Pondicherry Institute of Medical Sciences (PIMS) is a tertiary care hospital and teaching institute at Kalapet in the Union Territory of Puducherry, India. The college has been approved for full recognition by MCI for 150 seats for MBBS degree granted by the Pondicherry University. The PIMS is a unit of The Madras Medical Mission, a charitable society and hospital in Chennai promoted by the members of the Malankara Orthodox Christian community..
Ultrasound-guided regional anesthesia (UGRA) has changed how we manage pain by allowing doctors to visualize nerves and other structures in real time, making the process more accurate, effective, and safe while also reducing risk. This narrative review examines the latest advancements in UGRA techniques, evaluating their efficacy and safety, particularly for peripheral nerve and truncal plane blocks, their potential to diminish opioid consumption, and their clinical applications in perioperative care. This review followed the Scale for the Assessment of Narrative Review Articles (SANRA) quality assessment guidelines and searched six databases for studies published from January 2015 to October 2025, including trials, meta-analyses, cohort studies, reviews, and technical reports. This review aims to give doctors, anesthesia experts, and researchers the newest information and methods about UGRA, focusing on better ways to see needles and use additives like dexamethasone and dexmedetomidine to make regional anesthesia more effective and last longer, which can help lower opioid use and speed up recovery after surgery, while ultrasound guidance makes these techniques safer and more accurate. Another important finding is that real-time imaging and protocols help reduce safety concerns like toxicity, nerve damage, and infection. Artificial intelligence (AI) and robotics in UGRA enhance precision, safety, and recovery, paving the way for further standardization and accessibility.
Computed tomography [CT] is the frontline imaging modality for the assessment of polytrauma patients because of its speed, diagnostic accuracy and influence on immediate management. Ever since whole-body CT [WB-CT or “pan-scan”] was adopted, there has been ongoing debate about patient selection, optimal protocols and acquisition strategies, radiation safety, and its integration into streamlined trauma workflows. Evidence suggests that WB-CT shortens time-to-diagnosis and improves injury detection compared with region-specific selective CT, although mortality benefits are variable across studies and the radiation dose remains marginally higher. Newer protocol variants, such as the split-bolus single-pass technique, dual-energy CT [DECT], dose-reduced and hybrid timing strategies, monophasic acquisition in select patients aim to optimize diagnostic accuracy while reducing dose and contrast. Structured reporting using trauma-specific templates improve completeness and diagnostic performance, particularly among less experienced radiologists. Emerging tools such as artificial intelligence [AI] triage/flagging systems, photon-counting and spectral CT, and automated structured reporting can potentially improve the trauma workflow efficiency. This article reviews current guidelines, compares WB-CT with selective CT, discusses existing WB-CT protocols, proposes a practical optimized WB-CT protocol termed - ‘IMPACT Protocol [Integrated Multiphase Polytrauma Assessment CT]’,and offers recommendations for structured reporting and future implementation.
BACKGROUND:Sepsis is a life-threatening medical emergency requiring early identification and prompt intervention. Simple bedside hemodynamic indices such as shock index (SI) and Modified SI (MSI) have been proposed as early predictors of severity and outcome in sepsis. OBJECTIVES:The objective of the study was to compare the prognostic utility of SI and MSI in predicting severity and outcomes of sepsis among patients with and without comorbidities presenting to the emergency department (ED). MATERIALS AND METHODS:This prospective observational analytical study was conducted over 12 months in the ED of a Tertiary Care Teaching Hospital in Tamil Nadu. Fifty adult patients (18-65 years) presenting with sepsis (quick sequential organ failure assessment ≥2) were enrolled and divided into two groups: patients with comorbidities (Group A, n = 25) and without comorbidities (Group B, n = 25). SI (heart rate [HR]/systolic blood pressure) and MSI (HR/mean arterial pressure) were calculated at presentation. Primary outcomes included the need for mechanical ventilation. Receiver operating characteristic curve analysis was performed to assess predictive validity. RESULTS:Mortality was higher among patients with comorbidities (64%) compared to those without comorbidities (36%). Baseline vital parameters were comparable between groups (P > 0.05). Mean SI and MSI did not differ significantly between survivors and nonsurvivors. However, SI ≥1 was associated with higher mortality, particularly in patients with comorbidities. MSI ≤0.7 and ≥1.3 was associated with 100% mortality in both groups. In patients with comorbidities, MSI demonstrated fair predictive ability for the need for mechanical ventilation at 24 h (area under the curve 0.76; 95% confidence interval: 0.27-0.93), outperforming SI. CONCLUSION:Both SI and MSI are useful bedside tools for early risk stratification in sepsis. MSI demonstrated superior predictive performance compared to SI, particularly in patients with comorbidities.
