The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available. AJMS is both online and printed journal. The electronic -ISSN is 2091-0576 and Print-ISSN is 2467-9100. AJMS was added to DOAJ on 26th May 2020. Last Updated 15th March 2025 AJMS was added to CAB Abstracts and/or Global Health database on 15th December 2020. Coverage will start from Volume 11, No. 1, 2020 onwards. The Journal has started publishing on the new website https://ajmsjournal.info/index.php/AJMS/index The authors are advised to submit their articles on the new website.
Asian Journal of Medical Sciences Pokhara
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Evaluating the family adoption program as a noncommunicable disease surveillance tool in India: A systematic review
India faces a rising noncommunicable disease (NCD) burden, highlighting the need for effective surveillance. The family adoption program (FAP), a medical education initiative engaging students with communities, presents potential for data collection. This systematic review evaluated FAP’s effectiveness as an NCD surveillance tool. Following PRISMA guidelines, relevant databases were searched (2020–2025) for FAP studies reporting prevalence data on obesity, anemia, diabetes, or hypertension. Three FAP studies, including the National Medical Commission FAP Survey Report 2024, were compared against five national reports. While FAP-derived obesity prevalence closely matched National Family Health Survey −5 data, significant discrepancies were found for hypertension, anemia, and diabetes estimates. These were attributed to methodological inconsistencies, lack of population representativeness, and variations in training and equipment calibration within FAP compared to standardized national surveys. FAP data showed moderate–high bias risk. Although valuable for experiential learning and local health initiatives, FAP currently lacks the methodological rigor and representativeness for reliable national/state NCD surveillance without significant standardization and quality improvements.
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Gestational trophoblastic neoplasia with cardiac metastasis and multiple embolic manifestations: A rare case report
Gestational trophoblastic neoplasia (GTN) is a highly treatable malignancy with cure rates of approximately 100% in low-risk and 90% in high-risk cases. This report details an 18-year-old primigravida diagnosed with high-risk GTN after preterm intrauterine death, presenting with significant vaginal bleeding and an elevated beta-human chorionic gonadotropin level exceeding 300,000 mIU/mL. Imaging revealed a large uterine mass with myometrial invasion and pulmonary metastasis. With a World Health Organization risk score of 8, the patient experienced severe embolic complications, including transient ischemic attacks and infarcts. Treatment involved multi-agent chemotherapy, anticoagulants, and antibiotics, which led to complete regression of the cardiac mass and remission after four cycles. This case highlights the challenges in the risk stratification and management of GTN with unusual metastatic sites, such as the heart. The independent high-risk factor of tumor age, highest in GTN following term pregnancy, may explain the propensity for unusual metastatic sites and poorer prognostic importance of timely diagnosis and treatment for optimal outcomes.
Neurotherapy as an intervention for lumbar spondylosis
Lumbar spondylosis (LS) is a common degenerative spinal condition that contributes significantly to chronic low back pain and disability, particularly in older adults. This case report investigates the effectiveness of neurotherapy as a non-invasive treatment for LS. A 35-year-old woman with magnetic resonance imaging (MRI)-confirmed LS, opted against surgical intervention, and underwent 48 neurotherapy sessions over a 12-week period. The therapy targeted seven specific anatomical zones, aiming to enhance circulation, reduce nerve compression, and improve intervertebral spacing. Post-treatment MRI demonstrated a notable increase in L5-S1 disc space from 3.0 mm to 7.0 mm, indicating reduced spinal compression. In addition, the patient reported significant pain relief and improved mobility. These findings suggest that neurotherapy offers both symptomatic and structural benefits, making it a promising alternative to traditional treatments for LS. This case highlights the potential of neurotherapy as a non-invasive therapeutic option to address the root causes of LS and enhance patient outcomes.
Coughing up blood in tuberculosis: What three cases reveal about diagnosis and care
Hemoptysis, or coughing blood, is a significant and potentially life-threatening symptom of pulmonary tuberculosis (PTB). The severity of hemoptysis can vary from mild to life-threatening, with massive hemoptysis posing severe risks due to hemodynamic instability and airway compromise. The diagnostic process is complicated by the multiple etiologies of hemoptysis in post-PTB patients, necessitating the use of comprehensive imaging techniques such as computed tomography angiography. Treatment options include arterial embolization, which is preferred over surgical intervention because of the poor respiratory reserve observed in most PTB cases. This case series highlights three distinct presentations of hemoptysis in patients with PTB, including Rasmussen’s aneurysm, tuberculosis-associated malignancy, and PTB in a genetically predisposed individual, illustrating the spectrum of complications, including Rasmussen’s aneurysm, malignancy, and active infection in a genetically predisposed patient. This report emphasises the importance of a comprehensive diagnostic approach and individualised treatment strategies for optimal patient outcomes.
Death due to homicidal firearm injury and concealment of crime: A case series
A firearm is a dangerous weapon used by a person in self-defense and to kill another person because of various reasons. It is also used by the defense personnel for the safety and security of citizens of a country and other reasons. Unlicensed firearm weapons are used by many persons with ill intentions, such as robbery, threat, kidnapping, and murder. Injuries due to firearm weapons can be homicidal, suicidal, and accidental. In many cases, a person is killed by the assailant by firearm weapon, and then the body is disposed of at various places to conceal the crime. In the present case series, the authors present three cases of death due to firearm injuries where the disposal of the body by the assailant was done at different places to conceal the crime. However, on meticulous postmortem examination of the deceased, exact cause of death, manner of death, nature of injury (antemortem/postmortem), type of weapon, and time since death was opined helps the investigating agency to solve the crime and delivery of justice to the family of the victim.
