Indian Journal of Pharmaceutical and Biological Research

Management of Cystic Duct Stones: A Case Series with Review of Literature

Abu Nasar, Sapna Kaushik, K.S Goel, Manjit Tanwar — Sat, 22 Aug 2026 00:00:00 +0000

Background: Cystic duct stones are an uncommon presentation of gallstone disease but are clinically significant due to their association
with difficult cholecystectomy and complications such as Mirizzi syndrome. Preoperative diagnosis is often challenging.
Methods: This case series includes three patients diagnosed with cystic duct calculi at a tertiary care center. Clinical features,
radiological findings, intraoperative challenges, and outcomes were analyzed.
Results: The mean age of patients was 45 years, with a female predominance (2:1). All patients presented with right upper quadrant
pain. Preoperative imaging detected cystic duct stones in two cases (66.7%). Laparoscopic cholecystectomy was successful in two
patients, while one required conversion to open surgery due to distorted anatomy. No postoperative complications were observed.
Conclusion: Cystic duct stones require a high index of suspicion. MRCP improves diagnostic accuracy, and careful intraoperative
dissection is essential to avoid bile duct injury. Early recognition and appropriate surgical strategy ensure favorable outcomes.

Evaluation of Combination Antimicrobial Therapy Against Extended-Spectrum Beta-Lactamase Producing Enterobacterales: An In Vitro Study

Madupu Deepthi, A Sangeetha, Chandana Konda — Sat, 03 Oct 2026 00:00:00 +0000

Background: Extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales pose a significant therapeutic challenge due to multidrug resistance.Objectives: To evaluate the in vitro efficacy of selected antimicrobial combinations against ESBL-producing Enterobacterales. Materials and Methods: Clinically significant ESBL-producing isolates were identified using standard microbiological methods and confirmed by the combination disc method. Antimicrobial combinations were assessed using the checkerboard assay, and interactions were interpreted based on the Fractional Inhibitory Concentration Index (FICI).Results: Among the tested combinations, meropenem–amikacin demonstrated the highest synergistic activity, followed by piperacillin–tazobactam–amikacin, while most other combinations showed additive or indifferent effects. No antagonistic interactions were observed. Conclusion: Selected antimicrobial combinations exhibited promising in vitro synergistic activity against ESBL-producing Enterobacterales. These findings support further clinical evaluation of combination therapy as a potential strategy for managing infections caused by multidrug-resistant organisms

A study on clinical correlation with MRI findings in severe preeclampsia and eclampsia patients

Atal Bihari Dandpat, Rashmi Das, Pranati Pradhan, Manas Kumar Malik — Thu, 03 Sep 2026 00:00:00 +0000

Background: Preeclampsia and eclampsia are major hypertensive disorders of pregnancy and important causes of maternal and
perinatal morbidity and mortality worldwide. Neurological complications resulting from cerebral involvement are among the most
severe manifestations and contribute significantly to adverse maternal outcomes. Magnetic Resonance Imaging (MRI) has emerged
as a valuable tool for identifying structural and functional brain abnormalities associated with these conditions, particularly Posterior
Reversible Encephalopathy Syndrome (PRES), cerebral edema, and infarction.
Aim: To evaluate MRI findings in patients with severe preeclampsia and eclampsia and correlate these findings with neurological
symptoms, blood pressure, laboratory parameters, gravida status, gestational age, Glasgow Coma Scale (GCS) score, and areas of
brain involvement.
Methods: This prospective cross-sectional study was conducted among pregnant women diagnosed with severe preeclampsia and
eclampsia admitted to a tertiary care hospital. Detailed clinical evaluation, neurological examination, blood pressure assessment,
laboratory investigations, and MRI brain imaging were performed. MRI findings were analyzed and correlated with clinical and
laboratory parameters.
Results: MRI abnormalities were observed predominantly among patients presenting with neurological manifestations such as seizures,
headache, visual disturbances, and altered consciousness. The most common MRI finding was Posterior Reversible Encephalopathy
Syndrome (PRES), followed by cerebral edema and ischemic changes. Significant correlations were observed between MRI
abnormalities and severity of hypertension, neurological symptoms, and Glasgow Coma Scale scores. Brain involvement was most
frequently noted in the parieto-occipital regions.
Conclusion: MRI serves as an effective diagnostic modality for detecting cerebral involvement in severe preeclampsia and eclampsia.
Correlation of MRI findings with clinical and laboratory parameters facilitates early diagnosis, appropriate management, and improved
maternal outcomes.

Clinicopathological Evaluation Of Yolk Sac Tumor Of Testis: A Case Report

Shailendra Singh Sikawar, Romi Srivastava, Pawan Bhambani, Sanjeev Narang — Mon, 28 Sep 2026 00:00:00 +0000

Background: Yolk sac tumor (endodermal sinus tumor) is a malignant germ cell neoplasm and represents the most common malignant
testicular germ cell tumor in infants and young children. It is characteristically associated with elevated serum alpha-fetoprotein (AFP)
levels and demonstrates distinctive histopathological features that aid in diagnosis.
Case Presentation: A 2-year-old male child presented with a painless right scrotal swelling of three months’ duration. Ultrasonography
revealed a 5.2 × 4.6 × 4.1 cm heterogeneous solid intratesticular mass with prominent internal vascularity. Serum alpha-fetoprotein was
markedly elevated at 18,650 ng/mL, while serum beta-human chorionic gonadotropin was <2 mIU/mL and lactate dehydrogenase was
286 U/L. The patient underwent right radical inguinal orchiectomy. Gross examination revealed a 5.0 cm yellowish, soft to mucoid
tumor with focal hemorrhage and necrosis. Microscopic examination demonstrated a predominantly reticular/microcystic pattern
with characteristic Schiller-Duval bodies. PAS staining demonstrated PAS-positive hyaline globules. Immunohistochemistry showed
strong AFP, SALL4, and glypican-3 positivity, with negative OCT3/4 and CD30 expression. The findings confirmed the diagnosis
of pure prepubertal-type yolk sac tumor.
Conclusion: Yolk sac tumor is an aggressive yet highly treatable malignancy in pediatric patients. Early diagnosis through correlation
of clinical findings, age-adjusted serum AFP, imaging, histopathological examination, and immunohistochemistry is essential for
appropriate management and favorable outcome. Recognition of Schiller-Duval bodies, reticular/microcystic architecture, and PASpositive
hyaline globules provides important diagnostic clues.

An Unusual Presentation of 11β-Hydroxylase Deficiency: Gynecomastia with Precocious Puberty and Hypertension in a Child

Tue, 25 Aug 2026 00:00:00 +0000

Background: Congenital adrenal hyperplasia due to 11\beta-hydroxylase deficiency is a rare autosomal recessive disorder caused by mutations in the CYP11B1 gene, leading to impaired cortisol synthesis. This results in excess adrenocorticotropic hormone (ACTH) stimulation, adrenal hyperplasia, and overproduction of adrenal androgens. Accumulation of 11-deoxycorticosterone (DOC), a potent mineralocorticoid, leads to hypertension and hypokalemia. It accounts for a small proportion of Congenital Adrenal Hyperplasia cases and may present with features of virilization and early puberty.
Case Presentation: A 6-year-old male child presented with bilateral breast enlargement and premature development of pubic hair for 2 months. There was no history of exposure to exogenous hormones or similar complaints in the family. On examination, the child had height >97th percentile for age with features of precocious puberty (Tanner stage II). Blood pressure was elevated for age. No genital ambiguity or testicular enlargement was noted.
Laboratory evaluation revealed low serum cortisol with elevated adrenal androgens. Further hormonal analysis showed markedly increased 11-deoxycortisol levels with suppressed plasma renin activity, suggestive of mineralocorticoid excess. Serum electrolytes showed hypokalemia . Bone age was advanced compared to chronological age.
Based on clinical features of precocious puberty with hypertension and supportive biochemical findings, a diagnosis of 11\beta-hydroxylase deficiency was made. The child was initiated on hydrocortisone therapy with advice for regular follow-up and blood pressure monitoring.
Conclusion: This case highlights an atypical presentation of 11\beta-hydroxylase deficiency with gynecomastia and precocious puberty. The presence of hypertension alongside androgen excess is a key diagnostic clue. Early recognition and treatment with glucocorticoid therapy are essential to prevent complications such as persistent hypertension, early epiphyseal closure, and compromised adult height.

Prognostic Significance of Serum Albumin at Admission in Patients with Acute Coronary Syndrome

Thu, 03 Sep 2026 00:00:00 +0000

Background: Acute Coronary Syndrome (ACS) remains a major cause of morbidity and mortality worldwide despite advances in early diagnosis and reperfusion therapy. Accurate risk stratification at hospital admission is essential for identifying patients at increased risk of adverse clinical outcomes. Serum albumin, an inexpensive and widely available laboratory biomarker, reflects both nutritional status and systemic inflammation and has emerged as a potential predictor of cardiovascular outcomes. This study evaluated the prognostic significance of serum albumin measured at admission in patients presenting with ACS.
Aim: To determine the prognostic significance of serum albumin levels at admission in patients with Acute Coronary Syndrome.
Materials and Methods: A prospective observational study was conducted in the Department of General Medicine, Katihar Medical College, Bihar. A total of 140 consecutive patients diagnosed with ACS were enrolled. Patients were categorized according to admission serum albumin levels into hypoalbuminemia and normal albumin groups. Demographic characteristics, cardiovascular risk factors, ACS subtype, electrocardiographic findings, Killip class, left ventricular ejection fraction (LVEF), inflammatory markers, and in-hospital clinical outcomes were recorded. The primary outcome was in-hospital mortality, while secondary outcomes included heart failure, arrhythmias, cardiogenic shock, prolonged hospital stay, and major adverse cardiovascular events. Statistical analysis was performed using IBM SPSS Statistics version 26.0. Continuous variables were analysed using the independent Student’s t-test, whereas categorical variables were compared using the Chi-square or Fisher’s exact test. Logistic regression was used to identify independent predictors of adverse outcomes, and a p-value <0.05 was considered statistically significant.
Results: Among 140 patients, 56 (40.0%) had hypoalbuminemia and 84 (60.0%) had normal serum albumin levels. Patients with hypoalbuminemia showed significantly higher proportions of STEMI, reduced LVEF, elevated inflammatory markers, increased in-hospital complications, and higher mortality compared with patients having normal serum albumin (p<0.001). Admission hypoalbuminemia was strongly associated with adverse clinical outcomes and poor short-term prognosis.
Conclusion: Serum albumin measured at admission is a simple, inexpensive, and reliable prognostic biomarker in patients with Acute Coronary Syndrome. Hypoalbuminemia identifies patients at increased risk of severe myocardial injury, impaired cardiac function, and adverse in-hospital outcomes, making it valuable for early risk stratification and clinical decision-making.

