European Journal of Cardiovascular Medicine

Background: The development of biliary tract imaging since its inception for cholelithiasis and its complications has shown a significant change in the past few decades. Histopathology, serum bilirubin, and USG (ultrasonography) are unique as methods for detection of cholecystitis and cholelithiasis. Aim: The present study was aimed to assess the correlation between ultrasonography and histopathological efficacy in subjects with pathology of the gall bladder.  Methods: The present study assessed 208 subjects that underwent histopathological assessment and ultrasonographic abdominal scans. Clinical and demographic data were gathered along with the assessment of serum bilirubin levels. Data gathered were statistically analyzed for formulation of the results.  Results: There were higher number of females in the study with 162 and 46 subjects with cholelithiasis and cholecystitis respectively. In cholelithiasis, most common symptom was epigastric pain and nausea/vomiting, whereas in cholecystitis, most common symptoms were epigastric pain and dyspepsia. Almost perfect agreement was seen in ultrasonography and histopathology intraoperatively. Other than serum bilirubin and ultrasonography alone, serum bilirubin and ultrasonography showed a strong consistency. Conclusion: The present study concludes that serum bilirubin and ultrasonography as a combination marker approach presents a versatile tool for intervention guidance and quick decision-making tool in cases of biliary tract.

Background: Non-healing ulcers are chronic wounds that fail to progress through normal healing due to factors like poor circulation, infection, or underlying conditions. Freshly collected human amniotic membrane (HAM) has emerged as an effective biological dressing due to its anti-inflammatory, anti-microbial, and regenerative properties. Rich in growth factors and extracellular matrix components, HAM promotes tissue repair, reduces scarring, and accelerates healing, making it a promising treatment for managing non-healing ulcers Objective: The objective is to assess the role of freshly collected human amniotic membrane as a biological dressing in chronic non-healing ulcers by evaluating its impact on pro-angiogenic growth factor expression, endothelial and vascular markers, histopathological tissue regeneration, and modulation of cytokine levels. Method: Fresh human amniotic membrane was aseptically collected from consenting mothers undergoing elective cesarean section after screening for infections. The membrane was washed in sterile saline, trimmed, and immediately applied to chronic non-healing ulcers in 15 patients (study group). The control group (15 patients) received conventional dressing. All procedures followed ethical guidelines with informed consent from both donors and recipients, ensuring sterility and prompt application to preserve bioactivity. Healing outcomes were assessed through biochemical analysis, growth factor and cytokine profiling, and histological examination. Regular monitoring included pain score, wound size measurement, infection status, and duration of epithelialization. Results: After applying HAM as a biological dressing on chronic non-healing ulcers in 15 patients, significant improvements were observed compared to 15 control patients treated with conventional dressings. Clinically, the HAM group showed a greater wound size reduction (60% vs.30 %, p<0.01), enhanced granulation tissue formation, decreased pain scores, and reduced exudate levels.Histopathological analysis revealed increased neovascularization, demonstrated by higher microvessel density along with thicker epithelialization and reduced inflammatory infiltrate in the HAM group.VEGF levels in wound tissue and exudate were significantly elevated (4.2-fold increase, p<0.01) in the HAM group, alongside increased basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF), supporting enhanced angiogenesis and tissue regeneration.Blood parameters showed reduced systemic inflammation markers, including lower CRP and normalized white blood cell counts in the HAM group. These findings collectively indicate that fresh HAM promotes accelerated vascular regeneration and healing compared to conventional dressings. Conclusion: Fresh human amniotic membrane significantly improved healing outcomes in non-healing ulcer patients compared to conventional dressings. It accelerated wound closure, enhanced granulation tissue formation, and reduced pain and exudate. Improved histopathology and increased angiogenic growth factors like VEGF supported better vascular regeneration. Reduced inflammatory markers and normalized blood parameters further confirmed its effectiveness as a superior biological dressing.

Background: Hoarseness of voice is a common otolaryngological complaint, often reflecting a spectrum of underlying laryngeal lesions ranging from benign to malignant. Early identification of these lesions is critical for timely intervention and improved clinical outcomes. Aim: To evaluate the demographic profile, spectrum, site distribution, and clinical presentation of benign and malignant laryngeal lesions in patients presenting with hoarseness of voice. Materials and Methods: A cross-sectional observational study was conducted on 100 patients presenting with hoarseness of voice. All patients underwent detailed clinical examination, indirect laryngoscopy, and diagnostic confirmation using microlaryngoscopy and histopathology when indicated. Data were analyzed to determine the prevalence and distribution of benign and malignant lesions. Results: The majority of patients were between 41–60 years (46%), with a male predominance (62%). Benign lesions constituted 68% of cases, while malignant lesions accounted for 32%. Among benign conditions, vocal cord polyps (24%) and nodules (18%) were most frequent. Squamous cell carcinoma was the predominant malignant lesion (28%). The glottis was the most commonly affected site (56.3%), followed by the supraglottic region (28.1%). All patients presented with hoarseness (100%), while throat discomfort (38%), dysphagia (22%), odynophagia (16%), and dyspnea (8%) were additional symptoms. Conclusion: Benign lesions outnumber malignant ones among patients with hoarseness; however, a significant proportion harbors malignancy, with squamous cell carcinoma being the leading type. Glottic involvement is most common in malignancies. Comprehensive evaluation and early diagnostic workup are essential for prompt management and improved prognosis

Background: Tuberculosis (TB) and diabetes mellitus (DM) represent a growing syndemic of global health importance. Diabetes not only predisposes individuals to active TB but also alters its clinical, radiological, and pathological manifestations, thereby influencing treatment outcomes. Understanding these modifications is crucial for timely diagnosis and effective management. This study aimed to evaluate the pathological and radiological spectrum of pulmonary tuberculosis in association with diabetes mellitus and to establish correlations between these domains. Materials and Methods: This prospective, cross-sectional study was conducted at a tertiary care center in North Western India  over 12 months and included 216 patients with microbiologically or histopathologically confirmed pulmonary TB. Patients were divided into two groups: Group A (TB–DM, n=108) and Group B (TB-only, n=108). Demographic, clinical, and glycemic profiles were recorded. All patients underwent chest radiography, with HRCT performed where indicated. Radiological features assessed included lesion site, cavity characteristics, extent of disease, and associated findings. Biopsy and cytology samples were examined histopathologically for granuloma architecture, necrosis, fibrosis, and acid-fast bacilli. Statistical analysis was performed using SPSS, with correlation coefficients applied to evaluate radiological–pathological associations. Results: TB–DM patients were significantly older (mean age 52.4 vs 39.7 years; p < 0.001) and presented more often with hemoptysis (35.2% vs 19.4%; p = 0.01) and prolonged illness (8.9 vs 6.2 weeks; p < 0.001). Radiologically, lower lobe involvement (38.9% vs 17.6%; p = 0.001), thick-walled cavitary lesions (36.1% vs 16.7%; p = 0.002), and multilobar disease (40.7% vs 21.3%; p = 0.003) were more frequent in TB–DM patients. Pathologically, poorly formed granulomas (57.4% vs 34.3%; p = 0.001) and extensive caseous necrosis (65.7% vs 44.4%; p = 0.002) predominated, while healing fibrosis was reduced (17.6% vs 38.0%; p = 0.001). Radiological–pathological correlation showed strong associations between thick-walled cavities and necrosis (r = 0.62; p < 0.01), multilobar disease and poorly formed granulomas (r = 0.48; p = 0.02), and lower lobe lesions with impaired fibrotic response (r = 0.41; p = 0.03). Treatment outcomes were inferior in TB–DM patients, with lower sputum conversion at 2 months (66.7% vs 84.3%; p = 0.002) and higher relapse (13.0% vs 4.6%; p = 0.03). Conclusion: Diabetes mellitus significantly modifies the clinical, radiological, and pathological presentation of pulmonary tuberculosis and adversely impacts treatment outcomes. TB–DM patients are more likely to exhibit atypical lower lobe involvement, thick-walled cavitary lesions, disorganized granulomas, and extensive necrosis. Integrated pathological and radiological evaluation is essential for accurate diagnosis and tailored management in this high-risk population.

