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Background: Abnormal uterine bleeding [AUB] is one of the most common presentations among women of all age groups. It is ‘Bleeding from the uterine corpus that is abnormal in volume, regularity or timing for the majority of last 6 months. Common pathologies include hormonal imbalance patterns, atrophic endometrium, endometritis, endometrial polyp, endometrial hyperplasia and endometrial carcinoma. Material & Methods: All specimens of endometrial curettage, biopsy and hysterectomy received in department of pathology GMC, Haldwani from January 2020 to September 2021 , have been included in the study. Specimens were fixed in 10% formalin and processed routinely. Clinical details and endometrial thickness by ultrasonography were recorded and analysed. Microscopic examination was performed after routine and special stains. Results: Out of a total of 103 cases, abnormal uterine bleeding was frequently observed in the age group 40 – 49 years, followed by 50 – 59 years. Most common presenting complaint was menorrhagia followed by post menopausal bleeding. Most common histopathological finding was proliferative phase endometrium followed by secretory phase endometrium. The range of endometrial thickness recorded in the proliferative phase was mostly 4-9 mm followed by the secretory phase with 9 – 15 mm. Two cases of endometrial carcinoma were seen after 5th decade onward. All cases of endometrial hyperplasia and carcinoma had an endometrial thickness of more than 15 mm. Conclusion: AUB may be the only presenting complaint in patients with malignant or pre-malignant endometrial lesions. Histopathology helps to reach a definitive diagnosis crucial for management. Keywords: Abnormal uterine bleeding, Endometrial sampling, Endometrial thickness, Endometrial hyperplasia, Endometrial carcinoma

Abstract The aromatic compounds having structural configurations with two or more fused benzene rings are the polycyclic aromatic hydrocarbons (PAHs). Topological indices are valuable tools for studying the structure property relationships of PAHs and also helps in predicting various properties and activities. They find applications widely in computational chemistry, drug design and QSPR studies. This article focuses on analysing the potential predictive index for Sombor index (SO), elliptic Sombor index (ESO), Euler Sombor index (EU), reverse Sombor index (RSO), reverse elliptic Sombor index (RESO) and reverse Euler Sombor index (REU) using regression models for top priority 38 PAHs. From the study it is evident that, SO and RSO have proved to be potential predictive indices among the considered degree-based and reverse degree-based indices. The variation of best predictive index with minimal RMSE are plotted for linear, quadratic and cubic regression models for better understanding.

Abstract Background Lipocalin-2 (LCN2), a neutrophil gelatinase-associated protein, plays an important role in iron homeostasis, infection, and inflammation. Polymorphism in the LCN2 gene is linked to various diseases such as cardiovascular disease, renal damage, and colorectal and pancreatic cancer. Identifying deleterious functional non-synonymous SNPs in the LCN2 gene is crucial in understanding how these genetic variations affect its structure and function. Methods Several in silico tools such as SIFT, Polyphen-2, PROVEAN, PREDICT SNP, MAPP, and SNAP2 followed by I-MUTANT 2.0, MUpro, ConSurf, and NetsurfP-2.0, secondary structure of the protein by SOPMA and PSIPRED, while its interaction with other genes and proteins was analyzed using GeneMANIA and STRING, respectively, and AlphaFold for protein's 3D structure prediction. Results The study identified 6 potentially harmful nsSNPs (rs11556770, rs139418967, rs142623708, rs200107414, rs201365744, rs368926734) and their structure and function were analyzed using prediction tools. I-MUTANT 2.0 predicted an increase in stability with the nsSNPs rs139418967, while the other shows decrease in protein stability with the 6 nsSNPs (rs11556770, rs139418967, rs142623708, rs200107414, rs201365744, rs368926734) which was validated using MUpro. ConSurf identified the 6 high-risk nsSNPs to be in the conserved regions of the protein. The result showed that rs11556770, rs139418967, rs142623708, rs200107414, rs201365744, and rs368926734 were found to be highly conserved and the variant amino acids. According to NetsurfP-2.0 server, the result showed that rs11556770 (Q39H), rs139418967 (L6P), rs368926734 (Y135H) were predicted to be exposed and rs142623708 (M71I), rs200107414 (Y52C), rs368926734 (Y135) were buried. The PSIPRED server analysis indicated that the predominant secondary structure was a strand, with lesser occurrences of coil and helix. Conclusion Overall, the study identified detrimental nsSNPs of LCN2 using computational analysis which could be used for large population-based investigations and diagnosis.