Artificial Intelligence-Based Prediction Models for Suicide Risk Assessment and Prevention: A Retrospective Observational Study

Kanchan Garg, Raj Aryan, Rana Nasim — Tue, 25 Aug 2026 00:00:00 +0000

Background: Suicide remains one of the leading causes of preventable mortality worldwide and represents a major public health challenge. Despite advances in psychiatric assessment and mental health services, accurately identifying individuals at imminent risk of suicide remains difficult because suicidal behavior arises from a complex interaction of biological, psychological, social, and environmental factors. Conventional clinical risk assessment methods primarily rely on clinician judgment and standardized screening tools, which often demonstrate limited predictive accuracy and considerable inter-observer variability. Recent developments in artificial intelligence (AI) and machine learning (ML) have enabled the integration of large-scale hospital medical records, demographic variables, psychiatric history, medication profiles, laboratory findings, and behavioral characteristics to generate individualized suicide risk predictions. AI-driven predictive models have demonstrated superior performance compared with traditional statistical approaches by identifying complex nonlinear relationships and hidden interactions among multiple risk factors. However, evidence regarding the applicability of these models in routine clinical practice remains limited, particularly in retrospective hospital-based settings.
Objective: To evaluate the performance of artificial intelligence-based prediction models for suicide risk assessment and prevention using retrospective clinical data and to identify the most influential predictors associated with high suicide risk.
Materials and Methods: A retrospective observational study was conducted over four months using medical records of 100 patients who underwent psychiatric evaluation at PMCH, Patna. Demographic characteristics, psychiatric diagnoses, previous suicide attempts, substance use disorders, family history of mental illness, medication adherence, hospitalization history, depression severity scores, anxiety scores, and psychosocial variables were extracted from hospital medical records maintained in the Medical Record Department (MRD). Missing values were managed through multiple imputation where appropriate. Four predictive models—Logistic Regression, Random Forest, Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost)—were developed and internally validated using five-fold cross-validation. Model performance was evaluated using accuracy, sensitivity, specificity, precision, F1-score, area under the receiver operating characteristic curve (AUC), and calibration statistics. Statistical significance was considered at p <0.05.
Results: Among the 100 patients included, 36 were categorized as high suicide risk based on documented psychiatric evaluation. Previous suicide attempt, severe depressive symptoms, substance use disorder, medication non-adherence, unemployment, and multiple psychiatric hospitalizations were significantly associated with high suicide risk (p<0.05). XGBoost demonstrated the highest predictive performance with an AUC of 0.94, sensitivity of 91.7%, specificity of 89.1%, accuracy of 90.0%, and F1-score of 0.90. Random Forest achieved an AUC of 0.91, while SVM and Logistic Regression demonstrated AUC values of 0.88 and 0.84, respectively. Feature importance analysis identified previous suicide attempt, depression severity score, medication adherence, substance use disorder, psychiatric hospitalization history, and age as the strongest predictors.
Conclusion: Artificial intelligence-based prediction models demonstrated excellent discrimination in identifying patients at elevated suicide risk. Tree-based ensemble algorithms, particularly XGBoost, outperformed conventional logistic regression by effectively modeling complex clinical interactions. Integration of AI-assisted decision support into psychiatric practice may facilitate early identification of vulnerable individuals, optimize allocation of mental health resources, and strengthen suicide prevention strategies. Prospective multicenter validation studies are warranted before widespread clinical implementation.

An Unusual Culprit: Vertebrobasilar Dolichoectasia Presenting as Trigeminal Neuralgia

Taranisen Sethi, Shradhanjali Pani, Sourabh Tiwari — Sat, 29 Aug 2026 00:00:00 +0000

Background: Trigeminal neuralgia (TN) is a debilitating neuropathic pain disorder most commonly caused by neurovascular
compression at the trigeminal nerve root entry zone. While classical cases are typically due to small arterial loops, secondary causes
such as vertebrobasilar dolichoectasia (VBD) are rare but clinically significant and often under-recognized.
Case Presentation: We report a 62-year-old male presenting with a 6-month history of recurrent, severe, right-sided, electric shocklike
facial pain involving the maxillary and mandibular divisions of the trigeminal nerve. The pain was triggered by routine activities
such as chewing and speaking, consistent with classical trigeminal neuralgia. Neurological examination revealed mild hyperesthesia
over the affected dermatomes without motor deficit.
Magnetic resonance imaging with angiography demonstrated an abnormal vertebrobasilar configuration with significant rightward
lateral displacement and high bifurcation of the basilar artery. Although the arterial diameter did not meet conventional criteria for
ectasia, the vessel was seen abutting and indenting the cisternal segment of the right trigeminal nerve, confirming neurovascular
compression. These findings were consistent with vertebrobasilar dolichoectasia based on Smoker’s criteria.
The patient was treated with carbamazepine, resulting in significant symptomatic improvement, and remains under follow-up for
potential surgical intervention if symptoms become refractory.
Discussion: This case highlights an important diagnostic and pathophysiological consideration: vascular geometry and displacement
may be more critical than arterial diameter in producing symptomatic neurovascular conflict. Unlike classical TN, VBD-associated
TN involves a large, tortuous vessel capable of exerting sustained mechanical distortion on the trigeminal nerve. Recognition of such
structural causes is essential, as they carry distinct prognostic and therapeutic implications.
Conclusion: Vertebrobasilar dolichoectasia is an uncommon but important cause of secondary trigeminal neuralgia. Detailed
neurovascular imaging is crucial for diagnosis, as identification of vascular morphology—not merely vessel caliber—can influence
clinical decision-making and long-term management.

Estimation of Radiological Age From Sternum: An Autopsy-based Study in a Tertiary Care Hospital, Visakhapatnam

Sat, 29 Aug 2026 00:00:00 +0000

Background: Age estimation is a fundamental aspect of forensic identification, particularly in cases involving unknown deceased individuals, skeletal remains, and medicolegal investigations. The sternum is a durable bone that often withstands decomposition and can provide useful indicators for age estimation through assessment of fusion at the manubriosternal and xiphisternal joints.
Aim: To estimate radiological age from fusion status of the manubrium and xiphisternum with the body of the sternum in an autopsy population.
Methods: An autopsy-based cross-sectional study was conducted in the Department of Forensic Medicine, Andhra Medical College, Visakhapatnam. A total of 101 sterna obtained from cadavers aged 25–75 years were examined radiologically. Plain radiographs in anteroposterior and anterior oblique views were analyzed for fusion status of the manubriosternal and xiphisternal joints. Fusion was graded as non-fusion, partial fusion, or complete fusion. Age-wise and sex-wise distributions were evaluated.
Results: Among 101 sterna studied, 82 (81.2%) belonged to males and 19 (18.8%) to females. At the manubriosternal joint, non-fusion was observed in 79 (78.2%), partial fusion in 18 (17.9%), and complete fusion in 4 (3.9%) cases. At the xiphisternal joint, non-fusion was observed in 48 (47.5%), partial fusion in 30 (29.7%), and complete fusion in 23 (22.8%) cases. Fusion of the xiphisternum occurred earlier and more frequently than fusion of the manubrium. Complete xiphisternal fusion was absent below 35 years of age and became increasingly common after 45 years.
Conclusion: Radiological assessment of fusion of the sternum provides valuable information for forensic age estimation. The xiphisternal joint demonstrates earlier fusion and greater reliability compared with the manubriosternal joint. However, considerable individual variation exists, and sternum fusion should be used in conjunction with other age-estimation parameters.

Assessment of Heart Rate Variability and Autonomic Function in Patients with Major Depressive Disorder: A Comparative Study with Healthy Controls

Virinchi Sharma, Vishnu Gade, Kurukuntlasubramanyam . — Mon, 31 Aug 2026 00:00:00 +0000

Background: Major depressive disorder (MDD) is a common psychiatric disorder associated not only with psychological symptoms
but also with disturbances in cardiovascular and autonomic regulation. Heart rate variability (HRV) is a non-invasive physiological
marker that provides information regarding cardiac autonomic modulation. Reduced HRV, particularly reduced vagally mediated
components, has been reported in patients with depression and may partly explain the increased cardiovascular risk associated with
MDD. The present study was undertaken to assess HRV and autonomic function in patients with MDD and compare the findings
with healthy controls.
Materials and Methods: A comparative cross-sectional study was conducted among 120 adults, comprising 60 patients diagnosed
with MDD and 60 age- and sex-matched healthy controls. Participants underwent standardized cardiovascular autonomic assessment
and short-term resting ECG recording for HRV analysis. Time-domain parameters including SDNN and RMSSD and frequencydomain
parameters including low-frequency (LF), high-frequency (HF) power and LF/HF ratio were assessed. Heart rate and blood
pressure were also recorded. Independent-samples t-test and repeated-measures analysis were used for comparison. A p value <0.05
was considered statistically significant.
Results: Patients with MDD had significantly higher resting heart rate and significantly lower SDNN, RMSSD and HF-HRV compared
with healthy controls. The LF/HF ratio was significantly higher in the MDD group. Conventional autonomic tests also demonstrated
significantly reduced parasympathetic function in patients with MDD. The differences in HRV and autonomic function between the
groups were statistically significant, with p values <0.001 for most parameters.
Conclusion: Patients with MDD demonstrated significant alteration of cardiac autonomic function characterized predominantly by
reduced parasympathetic modulation and relative sympathovagal imbalance. HRV assessment may provide a useful non-invasive
physiological measure for identifying autonomic dysregulation in patients with MDD.

