bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of synbiotics supplement on alcohol use disorders identification test and biochemical parameters, gamma glutamyl transferase, lipopolysaccharide and immunoglobulin a levels, in high risk alcoholics
Authors: Vachrintr Sirisapsombat  , Parama Pratummas  , Phuttharaksa Phucharoen  , Thamthiwat Nararatwanchai  , Chaiyavat Chaiyasut  , Sasithorn Sirilun  , Phakkharawat Sittiprapaporn
Published: January 2025

Background: Alcohol consumption does not result in dependence or abuse among most people. Nevertheless, a significant group of the population as a whole unavoidably is troubled by chronic alcoholism.Alcohol is involved in a number of diseases, disorders, and injuries, and several social problems.
Aims and Objective: To investigate the possible effects of synbiotics supplement affecting to gut-brain axis in high risk alcohol drinkers through alterations between improving of gut related parameters and changes of alcohol use disorders identification test (AUDIT).
Materials and Methods: Single group, pre- and post-test study. Participants: 24 male patients, alcohol use disorders identification test at 8 or above. Exclusions included clinical diagnosis of cirrhosis, immunodeficiency, autoimmune disorder, use of drugs other than alcohol, pregnancy and lactation, use of antibiotics and herbs during the course of study. Intervention: Synbiotics containing probiotics 7 species and prebiotic 3 types once a day before bedtime for 8 weeks. Main outcome measures: Primary outcome- the efficacy of synbiotics supplement improving subjective AUDIT score. Secondary outcome- changes on gut related biochemical parameters (lipopolysaccharide and immunoglobulin A levels).
Results: Twenty high risk alcoholic subjects (with an average age of 46.14 ± 18.34 years) were supplemented with synbiotics contained 25 billion cells of probiotics per day for 8 weeks. After the end of intervention, there was significantly improved total AUDIT score (p=0.001). The changes in gamma glutamyl transferase (GGT), lipopolysaccharide and immunoglobulin A level was calculated. GGT (from 90.62 ± 56.65 U/l to 67.67 ± 57.00 U/l), lipopolysaccharide (from 23.19 ± 9.57 to 16.67 ± 4.52 mg/ml) and immunoglobulin A (from 377.13 ± 229.88 to 484.16 ± 290.98 ng/ml) levels were significantly changed when compared to the baseline value.
Conclusion: The results of the current study suggested that the consumption of synbiotics significantly improved subjective and objective parameters in high risk alcoholic patients, and further studies are mandatory to reveal the effects of synbiotics on gut health link to central neurological system.
COVID 19: An Epidemiological and Host Genetics Appraisal
Authors: Bandyopadhyay Arup Ratan
Published: January 2025

Coronaviruses (CoVs) is a single single-strand RNA genome approximately 26 - 32 kb in size. Out of the seven coronaviruses, three HCoVs (Human CoVs) have been discovered that causes severe pneumonia such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) and recently recognized SARS-CoV-2, which possesses varying degrees of lethality worldwide and happened to be bioterrorism in terms of the recent outbreak through human-to-human transmission from China to all over the world. Epidemiological and Clinical study on SARS-COV-2 have recently been reported world-wide but lack of data on prognosis factors including effective medicine or vaccine are yet to be clinically approved to prevent this infectious disease. Human pathogenic coronaviruses SARS-CoV-2 bind to their target cells through ACE2, which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. The difference in distribution, maturation, and functioning of viral receptors could be considered as a possible reason for the genetic heterogeneity of ACE2, and age and sex related difference in the incidence of the disease such as, the positive correlation with ACE2 expression and age including the severity of the infection of SARS-CoV-2. Since the ACE2 location in X chromosome, therefore, the males presumable might have more morbidity and mortality by SARS-CoV-2 than females due to sex-based immunological differences like greater observable circulating level of ACE2 in males or else it may be due to the patterns of life style variables such as prevalence of smoking among the males. Additionally, the Angiotensin-Converting Enzyme 1 (ACE1) is characterized by a genetic insertion/deletion (I/D) polymorphism in intron 16, which is associated with alterations in circulating and tissue concentrations of ACE, where the study reported as D allele is associated with a reduced expression of ACE2. Nevertheless, studies from different states of Indian population on ACE I/D gene polymorphism shows higher frequency of I allele which might explain the lower prevalence of SARS-CoV-2 in Indian population and consequently be subject matter of research of SARS-CoV-2 on epidemiological and public health issues.
Risk factors for persistent elevation of perioperative lactate levels in gastric cancer surgery
Authors: Selcuk Gulmez  , Orhan Uzun  , Aziz Serkan Senger  , Zehra Zeynep Keklikkiran  , Hilmi Bozkurt  , Sinan Omeroglu  , Emre Bozdag  , Deniz Avan  , Erdal Polat  , Mustafa Duman
Published: January 2025

