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Most common neuromuscular junction disorder is Myasthenia gravis (MG) which has variable clinical presentations. Diplopia and drooping of eyelids are the peculiarity of myasthenia gravis. Commonly disease manifests as a fluctuating weakness of skeletal muscles. Although respiratory symptoms may be the initial presenting complaint in a few patients, usually it develops during the later part of the disease course. The initial presentation of isolated prominent respiratory distress is a relatively rare presentation of myasthenia gravis unless accompanied by other clinical features. We report a 40-year-old female patient, who visited our hospital with presenting complaints of breathlessness and generalized myalgia and subsequently developed fatigable weakness during hospitalization.

Background Vitiligo, affecting 0.25% in India (>1% in Jharkhand), stigmatises and devastates self-esteem/relationships causing depression. Apart from medical treatment, surgical procedures like applying 5-fluorouracil after microneedling are to be confirmed in unstudied populations and across time periods. An interventional study was conducted among out-patients of a tertiary hospital in a high-prevalence population wherein earlier attempts were not conducted. Aims/Objectives To assess the effect of microneedling and applying 5% 5-fluorouracil on stable vitiligo patches. Methods and Materials Microneedling and topical application of 5-fluorouracil was planned on 30 subjects of 10–50 age-groups with stable vitiligo, from September 2019 to September 2021 every 15 days for 12 visits. Age, gender, site, size/stability of vitiligo patches, leukotrichia and vitiligo family history were studied. Repigmentation (overall and variable-wise) was measured at each visit using 76–100% (excellent), 51–75% (very good), 25 to 50% (good) and

Context Each year, about 21 million girls aged 15–19 in developing regions experience pregnancy, posing significant challenges for their health, well-being, and economic stability due to its vast impact. Aim To identify the risk factors contributing to teenage pregnancy as compared to Pregnancy in pregnant women in the rural area of the Khordha district with the assessment of their knowledge and, health-seeking behaviour (Contraception and STDs) among teenage and adult pregnant women in the study area. Settings and Design Hospital-based case-control study conducted at Bhubaneswar’s Community Health Centre. Material and Methods The study, conducted from April to July 2022, recruited 138 participants using consecutive sampling and interviewed them using a pretested semi-structured questionnaire. Statistical Analysis Chi-square and logistic regression assessed association and strength. Results Factors contributing to teenage pregnancy include education below high school (AOR = 2.46; 95%CI 0.89–6.79), SC and ST caste (AOR = 2.34; 95%CI 0.94–5.82), having more than three siblings (AOR = 4.45; 95%CI 1.53–12.96), and lack of communication about sexual issues (AOR = 2.84; 95%CI 1.25–6.39). Awareness of contraceptive methods was 34.8% among cases and 56.5% among controls (p = 0.02). Regarding STD awareness and symptoms, 15.2% of cases and 42.4% of controls were knowledgeable and experienced symptoms (p < 0.01). Conclusions This study suggests that factors such as lower education, minority caste, having more than three siblings, and lack of communication about sexual issues contribute to early pregnancy. These findings could enhance existing ARSH platforms by integrating regular engagement and sensitization efforts.

Context Tobacco addiction is an important public health problem. Among several theories of addiction proposed, PRIME theory of motivation is found to be a comprehensive one to synthesise prevention strategies. Aims This case study was conducted on the basis of PRIME theory to explain smokeless tobacco (SLT) addiction patterns among slum dwelling female residents of Cuttack district, Odisha. Settings and Design Cuttack district of Odisha state and Qualitative synthesis. Methods and Material Qualitative semistructured face-to-face interviews and framework analysis techniques were employed. The study was conducted over a period of 2 months between February 2020 and March 2020. Face-to-face interviews of 26 participants of Dasha Sahi slum using a semistructured questionnaire assessing responses based on five main themes including P, Plans; R, Responses; I, Impulses And Inhibitory Forces; M, Motives; and E, Evaluations of the said theory. Statistical Analysis Used Verbatim transcripts were analysed using thematic framework analysis. Results A majority of the participants were multiple SLT product users, and they did not have an immediate plan to quit. Most of the participants showed strong emotional attachment with these products and considered them the only source of pleasure (want) in a life full of miseries. The words “Tobacco” and “Nicotine” were medical jargons for them. Though they were aware of the harmful effects, they had a positive evaluative belief about its use because of cognitive dissonance. Most of them were habitual users living in an environment full of physical and social cues. Conclusions This case study is well in line with the PRIME theory in explaining the addictive behaviour; a comprehensive multi-strategic approach was formulated for inculcating quitting behaviour among this disadvantaged section of the population as suggested by the proposer of this theory.

Background The foremost concern and challenge in managing drug-resistant tuberculosis is ensuring a high health-related quality of life (HRQoL). The effectiveness of pre-extensively drug-resistant (Pre-XDR) tuberculosis management hinges on patients adhering to therapy, a crucial factor in averting the development of drug-resistant strains, ultimately enhancing HRQoL. Methodology This analytical longitudinal study spanned two years at a teaching hospital and involved collaboration between the Departments of Pharmacology and Pulmonary Medicine. A case record form was utilized to gather baseline data, encompassing patient demographics, medication details, WHO BREF HRQoL scores, and treatment adherence. Patients were classified as either adherent or nonadherent using three distinct criteria: the guidelines of the Revised National Tuberculosis Programme (RNTCP), the Morisky-Green-Levine Scale (MGLS), and the Batalla test. The sample size was determined based on 30% nonadherence rates from preliminary analysis of prior data, resulting in 86 patients included in the study. The association between the improvement of HRQoL score from the baseline with the predictor variables was assessed with a linear regression model. Comparison of nonadherence with the different predictors of the study population was assessed with binary logistic regression model. Results Analysis of demographic data revealed no notable differences in age and BMI between the Bedaquiline and Delamanid groups. However, there was a gender-related difference in treatment distribution, with more men in the Bedaquiline group. Other factors, such as marital status, socioeconomic status, employment status, stigma/discrimination, comorbidity, and addiction, showed no significant differences between the groups. Comparing HRQoL scores at baseline and after six months showed substantial improvements in all domains, indicating a positive impact of the treatment. Linear regression analysis revealed a strong association between QoL improvement and adherence. Adherence patterns did not significantly differ between the two treatment groups, as assessed by various criteria. The patients with high stigma, newly diagnosed Pre-XDR cases, and the presence of adverse events had higher odds of nonadherence. Conclusion This study highlights the substantial impact of Bedaquiline and Delamanid treatment on the HRQoL of Pre-XDR TB patients in Eastern India. Adherence to treatment plays a crucial role in improving QoL, and factors like stigma, newly diagnosed Pre-XDR patients, and adverse drug reactions influence adherence adversely. The findings emphasize the importance of patient support and education to enhance treatment outcomes.

Introduction Laparoscopic myomectomy is a commonly performed operation with fast recovery and excellent results. However, haemorrhagic nature of the operation mandates us to use variety of vasoconstrictive and uterotonic agents. Amongst which, one of them is vasopressin. It is a synthetic antidiuretic hormone analogue which has been in common use as a vasoconstrictive agent in various surgical procedures including laparoscopic myomectomy. Methods A meta-analysis of randomised controlled trials published from 2013 to 2023 (10 years) comparing the use of vasopressin against other drug or placebo or different doses of vasopressin was performed. The outcome measures were intraoperative blood loss, need for blood transfusion, difference in the haemoglobin (Hb) and haematocrit (Hct). Results We identified 176 articles through the study search, amongst which 12 articles were included for the meta-analysis. There was a significant heterogeneity in the studies with moderate risk of bias in eight studies and low risk of bias in four studies. Compared to placebo, vasopressin showed significantly lower odds need of blood transfusion (odds ratio [OR] 0.28, 95% confidence interval [CI]: 0.13–0.61, P = 0.002) and significantly lower pre–post fall in Hb (OR −3.12, 95% CI: −4.63–−1.60, P < 0.0001). However, there was no statistically significant difference in intraoperative blood loss (OR −0.56 (95% CI: −2.04–0.92, P = 0.46) and pre–post fall in Hct (OR −0.94, 95% CI: −1.96–0.07, P > 0.05). Compared to other drug (epinephrine, misoprostol and octreotide acetate), vasopressin showed no significant superiority in controlling blood loss (P > 0.05). Even the two doses of vasopressin (dilute vs. concentrated) showed no statistically significant difference between surgical blood loss and need for blood transfusion (P > 0.05). Conclusion Vasopressin is an efficacious drug to be used for controlling blood loss, decreasing blood transfusion requirement and maintaining Hb and Hct during laparoscopic myomectomy.