Serum 25-Hydroxyvitamin D Concentration Spectrum in Patients with Sickle Cell Disease: A Cross-Sectional Descriptive Study

Mansi Sharma, Ashish Koshti, Maneesh Sulya — Tue, 01 Sep 2026 00:00:00 +0000

Background: Low serum 25-hydroxyvitamin D [25(OH)D] concentrations are frequently reported in sickle cell disease (SCD), but prevalence estimates alone can obscure the depth and shape of the concentration distribution. Objective: To characterize the serum 25(OH)D concentration spectrum in patients with SCD using vitamin D measurements alone. Materials and Methods: A cross-sectional analysis was performed on 54 vitamin D measurements available in an institutional research database. Only the vitamin D variable was analyzed. Descriptive statistics and conventional concentration strata were used. Results: Mean 25(OH)D was 15.98 ± 8.62 ng/mL and median concentration was 14.40 ng/mL (range, 4.5–32.0 ng/mL). Thirty-four measurements (63.0%) were below 20 ng/mL, including 17 (31.5%) below 10 ng/mL. Sixteen (29.6%) were 20–29.9 ng/mL and only four (7.4%) were ≥30 ng/mL. Conclusion: The dataset demonstrates a pronounced lower-end shift in serum 25(OH)D concentrations. Reporting the complete concentration spectrum may be more informative than a binary deficient/non-deficient label. Longitudinal multicenter studies are needed to determine whether the depth and persistence of low 25(OH)D concentrations have clinical significance.

Utility of CBNAAT in Smear-Negative Pulmonary Tuberculosis: A Prospective Evaluation

Binita Gupta, Anupa Shilpi Khalkho, Anika Kujur, Vineeta Baxla — Wed, 02 Sep 2026 00:00:00 +0000

Background: Smear-negative pulmonary tuberculosis (PTB) poses a major diagnostic challenge, especially in high-burden countries like India. Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) has emerged as a rapid and sensitive diagnostic tool.
Objective: To evaluate the diagnostic utility of CBNAAT in smear-negative pulmonary tuberculosis patients.
Methods: A prospective observational study was conducted on 400 suspected smear-negative PTB patients at Sheikh Bhikhari Medical College, Hazaribagh, Jharkhand, India, from January 2025 to December 2025. All patients underwent sputum smear microscopy and CBNAAT testing. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using culture as reference.
Results: CBNAAT detected Mycobacterium tuberculosis in 110 (27.5%) cases. The sensitivity and specificity were 87.5% and 98.2%, respectively. The positive predictive value was 95.5% and the negative predictive value was 94.8%. Rifampicin resistance was detected in 10.9% of CBNAAT-positive cases.
Conclusion: CBNAAT demonstrates high diagnostic accuracy in smear-negative PTB and significantly improves early detection and drug resistance identification.

Role of Transvaginal Ultrasonography in Evaluation of Abnormal Uterine Bleeding in Perimenopausal Women: A Retrospective Observational Study

Lovely Jethwani, Neeraj Mehta, Shubhi Gupta — Sat, 05 Sep 2026 00:00:00 +0000

Background: Abnormal uterine bleeding (AUB) is one of the most frequent gynecological complaints among perimenopausal women and accounts for a substantial proportion of outpatient visits and gynecological interventions. During the perimenopausal transition, hormonal fluctuations often result in menstrual irregularities; however, structural uterine lesions, endometrial hyperplasia, and endometrial carcinoma must be excluded because of their significant clinical implications. Transvaginal ultrasonography (TVS) has become the preferred first-line imaging modality for evaluating women with AUB owing to its high-resolution visualization of the uterus, endometrium, and adnexa. Accurate assessment of endometrial thickness and uterine morphology facilitates early diagnosis and guides the need for further invasive investigations such as hysteroscopy or endometrial biopsy.
Objectives: To evaluate the role of transvaginal ultrasonography in identifying the causes of abnormal uterine bleeding among perimenopausal women and to analyze the ultrasonographic findings in relation to clinical presentation and histopathological diagnosis.
Methodology: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Vyas Medical College, Jodhpur. Medical records of 430 perimenopausal women presenting with abnormal uterine bleeding between January 2025 and December 2025 were reviewed. Demographic characteristics, menstrual history, ultrasonographic findings, endometrial thickness, associated pelvic pathology, histopathological reports, and management details were extracted from hospital records. Statistical analysis was performed using IBM SPSS Statistics Version 26.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Appropriate statistical tests were applied, and a p-value <0.05 was considered statistically significant.
Results: A total of 430 perimenopausal women with abnormal uterine bleeding were included in the study. The mean age was 45.8 ± 3.2 years, with the highest proportion of patients belonging to the 46–50 years age group (44.2%). Heavy menstrual bleeding (37.2%) was the most common presenting complaint, followed by irregular menstrual bleeding (26.3%). On transvaginal ultrasonography, endometrial hyperplasia (29.8%) was the most frequent finding, followed by fibroid uterus (25.6%), adenomyosis (15.8%), endometrial polyp (10.5%), and thickened endometrium >12 mm (8.4%), while 4.4% of women had no significant ultrasonographic abnormality. The mean endometrial thickness was 10.8 ± 3.6 mm, and women with significant endometrial pathology had significantly greater endometrial thickness (p < 0.001). Transvaginal ultrasonography demonstrated high diagnostic performance for detecting significant endometrial pathology, with a sensitivity of 91.4%, specificity of 88.2%, positive predictive value of 86.5%, negative predictive value of 92.6%, and overall diagnostic accuracy of 89.8%. Histopathological correlation showed high concordance between TVS findings and the final diagnosis, supporting its reliability as a first-line diagnostic modality.
Conclusion: Transvaginal ultrasonography is an effective, non-invasive, and reliable first-line diagnostic modality for evaluating abnormal uterine bleeding in perimenopausal women. It accurately identifies common uterine pathologies, assists in risk stratification based on endometrial thickness, and facilitates timely selection of patients requiring histopathological evaluation.

Impact of Pregnancy on Progression of Diabetic Retinopathy

Neel Chandra Siddhant, Manoj Agarwal, Nayan, Sayali Rathod — Sat, 05 Sep 2026 00:00:00 +0000

Background: diabetic retinopathy is a microvascular complication of diabetes mellitus and remains an important cause of visual morbidity. Pregnancy is known to influence the course of diabetic retinopathy due to metabolic, hormonal, and hemodynamic changes.
Objective: To assess the impact of pregnancy on the progression of diabetic retinopathy and identify associated risk factors among pregnant women with diabetes.
Methods: From April 2025 to February 2026, 150 pregnant women with pregestational or gestational diabetes participated in a prospective observational research. First-trimester, second-trimester, third-trimester, and postpartum ophthalmic exams were conducted. The conventional fundus examination was used to grade the progression of retinopathy. Glycemic control and maternal clinical indicators were noted. SPSS version 24 was used for the statistical analysis, and p <0.05 was deemed significant.
Results: Progression of diabetic retinopathy was observed in 42 (28%) women. Progression was significantly higher in women with pregestational diabetes, longer duration of diabetes, poor glycemic control (HbA1c >7%), and baseline retinopathy. Severe progression requiring laser treatment occurred in 10 (6.7%) patients. Women with diabetes duration >5 years had significantly higher progression rates (p=0.002).
Conclusion: Diabetic retinopathy is known to significantly worsen during pregnancy, especially in women who already have diabetes and have poor metabolic control. During pregnancy, intensive interdisciplinary monitoring and early ocular screening are crucial.

Dexmedetomidine Versus Dexamethasone as an Adjuvant in Supraclavicular Brachial Plexus Block: A Comparative Study

Ratikanta Nayak, Chinmayee Priyadarshini, Kamalakant Swain — Sat, 05 Sep 2026 00:00:00 +0000

Background: Supraclavicular brachial plexus block is widely used for upper limb surgeries because it provides excellent intraoperative anesthesia and prolonged postoperative analgesia. Various adjuvants have been added to local anesthetics to improve block characteristics and prolong analgesic duration. Dexmedetomidine and dexamethasone are among the most commonly used adjuvants in peripheral nerve blocks.
Aim: To compare dexmedetomidine and dexamethasone as adjuvants to bupivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor blockade, duration of postoperative analgesia, and adverse effects.
Materials and Methods: A prospective randomized comparative study was conducted in the Department of Anaesthesiology at SCB Medical College, Cuttack and SJMCH, Puri over a period of 11 months. A total of 110 patients undergoing elective upper limb surgeries under supraclavicular brachial plexus block were included. Patients were randomly allocated into two groups: Group DEX receiving dexmedetomidine 1 μg/kg with bupivacaine and Group DEXA receiving dexamethasone 8 mg with bupivacaine. Sensory block onset, motor block onset, duration of analgesia, hemodynamic parameters, and complications were evaluated. Statistical analysis was performed using IBM SPSS version 26.0. Independent t-test, Chi-square test, repeated measures ANOVA, and Kaplan–Meier survival analysis were applied. A p-value <0.05 was considered statistically significant.
Results: The onset of sensory block was significantly shorter in Group DEX compared to Group DEXA (8.42 ± 1.64 min vs 10.86 ± 1.88 min; p<0.001). Duration of postoperative analgesia was significantly prolonged in Group DEXA (846.5 ± 92.6 min) compared to Group DEX (768.2 ± 84.3 min; p<0.001). Bradycardia was more common in Group DEX (p=0.048).
Conclusion: Dexmedetomidine provides faster onset of blockade, whereas dexamethasone significantly prolongs postoperative analgesia and duration of blockade when used as adjuvants in supraclavicular brachial plexus block.

