European Journal of Cardiovascular Medicine

Background: The use of digital gadgets like smartphones, tablets, and laptops has grown along with time and technology advancements as well as during the COVID-19 epidemic. These digital devices have a propensity to produce a variety of systemic, visual, and ocular problems.

Background: Ambulatory assessment of the heart rate–corrected QT interval (QTc) within arrhythmia patients can be of diagnostic value where these patients are on QTc-prolonging medication. Repeating sequential 12-lead electrocardiograms (ECGs) to monitor the QTc is cumbersome, but Spandan Smartphone ECG devices can potentially solve this problem. Objective: Objective of this prospective and retrospective, cross-sectional, within patient diagnostic validation study was to validate the measurement of QTc interval in Spandan 12 lead ECG and to assess the accuracy of the 12 lead Spandan Smartphone ECG device in measuring the QTc intervals in the general cardiology outpatient population with normal ECG and arrhythmias. Materials and Methods: This single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from August 2022 to October 2022. All patients (n=1168) visiting the electrocardiogram (ECG) room at the Department of Cardiology of the SMIH, Dehradun during the study period were enrolled in the study by taking their written consent and explaining the purpose of the study. Results: Mean (SD) age was 54.36±4.9 years. The male gender (n=783,67.03%) shows the maximum frequency than female gender. Primary Coronary Intervention was noted in 426 (36.4%) of the study population. All the four parameters showed positive Pearson correlation between 12 Lead Standard ECG and Spandan Smartphone ECG. The maximum mean difference between 12 Lead Standard ECG and Spandan Smartphone ECG was noted for QTc parameter in overall participants. Conclusion: 12-lead Spandan Smartphone ECG allows for QTc assessment with good accuracy and can be used safely in ambulatory QTc monitoring. This may improve patient satisfaction and reduce healthcare costs

Due to advent of technology and internet, teaching too is now largely utilizing these modern devices and internet to impart education to the children. When it was mandatory to keep social distancing and hence avoid regular classes for medical students during the dreadful COVID pandemic, it was decided to teach the 1st year MBBS students online using the technology and the internet. This study aimed at determining if the students found this novel online teaching to be helpful or not. Methodology: A total of 100 1st year MBBS students in a tertiary medical college in central India were included in the study from September 2020 to February 2021 for 6 months. It was an observational study and an informed consent from the students was taken prior to the study. Classes were conducted as usual as per the institutional guidelines and feedback forms were collected after that. Results: Out of total 100 students, 65 were girls and 35 were boys. Average age of the class was 19.2  1.1 years. 85% had used mobile phones and internet for education before and 15% had never used it for education purpose. 75% had a concentration time of 30 minutes. About 50% students faced internet issues and faced moderate disturbance during the classes. 85% used mobile phones for the classes. 60% students opined that such online classes are effective for teaching anatomy while 40% told that it was not effective. Conclusion: The study concludes that currently online classes for the subject like anatomy are not as effective as regular classroom teaching. The factors could be low motivation, technology and internet problems, low attention span etc.

ntroduction: Women seek abortions for a number of reasons, including birth control. An unintended pregnancy puts a woman at danger; if she wants an abortion, safe services are not readily available to her. In India, septic abortion is largely caused by a lack 
of knowledge about the MTP Act and contraception, as well as a shortage of medical professionals with the necessary training. The purpose of the current study was to assess  people's knowledge, attitudes, and behaviours about septic abortion and the factors that are related to it. Materials and Methods:Through straightforward randomization, a total of 100 individuals who had septic abortions were chosen to be a part of the research. Interviews were used to learn more about these cases' knowledge, attitudes, and behaviours about septic abortion as well as other relevant aspects. The findings were examined and statistically examined. Result: Of the 100 instances examined, 46% of the participants lacked awareness regarding contraceptive devices. Compared to women living in towns, rural women knew less about contraception. The majority of cases learned about contraception from the media and medical professionals, such as radio (22.22%), PHC (22.22%), television (18.52%), and ASHA/ANM (18.52%). Women in urban areas were more knowledgeable with the MPT Act than those in rural areas, and 52% of abortions were performed by dais. Of the 100 instances that were examined, 60 cases (or 60%) involved the use of instruments to achieve a septic abortion.Conclusion:The current study demonstrates that a major contributing factor to the high rate of septic abortion in India is the lack of awareness among rural women 
on contraception and the MTP Act, as well as the abortions performed by unskilled individuals such as dais, quacks, and local practitioners. Therefore, in order to provide comprehensive and safe abortion services as well as higher quality abortion services, the health system must be strengthened.

