European Journal of Cardiovascular Medicine

Background: Chronic medical illnesses are among the leading causes of morbidity and mortality worldwide. In India, the prevalence of chronic diseases such as diabetes mellitus, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, cardiovascular diseases, and cancer has increased considerably over recent decades. Patients suffering from chronic medical illnesses are more vulnerable to psychiatric morbidity, particularly depression and anxiety, which adversely affect treatment adherence, prognosis, and quality of life. The coexistence of physical and psychological disorders negatively affects treatment adherence, disease outcomes, quality of life, and overall prognosis. Despite this, psychiatric morbidity often remains underdiagnosed in patients attending tertiary-care hospitals, particularly in resource-limited settings. Aim: To assess psychiatric morbidity and quality of life among patients with chronic medical illness attending a tertiary care teaching hospital. Material and Methods: This observational, cross-sectional study was conducted among 76 patients with established diagnoses of chronic medical illnesses, recruited from the outpatient and inpatient departments of medicine and allied specialties. Sociodemographic details and clinical parameters were recorded using a semi-structured proforma. Psychiatric morbidity was assessed using the General Health Questionnaire-28 (GHQ-28) for psychological distress, the Hospital Anxiety and Depression Scale (HADS) for screening depression and anxiety, and the Mini-International Neuropsychiatric Interview (MINI) for diagnostic confirmation. Statistical analysis was performed using SPSS version 25.0. Descriptive statistics were used for baseline characteristics. Chi-square tests and logistic regression analyses were applied to determine associations and independent predictors, with p < 0.05 considered statistically significant.  Results: Psychiatric morbidity was identified in 65.79% of patients. The most common diagnoses were depression (26.32%) and anxiety disorders (18.42%), followed by adjustment disorder (13.16%) and somatoform disorders (7.89%). Female patients had significantly higher psychiatric morbidity (76.47%) compared to males (57.14%, p = 0.041). Psychiatric morbidity was most prevalent among those with chronic kidney disease (80.00%) and diabetes mellitus (72.73%), both showing statistically significant associations (p = 0.041 and p = 0.032, respectively). Multivariable logistic regression analysis revealed that female gender (OR 2.10, p = 0.038), low socioeconomic status (OR 2.72, p = 0.024), diabetes mellitus (OR 2.48, p = 0.031), and chronic kidney disease (OR 3.12, p = 0.021) were independent predictors of psychiatric morbidity.  Conclusion: Psychiatric morbidity is highly prevalent among patients with chronic medical illnesses and significantly impairs quality of life. Early psychiatric assessment and integrated mental healthcare are essential components of chronic disease management. Psychiatric morbidity is highly prevalent among patients with chronic medical illnesses, particularly in women and those with diabetes or chronic kidney disease. These findings highlight the urgent need for routine psychiatric screening and integrated psychosocial interventions in tertiary-care hospital settings to improve holistic patient care.

Background: The neutrophil-to-lymphocyte ratio (NLR) reflects systemic inflammation and immune balance and may predict postoperative outcomes. This study evaluated preoperative NLR as a predictor of postoperative complications following major abdominal surgery. Methods: A prospective observational study was conducted at SMS Medical College, Jaipur (July 2015–June 2018) including 170 adults undergoing major abdominal surgery. Preoperative NLR was derived from routine blood counts. Postoperative complications were assessed for 30 days and graded using the Clavien–Dindo classification. Statistical analysis used SPSS v26.0 and R v4.2.2; logistic regression identified independent predictors. Results: Postoperative complications occurred in 35 patients (20.6%); major complications (Grade III–V) occurred in 5.9%. Patients with complications had higher median NLR (4.6 vs 3.0, p = 0.002). ROC analysis showed AUC 0.655 (95% CI 0.568–0.746) with an optimal cut-off NLR = 2.68 (sensitivity 88.6%, specificity 41.5%). Independent predictors of complications included NLR (OR 1.26, p = 0.021), ASA class (OR 1.42, p = 0.037), emergency surgery (OR 1.87, p = 0.033), and low albumin (OR 0.58, p = 0.028). High NLR was associated with greater ICU admissions (28.6% vs 10.4%, p = 0.012) and longer hospital stay (9 vs 6 days, p < 0.001). Mortality was 0.6%. Conclusion: Preoperative NLR ≥2.68 independently predicts postoperative complications and prolonged recovery after major abdominal surgery. Integration of NLR with clinical and biochemical parameters enhances perioperative risk stratification.