Structural and morphometric evaluation of the lumbar plexus and its branches: Focus on lumbar nerve roots
Background: Variations in Lumbar plexus anatomy can affect surgical and anaesthetic outcomes. Despite the documented general anatomy, detailed morphometric measurements of lumbar nerve roots and branches remain limited, especially in the Indian population. Understanding these morphometric characteristics is crucial for nerve reconstruction, identification of nerve pathologies, and radiological interpretation. Aims and Objectives: This study aims to provide a detailed morphometric analysis of the lumbar plexus and to establish statistical correlations between measurements while examining branching patterns. Materials and Methods: This cadaveric study included 100 specimens used for routine undergraduate dissection in the anatomy department. Results: The ventral rami of L1-L4 spinal nerves were present in all dissected lumbar plexuses. One specimen showed a T12 contribution, and four specimens received L5 contributions. The genital and femoral branches were seen as separate branches piercing the psoas major in 43% of specimens. The accessory obturator nerve (ON) was observed in 16% of specimens. The lateral femoral cutaneous nerve originated from the femoral nerve (FN) in 6% of cases. Statistically, the thickness of L3 and L4 roots was found to be positively correlated, independent of L1. A significant negative correlation was found between the femoral and ONs and the L3 and L4 roots. The ilioinguinal nerve had the longest course, whereas the FN had the shortest. The thickest nerve was the FN, and the thinnest was the ilioinguinal nerve. Conclusion: Morphometric knowledge can be useful during procedures, such as lumbar plexus blocks, estimating nerve root compression risks, selecting donor nerves for grafts, and planning nerve rehabilitation.
A comparative study of supraglottic airway devices blockbuster LMA versus BASKA mask in adult patients undergoing laparoscopic cholecystectomy under general anesthesia
Background: Supraglottic airway devices (SADs) have been extensively utilized as an alternative to tracheal intubation in the context of general anesthesia. Aims and Objectives: The study aimed to compare the utility of the new supraglottic airway Blockbuster and Baska Mask (BM) in patients undergoing laparoscopic cholecystectomy under general anesthesia. Materials and Methods: This prospective, single-blind, randomized study included 160 participants who underwent laparoscopic cholecystectomy at our tertiary care institute from May 2023 to May 2024. Participants were randomly assigned to two groups: Group I received the BM, whereas Group II received the Blockbuster laryngeal mask airway (LMA). The groups were compared in terms of demographic characteristics, ease of insertion, number of attempts, insertion time, oropharyngeal sealing pressure (OSP), adequacy of ventilation, hemodynamic changes, and complications. Independent samples t-test was used to compare continuous variables, whereas the chi-square test was used to assess associations between categorical variables. Results: The demographic characteristics of the two groups were comparable, with no significant differences (P>0.05). Our findings indicated that the number of attempts, ease of insertion, insertion time, and hemodynamic variables did not differ significantly between the two groups (P>0.05). Conclusion: Both SADs, the Blockbuster LMA and the BM, can be safely employed during general anesthesia and positive pressure ventilation for laparoscopic cholecystectomy. The Blockbuster LMA demonstrated a shorter insertion time compared to the BM, along with superior OSP.
A comparative study of ultrasound-guided caudal block versus anatomical landmark-based caudal block in pediatric patients undergoing infra-umbilical surgeries
Background: Pain is an unpleasant sensory and emotional experience that can lead to a variety of potentially negative sequelae in any age group. Thus, efficient and optimum pain management is essential. Optimum post-operative pain management is crucial for preventing adverse sequelae in the post-operative period. Caudal epidural block is a commonly performed regional anesthetic technique for maintaining intra- and post-operative analgesia for pediatric patients undergoing lower abdominal, urogenital, and lower limb surgeries. Aims and Objectives: This study was done to compare the success rate and complications between ultrasound (USG) and landmark-guided caudal epidural analgesia in infra-umbilical surgeries in children aged more than 1 month–<12 years. Materials and Methods: A total of 150 subjects were randomly allocated into two equal groups (each of 75 patients). Double blinding was done. Both the groups were compared for procedural time, occurrences of subcutaneous swelling, hemorrhagic tap, dural puncture, requirement of intraoperative fentanyl as rescue analgesia, and post-operative analgesia by revised Face, Legs, Activity, Cry, Consolability and Visual Analog Scale score. Results: USG-guided caudal block had significantly higher (P<0.001) procedure time (mean±standard deviation procedure time=11.6±1.6), significantly lower (P=0.003) incidence of subcutaneous swelling, and significantly lower (P=0.012) requirement of fentanyl. Post-operative pain was comparable. Conclusion: USG-guided caudal block was more time-consuming (P<0.001) but with a higher success rate and subcutaneous swelling (P=0.003) occurred less.
Analytical assessment of the efficacy and safety of pudendal nerve block in post-haemorrhoidectomy pain management
Background: Post-hemorrhoidectomy pain is a significant challenge, often necessitating the use of multiple analgesics, including opioids, which come with potential side effects such as nausea, constipation, and dependency. Alternative approaches like regional nerve blocks, including the pudendal nerve block (PNB), have been proposed to alleviate pain management with fewer side effects. Aims and Objectives: The current study was designed to compare the efficacy and safety of PNB over standard analgesia in Basaveshwar Teaching and General Hospital, Gulbarga. Materials and Methods: A randomized controlled trial was conducted involving patients undergoing hemorrhoidectomy. Participants were divided into two groups: One receiving PNB in addition to standard analgesics, and the other receiving only standard analgesics. Pain scores were assessed using the visual analog scale at regular intervals post-surgery. Secondary outcomes included the need for additional analgesics, hospital stay duration, and complications. Statistical analyses were performed to determine the significance of differences between groups. Results: Patients receiving PNB reported significantly lower pain scores compared to the control group (P<0.05). The use of additional analgesics was reduced by 30%, and no severe complications related to the nerve block were observed. Hospital stay duration was also slightly shorter in the intervention group. Conclusion: The PNB is an effective and safe adjunct for post-hemorrhoidectomy pain management. Its ability to reduce pain and decrease reliance on systemic analgesics makes it a promising alternative to traditional approaches.
