Malda Medical College and Hospital

Background: Elderly patients undergoing orthopaedic surgeries frequently have multiple comorbidities requiring polypharmacy, increasing the risk of adverse drug events. Potentially inappropriate medications (PIMs) further exacerbate these risks. However, limited data exist regarding their impact on surgical outcomes in this population. Methods: This retrospective observational study included 169 patients aged ≥60 years undergoing orthopaedic surgeries at a tertiary care center. Data on demographics, comorbidities, medication use, and outcomes were collected. Polypharmacy and PIMs were assessed using standard definitions and the Beers Criteria. Associations with postoperative complications were analyzed using appropriate statistical tests and multivariate regression. Results: Polypharmacy was observed in 83.4% of patients, with 29.0% experiencing hyperpoly pharmacy. PIMs were identified in 42.6% of patients. Increasing medication burden was significantly associated with higher rates of delirium (p=0.004), gastrointestinal complications (p=0.021), renal dysfunction (p=0.018), ICU admissions (p=0.031), and prolonged hospital stay (p<0.001). PIM use was also significantly associated with adverse outcomes including delirium (p=0.002) and gastrointestinal complications (p=0.001). Multivariate analysis identified hyperpoly pharmacy (AOR: 2.84, p=0.004) and PIM use (AOR: 2.47, p=0.006) as independent predictors. Conclusion: Polypharmacy and PIM use are highly prevalent and significantly impact postoperative outcomes in elderly orthopaedic patients. Rational prescribing and systematic medication review are essential to improve patient safety and clinical outcomes.

INTRODUCTION:Historically, childhood depression was overlooked due to perceived developmental immaturity. However, modern paradigms recognize it as a complex disorder often presenting with "masked" symptoms that differ from adult manifestations. In India, prevalence rates show an increasing trend, yet research on younger children remains sparse. This study aimed to delineate the clinical features, temperamental traits, and family environmental correlates of childhood depressive episodes in an eastern Indian hospital setting, while quantifying the perceptual gap between children and parents. METHODS:This institution-based, case-control study screened 145 children aged 5-12 years, resulting in a final population of 34 cases (diagnosed via the International Classification of Diseases, 10th Revision, Diagnostic Criteria for Research) and 34 age- and sex-matched controls. Assessment tools included the Pediatric Symptom Checklist (PSC), Center for Epidemiological Studies Depression Scale for Children (CES-DC), Draw-a-Person Test (DAP) for evolving personality traits, and the Family Environmental Scale (FES). Statistical analysis data were tabulated in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using SPSS version 16.0 (SPSS Inc., Chicago, IL). Categorical variables were summarized as frequencies and percentages, while numerical variables were expressed as means and standard deviations (SD). Inferential statistics included the chi-squared (χ2) test for categorical associations. Data were found to be normally distributed via the Shapiro-Wilk test (p = 0.413). Independent t-tests were done to compare numerical means between groups. Pearson's correlation coefficient (r), Crammer's V, and Cohen's d were calculated to quantify the magnitude of categorical variables. RESULTS:Depressive episode was diagnosed in 23.44% (n = 34) of children. Most cases were aged 9-12 years (n = 26, 76.5%) with a slight male preponderance (n = 18, 52.29%). Frequent symptoms included sleep disturbances (n = 28, 82.35%), irritability (n = 26, 76.47%), and somatic complaints (n = 22, 64.7%). Environmental stressors such as bullying (χ2 (1, n = 68), 11.691, p = 0.001, V = 0.415) and a lack of close friends (χ2 (1, n = 68), 23.611, p = 0.00, V = 0.589) were significantly more prevalent in cases. FES results indicated that depressed children lived in domestic environments characterized by lower cohesion (p = 0.032) and higher conflict (p = 0.00) and control (p = 0.00). DAP testing revealed significantly higher scores for anxiety (p = 0.00), low self-esteem (p = 0.001), and internalized aggression (p = 0.001) in the case group. Also noted was high discordance in illness perception (88%, n = 30), as parents' severity ratings did not match the child's self-report, with 64.7% (n = 22) of parents underestimating the severity. CONCLUSION:Children with depression present with varied symptoms, including somatic and behavioral problems. Childhood depression is a multi-dimensional disorder that correlates with the family environment and temperament of the child. The significant parent-child perceptual gap highlights the need for child-centric assessment tools and enhanced parental awareness to ensure early diagnosis and minimize long-term social impairment.