Background: The impact of high-risk surgery on tissue perfusion can be indirectly assessed by measuring lactate levels during surgery and intensive care unit (ICU) stay. While consistently high values are associated with poor prognosis, transient elevations do not mean poor clinical outcomes. Therefore, intraoperative and early postoperative blood lactate monitoring is essential for cancer patients.
Aims and Objective: This study aimed to determine the risk factors of persistently elevated lactate levels in the intraoperative and postoperative period in patients with elective gastric cancer surgery.
Materials and Methods: We retrospectively enrolled 293 patients who underwent curative resection for gastric cancer. Lactate values of all patients were examined during surgery and ICU-stay at 3rd, 6th, 12th, and 18th hours. All lactate values above 2 mmol/L were considered elevated. The patients were divided into two groups as those with perioperative persistently increased lactate levels and those without.
Results: Of the 293 patients, 60 (20.5%) had higher lactate levels in the perioperative period. According to multivariate logistic regression analysis, the operative time had the highest significance rate (p = 0.020) out of two significant variables, followed by the BMI ≥ 30 kg/m2 (p = 0.048). Besides, patients with perioperative hyperlactatemia had prolonged hospital stays (p = 0.034).
Conclusions: Operative time and obesity (BMI ≥ 30 kg/m2) were independent risk factors for persistent lactate elevation in the perioperative period. Also, perioperative hyperlactatemia extended the length of hospital stay.
Tackling AMR crisis in India: Changing paradigm
Authors: Sandeep Lahiry  , Rajesh Ramalingam  , Krunal Dalal  , Ashwini Pawar  , Yashpal Chugh  , Alap Gandhi  , Bhavesh Kotak
Published: January 2025

Antimicrobial resistance (AMR) is an important public health concern globally. For India, undoubtedly, AMR has had profound impact on its health & socioeconomic parameters. Several hospital and community-based surveys have indicated alarming rise in incidence of multidrug resistant microbes, especially ‘superbugs’, having direct links with antibiotic use/misuse. Additionally, paucity in data with regards to quantification of AMR crisis & its determinants has been concerning. However, the national commitment to address AMR has steadily increased of late, with an oft-restated realization – it is time to act. Recent initiatives like National Policy for Containment of AMR (2011), Chennai Declaration (2012), Anti-microbial Resistance Surveillance and Research Network (2013), The Red Line Campaign (2016), National Action Plan (NAP) for AMR (2017), ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) are promising measures expected to have positive impact on both clinical and economic outcome in India. This paper provides a snapshot of major strategies proposed in recent years, including educational and awareness initiatives, infection control guidelines, audit and feedback, antimicrobial stewardship, surveillance projects etc. It also identifies technical challenges & opportunities for improved AMR mitigation in India.
Knowledge, attitudes, and practices towards COVID-19 among hospital staff of West Bengal during COVID-19 outbreak: A hospital based cross sectional study
Authors: Amitava Acharyya  , Susmita Ghosh  , Manas Ghosh  , Kalyan Sarkar  , Sonali Ghosh  , Ambarish Bhattacharya  , Kaushik Ghosh
Published: January 2025

Background: COVID-19 disease is a highly contagious and totally unknown disease which is caused by SARS-CoV-2. This disease spread throughout the world irrespective of social, economical and political variation. Health care staff are the frontline COVID-19 worrier and their understanding of this disease is very important.
Aims and Objective: The aim of this study was to assess the knowledge, attitudes and practices (KAP) towards COVID-19 disease among the healthcare staff of a tertiary care hospital of West Bengal.
Materials and Methods: An analytic cross-sectional study was conducted at Murshidabad Medical College, Murshidabad from 25th April, 2020 to 2nd May, 2020. A total of 214 health care staff (83 nurses, 75 doctors, 20 para-medical staff, 24 administrative staff, and 12 sweepers) participated in this questionnaire based KAP study. The questionnaire was prepared according to the World Health Organization’ on Corona virus disease (COVID-19) “advice for the public”. The Systematic random sampling procedure was employed for data collection. The data was analysed using T-test, ANOVA, chi-square test and regression model. The informed consent was taken from each participant.
Result: Female (62%) participants were more than male (38%) participants. Mean age of the participants was 27.03±7.63 years. About the half participants were unmarried (55%) and studied up to bachelor’s degree (49%). The overall knowledge score found to be “medium level” with 77% reporting correct answers. The knowledge score was statistically different among age group, education level, marital status and occupational group of health care staff in this hospital by univariate analysis. The good attitudes and good practices were not related with knowledge score. The majority of the respondents (78%) had confidence on their attitude that “India can win the battle against COVID-19”. Only 86% participants wore masks while going out in the lock-down period and 79% participants had not visited any crowded place. Only 18% participants used traditional home remedies for flu like symptoms. In multivariate analysis, doctors were found with better knowledge score and attitude towards COVID-19 than other healthcare staff in this hospital.
Conclusion: The two preventive practice (social isolation and mask use) and optimistic attitude towards COVID-19 of health care staff were not totally depended on COVID-19 related knowledge score. However, knowledge score was depended on marital status, educational background, age, occupation and place of residence. Government should emphasize more on COVID-19 related health education and health promotion programme at community level.
Procalcitonin levels versus Microbiological profile in Central line associated bloodstream infections (CLABSI) of patients on Hemodialysis
Authors: Madhura NS  , Shashikala N  , Mythri Shankar  , Kowsalya R  , Mythri KM
Published: January 2025

