INTRODUCTION:Acute calculous cholecystitis is a common surgical condition with variable clinical severity. Early identification of severe disease remains challenging. Inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) have been proposed as simple indicators of systemic inflammation and disease severity. The present study aimed to evaluate the association of preoperative NLR and CRP levels with the severity of calculous cholecystitis and their relationship with clinical outcomes. MATERIALS AND METHODS:This prospective observational study was conducted over two years in a tertiary care centre and included 48 patients diagnosed with cholelithiasis with cholecystitis and undergoing laparoscopic cholecystectomy. Preoperative NLR and CRP levels were recorded within 24 hours prior to surgery. Based on intraoperative findings and histopathology, patients were classified into simple, purulent, and gangrenous cholecystitis. Correlation analysis was performed to assess the relationship between inflammatory markers and duration of hospital stay. RESULTS:The mean age was 45.08 ± 13.78 years, with female predominance 30 (62.5%). Simple cholecystitis was most common 23 (47.9%), followed by purulent 15 (31.3%) and gangrenous 10 (20.8%). Median NLR and CRP were 2.67 and 10.55 mg/dl, respectively. Both NLR and CRP increased significantly with worsening severity (p < 0.001). NLR showed a strong positive correlation with CRP (r = 0.641, p = 0.001). NLR (r = 0.427, p = 0.001) and CRP (r = 0.539, p = 0.001) correlated significantly with longer hospital stay. Age and BMI were not significantly associated with severity. CONCLUSION:Preoperative NLR and CRP levels are significantly associated with the severity of calculous cholecystitis and duration of hospitalization. These readily available biomarkers may serve as useful adjuncts in clinical severity assessment.
Introduction: Spirometry remains the cornerstone for the diagnosis and assessment of Chronic Obstructive Pulmonary Disease (COPD). However, it may not fully reflect the underlying structural lung injury, particularly in early disease and in older individuals. Surfactant Protein-B (SP-B) is a lung-specific molecule of particular interest, although its relationship with pulmonary function impairment in COPD is not well established. Aim: To evaluate the correlation of serum SP-B levels with pulmonary function parameters and diffusion abnormalities in patients with COPD and to compare these findings with age-matched healthy controls. Materials and Methods: This case-control study conducted in the Department of Respiratory Medicine, Shri B. M. Patil Medical College, Vijayapura, Karnataka, India. The study included 70 participants- 35 COPD patients and 35 age-matched healthy controls. Individuals over 50 years of age with either a smoking index greater than 10 pack-years or biomass exposure index above 30 were enrolled in the study. All participants underwent spirometry with Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) assessment as per American Thoracic Society (ATS) and European Respiratory Society (ERS) 2022 standards. Venous blood samples were collected, centrifuged and stored at -80°C and plasma SP-B levels were measured using a Human SP-B Sandwich ELISA Kit (AQTE01771, Aliquot Biotech). Parameters studied included COPD Assessment Test (CAT), modified Medical Research Council (mMRC) score, Forced Expiratory Volume in 1 second (FEV1%) predicted, post-bronchodilator FEV1/FVC ratio, FEV1 and FVC z-scores, DLCO, KCO (Carbon Monoxide Transfer Coefficient) and plasma SP-B levels. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.0, with p-value <0.05 considered statistically significant. Results: A total of 70 participants were included in the study, comprising 35 COPD cases and 35 age-matched controls. The COPD group consisted of 26 males and nine females with a mean age of 66.31±6.45 years, while controls included 23 males and 12 females with a mean age of 64.34±7.03 years. Mean serum SP-B levels were significantly higher in COPD cases compared to controls (3.00±0.58 ng/mL vs 1.79±0.63 ng/mL). COPD patients demonstrated significantly lower mean FEV1% predicted (42.97±12.18 vs 75.55±15.35), FVC % predicted (59.57±11.41 vs 74.31±14.18), post-bronchodilator FEV1/FVC ratio (54.28±10.60 vs 78.14±6.11), and DLCO values (13.47±4.99 vs 16.13±5.79) compared to controls. Serum SP-B levels showed significant inverse correlations with FEV1 % predicted, FVC % predicted, corresponding z-scores, and FEV1/FVC ratio. Conclusion: Serum SP-B is significantly elevated in COPD patients and demonstrated an inverse relationship with lung function parameters. SP-B shows considerable promise as a biomarker reflecting physiological impairment and alveolar injury in COPD patients.
