history, symptoms, radiographic findings, histopathology, and clinical staging. Most patients underwent fiberoptic bronchoscopy or fine-needle aspiration biopsy. Patients were classified based on morphology and assessed using the modified Karnofsky Performance Scale and Eastern Cooperative Oncology Group (ECOG).
Results: Most patients were male (74.5%), with a median age of 61 years. Most had an ECOG performance status of 0–2 (82.7%). Smoking was prevalent, with 53% of patients being current smokers. The most prominent symptoms at initial presentation were cough, dyspnea, fatigue, and weight loss. Adenocarcinoma was the predominant pathological type (47%). The right lung was more frequently affected, and most patients had comorbid conditions. Paclitaxel plus carboplatin was the primary first-line chemotherapy for most patients. A significant proportion (68.1%) were diagnosed at Stage IV, with the lung being the most common site of metastasis (46.8%).
Conclusion: Most cases are diagnosed at advanced metastatic stages due to delayed diagnosis, often being initially misdiagnosed as tuberculosis.
Assessment of olfactory fossa depth using computed tomography imaging in a tertiary care setting
Authors: Shantala Sawkar  , Adarsh AD  , Anil Kumar Sakalecha  , Mahima Kale R  , Soumya Z Chincholikar
Published: January 2025

Background: Chronic sinonasal disorders are commonly treated surgically with endoscopic sinus surgery. Keros classifies the olfactory fossa (OF) into three groups according to the ethmoid roof level. The depth of the OF is determined by the size of the lateral lamella of the cribriform plate. Multidetector computed tomography is gold standard in evaluating the structure of the nasal cavity and paranasal sinuses (PNS).
Aims and Objectives: The aim of the study was to examine non-enhanced computed tomography (CT) scans of the paranasal sinus and analyze the depth of the OF to identify and categorize different Keros types and to evaluate anatomical variances to prevent major surgical complications.
Materials and Methods: IM was a prospective study and 160 patients were enrolled for the study. The study was undertaken in the Department of Radiodiagnosis at Sri Devaraj Urs Medical College in Tamaka, Kolar. Patient with chronic sinonasal disorders undergoing pre-operative non-enhanced CT PNS study was enrolled in the study. The depth of the OF was measured and categorized into three groups according to Keros classification.
Results: Out of 160 participants, 115 (71.8%) were male. The depth of the OF on the right (P=0.28) or left (P=0.66) did not differ significantly between genders. In men, the most prevalent (n=92, 57.5%) was Type-II Keros on the right, with 80 (50%) patients on the left. Type-1 Keros was more common in females on the right side (18 patients, 11.2%), whereas Type-II Keros was more common on the left side (20 patients, 12.5%). The proportion of different types of Keros differed significantly across genders (P<0.001).
Conclusion: This study reveals that Keros Type-II was the most prevalent among participants. Comprehensive insights into the anatomical variability of the olfactory region are pivotal for through pre-operative assessment of patients with nasal and PNS disorders in preventing significant surgical complications.
A cross-sectional study on cardiac autonomic functions and inflammatory markers in chronic fatigue syndrome
Authors: Ayasha Nishad  , Abhishek Tiwari  , Waqas Alauddin  , Prajakta Radke
Published: January 2025

Background: Chronic fatigue syndrome (CFS) is a complex multisystem disease that affects around 1 million of the Indian population every year and is characterized by persistent fatigue. CFS is related to cardiovascular illness, and cardiovascular autonomic nervous system dysfunction is often seen. We investigated the state of cardiac autonomic function in CFS and associated it with their level of inflammatory markers and disease severity since there is not much research on the subject.
Aims and Objectives: The objective of this study is to evaluate cardiac autonomic functions by using heart rate variability (HRV) in patients with CFS and in healthy controls. The study aimed to evaluate the correlation between HRV and inflammatory markers in patients with CFS and in healthy controls.
Materials and Methods: Thirty controls and 30 diagnosed cases of CFS were used in the research. The short-term variability of heart rate was used to measure autonomic function. We measured tumor necrosis factor-alpha (TNF-α) and interleukin (IL-10) in 3 mL of overnight fasting serum. TNF-α and IL-10 were used to evaluate the severity of CFS.
Results: Patients with CFS showed a substantial reduction in low frequency (LF) (P=0.00*), high frequency (HF) (P=0.00*), LF/HF ratio (P=0.00*), and time domain parameters of HRV, namely RMSSD (P=0.03*), SDNN (P=0.00*), NN50 (P=0.00*) and total power (P=0.00*). Patients with CFS had considerably higher levels of TNF-α. TNF-α and LF/HF ratio and RMSSD, NN50, and HF were shown to have a substantially favorable correlation.
Conclusions: Our research indicates a substantial correlation between autonomic dysfunction and inflammatory activity, as well as the severity of CFS. Therefore, we suggest that HRV might be a useful technique for accurately screening CFS patients for autonomic disruption symptoms early on, which can significantly lower morbidity and death in the future.
Success rate of nasogastric tube insertion in anesthetized, intubated, adult patients: A comparison between endotracheal tube cuff inflated and deflated states
Authors: Nazimuddin Paik  , Soma Chakraborty  , Sangita Mandal  , Sarfraaz Rahman  , Sayantan Modak  , Arpan Chakraborty  , Mandal Mohanchandra
Published: January 2025