Trichotillomania is a clinical psychiatric manifestation involving significant hair loss in association with recurrent hair-pulling behavior, the etiology of which is still unknown. The aim of this study was to investigate the genetic and environmental and behavioral contribution to trichotillomania (hair-pulling disorder) and to relate the findings to contemporary theories about the etiology. This was a descriptive correlational and twins study design. 672 twins (MZ=474; DZ=202) were selected from Iranian twins associations in 2018. The Massachusetts General Hospital Hair-pulling Scale(1995) and the Self-Report of Zygosity were used as research instrument. Twin modeling methods were employed to decompose the variance in the liability trichotillomania (hair-pulling disorder) into additive genetic and shared and non-shared environmental factors. The data was analyzed by SPSS, STATA and M-plus. Univariate model-fitting analyses showed that genetic factors accounted for approximately 64% of the variance in TTM. The best extracted model for TTM was the DE model. The correlation coefficient results indicated that the correlation rate was 0/61 and 0/31 in MZ and DZ group respectively. It can be concluded that TTM phenotype is the results of a polygenetic. There is no intermediate despite of the dominance effect and it results from a gene-gene interaction or a dominant gene.

Abstract Breast cancer (BC) has emerged as the most common malignancy among females. The genomic profile of BC is diverse in nature and complex due to heterogeneity among various geographically different ethnic groups. The primary objective of this study was to carry out a comprehensive mutational analysis of Indian BC cases by performing whole exome sequencing. The cohort included patients with a median age of 48 years. TTN, TP53, MUC16, SYNE1, and OBSCN were the frequently altered genes found in our cohort. The PIK3CA and KLC3 genes are driver genes implicated in various cellular functions and cargo transportation through microtubules, respectively. Except for CCDC168 and PIK3CA, several gene pairings were found to be significantly linked with co-occurrence. Irrespective of their hormonal receptor status, RTK/RAS was observed with frequently altered signaling pathways. Further analysis of the mutational signature revealed that SBS13, SBS6, and SBS29 were mainly observed in our cohort. This study supplements the discovery of diagnostic biomarkers and provides new therapeutic options for the improved management of BC.

Abstract The maize leaf diseases create severe yield reductions and critical problems. The maize leaf disease should be discovered early, perfectly identified, and precisely diagnosed to make greater yield. This work studies three main leaf diseases: common rust, blight, and grey leaf spot. This approach involves pre-processing, including sampling and labelling, while ensuring class balance and preventing overfitting via the SMOTE algorithm. The maize leaf dataset with augmentation was used to classify these diseases using several deep-learning pre-trained networks, including VGG16, Resnet34, Resnet50, and SqueezeNet. The model was evaluated using a maize leaf dataset that included various leaf classes, mini-batch sizes, and input sizes. Performance measures, recall, precision, accuracy, F1-score, and confusion matrix were computed for each network. The SqueezeNet learning model produces an accuracy of 97% in classifying four different classes of plant leaf datasets. Comparatively, the SqueezeNet learning model has improved accuracy by 2–5% and reduced the mean square error by 4–11% over VGG16, Resnet34, and Resnet50 deep learning models.

Abstract Background Without increasing radiation exposure, ultralow-dose computed tomography (CT) of the chest provides improved diagnostic accuracy of radiological pneumonia diagnosis compared to a chest radiograph. Yet, radiologist resources to rapidly report the chest CTs are limited. This study aimed to assess the diagnostic accuracy of emergency clinicians’ assessments of chest ultralow-dose CTs for community-acquired pneumonia using a radiologist’s assessments as reference standard. Methods This was a cross-sectional diagnostic accuracy study. Ten emergency department clinicians (five junior clinicians, five consultants) assessed chest ultralow-dose CTs from acutely hospitalised patients suspected of having community-acquired pneumonia. Before assessments, the clinicians attended a focused training course on assessing ultralow-dose CTs for pneumonia. The reference standard was the assessment by an experienced emergency department radiologist. Primary outcome was the presence or absence of pulmonary opacities consistent with community-acquired pneumonia. Sensitivity, specificity, and predictive values were calculated using generalised estimating equations. Results All clinicians assessed 128 ultralow-dose CTs. The prevalence of findings consistent with community-acquired pneumonia was 56%. Seventy-eight percent of the clinicians’ CT assessments matched the reference assessment. Diagnostic accuracy estimates were: sensitivity = 83% (95%CI: 77–88), specificity = 70% (95%CI: 59–81), positive predictive value = 80% (95%CI: 74–84), negative predictive value = 78% (95%CI: 73–82). Conclusion This study found that clinicians could assess chest ultralow-dose CTs for community-acquired pneumonia with high diagnostic accuracy. A higher level of clinical experience was not associated with better diagnostic accuracy.