Introduction: Adiponectin (insulin-sensitizing, anti-inflammatory) typically decreases, while leptin (pro-inflammatory) increases with adiposity. Their adiponectin-to-leptin ratio (A/L ratio) integrates opposing adipokine signals and may reflect adipose tissue dysfunction, insulin resistance (IR), and metabolic syndrome (MetS). Materials and Methods: We conducted a case–control study among adults (18–65 y) attending a tertiary-care hospital. Cases were MetS patients (harmonized criteria), controls were age-/sex-matched adults without MetS. Fasting blood was assayed for adiponectin, leptin (ELISA), glucose, insulin (HOMA-IR), and lipids. Primary outcomes: A/L ratio differences, correlation with HOMA-IR, and diagnostic performance for MetS. Results: N=240 (120 MetS; 120 controls). Median (IQR) A/L ratio was 0.43 (0.27–0.71) in MetS vs 1.12 (0.78–1.68) in controls (p<0.001). A/L ratio correlated inversely with HOMA-IR (r=–0.61, p<0.001). ROC-AUC for MetS: 0.86 (95% CI 0.81–0.90). An A/L cut-off ≤0.65 yielded 80.8% sensitivity and 78.3% specificity. In multivariable models, lower A/L remained independently associated with MetS (aOR per 0.1 decrement 1.18, 95% CI 1.10–1.27; p<0.001). Conclusion: The A/L ratio is a practical, robust biomarker that tracks IR and discriminates MetS with good accuracy. It may complement standard risk assessment in resource-constrained clinical laboratories

Background: Chronic otitis media erodes the bone, destroys the ossicles and has the potential to cause life threatening complications. Methods: This is a prospective study involving patients with chronic otitis media. 90 patients were included and all of them are subjected to ossicular reconstruction either by canal wall down or intact canal wall surgery. Results: The mean (±SD) in group 1A pre op A-B gap was 35.45±12.7 and post op A-B gap was 23.4±7.18 and hence giving highly significant result i.e. p <0.001. In group 1B pre op A-B gap was 36.15±14.8 and post op AB gap was 23.6±8.8 and hence giving highly significant result i.e. p <0.001.In group 1C pre op A-B gap was 34.55±12.7 and post op A-B gap was 25.15±8.59 and hence giving highly significant result i.e. p <0.001.The mean (±SD) in group 2A pre op A-B gap was 34.15±10.61 and post op A-B gap was 25.4±9.19 and hence giving highly significant result i.e. p <0.001. In group 2B pre op A-B gap was 36.5±11.05 and post op A-B gap was 23.8 ±7.74 and hence giving highly significant result i.e. p <0. 001.In group 2C pre op A-B gap was 35.5 ±12.4 and post op A-B gap was 24.6±8.24 and hence giving highly significant result i.e. p <0.001. Conclusion: All the three modalities gave statistically significant improvement (p < 0.001) in A-B gap leading to improvement in hearing but among the three groups there was no statistically significant (p > 0.05) difference found in improvement of A-B gap.

Background: Breast cancer is the most common cancer among women globally and increasingly prevalent in India. Despite lower incidence rates, mortality remains high due to late-stage presentation and limited access to diagnostics. This study evaluates the clinicopathological features and hormone receptor status of breast cancer patients at a tertiary care center in Andhra Pradesh. Methods: A retrospective review of 50 histologically confirmed breast cancer patients from August 2017 to June 2019 was conducted. Clinical staging (AJCC 8th edition), histology, and IHC profiles (ER, PR, HER2/neu) were analyzed. Results: Most patients (54%) were aged 41–60 years. Stage III was the most common clinical stage (52%). Infiltrating ductal carcinoma was predominant (92%). Hormone receptor positivity (ER/PR+) was seen in 66% of cases, while triple-negative breast cancer occurred in 22%, mostly in younger women. Clinical and pathological staging differed in 16% of cases. Conclusion: Younger age at presentation and late-stage diagnosis remain key challenges. High hormone receptor positivity suggests scope for hormonal therapy, while triple-negative cases highlight the need for aggressive treatment and further research.