Effectiveness of dietary interventions on metabolic and hormonal profiles in women with polycystic ovary syndrome
Background: Polycystic ovary syndrome (PCOS) affects women globally and is rising in urban areas due to sedentary lifestyles and unhealthy dietary patterns. It involves hormonal and metabolic disturbances such as insulin resistance and obesity. Lifestyle changes can improve the pathophysiology and symptoms through dietary modifications. However, optimal strategies remain unclear. Aims and Objectives: The present study evaluates the effectiveness of a 12-week dietary intervention on metabolic and hormonal outcomes in women with PCOS. Materials and Methods: This open-label, randomized controlled interventional study was conducted on 59 diagnosed PCOS women after obtaining ethical clearance and written consent. Participants underwent a 12-week dietary intervention based on the Indian Council of Medical Research and National Institute of Nutrition’s Recommended Dietary Allowances. Metabolic and hormonal parameters were recorded at baseline, 6 weeks, and 12 weeks. Results were expressed as mean±standard deviation. Data were analyzed using repeated measures analysis of variance, with Bonferroni post hoc tests for pairwise comparisons, and a P<0.05 was considered statistically significant. Results: Most participants were young, urban, educated, and from higher socioeconomic backgrounds. Dietary modification led to significant reductions in hemoglobinA1c, lipid parameters (triglycerides, total cholesterol, and low-density lipoprotein), and an increase in high-density lipoprotein levels, reflecting improved metabolic health. Hormonal profiles also improved significantly, with reductions in LH, insulin, dehydroepiandrosterone, estradiol, prolactin, and testosterone, and increases in sex hormone binding globulin and progesterone. Conclusions: The findings indicate that structured dietary interventions are effective in improving both metabolic and hormonal parameters in women with PCOS. This highlights the potential of dietary modification as a valuable non-pharmacological approach to managing PCOS-related health issues.
The correlation of neutrophil-lymphocyte ratio and platelet–lymphocyte ratio with nephropathy in patients of type 2 diabetes mellitus-a hospital-based study from South India
Background: Diabetes is a group of metabolic diseases characterized by hyperglycemia due to defects in insulin secretion, action, or both. Diabetic nephropathy is among the serious complications of diabetes. Albuminuria is used as a biomarker for diabetic nephropathy. There is evidence of inflammation leading to the development and progression of diabetic nephropathy. White blood cell count, platelet counts have been used as markers of inflammation. Aims and Objectives: This study aims to determine a correlation between neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and diabetic nephropathy. Materials and Methods: This cross-sectional analytical study was done among 99 individuals availing of the Medical College Hospital services for 18 months. They were classified into three groups of thirty-three participants each, based on the urine albumin–creatinine ratio. The three groups were the normoalbuminuria, microalbuminuria, and macroalbuminuria groups. The NLR and PLR was calculated and compared among the three groups. Results: The mean NLR in diabetic patients with macroalbuminuria (2.68) was significantly higher than patients with normoalbuminuria (1.46) and microalbuminuria (1.80) (P=0.001). The mean PLR was also higher in diabetic patients with macroalbuminuria (156.80) when compared to patients with normoalbuminuria (90.94) and microalbuminuria (119.03) (P=0.001). Conclusions: Increased NLR and PLR levels are associated with diabetic nephropathy. A higher NLR and PLR value can indicate the progression of diabetic nephropathy due to worsening estimated glomerular filtration rate. NLR and PLR can be used as a simple prognostic marker for Diabetic Nephropathy.
Profile of inborn errors of metabolism among the neonates admitted in special newborn care unit of a tertiary care hospital
Background: Inborn errors of metabolism (IEM) refer to a group of hereditary disorders that occur due to the disruption of normal biochemical processes in the body. Although the incidence of IEM is rare, together their incidence is more than 1:1000.1 IEM usually presents with non-specific symptoms, which could only be ruled out by the presence of a high level of suspicion of the disease. This study shares our experiences of different presentations and incidences of metabolic disorders by doing tandem mass spectrometry and highlights the importance of metabolic screening as a part of routine newborn screening. Aims and Objectives: To study the profile of inborn errors of metabolism among the sick neonates admitted in the special newborn care unit (SNCU). Materials and Methods: This is a hospital-based cross-sectional study done at SNCU of a tertiary care hospital. A total of 100 consecutive newborns with suspicion of IEM were taken as study participants and underwent IEM screening. Results: Out of 100 newborns, the majority were male. Twenty-three newborns were diagnosed with IEM. The most common IEM noted is G6PD deficiency with an overall incidence of 34%, followed by amino acid disorder. Consanguinity shows a significant association with IEM, with an incidence of 72% with a P<0.001. Hypoglycemia (P=0.04) and feed intolerance (P=0.03) also show a significant association with IEM. Conclusion: The incidence of IEM has gradually increased with the advent of metabolic screening. Early diagnosis is crucial with respect to both management and genetic counseling. The higher degree of suspicion can only bring out the actual incidence and improve its outcome.
A cross-sectional study on the evaluation of laboratory analytical quality performance in a tertiary medical college in Eastern India
Background: Six Sigma is a powerful management tool that can be used in the laboratory to assess the quality of performance in the analytical phase. Aims and Objectives: This study aims to calculate the sigma metrics of 17 biochemistry test analytes over a period of 1 year from January to December 2024. The quality goal index (QGI) is measured for analytes with Sigma metric value <3. The total analytical error observed is compared with the established total allowable error (TEa) guidelines. The root cause analysis, followed by corrective action, will be taken for parameters with poor performance. An appropriate quality control (QC) strategy will be planned for these routine biochemistry tests for quality improvement. Materials and Methods: The daily internal quality control (IQC) and the monthly External quality assessment scheme samples were run for biochemistry analytes. The mean, standard deviation, coefficient of variation, Bias%, Total error observed (TEobs), and Sigma metric were calculated for each IQC level of each analyte. The QGI was measured for analytes with a Sigma value of <3. Results: The Sigma value was highest for direct bilirubin and the lowest for phosphorus. The QGI for analytes with Sigma <3 revealed the underlying cause as inaccuracy. The TEobs was higher than the TEa for albumin, creatinine, phosphorus, and total protein. The root cause analysis demonstrated various reasons for the observed inaccuracy. A QC strategy was designed for the laboratory, based on the guidelines proposed by Westgard and Cooper. Conclusion: This study has demonstrated that Sigma metrics can be used to assess laboratory quality, analyze the cause of low performance, and also design a QC strategy for optimum and better laboratory performance.
