Outcomes of Open Ventral Wall Hernia Repair with Abdominoplasty- Case Series
Background Ventral wall hernias are often associated with abdominal wall laxity and redundant skin. Combined hernia repair with abdominoplasty offers single-stage anatomical and aesthetic correction. Methods This retrospective case series included 25 patients who underwent concomitant open mesh hernioplasty with abdominoplasty. Demographic, operative, postoperative complication, umbilical viability, and 30-day recurrence data were analyzed. Results There were 21 females (84.0%) and 4 males (16.0%), with a mean age of 44.5 years. Diabetes mellitus was present in 17 patients (68.0%) and hypertension in 16 patients (64.0%). Onlay mesh repair was performed in 16 patients (64.0%) and retrorectus repair in 9 patients (36.0%). Superficial SSI occurred in 5 patients (20.0%) and deep SSI in 2 patients (8.0%). Umbilical viability was preserved in 19 patients (76.0%), mild epidermolysis occurred in 5 patients (20.0%), and deep ischemia/necrosis in 1 patient (4.0%). No recurrence was observed at 30 days. Conclusion Concomitant open ventral wall hernia repair with abdominoplasty is a feasible single-stage procedure with acceptable early wound outcomes, preserved umbilical viability, and no short-term recurrence.
Keywords: Ventral hernia; Abdominoplasty; Open mesh hernioplasty; Abdominal wall reconstruction; Surgical-site infection; Umbilical viability; Hernia recurrence; Case series.
Study of Electrolyte Abnormalities and Their Relationship with Clinical Outcomes in Chronic Kidney Disease Patients
Background Electrolyte disturbances are common in chronic kidney disease (CKD) and may contribute to adverse clinical outcomes. This study assessed the pattern of electrolyte abnormalities and their relationship with outcomes in CKD patients. Materials and Methods This prospective observational study included 150 adult CKD patients. Clinical characteristics, CKD stage, serum electrolytes, and relevant outcomes were assessed and analyzed. Results The mean age was 56.8 ± 13.4 years, and 60.7% were males. Overall, 74.7% had at least one electrolyte abnormality. Low bicarbonate (44.7%), hyperphosphatemia (40.7%), hypocalcemia (38.7%), hyponatremia (32.7%), and hyperkalemia (28.0%) were most frequent. Hyperkalemia increased from 9.8% in stage 3 to 44.4% in stage 5 CKD (p<0.001). Serum potassium (r=−0.39) and phosphate (r=−0.45) correlated negatively with eGFR, while bicarbonate correlated positively (r=0.42; all p<0.001). Electrolyte abnormalities, particularly hyperkalemia, were significantly associated with adverse clinical outcomes. Conclusion Electrolyte abnormalities were frequent and increased with advancing CKD. Regular monitoring and timely correction may help identify high-risk patients and improve clinical management.
Chronic kidney disease; electrolyte abnormalities; hyperkalemia; eGFR; clinical outcomes.
Study of Right Ventricular Dysfunction in Patients with Chronic Obstructive Pulmonary Disease Using Echocardiography
Background Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder associated with significant cardiovascular complications, particularly right ventricular (RV) dysfunction due to chronic hypoxia, pulmonary vascular remodeling, and increased pulmonary vascular resistance. Early detection of RV impairment is essential for risk stratification and management. Echocardiography provides a non-invasive approach for evaluating right ventricular structure and function in COPD patients. Aim The present study aimed to assess right ventricular dysfunction among patients with COPD using echocardiographic parameters and to evaluate its association with disease severity and serum CA125 levels. Materials and Methods This prospective observational study included 70 patients with COPD. All participants underwent detailed clinical assessment, spirometric evaluation, serum CA125 estimation, and transthoracic echocardiography. Right ventricular function was assessed using parameters including tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tissue Doppler-derived systolic velocity (S′), right ventricular myocardial performance index (MPI), and pulmonary artery systolic pressure (PASP). Results The mean age of participants was 61.8 ± 8.6 years, with male predominance (82.9%). Right ventricular dysfunction was identified in 24 (34.3%) patients. Patients with RV dysfunction demonstrated significantly lower TAPSE (15.2 ± 2.1 mm vs 19.8 ± 2.9 mm; p<0.001), reduced RVFAC (29.8 ± 5.6% vs 39.8 ± 6.2%; p<0.001), and higher PASP (55.6 ± 10.8 mmHg vs 31.6 ± 7.5 mmHg; p<0.001) compared with patients having preserved RV function. RV dysfunction was significantly associated with advanced COPD severity. Serum CA125 levels were significantly elevated among patients with RV dysfunction (48.6 ± 18.9 vs 24.8 ± 10.6 U/mL; p<0.001). Conclusion Right ventricular dysfunction is a common cardiovascular manifestation in COPD and is associated with disease severity, elevated pulmonary artery pressure, and increased CA125 levels. Echocardiographic assessment provides a valuable, non-invasive method for early detection of RV involvement and may improve prognostic evaluation and clinical management of COPD patients.
Chronic obstructive pulmonary disease; Right ventricular dysfunction; Echocardiography; TAPSE; Pulmonary hypertension; CA125; Right heart failure.
Correlation of Serum Eosinophil Count with Severity and Treatment Response in COPD
Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous respiratory disorder characterized by persistent airflow limitation, chronic inflammation, and variable response to therapy. Blood eosinophil count has emerged as an important biomarker for identifying eosinophilic COPD phenotype and predicting response to corticosteroid-based treatment. The present study was conducted to evaluate the correlation between serum eosinophil count, COPD severity, and treatment response among patients with COPD. Methods This prospective observational study included 110 patients diagnosed with COPD. All patients underwent detailed clinical evaluation, spirometry, and peripheral blood eosinophil estimation. COPD severity was assessed according to GOLD criteria, along with symptom assessment using standardized clinical parameters. Patients were followed after initiation of standard COPD therapy, and treatment response was evaluated based on changes in lung function, symptom scores, and exacerbation frequency. The association between serum eosinophil count and clinical outcomes was analyzed using appropriate statistical methods. Results The mean age of study participants was 61.8 ± 8.7 years, with male predominance (89.1%). The mean serum eosinophil count was 238.6 ± 156.4 cells/µL, and 31.8% of patients had eosinophil levels >300 cells/µL. Serum eosinophil count showed a significant correlation with FEV₁ (r=0.34, p<0.001) and symptom severity assessed by CAT score (r=-0.29, p=0.002). Patients with eosinophilic COPD demonstrated higher FEV₁ values and fewer exacerbations compared with non-eosinophilic patients. Following treatment, significant improvement was observed in FEV₁, CAT score, mMRC score, and exacerbation frequency, with greater clinical improvement among patients with higher eosinophil levels. Conclusion Serum eosinophil count serves as a valuable biomarker for COPD phenotyping and prediction of treatment response. Incorporation of eosinophil assessment into routine COPD evaluation may facilitate personalized therapy selection and improve clinical outcomes.
Chronic obstructive pulmonary disease; Blood eosinophil count; Eosinophilic phenotype; COPD severity; Treatment response; Inhaled corticosteroids; Biomarker.