Background:  The variety of airway devices are available today which may be broadly classified as supraglottic airway devices which are employed to protect the airway in both elective as well as emergency situations. Present study was aimed to study I- Gel Device in patients posted for short duration elective surgeries in a tertiary care center. Material and Methods: Present study was prospective, interventional study, conducted in patients aged 21-60 years of both sexes, with BMI range of 20-25 kg/m2, American society of anaesthesiologist classification 1 and 2, Mallampatti grade 1 and 2, undergoing different surgical procedures under general anesthesia, with spontaneous ventilation in supine position for not more than 1 hour. Results: In the study 77 patients were studied. It was observed that in 85% of patients insertion of I-Gel was successful in the first attempt. The heart rate, Mean Arterial Blood pressure (MAP), Mean Tidal Carbon dioxide & mean Oxygen Saturation percentage was observed before administration I-Gel, immediately after administration & after 5, 10 and 15 minutes from insertion and the mean was calculated. The gastric insufflation was absent in all patients after the administration of I-Gel, which shows that I-Gel has better sealing pressure and it fits well with the laryngeal anatomy. It was observed that only 12 % of patients reported sore throat after the removal of I– Gel, 10 % of patients had reported post-operative cough and only 7% patients reported dysphagia. Conclusion: Use of proper sized I-Gel suits to be ideal and seems to be an efficient and safe device for adult airway management in short duration (up to 30 minutes) minor surgeries while patient breathing spontaneously.

Fetal cardiac screening through ultrasound, particularly fetal echocardiography, plays a critical role in the early detection and management of congenital heart disease (CHD), one of the most common congenital anomalies worldwide. This comprehensive review explores the role of ultrasound in fetal cardiac screening, focusing on the basics, techniques, and guidelines of fetal echocardiography. The review covers the principles of ultrasound in fetal imaging, the indications for fetal echocardiography, and the clinical implications of early diagnosis. It delves into the techniques employed, including basic and advanced imaging modalities, Doppler ultrasound, and the application of 3D/4D imaging in the assessment of fetal cardiac anatomy and function. The article also discusses the standard protocols for performing fetal echocardiography, highlighting guidelines from major professional bodies, including the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and the Indian Radiological and Imaging Association (IRIA). The clinical applications of fetal echocardiography are illustrated through case studies that emphasize the impact of early diagnosis on perinatal management and outcomes. Additionally, the review addresses the challenges and limitations of fetal cardiac imaging, including technical difficulties and the influence of maternal and fetal factors on image quality. Looking forward, the review considers emerging trends in fetal cardiac screening, such as the integration of artificial intelligence and portable ultrasound devices, as well as the potential for early intervention through advanced surgical and therapeutic techniques. The conclusion underscores the importance of fetal echocardiography in improving outcomes for infants with CHD and calls for continued advancements in imaging technology and clinical practice to enhance the effectiveness of this critical diagnostic tool.