Background: CLABSI is one of the most common forms of hospital acquired systemic infection(sepsis), associated with high mortality. Although Procalcitonin (PCT) is proved be the earliest and specific marker for the diagnosis of sepsis, there is relatively sparse literature on the usage of this marker in CLABSI with chronic kidney disease (CKD).
Aims and Objective: To correlate the Procalcitonin levels with microbiological profile of CLABSI CKD patients.
Materials and Methods: A retrospective case control study was conducted in a tertiary care Nephro-Urology hospital in Bangalore, from January 2019 to December 2019 including all CKD patients (age>20 years) with central venous catheter undergoing Hemodialysis. Based on blood culture reports of these patients, they were divided into CLABSI (positive growth), and no growth. Procalcitonin was analyzed in both the groups. Statistical analysis was done using SPSS software version 17.
Results: Sixty-one percentage of the CKD patients of mean age 46 years had CLABSI. Most common isolate in CLABSI CKD was Staphylococcus aureus (35%), followed by Escherichia coli (19%), Klebsiella pneumoniae (10%). Mean PCT was significantly higher (p value 0.001) in CP-CKD (Culture positive-chronic kidney disease) patients (36. 1±35.ng/ml) compared to CN-CKD (Culture negative-chronic kidney disease) (4.6±10.0.ng/ml). Also mean PCT for Gram positive (GP) isolates (28.7±30.2) was significantly lower (P value 0.0008) than that for gram negative (GN) isolates (53.6±33.7).
Conclusion: The study highlights higher incidence of CLABSI in CKD patients. Higher PCT values were observed in gram negative bacteria compared to gram positive, indicating its probable role for differentiating CLABSI due to gram-positive and gram-negative bacteria.
Doppler Velocimetry evaluation in high-risk pregnancy for prediction of Preeclampsia
Authors: Rohini Singh  , Sudipa Mondal  , Bajaj Manisha , Debasmita Mandal
Published: January 2025

Background: The uterine and umbilical artery Doppler scan is a valuable tool for evaluation of utero-placental blood flow in pregnancy. They help in detecting uteroplacental insufficiency thus predicting preeclampsia and other effects of faulty placentation which increase the risk of adverse effects on both mother and fetus.
Aims and Objective: This study aimed to evaluate and compare the uterine artery and umbilical artery Doppler indices in second and third trimester for prediction of preeclampsia in high-risk pregnancies.
Materials and Methods: In this prospective observational study done over a years’ time, 50 high-risk pregnant mothers were recruited and the Doppler scans were done at 21-25 weeks and 31-35 weeks. The necessary clinical observations were recorded throughout the antenatal period and the data analysis was done.
Results: Majority (56%) were in 20-29 years range with mean age of 24±6.1 years. Out of the 50 women, 21 had abnormal uterine artery Doppler and 12 had umbilical artery abnormality along with uterine derangement. Preeclampsia developed in 3 of them. The hypertensive disorders of pregnancy were diagnosed in 13 women, preeclampsia in 3, eclampsia in 1and other HDPs in 9. The persistence of notch in uterine artery was observed in 7 women, of these 2 developed PIH. Only one patient had uterine artery PI>1.45 at 24 weeks who subsequently developed preeclampsia. Among 4 patients of preeclampsia and eclampsia, 3 had 2nd trimester uterine and 3rd trimester umbilical Doppler abnormalities and only 1 had normal doppler indices. In 2nd trimester the sensitivity, specificity and PPV are higher for uterine artery PI as compared to umbilical artery PI. Hence, uterine artery doppler seems to be a better screening tool for early prediction of PIH. The third trimester umbilical artery PI with higher specificity (96%) and PPV (50%) can diagnose preeclampsia better. One patient had absent diastolic flow and she developed preeclampsia and IUGR. The combined uterine and umbilical artery doppler is a better screening modality as it has a higher sensitivity (75%) and NPV (99.26%).
Conclusion: The uterine and umbilical artery Doppler velocimetry are potential tools for uteroplacental surveillance of high-risk pregnancies which can identify patients at risk and help in taking timely action to prevent complications.
Analysis of second wave of COVID-19 cases in Nepal with a logistic model
Authors: Radha Krishna Joshi  , Sarita Bhatt  , Tika Ram Lamichhane  , Madhav Prasad Ghimire
Published: January 2025

Background: COVID-19, caused by SARS-CoV-2, is a newly identified highly infectious disease. It has affected almost every country including Nepal causing a pandemic situation. Most of the properties of SARS-CoV-2 are not known and still under intense investigation. Due to high mutation rate, it reappears in many countries in the form of new variant. In Nepal, second wave impact of COVID-19 is mainly caused by newly found delta variant of SARS-CoV-2. In this case, the mathematical modelling is noted to play important role to understand control strategies for the spread of coronavirus.
Aims and Objective: To analyze the second wave impact by modelling the data of COVID-19 cases in Nepal.
Materials and Methods: We have analyzed COVID-19 daily cases and deaths reported by Ministry of Health and Population, Government of Nepal from April 1 to May 31, 2021. A logistic model has been used to present the trend line of COVID-19 infection in Nepal, based on the law of population growth developed by Verhulst.
Results: The results show a good fit between observed and predicted data by logistic model as indicated by coefficient of determination having value near to unity. The point of inflection from the logistic model predicted a maximum of 9951 daily new cases. The maximum number of cumulative cases estimated at the end of second wave was found to be 307293 with 95% confidence interval.
Conclusion: Logistic model properly describes the growth of COVID-19 cases with time. This type of data modelling and analysis will be very useful in predicting the upcoming trend of COVID-19 in Nepal as a basis for making health policy management by the government.
Age-related changes in the human primary motor cortex: A macroscopic and microscopic study
Authors: Anne George  , Usha K K
Published: January 2025