Assessment of Subclinical Left Ventricular Dysfunction in Type 2 Diabetes Mellitus Using Echocardiographic Strain Imaging
Background Type 2 diabetes mellitus (T2DM) is associated with a high burden of cardiovascular complications, including diabetic cardiomyopathy, which may develop before the onset of clinically apparent cardiac dysfunction. Conventional echocardiographic parameters such as left ventricular ejection fraction (LVEF) may fail to identify early myocardial abnormalities. Echocardiographic strain imaging, particularly global longitudinal strain (GLS), provides a sensitive method for detecting subclinical left ventricular (LV) dysfunction. Aim The present study was conducted to assess subclinical LV dysfunction in patients with T2DM using echocardiographic strain imaging and to evaluate its association with clinical and metabolic parameters. Methods This prospective observational study included 80 patients with type 2 diabetes mellitus who underwent clinical evaluation, biochemical assessment, conventional echocardiography, and two-dimensional speckle-tracking echocardiography (2D-STE). LV systolic function was assessed using LVEF, while myocardial deformation was evaluated using GLS. Associations between strain parameters and clinical variables, including duration of diabetes, glycaemic control, and cardiovascular risk factors, were analyzed. Results The mean age of study participants was 56.8 ± 9.4 years, with males comprising 62.5% of cases. The mean duration of diabetes was 8.2 ± 4.6 years. Although all patients had preserved LVEF (61.4 ± 4.8%), impaired GLS suggestive of subclinical LV dysfunction was observed in 40% of patients. Patients with impaired GLS had significantly longer duration of diabetes (10.8 ± 4.9 vs 6.5 ± 3.8 years, p<0.001) and higher HbA1c levels (8.5 ± 1.2 vs 7.3 ± 1.0%, p<0.001). GLS showed significant negative correlation with duration of diabetes and HbA1c levels. Conclusion Echocardiographic strain imaging enables detection of early myocardial dysfunction in patients with T2DM despite preserved LVEF. Global longitudinal strain may serve as a useful marker for early identification of diabetic cardiomyopathy and cardiovascular risk stratification.
Type 2 diabetes mellitus; diabetic cardiomyopathy; global longitudinal strain; speckle-tracking echocardiography; subclinical left ventricular dysfunction; echocardiography.
Association of Sarcopenia with Severity and Prognosis in Patients with Chronic Liver Disease
Background Chronic liver disease (CLD) is associated with progressive hepatic dysfunction and multiple complications that contribute to increased morbidity and mortality. Sarcopenia, characterized by loss of skeletal muscle mass and function, has emerged as an important extrahepatic manifestation of cirrhosis and a potential predictor of poor outcomes. This study was conducted to evaluate the association of sarcopenia with severity and prognosis among patients with chronic liver disease. Methods This prospective observational study included 90 patients diagnosed with chronic liver disease. All patients underwent clinical evaluation, laboratory investigations, assessment of liver disease severity using Child–Turcotte–Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores, and evaluation of skeletal muscle mass using computed tomography (CT)-based skeletal muscle index (SMI) at the third lumbar vertebral level. Patients were categorized into sarcopenic and non-sarcopenic groups, and their association with hepatic complications, hospitalization, and short-term outcomes was analyzed. Results Sarcopenia was identified in 35 patients (38.9%). Sarcopenic patients had significantly higher CTP scores (9.1 ± 1.8 vs 7.3 ± 1.6; p<0.001) and MELD scores (17.8 ± 5.4 vs 12.6 ± 4.3; p<0.001) compared with non-sarcopenic patients. Hepatic encephalopathy (45.7% vs 18.2%; p=0.008) and ascites (77.1% vs 45.5%; p=0.003) were significantly more frequent among sarcopenic individuals. Hospitalization rates were also higher in the sarcopenic group (65.7% vs 40.0%; p=0.020). Mortality showed a higher trend among sarcopenic patients (17.1% vs 5.5%), although statistical significance was not reached. Conclusion Sarcopenia is frequently observed in patients with chronic liver disease and is significantly associated with advanced disease severity, hepatic complications, and increased hospitalization risk. Assessment of skeletal muscle status may provide additional prognostic information and should be considered as an important component of comprehensive CLD management.
Sarcopenia; Chronic liver disease; Liver cirrhosis; Skeletal muscle index; Child–Turcotte–Pugh score; MELD score; Prognosis
Correlation of Serum Uric Acid with Severity and Progression of Chronic Kidney Disease
ABSTRACT Background: Chronic kidney disease (CKD) is a progressive disorder associated with increasing morbidity, mortality, and risk of end-stage kidney disease. Serum uric acid (SUA) has emerged as a potential biomarker in CKD due to its involvement in oxidative stress, endothelial dysfunction, inflammation, and renal microvascular injury. This study was conducted to evaluate the correlation between serum uric acid levels and severity and progression of chronic kidney disease. Methods: A hospital-based observational study was conducted among 100 adult patients diagnosed with chronic kidney disease. All participants underwent clinical evaluation and laboratory investigations, including serum uric acid, serum creatinine, blood urea nitrogen, eGFR, and urine protein assessment. CKD severity was categorized according to eGFR-based staging. The association between serum uric acid levels and renal function parameters was analyzed using appropriate statistical methods. Results: The majority of patients belonged to the 41–60 years age group (46.0%), with male predominance (64.0%). Hypertension was the most common comorbidity (72.0%), followed by diabetes mellitus (48.0%). Hyperuricemia was observed in 62.0% of patients, with a mean serum uric acid level of 7.82 ± 1.86 mg/dL. Serum uric acid showed a significant positive correlation with serum creatinine (r=0.624, p<0.001) and blood urea nitrogen (r=0.572, p<0.001) and a significant negative correlation with eGFR (r=−0.681, p<0.001). Mean uric acid levels increased progressively with advancing CKD stages (p<0.001). Logistic regression demonstrated that serum uric acid was an independent predictor of advanced CKD (Stage ≥4) (AOR 1.82, 95% CI 1.32–2.51, p<0.001). Conclusion: Elevated serum uric acid levels are significantly associated with worsening renal function and advanced CKD severity. Serum uric acid may serve as a simple and useful prognostic marker for identifying patients at higher risk of CKD progression.
Chronic kidney disease; Serum uric acid; Hyperuricemia; eGFR; CKD progression; Renal function; Prognostic marker.