Background: Perinatal asphyxia is a major cause of neonatal morbidity and mortality, often associated with hypoxic-ischemic encephalopathy (HIE) and multi-organ dysfunction. Among affected organs, the kidneys are particularly vulnerable, leading to acute kidney injury (AKI). Aim: To evaluate renal function among term neonates with perinatal asphyxia and assess its correlation with the degree of HIE. Material and Methods: A prospective case–control study was conducted including 120 term neonates, of which 60 had perinatal asphyxia (cases) and 60 were healthy controls. Renal function was assessed using serum creatinine, creatinine clearance, urine output, and urinary indices. Data were analyzed to compare renal function parameters between groups and correlated with the severity of HIE. Results: Asphyxiated neonates demonstrated significantly reduced creatinine clearance and urine output compared to controls. Urinary indices including FeNa, renal failure index, and osmolality were markedly altered. Severity of renal dysfunction was positively correlated with the stage of HIE. Conclusion: Perinatal asphyxia significantly impairs renal function in term neonates, with dysfunction correlating with HIE severity. Early recognition and monitoring are crucial to reduce morbidity and prevent long-term renal complications.

Background: Dengue fever is a common mosquito-borne infection that may present with systemic and organ-specific complications. Cardiac manifestations, particularly electrocardiographic (ECG) changes, are increasingly recognized in patients with dengue. Correlation of these cardiac abnormalities with established warning signs may provide critical prognostic information. Aim: To study cardiac manifestations in patients presenting with dengue infection and to observe electrocardiographic changes, with special emphasis on correlation with warning signs of dengue. Material and Methods: This observational study included 120 patients with laboratory-confirmed dengue infection. Baseline clinical data, warning signs, and 12-lead ECGs were obtained and analyzed. ECG abnormalities were correlated with clinical warning signs using appropriate statistical tests. Results: The most frequent ECG abnormality was sinus bradycardia, followed by sinus tachycardia and conduction disturbances. ECG abnormalities showed significant correlations with abdominal pain, mucosal bleeding, fluid accumulation, shock, respiratory distress, and ARDS, whereas persistent vomiting, lethargy, and hepatomegaly did not show significant associations. Conclusion: ECG monitoring should be considered an essential part of the evaluation of dengue patients, especially those presenting with warning signs, as it can facilitate early identification of cardiac involvement and improve management outcomes.

Purpose: Timely identification of clinical deterioration in pediatric patients is crucial for improving outcomes and reducing mortality. Traditional scoring systems like PELOD, PRISM, and PIM are effective but require extensive laboratory tests, making them impractical in low-resource settings. To address this, simpler bedside-based tools like Pediatric Early Warning Score (PEWS) and quick Sequential Organ Failure Assessment (qSOFA) have been introduced. PEWS incorporates multiple vital signs, while qSOFA relies on just three parameters. Although qSOFA was initially developed for adults, an age-adapted version is now being explored for pediatric use. These tools enable rapid, objective assessment of illness severity. However, limitations such as variability in scoring and lack of standardization persist. This study aims to compare the predictive accuracy of PEWS and age-adapted qSOFA in pediatric patients regarding the outcome of patients, probable stay duration and requirements of oxygen therapy and ventilator.  Methods: We conducted a prospective observational study between April 2023 and August 2024 in the pediatric ICU of a tertiary hospital in Jaipur, Rajasthan. Children aged 1 month to 18 years admitted to the PICU were enrolled after obtaining guardian consent. The primary outcomes assessed were hospital stay duration, discharge or death, and need for oxygen therapy or mechanical ventilation. A total of 279 patients were included. PEWS and age-adapted qSOFA scores were applied to evaluate their effectiveness in predicting outcomes using AUROC (Area under receiver operating curve) analysis and scatter plots. Results: The study found that PEWS outperformed Age-Adapted qSOFA in predicting pediatric mortality, with an AUROC of 0.88 vs. 0.65. PEWS showed optimal accuracy at a threshold ≥8 (sensitivity 80%, specificity 81%), while qSOFA was less specific (42%) even at its best sensitivity. PEWS also correlated better with longer hospital stays (Spearman’s ρ = 0.284) compared to qSOFA (ρ = 0.221). For oxygen therapy prediction, PEWS achieved AUROC 0.89 at threshold ≥6 (sensitivity 78%, specificity 85%), whereas qSOFA had AUROC 0.61. PEWS effectively predicted mechanical ventilation needs (AUROC 0.88 at threshold ≥7), unlike qSOFA (AUROC 0.60), which had high sensitivity (90%) but low specificity (42%).   Conclusions: Overall, PEWS proved to be a more reliable and clinically useful tool in pediatric ICU settings for predicting outcome of patient, oxygen therapy requirement and ventilation requirement. None of the scores proved to be significantly useful in predicting hospital stay duration

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder frequently complicated by cutaneous infections due to impaired immunity, poor glycemic control, and long disease duration. Understanding the prevalence and spectrum of dermatological manifestations in diabetics provides insights for early diagnosis and prevention. Aim: To evaluate the association between T2DM and cutaneous infections among patients attending a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted on 100 patients with T2DM. Detailed demographic data, duration of diabetes, and glycemic status (HbA1c) were recorded. Dermatological examination was performed to identify cutaneous infections. Data were analyzed, and associations were tested using chi-square statistics. Results: The mean age of participants was 54.6 ± 11.2 years, with a male-to-female ratio of 1.3:1. Poor glycemic control (HbA1c ≥ 7%) was observed in 68% of patients. Cutaneous infections were detected in 74% of cases, with fungal infections being most common (40%), followed by bacterial (22%) and viral infections (8%). Mixed infections were observed in 4%. Patients with poor glycemic control demonstrated significantly higher prevalence of infections (85%) compared to those with adequate control (50%) (p < 0.05). A longer duration of diabetes was also strongly associated with infections, rising from 58% in patients with < 5 years of disease to 88% in those with > 10 years (p < 0.05). Conclusion: Cutaneous infections are highly prevalent among patients with T2DM, particularly in those with poor glycemic control and long-standing disease. Early recognition and strict glycemic management may reduce dermatological morbidity in this population.

Background & Objectives: Laparoscopic cholecystectomy is the preferred surgical approach for gallbladder removal due to its minimally invasive nature. Postoperative port-site pain remains a key concern, affecting recovery and hospital stay. Gallbladder extraction is performed through either the epigastric or umbilical port, with conflicting reports on pain intensity associated with each approach. This study aims to compare postoperative port-site pain following gallbladder retrieval through these two ports. Methods: A randomized controlled trial was conducted on 60 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned into two groups: Group A (gallbladder extraction through the umbilical port) and Group B (epigastric port). Pain was assessed using the Visual Analogue Scale (VAS) at 1, 6, 12, 24, and 36 hours postoperatively. Additional postoperative complications, including port-site infection and wound dehiscence, were recorded. Results: Preliminary analysis indicates that patients in the umbilical port extraction group reported lower VAS scores at multiple time intervals compared to the epigastric port group. Pain intensity was highest in the first 24 hours for both groups but declined thereafter. The incidence of port-site complications showed no significant difference between the groups. Interpretation & Conclusion: Gallbladder extraction through the umbilical port appears to be associated with reduced postoperative port-site pain compared to the epigastric port. These findings suggest that choosing the umbilical port for extraction may enhance patient comfort and recovery without increasing surgical risks