Introduction: Manual small incision Cataract surgery (MSICS) is the most common intraocular surgery performed worldwide and has advanced technically in recent years. However, as in all surgeries, complications continue depending on the surgeon, surgical technique, and patient. In order to reduce the complications in cataract surgery, many studies have been carried out to detect ocular and systemic risk factors and to take precautions against them. Materials and Methods: Mature cataract patients who can perceive light or hand motion with preoperative vision make up the study population. Preoperative assessments, including comprehensive ophthalmic evaluations and demographic data collection, are performed for every patient who is enrolled. Results: Among the 60 cases that underwent manual small incision cataract surgery, there were 13 instances of posterior capsular rent (PCR). In general, the people who had PCR were 63.86 years old. PCR happened for various reasons. Conclusion: The study found a notable occurrence of posterior capsular rent (PCR) in patients who underwent manual small-incision cataract surgery, with 13 cases out of 60 surgeries. Potential risk factors for PCR included phacodonesis, zonular dialysis, small pupils, a history of trauma, and high myopia. These findings demonstrate the significance of understanding and managing the risk factors for posterior capsular rent (PCR) in manual small incision cataract surgery to enhance patient safety and surgical outcomes.

Objectives: To assess the prevalence of self-medication in urban Indian medical students and explore possible factors associated with this practice. Methods: After obtaining institutional ethics approval, 180 medical students from six medical colleges in Mumbai were recruited to participate via social media. They were administered a pre-validated questionnaire that assessed self-medication as a practice, along with the perceived stress scale (PSS-10) online. Anonymity and confidentiality were maintained Results: The prevalence of self-medication in medical students was found to be 83.9%, with no significant difference between genders or between academic years of medical education. The most used source of information for self-medicating was older prescriptions, and for procuring drugs was pharmacist stores. Common cold was the most cited indication. Anti-pyretics and anti-inflammatory drugs were the most commonly self-medicated drugs. It was found that 73.3% of medical students had self-medicated with non-over-the-counter (OTC) drugs. It was observed that 6.1% of medical students had experienced adverse drug reactions, and alarmingly, 0.6% of medical students continued self-medicating despite experiencing adverse drug reactions Conclusions: Most of the study participants admitted to having practised self-medication. It was alarming to find that an appreciable fraction of the study population had uncontrolled access to non-OTC drugs. Thus, there needs to be a greater emphasis on the education of medical students with respect to the problems encountered by self-medicating and a need to enforce stricter regulations, as well as to establish a more watertight monitoring system, to curb this hazardous practice.

Background: Population aging is a human success story. Getting older is associated with a higher incidence of chronic diseases which have proven to have oral manifestations. The future dentists should develop a positive attitude to provide care for elders. Objective: The objective of this questionnaire-based survey was to evaluate the attitude of undergraduate dental students’ toward elders in providing dental care to them. Materials and Methods: This cross-sectional study was conducted on 202 undergraduate dental students using a questionnaire including demographic characteristics and attitude sections. Data were fed into SPSS-20 and analyzed using descriptive statistics and independent t-test (α

Background: Regular utilization of dental services enables to improve and maintain oral and general health, in old age. The study assessed the factors acting as barriers and their association with the utilization of dental services among the elderly population aged 65–74 years in Davangere, India. Methodology: A cross-sectional door-to-door survey using a self-designed, structured, validated questionnaire was carried out with a sample of 1440 elders aged 65–74 years residing in Davangere city. They were randomly selected through a multistage sampling technique. Information regarding demographic details, systemic conditions, oral hygiene practices, perceived need, utilization rate of dental services, and factors acting as barriers for the utilization of dental services among elderly was collected. “Cronbach’s α test and test–retest” tests were performed to assess the validity and reliability of the questionnaire. The Chi-square test, Pearson correlation test, and multivariate logistic regression analysis were used to assess the association between various factors acting as barriers and utilization of dental services. Results: Fifty percent of elders perceived a problem in their oral cavity, and 41.4% had utilized dental service in the previous year. The factors such as location of clinic, appointment system, expense of treatment, self-care, inability to comprehend the dentist explanation, availability of specialist, and service on weekends were highly significant in the regression model (P < 0.0001). Conclusion: Education, economic condition, negative perception of dental treatment, presence of systemic conditions, inability to comprehend dentist explanation, and use of self-oral care were the most important barriers for the utilization of dental services.