Patel Nehal Dasharathlal Nehal Dasharathlal
Evaluation of inflammatory biomarkers as predictors of disease severity in patients with dengue fever
Background Dengue fever is a major mosquito-borne viral infection with a wide clinical spectrum ranging from uncomplicated febrile illness to severe dengue with plasma leakage, shock, organ dysfunction, and mortality. Early prediction of disease severity remains challenging due to overlapping clinical features during the initial phase. Inflammatory biomarkers may provide valuable insights into immune activation and help identify patients at risk of severe disease. Objective To evaluate the association of inflammatory biomarkers with disease severity and assess their predictive role in patients with dengue fever. Methods A prospective observational study was conducted among 110 patients with laboratory-confirmed dengue infection. Clinical findings, hematological parameters, biochemical investigations, and inflammatory biomarkers including C-reactive protein (CRP), ferritin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-10 (IL-10) were evaluated. Patients were classified according to disease severity, and biomarker levels were compared between severe and non-severe dengue groups. Receiver operating characteristic (ROC) analysis was performed to determine predictive accuracy. Results Among 110 patients, 38 (34.5%) developed severe dengue, while 72 (65.5%) had non-severe disease. Severe dengue patients demonstrated significantly higher levels of inflammatory biomarkers compared with non-severe cases. Ferritin levels were significantly elevated in severe dengue patients (986.4 ± 420.6 ng/mL vs 462.8 ± 238.5 ng/mL; p<0.001), followed by IL-6 (112.5 ± 48.7 pg/mL vs 38.4 ± 18.6 pg/mL; p<0.001) and CRP (28.6 ± 12.4 mg/L vs 14.2 ± 8.6 mg/L; p<0.001). ROC analysis showed ferritin had the highest predictive performance (AUC 0.842), followed by IL-6 (AUC 0.816). Conclusion Inflammatory biomarkers, particularly ferritin and IL-6, were significantly associated with severe dengue and demonstrated potential predictive value. Incorporation of these biomarkers with routine clinical parameters may improve early risk stratification and management of patients with dengue fever.
Dengue fever; inflammatory biomarkers; ferritin; C-reactive protein; interleukin-6; disease severity; predictive markers.
STUDY OF VITAMIN D STATUS IN HYPERTENSION
Background: Hypertension is a major cardiovascular risk factor associated with increased morbidity and mortality. Vitamin D has important extra-skeletal roles, including regulation of vascular function and blood pressure homeostasis. This study evaluated the association between vitamin D status and systemic hypertension. Materials and Methods: A hospital-based case-control study was conducted, over 6 months. The study included 100 participants comprising 50 newly diagnosed hypertensive patients (cases) and 50 normotensive controls. Serum vitamin D levels were measured and compared between both groups. Results: The mean vitamin D level was significantly lower among hypertensive patients compared with controls (20.84 ± 6.48 ng/mL vs 40.14 ± 15.27 ng/mL; p=0.001). A significant association was observed between reduced vitamin D levels and systemic hypertension. Conclusion: Hypertensive patients demonstrated significantly lower vitamin D levels compared with normotensive individuals. Vitamin D deficiency may be associated with hypertension and may serve as an additional cardiovascular risk marker.
Vitamin D, Hypertension, 25-hydroxyvitamin D, Blood pressure, Case-control study
ROLE OF THYROID AUTOANTIBODIES IN PREDICTING PROGRESSION OF SUBCLINICAL HYPOTHYROIDISM: A PROSPECTIVE COHORT STUDY
Background: Subclinical hypothyroidism (SCH) is a common thyroid disorder characterized by elevated serum thyroid-stimulating hormone (TSH) levels with normal free thyroxine (FT4) concentrations. Although many patients remain stable, a proportion progress to overt hypothyroidism. Identification of reliable predictors of progression is essential for appropriate monitoring and management. Thyroid autoantibodies, particularly thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), may serve as important markers of autoimmune thyroid dysfunction and disease progression. Objectives: To evaluate the role of thyroid autoantibodies in predicting progression of subclinical hypothyroidism to overt hypothyroidism and to identify clinical and biochemical factors associated with disease progression. Methods: A prospective cohort study was conducted among patients diagnosed with subclinical hypothyroidism. Baseline clinical characteristics, serum TSH, FT4, TPOAb, and TgAb levels were assessed at enrollment. Patients were followed prospectively, and progression to overt hypothyroidism was defined by elevated TSH levels with reduced FT4 concentrations during follow-up. The association between thyroid autoantibody status and progression was analyzed using appropriate statistical methods. Results: Among the enrolled patients, a proportion progressed to overt hypothyroidism during follow-up. Progression was significantly higher among individuals with positive thyroid autoantibodies, particularly TPOAb positivity. Patients who progressed had higher baseline TSH levels and lower FT4 concentrations compared with those who remained stable. Multivariate analysis demonstrated that TPOAb positivity and higher baseline TSH levels were independent predictors of progression. Conclusion: Thyroid autoantibody positivity, especially TPOAb, is an important predictor of progression from subclinical hypothyroidism to overt hypothyroidism. Assessment of thyroid autoantibodies along with baseline thyroid function tests may help identify high-risk patients and guide individualized follow-up and management strategies.
Subclinical hypothyroidism; Thyroid autoantibodies; Thyroid peroxidase antibody; Thyroglobulin antibody; Overt hypothyroidism; Disease progression; Prospective cohort study
EFFECT OF INTRAVENOUS MAGNESIUM SULFATE ON HEMODYNAMIC RESPONSES DURING LAPAROSCOPIC CHOLECYSTECTOMY
Background: During laparoscopic cholecystectomy, laryngoscopy, endotracheal intubation, and carbon dioxide pneumoperitoneum are linked to considerable sympathetic activation that causes hemodynamic oscillations. Magnesium sulfate may help reduce these reactions and enhance perioperative stability because of its sympatholytic and calcium antagonistic qualities. Aim & Objectives: To assess how intravenous magnesium sulfate affects hemodynamic reactions in patients having laparoscopic cholecystectomy under general anesthesia during endotracheal intubation and pneumoperitoneum. Methodology: One hundred patients undergoing elective laparoscopic cholecystectomy under general anesthesia participated in this hospital-based prospective interventional comparative study. Patients were divided into two groups of fifty at random. Prior to induction, Group A was given 30 mg/kg of magnesium sulfate intravenously, while Group B was given regular saline. Perioperative hemodynamic parameters were measured, including heart rate, mean arterial pressure, systolic and diastolic blood pressure, and SpO₂. Complications, analgesic need, and postoperative pain levels were all evaluated. SPSS version 30 was used for the statistical analysis, and p<0.05 was regarded as statistically significant. Results: Magnesium sulfate-treated patients showed considerably lower mean arterial pressure and perioperative heart rate than the control group (p<0.001). Group A had significantly lower postoperative pain levels and a lower need for rescue analgesics. In contrast to none in Group B, 52% of patients in Group A had minimal pain levels (NRS 0–2). The magnesium sulfate group experienced fewer perioperative problems (p=0.03). Conclusion: During laparoscopic cholecystectomy, intravenous magnesium sulfate improved perioperative stability with an acceptable safety profile, decreased the need for postoperative analgesics, and successfully suppressed hemodynamic responses during intubation and pneumoperitoneum.
Magnesium sulfate, hemodynamic response, pneumoperitoneum, endotracheal intubation, laparoscopic cholecystectomy, general anaesthesia.