Morphological analysis of sacral hiatus variations and their relevance in caudal epidural Anesthesia

Krishna Kumar Ram, Anuj Kumar, Ramanuj Singh — Mon, 07 Sep 2026 00:00:00 +0000

Background: Variations in the morphology of the sacral hiatus are clinically important because they may influence the success and safety of caudal epidural anesthesia. Knowledge of sacral hiatus anatomy is essential for accurate needle placement and prevention of procedural complications.
Objective: To evaluate morphological variations of the sacral hiatus and assess their relevance in caudal epidural anesthesia using retrospective computed tomography records.
Methods: A retrospective observational study was conducted at Anugrah Narayan Magadh Medical College and Hospital (ANMMCH), Gaya, over one year. CT scans of the pelvis and lumbosacral region from 200 adult patients were analyzed. Sacral hiatus shape, length, transverse width, anteroposterior diameter, and vertebral level of the apex and base were recorded. Associations with predicted difficult caudal epidural access were evaluated using Chi-square test, independent t-test, and logistic regression analysis.
Results: The inverted U-shaped sacral hiatus was the most common morphology (37.0%), followed by the inverted V shape (28.0%). Mean sacral hiatus length, transverse width, and anteroposterior diameter were 24.6 ± 5.1 mm, 13.2 ± 2.8 mm, and 5.6 ± 1.4 mm, respectively. The apex was most frequently located at S4 (48.0%). Male participants had significantly larger morphometric measurements than females (p < 0.01). Predicted difficult caudal epidural access was identified in 23.0% of cases. Narrow transverse width (AOR 3.94, p < 0.001), reduced anteroposterior diameter (AOR 2.86, p = 0.013), and irregular or bifid morphology (AOR 3.51, p = 0.002) were independent predictors of difficult access.
Conclusion: Substantial anatomical variability exists in the sacral hiatus. Pre-procedural recognition of these variations may improve the success and safety of caudal epidural anesthesia and reduce technical difficulty during needle placement.

Clinical Observation of Effect of Oral Melatonin 10 Mg as Premedication

Wed, 09 Sep 2026 00:00:00 +0000

Introduction: Preoperative anxiety has a significant impact on surgical outcomes. Oral melatonin, known for its anxiolytic and sedative properties, is used as a premedicant. This study aimed to evaluate the effects of administering 10 mg of oral melatonin two hours prior to elective surgery, focusing on its anxiolytic, sedative, amnestic, and perioperative effects.
Methodology: A prospective observational study was conducted at R. D. Gardi Medical College, Ujjain. The study included thirty patients, aged 18–75 years, with ASA physical status I–II, scheduled for elective surgery. Each patient received 10 mg of oral mouth-dissolving melatonin approximately 120 minutes before surgery. Perioperative measurements included anxiety and sedation levels.
Results: The mean age of participants was 40.44 ± 13.10 years, with 76.7% being male. Anxiety scores significantly decreased from 2.24 ± 1.39 at baseline to 0.00 postoperatively (p < 0.001). Sedation scores increased from 0.00 ± 0.00 to 1.32 ± 0.56 (p < 0.001), with all patients remaining arousable. Significant reductions were observed in pulse rate and blood pressure, while oxygen saturation remained stable. No instances of respiratory depression, haemodynamic and adverse events were reported.
Conclusion: Administering 10 mg of oral melatonin two hours before elective surgery effectively provided anxiolysis and mild sedation, maintaining haemodynamic and respiratory stability.

Comparative Study of Suture-Anchored Bi-Layer Mosquito Net Mesh with Standard Lichtenstein’s Prolene Mesh Inguinal Hernioplasty

Fri, 11 Sep 2026 00:00:00 +0000

Background: Tension-free mesh hernioplasty is the standard of care for inguinal hernia repair, but the cost of commercial polypropylene mesh limits access in resource-poor settings. Sterilized mosquito-net mesh has been proposed as a low-cost alternative. Objective: To compare a self-fabricated, suture-anchored bi-layer mosquito-net mesh with standard Lichtenstein polypropylene mesh hernioplasty. Methods: A prospective comparative study of 60 adult patients with primary unilateral inguinal hernia was conducted, with alternate allocation to mosquito-net mesh (Group A, n=30) or standard Lichtenstein mesh (Group B, n=30). Operating time, hospital stay, postoperative pain (VAS), wound healing, surgical site infection, seroma/hematoma, recurrence at 6 months, return to daily activity, and procedure cost were compared. Results: The groups were comparable at baseline for age, sex, symptom duration, hernia laterality, and anesthesia type. Operating time was significantly shorter with mosquito-net mesh (56.70±9.49 vs. 65.40±10.51 minutes, p=0.001), and cost was approximately 71% lower (Rs. 2558.83±348.37 vs. Rs. 8758.43±896.42, p<0.001). No significant difference was found in postoperative pain at any time point, hospital stay, infection, seroma/hematoma, recurrence, or return to activity. A borderline, non-significant trend toward delayed wound healing was observed with mosquito-net mesh (23.3% vs. 3.3%, p=0.052). Conclusion: Suture-anchored bi-layer mosquito-net mesh offers a safe, effective, and markedly cheaper alternative to standard polypropylene mesh for inguinal hernioplasty, with a shorter operating time and comparable complication and recurrence profile, though the wound-healing trend merits confirmation in larger trials.

Association between Menopause and Frozen Shoulder in Women: A Hospital-Based Cross-Sectional Observational Study

Rahul Anshuman, Amrita — Sat, 12 Sep 2026 00:00:00 +0000

Background: Frozen shoulder is a common musculoskeletal disorder characterized by progressive shoulder pain and restriction of both active and passive movements. Women, particularly during the menopausal transition, appear to be affected more frequently. Declining estrogen levels may influence collagen metabolism, connective tissue remodeling, and inflammatory pathways, thereby increasing susceptibility to adhesive capsulitis. However, evidence regarding this association remains limited.
Objective: To evaluate the association between menopausal status and frozen shoulder among women attending the outpatient department of a tertiary care hospital.
Materials and Methods: This hospital-based cross-sectional observational study was conducted over 18 months and included 35 women aged 40–70 years. Participants were classified as premenopausal or postmenopausal based on menstrual history. Demographic and clinical characteristics, menopausal status, body mass index (BMI), diabetes mellitus, pain severity, and shoulder range of motion were assessed. Statistical analysis included the Chi-square test, independent Student’s t-test, and multivariable logistic regression. A p-value <0.05 was considered statistically significant.
Results: Frozen shoulder was diagnosed in 21 (60.0%) participants. The prevalence was significantly higher among postmenopausal women than premenopausal women (78.3% vs. 25.0%; χ² = 8.97, p = 0.003). Women with frozen shoulder were significantly older than those without the condition (55.7 ± 4.1 vs. 50.9 ± 4.3 years, p = 0.002). On multivariable logistic regression analysis, postmenopausal status remained independently associated with frozen shoulder after adjustment for age, BMI, diabetes mellitus, and hypertension (adjusted OR = 5.84; 95% CI: 1.28–26.63; p = 0.023).
Conclusion: This study demonstrated a significant association between menopausal status and frozen shoulder among the women included in the study. Postmenopausal women showed a higher prevalence of frozen shoulder than premenopausal women, suggesting that menopausal hormonal changes may contribute to the development of the condition. Larger multicenter prospective studies with longer follow-up are warranted to further validate these findings.

Evaluation of Cataract Development in Patients on Chronic Steroid Therapy for Respiratory Diseases

Sheel Mani, Pankaj Kumar, Prem Prakash — Sat, 12 Sep 2026 00:00:00 +0000

Background: Chronic corticosteroid therapy remains a cornerstone in the management of respiratory diseases such as bronchial asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung diseases. However, prolonged steroid exposure is associated with ocular complications, particularly cataract formation.
Aim: To evaluate the prevalence and pattern of cataract development among patients receiving long-term steroid therapy for respiratory diseases.
Methods: This retrospective study was conducted at Government Medical College and Hospital, Purnea, Bihar, from April 2025 to March 2026. Medical records of 105 patients with respiratory diseases receiving corticosteroid therapy for at least six months were reviewed. Data regarding demographic characteristics, respiratory diagnosis, duration of steroid therapy, route of administration, and cataract status were analyzed.
Results: Among 105 patients, cataracts were detected in 42 (40.0%) cases. Posterior subcapsular cataract (PSC) was the most common subtype (57.1%). Cataract prevalence increased significantly with steroid duration exceeding three years (p<0.001). Patients receiving combined inhalational and oral steroids exhibited a significantly higher risk of cataract development than those receiving inhalational steroids alone (p=0.012).
Conclusion: Long-term steroid therapy is significantly associated with cataract formation, particularly PSC. Duration and cumulative exposure to corticosteroids are important risk factors. Regular ophthalmologic screening should be incorporated into the management of patients receiving chronic steroid therapy.