Abstract High dose radiation exposures are rare. However, medical management of such incidents is crucial due to mortality and tissue injury risks. Rapid radiation biodosimetry of high dose accidental exposures is highly challenging, considering that they usually involve non uniform fields leading to partial body exposures. The gold standard, dicentric assay and other conventional methods have limited application in such scenarios. As an alternative, we propose Premature Chromosome Condensation combined with Fluorescent In-situ Hybridization (G0-PCC-FISH) as a promising tool for partial body exposure biodosimetry. In the present study, partial body exposures were simulated ex-vivo by mixing of uniformly exposed blood with unexposed blood in varying proportions. After G0-PCC-FISH, Dolphin’s approach with background correction was used to provide partial body exposure dose estimates and these were compared with those obtained from conventional dicentric assay and G0-PCC-Fragment assay (conventional G0-PCC). Dispersion analysis of aberrations from partial body exposures was carried out and compared with that of whole-body exposures. The latter was inferred from a multi-donor, wide dose range calibration curve, a-priori established for whole-body exposures. With the dispersion analysis, novel multi-parametric methodology for discerning the partial body exposure from whole body exposure and accurate dose estimation has been formulated and elucidated with the help of an example. Dose and proportion dependent reduction in sensitivity and dose estimation accuracy was observed for Dicentric assay, but not in the two PCC methods. G0-PCC-FISH was found to be most accurate for the dose estimation. G0-PCC-FISH has potential to overcome the shortcomings of current available methods and can provide rapid, accurate dose estimation of partial body and high dose accidental exposures. Biological dose estimation can be useful to predict progression of disease manifestation and can help in pre-planning of appropriate & timely medical intervention.

Background Alzheimer disease (AD) leads to cognitive decline and alters functional connectivity (FC) in key brain regions. Resting-state functional magnetic resonance imaging (rs-fMRI) assesses these changes using static-FC for overall correlation and dynamic-FC for temporal variability.

Erythema nodosum leprosum (ENL) is an immune-mediated inflammatory reaction (antigen-antibody reaction involving complement) of leprosy. Available standard treatment in the form of steroids or thalidomide does not work in all ENL patients. Apremilast is an oral phosphodiesterase-4 inhibitor with potent immunomodulatory action. At present, apremilast is approved for chronic plaque psoriasis and psoriatic arthritis, however, not in ENL. The aim of this study was to assess the effectiveness of apremilast in chronic recalcitrant ENL. It was a case series, in which apremilast was started in 10 consecutive patients with recalcitrant ENL with 10 mg morning dose with a daily increment of 10 mg until day 6, when the recommended dose of 30 mg twice daily for adults is reached. Follow-up was done every 1 month till 6 months. Three patients showed good responses. The drug was well tolerated with few side effects. The most common adverse effect reported was headache (n = 5), followed by nausea (n = 4) and diarrhea (n = 4). Apremilast has lower cost and better safety profile compared to thalidomide and may be an option with limited effectiveness for ENL.

Background: Diabetic dyslipidemia poses a significant risk factor for cardiovascular complications in patients with diabetes mellitus. Empagliflozin and liraglutide are two commonly used medications in diabetes management, yet their comparative efficacy and safety in treating diabetic dyslipidemia remain under-explored. Aims and Objectives: This study aimed to assess the effectiveness and safety of Empagliflozin versus liraglutide in managing diabetic dyslipidemia. Materials and Methods: The study enrolled 100 participants with diabetes and dyslipidemia, divided equally into empagliflozin and liraglutide treatment groups. Baseline characteristics, including age, gender distribution, ethnicity, and duration of diabetes, were assessed and compared between the groups. Lipid profiles, encompassing total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, were evaluated at baseline and after 6 months of treatment. Safety outcomes, such as the occurrence of mild gastrointestinal symptoms, hypoglycemia, and serious adverse events, were also monitored. Results: Both treatment groups exhibited comparable baseline characteristics. Following 6 months of treatment, both empagliflozin and liraglutide demonstrated significant improvements in lipid profiles. Reductions in total cholesterol, LDL cholesterol, and triglycerides, along with increases in HDL cholesterol, were observed in both groups. Moreover, there were no significant differences in the occurrence of adverse events between the two treatment groups, indicating similar safety profiles. Conclusion: This study provides evidence supporting the effectiveness and safety of empagliflozin and liraglutide in managing diabetic dyslipidemia. These findings highlight the potential of both medications as viable therapeutic options for patients with diabetes and dyslipidemia.