Association of Time in Range Parameters Using Continuous Glucose Monitoring with Microvascular Complications in Patients with Type 2 Diabetes Mellitus
Background: Type 2 diabetes mellitus (T2DM) is associated with progressive microvascular complications, including diabetic retinopathy, nephropathy, and neuropathy. Although glycated hemoglobin (HbA1c) remains the standard marker of glycemic control, it does not reflect daily glucose fluctuations or glycemic variability. Continuous glucose monitoring (CGM)-derived Time in Range (TIR) provides a comprehensive assessment of glucose patterns and may serve as an important marker associated with diabetes-related complications. This study aimed to evaluate the association between CGM-derived TIR parameters and microvascular complications in patients with T2DM. Methods: This observational study included patients with T2DM who underwent continuous glucose monitoring. Demographic characteristics, clinical parameters, HbA1c levels, and CGM-derived metrics, including TIR, Time Above Range (TAR), Time Below Range (TBR), and glucose variability, were assessed. Microvascular complications were evaluated through appropriate clinical and laboratory assessments. The association between TIR parameters and microvascular complications was analyzed using appropriate statistical methods. Results: A total of 200 patients with T2DM were included in the analysis. Microvascular complications were present in 59% of participants. Patients with microvascular complications had significantly lower TIR compared with those without complications (43.2 ± 15.6% vs 70.9 ± 13.8%, p<0.001). They also demonstrated higher HbA1c levels, increased TAR, and greater glucose variability. Lower TIR was significantly associated with diabetic retinopathy, nephropathy, and neuropathy. Multivariate analysis showed that reduced TIR remained independently associated with microvascular complications after adjustment for clinical factors and HbA1c. Conclusion: CGM-derived Time in Range is significantly associated with microvascular complications in patients with T2DM and provides additional information beyond HbA1c for assessing glycemic control. Incorporation of TIR into routine diabetes management may improve risk stratification and support individualized strategies for prevention of diabetes-related complications.
Type 2 diabetes mellitus; Continuous glucose monitoring; Time in Range; Glycemic variability; HbA1c; Diabetic retinopathy; Diabetic nephropathy; Diabetic neuropathy.
TO STUDY OBSESSIVE COMPULSIVE SPECTRUM DISORDER AMONG THE SCHIZOPHRENIA PATIENTS IN TERTIARY CARE HOSPITAL, MUZAFFARNAGAR
Background: Obsessive–compulsive symptoms (OCS) and obsessive–compulsive disorder (OCD) are increasingly recognized as important comorbidities in schizophrenia and may adversely influence illness severity, treatment response, and functional outcome. Objective: To determine the prevalence of OCS and OCD among patients with schizophrenia and to evaluate their association with illness duration, schizophrenia severity, and the correlation between obsessive–compulsive symptom severity and psychotic psychopathology. Methods: This hospital-based observational study included 90 patients with schizophrenia attending the Psychiatry Outpatient and Inpatient Departments of Muzaffarnagar Medical College and Hospital. Socio-demographic and clinical data were recorded using a structured proforma. Schizophrenia severity was assessed using the Positive and Negative Syndrome Scale (PANSS), while obsessive–compulsive symptom severity was evaluated using the Yale–Brown Obsessive Compulsive Scale (Y-BOCS). Statistical analysis was performed using SPSS version 22.0, and a p-value <0.05 was considered statistically significant. Results: OCS were present in 43.3% of patients, while 13.3% fulfilled the diagnostic criteria for comorbid OCD. Patients with OCS had an earlier age at onset (22.6 ± 4.8 vs. 25.3 ± 5.4 years; p=0.015), longer duration of illness (10.9 ± 6.1 vs. 8.1 ± 5.2 years; p=0.024), and significantly higher PANSS total scores (115.16 ± 12.26 vs. 93.57 ± 9.48; p<0.001). A strong positive correlation was observed between Y-BOCS and PANSS total scores (r=0.818, p<0.001). Conclusion: Obsessive–compulsive symptoms are common among patients with schizophrenia and are associated with greater illness severity and longer disease duration. Routine screening for OCS may facilitate early identification and improve individualized management strategies. Keywords: Schizophrenia; Obsessive–compulsive symptoms; Obsessive–compulsive disorder; PANSS; Yale–Brown Obsessive Compulsive Scale; Y-BOCS; Psychopathology.
Schizophrenia; Obsessive–compulsive symptoms; Obsessive–compulsive disorder; PANSS; Yale–Brown Obsessive Compulsive Scale; Y-BOCS; Psychopathology.
Correlation of Thyroid Hormone Levels with Insulin Resistance in Newly Diagnosed Hypothyroidism
Background: Hypothyroidism is associated with several metabolic abnormalities, including insulin resistance (IR), which increases the risk of type 2 diabetes mellitus and cardiovascular disease. This study evaluated the correlation between thyroid hormone levels and insulin resistance in patients with newly diagnosed hypothyroidism. Methods: A hospital-based cross-sectional study was conducted among 90 newly diagnosed hypothyroid patients. Demographic and clinical data were recorded, and fasting blood samples were analysed for thyroid-stimulating hormone (TSH), free triiodothyronine (free T3), free thyroxine (free T4), fasting blood glucose, and fasting serum insulin. Insulin resistance was assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Correlation analysis and multiple linear regression were performed to identify predictors of insulin resistance. Results: The mean age of the participants was 41.8 ± 12.6 years, and 68.9% were females. The mean HOMA-IR was 3.98 ± 1.72, with 73.3% of patients demonstrating insulin resistance. Serum TSH showed a significant positive correlation with HOMA-IR (r = 0.621, p <0.001), whereas free T3 (r = −0.441, p <0.001) and free T4 (r = −0.514, p <0.001) showed significant negative correlations. Multiple linear regression identified TSH and BMI as independent positive predictors, while free T3 and free T4 were independent negative predictors of HOMA-IR. Conclusion: Insulin resistance is highly prevalent in newly diagnosed hypothyroidism and is significantly associated with the severity of thyroid dysfunction. Early assessment of insulin resistance may help identify patients at increased metabolic risk and facilitate timely therapeutic intervention.
Hypothyroidism; Insulin resistance; HOMA-IR; Thyroid-stimulating hormone; Free triiodothyronine; Free thyroxine; Thyroid hormone
COMPARATIVE STUDY OF COAGULATION PROFILE AND HAEMATOLOGICAL PARAMETERS IN PREGNANCY INDUCED HYPERTENSION (PIH)
Background: Pregnancy-induced hypertension (PIH) is a major cause of maternal and perinatal morbidity and mortality. Endothelial dysfunction and activation of the coagulation cascade in PIH may result in significant hematological and coagulation abnormalities, making their assessment important for early diagnosis and management. Materials and Methods: This hospital-based cross-sectional observational study was conducted on 110 pregnant women, including 55 women with PIH and 55 normotensive controls. Platelet count, bleeding time (BT), clotting time (CT), prothrombin time (PT), and activated partial thromboplastin time (aPTT) were evaluated using standard laboratory methods. Data were analyzed using appropriate statistical tests, with p < 0.05 considered statistically significant. Results: Women with PIH had significantly lower platelet counts (1.00 ± 0.50 vs. 3.09 ± 0.61 lakh/cu.mm; p < 0.0001). PT and aPTT also differed significantly between the two groups (p < 0.0001). Although BT and CT were altered in the PIH group, these differences were not statistically significant (p > 0.05). Pre-eclampsia was the most common clinical diagnosis (52.73%) among women with PIH. Conclusion: PIH is associated with significant hematological and coagulation abnormalities, particularly thrombocytopenia and altered coagulation parameters. Routine evaluation of platelet count and coagulation profile may facilitate early diagnosis, risk stratification, and timely management, thereby improving maternal and fetal outcomes.