Background: The diagnosis and treatment of disorders affecting colon, rectum, anus and the surrounding tissues are dealt with in a specialized field of medicine called colorectal surgery. It includes benign and malignant diseases which require surgery. ERAS protocol was developed initially for colorectal surgeries, offer a multimodal approach to improving surgical outcomes and reducing recovery time. Name of Institution: ESIC MC & PGIMSR, BANGALORE. AIM- To evaluate the outcomes of implementing ERAS protocol in colorectal surgeries. Objective. •          Length of hospital stay. •               Post-operative complications. •        Readmissions. •   Time of tolerance of diet. Materials And Methods: A prospective descriptive study done in ESICMC & PGIMSR Rajaji Nagar and KIDWAI MEMORIAL INSTITUTE OF ONCOLOGY Bangalore from March2023-August 2025 in 62 patients belonging to different age groups and both sexes who were admitted for colorectal surgeries were included in the study. Preoperative, intra-operative data, postoperative follow up details were collected. Results: The implementation of ERAS protocol for colorectal surgeries significantly reduces hospital stay and accelerates recovery through early mobilization and enteral feeding without increasing complication rates. These findings indicate wider implementation of ERAS guidelines for patients having colorectal surgeries to enhance clinical outcomes and optimize resource utilization. Conclusion: The implementation of ERAS protocol in colorectal surgeries significantly reduced the complications, reduced length of hospital stay, accelerated early oral feeds and ambulation of the patient without increasing the complications. These findings advocate for wider implementation of ERAS protocol in colorectal surgeries to enhance clinical outcomes and optimise resource utilization

Background: Obstructive Sleep Apnoea–Hypopnoea Syndrome (OSAHS) is a prevalent sleep disorder characterized by repeated upper airway obstruction during sleep, leading to intermittent hypoxia, sympathetic activation, and sleep fragmentation. Recent studies have proposed a potential association between vitamin D deficiency (VDD) and the pathogenesis of OSAHS due to its immunomodulatory, metabolic, and neuromuscular roles. Objective: This study aimed to evaluate the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and the severity of OSAHS among adult patients in the Indian population. Methods: A cross-sectional observational study was conducted at Jain ENT Hospital, Jaipur, from May to October 2023, involving 100 adults recently diagnosed with OSAHS using overnight polysomnography. OSAHS severity was graded based on the Apnoea–Hypopnoea Index (AHI) as per AASM 2012 guidelines. Serum 25(OH)D levels were measured and classified into deficiency (<20 ng/mL), insufficiency (21–29 ng/mL), and sufficiency (≥30 ng/mL). Statistical analysis was performed using the chi-square test (SPSS v21), with a significance level of p < 0.05. Results: Among the participants, 62% were male and the majority (66%) were aged between 40–59 years. No statistically significant association was found between obesity class and vitamin D status (p = 0.828) or between OSAHS severity and vitamin D levels (p = 0.762). Conclusion: This study found no significant correlation between vitamin D deficiency and OSAHS severity. The findings suggest that VDD may not independently contribute to the pathogenesis or progression of OSAHS. Further large-scale longitudinal studies are warranted to validate these results.

Introduction: Myocardial infarction (MI) is a major global health concern and a leading cause of morbidity and mortality. It results from prolonged ischemia due to atherosclerotic plaque rupture and coronary thrombosis, leading to irreversible myocardial necrosis. Despite significant advances in acute management and secondary prevention, MI continues to be associated with substantial complications, hospital readmissions, and recurrent cardiovascular events. Aims: The study aims to assess the role and clinical impact of pharmacists in the prevention, management, and post-care optimization of myocardial infarction (MI) within a tertiary care hospital setting. Methods: The study will be carried out at Medicare Hospital and Ajara Hospital, two tertiary care centers with specialized cardiology and pharmacy departments that provide advanced cardiac care and clinical pharmacy services essential for managing myocardial infarction. Result: Among the 201 participants, chest pain was the most frequent symptom (80%), followed by shortness of breath (73%), radiating chest pain (45%), and sweating with chest pain (41%). Other symptoms included generalized weakness (53%), palpitations with anxiety (33%), nausea and vomiting (18%), body or back pain (18%), burning micturition (14%), and pedal edema (2.5%). Conclusion: In this study of 201 myocardial infarction patients, chest pain was the predominant symptom, followed by dyspnoea and radiating pain, reflecting the typical MI profile. Many patients also presented with weakness, autonomic features, and atypical symptoms, emphasizing the importance of vigilant diagnosis, particularly in elderly and female patients.

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder requiring long-term pharmacotherapy. Polypharmacy is common in T2DM patients due to coexisting comorbidities, increasing the risk of adverse drug reactions, drug interactions, non-adherence, and reduced quality of life. Medication deprescribing, defined as the planned and supervised reduction or discontinuation of medications that may no longer be beneficial or may be causing harm, has emerged as an important strategy to optimize patient outcomes. Objectives: The primary objective of this study was to evaluate the prevalence, patterns, and outcomes of medication deprescribing among patients with T2DM. Secondary objectives included identifying barriers and facilitators to deprescribing and assessing the impact on glycemic control, adverse drug events, and patient satisfaction. Methods: This observational prospective study was conducted over a period of six months at Medicare Multi-Speciality Hospital, including a total of 200 patients diagnosed with type 2 diabetes mellitus. Patients were selected based on established diagnostic criteria for type 2 diabetes. Data were collected on key variables including age, gender, duration of diabetes, comorbidities, medications, dietary adherence, lifestyle factors, and treatment outcomes. The study aimed to assess patterns of medication use, deprescribing, adherence to diet and physical activity, and overall treatment success, providing insights into the management of type 2 diabetes in a real-world clinical setting. Results: Among 200 patients with type 2 diabetes mellitus (mean age 54.3 ± 11.3 years; 61.5% female), hypertension (48%), hypothyroidism (16%), and dyslipidemia (7%) were the most common comorbidities. Of 65 patients reviewed for deprescribing, sulfonylureas and insulin were most frequently deprescribed, while other antidiabetics were reduced to a lesser extent. Positive family history was noted in 28%, and 22% showed medication non-compliance. Most patients had no notable habits (73.5%), limited dietary adherence, and low to moderate physical activity. Treatment success was complete in 17%, partial in 15.5%, and absent in 7%, with 60.5% not applicable. Conclusion: Medication deprescribing in patients with T2DM is feasible, safe, and can improve medication adherence and overall patient satisfaction without adversely affecting glycemic control. Incorporating structured deprescribing strategies into routine clinical practice may enhance the quality of care and reduce medication-related complications in this population. Further large-scale studies are warranted to develop standardized deprescribing guidelines for T2DM

Background: AIBD (Autoimmune blistering disorders) lead to auto-antibodies formation against adhesion proteins from mucosa or skin and these antibodies are detected in bound form from tissues using DIF (direct immunofluorescence) or blood circulation using ELISA (enzyme-linked immunosorbent assay) or other methods. Aim: The present study was aimed to assess the concordance rate between ELISA and autoimmune bullous disorders assessed using DIF at an Indian healthcare Center. Methods: The present study assessed data retrospectively from the Department of Dermatology of the Institute using multivariant ELISA assay which could detect antibodies against collagen VII, envoplakin, BP230, BP180, desmoglein 3, and desmoglein1. Also, corresponding histopathological data were extracted from the records of the Institute. Final diagnosis was given considering histopathological features, clinical presentation, and corresponding DIF reports. Results: The study assessed 506 subjects where 388 subjects had Autoimmune blistering disorders and 118 subjects had non- Autoimmune blistering disorders. In AIBD group, 244 subjects had pemphigus and 144 subjects had pemphigoid respectively. The study results showed a good agreement level in final diagnosis and multivariant ELISA results with p<0.001. A good and moderate agreement was seen pemphigus vulgaris and non-autoimmune blistering disorders, bullous pemphigoid, and pemphigus foliaceous group with p<0.001. Fair agreement was seen in mucous membrane pemphigoid group with p<0.001. Conclusion: The present study concludes that there is a good agreement between gold standard diagnosis using histopathology, DIF, and clinical findings to the multivariant ELISA, hence, multivariant ELISA can be used to diagnose Autoimmune blistering disorders at places with limited resources where DIF is not available. Also, multivariant ELISA can help in improving etiological diagnosis for various AIBDs where target antigens are seen in multivariant panel.