Background: Accurate blood pressure (BP) measurement is crucial for hypertension management. Despite recommendations for back and feet support during BP measurements, adherence varies. The impact of unsupported back positions on BP readings remains controversial, necessitating further evaluation, particularly with oscillometric devices commonly used in clinical and home settings. Objective: To assess the impact of back and feet support on oscillometric blood pressure measurements. Methods: This study included 100 patients aged 18 and above of both genders visiting the outpatient department. BP was measured using an Oscillo metric device under two protocols: back and feet supported and unsupported. The SBP and DBP readings in the same position was recorded as the final BP. Differences between unsupported and supported conditions were calculated as delta BP and PV were calculated as (delta BP/BP with unsupported position) * 100. Paired sample t-test and ANOVA determined the significance of delta BP and PV across age, sex and hypertension history. Results: The study population had a mean age of 39.2±12.6 years, with 44 females and 56 males, 38 of whom had hypertension. BP readings were higher with unsupported back and feet (119.8±15.5/69.9±8.9 mmHg) than with support (119.2±16.4/68.2±8.8 mmHg), differing by 0.7±4.9/1.8±3.0 mmHg. SBP and DBP levels were consistently higher in the unsupported position across all subgroups, with no significant delta SBP/DBP differences between subgroups. The mean delta SBP and DBP were 5.5±1.56 mmHg and 4±1.52 mmHg, respectively. PV in SBP and DBP was 4.2±1.33% and 4.9±1.99%, with females and hypertensive patients showing larger PV. Conclusion: Proper back and feet support significantly affect the accuracy of oscillometric BP measurements, with unsupported positions leading to higher SBP and DBP. These findings emphasize the importance of standardizing patient placement during BP measurement to obtain accurate readings.

Background: Direct laryngoscopy and tracheal intubation is associated with a rise in the hemodynamic responses as well as intraocular pressure.¹ Pediatric airway is different from adult and the complications associated with laryngoscopy and intubation is higher. The use of supraglottic airway devices to maintain airway have been very effective in reducing the pressor response associated with tracheal intubation.^2,3 I-gel is a second generation supraglottic airway device made of a soft gel-like thermoplastic elastomer with a non-inflatable cuff. I-gel has got a channel for gastric suction catheter placement and its design is compatible with the anatomical structures so that it causes minimal pharyngeal tissue compression.⁴. Methods: The study was a prospective randomized controll trial. It was a comparative study with 60 pediatric patients of age group 2-12 yrs, undergoing strabismus surgery. The study duration was six months. Inclusion criterias were ASA physical status I/ II, Age group 2- 12yrs, both males and females were included in the study. Exclusion criteria were Patients with difficult airway, Patients with a history of allergy to multiple drugs, Cases of intubation following failure of I-gel insertion, patients with history of raised ICP. Patients were randomized into groups A and B of 30 each by a sealed envelope method. Group A patient’s airway was managed by I-gel supraglottic device and group B by tracheal intubation. The variables assessed were Intraocular pressure (IOP) of both eyes, Heart rate, Systolic blood pressure (Non-invasive blood pressure), Mean arterial pressure (Non-invasive blood pressure), Breath holding on extubation. The instrument used fo the study was Perkins applanation tonometer for measuring IOP. Results: The demographics of the two groups were age comparable. The mean age of group A was 5.77±2.69 and group B was 6.30±2.67 (p = 0.443) and mean weight was 21.47±9.87 in group A and 22.53±8.68 in group B (p = 0.658). Two groups were also gender matched with 17(56.7%) males & 13(43.3%) females in group A and 12(40%) males & 18(60%) females in group B. The baseline haemodynamic parameters were comparable between the groups.  Baseline heart rate (HR) in group A was 83.30±12.96 and in group B was 83.83±8.74 (p = 0.852). HR increased in both groups immediately following airway intervention and was found to be higher at 5 minutes after intervention. The HR immediately after airway intervention was 94.50±12.66 in group A and 101.33±14.07 in group B which was statistically not significant (p=0.053). The HR at 5minutes following intervention in group A was 87.23±14.89 and in group B 89.23±13.40 (p = 0.587).. Conclusion: I-gel is a safe and effective airway management device which provides better haemodynamic stability and stable intra ocular pressure in general anaesthesia for pediatric strabismus surgeries