Pregnancy-induced hypertension, pre-eclampsia, coagulation profile, platelet count, prothrombin time, activated partial thromboplastin time, thrombocytopenia
Association Between Vitamin D Status and Glycaemic Control in Patients with Type 2 Diabetes Mellitus
Background: Vitamin D deficiency has been increasingly recognized as a potential contributor to impaired glucose metabolism and poor glycaemic control in patients with type 2 diabetes mellitus (T2DM). However, the relationship between vitamin D status and glycaemic control remains inconsistent across different populations. Objectives: To evaluate the association between serum vitamin D levels and glycaemic control in patients with T2DM and to determine whether vitamin D deficiency is associated with adverse metabolic parameters. Methods: This hospital-based cross-sectional observational study included 150 adults with T2DM. Demographic, clinical, and biochemical data were recorded. Serum 25-hydroxyvitamin D [25(OH)D], fasting blood glucose (FBS), postprandial blood glucose (PPBS), glycated haemoglobin (HbA1c), and lipid profile were measured. Patients were categorized into vitamin D deficient (<20 ng/mL) and sufficient (≥20 ng/mL) groups. Continuous variables were compared using the independent samples t-test or Mann–Whitney U test, while categorical variables were analysed using the Chi-square test. Pearson correlation and multivariable logistic regression were performed to evaluate the association between vitamin D status and glycaemic control. Results: Vitamin D deficiency was observed in 62.7% of participants. Patients with vitamin D deficiency had significantly higher HbA1c (9.02 ± 1.48% vs. 7.74 ± 1.19%; p<0.001), FBS (182.6 ± 46.3 vs. 145.2 ± 39.5 mg/dL; p<0.001), and PPBS (262.7 ± 63.4 vs. 214.8 ± 54.1 mg/dL; p<0.001) than those with sufficient vitamin D levels. Vitamin D levels demonstrated a significant inverse correlation with HbA1c (r = −0.48, p<0.001). After adjustment for confounding variables, vitamin D deficiency remained an independent predictor of poor glycaemic control (adjusted OR 3.64; 95% CI: 1.74–7.63; p<0.001). Conclusion: Vitamin D deficiency was highly prevalent among patients with T2DM and was significantly associated with poorer glycaemic control and an adverse metabolic profile. Routine assessment of vitamin D status may aid in identifying patients at risk of poor metabolic control. Further prospective studies are warranted to determine whether correction of vitamin D deficiency improves long-term glycaemic outcomes.
Type 2 diabetes mellitus; Vitamin D deficiency; Glycaemic control; HbA1c; Hyperglycaemia; 25-hydroxyvitamin D; Insulin resistance.
Role of NT-proBNP in Predicting Short-Term Mortality and Rehospitalisation in Heart Failure
Background Heart failure (HF) is a major cause of morbidity, mortality, and recurrent hospitalization worldwide. Early identification of high-risk patients is essential for optimizing management and improving clinical outcomes. N-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as an important biomarker reflecting myocardial wall stress and may provide valuable prognostic information in patients with HF. Methods This prospective observational study included 110 consecutive patients admitted with heart failure. Clinical characteristics, laboratory investigations, including admission NT-proBNP levels, and echocardiographic parameters were recorded. Patients were followed for 90 days to assess the occurrence of all-cause mortality and rehospitalization due to worsening heart failure. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed to evaluate the prognostic value of NT-proBNP. Results The mean age of the study population was 64.3 ± 12.1 years, and 61.8% were male. During the 90-day follow-up, 18 patients (16.4%) died and 32 (29.1%) were rehospitalized. Patients with adverse outcomes had significantly higher admission NT-proBNP concentrations than those without events (p < 0.001). NT-proBNP levels were significantly associated with both short-term mortality and rehospitalization. After adjustment for potential confounders, admission NT-proBNP >5000 pg/mL independently predicted the composite endpoint of mortality or rehospitalization (adjusted OR 4.28, 95% CI 1.89–9.71; p < 0.001). Chronic kidney disease, age ≥65 years, and left ventricular ejection fraction <35% were also independent predictors. ROC analysis demonstrated good predictive performance of NT-proBNP, with an area under the curve of 0.84. Conclusion Admission NT-proBNP is a strong independent predictor of short-term mortality and rehospitalization in patients hospitalized with heart failure. Incorporating NT-proBNP into routine clinical assessment may improve early risk stratification, facilitate individualized management, and identify patients who may benefit from closer monitoring and intensified follow-up after hospital discharge.
Heart failure; NT-proBNP; Mortality; Rehospitalization; Prognosis; Biomarker; Risk stratification.
Correlation Between Ambulatory Blood Pressure Monitoring and Left Ventricular Hypertrophy
Background: Left ventricular hypertrophy (LVH) is an important manifestation of hypertension-mediated organ damage and is associated with increased cardiovascular morbidity and mortality. Ambulatory blood pressure monitoring (ABPM) provides a more comprehensive assessment of blood pressure than office measurements and may better predict cardiac target-organ damage. Methods: This hospital-based observational cross-sectional study included 90 adult patients with systemic hypertension. All participants underwent 24-hour ABPM and transthoracic echocardiography. Ambulatory blood pressure parameters were compared between patients with and without LVH. Correlation analysis was performed between ABPM indices and left ventricular mass index (LVMI), and multivariable logistic regression was used to identify independent predictors of LVH. Results: LVH was present in 46 (51.1%) patients. Individuals with LVH had significantly higher 24-hour, daytime and nighttime systolic blood pressure (SBP), pulse pressure and blood pressure load than those without LVH (all p<0.05). Nighttime SBP showed the strongest correlation with LVMI (r=0.76, p<0.001). Multivariable analysis identified nighttime SBP ≥130 mmHg (adjusted OR 4.26, 95% CI 1.82–9.96), non-dipping blood pressure pattern (adjusted OR 3.18, 95% CI 1.37–7.36), 24-hour SBP ≥140 mmHg (adjusted OR 2.91, 95% CI 1.24–6.83), and hypertension duration >10 years (adjusted OR 2.64, 95% CI 1.10–6.31) as independent predictors of LVH. Conclusion: ABPM-derived parameters, particularly nighttime SBP and abnormal nocturnal dipping, demonstrated a strong association with LVH and were superior to office blood pressure measurements in identifying hypertension-mediated cardiac damage. Routine use of ABPM may improve cardiovascular risk stratification and facilitate earlier intervention in patients with systemic hypertension.