Background: Although proper placement of nasogastric tube (NGT) is a simple procedure, it can turn into a tedious task in an anesthetized intubated patient due to the absence of propulsive movement of swallowing. Different techniques of NGT placement are in vogue in clinical practice with varying success rates. The effect of endotracheal tube (ETT) cuff deflation on the success rate of NGT placement has been evaluated only in one study, and the first-attempt success rate was reported to be not high (55%).
Aims and Objectives: This interventional study primarily aimed at comparing the success rates of proper placement of NGT in the first attempt between the ETT cuff inflated and deflated states.
Materials and Methods: The present study was carried out on 244 adults scheduled for abdominal surgeries requiring NGT insertion. Patients received NGT placement with either an ETT cuff inflated (Group A, n=122) or ETT cuff deflated (Group B, n=122). The success rate of correct placement of NGT in the first attempt was the primary outcome. Procedure time and adverse events were also evaluated.
Results: Considerably higher success rate of correct placement of NGT in the first attempt was noted with ETT cuff deflated over-inflated state (85.2% vs. 55.7%, P<0.001). A shorter procedure time was observed with ETT cuff deflated over an inflated state (16.8±7.0 vs. 38.1±27.33 P<0.001). Adverse events were comparable.
Conclusion: The higher success rate of correct NGT placement was observed with endotracheal cuff deflated state over cuff-inflated state. Faster placement of NGT was noted with endotracheal cuff deflated state.
Melatonin versus gabapentin as premedication for anxiolysis and attenuation of hemodynamic response to laryngoscopy and intubation in general anesthesia
Authors: Kalpana Rajendra Kulkarni  , Pradhan Monnaiah K  , Padma S  , Hema Viswanath K
Published: January 2025

Background: Perioperative anxiety adversely affects mental and physical well-being and it is associated with increased pain, stressor responses with general anesthesia (GA), and nausea-vomiting leading to delayed recovery. Recent studies have proven melatonin and gabapentin provide sedation, anxiolysis, and reduced pressure responses.
Aims and Objectives: This study aimed to compare melatonin and gabapentin as premedication for anxiolysis and attenuation of hemodynamic response to GA. Post-operative pain and sedation were also compared.
Materials and Methods: A total of 99 subjects (n=33 in each group) between 18 and 60 year of age, ASA I/II scheduled for elective abdominal surgeries of < 3h under GA were included in the study. Patients in Group A were administered melatonin (10 mg×2 tab.), those in Group B were administered gabapentin (400 mg×2 tabs), and those in control Group C were treated with Vitamin C (500 mg×2) before 2 h of surgery. At 0 min, 30 min, and 60 min assessments of anxiety, sedation, cognition, psychomotor function, and orientation were done.
Results: There were significantly low anxiety scores in Groups M and G compared to Group C at 60 min and 90 min (P=0.0000). Sedation score was significantly less in Group C patients compared to Group M and G at 30 min (P=0.0008), 60 min, and 90 min (P=0.0000) intervals. Heart rate and mean arterial pressure were increased in Group C patients as compared to Groups M and G.
Conclusion: This study showed that melatonin had more anxiolytic and less sedative action, so also cognitive functions and orientation were well preserved in melatonin-treated subjects than in gabapentin. Hemodynamic responses were comparable in melatonin- and gabapentin-treated patients.
To study and compare effect of isoflurane and sevoflurane on adult patients postoperatively under general anesthesia by measure liver function test
Authors: Vinita Rawat  , Gourab Bhaduri  , Shreya Dhir  , Sahil Yadav
Published: January 2025

Background: Effect of inhalational agents, namely, isoflurane and sevoflurane on patients having renal parameters has been explored quite often but the effect on liver function test has been rarely reviewed till date.
Aims and Objectives: The aim of the study was to study the pre-operative liver function of patients who underwent general anesthesia by measuring their liver function test, post-operative effects of isoflurane, sevoflurane, and comparison.
Materials and Methods: A total of 90 patients aged between 18 and 60 years who were further divided into two groups, that is, Group 1: (Isoflurane, n=45) and Group 2: (Sevoflurane, n=45) were included in the study.
Results: The study comprised 51.1% of males and 48.9% of females, with similar distribution in either group (P>0.05). Comparison of various pre-operative parameters at 24, 48, and 72 h in isoflurane cases showed that bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), protein, albumin, globulin were found to be statistically significant but urea, creatinine, prothrombin time, and international normalized ratio were insignificant (P>0.05, NS). Comparison of pre-operative hemoglobin with that at 24, 48, and 72 h in isoflurane cases showed that mean isoflurane was 12.69±1.77 which was found to be nil within 24 h, 48 h, and 72 h. Comparison of various parameters at 24, 48, and 72 h in sevoflurane cases showed that pre-operative mean sevoflurane was 0.49±0.18 which was found to increase within 72 h, that is, 0.60±0.18. Similarly, SGOT was found increased from pre-operative 27.58±8.09 to 29.32±7.32, SGPT 23.29±7.02 to 26.22±6.81.
Conclusion: Inhalation agent isoflurane and sevoflurane cause significant changes in patient’s liver function test, postoperatively under general anesthesia as indicated by various liver function parameters.
A rare case of intradural extramedullary epidermoid with focal diastematomyelia
Authors: Harsh Deo Pandey  , Avdhesh Shukla  , Vivek Kankane  , Avinash Sharma  , Sridham Sutradhar
Published: January 2025