Background: Hyperlipidaemia is a pathological condition of elevated lipid and cholesterol concentrations. Platelets have been shown to have a role in the thrombus formation as a consequence of atheromatous damage in hyperlipidaemic individuals. Platelet activity can be evaluated with platelet indices, including platelet distribution width and plateletcrit. Methods A cross-sectional analysis was conducted on 200 hyperlipidaemic patients in our hospital. Biochemical (Total Cholesterol, LDL, HDL, Triglycerides) and haematological (Platelet Count, PDW, P-LCR, PCT) parameters were taken from hospital records. Correlation analysis was employed to assess associations between lipid indices and platelet parameters. Results: The cohort comprised 52% males and 48% females, with the majority aged between 41–60 years (42.5%). The mean Total Cholesterol, LDL, HDL, and Triglycerides were 231.8 ± 25.9 mg/dL, 151.4 ± 28.4 mg/dL, 39.7 ± 14.9 mg/dL, and 146.5 ± 45.6 mg/dL respectively. Platelet Count and PDW averaged 291.7 ± 224.4 x10³/µL and 14.3 ± 3.2 respectively. All parameters show a statistically significant positive correlation with platelet count (p < 0.05), aligning with literature reporting enhanced platelet activity in hyperlipidaemic states. Conclusion: Present study indicates that PDWs are significantly higher in hyperlipidemic individuals. These indices are available without any additional cost to clinicians, pathologist and patients and hence can be used to assess the risk associated with hyperlipidaemia.

Background: Acute exacerbations of COPD (AECOPD) significantly impact patients. Up to 30% of AECOPD cases have unclear etiologies. Pulmonary embolism (PE), often underdiagnosed, is a crucial factor, with COPD being an independent PE risk. PE prevalence in AECOPD ranges from 12.72% to 23.57%, significantly higher than the general population. Overlapping symptoms with AECOPD lead to missed PE diagnoses, increasing mortality. This study aimed to determine PE incidence during AECOPD and describe clinical aspects. Methods: This prospective study included 50 AECOPD patients. COPD was confirmed via history, records, chest X-ray, and spirometry (post-bronchodilator FEV1/FVC < 0.70). AECOPD was defined as worsening respiratory symptoms beyond usual variation. All patients underwent Wells Score assessment. CT Pulmonary Angiography (CTPA) was performed for Wells Score >3. Results: Among 50 patients, 18 underwent CTPA, revealing PE in 6 (12% of total). PE was significantly associated with more severe GOLD classifications (p:0.0037), higher mean CRP levels (29.83 vs 14.0; p < 0.0001 and Wells score >3). Gender and age showed no significant association with PE. Conclusion: PE was detected in 12% of AECOPD patients, a significantly higher rate than in the general population. PE was significantly associated with severe GOLD classification, Wells Scores >3, and elevated CRP levels. Gender and age were not a predictor of PE.

Hypertension is a major public health challenge globally, particularly in India where control rates remain low. This case-control study aimed to identify socio-demographic factors determining hypertension control among patients registered in the NCD clinic at UHTC Ambalapuzha, Kerala. The study included 182 cases (hypertensive patients with controlled blood pressure) and 182 controls (hypertensive patients with uncontrolled blood pressure). Data on socio-demographic factors including age, gender, education, occupation, ration card type, and participation in self-help groups were collected. The mean age of cases was 64.27 ± 9.3 years and controls was 65.13 ± 9.16 years. The majority of participants were females (65.4% in cases, 58.8% in controls). Most participants had low education levels, with 38.5% of cases and 39% of controls having studied up to 8th-10th standard. Over half of the participants in both groups were unemployed, and more than three-fourths had BPL ration cards. No significant associations were found between hypertension control and age, gender, education, occupation, or ration card type. However, participation in self-help groups (Kudumbashree/Ayalkkoottam) was significantly associated with hypertension control (OR: 1.942, 95% CI: 1.145-3.292, p=0.013). The study concludes that while traditional socio-demographic factors may not significantly influence hypertension control in this population, community-based self-help groups appear to play a beneficial role and could be leveraged in hypertension control programs.

Background: Diabetes in elderly individuals often presents atypically, leading to delayed diagnosis and increased risk of complications. This study evaluates the spectrum of atypical presentations, complications, and hospitalisation burden of diabetes among elderly patients in Odisha, India. Methods: A retrospective observational study was conducted at Kalinga institute of medical sciences, Bhubaneswar, from APRIL 2023 to March 2024. Data from 710 elderly inpatients (≥65 years) were screened. Of these, 153 had diabetes mellitus (DM), and 100 patients underwent complete evaluation. Clinical history, laboratory data, and complications were analysed using SPSS v17.0. Findings: The prevalence of diabetes among hospitalised elderly patients was 21.5%. Atypical symptoms were common, including numbness, paraesthesia, and claudication (66.6%), altered mental status (58.3%), and nausea/vomiting (58.3%). Chronic complications were prevalent: peripheral neuropathy (54%), nephropathy (45%), retinopathy (24%). Macrovascular complications included CAD (34%) and CVA (25%). Cognitive decline (31%) and urinary incontinence (29%) were common geriatric issues. Infections (31%) and chronic diabetic complications (51%) were the leading causes of hospitalisation.  Interpretation: Diabetes in elderly patients commonly manifests with non-classical features and is frequently complicated by microvascular and macrovascular pathology, cognitive impairment, and recurrent infections. Enhanced clinical awareness and individualized care strategies are essential.

Introduction: The most popular regional blocks are neuraxial blocks, which comprise spinal and epidural blocks. This is because an anesthesiologist can create a dependable block with a single injection, and these blocks have well defined termination points.  Depending on the dosage, volume, and concentration of the local anesthetic used, each of these blocks results in motor, sensory, and sympathetic blockade. Aims: To compare following parameters among the two study groups: Group R (0.75% hyperbaric Ropivacaine) and Group L (0.5% hyperbaric Levobupivacaine) The level and onset of sensory and motor block. Materials & Methods: This was a prospective, randomized, double-blinded study conducted at the CB-UP Orthopaedic OT Complex of Medical College and Hospital, Kolkata, from December 2022 to November 2023. A total of 94 patients were enrolled in the study. Result: In our study, the mean time for onset of sensory block was longer in the Levobupivacaine group (8.36 ± 0.73 minutes) compared to the Ropivacaine group (4.53 ± 0.54 minutes, p < 0.001). Conversely, the onset of maximum motor block (Bromage score) was faster with Levobupivacaine (4.76 ± 0.66 minutes) than with Ropivacaine (8.51 ± 0.55 minutes, p < 0.001). Conclusion: We concluded that in this study, which compared 0.5% hyperbaric Levobupivacaine and 0.75% hyperbaric Ropivacaine for lower limb orthopaedic surgery, there were no statistically significant variations between the groups' demographic characteristics, such as gender and ASA physical status.

Background: Maternal anemia is highly prevalent in India and linked to adverse pregnancy outcomes. However, its impact on fetoplacental Doppler parameters remains underexplored. Objective: To evaluate the association between anemia severity and third-trimester Doppler changes, and their predictive value for perinatal outcomes. Methods: This cross-sectional study included 300 anemic pregnant women in the third trimester, grouped as mild (n=120), moderate (n=120), or severe (n=60) per WHO criteria. Doppler indices—umbilical artery (UA) S/D ratio, middle cerebral artery (MCA) pulsatility index (PI), and cerebroplacental ratio (CPR)—were assessed. Outcomes included birth weight, NICU admission, and perinatal mortality. Results: With increasing anemia severity, UA S/D ratio rose (2.71 to 3.52), while MCA PI (1.62 to 1.18) and CPR (1.18 to 0.72) declined (p<0.001). Abnormal Doppler waveforms occurred in 25% of severe anemia cases. Adverse outcomes increased with severity: low birth weight (15.0% to 45.0%), NICU admission (10.0% to 36.7%), and perinatal mortality (1.7% to 10.0%). Severe anemia independently predicted these outcomes, with adjusted odds ratios of 2.8, 3.4, and 3.1, respectively. Conclusion: Worsening maternal anemia is associated with significant Doppler changes and higher risks of neonatal complications. Routine Doppler assessment, especially CPR, may help identify high-risk foetuses and improve outcomes in pregnancies with moderate-to-severe anemia.