Medical education plays a pivotal role in ameliorating health-related outcomes by preparing health-care professionals with the desired knowledge, skills, and attitudes necessary to deliver effective patient-centered care. The purpose of the current review is to explore the role of medical education in rural areas, identify the potential challenges in the implementation, and propose suitable measures to overcome these challenges. The delivery of medical education in rural areas is expected to address the disparities in health-care delivery by serving people in underserved areas, thereby reducing the urban–rural divide. This is accomplished by ensuring timely access to medical services, resulting in the promotion of early diagnosis and better management of the disease. The process of delivery of medical education in rural settings has been associated with multiple challenges that must be systematically dealt with to improve the overall outcomes. In conclusion, promoting access to medical education in rural areas is a crucial step to establishing a robust and equitable health-care system that will aid in the attainment of universal health coverage. However, the need of the hour is to overcome the existing challenges to empower aspiring health-care professionals from rural backgrounds and also contribute to the overall health and well-being of underserved communities.

Background and purpose: To compare the efficacy, safety, and immunogenicity of recombinant insulin aspart 100 U/mL manufactured by BioGenomics Limited (BGL-ASP) with innovator NovoRapid® in type 2 diabetes mellitus patients (T2 DM). Experimental approach: This was a multicenter, open-label, randomized, parallel-group study in T2 DM patients, on premix human insulin therapy ± oral anti-diabetics. Besides self-monitored plasma glucose, fasting and post-prandial plasma glucose (FPG and PPG) were tested at baseline, week 12, and week 24. Anti-insulin aspart antibodies measured immunogenicity at 12 and 24 weeks. Findings/Results: 160 patients out of 320 patients randomly received BGL-ASP and the remaining patients received NovoRapid®. The changes in glycated hemoglobin (HbA1c) from baseline to weeks 12 and 24 for the BGL-ASP group were -0.8 ± 0.83 and -0.8 ± 0.81, respectively, while for the NovoRapid®group was -0.8 ± 1.01 and -0.9 ± 0.89, respectively. Changes in FPG and PPG were comparable between the treatment groups after 12 weeks and 24 weeks. The incidence of detectable antibodies at baseline, weeks 12, and 24 were comparable between treatment groups. Eighteen (11.3%) patients in the BGL-ASP group and 23 (14.4%) in the NovoRapid®group reported adverse events. Conclusion and implications: BGL-ASP and NovoRapid®were comparable and equally effective in lowering HbA1c, FPG, and PPG levels, with similar immunogenicity and safety profiles.

Background A long-term excess of fluoride ingestion from drinking water, food substances, and industrial pollution may result in fluorosis, a public health hazard. This survey aims to investigate the prevalence of dental and skeletal fluorosis, as well as the role of dietary variables. Materials and Methods A cross-sectional survey was conducted in Sonebhadra district. The Dean’s Fluorosis Index and physical exercises demonstrated by the United Nations International Children’s Emergency Fund for diagnosing dental and skeletal fluorosis, respectively. The dietary habits of the participants were ascertained using a prevalidated questionnaire. Results The participants’ socioeconomic status varied widely with heterogeneity. The frequent abnormalities found were genu varum (21.5%), genu valgum (6.8%), dental fluorosis (52.3%), and skeletal fluorosis (25.8%). Consequently, eight cases reported of multiple deformities. Conclusion The findings showed the increased prevalence of moderate-to-severe fluorosis in fluoride endemic areas of Sonebhadra district. Dental fluorosis was more common in those aged 18–64 years, particularly in males, but skeletal fluorosis increased with age.

We present a case of a patient with Bernard–Soulier syndrome (BSS) who had his impacted third mandibular molar surgically extracted. An uncommon congenital bleeding condition called BSS is inherited in an autosomal recessive fashion. The syndrome, which has an incidence of fewer than 1 in 1,000,000, is characterized by delayed bleeding time, thrombocytopenia, and abnormally large platelets. Even simple surgical procedures become difficult in these patients due to their increased propensity for bleeding. There are no established standards for the management of perioperative bleeding linked to BSS because the condition is uncommon. The regular management of these bleeding episodes involves the delivery of platelets matched to the patient’s human leukocyte antigen, which carries certain challenges. We explain the treatment plan used for a patient with BSS whose impacted third molar was successfully extracted surgically.

Background: The postgraduate curriculum needs to be given a definite shape so as to make health programs more intensive and integrative. In the present scenario, most of the information is unclear and infrequent. A structured public health competency-based education is an important aspect to consider for integrative health care. Evaluate the structured competency-based curriculum (SCBC) prepared on health program matters. Methods: Mixed method model involving postgraduate students, faculties in community medicine departments of selected medical colleges and stakeholders from district administration. The SCBC was piloted and validated for use. The evaluation was then done based on pre- and posttest performance analysis, satisfaction survey, and questionnaires for reaction and learning components. Results: For a complete understanding of the program, students had to invest 52 hours of stipulated time. CBC assessment mean scores for a) problems in PHC and programmatic evaluation (78.9%) and b) identification of success and failure of programs (78.2%) were more than 75% mean score; whereas, assessment scores for topics on a) resource allocation and b) evaluation of program as write-up was 65% and 52%, respectively. As compared to the conventional method, the SCBC showed a critical evaluation score of 70% with a 0.001 significance level. Discussion and Conclusion: Students’ narratives were that they could understand as well as integrate them better on the field. There was enhanced satisfaction and encouragement. Structured curriculum will also help in making learning more student-centric and go a long way in boosting their creativity.

Purpose: To estimate the vitreous cavity replacement volume after pars plana vitrectomy and analyze its correlation with axial length and refractive error. Methods: Observational cross-sectional study on 103 eyes undergoing vitrectomy. Fluid-air exchange was performed using a soft-tip cannula connected to a PVC tubing, the distal end of which opened into a 10-cc syringe without the plunger. The collected fluid was measured (and correction factors applied) to estimate the vitreous cavity volume. Results: The mean axial length of 103 eyes was 23.43 ± 1.54 mm. The mean vitreous cavity volume was 4.46 ± 0.83 mL (2.8–8.1 mL). There was a strong positive correlation between axial length and vitreous volume, which was stronger for pseudophakic and aphakic groups than for phakic groups. Conclusion: Accurate assessment of vitreous cavity volume can enable precise quantification of tamponade, intravitreal drugs, and intravitreal chemotherapeutic agents. This will allow better surgical outcomes, decreased toxicity, and increased cost-effectiveness due to lesser wastage. Objective: To estimate the vitreous cavity replacement volume after pars plana vitrectomy and analyze its correlation with axial length and refractive error.