Diastematomyelia is a rare congenital deformity, more common in females usually associated with cutaneous manifestation of spinal dysraphism with congenital scoliosis. We report a female patient 26 years old with scoliosis in the dorsolumbar spine with dorsolumbar focal diastematomyelia type-2 with intradural extramedullary epidermoid which is a rare entity.
Rare microorganisms in blood culture samples from intensive care unit patients in a tertiary care hospital in Eastern India – A dangerous threat
Authors: Sharmila Gupta  , Soma Bose
Published: January 2025

Background: Sepsis is a potentially life-threatening condition with significant mortality and morbidity. An estimated 48.9 million cases and 11 million deaths occur due to sepsis worldwide. The gold standard for the diagnosis of suspected sepsis patients is blood culture.
Aims and Objectives: The aims and objectives of the study are to evaluate the growth of rare microorganisms in blood cultures of intensive care unit (ICU) patients, to determine their antimicrobial susceptibility patterns, and also to assess the associated risk factors in those patients.
Materials and Methods: This study was conducted for 1 year (August 2023–July 2024) in our department including blood culture samples from ICU patients and relatively rare microorganisms isolated were included in the study accounting for 40 cases. Blood specimens were cultured in automated BD BACTECTM Fx40 blood culture system and identification of microorganisms and their antimicrobial susceptibility pattern were detected by Vitek2 system.
Results: Female patients were more in number than male patients and patients of 0–20 years’ age group were most commonly affected. Staphylococcus hominis was most commonly isolated out of all rarely isolated microorganisms. The different parameters for the assessment of sepsis severity in our study were C-reactive protein (CRP), Neutrophil count, D-dimer, Procalcitonin, and quick sequential organ failure assessment (qSOFA) score. Out of all, CRP was most commonly raised among sepsis patients. The most common risk factor involved was prolonged ICU stay.
Conclusion: Appropriate collection and processing of blood culture samples can reduce sepsis-related morbidity and mortality manifold. Combination of biomarkers study and qSOFA scoring system can improve diagnosis and monitoring of sepsis patients.
A clinical study of lens-induced glaucoma and its outcome after cataract surgery
Authors: Preethi G  , Pranitha Prabhu  , Shweta Sulabh  , Appineni Mounika  , Battula Bhavyasree
Published: January 2025

Background: Lens-induced glaucomas (LIGs) occur due to the lens’s size, position, or inflammation, causing either open-angle or angle-closure mechanisms. These conditions vary clinically, and understanding their effect on post-operative cataract surgery outcomes is crucial for achieving better visual results.
Aims and Objectives: The aim of the study was to evaluate the characteristics, risk factors, and their consequences in LIG on post-operative visual outcome, intraocular pressure, inflammation, and optic disc changes.
Materials and Methods: Patients diagnosed with LIG between December 2019 and April 2021 underwent cataract surgery and were assessed pre-and postoperatively for visual outcomes, intraocular pressure (IOP), inflammation, and optic disc changes.
Results: During the 18-month study, 2700 cataract cases attended the outpatient department at Oxford Medical College, Bangalore. Among them, 50 cases (1.85%) were diagnosed with LIG. The age range was 37–75 years, with a mean of 60.02 (61.70 years for females, 58.04 years for males). Best-corrected visual acuity (BCVA) of 6/12 or better was achieved in 48% of cases, while severe inflammation resulted in BCVA below 6/60 in 69.23%. Elevated IOP was noted in cases with symptoms lasting 2–4 weeks (39.67 mmHg). Glaucomatous disc damage affected 36% of cases, more common in phacomorphic glaucoma (54%) than phacolytic (28%), and significantly correlated with symptom duration over 2 weeks (P<0.01).
Conclusions: Planned small incision cataract surgery with intraocular lens implantation along with minimal tissue handling and a good follow-up protocol with efficient management of complications and inflammation play a major role in management and allow for good visual outcome and fewer complications post-surgery.
Comparison of transanal Hemorrhoidopexy versus laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation
Authors: Rajkumar Verma  , Prashant Kumar  , Pooja Prajapati
Published: January 2025

Background: Hemorrhoids are a common proctological disease that affects the quality of life in the patient population to a great extent. Nearly 4.4–36% of population is affected by hemorrhoids. The symptoms of hemorrhoids vary from painless bleeding to embarrassing and painful prolapsing mass.
Aims and Objectives: Comparison of transanal hemorrhoidopexy versus laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation in treatment of grade III and grade IV hemorrhoids.
Materials and Methods: The study was conducted on 50 cases of transanal hemorrhoidopexy and 50 cases laser hemorrhoidoplasty in Maharani Laxmi Bai Medical College, Jhansi between January 2021 and June 2022.
Results: Out of 50 cases of transanal hemorrhoidopexy, post-operative pain at 6 h was 2.02±0.795, at 12 h was 4.86±0.606, and at 24 h was 2.36±0.525 and 50 cases of laser hemorrhoidoplasty with Doppler-guided hemorrhoidal artery ligation (DGHAL) at 6 h was 1.1±0.303, at 12 h was 1.78±0.648, and at 24 h was 108±0.274. Mean hospital stay was 2.28±0.573 days in transanal hemorrhoidopexy and 1.12±0.328 days in laser hemorrhoidoplasty with DGHAL. Mean return to work in transanal hemorrhoidopexy was 7.422±1.071 days and in laser hemorrhoidoplasty with DGHAL was 3.2±0.80 days.
Conclusion: Laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation procedure significantly reduced duration of hospital stay, duration of return to work, and post-operative pain as compared to open transanal hemorrhoidopexy.
A prospective comparative study of levobupivacaine hydrochloride 0.5% with ropivacaine hydrochloride 0.75% for peri-operative epidural anesthesia in infra- umbilical surgeries
Authors: Shreya Putta  , Yadav Satyendra Singh , Ankita Gupta  , Rachna Gupta
Published: January 2025