Background: Laparoscopic surgery has become the preferred approach in many procedures owing to advantages such as reduced postoperative pain, shorter recovery time, and improved cosmetic outcomes. Establishing carbon dioxide (CO₂) pneumoperitoneum, however, induces physiological changes that may affect coagulation and fibrinolysis. Conflicting evidence exists regarding whether these alterations predispose patients to venous thromboembolism (VTE). Aim: To evaluate the effects of CO₂ pneumoperitoneum on coagulation parameters in patients undergoing laparoscopic surgeries. Methods: This prospective observational study included 50 patients aged 18–60 years undergoing laparoscopic cholecystectomy at a tertiary care hospital. Patients with pre-existing coagulation disorders, comorbidities, or those receiving anticoagulants were excluded. Blood samples were collected preoperatively and 6 hours postoperatively to assess Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), and D-dimer levels. Statistical analysis was performed using paired t-test, with p < 0.05 considered significant. Results: The mean preoperative PT was 11.91 ± 1.14 seconds compared to 11.78 ± 1.10 seconds postoperatively, a non-significant difference (p=0.5). Similarly, aPTT showed no significant change (27.53 ± 1.99 vs. 27.30 ± 1.94 seconds, p=0.5). In contrast, D-dimer levels increased significantly from 0.25 ± 0.04 µg/ml preoperatively to 0.69 ± 0.14 µg/ml postoperatively (p<0.0001), indicating a transient hypercoagulable state. No patient developed clinical or radiological evidence of deep vein thrombosis during the study period. Conclusion: Laparoscopic cholecystectomy with CO₂ pneumoperitoneum does not significantly alter PT or aPTT values but is associated with a significant postoperative rise in D-dimer levels. While these findings suggest biochemical evidence of hypercoagulability, the absence of thrombotic events highlights the need for individualized risk assessment rather than universal thromboprophylaxis. Larger multicentric studies with extended postoperative follow-up are warranted to establish definitive guidelines

Background: Diagnostic errors in internal medicine, particularly with complex multisystem conditions, remain a significant cause of patient morbidity and mortality. AI technologies, including machine learning, natural language processing, and clinical decision support systems, have the potential to reduce these errors and enhance diagnostic accuracy. Objective: This study aimed to evaluate the impact of AI tools on diagnostic accuracy, cognitive bias reduction, and time efficiency in internal medicine diagnoses, particularly focusing on multisystem and rare diseases. Methods: A prospective cohort study was conducted with 60 patients, focusing on those with complex conditions in internal medicine. Patients were diagnosed using traditional methods and AI-powered tools. AI tools included machine learning algorithms for diagnostic imaging, natural language processing for clinical notes, and clinical decision support systems integrated with electronic health records (EHR). Diagnostic errors, cognitive biases, and diagnostic times were assessed before and after AI integration. Results: Diagnostic Accuracy: The error rate decreased from 22% to 12% after AI tools were implemented, representing a 45% reduction in diagnostic errors, Cognitive Bias Reduction: 30% of clinicians overcame premature closure bias, and 25% overcame anchoring bias due to AI-driven suggestions. Disease-Specific Diagnostic Improvement: AI improved diagnostic accuracy in radiology (11% reduction in errors) and pathology (50% increase in cancer detection). Time Efficiency: The average time from consultation to diagnosis was reduced from 8.2 hours to 5.3 hours, a 35% reduction in diagnostic time. Rare Disease Diagnosis: AI flagged 8% of patients for potential rare diseases, with a 75% confirmation rate for these diagnoses. Conclusions: AI tools significantly enhance diagnostic accuracy, reduce cognitive biases, and improve time efficiency in internal medicine. AI is particularly effective in imaging and pathology, as well as diagnosing rare diseases. However, further research is needed to refine these technologies and address ethical, transparency, and data quality concerns.

Background: Acute myocardial infarction (AMI) remains a significant cause of cardiovascular mortality worldwide. In India, the age-standardized CVD death rate is 272 per 100,000—significantly above the global average. Early risk stratification is vital to guide treatment and improve prognosis. The Global Registry of Acute Coronary Events (GRACE) score is a validated tool to predict in-hospital mortality in acute coronary syndromes (ACS), including ST-elevation myocardial infarction (STEMI). Objective: To evaluate the prognostic accuracy of the GRACE risk score in predicting in-hospital outcomes among patients with STEMI. Methods: A prospective observational study was conducted on 44 patients admitted with STEMI to a tertiary care hospital. Diagnosis was based on clinical presentation, ECG, and cardiac biomarkers. GRACE scores were calculated at admission using eight clinical variables. Patients were stratified into low, intermediate, and high-risk groups and monitored for in-hospital outcomes. Results: The mean GRACE score was 134.9 ± 36.9. Of 44 patients, 6 (13.6%) died during hospitalization—all belonged to the high-risk GRACE category (>140). No mortality occurred in the low or intermediate groups. Higher GRACE scores, advanced Killip class, and lower systolic blood pressure were significantly associated with adverse outcomes. Conclusion: The GRACE score demonstrated strong predictive value for in-hospital mortality in STEMI patients. Its routine use at admission can aid clinicians in identifying high-risk patients, guiding interventions, and informing prognosis discussions.

Background: Paraproteinemia-associated renal diseases are a diagnostic challenge requiring integration of histopathology, immunofluorescence (IF), and serum studies. This study characterizes the renal lesions associated with paraproteinemia and highlights the diagnostic value of IF. Methods: A prospective analysis of 30 renal biopsies from patients with known or suspected paraproteinemia was conducted. Histopathological patterns were classified, and IF was used to detect light chain and complement deposition. Serum free light chain ratio and serum electrophoresis were correlated. Results: Light Chain Deposition Disease (LCDD) was the most frequent diagnosis (43.3%), followed by AL amyloidosis (23.3%), tubulointerstitial nephritis (TIN) with monoclonal light chains (20%), and myeloma cast nephropathy (MCN) (13.3%). Kappa restriction was observed in 70% of cases and lambda in 30%. IF positivity was high for light chains, especially in LCDD and TIN. Histological features included mesangial expansion, nodular sclerosis, and interstitial fibrosis. Mean serum creatinine was highest in TIN (3.4 mg/dL), followed by LCDD (3.13 mg/dL). Most patients had a skewed free light chain ratio (0.1 in 27 cases). Conclusion: Immunofluorescence, including paraffin-based IF when necessary, is essential in detecting monoclonal light chain deposition and differentiating paraproteinemia-related kidney diseases. Early and accurate diagnosis enables timely intervention to preserve renal function

Introduction: Psoriasis is a chronic inflammatory skin disorder affecting approximately 2% of the global population. It is characterized by rapid epidermal proliferation, inflammation, and aberrant keratinocyte maturation. Psoriasiform dermatitis shares similar histopathological features, often complicating the diagnosis. Accurate differentiation is essential for appropriate treatment planning. Immunohistochemical (IHC) markers such as Ki-67 (a proliferation marker), p53 (a tumor suppressor protein), and CD34 (a vascular marker) may aid in distinguishing these two entities.To evaluate the expression of Ki-67, p53, and CD34 in skin biopsies to differentiate psoriasis from psoriasiform dermatitis. Methods: A prospective observational study was conducted at MGM Medical College, Navi Mumbai, between June 2023 and December 2024. Thirty adult patients with suspected psoriasis or psoriasiform dermatitis were included after informed consent. Skin biopsies underwent routine H&E staining and IHC analysis using antibodies for Ki-67, p53, and CD34. Staining was graded based on the percentage of positive cells or vessels. Statistical analysis was performed, with p < 0.05 considered significant. Results: Of the 30 cases, 21 were diagnosed with psoriasis and 9 with psoriasiform dermatitis. The mean Ki-67 index was significantly higher in psoriasis (83.86%) than in psoriasiform dermatitis (62.18%) (p < 0.001). Similarly, p53 expression (28.31% vs. 10.39%) and CD34-positive vessel count (17.52 vs. 8.44) were significantly elevated in psoriasis (p < 0.001). Interpretation and Conclusion: Ki-67, p53, and CD34 are significantly overexpressed in psoriasis and can serve as reliable markers for distinguishing it from psoriasiform dermatitis.