Background The role of dual-modality drainage of walled-off necrosis (WON) in patients with acute pancreatitis (AP) is established. However, there are no data on the association of clinical outcomes with the timing of percutaneous catheter drainage (PCD). We investigated the impact of the timing of PCD following endoscopic drainage of WON on clinical outcomes in AP.

Purpose: In this study, the changes in optical coherence tomography (OCT) were correlated with the post-treatment visual outcome of optic neuritis, thereby determining the patients who are at risk of optic atrophy. Design: Prospective observational study. Methodology: All patients presenting to the outpatient department (OPD) with acute visual loss, pain on ocular movements and colour desaturation were subjected to comprehensive ophthalmic examination and OCT retinal nerve fibre layer (RNFL) analysis. All patients were treated with an Optic Neuritis Treatment Trial (ONTT) regimen and followed for one year. Results: Of 25 patients, 40% were 20 to 40 years of age, and females outnumbered males by 28%. The right eye had 48% unilateral affection and 12% bilateral affection; 56% had a central scotoma, and 24% had a centrocaecal scotoma. The most common aetiologies are as follows: idiopathic (84%), multiple sclerosis (MS) (12%) and Devic’s disease (4%). 60% presented with a visual acuity of 6/60–1/60 and 32% with a visual acuity of 6/18–6/36. Patients whose RNFL thickness was below 90 microns post-treatment had poorer visual outcome. Conclusion: In this study, optic neuritis was more common in females of 20 to 45 years with unilateral affection in the right eye. The most common field defect was central scotoma, and the most common cause of optic neuritis was idiopathic. It was also found that the visual acuity in optic neuritis can range from 6/18 to no PL. Of the 25 patients in the study, three patients had retrobulbar neuritis and six patients developed disc pallor during recovery after treatment.

Background: Head-and-neck cancer and its treatment can decrease the quality of life (QoL) of patients in consequence of the loss of structural and functional integrity of the oro- and nasopharyngeal region. Maxillofacial prosthetic treatment is advised when anatomical structures of the head and neck are not replaceable by living tissue, when recurrence is likely, when radiotherapy is administered, or when fragment of fractured bones are severely displaced. The aim of the study was to examine whether prosthetic rehabilitation of maxillofacial defects affects the QoL of patients using the University of Washington (UW)-QoL. Materials and Methods: This was the prospective interventional study using pre- and post-design using a convenience sampling method. The prosthesis was fabricated as per the clinical situation using heat-polymerized polymethyl methacrylate, maxillofacial silicone, or a combination of both. Results: The overall mean composite QOL score before rehabilitation was 68.05 ± 16.98 and after rehabilitation, it was 73.22 ± 11.28. Chewing and saliva (dryness of the mouth) had the lowest scores (55 ± 9.2, 62 ± 8.6, respectively) among all domains, whereas pain and anxiety had the highest scores (93 ± 3.7, 95 ± 1.5, respectively). The domains of appearance, speech, swallowing, chewing, saliva, and overall QoL showed statistically significant improvements postprosthetic rehabilitation. Conclusions: In the present study and selected population, the subjective analysis using UW-QOL showed that despite altered anatomy following resection and reconstruction, compromised physiology following chemoradiation, the oral cancer patients coped well and adapted to near-normal oral status after prosthetic rehabilitation. This was evident from their improved QOL after 1 month of prosthetic rehabilitation.

