Government Medical College (Kota)

Abstract Background: Esophageal varices (EVs) are a common and serious complication of portal hypertension in cirrhosis, with bleeding leading to significant morbidity and mortality. Upper gastrointestinal endoscopy remains the gold standard for diagnosis, but it is invasive, expensive, and resource-intensive. Noninvasive predictors can help prioritize patients for screening. Aims and Objectives: To assess clinical, biochemical, and radiological noninvasive parameters in predicting the presence and severity of EVs and to determine the most accurate predictor of high-risk varices in cirrhotic patients. Materials and Methods: This hospital-based, cross-sectional study included 100 adults with confirmed liver cirrhosis. All participants underwent upper gastro intestinal endoscopy and variceal grading according to Paquet’s classification. Eight parameters—Child-Pugh class, platelet count, spleen diameter, portal vein diameter (PVD), the platelet count-to-spleen diameter (PC/SD) ratio, aspartate aminotransferase/alanine aminotransferase ratio, APRI, and FIB-4 index—were analyzed for their association with (1) presence versus absence of varices, (2) variceal Grades 0–4, and (3) high-risk (Grades 3–4) versus low-risk (Grades 0–2) varices. Statistical tools included the Mann–Whitney U test, Spearman correlation, and receiver operating characteristic analysis. Results: Varices were present in 87% of patients. Significant predictors were low platelet count ( P < 0.0001), larger spleen size ( P < 0.0001), low PC/SD ratio ( P < 0.0001), higher Child-Pugh score ( P = 0.0010), and increased PVD ( P = 0.0001). Variceal grade correlated positively with Child-Pugh score ( r = 0.73), spleen size ( r = 0.51), and portal vein size ( r = 0.43), and negatively with PC/SD ratio ( r = −0.65). The best predictor for high-risk varices was Child-Pugh class C (area under the curve [AUC] = 0.866), followed by a spleen size of ≥15.7 cm (AUC: 0.864), a PC/SD ratio of <356.38 (AUC: 0.836), and a PVD of ≥16.7 mm (AUC: 0.825, with 91% specificity). Conclusion: Child-Pugh class, spleen diameter, PC/SD ratio, and PVD are reliable, easily measurable indicators for detecting and grading EVs, and can reduce unnecessary endoscopies in resource-limited settings.

Introduction: Maternal and child health is a key public health priority, yet maternal mortality and morbidity remain high in rural India despite national improvements due to poor access, sociocultural constraints, and low quality of care. Client satisfaction is increasingly recognized as a key indicator of healthcare quality, influencing service utilization, adherence to medical advice, and continuity of care this study was conducted to assess client satisfaction among puerperal women which is crucial to bridge service gaps and improve outcomes. Methods: A community-based cross-sectional study was conducted over one year in 16 villages under the RHTC, Digod, attached to the Department of Community Medicine, Government Medical College, Kota, and Rajasthan. A total of 200 puerperal women were selected using standard sample size calculation. Data were collected through interviewer method using a semi-structured questionnaire after ethical approval. Data analysis was done using appropriate statistical test. Results: Majority of respondents in this study were Hindus (90.5%). It was observed that the majority of participants (61%) reported high satisfaction (score range: 40–50), followed by 30.5% with moderate satisfaction (score range: 30–39), and only 8.5% reported low satisfaction (score range: 10–29). Conclusion: The study revealed that a majority of puerperal women were highly satisfied with maternal healthcare services. However, lower satisfaction in domains like breastfeeding and nutrition counselling highlights the need to strengthen interpersonal communication and health education efforts.

Background: Gunshot residue (GSR) has been used historically to distinguish between the entry and exit points of gunshot wounds. It has been broadly accepted in the forensic science community that entry wounds will have a presence of GSR, but exit wounds will not. However, this is no longer the case in the rapidly advancing field of forensics. Several real-world scenarios and laboratory experiments have demonstrated that GSR can be detected in exit wounds of gunshot victims. There is currently a need to re-evaluate the identification and determination of entry and exit wounds. Methodology-This case study discusses a fatal gunshot wound in an 8-year-old boy who was shot at close range by a .32 MK III revolver. Result- Gunshot residue was found at both the entry and exit points of the wound using a sodium rhodizonate test. Conclusion-It signifies that not only the presence of GSR but also the quantitative analysis of GSR plays a vital role in differentiating between the entry and exit wounds of a firearm.

Heart failure (HF) encompasses a spectrum of clinical syndromes with substantial global morbidity and mortality, primarily linked to coronary artery disease. Affecting over 37 million individuals worldwide, its prevalence increases with age. HF is classified into three major categories: heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and the intermediate phenotype, heart failure with mid-range ejection fraction (HFmrEF). Despite similar symptomatology, differentiating HFpEF from HFrEF remains challenging, particularly through biomarker evaluation. The diagnostic and prognostic roles of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are well established; however, an unmet need persists in accurately distinguishing HFpEF from HFrEF, as NT-proBNP levels are often influenced by age, renal function, and obesity, which confound its interpretation in HFpEF. This review uniquely integrates current evidence delineating the biomarker's pathophysiological underpinnings, clinical thresholds, and predictive capacities across HF phenotypes, while contrasting its limitations and interpretive nuances in real-world practice. For instance, while elevated NT-proBNP levels in HFrEF strongly correlate with ventricular dysfunction severity and guide therapy initiation, their diagnostic specificity in HFpEF is reduced, often necessitating adjunctive imaging or additional biomarkers for confirmation. Advances in proteomics are reshaping biomarker discovery, enabling the identification of novel cardiac stress markers such as soluble ST2 and growth differentiation factor-15 (GDF-15), which complement NT-proBNP by reflecting distinct molecular pathways of myocardial remodeling and inflammation. Although NT-proBNP remains the gold standard for prognostic assessment and risk stratification in HF, its diagnostic performance, particularly in HFpEF, must be interpreted within the broader biomarker landscape. Future directions should emphasize proteomic integration and multimarker strategies to achieve precision-based HF phenotyping and improved therapeutic outcomes.

Endotracheal intubation is a routine yet critical procedure during general anesthesia that can cause a spectrum of laryngeal injuries, potentially affecting vocal function and airway integrity. The route of intubation, oral versus nasal, may influence the incidence and severity of such injuries, but evidence is inconclusive. This study aims to prospectively compare the incidence, severity, and clinical impact of laryngeal injuries following oral and nasal intubation in adult patients undergoing elective surgeries under general anesthesia. A prospective observational study was conducted involving 67 patients scheduled for elective surgery with endotracheal intubation. Patients were allocated into oral (n = 35) and nasal (n = 32) intubation groups based on surgical requirements. Flexible fiberoptic laryngoscopy was performed within six hours of extubation to evaluate laryngeal injuries, graded using the Eckerbom classification. Hoarseness severity was assessed and recorded. Statistical analysis including chi-square tests and multivariate logistic regression identified predictors of injury and compared groups, with significance set at p < 0.05. The incidence and severity of laryngeal injuries did not significantly differ between oral and nasal intubation groups (p = 0.67). Grade 0 injury (no visible abnormality) was predominant (oral 65.7