Introduction: Incorrect inhaler technique is a common cause of poor disease control in asthma and COPD patients, leading to reduced drug delivery and increased morbidity. Brief educational interventions may improve technique and clinical outcomes. Materials and Methods: A pre–post interventional study was conducted on 60 asthma/COPD patients using metered-dose inhalers (MDI) or dry powder inhalers (DPI) at Shri BM Patil Medical College Vijayapura. Baseline inhaler technique was assessed using standardized checklists. A brief educational intervention including demonstration, video, and leaflet was provided. Reassessment was done after 7 days. Statistical analysis included paired t-test and Wilcoxon test. Result: Baseline correct technique was observed in only 35–40% of patients. Post-intervention, inhaler technique scores improved significantly (MDI: 4.1 ± 1.5 to 7.1 ± 0.9; DPI: 3.2 ± 1.2 to 5.4 ± 0.6; p < 0.05), with 80–85% achieving correct technique. Symptom scores also improved significantly, with ACT increasing (16 ± 3 to 21 ± 2) and CAT decreasing (22 ± 5 to 16 ± 4) (p < 0.01). Conclusion: A brief educational intervention significantly improves inhaler technique and symptom control in asthma and COPD patients and should be incorporated into routine clinical practice.
Digital learning technologies have transformed medical education, with artificial intelligence (AI) and gamification emerging as two of the most active areas of innovation. While each has demonstrated value independently, their integration offers distinctive potential to personalise learning, sustain engagement, and produce durable educational outcomes. Yet the convergence remains empirically disjointed and theoretically underdeveloped. This pedagogically grounded critical review synthesises the evidence at the crossroads of AI and gamification in medical and health professional education, drawing on randomised trials, scoping reviews, meta-analyses, and case studies from PubMed, DOAJ, ERIC, and Web of Science. We propose an operational definition of AI-enhanced gamification and introduce an integration matrix linking five AI methods (reinforcement learning, Bayesian learner modelling, natural language processing, computer vision, recommender systems) to specific gamification elements and to learning mechanisms grounded in Self-Determination Theory, Flow Theory, constructivism, Vygotsky's Zone of Proximal Development, connectivism, the TPACK model, and the Behaviour Change Technique taxonomy. We map applications across health literacy, mental health psychoeducation, rehabilitation, and medical education, supported by ten real-world examples. We identify challenges in theoretical grounding, outcome measurement, validation, algorithmic bias, reproducibility, equity, and regulation, and close with a prioritised, feasibility-tagged research agenda for advancing AI-enhanced gamification as a credible digital learning innovation in medical education.
Introduction Diabetic foot ulcers represent a major cause of morbidity and are frequently associated with infection, delayed healing, and limb loss. Accurate risk stratification using standardized scoring systems is essential for predicting outcomes and guiding management decisions. The present study aimed to evaluate and compare three ulcer scoring systems (Diabetic Ulcer Severity Score (DUSS), Site, Ischemia, Neuropathy, Bacterial Infection, Area, and Depth (SINBAD) scoring, and University of Texas classification) in predicting clinical outcomes, specifically secondary healing, requirement of split-thickness skin grafting (STSG), and lower limb amputation, among patients with diabetic foot ulcers. Materials and methods This prospective observational study included 107 patients aged ≥35 years with diabetic foot ulcers treated at a tertiary care centre over two years. Ulcers were assessed at baseline using the Diabetic Ulcer Severity Score, the University of Texas (UT) classification, and the SINBAD scoring system. Patients were followed until a definitive outcome. Clinical outcomes were categorized as secondary healing, requirement of split-thickness skin grafting, or lower limb amputation. Non-parametric statistical analysis was performed using the Kruskal-Wallis test, and a p-value <0.05 was considered statistically significant. Results The mean age of participants was 56.84 ± 12.32 years, with a male predominance (84, 78.3%). Most ulcers were located in the midfoot (45, 42.1%) and forefoot (44, 41.1%). STSG was required in 84 (78.5%) patients, amputation was performed in 18 (16.8%), and secondary healing occurred in five (4.7%). DUSS and UT classification did not show statistically significant differences across outcome groups. In contrast, SINBAD scores were significantly higher in the amputation group (median 5, IQR 4-6) compared to the STSG group (median 4, IQR 3-5) and secondary healing group (median 2, IQR 1-2) (H=8.02, p=0.018), demonstrating better discriminatory ability. Conclusion Among the evaluated scoring systems, SINBAD showed superior predictive performance for adverse clinical outcomes and may serve as a practical tool for risk stratification in diabetic foot ulcer management.