Introduction: Acute poisoning remains a significant global public health concern, contributing substantially to morbidity and mortality in India with patterns shaped by agricultural practices, access to highly hazardous pesticides, and social determinants.  Understanding the patterns, predictors, and outcomes of acute poisoning cases is crucial for developing effective prevention strategies and improving patient management.  Materials & Methods: This hospital-based retrospective study analyzed 220 acute poisoning cases admitted to a tertiary care hospital in Gujarat. Data collected included socio-demographic details, type of poison, manner of poisoning, time since exposure, severity at admission, hospital stay duration, and outcome.  Results: Of 220 cases, young adults (21-30 years, 37.3%) and males (62.7%) were most affected, predominantly from rural (72.3%) and lower socio-economic backgrounds (42.7%). Pesticides were the leading agents (55%), with organophosphates (30%) and aluminum phosphide (16.4%) being common. Suicidal intent accounted for 76.4% of cases. Overall mortality was 6.8%. Severe poisoning at admission (aOR 6.5, p<0.001) and aluminum phosphide ingestion (aOR 4.8, p=0.002) were the strongest independent predictors for mortality. Conclusion: Acute poisoning in Gujarat disproportionately affects young adult males from rural, lower socio-economic strata, with pesticides being the primary agents, often with suicidal intent. Mortality is significantly influenced by the type of poison, severity at admission, and delayed presentation. Targeted interventions focusing on restricting access to highly toxic agents like aluminum phosphide, improving emergency medical services, and addressing socio-economic disparities are essential to reduce the burden of acute poisoning in the region

Background: Salivary gland lesions constitute a heterogeneous group of neoplastic and non-neoplastic disorders with wide histological diversity. Fine needle aspiration cytology (FNAC) serves as a rapid, cost-effective, and minimally invasive preoperative diagnostic tool. However, histopathological examination (HPE) remains the gold standard for final diagnosis. Objectives: To analyze the spectrum of salivary gland lesions in surgically resected specimens and to evaluate the diagnostic accuracy of FNAC by correlating cytological findings with histopathological outcomes. Materials and Methods: This prospective study was conducted in the Department of Pathology, Maharajah’s Institute of Medical Sciences, Nellimarla, Vizianagaram, from June 2010 to June 2014. A total of 34 surgically resected salivary gland specimens with prior FNAC reports were included. Relevant clinical data were recorded. Specimens were grossly examined, processed, and stained with Hematoxylin and Eosin for histopathological evaluation. Cytohistological correlation was carried out, and diagnostic accuracy parameters were calculated. Results: Of the 34 cases, benign neoplasms (67.65%) outnumbered malignant neoplasms (20.59%) and non-neoplastic lesions (11.76%). Pleomorphic adenoma was the most common benign tumor (55.88%), while adenoid cystic carcinoma and mucoepidermoid carcinoma were the predominant malignant tumors. The parotid gland (70.59%) was the most frequently involved site. FNAC showed a sensitivity of 87.5%, specificity of 100%, and overall diagnostic accuracy of 88.24% when compared with histopathology. Conclusion: Pleomorphic adenoma remains the most common salivary gland lesion, with the parotid gland being the principal site of involvement. FNAC proves to be a reliable first-line diagnostic tool with high specificity, but histopathology continues to be indispensable for definitive diagnosis, grading, and management planning.

Background & Objectives: Antinuclear autoantibodies (ANA) are key biomarkers in systemic autoimmune diseases. Indirect immunofluorescence assay (IIFA) on HEp-2 cells and line immunoassay (LIA) is widely used for ANA detection and profiling. Materials and Methods: In this prospective study (July 2023–December 2024), 50 adults with suspected systemic autoimmune disorders underwent ANA testing by IIFA (titre ≥1:80) and LIA (18-antigen strip). Patterns, titers, and band intensities were recorded. LIA sensitivity and specificity were calculated relative to IIFA. Results: ANA positivity by IIFA was 68% (34/50), with speckled (50%), nucleolar (29.4%), homogeneous (17.8%), and centromere (2.9%) patterns. LIA detected specific autoantibodies in 32% (16/50), most commonly anti-SSA/Ro-52 and anti-U1-snRNP, with clinical diagnoses of SLE (31.25%) and Sjögren’s syndrome (25%). LIA sensitivity was 44.12% and specificity 93.75%. Interpretation & Conclusion: IIFA provides a sensitive screening tool, while LIA offers high specificity and antigen-level resolution. A combined approach enhances diagnostic accuracy and immunological subclassification

Background: Anemia is the most common extraintestinal complication of Inflammatory Bowel Disease (IBD), significantly impairing patients' quality of life. It arises from a complex interplay of iron deficiency (ID), chronic inflammation, and micronutrient deficiencies. The prevalence and characteristics of anemia can vary based on disease type, activity, and patient population. Objective: This study aimed to determine the prevalence of anemia, characterize its subtypes, and identify associated clinical and biochemical risk factors in a cohort of IBD patients at a tertiary care center. Methods: A retrospective cross-sectional study was conducted on 250 adult patients (130 with Crohn's disease [CD], 120 with Ulcerative Colitis [UC]) diagnosed with IBD. Data on demographics, disease characteristics, and laboratory parameters including complete blood count, iron studies (ferritin, transferrin saturation [TSAT]), and C-reactive protein (CRP) were extracted from electronic medical records. Anemia was defined by WHO criteria (hemoglobin <13 g/dL for men, <12 g/dL for women). Anemia subtypes were classified as iron deficiency anemia (IDA), anemia of chronic disease (ACD), or mixed-type. Statistical analysis was performed using t-tests and chi-square tests, with p<0.05 considered significant. Results: The overall prevalence of anemia was 40.0% (100/250). Anemia was significantly more prevalent in patients with CD (47.7%) than in UC (31.7%; p=0.012). Anemic patients had a longer disease duration (8.9 ± 4.1 vs. 6.2 ± 3.5 years; p<0.001) and higher mean CRP levels (25.4 ± 12.1 mg/L vs. 8.2 ± 4.5 mg/L; p<0.001) compared to non-anemic patients. Among anemic patients, IDA was the most common subtype (55.0%), followed by mixed-type anemia (25.0%) and ACD (20.0%). Patients with active disease had a significantly higher prevalence of anemia compared to those in remission (65.8% vs. 21.3%; p<0.001). Conclusion: Anemia remains a significant burden in our IBD population, particularly among patients with Crohn's disease and active inflammation. Iron deficiency is the primary driver, but a substantial proportion of patients exhibit features of mixed or inflammatory-driven anemia. These findings underscore the necessity of routine screening and a comprehensive diagnostic approach that considers both iron status and inflammatory activity to guide appropriate management.

Background: Surgical Site Infections (SSI) are among the most common healthcare-associated infections and contribute significantly to morbidity, prolonged hospital stays, and healthcare costs. Aims and Objective: To assess the prevalence and associated risk factors of patients with Surgical Site Infections in a Tertiary Care Hospital of Arunachal Pradesh, India. Materials and method: A total of 2050 patients who underwent surgery were studied. Patients developing SSI (n=500) were analysed for demographic characteristics, surgical factors, comorbidities, BMI, antibiotic prophylaxis, and microbiological isolates. Results: The overall incidence of SSI was 24.4%. Females (54%) were slightly more affected than males (46%). Highest SSI prevalence was in age groups 22–29 years (24.8%) and >60 years (22.4%). Diabetes was present in 62.2% of SSI patients. Emergency operations accounted for 81.6% of SSIs. Dirty (47.8%) and contaminated (36.2%) wounds contributed to most cases. Longer duration surgeries (>2 hrs) had higher SSI rates (78.4%). Post-operative antibiotic administration was common (75.2%), contrary to guidelines. Among 161 culture-positive isolates, Pseudomonas aeruginosa (42.2%) and Staphylococcus aureus (29.8%) predominated. Both underweight (35.6%) and overweight/obese patients (52.4%) were at greater risk compared to normal BMI (12%). Conclusion: High SSI rates were associated with emergency surgeries, longer duration, diabetes, and inappropriate timing of antibiotic prophylaxis. Strengthening infection control measures, optimizing antibiotic use, and addressing modifiable patient risk factors are crucial to reducing SSI burden