Formulating a research question and selecting an appropriate study design for answering that question are crucial initial steps in the research process. The population, intervention, control group, and outcomes measures (PICO time and setting [TS]) framework provides a practical guide in this regard, which stands for population, intervention, control, outcome, type of research question, and study design. The various study designs have their own merits and demerits, and implementing the methodology meticulously requires knowledge of all of these. Similarly, different methods of sample size calculation are warranted based on the most appropriate study design and outcome variables of interest. Sometimes, a post hoc power analysis can be performed after the sample size calculation, to check whether the study was adequately powered or not. There are multiple validated free software tools for sample size calculation, including Open-Epi, R, StatCalc, etc. The practice by most researchers of reporting significant P values is to be replaced by reporting effect sizes, as the latter is a much better estimate of the strength of association. This review provides a comprehensive, ready reckoner for busy family physicians to quickly identify the appropriate study design for answering any applied research questions in their minds and estimating the sample size required for the same.

Objective: Pharmacogenomics plays an important role in drug metabolism. A stable anticoagulation is important for primary and secondary prevention of cardioembolic stroke and cerebral venous sinus thrombosis (CVST). We report the role of cytochrome P450 (CYP2C9*2/*3) and vitamin K epoxide reductase subunit 1 (VKORC1) genotypes and acquired causes in maintaining stability of anticoagulation following acenocoumarin in cardioembolic stroke and CVST. Methods: The study comprised 157 individuals with cardioembolic stroke and CVST who were on acenocoumarin. Their comorbidities, comedication, and dietary habits were noted. Prothrombin time and international normalized ratio (INR) were measured during follow-up, and the coagulation status was categorized as stable (>50% occasions in therapeutic range) and unstable (>50% below and above therapeutic range). Genotyping of VKORC1, CYP2C9*2, and CYP2C9*3 was done by polymerase chain reaction-restriction fragment length polymorphism. Bleeding and embolic complications were noted. The predictors of unstable INR were evaluated using multivariate analysis. Results: INR was stable in 47.8% and unstable in 52.2% of patients. Patients with mutant genotypes required low dose of acenocoumarin. The predictors of unstable INR were metallic valve (odds ratio [OR] 4.07, 95% confidence interval [CI] 1.23–13.49, P = 0.02), use of digoxin (OR 0.031, 95% CI 0.13–0.74, P = 0.09), proton pump inhibitor (OR 0.23, 95% CI 0.06–0.91, P = 0.037), sodium valproate (OR 0.22, 95% CI 0.05–0.85, P = 0.029), and CYP2C9*2 genotype (OR 5.57, 95% CI 1.19–26.06, P = 0.02). Conclusions: Variant genotypes of VKORC1, CYP2C9*2, and CYP2C9*3 required lower dose of acenocoumarin, and CYP2C9*2 was associated with unstable INR. Comedication is a modifiable risk factor that needs attention.

Abstract Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP)

Introduction: The mobile phone has evolved into an indispensable accessory carried by everyone. With its increasing usage, there is a parallel rise in mobile phone addictions. Nomophobia, short for no mobile phone phobia, is characterized as a fear specific to the absence of mobile phones. Objectives: (1) To assess the prevalence of nomophobia among adolescents and adults residing in semi-urban Chennai. (2) To understand the patterns of mobile phone usage and explore the health-related consequences of nomophobia. Methods: This cross-sectional study was conducted among adolescents and adults (15–50 years) in semi-urban Chennai from July to September 2022. The sample size was 220, and the study utilized the Test of Mobile Phone Dependence Brief as an assessment tool. Participants scoring >30 were identified as nomophobic, indicating mobile phone dependence. Results: Among the 220 study participants, there was an almost equal distribution between males and females, with a majority falling within the 21–25 age group. Approximately 26.1% belonged to the upper middle class and 89.1% were married. The prevalence of nomophobia was notably high at 68.6% (151 out of 220). A significant association was found between social class and mobile phone addiction, with the middle class exhibiting higher levels of addiction. Conclusion: The study highlights that a substantial majority of adults exhibit mobile phone addiction, almost two-thirds of the participants. There is a pressing need for health awareness programmes targeting adults to educate them about the adverse effects of mobile phone addiction. Additionally, reinforcing strategies for effective and time-restricted mobile phone usage is essential.