Stroke in young adults: A 3-month outcome analysis and predictors of mortality in Northeast India – A regional perspective
Background: Stroke in young adults (18–50 years) is a growing public health challenge, with Northeast India reports a disproportionately high incidence (36.7% of total strokes). This study analyzes functional outcomes and mortality predictors using the modified Rankin scale in young stroke patients. Aims and Objectives: To study the various stroke subtypes among young adults from this country region. Second, to study the outcome of stroke at the 28th and 30th day, and further analyze the predictors of mortality. Materials and Methods: A prospective cohort of 128 young stroke patients (ischemic, hemorrhagic, and venous thrombosis) was assessed at discharge and 3-month follow-up. Regression analysis identified predictors of mortality and poor outcomes. Results: Out of 348 stroke cases, 128 (36.7%) were young patients (aged 18–55). Ischemic stroke was most common (49.2%), followed by intracerebral hemorrhage (45.3%), subarachnoid hemorrhage (3.9%), and cerebral venous thrombosis (1.6%). The study observed a total of 22 patient deaths (5.8% mortality rate). The timing of these deaths was as follows: eight patients died at discharge, nine patients passed away within the first 28 days, and five patients died by the end of three months. Conclusion: Targeted interventions addressing stroke severity, subtype, and complications are critical to improving outcomes in young adults.
Exclusive breastfeeding until six months of age and its influence on anthropometric indices: A prospective observational study
Background: The WHO recommends exclusive breastfeeding (EBF) for the first 6 months of life, for all infants; and prescribes WHO Multicentre Growth Reference Study charts for growth monitoring. However, real-time differences in growth patterns between EBF and non-EBF infants and its influencing factors have not been well documented and analyzed in India. Aims and Objectives: We conducted a prospective study to assess the prevalence of EBF and the extent of influence of modifiable and nonmodifiable variables on anthropometric indices among infants from birth to 6 months of age. Materials and Methods: Healthy term infants born in a tertiary care hospital in South India were recruited at birth. Sociodemographic data were collected, and diary cards were given to mothers to record daily feeding patterns. Weight, length, and head circumference (HC) were measured using standardized calibrated equipment at birth, 6, 10, 14, and 26 weeks during their routine immunization visits. Data were analyzed and compared for each anthropometric parameter and gain, for each time point and interval, respectively, using SPSS IBM Statistics 22. Generalized estimating equation (GEE) was calculated to assess the independent influence of potential sociodemographic predictors on anthropometric gains. Results: The prevalence of EBF among 450 infants (M: F=1.3:1) who completed the study was 47% at 6 months. The mean duration of EBF was 22.13 weeks (95% CI 18.18–22.57). The GEE analysis showed that the weights, lengths, and HCs of female babies were significantly 392 g, 1.10 cm, and 0.74 cm lesser respectively, compared to male babies across the time period (each P<0.001). Firstborns had significantly lower growth indices than second born infants (each P≤0.02). Furthermore, among infants not given EBF, their weight was significantly 119 g (P=0.02) less compared to those given EBF. Conclusions: Among the significantly influential predictors/parameters, EBF-a modifiable factor, independently influences infant anthropometric parameters positively.
Comparative evaluation of the effectiveness and safety of trichloroacetic acid chemical reconstruction of skin scars versus microneedling in facial atrophic acne scars
Background: Acne vulgaris is a common skin condition that affects numerous adolescents and young adults, often resulting in atrophic acne scars that can cause significant psychological distress for many individuals. Aims and Objectives: The primary objective of this study is to assess the effectiveness and safety of trichloroacetic acid (TCA) chemical reconstruction in comparison to microneedling for the treatment of atrophic acne scars. Materials and Methods: In this study, patients with facial atrophic acne scars were randomly assigned to one of two groups, each consisting of 20 participants. They received either TCA chemical reconstruction of skin scars (CROSS) or microneedling treatment at 4-week intervals for 16 weeks. The final outcomes were assessed 4 weeks following the last treatment session. Various evaluation methods were employed, including Goodman and Baron’s qualitative and quantitative acne scarring grading systems, the physician’s global assessment (PGA), and a visual analog scale to measure treatment results in both groups. Additionally, any side effects were documented during each visit. Results: On completion of the treatment, there was a notable enhancement in the qualitative acne scar grades, as assessed by Goodman and Baron, alongside a reduction in the mean quantitative acne scar scores. The percentage decrease in these scores, as well as the evaluations from PGA and visual analog scales, showed comparable results across both groups, with no significant differences observed and minimal adverse effects reported. Conclusion: Both microneedling and TCA CROSS are effective and safe in diminishing facial acne scars, yielding similar outcomes between the two treatment groups.
A randomized comparison of three early medical abortion regimes: Mifepristone and misoprostol, misoprostol alone and methotrexate and misoprostol
Background: Abortion is defined as the spontaneous or induced termination of pregnancy before fetal viability. It is extremely likely that couples will experience at least one unwanted pregnancy at some time during their reproductive years. Majority of abortions are performed in the first trimester. Aims and Objectives: The aim of the study was to evaluate and compare the efficacy and adverse effect profile of three regimes for medical abortion up to 56 days of gestation, that is, mifepristone and misoprostol, misoprostol alone and methotrexate and misoprostol. Materials and Methods: Ninety women attending the outpatient department for the purpose of medical abortion up to 56 days of pregnancy were enrolled for the study and divided into three groups. Group I received mifepristone and misoprostol. Group II received misoprostol alone and Group III received methotrexate and misoprostol. All women were followed up on day 14 and day 28 and assessed for completeness of abortion, side effects and complications, if any. Results: Four women (13.33%) in Group I, seven (23.33%) in Group II and 16 (53.33%) in Group III needed surgical evacuation as medical termination was unsuccessful. Nausea, vomiting and fever were the most common side effects in the study. Conclusion: The regime of mifepristone and misoprostol was found to be the most efficacious of the three regimes studied. All the regimes were safe as they did not result in any major complication.