Introduction: Injuries to the acromioclavicular (AC) joint can range from modest, transient pain to significant displacement, chronic pain, and shoulder biomechanical changes that result in long-term disability. Aim and Objective: We aimed to evaluate the functional outcome of anatomical reconstruction of ACJ using autologous semitendinosus graft in type III-VI AC joint dislocations. MATERIALS AND METHODS: In this study, 20 patients with AC joint dislocation (Rockwood type III-VI) were managed by surgical fixation using autologous semitendinosus graft from November 01, 2019, to October 31, 2020, at our center. After providing written informed consent, the study enrolled patients who satisfied the inclusion criteria. Preoperative, three-month, and six-month UCLA shoulder scores were assessed. Results: Mean age of participants was 36.5 years (SD: 9.86). Radiological evaluation at each visit suggested a 100.0% success rate of this method. 95% of the participants had no complications, while 5.0% had DVT. No participants had SSI. Conclusions: Autologous semitendinosus graft fixation of type III-VI AC joint injuries is a viable surgical option with the advantages of being a biological fixation, single surgery, and having excellent functional outcomes. However, extensive multicentric comparative studies are required to draw definitive conclusions.

We present a case of multifocal central serous chorioretinopathy (CSCR) in a 40-year-old male who presented with gradual loss of vision in both of his eyes during the previous 3 months. The anterior segment examination was normal; the dilated fundus examination revealed severe retinal elevation in the macular area in both eyes. Optical coherence tomography confirmed the presence of subretinal fluid with a central macular thickness of 353 μm OD and 356 μm OS. On the basis of ocular findings, a diagnosis of multifocal CSCR was made. One month later, the patient complained of further vision loss. His erythrocyte sedimentation rate was elevated, and the Mantoux test (22 mm × 22 mm), the QuantiFERON TB gold (5 IU/ml), and the cytomegalovirus immunoglobulin G (2277.92 AU/ml) yielded positive results. A diagnosis of latent tuberculosis infection was made. After 2 months of starting antitubercular treatment, the patient’s visual acuity improved.

Background: It has been widely reported that the new coronavirus has adverse effects on the musculoskeletal system. The primary goal of this study is to establish the frequency of musculoskeletal complaints with extended COVID-19 syndrome. Methods: This retrospective cohort research examined the occurrence of musculoskeletal problems in patients with chronic COVID-19 syndrome. Results: About 100 COVID-19 patients tested positive, of which 27 (27.0%) had a minimum of one orthopedic impairment. Patients with orthopedic conditions were significantly younger than those without (53.7 years vs. 58.1 years, P = 0.003), and their incidence was significantly higher in obese than nonobese patients (P = 0.022). Furthermore, patients with diabetes had significantly more orthopedic symptoms than those with cardiac or pulmonary complications. Conclusion: According to our research, patients who are obese or diabetic have a higher probability of experiencing musculoskeletal symptoms when infected with COVID-19. In addition, analysis is needed to determine whether these orthopedic conditions persist during active disease and postinfection.

Introduction: The study has been conducted to evaluate the functional outcome of acute tibial eminence fractures treated arthroscopically with a pull-through suture technique. MATERIALS AND METHODS: This prospective study was conducted between December 2020 and September 2022 on patients with Meyers and Mckeever II and III anterior tibial spine fractures treated arthroscopically using a pull-through suture technique. Results: Of the 20 patients included in the study, the majority of the patients, i.e., 40%, ranged in age from 20 to 30 years and 90% were male patients. The most common cause of injury was road traffic accidents among 60% of cases, followed by falls from bicycles or stairs and rest owing to sports injuries. In the current study, majority of the patients, i.e., 65%, operated were of Meyers and Mckeever type 3 injury. There was substantial improvement between the mean preoperative Lysholm score of 51.05 and the mean postoperative Lysholm score of 92.10 after 9 months with 95% of patients having good-to-excellent result in the end. Conclusion: Using an arthroscopic pull-through suture approach to treat acute tibial eminence fractures results in good rigid fixation and improves the functional outcome.

Introduction: Shoulder pain is the third most common cause of musculoskeletal consultation causing significant pain and disability in performing tasks for daily living. For the diagnosis of shoulder joint pathologies, magnetic resonance imaging (MRI) and arthroscopy are commonly used. Currently arthroscopy is the gold standard in diagnosing shoulder pathologies. Also, many studies have reported MRI to be sensitive and accurate tool for investigations. The aim of the study is to compare the efficacy of MRI and arthroscopy in the diagnosis of shoulder pathologies and find the correlation between MRI and arthroscopic finding. MATERIALS AND METHODS: The prospective, comparative study was conducted between January 2020 and July 2021; patients presenting to the institute with chronic shoulder pain were included in the study after applying selection criteria. MRI followed by shoulder arthroscopy was performed for all patients, and the data were statistically analyzed. Results: Synovitis (65.9%) was the most common pathology. MRI reported high specificity (100%) for full-thickness rotator cuff tear, rotator cuff tendinitis, subacromial bursitis, and Bankart’s lesion followed by superior labrum, anterior and posterior (SLAP) lesion (96.6%), and bicep tendinitis (95.8%) while moderate specificity for synovitis (78.6%) and partial rotator cuff tear (66.7%). MRI reported to have high sensitivity for Hill–Sachs lesion, subacromial bursitis, and partial-thickness rotator cuff tear and Bankart’s lesion and low sensitivity for full-thickness rotator cuff tear, synovitis, SLAP lesions, and bicep tendinitis. MRI detected subacromial bursitis (0.807), Bankart’s lesion (0.792), and Hill–Sachs lesion (0.707) with substantial correlation whereas it detected synovitis (0.064) with only slight correlation. The accuracy of MRI was highest in diagnosing subacromial bursitis (0.90) and Bankart’s lesion (0.90) and lowest for synovitis (0.46). Conclusion: MRI is an effective technique for the diagnosis of rotator cuff tears, subacromial bursitis, synovitis, and rotator cuff tendinitis but was less effective in detecting SLAP lesions and less in differentiating the partial or complete rotator cuff tear.

A cross-sectional, web-based survey was conducted to assess the health-care professionals (HCPs)’ perception toward existing medical device postmarket surveillance (PMS) practices in India. A total of 1756 responses (medical practitioners [19.8%], nurses [22.5%], pharmacists [21.4%], and biomedical engineers [13.8%]) were recorded and analyzed. About 71.2% of participants were aware about the ongoing PMS program, 87.5% were aware that medical devices are under regulation in India, and 83.3% were aware about who can report medical device adverse event (MDAE). About 56.3% of participants agreed that they take regular feedback from patients after using high-risk medical device. Majority of participants (69.4%) were aware about tools for reporting MDAE and the online reporting form is the most preferable tool among users. About 76.2% of participants were agreeing that reporting of MDAE is their professional/ethical responsibility. This study reveals that Indian HCPs show a good understanding of PMS practices and a positive perception toward MDAE reporting. However, underreporting still remains a challenge in India.

Acute lymphoblastic leukemia (ALL) in children is a complicated and heterogeneous disease impacted by various genetic susceptibility factors. The significance of genetic testing in pediatric ALL diagnosis and management, the role of minimal residual disease (MRD) monitoring, and ethical issues and problems in pediatric genetic testing are discussed in this narrative review. It also looks ahead to the future of genetic susceptibility research, focusing on data integration, artificial intelligence-driven insights, and the possible finding of novel treatment targets. We hope to provide a complete view of the current status and hopeful future of precision medicine in pediatric oncology as we traverse these numerous facets of pediatric ALL. Pediatric ALL is a significant problem in the world of pediatric cancer, requiring a detailed understanding of its genetic foundations and the importance of genetic testing. This narrative review investigates the complex world of pediatric ALL, shedding light on the intricate web of genetic susceptibility factors that influence the progression and treatment results. While we investigate the importance of genetic testing, the critical function of MRD monitoring, and the ethical concerns inherent in pediatric genetic testing, we also look forward to the potential horizons of genetic susceptibility research.