Introduction: Implantation of cardiac implantable electrophysiological devices (CIEDs), including permanent pacemakers and implantable cardioverter-defibrillators has been on the rise over the past years, largely due to the expanded indications for CIED implantation for primary prevention. Infection associated with implantable devices is a serious complication with high morbidity leading to mortality. The importance of appropriate empirical antibiotic coverage is illustrated by studies that document the association between inappropriate selection and increased mortality in patients with permanent pacemaker implantation. Increasing multi drug resistance problem could be due to mutations, over use of broad-spectrum antibiotics, across the counter availability of antibiotics and lack of infection control policy in the hospital settings. Methodology: A prospective observational study conducted at the major tertiary care centre of the State of Himachal Pradesh, for duration of one year. Patients who had undergone interventional cardiology procedure and developing any sign or symptom of general or systemic infection were included. Results: On direct Gram staining of clinical samples, microorganisms were seen in 12 (70.58%) samples and in 5 (29.41%) samples no microorganism seen. Out of 12 positive samples, Gram positive cocci were isolated from ten samples accounting for 83.33% of total isolates, while Gram negative bacilli were isolated from one sample (8.33%) and both Gram positive cocci and Gram-negative bacilli were isolated from single sample accounting for 8.33% of total isolates. Majority of the isolates were S.aureus (46%), followed by S.epidermidis (38%). Pseudomonas aeruginosa and Achromobacter spp. were 8% each. Out of 11 Staphylococcus isolates, 6 (54.54%) were identified as Staphylococcus aureus (S.aureus) and 5 (45.45%) were Staphylococcus epidermidis (S.epidermidis). There was 100% sensitivity to Vancomycin, Daptomycin and Linezolid. Almost 64% samples were resistant to Oxacillin, Cefoxitin, Cefazolin and Erythromycin; 45% were resistant to Co-trimoxazole and Clindamycin; 18% were resistant to Gentamicin and 9% were resistant to teicoplanin and Rifampicin. All the isolates were resistant to Ampicillin and Penicillin G. Out of 6 isolates of S.aureus, 3 (50%) were MRSA. Out of 5 isolates of S.epidermidis 4 (80%) were Methicillin resistant. All the MRSA isolates were sensitive to daptomycin, teicoplanin, vancomycin, linezolid and rifampicin but they were resistant to erythromycin, ampicillin and penicillin G. 67% isolates were sensitive to gentamicin, co-trimoxazole and clindamycin. All Methicillin resistant S.epidermidis were sensitive to daptomycin, vancomycin and linezolid. 75% were sensitive to gentamicin, teicoplanin and rifampicin and only 25% were sensitive to co-trimoxazole. However, all were resistant to erythromycin and clindamycin. In single isolate of Achromobacter spp resistance was observed for gentamicin, imipenem, meropenem, ciprofloxacin, levofloxacin and tetracycline. The isolate was sensitive to ceftazidime, piperacillin-tazobactam and co-trimoxazole. Single isolate of Pseudomonas aeruginosa was sensitive to amikacin, gentamicin, imipenem, meropenem, ceftazidime, cefepime, aztreonam, ciprofloxacin, levofloxacin and piperacillin-tazobactam. Conclusion: The present study indicated an infection rate of 8.1% following permanent pacemaker implantation. 84% of the causative organisms were Staphylococcus species and out of which 64% were methicillin resistant. Staphylococcus has been reported as a major cause of community and hospital acquired infections. Infections caused by Staphylococcus used to respond to β-lactam and related group of antibiotics. Vancomycin has been used as the drug of choice for treating MRSA infections. Further, the regular surveillance of hospital associated infections including monitoring antibiotic sensitivity pattern of MRSA and formulation of definite antibiotic policy may be useful for reducing the incidence of MRSA infection.