Background: Epidural anesthesia is a neuraxial regional anesthesia used to provide surgical anesthesia, to supplement general anesthesia, and to provide intra and post-operative analgesia. Levobupivacaine and ropivacaine are local anesthetic agents used in an epidural.
Aims and Objectives: The aim of this study is to evaluate the onset and duration of sensory and motor block, duration of analgesia, hemodynamics, and adverse effects of levobupivacaine and ropivacaine given epidurally for infra-umbilical surgeries.
Materials and Methods: This prospective randomized study was conducted in a total of 142 patients undergoing an infra-umbilical surgery, divided into two groups of 71 patients each. Group L received 15 mL of 0.5% levobupivacaine and Group R received 15 mL of 0.75% of ropivacaine. The onset and duration of sensory and motor blockade, duration of analgesia, hemodynamics, and side effects were assessed.
Results: The mean time of onset of sensory and motor block is faster with ropivacaine (P<0.05). The duration of sensory and motor block and analgesia was longer with ropivacaine (P<0.05), whereas the incidence of side effects such as hypotension was more with ropivacaine.
Conclusion: Our study concluded that ropivacaine produced a superior quality of epidural block but levobupivacaine had a more stable hemodynamic profile.
Comparative evaluation of ultrasound and fluoroscope guided intra-articular sacroiliac joint injection in patients with sacroiliac joint pain
Authors: Kanika  , Amit Kumar  , Naveen Malhotra  , Anshul  , Jyotsna  , Navya Malhotra
Published: January 2025

Background: Tissues which transmit pain in the lower back include disc, nerve root, dura, muscles, ligaments, facet joints, and sacroiliac joint (SIJ). The SIJ contributes around 13–30% in patients with chronic low back pain. The SIJ is difficult to enter with a needle because of its complex configuration. Ultrasound and fluoroscopy are the two tools which guide in performing SIJ injections.
Aims and Objectives: The SIJ is susceptible to arthritis, trauma, and degeneration which lead to pain and dysfunction. Intra-articular SIJ injections (IASIJIs) have diagnostic and therapeutic value and have been administered for the treatment of SIJ pain.
Materials and Methods: Sixty patients (aged 20–60 years) with pain patterns consistent with SIJ pain who did not respond to conservative treatment were included in the study. The patients were randomly divided into two groups of 30 each: Group U (n=30): Ultrasound-guided IASIJI and Group F (n=30): Fluoroscope-guided IASIJI. A total of 3 mL drug solution comprising 1 mL of 0.25% bupivacaine plus 2 mL of methylprednisolone (80 mg) was injected in both groups.
Results: There was a statistically significant improvement in pain scores after IASIJI in both groups. The change in pain score was significantly more in Group F as compared to Group U at 3 and 6 months after IASIJI. Two weeks after IASIJI, the mean pain score in both groups remained < 2 at all time intervals throughout the study period. The variation in the Oswestry Disability Index (ODI) at different time intervals when compared to ODI before injection in both the groups was clinically and statistically significant (P<0.001). The change in ODI was more in Group F as compared to Group U at all time intervals. Excellent patient satisfaction was reported by the majority of the patients at different time intervals in both groups.
Conclusion: Both techniques were effective and provided good pain relief to the patients with SIJ pain. Fluoroscope-guided SIJ injection is better than ultrasound-guided SIJ injection in terms of improvement in pain score and functional disability.
Combination of ultrasound-guided pectoral nerve block I and serratus anterior plane block for attenuation of surgical stress response during modified radical mastectomy: A prospective interventional randomized controlled trial
Authors: Monotosh Pramanik  , Shalini Chaudhuri  , Sandipan Banerjee  , Uddalak Chattopadhyay  , Syed Sadaqat Hussain  , Nikhil Kumar Singh  , Jyotirmay Kirtania
Published: January 2025