Background Scrub typhus is a significant cause of acute febrile illness in endemic regions, with the potential to cause severe complications in children. Early diagnosis is challenging due to nonspecific clinical presentation, which may delay appropriate treatment and worsen outcomes. This study aimed to assess the clinical profile, disease severity and factors influencing progression in pediatric scrub typhus, with focus on diagnostic recognition and outcomes. Methods A retrospective observational study was conducted at a tertiary care center in South India from January 2019 to December 2024. Pediatric patients aged less than 18 years with laboratory-confirmed scrub typhus based on IgM enzyme-linked immunosorbent assay were included. Clinical, laboratory and epidemiological data were collected from hospital records. Disease severity was categorized as moderate or severe based on predefined criteria. Categorical variables were analyzed using Chi-square or Fisher’s exact test, and a p-value of < 0.05 was considered statistically significant. Results Out of 5666 suspected cases, 203 tested positive and 191 were included in the final analysis. The mean age was 7.07 ± 4.63 years, with 75.4% of cases occurring in children aged ≤ 10 years. A male predominance was observed (62.3%) and most patients were from rural areas (58.6%). The majority required hospitalization (90.6%). Fever was the most common symptom (98.9%), followed by vomiting and cough. Eschar was present in 39.8% of patients and rash in 14.7%. Severe disease occurred in 18.8% of cases. Eschar was significantly associated with moderate disease (p = 0.004), whereas rash was associated with severe disease (p = 0.016). No mortality was observed. Conclusion Pediatric scrub typhus demonstrates considerable clinical heterogeneity, with a substantial proportion progressing to severe disease. The absence of consistent predictors of severity in pediatric population suggests that delayed clinical recognition and treatment may play a key role in disease progression. Early suspicion, thorough clinical examination and prompt initiation of appropriate therapy are essential to improve outcomes in endemic settings. A hypothesis-generating conceptual framework, the Recognition-Sensitive Severity Model, which conceptualizes disease severity as a time-dependent and healthcare-system modifiable outcome, is proposed to further explain these findings.
Background: Persons with diabetes are at an increased risk of developing active tuberculosis, necessitating routine bidirectional screening under the National Tuberculosis Elimination Programme (NTEP) and the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD; formerly the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, or NPCDCS). This study aimed to estimate the prevalence of tuberculosis and identify associated factors among persons with diabetes in selected field practice areas of Puducherry. Methods: A community-based cross-sectional study was conducted among 782 persons with diabetes registered under the NCD clinics of two Government Primary Health Centres in Puducherry from February 2021 to December 2022. Participants were screened for symptoms suggestive of TB using a validated structured questionnaire based on NTEP guidelines. Symptomatic individuals underwent sputum examination, CBNAAT, and chest radiography. Results: The prevalence of tuberculosis among persons with diabetes was 1.8% (95% CI: 0.97%–3%). In multivariable logistic regression analysis, male gender (aOR: 6.64; 95% CI: 1.28–34.35), family history of diabetes (aOR: 9.82; 95% CI: 1.99–48.28), significant weight loss (aOR: 84.68; 95% CI: 14.98–478.59), joint pain and swelling (aOR: 6.91; 95% CI: 1.20–39.77), and lack of physical activity (aOR: 4.47; 95% CI: 1.23–16.22) were independently associated with tuberculosis. Conclusion: The study identified a considerable burden of tuberculosis among persons with diabetes in the community. Active TB screening among diabetic individuals can facilitate early case detection and strengthen TB-DM collaborative activities under NTEP.