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, accounting for approximately 18 million deaths annually. Despite progress in treatment and management, the global burden of CVD continues to rise, fueled by aging populations, urbanization, and the growing prevalence of modifiable risk factors such as hypertension, diabetes, and obesity. Traditional prevention strategies have focused on controlling these risk factors through lifestyle modifications and pharmacological interventions. However, the persistence of high CVD-related morbidity and mortality rates highlights the limitations of conventional approaches, necessitating innovative solutions. This systematic review summarizes evidence for recent advances in cardiovascular disease prevention across 34 studies, emphasizing digital health technologies, precision medicine, therapeutic innovation of pharmacological agents, and public health initiatives. Wearable devices, artificial intelligence (AI)-powered data processing, and other digital tools are revolutionizing cardiovascular prevention through improved early detection, risk stratification, and personalized care. With recent pharmacologic breakthroughs like RNA-based remedies and PCSK9 inhibitors, we now have potent alternatives for treating lipid disorders and ameliorating cardiovascular events. Precision medicine approaches are also being employed to develop polygenic risk scores (PRS) and for biomarker-guided prevention of these at-risk individuals. It has been shown that public health approaches utilizing mobile health (mHealth) technologies and community-based interventions can effectively encourage healthy practices and increase access to preventive services. The results highlight the life-changing possibilities of introducing new technologies and therapies in conjunction with new prevention methods. Not only do these advances fill gaps in current strategies, but they also provide scalable approaches to closing global divides in cardiovascular health. This holistic approach, which takes lessons from old practices and combines them with the best modern innovations, marks an important step in reducing the global burden of CVD, ultimately improving patient outcomes.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major bacterial pathogen responsible for both healthcare- and community-associated infections. Healthcare-associated MRSA (HA-MRSA), a subtype of MRSA, is a notorious pathogen in hospital environments, particularly in susceptible patients with open wounds, invasive devices, or weakened immune systems. Community-associated MRSA (CA-MRSA), the other variant, has recently emerged as a major public health concern. This study was conducted to determine and compare the prevalence and antibiotic susceptibility patterns of HA-MRSA and CA-MRSA in a tertiary care hospital in West Bengal. Materials and Methods: In this hospital-based cross-sectional study, various clinical samples submitted to the bacteriology laboratory of the Department of Microbiology of Burdwan Medical College over a nine month period, were screened for MRSA growth using standard microbiological techniques. The isolates were classified as either community-associated MRSA (CA-MRSA) or healthcare-associated MRSA (HA-MRSA) based on the established criteria. Subsequently, antimicrobial susceptibility tests were performed on the MRSA isolates. Results: Of the 694 Staphylococcus aureus isolates, 285 (41.1%) were identified as Methicillin-resistant Staphylococcus aureus (MRSA), and 409 (58.9%) were Methicillin-sensitive Staphylococcus aureus (MSSA). Among the MRSA isolates, 191 (67%) were classified as healthcare-associated MRSA (HA-MRSA) and 94 (33%) as community-associated MRSA (CA-MRSA), with prevalence rates of 27.5% and 13.5%, respectively. Conclusions: This study showed that the prevalence and resistance of HA-MRSA to different antibiotics were significantly higher than those of CA-MRSA. These findings highlight the need for enhanced infection control measures and antimicrobial stewardship programs in healthcare settings to mitigate the spread of MRSA, particularly more resistant HA-MRSA strains.