Background: General anesthesia with multimodal analgesia is the standard anesthetic management during modified radical mastectomy. In this study, a combined ultrasound-guided pectoral nerve block (PECS I) and serratus anterior plane (SAP) block were used for surgical stress response attenuation and post-operative analgesia.
Aims and Objectives: This study aimed to compare the efficacy of combined PECS I and SAP block to intravenous (IV) multimodal analgesia in attenuating surgical stress response and post-operative analgesia in patients who underwent modified radical mastectomy with axillary clearance. The primary objective was to estimate the intraoperative fentanyl requirement to reduce autonomic response due to surgical stimulus. The intraoperative vitals, post-operative numeric rating scale pain score, post-operative analgesic use in the recovery room, and incidence of post-operative nausea vomiting were the secondary objectives.
Materials and Methods: Thirty-six consenting patients were randomized into two groups. After induction of general anesthesia, Group B patients received ultrasound-guided PECS I and SAP block whereas Group C patients received IV analgesics only. Intraoperative fentanyl dosage to keep the systolic blood pressure (SBP) and heart rate (HR) within 20% of baseline were noted in the both groups. Intraoperative vitals, post-operative pain score, analgesic requirement, and incidence of post-operative nausea, and vomiting were also recorded in the both groups.
Results: Surgical stress response attenuation was achieved with a lower dosage of fentanyl in Group B compared to Group C (intraoperative fentanyl [mean±SD], 116.11±25.70 μg vs. 134.44±20.07 μg, P=0.023). Compared to Group C, intraoperative reduction in SBP and HR was higher in Group B (SBP reduction [mean±SD], 24.03±12.5 mm of Hg vs. 15.2±13.05 mm of Hg, P=0.045 and HR reduction [mean±SD], 18.61±6.6 beats/min vs. 10.73±10.03 beats/min, P=0.009, respectively). The apparently higher pain scores in the control group were statistically insignificant.
Conclusion: A combined PECS I and SAP block attenuates intraoperative autonomic stress response due to the surgical stimulus with significantly less opioid requirement.
Assessing the link between rivaroxaban concentration and the onset of renal impairment in elderly patients: A retrospective observational study
Authors: Motakatla Usha Rani  , Chitra Karuppiah  , Penupothu Sree Nagamani
Published: January 2025

Background: Rivaroxaban is a widely used anticoagulant, but its impact on renal function, particularly at varying plasma concentrations, remains a critical area of investigation. This study examines the relationship between rivaroxaban concentration and renal impairment in elderly patients.
Aims and Objectives: The aim of the study was to investigate the relationship between rivaroxaban plasma concentrations and the incidence of renal impairment in elderly patients.
Materials and Methods: A retrospective observational study was conducted on 100 elderly patients prescribed rivaroxaban for atrial fibrillation or venous thromboembolism prevention. Patients were categorized based on their rivaroxaban plasma concentrations into three groups: Low (<50 ng/mL), medium (between 50 and 200 ng/mL), and high (>200 ng/mL). Renal impairment was characterized as having an estimated glomerular filtration rate <60 mL/min/1.73 m². The analysis of the data consisted of Chi-square testing and multivariable logistic regression, with adjustments made for age, gender, baseline renal function, and treatment indication.
Results: The incidence of renal impairment escalated with increasing rivaroxaban concentrations, 20%, 40%, and 60% in low, medium, and high concentration groups, respectively. Statistical analysis revealed a significant association between rivaroxaban concentration and renal impairment (χ2=10.57, P=0.005). Patients with high concentrations had 2.8-fold higher odds of developing renal impairment compared to the low concentration group. Cox proportional hazards analysis showed a 2.2 times higher hazard of renal impairment in high versus low concentration groups over 18 months.
Conclusion: Higher trough plasma concentrations of rivaroxaban are associated with an increased risk of renal impairment in elderly patients. This finding highlights the importance of monitoring rivaroxaban levels to mitigate renal risks.
A comprehensive guide to pulmonary function tests for 1st-year medical students – Simplifying PFTS and their interpretation
Authors: Mudasir Bashir  , Neeru Garg  , Maha Muzaffar  , Mahpara Nyiem  , Iram Jaan  , Nida Nowreen
Published: January 2025

Pulmonary function tests (PFTs) constitute a set of non-invasive diagnostic procedures designed to evaluate the functional capabilities of the respiratory system. These tests hold pivotal significance in the identification, tracking, and treatment of diverse respiratory conditions, including asthma, chronic obstructive pulmonary disease, interstitial lung diseases, and restrictive lung disorders. This review article aims to provide medical students with a comprehensive overview of PFTs and their interpretation, offering valuable insights into their crucial role in the diagnosis and management of respiratory ailments.
Effect of highly sensitive C-reactive protein on cardiovascular risk of Type 2 diabetes mellitus adults: A systematic review
Authors: Benoy Upreti  , Mingma Lhamu Sherpa  , Karma Lakhi Bhutia
Published: January 2025

Diabetes mellitus (DM) is a significant global health issue that affects nearly 537 million of people, with Type 2 DM (T2DM) accounting for the majority of cases. Death is frequently the result of diabetes-related complications, particularly cardiovascular illnesses, neuropathy, retinopathy, and nephropathy. Type 2 diabetes and cardiovascular events, such as coronary heart disease (CHD), are linked to a greater likelihood of creating when C-reactive protein (CRP), a representative acute phase inflammation response protein, is elevated. The purpose of this systematic review is to examine how T2DM adults’ cardiovascular risk is affected by highly sensitive CRP (hsCRP). The information found through searches of digital sources such as EBSCO, EMBASE, PubMed, Scopus, and Web of Science. The investigator separately reviewed each abstract and title in comparison to predetermined inclusion and exclusion standards. Google Scholar was used for further research. Using terms, a thorough search plan was created. The terms “hs-CRP,” “Type 2 diabetes mellitus,” and “cardiovascular disease” have been utilized. To translate the results for other databases, the original search was done in PubMed. To find additional pertinent papers, reference lists of the research included and previously released reviews were also examined. The findings state that people with DM have a higher risk of developing heart disease. Due to their elevated carbohydrate intake, unhealthy diet, and genetic disposition, Asian Indians are at a high risk of developing cardiovascular disease and DM. Diabetes patients’ cardiovascular risk is primarily determined by insulin sensitivity, which can be assessed using the markers hsCRP and tumor necrosis factor-. Lipid profile is important in cardiovascular diseases because high blood glucose levels encourage the body’s production of cholesterol, which increases the risk of heart malfunction in obese diabetic patients.
Direct observation of procedural skills evaluation of suturing skills in surgical interns: A comprehensive analysis
Authors: Sangameshwar Patil  , Anveer Allad  , Jyothi Patil  , Pavankumar M Patil
Published: January 2025