Background: Variations in the sciatic nerve’s exit from the pelvis may contribute to sciatica, yet their anatomical significance remains underexplored. This study investigates the relationship between sciatic nerve exit patterns and potential predisposition to nerve compression. Aim: To elucidate the importance of sciatic nerve exit variations in the occurrence of sciatica using cadaveric lower limbs. Methods: Sixty lower limbs from 30 cadavers (15 male, 15 female) were dissected to classify sciatic nerve exit patterns relative to the piriformis muscle: Type A (below piriformis), Type B (piercing piriformis), or Type C (above piriformis). Morphometric measurements, including distance to the ischial spine, were recorded, and statistical differences were assessed (p < 0.05 considered significant). Results: Type A was predominant (48 limbs, 80%), followed by Type B (8 limbs, 13.3%) and Type C (4 limbs, 6.7%). No sex or side differences were significant (p = 0.72, p = 0.58). Mean distances to the ischial spine were 3.5 ± 0.8 cm (Type A), 2.9 ± 0.6 cm (Type B), and 2.7 ± 0.5 cm (Type C), with significant variation (p = 0.03). Types B and C showed a 1.2 cm clearance reduction versus Type A (p < 0.05), with accessory fibrous bands in 3 limbs (2 Type B, 1 Type C). These findings suggest increased compression risk in atypical variants. Conclusion: Type B and C variations may predispose individuals to sciatica due to altered nerve trajectories and reduced clearance, warranting further clinical correlation.

Background: Chronic kidney disease (CKD) is a growing health issue that poses both medical and financial challenges. For patients with CKD, kidney transplantation represents the best treatment option. Unfortunately, this option is often unattainable for many CKD patients, especially in developing countries like India. OBJECTIVES: To estimate the prevalence of lipid abnormalities in chronic kidney disease patients. To evaluate the Quantitative assessment of lipid abnormalities in chronic kidney disease patients. MATERIAL & METHODS: Study Design:  Hospital-based, cross-sectional study.  Study area: The study was conducted in the Department of General Medicine at Narayana Medical College, Nellore.  Study period: 1 year.  Sample size: The study consisted of a total of 30 subjects and 30 controls.  Sampling Technique:  Simple Random technique. Results: As compared to <150 and 150-199 among males, t= 9.241, P<0.001 is statistically highly significant. As compared to borderline high and high among males, t=5.047 P<0.001 is statistically highly significant. As compared to <150 and 150 – 199 among females, t=4.268, P<0.05 is statistically significant.    CONCLUSION: In conclusion, this study of 50 CKD patients revealed that Type 2 diabetes (38%) and hypertension (32%) were the leading causes, with most patients aged 41-50 years. A significant proportion of diabetic (52.6%) and hypertensive (75%) patients with 5-15 years of disease duration developed CKD

Background: Scrotal swelling is a frequent issue faced in everyday medical practice among males of all ages. The range of potential causes for scrotal swellings includes simple hydrocele, varicocele, epididymal-orchitis, testicular torsion, trauma, and testicular cancer, among others. Objectives:  to assess the accuracy of high-resolution sonography and colour Doppler in the diagnosis of scrotal swellings.To evaluate the sonographic appearance of the spectrum of scrotal swellings. Material & Methods: Study Design: A prospective hospital-based cross-sectional study. Study area: Department of Radio Diagnosis, M. V. J Medical College & Research Hospital, Hoskote, Bangalore. Study Period: 1 year. Study population:  Patients referred to the Department of Radiology for ultrasonography for scrotal swellings.  Sample size: The study consisted of 100 subjects. Sampling method: Simple random technique. Inclusion criteria: All cases with clinical evidence of scrotal swelling. Results: In our study, out of 100 cases, 52 cases were detected to have inflammatory scrotal pathologies on high-resolution ultrasonography and colour Doppler study. Out of all the inflammatory pathologies, Chronic Epididymo-orchitis was the commonest, noted in 16 cases (30.7%). The next most frequent inflammatory pathology detected was acute Epididymo-orchitis, noted in 12 cases (23.0%).  Conclusion: In conclusion, high-resolution ultrasound (USG) and colour Doppler sonography are highly effective, non-invasive tools for evaluating scrotal swellings. They provide excellent sensitivity in diagnosing acute inflammatory conditions (e.g., epididymal-orchitis), differentiating testicular from extra-testicular pathologies, and identifying cystic versus solid lesions.