Impact of burn injuries on maternal and fetal outcomes during pregnancy: A prospective study at a tertiary care hospital
Background: Burn injuries are a significant public health concern in India, consuming substantial healthcare resources, with a higher prevalence in rural areas. The management of burns during pregnancy is particularly challenging due to limited published data, making treatment difficult in peripheral hospitals. Given this context, we conducted a retrospective analytical study on burn injuries in pregnant women. Aims and Objectives: This study aims to analyze the clinical presentation of pregnant burn patients and evaluate the impact of burns on maternal and fetal outcomes. Materials and Methods: A total of 33 pregnant women with burn injuries were analyzed. The study assessed the causes of burns, maternal mortality, and fetal complications. Results: Among 187 female burn patients of reproductive age admitted during the study period, 33 (17.6%) were pregnant. Of these, 27 had burns covering <50% of the total body surface area (TBSA), while 6 had burns exceeding 50% TBSA. Maternal mortality was lowest in cases with TBSA below 25% and significantly increased when TBSA exceeded 50%. Fetal mortality followed a similar pattern. Burn severity, shock, and respiratory complications were the primary determinants of maternal and fetal outcomes. Conclusion: Burn injuries during pregnancy have severe consequences for both maternal and fetal health. While early and aggressive management can mitigate some adverse effects, prevention remains the most effective strategy to reduce morbidity and mortality.
Rituximab in pemphigus and pemphigoid patients: Treatment outcomes and safety profile - A 6-year tertiary center study
Background: Pemphigus and pemphigoid are autoimmune blistering disorders characterized by autoantibodies attacking skin and mucous membranes. Rituximab, targeting CD20-positive B cells, has emerged as a treatment option for resistant cases. Aims and Objectives: To evaluate the treatment outcomes and safety profile of rituximab in patients with pemphigus and pemphigoid diseases treated at a tertiary care center over 6 years. Materials and Methods: This retrospective study analyzed the outcomes of 23 patients treated with rituximab for pemphigus and pemphigoid diseases at a tertiary care hospital between February 2017 and February 2023. Data included demographics, disease characteristics, treatment specifics, and adverse reactions. Treatment response was evaluated using the Nikolsky sign, and the World Health Organization causality assessment scale classified adverse events. Statistical analysis was conducted with SPSS version 25.0. Results: The study included 23 patients (52.2% male), with a mean age of 50.48 years. Majority of the patients were diagnosed with pemphigus vulgaris (60.9%). Of the 23 patients, 17 (73.9%) achieved complete remission, while 6 (26.1%) attained partial remission. Most patients (43.5%) required two cycles of rituximab, with complete remission achieved after two cycles in 52.9% of those in remission. Patients with partial remission required more infusions, with 33.3% receiving three or more cycles. Adverse drug reactions (ADRs) were observed in 5 patients (21.7%), all of whom experienced mild, infusion-related symptoms, such as pruritus (8.7%) and dyspnea (4.3%). A significant association between gender and ADRs was found, with females more prone to ADRs (P=0.008). No severe reactions were reported, and all ADRs were resolved. Conclusion: Rituximab shows high efficacy in inducing remission in pemphigus and pemphigoid patients, with a manageable safety profile. Individualized treatment regimens, including the number of cycles, may optimize outcomes.
A retrospective observational study analyzing the clinical presentation, complications, and outcome of Melioidosis in a tertiary healthcare center in South India
Background: Melioidosis is caused by a saprophytic environmental Gram-negative bacterium Burkholderia pseudomallei. It is widespread in Northern Australia and South-east Asia and has shown an increasing trend in India. There are limited studies done in South India analyzing the clinical profile of melioidosis patients, hence the need for this study. Aims and Objectives: To analyze the demographic data, clinical presentation, investigations, treatment, complications, and outcomes in patients with melioidosis. Materials and Methods: A retrospective observational study was done on 35 patients who were admitted to a tertiary health care centre in South India from January 2017 to March 2025, who had culture-proven melioidosis. The spectrum of clinical profiles was analyzed. Results: 35 patients were studied, 68.6% were male, 71.5% were in the age group of 45–65 years, clustering of cases was seen around the rainy months, fever and cough were the most common symptoms (94.3% and 42.9%, respectively), diabetes mellitus was the most common risk factor. The most common presentation was abscess (45.71%) and pneumonia (37.1%). 42.9% required intensive care, and 2 out of 35 patients died. Conclusion: Melioidosis is an acute infection that may lead to sepsis and multi-organ dysfunction. It is often misdiagnosed due to variable clinical presentation and a lack of awareness among clinicians. Diabetes is the most common risk factor. Pneumonia, abscesses, and hepatosplenomegaly should raise suspicion of melioidosis. Blood cultures are positive in almost all cases and respond well to carbapenems/ceftazidime with cotrimoxazole. Early diagnosis and prompt treatment are paramount in improving patient outcomes.
Diagnostic value of leukocytosis in patients presenting to the emergency department with abdominal pain: A retrospective observational study
Background: Abdominal pain is one of the most common complaints in emergency departments (EDs) and poses diagnostic challenges due to its broad differential diagnosis. Leukocytosis is frequently used as a biomarker in clinical evaluation; however, its diagnostic value in predicting surgical conditions remains unclear. Aims and Objectives: This study aimed to assess the diagnostic value of leukocytosis in patients presenting to the ED with abdominal pain and determine its relationship with the need for surgical intervention. Materials and Methods: This retrospective, cross-sectional study was conducted at Esenyurt Necmi Kadıoğlu State Hospital ED, analyzing medical records of adult patients presenting with abdominal pain between January 1, 2023, and December 31, 2024. Patients were categorized based on white blood cell (WBC) count into four groups. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of leukocytosis in predicting surgical needs were calculated. Statistical analyses included receiver operating characteristic curve analysis, Chi-square tests, and logistic regression modeling. Results: A total of 750 patients were included in the final analysis. Leukocytosis was observed in 59.7% of patients. Surgical intervention was required in 41.2% of cases. A significant association was found between elevated WBC counts and the need for surgery (P=0.002). Leukocytosis showed 85% sensitivity, 75% specificity, 78% PPV, and 80% NPV. Patients with WBC >15.0×103/μL were 3.5 times more likely to require surgery. Conclusions: Leukocytosis is a useful diagnostic marker for identifying patients with abdominal pain who may require surgical intervention. However, due to its limited specificity, it should be interpreted alongside clinical and imaging findings. Further multicenter prospective studies are needed to validate these findings and improve diagnostic algorithms.
Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational study
Background: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus. Intravenous cyclophosphamide (CYC) is the standard induction therapy for proliferative LN, but it is associated with serious adverse effects such as sterility and bone marrow suppression. Mycophenolate mofetil (MMF) has emerged as a promising alternative, offering better renal outcomes and preserving fertility in women of childbearing age. Aims and Objectives: To compare the treatment outcomes and safety of MMF plus prednisolone versus CYC plus prednisolone in the induction treatment of LN. Materials and Methods: Patients with Class 3 and 4 LN who received either oral MMF (2 g/day) or CYC (0.75–1 g/m2) were included in the study. Remission rates and adverse events were measured as treatment outcomes. Results: The study found 81% remission in the MMF group compared to 76.4% in the CYC group (not statistically significant). Adverse effects in the MMF group included headache (52.4%), bone marrow toxicity (47.6%), back pain (42.9%), and gastrointestinal side effects (42.8%). The CYC group had higher rates of bone marrow toxicity (57.1%), respiratory infections (33.3%), and mucocutaneous infections (57.1%). Notably, alopecia (4.8% vs. 52.4%, P=0.001) and amenorrhea (4.8% vs. 28.6%, P=0.04) were significantly lower in the MMF group. Conclusion: The MMF-steroid regimen is highly effective for inducing remission in proliferative LN and offers a more favorable safety profile than the CYC-steroid regimen.
Chemotherapy-induced neutropenia and its determinants in patients with solid malignancies: A prospective observational study
Background: Chemotherapy-induced neutropenia (CIN) is a significant dose-limiting toxicity of chemotherapy that can lead to severe infection and treatment disruption. Febrile neutropenia (FN) has an in-hospital mortality rate of 2–7% in adults with solid tumors. Aims and Objectives: This study evaluated the incidence, risk factors, and outcomes of CIN and FN in patients with solid malignancies in India. Materials and Methods: In this hospital-based prospective observational study conducted at Tirunelveli Medical College Hospital, 1,252 adult patients with solid tumors underwent chemotherapy over a 12-month period. Among these patients, 142 developed CIN and were included in the analysis. Demographic data, cancer stage, nutritional status, laboratory parameters, and radiotherapy and chemotherapy histories were recorded. CIN and FN were defined according to the common terminology criteria for adverse events v5.0. Patients were monitored for neutropenia and FN. Chemotherapy modifications, infection rates, and mortality were also recorded. Risk factor associations were analyzed using Chi-square and logistic regression analyses. Results: Among 142 patients (66.2% women), severe neutropenia (grade 3–4) occurred in 37.3% of patients, and FN occurred in 2.2% of patients, mostly during the initial chemotherapy cycle. Independent CIN risk factors included age >60 years (odds ratio [OR]: 2.21, P=0.043), male sex (OR: 2.93, P=0.005), underweight body mass index (OR: 2.35, P=0.086), smoking (OR: 3.54, P=0.003), comorbidities (OR: 3.08, P=0.02). Prophylactic granulocyte colony-stimulating factor (G-CSF) significantly lowered FN incidence (13.2% vs. 28.8%, P=0.038). The clinical consequences included dose delays (18.3%), reductions (17.6%), FN-related hospitalizations, and FN-related mortality (4.9%), predominantly in elderly patients. Conclusion: CIN and FN significantly affected the chemotherapy outcomes. Older age, malnutrition, comorbidities, and aggressive regimens increase the risk of developing this disease. Nutritional assessment and selective prophylactic G-CSF administration are critical for optimizing cancer care outcomes in resource-limited settings.
A study to assess hepatic steatosis and fibrosis in chronic hepatitis B patients with the help of non-invasive tests
Background: Chronic hepatitis B (CHB) is a persistent global health issue, frequently leading to hepatic fibrosis and steatosis. Although liver biopsy remains the diagnostic benchmark, its invasiveness necessitates safer alternatives. Non-invasive methods such as FibroScan, aspartate transaminase to platelet ratio index (APRI), and Fibrosis-4 (FIB-4) scores have shown promise in assessing liver pathology. Aims and Objectives: To evaluate the diagnostic performance of APRI, FIB-4, and FibroScan in detecting hepatic fibrosis and steatosis in CHB patients and their correlation with biochemical and virological parameters. Materials and Methods: This cross-sectional study was conducted at Maharani Laxmi Bai Medical College, Jhansi, from January 2023 to June 2024. A total of 112 patients with CHB were enrolled. Liver stiffness and steatosis were assessed using FibroScan and controlled attenuation parameters. APRI and FIB-4 scores were calculated, and laboratory values, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hepatitis B virus (HBV) DNA, were analyzed. Results: Advanced FIB-4 was observed in 42 patients (37.50%) and severe steatosis (S3) in 41 patients (36.60%). Elevated AST levels (>2×upper limit of normal) were found in 54 patients (48.21%) and ALT in 57 patients (50.89%). High HBV DNA levels (>20,000 IU/mL) were present in 59 patients (52.67%). APRI score >1.5 showed a sensitivity of 85.71% and specificity of 79.55% (area under the curve [AUC]: 0.837), whereas FIB-4 score >3.25 had a sensitivity of 64.29% and specificity of 85.37% (AUC: 0.815). Both scores showed limited utility in detecting steatosis. Conclusion: FibroScan, APRI, and FIB-4 are effective non-invasive tools for assessing hepatic fibrosis in CHB patients. They offer viable alternatives to biopsy, especially in settings with limited resources.