Background: Cerebral hemisphere has outer gray matter and inner white matter. The cerebrum is folded into gyri and sulci in order to accommodate it in the skull. The thickness of the gray matter varies at sulci and gyri and the mean thickness may be from 1.5 mm to 4.0 mm.
Aims and Objectives: (1) To demonstrate the cells and laminar architecture of the primary motor cortex with different stains. (2) To find out the age-related changes in the thickness of the primary motor cortex and the depth of the central sulcus.
Materials and Methods: Cross-sectional study was done using 50 adult human brains and 10 fetal brains obtained from the Department of Forensic medicine and OBG, respectively, in a Government Medical College in Kerala during 2001–2003. At autopsy, the central sulcus and the precentral gyrus were identified. Depth of central sulcus and thickness of precentral gyrus, in upper, middle, and lower parts were measured using Vernier calipers. Tissue specimens were taken from the precentral gyrus and after fixation in 10% formalin, hematoxylin, and eosin-stained slides were prepared and viewed under a light microscope identifying six laminae. Using an oculo micrometer, width of the six laminae were measured. Pyramidal cells and stellate cells were observed and their size measured.
Results: Depth of the central sulcus was more on the right side but it was minimal on the middle part of both sides. The thickness of the precentral gyrus varied from 1 to 6 mm. Maximum thickness of 6 mm was found in the middle and lower parts in the 21–30 age group. Lamina 5 was the widest of all laminae. Maximum width of 1000 μ was noted in the 41–50 age group.
Conclusion: Grey matter thickness of 1-6 mm noted in this study was comparable with other studies. Pyramidal cells of varying sizes were seen in all sections with different staining methods. It was confirmed that neuronal loss is inevitable as age advances.
Reversible Hyperpigmentation: A Diagnostic Dilemma
Authors: Somnath Maitra  , Kaushik Hazra  , Biswaroop Mukherjee
Published: January 2025

Vitamin B12 deficiency presents as megaloblastic anemia with neurological, skin and other clinical manifestations. We present here an interesting case of anemia presenting with generalized weakness and nonspecific symptoms in a female who is a vegetarian. There was acral hyperpigmentation without any other clinical features, Investigations revealed megaloblastic anemia with low vitamin B12 and normal RBC folate levels. The patient improved after blood transfusion and intramuscular vitamin B12 injections and the skin lesions faded away suggesting vitamin B12 deficiency to be the cause of hyperpigmentation, which is an uncommon manifestation. The importance lies in the fact that this cause of reversible hyperpigmentation should be thought of by clinicians to start prompt treatment.
Management of Rectal lymphoma in a renal transplant patient- experience from the developing world
Authors: Muhammad Danish  , Zain Majid  , Ghazi Abrar  , Farina Hanif  , Nasir Hasan Luck
Published: January 2025

Rectal lymphomas are of a rare occurrence. We hereby report the case of a middle aged renal transplant patient, who presented 4 years post live related renal transplantation with per rectal bleeding and on workup was found to have rectal lymphoma. Later on he underwent a battery of investigations including Lower GI endoscopy, CT scan, PET scan which confirmed his findings. He was managed with 4 cycles of rituximab and repeat PET scan showed decrease in the size of the lesion.
Non Government Organizations (NGO)-The gap fillers during COVID-19 lockdown in Assam, India
Authors: Joyeeta Talukdar  , Abhibroto Karmakar  , Ruby Dhar  , Arun Kumar  , Subhradip Karmakar
Published: January 2025

COVID-19 pandemic caused due to SARS-CoV2 has disrupted the spectrum of health care.  The wide arrays of supportive and palliative care needed for patients with ailments were grossly neglected, due to the diversion of resources and healthcare professionals in COVID management. This deficiency was further exaggerated by extended lockdown and closure of outdoor patient care services resulting in unprecedented crisis in disease management. Further, COVID-19 has been associated with increased risk of morbidity and mortality arising from associated risk factors in geriatric subjects and those with other high risk co-morbidities like hypertension, COPD, diabetes and cancer. North East Indian states and the adjoining regions seem to have suffered substantially during the COVID-19 crisis due to their pre-existing vulnerabilities and under developed health care infrastructure and logistics.  This deficiency, however, seems to have been fulfilled substantially by the participation of NGO (Non-Government Organizations) and other volunteer services who has actively participated to provide basic healthcare and other life support to cancer patients in this crisis.
Prevalence and associated risk factors for diabetic retinopathy at first ophthalmological contact
Authors: Bhavkaran Singh  , Prempal Kaur  , Jaspreet Singh  , Parveen Grang
Published: January 2025