Catheter Associated Urinary Tract Infection in Patients Admitted to Katihar Medical College Hospital, Katihar, Bihar

Suruchi, Kahkashan Akhter, Sangeeta Dey, Fauzia Yashmin — Mon, 14 Sep 2026 00:00:00 +0000

Catheter associated urinary tract infection (CAUTI) is the commonest device associated infection acquired from hospital settings. CAUTI accounts for 80% of all nosocomial urinary tract infection and 40% of all hospital acquired infection. Approximately 15% to 25% of patients in hospitals have to undergo catheterization at some time during their stay. CAUTI according to the Centre of Disease Control and Prevention (CDC) is defined as urinary tract infection where an indwelling urinary catheter was in place for more than two calendar days on the day of event (day one being the day of device placement).
Materials and Methods: This prospective observational study was carried out from April 2024 to September 2025 over a period of 18 months in the department of Microbiology, Katihar Medical College, Katihar, Bihar. Determination of the risk factors and etiological agents associated with CAUTI, antimicrobial and antifungal susceptibility pattern of isolates was done using standard microbiological procedures. CAUTI rate was calculated per 1000 catheter days.
Results: A total of 3826 urine samples were received in the laboratory during the study period, out of which 3453 were voided urine samples and 373 were catheterized urine samples. 621 of the voided urine samples and 57 of the catheterized urine samples showed growth. CAUTI rate was found to be 8.8 per 1000 urinary catheter days. Maximum CAUTI patients were seen in 51-60 years age group 20/57(35.1%) followed by 41-50 years age group 12/57 (21.1%). Female to male ratio was found to be 3:1. The highest number of CAUTI cases were seen from the Obstetrics and Gynaecology department comprising 20/57 (35.1%), followed by General Medicine 17/57 (29.8%) whereas the least number of CAUTI cases were seen from the Orthopaedics department accounting for 2/57 (3.5%). Predominant isolates were Escherichia coli 22/57 (38.6%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa 7/57 (12.3%) each. Less common ones were Candida albicans 5/57 (8.8%), Enterococcus faecalis 4/57 (7.0%), Acinetobacter baumannii and Enterobacter spp. 3/57 (5.3%) each, Candida tropicalis and Candida guilliermondii 2/57 (3.5%) each, Enterococcus faecium and Serratia spp. 1/57 (1.7%) each. The association of gender, age group, duration of catheterization with CAUTI was found to be statistically significant (p value<0.05) whereas diabetes and hypertension were independent risk factors of CAUTI. Gram-positive cocci showed 100% resistance to gentamicin high level, ciprofloxacin, levofloxacin and erythromycin. Gram- negative bacilli (fermenters) showed 100% resistance to cefalotin and ampicillin followed by cefixime (94.0%), ceftriaxone (93.9%). Gram- negative bacilli (non-fermenters) showed 100% resistance to cotrimoxazole, levofloxacin, cephalosporins, carbapenems and aztreonam. Antifungal susceptibility pattern of Candida species showed 100% sensitivity to amphotericin B, voriconazole, micafungin, flucytosine and fluconazole.
Conclusion: CAUTI rate was found to be 8.8 per 1000 urinary catheter days which is similar to the CAUTI rates reported in several other studies done across India. The duration of urinary catheterization was found to be a predominant risk factor for CAUTI. Maximum CAUTI patients were seen in 51-60 years age group. Female to male ratio was found to be 3:1. There was a predominance of Gram-negative pathogens, majority of which were multidrug resistant.

Percutaneous Autologous Bone Marrow Injection in the Treatment of Delayed Union of Long Bone Fractures After Definitive Fixation

Tue, 15 Sep 2026 00:00:00 +0000

Background: Delayed union of long bone fractures remains a significant challenge in orthopedic practice despite advances in fixation techniques. Autologous bone marrow injection has emerged as a minimally invasive biological method for enhancing fracture healing by delivering osteogenic progenitor cells and growth factors directly to the fracture site.
Aim: To evaluate the effectiveness of percutaneous autologous bone marrow injection in the treatment of delayed union of long bone fractures following definitive fixation.
Methods: A prospective observational study was conducted in the Department of Orthopaedics, Patna Medical College Hospital (PMCH), from January 2024 to January 2026. Thirty-five patients with delayed union of long bone fractures after definitive fixation underwent percutaneous autologous bone marrow injection. Clinical and radiological outcomes were assessed at regular follow-up intervals. Fracture union rates, time to union, functional outcomes, and complications were analyzed.
Results: Among 35 patients, 30 (85.7%) achieved complete fracture union following bone marrow injection. The mean time to radiological union was 14.2 ± 3.8 weeks. Tibial fractures constituted the majority of cases (42.9%). Union rates were significantly higher among patients treated within six months of injury compared with later intervention (p=0.018). No major procedure-related complications were observed.
Conclusion: Percutaneous autologous bone marrow injection is a safe, effective, and minimally invasive treatment modality for delayed union of long bone fractures. Early intervention appears to improve healing outcomes and may reduce the need for secondary surgical procedures.

Fixation of Acetabular Fractures with Quadrilateral Plate Involvement Using Intrapelvic Reduction and Buttress Plate via Modified Stoppa Approach: A Clinico-Radiological and Functional Outcome Evaluation

Tue, 15 Sep 2026 00:00:00 +0000

Background: Acetabular fractures involving the quadrilateral plate represent complex injuries that pose significant challenges in achieving anatomical reduction and stable fixation. The modified Stoppa approach provides excellent visualization of the quadrilateral surface while minimizing surgical morbidity compared with traditional extensile approaches.
Aim: To evaluate the clinico-radiological and functional outcomes of acetabular fractures involving the quadrilateral plate treated with intrapelvic reduction and buttress plate fixation through the modified Stoppa approach.
Methods: A prospective observational study was conducted in the Department of Orthopaedics, Patna Medical College Hospital (PMCH), from March 2024 to March 2026. Thirty patients with acetabular fractures involving the quadrilateral plate underwent open reduction and internal fixation using buttress plating through the modified Stoppa approach. Clinical outcomes, radiological reduction quality, fracture union, and functional outcomes using the Harris Hip Score (HHS) were assessed over a minimum follow-up period of 12 months.
Results: The mean age was 43.8 ± 12.4 years, with males constituting 76.7% of cases. Anatomical reduction was achieved in 70.0% of patients, while satisfactory reduction was obtained in 90.0%. Fracture union was observed in 28 patients (93.3%). At final follow-up, excellent-to-good Harris Hip Scores were achieved in 83.3% of patients. Better radiological reduction significantly correlated with superior functional outcomes (p=0.004).
Conclusion: The modified Stoppa approach with quadrilateral buttress plating provides excellent exposure, reliable fixation, high union rates, and favorable functional outcomes in acetabular fractures involving the quadrilateral plate.

Thyroid Function Profile in Women with Polycystic Ovary Syndrome: A Cross-Sectional Study

Ambyada Mounika, Keshamalla Swetha, Bussu Sowmyaveni — Wed, 16 Sep 2026 00:00:00 +0000

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age and is characterized by reproductive, hormonal and metabolic abnormalities. Thyroid dysfunction, particularly subclinical hypothyroidism and autoimmune thyroid disease, has been reported with variable frequency among women with PCOS. Thyroid abnormalities may further contribute to menstrual irregularities, infertility and metabolic dysfunction. The present study was undertaken to assess the thyroid function profile in women with PCOS and compare it with apparently healthy women.
Materials and Methods: A hospital-based comparative cross-sectional study was conducted at Jangaon Government Hospital, Telangana, India, among 120 women aged 18–40 years. The study included 60 women diagnosed with PCOS and 60 age- and BMI-matched healthy controls. Serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and anti-thyroid peroxidase antibody (anti-TPO) were estimated. Anthropometric and selected metabolic parameters were also assessed. Data were analyzed using independent Student’s t-test, chi-square test and Pearson correlation analysis. A p value <0.05 was considered statistically significant.
Results: Women with PCOS demonstrated significantly higher serum TSH compared with healthy controls (3.42 ± 1.48 vs. 2.31 ± 1.02 mIU/L; p<0.001). FT3 and FT4 were significantly lower in the PCOS group. Anti-TPO concentrations were significantly higher in women with PCOS. Subclinical hypothyroidism was observed in 13.3% of women with PCOS compared with 3.3% of controls (p=0.049). TSH showed significant positive correlations with BMI, fasting insulin and HOMA-IR.
Conclusion: Women with PCOS demonstrated significant alterations in thyroid function, characterized predominantly by higher TSH concentrations, lower thyroid hormone concentrations within the reference range and increased frequency of subclinical hypothyroidism and anti-TPO positivity. Assessment of thyroid function may therefore be clinically useful in women with PCOS, particularly those with menstrual irregularity and metabolic risk factors.

Risk of Malignancy in Bethesda Category III and IV Thyroid Nodules

Wed, 16 Sep 2026 00:00:00 +0000

Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides a standardized framework for thyroid fine-needle aspiration cytology (FNAC). Bethesda Category III (Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance) and Category IV (Follicular Neoplasm/Suspicious for Follicular Neoplasm) represent indeterminate thyroid nodules with variable risks of malignancy, creating challenges in clinical management.
Aim: To determine the risk of malignancy in Bethesda Category III and IV thyroid nodules and correlate cytological findings with final histopathological diagnosis.
Methods: A prospective observational study was conducted at Rabindranath Tagore Medical College, Udaipur, Rajasthan, from March 2024 to March 2026. Eighty patients diagnosed with Bethesda Category III or IV thyroid nodules who subsequently underwent surgery were included. Histopathological examination served as the gold standard for diagnosis. The malignancy rates in both Bethesda categories were analyzed.
Results: Among 80 patients, 45 (56.3%) belonged to Bethesda Category III and 35 (43.7%) to Category IV. Histopathological examination revealed malignancy in 14 (31.1%) Category III nodules and 18 (51.4%) Category IV nodules. Papillary thyroid carcinoma was the most common malignancy. Category IV nodules demonstrated a significantly higher risk of malignancy compared to Category III nodules (p=0.041).
Conclusion: Bethesda Category IV thyroid nodules carry a significantly higher risk of malignancy than Category III nodules. Histopathological evaluation remains essential for definitive diagnosis and appropriate surgical management.

