The Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) is a medical school located at Pondicherry, the capital of the Union Territory of Puducherry, in India. JIPMER is an Institute of National Importance (INI) and a tertiary care referral hospital. It is under the direct administrative control of the Ministry of Health and Family Welfare, and Indian Government, with autonomy to run its internal administration.JIPMER has over 300 faculty members, over 700 resident physicians and over 800 nursing, administrative and support staff. It admits 150 undergraduate students and 200 postgraduate students annually.
Melatonin (N‑acetyl‑5‑methoxytryptamine), traditionally viewed as a pineal neurohormone regulating circadian rhythms, is now recognized as a pleiotropic molecule with significant implications for musculoskeletal (MSK) health. Its receptor‑dependent and receptor‑independent actions influence bone, cartilage, muscle, tendon, ligament, and spine biology, positioning melatonin as a potential therapeutic agent across diverse MSK pathologies. Experimental, translational, and clinical studies were surveyed to evaluate melatonin’s role in MSK medicine. The literature was analyzed for insights into molecular mechanisms, therapeutic targets, and clinical applications, with particular emphasis on receptor signaling pathways, antioxidant and mitochondrial effects, and epigenetic regulation. Evidence spanning bone, cartilage, muscle, tendon, ligament, spine, and autoimmune MSK conditions was incorporated to provide a comprehensive synthesis. Melatonin exerts its effects through MT1/MT2 receptor signaling, stabilization of Wnt/β‑catenin pathways, modulation of circadian clock genes, andreceptor‑independent mechanisms such as antioxidant activity, mitochondrial protection, and regulation via non‑coding RNAs. In bone biology, it enhances osteoblastogenesis, suppresses osteoclastogenesis, and modulates RANKL/OPG and NLRP3 inflammasome pathways, thereby mitigating osteoporosis and accelerating fracture healing through angiogenesis and callus formation, although dosing requires careful optimization to balance remodeling. In cartilage, melatonin resynchronizes disrupted circadian clocks, inhibits NF‑κB‑mediated inflammation, and preserves extracellular matrix integrity, with novel delivery systems currently under investigation. Skeletal muscle studies highlight its role in Pax7 regulation and Wnt signaling, contributing to the prevention of sarcopenia and cachexia. Evidence also supports its benefits in tendon and ligament repair, while in spinal pathologies melatonin demonstrates protective effects against intervertebral disc degeneration, spinal cord injury, and chronic back pain. Beyond structural tissues, melatonin exhibits cytoprotective roles in musculoskeletal oncology and shows therapeutic promise in systemic autoimmune conditions such as rheumatoid arthritis, lupus, gout, and fibromyalgia. Clinical trials further reveal analgesic, sedative, and sleep‑modulating effects, though translation gaps remain regarding optimal dosing strategies and bioavailability. Melatonin is a multifaceted agent bridging molecular cytoprotection with translational musculoskeletal medicine. Its diverse actions across bone, cartilage, muscle, tendon, ligament, and spine highlight therapeutic promise. However, clinical translation requires precision‑based dosing strategies, improved bioavailability, and rigorous validation in large‑scale trials to fully establish its role in MSK health.
The major goals of anesthesia in patients with severe traumatic brain injury (TBI) are—maintenance of hemodynamic stability, optimal cerebral perfusion pressure, lowering of ICP, and providing a relaxed brain. Although both inhalational and intravenous anesthetics are commonly employed, there is no clear consensus on which technique is better for the anesthetic management of severe TBI. Ninety patients, 18–60 years of age, of either gender, with GCS < 8, posted for emergency evacuation of acute subdural hematoma were enrolled in this prospective trial, and they were randomized into two groups of 45 each. Patients in group P received propofol infusion at 100–150 mg/kg/min for maintenance of anesthesia and those in group I received ≤ 1 MAC of isoflurane. Hemodynamic parameters were monitored in all patients. ICP was measured at the dural opening and brain relaxation was assessed by the operating surgeon on a four-point scale (1-perfectly relaxed, 2-satisfactorily relaxed, 3-firm brain, and 4-bulging brain) at the dural opening. It was reassessed at dural closure. Brain relaxation, both at dural opening and closure, was significantly better in patients who received propofol compared to those who received isoflurane. ICP was significantly lower (25.47 ± 3.72 mmHg vs. 23.41 ± 3.97 mmHg) in the TIVA group. Hemodynamic parameters were well maintained in both groups. In patients with severe TBI, total intravenous (Propofol)-based anesthesia provided better brain relaxation, maintained a lower ICP along with better hemodynamics when compared to inhalational anesthesia. Clinical trials registry (NCT03146104).
Physical activity during pregnancy is essential as it impacts maternal and fetal outcomes. Understanding physical activity patterns helps refine guidelines specific to pregnant women. This study aims to assess current physical activity levels in pregnant women, identify associated factors, and compare their pregnancy activity to pre-pregnancy levels. This cross-sectional study was conducted from September 2023 to January 2024. It included pregnant women in all trimesters who were receiving prenatal services from three PHCs, one multi-speciality, one maternity home, and one private clinic in rural and urban Puducherry, respectively. Participants enrolled at these study sites were interviewed to determine their physical activity level before and during pregnancy, which was then categorized based on the energy costs they spent. Additionally, 10
Alcohol dependence is often associated with various medical and psychiatric conditions, that influence overall treatment outcomes. Available evidence largely comes from single-centre epidemiological studies with no comprehensive data on comorbidity patterns among treatment-seeking populations. To examine proportion and patterns of medical and psychiatric comorbidities among treatment-seeking patients with alcohol dependence across multiple centres in India, and to evaluate variations across centres. This multicentric, cross-sectional observational study was conducted across 16 institutes in India from December 2023 to December 2024. Adults aged 18 years and above, diagnosed with alcohol dependence according to ICD-11 were included using purposive sampling. Structured checklist and Charlson Comorbidity Index were used to document medical comorbidities. Psychiatric comorbidities were documented based on routine clinical diagnostic interviews based on ICD-11. A total of 1850 patients were enrolled in the study with mean age of 39.6 years and male predominance (98.5
Laparoscopic cholecystectomy (LC) is the standard surgical treatment for gallstone disease (GSD). Despite its minimally invasive advantages, port site infection (PSI) remains a notable postoperative complication. Metabolic factors implicated in gallstone formation, such as elevated serum cholesterol, may also influence wound healing and infection risk. This study aimed to evaluate the association between preoperative serum cholesterol levels and the occurrence of PSI following LC. Assuming an expected PSI incidence of 4.5