Aim: This study aimed to evaluate the correlation between the presence of two canals in mandibular incisors and multiple canals in mandibular premolars in the Western Uttar Pradesh population of India using cone-beam computed tomography (CBCT). Methods: CBCT scans with 0.125-mm voxel size and 50 mm × 50 mm field of view of 800 patients were evaluated for the parameters; a number of canals, root canal configurations (according to Vertucci’s classification), unilateral/bilateral occurrences, and correlation between presence of two canal configuration in mandibular incisors and multiple canals (>1 canal) in mandibular premolars. The data obtained were subjected to statistical analysis using the SPSS statistical program version 22.0 using the Chi-square test. The significance level was set as 5%. Results: According to the current analysis, the prevalence of mandibular incisors with one canal was 68.1% and two canals were 31.9% whereas in mandibular premolars prevalence of one canal was 71.5%, two canals were 27.2%, and three canals were 1.3%. The incidence of Vertucci type I canal configuration (68.1% mandibular incisors and 71.5% mandibular premolars) was more prevalent than the other types. The incidence of C-shaped canals was 2.6%. The prevalence of bilateral occurrence of the same canal configuration was 16.6%. A positive correlation was found between the presence of two canals in mandibular incisors with multiple canals in mandibular premolars (20.4%). Conclusion: The root canal morphology of mandibular premolar teeth of the Western Uttar Pradesh Indian population is complex. Two canals in mandibular incisors are frequently associated with multiple canals in mandibular premolars.

Background: Oral lichen planus(OLP) lesions are chronic, rarely undergo spontaneous remission, potentially pre-malignant and often source of morbidity when erosive/ulcerative or erythematous lesions are present, suggesting that oral lichen planus does have an impact on quality life.It can be triggered by psychological or physical stress. Aim: was to determine the influence of stress anxiety and depression in patients with OLP using ,Depression ,stress and anxiety scale 21 questionnaire(DASS21). Methods: 90 patients were enrolled into this study. Psychometric evaluation was done using DASS-21 questionnaire. Patients were asked to rate the extent to which they had experienced each symptom over the previous week on a four-point scale ranging between 0 .Based on the score obtained, extent of a given negative emotion was classified as normal, mild, moderate, severe or extremely severe. It has 21questions divided into three sub scales of seven items each to evaluate the effect of stress, anxiety and depression respectively among OLP patients. Results: The atrophic-erosive type showed highest stress levels ie 16.7%,while,1.5% of the patients showed severe stress level in reticular type .(p-value of 0.005) whereas severe levels of anxiety was seen in 10.4% with reticular type, 8.3% with atrophic-erosive type and combined type with 9.1%. Extremely severe levels of anxiety was seen only in 3% of reticular type , 8.3% with atrophic-erosive pattern and 9.1% showed combined pattern. The results were not statistically significant. Conclusion: OLP have periods of relapses and remissions. burning sensation were high, irrespective of the clinical pattern seen. We found that the levels of stress and anxiety were comparatively higher compared to depression in patients with oral lichen planus.

Alzheimer’s disease is a neurological disorder marked by the accumulation of amyloid beta (Aβ) aggregates, resulting from mutations in the amyloid precursor protein. The enzyme β-secretase, also known as β-site amyloid precursor protein cleaving enzyme 1 (BACE1), plays a crucial role in generating Aβ peptides. With no targeted therapy available for Alzheimer’s disease, inhibiting BACE1 aspartic protease has emerged as a primary treatment target. Since 1999, compounds demonstrating potential binding to the BACE1 receptor have advanced to human trials. Structural optimization of synthetically derived compounds, coupled with computational approaches, has offered valuable insights for developing highly selective leads with drug-like properties. This review highlights pivotal studies on the design and development of BACE1 inhibitors as anti-Alzheimer’s disease agents. It summarizes computational methods employed in facilitating drug discovery for potential BACE1 inhibitors and provides an update on their clinical status, indicating future directions for novel BACE1 inhibitors. The promising clinical results of Elenbecestat (E-2609) catalyze the development of effective, selective BACE1 inhibitors in the future.

INTRODUCTION: Renal disorders are becoming increasingly common today. There is a clear correlation between social and economic deprivation and the advancement of many kidney illnesses, as well as premature death. OBJECTIVE: The objective is to reveal trends in the prevalence of renal diseases among the population below the poverty line (BPL) using the Karnataka method. METHODS: The current study is based on the data available on the government-managed website containing details about people who received treatment for several renal diseases under various government health insurance schemes by the BPL population from 2010 to 2020 in Karnataka state, South India. RESULTS: Renal calculi, enlarged prostate, and bladder calculus are the most common renal disorders among BPL communities in the age group of 20–40 years. Regarding renal calculi, there is a consistent increase in cases from 563 in 2010–2011 to a peak of 3901 in 2020–2021, indicating a continuous upward trend. Fluctuations are observed in the case of an enlarged prostate, with variations in the number of cases each passing year. Bladder calculus disease also shows an increasing trend, particularly evident from 2017 to 2018 onward. CONCLUSION: This study found the potential relationship between socioeconomic status and renal diseases among individuals in the BPL segment of Karnataka state. Renal disorders such as calculi, renal failure, and chronic kidney disease exhibit a rising trend over time, whereas diseases such as enlarged prostate and bladder calculus display fluctuations. The findings underscore the urgent necessity for targeted healthcare interventions and awareness programs tailored to BPL communities.

Background: The mitochondrial DNA (mtDNA) G10398A polymorphism has been associated with bipolar disorder (BD). It leads to an amino acid substitution within NADH dehydrogenase subunit, thereby altering the mitochondrial complex I function. This exploratory case–control study assesses the association of mtDNA G10398A with the risk of BD and its relationship to clinical variables in Indian patients. Methods: Cases met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of BD-I in remission and had a family history of BD or recurrent unipolar disorder in biological relatives. The healthy controls (HC) had no known illness and were screened negative for Family Interview for Genetic Studies. Participants were assessed using Clinical Pro forma, NIMH-Life Chart Method and Alda lithium response scale. The mtDNA G10398A was assessed with real-time polymerase chain reaction using TaqMan assay. Results: A total of 82 participants were recruited across cases and controls, with 42 patients (50% with maternal history) and 40 healthy individuals with similar demographic profiles. The mean age of onset was 25.16 (standard deviation [SD] 7.6) years, with illness for 11.59 years (SD: 7.18). Allele A was found in 50% of cases compared to 32.5% HC (odds ratio = 2.08; 95% confidence interval [CI]: 0.85–5.09). Findings remain non-significant for patients with maternal mood disorders (allele A: 38.9%; 21/42). Cases with allele G had significantly higher body mass index (BMI) (P = 0.008) than those with allele A. Conclusion: The study adds information on mtDNA 10398A amongst Indian patient samples and healthy individuals. No significant group difference was found with respect to mtDNA G10398A. The positive association of allele G with higher BMI has potential clinical relevance that can be further investigated in larger samples.