Background: Type 2 diabetes mellitus (DM) is now considered as a growing global public health concern due to cost associated with diabetic micro and macrovascular complications. Diabetic retinopathy (DR) is one of the leading causes of vision loss. Accurate estimation of prevalence of DR among diabetic patients and associated risk factors are of crucial importance to plan and execute preventive strategies in the community.
Aims and Objectives: The present cross sectional hospital based observational study was undertaken to determine the prevalence of DR in diabetic patients at their first ophthalmological contact and toevaluate associated risk factors.
Materials and Methods: In this cross sectional hospital based observational study, all diabetic patients visiting ophthalmology clinic for the first time after being diagnosed as diabetic were enrolled. After recording demographic data and biochemical findings, each patient was investigated for DR and correlated with associated risk factors.
Results: Of 1699 patients, majority (68.9%) of them had come to ophthalmology clinic with complaint of decreased vision. Only 16.12 % (274) patients had been referred for retinal exam by treating physician. DR was prevalent in 242(16.98%) non-referred and 31(11.31%) referred patients. Mean age and mean duration of diabetes was significantly higher in non-referred patients. Vision threatening DR was also significantly higher in nonreferred patients. Prevalence of DR was significantly correlated with age at presentation, duration of diabetes, rural background, uncontrolled diabetes, systolic blood pressure and high BMI.
Conclusion: Low referral by treating physician and lack of awareness among patient accounts for late presentation of diabetic patients to ophthalmologist. Beyond just developing strategies to promote screening programs for early detection and management of DR, education of the patients,comprehensive planning and coordination between ophthalmologist and physician can go a long way to decrease the economic and social burden of preventable blindness due to diabetic retinopathy.
Reproductive health and birth practices among early married females: A cross-sectional study in Jaipur India
Authors: Chintu Chaudhary  , Mohd Najmul Aqib Khan  , Sameena Ahmad
Published: January 2025

Background: Early marriage is not only a violation of females but also causes harm to their physical and psychological health.
Aims and Objectives: The aim of the study was to determine the prevalence of early marriage and its association with reproductive health of females.
Materials and Methods: This community based cross-sectional study was conducted among 322 married females in the field practice areas of JNU-IMRC, Jaipur, Rajasthan. The data were analyzed using Statistical Package for the Social Sciences 20.0.
Results: The study found that 53.4% of the females had married before the age of 18 years. Significant associations were found between age at marriage, their socio-economic status, number of children, awareness of contraception, and history of various obstetric complications (P<0.05).
Conclusion: The study brings forth the fact that early marriages have an adverse effect on reproductive health of the females. Rigorous efforts and policies should be put in place for the adolescents to understand their reproductive health better.
Factors contributing to rising cesarean section rates in South Asian countries: A systematic review
Authors: Sulochana Dhakal-Rai  , Edwin van Teijlingen  , Pramod Raj Regmi  , Juliet Wood  , Ganesh Dangal  , Keshar Bahadur Dhakal
Published: January 2025

Rising cesarean section (CS) rates are a global public health problem. The systematic review investigates key indications for performing CS and factors significantly associated with the rising rate of CS in South Asia. Primary studies in South Asia published between January 2010 and December 2018 were searched using relevant electronic databases: MEDLINE, Scopus, PubMed, Web of Science, CINAHL, NepJOL, and BanglaJOL. A narrative synthesis of the indications for performing CS and factors significantly associated with the rising CS rates was performed using content analysis. A total of 68 studies were included in this review. The most common medical indication for CS was fetal distress, followed by previous CS, antepartum hemorrhage (including placenta previa/abruption), cephalopelvic disproportion, failed induction, hypertensive disorders in pregnancy, oligohydramnios, and non-progress of labor. Maternal request was the most common non-medical indication for conducting CS. Higher maternal age was the most common significant factor associated with the rising CS rate followed by higher maternal education, urban residency, higher economic status, previous CS, pregnancy/childbirth complications, and lower parity/nulliparity. Preference for CS and increasing private number hospital were also factors contributing to the rising rate. Several key indicators and factors significantly associated with rising CS rate are revealed. These key indicators and significant factors reflect the global trend. Reduction in the use of primary CS, unless medically warranted, would help stem rates of CS. Realistic and candid explanation to pregnant women and their families regarding the benefits of vaginal birth for women and babies should form an integral part of maternity care as these are issues of public health.
Myriad Manifestations of Gallbladder Carcinoma on Multidetector Computed Tomography: Retrospective Study of 230 Patients from Tertiary Care Centre of North India
Authors: Varun Gupta  , Nishant Lohia  , Harish S  , Sawant Milind , Yogesh Kumar Bharadwaj
Published: January 2025

Background: Gallbladder carcinoma is endemic in India. Though imaging findings of gallbladder carcinoma are very well-described in the literature, the research question that guided this study was to evaluate various imaging manifestations of the disease in this particular geographic region of North India which is a highly endemic region for gallbladder cancer and compare with studies from other parts of the world.
Aims and Objective: The purpose of the study was to retrospectively analyse spectrum of findings on Multidetector Computed Tomography (MDCT) in histologically proven gallbladder carcinoma detected at a tertiary care centre from the NorthIndia. The primary objective was to define the various patterns of growth while the secondary objective was to analyse the specific prevalence and patterns of spread of the disease.
Materials and Methods: We retrospectively studied contrast enhanced Computed Tomography (CECT) findings in 230 patients of histologically proven gallbladder carcinoma. Patients with previous cholecystectomy or biliary intervention were excluded.
Results: In our study, focal or asymmetrical wall thickening of the gallbladder was the most common growth pattern seen in 140(61%) patients. Contiguous infiltration of liver was seen in 190 (83%) cases. Regional nodal involvement was observed in 90 (39%) patients, while 100 (43%) patients had both regional & distant nodal involvement. Liver and peritoneal metastases were noted in 71 (31%) patients and 96 (42%) patients respectively. Majority (81%) of patients had stage IV disease.
Conclusion: MDCT provides comprehensive information regarding the local extent as well as distant spread of gallbladder carcinoma. Asymmetric gall bladder wall thickening in this geographical region must be considered suspicious and should evoke histopathological analysis to exclude malignancy.
Relationship of severity of coronary artery disease with fasting blood sugar and glycosylated hemoglobin
Authors: Avishek Saha  , Madhumita Kuila  , Ranjan Kumar Sharma
Published: January 2025