Background: The internship period in medical education serves as a critical phase for students transitioning from theoretical learning to practical application within clinical settings. Surgical specialties, in particular, demand a high level of skill and competence from interns due to the inherent risks associated with surgical procedures. However, there is often a gap between the theoretical knowledge gained in medical college and the practical skills required in surgical practice.
Aims and Objectives: Therefore, keeping all the above facts in mind, the present study was undertaken to implement direct observation of procedural skills (DOPS) as a method for evaluating the suturing skills performance in interns.
Materials and Methods: This study focused on an intern in the Department of Surgery, aiming to assess their suturing skills using the DOPS method. A structured workshop was conducted to provide interns with hands-on training in suturing techniques. Subsequently, interns were divided into groups and assessed by assigned assessors using the checklist. Feedback was provided to interns after each assessment session. Data were collected through self-administered questionnaires distributed to interns and assessors, and statistical analysis was performed using SPSS software.
Results: Analysis of the data revealed a significant improvement in suturing skill scores among interns following the implementation of DOPS assessments. Mean scores increased substantially from the initial to subsequent attempts, indicating enhanced proficiency in suturing skills. Interns expressed positive perceptions of the DOPS methodology, highlighting its effectiveness in driving learning and improving confidence in performing surgical procedures.
Conclusion: DOPS not only facilitates skill development but also promotes confidence and competence in interns, preparing them for clinical practice. Overall, DOPS emerges as a valuable approach for evaluating and improving suturing skills among interns, contributing to their professional development as competent health-care practitioners.
Role of low-dose deflazacort with tamsulosin versus tamsulosin alone for medical expulsive therapy of ureteric stone
Authors: Arka Banerjee  , Pranab Kumar Ghosh  , Hindol Mondal
Published: January 2025

Background: Urolithiasis is a common condition in daily urological practice. Medical Expulsive Therapy (MET) is non-invasive approach for removal of ureteric stone. In MET, alpha-blocker Tamsulosin is commonly used in treating urolithiasis but it does not address the pathology of inflammation presents in such condition. With addition of low dose Deflazacort as anti-inflammatory agent, there may have a potential to improve the pathology and outcome of the treatment.
Aims and Objectives: This study aims to find the efficacy of low-dose deflazacort combined with tamsulosin in the MET for distal ureterolithiasis.
Materials and Methods: This prospective randomized controlled trial was conducted from December 2022 to December 2023 in Rampurhat Government Medical College and Hospital. A total of 130 patients with ureteric stone ≤10 mm were randomized into two groups. Tamsulosin group received tamsulosin (0.4 mg once daily for 28 days). Deflazacort group received tamsulosin (0.4 mg once daily for 28 days) with deflazacort (12 mg once daily for 10 days). All subjects were reviewed on 14 days and 28 days. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic episodes, and hospitalization were recorded. Adverse effects of drugs were noted.
Results: Among 130 patients randomized, 4 patients were lost to follow-up and 8 patients required early intervention. Deflazacort group had similar rate of stone expulsion (88% vs. 80%, P=0.548). There were significantly shorter expulsion time (10.15 days vs. 14.28 days, P<0.001) and less number of colic episodes (33 episodes vs. 21 episodes, P=0.026) and less analgesic requirements (65% vs. 82.5%, P=0.022) in deflazacort group. No significant side effects were noted during the study.
Conclusion: Low-dose deflazacort added to tamsulosin provides a significant advantage in ureteric stone expulsion without any extra side effects. With a comparable rate of stone passage, there are more rapid stone expulsion, low analgesic requirement, and less colic episodes when low-dose deflazacort is added to tamsulosin for ureteric stone ≤10 mm.
Stress hyperglycemia as a prognostic indicator of the clinical outcome in patients with ischemic stroke
Authors: Latha V  , Shashibhushan J
Published: January 2025