Purpose Orbital cellulitis is an acute post-septal orbital infection caused mostly by bacteria. This may result in serious complications including blindness, meningitis, cavernous sinus thrombosis, brain abscess, and even death. The delay in treatment increases morbidity and mortality. The purpose of present study was to review cases of orbital cellulitis in recent years regarding its clinical presentation, diagnostic evaluation, treatment policy, complications, and disabilities. The outcome of study will help in early diagnosis and better management of orbital cellulitis cases. Materials and Method Total 20 cases of orbital cellulitis in children from March 2021 to February 2024 were evaluated and analyzed in department of ophthalmology, Patna Medical College and Hospital, Patna. Result Total 20 children with ages

Background: End to side anastomosis (ESA) poses difficulty at corners in small calibre vessels. S shaped arteriotomy (SSA) overcomes this. Aims: This study presents the results of SSA and explains the concept involved. Settings and Design: It is an observational study with retrospective analysis. Methods and Material: SSA coverts a narrow V at the corners into a broader U which pry open the edges. Altered dynamics acting on arterial wall result in this. SSA was utilised for carrying out arteriovenous fistulas [radio- cephalic and brachio-cephalic arteriovenous fistulas (AVFs)] and crural bypasses. The patency of AVFs was determined by doppler and / or ability to carry out successful dialysis. Crural bypass were followed by doppler and/ or CT angiography for patency. Statistical Analysis Used: Results are presented as a descriptive analysis. Results: One hundred ESAs were done. This included sixty- five radio cephalic AVFs, twenty brachio-cephalic AVFs and fifteen femoro-crural bypasses. The mean diameter of the radial artery was 1.97 +/- 0.24mm; while the average diameter of brachial artery was 3.3 +/- 0.43mm; and that of crural arteries was 2.4 +/- 0.43mm. Twelve radio cephalic AVFs thrombosed, but rest of AVFs matured with a mean follow up of 6 months. The total follow up for crural bypasses was 21 months. The cumulative patency rate was 100 percent at 10 months and 82% at 21 months. Conclusions: SSA helps in better visualising of the corners and facilitates ESA with satisfactory results. This happens due to redistribution of forces acting on the arterial wall.

Foster–Kennedy Syndrome presents with optic atrophy in one eye and papilledema in the contralateral eye. It originates from a variety of intracranial pathologies, but most often a subfrontal mass. There is compression of the ipsilateral optic nerve by the intracranial mass, often an anterior cranial fossa meningioma. Females are mostly affected. Progressive visual loss, headache, vomiting, seizure episodes, psychiatric illness, diplopia, anosmia, and loss of consciousness are the common presenting features. We present a case of Foster–Kennedy syndrome in a 13-year-old girl child with optochiasmatic Glioma.

Introduction: The cornea of the eye is the most vulnerable organ to external insult. Contact lens is no exception. Changes in corneal epithelium, stroma, and loss of hexagonal shape in the endothelium have been taught in contact lens classes. We wanted to understand the cell density of endothelium in prolonged contact lens wear. Methods: It was a prospective, observational, cross-sectional study. The volunteers were divided into two groups: group 1 wore their contact lenses for over 5 years and group 2 never wore contact lenses. Specular microscopy was performed using Topcon SP-3000P. Computerized morphometry was used to evaluate the mean cell density of the corneal endothelial cells. Result: A statistically significant decrease in corneal endothelial cell density was observed in contact lens wearers. Conclusion: The use of contact lenses for a prolonged period significantly decreases corneal endothelial cell density. Suitable intervention may prevent such changes in the cornea.

Arthroscopic shoulder surgeries are routinely practiced in many orthopedic centers for diagnostic and therapeutic purposes. The patient is commonly made to lie in a lateral position to carry out the procedure. We had a 71-year-old patient who underwent right shoulder arthroscopy for rotator cuff injury; the duration of surgery was 300 min. The patient developed subcutaneous edema over the neck and anterior chest. Further evaluation revealed airway edema as well. The patient was shifted to ICU for monitoring and overnight ventilation. Other radiological investigations confirmed the edema in subcutaneous and deep tissues of the neck and chest. The patient was extubated the next day morning after the edema improved. She was shifted to the ward for further management. Airway edema after shoulder arthroscopy, though uncommon, can be predicted in susceptible patients with prolonged surgeries and excess fluid irrigation. Timely diagnosis and intervention with coordination among the treating teams can result in positive outcomes.

Purpose: The COVID-19 pandemic was caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV2). The impact of the pandemic is becoming more apparent now on various tissues and body organs. Limited knowledge is present about the characteristics, duration, and long-term sequelae of ocular problems post-COVID-19 infection. The purpose of the present study was to evaluate and analyze the ocular problems occurring in healthcare workers after COVID-19 infection. Material and Method: This was a cross-sectional survey study conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna. The participants were healthcare workers who were exposed to COVID-19 infection ≥6 months back. A questionnaire was prepared. Responses were evaluated and analyzed. Patient consent and institutional committee permission were taken as per norms. Result: A total of 210 healthcare workers who were infected with COVID-19 >6 months back responded with complete answers. The maximum number of respondents was between the ages of 31 and 60 (73.3%). The pre-covid ocular problems were present in 25% of the participants, especially in those having chronic diseases (such as diabetes, hypertension, or both). Post-ocular problems were faced by 60% of the participants, which was significant (P < 0.01). Dry eye, itching, and foreign body sensations were present in 60% of those facing ocular problems (P < 0.01). Ocular surface manifestations were more common. Conclusion: A knowledge, understanding, and awareness about ocular problems and their long-term sequelae in post-COVID-19-infected patients will help in early diagnosis and better management of such patients.

Background Cryosurgery remains an important treatment modality in dermatology practice. HYDROZID®, a new portable cryosurgery medical device using norflurane as a cryogen, was recently introduced in the Indian market. This paper reports the findings of the phase IV study conducted in India. Aims This is a prospective phase IV study to evaluate its safety and efficacy in the treatment of superficial epidermal and dermal lesions. Methods The study was conducted across 4 centres in India. The cryosurgery cycles were decided based on the skin lesion considered for the treatment. Safety and efficacy parameters were assessed at day 1, day 7, day 14, day 30 (±2) (end of treatment), and day 60 (±2) after the initial cryosurgery treatment. The local skin reactions scale, pain VAS scale, and Vancouver scale for assessment of pigmentation and scarring were used for the assessment of cutaneous reactions. Assessment of efficacy was done by evaluating the total disappearance of skin lesions at the end of the study visit. Results Ninety-seven patients completed the study. The reported post-procedural pain was mild to moderate and subsided over the period of 24 hours. There was no pain observed in 84.76% of patients at the end of 24 hours. Complete disappearance of the lesion was seen in 47.4% of patients at the end of the study, while the reduction in the diameter of skin lesions by more than 50% was observed in 79.38% of patients. Conclusion The data from this study support good clinical tolerability and safety of the Hydrozid® portable cryo device.

Background: Very few studies have examined the impact of the concurrent presence of periodontitis (PD) and type 2 diabetes mellitus (T2DM) on serum Vitamin D levels, particularly in developing nations like India, and needs further investigation. Aim: This study aims to assess the relationship between serum Vitamin D values and PD in T2DM patients and to study the correlation between socioeconomic and demographic variables that influence the serum Vitamin D levels and the extent of PD in patients with T2DM. Materials and Methods: This was a cross-sectional, hospital-based research. Medical, dental, and diet histories were obtained from the participants, and their socioeconomic status (SES) was determined. Clinical parameters – plaque index (PI), gingival index (GI), sites with gingival bleeding, probing pocket depth (PPD), and clinical attachment level (CAL) were compared among three groups -patients with generalized Stage III Grade B PD with T2DM (n=35), patients with generalized stage III Grade B PD (n=35) and healthy controls (n=35) and the clinical parameters - plaque index(PI), gingival index(GI), sites with gingival bleeding, probing pocket depth(PPD), and clinical attachment level(CAL) were measured. Biochemical tests included the evaluation of serum 25-hydroxyvitamin D (25[OH] D) and hemoglobin A1C (HbA1c) levels. Statistical Analysis: Periodontal and biochemical parameters were compared using a one-way analysis of variance across the three groups. The association between clinical parameters, SES, and 25(OH)D was examined using Pearson’s correlation coefficient test and linear regression analysis. Results: The serum 25(OH)D levels were lowest in the subjects with generalized Stage III Grade B PD with T2DM (13.54 ± 3.31 ng/mL). Furthermore, there was a significant (P < 0.01) negative correlation between serum 25(OH)D and periodontal parameters, PI (−0.442), PPD (−0.474), CAL (−0.459), sites with gingival bleeding (−0.354), and GI (−0.346) among the groups. The regression analyses showed that an increase in periodontal parameters (PI, GI, PPD, and CAL) and a higher HbA1c was linked to a lower 25(OH)D. However, the periodontal parameters and 25(OH)D levels showed no correlation with socioeconomic and demographic parameters in the study. Conclusion: Serum Vitamin D values are negatively influenced by the synergistic effect of PD and T2DM or by the presence of PD alone. However, the association of SES on serum Vitamin D values in individuals with PD and T2DM or PD alone could not be demonstrated.