Background: The Pradhan Mantri Jan Arogya Yojana (PMJAY) was introduced to improve healthcare accessibility by providing financial support for various medical interventions, including cardiovascular procedures. This study evaluates the impact of PMJAY implementation on the volume of Cardiac interventions including coronary angioplasties, intra-cardiac device implantation and electrophysiology studies with radiofrequency ablation (EPS/RFA) in Kashmir. Methods: The current study was a retrospective observational study carried out in the Department of Cardiology, Government Medical College, Srinagar, J & K. Data regarding all interventional cardiac procedures performed over three calendar years, before and after the launch of PMJAY SEHAT scheme, was collected and analysed. Results: A comparative analysis of cardiovascular procedures before (2018–2020) and after (2021–2023) the implementation of PMJAY scheme revealed significant trends. The number of angiographies increased substantially from 1,661 in the pre-PMJAY period to 3,858 in the post-PMJAY period (p < 0.0001), while angioplasties also showed a significant rise from 1,308 to 2,103 (p < 0.0001). Pacemaker implantations increased from 490 to 913; however, this difference was not statistically significant (p = 0.215), indicating that the scheme may not have strongly influenced the adoption of pacemaker therapy. In contrast, Cardiac Resynchronization Therapy (CRT-P/CRT-D) and Automated Implantable Cardioverter Defibrillator (AICD) implantations demonstrated an exponential increase from 24 in the pre-PMJAY to 127 in the post-PMJAY period (p < 0.0001), suggesting improved access to advanced cardiac therapies. Similarly, EPS/RFA procedures showed a sharp rise from 80 in the pre-PMJAY period to 289 post-PMJAY (p < 0.0001), reflecting greater utilization of electrophysiological interventions. Conclusion: The findings indicate that PMJAY has played a crucial role in expanding access to cardiovascular treatment in Kashmir, particularly for advanced and hitherto unaffordable cardiac interventions. These results emphasize the importance of financial support programs in reducing healthcare disparities and improving outcomes for patients requiring specialized cardiac therapies. Sustained efforts are needed to further strengthen healthcare infrastructure and optimize utilization of high-cost cardiac procedures in resource-limited settings.

Background: In this study we evaluated the utility of RAPID score in Parapneumonic effusion and empyema. Both of which are most common causes of exudative pleural effusion and this score was developed by Rahman et al by using multicentre intrapleural trial 1[MIST1 and MIST2]. Most of the patients with parapneumonic effusion usually recovers but mortality rate still around 10% along with long hospital stay, surgical interventions requirement, morbidity (3‑month follow up) despite of advances in treatment specially in empyema cases. For this reason, this study was done as there is no such study have done by anyone in our knowledge specially in India. After calculating RAPID score in pleural infection then patients were stratified in the different risk categories and association was compared with these risk categories with different variables. Methods: This is a prospective study at tertiary in which clinical utility of RAPID score in pleural infection in INDIAN population where tuberculosis infection is predominant. Baseline RAPID score was calculated on admission and stratified into risk category according to RAPID score. Primary outcome both mortality and morbidity, secondary outcome need of surgical interventions, length of hospital at 3‑months in different risk category. Results: Overall, 120 patients were included in this study. Mortality was 7 (5.83%) in our study. Total 17 (14.17%) patients needed surgery and length of hospital study was compared in all three categories of RAPID score. Total 26 (21.67%) patients had <7 days and 94 (78.33%) >7 days hospital stays. Most common organism isolate was mycobacterium tuberculosis. RAPID score was compared in Tubercular And non‑tubercular organisms. Conclusion: Prognostic utility of RAPID score is well established especially in non‑tubercular organisms. Here, in our study management utility of RAPID score also found useful. It performs good some aspects in tubercular aetiology.