Evaluation of foundation course program a cross-sectional study among phase 1 Bachelor of Medicine and Bachelor of Surgery students in the state of West Bengal
Background: The foundation course (FC) at the beginning of the Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum is implemented which will provide a sound foundation for learning in the medical course and later in their professional career. Institutions are encouraged by National Medical Commission to develop their own FC module that addresses the local needs and brings out the Institutional flavor while aligning the whole program to the outcomes identified in the FC booklet. Aims and Objectives: To evaluate FC program from Students’ perception by quantitative method (Kirkpatrick level 1). Materials and Methods: This cross-sectional, observational study was conducted among 250 students of the 2024–2025 batch of phase I MBBS for 6 months after obtaining Institutional Ethics Committee permission in a Government Medical College of West Bengal. A pre-tested and validated questionnaire (Pro forma) in Google Forms was given to the students after provided details about its various items and strict anonymity was maintained. The opinions of students regarding the utility of the sessions were sorted in a Likert scale and responses were compared using the Chi-square test. Results: Out of 250 undergraduate students, only 215 voluntarily participated, among them 147 (68.4%) were male and 68 (31.4%) were female. The mean age of the participants was 19.58±1.36 years. Among all the topics taught, the role of a physician, cardiopulmonary resuscitation (CPR), Community orientation module, and Medical ethics were appreciated most. The majority of the students perceived that topic on-skill modules such as basic life support and CPR should be a part of their curriculum since they are must for becoming an Indian medical graduate. Sessions on computer skill, sports, and Yoga showed low student consensus revealing that these areas need to be improved. Conclusion: Students appreciated that the course allowed them time to adapt to the academic and Institutional environment and provided a solid foundation to face upcoming challenges while some sessions of FC needs upgradation.
Microbiological profile and antibiotic susceptibility of body fluids or swabs of acute leukemia patients with sepsis in a tertiary care hospital
Background: Therapeutic approach to children with acute leukemia and sepsis involves identification of the causative organism and institution of appropriate antimicrobial therapy. The pattern of local flora and antibiotic susceptibility should guide empirical antimicrobial therapy. Aims and Objectives: To identify the bacteria and fungi causing sepsis in children with acute leukemia and study their antimicrobial profile. Materials and Methods: This descriptive observational study with a cross-sectional study design involved 100 consecutive children admitted to the inpatient department with acute leukemia and clinical sepsis with an acute rise of pediatric sequential organ failure assessment score of more than 2. All possible samples, including blood, urine, and pus were sent for culture and sensitivity. Data were analyzed using the Statistical Package for the Social Sciences 23 software. Results: All children had fever. Most common form of infection was pneumonia (27%). Positive microbial growth was found in 23.18% of all the samples (n=220). Gram-negative bacteria were most commonly (49.01%) isolated followed by Gram-positive (27.45%) organisms and fungi (23.52%). Overall, the most common organism was Klebsiella (15.68%). Klebsiella showed 50% sensitivity toward tigecycline and colistin and 37.5% sensitivity toward meropenem, amikacin, and levofloxacin each. Gram-positive organisms showed 100% sensitivity toward vancomycin, linezolid, daptomycin, and tigecycline. We got 23.52% pan resistant organisms. Conclusion: Sepsis is the leading cause of morbidity and mortality among children with acute leukemia. The major causative agents were Gram-negative rods followed by Gram-positive microbes and fungi. Appropriate antimicrobial therapy must be initiated as per the culture sensitivity pattern of the local area to improve outcome and to reduce emergence of drug resistance.
Impact of continuing anti-platelet drugs during manual small incision cataract surgery under subtenon’s anesthesia in tertiary care in South India
Background: Antiplatelet drugs are routinely used in elderly patients with atherosclerotic diseases to prevent cardiovascular ischemic events such as acute coronary syndrome, myocardial infarction, or stroke. While various studies have established the safety of continuing anti-platelet drugs during phacoemulsification. Hence, the current study was undertaken. Aims and Objectives: To observe the impact of continuing anti-platelet drugs during manual small incision cataract surgery (MSICS) under subtenon’s anesthesia in tertiary care in South India. Materials and Methods: Patients undergoing small incision cataract surgery in a medical college in South India from August 2024 to December 2024 were part of the study after obtaining written informed consent. They were randomly assigned to two groups. Group1-patients taking antiplatelet drugs for a thromboembolic disorder and Group 2-patients not on antiplatelets drugs. MSICS was performed under subtenon’s anesthesia using a blunt cannula (no sharp needle prick). Patients were monitored intraoperatively, postoperatively on day 1, day 7, and 30 for any ocular hemorrhage and thromboembolic events. Results: Incidence of hemorrhagic complications was 46% in group 1 and 26% in the control group on the first post-operative day. The subconjunctival hemorrhages resolved spontaneously, and there was no difference between the two groups at the end of 1 month post-surgery. There was also no difference in the final best-corrected visual acuity between the two groups. The hemorrhages that occurred were self-limiting and visually insignificant. No patient had a retrobulbar, vitreous, choroidal hemorrhage, or a sight-threatening complication. No thromboembolic events were noted in the 1-month post-operative period. Conclusion: The present study results explain that it is safe to continue antiplatelets in MSICS performed under subtenon anesthesia by an experienced surgeon.
Fine-tuning electroconvulsive therapy: A cognitive comparison of brief and ultra-brief pulse widths
Background: Electroconvulsive therapy (ECT) has been a cornerstone in managing severe psychiatric illnesses. However, concerns about its cognitive side effects have led to evolving techniques aimed at minimizing cognitive impairments. Specifically, the use of ultra-brief pulse width (0.5 ms) compared to brief pulse width (1.5 ms) in bitemporal modified ECT (MECT) offers a promising avenue for cognitive preservation. Aims and Objectives: To compare the cognitive outcomes associated with brief and ultra-brief pulse widths in bitemporal MECT. Materials and Methods: This prospective, randomized comparative study was conducted at a rural tertiary care hospital in Northern India. Sixty-six patients aged 18–60 years, diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or severe depression, were randomly assigned to receive either brief or ultra-brief pulse MECT. Cognitive functions were assessed using standardized tools, including the Hindi mental status examination and Battery for ECT-related cognitive deficits. Pre- and post-treatment evaluations were compared to determine changes in cognitive performance. Results: Both groups exhibited some level of cognitive change following treatment. However, patients receiving ultra-brief pulse MECT demonstrated significantly better preservation of cognitive functions, notably in memory retention, attention, and executive functioning (P<0.05). Domains such as verbal learning, processing speed, and short-term recall were notably less affected in the ultra-brief group compared to the brief pulse group. Conclusion: Ultra brief pulse width in bitemporal MECT appears to offer a cognitive advantage over brief pulse width, suggesting it may be the preferred choice when cognitive preservation is a clinical priority.