Background: Stroke is gaining worldwide importance as the focus now shifts to non-communicable diseases. According to the World Health Organization, over 15 million people, equating to one in every 400 people, suffer stroke worldwide per year. There are many factors which affect the outcome of stroke – artery involved, size of the infarct, associated co-morbidities, age of the patient, collateral blood supply, and many more. Among those one of the factors proposed is stress hyperglycemia (SH).
Aims and Objectives: The aims and objectives of the study are to identify the occurrence of SH in patients admitted with ischemic stroke and to assess the relation of SH in clinical outcomes in patients with ischemic stroke.
Materials and Methods: The prospective study was conducted on patients admitted to medical college hospitals affiliated with VIMS, Ballari. All patients age more than 18 years presenting with acute-onset ischemic stroke were taken into the study, and GRBS was done at presentation and at every 6th hourly for 48 h to identify hyperglycemia. Hemoglobin A1c was done to rule out overt diabetes and previously undiagnosed diabetes mellitus. Clinical outcome and functional recovery using the modified ranking scale (MRS) were done at the time of admission, at discharge, and at every month for 3 months.
Results: Out of 150 patients, 63 (42%) of them had SH. The majority of patients belong to 60–69 years age group. The mean age of patients with SH was 60.2 years and that of patients without SH was 57.75 years. MRS score at the time of admission and during follow-up was higher in SH patients than no SH patients (P<0.001). Patients with SH were more prone to urinary tract infection (n=19 [SH]; n=8 [no SH] P<0.001), bed sores (n=10 [SH]; n=18 [no SH] P<0.008), lower respiratory tract infection (n=30 [SH]; n=34 [no SH], P=0.000), and duration of hospital stay (P=0.000). Delay in presentation to a health facility after the onset of stroke symptoms was found to be a significant contributing factor in SH patients (P<0.003).
Conclusion: The prevalence of SH in ischemic stroke is high. Patients with SH had longer duration of hospital stay, high mortality rate, higher incidence of complications, and poor functional recovery.
An unusual case of longest intussusceptum without any pathological lead point in an adult: A rare case report from a peripheral tertiary care institute of Eastern India
Authors: Manojit Sarkar  , Rahul Dasgupta  , Pintu Mudi  , Nilima Shejole  , Amit Ray
Published: January 2025

Bowel obstruction is known to be caused by intussusception, which is far more common in pediatric patients. The majority of people with adult intussusception require a predisposing cause, which might be a benign lesion, a malignant lesion, or an irregularity of the intestinal wall such as inflammatory bowel disease. Adult intussusception is a very rare condition. We present the case of a patient presenting with upper abdominal pain, nausea, vomiting, and weakness. The patient had ongoing mild intermittent abdominal pain for months which was investigated with an upper gastrointestinal endoscopy that showed gastritis. There were features of peritonism on clinical examination and this was associated with raised inflammatory markers. A contrast-enhanced multidetector computed tomography (MDCT) scan showed a long-segment telescoping of the ileum into the cecum with ascending colon with proximal bowel distension suggesting bowel obstruction: Ileocolic intussusception. The patient underwent emergency surgical resection with a double-barrel stoma. Histopathology assessment did not identify a causative factor for the intussusception. An uncommon instance of adult idiopathic enteroenteric intussusception is presented here. The diagnosis can be established with the use of the clinical history of chronic intermittent abdominal pain, entire abdomen ultrasonography, and abdomen MDCT. In patients who are unstable and exhibit indications of peritonitis, surgery remains the only choice, even though a more cautious strategy is outlined in the literature. Adult intussusception is a rare and challenging diagnosis to make. Individuals suffering from intussusception may experience prolonged bouts of sporadic abdominal pain that intensify suddenly as a result of acute obstruction. The most helpful investigative technique for confirming the intussusception diagnosis is CT.
Efficacy and safety of low-dose celecoxib with chemoradiation in locally advanced head-and-neck squamous cell carcinoma
Authors: Rethinesh Kumar T  , Jabapriya B  , Angappan P
Published: January 2025

Background: Head-and-neck squamous cell carcinoma (HNSCC) is a major cancer in India with a poor prognosis. Novel antineoplastic agents, such as selective cyclooxygenase-2 inhibitors such as celecoxib, have shown antitumor, anti-angiogenesis, and radiosensitizing effects, improving radiotherapy response in many cancers.
Aims and Objectives: This study aimed to determine the efficacy and safety of low-dose celecoxib combined with concurrent chemoradiation in Locally Advanced HNSCC.
Materials and Methods: A double-arm prospective randomized control study was conducted, in which 103 eligible locally advanced HNSCC patients were randomized to concurrent chemoradiotherapy 66 Gy/2 Gy/33 fractions/61/2 weeks along with Inj Cisplatin 40 mg/m2 weekly either with celecoxib 100 mg twice daily (Study Arm – 62) or placebo (Control Arm – 41). Tumor response was evaluated using response evaluation criteria in solid tumors criteria 1.1 and acute toxicities based on the radiation therapy oncology group and common terminology criteria for adverse events criteria 5.0.
Results: On analysis using the Chi-square test, the complete response rate was 65.6% in the study arm compared to 44.7% in the control arm, with P=0.0441 (significant at P<0.05). The incidence of acute dermatitis and mucositis (grade ≥3) in the study and control arms was 29.3% versus 23.6%, with P=0.544 and 40% versus 37% with a P=0.782 (insignificant at P<0.05), respectively. The patients in both arms were followed up to assess late toxicities, locoregional control rate, disease-free survival, and overall survival.
Conclusion: Adding low-dose daily celecoxib to concurrent chemoradiation with weekly cisplatin in locally advanced HNSCC significantly improved the clinical response rates with acceptable treatment-related toxicities.
Evaluation of cardiac output in neonatal sepsis
Authors: Angana Bhattacharjee  , Saugata Chaudhuri  , Maitreyi Basu
Published: January 2025

