Hungry bone syndrome (HBS) is a well-recognised complication after curative parathyroidectomy in primary hyperparathyroidism (PHPT), contributing to morbidity and prolonged hospitalisation. Reported predictors remain inconsistent, and data from Indian cohorts are limited, particularly in settings where vitamin D deficiency and advanced skeletal disease may modify risk. This retrospective observational cohort study was conducted at a tertiary surgical centre between January 2023 and December 2025. Twenty-five consecutive patients with biochemically proven PHPT who underwent curative parathyroidectomy were included. Preoperative variables included serum calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase (ALP), and 25-OH vitamin D. For this study, HBS was defined as postoperative hypocalcaemia persisting for more than 72 h after surgery and requiring clinically significant calcium supplementation; transient asymptomatic biochemical hypocalcaemia was not classified as HBS. Receiver operating characteristic (ROC) curves were constructed, and a three-point bedside score was evaluated in an exploratory manner. HBS developed in 7 patients (28
Chikungunya virus (CHIKV), an arbovirus primarily associated with febrile illness and polyarthritis, can lead to rare but significant neurological complications. We present a series of (number) cases involving (specific conditions, e.g., encephalitis, Guillain–Barré syndrome, or myelitis) in patients aged (age range, e.g., 15–65 years) who presented with (common symptoms, e.g., fever, altered sensorium, and motor deficits) following a febrile illness. The diagnosis was confirmed through specific diagnostic methods, e.g., CHIKV RNA polymerase chain reaction or serology, with findings such as key results, e.g., cerebrospinal fluid pleocytosis, and imaging abnormalities. Management included specific interventions, e.g., supportive care, immunotherapy, leading to outcomes, e.g., variable recovery from full resolution to persistent deficits. This series underscores the diverse neurological spectrum of CHIKV infection and highlights the need for heightened clinical suspicion, early diagnosis, and comprehensive management strategies to improve patient outcomes.
Abstract Achieving equitable health care for all individuals is imperative for the establishment of a healthy society. A nation that mitigates the financial burden associated with health care while emphasizing preventive measures not only enhances public health outcomes but also contributes to the stability of its population. India follows a multi-payer universal healthcare framework. To assess the overall health of a country’s citizens, several key health indicators have been established. They play a critical role in understanding health conditions and guiding policy decisions aimed at improving health outcomes. In India, these indicators are shaped by a variety of geographical, cultural, and socio-economic factors. They are crucial for policy formulation by assisting policymakers in identifying health priorities and allocating resources effectively and monitoring progress by tracking advancements toward health objectives. Despite progress, India’s healthcare sector continues to face several challenges. A segment of the population lives under the poverty line, which restricts access to health care. There are inadequate health infrastructure facilities in rural and remote areas. The Indian healthcare sector has experienced significant growth over the years, driving economic growth, creating employment opportunities, and improving patient outcomes. The government is working toward health care for all. Primary health care enhances the performance of health systems by reducing overall healthcare expenditure while improving population health and access. Reforms in the healthcare system should be monitored with indicators that reflect the core characteristics of primary health care. However, the government will have to increase the budget for health care to achieve healthcare access for all citizens of India.
Introduction: Chest tube removal (CTR) is a painful procedure after cardiothoracic surgery. Non-pharmacological measures that are inexpensive and easy to administer may complement routine analgesia. This study evaluated the effectiveness of local ice-cold application on pain associated with CTR. Methods: A quantitative experimental pretest–posttest control-group study was conducted among 60 postoperative cardiothoracic patients in the cardiothoracic vascular surgery intensive care unit of a 600-bed tertiary/superspecialty cardiothoracic hospital in Western Maharashtra. Participants were randomly allocated by lottery to an ice-cold application group (n=30) or control group (n=30). Both groups received routine analgesia. In the intervention group, two ice packs (17 × 8 cm), wrapped in sterile gauze, were placed around the chest-tube insertion site for 15 min before removal. Pain was assessed before, immediately after, and 15 min after CTR using the Numeric Pain Rating Scale (NPRS) and Modified Comfort Scale. Between-group comparisons used the Mann–Whitney test; within-group comparisons used the Wilcoxon signed-rank test. Results: Immediately after CTR, mean NPRS was 4.77 ± 1.135 in the intervention group versus 7.10 ± 0.995 in controls (Z=5.81, p<0.0001). At 15 min, mean NPRS was 3.13 ± 0.973 versus 3.97 ± 1.217 (Z=2.58, p=0.01). Modified Comfort Scale scores immediately after CTR were 10.63 ± 1.650 versus 14.40 ± 1.610 (Z=5.92, p<0.0001); at 15 min the difference was not significant (8.17 ± 1.821 vs 8.43 ± 1.716; Z=0.73, p=0.47). Within the intervention group, pain decreased significantly from baseline to both post-CTR assessments (p<0.0001). No adverse incident was reported. Conclusion: A 15-min local ice-cold application before CTR was associated with lower immediate pain and lower NPRS at 15 min after removal. It may be considered as a simple adjunct to routine
Abstract Background: Varicose veins are a common and debilitating vascular condition resulting from impaired venous return against gravity, a consequence of upright posture. If left untreated, they may lead to serious complications such as lipo-dermato-sclerosis, non-healing ulcers, and bleeding. Early detection, severity assessment, and appropriate intervention are essential to prevent these complications. This study aimed to evaluate the demographic profile, clinical presentation, management strategies, and treatment outcomes among patients with primary varicose veins. Patients and Methods: A prospective observational study was conducted over 24 months at a tertiary care hospital in India, enrolling 75 patients (105 limbs) who met inclusion criteria. Data collected included demographic characteristics, clinical presentation, duplex ultrasound findings, CEAP classification, preoperative Venous Clinical Severity Score (VCSS), treatment modality, surgical complications, and recurrence. Descriptive statistics were applied to baseline characteristics, while categorical variables were analysed using the Chi-square test, with P < 0.05 considered statistically significant. Results: Mean age at presentation was 44 ± 14.4 years, with a male predominance (88%). Dilated veins (100%) and leg pain (92.3%) were the most frequent symptoms. CEAP class C2 was the most common clinical grade (65.7%), and Sapheno-Femoral Junction incompetence was the predominant duplex finding (60.9%). Radio-Frequency Ablation (RFA) was the preferred modality of treatment which was performed in 75.2% ( n = 79) of limbs. Postoperative complications were seen in 14 (13.3%) limbs, pain being the most common, seen in 10 (9.5%) limbs. The mean VCSS significantly decreased from 6.14 preoperatively to 2.04 postoperatively ( P < 0.001). Follow-up duplex scans at 6 months demonstrated complete vessel occlusion with no recurrence in all patients. Conclusion: Management of varicose veins requires a multimodality approach. Radiofrequency ablation, as a minimally invasive technique, demonstrated excellent outcomes in this cohort, with low morbidity, significant symptom improvement, and high success rates.