Background: Legionella pneumophila is a common cause of Community Acquired Pneumonia (CAP) which is often associated with a severe clinical course and a mortality rate of 5% to 25% among immunocompetent patients. Complications of Legionella infection include acute renal and respiratory failures, disseminated intravascular coagulation and septic shock which often require intensive level of medical care. Reported cases of myocardial dysfunction and acute systolic heart failure from legionella disease are rare. This case describes an atypical presentation of legionella pneumonia in a previously healthy patient complicated by multi-organ failure. Case Presentation: A 63 year old female with medical history of hypertension was admitted to the intensive care unit for acute onset of altered mental status, decreased oral intake, subjective fevers, dizziness and diarrhea. Physical exam was remarkable for temperature of 101.2 F, pulse rate 112 beats/minute, respiratory rate 22 cycles/minute and blood pressure 88/60 mmHg. Laboratory studies showed leukocytosis, markedly elevated serum Creatinine Kinase (CPK), and creatinine and lactic acid levels. Troponin was elevated; however no evidence of cardiac ischemia on electrocardiogram. Chest X-ray revealed right mid-lung opacities consistent with pneumonia. A Transthoracic Echo (TTE) showed reduced ejection fraction of 35% and urine legionella antigen test was positive for Legionella pneumophilia group 1 antigen. She was admitted to the medical Intensive Care Unit (ICU) and initiated on Intravenous (IV) fluids and empiric antibiotics for CAP (IV Ceftriaxone 2 g daily and Azithromycin 500 mg daily) and by day 5 of hospitalization, her fever had completely resolved and neurological status returned to normal. Her serum CPK and creatinine levels significantly improved and troponin levels normalized. She was discharged home to follow up with infectious disease and cardiology team outpatient. A repeat TTE six weeks later showed normal ejection fraction of 60% to 65% and a normal cardiac stress test.

Introduction: Most epidemiological data concerning low back pain (LBP) are related to developed and industrialized countries but little information about LBP in the general population in developing and low-income countries. Back pain affects 60-80% of people at some time in their lives. Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare case of serious underlying pathology. Aim of the study: The aim of the study is to evaluate the different causes of low back pain, occupational and risk factors, association with age and sex of the patient and their life styles. Materials and Methods: The present study is a retrospective study of 300 patients of low back pain between the age group of 31-70 years of both sexes who were admitted and treated at Dept. of Forensic Medicine, Kushtia Medical College Hospital, Kushtia, Bangladesh from January 2020 to December 2020. The information was collected from the patients regarding their occupation, education, obesity, smoking, tuberculosis, diabetes, alcohol consumption, osteoporosis, Osteoarthritis and history of trauma. The provisional diagnosis of cases was done and confirmed radiologically. A proforma was prepared and the patient’s age, sex, duration of symptoms, place of living and the cause for low back pain was noted. A neurological examination of the lower limbs was performed. Results: The author tabulated 300 patients of low back pain into four categories according to age and noted the number of cases in each group. The highest number of cases (124) is observed in the age group of 31-40 years (41%) and the lowest number of cases (45) is observed in the age group of 51-60 years (15%). All patients were thoroughly interrogated (occupational, trauma, infection, diabetes mellitus, smoking, alcohol and medication history), subjected to a rigorous clinical examination and a battery of investigations. In 300 cases of LBP studied, the most common cause for back pain was disc prolapse (44%). The next common causes were lumbar spondylosis, spondylolisthesis and lumbar spinal stenosis (17%, 10% & 10% respectively).The study found association between low back pain and various factors. Prevention is the best strategy for avoiding low back pain but is realistically hard to practice because the problem of low back pain has many environmental and intrinsic risk factors. Conclusion: Low back pain affects a large proportion of the population and is difficult to diagnose. Physicians must accept the diagnostic ambiguity that often accompanies the condition. Identification of etiological and risk factors, cause for back pain and type of occupation and instituting preventive measures, as well as rehabilitation of patients can lead to a meaningful reduction in the incidence of debilitating back pain.