Background: Adenovirus infection is a significant cause of pediatric respiratory illness and may lead to severe disease requiring pediatric intensive care unit (PICU) admission. Affected children commonly present with fever, cough, and respiratory distress, with occasional gastrointestinal symptoms or conjunctivitis. The illness predominantly affects younger children and shows seasonal variation, often peaking in colder months. Understanding the clinicoepidemiological profile of severe adenoviral infection is essential for early diagnosis, timely management, and improved outcomes in tertiary care settings. Aims and Objectives: To describe the clinical profile, laboratory abnormalities, and outcomes of adenovirus infection in children admitted to a PICU. Materials and Methods: A retrospective observational study was conducted among 62 children aged 1–5 years with reverse transcription polymerase chain reaction confirmed adenovirus infection admitted to the PICU of Malda Medical College and Hospital, Malda. Demographic, clinical, laboratory, and outcome data were analyzed. Results: Infants and children aged ≤5 years constituted equal proportions (50% each), with a male predominance (58.1%). Fever and respiratory symptoms were present in all cases. Laboratory abnormalities were frequent, with transaminitis in 71%, elevated C-reactive protein in 53.2%, anemia in 33.9%, thrombocytopenia in 27.4%, and dyselectrolytemia in 32.3%. Overall mortality was 29%. Non-survivors had significantly higher alanine aminotransferase and aspartate aminotransferase levels, and liver dysfunction was more frequent among non-survivors (44.4% vs. 15.9%). Conclusion: Adenovirus infection in critically ill children presents as a severe multisystem disease with significant mortality. Early recognition and careful monitoring of organ dysfunction are essential.

Objectives: Patients considering clear aligner therapy should understand treatment requirements, limitations, and the importance of professional supervision. As many patients now seek orthodontic information from artificial intelligence (AI) chatbots, this study evaluated how effectively these systems communicate patient-facing information related to clear aligner therapy. Material and Methods: Twenty common patient-facing questions about clear aligner therapy were developed using conversational language. Three large language models (LLM), ChatGPT 5.2, Claude Sonnet 4.5, and Gemini Flash 3, generated responses using default settings. Three orthodontic specialists, blinded to model identity, rated responses for quality and empathy using 5-point Likert scales. Readability was assessed using the Flesch–Kincaid Grade Level. Inter-rater reliability was evaluated using intraclass correlation coefficients (2,1). Model performance was compared using repeated-measures analysis of variance with Bonferroni-adjusted post hoc testing. Results: Inter-rater reliability ranged from fair to good. Significant differences were observed among models for quality (F[2,38] = 11.43; p < 0.001) and empathy (F[2,38] = 3.92; p = 0.028), while readability did not differ significantly ( p = 0.321). Gemini Flash 3 achieved the highest mean scores for both quality (4.57 ± 0.42) and empathy (4.28 ± 0.51). All models consistently encouraged professional orthodontic consultation and avoided recommending unsupervised treatment. Conclusion: Large language models can provide appropriate patient-facing information about clear aligner therapy, though meaningful differences in communication quality and empathy exist. Clinical oversight remains essential when integrating AI tools into orthodontic patient education.

Abstract Background and Aim: Indian medical education is transforming, with an increase in the number of students who are shifting from traditional medical college and textbook-based learning to online coaching platforms which prepare them for postgraduate (PG) entrance examinations. This is a novel study that explores the attitude of Phase II MBBS students when choosing their learning methods in the backdrop of this evolving educational scenario. Materials and Methods: A cross-sectional descriptive study with comparative analysis was conducted among 100 Phase II MBBS students in a medical college in eastern India. Students responded to a 20-item, 5-point Likert scale questionnaire which assessed their perceptions regarding medical college/textbook-based learning and online coaching-based learning. Data were analyzed using descriptive statistics and independent t -tests. Results: Of the 100 students included in the study, 55% of students favored online coaching-based learning, while 45% of students preferred traditional college and textbook-based learning. Mann–Whitney U -tests revealed statistically significant differences ( P < 0.001) between the two groups. Conclusion: The study highlighted a growing preference among MBBS students for online coaching platforms as these platforms offer PG examination-oriented content with the benefit of ease of accessibility and convenience. There is a need to preserve the clinical skill development, which is facilitated by traditional teaching. A blend of both these approaches may be the key to balancing these complementary learning methods.