Impact of Iron Deficiency Anemia on Hemoglobin A1c Levels in Diabetic Individuals

Hiya Mehta, Sohil Takodara, Hiranmoy Karmakar — Wed, 16 Sep 2026 00:00:00 +0000

Background: Iron deficiency anemia (IDA) is one of the most common hematological disorders and may influence glycemic indices such as HbA1c independent of blood glucose levels. This can affect the interpretation of diabetic status in affected individuals.
Aim: To evaluate hematological parameters and HbA1c levels among male and female patients with iron deficiency anemia and to assess gender-wise differences.
Methods: This observational study included 100 patients with iron deficiency anemia, comprising 50 males and 50 females. Hematological parameters including hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), random blood sugar (RBS), and HbA1c were analyzed. Data were expressed as mean ± standard deviation.
Results: The mean age was 55.39 ± 17.60 years in males and 57.50 ± 17.19 years in females. Mean Hb levels were 9.76 ± 2.48 g/dL in males and 9.51 ± 2.47 g/dL in females. MCV and MCH values were reduced in both groups, consistent with microcytic hypochromic anemia. Females demonstrated higher mean HbA1c levels (7.62 ± 2.50%) compared to males (6.93 ± 2.02%). Mean RBS values were also higher among females (168.50 ± 115.61 mg/dL) than males (151.70 ± 85.30 mg/dL).
Conclusion: Patients with iron deficiency anemia showed altered hematological indices and elevated HbA1c levels, particularly among females. Iron deficiency may influence HbA1c interpretation, and caution should be exercised while diagnosing or monitoring diabetes in anemic patients.

Role of Serum Procalcitonin as an Early Biomarker of Severity in Acute Pancreatitis: A Prospective Observational Study

Charu Gunjal, Ankita Sharma, Ankur Purohit, Sarla Mahawar, G.G. Kaushik — Thu, 10 Sep 2026 00:00:00 +0000

Background: Early prediction of severe acute pancreatitis (SAP) remains a clinical challenge despite the availability of several prognostic scoring systems. Serum procalcitonin (PCT), an inflammatory biomarker that rises rapidly during systemic inflammation and infection, has emerged as a promising predictor of disease severity. Early estimation of PCT may facilitate prompt identification of patients requiring intensive management.
Objective: To evaluate the role of serum procalcitonin as an early biomarker of severity in patients with acute pancreatitis and determine its association with Ranson score.
Materials and Methods: This prospective observational study was conducted from May 2022 to May 2024 in the Department of Biochemistry in collaboration with the Department of General Surgery at J.L.N. Medical College and Associated Hospitals, Ajmer. Adult patients diagnosed with acute pancreatitis according to the Revised Atlanta Classification were enrolled after obtaining informed consent. Serum procalcitonin was measured within 24 hours of admission using an immunoassay-based method. Disease severity was assessed using the Ranson scoring system and patients were categorized into mild, moderately severe, and severe acute pancreatitis. Statistical analysis was performed using SPSS version 26.0. Continuous variables were expressed as mean ± SD, and categorical variables as frequencies and percentages. Pearson correlation, one-way ANOVA, ROC curve analysis, and multivariable logistic regression were used where appropriate. A p-value <0.05 was considered statistically significant.
Results: Serum procalcitonin levels increased progressively with increasing severity of acute pancreatitis and demonstrated a significant positive correlation with Ranson score. ROC analysis showed excellent diagnostic performance for predicting severe acute pancreatitis. Elevated PCT was independently associated with persistent organ failure and severe disease.
Conclusion: Serum procalcitonin is a valuable early biomarker for predicting severe acute pancreatitis. Its routine assessment at admission may improve early risk stratification and clinical decision-making.

Histopathological Spectrum of Appendectomy Specimens: A Retrospective Study at a Tertiary Care Hospital

Kanwar Singh Goel, Samarth Shah, Abu Nasar, Darsh Ponkia — Thu, 17 Sep 2026 00:00:00 +0000

Background: Appendectomy is one of the most commonly performed emergency surgical procedures, and histopathological examination remains important for confirming acute appendicitis and detecting unexpected inflammatory, infectious, parasitic, and neoplastic lesions. This study aimed to evaluate the histopathological spectrum of appendectomy specimens received at a tertiary care hospital.
Methods: Demographic, clinical, and histopathological data were retrieved from pathology records. Specimens were routinely processed, stained with hematoxylin and eosin, and categorized according to the final histopathological diagnosis. Associations between demographic variables and histopathological findings were assessed using appropriate statistical tests, with P < 0.05 considered statistically significant.
Results: The mean age of the patients was 29.8 ± 15.2 years, with the highest proportion belonging to the 21–30-year age group (27.1%). Males constituted 55.7% of cases. Acute inflammatory lesions were identified in 106 specimens (75.7%), with acute suppurative appendicitis being the most frequent diagnosis (37.1%). Chronic/reactive lesions accounted for 12.9%, while 5.0% of specimens were histologically unremarkable.
Conclusion: Acute inflammatory lesions constituted the predominant histopathological finding in appendectomy specimens.

Functional Outcome of Quadratus Femoris Muscle Pedicle Bone Graft with Internal Fixation in Neglected Fracture Neck of Femur

Kunal Anand, Saurav Kumar, Kapil Ray — Fri, 18 Sep 2026 00:00:00 +0000

Aim: To evaluate the functional and radiological outcomes of quadratus femoris muscle pedicle bone grafting with internal fixation
in patients with neglected fracture neck of femur.
Materials and Methods: A retrospective observational study was conducted in the Department of Orthopaedics, Darbhanga Medical
College and Hospital, Laheriasarai, Darbhanga, Bihar, India, over a period of two years. Fourteen patients diagnosed with neglected
fracture neck of femur who underwent quadratus femoris muscle pedicle bone grafting with internal fixation were included. Demographic
characteristics, fracture pattern, duration between injury and surgery, operative details, radiological union, complications, and functional
outcomes assessed using the Harris Hip Score (HHS) were retrieved from hospital records. Descriptive statistics were used to summarize
the data. Fisher’s exact test and Mann–Whitney U test were applied where appropriate, with statistical significance set at p < 0.05.
Results: The mean age of the patients was 37.9 ± 10.8 years, with males comprising 64.3% of the study population. The average
interval between injury and surgery was 9.1 ± 3.8 weeks, and the mean follow-up duration was 16.8 ± 5.4 months. Radiological union
was achieved in 12 (85.7%) patients, with a mean union time of 5.8 ± 1.2 months. The mean Harris Hip Score at final follow-up was
85.1 ± 11.3. Excellent and good functional outcomes were observed in 64.3% of patients. One patient (7.1%) developed avascular
necrosis, two (14.3%) had non-union, and one (7.1%) experienced superficial wound infection. Earlier surgical intervention was
associated with better functional outcomes (p = 0.03).
Conclusion: Quadratus femoris muscle pedicle bone grafting with internal fixation demonstrated satisfactory radiological union and
favorable functional outcomes while maintaining a relatively low complication rate in patients with neglected fracture neck of femur.
This technique appears to be an effective femoral head-preserving procedure for carefully selected young and active patients. Larger
prospective studies with longer follow-up are required to confirm these findings.
Background: Neglected fracture neck of femur remains a challenging orthopedic condition, particularly in young and active individuals,
because of the high risks of non-union and avascular necrosis (AVN). Quadratus femoris muscle pedicle bone grafting combined with
internal fixation has been proposed as a biological augmentation technique to improve fracture healing by enhancing vascularity and
providing mechanical stability.

A study to improve knowledge and attitude regarding HPV infection, cervical cancer and its vaccination among undergraduate students in Government Medical College, Almora, Uttarakhand: An Educational intervention

Preeti Preeti, Vikram Singh Dhapola, Vanya Singh — Fri, 18 Sep 2026 00:00:00 +0000

Background and Aim: Human papillomavirus (HPV) is the most common sexually transmitted infection and a primary cause of
cervical cancer in women. Although incurable, HPV infection can be largely prevented through timely vaccination. This study aims
to explore the basic understanding of medical students about cervical cancer, HPV and HPV vaccination.
Methods: This was a descriptive, questionnaire based cross‑sectional study conducted among the undergraduate medical students from
March 2025 to May 2025. A total of 380 respondents participated in the study and SPSS Version 29.0.2.0 was used to analyse the data.
Results : A total of 380 students attended four educational lectures on human papillomavirus (HPV), cervical cancer, and the HPV
vaccine and completed pre- and post-tests. Most participants were younger than 21 years (56.6%), with nearly equal representation of
males and females. Post-test results showed improved knowledge regarding HPV and cervical cancer, particularly about risk factors
and preventive measures. Knowledge of the HPV vaccine also increased, especially regarding the recommended age of vaccination
in India and required doses. Participants additionally demonstrated more positive attitudes toward HPV vaccination, including greater
acceptance among sexually active females and increased recognition of HPV infection as a public health concern.
Conclusion: This study suggests that including material on HPV vaccination in the standard medical student curriculum could help
increase physician recommendation for the HPV vaccine.