Since the first reports of a novel Coronavirus Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), emerged from the province of Wuhan, China in December 2019 [1], it has brought the entire worldwide to a standstill and impacted every single individual on the planet. In this age of globalization, as expected, the eyes of the world have been vehemently focused on the medical fraternity in hopes of a so far elusive cure. In spite of hundreds of clinical trials, anecdotal reports and off-label attempts, no therapy has proven to be effective in improving outcomes nor provide effective prophylaxis. Intense social, political and media scrutiny, along with the sheer scale of the pandemic, have presented a unique challenge to the medical and scientific fraternity to be able to develop effective remedies in an extremely limited amount of time, and at times, with limited resources as well. Unfortunately, the discovery and licensing of a nascent molecule as an effective drug involves a prolonged gestational period, creating an unacceptable lag between therapeutic need and availability. Drug repurposing, a novel approach which involves identification of new indications for pre-existing drugs, is an economic and time saving endeavor [2], allowing a drug to directly enter phase III or IV clinical trials, thereby saving billions of dollars in production cost [3]. Much like the Middle East Respiratory Syndrome virus (MERS), the SARS-CoV-2 spreads through the respiratory route; however, unlike the former which utilizes Dipeptidyl Peptidase 4 (DPP4), it utilizes Angiotensin Converting Enzyme 2 (ACE 2) as a receptor to enter cells [4,5]. Fusion, is followed by endocytosis of the virion, which is facilitated by an acidic environment, wherein comes in to play diprotic bases such as hydroxychloroquine and chloroquine [6]. Activation of the main RNA Dependent RNA Polymerase (RDRP) enzyme requires proteolysis by a viral protease. Inhibition of the latter by anti-retroviral agents such as lopinavir, ritonavir and darunavir hold therapeutic promise [6]. Agents targeting RDRP such as remdesivir, favipiravir and arbidol have demonstrated some degree of in vitro and in vivo activity against SARS-CoV-2.

Background: Diabetes is one of the most common chronic diseases. The development of albuminuria in Type 2 Diabetes (T2DM) increases the risk for renal disease. Methods: The study was retrospective conducted at the Primary Health Care Clinics at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. A total of 1583 Saudi with T2DM were randomly selected. Results: Total of 1583 patients with T2DM included in this study; 636 (40.2%) male and 8947 (59.8%) female with mean age 56.0

Acute Respiratory Distress Syndrome (ARDS) is a major medical emergency requesting acute therapeutic intervention. Here we report that Nitric Oxide (NO) gas attenuates ARDS in mice. Using a novel portable NO generator we found that NO at 20 ppm attenuates endotoxin (LPS) induced neutrophil recruitment lung alveolar epithelial damage reduced inflammatory cytokines, neutrophil. Therefore, the data suggest that the use of a portable NO generator may be considered as an interesting therapeutic possibility for patients with severe ARDS.

Background: In recent years, there has been a greater emphasis on the epidemiological of mistakes and adverse outcomes rather than on procedures that decrease such incidents. aim of study is to: Assess nurses Knowledge regarding preoperative nursing safety practices for cardiac catheterization patients. Methodology: The descriptive research design was utilized for this study. and the sitting of the study was at AL Hussein teaching hospital in Al muthanna governorate. The subjects of the study consisted of all nurses (30 nurses) working at the above mentioned. The toll of the study included the safety practices in the postoperative phase cardiac catheterization. These were categorized a checklist related to the availability of the equipment and safety items provided for patients at the catheterization unit. This checklist items was checked as being either available (2) ,or (1) not available (0). As regard safety it is a three Likert scale ranged from done completely (2), done incompletely (1), to not done (0). Result: the main results of study reveal that, there was no a highly significant relation between socio-demographic characteristics and nursing safety practices for cardiac catheterization patients at preoperative phase. Conclusion: the studied nurses had no significance in practicing safety practices in cardiac catheterization centers. Educational levels and years of experience had no statistical significant effects on nurses' safety practices. Recommendation: Pre- services on the job training programs are advocated for all nurses about patients' safety in nursing work requirement and utilize the results of the current study to ameliorate& update cardiac catheterization patient’s safety practices with continuing evaluation.