Background:Chronic Kidney Disease (CKD) is a significant public health problem associated with considerable morbidity and mortality. It is known to cause retinal vascular changes and retinopathy that reflects changes occurring in the kidneys. Optical coherence tomography (OCT) is a promising biomarker for assessing retinal changes associated with CKD. This study was conducted to evaluate retinal alterations in patients with CKD using spectral-domain optical coherence tomography (SD-OCT), correlate these findings with biochemical parameters to facilitate early screening and timely detection, and assess disease progression. Materials and methods:This single-centre, cross-sectional study included 60 eyes of 60 patients with stage 3, 4, or 5 CKD. Data collected included age, sex, glycaemic status, serum electrolytes, blood urea nitrogen (BUN), and serum creatinine. Fundus examination and various OCT parameters were measured. Central retinal thickness (CRT) and central choroidal thickness (CCT) were measured manually at the subfoveal region. Automated segmentation was used to measure retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thicknesses across all quadrants and sectors using SD-OCT. Descriptive and inferential statistical analyses were applied to assess significance. Results:Most patients were in Stage 3 CKD, with the majority having a disease duration of 1-3 years. Mean retinal thickness reduced from stage 3 to 5 with no statistical significance, while choroidal thickness remained preserved. Inferior RNFL thickness declined significantly with worsening CKD, whereas temporal RNFL and GCC showed borderline significance. Retinal parameters did not differ by CKD duration. Elevated HbA1c was associated with increased retinal thickness and thicker inferior RNFL. Both hypernatremia and hyperkalemia were associated with reduced retinal thickness. A higher glomerular filtration rate (GFR) was positively correlated with inferior RNFL thickness. Discussion:The findings of this study suggest that chronic kidney disease is associated with progressive neuroretinal changes, particularly thinning of the inferior retinal nerve fibre layer, which may reflect underlying microvascular and neurodegenerative processes occurring in CKD. The preservation of choroidal thickness despite declining renal function indicates that neuroretinal alterations may precede detectable choroidal changes. The observed associations between OCT parameters and biochemical markers, including HbA1c, serum sodium, potassium, and GFR, further support the influence of systemic metabolic and renal status on retinal structure. Conclusion:The study highlights that chronic kidney disease is associated with neuroretinal alterations that become more pronounced as disease severity increases. Optical Coherence Tomography has emerged as an important biomarker for evaluating these retinal changes. Further, by correlating OCT findings with biochemical parameters, we can evaluate the impact of systemic parameters in CKD on the retina. Therefore, OCT is an important tool in CKD that helps with screening, monitoring, and assessing disease progression.
Objective: To investigate serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP), insulin-like growth factor binding protein-7 (IGFBP-7), and C1q tumor necrosis factor-related protein 12 (CTRP12) levels and significance in patients with chronic heart failure (CHF). Methods: The CHF group consisted of 116 CHF patients who received care at this hospital between October 2023 and March 2025. The patients were classified into Grade II (47 patients), Grade III (41 patients), or Grade IV (28 patients) based on the heart function classification of the New York Heart Association (NYHA). The control group consisted of 64 healthy patients who were examined physically in the hospital throughout the same time period. Using multivariate logistic regression, the factors impacting MACEs in patients with congestive heart failure were examined. Through the use of the receiver operating characteristic (ROC) curve, researchers were able to assess the predictive power of blood NT-pro-BNP, IGFBP-7, and CTRP12 for MACEs in chronic heart failure patients. Results: Comparing the CHF group to the control group, the LVEDD increased, the LVEF and serum CTRP12 decreased, and the levels of NT-pro-BNP, IGFBP-7, Hcy, and hs-CRP climbed (P<0.05). Among patients with CHF of different grades, serum NT-pro-BNP, IGFBP-7, Hcy, hs-CRP, and LVEDD levels were all lower in Grade II patients than in Grade III patients. Furthermore, the differences between any two grades were statistically significant (P<0.05). The levels of LVEF and serum CTRP12 in the MACE group decreased, the LVEDD increased, and the levels of serum Hcy, hs-CRP, NT-pro-BNP and IGFBP-7 increased (P<0.05). MACEs in CHF patients were influenced by serum NT-pro-BNP, IGFBP-7, and CTRP12 (P<0.05). The areas under the curve (AUCs) of serum NT-pro-BNP, IGFBP-7, CTRP12 alone and the combination of the three for predicting MACEs in patients with CHF were 0.862 (95% CI: 0.786–0.919), 0.805 (95% CI: 0.721–0.872), and 0.860 (95% CI: 0.784–0.918) and 0.961 (95% CI: 0.908–0.988), respectively. The AUCs of the three combined predictions were significantly greater than those of the individual predictions of NT-pro-BNP, IGFBP-7, and CTRP12 (Z=3.050, 3.883, 3.218, all P<0.05). Conclusion: Serum levels of IGFBP-7 and NT-pro-BNP increase in CHF patients, whereas the level of CTRP12 decreases. Additionally, once functional classification was applied, NT-pro-BNP, IGFBP-7, and CTRP12 levels changed. The combined detection of these three parameters has better efficacy in predicting MACEs in patients with CHF.