Ambulatory blood pressure monitoring; systemic hypertension; left ventricular hypertrophy; left ventricular mass index; nocturnal hypertension; non-dipping pattern
Predictors of Rehospitalization in Patients with Acute Decompensated Heart Failure (ADHF)
Background: Acute decompensated heart failure (ADHF) is a major cause of hospitalisation and is associated with frequent rehospitalisation, leading to increased morbidity, mortality, and healthcare costs. Early identification of patients at high risk of readmission is essential for improving outcomes. Methods: This prospective observational study included 150 patients admitted with ADHF at a tertiary care hospital. Demographic characteristics, comorbidities, laboratory investigations, echocardiographic parameters, lung ultrasound findings, Venous Excess Ultrasound Score (VExUS), and discharge medications were recorded. Patients were followed for 180 days for rehospitalisation. Univariable and multivariable logistic regression analyses were performed to identify independent predictors. Results: During follow-up, 45 patients (30.0%) experienced rehospitalisation. Rehospitalised patients were significantly older and had a higher prevalence of hypertension, diabetes mellitus, chronic kidney disease, and previous heart failure admission. They also had significantly higher serum creatinine, NT-proBNP, pulmonary artery systolic pressure, lung B-line score, and residual congestion, along with lower eGFR, serum sodium, LVEF, and TAPSE (all p<0.05). Multivariable analysis identified residual congestion at discharge (aOR 4.21), previous heart failure admission (aOR 3.06), hyponatraemia (aOR 2.72), NT-proBNP >7500 pg/mL (aOR 2.44), eGFR <60 mL/min/1.73 m² (aOR 2.18), and VExUS ≥2 (aOR 1.97) as independent predictors of rehospitalisation. Conclusion: Residual congestion, previous heart failure admission, renal dysfunction, hyponatraemia, elevated NT-proBNP, and increased VExUS score independently predicted 180-day rehospitalisation in patients with ADHF. Early risk stratification and optimisation of discharge management may reduce recurrent hospitalisations.
Acute decompensated heart failure (ADHF); Rehospitalization; Residual congestion; NT-proBNP; VExUS; Guideline-directed medical therapy; Renal dysfunction; Prognostic factors
Clinical Profile and Endoscopic Spectrum of Upper Gastrointestinal Bleeding at a Tertiary Care Centre.
Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency associated with considerable morbidity and mortality despite advances in endoscopic and medical management. Understanding its clinical profile and endoscopic spectrum is essential for timely diagnosis and effective treatment. Methods: This hospital-based observational study included 100 consecutive adult patients presenting with UGIB at a tertiary care centre. Demographic characteristics, clinical presentation, laboratory findings, endoscopic diagnoses, therapeutic interventions, and in-hospital outcomes were recorded and analysed using appropriate statistical methods. Results: The mean age of the patients was 54.82 ± 15.64 years, and 72% were males. Chronic liver disease (38%) was the most common comorbidity. Haematemesis (38%) was the commonest presenting symptom, while pallor (71%) was the most frequent clinical finding. Endoscopy identified oesophageal varices (31%) as the leading cause of UGIB, followed by duodenal ulcer (22%) and erosive gastritis (13%). Therapeutic endoscopy was performed in 61% of patients, with variceal band ligation being the most common intervention (29%). Blood transfusion was required in 68% of patients. Variceal bleeding was significantly associated with alcohol consumption, chronic liver disease, shock at presentation, higher INR, increased blood transfusion requirements, and therapeutic endoscopic intervention (all p<0.05). The mean hospital stay was 6.82 ± 3.41 days, and in-hospital mortality was 6%. Conclusion: Variceal bleeding was the predominant cause of UGIB and was associated with greater clinical severity than non-variceal bleeding. Early resuscitation, prompt endoscopic evaluation, and timely therapeutic intervention are essential for improving patient outcomes.
Upper gastrointestinal bleeding; Endoscopy; Oesophageal varices; Peptic ulcer disease; Variceal bleeding; Therapeutic endoscopy; Clinical profile.
Correlation between hba1c variability and diabetic neuropathy in type 2 diabetes mellitus
Background: Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of type 2 diabetes mellitus (T2DM). Emerging evidence suggests that long-term glycaemic variability, in addition to mean glycated haemoglobin (HbA1c), may contribute to the development of neuropathy. Methods: This prospective observational study included 120 patients with T2DM attending a tertiary care centre. Clinical characteristics, glycaemic profile, and serial HbA1c measurements were recorded. HbA1c variability was assessed using standard deviation (SD) and coefficient of variation (CV). DPN was evaluated using clinical neurological examination together with the Michigan Neuropathy Screening Instrument (MNSI), Neuropathy Symptom Score (NSS), and Neuropathy Disability Score (NDS). Correlation analysis and multivariable logistic regression were performed to identify factors independently associated with DPN. Results: DPN was present in 54 (45.0%) patients. Patients with DPN had significantly higher mean HbA1c (8.94 ± 1.18% vs. 7.89 ± 1.08%), HbA1c SD (1.02 ± 0.34% vs. 0.58 ± 0.24%), and HbA1c CV (11.56 ± 4.12% vs. 7.67 ± 3.62%) than those without DPN (all p<0.001). HbA1c SD demonstrated the strongest positive correlation with MNSI (r=0.624), NSS (r=0.587), and NDS (r=0.608). Multivariable analysis identified longer diabetes duration (adjusted OR 1.16, 95% CI 1.07–1.26), higher mean HbA1c (adjusted OR 1.42, 95% CI 1.03–1.97), HbA1c SD (adjusted OR 1.31, 95% CI 1.16–1.48), and HbA1c CV (adjusted OR 1.12, 95% CI 1.03–1.22) as independent predictors of DPN. Conclusion: Greater long-term HbA1c variability is independently associated with the presence and severity of diabetic peripheral neuropathy. Assessment of HbA1c variability alongside mean HbA1c may improve risk stratification and facilitate earlier identification and prevention of diabetic neuropathy in patients with T2DM.
Type 2 diabetes mellitus; Diabetic peripheral neuropathy; HbA1c variability; Glycated haemoglobin; Glycaemic variability; Michigan Neuropathy Screening Instrument; Neuropathy Disability Score
Evaluation of cardiac autonomic dysfunction in patients with Type 2 DM
Abstract Background: Cardiovascular autonomic dysfunction is a common but often underdiagnosed complication of type 2 diabetes mellitus (T2DM) that contributes to increased cardiovascular morbidity and mortality. Objective: To evaluate cardiac autonomic dysfunction in patients with T2DM and determine its association with clinical and metabolic characteristics. Materials and Methods: This hospital-based cross-sectional study included 90 patients with T2DM. Clinical details, anthropometric measurements, and laboratory parameters, including glycated haemoglobin (HbA1c), were recorded. Cardiac autonomic function was assessed using Ewing's cardiovascular autonomic reflex tests. Cardiac autonomic neuropathy (CAN) was classified according to Ewing's criteria. Statistical analysis was performed using SPSS version 26.0, with p <0.05 considered statistically significant. Results: The mean age of the participants was 56.84 ± 10.92 years, and 61.1% were males. Cardiac autonomic dysfunction was present in 56.7% of patients, with 23.3% having early CAN, 22.2% definite CAN, and 11.1% severe CAN. Abnormal Valsalva ratio (36.7%) and deep breathing test (35.6%) were the most common abnormalities. Patients with CAN had significantly older age, longer duration of diabetes, higher HbA1c, higher BMI, and a greater prevalence of hypertension (p <0.05). Duration of diabetes >10 years, HbA1c >8%, age >60 years, and hypertension were independent predictors of CAN. Conclusion: Cardiac autonomic dysfunction is highly prevalent among patients with T2DM and is significantly associated with longer disease duration, poor glycaemic control, older age, and hypertension. Routine screening using cardiovascular autonomic reflex tests may facilitate early diagnosis and improve cardiovascular risk stratification.