Comparative Analgesic Efficacy of Adding Magnesium Sulphate to Bupivacaine in Serratus Anterior Plane Block to Reduce Pain After Mastectomy: A Prospective Comparative Study at SCB Medical College & Hospital, Cuttack

Sabita Swain, Debashisa Padhi, Sunil Kumar Das, Rashmi Rani Mahanty — Mon, 21 Sep 2026 00:00:00 +0000

Background: Postoperative pain following mastectomy remains a significant clinical challenge despite advancements in multimodal analgesia. Inadequate pain control may result in delayed recovery, prolonged hospitalization, increased opioid consumption, and development of chronic post-mastectomy pain syndrome. Serratus anterior plane (SAP) block has emerged as an effective regional anesthetic technique for postoperative analgesia in breast surgeries. Magnesium sulphate, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been investigated as an adjuvant to local anesthetics to enhance analgesic efficacy and prolong block duration.
Objective: To compare the analgesic efficacy of bupivacaine alone versus bupivacaine combined with magnesium sulphate in ultrasound-guided serratus anterior plane block for postoperative pain relief after mastectomy.
Materials and Methods: A prospective randomized comparative study was conducted at SCB Medical College & Hospital, Cuttack, from December 2024 to February 2026. A total of 100 female patients undergoing elective mastectomy under general anesthesia were enrolled and divided into two groups of 50 each. Group B received 0.25% bupivacaine in SAP block, while Group BM received 0.25% bupivacaine with magnesium sulphate 150 mg. Postoperative pain was assessed using Visual Analog Scale (VAS) scores at multiple time intervals. Time to first rescue analgesia, total analgesic consumption, hemodynamic parameters, and adverse effects were recorded. Statistical analysis was performed using SPSS version 26. Independent t-test, Chi-square test, and repeated measures ANOVA were applied.
Results: The mean postoperative VAS scores were significantly lower in Group BM compared to Group B at 4, 8, 12, and 24 hours postoperatively (p<0.001). The mean duration of analgesia was significantly prolonged in Group BM (13.6 ± 2.1 hours) compared to Group B (7.2 ± 1.4 hours) (p<0.001). Total rescue analgesic consumption was significantly reduced in Group BM (92 ± 28 mg) compared to Group B (168 ± 34 mg) (p<0.001). Hemodynamic stability was better maintained in Group BM. Incidence of postoperative nausea and vomiting was lower in Group BM, although statistically insignificant.
Conclusion: Addition of magnesium sulphate to bupivacaine in serratus anterior plane block significantly improves postoperative analgesia after mastectomy by reducing pain scores, prolonging duration of analgesia, and decreasing rescue analgesic requirements without significant adverse effects.

Clinicopathological Profile and Tnm Stage Distribution of Colorectal Adenocarcinoma

Sudhanshu Suman, Pawan Bhambani, Sanjeev Narang, Romi Srivastava, V.K Jain — Wed, 23 Sep 2026 00:00:00 +0000

Background: Colorectal cancer (CRC) stands as a formidable global health challenge, representing the third most commonly
diagnosed malignancy and the second leading cause of cancer-related mortality worldwide. From a histopathological perspective,
the landscape of CRC is dominated by adenocarcinoma. The clinical impact of colorectal adenocarcinoma is intrinsically linked to
the stage at which the disease is detected. Accurate pathological staging and identification of adverse histopathological features are
therefore essential for prognosis and treatment planning.
Methods: This prospective observational study included 50 consecutive patients with a new, histologically confirmed diagnosis
of colorectal adenocarcinoma at a tertiary care hospital. Demographic and clinical characteristics, tumor localization, histological
grade, lymphovascular invasion (LVI), perineural invasion (PNI), and TNM stage were evaluated. Patients were stratified into three
age groups: <40 years, 40-59 years, and ≥60 years. Pathological staging was performed according to the eighth edition of the AJCC/
UICC TNM staging system. Associations between categorical variables were assessed using the Chi-square test or Fisher’s exact test,
as appropriate. A p-value of less than 0.05 was considered statistically significant.
Results: The mean age of the study cohort was 57.8 ± 12.1 years, with 46.0% of patients aged ≥60 years. Males constituted 64.0%
of the cohort. Rectal bleeding was the most common presenting symptom (62.0%), followed by altered bowel habits (56.0%) and
abdominal pain (44.0%). The rectum was the most common primary tumor site (42.0%), followed by the left colon (36.0%) and right
colon (22.0%). Moderately differentiated adenocarcinoma was the predominant histological grade (64.0%), while poorly differentiated
tumors accounted for 22.0%. LVI was present in 48.0% and PNI in 28.0% of patients. Stage III was the most common stage group
(38.0%), followed by Stage II (26.0%), Stage IV (24.0%), and Stage I (12.0%). Overall, 62.0% of patients presented with Stage III/
IV disease. Advanced stage was significantly associated with older age (p=0.04), poor tumor differentiation (p<0.01), lymph node
positivity (p<0.001), and LVI (p<0.001).
Conclusion: Colorectal adenocarcinoma in the studied population predominantly presented at an advanced stage, particularly among
older male adults. Rectal and left-sided tumors were the most frequent, while poor differentiation, lymph node positivity, and LVI
were strongly associated with advanced disease. These findings emphasize the importance of structured early detection and screening
programs and meticulous histopathological evaluation for appropriate stage-based management.

Evaluation of Inflammatory Biomarkers and Oxidative Stress Parameters Before and After Low-Dose Thalidomide Therapy in Patients with β-Thalassemia

Manamohan Biswal, Rajeeb Kumar Nayak, Mitanjali Behera — Thu, 24 Sep 2026 00:00:00 +0000

Background: β-Thalassemia is a hereditary hemoglobinopathy characterized by ineffective erythropoiesis, chronic hemolytic anemia,
iron overload, oxidative stress, and persistent inflammation. Increased production of reactive oxygen species and elevated inflammatory
cytokines contribute significantly to disease progression and multiple organ complications. Low-dose thalidomide has emerged as
a promising therapeutic option due to its ability to induce fetal hemoglobin production, improve erythropoiesis, reduce transfusion
requirements, and exert anti-inflammatory effects. However, limited data are available regarding its influence on inflammatory
biomarkers and oxidative stress parameters in patients with β-thalassemia.
Objective: To evaluate changes in inflammatory biomarkers and oxidative stress parameters before and after low-dose thalidomide
therapy in patients with β-thalassemia.
Materials and Methods: A retrospective observational study was conducted in the Department of Clinical Hematology, S.C.B. Medical
College and Hospital, Cuttack, Odisha, India, from September 2025 to June 2026. Medical records of patients with β-thalassemia
receiving low-dose thalidomide therapy were reviewed. Demographic characteristics, clinical features, hematological parameters,
inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and oxidative
stress markers including malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and total antioxidant
capacity (TAC) were collected before initiation of therapy and after six months of treatment. Statistical analysis was performed using
SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation and compared using paired Student’s t-test.
A p-value <0.05 was considered statistically significant.
Results: Following six months of low-dose thalidomide therapy, significant reductions were observed in serum CRP, IL-6, TNF-α,
and MDA levels (all p<0.001). Antioxidant parameters including SOD, GPx, and TAC showed significant improvement after treatment
(p<0.001). Mean hemoglobin concentration increased significantly, while annual transfusion requirements decreased. No serious
adverse events requiring permanent discontinuation of therapy were observed.
Conclusion: Low-dose thalidomide significantly reduced systemic inflammation and oxidative stress while improving antioxidant
defense and hematological parameters in patients with β-thalassemia. These findings support its potential role as an effective adjunctive
therapy in the management of transfusion-dependent β-thalassemia.

Lymphocyte-To-C-Reactive Protein Ratio As An Early Prognostic Marker In Emergency Department Patients With Sepsis: A Retrospective StuDY

Palak Raj, Riya Shah, Sanjeev Narang, Romi Srivastava, V K Jain — Mon, 28 Sep 2026 00:00:00 +0000

Background: Sepsis is a life-threatening condition associated with systemic inflammation, immune dysfunction and organ failure.
Early identification of patients at increased risk of mortality and acute kidney injury (AKI) remains challenging. The lymphocyte-to-Creactive
protein ratio (LCR) combines information on lymphocyte depletion and systemic inflammation and may have prognostic value.
Methods: A retrospective observational study was conducted among 400 adult patients with sepsis presenting to the emergency
department. Baseline demographic, clinical and laboratory data were collected. LCR was calculated from the initial absolute
lymphocyte count and CRP concentration. Patients were categorized into four LCR quartiles. The primary outcome was 30-day allcause
mortality, while AKI was evaluated as a secondary outcome. ROC analysis, Kaplan-Meier survival analysis and multivariable
regression were performed.
Results: Overall, 110 patients (27.5%) died within 30 days and 182 (45.5%) developed AKI. Mortality decreased progressively across
LCR quartiles, from 36.6% in Q1 to 16.2% in Q4 (p=0.003). AKI similarly decreased from 59.4% in Q1 to 31.3% in Q4 (p<0.001).
Lower LCR was associated with higher disease severity, inflammatory burden and organ dysfunction. LCR demonstrated an AUC of
0.671 for 30-day mortality and 0.648 for AKI. Kaplan-Meier analysis showed significantly poorer survival among patients with lower
LCR (log-rank p<0.001). Higher LCR remained associated with lower mortality and AKI after multivariable adjustment.
Conclusion: Lower LCR was associated with increased 30-day mortality and AKI in emergency department patients with sepsis.
LCR may serve as a simple adjunctive biomarker for early risk stratification.