Introduction: In acute inferior wall myocardial infarction (IWMI) and occlusion of the right coronary artery (RCA), the most important element is to recognize the culprit artery and the location and size of the infarct, which is essential in the treatment. Adequate knowledge about clinical determinants can aid in prompt and effective management. Materials and Methods: A cross-sectional study was conducted to find determinants of RCA occlusion among 103 subjects with IWMI from rural western India. Results: About 86.4% of subjects were male. Females experienced IWMI at a later age than males (62.4 ± 10.3 vs. 58.6.1 ± 11.8 years). Bradycardia was more prevalent than tachycardia (44.66% vs. 15.53%). Males had a 5.17 times higher odds of having RCA involvement in IWMI. Subjects with deranged lipid profiles had 2.37 times higher odds of involvement of RCA. RCA involvement was significantly associated with bradycardia (P = 0.006, aOR = 15.31, 95% confidence interval [CI] = 2.21–105.7) but not with tachycardia (P = 0.903). Proximal site occlusion was significantly associated (P = 0.027; aOR = 0.103; 95% CI = 0.013–0.772) with bradycardia compared to distal sites. Triple-vessel disease had significantly (P < 0.05) 12.9 times higher odds than single-vessel disease. Total occlusion of RCA was 2.9 times higher than obstructive coronary artery disease. Conclusion: These findings suggest determinants associated with RCA involvement in IWMI, including gender, lipid profile, cardiac rhythm disturbances (particularly bradycardia), and the extent and site of coronary artery occlusion. Incorporating these factors into clinical practice, clinicians can better predict the underlying pathophysiology of IWMI, anticipate its hemodynamic and electrophysiologic consequences, and tailor management strategies accordingly.

Introduction: Cardiovascular disease, particularly myocardial infarction (MI), remains a leading cause of mortality globally and in India. The prevalence of coronary artery disease (CAD) among young adults in India presents unique challenges, marked by earlier onset and distinct risk factor profiles. However, comprehensive data on young MI patients in rural areas are scarce, necessitating an investigation into their demographics, clinical characteristics, and outcomes. Materials and Methods: This institution-based, cross-sectional study was conducted at the Department of Cardiology, NIMS Super Specialty Hospital, Jaipur, focused on individuals under 45 years old admitted with MI. Data encompassing demographic, clinical, echocardiographic, and angiographic profiles were collected and analyzed. The study spanned from December 2022 to December 2023. Results: Among 45 young MI patients studied, males constituted a substantial majority (86.67%). Lower socioeconomic status (SES) was prevalent (71.11%), and risk factors such as smoking (51.11%) and hypertension (35.56%) were notable. Troponin-T/CPK MB levels were significantly elevated in 57.78% of cases, indicating myocardial damage. Angiographic assessments revealed predominance in left anterior descending (LAD) artery abnormalities (55.56%) and a significant proportion underwent primary percutaneous transluminal coronary angioplasty (PTCA) (46.67%). Conclusion: The study highlights the concerning prevalence of MI among young adults in rural areas of India, with a predominance of males and a high prevalence of traditional risk factors such as smoking and hypertension, as well as the notable influence of low SES (P = 0.0046). Contrary to previous studies that linked higher SES and sedentary lifestyles to an increased risk of CAD, this study underscores the significant burden of CAD among young individuals from lower socioeconomic groups. The elevated levels of troponin-T and CPK-MB, along with the predominance of LAD artery abnormalities, emphasize the severity and distinct coronary involvement patterns in this demographic. These findings highlight the urgent need for targeted preventive strategies and improved access to health-care services for young adults in lower socioeconomic groups in rural areas.

Diabetes mellitus (DM) is a common endocrine disorder. It has an impact on various organs and systems in the body. Both hypo- and hyper-glycemia can lead to cognitive impairment through several metabolic pathways. Previously, the battery of studies has reported the decline in cognitive functions through preclinical studies using in vivo and in vitro methods as well as clinical studies in elderly populations. Previous reports of the clinical studies had limited to one domain of cognitive function, the elderly population, and inflammatory cytokines/chemokines and tau protein levels. The present review article attempts to find the various mechanisms and their inter correlation leading to cognitive impairment among patients with DM.

The discovery of targetable mutations in non-small-cell lung cancer (NSCLC) has opened up a plethora of therapeutic options. Epidermal growth factor receptor (EGFR) mutations are found in 10%–20% of NSCLC; however, it is extremely rare in small-cell lung cancer (SCLC), and the efficacy of EGFR tyrosine kinase inhibitors (TKIs) in SCLC is unclear. Here, we describe the case of a 57-year-old nonsmoker lady who was diagnosed with metastatic SCLC. She received multiple lines of palliative chemotherapy. She was deemed unfit for further chemotherapy and immunotherapy and was started on tablet erlotinib empirically. On follow-up imaging with positron emission tomography-computed tomography, she had a partial response and has currently on erlotinib for 2.5 years without disease progression. Although cases with transformation of EGFR-mutated NSCLC to SCLC have been observed, de novo EGFR mutation in SCLC is infrequent. It has been observed that de novo EGFR mutation in SCLC is associated with females, non-smokers, and patients in the eastern part of the world. The current guidelines do not recommend molecular testing for EGFR mutations in SCLC. We described a case of SCLC who had a response to TKI and such cases warrant an answer to whether EGFR mutation testing should be recommended in nonsmoker, females with SCLC, or for them who have failed the first line of chemotherapy.

Introduction: Colposcopy is important for triaging any abnormal cervical screening test. Scarcity of trained colposcopists and colposcopy centers is a big hurdle to screening programs in low- and middle-income countries. Objectives of the Study: The objective was to assess the performance of the artificial intelligence incorporated into the mobile optical device technologies (ODT) Enhanced Visual Assessment (EVA visual check) against physician colposcopic diagnosis and the gold standard of histopathology. Materials and Methods: It was a cross-sectional observational study conducted on women referred to a colposcopy clinic following an abnormal screening test. Colposcopic examination was performed by colposcopists using the MobileODT EVA system. Physician’s impression and Visual Check analysis were compared with the final histopathological analysis or cytology. Cases with normal cytology and normal colposcopy did not undergo biopsy, and these were considered normal. Results: A total of 2050 women were screened, and 147 screen-positive women were recruited in the study. EVA Visual Check had a sensitivity of 86.8% (75–95), specificity of 28.7% (20–39), positive predictive value (PPV) of 40.7% (32–50), negative predictive value (NPV) of 79.4% (62–91), and diagnostic accuracy of 49.7% (41–58) for diagnosing cervical intraepithelial neoplasia (CIN) 1+ lesions. EVA Visual Check has a sensitivity of 89.3% (72–98), specificity of 26.1% (18–35), PPV of 22.1% (15–31), NPV of 91.2% (76–98), and diagnostic accuracy of 38.1% (30–46) for CIN 2+ lesions. Conclusion: MobileODT EVA colposcope with AI has sensitivity comparable to physician’s diagnosis, whereas specificity, PPV, and NPV were less than that of physician’s diagnosis. It could prove valuable for triage of screen-positive women for further management.