Type 2 diabetes mellitus; cardiovascular autonomic neuropathy; cardiac autonomic dysfunction; Ewing's cardiovascular reflex tests; HbA1c.
Study of Correlation of Six Minute Walk Test and Spirometry Severity of Chronic Obstructive Pulmonary Disease (COPD)
Background: Chronic obstructive pulmonary disease (COPD) is associated with progressive airflow limitation and reduced exercise capacity. The six-minute walk test (6MWT) provides a simple assessment of functional status and may complement spirometry in evaluating disease severity. Materials and Methods: This prospective cross-sectional study included 100 patients with spirometry-confirmed COPD attending the Department of Respiratory Medicine, K.D. Medical College and Research Centre, Mathura, between April 2024 and October 2025. Spirometric parameters (FEV₁, FVC, FEV₁/FVC ratio, and MVV) and 6MWD were recorded. Correlation analysis was performed using Pearson's or Spearman's correlation coefficients, with p<0.05 considered statistically significant. Results: The mean FEV₁ was 52.6 ± 18.4% predicted, and 64% of patients had moderate-to-severe COPD. Mean 6MWD decreased progressively from 415 ± 42 m in mild COPD to 240 ± 48 m in very severe COPD (p<0.001). A strong positive correlation was observed between 6MWD and FEV₁ (r=0.78, p<0.001), while moderate positive correlations were found with FVC, FEV₁/FVC ratio, and MVV. Exercise-induced oxygen desaturation and heart rate increased significantly with worsening disease severity. FEV₁ was the strongest independent predictor of 6MWD. Conclusion: Six-minute walk distance correlates significantly with spirometric impairment and declines with increasing COPD severity. The 6MWT is a simple and reliable adjunct to spirometry for assessing functional capacity and disease severity in patients with COPD.
Chronic obstructive pulmonary disease, COPD, six-minute walk test, 6MWD, spirometry, FEV₁, exercise capacity
Role of High-Sensitivity Cardiac Troponin and NT-proBNP in Predicting Short-Term Outcomes Following Acute Myocardial Infarction
Background: Early risk stratification following acute myocardial infarction (AMI) is essential for identifying patients at increased risk of adverse clinical outcomes. High-sensitivity cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are established cardiac biomarkers reflecting myocardial injury and ventricular stress, respectively. Methods: This prospective observational study included 80 patients with AMI admitted to a tertiary care hospital. Baseline hs-cTn and NT-proBNP levels were measured at admission. Patients were followed for 30 days to assess composite adverse outcomes, including acute heart failure, cardiogenic shock, recurrent myocardial infarction, significant arrhythmias, prolonged hospital stay, and all-cause mortality. Receiver operating characteristic (ROC) analysis and multivariable logistic regression were performed to evaluate the prognostic performance of the biomarkers. Results: Composite adverse outcomes occurred in 29 (36.3%) patients. Patients with adverse outcomes had significantly higher hs-cTn (4826 ± 1928 vs. 2633 ± 1397 ng/L; p<0.001) and NT-proBNP levels (4212 ± 1836 vs. 1504 ± 864 pg/mL; p<0.001). NT-proBNP demonstrated superior predictive ability (AUC 0.901) compared with hs-cTn (AUC 0.842), while the combined biomarker model achieved the highest accuracy (AUC 0.936). Multivariable analysis identified NT-proBNP >2500 pg/mL, hs-cTn >3650 ng/L, and LVEF <40% as independent predictors of adverse outcomes. Conclusion: Both hs-cTn and NT-proBNP were valuable prognostic biomarkers in AMI, with NT-proBNP showing superior predictive performance. Combined assessment of both biomarkers improved early risk stratification and may facilitate timely therapeutic interventions in high-risk patients.
Acute myocardial infarction; High-sensitivity cardiac troponin; NT-proBNP; Prognosis; Risk stratification; Biomarkers; Short-term outcomes; Receiver operating characteristic.
Clinical Outcomes of Exploratory Laparotomy in Children with Acute Abdomen: A Prospective Observational Study
Abstract Background: Acute abdomen is a common paediatric surgical emergency requiring prompt diagnosis and timely intervention. Exploratory laparotomy remains the definitive treatment for many life-threatening abdominal conditions in children. Methods: This prospective observational study was conducted over 18 months (July 2024–December 2025) at the Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research. Fifty children aged 0–12 years presenting with acute abdomen and undergoing exploratory laparotomy were enrolled. Demographic characteristics, clinical presentation, laboratory and radiological findings, operative details, postoperative recovery, complications, and duration of hospital stay were recorded and analyzed. Results: Infants aged less than one year constituted the largest age group (32.0%), with a mean age of 5.14 ± 4.16 years. Females accounted for 56.0% of the study population. Most children (78.0%) had normal nutritional status. Multiple air-fluid levels were the commonest radiological finding (34.0%). The mean duration of hospital stay was 9.64 ± 5.93 days. Most patients had satisfactory postoperative recovery; however, wound infection, wound dehiscence, prolonged ileus, and stoma formation were observed in a subset of children, particularly those presenting with perforation peritonitis, bowel gangrene, severe sepsis, delayed presentation, and poor nutritional status. Conclusion: Exploratory laparotomy is an effective lifesaving procedure for children with acute abdomen. Early diagnosis, timely surgical intervention, adequate resuscitation, and meticulous perioperative care are essential to minimize postoperative complications and improve surgical outcomes.
Acute abdomen; Exploratory laparotomy; Paediatric surgery; Intestinal obstruction; Perforation peritonitis; Postoperative complications; Surgical outcomes.
Assessing suicide risk in young males with mild depression
Background: Mild depression is associated with an increased risk of suicidal ideation. This study compared the effectiveness of pharmacotherapy alone and pharmacotherapy combined with dimension-based psychotherapy in reducing depressive symptoms and suicide risk. Methods: In this prospective, randomized, hospital-based study, 26 young adult males (18–35 years) with mild depression (HAM-D 10–14) and suicidal ideation were randomized to receive pharmacotherapy alone (n = 13) or pharmacotherapy plus dimension-based psychotherapy (n = 13). Depressive severity and suicidal ideation were assessed using the Hamilton Depression Rating Scale (HAM-D) and Beck Scale for Suicide Ideation (BSI) over eight follow-up visits. Results: Both groups showed significant reductions in HAM-D and BSI scores during follow-up (p < 0.001). However, the combined therapy group demonstrated significantly greater improvement in depressive symptoms from the second follow-up and suicidal ideation from the sixth follow-up onward. Conclusion: Pharmacotherapy combined with dimension-based psychotherapy was more effective than pharmacotherapy alone in reducing depressive symptoms and suicidal ideation, supporting the integration of structured psychotherapy into the management of mild depression.