Background: Clinical decision support systems based on artificial intelligence (AI-CDSS) are being widely adopted in medical specialties to enhance diagnostic precision, streamline workflows, and improve patient outcomes. Though potentially valuable, usability, trust, and integration issues are major hurdles to large-scale adoption. Objective: The objective was to conduct a synthesis of the latest evidence regarding the uses, effects, and impediments of AI-CDSS in multidisciplinary clinical practice, alongside comparing rates of adoption and clinician attitudes between care environments. Methods: A scoping review design was used, and literature searches were undertaken in PubMed, Scopus, and Web of Science between January 2020 and July 2025. Searches included studies reporting on the implementation or evaluation of AI-CDSS in clinical practice in primary care, oncology, emergency medicine, and community health. Data were extracted to a matrix and synthesized thematically. Results: Sixty-two studies were included, most published since 2021, demonstrating increasing interest. AI-CDSS for primary care enhanced diagnostic performance and consultation speed, whereas oncology applications demonstrated improvements in cancer diagnosis and treatment planning. Emergency medicine reported results highlighted the need for expeditious triage and workflow optimization, while community health applications highlighted the optimization of resource allocation. Inhibitors were limited transparency, clinician skepticism, alert fatigue, and integration complexities. Comparative results showed that institutional context, usability of the system, and perceived trust were highly influential for willingness to implement AI-CDSS. Conclusion: AI-CDSS show evident benefits across specialties but need explainable design, clinician buy-in, and compliance with regulation for sustainable incorporation into healthcare systems.

Background: Artificial intelligence (AI) has become more relevant in healthcare, especially in the management of chronic diseases, where precise diagnosis, long-term monitoring, and individualized interventions are paramount. Its potential aside, there are questions about how it would be integrated in clinical practice, within ethical considerations, and with equal access. Objective: This review sought to integrate current evidence concerning AI-supported diagnostic trends in chronic disease management, emphasizing technological developments, human aspects, and clinical implications. Methods: A narrative review approach was adopted, with literature sourced from PubMed, Scopus, and Web of Science. Studies published in the past decade were included if they evaluated AI applications in chronic illness diagnosis, decision support, or patient engagement. Data were thematically synthesized into domains of diagnostic accuracy, human–technology interaction, and access to care. Results: Evidence shows that AI models improve diagnostic accuracy across conditions including diabetes, hypertension, and cardiovascular disease, frequently outperforming traditional techniques. Clinical decision support systems enhanced workflow productivity and treatment customization. Conversational agents and remote monitoring devices improved patient engagement, especially in rural and under-resourced environments. Yet provider trust, transparency in systems, and ethical governance remain essential drivers of adoption. Comparative analysis with previous studies across oncology, osteoporosis, and pandemic response further affirmed AI’s cross-domain utility, while underscoring the importance of regulatory and methodological rigor. Conclusion: AI holds substantial promise in transforming chronic illness management, but its effectiveness will depend on transparent design, ethical integration, and alignment with human-centered care values.

Background: The Inferior Vena Caval Collapsibility Index (IVCCI) is a simple, non-invasive ultrasonographic tool to assess intravascular volume status and fluid responsiveness. In spinal anaesthesia (SA), hypotension is a common complication, often related to preoperative hypovolemia from fasting. Identifying fluid-responsive patients preoperatively may help prevent intraoperative hypotension. However, limited studies have evaluated IVCCI for this purpose. Aim: To evaluate preoperative IVCCI and correlate it with hemodynamic changes following spinal anaesthesia. Methods: An observational study was conducted on 80 ASA I and II patients undergoing elective surgery under SA. Preoperatively, an 18G IV line was secured, and inferior vena cava (IVC) diameters during inspiration and expiration were measured using a 2–6 MHz curvilinear probe in the subcostal long-axis view with M-mode ultrasound. IVCCI was calculated as: IVCCI = [(IVCₑₓ – IVCᵢₙ) / IVCₑₓ] × 100 Patients were then given 500 mL Ringer Lactate over 15 minutes, and IVC measurements were repeated. After SA, hemodynamic parameters (SBP, DBP, MAP, HR) were recorded every 10 minutes. Results: Pre-bolus mean IVCCI was 40.51% (SD 3.06), suggesting preoperative hypovolemia. Post-bolus IVCCI reduced to 36.37% (SD 2.17), indicating fluid responsiveness. A significant negative correlation was found between IVCCI and hemodynamic parameters, especially MAP (r = -0.2, p < 0.0001). Conclusion: IVCCI is a useful, bedside predictor of fluid status and responsiveness. A preoperative fluid bolus effectively reduces IVCCI and helps maintain intraoperative hemodynamic stability in patients undergoing spinal anaesthesia. Incorporating IVCCI assessment into routine preoperative evaluation may help anticipate and manage SA-induced hypotension.

Background: Peak expiratory flow rate (PEFR) is influenced by various anthropometric factors, with conflicting evidence regarding the relationship between body mass index (BMI) and respiratory function in children. Objective: To investigate the correlation between BMI and PEFR in healthy school-going children aged 8-15 years and assess the influence of demographic, anthropometric, and environmental factors. Methods: A cross-sectional study was conducted among 208 healthy school children aged 8-15 years in secondary schools of Hyderabad, India. Anthropometric measurements including height, weight, and BMI were recorded. PEFR was measured using Mini Wright's peak flow meter. Statistical analysis included Pearson correlation, simple linear regression, and multiple linear regression analyses. Results: The study population comprised 117 males (56.3%) and 91 females (43.8%) with mean age 9.53±1.34 years. Simple linear regression showed BMI had a weak positive correlation with PEFR (r=0.20, p<0.001). Height demonstrated the strongest correlation with PEFR (r=0.63, p<0.001), followed by age (r=0.54, p<0.001) and weight (r=0.47, p<0.001). In multiple regression analysis controlling for confounding variables, BMI's influence on PEFR became non-significant, while age, gender, and exposure to mosquito repellents remained significant predictors. Conclusion: BMI shows a weak positive correlation with PEFR in isolation, but this relationship is not significant when controlling for other variables. Height, age, and gender are stronger predictors of PEFR in children. The apparent BMI-PEFR relationship is likely mediated by other anthropometric and demographic factors

Stroke is a leading cause of morbidity and mortality worldwide, contributing substantially to global disease burden. Ischemic strokes account for nearly 85% of all stroke cases and are associated with substantial neurological deficits. Serum calcium plays a pivotal role in neuronal function, and its dysregulation during cerebral ischemia has been implicated in worsened neuronal injury. This study was conducted to investigate the relationship between serum calcium levels and infarct size among patients with acute ischemic stroke. Fifty patients aged above 40 years, diagnosed radiologically by CT scan, were included. Serum calcium and albumin were measured, and corrected calcium was calculated. Infarct size was estimated using the ABC/2 method. Statistical analysis revealed a significant negative correlation between serum calcium and infarct size (r = -0.2933, p = 0.04). Corrected calcium demonstrated a stronger inverse correlation (r = -0.6303, p = 0.01). These findings suggest that lower serum calcium levels are associated with larger infarct sizes, highlighting the potential role of serum calcium as a prognostic biomarker in acute ischemic stroke.

Background: Diabetes mellitus is a major risk factor for coronary artery disease (CAD), yet the relative angiographic severity of CAD across the glycemic spectrum—including pre-diabetes—remains incompletely defined. Methods: We conducted a cross-sectional observational study of 412 consecutive patients presenting with a first episode of acute coronary syndrome (ACS) who underwent coronary angiography. Patients were classified as diabetic (n = 213), pre-diabetic (n = 76), or non-diabetic (n = 123) according to ADA criteria. The severity of CAD was quantified using the Gensini scoring system. Associations between glycemic status, HbA1c, duration of diabetes, and angiographic severity were analyzed using ANOVA and Pearson’s correlation. Results: The mean Gensini score was 47.1 ± 31.1 in diabetics, 41.5 ± 25.1 in pre-diabetics, and 38.5 ± 33.9 in non-diabetics (p = 0.049). Triple-vessel disease was most prevalent in diabetics (29.1%) compared with pre-diabetics (14.5%) and non-diabetics (14.6%, p< 0.001). Duration of diabetes correlated strongly with CAD severity (r = 0.69, p< 0.001), with patients having >10 years’ diabetes showing the highest mean Gensini score (85.0) versus 34.5 in newly detected cases. In contrast, HbA1c stratification (<6.5%, 6.5–8.9%, >9%) showed no significant association with severity (p = 0.484). Low HDL cholesterol was the most common lipid abnormality across all groups (63–73%). Correlation analyses revealed significant associations between Gensini score and glycemic indices in diabetics (RBS p = 0.0001, FBS p = 0.0079, PPBS p = 0.0043), whereas in non-diabetics, FBS (p = 0.012) and PPBS (p = 0.008) also correlated with CAD burden. Conclusion: Diabetic patients with ACS exhibited the greatest angiographic severity of CAD, followed by pre-diabetics and non-diabetics. The duration of diabetes, rather than HbA1c at a single point in time, was the strongest determinant of severity. These findings emphasize the cumulative impact of chronic hyperglycemia on atherosclerotic burden and underscore the importance of early detection and aggressive management in both diabetes and pre-diabetes to reduce the risk of severe, multi-vessel coronary disease.