Background: Contraceptive use plays a vital role in preventing unintended pregnancies and promoting maternal and child health. However, despite the availability of various contraceptive methods, misconceptions and socio-cultural factors often hinder their proper use, particularly in rural areas.This study aims to assess the knowledge, attitude, and practices regarding contraceptive use among married women of reproductive age attending a family planning clinic. It seeks to identify factors influencing the acceptance and utilization of contraception. Methods: A cross-sectional study was conducted among 200 married women attending a family planning clinic in the Department of Obstetrics & Gynaecology at Konaseema Institute of Medical Sciences, Andhra Pradesh, for six months. Data were collected using a pre-designed proforma, which included questions on socio-demographic characteristics, knowledge, attitude, and practices related to contraceptive use. Results: The majority of participants (92%) were aware of at least one contraceptive method. The most commonly known methods were oral contraceptive pills (OCPs), intrauterine contraceptive devices (IUCDs), and condoms. However, only 77% were using or willing to use contraception, and just 41% used it correctly. ASHA workers (41.5%) and television (40%) were the primary sources of information. The most preferred methods were OCPs (39%) and natural methods (15.5%). Common reasons for non-use included myths, side effect concerns, and husband opposition. A significant association was found between educational status and contraceptive knowledge (p < 0.0002). Conclusion: While knowledge of contraceptive methods is widespread, correct usage remains low. Myths and misconceptions play a significant role in non-use. Educational interventions, particularly through healthcare workers, are essential to improve contraceptive use and correct application, especially in rural areas.

Background Cardiac implantable electronic devices (CIEDs) are life-saving interventions, but complications such as pocket infections and erosions pose significant clinical and economic challenges, particularly in resource-limited settings. Objective: This study evaluates the incidence, risk factors, microbial profile, and outcomes of management strategies for pacemaker pocket complications at Assam Medical College, Dibrugarh, India. Methods: A retrospective analysis was conducted on 1,056 patients who underwent pacemaker implantation between January 2022 and July 2024. Data on demographics, comorbidities, device types, and outcomes were collected for 33 patients (3.1%) who developed pocket complications. Infections were classified per EHRA guidelines into localised (Grade A) and systemic (Grade B). Management approaches included explantation, conservative strategies, and debridement with reimplantation. Results: The mean age of patients with pocket complications was 69.3 years, with a male-to-female ratio of 2.3:1. Diabetes (48%), hypertension (55%), and COPD (33%) were common risk factors. Box changes had the highest erosion rate (5.06%). Most pus cultures showed no microbial growth (82%), followed by Staphylococcus aureus (12%). Device explantation and reimplantation were the most successful strategies, with 87.5% favourable outcomes. Conservative management had limited success, with reinfections in 5 of 6 patients. Conclusion: Pacemaker pocket infections are a significant concern, particularly in populations with high comorbidities and limited healthcare access. While device explantation and reimplantation offer the best outcomes, conservative approaches are less effective and should be reserved for select cases. Strengthening perioperative care and follow-up protocols is essential to reduce the burden of these complications.

Aim: The aim of the present study was to compare the efficacy of volar locking plate and K wire fixation with POP cast procedure in intra articular distal end radius fractures among elderly patients. Methods: The Study was conducted at Maharishi Markandeshwar Medical College and Hospital (MMMCH), Kumarhatti, Solan, Himachal Pradesh, India from December 2020 to December 2022. All confirmed cases of stable and unstable distal radius fracture registered at the orthopedic department of MMMCH, Kumarhatti, Solan. Results: The difference between mean age participants, gender wise, fracture side wise, mode of injury wise, AO fracture and type of injury wise distribution of participants was statistically not significant (p>0.05). The difference between mean DASH score at post-operative duration 2, 4, 6 months of participants of VLP & K wire group was statistically significant (p<0.05). The difference between mean range of motion of participants of VLP & K wire group was statistically significant for all parameters (p<0.05). The difference between mean parameters for radiological evaluation participants of VLP & K wire group was statistically significant for all parameters (p<0.05) except ulnar variance (p>0.05). The distribution of participants according to complication were statistically not significant (p>0.05). Conclusion: Distal radius fractures are injuries that can cause a loss of wrist function and disability and are most commonly seen in elderly patients. The use of percutaneous pin fixation, Kapandji’s intrafocal pinning ext fix devices that permit distraction and palmar translation, low profile internal fixation plates, arthroscopically assisted reduction, and bone grafting techniques including bone‑graft substitutes, all have contributed to improved fracture stability and outcome.