Background: Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the 1st month of life imposing significant cardiovascular compromise which poses a huge burden of morbidity. The essential objective of functional neonatal echocardiography is to recognize features of cardiovascular compromise earlier and help in timely institution of management. This study provides an overview regarding the variability of cardiac output (CO) in neonates with culture-positive sepsis.
Aims and Objectives: The aims and objectives of the study are to assess the variability of CO in term neonates with Gram-positive sepsis and Gram-negative sepsis.
Materials and Methods: The observational cross-sectional study was conducted in the Department of Paediatrics for 18 months in a tertiary care center. 2D echocardiography was performed on all the neonates who came positive for sepsis screen within the first 2 days of institution of antibiotics. CO was calculated from the echocardiographic finding of Aortic Root Diameter (d), Velocity Time Integral, and Heart Rate recorded at the same time. Normal range of left ventricular output has been defined as 150–300 mL/kg/min each.
Results: In Gram-negative group, the mean CO (Mean±SD) of patients was 386.4545±34.2284 mL/kg/min while in Gram-positive group, the mean CO (Mean±SD) of patients was 345.1532±37.6044 mL/kg/min and the variation stands significant at P<0.0001.
Conclusion: This research confers about hyperdynamic circulatory status of neonatal sepsis as reflected by increased CO beyond the normal limit in septic neonates. On comparison, a strikingly higher CO was observed in Gram-negative sepsis group than Gram-positive group.
Evaluation of different modalities in prevention of seroma formation post-modified radical mastectomy – An observational study from a rural tertiary care center
Authors: Bibaswan Chakrabarty  , Jaya Bagchi Samaddar  , Dwaipayan Samaddar  , Debasis Ray
Published: January 2025

Background: Seroma, a recognized complication of modified radical mastectomy (MRM) delays the administration of adjuvant therapy and also effects adverse events.
Aims and Objectives: This study was conducted to study the sociodemographic and clinical profile of patients developing seroma post MRM and compare the effectiveness of different modalities of seroma prevention since there is a dearth of literature on this matter in our sub-Himalayan region.
Materials and Methods: This was an observational study conducted from February 2021 to August 2022 on 60 women with carcinoma breast who underwent MRM. They were studied for sociodemographic profile, cancer characteristics, and seroma prevention techniques and followed up during the study period. Preventive modalities used were quilting, octreotide therapy, suction drains with early drain removal, passive low suction drains, sharp dissection technique, and sclerotherapy. The results were analyzed using the Statistical Package for the Social Sciences version 22.
Results: The mean age was 49.7±9.4 years, 18.3% had hypertension and 10.0% diabetes mellitus, and 58.3% presented with breast lump. Overall incidence of seroma was 23.3%; the highest was observed in sclerotherapy (50%), and the lowest was in quilting (7.1%) (P=0.235). The presence of hypertension (P=0.026) and the non-administration of neoadjuvant chemotherapy (P=0.010) was significantly associated with developing seroma. Sharp dissection was associated with wound infection (33.3%), sclerotherapy with flap necrosis (50%), and quilting with shoulder stiffness (21.4%).
Conclusion: The lowest incidence of seroma was in quilting and the highest in sclerotherapy. Adverse events such as wound infection, shoulder stiffness, and flap necrosis were the lowest among patients discharged with passive drains and highest in sclerotherapy.
Comparison of conventional percutaneous nephrolithotomy versus endoscopic combined intrarenal surgery in complex renal calculus – Our institutional experience
Authors: Rajasekar Maruthamuthu  , Jayaprakash Narashimman  , Mahendran Ganesamoorthy  , Thiruvarul PV  , Prasad Sivasamy
Published: January 2025

Background: Complex renal calculi, characterized by their size, location, and composition, pose a significant challenge to urologists due to the potential for complications and the difficulty in achieving complete stone clearance. Conventional percutaneous nephrolithotomy (PCNL) and endoscopic combined intrarenal surgery (ECIRS) are two established techniques for managing these complex renal calculi.
Aims and Objectives: The aims and objectives are to compare the effectiveness, safety, and outcomes of PCNL versus ECIRS in managing complex renal calculi in a cohort of 60 cases treated at GMKMCH-Salem.
Materials and Methods: A retrospective analysis was conducted on 60 patients with complex renal calculi who underwent either conventional PCNL or ECIRS during a specified period at GMKMCH-Salem. Patient demographics, stone characteristics, procedural details, intraoperative and post-operative parameters, and complications were analyzed and compared between the two treatment groups.
Results: The study found that both PCNL and ECIRS techniques were effective in treating complex renal calculi. However, significant differences were observed between the two groups in terms of outcomes. The ECIRS technique exhibited superior outcomes with higher stone clearance rates (P<0.001), shorter operative times (P<0.05), and reduced hospital stays (P<0.05) compared to conventional PCNL.
Conclusion: This study demonstrates that ECIRS is a promising alternative to conventional PCNL in the management of complex renal calculi. The ECIRS technique yielded higher stone clearance rates, shorter operative times, and reduced hospital stays, potentially improving patient outcomes and reducing health-care costs. Although our findings show favorable results for ECIRS, the decision between conventional PCNL and ECIRS should be based on individual patient characteristics, surgeon expertise, and resource availability.