Background: Vitamin D, traditionally known for its role in bone metabolism, is now recognized as a pleiotropic hormone with significant immunomodulatory and metabolic functions. A growing body of evidence suggests a link between vitamin D deficiency and the pathogenesis and control of type 2 diabetes mellitus (T2DM). However, the prevalence and clinical correlates of this deficiency vary across populations. Methods: We conducted a cross-sectional study involving 412 adult patients with T2DM attending a tertiary care diabetes clinic. Data on demographics, duration of diabetes, and current medications were collected. Fasting blood samples were analyzed for serum 25-hydroxyvitamin D [25(OH)D] and glycated hemoglobin (HbA1c). Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Patients were also stratified by glycemic control (good: HbA1c <7.0%; moderate: HbA1c 7.0–8.0%; poor: HbA1c >8.0%). Results: The mean age of the cohort was 58.6 ± 10.2 years, with a mean diabetes duration of 11.4 ± 6.8 years. The overall mean serum 25(OH)D level was 21.3 ± 9.5 ng/mL. The prevalence of vitamin D deficiency was 46.1% (n=190), while 30.3% (n=125) were insufficient, yielding a combined prevalence of hypovitaminosis D of 76.4%. A significant inverse relationship was observed between vitamin D levels and glycemic control. The mean 25(OH)D level was significantly lower in patients with poor glycemic control (17.8 ± 7.2 ng/mL) compared to those with good control (26.5 ± 8.1 ng/mL; p<0.001). Furthermore, Pearson correlation analysis revealed a significant negative correlation between serum 25(OH)D and HbA1c (r = -0.42, p<0.001). Patients with a longer duration of diabetes (>10 years) also had significantly lower mean 25(OH)D levels than those with a shorter duration (<5 years) (18.9 ± 8.5 ng/mL vs. 24.1 ± 9.8 ng/mL; p=0.002). Conclusion: Vitamin D deficiency and insufficiency are highly prevalent among patients with T2DM. Lower vitamin D status is significantly associated with poorer glycemic control and longer disease duration. These findings suggest that screening for and potentially correcting vitamin D deficiency should be considered as part of the comprehensive management of patients with T2DM

Background: Ophthalmia neonatorum (ON) is an important cause of neonatal morbidity, ranging from conjunctivitis to corneal ulceration and blindness. Although preventive strategies exist, etiological patterns vary, with non–sexually transmitted bacteria now common. Prospective Indian data on maternal and perinatal risk factors remain limited. This study aimed to describe the clinical spectrum, microbiological profile, outcomes, and risk factors associated with severe ON. Materials and Methods: A prospective observational study was conducted in the Departments of Ophthalmology and Pediatrics, Mamata Medical College, Khammam, over 12 months. One hundred neonates (≤28 days) with conjunctivitis were enrolled. Maternal and perinatal histories were recorded, and ocular examination included laterality, discharge, congestion, lid edema, membranes, corneal involvement, and anterior chamber reaction. Conjunctival swabs were subjected to Gram stain and culture on blood agar, MacConkey, chocolate, and Thayer–Martin media. Antimicrobial susceptibility testing followed CLSI guidelines. Follow-up was performed at 48–72 hours, 7 days, and 14 days. Results: Of 100 neonates, 62% were delivered vaginally, 28% were preterm, and 22% had low birth weight. PROM was present in 20% and maternal infection in 18%. Clinically, mucopurulent discharge (65%) was most frequent; membranes, corneal involvement, and anterior chamber reaction occurred in 12%, 8%, and 3% respectively. Culture positivity was 76%; Staphylococcus aureus (32%) and coagulase-negative staphylococci (18%) predominated, while N. gonorrhoeae was isolated in 2 cases. Isolates showed high sensitivity to ciprofloxacin and ceftriaxone, with reduced sensitivity to erythromycin. Clinical improvement occurred in 62% by 72 hours, 85% by 7 days, and 94% by 14 days. Severe outcomes correlated with inadequate antenatal screening, PROM, and maternal infection. Conclusion: Staphylococcal species were the leading causes of ON, with gonococcal cases rare. Most neonates improved with timely therapy, but perinatal risk factors predicted severity. Strengthening antenatal care, infection control, and culture-guided management is vital to reduce morbidity.

Background: Congenital variations in coronary anatomy are uncommon, and complete absence of the left main coronary artery (LMCA) with a right coronary artery (RCA) supplying almost the entire heart is exceptionally rare. In such cases, the myocardium depends entirely on a single dominant vessel, so any blockage can cause extensive ischemia and carry a high risk of sudden death. Detecting this pattern early through modern imaging is important for accurate diagnosis and planning preventive or therapeutic interventions. Methods: A 47-year-old man experienced intermittent, non-radiating chest discomfort over ten days. Clinical evaluation was unremarkable. ECG showed a left bundle branch block, while cardiac enzyme levels were within normal range. Echocardiography revealed mild segmental wall motion changes in the left ventricle with preserved ejection fraction (~50%). Conventional coronary angiography suggested absence of LMCA with retrograde filling of left-sided branches from the RCA. Computed tomography (CT) coronary angiography was performed to clarify vessel anatomy, calibre, and distribution, and the findings were reviewed in relation to the Lipton–Yamanaka classification. Results: CT imaging demonstrated complete absence of the LMCA. The left coronary system arose as two small-calibre arteries from the left coronary sinus: a hypoplastic left anterior descending artery (1.3 mm diameter, containing a 3.8 cm segment of myocardial bridging, poorly visualized distally) and a hypoplastic left circumflex artery (1.1 mm diameter, non-dominant, continuing as obtuse marginal). The RCA originated from the right coronary sinus, measured 4.5 mm in diameter, and was superdominant, supplying the posterior descending artery, posterolateral ventricular branches, inferior wall, and most of the lateral wall. The vessel showed no signs of atherosclerosis. This anatomical combination did not match any existing Lipton–Yamanaka subtype. Conclusion: This case illustrates an extremely rare coronary configuration involving absent LMCA, markedly underdeveloped LAD and LCx, and a superdominant RCA supplying the majority of the myocardium. Such dependence on a single vessel greatly magnifies the consequences of any obstruction. The mechanism of symptoms in these anomalies may involve small vessel calibre, myocardial bridging, or altered flow dynamics rather than plaque disease. CT coronary angiography is invaluable for defining anatomy, assessing risk, and guiding safe management

Leptospirosis and scrub typhus, while significant causes of acute febrile illness in endemic regions, rarely lead to cardiac complications in children. This case report presents a unique instance of a 13-year-old previously healthy female who developed hypotension and sinus bradycardia during an episode of leptospirosis, which was successfully treated with doxycycline. However, the weeks following this initial episode saw the persistence of bradycardia, syncope, and left-sided chest pain, leading to a cardiology evaluation. Despite the absence of conduction block in serial ECGs and Holter monitoring, her symptoms continued until a second febrile episode—scrub typhus—again triggered symptomatic bradycardia. The patient responded well to doxycycline and a short course of corticosteroids, with complete resolution of symptoms and normalization of heart rate. This case highlights the potential of sequential tropical infections to precipitate functional sinus node disturbances in children and underscores the importance of including reversible infectious causes in the differential diagnosis of pediatric bradyarrhythmias.