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.

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.

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.