Background: Rivaroxaban is a widely used anticoagulant, but its impact on renal function, particularly at varying plasma concentrations, remains a critical area of investigation. This study examines the relationship between rivaroxaban concentration and renal impairment in elderly patients. Aims and Objectives: The aim of the study was to investigate the relationship between rivaroxaban plasma concentrations and the incidence of renal impairment in elderly patients. Materials and Methods: A retrospective observational study was conducted on 100 elderly patients prescribed rivaroxaban for atrial fibrillation or venous thromboembolism prevention. Patients were categorized based on their rivaroxaban plasma concentrations into three groups: Low (200 ng/mL). Renal impairment was characterized as having an estimated glomerular filtration rate

Background: Laparoscopic cholecystectomy (LC) is a common surgical procedure, the difficulty of which can vary significantly based on pre-operative factors. Identifying these factors can improve surgical planning, patient counseling, and outcomes. Aims and Objectives: To develop a predictive scoring system for assessing the difficulty of LC preoperatively based on individual patient parameters. To employ operative time and intra-operative events to validate the accuracy of the scoring system in reflecting the technical difficulty of LCs. Materials and Methods: This prospective study enrolled 104 patients scheduled for LC, assessing them with a pre-operative scoring system to predict operative difficulty. Patients were categorized into groups indicating expected levels of difficulty: Easy, difficult, and very difficult. Demographic information, clinical characteristics, and operative outcomes were analyzed to validate the scoring system’s predictive accuracy. Results: Of the patients assessed, 68.3% were predicted to have an easy LC (scores 0–5), whereas 31.7% were anticipated to face a difficult LC (scores 6–10). Key predictors of operative difficulty included age, sex, history of previous hospitalization for acute cholecystitis, body mass index (BMI), the presence of an abdominal scar, palpable gallbladder (GB), thickened GB wall, pericholecystic collection, and impacted stone. The study found that operative outcomes closely aligned with pre-operative predictions, confirming the scoring system’s moderate predictive accuracy (area under the curve of 0.798). Conclusion: The pre-operative scoring system demonstrated moderate effectiveness in predicting LC difficulty, with significant predictors including a history of hospitalization, BMI, palpable GB, and thickened GB wall. These findings can aid in pre-operative planning and optimizing patient outcomes.

Background: Kikuchi–Fujimoto disease (KFD) presents with painful cervical lymphadenopathy, persistent high-grade fever, leukopenia, and deranged liver function tests. KFD usually has a benign course and is self-limiting but may sometimes cause fatal complications such as secondary histiocytic lymphohistiocytosis (HLH). Case report: We report a 13-year-old boy, a known case of thalassemia major on regular blood transfusions with post-splenectomy status and on chelators. He presented with persistent high-grade fever and cervical lymphadenopathy. The initial diagnosis of KFD was confirmed by lymph node biopsy. Given persistent fever, bicytopenia, and high ferritin levels, HLH was considered. Lymph node biopsy confirmed the diagnosis of KFD with secondary HLH. The child had neurological manifestations in the form of convulsions. He recovered with steroids and supportive care. Conclusions: This case report emphasizes that although KFD is benign, complications, including secondary HLH and neurological complications, may occur that need to be recognized and managed.

Cornelia de Lange Syndrome (CdLS) is a rare, dominantly inherited multisystem developmental disorder characterized by highly variable manifestations of growth and developmental delays, upper limb involvement, hypertrichosis, cardiac, gastrointestinal, craniofacial, and other systemic features. Pathogenic variants in genes encoding cohesin complex structural subunits and regulatory proteins (NIPBL, SMC1A, SMC3, HDAC8, and RAD21) are the major pathogenic contributors to CdLS. Heterozygous or hemizygous variants in the genes encoding these five proteins have been found to be contributory to CdLS, with variants in NIPBL accounting for the majority (>60%) of cases, and the only gene identified to date that results in the severe or classic form of CdLS when mutated. Pathogenic variants in cohesin genes other than NIPBL tend to result in a less severe phenotype. Causative variants in additional genes, such as ANKRD11, EP300, AFF4, TAF1, and BRD4, can cause a CdLS-like phenotype. The common role that these genes, and others, play as critical regulators of developmental transcriptional control has led to the conditions they cause being referred to as disorders of transcriptional regulation (or DTRs). Here, we report the results of a comprehensive molecular analysis in a cohort of 716 probands with typical and atypical CdLS in order to delineate the genetic contribution of causative variants in cohesin complex genes as well as novel candidate genes, genotype-phenotype correlations, and the utility of genome sequencing in understanding the mutational landscape in this population.