Background: Diabetes mellitus (DM) is one of the major risk factors for coronary artery disease (CAD). Accordingly, in this study, attempt is to be made to assess the association of severity of CAD by angiography with fasting blood sugar (FBS) and hemoglobin A1c (HbA1c).
Aims and Objectives: To evaluate coronary angiographic abnormalities in patients of Diabetes.
Materials and Methods: Six hundred adult patients of both sexes admitted in the department of cardiology, Nil Ratan Sircar Medical College and Hospital, Kolkata with ischemic heart disease from June 2018 to February 2020 underwent FBS and glycosylated Hb besides other routine tests. Coronary angiography done and the severity of CAD was assessed by SYNTAX SCORE was correlated. It is an observational, Cross-sectional hospital-based single center study.
Results: Syntax scores were highest in the body mass index ≥30 kg/m2 group (16.5). Patients with Syntax score ≥33 are found to have much higher values of HbA1c (6.8±1.3) compared to those with Syntax score of ≤22 (6.4±1.8). Fasting blood glucose level in Syntax score ≥33 group has been found to be significantly higher compared to the group of Syntax score ≤22.
Conclusion: Patients having DM and/or metabolic syndrome are found to have more severe form of CAD than those who don’t have either of these.
Preventing pressure ulcers in aged care by auditing, and changing, work practices
Authors: Sharp Catherine , Julie Campbell
Published: January 2025

Background: Two nurse consultants concerned with ongoing pressure ulcer development in a 44-bed residential aged care facility in Sydney, Australia, audited pressure ulcers and the use of air mattresses.
Aims and Objectives: To measure and reduce the prevalence of pressure ulcers; audit air mattresses in use; reduce the physical workload for care staff repositioning residents; introduce an alternating pressure air mattress, allow residents to sleep undisturbed, and provide bedside education for all nursing staff.
Materials and Methods: Pressure ulcer prevalence was determined, “air” mattresses were inspected, and repositioning regimes were considered. All residents at risk of pressure ulcers were provided with a “Nodec A” mattress, allowed to sleep undisturbed, and bedside training was given to staff.
Results: Pressure ulcer prevalence was 18.1%. Eight of 44 residents had a total of 10 pressure ulcers; four sacral, three heel ulcers, two buttocks, and one hip. An audit of “air” mattresses showed half, seven of 14 (50%), was not working. Four alarm lights were on; two were set on static mode and one was deflated. Six months after the introduction of the “Nodec A” alternating pressure air mattress all pressure ulcers had healed, and the facility was pressure ulcer free.
Conclusion: Residents nursed on the “Nodec A” were pressure ulcer free and slept for hours without being repositioned and woken.
Atypical presentation of the World Health Organization Grade 1 meningioma: A case report
Authors: Rajnish Kumar Jaiswal  , Sibaji Dasgupta
Published: January 2025

Meningiomas are the most common benign neoplasm of the brain whereas ectopic presentation, although reported, is rare. Among these ectopic tumors, there are a group of purely intraosseous meningiomas, which usually are diagnosed differentially from common primary osseous tumor such as fibrous dysplasia and osteoid osteoma. The World Health Organization (WHO) Grade 1 meningioma with an involvement of scalp, calvarial bone, dura, and brain seen rarely. This type of atypical presentation of the WHO Grade 1 meningioma rarely documented. The main theories to justify the unusual topography appear to be embryological remains of neuroectodermal tissue or cellular dedifferentiation. Surgical treatment seems the best curative option. Meningioma with bony involvement could be very aggressive tumor, need to prepare accordingly for surgery.
Nasal basal cell carcinoma in xeroderma pigmentosum - diagnosis, workup, management, and reconstruction
Authors: Sanket D Vakharia  , Parag Watve  , Gautam Purohit
Published: January 2025

Xeroderma pigmentosum (XP) is genetic autosomal recessive disorder with photosensitivity on exposure to sun and also presents with various malignancies such as squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. A 22-year-old female visited our outpatient clinic with 18 months history of pigmented nodule on her nose. She was diagnosed with XP since she was 2 years old. Physical examination revealed a waxy, blackish-brown nodule on her nose. Incisional biopsy was performed. The histological findings revealed multiple, palisaded basophilic tumor masses surrounded by prominent infiltrating lymphocytes confirming our clinical diagnosis. She was advised sun protection with the use of protective clothing and glasses. XP leads to chances of various malignancies. Early diagnosis, proper clinical examination, histopathological examination for the diagnosis of condition is must to come to proper diagnosis. Instructions to the patients to take proper protection from sun and wearing protective clothing must be given.
Dermatoglyphics - A predictor of disease
Authors: Tewari Vineeta , Jay Tewari  , Tahsin Munsif  , Prince Kapoor  , Ajoy Tewari
Published: January 2025