Background: Despite the enactment of Sustainable Development Goal (SDG) and National Food Security Act, food insecurity in India has been growing. Objectives: This study aimed to estimate the current magnitude of food insecurity in a rural setting of West Bengal; to find out the association of food insecurity with the health and socio-demographic profile of the study population, if any; to explore their food situation and its various impacts on the study population; and to integrate the findings from the qualitative and quantitative strands. Methods: An observational study with a cross-sectional design using a mixed-methods approach was conducted in Muchisa. Two hundred and twelve households were selected through cluster random sampling for the quantitative strand. The participants were interviewed using a predesigned, pretested, and structured schedule from February 6–March 26, 2021. Qualitative data were collected from 10% of food-insecure households employing an in-depth interview guide. Statistical evaluation was done using Microsoft Office Excel 2007 and Statistical Package for the Social Sciences (SPSS) Version 25.0. The data were analyzed using Pearson’s Chi-square test, Cochran–Armitage trend test, ordinal logistic regression, and thematic analysis. A P value of

Background: Unmet healthcare need among elderly is the want for essential healthcare which is not fulfilled. Health needs of the elderly often go unrecognized. Functional limitation is one of the contributors in this unmet health need. The situation is worse in rural areas due to lack of awareness and lower socio-economic status. The study aimed to estimate the burden of unmet health needs among the elderly of Budge-Budge II block in West Bengal, to assess their morbidity pattern and to evaluate the predictors of this unmet health need. Materials and Methods: A community-based descriptive study, cross-sectional in design was conducted for a period of 3 months in selected villages of Budge-Budge II block, West Bengal. Data on unmet need were collected by face-to-face interview of 396 participants selected by simple random sampling using EASYCare standard (2010) questionnaire. Results: The most prevalent unmet health need was for preventive care (87.37%), followed by mental health and wellbeing (84.09%). Hypertension was the most common morbidity (52.02%) reported among the study population. Belonging to the age group of 60-69 years had a lower odds of experiencing unmet health needs, whereas being a homemaker or engagement in agricultural work had higher odds of facing unmet health needs among the study participants. Conclusions: The unmet health need of the elderly is a major public health problem that is influenced by age, marital status, and nature of work.

The recently re-emerged mpox (monkeypox) virus that causes mpox disease is a member of genus Orthopoxvirus and has unprecedentedly spread worldwide. Numerous studies have contributed to our understanding of its evolution, pathophysiology, and clinical manifestations. The current outbreak of the mpox virus depicts its novel route of transmission as a new variant. However, the exact reason for its transition from an epidemic to a pandemic remains unclear. Furthermore, other poxviruses such as vaccinia virus, variola virus, and cowpox virus, also belong to the same genus, Orthopoxvirus. In the present review, our objective was to summarize the evidence on evolution, pathophysiology, and clinical manifestations of mpox virus and its related poxviruses. The present review would aid in a better understanding of the current circulating mpox virus and its differences from other poxviruses. In addition, the shared genetic factors contributing to virulence in these Orthopoxvirus highlight their evolutionary connections and genetic similarities. While they exhibit differences in virulence, studying these genetic relationships is crucial for understanding their biology, pathogenicity, and the development of effective vaccines and antiviral therapeutics to curb mpox disease.

Recombinant technology-based vaccines have emerged as a highly effective way to prevent a wide range of illnesses. The technology improved vaccine manufacturing, rendering it more efficient and economical. These vaccines have multiple advantages compared to conventional vaccines. The pandemic has heightened awareness of the advantages of these vaccine technologies; trust and acceptance of these vaccines are steadily growing globally. This work offers an overview of the prospects and advantages associated with recombinant vaccines. Additionally, it discusses some of the challenges likely to arise in the future. Their ability to target diverse pathogen classes underscores their contributions to preventing previously untreatable diseases (especially vector-borne and emerging diseases) and hurdles faced throughout the vaccine development process, especially in enhancing the effectiveness of these vaccines. Moreover, their compatibility with emerging vaccination platforms of the future like virus-like particles and CRISPR/Cas9 for the production of next-generation vaccines may offer many prospects. This review also reviewed the hurdles faced throughout the vaccine development process, especially in enhancing the effectiveness of these vaccines against vector-borne diseases, emerging diseases, and untreatable diseases with high mortality rates like AIDS as well as cancer.

Aim: There is a need to elucidate intermittent Theta burst stimulation (iTBS) as a novel treatment in persistent somatoform pain disorder (PSPD). Methods: Twenty patients were randomly allocated to active iTBS (n = 11) and sham iTBS (n = 9) and received 10 iTBS sessions, 2 sessions per day, sequentially to primary motor and dorsolateral prefrontal cortices for 5 days in a week. Each iTBS session comprised of 2 sec. per train of 10 bursts (3 pulses per burst at 50 Hz; total 30 pulses) and were given with a gap of 5 Hz, total of 20 trains, and 600 pulses. Visual Analogue Scale, Brief Pain Inventory and Global Pain Scale (GPS), Montgomery and Asberg Depression Rating Scale, Hamilton Anxiety Rating Scale - Anxiety, World Health Organization Quality-of-Life Scale-brief, and Pittsburgh Sleep Quality Index were applied at baseline, after last session, and at 2 weeks after last TBS session. Intention to treat analysis was conducted. Results: Both groups were comparable for baseline psychopathology scores including clinical variables like age (t = 0.865; P = 0.398), duration of illness (t = 1.600; P = 0.127), and motor threshold (t = 0.304; P = 0.765). On repeated measures ANOVA, a significant within-group time effect for VAS, BPI-Severity, BPI-Interference, BDI – II, MADRS, HAM-A, and WHOQOL- BREF was found for active and sham TBS groups, respectively. GPS scores had significant within-group (active) * time interaction (F = 11.651; P = .001; ηp2 = 0.538) and between-group * time interaction (F = 3.407; P = 0.044; ηp2 = 0.159). However, between-group * time effect interaction was lost after covariance (F = 1.726; P = 0.196; ηp2 = 0.110). Conclusion: No major adverse effects were reported. Our pilot trial concludes that safe therapeutic efficacy of iTBS in PSPD is inconclusive. Lower total number of sessions along with small sample size may limit the study findings.

Introduction: Although H3N2 outbreaks were once rare, they have become more common in recent years. With a significant toll on health-care resources and the ability to cripple any society, the epidemiological significance of this disease is paramount. While most of the previous studies on influenza outbreaks have reported H1N1 disease, there is a scarcity of literature regarding the H3N2 clinicoradiological profile. Hereby, we present the clinicoradiological profile of a series of H3N2 cases from western India. Materials and Methods: This is a retrospective chart-based review of clinicoradiological profile of a series of cases that were reported to a tertiary care center in western India between February 2023 and March 2023. Results: A total of 10 patients had tested positive for H3N2. All patients had a history of fever lasting an average of 4.7 days, and six had varying degrees of dyspnea. One patient had gastrointestinal symptoms, and six developed tachypnea with hypoxemia requiring oxygen supplementation. One patient with multiple comorbidities required invasive mechanical ventilation and had a complicated course with a superadded bacterial infection. Out of the four patients with radiographic findings, two had atypical pneumonia/acute infective etiology. Conclusion: This study provides valuable insights into the clinical presentation and management of H3N2 infections. The findings highlight the importance of influenza vaccination and early detection of H3N2 infections to prevent severe complications. The successful outcomes of the patients in this study demonstrate the effectiveness of prompt intervention and appropriate treatment in managing H3N2 infections.