Clinical and radiological study of single-level degenerative lumbar disc disease in Eastern India Medical College
Background: Low back pain secondary to lumbar disc degenerative disease (LDDD) usually affects young to middle-aged persons. It presents as a sharp shooting type of pain, mild tingling sensation, and a dull ache. There are many risk factors associated with the LDDD, such as advancing age, smoking, and obesity. The annual incidence of prolapsed lumbar intervertebral disc is about 5–10%. Lumbar disc herniation is the pathological condition for which spinal surgery is most often performed. Treatment for lumbar disc herniation can be conservative or surgical, and which one is effective is always controversial. The purpose of conducting this study is to assess different clinical features, magnetic resonance imaging (MRI) characteristics, and postsurgical outcome of single-level lumbar disc disease. Aims and Objectives: To evaluate the clinical symptoms, functional status, and most commonly affected lumbar level in patients with single-level LDDD along with post-operative outcome of that level. Materials and Methods: 50 symptomatic patients who were diagnosed as single-level disc degenerative disease by MRI, not responding to conservative treatment, were included in our study. It is conducted over a period of 2 years in Bangur Institute of Neuroscience. Any patient having previous surgery is excluded from our study. Results: It has been found that L4-L5 level disc herniation and posterolateral site is more common. The most common type is protrusion. Conclusion: It helps surgeons to locate the level, type, and site of degenerative disc disease in symptomatic patients who fail to respond to conservative management. Surgical outcome is better than conservative management.
Comparison of clinico-radiological profile of pulmonary tuberculosis in diabetic and non-diabetic patients in a tertiary care hospital – An observational analytical study
Background: Diabetes mellitus (DM) is becoming more widely acknowledged as a significant comorbidity that negatively affects outcomes of pulmonary tuberculosis (PTB), which remains a significant worldwide health burden. The interplay between TB and DM modifies clinical, microbiological, and radiological characteristics, necessitating detailed evaluation. Aims and Objectives: The study aims to evaluate the impact of glycemic management on disease presentation and compare the clinico-radiological and microbiological profiles of PTB patients with and without DM. Materials and Methods: This observational, hospital-based study included adult patients newly diagnosed with PTB. Patients were stratified into diabetics and non-diabetics based on history and glycosylated hemoglobin levels. Data on clinical symptoms, sputum smear positivity, and chest radiographic findings were recorded. Diabetics were further categorized based on glycemic control. Statistical analyses were performed to identify differences between groups. Results: Diabetic patients had a higher prevalence of cough (98.1%), fever (87.0%), hemoptysis (35.2%), and weight loss (90.7%) compared to non-diabetics (P<0.05). Sputum positivity was significantly higher in diabetics (90%) than in non-diabetics (75%) (P<0.001). A higher bacillary load (3+smear grade) was observed in 50% of poorly controlled diabetics, compared to 30% of well-controlled diabetics and 20% of non-diabetics (P<0.001). Radiologically, diabetics showed more lower lung field involvement (31.5% vs. 10.2%) and multilobar disease (68.5% vs. 45.3%) compared to non-diabetics (P<0.05). Conclusion: More severe symptoms, larger bacillary loads, and extensive, unusual radiological presentations are linked to DM, especially when it is poorly controlled, in PTB. Hence, for the best care, early identification and stringent glycemic control are essential.
A comparative study of minivac suction drain in Lichtenstein tension-free mesh inguinal hernioplasty at Basaweshwar teaching and general hospital, Kalaburagi, Karnataka
Background: Despite the high prevalence of inguinal hernias worldwide, intraoperative drain placement remains a controversial topic. The benefit of reducing post-operative complications has not yet been clearly demonstrated. This study investigates whether a drain prevents post-operative complications after the Lichtenstein tension-free mesh hernioplasty technique. Aims and Objectives: The study is to compare minivac suction drain in Lichtenstein tension-free mesh hernioplasty in inguinal hernia repair at Basaweshwar teaching and general hospital, Gulbarga. To study the merits and demerits of minivac suction drain in inguinal hernia repairs. Materials and Methods: This study is a retrospective comparative study to compare 50 patients with inguinal hernia undergoing Lichtenstein tension-free mesh hernioplasty over a period of 2 years. Patients were randomized into two groups, one group containing 25 patients with a minivac drain and one group containing 25 patients without a drain. Results were compared in two groups for hematoma, seroma, wound infection, pain, and duration of hospital stay. Results: From the study, it is concluded that keeping a drain in Lichtenstein tension-free mesh hernioplasty is beneficial in complications associated with Seroma and Hematoma formation and reduction in hospital stay, but no significant difference in pain post-surgery. In our study, three patients in the drain group had wound infection, whereas in the non-drain group six patients had infection, but it was not statistically significant. At the end of the study, we can conclude that the patients with a drain benefited in the form of less chances of seroma and hematoma. Conclusion: From the study, it is concluded that the use of suction drain in Lichtenstein tension-free mesh hernioplasty is beneficial in complications associated with Seroma and Hematoma formation and reduction in hospital stay, but no significant difference in post-operative pain.
OncoBiome: The Emerging Frontier in Cancer-Microbiome Interactions
OncoBiome represents the complex interplay between the human microbiome and cancer biology—a rapidly evolving field investigating how microbial communities influence cancer development, progression, treatment efficacy, and patient outcomes. This bidirectional relationship encompasses multiple dimensions of host-microbe interactions across various body sites and cancer types. Key mechanistic pathways by which the microbiome can influence carcinogenesis involve direct genotoxicity, chronic inflammation leading to persistent microbial dysbiosis, which can create pro-inflammatory environments conducive to cancer development (e.g., H. pylori in gastric cancer, Fusobacterium nucleatum in colorectal cancer). Metabolic modulation involving microbial metabolites like short-chain fatty acids, secondary bile acids, and trimethylamine N-oxide can influence cellular proliferation, apoptosis, and immune function. Further, microbiome composition shapes local and systemic immune responses, potentially affecting immune surveillance of cancer cells. Future research directions include investigating the microbiome's role in Cancer prevention strategies, enhancing immunotherapy response, reducing treatment-related toxicities, developing novel microbiome-based therapeutics, and mitigating cancer recurrence. The OncoBiome represents a promising frontier in precision oncology, potentially offering new insights for cancer prevention, diagnosis, and treatment through the lens of the human microbiome.