Dermatoglyphics is the scientific study of the pattern of dermal ridges on the palmar surface of digits, palm and sole. Characteristically, hair does not grow in this area. These ridges serve well to enhance contact. The development of these ridges and the development of the nervous system occur simultaneously in the intrauterine period. The pattern of dermal ridges begins to develop around the 13th week and is completed by the 19th week of intrauterine life. Once the fingerprint pattern develops, it does not change and persists throughout life. Unusual dermatoglyphic patterns often relate to genetic disorders. Dermatoglyphics may be used as an additional screening tool to identify early risk factors that may help prevent additional complications of various diseases. In this review, we will be discussing dermatoglyphics and its important role in the diagnosis of diseases which have some genetic basis.
The comparative effects of desflurane and isoflurane on intraoperative cerebral hemodynamics, cardiovascular changes, and post-operative recovery in patients undergoing craniotomy for supratentorial tumors
Authors: Titas Mandal  , Maitreyee Mukherjee  , Amita Acharjee  , Soumya Chakrabarti
Published: January 2025

Background: Preserving hemodynamic stability, providing a slack brain, and enabling early recovery are the main criteria of neuroanesthesia. The most commonly used volatile anesthetic for neurosurgeries is isoflurane due to its favorable effects on cerebral blood flow and intracranial pressure. On the other hand, desflurane, having lower blood gas partition coefficient, favors rapid recovery from anesthesia.
Aims and Objectives: This study was conducted for comparing the effects of desflurane and isoflurane on intraoperative cerebral and cardiovascular hemodynamics and post-operative recovery among patients with supratentorial neoplasms posted for craniotomy.
Materials and Methods: A total of 52 patients aged 20–60, ASA I and II, scheduled for craniotomy under general anesthesia, were randomized into Group I (isoflurane) and Group D (desflurane). All patients received standardized anesthetic protocol and anesthesia was maintained either with isoflurane or desflurane (≤1 MAC). Lumbar cerebrospinal fluid pressure (LCSFP) and cerebral perfusion pressure (CPP) were monitored every 5 min till dura was opened and the degree of dural tension and brain swelling were assessed by neurosurgeons, blinded to the study, at the time of dural opening. Perioperative heart rate, mean arterial pressure, and post-operative recovery time were also noted.
Results: No statistically significant changes were observed among two groups regarding change in LCSFP, CPP, dural tension, brain swelling, and cardiovascular changes. Post-operative recovery time was significantly shorter in desflurane group (P<0.001) than isoflurane group.
Conclusion: Desflurane and isoflurane both can be used safely in maintaining neuroanesthesia. However, due to a significantly faster recovery which facilitates early post-operative neurological assessment, desflurane may be considered a better alternative to isoflurane.
PANC-3 score in predicting the severity of acute pancreatitis
Authors: Anandaravi BN  , Manjunath RD  , Darshan Shetty
Published: January 2025

Background: Acute pancreatitis (AP) presents as acute abdomen, Inflammatory process of pancreas associated with local and systemic complications. Many scores (such as Ranson’s, APACHE II, and Bedside index for severity in AP) that help us in predicting severity at the time of admission, but these are time consuming and require complex calculation and are not economically cheap. Our aim here is to analyze the simplified stratification system of PANC3 SCORE and its assessment in predicting severity of AP as decided by Modified Marshall Score.
Aims and Objectives: PANC-3 score in predicting the severity of acute pancreatitis.
Materials and Methods: PANC3 Scoring system is simple, easy to access readily available and economic, as it involves these criteria (hematocrit, body mass index, and pleural effusion). It is a prospective study in which 100 patients were evaluated with PANC3 Scoring, who were diagnosed with AP and admitted to the department of general surgery, Mysore Medical College and Research Institute.
Results: The results showed that PANC3 score had a 96.25% specificity, 70% sensitivity, 82.35% positive predictive value, and 92.77% negative predictive value.
Conclusion: PANC3 SCORE is cost effective, can be determined at the time of admission, thus early prediction of disease severity and early referral to higher center.
A cheaper external fixator for phalynx fractures of hand - functional outcome study
Authors: Pamarthi Srinivas  , Sai Phanindra M  , Sathish Kumar Dake  , Raju Byshetty
Published: January 2025

Background: Phalynx fractures account for 2.9% of fractures and are most commonly associated with machinery injuries in middle and young-aged individuals. Many external fixators are used for the fixation of phalanges with complexity which are costly. In this study, we used a cheap, easy fixator to construct and can be used as an emergency or definitive fixation.
Aims and Objectives: The aim of the study was to evaluate the functional outcome after using a cheaper external fixator for phalynx fractures in place of costly mini external fixators for fixation which is used normally.
Materials and Methods: We had done this study on 28 patients with phalangeal fractures, mostly due to machinery injuries which are open injuries (22 patients), with male predominance (20). The mean age group in our study was 34.89 years. The most common phalynx involved was the middle phalynx of the ring finger (11 cases). We made a fixator with syringe caps and K-wires as fixators.
Results: Total active motion score used to assess the functional outcome after 3 months of follow-up and serial X-rays for assessing union. At the end of 3 months, 22 patients (78.5%) had shown excellent results, two patients (7.1%) had fair results, three (10.7%) had good results, and one patient (3.5%) had poor results.
Conclusion: We suggest this fixator as this is cheap and easy to reconstruct with the instruments commonly available in OT. This fixator gives similar results to complex high-end fixators as compared to previous studies. This needs less expertise and training and is cost-effective for the patient.
Myocarditis associated with malarial fever: An unusual presentation
Authors: Anoop Kumar  , Prachi Garg  , Jai Prakash  , Gaurav Arya  , Kirti Berwal  , Ekal Arora
Published: January 2025