Background: Wearable cardiovascular monitoring devices have emerged as promising tools for real-time arrhythmia detection and patient-managed care. Their diagnostic value, usability, and impact on clinical outcomes remain areas of active investigation. Objective: To systematically evaluate the diagnostic accuracy, clinical utility, and user acceptability of wearable devices in detecting arrhythmias, particularly atrial fibrillation (AF). Data Sources: A systematic search was conducted in PubMed (2018–2025) using terms related to “wearables,” “arrhythmia,” and “cardiac monitoring.” Filters applied included free full-text availability and original human studies. Study Selection: Studies were included if they assessed wearable, non-invasive devices (e.g., smartwatches, ECG patches) for arrhythmia detection and reported diagnostic performance or clinical outcomes. Data Extraction and Synthesis: Twelve studies were included. Data on study design, population, device type, diagnostic accuracy, intervention changes, and usability were extracted and narratively synthesized. Main Outcomes and Measures: Primary outcomes were AF detection rate, sensitivity, specificity, and clinical intervention changes. Results: Wearables demonstrated sensitivity ranging from 84% to 95% and specificity up to 93%. Intervention changes occurred in up to 35% of cases. High patient satisfaction and adherence were reported. Conclusions and Relevance: Wearable cardiac monitors provide accurate, patient-friendly arrhythmia detection and support timely clinical intervention, reinforcing their role in modern cardiovascular care.

Background: Subtrochanteric femur fractures are complex injuries that pose significant challenges due to high biomechanical stress and anatomical variability in the proximal femur. Timely and effective surgical fixation is essential to restore function and reduce complications. Among the available options, intramedullary nails and extramedullary plates are commonly used, but their relative efficacy remains a topic of ongoing debate. This study aims to compare the clinical outcomes and complication rates associated with these two fixation methods. Materials and Methods: A retrospective study was conducted on 100 patients at the Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Patients were categorized into two groups based on the type of implant used. Group A included those treated with intramedullary (IM) devices, such as intramedullary femoral nails or proximal femoral nails. Group B comprised patients who received extramedullary (EM) implants, specifically 95° condylar plates or locked anatomical proximal femoral plates. The study evaluated multiple parameters, including patient age, gender, side of hip fracture, mechanism of injury, type of anesthesia administered, preoperative waiting time, duration of follow-up, fracture classification, Harris Hip Score (HHS), and any mechanical complications. Statistical analysis was performed using GraphPad software, version 8.4.3. Results: This comparative study analyzed 100 patients with subtrochanteric femur fractures, divided into intramedullary nail (Group A; n=55) and extramedullary plate (Group B; n=45) fixation groups. Both groups had similar baseline demographics (age, gender, fracture side, preoperative time; p > 0.05). The average follow-up period was 18.65 months. The most common fracture etiology was falls, with Seinsheimer type 2b being predominant.  In terms of postoperative complications, Group A (IM) had slightly higher rates of delayed union (21.82% vs. 17.78%), non-union (5.45% vs. 2.22%), malalignment (14.54% vs. 11.11%), implant failure (10.91% vs. 4.44%), and limb shortening (9.09% vs. 8.89%) compared to Group B (EM), though differences were not statistically significant (p > 0.05). No cases of infection were recorded in Group A, only 2 patients (4.44%) in Group B experienced postoperative infections, with a proximal femoral locking plate, which was treated by removing the implants. Malalignment did not significantly influence outcomes (p = 0.665). Functional assessment via Harris Hip Score showed comparable results (mean 86.5) between groups, suggesting no superiority of one fixation method over the other in terms of clinical outcomes. Conclusion: Intramedullary and extramedullary fixation methods both offer effective outcomes for subtrochanteric fractures, each with distinct advantages and limitations. While IM fixation minimizes soft tissue damage, EM fixation allows better anatomical alignment. Our study found both techniques to be comparably effective, though the ideal choice remains subject to further research.