Abstract Mental disorders affect approximately 450 million people globally, with a disproportionate burden in low- and middle-income countries where cultural and religious beliefs strongly influence illness perceptions and pathways to care. In such settings, symptoms are often interpreted through spiritual or supernatural frameworks, contributing to delays in accessing psychiatric treatment. This case series aims to illustrate how cultural and religious explanatory models shape symptom interpretation and help-seeking behavior, and to derive implications for culturally competent psychiatric care. This study was conducted in a tertiary care psychiatry setting in India. Four cases were purposively selected over a defined clinical period based on the presence of culturally mediated interpretations that significantly influenced care pathways. Data were obtained from clinical interviews, patient records, and collateral information from family members. The cases included obsessive-compulsive disorder misinterpreted as spiritual awakening, mania perceived as divine inspiration, dissociative disorder viewed as spirit possession, and psychosis following head injury attributed to supernatural causes. Cultural validation of symptoms contributed to delays in psychiatric consultation ranging from weeks to several months. Variations were observed in how different symptom types were interpreted, with some behaviors normalized or reinforced and others stigmatized or concealed. Cultural explanatory models play a significant role in shaping mental illness trajectories and delays in care. Clinicians should actively elicit and engage with patients’ cultural beliefs using culturally sensitive approaches. Training in cultural competence and collaboration with faith healers and community stakeholders may improve early identification and referral, thereby reducing delays and improving outcomes.
Background Primary aldosteronism (PA) is a treatable but often missed cause of hypertension (HTN). Relying solely on resistant HTN or hypokalemia for screening overlooks many patients with mild disease. We aimed to determine the observed frequency of PA among routine outpatient adults with low grade HTN. Methods In this single centre observational study, we enrolled 300 consecutive adults (18–70 yrs) with low grade HTN (well controlled BP <140/90 mmHg and Grade 1 HTN <160/100 mmHg). We excluded secondary HTN, eGFR <45 mL/min/1.73 m², resistant HTN and diagnosed diabetes. Interfering antihypertensives were withdrawn. Morning fasting plasma aldosterone concentration (PAC) and direct renin concentration (DRC) were measured. Patients with aldosterone to renin ratio (ARR) >2.5 ng/dL per mU/L (with PAC >10 and DRC ≤8.2) underwent confirmatory saline suppression. Results PA was confirmed in 24/300 (8.0%) patients. The mean ARR was significantly higher in PA cases than non PA (3.52 ± 1.1 vs 0.94 ± 0.9 ng/dL per mU/L; p<0.0001). PA patients had lower serum potassium (3.42 vs 4.13 mEq/L), higher fasting glucose (122.1 vs 104.2 mg/dL) and higher frequency of left ventricular hypertrophy, (LVH) (58.3% vs 20.2%), stroke (16.7% vs 1.8%), and obstructive sleep apnea (OSA) (20.9% vs 2.5%). Most PA cases were asymptomatic. Conclusions Among routine patients with low grade HTN, the observed frequency of PA was 8%, associated with significantly higher cardiometabolic burden despite similar blood pressure (BP). We strongly reinforce the existing recommendation that every hypertensive patient should be screened for PA at least once. In practical terms, we specifically urge clinicians to ensure this strategy includes routine patients with low grade HTN.
Fluorescence dermoscopy under 365 nm light provides a non-invasive, rapid diagnostic aid in identifying ectoparasites such as Pediculus humanus capitis. We report a case of a 43-year-old female presenting with persistent itching and scaling of the scalp, later confirmed as pediculosis capitis through 365 nm fluorescence dermoscopy. This modality demonstrated bright blue fluorescence of the lice and yellow-green fluorescence of nits, differentiating it from seborrheic dermatitis and scalp psoriasis. Treatment with two applications of 1