Association of Poor Long-Term Glycemic Control with Stroke Pattern, National Institutes of Health Stroke Scale Score, and Early Prognosis in Patients with Acute Cerebrovascular Event

Preeti Gupta, Anusha Chouhan, Venugopal Margekar, R. K. Patel — Fri, 02 Oct 2026 00:00:00 +0000

Background: Stroke remains one of the leading causes of mortality and long-term disability worldwide. Diabetes mellitus is a major
modifiable risk factor for cerebrovascular disease, and chronic hyperglycaemia contributes to endothelial dysfunction, accelerated
atherosclerosis, and impaired cerebral circulation. Glycated haemoglobin (HbA1c) reflects long-term glycaemic control over the
preceding two to three months and has emerged as an important biomarker for predicting vascular complications. Although several
studies have evaluated the association between HbA1c and stroke outcomes, evidence regarding its relationship with stroke pattern,
National Institutes of Health Stroke Scale (NIHSS) score, and early prognosis in the Indian population remains limited.
Methodology: A hospital-based cross-sectional observational study was conducted in the Department of Medicine, Pt. JNM Medical
College and Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, over one year. One hundred consecutive adult patients presenting with
acute cerebrovascular events confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) were enrolled. Clinical
characteristics, vascular risk factors, HbA1c, stroke subtype, NIHSS score at admission, and early clinical outcome were recorded.
Patients were categorized into good glycaemic control (HbA1c <7.0%) and poor glycaemic control (HbA1c ≥7.0%). Statistical
analysis included Chi-square test, independent Student’s t-test, Pearson correlation, and multivariable logistic regression. A p-value
<0.05 was considered statistically significant.
Results: Among the 100 enrolled patients, 62% had poor long-term glycaemic control (HbA1c ≥7.0%). Poor glycaemic control was
significantly associated with ischemic stroke (77.4% vs. 57.9%; p=0.039), higher NIHSS scores (13.8±5.2 vs. 9.7±4.6; p<0.001),
severe stroke (43.5% vs. 18.4%; p=0.012), and poor early clinical outcome (54.8% vs. 26.3%; p=0.006). HbA1c showed a moderate
positive correlation with NIHSS score (r=0.49, p<0.001). Multivariable logistic regression identified HbA1c ≥7.0% (OR 3.46, 95% CI
1.38–8.66; p=0.008), hypertension (OR 2.81, 95% CI 1.10–7.19; p=0.031), and age ≥60 years (OR 2.47, 95% CI 1.01–6.04; p=0.047)
as independent predictors of poor early prognosis.
Conclusion: Poor long-term glycaemic control is significantly associated with greater stroke severity, higher NIHSS scores, ischemic
stroke predominance, and poorer early prognosis in patients with acute cerebrovascular events. HbA1c may serve as a useful prognostic
biomarker for early risk stratification in acute stroke.
Recommendation: Routine HbA1c assessment should be incorporated into the initial evaluation of patients presenting with acute
stroke. Early identification of poor glycaemic control may facilitate risk stratification, optimize management, and improve neurological
outcomes. Larger multicentre prospective studies are recommended to validate these findings.

Diagnostic Accuracy of Neutrophil-to-Lymphocyte Ratio and Platelet-to- Lymphocyte Ratio for Detection of Microalbuminuria in Patients with Diabetes Mellitus: A Hospital-Based Cross-Sectional Observational Study

Anusha Chouhan, Venugopal Margekar, Preeti Gupta — Fri, 02 Oct 2026 00:00:00 +0000

Background: Diabetes mellitus (DM) is one of the leading causes of chronic kidney disease worldwide. Diabetic nephropathy develops
gradually, with microalbuminuria representing the earliest clinically detectable manifestation of renal involvement. Early identification
of patients at increased risk is essential because timely intervention can delay or prevent progression to overt nephropathy and endstage
renal disease. Although urinary albumin estimation remains the gold standard for detecting microalbuminuria, it may not always
be readily available in resource-limited settings. Chronic low-grade inflammation plays a pivotal role in the development of diabetic
vascular complications. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), derived from routine complete
blood counts, have emerged as inexpensive inflammatory biomarkers reflecting systemic inflammation. Their potential diagnostic
value in identifying microalbuminuria among patients with diabetes has generated increasing research interest.
Methodology: A hospital-based cross-sectional observational study was conducted in the Department of Medicine, Pt. Jawaharlal
Nehru Memorial Medical College and Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, over one year. One hundred twenty adult patients
with diabetes mellitus fulfilling the eligibility criteria were enrolled consecutively. Clinical characteristics, duration of diabetes,
anthropometric measurements, laboratory investigations, complete blood count parameters, NLR, PLR, HbA1c, and urinary albumin
excretion were recorded. Diagnostic performance of NLR and PLR for detecting microalbuminuria was evaluated using receiver
operating characteristic (ROC) curve analysis. Statistical analysis was performed using IBM SPSS Statistics version 26.0.
Results: Among 120 patients, 48 (40.0%) had microalbuminuria. Patients with microalbuminuria demonstrated significantly higher
mean NLR (3.91 ± 1.24 vs. 2.18 ± 0.76; p<0.001) and PLR (164.7 ± 39.8 vs. 118.5 ± 28.9; p<0.001) compared with normoalbuminuric
patients. ROC analysis showed that NLR had an area under the curve (AUC) of 0.86 (95% CI: 0.79–0.92), whereas PLR demonstrated
an AUC of 0.81 (95% CI: 0.73–0.89). At an optimal cut-off value of 2.95, NLR showed 83.3% sensitivity and 80.6% specificity for
detecting microalbuminuria.
Conclusion: Both NLR and PLR were significantly associated with microalbuminuria among patients with diabetes mellitus. NLR
demonstrated superior diagnostic accuracy compared with PLR and may serve as a practical, inexpensive, and readily available
screening biomarker for early diabetic nephropathy.

Predictor of Vitamin B12 Deficiency in Type 2 Diabetes Mellitus Patients Receiving Metformin: A Cross-Sectional Analysis

Venugopal Margekar, Preeti Gupta, Anusha Chouhan, Manish Patil — Fri, 02 Oct 2026 00:00:00 +0000

Background: Metformin remains the first-line pharmacological therapy for type 2 diabetes mellitus (T2DM) because of its proven
efficacy, safety profile, and cardiovascular benefits. However, prolonged metformin therapy has increasingly been associated with
reduced vitamin B12 absorption, potentially leading to biochemical deficiency and clinical manifestations such as anemia, peripheral
neuropathy, cognitive impairment, and worsening diabetic neuropathy. Despite growing awareness, routine screening for vitamin
B12 deficiency among metformin-treated patients is not universally practiced, particularly in resource-limited settings. Identifying
clinical predictors of vitamin B12 deficiency may facilitate early diagnosis and timely intervention.
Methodology: A hospital-based cross-sectional study was conducted in the Department of Medicine, Pt. JNM Medical College and
Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, over one year. Eighty-five adults with type 2 diabetes mellitus receiving metformin
therapy were included. Demographic characteristics, anthropometric measurements, duration of diabetes, metformin dose, treatment
duration, glycemic indices, hematological parameters, and serum vitamin B12 concentrations were evaluated. Vitamin B12 deficiency
was defined according to standard laboratory reference values. Appropriate statistical analyses including Chi-square test, independent
t-test, Pearson correlation, and multivariable logistic regression were performed, with statistical significance considered at p <0.05.
Results: Among 85 participants, vitamin B12 deficiency was identified in 28 (32.9%). Vitamin B12 deficiency was significantly
associated with longer duration of metformin therapy (>5 years), higher daily metformin dose (≥2000 mg/day), poor glycaemic control
(HbA1c ≥7.0%), and the presence of peripheral neuropathy (all p<0.05) on univariate analysis. Multivariable logistic regression
demonstrated that prolonged metformin therapy (OR 3.42, 95% CI 1.29–9.10; p=0.013), higher daily metformin dose (OR 2.84, 95%
CI 1.08–7.43; p=0.034), and peripheral neuropathy (OR 4.18, 95% CI 1.55–11.24; p=0.005) were independent predictors of vitamin
B12 deficiency, whereas HbA1c was not independently associated after adjustment (p=0.102).
Conclusion: Vitamin B12 deficiency appears to be relatively common among patients with type 2 diabetes mellitus receiving longterm
metformin therapy. Extended treatment duration, higher metformin dosage, and suboptimal glycemic control may independently
predict deficiency. Periodic monitoring of vitamin B12 status may facilitate early detection and reduce long-term neurological and
hematological complications.
Recommendation: Routine vitamin B12 screening should be considered for patients receiving prolonged metformin therapy, particularly
those with poor glycemic control, higher daily doses, or clinical evidence of neuropathy. Larger multicentre prospective studies are
recommended to validate these observations.

Clinical Profile and Treatment Outcome of Infantile Spasms Of varied etiology: A Hospital-Based Observational Study

Arpita Jalan, Sunil Kumar Agarwalla, Subash Kishan — Mon, 28 Sep 2026 00:00:00 +0000

Objective: To evaluate the clinical profile, neuroimaging and electroencephalographic findings, and outcomes among children diagnosed with infantile spasms.
Methods: This prospective observational hospital-based study was conducted in the Department of Pediatrics, S.C.B. Medical College and Hospital and SVPPGIP, Cuttack, Odisha, from August 2023 to July 2025. Fifty children clinically diagnosed with infantile spasms and/or confirmed with electroencephalography (EEG) findings were included. Demographic details, perinatal history, developmental status, EEG and magnetic resonance imaging (MRI) findings, type of spasms, and treatment response to adrenocorticotropic hormone (ACTH) were analyzed.
Results: Among the 50 children enrolled, 26 (52%) were females and 24 (48%) were males. Majority of children (94%) belonged to the age group of 6 months to 2 years. History suggestive of birth asphyxia was present in 80% of cases. Developmental delay was observed in 76% of children. Flexor spasms were the most common type (62%), followed by mixed spasms (22%) and extensor spasms (16%). EEG abnormalities were noted in 48% and MRI abnormalities in 42% of children. Complete seizure control with ACTH therapy was achieved in all children with extensor spasms, 74.2% of children with flexor spasms, and 54.5% of children with mixed spasms. A statistically significant association was observed between developmental outcome after follow-up and type of spasm (p=0.043).
Conclusion: Infantile spasms commonly present between 6 months and 2 years of age and are frequently associated with birth asphyxia and developmental delay. Flexor spasms were the predominant presentation. ACTH therapy achieved favorable seizure control, particularly in children with extensor and flexor spasms. Early recognition and prompt treatment may improve both seizure and developmental outcomes.