Background: Uncontrolled glycemic parameters in type 2 diabetes mellitus (T2DM) are a major concern. The present study aimed to evaluate the effectiveness of continuous glucose monitoring (CGM) on glycemic control in type 2 diabetics on insulin therapy. Materials and Methods: This prospective observational study was done in the Outpatient Department of General Medicine from January 1, 2021 till December 31, 2021 on patients with confirmed T2DM and on insulin therapy. Patients underwent detailed history and physical examination. The CGM device was inserted to record blood glucose levels throughout the day and night for monitoring. Parameters like glycosylated hemoglobin (HbA1c), fasting blood sugar (FBS), post-paradial blood sugar (PPBS), and lipid profile parameters [cholesterol, triglyceride (TG), and low-density lipoprotein (LDL)] were compared at baseline and after a follow-up of 3 months. P-value < 0.05 was used to indicate significant difference. Results: Of 107 patients screened, 100 were included in the study and seven were excluded. The mean age of the patients was 60.6 ± 11.1 years. Fifty-six (56%) of the patients were males, and 44 (44%) were females. The mean body mass index (BMI) was 22.9 ± 2.4 kg/m2. Compared to baseline values, after 3 months of CGM, there was significantly decreased HbA1c (9.41 ± 0.83 vs 9.87 ± 1.16 g%, P < 0.001), FBS (194.640 ± 22.4587 vs 205.10 ± 35.7758 mg/dl, P = 0.002), PPBS (271.160 ± 29.1235 vs 299.180 ± 42.3798, P < 0.001), cholesterol (184.470 ± 28.5192 vs 198.430 ± 38.8367 mg/dl, P < 0.001), LDL (102.410 ± 22.8973 vs 112.040 ± 30.8859, P < 0.001), and TG (140.890 ± 18.0979 vs 146.730 ± 20.8665 mg/dl, P < 0.001). Conclusion: There was a significant improvement in the glycemic parameters and lipid profile parameters with the adoption of CGM. Overall, CGM is a novel method for practical use for management of patients with T2DM.

Introduction: Non-small cell lung cancer (NSCLC) is the leading cause of mortality globally. Early imaging detection modalities are associated with high false-positive rates and radiation exposure. A non-invasive biomarker can serve as an improvised method for early detection. MicroRNAs can serve as a potential non-invasive biomarker as they are stable in circulation, tissue or biological process-specific, easy to detect, cost-effective, and not associated with radiation hazards. This study validates circulating microRNA in NSCLC of the Indian population and studies its correlation with clinicopathological parameters. Materials and Methods: Circulating microRNA (-miR-193b, miR-301a, miR-7, and miR-25) was evaluated in 101 cases of tissue-proven NSCLC and 28 controls in serum samples. Results: There were 67 male and 34 female patients (Male: Female = 1.97:1). The age range was 25 to 86 years with a median age of 60 years. There was a significant upregulation in the expression of miR-193b in the NSCLC group as compared to controls (P = 0.034). MiR-7 was also upregulated while miR-25 and miR-301a were downregulated in NSCLC as compared to controls; however, a level of significance was not achieved. ROC curve analysis for miR-193b showed an AUC of 0.636 (95% CI, 0.522-0.750; P-value = 0.036) between NSCLC cases and controls. Conclusion: The present study showed variable expression of the above-studied miRNAs. MiR-193b showed a significant upregulation in cancer patients; however, the other three miRNAs were not conclusive. This suggests that profiling of microRNA in each population is essential to search for a valid non-invasive biomarker in that population.

Background: The incidence of meningoencephalitis (ME) in India is poorly understood, and the exact etiological diagnosis is often not possible. This study was planned to elucidate the bacterial and viral etiological diagnosis of ME in children less than 5 years of age. Materials and Methods: The present study was conducted in Virus Research and Diagnostic Laboratory (VRDL), Department of Microbiology, King George’s Medical University, Lucknow, from July 2020 to June 2022. Serum, cerebrospinal fluid (CSF), and nose/throat swabs were collected from all the enrolled cases of meningoencephalitis in children below 5 years of age and tested for various etiological agents by ELISA and/or real-time PCR. Results: Of 130 enrolled cases, 50 (38.5%) cases tested positive for one or more etiological agents. Etiological agents of ME detected were Japanese encephalitis virus (JEV) (8.46%), adenovirus (6.92%), influenza virus (5.38%), dengue virus (3.85%), Parvo B-19 virus (3.08%), Orientia tsutsugamushi (3.08%), Herpes Simplex Virus-1 (HSV-1) (1.54%), measles virus (1.54%), and Varicella-Zoster Virus (VZV) (1.54%). Rubella virus, Chikungunya virus (CHKV), Mumps virus, Enteroviruses, Parecho virus, John Cunningham virus (JC), BK virus, Nipah virus, Kyasanur Forest Disease virus (KFD), Chandipura virus, Herpes Simplex Virus (HSV-2), SARS CoV-2, N. Meningitides, and H. Influenzae were tested but not detected in any of the cases. Conclusion: We identified the etiological agents in 50/130 (38.5%) suspected ME cases in children less than 5 years of age, using molecular and ELISA-based diagnostic methods. The four most common pathogens detected were JEV, adenovirus, influenza virus, and dengue virus.

Sclerosing stromal tumor is a benign sex cord-stromal tumor, that commonly occurs in the second and third decades of age. Intraoperative diagnosis of this entity poses a great challenge because of the rare occurrence and can mimic malignant lesions. A 15-year-old female presented with a right ovarian mass. Serum markers were within normal limits. The radiological evaluation showed a large heterogeneously enhancing solid cystic abdominopelvic mass of size 16 × 14 × 9 cm with non-visualization of both ovaries separately and a few areas of calcification with mild ascites. An open cystectomy was performed. A part of the cyst wall was sent for an intraoperative frozen section. It was reported as sclerosing stromal tumor, and the post-operative specimen also confirmed the same. Areas of calcification and ossification were also identified as additional findings. We reported this case because of the uncommon occurrence, highlighting additional histological features, and also did a literature review, especially focussing on the intra-operative diagnosis.

Advanced pregnancy is associated with a higher risk of complicated aortopathies owing to the physiologic changes in pregnancy. The diagnosis can be elusive due to its rare incidence. The optimal treatment strategy is chosen based on the clinical condition of the patient, gestational age, and the severity of the aortic disease. A healthy young primigravida presented with acute chest pain in the early second trimester, diagnosed as a thoracic aortic aneurysm that had ruptured causing hemothorax. She underwent emergency endovascular repair under general anesthesia. Aortic disease should always be ruled out early in acute chest pain in pregnancy. Expeditious and strategic management helps improve maternal and fetal outcomes.

Musculoskeletal pathologies affecting shoulder girdle joints, other than gleno-humeral joint such as acromioclavicular joint arthritis, tendonitis, subacromial bursitis, subdeltoid bursitis, and osteochondritis dissecans, are relatively rare. In Middle East and Asian countries, public health services are generally availed by a large number of patients in primary health centres, rural hospitals, and district hospitals, but the scarcity of specialist orthopaedic surgeons in such hospitals usually leads to misdiagnosis of rare musculoskeletal pathologies, which may result in complications and morbidity. The study aims to determine the presentation, progression, diagnostic evaluation, and treatment of musculoskeletal pathologies affecting the shoulder girdle and develop an algorithm to screen such pathologies. A systematic literature search of four medical databases (PubMed, Scopus, Web of Science and Google Scholar) was conducted, from 1st January 1950 to 31st December 2022. Studies (case reports, prospective studies, review articles) reporting pathological conditions affecting shoulder girdles, with a focus on clinical presentation, physical examination tests required for diagnostic evaluation, and management, were included. The relevant data was extracted from the selected studies and tabulated for analysis. Seventeen studies were included in the final analysis. Several case reports, case series and review articles showed that very few musculoskeletal conditions can be correctly diagnosed based on only physical examination tests. Radiological and anatomical basis of each of the cases were discussed. An algorithm was prepared to help diagnose shoulder girdle pathologies based on clinical presentation and examination findings.