Malaria is endemic in India and complicated malaria is usually caused by Plasmodium (P) falciparum, but Plasmodium vivax can also cause life-threatening conditions in some cases. We report one such case of 47 years male presenting with myocarditis associated with P. vivax malaria.
Study of metabolic syndrome in patients of Vitiligo: A single-center observational study
Authors: Vishal Gourh  , Anita Arya  , Anand Dubey  , Simmi Dube
Published: January 2025

Background: Metabolic syndrome (MetS) has been observed in patients with vitiligo. Literature suggests that there is some link between vitiligo and MetS. Autoimmunity, oxidative stress, and decreased number of melanocytes are involved in its pathogenesis.
Aims and Objectives: This study aimed to assess MetS in patients of vitiligo, its association with different types of vitiligo, age of patients, and duration of vitiligo.
Materials and Methods: We enrolled 62 vitiligo patients who met inclusion criteria in this cross-sectional study from August 1, 2020 to July 31, 2021. Detailed history, physical examination, and blood investigations were done in all patients and NCEP ATP III criteria were used for diagnosis of MetS.
Results: Mean age of participants was 35.98±15.48 years; M: F: was 1:2.3. MetS was observed in 12.9% vitiligo patients. Advancing age and non-segmental vitiligo were significantly associated with MetS (P<0.05).
Conclusion: Vitiligo is a condition which may affect individual at any age and carries risk of developing MetS in the future. In our study, MetS is observed in 12.9% patients with vitiligo. Early identification of MetS and appropriate management of such patients may help in reducing cardiovascular morbidity and mortality. Further prospective studies required to establish relation between vitiligo and MetS.
To determine the relation of mean platelet volume with diabetes mellitus
Authors: Milind Jivanlal Manvar  , Rajesh Sukumar Roy  , Viralkumar Mohanbhai Jadav  , Amalkumar Bankimchandra Bhattacharya
Published: January 2025

Background: Diabetes mellitus (DM) is a complex metabolic disorder portrayed by chronic hyperglycemia bringing about intricacies influencing the peripheral nerves, kidneys, eyes, and macrovascular structures. Mean platelet volume (MPV) is also considered to impact the advancement of microvascular complications of diabetes mellitus which has been looked for in this study.
Aims and Objectives: The aims of this study were as follows: (1) To study association of MPV with Nephropathy and Retinopathy in Diabetes. (2) To Study correlation of MPV with hemoglobin A1c (HbA1C), fasting blood sugar, post-prandial blood sugar, and body mass index (BMI).
Materials and Methods: This was an observational study conducted over 18 months period on patients (both males and females) seeking medical attention for newly diagnosed or previously diagnosed DM. Selective sampling technique was used and 200 diabetic patients were enrolled in the study during the study period.
Results: (1) The incidence of retinopathy and increased Hba1c was significantly higher in poorly controlled diabetics as compared to controlled diabetics. (2) In good glycemic control group, mean MPV was 8.58 fL and, in poor glycemic control group, mean MPV was 10.21 fL.
Conclusion: There was a positive correlation between MPV and HbA1C, microalbuminuria, BMI, fasting, and post-prandial blood sugar levels. There was no significant association between MPV and retinopathy.
To compare COVID-19 disease in elderly (young old and elderly-old) in a tertiary care center
Authors: Ravi Krishnegowda  , Avinash Hanbe Rajanna  , Bhargav V Bhat  , Yamini Marimuthu
Published: January 2025

Background: SARS‐Cov‐2 is a coronavirus that caused the coronavirus disease 2019 (COVID‐19) disease outbreak in late 2019 in Wuhan China. By early 2020, the disease had rapidly spread across the world and was declared a global pandemic as a public health emergency of international concern. The mechanisms behind the behavior of SARS-cov-2 in the elderly include immunosenescence and related impaired antiviral immunity, mature immunity, and related hyper-inflammatory responses. We aim to summarize the clinical features and outcomes of elderly COVID-19 patients and compare the difference between young-old patients (60–74 years old) and elderly-old patients (≥75 years old).
Aims and Objective: (1) The aim of the study was to compare the clinical and biochemical profile of young-old patients and elderly-old COVID-19 patients.
Materials and Methods: A cross-sectional study was conducted on a total of 389 patients, during the study period from March 2021 to September 2021. Case record form with follow-up chart was used to record the duration of disease, history of treatment, and complications. Patients underwent biochemical investigations.
Results: The study includes 389 patients, 331 were not young-old and 58 were elderly-old. Mean age of young-old group 65.01±4.10 years and elderly-old group 80.74±5.35 years. Mortality in elderly-old group (29.3%) and young-old group (15.4%) with significant P=0.02. Comparing inflammatory markers such as total leucocyte count and neutrophil count are more in elderly-old than young-old COVID-19 patients, this difference is statistically significant P<0.005.
Conclusion: Elderly patients usually have chronic comorbidities and are likely to have a severe or critically severe condition. They could show atypical symptoms. Elderly-old patients tend to have more complications than young-old patients during hospitalization. Careful nursing, observation, and systemic treatment are very important in elderly patients.