Mild depression; Suicidal ideation; Suicide risk; Dimension-based psychotherapy; Pharmacotherapy; Hamilton Depression Rating Scale (HAM-D).
Scrotal Reconstruction Using Bilateral Fasciocutaneous Thigh Pouches After Debridement for Fournier's Gangrene: A Case Report
We report the case of a 64-year-old male who presented with progressive bilateral scrotal swelling, pain, fever, and local discomfort. Clinical examination revealed diffuse scrotal edema, erythema, and areas of necrosis. Laboratory investigations showed marked leukocytosis (25,800 cells/mm³), while ultrasonography demonstrated bilateral epididymitis, funiculitis, and diffuse scrotal wall edema. A diagnosis of Fournier’s gangrene was established, and the patient underwent emergency surgical debridement. Intraoperative findings included extensive necrosis of the superficial and deep fascial layers with foul-smelling necrotic fluid and slough formation. Following infection control and development of healthy granulation tissue, definitive reconstruction was performed using bilateral fasciocutaneous thigh pouches. The testes were transposed into bilateral medial thigh pockets, and the remaining viable scrotal tissue was approximated to provide adequate coverage.The postoperative period was uneventful. The patient demonstrated satisfactory wound healing, preservation of testicular viability, and no evidence of recurrent infection or reconstructive complications. Follow-up evaluation showed good functional recovery and an acceptable cosmetic outcome.
Fournier’s gangrene; Scrotal reconstruction; Fasciocutaneous thigh pouch; Necrotizing fasciitis; Testicular coverage; Debridement; Scrotal defect reconstruction.
Comparing the efficacy of topical sucralfate versus silver sulfadiazine in management of burns
Background: Second-degree superficial burns constitute a substantial proportion of burn injuries and require effective topical therapy to promote wound healing, prevent infection, reduce pain, and improve functional and cosmetic outcomes. Although silver sulfadiazine (SSD) has traditionally been considered the standard topical agent, concerns regarding delayed epithelialization have prompted evaluation of alternative agents such as topical sucralfate. Aim: To compare the efficacy of topical sucralfate and silver sulfadiazine in the management of second-degree superficial burns. Materials and Methods: This prospective comparative clinical study was conducted in the Department of General Surgery over a period of 18 months. Sixty patients with second-degree superficial burns involving ≤40% total body surface area were enrolled and randomly allocated into two equal groups: Group A received topical sucralfate and Group B received 1% silver sulfadiazine. Patients were assessed for time to granulation tissue formation, time to complete wound healing, wound infection, pain score, duration of hospital stay, and scar quality. Statistical analysis was performed using the independent t-test and Chi-square test, with a p-value of <0.05 considered statistically significant. Results: The mean age of the study population was 43.8 ± 11.2 years, with females accounting for 56.7% of cases. Granulation tissue appeared significantly earlier in the sucralfate group compared with the SSD group (5.07 ± 0.78 vs. 8.17 ± 0.75 days; p<0.001). Complete wound healing occurred faster with sucralfate (12.20 ± 0.81 vs. 15.00 ± 0.91 days; p<0.001). Patients treated with sucralfate had significantly lower pain scores (2.63 ± 0.49 vs. 4.43 ± 0.50; p<0.001) and shorter hospital stay (8.03 ± 0.89 vs. 11.03 ± 0.81 days; p<0.001). Although wound infection rates were lower in the sucralfate group (16.7% vs. 26.7%), the difference was not statistically significant (p=0.531). Scar quality was significantly superior in the sucralfate group, with all patients demonstrating excellent or good outcomes (p<0.001). Conclusion: Topical sucralfate was found to be superior to silver sulfadiazine in the management of second-degree superficial burns. It significantly accelerated wound healing, reduced pain, shortened hospitalization, and improved scar quality while providing comparable infection control. Topical sucralfate may therefore be considered an effective and safe alternative to conventional silver sulfadiazine in superficial partial-thickness burns.
Second-degree superficial burns; Sucralfate; Silver sulfadiazine; Wound healing; Granulation tissue; Pain score; Scar quality; Hospital stay.
Comparative study between mandakini off-loading and conventional gauze dressing in the management of diabetic foot plantar ulcers
Background: Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus and a leading cause of morbidity, hospitalization, and lower-limb amputation. Effective off-loading is essential for optimal wound healing, but conventional methods remain costly, complex, and less patient-friendly in resource-limited settings. Aim: To compare the clinical efficacy of Mandakini off-loading dressing with conventional gauze dressing in the management of diabetic plantar foot ulcers. Materials and Methods: This prospective comparative study was conducted over 18 months at Navodaya Medical College Hospital and Research Centre, Raichur. A total of 154 patients with Wagner grade 1 and 2 plantar DFUs were enrolled and divided into two groups of 76 each. Group A received Mandakini off-loading dressing, while Group B received conventional wet gauze dressing. Outcomes assessed included wound healing time, wound size reduction, granulation tissue formation, infection rate, recurrence, and amputation rate. Statistical analysis was performed using SPSS version 25, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between both groups. Mean healing time was significantly shorter in Group A (4.3 ± 1.1 weeks) compared to Group B (5.8 ± 1.3 weeks) (p < 0.001). Infection rate (13.2% vs 28.9%) and ulcer recurrence (7.9% vs 21.1%) were significantly lower in Group A. Wound contraction and granulation tissue formation were also significantly better in the Mandakini group (p < 0.001). Although amputation rates were lower in Group A (2.6% vs 7.9%), the difference was not statistically significant. Conclusion: Mandakini off-loading dressing is a simple, cost-effective, and clinically superior alternative to conventional gauze dressing, providing faster healing and better overall outcomes in diabetic plantar ulcers.
The Future of Medical Education: Bridging Research Gaps Through Digital Innovation — An Indian Perspective
Medical education worldwide is undergoing digital transformation; however, India struggles with inadequate infrastructure, faculty development, and research integration into its medical curriculum. While CBME is a welcome change, there is a lack of focus on competency development regarding crucial clinical skills, critical reasoning, lack of adherence to guidelines, infrastructure, and inadequate digital training that surfaced during COVID-19. Online learning has become difficult to access for students from rural areas and other backward communities. Technology-enabled learning and assessment tools including simulation laboratories are not widely used or available. Also, technology-enhanced teaching, using innovations such as artificial intelligence, immersive virtual reality, mobile medical education, flipped classrooms, game-based learning, orombotics, and simulation-based medical education, has not been fully integrated into the system. There is a lack of research culture and emphasis on evidence-based teaching and learning. Policy-level initiatives, faculty development programs, and multicentric collaborative research are the need of the hour. Indian medical education can be revolutionized by adopting a learner-centric approach, enabling technologies and pushing medical students and doctors toward research.